Florida Senate - 2015 COMMITTEE AMENDMENT
Bill No. CS for CS for SB 614
Senate . House
Comm: WD .
The Committee on Rules (Benacquisto) recommended the following:
1 Senate Amendment to Amendment (395678) (with title
4 Between lines 830 and 831
6 Section 23. Section 288.924, Florida Statutes, is created
7 to read:
8 288.924 Medical tourism for quality health care services;
9 medical tourism marketing advisory council and plan.—
10 (1) ADVISORY COUNCIL FOR MEDICAL TOURISM.—The Advisory
11 Council for Medical Tourism is created within the Florida
12 Tourism Industry Marketing Corporation to serve as an advisory
13 body to the Division of Tourism Industry Marketing Corporation
14 within Enterprise Florida, Inc. The council shall provide
15 insight and expertise related to developing, marketing, and
16 promoting this state’s medical tourism industry.
17 (2) MEMBERSHIP.—
18 (a) The council shall consist of 12 members with three
19 members appointed by the Governor, three members appointed by
20 the President of the Senate, three members appointed by Speaker
21 of the House of Representatives, and three members appointed by
22 VISIT Florida, Inc. The council shall be chaired by the
23 President and CEO of VISIT Florida or his or her designee.
24 (b) Members shall be appointed to 4-year terms. All terms
25 end on September 30. Initial appointments must be made by
26 September 1, 2015. To allow for staggered terms, one appointee
27 from each appointing official will serve a term of 2 years for
28 the initial term.
29 (c) A council member’s absence from three consecutive
30 meetings will result in his or her automatic removal from the
32 (d) No more than one member of the council may be an
33 employee of a single company, organization, or association.
34 (e) A council member is eligible for re-appointment, but
35 may not serve more than two consecutive terms.
36 (3) MEETINGS; ORGANIZATION.—
37 (a) The council shall meet at least once per quarter, but
38 may meet as often as the council deems necessary.
39 (b) The Division of Tourism Marketing shall provide staff
40 assistance to the council, whose duties must include, but are
41 not limited to, keeping records of the proceedings of the
42 council, and serving as custodian of all books, documents, and
43 papers filed with the council.
44 (c) A majority of the members of the council constitutes a
46 (d) Council members are entitled to receive, from funds of
47 the corporation, reimbursement for per diem and travel expenses
48 as provided by s. 112.061.
49 (4) POWERS AND DUTIES.— The council’s responsibilities
50 include, but are not limited to:
51 (a) Develop and implement a 4-year marketing plan in
52 coordination with the Division of Tourism Marketing with
53 specific initiatives to advance this state as a destination for
54 medical tourism.
55 (b) Adopt bylaws for the governance of council affairs and
56 the conduct of its business under this act.
57 (c) Advise the Florida Tourism Industry Marketing
58 Corporation on its medical tourism program and any changes that
59 might facilitate meeting the marketing plan objectives.
60 (d) Consider and study the needs of the medical tourism
61 industry for the purpose of advising the Florida Tourism
62 Marketing Corporation.
63 (e) Identify state and local government actions that may
64 impact the medical tourism industry, or that may appear to
65 industry representatives as affecting medical tourism in the
66 state, and advising the Florida Tourism Industry Marketing
67 Corporation of such actions.
68 (f) Promote national and international awareness of the
69 qualifications, scope of services, and specialized expertise of
70 health care providers throughout this state; and
71 (g) Promote national and international awareness of
72 medical-related conferences, training, or business opportunities
73 to attract practitioners from the medical field to destinations
74 in this state.
75 (h). Consider all matters submitted to it by the Florida
76 Tourism Industry Marketing Corporation.
77 (i) Suggest policies and practices that may improve
78 interaction with the medical tourism industry and enhance
79 related state economic development initiatives.
80 (j) Establish an evaluation plan to determine the return on
81 the use of investment of state and local funds for medical
82 tourism or other mechanisms to determine the effectiveness of
83 the state’s medical tourism plans.
84 (5) ALLOCATION OF FUNDS FOR MARKETING PLAN.—Annually, at
85 least $2 million of the funds appropriated in the General
86 Appropriations Act to the Florida Tourism Industry Marketing
87 Corporation shall be allocated for the development and
88 implementation of the medical tourism marketing plan.
