Florida Senate - 2016                                     SB 178
       By Senator Bean
       4-00255-16                                             2016178__
    1                        A bill to be entitled                      
    2         An act relating to quality health care services;
    3         amending s. 288.0001, F.S.; requiring the Office of
    4         Economic and Demographic Research and the Office of
    5         Program Policy Analysis and Government Accountability
    6         to complete a periodic analysis of the medical tourism
    7         marketing plan; amending s. 288.901, F.S.; requiring
    8         Enterprise Florida, Inc., to market this state as a
    9         health care destination in collaboration with the
   10         Department of Economic Opportunity; amending s.
   11         288.923, F.S.; requiring the Division of Tourism
   12         Marketing of Enterprise Florida, Inc., to include a
   13         discussion of the promotion of medical tourism for
   14         quality health care services in its 4-year marketing
   15         plan; creating s. 288.924, F.S.; providing criteria
   16         for the medical tourism initiatives to be included in
   17         the division’s marketing plan; creating s. 624.27,
   18         F.S.; defining terms; specifying that a direct primary
   19         care agreement does not constitute insurance and is
   20         not subject to the Florida Insurance Code; specifying
   21         that entering into a direct primary care agreement
   22         does not constitute the business of insurance and is
   23         not subject to the code; providing that a health care
   24         provider is not required to obtain a certificate of
   25         authority or license to market, sell, or offer to sell
   26         a direct primary care agreement; specifying criteria
   27         for a direct primary care agreement; amending s.
   28         766.1115, F.S.; redefining terms relating to agency
   29         relationships with governmental health care
   30         contractors; deleting an obsolete date; extending
   31         sovereign immunity to include employees or agents of a
   32         health care provider that executes a contract with a
   33         governmental contractor; clarifying that a receipt of
   34         specified notice must be acknowledged by a patient or
   35         the patient’s representative at the initial visit;
   36         requiring the posting of notice that a specified
   37         health care provider is an agent of a governmental
   38         contractor; amending s. 768.28, F.S.; redefining the
   39         term “officer, employee, or agent” to include
   40         employees or agents of a health care provider to
   41         conform to changes made by the act; providing an
   42         effective date.
   44  Be It Enacted by the Legislature of the State of Florida:
   46         Section 1. Paragraph (b) of subsection (2) of section
   47  288.0001, Florida Statutes, is amended to read:
   48         288.0001 Economic Development Programs Evaluation.—The
   49  Office of Economic and Demographic Research and the Office of
   50  Program Policy Analysis and Government Accountability (OPPAGA)
   51  shall develop and present to the Governor, the President of the
   52  Senate, the Speaker of the House of Representatives, and the
   53  chairs of the legislative appropriations committees the Economic
   54  Development Programs Evaluation.
   55         (2) The Office of Economic and Demographic Research and
   56  OPPAGA shall provide a detailed analysis of economic development
   57  programs as provided in the following schedule:
   58         (b) By January 1, 2015, and every 3 years thereafter, an
   59  analysis of the following:
   60         1. The entertainment industry financial incentive program
   61  established under s. 288.1254.
   62         2. The entertainment industry sales tax exemption program
   63  established under s. 288.1258.
   64         3. VISIT Florida and its programs established or funded
   65  under ss. 288.122, 288.1226, 288.12265, and 288.124, and
   66  288.924.
   67         4. The Florida Sports Foundation and related programs
   68  established under ss. 288.1162, 288.11621, 288.1166, 288.1167,
   69  288.1168, 288.1169, and 288.1171.
