Florida Senate - 2015                        COMMITTEE AMENDMENT
       Bill No. CS for CS for SB 532
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/23/2015           .                                

       The Committee on Appropriations (Grimsley) recommended the
    1         Senate Amendment (with title amendment)
    3         Between lines 232 and 233
    4  insert:
    5         Section 8. Section 296.42, Florida Statutes, is created to
    6  read:
    7         296.42 Site selection process for state veterans’ nursing
    8  homes.—
    9         (1) The department shall contract for a study to determine
   10  the need for new state veterans’ nursing homes and the most
   11  appropriate counties in which to locate the homes based on the
   12  greatest level of need. The department shall submit the study to
   13  the Governor, the President of the Senate, and the Speaker of
   14  the House of Representatives by November 1, 2015.
   15         (2) The study shall use the following criteria to rank each
   16  county according to need:
   17         (a) The distance from the geographic center of the county
   18  to the nearest existing state veterans’ nursing home.
   19         (b) The number of veterans age 65 years or older residing
   20  in the county.
   21         (c) The presence of an existing federal Veterans’ Health
   22  Administration medical center or outpatient clinic in the
   23  county.
   24         (d) Elements of emergency health care in the county, as
   25  determined by:
   26         1. The number of general hospitals.
   27         2. The number of emergency room holding beds per hospital.
   28  The term “emergency room holding bed” means a bed located in the
   29  emergency room of a hospital licensed under ch. 395 which is
   30  used for a patient admitted to the hospital through the
   31  emergency room, but is waiting for an available bed in an
   32  inpatient unit of the hospital.
   33         3. The number of employed physicians per hospital in the
   34  emergency room 24 hours per day.
   35         (e) The number of existing community nursing home beds per
   36  1,000 males age 65 years or older residing in the county.
   37         (f) The presence of an accredited educational institution
   38  offering health care programs in the county.
   39         (g) The county poverty rate.
   40         (3) For each new nursing home, the department shall select
   41  the highest-ranked county in the applicable study under this
   42  section which does not have a veterans’ nursing home. If the
   43  highest-ranked county cannot serve as the site, the department
   44  shall select the next-highest ranked county. The selection is
   45  subject to the approval of the Governor and Cabinet.
   46         (4) The department shall use the 2014 site selection study
   47  to select a county for any new state veterans’ nursing home
   48  authorized before November 1, 2015.
   49         (5) The department shall use the November 2015 site
   50  selection study ranking to select each new state veterans’
   51  nursing home site authorized before July 1, 2020.
   52         (6) The department shall contract for and submit a new site
   53  selection study to the Governor, the President of the Senate,
   54  and the Speaker of the House of Representatives using the county
   55  ranking criteria in paragraph (3) by November 1, 2019 for site
   56  selections on or after July 1, 2020. The department must conduct
   57  new site selection studies every 4 years using the county
   58  ranking criteria under paragraph (3) with each report due by
   59  November 1st for the selection period that begins the following
   60  July 1st.
   61         Section 9. Section 624.27, Florida Statutes, is created to
   62  read:
   63         624.27 Application of code as to direct primary care
   64  agreements.—
   65         (1) As used in this section, the term:
   66         (a) “Direct primary care agreement” means a contract
   67  between a primary care provider or primary care group practice
   68  and a patient, the patient’s legal representative, or an
   69  employer which must satisfy the criteria in subsection (4) and
   70  does not indemnify for services provided by a third party.
   71         (b) “Primary care provider” means a health care provider
   72  licensed under chapter 458, chapter 459, or chapter 464 who
   73  provides medical services to patients which are commonly
   74  provided without referral from another health care provider.
   75         (c) “Primary care service” means the screening, assessment,
   76  diagnosis, and treatment of a patient for the purpose of
   77  promoting health or detecting and managing disease or injury
   78  within the competency and training of the primary care provider.
   79         (2) A direct primary care agreement does not constitute
   80  insurance and is not subject to this code. The act of entering
   81  into a direct primary care agreement does not constitute the
   82  business of insurance and is not subject to this code.
   83         (3) A primary care provider or an agent of a primary care
   84  provider is not required to obtain a certificate of authority or
   85  license under this code to market, sell, or offer to sell a
   86  direct primary care agreement.
   87         (4) For purposes of this section, a direct primary care
   88  agreement must:
   89         (a) Be in writing.
