Florida Senate - 2012 SENATOR AMENDMENT
Bill No. CS/CS/HB 1419, 1st Eng.
Barcode 609984
LEGISLATIVE ACTION
Senate . House
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Senator Garcia moved 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 83.42, Florida
6 Statutes, is amended to read:
7 83.42 Exclusions from application of part.—This part does
8 not apply to:
9 (1) Residency or detention in a facility, whether public or
10 private, when residence or detention is incidental to the
11 provision of medical, geriatric, educational, counseling,
12 religious, or similar services. For residents of a facility
13 licensed under part II of chapter 400, the provisions of s.
14 400.0255 are the exclusive procedures for all transfers and
15 discharges.
16 Section 2. Present paragraphs (f) through (k) of subsection
17 (10) of section 112.0455, Florida Statutes, are redesignated as
18 paragraphs (e) through (j), respectively, and present paragraph
19 (e) of subsection (10), subsection (12), and paragraph (e) of
20 subsection (14) of that section are amended to read:
21 112.0455 Drug-Free Workplace Act.—
22 (10) EMPLOYER PROTECTION.—
23 (e) Nothing in this section shall be construed to operate
24 retroactively, and nothing in this section shall abrogate the
25 right of an employer under state law to conduct drug tests prior
26 to January 1, 1990. A drug test conducted by an employer prior
27 to January 1, 1990, is not subject to this section.
28 (12) DRUG-TESTING STANDARDS; LABORATORIES.—
29 (a) The requirements of part II of chapter 408 apply to the
30 provision of services that require licensure pursuant to this
31 section and part II of chapter 408 and to entities licensed by
32 or applying for such licensure from the Agency for Health Care
33 Administration pursuant to this section. A license issued by the
34 agency is required in order to operate a laboratory.
35 (b) A laboratory may analyze initial or confirmation drug
36 specimens only if:
37 1. The laboratory is licensed and approved by the Agency
38 for Health Care Administration using criteria established by the
39 United States Department of Health and Human Services as general
40 guidelines for modeling the state drug testing program and in
41 accordance with part II of chapter 408. Each applicant for
42 licensure and licensee must comply with all requirements of part
43 II of chapter 408.
44 2. The laboratory has written procedures to ensure chain of
45 custody.
46 3. The laboratory follows proper quality control
47 procedures, including, but not limited to:
48 a. The use of internal quality controls including the use
49 of samples of known concentrations which are used to check the
50 performance and calibration of testing equipment, and periodic
51 use of blind samples for overall accuracy.
52 b. An internal review and certification process for drug
53 test results, conducted by a person qualified to perform that
54 function in the testing laboratory.
55 c. Security measures implemented by the testing laboratory
56 to preclude adulteration of specimens and drug test results.
57 d. Other necessary and proper actions taken to ensure
58 reliable and accurate drug test results.
59 (c) A laboratory shall disclose to the employer a written
60 test result report within 7 working days after receipt of the
61 sample. All laboratory reports of a drug test result shall, at a
62 minimum, state:
63 1. The name and address of the laboratory which performed
64 the test and the positive identification of the person tested.
65 2. Positive results on confirmation tests only, or negative
66 results, as applicable.
67 3. A list of the drugs for which the drug analyses were
68 conducted.
69 4. The type of tests conducted for both initial and
70 confirmation tests and the minimum cutoff levels of the tests.
71 5. Any correlation between medication reported by the
72 employee or job applicant pursuant to subparagraph (8)(b)2. and
73 a positive confirmed drug test result.
74
75 A No report may not shall disclose the presence or absence of
76 any drug other than a specific drug and its metabolites listed
77 pursuant to this section.
78 (d) The laboratory shall submit to the Agency for Health
79 Care Administration a monthly report with statistical
80 information regarding the testing of employees and job
81 applicants. The reports shall include information on the methods
82 of analyses conducted, the drugs tested for, the number of
83 positive and negative results for both initial and confirmation
84 tests, and any other information deemed appropriate by the
85 Agency for Health Care Administration. No monthly report shall
86 identify specific employees or job applicants.
87 (d)(e) Laboratories shall provide technical assistance to
88 the employer, employee, or job applicant for the purpose of
89 interpreting any positive confirmed test results which could
90 have been caused by prescription or nonprescription medication
91 taken by the employee or job applicant.
92 (14) DISCIPLINE REMEDIES.—
93 (e) Upon resolving an appeal filed pursuant to paragraph
94 (c), and finding a violation of this section, the commission may
95 order the following relief:
96 1. Rescind the disciplinary action, expunge related records
97 from the personnel file of the employee or job applicant and
98 reinstate the employee.
99 2. Order compliance with paragraph (10)(f) (10)(g).
100 3. Award back pay and benefits.
101 4. Award the prevailing employee or job applicant the
102 necessary costs of the appeal, reasonable attorney’s fees, and
103 expert witness fees.
104 Section 3. Paragraph (n) of subsection (1) of section
105 154.11, Florida Statutes, is amended to read:
106 154.11 Powers of board of trustees.—
107 (1) The board of trustees of each public health trust shall
108 be deemed to exercise a public and essential governmental
109 function of both the state and the county and in furtherance
110 thereof it shall, subject to limitation by the governing body of
111 the county in which such board is located, have all of the
112 powers necessary or convenient to carry out the operation and
113 governance of designated health care facilities, including, but
114 without limiting the generality of, the foregoing:
115 (n) To appoint originally the staff of physicians to
116 practice in any designated facility owned or operated by the
117 board and to approve the bylaws and rules to be adopted by the
118 medical staff of any designated facility owned and operated by
119 the board, such governing regulations to be in accordance with
120 the standards of the Joint Commission on the Accreditation of
121 Hospitals which provide, among other things, for the method of
122 appointing additional staff members and for the removal of staff
123 members.
124 Section 4. Subsection (15) of section 318.21, Florida
125 Statutes, is amended to read:
126 318.21 Disposition of civil penalties by county courts.—All
127 civil penalties received by a county court pursuant to the
128 provisions of this chapter shall be distributed and paid monthly
129 as follows:
130 (15) Of the additional fine assessed under s. 318.18(3)(e)
131 for a violation of s. 316.1893, 50 percent of the moneys
132 received from the fines shall be remitted to the Department of
133 Revenue and deposited into the Brain and Spinal Cord Injury
134 Trust Fund of Department of Health and appropriated to the
135 Department of Health Agency for Health Care Administration as
136 general revenue to provide an enhanced Medicaid payment to
137 nursing homes that serve Medicaid recipients who have with brain
138 and spinal cord injuries that are medically complex and who are
139 technologically and respiratory dependent. The remaining 50
140 percent of the moneys received from the enhanced fine imposed
141 under s. 318.18(3)(e) shall be remitted to the Department of
142 Revenue and deposited into the Department of Health Emergency
143 Medical Services Trust Fund to provide financial support to
144 certified trauma centers in the counties where enhanced penalty
145 zones are established to ensure the availability and
146 accessibility of trauma services. Funds deposited into the
147 Emergency Medical Services Trust Fund under this subsection
148 shall be allocated as follows:
149 (a) Fifty percent shall be allocated equally among all
150 Level I, Level II, and pediatric trauma centers in recognition
151 of readiness costs for maintaining trauma services.
152 (b) Fifty percent shall be allocated among Level I, Level
153 II, and pediatric trauma centers based on each center’s relative
154 volume of trauma cases as reported in the Department of Health
155 Trauma Registry.
156 Section 5. Paragraph (g) of subsection (1) of section
157 383.011, Florida Statutes, is amended to read:
158 383.011 Administration of maternal and child health
159 programs.—
160 (1) The Department of Health is designated as the state
161 agency for:
162 (g) Receiving the federal funds for the “Special
163 Supplemental Nutrition Program for Women, Infants, and
164 Children,” or WIC, authorized by the Child Nutrition Act of
165 1966, as amended, and for providing clinical leadership for
166 administering the statewide WIC program.
167 1. The department shall establish an interagency agreement
168 with the Department of Children and Family Services for
169 management of the program. Responsibilities are delegated to
170 each department as follows:
171 a. The department shall provide clinical leadership, manage
172 program eligibility, and distribute nutritional guidance and
173 information to participants.
174 b. The Department of Children and Family Services shall
175 develop and implement an electronic benefits transfer system.
176 c. The Department of Children and Family Services shall
177 develop a cost containment plan that provides timely and
178 accurate adjustments based on wholesale price fluctuations and
179 adjusts for the number of cash registers in calculating
180 statewide averages.
181 d. The department shall coordinate submission of
182 information to appropriate federal officials in order to obtain
183 approval of the electronic benefits system and cost containment
184 plan, which must include the participation of WIC-only stores.
185 2. The department shall assist the Department of Children
186 and Family Services in the development of the electronic
187 benefits system to ensure full implementation no later than July
188 1, 2013.
189 Section 6. Section 383.141, Florida Statutes, is created to
190 read:
191 383.141 Prenatally diagnosed conditions; patient to be
192 provided information; definitions; clearinghouse of information;
193 advisory council.—
194 (1) The Legislature finds that pregnant women who choose to
195 undergo prenatal testing for developmental disabilities should
196 have access to timely and informative counseling about the
197 conditions being tested for, the accuracy of such tests, and
198 resources for obtaining support services for such conditions. It
199 is especially essential for a pregnant woman whose unborn child
200 has been diagnosed with a developmental disability through
201 prenatal testing to be adequately informed of the accuracy of
202 such testing, implications of the diagnosis, possible treatment
203 options, and available support networks, as the results of such
204 testing and that the counseling that follows may lead to the
205 unnecessary abortion of unborn humans.
206 (2) As used in this section, the term:
207 (a) “Down syndrome” means a chromosomal disorder caused by
208 an error in cell division which results in the presence of an
209 extra whole or partial copy of chromosome 21.
210 (b) “Developmental disability” includes Down syndrome and
211 other developmental disabilities defined by s. 393.063(9).
212 (c) “Health care provider” means a practitioner licensed or
213 registered under chapter 458 or chapter 459 or an advanced
214 registered nurse practitioner certified under chapter 464.
215 (d) “Prenatally diagnosed condition” means an adverse fetal
216 health condition identified by prenatal testing.
217 (e) “Prenatal test” or “prenatal testing” means a
218 diagnostic procedure or screening procedure performed on a
219 pregnant woman or her unborn offspring to obtain information
220 about her offspring’s health or development.
221 (3) When a developmental disability is diagnosed based on
222 the results of a prenatal test, the health care provider who
223 ordered the prenatal test, or his or her designee, shall provide
224 the patient with current information about the nature of the
225 developmental disability, the accuracy of the prenatal test, and
226 resources for obtaining relevant support services, including
227 hotlines, resource centers, and information clearinghouses
228 related to Down syndrome or other prenatally diagnosed
229 developmental disabilities; support programs for parents and
230 families; and developmental evaluation and intervention services
231 under s. 391.303.
232 (4) The Department of Health shall establish a
233 clearinghouse of information related to developmental
234 disabilities concerning providers of supportive services,
235 information hotlines specific to Down syndrome and other
236 prenatally diagnosed developmental disabilities, resource
237 centers, educational programs, other support programs for
238 parents and families, and developmental evaluation and
239 intervention services under s. 391.303. Such information shall
240 be made available to health care providers for use in counseling
241 pregnant women whose unborn children have been prenatally
242 diagnosed with developmental disabilities.
243 (a) There is established an advisory council within the
244 Department of Health which consists of health care providers and
245 caregivers who perform health care services for persons who have
246 developmental disabilities, including Down syndrome and autism.
247 This group shall consist of nine members:
248 1. Three members appointed by the Governor;
249 2. Three members appointed by the President of the Senate;
250 and
251 3. Three members appointed by the Speaker of the House of
252 Representatives.
253 (b) The advisory council shall provide technical assistance
254 to the Department of Health in the establishment of the
255 information clearinghouse and give the department the benefit of
256 the council members’ knowledge and experience relating to the
257 needs of patients and families of patients with developmental
258 disabilities and available support services.
259 (c) Members of the council shall elect a chairperson and a
260 vice chairperson. The elected chairperson and vice chairperson
261 shall serve in these roles until their terms of appointment on
262 the council expire.
263 (d) The advisory council shall meet quarterly to review
264 this clearinghouse of information, and may meet more often at
265 the call of the chairperson or as determined by a majority of
266 members.
267 (e) The council members shall be appointed to 4-year terms,
268 except that, to provide for staggered terms, one initial
269 appointee each from the Governor, the President of the Senate,
270 and the Speaker of the House of Representatives shall be
271 appointed to a 2-year term, one appointee each from these
272 officials shall be appointed to a 3-year term, and the remaining
273 initial appointees shall be appointed to 4-year terms. All
274 subsequent appointments shall be for 4-year terms. A vacancy
275 shall be filled for the remainder of the unexpired term in the
276 same manner as the original appointment.
277 (f) Members of the council shall serve without compensation
278 but are entitled to reimbursement for per diem and travel
279 expenses as provided in s. 112.061.
280 (g) The Department of Health shall provide administrative
281 support for the advisory council.
282 Section 7. Section 383.325, Florida Statutes, is repealed.
283 Section 8. Section 385.2031, Florida Statutes, is created
284 to read:
285 385.2031 Resource for research in the prevention and
286 treatment of diabetes.—The Florida Hospital/Sanford-Burnham
287 Translational Research Institute for Metabolism and Diabetes is
288 designated as a resource in this state for research in the
289 prevention and treatment of diabetes.
290 Section 9. Subsection (7) of section 394.4787, Florida
291 Statutes, is amended to read:
292 394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and
293 394.4789.—As used in this section and ss. 394.4786, 394.4788,
294 and 394.4789:
295 (7) “Specialty psychiatric hospital” means a hospital
296 licensed by the agency pursuant to s. 395.002(26) 395.002(28)
297 and part II of chapter 408 as a specialty psychiatric hospital.
298 Section 10. Subsection (2) of section 394.741, Florida
299 Statutes, is amended to read:
300 394.741 Accreditation requirements for providers of
301 behavioral health care services.—
302 (2) Notwithstanding any provision of law to the contrary,
303 accreditation shall be accepted by the agency and department in
304 lieu of the agency’s and department’s facility licensure onsite
305 review requirements and shall be accepted as a substitute for
306 the department’s administrative and program monitoring
307 requirements, except as required by subsections (3) and (4),
308 for:
309 (a) Any organization from which the department purchases
310 behavioral health care services that is accredited by the Joint
311 Commission on Accreditation of Healthcare Organizations or the
312 Council on Accreditation for Children and Family Services, or
313 has those services that are being purchased by the department
314 accredited by the Commission on Accreditation of Rehabilitation
315 Facilities CARF—the Rehabilitation Accreditation Commission.
316 (b) Any mental health facility licensed by the agency or
317 any substance abuse component licensed by the department that is
318 accredited by the Joint Commission on Accreditation of
319 Healthcare Organizations, the Commission on Accreditation of
320 Rehabilitation Facilities CARF—the Rehabilitation Accreditation
321 Commission, or the Council on Accreditation of Children and
322 Family Services.
323 (c) Any network of providers from which the department or
324 the agency purchases behavioral health care services accredited
325 by the Joint Commission on Accreditation of Healthcare
326 Organizations, the Commission on Accreditation of Rehabilitation
327 Facilities CARF—the Rehabilitation Accreditation Commission, the
328 Council on Accreditation of Children and Family Services, or the
329 National Committee for Quality Assurance. A provider
330 organization, which is part of an accredited network, is
331 afforded the same rights under this part.
332 Section 11. Present subsections (15) through (33) of
333 section 395.002, Florida Statutes, are redesignated as
334 subsections (14) through (30), respectively, and present
335 subsections (1), (14), (24), (28), (30), and (31) of that
336 section are amended, to read:
337 395.002 Definitions.—As used in this chapter:
338 (1) “Accrediting organizations” means nationally recognized
339 or approved accrediting organizations whose standards
340 incorporate comparable licensure requirements as determined by
341 the agency the Joint Commission on Accreditation of Healthcare
342 Organizations, the American Osteopathic Association, the
343 Commission on Accreditation of Rehabilitation Facilities, and
344 the Accreditation Association for Ambulatory Health Care, Inc.
345 (14) “Initial denial determination” means a determination
346 by a private review agent that the health care services
347 furnished or proposed to be furnished to a patient are
348 inappropriate, not medically necessary, or not reasonable.
349 (24) “Private review agent” means any person or entity
350 which performs utilization review services for third-party
351 payors on a contractual basis for outpatient or inpatient
352 services. However, the term shall not include full-time
353 employees, personnel, or staff of health insurers, health
354 maintenance organizations, or hospitals, or wholly owned
355 subsidiaries thereof or affiliates under common ownership, when
356 performing utilization review for their respective hospitals,
357 health maintenance organizations, or insureds of the same
358 insurance group. For this purpose, health insurers, health
359 maintenance organizations, and hospitals, or wholly owned
360 subsidiaries thereof or affiliates under common ownership,
361 include such entities engaged as administrators of self
362 insurance as defined in s. 624.031.
363 (26)(28) “Specialty hospital” means any facility which
364 meets the provisions of subsection (12), and which regularly
365 makes available either:
366 (a) The range of medical services offered by general
367 hospitals, but restricted to a defined age or gender group of
368 the population;
369 (b) A restricted range of services appropriate to the
370 diagnosis, care, and treatment of patients with specific
371 categories of medical or psychiatric illnesses or disorders; or
372 (c) Intensive residential treatment programs for children
373 and adolescents as defined in subsection (14) (15).
374 (28)(30) “Urgent care center” means a facility or clinic
375 that provides immediate but not emergent ambulatory medical care
376 to patients with or without an appointment. The term includes an
377 offsite It does not include the emergency department of a
378 hospital that is presented to the general public in any manner
379 as a department where immediate and not only emergent medical
380 care is provided. The term also includes:
381 (a) An offsite facility of a facility licensed under
382 chapter 395, or a joint venture between a facility licensed
383 under chapter 395 and a provider licensed under chapter 458 or
384 chapter 459, that does not require a patient to make an
385 appointment and is presented to the general public in any manner
386 as a facility where immediate but not emergent medical care is
387 provided.
388 (b) A clinic organization that is licensed under part X of
389 chapter 400, maintains three or more locations using the same or
390 a similar name, does not require a patient to make an
391 appointment, and holds itself out to the general public in any
392 manner as a facility or clinic where immediate but not emergent
393 medical care is provided.
394 (31) “Utilization review” means a system for reviewing the
395 medical necessity or appropriateness in the allocation of health
396 care resources of hospital services given or proposed to be
397 given to a patient or group of patients.
398 Section 12. Paragraph (c) of subsection (1) and paragraph
399 (b) of subsection (2) of section 395.003, Florida Statutes, are
400 amended to read:
401 395.003 Licensure; denial, suspension, and revocation.—
402 (1)
403 (c) Until July 1, 2006, additional emergency departments
404 located off the premises of licensed hospitals may not be
405 authorized by the agency.
406 (2)
407 (b) The agency shall, at the request of a licensee that is
408 a teaching hospital as defined in s. 408.07(45), issue a single
409 license to a licensee for facilities that have been previously
410 licensed as separate premises, provided such separately licensed
411 facilities, taken together, constitute the same premises as
412 defined in s. 395.002(22) 395.002(23). Such license for the
413 single premises shall include all of the beds, services, and
414 programs that were previously included on the licenses for the
415 separate premises. The granting of a single license under this
416 paragraph shall not in any manner reduce the number of beds,
417 services, or programs operated by the licensee.
418 Section 13. Subsection (3) of section 395.0161, Florida
419 Statutes, is amended to read:
420 395.0161 Licensure inspection.—
421 (3) In accordance with s. 408.805, an applicant or licensee
422 shall pay a fee for each license application submitted under
423 this part, part II of chapter 408, and applicable rules. With
424 the exception of state-operated licensed facilities, each
425 facility licensed under this part shall pay to the agency, at
426 the time of inspection, the following fees:
427 (a) Inspection for licensure.—A fee shall be paid which is
428 not less than $8 per hospital bed, nor more than $12 per
429 hospital bed, except that the minimum fee shall be $400 per
430 facility.
431 (b) Inspection for lifesafety only.—A fee shall be paid
432 which is not less than 75 cents per hospital bed, nor more than
433 $1.50 per hospital bed, except that the minimum fee shall be $40
434 per facility.
435 Section 14. Subsections (2) and (4) of section 395.0193,
436 Florida Statutes, are amended to read:
437 395.0193 Licensed facilities; peer review; disciplinary
438 powers; agency or partnership with physicians.—
439 (2) Each licensed facility, as a condition of licensure,
440 shall provide for peer review of physicians who deliver health
441 care services at the facility. Each licensed facility shall
442 develop written, binding procedures by which such peer review
443 shall be conducted. Such procedures must shall include:
444 (a) Mechanism for choosing the membership of the body or
445 bodies that conduct peer review.
446 (b) Adoption of rules of order for the peer review process.
447 (c) Fair review of the case with the physician involved.
448 (d) Mechanism to identify and avoid conflict of interest on
449 the part of the peer review panel members.
450 (e) Recording of agendas and minutes which do not contain
451 confidential material, for review by the Division of Medical
452 Quality Assurance of the department Health Quality Assurance of
453 the agency.
454 (f) Review, at least annually, of the peer review
455 procedures by the governing board of the licensed facility.
456 (g) Focus of the peer review process on review of
457 professional practices at the facility to reduce morbidity and
458 mortality and to improve patient care.
459 (4) Pursuant to ss. 458.337 and 459.016, any disciplinary
460 actions taken under subsection (3) shall be reported in writing
461 to the Division of Medical Quality Assurance of the department
462 Health Quality Assurance of the agency within 30 working days
463 after its initial occurrence, regardless of the pendency of
464 appeals to the governing board of the hospital. The notification
465 shall identify the disciplined practitioner, the action taken,
466 and the reason for such action. All final disciplinary actions
467 taken under subsection (3), if different from those which were
468 reported to the department agency within 30 days after the
469 initial occurrence, shall be reported within 10 working days to
470 the Division of Medical Quality Assurance of the department
471 Health Quality Assurance of the agency in writing and shall
472 specify the disciplinary action taken and the specific grounds
473 therefor. The division shall review each report and determine
474 whether it potentially involved conduct by the licensee that is
475 subject to disciplinary action, in which case s. 456.073 shall
476 apply. The reports are not subject to inspection under s.
477 119.07(1) even if the division’s investigation results in a
478 finding of probable cause.
479 Section 15. Section 395.1023, Florida Statutes, is amended
480 to read:
481 395.1023 Child abuse and neglect cases; duties.—Each
482 licensed facility shall adopt a protocol that, at a minimum,
483 requires the facility to:
484 (1) Incorporate a facility policy that every staff member
485 has an affirmative duty to report, pursuant to chapter 39, any
486 actual or suspected case of child abuse, abandonment, or
487 neglect; and
488 (2) In any case involving suspected child abuse,
489 abandonment, or neglect, designate, at the request of the
490 Department of Children and Family Services, a staff physician to
491 act as a liaison between the hospital and the Department of
492 Children and Family Services office which is investigating the
493 suspected abuse, abandonment, or neglect, and the child
494 protection team, as defined in s. 39.01, when the case is
495 referred to such a team.
496
497 Each general hospital and appropriate specialty hospital shall
498 comply with the provisions of this section and shall notify the
499 agency and the Department of Children and Family Services of its
500 compliance by sending a copy of its policy to the agency and the
501 Department of Children and Family Services as required by rule.
502 The failure by a general hospital or appropriate specialty
503 hospital to comply shall be punished by a fine not exceeding
504 $1,000, to be fixed, imposed, and collected by the agency. Each
505 day in violation is considered a separate offense.
506 Section 16. Subsection (2) and paragraph (d) of subsection
507 (3) of section 395.1041, Florida Statutes, are amended to read:
508 395.1041 Access to emergency services and care.—
509 (2) INVENTORY OF HOSPITAL EMERGENCY SERVICES.—The agency
510 shall establish and maintain an inventory of hospitals with
511 emergency services. The inventory shall list all services within
512 the service capability of the hospital, and such services shall
513 appear on the face of the hospital license. Each hospital having
514 emergency services shall notify the agency of its service
515 capability in the manner and form prescribed by the agency. The
516 agency shall use the inventory to assist emergency medical
517 services providers and others in locating appropriate emergency
518 medical care. The inventory shall also be made available to the
519 general public. On or before August 1, 1992, the agency shall
520 request that each hospital identify the services which are
521 within its service capability. On or before November 1, 1992,
522 the agency shall notify each hospital of the service capability
523 to be included in the inventory. The hospital has 15 days from
524 the date of receipt to respond to the notice. By December 1,
525 1992, the agency shall publish a final inventory. Each hospital
526 shall reaffirm its service capability when its license is
527 renewed and shall notify the agency of the addition of a new
528 service or the termination of a service prior to a change in its
529 service capability.
530 (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
531 FACILITY OR HEALTH CARE PERSONNEL.—
532 (d)1. Every hospital shall ensure the provision of services
533 within the service capability of the hospital, at all times,
534 either directly or indirectly through an arrangement with
535 another hospital, through an arrangement with one or more
536 physicians, or as otherwise made through prior arrangements. A
537 hospital may enter into an agreement with another hospital for
538 purposes of meeting its service capability requirement, and
539 appropriate compensation or other reasonable conditions may be
540 negotiated for these backup services.
541 2. If any arrangement requires the provision of emergency
542 medical transportation, such arrangement must be made in
543 consultation with the applicable provider and may not require
544 the emergency medical service provider to provide transportation
545 that is outside the routine service area of that provider or in
546 a manner that impairs the ability of the emergency medical
547 service provider to timely respond to prehospital emergency
548 calls.
549 3. A hospital is shall not be required to ensure service
550 capability at all times as required in subparagraph 1. if, prior
551 to the receiving of any patient needing such service capability,
552 such hospital has demonstrated to the agency that it lacks the
553 ability to ensure such capability and it has exhausted all
554 reasonable efforts to ensure such capability through backup
555 arrangements. In reviewing a hospital’s demonstration of lack of
556 ability to ensure service capability, the agency shall consider
557 factors relevant to the particular case, including the
558 following:
559 a. Number and proximity of hospitals with the same service
560 capability.
561 b. Number, type, credentials, and privileges of
562 specialists.
563 c. Frequency of procedures.
564 d. Size of hospital.