89 (6) REPEAL.—This section is repealed July 1, 2020.
90 Section 24. Paragraph (c) of subsection (4) of section
91 288.923, Florida Statutes, is amended to read
92 288.923 Division of Tourism Marketing; definitions;
94 (4) The division’s responsibilities and duties include, but
95 are not limited to:
96 (c) Developing a 4-year marketing plan.
97 1. At a minimum, the marketing plan shall discuss the
99 a. Continuation of overall tourism growth in this state.
100 b. Expansion to new or under-represented tourist markets.
101 c. Maintenance of traditional and loyal tourist markets.
102 d. Coordination of efforts with county destination
103 marketing organizations, other local government marketing
104 groups, privately owned attractions and destinations, and other
105 private sector partners to create a seamless, four-season
106 advertising campaign for the state and its regions.
107 e. Development of innovative techniques or promotions to
108 build repeat visitation by targeted segments of the tourist
110 f. Consideration of innovative sources of state funding for
111 tourism marketing.
112 g. Promotion of nature-based tourism and heritage tourism.
113 h. Development of a component to address emergency response
114 to natural and manmade disasters from a marketing standpoint.
115 2. The plan shall be annual in construction and ongoing in
116 nature. Any annual revisions of the plan shall carry forward the
117 concepts of the remaining 3-year portion of the plan and
118 consider a continuum portion to preserve the 4-year timeframe of
119 the plan. The plan also shall include recommendations for
120 specific performance standards and measurable outcomes for the
121 division and direct-support organization. The department, in
122 consultation with the board of directors of Enterprise Florida,
123 Inc., shall base the actual performance metrics on these
125 3. The 4-year marketing plan shall be developed in
126 collaboration with the Florida Tourism Industry Marketing
127 Corporation. The plan shall be annually reviewed and approved by
128 the board of directors of Enterprise Florida, Inc.
129 (d) Developing a 4-year marketing plan for the promotion of
130 medical tourism as provided under s. 288.924.
131 Section 25. Section 296.42, Florida Statutes, is created to
133 296.42 Site selection process for state veterans’ nursing
135 (1) The department shall contract for a study to determine
136 the need for new state veterans’ nursing homes and the most
137 appropriate counties in which to locate the homes based on the
138 greatest level of need. The department shall submit the study to
139 the Governor, the President of the Senate, and the Speaker of
140 the House of Representatives by November 1, 2015.
141 (2) The study shall use the following criteria to rank each
142 county according to need:
143 (a) The distance from the geographic center of the county
144 to the nearest existing state veterans’ nursing home.
145 (b) The number of veterans age 65 years or older residing
146 in the county.
147 (c) The presence of an existing federal Veterans’ Health
148 Administration medical center or outpatient clinic in the
150 (d) Elements of emergency health care in the county, as
151 determined by:
152 1. The number of general hospitals.
153 2. The number of emergency room holding beds per hospital.
154 The term “emergency room holding bed” means a bed located in the
155 emergency room of a hospital licensed under ch. 395 which is
156 used for a patient admitted to the hospital through the
157 emergency room, but is waiting for an available bed in an
158 inpatient unit of the hospital.
159 3. The number of employed physicians per hospital in the
160 emergency room 24 hours per day.
161 (e) The number of existing community nursing home beds per
162 1,000 males age 65 years or older residing in the county.
163 (f) The presence of an accredited educational institution
164 offering health care programs in the county.
165 (g) The county poverty rate.
166 (3) For each new nursing home, the department shall select
167 the highest-ranked county in the applicable study under this
168 section which does not have a veterans’ nursing home. If the
169 highest-ranked county cannot serve as the site, the department
170 shall select the next-highest ranked county. The selection is
171 subject to the approval of the Governor and Cabinet.
172 (4) The department shall use the 2014 site selection study
173 to select a county for any new state veterans’ nursing home
174 authorized before November 1, 2015.
175 (5) The department shall use the November 2015 site
176 selection study ranking to select each new state veterans’
177 nursing home site authorized before July 1, 2020.