   90         (b) Be signed by the primary care provider or an agent of
   91  the primary care provider and the patient or the patient’s legal
   92  representative.
   93         (c) Allow a party to terminate the agreement by written
   94  notice to the other party after a period specified in the
   95  agreement.
   96         (d) Describe the scope of the primary care services that
   97  are covered by the monthly fee.
   98         (e) Specify the monthly fee and any fees for primary care
   99  services not covered by the monthly fee.
  100         (f) Specify the duration of the agreement and any automatic
  101  renewal provisions.
  102         (g) Offer a refund to the patient of monthly fees paid in
  103  advance if the primary care provider ceases to offer primary
  104  care services for any reason.
  105         (h) State that the agreement is not health insurance.
  106         Section 10. Paragraphs (a) and (d) of subsection (3) and
  107  subsections (4) and (5) of section 766.1115, Florida Statutes,
  108  are amended to read:
  109         766.1115 Health care providers; creation of agency
  110  relationship with governmental contractors.—
  111         (3) DEFINITIONS.—As used in this section, the term:
  112         (a) “Contract” means an agreement executed in compliance
  113  with this section between a health care provider and a
  114  governmental contractor which allows the health care provider,
  115  or any employee or agent of the health care provider, to deliver
  116  health care services to low-income recipients as an agent of the
  117  governmental contractor. The contract must be for volunteer,
  118  uncompensated services, except as provided in paragraph (4)(g).
  119  For services to qualify as volunteer, uncompensated services
  120  under this section, the health care provider must receive no
  121  compensation from the governmental contractor for any services
  122  provided under the contract and must not bill or accept
  123  compensation from the recipient, or a public or private third
  124  party payor, for the specific services provided to the low
  125  income recipients covered by the contract except as provided in
  126  paragraph (4)(g). A free clinic as described in subparagraph
  127  (3)(d)14. may receive a legislative appropriation, a grant
  128  through a legislative appropriation, or a grant from a
  129  governmental entity or nonprofit corporation to support the
  130  delivery of such contracted services by volunteer health care
  131  providers, including the employment of health care providers to
  132  supplement, coordinate, or support the delivery of services by
  133  volunteer health care providers. Such an appropriation or grant
  134  does not constitute compensation under this paragraph from the
  135  governmental contractor for services provided under the
  136  contract, nor does receipt and use of the appropriation or grant
  137  constitute the acceptance of compensation under this paragraph
  138  for the specific services provided to the low-income recipients
  139  covered by the contract.
  140         (d) “Health care provider” or “provider” means:
  141         1. A birth center licensed under chapter 383.
  142         2. An ambulatory surgical center licensed under chapter
  143  395.
  144         3. A hospital licensed under chapter 395.
  145         4. A physician or physician assistant licensed under
  146  chapter 458.
  147         5. An osteopathic physician or osteopathic physician
  148  assistant licensed under chapter 459.
  149         6. A chiropractic physician licensed under chapter 460.
  150         7. A podiatric physician licensed under chapter 461.
  151         8. A registered nurse, nurse midwife, licensed practical
  152  nurse, or advanced registered nurse practitioner licensed or
  153  registered under part I of chapter 464 or any facility which
  154  employs nurses licensed or registered under part I of chapter
  155  464 to supply all or part of the care delivered under this
  156  section.
  157         9. A midwife licensed under chapter 467.
  158         10. A health maintenance organization certificated under
  159  part I of chapter 641.
  160         11. A health care professional association and its
  161  employees or a corporate medical group and its employees.
  162         12. Any other medical facility the primary purpose of which
  163  is to deliver human medical diagnostic services or which
  164  delivers nonsurgical human medical treatment, and which includes
  165  an office maintained by a provider.
  166         13. A dentist or dental hygienist licensed under chapter
  167  466.
  168         14. A free clinic that delivers only medical diagnostic
  169  services or nonsurgical medical treatment free of charge to all
  170  low-income recipients.
  171         15. Any other health care professional, practitioner,
  172  provider, or facility under contract with a governmental
  173  contractor, including a student enrolled in an accredited
  174  program that prepares the student for licensure as any one of
  175  the professionals listed in subparagraphs 4.-9.