565 4. The agency shall publish proposed rules implementing a
566 reasonable exemption procedure by November 1, 1992. Subparagraph
567 1. shall become effective upon the effective date of said rules
568 or January 31, 1993, whichever is earlier. For a period not to
569 exceed 1 year from the effective date of subparagraph 1., a
570 hospital requesting an exemption shall be deemed to be exempt
571 from offering the service until the agency initially acts to
572 deny or grant the original request. The agency has 45 days after
573 from the date of receipt of the request to approve or deny the
574 request. After the first year from the effective date of
575 subparagraph 1., If the agency fails to initially act within
576 that the time period, the hospital is deemed to be exempt from
577 offering the service until the agency initially acts to deny the
578 request.
579 Section 17. Section 395.1046, Florida Statutes, is
580 repealed.
581 Section 19. Section 395.107, Florida Statutes, is amended
582 to read:
583 395.107 Urgent care centers; publishing and posting
584 schedule of charges; penalties.—
585 (1) An urgent care center must publish and post a schedule
586 of charges for the medical services offered to patients.
587 (2) The schedule of charges must describe the medical
588 services in language comprehensible to a layperson. The schedule
589 must include the prices charged to an uninsured person paying
590 for such services by cash, check, credit card, or debit card.
591 The schedule must be posted in a conspicuous place in the
592 reception area of the urgent care center and must include, but
593 is not limited to, the 50 services most frequently provided by
594 the urgent care center. The schedule may group services by three
595 price levels, listing services in each price level. The posting
596 may be a sign, which must be at least 15 square feet in size, or
597 may be through an electronic messaging board. If an urgent care
598 center is affiliated with a facility licensed under this
599 chapter, the schedule must include text that notifies the
600 insured patients whether the charges for medical services
601 received at the center will be the same as, or more than,
602 charges for medical services received at the affiliated
603 hospital. The text notifying the patient of the schedule of
604 charges shall be in a font size equal to or greater than the
605 font size used for prices and must be in a contrasting color.
606 The text that notifies the insured patients whether the charges
607 for medical services received at the center will be the same as,
608 or more than, charges for medical services received at the
609 affiliated hospital shall be included in all media and Internet
610 advertisements for the center and in language comprehensible to
611 a layperson.
612 (3) The posted text describing the medical services must
613 fill at least 12 square feet of the posting. A center may use an
614 electronic device or messaging board to post the schedule of
615 charges. Such a device must be at least 3 square feet and
616 patients must be able to access the schedule during all hours of
617 operation of the urgent care center.
618 (4) An urgent care center that is operated and used
619 exclusively for employees and the dependents of employees of the
620 business that owns or contracts for the urgent care center is
621 exempt from this section.
622 (5) The failure of an urgent care center to publish and
623 post a schedule of charges as required by this section shall
624 result in a fine of not more than $1,000, per day, until the
625 schedule is published and posted.
626 Section 20. Paragraph (e) of subsection (4) of section
627 395.3025, Florida Statutes, is amended to read:
628 395.3025 Patient and personnel records; copies;
629 examination.—
630 (4) Patient records are confidential and must not be
631 disclosed without the consent of the patient or his or her legal
632 representative, but appropriate disclosure may be made without
633 such consent to:
634 (e) The department agency upon subpoena issued pursuant to
635 s. 456.071., but The records obtained thereby must be used
636 solely for the purpose of the agency, the department, and the
637 appropriate professional board in an its investigation,
638 prosecution, and appeal of disciplinary proceedings. If the
639 department agency requests copies of the records, the facility
640 shall charge a fee pursuant to this section no more than its
641 actual copying costs, including reasonable staff time. The
642 records must be sealed and must not be available to the public
643 pursuant to s. 119.07(1) or any other statute providing access
644 to records, nor may they be available to the public as part of
645 the record of investigation for and prosecution in disciplinary
646 proceedings made available to the public by the agency, the
647 department, or the appropriate regulatory board. However, the
648 department agency must make available, upon written request by a
649 practitioner against whom probable cause has been found, any
650 such records that form the basis of the determination of
651 probable cause.
652 Section 21. Subsection (2) of section 395.3036, Florida
653 Statutes, is amended to read:
654 395.3036 Confidentiality of records and meetings of
655 corporations that lease public hospitals or other public health
656 care facilities.—The records of a private corporation that
657 leases a public hospital or other public health care facility
658 are confidential and exempt from the provisions of s. 119.07(1)
659 and s. 24(a), Art. I of the State Constitution, and the meetings
660 of the governing board of a private corporation are exempt from
661 s. 286.011 and s. 24(b), Art. I of the State Constitution when
662 the public lessor complies with the public finance
663 accountability provisions of s. 155.40(5) with respect to the
664 transfer of any public funds to the private lessee and when the
665 private lessee meets at least three of the five following
666 criteria:
667 (2) The public lessor and the private lessee do not
668 commingle any of their funds in any account maintained by either
669 of them, other than the payment of the rent and administrative
670 fees or the transfer of funds pursuant to s. 155.40 subsection
671 (2).
672 Section 22. Section 395.3037, Florida Statutes, is
673 repealed.
674 Section 23. Subsections (1), (4), and (5) of section
675 395.3038, Florida Statutes, are amended to read:
676 395.3038 State-listed primary stroke centers and
677 comprehensive stroke centers; notification of hospitals.—
678 (1) The agency shall make available on its website and to
679 the department a list of the name and address of each hospital
680 that meets the criteria for a primary stroke center and the name
681 and address of each hospital that meets the criteria for a
682 comprehensive stroke center. The list of primary and
683 comprehensive stroke centers shall include only those hospitals
684 that attest in an affidavit submitted to the agency that the
685 hospital meets the named criteria, or those hospitals that
686 attest in an affidavit submitted to the agency that the hospital
687 is certified as a primary or a comprehensive stroke center by
688 the Joint Commission on Accreditation of Healthcare
689 Organizations.
690 (4) The agency shall adopt by rule criteria for a primary
691 stroke center which are substantially similar to the
692 certification standards for primary stroke centers of the Joint
693 Commission on Accreditation of Healthcare Organizations.
694 (5) The agency shall adopt by rule criteria for a
695 comprehensive stroke center. However, if the Joint Commission on
696 Accreditation of Healthcare Organizations establishes criteria
697 for a comprehensive stroke center, the agency shall establish
698 criteria for a comprehensive stroke center which are
699 substantially similar to those criteria established by the Joint
700 Commission on Accreditation of Healthcare Organizations.
701 Section 24. Paragraph (e) of subsection (2) of section
702 395.602, Florida Statutes, is amended to read:
703 395.602 Rural hospitals.—
704 (2) DEFINITIONS.—As used in this part:
705 (e) “Rural hospital” means an acute care hospital licensed
706 under this chapter, having 100 or fewer licensed beds and an
707 emergency room, which is:
708 1. The sole provider within a county with a population
709 density of no greater than 100 persons per square mile;
710 2. An acute care hospital, in a county with a population
711 density of no greater than 100 persons per square mile, which is
712 at least 30 minutes of travel time, on normally traveled roads
713 under normal traffic conditions, from any other acute care
714 hospital within the same county;
715 3. A hospital supported by a tax district or subdistrict
716 whose boundaries encompass a population of 100 persons or fewer
717 per square mile;
718 4. A hospital in a constitutional charter county with a
719 population of over 1 million persons that has imposed a local
720 option health service tax pursuant to law and in an area that
721 was directly impacted by a catastrophic event on August 24,
722 1992, for which the Governor of Florida declared a state of
723 emergency pursuant to chapter 125, and has 120 beds or less that
724 serves an agricultural community with an emergency room
725 utilization of no less than 20,000 visits and a Medicaid
726 inpatient utilization rate greater than 15 percent;
727 4.5. A hospital with a service area that has a population
728 of 100 persons or fewer per square mile. As used in this
729 subparagraph, the term “service area” means the fewest number of
730 zip codes that account for 75 percent of the hospital’s
731 discharges for the most recent 5-year period, based on
732 information available from the hospital inpatient discharge
733 database in the Florida Center for Health Information and Policy
734 Analysis at the Agency for Health Care Administration; or
735 5.6. A hospital designated as a critical access hospital,
736 as defined in s. 408.07(15).
737
738 Population densities used in this paragraph must be based upon
739 the most recently completed United States census. A hospital
740 that received funds under s. 409.9116 for a quarter beginning no
741 later than July 1, 2002, is deemed to have been and shall
742 continue to be a rural hospital from that date through June 30,
743 2015, if the hospital continues to have 100 or fewer licensed
744 beds and an emergency room, or meets the criteria of
745 subparagraph 4. An acute care hospital that has not previously
746 been designated as a rural hospital and that meets the criteria
747 of this paragraph shall be granted such designation upon
748 application, including supporting documentation to the Agency
749 for Health Care Administration.
750 Section 25. Subsections (8) and (16) of section 400.021,
751 Florida Statutes, are amended to read:
752 400.021 Definitions.—When used in this part, unless the
753 context otherwise requires, the term:
754 (8) “Geriatric outpatient clinic” means a site for
755 providing outpatient health care to persons 60 years of age or
756 older, which is staffed by a registered nurse or a physician
757 assistant, or by a licensed practical nurse who is under the
758 direct supervision of a registered nurse, an advanced registered
759 nurse practitioner, a physician assistant, or a physician.
760 (16) “Resident care plan” means a written plan developed,
761 maintained, and reviewed not less than quarterly by a registered
762 nurse, with participation from other facility staff and the
763 resident or his or her designee or legal representative, which
764 includes a comprehensive assessment of the needs of an
765 individual resident; the type and frequency of services required
766 to provide the necessary care for the resident to attain or
767 maintain the highest practicable physical, mental, and
768 psychosocial well-being; a listing of services provided within
769 or outside the facility to meet those needs; and an explanation
770 of service goals. The resident care plan must be signed by the
771 director of nursing or another registered nurse employed by the
772 facility to whom institutional responsibilities have been
773 delegated and by the resident, the resident’s designee, or the
774 resident’s legal representative. The facility may not use an
775 agency or temporary registered nurse to satisfy the foregoing
776 requirement and must document the institutional responsibilities
777 that have been delegated to the registered nurse.
778 Section 26. Paragraph (g) of subsection (2) of section
779 400.0239, Florida Statutes, is amended to read:
780 400.0239 Quality of Long-Term Care Facility Improvement
781 Trust Fund.—
782 (2) Expenditures from the trust fund shall be allowable for
783 direct support of the following:
784 (g) Other initiatives authorized by the Centers for
785 Medicare and Medicaid Services for the use of federal civil
786 monetary penalties, including projects recommended through the
787 Medicaid “Up-or-Out” Quality of Care Contract Management Program
788 pursuant to s. 400.148.
789 Section 27. Subsection (15) of section 400.0255, Florida
790 Statutes, is amended to read:
791 400.0255 Resident transfer or discharge; requirements and
792 procedures; hearings.—
793 (15)(a) The department’s Office of Appeals Hearings shall
794 conduct hearings requested under this section.
795 (a) The office shall notify the facility of a resident’s
796 request for a hearing.
797 (b) The department shall, by rule, establish procedures to
798 be used for fair hearings requested by residents. The These
799 procedures must shall be equivalent to the procedures used for
800 fair hearings for other Medicaid cases brought pursuant to s.
801 409.285 and applicable rules, chapter 10-2, part VI, Florida
802 Administrative Code. The burden of proof must be clear and
803 convincing evidence. A hearing decision must be rendered within
804 90 days after receipt of the request for hearing.
805 (c) If the hearing decision is favorable to the resident
806 who has been transferred or discharged, the resident must be
807 readmitted to the facility’s first available bed.
808 (d) The decision of the hearing officer is shall be final.
809 Any aggrieved party may appeal the decision to the district
810 court of appeal in the appellate district where the facility is
811 located. Review procedures shall be conducted in accordance with
812 the Florida Rules of Appellate Procedure.
813 Section 28. Subsection (2) of section 400.063, Florida
814 Statutes, is amended to read:
815 400.063 Resident protection.—
816 (2) The agency is authorized to establish for each
817 facility, subject to intervention by the agency, may establish a
818 separate bank account for the deposit to the credit of the
819 agency of any moneys received from the Health Care Trust Fund or
820 any other moneys received for the maintenance and care of
821 residents in the facility, and may the agency is authorized to
822 disburse moneys from such account to pay obligations incurred
823 for the purposes of this section. The agency may is authorized
824 to requisition moneys from the Health Care Trust Fund in advance
825 of an actual need for cash on the basis of an estimate by the
826 agency of moneys to be spent under the authority of this
827 section. A Any bank account established under this section need
828 not be approved in advance of its creation as required by s.
829 17.58, but must shall be secured by depository insurance equal
830 to or greater than the balance of such account or by the pledge
831 of collateral security in conformance with criteria established
832 in s. 18.11. The agency shall notify the Chief Financial Officer
833 of an any such account so established and shall make a quarterly
834 accounting to the Chief Financial Officer for all moneys
835 deposited in such account.
836 Section 29. Subsections (1) and (5) of section 400.071,
837 Florida Statutes, are amended to read:
838 400.071 Application for license.—
839 (1) In addition to the requirements of part II of chapter
840 408, the application for a license must shall be under oath and
841 must contain the following:
842 (a) The location of the facility for which a license is
843 sought and an indication, as in the original application, that
844 such location conforms to the local zoning ordinances.
845 (b) A signed affidavit disclosing any financial or
846 ownership interest that a controlling interest as defined in
847 part II of chapter 408 has held in the last 5 years in any
848 entity licensed by this state or any other state to provide
849 health or residential care which has closed voluntarily or
850 involuntarily; has filed for bankruptcy; has had a receiver
851 appointed; has had a license denied, suspended, or revoked; or
852 has had an injunction issued against it which was initiated by a
853 regulatory agency. The affidavit must disclose the reason any
854 such entity was closed, whether voluntarily or involuntarily.
855 (c) The total number of beds and the total number of
856 Medicare and Medicaid certified beds.
857 (b)(d) Information relating to the applicant and employees
858 which the agency requires by rule. The applicant must
859 demonstrate that sufficient numbers of qualified staff, by
860 training or experience, will be employed to properly care for
861 the type and number of residents who will reside in the
862 facility.
863 (e) Copies of any civil verdict or judgment involving the
864 applicant rendered within the 10 years preceding the
865 application, relating to medical negligence, violation of
866 residents’ rights, or wrongful death. As a condition of
867 licensure, the licensee agrees to provide to the agency copies
868 of any new verdict or judgment involving the applicant, relating
869 to such matters, within 30 days after filing with the clerk of
870 the court. The information required in this paragraph shall be
871 maintained in the facility’s licensure file and in an agency
872 database which is available as a public record.
873 (5) As a condition of licensure, each facility must
874 establish and submit with its application a plan for quality
875 assurance and for conducting risk management.
876 Section 30. Section 400.0712, Florida Statutes, is amended
877 to read:
878 400.0712 Application for inactive license.—
879 (1) As specified in this section, the agency may issue an
880 inactive license to a nursing home facility for all or a portion
881 of its beds. Any request by a licensee that a nursing home or
882 portion of a nursing home become inactive must be submitted to
883 the agency in the approved format. The facility may not initiate
884 any suspension of services, notify residents, or initiate
885 inactivity before receiving approval from the agency; and a
886 licensee that violates this provision may not be issued an
887 inactive license.
888 (1)(2) In addition to the powers granted under part II of
889 chapter 408, the agency may issue an inactive license for a
890 portion of the total beds of to a nursing home facility that
891 chooses to use an unoccupied contiguous portion of the facility
892 for an alternative use to meet the needs of elderly persons
893 through the use of less restrictive, less institutional
894 services.
895 (a) The An inactive license issued under this subsection
896 may be granted for a period not to exceed the current licensure
897 expiration date but may be renewed by the agency at the time of
898 licensure renewal.
899 (b) A request to extend the inactive license must be
900 submitted to the agency in the approved format and approved by
901 the agency in writing.
902 (c) A facility Nursing homes that receives receive an
903 inactive license to provide alternative services may shall not
904 be given receive preference for participation in the Assisted
905 Living for the Elderly Medicaid waiver.
906 (2)(3) The agency shall adopt rules pursuant to ss.
907 120.536(1) and 120.54 necessary to administer implement this
908 section.
909 Section 31. Section 400.111, Florida Statutes, is amended
910 to read:
911 400.111 Disclosure of controlling interest.—In addition to
912 the requirements of part II of chapter 408, the nursing home
913 facility, if requested by the agency, licensee shall submit a
914 signed affidavit disclosing any financial or ownership interest
915 that a controlling interest has held within the last 5 years in
916 any entity licensed by the state or any other state to provide
917 health or residential care which entity has closed voluntarily
918 or involuntarily; has filed for bankruptcy; has had a receiver
919 appointed; has had a license denied, suspended, or revoked; or
920 has had an injunction issued against it which was initiated by a
921 regulatory agency. The affidavit must disclose the reason such
922 entity was closed, whether voluntarily or involuntarily.
923 Section 32. Subsection (2) of section 400.1183, Florida
924 Statutes, is amended to read:
925 400.1183 Resident grievance procedures.—
926 (2) Each nursing home facility shall maintain records of
927 all grievances and a shall report, subject to agency inspection,
928 of to the agency at the time of relicensure the total number of
929 grievances handled during the prior licensure period, a
930 categorization of the cases underlying the grievances, and the
931 final disposition of the grievances.
932 Section 33. Section 400.141, Florida Statutes, is amended
933 to read:
934 400.141 Administration and management of nursing home
935 facilities.—
936 (1) A nursing home facility must Every licensed facility
937 shall comply with all applicable standards and rules of the
938 agency and must shall:
939 (a) Be under the administrative direction and charge of a
940 licensed administrator.
941 (b) Appoint a medical director licensed pursuant to chapter
942 458 or chapter 459. The agency may establish by rule more
943 specific criteria for the appointment of a medical director.
944 (c) Have available the regular, consultative, and emergency
945 services of state-licensed physicians licensed by the state.
946 (d) Provide for resident use of a community pharmacy as
947 specified in s. 400.022(1)(q). Notwithstanding any other law to
948 the contrary notwithstanding, a registered pharmacist licensed
949 in this state who in Florida, that is under contract with a
950 facility licensed under this chapter or chapter 429 must, shall
951 repackage a nursing facility resident’s bulk prescription
952 medication, which was has been packaged by another pharmacist
953 licensed in any state, in the United States into a unit dose
954 system compatible with the system used by the nursing home
955 facility, if the pharmacist is requested to offer such service.
956 1. In order to be eligible for the repackaging, a resident
957 or the resident’s spouse must receive prescription medication
958 benefits provided through a former employer as part of his or
959 her retirement benefits, a qualified pension plan as specified
960 in s. 4972 of the Internal Revenue Code, a federal retirement
961 program as specified under 5 C.F.R. s. 831, or a long-term care
962 policy as defined in s. 627.9404(1).
963 2. A pharmacist who correctly repackages and relabels the
964 medication and the nursing facility that which correctly
965 administers such repackaged medication under this paragraph may
966 not be held liable in any civil or administrative action arising
967 from the repackaging.
968 3. In order to be eligible for the repackaging, a nursing
969 facility resident for whom the medication is to be repackaged
970 must shall sign an informed consent form provided by the
971 facility which includes an explanation of the repackaging
972 process and which notifies the resident of the immunities from
973 liability provided under in this paragraph.
974 4. A pharmacist who repackages and relabels prescription
975 medications, as authorized under this paragraph, may charge a
976 reasonable fee for costs resulting from the implementation of
977 this provision.
978 (e) Provide for the access of the facility residents with
979 access to dental and other health-related services, recreational
980 services, rehabilitative services, and social work services
981 appropriate to their needs and conditions and not directly
982 furnished by the licensee. If When a geriatric outpatient nurse
983 clinic is conducted in accordance with rules adopted by the
984 agency, outpatients attending such clinic may shall not be
985 counted as part of the general resident population of the
986 nursing home facility, nor may shall the nursing staff of the
987 geriatric outpatient clinic be counted as part of the nursing
988 staff of the facility, until the outpatient clinic load exceeds
989 15 a day.
990 (f) Be allowed and encouraged by the agency to provide
991 other needed services under certain conditions. If the facility
992 has a standard licensure status, and has had no class I or class
993 II deficiencies during the past 2 years or has been awarded a
994 Gold Seal under the program established in s. 400.235, it may be
995 encouraged by the agency to provide services, including, but not
996 limited to, respite and adult day services, which enable
997 individuals to move in and out of the facility. A facility is
998 not subject to any additional licensure requirements for
999 providing these services, under the following conditions:.
1000 1. Respite care may be offered to persons in need of short
1001 term or temporary nursing home services, if for each person
1002 admitted under the respite care program, the licensee:.
1003 a. Has a contract that, at a minimum, specifies the
1004 services to be provided to the respite resident and includes the
1005 charges for services, activities, equipment, emergency medical
1006 services, and the administration of medications. If multiple
1007 respite admissions for a single individual are anticipated, the
1008 original contract is valid for 1 year after the date of
1009 execution;
1010 b. Has a written abbreviated plan of care that, at a
1011 minimum, includes nutritional requirements, medication orders,
1012 physician assessments and orders, nursing assessments, and
1013 dietary preferences. The physician or nursing assessments may
1014 take the place of all other assessments required for full-time
1015 residents; and
1016 c. Ensures that each respite resident is released to his or
1017 her caregiver or an individual designated in writing by the
1018 caregiver.
1019 2. A person admitted under a respite care program is:
1020 a. Covered by the residents’ rights set forth in s.
1021 400.022(1)(a)-(o) and (r)-(t). Funds or property of the respite
1022 resident are not considered trust funds subject to s.
1023 400.022(1)(h) until the resident has been in the facility for
1024 more than 14 consecutive days;
1025 b. Allowed to use his or her personal medications for the
1026 respite stay if permitted by facility policy. The facility must
1027 obtain a physician’s order for the medications. The caregiver
1028 may provide information regarding the medications as part of the
1029 nursing assessment which must agree with the physician’s order.
1030 Medications shall be released with the respite resident upon
1031 discharge in accordance with current physician’s orders; and
1032 c. Exempt from rule requirements related to discharge
1033 planning.
1034 3. A person receiving respite care is entitled to reside in
1035 the facility for a total of 60 days within a contract year or
1036 calendar year if the contract is for less than 12 months.
1037 However, each single stay may not exceed 14 days. If a stay
1038 exceeds 14 consecutive days, the facility must comply with all
1039 assessment and care planning requirements applicable to nursing
1040 home residents.
1041 4. The respite resident must provide medical information
1042 from a physician, physician assistant, or nurse practitioner and
1043 other information from the primary caregiver as may be required
1044 by the facility before or at the time of admission. The medical
1045 information must include a physician’s order for respite care
1046 and proof of a physical examination by a licensed physician,
1047 physician assistant, or nurse practitioner. The physician’s
1048 order and physical examination may be used to provide
1049 intermittent respite care for up to 12 months after the date the
1050 order is written.
1051 5. A person receiving respite care resides in a licensed
1052 nursing home bed.
1053 6. The facility assumes the duties of the primary
1054 caregiver. To ensure continuity of care and services, the
1055 respite resident is entitled to retain his or her personal
1056 physician and must have access to medically necessary services
1057 such as physical therapy, occupational therapy, or speech
1058 therapy, as needed. The facility must arrange for transportation
1059 to these services if necessary. Respite care must be provided in
1060 accordance with this part and rules adopted by the agency.
1061 However, the agency shall, by rule, adopt modified requirements
1062 for resident assessment, resident care plans, resident
1063 contracts, physician orders, and other provisions, as
1064 appropriate, for short-term or temporary nursing home services.
1065 7. The agency allows shall allow for shared programming and
1066 staff in a facility that which meets minimum standards and
1067 offers services pursuant to this paragraph, but, if the facility
1068 is cited for deficiencies in patient care, the agency may
1069 require additional staff and programs appropriate to the needs
1070 of service recipients. A person who receives respite care may
1071 not be counted as a resident of the facility for purposes of the
1072 facility’s licensed capacity unless that person receives 24-hour
1073 respite care. A person receiving either respite care for 24
1074 hours or longer or adult day services must be included when
1075 calculating minimum staffing for the facility. Any costs and
1076 revenues generated by a nursing home facility from
1077 nonresidential programs or services must shall be excluded from
1078 the calculations of Medicaid per diems for nursing home
1079 institutional care reimbursement.
1080 (g) If the facility has a standard license or is a Gold
1081 Seal facility, exceeds the minimum required hours of licensed
1082 nursing and certified nursing assistant direct care per resident
1083 per day, and is part of a continuing care facility licensed
1084 under chapter 651 or a retirement community that offers other
1085 services pursuant to part III of this chapter or part I or part
1086 III of chapter 429 on a single campus, be allowed to share
1087 programming and staff. At the time of inspection and in the
1088 semiannual report required pursuant to paragraph (o), a
1089 continuing care facility or retirement community that uses this
1090 option must demonstrate through staffing records that minimum
1091 staffing requirements for the facility were met. Licensed nurses
1092 and certified nursing assistants who work in the nursing home
1093 facility may be used to provide services elsewhere on campus if
1094 the facility exceeds the minimum number of direct care hours
1095 required per resident per day and the total number of residents
1096 receiving direct care services from a licensed nurse or a
1097 certified nursing assistant does not cause the facility to
1098 violate the staffing ratios required under s. 400.23(3)(a).
1099 Compliance with the minimum staffing ratios must shall be based
1100 on the total number of residents receiving direct care services,
1101 regardless of where they reside on campus. If the facility
1102 receives a conditional license, it may not share staff until the
1103 conditional license status ends. This paragraph does not
1104 restrict the agency’s authority under federal or state law to
1105 require additional staff if a facility is cited for deficiencies
1106 in care which are caused by an insufficient number of certified
1107 nursing assistants or licensed nurses. The agency may adopt
1108 rules for the documentation necessary to determine compliance
1109 with this provision.
1110 (h) Maintain the facility premises and equipment and
1111 conduct its operations in a safe and sanitary manner.
1112 (i) If the licensee furnishes food service, provide a
1113 wholesome and nourishing diet sufficient to meet generally
1114 accepted standards of proper nutrition for its residents and
1115 provide such therapeutic diets as may be prescribed by attending
1116 physicians. In adopting making rules to implement this
1117 paragraph, the agency shall be guided by standards recommended
1118 by nationally recognized professional groups and associations
1119 with knowledge of dietetics.