   70         Section 2. Subsection (2) of section 288.901, Florida
   71  Statutes, is amended to read:
   72         288.901 Enterprise Florida, Inc.—
   73         (2) PURPOSES.—Enterprise Florida, Inc., shall act as the
   74  economic development organization for the state, using utilizing
   75  private sector and public sector expertise in collaboration with
   76  the department to:
   77         (a) Increase private investment in Florida;
   78         (b) Advance international and domestic trade opportunities;
   79         (c) Market the state both as a probusiness location for new
   80  investment and as an unparalleled tourist destination;
   81         (d) Revitalize Florida’s space and aerospace industries,
   82  and promote emerging complementary industries;
   83         (e) Promote opportunities for minority-owned businesses;
   84         (f) Assist and market professional and amateur sport teams
   85  and sporting events in Florida; and
   86         (g) Assist, promote, and enhance economic opportunities in
   87  this state’s rural and urban communities; and
   88         (h) Market the state as a health care destination by using
   89  the medical tourism initiatives as described in s. 288.924 to
   90  promote quality health care services in this state.
   91         Section 3. Paragraph (c) of subsection (4) of section
   92  288.923, Florida Statutes, is amended to read:
   93         288.923 Division of Tourism Marketing; definitions;
   94  responsibilities.—
   95         (4) The division’s responsibilities and duties include, but
   96  are not limited to:
   97         (c) Developing a 4-year marketing plan.
   98         1. At a minimum, the marketing plan shall discuss the
   99  following:
  100         a. Continuation of overall tourism growth in this state.
  101         b. Expansion to new or under-represented tourist markets.
  102         c. Maintenance of traditional and loyal tourist markets.
  103         d. Coordination of efforts with county destination
  104  marketing organizations, other local government marketing
  105  groups, privately owned attractions and destinations, and other
  106  private sector partners to create a seamless, four-season
  107  advertising campaign for the state and its regions.
  108         e. Development of innovative techniques or promotions to
  109  build repeat visitation by targeted segments of the tourist
  110  population.
  111         f. Consideration of innovative sources of state funding for
  112  tourism marketing.
  113         g. Promotion of nature-based tourism and heritage tourism.
  114         h. Promotion of medical tourism for quality health care
  115  services, as provided under s. 288.924.
  116         i.h. Development of a component to address emergency
  117  response to natural and manmade disasters from a marketing
  118  standpoint.
  119         2. The plan shall be annual in construction and ongoing in
  120  nature. Any annual revisions of the plan shall carry forward the
  121  concepts of the remaining 3-year portion of the plan and
  122  consider a continuum portion to preserve the 4-year timeframe of
  123  the plan. The plan also shall include recommendations for
  124  specific performance standards and measurable outcomes for the
  125  division and direct-support organization. The department, in
  126  consultation with the board of directors of Enterprise Florida,
  127  Inc., shall base the actual performance metrics on these
  128  recommendations.
  129         3. The 4-year marketing plan shall be developed in
  130  collaboration with the Florida Tourism Industry Marketing
  131  Corporation. The plan shall be annually reviewed and approved by
  132  the board of directors of Enterprise Florida, Inc.
  133         Section 4. Section 288.924, Florida Statutes, is created to
  134  read:
  135         288.924 Medical tourism for quality health care services;
  136  medical tourism marketing plan.—The Division of Tourism
  137  Marketing shall include within the 4-year marketing plan
  138  required under s. 288.923(4) specific initiatives to advance
  139  this state as a destination for quality bundled health care
  140  services. The plan must:
  141         (1) Promote national and international awareness of the
  142  qualifications, scope of services, and specialized expertise of
  143  health care providers throughout this state;
  144         (2) Promote national and international awareness of
  145  medical-related conferences, training, or business opportunities
  146  to attract practitioners from the medical field to destinations
  147  in this state; and
  148         (3) Include an initiative that showcases selected,
  149  qualified providers offering bundled packages of health care and
  150  support services. The selection of providers to be showcased
  151  must be conducted through a solicitation of proposals from
  152  Florida hospitals and other licensed providers for plans that
  153  describe available services, provider qualifications, and
  154  special arrangements for food, lodging, transportation, or other
  155  support services and amenities that may be provided to visiting
  156  patients and their families. A single health care provider may
  157  submit a proposal describing the available health care services
  158  offered through a network of multiple providers and explaining
  159  support services and other amenities associated with the care.