178 (6) The department shall contract for and submit a new site
179 selection study to the Governor, the President of the Senate,
180 and the Speaker of the House of Representatives using the county
181 ranking criteria in paragraph (3) by November 1, 2019 for site
182 selections on or after July 1, 2020. The department must conduct
183 new site selection studies every 4 years using the county
184 ranking criteria under paragraph (3) with each report due by
185 November 1st for the selection period that begins the following
186 July 1st.
187 Section 26. Section 624.27, Florida Statutes, is created to
189 624.27 Application of code as to direct primary care
191 (1) As used in this section, the term:
192 (a) “Direct primary care agreement” means a contract
193 between a primary care provider or primary care group practice
194 and a patient, the patient’s legal representative, or an
195 employer which must satisfy the criteria in subsection (4) and
196 does not indemnify for services provided by a third party.
197 (b) “Primary care provider” means a health care provider
198 licensed under chapter 458, chapter 459, or chapter 464 who
199 provides medical services to patients which are commonly
200 provided without referral from another health care provider.
201 (c) “Primary care service” means the screening, assessment,
202 diagnosis, and treatment of a patient for the purpose of
203 promoting health or detecting and managing disease or injury
204 within the competency and training of the primary care provider.
205 (2) A direct primary care agreement does not constitute
206 insurance and is not subject to this code. The act of entering
207 into a direct primary care agreement does not constitute the
208 business of insurance and is not subject to this code.
209 (3) A primary care provider or an agent of a primary care
210 provider is not required to obtain a certificate of authority or
211 license under this code to market, sell, or offer to sell a
212 direct primary care agreement.
213 (4) For purposes of this section, a direct primary care
214 agreement must:
215 (a) Be in writing.
216 (b) Be signed by the primary care provider or an agent of
217 the primary care provider and the patient or the patient’s legal
219 (c) Allow a party to terminate the agreement by written
220 notice to the other party after a period specified in the
222 (d) Describe the scope of the primary care services that
223 are covered by the monthly fee.
224 (e) Specify the monthly fee and any fees for primary care
225 services not covered by the monthly fee.
226 (f) Specify the duration of the agreement and any automatic
227 renewal provisions.
228 (g) Offer a refund to the patient of monthly fees paid in
229 advance if the primary care provider ceases to offer primary
230 care services for any reason.
231 (h) State that the agreement is not health insurance.
232 Section 26. Paragraphs (a) and (e) of subsection (3) and
233 subsections (4) and (5) of section 766.1115, Florida Statutes,
234 are amended to read:
235 Section 27. Paragraphs (a) and (d) of subsection (3) and
236 subsections (4) and (5) of section 766.1115, Florida Statutes,
237 are amended to read:
238 766.1115 Health care providers; creation of agency
239 relationship with governmental contractors.—
240 (3) DEFINITIONS.—As used in this section, the term:
241 (a) “Contract” means an agreement executed in compliance
242 with this section between a health care provider and a
243 governmental contractor which allows the health care provider,
244 or any employee or agent of the health care provider, to deliver
245 health care services to low-income recipients as an agent of the
246 governmental contractor. The contract must be for volunteer,
247 uncompensated services
, except as provided in paragraph (4)(g).
248 For services to qualify as volunteer, uncompensated services
249 under this section, the health care provider must receive no
250 compensation from the governmental contractor for any services
251 provided under the contract and must not bill or accept
252 compensation from the recipient, or a public or private third
253 party payor, for the specific services provided to the low
254 income recipients covered by the contract, except as provided in
255 paragraph (4)(g). A free clinic as described in subparagraph
256 (3)(d)14. may receive a legislative appropriation, a grant
257 through a legislative appropriation, or a grant from a
258 governmental entity or nonprofit corporation to support the
259 delivery of such contracted services by volunteer health care
260 providers, including the employment of health care providers to
261 supplement, coordinate, or support the delivery of services by
262 volunteer health care providers. Such an appropriation or grant
263 does not constitute compensation under this paragraph from the
264 governmental contractor for services provided under the
265 contract, nor does receipt and use of the appropriation or grant
266 constitute the acceptance of compensation under this paragraph
267 for the specific services provided to the low-income recipients
268 covered by the contract.
269 (d) “Health care provider” or “provider” means:
270 1. A birth center licensed under chapter 383.
271 2. An ambulatory surgical center licensed under chapter
273 3. A hospital licensed under chapter 395.
274 4. A physician or physician assistant licensed under
275 chapter 458.