1120 (j) Keep full records of resident admissions and
1121 discharges; medical and general health status, including medical
1122 records, personal and social history, and identity and address
1123 of next of kin or other persons who may have responsibility for
1124 the affairs of the resident residents; and individual resident
1125 care plans, including, but not limited to, prescribed services,
1126 service frequency and duration, and service goals. The records
1127 must shall be open to agency inspection by the agency. The
1128 licensee shall maintain clinical records on each resident in
1129 accordance with accepted professional standards and practices,
1130 which must be complete, accurately documented, readily
1131 accessible, and systematically organized.
1132 (k) Keep such fiscal records of its operations and
1133 conditions as may be necessary to provide information pursuant
1134 to this part.
1135 (l) Furnish copies of personnel records for employees
1136 affiliated with such facility, to any other facility licensed by
1137 this state requesting this information pursuant to this part.
1138 Such information contained in the records may include, but is
1139 not limited to, disciplinary matters and reasons any reason for
1140 termination. A Any facility releasing such records pursuant to
1141 this part is shall be considered to be acting in good faith and
1142 may not be held liable for information contained in such
1143 records, absent a showing that the facility maliciously
1144 falsified such records.
1145 (m) Publicly display a poster provided by the agency
1146 containing the names, addresses, and telephone numbers for the
1147 state’s abuse hotline, the State Long-Term Care Ombudsman, the
1148 Agency for Health Care Administration consumer hotline, the
1149 Advocacy Center for Persons with Disabilities, the Florida
1150 Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
1151 with a clear description of the assistance to be expected from
1152 each.
1153 (n) Submit to the agency the information specified in s.
1154 400.071(1)(b) for a management company within 30 days after the
1155 effective date of the management agreement.
1156 (o)1. Submit semiannually to the agency, or more frequently
1157 if requested by the agency, information regarding facility
1158 staff-to-resident ratios, staff turnover, and staff stability,
1159 including information regarding certified nursing assistants,
1160 licensed nurses, the director of nursing, and the facility
1161 administrator. For purposes of this reporting:
1162 a. Staff-to-resident ratios must be reported in the
1163 categories specified in s. 400.23(3)(a) and applicable rules.
1164 The ratio must be reported as an average for the most recent
1165 calendar quarter.
1166 b. Staff turnover must be reported for the most recent 12
1167 month period ending on the last workday of the most recent
1168 calendar quarter prior to the date the information is submitted.
1169 The turnover rate must be computed quarterly, with the annual
1170 rate being the cumulative sum of the quarterly rates. The
1171 turnover rate is the total number of terminations or separations
1172 experienced during the quarter, excluding any employee
1173 terminated during a probationary period of 3 months or less,
1174 divided by the total number of staff employed at the end of the
1175 period for which the rate is computed, and expressed as a
1176 percentage.
1177 c. The formula for determining staff stability is the total
1178 number of employees that have been employed for more than 12
1179 months, divided by the total number of employees employed at the
1180 end of the most recent calendar quarter, and expressed as a
1181 percentage.
1182 (n) Comply with state minimum staffing requirements:
1183 1.d. A nursing facility that has failed to comply with
1184 state minimum-staffing requirements for 2 consecutive days is
1185 prohibited from accepting new admissions until the facility has
1186 achieved the minimum-staffing requirements for a period of 6
1187 consecutive days. For the purposes of this subparagraph sub
1188 subparagraph, any person who was a resident of the facility and
1189 was absent from the facility for the purpose of receiving
1190 medical care at a separate location or was on a leave of absence
1191 is not considered a new admission. Failure by the facility to
1192 impose such an admissions moratorium is subject to a $1,000 fine
1193 constitutes a class II deficiency.
1194 2.e. A nursing facility that which does not have a
1195 conditional license may be cited for failure to comply with the
1196 standards in s. 400.23(3)(a)1.b. and c. only if it has failed to
1197 meet those standards on 2 consecutive days or if it has failed
1198 to meet at least 97 percent of those standards on any one day.
1199 3.f. A facility that which has a conditional license must
1200 be in compliance with the standards in s. 400.23(3)(a) at all
1201 times.
1202 2. This paragraph does not limit the agency’s ability to
1203 impose a deficiency or take other actions if a facility does not
1204 have enough staff to meet the residents’ needs.
1205 (o)(p) Notify a licensed physician when a resident exhibits
1206 signs of dementia or cognitive impairment or has a change of
1207 condition in order to rule out the presence of an underlying
1208 physiological condition that may be contributing to such
1209 dementia or impairment. The notification must occur within 30
1210 days after the acknowledgment of such signs by facility staff.
1211 If an underlying condition is determined to exist, the facility
1212 shall arrange, with the appropriate health care provider,
1213 arrange for the necessary care and services to treat the
1214 condition.
1215 (p)(q) If the facility implements a dining and hospitality
1216 attendant program, ensure that the program is developed and
1217 implemented under the supervision of the facility director of
1218 nursing. A licensed nurse, licensed speech or occupational
1219 therapist, or a registered dietitian must conduct training of
1220 dining and hospitality attendants. A person employed by a
1221 facility as a dining and hospitality attendant must perform
1222 tasks under the direct supervision of a licensed nurse.
1223 (r) Report to the agency any filing for bankruptcy
1224 protection by the facility or its parent corporation,
1225 divestiture or spin-off of its assets, or corporate
1226 reorganization within 30 days after the completion of such
1227 activity.
1228 (q)(s) Maintain general and professional liability
1229 insurance coverage that is in force at all times. In lieu of
1230 such general and professional liability insurance coverage, a
1231 state-designated teaching nursing home and its affiliated
1232 assisted living facilities created under s. 430.80 may
1233 demonstrate proof of financial responsibility as provided in s.
1234 430.80(3)(g).
1235 (r)(t) Maintain in the medical record for each resident a
1236 daily chart of certified nursing assistant services provided to
1237 the resident. The certified nursing assistant who is caring for
1238 the resident must complete this record by the end of his or her
1239 shift. The This record must indicate assistance with activities
1240 of daily living, assistance with eating, and assistance with
1241 drinking, and must record each offering of nutrition and
1242 hydration for those residents whose plan of care or assessment
1243 indicates a risk for malnutrition or dehydration.
1244 (s)(u) Before November 30 of each year, subject to the
1245 availability of an adequate supply of the necessary vaccine,
1246 provide for immunizations against influenza viruses to all its
1247 consenting residents in accordance with the recommendations of
1248 the United States Centers for Disease Control and Prevention,
1249 subject to exemptions for medical contraindications and
1250 religious or personal beliefs. Subject to these exemptions, any
1251 consenting person who becomes a resident of the facility after
1252 November 30 but before March 31 of the following year must be
1253 immunized within 5 working days after becoming a resident.
1254 Immunization may shall not be provided to any resident who
1255 provides documentation that he or she has been immunized as
1256 required by this paragraph. This paragraph does not prohibit a
1257 resident from receiving the immunization from his or her
1258 personal physician if he or she so chooses. A resident who
1259 chooses to receive the immunization from his or her personal
1260 physician shall provide proof of immunization to the facility.
1261 The agency may adopt and enforce any rules necessary to
1262 administer comply with or implement this paragraph.
1263 (t)(v) Assess all residents for eligibility for
1264 pneumococcal polysaccharide vaccination or revaccination (PPV)
1265 and vaccinate residents when indicated within 60 days after the
1266 effective date of this act in accordance with the
1267 recommendations of the United States Centers for Disease Control
1268 and Prevention, subject to exemptions for medical
1269 contraindications and religious or personal beliefs. Residents
1270 admitted after the effective date of this act shall be assessed
1271 within 5 working days after of admission and, if when indicated,
1272 vaccinate such residents vaccinated within 60 days in accordance
1273 with the recommendations of the United States Centers for
1274 Disease Control and Prevention, subject to exemptions for
1275 medical contraindications and religious or personal beliefs.
1276 Immunization may shall not be provided to any resident who
1277 provides documentation that he or she has been immunized as
1278 required by this paragraph. This paragraph does not prohibit a
1279 resident from receiving the immunization from his or her
1280 personal physician if he or she so chooses. A resident who
1281 chooses to receive the immunization from his or her personal
1282 physician shall provide proof of immunization to the facility.
1283 The agency may adopt and enforce any rules necessary to
1284 administer comply with or implement this paragraph.
1285 (u)(w) Annually encourage and promote to its employees the
1286 benefits associated with immunizations against influenza viruses
1287 in accordance with the recommendations of the United States
1288 Centers for Disease Control and Prevention. The agency may adopt
1289 and enforce any rules necessary to administer comply with or
1290 implement this paragraph.
1291
1292 This subsection does not limit the agency’s ability to impose a
1293 deficiency or take other actions if a facility does not have
1294 enough staff to meet residents’ needs.
1295 (2) Facilities that have been awarded a Gold Seal under the
1296 program established in s. 400.235 may develop a plan to provide
1297 certified nursing assistant training as prescribed by federal
1298 regulations and state rules and may apply to the agency for
1299 approval of their program.
1300 Section 34. Subsection (3) of section 400.142, Florida
1301 Statutes, is amended to read:
1302 400.142 Emergency medication kits; orders not to
1303 resuscitate.—
1304 (3) Facility staff may withhold or withdraw cardiopulmonary
1305 resuscitation if presented with an order not to resuscitate
1306 executed pursuant to s. 401.45. The agency shall adopt rules
1307 providing for the implementation of such orders. Facility staff
1308 and facilities are shall not be subject to criminal prosecution
1309 or civil liability, or nor be considered to have engaged in
1310 negligent or unprofessional conduct, for withholding or
1311 withdrawing cardiopulmonary resuscitation pursuant to such an
1312 order and rules adopted by the agency. The absence of an order
1313 not to resuscitate executed pursuant to s. 401.45 does not
1314 preclude a physician from withholding or withdrawing
1315 cardiopulmonary resuscitation as otherwise permitted by law.
1316 Section 35. Subsections (9) through (15) of section
1317 400.147, Florida Statutes, are renumbered as subsections (8)
1318 through (13), respectively, and present subsections (7), (8),
1319 and (10) of that section are amended to read:
1320 400.147 Internal risk management and quality assurance
1321 program.—
1322 (7) The nursing home facility shall initiate an
1323 investigation and shall notify the agency within 1 business day
1324 after the risk manager or his or her designee has received a
1325 report pursuant to paragraph (1)(d). The facility must complete
1326 the investigation and submit a report to the agency within 15
1327 calendar days after the adverse incident occurred. The
1328 notification must be made in writing and be provided
1329 electronically, by facsimile device or overnight mail delivery.
1330 The agency shall develop a form for the report which
1331 notification must include the name of the risk manager,
1332 information regarding the identity of the affected resident, the
1333 type of adverse incident, the initiation of an investigation by
1334 the facility, and whether the events causing or resulting in the
1335 adverse incident represent a potential risk to any other
1336 resident. The report notification is confidential as provided by
1337 law and is not discoverable or admissible in any civil or
1338 administrative action, except in disciplinary proceedings by the
1339 agency or the appropriate regulatory board. The agency may
1340 investigate, as it deems appropriate, any such incident and
1341 prescribe measures that must or may be taken in response to the
1342 incident. The agency shall review each report incident and
1343 determine whether it potentially involved conduct by the health
1344 care professional who is subject to disciplinary action, in
1345 which case the provisions of s. 456.073 shall apply.
1346 (8)(a) Each facility shall complete the investigation and
1347 submit an adverse incident report to the agency for each adverse
1348 incident within 15 calendar days after its occurrence. If, after
1349 a complete investigation, the risk manager determines that the
1350 incident was not an adverse incident as defined in subsection
1351 (5), the facility shall include this information in the report.
1352 The agency shall develop a form for reporting this information.
1353 (b) The information reported to the agency pursuant to
1354 paragraph (a) which relates to persons licensed under chapter
1355 458, chapter 459, chapter 461, or chapter 466 shall be reviewed
1356 by the agency. The agency shall determine whether any of the
1357 incidents potentially involved conduct by a health care
1358 professional who is subject to disciplinary action, in which
1359 case the provisions of s. 456.073 shall apply.
1360 (c) The report submitted to the agency must also contain
1361 the name of the risk manager of the facility.
1362 (d) The adverse incident report is confidential as provided
1363 by law and is not discoverable or admissible in any civil or
1364 administrative action, except in disciplinary proceedings by the
1365 agency or the appropriate regulatory board.
1366 (10) By the 10th of each month, each facility subject to
1367 this section shall report any notice received pursuant to s.
1368 400.0233(2) and each initial complaint that was filed with the
1369 clerk of the court and served on the facility during the
1370 previous month by a resident or a resident’s family member,
1371 guardian, conservator, or personal legal representative. The
1372 report must include the name of the resident, the resident’s
1373 date of birth and social security number, the Medicaid
1374 identification number for Medicaid-eligible persons, the date or
1375 dates of the incident leading to the claim or dates of
1376 residency, if applicable, and the type of injury or violation of
1377 rights alleged to have occurred. Each facility shall also submit
1378 a copy of the notices received pursuant to s. 400.0233(2) and
1379 complaints filed with the clerk of the court. This report is
1380 confidential as provided by law and is not discoverable or
1381 admissible in any civil or administrative action, except in such
1382 actions brought by the agency to enforce the provisions of this
1383 part.
1384 Section 36. Section 400.148, Florida Statutes, is repealed.
1385 Section 37. Subsection (3) of section 400.19, Florida
1386 Statutes, is amended to read:
1387 400.19 Right of entry and inspection.—
1388 (3) The agency shall every 15 months conduct at least one
1389 unannounced inspection every 15 months to determine the
1390 licensee’s compliance by the licensee with statutes, and related
1391 with rules promulgated under the provisions of those statutes,
1392 governing minimum standards of construction, quality and
1393 adequacy of care, and rights of residents. The survey must shall
1394 be conducted every 6 months for the next 2-year period if the
1395 nursing home facility has been cited for a class I deficiency,
1396 has been cited for two or more class II deficiencies arising
1397 from separate surveys or investigations within a 60-day period,
1398 or has had three or more substantiated complaints within a 6
1399 month period, each resulting in at least one class I or class II
1400 deficiency. In addition to any other fees or fines under in this
1401 part, the agency shall assess a fine for each facility that is
1402 subject to the 6-month survey cycle. The fine for the 2-year
1403 period is shall be $6,000, one-half to be paid at the completion
1404 of each survey. The agency may adjust this fine by the change in
1405 the Consumer Price Index, based on the 12 months immediately
1406 preceding the increase, to cover the cost of the additional
1407 surveys. The agency shall verify through subsequent inspection
1408 that any deficiency identified during inspection is corrected.
1409 However, the agency may verify the correction of a class III or
1410 class IV deficiency unrelated to resident rights or resident
1411 care without reinspecting the facility if adequate written
1412 documentation has been received from the facility, which
1413 provides assurance that the deficiency has been corrected. The
1414 giving or causing to be given of advance notice of such
1415 unannounced inspections by an employee of the agency to any
1416 unauthorized person shall constitute cause for suspension of at
1417 least not fewer than 5 working days according to the provisions
1418 of chapter 110.
1419 Section 38. Present subsection (6) of section 400.191,
1420 Florida Statutes, is renumbered as subsection (7) and a new
1421 subsection (6) is added to that section to read:
1422 400.191 Availability, distribution, and posting of reports
1423 and records.—
1424 (6) A nursing home facility may charge a reasonable fee for
1425 copying resident records. The fee may not exceed $1 per page for
1426 the first 25 pages and 25 cents per page for each page in excess
1427 of 25 pages.
1428 Section 39. Subsection (5) of section 400.23, Florida
1429 Statutes, is amended to read:
1430 400.23 Rules; evaluation and deficiencies; licensure
1431 status.—
1432 (5) The agency, in collaboration with the Division of
1433 Children’s Medical Services of the Department of Health, must,
1434 no later than December 31, 1993, adopt rules for:
1435 (a) Minimum standards of care for persons under 21 years of
1436 age who reside in nursing home facilities. The rules must
1437 include a methodology for reviewing a nursing home facility
1438 under ss. 408.031-408.045 which serves only persons under 21
1439 years of age. A facility may be exempted exempt from these
1440 standards for specific persons between 18 and 21 years of age,
1441 if the person’s physician agrees that minimum standards of care
1442 based on age are not necessary.
1443 (b) Minimum staffing requirements for persons under 21
1444 years of age who reside in nursing home facilities, which apply
1445 in lieu of the requirements contained in subsection (3).
1446 1. For persons under 21 years of age who require skilled
1447 care:
1448 a. A minimum combined average of 3.9 hours of direct care
1449 per resident per day must be provided by licensed nurses,
1450 respiratory therapists, respiratory care practitioners, and
1451 certified nursing assistants.
1452 b. A minimum licensed nursing staffing of 1.0 hour of
1453 direct care per resident per day must be provided.
1454 c. No more than 1.5 hours of certified nursing assistant
1455 care per resident per day may be counted in determining the
1456 minimum direct care hours required.
1457 d. One registered nurse must be on duty on the site 24
1458 hours per day on the unit where children reside.
1459 2. For persons under 21 years of age who are medically
1460 fragile:
1461 a. A minimum combined average of 5.0 hours of direct care
1462 per resident per day must be provided by licensed nurses,
1463 respiratory therapists, respiratory care practitioners, and
1464 certified nursing assistants.
1465 b. A minimum licensed nursing staffing of 1.7 hours of
1466 direct care per resident per day must be provided.
1467 c. No more than 1.5 hours of certified nursing assistant
1468 care per resident per day may be counted in determining the
1469 minimum direct care hours required.
1470 d. One registered nurse must be on duty on the site 24
1471 hours per day on the unit where children reside.
1472 Section 40. Subsection (1) of section 400.275, Florida
1473 Statutes, is amended to read:
1474 400.275 Agency duties.—
1475 (1) The agency shall ensure that each newly hired nursing
1476 home surveyor, as a part of basic training, is assigned full
1477 time to a licensed nursing home for at least 2 days within a 7
1478 day period to observe facility operations outside of the survey
1479 process before the surveyor begins survey responsibilities. Such
1480 observations may not be the sole basis of a deficiency citation
1481 against the facility. The agency may not assign an individual to
1482 be a member of a survey team for purposes of a survey,
1483 evaluation, or consultation visit at a nursing home facility in
1484 which the surveyor was an employee within the preceding 2 5
1485 years.
1486 Section 41. Subsection (27) of section 400.462, Florida
1487 Statutes, is amended to read:
1488 400.462 Definitions.—As used in this part, the term:
1489 (27) “Remuneration” means any payment or other benefit made
1490 directly or indirectly, overtly or covertly, in cash or in kind.
1491 However, if the term is used in any provision of law relating to
1492 health care providers, the term does not apply to an item that
1493 has an individual value of up to $15, including, but not limited
1494 to, a plaque, a certificate, a trophy, or a novelty item that is
1495 intended solely for presentation or is customarily given away
1496 solely for promotional, recognition, or advertising purposes.
1497 Section 42. For the purpose of incorporating the amendment
1498 made by this act to section 400.509, Florida Statutes, in a
1499 reference thereto, paragraph (b) of subsection (5) of section
1500 400.464, Florida Statutes, is reenacted to read:
1501 400.464 Home health agencies to be licensed; expiration of
1502 license; exemptions; unlawful acts; penalties.—
1503 (5) The following are exempt from the licensure
1504 requirements of this part:
1505 (b) Home health services provided by a state agency, either
1506 directly or through a contractor with:
1507 1. The Department of Elderly Affairs.
1508 2. The Department of Health, a community health center, or
1509 a rural health network that furnishes home visits for the
1510 purpose of providing environmental assessments, case management,
1511 health education, personal care services, family planning, or
1512 followup treatment, or for the purpose of monitoring and
1513 tracking disease.
1514 3. Services provided to persons with developmental
1515 disabilities, as defined in s. 393.063.
1516 4. Companion and sitter organizations that were registered
1517 under s. 400.509(1) on January 1, 1999, and were authorized to
1518 provide personal services under a developmental services
1519 provider certificate on January 1, 1999, may continue to provide
1520 such services to past, present, and future clients of the
1521 organization who need such services, notwithstanding the
1522 provisions of this act.
1523 5. The Department of Children and Family Services.
1524 Section 43. Subsection (6) of section 400.474, Florida
1525 Statutes, is amended, present subsection (7) is redesignated as
1526 subsection (8), and a new subsection (7) is added to that
1527 section, to read:
1528 400.474 Administrative penalties.—
1529 (6) The agency may deny, revoke, or suspend the license of
1530 a home health agency and shall impose a fine of $5,000 against a
1531 home health agency that:
1532 (a) Gives remuneration for staffing services to:
1533 1. Another home health agency with which it has formal or
1534 informal patient-referral transactions or arrangements; or
1535 2. A health services pool with which it has formal or
1536 informal patient-referral transactions or arrangements,
1537
1538 unless the home health agency has activated its comprehensive
1539 emergency management plan in accordance with s. 400.492. This
1540 paragraph does not apply to a Medicare-certified home health
1541 agency that provides fair market value remuneration for staffing
1542 services to a non-Medicare-certified home health agency that is
1543 part of a continuing care facility licensed under chapter 651
1544 for providing services to its own residents if each resident
1545 receiving home health services pursuant to this arrangement
1546 attests in writing that he or she made a decision without
1547 influence from staff of the facility to select, from a list of
1548 Medicare-certified home health agencies provided by the
1549 facility, that Medicare-certified home health agency to provide
1550 the services.
1551 (b) Provides services to residents in an assisted living
1552 facility for which the home health agency does not receive fair
1553 market value remuneration.
1554 (c) Provides staffing to an assisted living facility for
1555 which the home health agency does not receive fair market value
1556 remuneration.
1557 (d) Fails to provide the agency, upon request, with copies
1558 of all contracts with assisted living facilities which were
1559 executed within 5 years before the request.
1560 (e) Gives remuneration to a case manager, discharge
1561 planner, facility-based staff member, or third-party vendor who
1562 is involved in the discharge planning process of a facility
1563 licensed under chapter 395, chapter 429, or this chapter from
1564 whom the home health agency receives referrals.
1565 (f) Fails to submit to the agency, within 15 days after the
1566 end of each calendar quarter, a written report that includes the
1567 following data based on data as it existed on the last day of
1568 the quarter:
1569 1. The number of insulin-dependent diabetic patients
1570 receiving insulin-injection services from the home health
1571 agency;
1572 2. The number of patients receiving both home health
1573 services from the home health agency and hospice services;
1574 3. The number of patients receiving home health services
1575 from that home health agency; and
1576 4. The names and license numbers of nurses whose primary
1577 job responsibility is to provide home health services to
1578 patients and who received remuneration from the home health
1579 agency in excess of $25,000 during the calendar quarter.
1580 (f)(g) Gives cash, or its equivalent, to a Medicare or
1581 Medicaid beneficiary.
1582 (g)(h) Has more than one medical director contract in
1583 effect at one time or more than one medical director contract
1584 and one contract with a physician-specialist whose services are
1585 mandated for the home health agency in order to qualify to
1586 participate in a federal or state health care program at one
1587 time.
1588 (h)(i) Gives remuneration to a physician without a medical
1589 director contract being in effect. The contract must:
1590 1. Be in writing and signed by both parties;
1591 2. Provide for remuneration that is at fair market value
1592 for an hourly rate, which must be supported by invoices
1593 submitted by the medical director describing the work performed,
1594 the dates on which that work was performed, and the duration of
1595 that work; and
1596 3. Be for a term of at least 1 year.
1597
1598 The hourly rate specified in the contract may not be increased
1599 during the term of the contract. The home health agency may not
1600 execute a subsequent contract with that physician which has an
1601 increased hourly rate and covers any portion of the term that
1602 was in the original contract.
1603 (i)(j) Gives remuneration to:
1604 1. A physician, and the home health agency is in violation
1605 of paragraph (g) (h) or paragraph (h) (i);
1606 2. A member of the physician’s office staff; or
1607 3. An immediate family member of the physician,
1608
1609 if the home health agency has received a patient referral in the
1610 preceding 12 months from that physician or physician’s office
1611 staff.
1612 (j)(k) Fails to provide to the agency, upon request, copies
1613 of all contracts with a medical director which were executed
1614 within 5 years before the request.
1615 (k)(l) Demonstrates a pattern of billing the Medicaid
1616 program for services to Medicaid recipients which are medically
1617 unnecessary as determined by a final order. A pattern may be
1618 demonstrated by a showing of at least two such medically
1619 unnecessary services within one Medicaid program integrity audit
1620 period.
1621
1622 Nothing in paragraph (e) or paragraph (i) (j) shall be
1623 interpreted as applying to or precluding any discount,
1624 compensation, waiver of payment, or payment practice permitted
1625 by 42 U.S.C. s. 1320a-7(b) or regulations adopted thereunder,
1626 including 42 C.F.R. s. 1001.952 or s. 1395nn or regulations
1627 adopted thereunder.
1628 (7) Each home health agency shall submit to the agency,
1629 within 15 days after the end of each calendar quarter, a written
1630 report that includes the following data as it existed on the
1631 last day of the quarter:
1632 (a) The number of insulin-dependent diabetic patients
1633 receiving insulin-injection services from the home health
1634 agency.
1635 (b) The number of patients receiving home health services
1636 from the home health agency who are also receiving hospice
1637 services.
1638 (c) The number of patients receiving home health services
1639 from the home health agency.
1640 (d) The names and license numbers of nurses whose primary
1641 job responsibility is to provide home health services to
1642 patients and who received remuneration from the home health
1643 agency in excess of $25,000 during the calendar quarter.
1644 (e) The number of physicians who were paid by the home
1645 health agency for professional services of any kind during the
1646 calendar quarter, the amount paid to each physician, and the
1647 number of hours each physician spent performing those services.
1648
1649 If the quarterly report is not received by the agency on or
1650 before the deadline, the agency shall impose a fine in the
1651 amount of $200 for each day that the report is late, which may
1652 not exceed $5,000 per quarter.
1653 Section 44. Section 400.484, Florida Statutes, is amended
1654 to read:
1655 400.484 Right of inspection; violations deficiencies;
1656 fines.—
1657 (1) In addition to the requirements of s. 408.811, the
1658 agency may make such inspections and investigations as are
1659 necessary in order to determine the state of compliance with
1660 this part, part II of chapter 408, and applicable rules.
1661 (2) The agency shall impose fines for various classes of
1662 violations deficiencies in accordance with the following
1663 schedule:
1664 (a) A class I violation is defined in s. 408.813 deficiency
1665 is any act, omission, or practice that results in a patient’s
1666 death, disablement, or permanent injury, or places a patient at
1667 imminent risk of death, disablement, or permanent injury. Upon
1668 finding a class I violation deficiency, the agency shall impose
1669 an administrative fine in the amount of $15,000 for each
1670 occurrence and each day that the violation deficiency exists.
