Florida Senate - 2015                             CS for SB 1146
       By the Committee on Health Policy; and Senator Simmons
       588-02134-15                                          20151146c1
    1                        A bill to be entitled                      
    2         An act relating to agency relationships with
    3         governmental health care contractors; amending s.
    4         766.1115, F.S.; redefining terms; deleting an obsolete
    5         date; extending sovereign immunity to employees or
    6         agents of a health care provider that executes a
    7         contract with a governmental contractor; authorizing
    8         such health care provider to collect from a patient,
    9         or the parent or guardian of a patient, a nominal fee
   10         for administrative costs under certain circumstances;
   11         limiting the nominal fee; clarifying that a receipt of
   12         specified notice must be acknowledged by a patient or
   13         the patient’s representative at the initial visit;
   14         requiring the posting of notice that a specified
   15         health care provider is an agent of a governmental
   16         contractor; amending s. 768.28, F.S.; redefining the
   17         term “officer, employee, or agent” to include
   18         employees or agents of a health care provider;
   19         providing an effective date.
   21  Be It Enacted by the Legislature of the State of Florida:
   23         Section 1. Paragraphs (a) and (d) of subsection (3) and
   24  subsections (4) and (5) of section 766.1115, Florida Statutes,
   25  are amended to read:
   26         766.1115 Health care providers; creation of agency
   27  relationship with governmental contractors.—
   28         (3) DEFINITIONS.—As used in this section, the term:
   29         (a) “Contract” means an agreement executed in compliance
   30  with this section between a health care provider and a
   31  governmental contractor which allows the health care provider,
   32  or any employee or agent of the health care provider, to deliver
   33  health care services to low-income recipients as an agent of the
   34  governmental contractor. The contract must be for volunteer,
   35  uncompensated services, except as provided in paragraph (4)(g).
   36  For services to qualify as volunteer, uncompensated services
   37  under this section, the health care provider must receive no
   38  compensation from the governmental contractor for any services
   39  provided under the contract and must not bill or accept
   40  compensation from the recipient, or a public or private third
   41  party payor, for the specific services provided to the low
   42  income recipients covered by the contract, except as provided in
   43  paragraphs (4)(g) and (h). A free clinic as described in
   44  subparagraph (3)(d)14. may receive a legislative appropriation,
   45  a grant through a legislative appropriation, or a grant from a
   46  governmental entity or nonprofit corporation to support the
   47  delivery of such contracted services by volunteer health care
   48  providers, including the employment of health care providers to
   49  supplement, coordinate, or support the delivery of services by
   50  volunteer health care providers. Such an appropriation or grant
   51  does not constitute compensation under this paragraph from the
   52  governmental contractor for services provided under the
   53  contract, nor does receipt and use of the appropriation or grant
   54  constitute the acceptance of compensation under this paragraph
   55  for the specific services provided to the low-income recipients
   56  covered by the contract.
   57         (d) “Health care provider” or “provider” means:
   58         1. A birth center licensed under chapter 383.
   59         2. An ambulatory surgical center licensed under chapter
   60  395.
   61         3. A hospital licensed under chapter 395.
   62         4. A physician or physician assistant licensed under
   63  chapter 458.
   64         5. An osteopathic physician or osteopathic physician
   65  assistant licensed under chapter 459.
   66         6. A chiropractic physician licensed under chapter 460.
   67         7. A podiatric physician licensed under chapter 461.
   68         8. A registered nurse, nurse midwife, licensed practical
   69  nurse, or advanced registered nurse practitioner licensed or
   70  registered under part I of chapter 464 or any facility which
   71  employs nurses licensed or registered under part I of chapter
   72  464 to supply all or part of the care delivered under this
   73  section.
   74         9. A midwife licensed under chapter 467.
   75         10. A health maintenance organization certificated under
   76  part I of chapter 641.
   77         11. A health care professional association and its
   78  employees or a corporate medical group and its employees.
   79         12. Any other medical facility the primary purpose of which
   80  is to deliver human medical diagnostic services or which
   81  delivers nonsurgical human medical treatment, and which includes
   82  an office maintained by a provider.
   83         13. A dentist or dental hygienist licensed under chapter
   84  466.
   85         14. A free clinic that delivers only medical diagnostic
   86  services or nonsurgical medical treatment free of charge to all
   87  low-income recipients, except as provided in paragraph (4)(h).
   88         15. Any other health care professional, practitioner,
   89  provider, or facility under contract with a governmental
   90  contractor, including a student enrolled in an accredited
   91  program that prepares the student for licensure as any one of
   92  the professionals listed in subparagraphs 4.-9.
   94  The term includes any nonprofit corporation qualified as exempt
   95  from federal income taxation under s. 501(a) of the Internal
   96  Revenue Code, and described in s. 501(c) of the Internal Revenue
   97  Code, which delivers health care services provided by licensed
   98  professionals listed in this paragraph, any federally funded
   99  community health center, and any volunteer corporation or
  100  volunteer health care provider that delivers health care
  101  services.