  177  The term includes any nonprofit corporation qualified as exempt
  178  from federal income taxation under s. 501(a) of the Internal
  179  Revenue Code, and described in s. 501(c) of the Internal Revenue
  180  Code, which delivers health care services provided by licensed
  181  professionals listed in this paragraph, any federally funded
  182  community health center, and any volunteer corporation or
  183  volunteer health care provider that delivers health care
  184  services.
  185         (4) CONTRACT REQUIREMENTS.—A health care provider that
  186  executes a contract with a governmental contractor to deliver
  187  health care services on or after April 17, 1992, as an agent of
  188  the governmental contractor, or any employee or agent of such
  189  health care provider, is an agent for purposes of s. 768.28(9),
  190  while acting within the scope of duties under the contract, if
  191  the contract complies with the requirements of this section and
  192  regardless of whether the individual treated is later found to
  193  be ineligible. A health care provider, or any employee or agent
  194  of such health care provider, shall continue to be an agent for
  195  purposes of s. 768.28(9) for 30 days after a determination of
  196  ineligibility to allow for treatment until the individual
  197  transitions to treatment by another health care provider. A
  198  health care provider under contract with the state, or any
  199  employee or agent of such health care provider, may not be named
  200  as a defendant in any action arising out of medical care or
  201  treatment provided on or after April 17, 1992, under contracts
  202  entered into under this section. The contract must provide that:
  203         (a) The right of dismissal or termination of any health
  204  care provider delivering services under the contract is retained
  205  by the governmental contractor.
  206         (b) The governmental contractor has access to the patient
  207  records of any health care provider delivering services under
  208  the contract.
  209         (c) Adverse incidents and information on treatment outcomes
  210  must be reported by any health care provider to the governmental
  211  contractor if the incidents and information pertain to a patient
  212  treated under the contract. The health care provider shall
  213  submit the reports required by s. 395.0197. If an incident
  214  involves a professional licensed by the Department of Health or
  215  a facility licensed by the Agency for Health Care
  216  Administration, the governmental contractor shall submit such
  217  incident reports to the appropriate department or agency, which
  218  shall review each incident and determine whether it involves
  219  conduct by the licensee that is subject to disciplinary action.
  220  All patient medical records and any identifying information
  221  contained in adverse incident reports and treatment outcomes
  222  which are obtained by governmental entities under this paragraph
  223  are confidential and exempt from the provisions of s. 119.07(1)
  224  and s. 24(a), Art. I of the State Constitution.
  225         (d) Patient selection and initial referral must be made by
  226  the governmental contractor or the provider. Patients may not be
  227  transferred to the provider based on a violation of the
  228  antidumping provisions of the Omnibus Budget Reconciliation Act
  229  of 1989, the Omnibus Budget Reconciliation Act of 1990, or
  230  chapter 395.
  231         (e) If emergency care is required, the patient need not be
  232  referred before receiving treatment, but must be referred within
  233  48 hours after treatment is commenced or within 48 hours after
  234  the patient has the mental capacity to consent to treatment,
  235  whichever occurs later.
  236         (f) The provider is subject to supervision and regular
  237  inspection by the governmental contractor.
  238         (g) As an agent of the governmental contractor for purposes
  239  of s. 768.28(9), while acting within the scope of duties under
  240  the contract, A health care provider licensed under chapter 466,
  241  as an agent of the governmental contractor for purposes of
  242  s.768.28(9), may allow a patient, or a parent or guardian of the
  243  patient, to voluntarily contribute a monetary amount to cover
  244  costs of dental laboratory work related to the services provided
  245  to the patient within the scope of duties under the contract.
  246  This contribution may not exceed the actual cost of the dental
  247  laboratory charges.
  249  A governmental contractor that is also a health care provider is
  250  not required to enter into a contract under this section with
  251  respect to the health care services delivered by its employees.
  252         (5) NOTICE OF AGENCY RELATIONSHIP.—The governmental
  253  contractor must provide written notice to each patient, or the
  254  patient’s legal representative, receipt of which must be
  255  acknowledged in writing at the initial visit, that the provider
  256  is an agent of the governmental contractor and that the
  257  exclusive remedy for injury or damage suffered as the result of
  258  any act or omission of the provider or of any employee or agent
  259  thereof acting within the scope of duties pursuant to the
  260  contract is by commencement of an action pursuant to the
  261  provisions of s. 768.28. Thereafter, and with respect to any
  262  federally funded community health center, the notice
  263  requirements may be met by posting in a place conspicuous to all
  264  persons a notice that the health care provider federally funded
  265  community health center is an agent of the governmental
  266  contractor and that the exclusive remedy for injury or damage
  267  suffered as the result of any act or omission of the provider or
  268  of any employee or agent thereof acting within the scope of
  269  duties pursuant to the contract is by commencement of an action
  270  pursuant to the provisions of s. 768.28.