1671 (b) A class II violation is defined in s. 408.813
1672 deficiency is any act, omission, or practice that has a direct
1673 adverse effect on the health, safety, or security of a patient.
1674 Upon finding a class II violation deficiency, the agency shall
1675 impose an administrative fine in the amount of $5,000 for each
1676 occurrence and each day that the violation deficiency exists.
1677 (c) A class III violation is defined in s. 408.813
1678 deficiency is any act, omission, or practice that has an
1679 indirect, adverse effect on the health, safety, or security of a
1680 patient. Upon finding an uncorrected or repeated class III
1681 violation deficiency, the agency shall impose an administrative
1682 fine not to exceed $1,000 for each occurrence and each day that
1683 the uncorrected or repeated violation deficiency exists.
1684 (d) A class IV violation is defined in s. 408.813
1685 deficiency is any act, omission, or practice related to required
1686 reports, forms, or documents which does not have the potential
1687 of negatively affecting patients. These violations are of a type
1688 that the agency determines do not threaten the health, safety,
1689 or security of patients. Upon finding an uncorrected or repeated
1690 class IV violation deficiency, the agency shall impose an
1691 administrative fine not to exceed $500 for each occurrence and
1692 each day that the uncorrected or repeated violation deficiency
1693 exists.
1694 (3) In addition to any other penalties imposed pursuant to
1695 this section or part, the agency may assess costs related to an
1696 investigation that results in a successful prosecution,
1697 excluding costs associated with an attorney’s time.
1698 Section 45. For the purpose of incorporating the amendment
1699 made by this act to section 400.509, Florida Statutes, in a
1700 reference thereto, paragraph (a) of subsection (6) of section
1701 400.506 is reenacted, present subsection (17) of that section is
1702 renumbered as subsection (18), and a new subsection (17) is
1703 added to that section, to read:
1704 400.506 Licensure of nurse registries; requirements;
1705 penalties.—
1706 (6)(a) A nurse registry may refer for contract in private
1707 residences registered nurses and licensed practical nurses
1708 registered and licensed under part I of chapter 464, certified
1709 nursing assistants certified under part II of chapter 464, home
1710 health aides who present documented proof of successful
1711 completion of the training required by rule of the agency, and
1712 companions or homemakers for the purposes of providing those
1713 services authorized under s. 400.509(1). A licensed nurse
1714 registry shall ensure that each certified nursing assistant
1715 referred for contract by the nurse registry and each home health
1716 aide referred for contract by the nurse registry is adequately
1717 trained to perform the tasks of a home health aide in the home
1718 setting. Each person referred by a nurse registry must provide
1719 current documentation that he or she is free from communicable
1720 diseases.
1721 (17) An administrator may manage only one nurse registry,
1722 except that an administrator may manage up to five registries if
1723 all five registries have identical controlling interests as
1724 defined in s. 408.803 and are located within one agency
1725 geographic service area or within an immediately contiguous
1726 county. An administrator shall designate, in writing, for each
1727 licensed entity, a qualified alternate administrator to serve
1728 during the administrator’s absence.
1729 Section 46. Subsection (1) of section 400.509, Florida
1730 Statutes, is amended to read:
1731 400.509 Registration of particular service providers exempt
1732 from licensure; certificate of registration; regulation of
1733 registrants.—
1734 (1) Any organization that provides companion services or
1735 homemaker services and does not provide a home health service to
1736 a person is exempt from licensure under this part. However, any
1737 organization that provides companion services or homemaker
1738 services must register with the agency. An organization under
1739 contract with the Agency for Persons with Disabilities which
1740 provides companion services only for persons with a
1741 developmental disability, as defined in s. 393.063, is exempt
1742 from registration.
1743 Section 47. Subsection (3) of section 400.601, Florida
1744 Statutes, is amended to read:
1745 400.601 Definitions.—As used in this part, the term:
1746 (3) “Hospice” means a centrally administered corporation or
1747 a limited liability company that provides providing a continuum
1748 of palliative and supportive care for the terminally ill patient
1749 and his or her family.
1750 Section 48. Paragraph (i) of subsection (1) and subsection
1751 (4) of section 400.606, Florida Statutes, are amended to read:
1752 400.606 License; application; renewal; conditional license
1753 or permit; certificate of need.—
1754 (1) In addition to the requirements of part II of chapter
1755 408, the initial application and change of ownership application
1756 must be accompanied by a plan for the delivery of home,
1757 residential, and homelike inpatient hospice services to
1758 terminally ill persons and their families. Such plan must
1759 contain, but need not be limited to:
1760 (i) The projected annual operating cost of the hospice.
1761
1762 If the applicant is an existing licensed health care provider,
1763 the application must be accompanied by a copy of the most recent
1764 profit-loss statement and, if applicable, the most recent
1765 licensure inspection report.
1766 (4) A freestanding hospice facility that is primarily
1767 engaged in providing inpatient and related services and that is
1768 not otherwise licensed as a health care facility shall be
1769 required to obtain a certificate of need. However, a
1770 freestanding hospice facility that has with six or fewer beds is
1771 shall not be required to comply with institutional standards
1772 such as, but not limited to, standards requiring sprinkler
1773 systems, emergency electrical systems, or special lavatory
1774 devices.
1775 Section 49. Section 400.915, Florida Statutes, is amended
1776 to read:
1777 400.915 Construction and renovation; requirements.—The
1778 requirements for the construction or renovation of a PPEC center
1779 shall comply with:
1780 (1) The provisions of chapter 553, which pertain to
1781 building construction standards, including plumbing, electrical
1782 code, glass, manufactured buildings, accessibility for the
1783 physically disabled;
1784 (2) The provisions of s. 633.022 and applicable rules
1785 pertaining to physical minimum standards for nonresidential
1786 child care physical facilities in rule 10M-12.003, Florida
1787 Administrative Code, Child Care Standards; and
1788 (3) The standards or rules adopted pursuant to this part
1789 and part II of chapter 408.
1790 Section 50. Subsection (1) of section 400.925, Florida
1791 Statutes, is amended to read:
1792 400.925 Definitions.—As used in this part, the term:
1793 (1) “Accrediting organizations” means the Joint Commission
1794 on Accreditation of Healthcare Organizations or other national
1795 accreditation agencies whose standards for accreditation are
1796 comparable to those required by this part for licensure.
1797 Section 51. Section 400.931, Florida Statutes, is amended
1798 to read:
1799 400.931 Application for license; fee; provisional license;
1800 temporary permit.—
1801 (1) In addition to the requirements of part II of chapter
1802 408, the applicant must file with the application satisfactory
1803 proof that the home medical equipment provider is in compliance
1804 with this part and applicable rules, including:
1805 (a) A report, by category, of the equipment to be provided,
1806 indicating those offered either directly by the applicant or
1807 through contractual arrangements with existing providers.
1808 Categories of equipment include:
1809 1. Respiratory modalities.
1810 2. Ambulation aids.
1811 3. Mobility aids.
1812 4. Sickroom setup.
1813 5. Disposables.
1814 (b) A report, by category, of the services to be provided,
1815 indicating those offered either directly by the applicant or
1816 through contractual arrangements with existing providers.
1817 Categories of services include:
1818 1. Intake.
1819 2. Equipment selection.
1820 3. Delivery.
1821 4. Setup and installation.
1822 5. Patient training.
1823 6. Ongoing service and maintenance.
1824 7. Retrieval.
1825 (c) A listing of those with whom the applicant contracts,
1826 both the providers the applicant uses to provide equipment or
1827 services to its consumers and the providers for whom the
1828 applicant provides services or equipment.
1829 (2) An applicant for initial licensure, change of
1830 ownership, or license renewal to operate a licensed home medical
1831 equipment provider at a location outside the state must submit
1832 documentation of accreditation or an application for
1833 accreditation from an accrediting organization that is
1834 recognized by the agency. An applicant that has applied for
1835 accreditation must provide proof of accreditation that is not
1836 conditional or provisional within 120 days after the date the
1837 agency receives the application for licensure or the application
1838 shall be withdrawn from further consideration. Such
1839 accreditation must be maintained by the home medical equipment
1840 provider in order to maintain licensure. As an alternative to
1841 submitting proof of financial ability to operate as required in
1842 s. 408.810(8), the applicant may submit a $50,000 surety bond to
1843 the agency.
1844 (3) As specified in part II of chapter 408, the home
1845 medical equipment provider must also obtain and maintain
1846 professional and commercial liability insurance. Proof of
1847 liability insurance, as defined in s. 624.605, must be submitted
1848 with the application. The agency shall set the required amounts
1849 of liability insurance by rule, but the required amount must not
1850 be less than $250,000 per claim. In the case of contracted
1851 services, it is required that the contractor have liability
1852 insurance not less than $250,000 per claim.
1853 (4) When a change of the general manager of a home medical
1854 equipment provider occurs, the licensee must notify the agency
1855 of the change within 45 days.
1856 (5) In accordance with s. 408.805, an applicant or a
1857 licensee shall pay a fee for each license application submitted
1858 under this part, part II of chapter 408, and applicable rules.
1859 The amount of the fee shall be established by rule and may not
1860 exceed $300 per biennium. The agency shall set the fees in an
1861 amount that is sufficient to cover its costs in carrying out its
1862 responsibilities under this part. However, state, county, or
1863 municipal governments applying for licenses under this part are
1864 exempt from the payment of license fees.
1865 (6) An applicant for initial licensure, renewal, or change
1866 of ownership shall also pay an inspection fee not to exceed
1867 $400, which shall be paid by all applicants except those not
1868 subject to licensure inspection by the agency as described in s.
1869 400.933.
1870 Section 52. Section 400.967, Florida Statutes, is amended
1871 to read:
1872 400.967 Rules and classification of violations
1873 deficiencies.—
1874 (1) It is the intent of the Legislature that rules adopted
1875 and enforced under this part and part II of chapter 408 include
1876 criteria by which a reasonable and consistent quality of
1877 resident care may be ensured, the results of such resident care
1878 can be demonstrated, and safe and sanitary facilities can be
1879 provided.
1880 (2) Pursuant to the intention of the Legislature, the
1881 agency, in consultation with the Agency for Persons with
1882 Disabilities and the Department of Elderly Affairs, shall adopt
1883 and enforce rules to administer this part and part II of chapter
1884 408, which shall include reasonable and fair criteria governing:
1885 (a) The location and construction of the facility;
1886 including fire and life safety, plumbing, heating, cooling,
1887 lighting, ventilation, and other housing conditions that ensure
1888 the health, safety, and comfort of residents. The agency shall
1889 establish standards for facilities and equipment to increase the
1890 extent to which new facilities and a new wing or floor added to
1891 an existing facility after July 1, 2000, are structurally
1892 capable of serving as shelters only for residents, staff, and
1893 families of residents and staff, and equipped to be self
1894 supporting during and immediately following disasters. The
1895 agency shall update or revise the criteria as the need arises.
1896 All facilities must comply with those lifesafety code
1897 requirements and building code standards applicable at the time
1898 of approval of their construction plans. The agency may require
1899 alterations to a building if it determines that an existing
1900 condition constitutes a distinct hazard to life, health, or
1901 safety. The agency shall adopt fair and reasonable rules setting
1902 forth conditions under which existing facilities undergoing
1903 additions, alterations, conversions, renovations, or repairs are
1904 required to comply with the most recent updated or revised
1905 standards.
1906 (b) The number and qualifications of all personnel,
1907 including management, medical nursing, and other personnel,
1908 having responsibility for any part of the care given to
1909 residents.
1910 (c) All sanitary conditions within the facility and its
1911 surroundings, including water supply, sewage disposal, food
1912 handling, and general hygiene, which will ensure the health and
1913 comfort of residents.
1914 (d) The equipment essential to the health and welfare of
1915 the residents.
1916 (e) A uniform accounting system.
1917 (f) The care, treatment, and maintenance of residents and
1918 measurement of the quality and adequacy thereof.
1919 (g) The preparation and annual update of a comprehensive
1920 emergency management plan. The agency shall adopt rules
1921 establishing minimum criteria for the plan after consultation
1922 with the Division of Emergency Management. At a minimum, the
1923 rules must provide for plan components that address emergency
1924 evacuation transportation; adequate sheltering arrangements;
1925 postdisaster activities, including emergency power, food, and
1926 water; postdisaster transportation; supplies; staffing;
1927 emergency equipment; individual identification of residents and
1928 transfer of records; and responding to family inquiries. The
1929 comprehensive emergency management plan is subject to review and
1930 approval by the local emergency management agency. During its
1931 review, the local emergency management agency shall ensure that
1932 the following agencies, at a minimum, are given the opportunity
1933 to review the plan: the Department of Elderly Affairs, the
1934 Agency for Persons with Disabilities, the Agency for Health Care
1935 Administration, and the Division of Emergency Management. Also,
1936 appropriate volunteer organizations must be given the
1937 opportunity to review the plan. The local emergency management
1938 agency shall complete its review within 60 days and either
1939 approve the plan or advise the facility of necessary revisions.
1940 (h) The use of restraint and seclusion. Such rules must be
1941 consistent with recognized best practices; prohibit inherently
1942 dangerous restraint or seclusion procedures; establish
1943 limitations on the use and duration of restraint and seclusion;
1944 establish measures to ensure the safety of clients and staff
1945 during an incident of restraint or seclusion; establish
1946 procedures for staff to follow before, during, and after
1947 incidents of restraint or seclusion, including individualized
1948 plans for the use of restraints or seclusion in emergency
1949 situations; establish professional qualifications of and
1950 training for staff who may order or be engaged in the use of
1951 restraint or seclusion; establish requirements for facility data
1952 collection and reporting relating to the use of restraint and
1953 seclusion; and establish procedures relating to the
1954 documentation of the use of restraint or seclusion in the
1955 client’s facility or program record.
1956 (3) The agency shall adopt rules to provide that, when the
1957 criteria established under this part and part II of chapter 408
1958 are not met, such violations deficiencies shall be classified
1959 according to the nature of the violation deficiency. The agency
1960 shall indicate the classification on the face of the notice of
1961 violation deficiencies as follows:
1962 (a) A class I violation is defined in s. 408.813
1963 deficiencies are those which the agency determines present an
1964 imminent danger to the residents or guests of the facility or a
1965 substantial probability that death or serious physical harm
1966 would result therefrom. The condition or practice constituting a
1967 class I violation must be abated or eliminated immediately,
1968 unless a fixed period of time, as determined by the agency, is
1969 required for correction. A class I violation deficiency is
1970 subject to a civil penalty in an amount not less than $5,000 and
1971 not exceeding $10,000 for each violation deficiency. A fine may
1972 be levied notwithstanding the correction of the violation
1973 deficiency.
1974 (b) A class II violation is defined in s. 408.813
1975 deficiencies are those which the agency determines have a direct
1976 or immediate relationship to the health, safety, or security of
1977 the facility residents, other than class I deficiencies. A class
1978 II violation deficiency is subject to a civil penalty in an
1979 amount not less than $1,000 and not exceeding $5,000 for each
1980 violation deficiency. A citation for a class II violation
1981 deficiency shall specify the time within which the violation
1982 deficiency must be corrected. If a class II violation deficiency
1983 is corrected within the time specified, no civil penalty shall
1984 be imposed, unless it is a repeated offense.
1985 (c) A class III violation is defined in s. 408.813
1986 deficiencies are those which the agency determines to have an
1987 indirect or potential relationship to the health, safety, or
1988 security of the facility residents, other than class I or class
1989 II deficiencies. A class III violation deficiency is subject to
1990 a civil penalty of not less than $500 and not exceeding $1,000
1991 for each violation deficiency. A citation for a class III
1992 violation deficiency shall specify the time within which the
1993 violation deficiency must be corrected. If a class III violation
1994 deficiency is corrected within the time specified, no civil
1995 penalty shall be imposed, unless it is a repeated offense.
1996 (d) A class IV violation is defined in s. 408.813. Upon
1997 finding an uncorrected or repeated class IV violation, the
1998 agency shall impose an administrative fine not to exceed $500
1999 for each occurrence and each day that the uncorrected or
2000 repeated violation exists.
2001 (4) The agency shall approve or disapprove the plans and
2002 specifications within 60 days after receipt of the final plans
2003 and specifications. The agency may be granted one 15-day
2004 extension for the review period, if the secretary of the agency
2005 so approves. If the agency fails to act within the specified
2006 time, it is deemed to have approved the plans and
2007 specifications. When the agency disapproves plans and
2008 specifications, it must set forth in writing the reasons for
2009 disapproval. Conferences and consultations may be provided as
2010 necessary.
2011 (5) The agency may charge an initial fee of $2,000 for
2012 review of plans and construction on all projects, no part of
2013 which is refundable. The agency may also collect a fee, not to
2014 exceed 1 percent of the estimated construction cost or the
2015 actual cost of review, whichever is less, for the portion of the
2016 review which encompasses initial review through the initial
2017 revised construction document review. The agency may collect its
2018 actual costs on all subsequent portions of the review and
2019 construction inspections. Initial fee payment must accompany the
2020 initial submission of plans and specifications. Any subsequent
2021 payment that is due is payable upon receipt of the invoice from
2022 the agency. Notwithstanding any other provision of law, all
2023 money received by the agency under this section shall be deemed
2024 to be trust funds, to be held and applied solely for the
2025 operations required under this section.
2026 Section 53. Subsections (4) and (7) of section 400.9905,
2027 Florida Statutes, are amended to read:
2028 400.9905 Definitions.—
2029 (4) “Clinic” means an entity at which health care services
2030 are provided to individuals and which tenders charges for
2031 reimbursement for such services, including a mobile clinic and a
2032 portable health service or equipment provider. For purposes of
2033 this part, the term does not include and the licensure
2034 requirements of this part do not apply to:
2035 (a) Entities licensed or registered by the state under
2036 chapter 395; or entities licensed or registered by the state and
2037 providing only health care services within the scope of services
2038 authorized under their respective licenses granted under ss.
2039 383.30-383.335, chapter 390, chapter 394, chapter 397, this
2040 chapter except part X, chapter 429, chapter 463, chapter 465,
2041 chapter 466, chapter 478, part I of chapter 483, chapter 484, or
2042 chapter 651; end-stage renal disease providers authorized under
2043 42 C.F.R. part 405, subpart U; or providers certified under 42
2044 C.F.R. part 485, subpart B or subpart H; or any entity that
2045 provides neonatal or pediatric hospital-based health care
2046 services or other health care services by licensed practitioners
2047 solely within a hospital licensed under chapter 395.
2048 (b) Entities that own, directly or indirectly, entities
2049 licensed or registered by the state pursuant to chapter 395; or
2050 entities that own, directly or indirectly, entities licensed or
2051 registered by the state and providing only health care services
2052 within the scope of services authorized pursuant to their
2053 respective licenses granted under ss. 383.30-383.335, chapter
2054 390, chapter 394, chapter 397, this chapter except part X,
2055 chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
2056 part I of chapter 483, chapter 484, chapter 651; end-stage renal
2057 disease providers authorized under 42 C.F.R. part 405, subpart
2058 U; or providers certified under 42 C.F.R. part 485, subpart B or
2059 subpart H; or any entity that provides neonatal or pediatric
2060 hospital-based health care services by licensed practitioners
2061 solely within a hospital licensed under chapter 395.
2062 (c) Entities that are owned, directly or indirectly, by an
2063 entity licensed or registered by the state pursuant to chapter
2064 395; or entities that are owned, directly or indirectly, by an
2065 entity licensed or registered by the state and providing only
2066 health care services within the scope of services authorized
2067 pursuant to their respective licenses granted under ss. 383.30
2068 383.335, chapter 390, chapter 394, chapter 397, this chapter
2069 except part X, chapter 429, chapter 463, chapter 465, chapter
2070 466, chapter 478, part I of chapter 483, chapter 484, or chapter
2071 651; end-stage renal disease providers authorized under 42
2072 C.F.R. part 405, subpart U; or providers certified under 42
2073 C.F.R. part 485, subpart B or subpart H; or any entity that
2074 provides neonatal or pediatric hospital-based health care
2075 services by licensed practitioners solely within a hospital
2076 under chapter 395.
2077 (d) Entities that are under common ownership, directly or
2078 indirectly, with an entity licensed or registered by the state
2079 pursuant to chapter 395; or entities that are under common
2080 ownership, directly or indirectly, with an entity licensed or
2081 registered by the state and providing only health care services
2082 within the scope of services authorized pursuant to their
2083 respective licenses granted under ss. 383.30-383.335, chapter
2084 390, chapter 394, chapter 397, this chapter except part X,
2085 chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
2086 part I of chapter 483, chapter 484, or chapter 651; end-stage
2087 renal disease providers authorized under 42 C.F.R. part 405,
2088 subpart U; or providers certified under 42 C.F.R. part 485,
2089 subpart B or subpart H; or any entity that provides neonatal or
2090 pediatric hospital-based health care services by licensed
2091 practitioners solely within a hospital licensed under chapter
2092 395.
2093 (e) An entity that is exempt from federal taxation under 26
2094 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
2095 under 26 U.S.C. s. 409 that has a board of trustees not less
2096 than two-thirds of which are Florida-licensed health care
2097 practitioners and provides only physical therapy services under
2098 physician orders, any community college or university clinic,
2099 and any entity owned or operated by the federal or state
2100 government, including agencies, subdivisions, or municipalities
2101 thereof.
2102 (f) A sole proprietorship, group practice, partnership, or
2103 corporation that provides health care services by physicians
2104 covered by s. 627.419, that is directly supervised by one or
2105 more of such physicians, and that is wholly owned by one or more
2106 of those physicians or by a physician and the spouse, parent,
2107 child, or sibling of that physician.
2108 (g) A sole proprietorship, group practice, partnership, or
2109 corporation that provides health care services by licensed
2110 health care practitioners under chapter 457, chapter 458,
2111 chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
2112 chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
2113 chapter 490, chapter 491, or part I, part III, part X, part
2114 XIII, or part XIV of chapter 468, or s. 464.012, which are
2115 wholly owned by one or more licensed health care practitioners,
2116 or the licensed health care practitioners set forth in this
2117 paragraph and the spouse, parent, child, or sibling of a
2118 licensed health care practitioner, so long as one of the owners
2119 who is a licensed health care practitioner is supervising the
2120 business activities and is legally responsible for the entity’s
2121 compliance with all federal and state laws. However, a health
2122 care practitioner may not supervise services beyond the scope of
2123 the practitioner’s license, except that, for the purposes of
2124 this part, a clinic owned by a licensee in s. 456.053(3)(b) that
2125 provides only services authorized pursuant to s. 456.053(3)(b)
2126 may be supervised by a licensee specified in s. 456.053(3)(b).
2127 (h) Clinical facilities affiliated with an accredited
2128 medical school at which training is provided for medical
2129 students, residents, or fellows.
2130 (i) Entities that provide only oncology or radiation
2131 therapy services by physicians licensed under chapter 458 or
2132 chapter 459 or entities that provide oncology or radiation
2133 therapy services by physicians licensed under chapter 458 or
2134 chapter 459 which are owned by a corporation whose shares are
2135 publicly traded on a recognized stock exchange.
2136 (j) Clinical facilities affiliated with a college of
2137 chiropractic accredited by the Council on Chiropractic Education
2138 at which training is provided for chiropractic students.
2139 (k) Entities that provide licensed practitioners to staff
2140 emergency departments or to deliver anesthesia services in
2141 facilities licensed under chapter 395 and that derive at least
2142 90 percent of their gross annual revenues from the provision of
2143 such services. Entities claiming an exemption from licensure
2144 under this paragraph must provide documentation demonstrating
2145 compliance.
2146 (l) Orthotic, or prosthetic, pediatric cardiology,
2147 perinatology, or anesthesia clinical facilities that are a
2148 publicly traded corporation or that are wholly owned, directly
2149 or indirectly, by a publicly traded corporation. As used in this
2150 paragraph, a publicly traded corporation is a corporation that
2151 issues securities traded on an exchange registered with the
2152 United States Securities and Exchange Commission as a national
2153 securities exchange.
2154 (m) Entities that are owned by a corporation that has $250
2155 million or more in total annual sales of health care services
2156 provided by licensed health care practitioners when one or more
2157 of the owners of the entity is a health care practitioner who is
2158 licensed in this state, is responsible for supervising the
2159 business activities of the entity, and is legally responsible
2160 for the entity’s compliance with state law for purposes of this
2161 section.
2162 (n) Entities that are owned or controlled, directly or
2163 indirectly, by a publicly traded entity with $100 million or
2164 more, in the aggregate, in total annual revenues derived from
2165 providing health care services by licensed health care
2166 practitioners that are employed or contracted by an entity
2167 described in this paragraph.
2168 (o) Entities that employ 50 or more licensed health care
2169 practitioners licensed under chapter 458 or chapter 459 when the
2170 billing for medical services is under a single tax
2171 identification number. The application for exemption from
2172 licensure requirements under this paragraph shall contain the
2173 name, residence address, business address, and telephone numbers
2174 of the entity that owns the clinic; a complete list of the names
2175 and contact information of all the officers and directors of the
2176 corporation; the name, residence address, business address, and
2177 medical practitioner license number of each health care
2178 practitioner employed by the entity; the corporate tax
2179 identification number of the entity seeking an exemption; a
2180 listing of health care services to be provided by the entity at
2181 the health care clinics owned or operated by the entity; and a
2182 certified statement prepared by an independent certified public
2183 accountant which states that the entity and the health care
2184 clinics owned or operated by the entity have not received
2185 payment for health care services under personal injury
2186 protection insurance coverage for the preceding year. If the
2187 agency determines that an entity that is exempt under this
2188 paragraph has received payments for medical services under
2189 personal injury protection insurance coverage, the agency may
2190 deny or revoke the exemption from licensure under this
2191 paragraph.
2192 (7) “Portable health service or equipment provider” means
2193 an entity that contracts with or employs persons to provide
2194 portable health services or equipment to multiple locations
2195 performing treatment or diagnostic testing of individuals, that
2196 bills third-party payors for those services, and that otherwise
2197 meets the definition of a clinic in subsection (4).
2198 Section 54. Paragraph (b) of subsection (1) and subsection
2199 (4) of section 400.991, Florida Statutes, are amended to read:
2200 400.991 License requirements; background screenings;
2201 prohibitions.—
2202 (1)
2203 (b) Each mobile clinic must obtain a separate health care
2204 clinic license and must provide to the agency, at least
2205 quarterly, its projected street location to enable the agency to
2206 locate and inspect such clinic. A portable health service or
2207 equipment provider must obtain a health care clinic license for
2208 a single administrative office and is not required to submit
2209 quarterly projected street locations.