  102         (4) CONTRACT REQUIREMENTS.—A health care provider that
  103  executes a contract with a governmental contractor to deliver
  104  health care services on or after April 17, 1992, as an agent of
  105  the governmental contractor, or any employee or agent of such
  106  health care provider, is an agent for purposes of s. 768.28(9),
  107  while acting within the scope of duties under the contract, if
  108  the contract complies with the requirements of this section and
  109  regardless of whether the individual treated is later found to
  110  be ineligible. A health care provider, or any employee or agent
  111  of the health care provider, shall continue to be an agent for
  112  purposes of s. 768.28(9) for 30 days after a determination of
  113  ineligibility to allow for treatment until the individual
  114  transitions to treatment by another health care provider. A
  115  health care provider under contract with the state, or any
  116  employee or agent of such health care provider, may not be named
  117  as a defendant in any action arising out of medical care or
  118  treatment provided on or after April 17, 1992, under contracts
  119  entered into under this section. The contract must provide that:
  120         (a) The right of dismissal or termination of any health
  121  care provider delivering services under the contract is retained
  122  by the governmental contractor.
  123         (b) The governmental contractor has access to the patient
  124  records of any health care provider delivering services under
  125  the contract.
  126         (c) Adverse incidents and information on treatment outcomes
  127  must be reported by any health care provider to the governmental
  128  contractor if the incidents and information pertain to a patient
  129  treated under the contract. The health care provider shall
  130  submit the reports required by s. 395.0197. If an incident
  131  involves a professional licensed by the Department of Health or
  132  a facility licensed by the Agency for Health Care
  133  Administration, the governmental contractor shall submit such
  134  incident reports to the appropriate department or agency, which
  135  shall review each incident and determine whether it involves
  136  conduct by the licensee that is subject to disciplinary action.
  137  All patient medical records and any identifying information
  138  contained in adverse incident reports and treatment outcomes
  139  which are obtained by governmental entities under this paragraph
  140  are confidential and exempt from the provisions of s. 119.07(1)
  141  and s. 24(a), Art. I of the State Constitution.
  142         (d) Patient selection and initial referral must be made by
  143  the governmental contractor or the provider. Patients may not be
  144  transferred to the provider based on a violation of the
  145  antidumping provisions of the Omnibus Budget Reconciliation Act
  146  of 1989, the Omnibus Budget Reconciliation Act of 1990, or
  147  chapter 395.
  148         (e) If emergency care is required, the patient need not be
  149  referred before receiving treatment, but must be referred within
  150  48 hours after treatment is commenced or within 48 hours after
  151  the patient has the mental capacity to consent to treatment,
  152  whichever occurs later.
  153         (f) The provider is subject to supervision and regular
  154  inspection by the governmental contractor.
  155         (g) As an agent of the governmental contractor for purposes
  156  of s. 768.28(9), while acting within the scope of duties under
  157  the contract, A health care provider licensed under chapter 466,
  158  as an agent of the governmental contractor for purposes of s.
  159  768.28(9), may allow a patient, or a parent or guardian of the
  160  patient, to voluntarily contribute a monetary amount to cover
  161  costs of dental laboratory work related to the services provided
  162  to the patient within the scope of duties under the contract.
  163  This contribution may not exceed the actual cost of the dental
  164  laboratory charges.
  165         (h) A health care provider that is a free clinic under
  166  subparagraph (3)(d)14., as an agent of the governmental
  167  contractor for purposes of s. 768.28(9), may allow a patient, or
  168  a parent or guardian of the patient, to pay a nominal fee for
  169  administrative costs related to the services provided to the
  170  patient under the contract. For purposes of this paragraph, a
  171  nominal fee may not exceed $10 per visit.
  173  A governmental contractor that is also a health care provider is
  174  not required to enter into a contract under this section with
  175  respect to the health care services delivered by its employees.
  176         (5) NOTICE OF AGENCY RELATIONSHIP.—The governmental
  177  contractor must provide written notice to each patient, or the
  178  patient’s legal representative, receipt of which must be
  179  acknowledged in writing at the initial visit, that the provider
  180  is an agent of the governmental contractor and that the
  181  exclusive remedy for injury or damage suffered as the result of
  182  any act or omission of the provider or of any employee or agent
  183  thereof acting within the scope of duties pursuant to the
  184  contract is by commencement of an action pursuant to the
  185  provisions of s. 768.28. Thereafter, and with respect to any
  186  federally funded community health center, the notice
  187  requirements may be met by posting in a place conspicuous to all
  188  persons a notice that the health care provider federally funded
  189  community health center is an agent of the governmental
  190  contractor and that the exclusive remedy for injury or damage
  191  suffered as the result of any act or omission of the provider or
  192  of any employee or agent thereof acting within the scope of
  193  duties pursuant to the contract is by commencement of an action
  194  pursuant to the provisions of s. 768.28.
  195         Section 2. Paragraph (b) of subsection (9) of section
  196  768.28, Florida Statutes, is amended to read:
  197         768.28 Waiver of sovereign immunity in tort actions;
  198  recovery limits; limitation on attorney fees; statute of
  199  limitations; exclusions; indemnification; risk management
  200  programs.—
  201         (9)
  202         (b) As used in this subsection, the term:
  203         1. “Employee” includes any volunteer firefighter.
  204         2. “Officer, employee, or agent” includes, but is not
  205  limited to, any health care provider, and its employees or
  206  agents, when providing services pursuant to s. 766.1115; any
  207  nonprofit independent college or university located and
  208  chartered in this state which owns or operates an accredited
  209  medical school, and its employees or agents, when providing
  210  patient services pursuant to paragraph (10)(f); and any public
  211  defender or her or his employee or agent, including, among
  212  others, an assistant public defender and an investigator.
  213         Section 3. This act shall take effect July 1, 2015.