276 5. An osteopathic physician or osteopathic physician
277 assistant licensed under chapter 459.
278 6. A chiropractic physician licensed under chapter 460.
279 7. A podiatric physician licensed under chapter 461.
280 8. A registered nurse, nurse midwife, licensed practical
281 nurse, or advanced registered nurse practitioner licensed or
282 registered under part I of chapter 464 or any facility which
283 employs nurses licensed or registered under part I of chapter
284 464 to supply all or part of the care delivered under this
286 9. A midwife licensed under chapter 467.
287 10. A health maintenance organization certificated under
288 part I of chapter 641.
289 11. A health care professional association and its
290 employees or a corporate medical group and its employees.
291 12. Any other medical facility the primary purpose of which
292 is to deliver human medical diagnostic services or which
293 delivers nonsurgical human medical treatment, and which includes
294 an office maintained by a provider.
295 13. A dentist or dental hygienist licensed under chapter
297 14. A free clinic that delivers only medical diagnostic
298 services or nonsurgical medical treatment free of charge to all
299 low-income recipients.
300 15. Any other health care professional, practitioner,
301 provider, or facility under contract with a governmental
302 contractor, including a student enrolled in an accredited
303 program that prepares the student for licensure as any one of
304 the professionals listed in subparagraphs 4.-9.
306 The term includes any nonprofit corporation qualified as exempt
307 from federal income taxation under s. 501(a) of the Internal
308 Revenue Code, and described in s. 501(c) of the Internal Revenue
309 Code, which delivers health care services provided by licensed
310 professionals listed in this paragraph, any federally funded
311 community health center, and any volunteer corporation or
312 volunteer health care provider that delivers health care
314 (4) CONTRACT REQUIREMENTS.—A health care provider that
315 executes a contract with a governmental contractor to deliver
316 health care services on or after April 17, 1992, as an agent of
317 the governmental contractor, or any employee or agent of such
318 health care provider, is an agent for purposes of s. 768.28(9),
319 while acting within the scope of duties under the contract, if
320 the contract complies with the requirements of this section and
321 regardless of whether the individual treated is later found to
322 be ineligible. A health care provider, or any employee or agent
323 of the health care provider, shall continue to be an agent for
324 purposes of s. 768.28(9) for 30 days after a determination of
325 ineligibility to allow for treatment until the individual
326 transitions to treatment by another health care provider. A
327 health care provider under contract with the state, or any
328 employee or agent of such health care provider, may not be named
329 as a defendant in any action arising out of medical care or
330 treatment provided on or after April 17, 1992, under contracts
331 entered into under this section. The contract must provide that:
332 (a) The right of dismissal or termination of any health
333 care provider delivering services under the contract is retained
334 by the governmental contractor.
335 (b) The governmental contractor has access to the patient
336 records of any health care provider delivering services under
337 the contract.
338 (c) Adverse incidents and information on treatment outcomes
339 must be reported by any health care provider to the governmental
340 contractor if the incidents and information pertain to a patient
341 treated under the contract. The health care provider shall
342 submit the reports required by s. 395.0197. If an incident
343 involves a professional licensed by the Department of Health or
344 a facility licensed by the Agency for Health Care
345 Administration, the governmental contractor shall submit such
346 incident reports to the appropriate department or agency, which
347 shall review each incident and determine whether it involves
348 conduct by the licensee that is subject to disciplinary action.
349 All patient medical records and any identifying information
350 contained in adverse incident reports and treatment outcomes
351 which are obtained by governmental entities under this paragraph
352 are confidential and exempt from the provisions of s. 119.07(1)
353 and s. 24(a), Art. I of the State Constitution.
354 (d) Patient selection and initial referral must be made by
355 the governmental contractor or the provider. Patients may not be
356 transferred to the provider based on a violation of the
357 antidumping provisions of the Omnibus Budget Reconciliation Act
358 of 1989, the Omnibus Budget Reconciliation Act of 1990, or
359 chapter 395.
360 (e) If emergency care is required, the patient need not be
361 referred before receiving treatment, but must be referred within
362 48 hours after treatment is commenced or within 48 hours after
363 the patient has the mental capacity to consent to treatment,
364 whichever occurs later.