2210 (4) In addition to the requirements of part II of chapter
2211 408, the applicant must file with the application satisfactory
2212 proof that the clinic is in compliance with this part and
2213 applicable rules, including:
2214 (a) A listing of services to be provided either directly by
2215 the applicant or through contractual arrangements with existing
2216 providers;
2217 (b) The number and discipline of each professional staff
2218 member to be employed; and
2219 (c) Proof of financial ability to operate as required under
2220 ss. s. 408.810(8) and 408.8065. As an alternative to submitting
2221 proof of financial ability to operate as required under s.
2222 408.810(8), the applicant may file a surety bond of at least
2223 $500,000 which guarantees that the clinic will act in full
2224 conformity with all legal requirements for operating a clinic,
2225 payable to the agency. The agency may adopt rules to specify
2226 related requirements for such surety bond.
2227 Section 55. Paragraphs (g) and (i) of subsection (1) and
2228 paragraph (a) of subsection (7) of section 400.9935, Florida
2229 Statutes, are amended to read:
2230 400.9935 Clinic responsibilities.—
2231 (1) Each clinic shall appoint a medical director or clinic
2232 director who shall agree in writing to accept legal
2233 responsibility for the following activities on behalf of the
2234 clinic. The medical director or the clinic director shall:
2235 (g) Conduct systematic reviews of clinic billings to ensure
2236 that the billings are not fraudulent or unlawful. Upon discovery
2237 of an unlawful charge, the medical director or clinic director
2238 shall take immediate corrective action. If the clinic performs
2239 only the technical component of magnetic resonance imaging,
2240 static radiographs, computed tomography, or positron emission
2241 tomography, and provides the professional interpretation of such
2242 services, in a fixed facility that is accredited by the Joint
2243 Commission on Accreditation of Healthcare Organizations or the
2244 Accreditation Association for Ambulatory Health Care, and the
2245 American College of Radiology; and if, in the preceding quarter,
2246 the percentage of scans performed by that clinic which was
2247 billed to all personal injury protection insurance carriers was
2248 less than 15 percent, the chief financial officer of the clinic
2249 may, in a written acknowledgment provided to the agency, assume
2250 the responsibility for the conduct of the systematic reviews of
2251 clinic billings to ensure that the billings are not fraudulent
2252 or unlawful.
2253 (i) Ensure that the clinic publishes a schedule of charges
2254 for the medical services offered to patients. The schedule must
2255 include the prices charged to an uninsured person paying for
2256 such services by cash, check, credit card, or debit card. The
2257 schedule must be posted in a conspicuous place in the reception
2258 area of the urgent care center and must include, but is not
2259 limited to, the 50 services most frequently provided by the
2260 clinic. The schedule may group services by three price levels,
2261 listing services in each price level. The posting may be a sign
2262 that must be at least 15 square feet in size or through an
2263 electronic messaging board that is at least 3 square feet in
2264 size. The failure of a clinic to publish and post a schedule of
2265 charges as required by this section shall result in a fine of
2266 not more than $1,000, per day, until the schedule is published
2267 and posted.
2268 (7)(a) Each clinic engaged in magnetic resonance imaging
2269 services must be accredited by the Joint Commission on
2270 Accreditation of Healthcare Organizations, the American College
2271 of Radiology, or the Accreditation Association for Ambulatory
2272 Health Care, within 1 year after licensure. A clinic that is
2273 accredited by the American College of Radiology or is within the
2274 original 1-year period after licensure and replaces its core
2275 magnetic resonance imaging equipment shall be given 1 year after
2276 the date on which the equipment is replaced to attain
2277 accreditation. However, a clinic may request a single, 6-month
2278 extension if it provides evidence to the agency establishing
2279 that, for good cause shown, such clinic cannot be accredited
2280 within 1 year after licensure, and that such accreditation will
2281 be completed within the 6-month extension. After obtaining
2282 accreditation as required by this subsection, each such clinic
2283 must maintain accreditation as a condition of renewal of its
2284 license. A clinic that files a change of ownership application
2285 must comply with the original accreditation timeframe
2286 requirements of the transferor. The agency shall deny a change
2287 of ownership application if the clinic is not in compliance with
2288 the accreditation requirements. When a clinic adds, replaces, or
2289 modifies magnetic resonance imaging equipment and the
2290 accreditation agency requires new accreditation, the clinic must
2291 be accredited within 1 year after the date of the addition,
2292 replacement, or modification but may request a single, 6-month
2293 extension if the clinic provides evidence of good cause to the
2294 agency.
2295 Section 56. Paragraph (a) of subsection (2) of section
2296 408.033, Florida Statutes, is amended to read:
2297 408.033 Local and state health planning.—
2298 (2) FUNDING.—
2299 (a) The Legislature intends that the cost of local health
2300 councils be borne by assessments on selected health care
2301 facilities subject to facility licensure by the Agency for
2302 Health Care Administration, including abortion clinics, assisted
2303 living facilities, ambulatory surgical centers, birthing
2304 centers, clinical laboratories except community nonprofit blood
2305 banks and clinical laboratories operated by practitioners for
2306 exclusive use regulated under s. 483.035, home health agencies,
2307 hospices, hospitals, intermediate care facilities for the
2308 developmentally disabled, nursing homes, health care clinics,
2309 and multiphasic testing centers and by assessments on
2310 organizations subject to certification by the agency pursuant to
2311 chapter 641, part III, including health maintenance
2312 organizations and prepaid health clinics. Fees assessed may be
2313 collected prospectively at the time of licensure renewal and
2314 prorated for the licensure period.
2315 Section 57. Subsection (2) of section 408.034, Florida
2316 Statutes, is amended to read:
2317 408.034 Duties and responsibilities of agency; rules.—
2318 (2) In the exercise of its authority to issue licenses to
2319 health care facilities and health service providers, as provided
2320 under chapters 393 and 395 and parts II, and IV, and VIII of
2321 chapter 400, the agency may not issue a license to any health
2322 care facility or health service provider that fails to receive a
2323 certificate of need or an exemption for the licensed facility or
2324 service.
2325 Section 58. Paragraph (d) of subsection (1) of section
2326 408.036, Florida Statutes, is amended to read:
2327 408.036 Projects subject to review; exemptions.—
2328 (1) APPLICABILITY.—Unless exempt under subsection (3), all
2329 health-care-related projects, as described in paragraphs (a)
2330 (g), are subject to review and must file an application for a
2331 certificate of need with the agency. The agency is exclusively
2332 responsible for determining whether a health-care-related
2333 project is subject to review under ss. 408.031-408.045.
2334 (d) The establishment of a hospice or hospice inpatient
2335 facility, except as provided in s. 408.043.
2336 Section 59. Paragraph (c) of subsection (1) of section
2337 408.037, Florida Statutes, is amended to read:
2338 408.037 Application content.—
2339 (1) Except as provided in subsection (2) for a general
2340 hospital, an application for a certificate of need must contain:
2341 (c) An audited financial statement of the applicant or the
2342 applicant’s parent corporation if audited financial statements
2343 of the applicant do not exist. In an application submitted by an
2344 existing health care facility, health maintenance organization,
2345 or hospice, financial condition documentation must include, but
2346 need not be limited to, a balance sheet and a profit-and-loss
2347 statement of the 2 previous fiscal years’ operation.
2348 Section 60. Subsection (2) of section 408.043, Florida
2349 Statutes, is amended to read:
2350 408.043 Special provisions.—
2351 (2) HOSPICES.—When an application is made for a certificate
2352 of need to establish or to expand a hospice, the need for such
2353 hospice shall be determined on the basis of the need for and
2354 availability of hospice services in the community. The formula
2355 on which the certificate of need is based shall discourage
2356 regional monopolies and promote competition. The inpatient
2357 hospice care component of a hospice which is a freestanding
2358 facility, or a part of a facility, which is primarily engaged in
2359 providing inpatient care and related services and is not
2360 otherwiselicensed as a another type health care facility, shall
2361 also be required to obtain a certificate of need. Provision of
2362 hospice care by any current provider of health care is a
2363 significant change in service and therefore requires a
2364 certificate of need for such services.
2365 Section 61. Paragraph (k) of subsection (3) of section
2366 408.05, Florida Statutes, is amended to read:
2367 408.05 Florida Center for Health Information and Policy
2368 Analysis.—
2369 (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.—In order to
2370 produce comparable and uniform health information and statistics
2371 for the development of policy recommendations, the agency shall
2372 perform the following functions:
2373 (k) Develop, in conjunction with the State Consumer Health
2374 Information and Policy Advisory Council, and implement a long
2375 range plan for making available health care quality measures and
2376 financial data that will allow consumers to compare health care
2377 services. The health care quality measures and financial data
2378 the agency must make available shall include, but is not limited
2379 to, pharmaceuticals, physicians, health care facilities, and
2380 health plans and managed care entities. The agency shall update
2381 the plan and report on the status of its implementation
2382 annually. The agency shall also make the plan and status report
2383 available to the public on its Internet website. As part of the
2384 plan, the agency shall identify the process and timeframes for
2385 implementation, any barriers to implementation, and
2386 recommendations of changes in the law that may be enacted by the
2387 Legislature to eliminate the barriers. As preliminary elements
2388 of the plan, the agency shall:
2389 1. Make available patient-safety indicators, inpatient
2390 quality indicators, and performance outcome and patient charge
2391 data collected from health care facilities pursuant to s.
2392 408.061(1)(a) and (2). The terms “patient-safety indicators” and
2393 “inpatient quality indicators” shall be as defined by the
2394 Centers for Medicare and Medicaid Services, the National Quality
2395 Forum, the Joint Commission on Accreditation of Healthcare
2396 Organizations, the Agency for Healthcare Research and Quality,
2397 the Centers for Disease Control and Prevention, or a similar
2398 national entity that establishes standards to measure the
2399 performance of health care providers, or by other states. The
2400 agency shall determine which conditions, procedures, health care
2401 quality measures, and patient charge data to disclose based upon
2402 input from the council. When determining which conditions and
2403 procedures are to be disclosed, the council and the agency shall
2404 consider variation in costs, variation in outcomes, and
2405 magnitude of variations and other relevant information. When
2406 determining which health care quality measures to disclose, the
2407 agency:
2408 a. Shall consider such factors as volume of cases; average
2409 patient charges; average length of stay; complication rates;
2410 mortality rates; and infection rates, among others, which shall
2411 be adjusted for case mix and severity, if applicable.
2412 b. May consider such additional measures that are adopted
2413 by the Centers for Medicare and Medicaid Studies, National
2414 Quality Forum, the Joint Commission on Accreditation of
2415 Healthcare Organizations, the Agency for Healthcare Research and
2416 Quality, Centers for Disease Control and Prevention, or a
2417 similar national entity that establishes standards to measure
2418 the performance of health care providers, or by other states.
2419
2420 When determining which patient charge data to disclose, the
2421 agency shall include such measures as the average of
2422 undiscounted charges on frequently performed procedures and
2423 preventive diagnostic procedures, the range of procedure charges
2424 from highest to lowest, average net revenue per adjusted patient
2425 day, average cost per adjusted patient day, and average cost per
2426 admission, among others.
2427 2. Make available performance measures, benefit design, and
2428 premium cost data from health plans licensed pursuant to chapter
2429 627 or chapter 641. The agency shall determine which health care
2430 quality measures and member and subscriber cost data to
2431 disclose, based upon input from the council. When determining
2432 which data to disclose, the agency shall consider information
2433 that may be required by either individual or group purchasers to
2434 assess the value of the product, which may include membership
2435 satisfaction, quality of care, current enrollment or membership,
2436 coverage areas, accreditation status, premium costs, plan costs,
2437 premium increases, range of benefits, copayments and
2438 deductibles, accuracy and speed of claims payment, credentials
2439 of physicians, number of providers, names of network providers,
2440 and hospitals in the network. Health plans shall make available
2441 to the agency any such data or information that is not currently
2442 reported to the agency or the office.
2443 3. Determine the method and format for public disclosure of
2444 data reported pursuant to this paragraph. The agency shall make
2445 its determination based upon input from the State Consumer
2446 Health Information and Policy Advisory Council. At a minimum,
2447 the data shall be made available on the agency’s Internet
2448 website in a manner that allows consumers to conduct an
2449 interactive search that allows them to view and compare the
2450 information for specific providers. The website must include
2451 such additional information as is determined necessary to ensure
2452 that the website enhances informed decisionmaking among
2453 consumers and health care purchasers, which shall include, at a
2454 minimum, appropriate guidance on how to use the data and an
2455 explanation of why the data may vary from provider to provider.
2456 4. Publish on its website undiscounted charges for no fewer
2457 than 150 of the most commonly performed adult and pediatric
2458 procedures, including outpatient, inpatient, diagnostic, and
2459 preventative procedures.
2460 Section 62. Paragraph (a) of subsection (1) of section
2461 408.061, Florida Statutes, is amended to read:
2462 408.061 Data collection; uniform systems of financial
2463 reporting; information relating to physician charges;
2464 confidential information; immunity.—
2465 (1) The agency shall require the submission by health care
2466 facilities, health care providers, and health insurers of data
2467 necessary to carry out the agency’s duties. Specifications for
2468 data to be collected under this section shall be developed by
2469 the agency with the assistance of technical advisory panels
2470 including representatives of affected entities, consumers,
2471 purchasers, and such other interested parties as may be
2472 determined by the agency.
2473 (a) Data submitted by health care facilities, including the
2474 facilities as defined in chapter 395, shall include, but are not
2475 limited to: case-mix data, patient admission and discharge data,
2476 hospital emergency department data which shall include the
2477 number of patients treated in the emergency department of a
2478 licensed hospital reported by patient acuity level, data on
2479 hospital-acquired infections as specified by rule, data on
2480 complications as specified by rule, data on readmissions as
2481 specified by rule, with patient and provider-specific
2482 identifiers included, actual charge data by diagnostic groups,
2483 financial data, accounting data, operating expenses, expenses
2484 incurred for rendering services to patients who cannot or do not
2485 pay, interest charges, depreciation expenses based on the
2486 expected useful life of the property and equipment involved, and
2487 demographic data. The agency shall adopt nationally recognized
2488 risk adjustment methodologies or software consistent with the
2489 standards of the Agency for Healthcare Research and Quality and
2490 as selected by the agency for all data submitted as required by
2491 this section. Data may be obtained from documents such as, but
2492 not limited to: leases, contracts, debt instruments, itemized
2493 patient bills, medical record abstracts, and related diagnostic
2494 information. Reported data elements shall be reported
2495 electronically and in accordance with rule 59E-7.012, Florida
2496 Administrative Code. Data submitted shall be certified by the
2497 chief executive officer or an appropriate and duly authorized
2498 representative or employee of the licensed facility that the
2499 information submitted is true and accurate.
2500 Section 63. Subsection (43) of section 408.07, Florida
2501 Statutes, is amended to read:
2502 408.07 Definitions.—As used in this chapter, with the
2503 exception of ss. 408.031-408.045, the term:
2504 (43) “Rural hospital” means an acute care hospital licensed
2505 under chapter 395, having 100 or fewer licensed beds and an
2506 emergency room, and which is:
2507 (a) The sole provider within a county with a population
2508 density of no greater than 100 persons per square mile;
2509 (b) An acute care hospital, in a county with a population
2510 density of no greater than 100 persons per square mile, which is
2511 at least 30 minutes of travel time, on normally traveled roads
2512 under normal traffic conditions, from another acute care
2513 hospital within the same county;
2514 (c) A hospital supported by a tax district or subdistrict
2515 whose boundaries encompass a population of 100 persons or fewer
2516 per square mile;
2517 (d) A hospital with a service area that has a population of
2518 100 persons or fewer per square mile. As used in this paragraph,
2519 the term “service area” means the fewest number of zip codes
2520 that account for 75 percent of the hospital’s discharges for the
2521 most recent 5-year period, based on information available from
2522 the hospital inpatient discharge database in the Florida Center
2523 for Health Information and Policy Analysis at the Agency for
2524 Health Care Administration; or
2525 (e) A critical access hospital.
2526
2527 Population densities used in this subsection must be based upon
2528 the most recently completed United States census. A hospital
2529 that received funds under s. 409.9116 for a quarter beginning no
2530 later than July 1, 2002, is deemed to have been and shall
2531 continue to be a rural hospital from that date through June 30,
2532 2015, if the hospital continues to have 100 or fewer licensed
2533 beds and an emergency room, or meets the criteria of s.
2534 395.602(2)(e)4. An acute care hospital that has not previously
2535 been designated as a rural hospital and that meets the criteria
2536 of this subsection shall be granted such designation upon
2537 application, including supporting documentation, to the Agency
2538 for Health Care Administration.
2539 Section 64. Section 408.10, Florida Statutes, is amended to
2540 read:
2541 408.10 Consumer complaints.—The agency shall:
2542 (1) publish and make available to the public a toll-free
2543 telephone number for the purpose of handling consumer complaints
2544 and shall serve as a liaison between consumer entities and other
2545 private entities and governmental entities for the disposition
2546 of problems identified by consumers of health care.
2547 (2) Be empowered to investigate consumer complaints
2548 relating to problems with health care facilities’ billing
2549 practices and issue reports to be made public in any cases where
2550 the agency determines the health care facility has engaged in
2551 billing practices which are unreasonable and unfair to the
2552 consumer.
2553 Section 65. Effective May 1, 2012, subsection (15) is added
2554 to section 408.7056, Florida Statutes, to read:
2555 408.7056 Subscriber Assistance Program.—
2556 (15) This section applies only to prepaid health clinics
2557 certified under chapter 641, Florida Healthy Kids plans, and
2558 health plan insurance policies or health maintenance contracts
2559 that meet the requirements of 45 C.F.R. s. 147.140 and only if
2560 the health plan has not elected to have all of its health
2561 insurance policies or health maintenance contracts subject to
2562 the applicable internal grievance and external review processes
2563 by an independent review organization. A health plan must notify
2564 the agency in writing if it elects to have all of its health
2565 insurance policies or health maintenance contracts subject to
2566 the processes of external review by an independent review
2567 organization.
2568 Section 66. Subsections (12) through (30) of section
2569 408.802, Florida Statutes, are renumbered as subsections (11)
2570 through (29), respectively, and present subsection (11) of that
2571 section is amended, to read:
2572 408.802 Applicability.—The provisions of this part apply to
2573 the provision of services that require licensure as defined in
2574 this part and to the following entities licensed, registered, or
2575 certified by the agency, as described in chapters 112, 383, 390,
2576 394, 395, 400, 429, 440, 483, and 765:
2577 (11) Private review agents, as provided under part I of
2578 chapter 395.
2579 Section 67. Subsection (3) is added to section 408.804,
2580 Florida Statutes, to read:
2581 408.804 License required; display.—
2582 (3) Any person who knowingly alters, defaces, or falsifies
2583 a license certificate issued by the agency, or causes or
2584 procures any person to commit such an offense, commits a
2585 misdemeanor of the second degree, punishable as provided in s.
2586 775.082 or s. 775.083. Any licensee or provider who displays an
2587 altered, defaced, or falsified license certificate is subject to
2588 the penalties set forth in s. 408.815 and an administrative fine
2589 of $1,000 for each day of illegal display.
2590 Section 68. Paragraph (d) of subsection (2) of section
2591 408.806, Florida Statutes, is amended, and paragraph (e) is
2592 added to that subsection, to read:
2593 408.806 License application process.—
2594 (2)
2595 (d) The agency shall notify the licensee by mail or
2596 electronically at least 90 days before the expiration of a
2597 license that a renewal license is necessary to continue
2598 operation. The licensee’s failure to timely file submit a
2599 renewal application and license application fee with the agency
2600 shall result in a $50 per day late fee charged to the licensee
2601 by the agency; however, the aggregate amount of the late fee may
2602 not exceed 50 percent of the licensure fee or $500, whichever is
2603 less. The agency shall provide a courtesy notice to the licensee
2604 by United States mail, electronically, or by any other manner at
2605 its address of record or mailing address, if provided, at least
2606 90 days before the expiration of a license. This courtesy notice
2607 must inform the licensee of the expiration of the license. If
2608 the agency does not provide the courtesy notice or the licensee
2609 does not receive the courtesy notice, the licensee continues to
2610 be legally obligated to timely file the renewal application and
2611 license application fee with the agency and is not excused from
2612 the payment of a late fee. If an application is received after
2613 the required filing date and exhibits a hand-canceled postmark
2614 obtained from a United States post office dated on or before the
2615 required filing date, no fine will be levied.
2616 (e) The applicant must pay the late fee before a late
2617 application is considered complete and failure to pay the late
2618 fee is considered an omission from the application for licensure
2619 pursuant to paragraph (3)(b).
2620 Section 69. Paragraph (b) of subsection (1) of section
2621 408.8065, Florida Statutes, is amended to read:
2622 408.8065 Additional licensure requirements for home health
2623 agencies, home medical equipment providers, and health care
2624 clinics.—
2625 (1) An applicant for initial licensure, or initial
2626 licensure due to a change of ownership, as a home health agency,
2627 home medical equipment provider, or health care clinic shall:
2628 (b) Submit projected pro forma financial statements,
2629 including a balance sheet, income and expense statement, and a
2630 statement of cash flows for the first 2 years of operation which
2631 provide evidence that the applicant has sufficient assets,
2632 credit, and projected revenues to cover liabilities and
2633 expenses.
2634
2635 All documents required under this subsection must be prepared in
2636 accordance with generally accepted accounting principles and may
2637 be in a compilation form. The financial statements must be
2638 signed by a certified public accountant.
2639 Section 70. Subsection (9) of section 408.810, Florida
2640 Statutes, is amended to read:
2641 408.810 Minimum licensure requirements.—In addition to the
2642 licensure requirements specified in this part, authorizing
2643 statutes, and applicable rules, each applicant and licensee must
2644 comply with the requirements of this section in order to obtain
2645 and maintain a license.
2646 (9) A controlling interest may not withhold from the agency
2647 any evidence of financial instability, including, but not
2648 limited to, checks returned due to insufficient funds,
2649 delinquent accounts, nonpayment of withholding taxes, unpaid
2650 utility expenses, nonpayment for essential services, or adverse
2651 court action concerning the financial viability of the provider
2652 or any other provider licensed under this part that is under the
2653 control of the controlling interest. A controlling interest
2654 shall notify the agency within 10 days after a court action to
2655 initiate bankruptcy, foreclosure, or eviction proceedings
2656 concerning the provider in which the controlling interest is a
2657 petitioner or defendant. Any person who violates this subsection
2658 commits a misdemeanor of the second degree, punishable as
2659 provided in s. 775.082 or s. 775.083. Each day of continuing
2660 violation is a separate offense.
2661 Section 71. Subsection (3) is added to section 408.813,
2662 Florida Statutes, to read:
2663 408.813 Administrative fines; violations.—As a penalty for
2664 any violation of this part, authorizing statutes, or applicable
2665 rules, the agency may impose an administrative fine.
2666 (3) The agency may impose an administrative fine for a
2667 violation that is not designated as a class I, class II, class
2668 III, or class IV violation. Unless otherwise specified by law,
2669 the amount of the fine may not exceed $500 for each violation.
2670 Unclassified violations include:
2671 (a) Violating any term or condition of a license.
2672 (b) Violating any provision of this part, authorizing
2673 statutes, or applicable rules.
2674 (c) Exceeding licensed capacity.
2675 (d) Providing services beyond the scope of the license.
2676 (e) Violating a moratorium imposed pursuant to s. 408.814.
2677 Section 72. Subsection (37) of section 409.912, Florida
2678 Statutes, is amended to read:
2679 409.912 Cost-effective purchasing of health care.—The
2680 agency shall purchase goods and services for Medicaid recipients
2681 in the most cost-effective manner consistent with the delivery
2682 of quality medical care. To ensure that medical services are
2683 effectively utilized, the agency may, in any case, require a
2684 confirmation or second physician’s opinion of the correct
2685 diagnosis for purposes of authorizing future services under the
2686 Medicaid program. This section does not restrict access to
2687 emergency services or poststabilization care services as defined
2688 in 42 C.F.R. part 438.114. Such confirmation or second opinion
2689 shall be rendered in a manner approved by the agency. The agency
2690 shall maximize the use of prepaid per capita and prepaid
2691 aggregate fixed-sum basis services when appropriate and other
2692 alternative service delivery and reimbursement methodologies,
2693 including competitive bidding pursuant to s. 287.057, designed
2694 to facilitate the cost-effective purchase of a case-managed
2695 continuum of care. The agency shall also require providers to
2696 minimize the exposure of recipients to the need for acute
2697 inpatient, custodial, and other institutional care and the
2698 inappropriate or unnecessary use of high-cost services. The
2699 agency shall contract with a vendor to monitor and evaluate the
2700 clinical practice patterns of providers in order to identify
2701 trends that are outside the normal practice patterns of a
2702 provider’s professional peers or the national guidelines of a
2703 provider’s professional association. The vendor must be able to
2704 provide information and counseling to a provider whose practice
2705 patterns are outside the norms, in consultation with the agency,
2706 to improve patient care and reduce inappropriate utilization.
2707 The agency may mandate prior authorization, drug therapy
2708 management, or disease management participation for certain
2709 populations of Medicaid beneficiaries, certain drug classes, or
2710 particular drugs to prevent fraud, abuse, overuse, and possible
2711 dangerous drug interactions. The Pharmaceutical and Therapeutics
2712 Committee shall make recommendations to the agency on drugs for
2713 which prior authorization is required. The agency shall inform
2714 the Pharmaceutical and Therapeutics Committee of its decisions
2715 regarding drugs subject to prior authorization. The agency is
2716 authorized to limit the entities it contracts with or enrolls as
2717 Medicaid providers by developing a provider network through
2718 provider credentialing. The agency may competitively bid single
2719 source-provider contracts if procurement of goods or services
2720 results in demonstrated cost savings to the state without
2721 limiting access to care. The agency may limit its network based
2722 on the assessment of beneficiary access to care, provider
2723 availability, provider quality standards, time and distance
2724 standards for access to care, the cultural competence of the
2725 provider network, demographic characteristics of Medicaid
2726 beneficiaries, practice and provider-to-beneficiary standards,
2727 appointment wait times, beneficiary use of services, provider
2728 turnover, provider profiling, provider licensure history,
2729 previous program integrity investigations and findings, peer
2730 review, provider Medicaid policy and billing compliance records,
2731 clinical and medical record audits, and other factors. Providers
2732 are not entitled to enrollment in the Medicaid provider network.