  160  The Florida Tourism Industry Marketing Corporation shall assess
  161  the qualifications and credentials of providers submitting
  162  proposals. To be qualified for selection, a health care provider
  163  must:
  164         (a) Have a full, active, and unencumbered Florida license
  165  and ensure that all health care providers participating in the
  166  proposal have full, active, and unencumbered Florida licenses;
  167         (b) Have a current accreditation that is not conditional or
  168  provisional from a nationally recognized accrediting body;
  169         (c) Be a recipient of the Cancer Center of Excellence
  170  Award, as described in s. 381.925, within the recognized 3-year
  171  period of the award, or have a current national or international
  172  recognition given through a specific qualifying process in
  173  another specialty area; and
  174         (d) Meet other criteria as determined by the Florida
  175  Tourism Industry Marketing Corporation in collaboration with the
  176  Agency for Health Care Administration and the Department of
  177  Health.
  178         Section 5. Section 624.27, Florida Statutes, is created to
  179  read:
  180         624.27 Application of code as to direct primary care
  181  agreements.—
  182         (1) As used in this section, the term:
  183         (a) “Direct primary care agreement” means a contract
  184  between a primary care provider or primary care group practice
  185  and a patient, the patient’s legal representative, or an
  186  employer which meets the requirements specified under subsection
  187  (4) and does not indemnify for services provided by a third
  188  party.
  189         (b) “Primary care provider” means a health care provider
  190  licensed under chapter 458, chapter 459, or chapter 464 that
  191  provides medical services to patients which are commonly
  192  provided without referral from another health care provider.
  193         (c) “Primary care service” means the screening, assessment,
  194  diagnosis, and treatment of a patient for the purpose of
  195  promoting health or detecting and managing disease or injury
  196  within the competency and training of the primary care provider.
  197         (2) A direct primary care agreement does not constitute
  198  insurance and is not subject to this code. The act of entering
  199  into a direct primary care agreement does not constitute the
  200  business of insurance and is not subject to this code.
  201         (3) A primary care provider or an agent of a primary care
  202  provider is not required to obtain a certificate of authority or
  203  license under this code to market, sell, or offer to sell a
  204  direct primary care agreement.
  205         (4) For purposes of this section, a direct primary care
  206  agreement must:
  207         (a) Be in writing.
  208         (b) Be signed by the primary care provider or an agent of
  209  the primary care provider and the patient or the patient’s legal
  210  representative.
  211         (c) Allow a party to terminate the agreement by written
  212  notice to the other party after a period specified in the
  213  agreement.
  214         (d) Describe the scope of the primary care services that
  215  are covered by the monthly fee.
  216         (e) Specify the monthly fee and any fees for primary care
  217  services not covered by the monthly fee.
  218         (f) Specify the duration of the agreement and any automatic
  219  renewal provisions.
  220         (g) Offer a refund to the patient of monthly fees paid in
  221  advance if the primary care provider ceases to offer primary
  222  care services for any reason.
  223         (h) State that the agreement is not health insurance.
  224         Section 6. Paragraphs (a) and (d) of subsection (3) and
  225  subsections (4) and (5) of section 766.1115, Florida Statutes,
  226  are amended to read:
  227         766.1115 Health care providers; creation of agency
  228  relationship with governmental contractors.—
  229         (3) DEFINITIONS.—As used in this section, the term:
  230         (a) “Contract” means an agreement executed in compliance
  231  with this section between a health care provider and a
  232  governmental contractor which allows the health care provider,
  233  or any employee or agent of the health care provider, to deliver
  234  health care services to low-income recipients as an agent of the
  235  governmental contractor. The contract must be for volunteer,
  236  uncompensated services, except as provided in paragraph (4)(g).