365 (f) The provider is subject to supervision and regular
366 inspection by the governmental contractor.
367 (g) As an agent of the governmental contractor for purposes
368 of s. 768.28(9), while acting within the scope of duties under
369 the contract, A health care provider licensed under chapter 466,
370 as an agent of the governmental contractor for purposes of s.
371 768.28(9), may allow a patient, or a parent or guardian of the
372 patient, to voluntarily contribute a monetary amount to cover
373 costs of dental laboratory work related to the services provided
374 to the patient within the scope of duties under the contract.
375 This contribution may not exceed the actual cost of the dental
376 laboratory charges.
378 A governmental contractor that is also a health care provider is
379 not required to enter into a contract under this section with
380 respect to the health care services delivered by its employees.
381 (5) NOTICE OF AGENCY RELATIONSHIP.—The governmental
382 contractor must provide written notice to each patient, or the
383 patient’s legal representative, receipt of which must be
384 acknowledged in writing at the initial visit, that the provider
385 is an agent of the governmental contractor and that the
386 exclusive remedy for injury or damage suffered as the result of
387 any act or omission of the provider or of any employee or agent
388 thereof acting within the scope of duties pursuant to the
389 contract is by commencement of an action pursuant to the
390 provisions of s. 768.28. Thereafter, and with respect to any
391 federally funded community health center, the notice
392 requirements may be met by posting in a place conspicuous to all
393 persons a notice that the health care provider federally funded
394 community health center is an agent of the governmental
395 contractor and that the exclusive remedy for injury or damage
396 suffered as the result of any act or omission of the provider or
397 of any employee or agent thereof acting within the scope of
398 duties pursuant to the contract is by commencement of an action
399 pursuant to the provisions of s. 768.28.
400 Section 28. Section 7. Paragraph (b) of subsection (9) of
401 section 768.28, Florida Statutes, is amended to read:
402 768.28 Waiver of sovereign immunity in tort actions;
403 recovery limits; limitation on attorney fees; statute of
404 limitations; exclusions; indemnification; risk management
407 (b) As used in this subsection, the term:
408 1. “Employee” includes any volunteer firefighter.
409 2. “Officer, employee, or agent” includes, but is not
410 limited to, any health care provider, and its employees or
411 agents, when providing services pursuant to s. 766.1115; any
412 nonprofit independent college or university located and
413 chartered in this state which owns or operates an accredited
414 medical school, and its employees or agents, when providing
415 patient services pursuant to paragraph (10)(f); and any public
416 defender or her or his employee or agent, including, among
417 others, an assistant public defender and an investigator.
420 ================= T I T L E A M E N D M E N T ================
421 And the title is amended as follows:
422 Delete lines 882 - 962
423 and insert:
424 An act relating to access to health care services;
425 amending s. 110.12315, F.S.; expanding the categories
426 of persons who may prescribe brand drugs under the
427 prescription drug program when medically necessary;
428 amending ss. 310.071, 310.073, and 310.081, F.S.;
429 exempting controlled substances prescribed by an
430 advanced registered nurse practitioner or a physician
431 assistant from the disqualifications for certification
432 or licensure, and for continued certification or
433 licensure, as a deputy pilot or state pilot; repealing
434 s. 383.336, F.S., relating to provider hospitals,
435 practice parameters, and peer review boards; amending
436 s. 395.1051, F.S.; requiring a hospital to notify
437 certain obstetrical physicians within a specified
438 timeframe before the hospital closes its obstetrical
439 department or ceases to provide obstetrical services;
440 amending s. 456.072, F.S.; applying existing penalties
441 for violations relating to the prescribing or
442 dispensing of controlled substances by an advanced
443 registered nurse practitioner; amending s. 456.44,
444 F.S.; deleting an obsolete date; requiring advanced
445 registered nurse practitioners and physician
446 assistants who prescribe controlled substances for
447 certain pain to make a certain designation, comply
448 with registration requirements, and follow specified
449 standards of practice; requiring certain respective
450 entities review the information to determine whether
451 disciplinary action is appropriate; requiring the
452 respective board to forward certain findings to the
453 Board of Nursing; providing applicability; amending s.
454 458.326, F.S.; defining the term “interventional pain
455 medicine”; limiting the practice of interventional
456 pain medicine to specified circumstances; amending ss.