2733 The agency shall determine instances in which allowing Medicaid
2734 beneficiaries to purchase durable medical equipment and other
2735 goods is less expensive to the Medicaid program than long-term
2736 rental of the equipment or goods. The agency may establish rules
2737 to facilitate purchases in lieu of long-term rentals in order to
2738 protect against fraud and abuse in the Medicaid program as
2739 defined in s. 409.913. The agency may seek federal waivers
2740 necessary to administer these policies.
2741 (37)(a) The agency shall implement a Medicaid prescribed
2742 drug spending-control program that includes the following
2743 components:
2744 1. A Medicaid preferred drug list, which shall be a listing
2745 of cost-effective therapeutic options recommended by the
2746 Medicaid Pharmacy and Therapeutics Committee established
2747 pursuant to s. 409.91195 and adopted by the agency for each
2748 therapeutic class on the preferred drug list. At the discretion
2749 of the committee, and when feasible, the preferred drug list
2750 should include at least two products in a therapeutic class. The
2751 agency may post the preferred drug list and updates to the list
2752 on an Internet website without following the rulemaking
2753 procedures of chapter 120. Antiretroviral agents are excluded
2754 from the preferred drug list. The agency shall also limit the
2755 amount of a prescribed drug dispensed to no more than a 34-day
2756 supply unless the drug products’ smallest marketed package is
2757 greater than a 34-day supply, or the drug is determined by the
2758 agency to be a maintenance drug in which case a 100-day maximum
2759 supply may be authorized. The agency may seek any federal
2760 waivers necessary to implement these cost-control programs and
2761 to continue participation in the federal Medicaid rebate
2762 program, or alternatively to negotiate state-only manufacturer
2763 rebates. The agency may adopt rules to administer this
2764 subparagraph. The agency shall continue to provide unlimited
2765 contraceptive drugs and items. The agency must establish
2766 procedures to ensure that:
2767 a. There is a response to a request for prior consultation
2768 by telephone or other telecommunication device within 24 hours
2769 after receipt of a request for prior consultation; and
2770 b. A 72-hour supply of the drug prescribed is provided in
2771 an emergency or when the agency does not provide a response
2772 within 24 hours as required by sub-subparagraph a.
2773 2. Reimbursement to pharmacies for Medicaid prescribed
2774 drugs shall be set at the lowest of: the average wholesale price
2775 (AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
2776 plus 1.5 percent, the federal upper limit (FUL), the state
2777 maximum allowable cost (SMAC), or the usual and customary (UAC)
2778 charge billed by the provider.
2779 3. The agency shall develop and implement a process for
2780 managing the drug therapies of Medicaid recipients who are using
2781 significant numbers of prescribed drugs each month. The
2782 management process may include, but is not limited to,
2783 comprehensive, physician-directed medical-record reviews, claims
2784 analyses, and case evaluations to determine the medical
2785 necessity and appropriateness of a patient’s treatment plan and
2786 drug therapies. The agency may contract with a private
2787 organization to provide drug-program-management services. The
2788 Medicaid drug benefit management program shall include
2789 initiatives to manage drug therapies for HIV/AIDS patients,
2790 patients using 20 or more unique prescriptions in a 180-day
2791 period, and the top 1,000 patients in annual spending. The
2792 agency shall enroll any Medicaid recipient in the drug benefit
2793 management program if he or she meets the specifications of this
2794 provision and is not enrolled in a Medicaid health maintenance
2795 organization.
2796 4. The agency may limit the size of its pharmacy network
2797 based on need, competitive bidding, price negotiations,
2798 credentialing, or similar criteria. The agency shall give
2799 special consideration to rural areas in determining the size and
2800 location of pharmacies included in the Medicaid pharmacy
2801 network. A pharmacy credentialing process may include criteria
2802 such as a pharmacy’s full-service status, location, size,
2803 patient educational programs, patient consultation, disease
2804 management services, and other characteristics. The agency may
2805 impose a moratorium on Medicaid pharmacy enrollment if it is
2806 determined that it has a sufficient number of Medicaid
2807 participating providers. The agency must allow dispensing
2808 practitioners to participate as a part of the Medicaid pharmacy
2809 network regardless of the practitioner’s proximity to any other
2810 entity that is dispensing prescription drugs under the Medicaid
2811 program. A dispensing practitioner must meet all credentialing
2812 requirements applicable to his or her practice, as determined by
2813 the agency.
2814 5. The agency shall develop and implement a program that
2815 requires Medicaid practitioners who prescribe drugs to use a
2816 counterfeit-proof prescription pad for Medicaid prescriptions.
2817 The agency shall require the use of standardized counterfeit
2818 proof prescription pads by Medicaid-participating prescribers or
2819 prescribers who write prescriptions for Medicaid recipients. The
2820 agency may implement the program in targeted geographic areas or
2821 statewide.
2822 6. The agency may enter into arrangements that require
2823 manufacturers of generic drugs prescribed to Medicaid recipients
2824 to provide rebates of at least 15.1 percent of the average
2825 manufacturer price for the manufacturer’s generic products.
2826 These arrangements shall require that if a generic-drug
2827 manufacturer pays federal rebates for Medicaid-reimbursed drugs
2828 at a level below 15.1 percent, the manufacturer must provide a
2829 supplemental rebate to the state in an amount necessary to
2830 achieve a 15.1-percent rebate level.
2831 7. The agency may establish a preferred drug list as
2832 described in this subsection, and, pursuant to the establishment
2833 of such preferred drug list, negotiate supplemental rebates from
2834 manufacturers that are in addition to those required by Title
2835 XIX of the Social Security Act and at no less than 14 percent of
2836 the average manufacturer price as defined in 42 U.S.C. s. 1936
2837 on the last day of a quarter unless the federal or supplemental
2838 rebate, or both, equals or exceeds 29 percent. There is no upper
2839 limit on the supplemental rebates the agency may negotiate. The
2840 agency may determine that specific products, brand-name or
2841 generic, are competitive at lower rebate percentages. Agreement
2842 to pay the minimum supplemental rebate percentage guarantees a
2843 manufacturer that the Medicaid Pharmaceutical and Therapeutics
2844 Committee will consider a product for inclusion on the preferred
2845 drug list. However, a pharmaceutical manufacturer is not
2846 guaranteed placement on the preferred drug list by simply paying
2847 the minimum supplemental rebate. Agency decisions will be made
2848 on the clinical efficacy of a drug and recommendations of the
2849 Medicaid Pharmaceutical and Therapeutics Committee, as well as
2850 the price of competing products minus federal and state rebates.
2851 The agency may contract with an outside agency or contractor to
2852 conduct negotiations for supplemental rebates. For the purposes
2853 of this section, the term “supplemental rebates” means cash
2854 rebates. Value-added programs as a substitution for supplemental
2855 rebates are prohibited. The agency may seek any federal waivers
2856 to implement this initiative.
2857 8. The agency shall expand home delivery of pharmacy
2858 products. The agency may amend the state plan and issue a
2859 procurement, as necessary, in order to implement this program.
2860 The procurements must include agreements with a pharmacy or
2861 pharmacies located in the state to provide mail order delivery
2862 services at no cost to the recipients who elect to receive home
2863 delivery of pharmacy products. The procurement must focus on
2864 serving recipients with chronic diseases for which pharmacy
2865 expenditures represent a significant portion of Medicaid
2866 pharmacy expenditures or which impact a significant portion of
2867 the Medicaid population. The agency may seek and implement any
2868 federal waivers necessary to implement this subparagraph.
2869 9. The agency shall limit to one dose per month any drug
2870 prescribed to treat erectile dysfunction.
2871 10.a. The agency may implement a Medicaid behavioral drug
2872 management system. The agency may contract with a vendor that
2873 has experience in operating behavioral drug management systems
2874 to implement this program. The agency may seek federal waivers
2875 to implement this program.
2876 b. The agency, in conjunction with the Department of
2877 Children and Family Services, may implement the Medicaid
2878 behavioral drug management system that is designed to improve
2879 the quality of care and behavioral health prescribing practices
2880 based on best practice guidelines, improve patient adherence to
2881 medication plans, reduce clinical risk, and lower prescribed
2882 drug costs and the rate of inappropriate spending on Medicaid
2883 behavioral drugs. The program may include the following
2884 elements:
2885 (I) Provide for the development and adoption of best
2886 practice guidelines for behavioral health-related drugs such as
2887 antipsychotics, antidepressants, and medications for treating
2888 bipolar disorders and other behavioral conditions; translate
2889 them into practice; review behavioral health prescribers and
2890 compare their prescribing patterns to a number of indicators
2891 that are based on national standards; and determine deviations
2892 from best practice guidelines.
2893 (II) Implement processes for providing feedback to and
2894 educating prescribers using best practice educational materials
2895 and peer-to-peer consultation.
2896 (III) Assess Medicaid beneficiaries who are outliers in
2897 their use of behavioral health drugs with regard to the numbers
2898 and types of drugs taken, drug dosages, combination drug
2899 therapies, and other indicators of improper use of behavioral
2900 health drugs.
2901 (IV) Alert prescribers to patients who fail to refill
2902 prescriptions in a timely fashion, are prescribed multiple same
2903 class behavioral health drugs, and may have other potential
2904 medication problems.
2905 (V) Track spending trends for behavioral health drugs and
2906 deviation from best practice guidelines.
2907 (VI) Use educational and technological approaches to
2908 promote best practices, educate consumers, and train prescribers
2909 in the use of practice guidelines.
2910 (VII) Disseminate electronic and published materials.
2911 (VIII) Hold statewide and regional conferences.
2912 (IX) Implement a disease management program with a model
2913 quality-based medication component for severely mentally ill
2914 individuals and emotionally disturbed children who are high
2915 users of care.
2916 11. The agency shall implement a Medicaid prescription drug
2917 management system.
2918 a. The agency may contract with a vendor that has
2919 experience in operating prescription drug management systems in
2920 order to implement this system. Any management system that is
2921 implemented in accordance with this subparagraph must rely on
2922 cooperation between physicians and pharmacists to determine
2923 appropriate practice patterns and clinical guidelines to improve
2924 the prescribing, dispensing, and use of drugs in the Medicaid
2925 program. The agency may seek federal waivers to implement this
2926 program.
2927 b. The drug management system must be designed to improve
2928 the quality of care and prescribing practices based on best
2929 practice guidelines, improve patient adherence to medication
2930 plans, reduce clinical risk, and lower prescribed drug costs and
2931 the rate of inappropriate spending on Medicaid prescription
2932 drugs. The program must:
2933 (I) Provide for the adoption of best practice guidelines
2934 for the prescribing and use of drugs in the Medicaid program,
2935 including translating best practice guidelines into practice;
2936 reviewing prescriber patterns and comparing them to indicators
2937 that are based on national standards and practice patterns of
2938 clinical peers in their community, statewide, and nationally;
2939 and determine deviations from best practice guidelines.
2940 (II) Implement processes for providing feedback to and
2941 educating prescribers using best practice educational materials
2942 and peer-to-peer consultation.
2943 (III) Assess Medicaid recipients who are outliers in their
2944 use of a single or multiple prescription drugs with regard to
2945 the numbers and types of drugs taken, drug dosages, combination
2946 drug therapies, and other indicators of improper use of
2947 prescription drugs.
2948 (IV) Alert prescribers to recipients who fail to refill
2949 prescriptions in a timely fashion, are prescribed multiple drugs
2950 that may be redundant or contraindicated, or may have other
2951 potential medication problems.
2952 12. The agency may contract for drug rebate administration,
2953 including, but not limited to, calculating rebate amounts,
2954 invoicing manufacturers, negotiating disputes with
2955 manufacturers, and maintaining a database of rebate collections.
2956 13. The agency may specify the preferred daily dosing form
2957 or strength for the purpose of promoting best practices with
2958 regard to the prescribing of certain drugs as specified in the
2959 General Appropriations Act and ensuring cost-effective
2960 prescribing practices.
2961 14. The agency may require prior authorization for
2962 Medicaid-covered prescribed drugs. The agency may prior
2963 authorize the use of a product:
2964 a. For an indication not approved in labeling;
2965 b. To comply with certain clinical guidelines; or
2966 c. If the product has the potential for overuse, misuse, or
2967 abuse.
2968
2969 The agency may require the prescribing professional to provide
2970 information about the rationale and supporting medical evidence
2971 for the use of a drug. The agency shall may post prior
2972 authorization, step-edit criteria and protocol, and updates to
2973 the list of drugs that are subject to prior authorization on the
2974 agency’s an Internet website within 21 days after the prior
2975 authorization and step-edit criteria and protocol and updates
2976 are approved by the agency. For purposes of this subparagraph,
2977 the term “step-edit” means an automatic electronic review of
2978 certain medications subject to prior authorization without
2979 amending its rule or engaging in additional rulemaking.
2980 15. The agency, in conjunction with the Pharmaceutical and
2981 Therapeutics Committee, may require age-related prior
2982 authorizations for certain prescribed drugs. The agency may
2983 preauthorize the use of a drug for a recipient who may not meet
2984 the age requirement or may exceed the length of therapy for use
2985 of this product as recommended by the manufacturer and approved
2986 by the Food and Drug Administration. Prior authorization may
2987 require the prescribing professional to provide information
2988 about the rationale and supporting medical evidence for the use
2989 of a drug.
2990 16. The agency shall implement a step-therapy prior
2991 authorization approval process for medications excluded from the
2992 preferred drug list. Medications listed on the preferred drug
2993 list must be used within the previous 12 months before the
2994 alternative medications that are not listed. The step-therapy
2995 prior authorization may require the prescriber to use the
2996 medications of a similar drug class or for a similar medical
2997 indication unless contraindicated in the Food and Drug
2998 Administration labeling. The trial period between the specified
2999 steps may vary according to the medical indication. The step
3000 therapy approval process shall be developed in accordance with
3001 the committee as stated in s. 409.91195(7) and (8). A drug
3002 product may be approved without meeting the step-therapy prior
3003 authorization criteria if the prescribing physician provides the
3004 agency with additional written medical or clinical documentation
3005 that the product is medically necessary because:
3006 a. There is not a drug on the preferred drug list to treat
3007 the disease or medical condition which is an acceptable clinical
3008 alternative;
3009 b. The alternatives have been ineffective in the treatment
3010 of the beneficiary’s disease; or
3011 c. Based on historic evidence and known characteristics of
3012 the patient and the drug, the drug is likely to be ineffective,
3013 or the number of doses have been ineffective.
3014
3015 The agency shall work with the physician to determine the best
3016 alternative for the patient. The agency may adopt rules waiving
3017 the requirements for written clinical documentation for specific
3018 drugs in limited clinical situations.
3019 17. The agency shall implement a return and reuse program
3020 for drugs dispensed by pharmacies to institutional recipients,
3021 which includes payment of a $5 restocking fee for the
3022 implementation and operation of the program. The return and
3023 reuse program shall be implemented electronically and in a
3024 manner that promotes efficiency. The program must permit a
3025 pharmacy to exclude drugs from the program if it is not
3026 practical or cost-effective for the drug to be included and must
3027 provide for the return to inventory of drugs that cannot be
3028 credited or returned in a cost-effective manner. The agency
3029 shall determine if the program has reduced the amount of
3030 Medicaid prescription drugs which are destroyed on an annual
3031 basis and if there are additional ways to ensure more
3032 prescription drugs are not destroyed which could safely be
3033 reused.
3034 (b) The agency shall implement this subsection to the
3035 extent that funds are appropriated to administer the Medicaid
3036 prescribed-drug spending-control program. The agency may
3037 contract all or any part of this program to private
3038 organizations.
3039 (c) The agency shall submit quarterly reports to the
3040 Governor, the President of the Senate, and the Speaker of the
3041 House of Representatives which must include, but need not be
3042 limited to, the progress made in implementing this subsection
3043 and its effect on Medicaid prescribed-drug expenditures.
3044 Section 73. Effective upon this act becoming a law,
3045 subsection (1) of section 409.975, Florida Statutes, is amended
3046 to read:
3047 409.975 Managed care plan accountability.—In addition to
3048 the requirements of s. 409.967, plans and providers
3049 participating in the managed medical assistance program shall
3050 comply with the requirements of this section.
3051 (1) PROVIDER NETWORKS.—Managed care plans must develop and
3052 maintain provider networks that meet the medical needs of their
3053 enrollees in accordance with standards established pursuant to
3054 s. 409.967(2)(b). Except as provided in this section, managed
3055 care plans may limit the providers in their networks based on
3056 credentials, quality indicators, and price.
3057 (a)1. Plans must include all providers in the region that
3058 are classified by the agency as essential Medicaid providers for
3059 the essential services they provide, unless the agency approves,
3060 in writing, an alternative arrangement for securing the types of
3061 services offered by the essential providers. Providers are
3062 essential for serving Medicaid enrollees if they offer services
3063 that are not available from any other provider within a
3064 reasonable access standard, or if they provided a substantial
3065 share of the total units of a particular service used by
3066 Medicaid patients within the region during the last 3 years and
3067 the combined capacity of other service providers in the region
3068 is insufficient to meet the total needs of the Medicaid
3069 patients. The agency may not classify physicians and other
3070 practitioners as essential providers. The agency, at a minimum,
3071 shall determine which providers in the following categories are
3072 essential Medicaid providers:
3073 a.1. Federally qualified health centers.
3074 b.2. Statutory teaching hospitals as defined in s.
3075 408.07(45).
3076 c.3. Hospitals that are trauma centers as defined in s.
3077 395.4001(14).
3078 d.4. Hospitals located at least 25 miles from any other
3079 hospital with similar services.
3080 2. Until the selection of managed care plans as specified
3081 in s. 409.966, each essential Medicaid provider and each
3082 hospital that is necessary in order for a managed care plan to
3083 demonstrate an adequate network, as determined by the agency, is
3084 deemed a part of that managed care plan’s network for purposes
3085 of the plan’s enrollment or expansion in the Medicaid program. A
3086 hospital that is necessary for a managed care plan to
3087 demonstrate an adequate network is an essential hospital. An
3088 essential Medicaid provider is deemed a part of a managed care
3089 plan’s network for the essential services it provides for
3090 purposes of the plan’s enrollment or expansion in the Medicaid
3091 program. The managed care plan, each essential Medicaid
3092 provider, and each essential hospital shall negotiate in good
3093 faith to enter into a provider network contract. During the plan
3094 selection process, the managed care plan is not required to have
3095 written agreements or contracts with essential Medicaid
3096 providers or essential hospitals.
3097 3. Managed care plans that have not contracted with all
3098 essential Medicaid providers or essential hospitals in the
3099 region as of the first date of recipient enrollment, or with
3100 whom an essential Medicaid provider or essential hospital has
3101 terminated its contract, must continue to negotiate in good
3102 faith with such essential Medicaid providers or essential
3103 hospitals for 1 year, or until an agreement is reached, or until
3104 a complaint is resolved as provided in paragraph (e), whichever
3105 is first. Each essential Medicaid provider must continue to
3106 negotiate in good faith during that year to enter into a
3107 provider network contract for at least the essential services it
3108 provides. Each essential hospital must continue to negotiate in
3109 good faith during that year to enter into a provider network
3110 contract. Payments for services rendered by a nonparticipating
3111 essential Medicaid provider or essential hospital shall be made
3112 at the applicable Medicaid rate as of the first day of the
3113 contract between the agency and the plan. A rate schedule for
3114 all essential Medicaid providers and essential hospitals shall
3115 be attached to the contract between the agency and the plan.
3116 4. After 1 year, managed care plans that are unable to
3117 contract with essential Medicaid providers and essential
3118 hospitals shall notify the agency and propose an alternative
3119 arrangement for securing the essential services for Medicaid
3120 enrollees. The arrangement must rely on contracts with other
3121 participating providers, regardless of whether those providers
3122 are located within the same region as the nonparticipating
3123 essential service provider. If the alternative arrangement is
3124 approved by the agency, payments to nonparticipating essential
3125 Medicaid providers and essential hospitals after the date of the
3126 agency’s approval shall equal 90 percent of the applicable
3127 Medicaid rate. If the alternative arrangement is not approved by
3128 the agency, payment to nonparticipating essential Medicaid
3129 providers and essential hospitals shall equal 110 percent of the
3130 applicable Medicaid rate.
3131 (b)1. Certain providers are statewide resources and
3132 essential providers for all managed care plans in all regions.
3133 All managed care plans must include these essential providers in
3134 their networks for the essential services they provide.
3135 Statewide essential providers include:
3136 a.1. Faculty plans of Florida medical schools.
3137 b.2. Regional perinatal intensive care centers as defined
3138 in s. 383.16(2).
3139 c.3. Hospitals licensed as specialty children’s hospitals
3140 as defined in s. 395.002(28).
3141 d.4. Accredited and integrated systems serving medically
3142 complex children that are comprised of separately licensed, but
3143 commonly owned, health care providers delivering at least the
3144 following services: medical group home, in-home and outpatient
3145 nursing care and therapies, pharmacy services, durable medical
3146 equipment, and Prescribed Pediatric Extended Care.
3147 2. Until the selection of managed care plans as specified
3148 in s. 409.966, each statewide essential provider is deemed a
3149 part of that managed care plan’s network for the essential
3150 services they provide and for purposes of the plan’s enrollment
3151 or expansion in the Medicaid program. The managed care plan and
3152 each statewide essential provider shall negotiate in good faith
3153 to enter into a provider network contract. During the plan
3154 selection process, the managed care plan is not required to have
3155 written agreements or contracts with statewide essential
3156 providers or essential hospitals.
3157 3. Managed care plans that have not contracted with all
3158 statewide essential providers in all regions as of the first
3159 date of recipient enrollment and all statewide essential
3160 providers that have not entered into a contract with each
3161 managed care plan must continue to negotiate in good faith. to
3162 enter into a provider network contract for at least the
3163 essential services. As of the first day of the contract between
3164 the agency and the plan, and until a provider network contract
3165 is signed, payments: Payments
3166 a. To physicians on the faculty of nonparticipating Florida
3167 medical schools shall be made at the applicable Medicaid rate.
3168 Payments
3169 b. For services rendered by regional perinatal intensive
3170 care centers shall be made at the applicable Medicaid rate as of
3171 the first day of the contract between the agency and the plan.
3172 Payments
3173 c. To nonparticipating specialty children’s hospitals shall
3174 equal the highest rate established by contract between that
3175 provider and any other Medicaid managed care plan.
3176 (c) After 12 months of active participation in a plan’s
3177 network, the plan may exclude any essential provider from the
3178 network for failure to meet quality or performance criteria. If
3179 the plan excludes an essential provider from the plan, the plan
3180 must provide written notice to all recipients who have chosen
3181 that provider for care. The notice shall be provided at least 30
3182 days before the effective date of the exclusion.
3183 (d) Each managed care plan must offer a network contract to
3184 each home medical equipment and supplies provider in the region
3185 which meets quality and fraud prevention and detection standards
3186 established by the plan and which agrees to accept the lowest
3187 price previously negotiated between the plan and another such
3188 provider.
3189 (e)1. At any time during negotiations a managed care plan,
3190 an essential Medicaid provider, an essential hospital, or a
3191 statewide essential provider may file a complaint with the
3192 agency alleging that, in provider network negotiations, the
3193 other party is not negotiating in good faith. The agency shall
3194 review each complaint and make a determination as to whether one
3195 or both parties have failed to negotiate in good faith. If the
3196 agency determines that:
3197 a. The managed care plan was not negotiating in good faith,
3198 payment to the nonparticipating essential Medicaid provider,
3199 essential hospital, or statewide essential provider shall equal
3200 110 percent of the applicable Medicaid rate or the highest
3201 contracted rate the provider has with a plan, whichever is
3202 higher.
3203 b. The essential Medicaid provider, essential hospital, or
3204 statewide essential provider was not negotiating in good faith,
3205 payment to the nonparticipating provider shall equal 90 percent
3206 of the applicable Medicaid rate or the lowest contracted rate
3207 the provider has with a plan, whichever is lower.
3208 c. Both parties were not negotiating in good faith, payment
3209 to the nonparticipating provider shall be made at the applicable
3210 Medicaid rate.
3211 2. In making a determination under this paragraph regarding
3212 a managed care plan’s good faith efforts to negotiate, the
3213 agency shall, at a minimum, consider whether the managed care
3214 plan has:
3215 a. Offered payment rates that are comparable to other
3216 managed care plan rates to the provider or that are comparable
3217 to fee-for-service rates for the provider.
3218 b. Proposed its prepayment edits and audits and prior
3219 authorizations in a manner comparable to other managed care
3220 plans or comparable to current fee for service utilization
3221 management and prior authorization procedures for non-emergent
3222 services.
3223 c. Offered to pay the provider’s undisputed claims faster
3224 or equal to existing Medicaid managed care plan contract
3225 standards and, if the managed care plan’s claims payment system
3226 has been used in other markets, has it failed to meet these
3227 standards.
3228 d. Offered a provider dispute resolution system that meets
3229 or exceeds existing Medicaid managed care plan contract
3230 requirements.
3231 e. If the provider is a hospital essential provider,
3232 offered a reasonable payment amount for utilization of the
3233 hospital emergency room for non-emergent care, developed
3234 referral arrangements with the hospital for non-emergent care,
3235 and offered reasonable prior or post authorization requirements
3236 for non-emergent care in the emergency room.
3237 f. Attempted to work with the provider to assist the
3238 provider with any patient volume arrangements and whether
3239 patient volume arrangements benefit the provider.
3240 g. Demonstrated its financial viability and commitment to
3241 meeting its financial obligations.
3242 h. Demonstrated its ability to support HIPAA-compliant
3243 electronic data interchange transactions.
3244 3. In making a determination under this paragraph regarding
3245 a provider’s good faith efforts to negotiate, the agency shall,
3246 at a minimum, consider whether the provider has:
3247 a. Met with the managed care plan at a reasonable frequency
3248 and involved empowered decision makers in the meetings.
3249 b. Offered reasonable rates that are comparable to other
3250 managed care plan rates or comparable to fee-for-service rates
3251 to the provider.
3252 c. Negotiated managed care plan prepayment edits, audits,
3253 and prior authorizations in a manner comparable to other managed
3254 care plans or comparable to fee for service utilization
3255 management and prior authorization procedures for nonemergent
3256 services.
3257 d. Negotiated reasonable payment timeframes for payment of
3258 undisputed claims that are comparable to existing Medicaid
3259 managed care plan standards or comparable to fee-for-service
3260 experience.
3261 e. Researched other providers’ experience with the managed
3262 care plan’s claims payment system for timeliness of payment.