  237  For services to qualify as volunteer, uncompensated services
  238  under this section, the health care provider must receive no
  239  compensation from the governmental contractor for any services
  240  provided under the contract and must not bill or accept
  241  compensation from the recipient, or a public or private third
  242  party payor, for the specific services provided to the low
  243  income recipients covered by the contract, except as provided in
  244  paragraph (4)(g). A free clinic as described in subparagraph
  245  (3)(d)14. may receive a legislative appropriation, a grant
  246  through a legislative appropriation, or a grant from a
  247  governmental entity or nonprofit corporation to support the
  248  delivery of such contracted services by volunteer health care
  249  providers, including the employment of health care providers to
  250  supplement, coordinate, or support the delivery of services by
  251  volunteer health care providers. Such an appropriation or grant
  252  does not constitute compensation under this paragraph from the
  253  governmental contractor for services provided under the
  254  contract, nor does receipt and use of the appropriation or grant
  255  constitute the acceptance of compensation under this paragraph
  256  for the specific services provided to the low-income recipients
  257  covered by the contract.
  258         (d) “Health care provider” or “provider” means:
  259         1. A birth center licensed under chapter 383.
  260         2. An ambulatory surgical center licensed under chapter
  261  395.
  262         3. A hospital licensed under chapter 395.
  263         4. A physician or physician assistant licensed under
  264  chapter 458.
  265         5. An osteopathic physician or osteopathic physician
  266  assistant licensed under chapter 459.
  267         6. A chiropractic physician licensed under chapter 460.
  268         7. A podiatric physician licensed under chapter 461.
  269         8. A registered nurse, nurse midwife, licensed practical
  270  nurse, or advanced registered nurse practitioner licensed or
  271  registered under part I of chapter 464 or any facility which
  272  employs nurses licensed or registered under part I of chapter
  273  464 to supply all or part of the care delivered under this
  274  section.
  275         9. A midwife licensed under chapter 467.
  276         10. A health maintenance organization certificated under
  277  part I of chapter 641.
  278         11. A health care professional association and its
  279  employees or a corporate medical group and its employees.
  280         12. Any other medical facility the primary purpose of which
  281  is to deliver human medical diagnostic services or which
  282  delivers nonsurgical human medical treatment, and which includes
  283  an office maintained by a provider.
  284         13. A dentist or dental hygienist licensed under chapter
  285  466.
  286         14. A free clinic that delivers only medical diagnostic
  287  services or nonsurgical medical treatment free of charge to all
  288  low-income recipients.
  289         15. Any other health care professional, practitioner,
  290  provider, or facility under contract with a governmental
  291  contractor, including a student enrolled in an accredited
  292  program that prepares the student for licensure as any one of
  293  the professionals listed in subparagraphs 4.-9.
  295  The term includes any nonprofit corporation qualified as exempt
  296  from federal income taxation under s. 501(a) of the Internal
  297  Revenue Code, and described in s. 501(c) of the Internal Revenue
  298  Code, which delivers health care services provided by licensed
  299  professionals listed in this paragraph, any federally funded
  300  community health center, and any volunteer corporation or
  301  volunteer health care provider that delivers health care
  302  services.
  303         (4) CONTRACT REQUIREMENTS.—A health care provider that
  304  executes a contract with a governmental contractor to deliver
  305  health care services on or after April 17, 1992, as an agent of
  306  the governmental contractor, or any employee or agent of such
  307  health care provider, is an agent for purposes of s. 768.28(9),
  308  while acting within the scope of duties under the contract, if
  309  the contract complies with the requirements of this section and
  310  regardless of whether the individual treated is later found to
  311  be ineligible. A health care provider, or any employee or agent
  312  of the health care provider, shall continue to be an agent for
  313  purposes of s. 768.28(9) for 30 days after a determination of
  314  ineligibility to allow for treatment until the individual
  315  transitions to treatment by another health care provider. A
  316  health care provider under contract with the state, or any
  317  employee or agent of such health care provider, may not be named
  318  as a defendant in any action arising out of medical care or
  319  treatment provided on or after April 17, 1992, under contracts
  320  entered into under this section. The contract must provide that:
  321         (a) The right of dismissal or termination of any health
  322  care provider delivering services under the contract is retained
  323  by the governmental contractor.
  324         (b) The governmental contractor has access to the patient
  325  records of any health care provider delivering services under
  326  the contract.