  271         Section 11. Paragraph (b) of subsection (9) of section
  272  768.28, Florida Statutes, is amended to read:
  273         768.28 Waiver of sovereign immunity in tort actions;
  274  recovery limits; limitation on attorney fees; statute of
  275  limitations; exclusions; indemnification; risk management
  276  programs.—
  277         (9)
  278         (b) As used in this subsection, the term:
  279         1. “Employee” includes any volunteer firefighter.
  280         2. “Officer, employee, or agent” includes, but is not
  281  limited to, any health care provider, and its employees or
  282  agents, when providing services pursuant to s. 766.1115; any
  283  nonprofit independent college or university located and
  284  chartered in this state which owns or operates an accredited
  285  medical school, and its employees or agents, when providing
  286  patient services pursuant to paragraph (10)(f); and any public
  287  defender or her or his employee or agent, including, among
  288  others, an assistant public defender and an investigator.
  290  ================= T I T L E  A M E N D M E N T ================
  291  And the title is amended as follows:
  292         Delete lines 2 - 24
  293  and insert:
  294         An act relating to the access to health care services;
  295         amending ss. 458.347 and 459.022, F.S.; revising the
  296         authority of a licensed physician assistant to order
  297         medication under the direction of a supervisory
  298         physician for a specified patient; amending s.
  299         464.012, F.S.; authorizing an advanced registered
  300         nurse practitioner to order medication for
  301         administration to a specified patient; amending s.
  302         465.003, F.S.; revising the term “prescription” to
  303         exclude an order for drugs or medicinal supplies by a
  304         licensed practitioner that is dispensed for certain
  305         administration; amending s. 893.02, F.S.; revising the
  306         term “administer” to include the term
  307         “administration”; revising the term “prescription” to
  308         exclude an order for drugs or medicinal supplies by a
  309         licensed practitioner that is dispensed for certain
  310         administration; amending s. 893.04, F.S.; conforming
  311         provisions to changes made by act; amending s. 893.05,
  312         F.S.; authorizing a licensed practitioner to authorize
  313         a licensed physician assistant or advanced registered
  314         nurse practitioner to order controlled substances for
  315         a specified patient under certain circumstances;
  316         creating s. 296.42, F.S.; directing the Department of
  317         Veterans’ Affairs to contract for a study to determine
  318         the need and location for additional state veterans’
  319         nursing homes; directing the department to submit the
  320         study to the Governor and Legislature; providing study
  321         criteria for ranking each county according to need;
  322         providing site selection criteria; requiring approval
  323         of the Governor and Cabinet for site selection;
  324         requiring the department to use specified studies to
  325         select new nursing home sites; directing the
  326         department to contract for subsequent studies and
  327         submit the studies to the Governor and Legislature;
  328         creating s. 624.27, F.S.; providing definitions;
  329         specifying that a direct primary care agreement does
  330         not constitute insurance and is not subject to the
  331         Florida Insurance Code; specifying that entering into
  332         a direct primary care agreement does not constitute
  333         the business of insurance and is not subject to the
  334         code; providing that a health care provider is not
  335         required to obtain a certificate of authority to
  336         market, sell, or offer to sell a direct primary care
  337         agreement; specifying criteria for a direct primary
  338         care agreement; amending s. 766.1115, F.S.; redefining
  339         terms relating to agency relationships with
  340         governmental health care contractors; deleting an
  341         obsolete date; extending sovereign immunity to
  342         employees or agents of a health care provider that
  343         executes a contract with a governmental contractor;
  344         clarifying that a receipt of specified notice must be
  345         acknowledged by a patient or the patient’s
  346         representative at the initial visit; requiring the
  347         posting of notice that a specified health care
  348         provider is an agent of a governmental contractor;
  349         amending s. 768.28, F.S.; redefining the term
  350         “officer, employee, or agent” to include employees or
  351         agents of a health care provider;