3263 f. Negotiated with the managed care plan regarding a
3264 provider dispute resolution system that meets or exceeds the
3265 managed care plan’s Medicaid contract requirements.
3266 g. If the provider is an essential hospital, negotiated
3267 with the managed care plan regarding primary care alternatives
3268 to nonemergent use of the emergency room.
3269 h. Negotiated patient volume arrangements with the managed
3270 care plan.
3271 i. Developed, or is developing, a hospital-based provider
3272 service network.
3273 j. Already contracted with other Medicaid managed care
3274 plans.
3275 4. Either party may appeal a determination by the agency
3276 under this paragraph pursuant to chapter 120. The party
3277 appealing the agency’s determination shall pay the appellee’s
3278 attorney fees and costs, accrued from the date the agency began
3279 its review of the complaint, in an amount up to $1 million if it
3280 loses the appeal.
3281 Section 74. Section 429.11, Florida Statutes, is amended to
3282 read:
3283 429.11 Initial application for license; provisional
3284 license.—
3285 (1) Each applicant for licensure must comply with all
3286 provisions of part II of chapter 408 and must:
3287 (a) Identify all other homes or facilities, including the
3288 addresses and the license or licenses under which they operate,
3289 if applicable, which are currently operated by the applicant or
3290 administrator and which provide housing, meals, and personal
3291 services to residents.
3292 (b) Provide the location of the facility for which a
3293 license is sought and documentation, signed by the appropriate
3294 local government official, which states that the applicant has
3295 met local zoning requirements.
3296 (c) Provide the name, address, date of birth, social
3297 security number, education, and experience of the administrator,
3298 if different from the applicant.
3299 (2) The applicant shall provide proof of liability
3300 insurance as defined in s. 624.605.
3301 (3) If the applicant is a community residential home, the
3302 applicant must provide proof that it has met the requirements
3303 specified in chapter 419.
3304 (4) The applicant must furnish proof that the facility has
3305 received a satisfactory firesafety inspection. The local
3306 authority having jurisdiction or the State Fire Marshal must
3307 conduct the inspection within 30 days after written request by
3308 the applicant.
3309 (5) The applicant must furnish documentation of a
3310 satisfactory sanitation inspection of the facility by the county
3311 health department.
3312 (6) In addition to the license categories available in s.
3313 408.808, a provisional license may be issued to an applicant
3314 making initial application for licensure or making application
3315 for a change of ownership. A provisional license shall be
3316 limited in duration to a specific period of time not to exceed 6
3317 months, as determined by the agency.
3318 (6)(7) A county or municipality may not issue an
3319 occupational license that is being obtained for the purpose of
3320 operating a facility regulated under this part without first
3321 ascertaining that the applicant has been licensed to operate
3322 such facility at the specified location or locations by the
3323 agency. The agency shall furnish to local agencies responsible
3324 for issuing occupational licenses sufficient instruction for
3325 making such determinations.
3326 Section 75. Section 429.71, Florida Statutes, is amended to
3327 read:
3328 429.71 Classification of violations deficiencies;
3329 administrative fines.—
3330 (1) In addition to the requirements of part II of chapter
3331 408 and in addition to any other liability or penalty provided
3332 by law, the agency may impose an administrative fine on a
3333 provider according to the following classification:
3334 (a) Class I violations are defined in s. 408.813 those
3335 conditions or practices related to the operation and maintenance
3336 of an adult family-care home or to the care of residents which
3337 the agency determines present an imminent danger to the
3338 residents or guests of the facility or a substantial probability
3339 that death or serious physical or emotional harm would result
3340 therefrom. The condition or practice that constitutes a class I
3341 violation must be abated or eliminated within 24 hours, unless a
3342 fixed period, as determined by the agency, is required for
3343 correction. A class I violation deficiency is subject to an
3344 administrative fine in an amount not less than $500 and not
3345 exceeding $1,000 for each violation. A fine may be levied
3346 notwithstanding the correction of the deficiency.
3347 (b) Class II violations are defined in s. 408.813 those
3348 conditions or practices related to the operation and maintenance
3349 of an adult family-care home or to the care of residents which
3350 the agency determines directly threaten the physical or
3351 emotional health, safety, or security of the residents, other
3352 than class I violations. A class II violation is subject to an
3353 administrative fine in an amount not less than $250 and not
3354 exceeding $500 for each violation. A citation for a class II
3355 violation must specify the time within which the violation is
3356 required to be corrected. If a class II violation is corrected
3357 within the time specified, no civil penalty shall be imposed,
3358 unless it is a repeated offense.
3359 (c) Class III violations are defined in s. 408.813 those
3360 conditions or practices related to the operation and maintenance
3361 of an adult family-care home or to the care of residents which
3362 the agency determines indirectly or potentially threaten the
3363 physical or emotional health, safety, or security of residents,
3364 other than class I or class II violations. A class III violation
3365 is subject to an administrative fine in an amount not less than
3366 $100 and not exceeding $250 for each violation. A citation for a
3367 class III violation shall specify the time within which the
3368 violation is required to be corrected. If a class III violation
3369 is corrected within the time specified, no civil penalty shall
3370 be imposed, unless it is a repeated violation offense.
3371 (d) Class IV violations are defined in s. 408.813 those
3372 conditions or occurrences related to the operation and
3373 maintenance of an adult family-care home, or related to the
3374 required reports, forms, or documents, which do not have the
3375 potential of negatively affecting the residents. A provider that
3376 does not correct A class IV violation within the time limit
3377 specified by the agency is subject to an administrative fine in
3378 an amount not less than $50 and not exceeding $100 for each
3379 violation. Any class IV violation that is corrected during the
3380 time the agency survey is conducted will be identified as an
3381 agency finding and not as a violation, unless it is a repeat
3382 violation.
3383 (2) The agency may impose an administrative fine for
3384 violations which do not qualify as class I, class II, class III,
3385 or class IV violations. The amount of the fine shall not exceed
3386 $250 for each violation or $2,000 in the aggregate. Unclassified
3387 violations may include:
3388 (a) Violating any term or condition of a license.
3389 (b) Violating any provision of this part, part II of
3390 chapter 408, or applicable rules.
3391 (c) Failure to follow the criteria and procedures provided
3392 under part I of chapter 394 relating to the transportation,
3393 voluntary admission, and involuntary examination of adult
3394 family-care home residents.
3395 (d) Exceeding licensed capacity.
3396 (e) Providing services beyond the scope of the license.
3397 (f) Violating a moratorium.
3398 (3) Each day during which a violation occurs constitutes a
3399 separate offense.
3400 (4) In determining whether a penalty is to be imposed, and
3401 in fixing the amount of any penalty to be imposed, the agency
3402 must consider:
3403 (a) The gravity of the violation.
3404 (b) Actions taken by the provider to correct a violation.
3405 (c) Any previous violation by the provider.
3406 (d) The financial benefit to the provider of committing or
3407 continuing the violation.
3408 (5) As an alternative to or in conjunction with an
3409 administrative action against a provider, the agency may request
3410 a plan of corrective action that demonstrates a good faith
3411 effort to remedy each violation by a specific date, subject to
3412 the approval of the agency.
3413 (5)(6) The department shall set forth, by rule, notice
3414 requirements and procedures for correction of deficiencies.
3415 Section 76. Section 429.195, Florida Statutes, is amended
3416 to read:
3417 429.195 Rebates prohibited; penalties.—
3418 (1) It is unlawful for any assisted living facility
3419 licensed under this part to contract or promise to pay or
3420 receive any commission, bonus, kickback, or rebate or engage in
3421 any split-fee arrangement in any form whatsoever with any
3422 person, health care provider, or health care facility as
3423 provided in s. 817.505 physician, surgeon, organization, agency,
3424 or person, either directly or indirectly, for residents referred
3425 to an assisted living facility licensed under this part. A
3426 facility may employ or contract with persons to market the
3427 facility, provided the employee or contract provider clearly
3428 indicates that he or she represents the facility. A person or
3429 agency independent of the facility may provide placement or
3430 referral services for a fee to individuals seeking assistance in
3431 finding a suitable facility; however, any fee paid for placement
3432 or referral services must be paid by the individual looking for
3433 a facility, not by the facility.
3434 (2) This section does not apply to:
3435 (a) An individual employed by the assisted living facility
3436 or with whom the facility contracts to market the facility, if
3437 the individual clearly indicates that he or she works with or
3438 for the facility.
3439 (b) Payments by an assisted living facility to a referral
3440 service that provides information, consultation, or referrals to
3441 consumers to assist them in finding appropriate care or housing
3442 options for seniors or disabled adults if such referred
3443 consumers are not Medicaid recipients.
3444 (c) A resident of an assisted living facility who refers a
3445 friend, family member, or other individuals with whom the
3446 resident has a personal relationship to the assisted living
3447 facility, in which case the assisted living facility may provide
3448 a monetary reward to the resident for making such referral.
3449 (3)(2) A violation of this section shall be considered
3450 patient brokering and is punishable as provided in s. 817.505.
3451 Section 77. Section 429.915, Florida Statutes, is amended
3452 to read:
3453 429.915 Conditional license.—In addition to the license
3454 categories available in part II of chapter 408, the agency may
3455 issue a conditional license to an applicant for license renewal
3456 or change of ownership if the applicant fails to meet all
3457 standards and requirements for licensure. A conditional license
3458 issued under this subsection must be limited to a specific
3459 period not exceeding 6 months, as determined by the agency, and
3460 must be accompanied by an approved plan of correction.
3461 Section 78. Subsection (3) of section 430.80, Florida
3462 Statutes, is amended to read:
3463 430.80 Implementation of a teaching nursing home pilot
3464 project.—
3465 (3) To be designated as a teaching nursing home, a nursing
3466 home licensee must, at a minimum:
3467 (a) Provide a comprehensive program of integrated senior
3468 services that include institutional services and community-based
3469 services;
3470 (b) Participate in a nationally recognized accreditation
3471 program and hold a valid accreditation, such as the
3472 accreditation awarded by the Joint Commission on Accreditation
3473 of Healthcare Organizations, or, at the time of initial
3474 designation, possess a Gold Seal Award as conferred by the state
3475 on its licensed nursing home;
3476 (c) Have been in business in this state for a minimum of 10
3477 consecutive years;
3478 (d) Demonstrate an active program in multidisciplinary
3479 education and research that relates to gerontology;
3480 (e) Have a formalized contractual relationship with at
3481 least one accredited health profession education program located
3482 in this state;
3483 (f) Have senior staff members who hold formal faculty
3484 appointments at universities, which must include at least one
3485 accredited health profession education program; and
3486 (g) Maintain insurance coverage pursuant to s.
3487 400.141(1)(q) 400.141(1)(s) or proof of financial responsibility
3488 in a minimum amount of $750,000. Such proof of financial
3489 responsibility may include:
3490 1. Maintaining an escrow account consisting of cash or
3491 assets eligible for deposit in accordance with s. 625.52; or
3492 2. Obtaining and maintaining pursuant to chapter 675 an
3493 unexpired, irrevocable, nontransferable and nonassignable letter
3494 of credit issued by any bank or savings association organized
3495 and existing under the laws of this state or any bank or savings
3496 association organized under the laws of the United States which
3497 that has its principal place of business in this state or has a
3498 branch office that which is authorized to receive deposits in
3499 this state. The letter of credit shall be used to satisfy the
3500 obligation of the facility to the claimant upon presentment of a
3501 final judgment indicating liability and awarding damages to be
3502 paid by the facility or upon presentment of a settlement
3503 agreement signed by all parties to the agreement if when such
3504 final judgment or settlement is a result of a liability claim
3505 against the facility.
3506 Section 79. Paragraph (h) of subsection (2) of section
3507 430.81, Florida Statutes, is amended to read:
3508 430.81 Implementation of a teaching agency for home and
3509 community-based care.—
3510 (2) The Department of Elderly Affairs may designate a home
3511 health agency as a teaching agency for home and community-based
3512 care if the home health agency:
3513 (h) Maintains insurance coverage pursuant to s.
3514 400.141(1)(q) 400.141(1)(s) or proof of financial responsibility
3515 in a minimum amount of $750,000. Such proof of financial
3516 responsibility may include:
3517 1. Maintaining an escrow account consisting of cash or
3518 assets eligible for deposit in accordance with s. 625.52; or
3519 2. Obtaining and maintaining, pursuant to chapter 675, an
3520 unexpired, irrevocable, nontransferable, and nonassignable
3521 letter of credit issued by any bank or savings association
3522 authorized to do business in this state. This letter of credit
3523 shall be used to satisfy the obligation of the agency to the
3524 claimant upon presentation of a final judgment indicating
3525 liability and awarding damages to be paid by the facility or
3526 upon presentment of a settlement agreement signed by all parties
3527 to the agreement if when such final judgment or settlement is a
3528 result of a liability claim against the agency.
3529 Section 80. Paragraph (d) of subsection (9) of section
3530 440.102, Florida Statutes, is amended to read:
3531 440.102 Drug-free workplace program requirements.—The
3532 following provisions apply to a drug-free workplace program
3533 implemented pursuant to law or to rules adopted by the Agency
3534 for Health Care Administration:
3535 (9) DRUG-TESTING STANDARDS FOR LABORATORIES.—
3536 (d) The laboratory shall submit to the Agency for Health
3537 Care Administration a monthly report with statistical
3538 information regarding the testing of employees and job
3539 applicants. The report must include information on the methods
3540 of analysis conducted, the drugs tested for, the number of
3541 positive and negative results for both initial tests and
3542 confirmation tests, and any other information deemed appropriate
3543 by the Agency for Health Care Administration. A monthly report
3544 must not identify specific employees or job applicants.
3545 Section 81. Paragraph (a) of subsection (2) of section
3546 440.13, Florida Statutes, is amended to read:
3547 440.13 Medical services and supplies; penalty for
3548 violations; limitations.—
3549 (2) MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.—
3550 (a) Subject to the limitations specified elsewhere in this
3551 chapter, the employer shall furnish to the employee such
3552 medically necessary remedial treatment, care, and attendance for
3553 such period as the nature of the injury or the process of
3554 recovery may require, which is in accordance with established
3555 practice parameters and protocols of treatment as provided for
3556 in this chapter, including medicines, medical supplies, durable
3557 medical equipment, orthoses, prostheses, and other medically
3558 necessary apparatus. Remedial treatment, care, and attendance,
3559 including work-hardening programs or pain-management programs
3560 accredited by the Commission on Accreditation of Rehabilitation
3561 Facilities or the Joint Commission on the Accreditation of
3562 Health Organizations or pain-management programs affiliated with
3563 medical schools, shall be considered as covered treatment only
3564 when such care is given based on a referral by a physician as
3565 defined in this chapter. Medically necessary treatment, care,
3566 and attendance does not include chiropractic services in excess
3567 of 24 treatments or rendered 12 weeks beyond the date of the
3568 initial chiropractic treatment, whichever comes first, unless
3569 the carrier authorizes additional treatment or the employee is
3570 catastrophically injured.
3571
3572 Failure of the carrier to timely comply with this subsection
3573 shall be a violation of this chapter and the carrier shall be
3574 subject to penalties as provided for in s. 440.525.
3575 Section 82. Subsection (9) is added to section 465.014,
3576 Florida Statutes, to read:
3577 465.014 Pharmacy technician.—
3578 (9) This section does not apply to a practitioner
3579 authorized to dispense drugs under s. 465.0276 or any medical
3580 assistant or licensed health care professional acting under the
3581 direct supervision of such practitioner if the practitioner is
3582 treating a patient who provides proof of insurance through a
3583 public or private payor source. Medical personnel under the
3584 direct supervision of the practitioner may perform all
3585 activities required by s. 465.0276.
3586 Section 83. Paragraph (a) of subsection (2) of section
3587 468.1695, Florida Statutes, is amended to read:
3588 468.1695 Licensure by examination.—
3589 (2) The department shall examine each applicant who the
3590 board certifies has completed the application form and remitted
3591 an examination fee set by the board not to exceed $250 and who:
3592 (a)1. Holds a baccalaureate degree from an accredited
3593 college or university and majored in health care administration,
3594 health services administration, or an equivalent major, or has
3595 credit for at least 60 semester hours in subjects, as prescribed
3596 by rule of the board, which prepare the applicant for total
3597 management of a nursing home; and
3598 2. Has fulfilled the requirements of a college-affiliated
3599 or university-affiliated internship in nursing home
3600 administration or of a 1,000-hour nursing home administrator-in
3601 training program prescribed by the board; or
3602 Section 84. Subsection (1) of section 483.035, Florida
3603 Statutes, is amended to read:
3604 483.035 Clinical laboratories operated by practitioners for
3605 exclusive use; licensure and regulation.—
3606 (1) A clinical laboratory operated by one or more
3607 practitioners licensed under chapter 458, chapter 459, chapter
3608 460, chapter 461, chapter 462, or chapter 466, or as an advanced
3609 registered nurse practitioner licensed under part I in chapter
3610 464, exclusively in connection with the diagnosis and treatment
3611 of their own patients, must be licensed under this part and must
3612 comply with the provisions of this part, except that the agency
3613 shall adopt rules for staffing, for personnel, including
3614 education and training of personnel, for proficiency testing,
3615 and for construction standards relating to the licensure and
3616 operation of the laboratory based upon and not exceeding the
3617 same standards contained in the federal Clinical Laboratory
3618 Improvement Amendments of 1988 and the federal regulations
3619 adopted thereunder.
3620 Section 85. Subsections (1) and (9) of section 483.051,
3621 Florida Statutes, are amended to read:
3622 483.051 Powers and duties of the agency.—The agency shall
3623 adopt rules to implement this part, which rules must include,
3624 but are not limited to, the following:
3625 (1) LICENSING; QUALIFICATIONS.—The agency shall provide for
3626 biennial licensure of all nonwaived clinical laboratories
3627 meeting the requirements of this part and shall prescribe the
3628 qualifications necessary for such licensure, including, but not
3629 limited to, application for or proof of a federal Clinical
3630 Laboratory Improvement Amendment (CLIA) certificate. For
3631 purposes of this section, the term “nonwaived clinical
3632 laboratories” means laboratories that perform any test that the
3633 Centers for Medicare and Medicaid Services has determined does
3634 not qualify for a certificate of waiver under the Clinical
3635 Laboratory Improvement Amendments of 1988 and the federal rules
3636 adopted thereunder.
3637 (9) ALTERNATE-SITE TESTING.—The agency, in consultation
3638 with the Board of Clinical Laboratory Personnel, shall adopt, by
3639 rule, the criteria for alternate-site testing to be performed
3640 under the supervision of a clinical laboratory director. The
3641 elements to be addressed in the rule include, but are not
3642 limited to: a hospital internal needs assessment; a protocol of
3643 implementation including tests to be performed and who will
3644 perform the tests; criteria to be used in selecting the method
3645 of testing to be used for alternate-site testing; minimum
3646 training and education requirements for those who will perform
3647 alternate-site testing, such as documented training, licensure,
3648 certification, or other medical professional background not
3649 limited to laboratory professionals; documented inservice
3650 training as well as initial and ongoing competency validation;
3651 an appropriate internal and external quality control protocol;
3652 an internal mechanism for identifying and tracking alternate
3653 site testing by the central laboratory; and recordkeeping
3654 requirements. Alternate-site testing locations must register
3655 when the clinical laboratory applies to renew its license. For
3656 purposes of this subsection, the term “alternate-site testing”
3657 means any laboratory testing done under the administrative
3658 control of a hospital, but performed out of the physical or
3659 administrative confines of the central laboratory.
3660 Section 86. Subsection (1) of section 483.23, Florida
3661 Statutes, is amended to read:
3662 483.23 Offenses; criminal penalties.—
3663 (1)(a) It is unlawful for any person to:
3664 1. Operate, maintain, direct, or engage in the business of
3665 operating a clinical laboratory unless she or he has obtained a
3666 clinical laboratory license from the agency or is exempt under
3667 s. 483.031.
3668 2. Conduct, maintain, or operate a clinical laboratory,
3669 other than an exempt laboratory or a laboratory operated under
3670 s. 483.035, unless the clinical laboratory is under the direct
3671 and responsible supervision and direction of a person licensed
3672 under part III of this chapter.
3673 3. Allow any person other than an individual licensed under
3674 part III of this chapter to perform clinical laboratory
3675 procedures, except in the operation of a laboratory exempt under
3676 s. 483.031 or a laboratory operated under s. 483.035.
3677 4. Violate or aid and abet in the violation of any
3678 provision of this part or the rules adopted under this part.
3679 (b) The performance of any act specified in paragraph (a)
3680 shall be referred by the agency to the local law enforcement
3681 agency and constitutes a misdemeanor of the second degree,
3682 punishable as provided in s. 775.082 or s. 775.083.
3683 Additionally, the agency may issue and deliver a notice to cease
3684 and desist from such act and may impose by citation an
3685 administrative penalty not to exceed $5,000 per act. Each day
3686 that unlicensed activity continues after issuance of a notice to
3687 cease and desist constitutes a separate act.
3688 Section 87. Section 483.294, Florida Statutes, is amended
3689 to read:
3690 483.294 Inspection of centers.—In accordance with s.
3691 408.811, the agency shall biennially, at least once annually,
3692 inspect the premises and operations of all centers subject to
3693 licensure under this part.
3694 Section 88. Paragraph (a) of subsection (54) of section
3695 499.003, Florida Statutes, is amended to read:
3696 499.003 Definitions of terms used in this part.—As used in
3697 this part, the term:
3698 (54) “Wholesale distribution” means distribution of
3699 prescription drugs to persons other than a consumer or patient,
3700 but does not include:
3701 (a) Any of the following activities, which is not a
3702 violation of s. 499.005(21) if such activity is conducted in
3703 accordance with s. 499.01(2)(g):
3704 1. The purchase or other acquisition by a hospital or other
3705 health care entity that is a member of a group purchasing
3706 organization of a prescription drug for its own use from the
3707 group purchasing organization or from other hospitals or health
3708 care entities that are members of that organization.
3709 2. The sale, purchase, or trade of a prescription drug or
3710 an offer to sell, purchase, or trade a prescription drug by a
3711 charitable organization described in s. 501(c)(3) of the
3712 Internal Revenue Code of 1986, as amended and revised, to a
3713 nonprofit affiliate of the organization to the extent otherwise
3714 permitted by law.
3715 3. The sale, purchase, or trade of a prescription drug or
3716 an offer to sell, purchase, or trade a prescription drug among
3717 hospitals or other health care entities that are under common
3718 control. For purposes of this subparagraph, “common control”
3719 means the power to direct or cause the direction of the
3720 management and policies of a person or an organization, whether
3721 by ownership of stock, by voting rights, by contract, or
3722 otherwise.
3723 4. The sale, purchase, trade, or other transfer of a
3724 prescription drug from or for any federal, state, or local
3725 government agency or any entity eligible to purchase
3726 prescription drugs at public health services prices pursuant to
3727 Pub. L. No. 102-585, s. 602 to a contract provider or its
3728 subcontractor for eligible patients of the agency or entity
3729 under the following conditions:
3730 a. The agency or entity must obtain written authorization
3731 for the sale, purchase, trade, or other transfer of a
3732 prescription drug under this subparagraph from the State Surgeon
3733 General or his or her designee.
3734 b. The contract provider or subcontractor must be
3735 authorized by law to administer or dispense prescription drugs.
3736 c. In the case of a subcontractor, the agency or entity
3737 must be a party to and execute the subcontract.
3738 d. A contract provider or subcontractor must maintain
3739 separate and apart from other prescription drug inventory any
3740 prescription drugs of the agency or entity in its possession.
3741 d.e. The contract provider and subcontractor must maintain
3742 and produce immediately for inspection all records of movement
3743 or transfer of all the prescription drugs belonging to the
3744 agency or entity, including, but not limited to, the records of
3745 receipt and disposition of prescription drugs. Each contractor
3746 and subcontractor dispensing or administering these drugs must
3747 maintain and produce records documenting the dispensing or
3748 administration. Records that are required to be maintained
3749 include, but are not limited to, a perpetual inventory itemizing
3750 drugs received and drugs dispensed by prescription number or
3751 administered by patient identifier, which must be submitted to
3752 the agency or entity quarterly.
3753 e.f. The contract provider or subcontractor may administer
3754 or dispense the prescription drugs only to the eligible patients
3755 of the agency or entity or must return the prescription drugs
3756 for or to the agency or entity. The contract provider or
3757 subcontractor must require proof from each person seeking to
3758 fill a prescription or obtain treatment that the person is an
3759 eligible patient of the agency or entity and must, at a minimum,
3760 maintain a copy of this proof as part of the records of the
3761 contractor or subcontractor required under sub-subparagraph e.
3762 f.g. In addition to the departmental inspection authority
3763 set forth in s. 499.051, the establishment of the contract
3764 provider and subcontractor and all records pertaining to
3765 prescription drugs subject to this subparagraph shall be subject
3766 to inspection by the agency or entity. All records relating to
3767 prescription drugs of a manufacturer under this subparagraph
3768 shall be subject to audit by the manufacturer of those drugs,
3769 without identifying individual patient information.
3770 Section 89. Section 624.49, Florida Statutes, is created to
3771 read:
3772 624.49 Prohibition on contracts.—Notwithstanding any other
3773 provision of law, a managed care entity, insurance carrier,
3774 self-insured entity, or third-party administrator, or an agent
3775 thereof which is governed by state law, may not impose a
3776 contracted reimbursement rate on a medical provider for goods or
3777 services provided or rendered pursuant to chapter 440 unless the
3778 carrier directly contracts with the provider for that rate.
3779 Section 90. Subsection (1) of section 627.645, Florida
3780 Statutes, is amended to read:
3781 627.645 Denial of health insurance claims restricted.—
3782 (1) No claim for payment under a health insurance policy or
3783 self-insured program of health benefits for treatment, care, or
3784 services in a licensed hospital which is accredited by the Joint
3785 Commission on the Accreditation of Hospitals, the American
3786 Osteopathic Association, or the Commission on the Accreditation
3787 of Rehabilitative Facilities shall be denied because such
3788 hospital lacks major surgical facilities and is primarily of a
3789 rehabilitative nature, if such rehabilitation is specifically
3790 for treatment of physical disability.