  327         (c) Adverse incidents and information on treatment outcomes
  328  must be reported by any health care provider to the governmental
  329  contractor if the incidents and information pertain to a patient
  330  treated under the contract. The health care provider shall
  331  submit the reports required by s. 395.0197. If an incident
  332  involves a professional licensed by the Department of Health or
  333  a facility licensed by the Agency for Health Care
  334  Administration, the governmental contractor shall submit such
  335  incident reports to the appropriate department or agency, which
  336  shall review each incident and determine whether it involves
  337  conduct by the licensee that is subject to disciplinary action.
  338  All patient medical records and any identifying information
  339  contained in adverse incident reports and treatment outcomes
  340  which are obtained by governmental entities under this paragraph
  341  are confidential and exempt from the provisions of s. 119.07(1)
  342  and s. 24(a), Art. I of the State Constitution.
  343         (d) Patient selection and initial referral must be made by
  344  the governmental contractor or the provider. Patients may not be
  345  transferred to the provider based on a violation of the
  346  antidumping provisions of the Omnibus Budget Reconciliation Act
  347  of 1989, the Omnibus Budget Reconciliation Act of 1990, or
  348  chapter 395.
  349         (e) If emergency care is required, the patient need not be
  350  referred before receiving treatment, but must be referred within
  351  48 hours after treatment is commenced or within 48 hours after
  352  the patient has the mental capacity to consent to treatment,
  353  whichever occurs later.
  354         (f) The provider is subject to supervision and regular
  355  inspection by the governmental contractor.
  356         (g) As an agent of the governmental contractor for purposes
  357  of s. 768.28(9), while acting within the scope of duties under
  358  the contract, A health care provider licensed under chapter 466,
  359  as an agent of the governmental contractor for purposes of s.
  360  768.28(9), may allow a patient, or a parent or guardian of the
  361  patient, to voluntarily contribute a monetary amount to cover
  362  costs of dental laboratory work related to the services provided
  363  to the patient within the scope of duties under the contract.
  364  This contribution may not exceed the actual cost of the dental
  365  laboratory charges.
  367  A governmental contractor that is also a health care provider is
  368  not required to enter into a contract under this section with
  369  respect to the health care services delivered by its employees.
  370         (5) NOTICE OF AGENCY RELATIONSHIP.—The governmental
  371  contractor must provide written notice to each patient, or the
  372  patient’s legal representative, receipt of which must be
  373  acknowledged in writing at the initial visit, that the provider
  374  is an agent of the governmental contractor and that the
  375  exclusive remedy for injury or damage suffered as the result of
  376  any act or omission of the provider or of any employee or agent
  377  thereof acting within the scope of duties pursuant to the
  378  contract is by commencement of an action pursuant to the
  379  provisions of s. 768.28. Thereafter, and with respect to any
  380  federally funded community health center, the notice
  381  requirements may be met by posting in a place conspicuous to all
  382  persons a notice that the health care provider federally funded
  383  community health center is an agent of the governmental
  384  contractor and that the exclusive remedy for injury or damage
  385  suffered as the result of any act or omission of the provider or
  386  of any employee or agent thereof acting within the scope of
  387  duties pursuant to the contract is by commencement of an action
  388  pursuant to the provisions of s. 768.28.
  389         Section 7. Paragraph (b) of subsection (9) of section
  390  768.28, Florida Statutes, is amended to read:
  391         768.28 Waiver of sovereign immunity in tort actions;
  392  recovery limits; limitation on attorney fees; statute of
  393  limitations; exclusions; indemnification; risk management
  394  programs.—
  395         (9)
  396         (b) As used in this subsection, the term:
  397         1. “Employee” includes any volunteer firefighter.
  398         2. “Officer, employee, or agent” includes, but is not
  399  limited to, any health care provider, and its employees or
  400  agents, when providing services pursuant to s. 766.1115; any
  401  nonprofit independent college or university located and
  402  chartered in this state which owns or operates an accredited
  403  medical school, and its employees or agents, when providing
  404  patient services pursuant to paragraph (10)(f); and any public
  405  defender or her or his employee or agent, including, among
  406  others, an assistant public defender and an investigator.
  407         Section 8. This act shall take effect July 1, 2016.