457 458.3265 and 459.0137, F.S.; limiting the authority to
458 prescribe a controlled substance in a pain-management
459 clinic to a physician licensed under ch. 458 or ch.
460 459, F.S.; amending s. 458.347, F.S.; revising the
461 required continuing education requirements for a
462 physician assistant; amending s. 458.347, F.S.;
463 requiring the Council of Physician Assistants to
464 create a formulary which includes the controlled
465 substances a physician assistant is authorized to
466 prescribe; amending s. 464.003, F.S.; revising the
467 definition of the term “advanced or specialized
468 nursing practice”; deleting the joint committee
469 established in the definition; amending s. 464.012,
470 F.S.; requiring the Board of Nursing to establish a
471 committee make recommendations regarding the need for
472 adoption of a formulary of controlled substances that
473 may be prescribed by an advanced registered nurse
474 practitioner; specifying the membership of the
475 committee; providing parameters for the
476 recommendations of the committee; requiring that any
477 formulary be adopted by board rule; specifying the
478 process for amending the formulary and imposing a
479 burden of proof; limiting the formulary’s application
480 in certain instances; requiring the board to adopt the
481 committee’s initial recommendations by a specified
482 date; amending s. 464.012, F.S.; authorizing an
483 advanced registered nurse practitioner to prescribe,
484 dispense, administer, or order drugs, rather than to
485 monitor and alter drug therapies; providing an
486 exception; amending s. 464.013, F.S.; revising
487 conditions for renewal of a license or certificate;
488 amending s. 464.018, F.S.; specifying acts that
489 constitute grounds for denial of a license or for
490 disciplinary action against an advanced registered
491 nurse practitioner; requiring that in certain
492 disciplinary cases, the board notify certain entities
493 and forward all materials to the respective board;
494 amending s. 893.02, F.S.; redefining the term
495 “practitioner” to include advanced registered nurse
496 practitioners and physician assistants under the
497 Florida Comprehensive Drug Abuse Prevention and
498 Control Act; amending s. 948.03, F.S.; providing that
499 possession of drugs or narcotics prescribed by an
500 advanced registered nurse practitioner or physician
501 assistant does not violate a prohibition relating to
502 the possession of drugs or narcotics during probation;
503 amending s. 288.923, F.S.; requiring the Division of
504 Tourism Marketing to prepare a 4-year plan for the
505 promotion of medical tourism for quality health care
506 services; creating s. 288.924, F.S.; creating the
507 Medical Tourism Advisory Council; designating
508 membership terms and responsibilities for the council;
509 allocating funds from the corporation to the council
510 for development of the medical tourism marketing plan;
511 creating s. 296.42, F.S.; directing the Department of
512 Veterans’ Affairs to contract for a study to determine
513 the need and location for additional state veterans’
514 nursing homes; directing the department to submit the
515 study to the Governor and Legislature; providing study
516 criteria for ranking each county according to need;
517 providing site selection criteria; requiring approval
518 of the Governor and Cabinet for site selection;
519 requiring the department to use specified studies to
520 select new nursing home sites; directing the
521 department to contract for subsequent studies and
522 submit the studies to the Governor and Legislature;
523 creating s. 624.27, F.S.; providing definitions;
524 specifying that a direct primary care agreement does
525 not constitute insurance and is not subject to the
526 Florida Insurance Code; specifying that entering into
527 a direct primary care agreement does not constitute
528 the business of insurance and is not subject to the
529 code; providing that a health care provider is not
530 required to obtain a certificate of authority to
531 market, sell, or offer to sell a direct primary care
532 agreement; specifying criteria for a direct primary
533 care agreement; amending s. 766.1115, F.S.; redefining
534 terms relating to agency relationships with
535 governmental health care contractors; deleting an
536 obsolete date; extending sovereign immunity to
537 employees or agents of a health care provider that
538 executes a contract with a governmental contractor;
539 clarifying that a receipt of specified notice must be
540 acknowledged by a patient or the patient’s
541 representative at the initial visit; requiring the
542 posting of notice that a specified health care
543 provider is an agent of a governmental contractor;
544 amending s. 768.28, F.S.; redefining the term
545 “officer, employee, or agent” to include employees or
546 agents of a health care provider; conforming