3791 Section 91. Effective May 1, 2012, paragraph (h) is added
3792 to subsection (1) of section 627.602, Florida Statutes, to read:
3793 627.602 Scope, format of policy.—
3794 (1) Each health insurance policy delivered or issued for
3795 delivery to any person in this state must comply with all
3796 applicable provisions of this code and all of the following
3797 requirements:
3798 (h) Section 641.32 and the Employee Retirement Income
3799 Security Act of 1974, as implemented by 29 C.F.R. s. 2560.503-1,
3800 relating to internal grievances. This paragraph does not apply
3801 to a health insurance policy that is subject to the Subscriber
3802 Assistance Program in s. 408.7056 or to the types of health
3803 benefit plans listed in s. 627.6561(5)(b)-(e) issued in any
3804 market.
3805 Section 92. Effective May 1, 2012, section 627.6513,
3806 Florida Statutes, is created to read:
3807 627.6513 Section 641.312 and the Employee Retirement Income
3808 Security Act of 1974, as implemented by 29 C.F.R. s. 2560.503-1,
3809 relating to internal grievances, apply to all group health
3810 insurance policies issued under this part. This section does not
3811 apply to a group health insurance policy that is subject to the
3812 Subscriber Assistance Program in s. 408.7056 or to the types of
3813 health benefit plans listed in s. 627.6561(5)(b)-(e) issued in
3814 any market.
3815 Section 93. Paragraph (c) of subsection (2) of section
3816 627.668, Florida Statutes, is amended to read:
3817 627.668 Optional coverage for mental and nervous disorders
3818 required; exception.—
3819 (2) Under group policies or contracts, inpatient hospital
3820 benefits, partial hospitalization benefits, and outpatient
3821 benefits consisting of durational limits, dollar amounts,
3822 deductibles, and coinsurance factors shall not be less favorable
3823 than for physical illness generally, except that:
3824 (c) Partial hospitalization benefits shall be provided
3825 under the direction of a licensed physician. For purposes of
3826 this part, the term “partial hospitalization services” is
3827 defined as those services offered by a program accredited by the
3828 Joint Commission on Accreditation of Hospitals (JCAH) or in
3829 compliance with equivalent standards. Alcohol rehabilitation
3830 programs accredited by the Joint Commission on Accreditation of
3831 Hospitals or approved by the state and licensed drug abuse
3832 rehabilitation programs shall also be qualified providers under
3833 this section. In any benefit year, if partial hospitalization
3834 services or a combination of inpatient and partial
3835 hospitalization are utilized, the total benefits paid for all
3836 such services shall not exceed the cost of 30 days of inpatient
3837 hospitalization for psychiatric services, including physician
3838 fees, which prevail in the community in which the partial
3839 hospitalization services are rendered. If partial
3840 hospitalization services benefits are provided beyond the limits
3841 set forth in this paragraph, the durational limits, dollar
3842 amounts, and coinsurance factors thereof need not be the same as
3843 those applicable to physical illness generally.
3844 Section 94. Subsection (3) of section 627.669, Florida
3845 Statutes, is amended to read:
3846 627.669 Optional coverage required for substance abuse
3847 impaired persons; exception.—
3848 (3) The benefits provided under this section shall be
3849 applicable only if treatment is provided by, or under the
3850 supervision of, or is prescribed by, a licensed physician or
3851 licensed psychologist and if services are provided in a program
3852 accredited by the Joint Commission on Accreditation of Hospitals
3853 or approved by the state.
3854 Section 95. Paragraph (a) of subsection (1) of section
3855 627.736, Florida Statutes, is amended to read:
3856 627.736 Required personal injury protection benefits;
3857 exclusions; priority; claims.—
3858 (1) REQUIRED BENEFITS.—Every insurance policy complying
3859 with the security requirements of s. 627.733 shall provide
3860 personal injury protection to the named insured, relatives
3861 residing in the same household, persons operating the insured
3862 motor vehicle, passengers in such motor vehicle, and other
3863 persons struck by such motor vehicle and suffering bodily injury
3864 while not an occupant of a self-propelled vehicle, subject to
3865 the provisions of subsection (2) and paragraph (4)(e), to a
3866 limit of $10,000 for loss sustained by any such person as a
3867 result of bodily injury, sickness, disease, or death arising out
3868 of the ownership, maintenance, or use of a motor vehicle as
3869 follows:
3870 (a) Medical benefits.—Eighty percent of all reasonable
3871 expenses for medically necessary medical, surgical, X-ray,
3872 dental, and rehabilitative services, including prosthetic
3873 devices, and medically necessary ambulance, hospital, and
3874 nursing services. However, the medical benefits shall provide
3875 reimbursement only for such services and care that are lawfully
3876 provided, supervised, ordered, or prescribed by a physician
3877 licensed under chapter 458 or chapter 459, a dentist licensed
3878 under chapter 466, or a chiropractic physician licensed under
3879 chapter 460 or that are provided by any of the following persons
3880 or entities:
3881 1. A hospital or ambulatory surgical center licensed under
3882 chapter 395.
3883 2. A person or entity licensed under ss. 401.2101-401.45
3884 that provides emergency transportation and treatment.
3885 3. An entity wholly owned by one or more physicians
3886 licensed under chapter 458 or chapter 459, chiropractic
3887 physicians licensed under chapter 460, or dentists licensed
3888 under chapter 466 or by such practitioner or practitioners and
3889 the spouse, parent, child, or sibling of that practitioner or
3890 those practitioners.
3891 4. An entity wholly owned, directly or indirectly, by a
3892 hospital or hospitals.
3893 5. A health care clinic licensed under ss. 400.990-400.995
3894 that is:
3895 a. Accredited by the Joint Commission on Accreditation of
3896 Healthcare Organizations, the American Osteopathic Association,
3897 the Commission on Accreditation of Rehabilitation Facilities, or
3898 the Accreditation Association for Ambulatory Health Care, Inc.;
3899 or
3900 b. A health care clinic that:
3901 (I) Has a medical director licensed under chapter 458,
3902 chapter 459, or chapter 460;
3903 (II) Has been continuously licensed for more than 3 years
3904 or is a publicly traded corporation that issues securities
3905 traded on an exchange registered with the United States
3906 Securities and Exchange Commission as a national securities
3907 exchange; and
3908 (III) Provides at least four of the following medical
3909 specialties:
3910 (A) General medicine.
3911 (B) Radiography.
3912 (C) Orthopedic medicine.
3913 (D) Physical medicine.
3914 (E) Physical therapy.
3915 (F) Physical rehabilitation.
3916 (G) Prescribing or dispensing outpatient prescription
3917 medication.
3918 (H) Laboratory services.
3919
3920 The Financial Services Commission shall adopt by rule the form
3921 that must be used by an insurer and a health care provider
3922 specified in subparagraph 3., subparagraph 4., or subparagraph
3923 5. to document that the health care provider meets the criteria
3924 of this paragraph, which rule must include a requirement for a
3925 sworn statement or affidavit.
3926
3927 Only insurers writing motor vehicle liability insurance in this
3928 state may provide the required benefits of this section, and no
3929 such insurer shall require the purchase of any other motor
3930 vehicle coverage other than the purchase of property damage
3931 liability coverage as required by s. 627.7275 as a condition for
3932 providing such required benefits. Insurers may not require that
3933 property damage liability insurance in an amount greater than
3934 $10,000 be purchased in conjunction with personal injury
3935 protection. Such insurers shall make benefits and required
3936 property damage liability insurance coverage available through
3937 normal marketing channels. Any insurer writing motor vehicle
3938 liability insurance in this state who fails to comply with such
3939 availability requirement as a general business practice shall be
3940 deemed to have violated part IX of chapter 626, and such
3941 violation shall constitute an unfair method of competition or an
3942 unfair or deceptive act or practice involving the business of
3943 insurance; and any such insurer committing such violation shall
3944 be subject to the penalties afforded in such part, as well as
3945 those which may be afforded elsewhere in the insurance code.
3946 Section 96. Effective May 1, 2012, section 641.312,
3947 Florida Statutes, is created to read:
3948 641.312 The Financial Services Commission may adopt rules
3949 to administer the National Association of Insurance
3950 Commissioners’ Uniform Health Carrier External Review Model Act,
3951 dated April 2010. This section does not apply to a health
3952 maintenance contract that is subject to the Subscriber
3953 Assistance Program in s. 408.7056 or to the types of health
3954 benefit plans listed in s. 625.6561(5)(b)-(e) issued in any
3955 market.
3956 Section 97. Subsection (12) of section 641.495, Florida
3957 Statutes, is amended to read:
3958 641.495 Requirements for issuance and maintenance of
3959 certificate.—
3960 (12) The provisions of part I of chapter 395 do not apply
3961 to a health maintenance organization that, on or before January
3962 1, 1991, provides not more than 10 outpatient holding beds for
3963 short-term and hospice-type patients in an ambulatory care
3964 facility for its members, provided that such health maintenance
3965 organization maintains current accreditation by the Joint
3966 Commission on Accreditation of Health Care Organizations, the
3967 Accreditation Association for Ambulatory Health Care, or the
3968 National Committee for Quality Assurance.
3969 Section 98. Subsection (13) of section 651.118, Florida
3970 Statutes, is amended to read:
3971 651.118 Agency for Health Care Administration; certificates
3972 of need; sheltered beds; community beds.—
3973 (13) Residents, as defined in this chapter, are not
3974 considered new admissions for the purpose of s. 400.141(1)(n)
3975 400.141(1)(o)1.d.
3976 Section 99. Subsection (2) of section 766.1015, Florida
3977 Statutes, is amended to read:
3978 766.1015 Civil immunity for members of or consultants to
3979 certain boards, committees, or other entities.—
3980 (2) Such committee, board, group, commission, or other
3981 entity must be established in accordance with state law or in
3982 accordance with requirements of the Joint Commission on
3983 Accreditation of Healthcare Organizations, established and duly
3984 constituted by one or more public or licensed private hospitals
3985 or behavioral health agencies, or established by a governmental
3986 agency. To be protected by this section, the act, decision,
3987 omission, or utterance may not be made or done in bad faith or
3988 with malicious intent.
3989 Section 100. Paragraph (j) is added to subsection (3) of
3990 section 817.505, Florida Statutes, to read:
3991 817.505 Patient brokering prohibited; exceptions;
3992 penalties.—
3993 (3) This section shall not apply to:
3994 (j) Payments by an assisted living facility, as defined in
3995 s. 429.02, or an agreement for or solicitation, offer, or
3996 receipt of such payment by a referral service permitted under s.
3997 429.195(2).
3998 Section 101. Except as otherwise expressly provided in this
3999 act, this act shall take effect July 1, 2012.
4000
4001 ================= T I T L E A M E N D M E N T ================
4002 And the title is amended as follows:
4003 Delete everything before the enacting clause
4004 and insert:
4005 A bill to be entitled
4006 An act relating to health care facilities; amending s.
4007 83.42, F.S., relating to exclusions from part II of
4008 ch. 83, F.S., the Florida Residential Landlord and
4009 Tenant Act; clarifying that the procedures in s.
4010 400.0255, F.S., for transfers and discharges are
4011 exclusive to residents of a nursing home licensed
4012 under part II of ch. 400, F.S.; amending s. 112.0455,
4013 F.S., relating to the Drug-Free Workplace Act;
4014 deleting a provision regarding retroactivity of the
4015 act; deleting a provision that the act does not
4016 abrogate the right of an employer under state law to
4017 conduct drug tests before a specified date; deleting a
4018 provision that requires a laboratory to submit to the
4019 Agency for Health Care Administration a monthly report
4020 containing statistical information regarding the
4021 testing of employees and job applicants; amending s.
4022 318.21, F.S.; providing that a portion of the
4023 additional fines assessed for traffic violations
4024 within an enhanced penalty zone be remitted to the
4025 Department of Revenue and deposited into the Brain and
4026 Spinal Cord Injury Trust Fund of the Department of
4027 Health to serve certain Medicaid recipients; amending
4028 s. 383.011, F.S.; requiring the Department of Health
4029 to establish an interagency agreement with the
4030 Department of Children and Family Services for
4031 management of the Special Supplemental Nutrition
4032 Program for Women, Infants, and Children; specifying
4033 responsibilities of each department; creating s.
4034 383.141, F.S.; providing legislative findings;
4035 providing definitions; requiring that health care
4036 providers provide pregnant women with current
4037 information about the nature of the developmental
4038 disabilities tested for in certain prenatal tests, the
4039 accuracy of such tests, and resources for obtaining
4040 support services for Down syndrome and other
4041 prenatally diagnosed developmental disabilities and
4042 that the counseling that follows such diagnosis may
4043 lead to the unnecessary abortion of unborn humans;
4044 providing duties for the Department of Health
4045 concerning establishment of an information
4046 clearinghouse; creating an advocacy council within the
4047 Department of Health to provide technical assistance
4048 in forming the clearinghouse; providing membership for
4049 the council; providing duties of the council;
4050 providing terms for members of the council; providing
4051 for election of a chairperson and vice chairperson;
4052 providing meeting times for the council; requiring the
4053 members to serve without compensation but be
4054 reimbursed for per diem and travel expenses; requiring
4055 the Department of Health to provide administrative
4056 support; repealing s. 383.325, F.S., relating to
4057 confidentiality of inspection reports of a licensed
4058 birth center facilities; creating s. 385.2031, F.S.;
4059 designating the Florida Hospital/Sandford-Burnham
4060 Translational Research Institute for Metabolism and
4061 Diabetes as a resource for research in the prevention
4062 and treatment of diabetes; amending s. 394.4787, F.S.;
4063 conforming a cross-reference; amending s. 395.002,
4064 F.S.; revising and deleting definitions applicable to
4065 the regulation of hospitals and other licensed
4066 facilities; conforming a cross-reference; amending s.
4067 395.003, F.S.; deleting an obsolete provision;
4068 conforming a cross-reference; amending s. 395.0161,
4069 F.S.; deleting a requirement that facilities licensed
4070 under part I of ch. 395, F.S., pay licensing fees at
4071 the time of inspection; amending s. 395.0193, F.S.;
4072 requiring a licensed facility to report certain peer
4073 review information and final disciplinary actions to
4074 the Division of Medical Quality Assurance of the
4075 Department of Health, rather than the Division of
4076 Health Quality Assurance of the Agency for Health Care
4077 Administration; amending s. 395.1023, F.S.; providing
4078 for the Department of Children and Family Services,
4079 rather than the Department of Health, to perform
4080 certain functions with respect to child protection
4081 cases; requiring certain hospitals to notify the
4082 Department of Children and Family Services of
4083 compliance; amending s. 395.1041, F.S., relating to
4084 hospital emergency services and care; deleting
4085 obsolete provisions; repealing s. 395.1046, F.S.,
4086 relating to procedures employed by the Agency for
4087 Health Care Administration when investigating
4088 complaints against hospitals; amending s. 400.0239,
4089 F.S.; conforming a provision to changes made by the
4090 act; amending s. 400.0255, F.S.; revising provisions
4091 relating to hearings on resident transfer or
4092 discharge; amending s. 400.063, F.S.; deleting an
4093 obsolete cross-reference; amending s. 400.071, F.S.;
4094 deleting provisions requiring a license applicant to
4095 submit a signed affidavit relating to financial or
4096 ownership interests, the number of beds, copies of
4097 civil verdicts or judgments involving the applicant,
4098 and a plan for quality assurance and risk management;
4099 amending s. 400.0712, F.S.; revising provisions
4100 relating to the issuance of inactive licenses;
4101 amending s. 400.111, F.S.; providing that a licensee
4102 must provide certain information relating to financial
4103 or ownership interests if requested by the Agency for
4104 Health Care Administration; amending s. 400.1183,
4105 F.S.; revising requirements relating to nursing home
4106 facility grievance reports; amending s. 400.141, F.S.;
4107 revising provisions relating to the provision of
4108 respite care in a facility; deleting requirements for
4109 the submission of certain reports to the agency
4110 relating to ownership interests, staffing ratios, and
4111 bankruptcy; deleting an obsolete provision; amending
4112 s. 400.142, F.S.; deleting the agency’s authority to
4113 adopt rules relating to orders not to resuscitate;
4114 amending s. 400.147, F.S.; revising provisions
4115 relating to adverse incident reports; deleting certain
4116 reporting requirements; repealing s. 400.148, F.S.,
4117 relating to the Medicaid “Up-or-Out” Quality of Care
4118 Contract Management Program; amending s. 400.19, F.S.;
4119 revising provisions relating to agency inspections of
4120 nursing home facilities; amending s. 400.191, F.S.;
4121 authorizing the facility to charge a fee for copies of
4122 resident records; amending s. 400.23, F.S.; specifying
4123 the content of rules relating to nursing home facility
4124 staffing requirements for residents under 21 years of
4125 age; amending s. 400.275, F.S.; revising agency duties
4126 with regard to training nursing home surveyor teams;
4127 revising requirements for team members; amending s.
4128 400.462, F.S.; revising the definition of
4129 “remuneration” to exclude items having a value of $15
4130 or less; amending s. 400.474, F.S.; revising the
4131 requirements for a quarterly report submitted to the
4132 Agency for Health Care Administration by each home
4133 health agency; amending s. 400.484, F.S.; revising the
4134 classification of violations by a home health agency
4135 for which the agency imposes an administrative fine;
4136 amending and reenacting s. 400.506, F.S., relating to
4137 licensure of nurse registries, to incorporate the
4138 amendment made to s. 400.509, F.S., in a reference
4139 thereto; authorizing an administrator to manage up to
4140 five nurse registries under certain circumstances;
4141 requiring an administrator to designate, in writing,
4142 for each licensed entity, a qualified alternate
4143 administrator to serve during the administrator’s
4144 absence; amending s. 400.509, F.S.; providing that
4145 organizations that provide companion or homemaker
4146 services only to persons with developmental
4147 disabilities, under contract with the Agency for
4148 Persons with Disabilities, are exempt from
4149 registration with the Agency for Health Care
4150 Administration; reenacting ss. 400.464(5)(b) and
4151 400.506(6)(a), F.S., relating to home health agencies
4152 and licensure of nurse registries, respectively, to
4153 incorporate the amendment made to s. 400.509, F.S., in
4154 references thereto; amending s. 400.601, F.S.;
4155 revising the definition of the term “hospice” to
4156 include limited liability companies; amending s.
4157 400.606, F.S.; revising the content requirements of
4158 the plan accompanying an initial or change-of
4159 ownership application for licensure of a hospice;
4160 revising requirements relating to certificates of need
4161 for certain hospice facilities; amending s. 400.915,
4162 F.S.; correcting an obsolete cross-reference to
4163 administrative rules; amending s. 400.931, F.S.;
4164 requiring each applicant for initial licensure, change
4165 of ownership, or license renewal to operate a licensed
4166 home medical equipment provider at a location outside
4167 the state to submit documentation of accreditation, or
4168 an application for accreditation, from an accrediting
4169 organization that is recognized by the Agency for
4170 Health Care Administration; requiring an applicant
4171 that has applied for accreditation to provide proof of
4172 accreditation within a specified time; deleting a
4173 requirement that an applicant for a home medical
4174 equipment provider license submit a surety bond to the
4175 agency; amending s. 400.967, F.S.; revising the
4176 classification of violations by intermediate care
4177 facilities for the developmentally disabled; providing
4178 a penalty for certain violations; amending s.
4179 400.9905, F.S.; revising the definitions of the terms
4180 “clinic” and “portable equipment provider”; revising
4181 requirements for an application for exemption from
4182 health care clinic licensure requirements for certain
4183 entities; providing for the agency to deny or revoke
4184 the exemption under certain circumstances; including
4185 health services provided to multiple locations within
4186 the definition of the term “portable health service or
4187 equipment provider”; amending s. 400.991, F.S.;
4188 conforming terminology; revising application
4189 requirements relating to documentation of financial
4190 ability to operate a mobile clinic; amending s.
4191 400.9935, F.S.; adding additional responsibilities of
4192 medical and clinic directors with respect to the
4193 posting of a schedule of charges for services;
4194 amending s. 408.033, F.S.; providing that fees
4195 assessed on selected health care facilities and
4196 organizations may be collected prospectively at the
4197 time of licensure renewal and prorated for the
4198 licensing period; amending s. 408.034, F.S.; revising
4199 agency authority relating to licensing of intermediate
4200 care facilities for the developmentally disabled;
4201 amending s. 408.036, F.S.; conforming provisions to
4202 changes made by the act; amending s. 408.037, F.S.;
4203 revising requirements for the financial information to
4204 be included in an application for a certificate of
4205 need; amending s. 408.043, F.S.; revising requirements
4206 for certain freestanding inpatient hospice care
4207 facilities to obtain a certificate of need; amending
4208 s. 408.061, F.S.; revising data reporting requirements
4209 for health care facilities; amending s. 408.07, F.S.;
4210 deleting a cross-reference; amending s. 408.10, F.S.;
4211 removing agency authority to investigate certain
4212 consumer complaints; amending s. 408.7056, F.S.;
4213 providing that the Subscriber Assistance Program
4214 applies to clinics and health plans that meet certain
4215 requirements; amending s. 408.802, F.S.; removing
4216 applicability of part II of ch. 408, F.S., relating to
4217 general licensure requirements, to private review
4218 agents; amending s. 408.804, F.S.; providing penalties
4219 for altering, defacing, or falsifying a license
4220 certificate issued by the agency or displaying such an
4221 altered, defaced, or falsified certificate; amending
4222 s. 408.806, F.S.; revising agency responsibilities for
4223 notification of licensees of impending expiration of a
4224 license; requiring payment of a late fee for a license
4225 application to be considered complete under certain
4226 circumstances; amending s. 408.8065, F.S.; revising
4227 the requirements for becoming licensed as a home
4228 health agency, home medical equipment provider, or
4229 health care clinic; amending s. 408.810, F.S.;
4230 requiring that the controlling interest of a health
4231 care licensee notify the agency of certain court
4232 proceedings; providing a penalty; amending s. 408.813,
4233 F.S.; authorizing the agency to impose fines for
4234 unclassified violations of part II of ch. 408, F.S.;
4235 amending s. 409.912, F.S.; revising provisions
4236 requiring the agency to post certain information
4237 relating to drugs subject to prior authorization on
4238 its Internet website; providing a definition of the
4239 term “step edit”; amending s. 409.975, F.S.; requiring
4240 good faith negotiations between Medicaid managed care
4241 plans and essential Medicaid providers; providing that
4242 a statewide essential provider is part of a Medicaid
4243 managed care plan’s network for purposes of the
4244 managed care plan’s application for enrollment or
4245 expansion in the Medicaid program; requiring good
4246 faith negotiations between Medicaid managed care plans
4247 and statewide essential providers; authorizing
4248 Medicaid managed care plans and certain Medicaid
4249 providers to file a complaint alleging that, in
4250 provider network negotiations, the other party is not
4251 negotiating in good faith; requiring the Agency for
4252 Health Care Administration to review such complaints
4253 and make a determination as to whether one or both
4254 parties have failed to negotiate in good faith;
4255 providing criteria for the agency to consider in
4256 making a determination about good faith negotiations;
4257 providing financial penalties for parties that do not
4258 negotiate in good faith; authorizing appeal of the
4259 agency’s determination pursuant to chapter 120, F.S.;
4260 providing for payment of attorney’s fees and costs;
4261 amending s. 429.11, F.S.; revising licensure
4262 application requirements for assisted living
4263 facilities to eliminate provisional licenses; amending
4264 s. 429.71, F.S.; revising the classification of
4265 violations by adult family-care homes; amending s.
4266 429.195, F.S.; providing exceptions to applicability
4267 of assisted living facility rebate restrictions;
4268 amending s. 429.915, F.S.; revising agency
4269 responsibilities regarding the issuance of conditional
4270 licenses; amending ss. 430.80, 430.81, and 651.118,
4271 F.S.; conforming cross-references; amending s.
4272 440.102, F.S.; removing a requirement that a
4273 laboratory submit to the Agency for Health Care
4274 Administration a monthly report containing statistical
4275 information regarding the testing of employees and job
4276 applicants; amending s. 465.014, F.S.; providing that
4277 the provisions governing pharmacy technicians do not
4278 apply to a practitioner authorized to dispense drugs
4279 or a medical assistant or licensed health care
4280 professional acting under the direct supervision of
4281 such a practitioner under certain circumstances;
4282 amending s. 468.1695, F.S.; providing that a health
4283 services administration or equivalent major satisfies
4284 the education requirements for nursing home
4285 administrator applicants; amending s. 483.035, F.S.;
4286 providing for a clinical laboratory to be operated by
4287 certain nurses; amending s. 483.051, F.S.; requiring
4288 the Agency for Health Care Administration to provide
4289 for biennial licensure of all nonwaived laboratories
4290 that meet certain requirements; requiring the agency
4291 to prescribe qualifications for such licensure;
4292 defining nonwaived laboratories as laboratories that
4293 do not have a certificate of waiver from the Centers
4294 for Medicare and Medicaid Services; deleting
4295 requirements for the registration of an alternate site
4296 testing location when the clinical laboratory applies
4297 to renew its license; amending s. 483.23, F.S.;
4298 providing that certain violations relating to the
4299 operation of a clinical laboratory be referred by the
4300 Agency for Health Care Administration to the local law
4301 enforcement agency; authorizing the Agency for Health
4302 Care Administration to provide a cease and desist
4303 notice and impose administrative penalties and fines;
4304 amending s. 483.294, F.S.; revising the frequency of
4305 agency inspections of multiphasic health testing
4306 centers; amending s. 499.003, F.S.; removing the
4307 requirement for certain prescription drug purchasers
4308 to maintain a separate inventory of certain
4309 prescription drugs; creating s. 624.49, F.S.;
4310 prohibiting a managed care entity, insurance carrier,
4311 self-insured entity, or third-party administrator, or
4312 an agent thereof, from imposing a contracted
4313 reimbursement rate on a medical provider for certain
4314 goods or services unless the carrier directly
4315 contracts with the provider for that rate; amending
4316 and creating, respectively, ss. 627.602 and 627.6513,
4317 F.S.; providing that the Uniform Health Carrier
4318 External Review Model Act and the Employee Retirement
4319 Income Security Act apply to individual and group
4320 health insurance policies except those subject to the
4321 Subscriber Assistance Program under s. 408.7056, F.S.;
4322 creating s. 641.312, F.S.; allowing the Office of
4323 Insurance Regulation to adopt rules to administer the
4324 National Association of Insurance Commissioners’
4325 Uniform Health Carrier External Review Model Act;
4326 providing that the Uniform Health Carrier External
4327 Review Model Act does not apply to a health
4328 maintenance contract that is subject to the Subscriber
4329 Assistance Program under s. 408.7056, F.S. or certain
4330 other health benefit plans; amending s. 817.505, F.S.;
4331 providing an exception to provisions prohibiting
4332 patient brokering; providing effective dates.