Florida Senate - 2016                              CS for SB 178
       By the Committee on Health Policy; and Senators Bean and Gaetz
       588-01763-16                                           2016178c1
    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; amending s. 766.1115,
   18         F.S.; redefining terms relating to agency
   19         relationships with governmental health care
   20         contractors; deleting an obsolete date; extending
   21         sovereign immunity to include employees or agents of a
   22         health care provider that executes a contract with a
   23         governmental contractor; clarifying that a receipt of
   24         specified notice must be acknowledged by a patient or
   25         the patient’s representative at the initial visit;
   26         requiring the posting of notice that a specified
   27         health care provider is an agent of a governmental
   28         contractor; amending s. 768.28, F.S.; redefining the
   29         term “officer, employee, or agent” to include
   30         employees or agents of a health care provider to
   31         conform to changes made by the act; providing an
   32         effective date.
   34  Be It Enacted by the Legislature of the State of Florida:
   36         Section 1. Paragraph (b) of subsection (2) of section
   37  288.0001, Florida Statutes, is amended to read:
   38         288.0001 Economic Development Programs Evaluation.—The
   39  Office of Economic and Demographic Research and the Office of
   40  Program Policy Analysis and Government Accountability (OPPAGA)
   41  shall develop and present to the Governor, the President of the
   42  Senate, the Speaker of the House of Representatives, and the
   43  chairs of the legislative appropriations committees the Economic
   44  Development Programs Evaluation.
   45         (2) The Office of Economic and Demographic Research and
   46  OPPAGA shall provide a detailed analysis of economic development
   47  programs as provided in the following schedule:
   48         (b) By January 1, 2015, and every 3 years thereafter, an
   49  analysis of the following:
   50         1. The entertainment industry financial incentive program
   51  established under s. 288.1254.
   52         2. The entertainment industry sales tax exemption program
   53  established under s. 288.1258.
   54         3. VISIT Florida and its programs established or funded
   55  under ss. 288.122, 288.1226, 288.12265, and 288.124, and
   56  288.924.
   57         4. The Florida Sports Foundation and related programs
   58  established under ss. 288.1162, 288.11621, 288.1166, 288.1167,
   59  288.1168, 288.1169, and 288.1171.
   60         Section 2. Subsection (2) of section 288.901, Florida
   61  Statutes, is amended to read:
   62         288.901 Enterprise Florida, Inc.—
   63         (2) PURPOSES.—Enterprise Florida, Inc., shall act as the
   64  economic development organization for the state, using utilizing
   65  private sector and public sector expertise in collaboration with
   66  the department to:
   67         (a) Increase private investment in Florida;
   68         (b) Advance international and domestic trade opportunities;
   69         (c) Market the state both as a probusiness location for new
   70  investment and as an unparalleled tourist destination;
   71         (d) Revitalize Florida’s space and aerospace industries,
   72  and promote emerging complementary industries;
   73         (e) Promote opportunities for minority-owned businesses;
   74         (f) Assist and market professional and amateur sport teams
   75  and sporting events in Florida; and
   76         (g) Assist, promote, and enhance economic opportunities in
   77  this state’s rural and urban communities; and
   78         (h) Market the state as a health care destination by using
   79  the medical tourism initiatives as described in s. 288.924 to
   80  promote quality health care services in this state.
   81         Section 3. Paragraph (c) of subsection (4) of section
   82  288.923, Florida Statutes, is amended to read:
   83         288.923 Division of Tourism Marketing; definitions;
   84  responsibilities.—
   85         (4) The division’s responsibilities and duties include, but
   86  are not limited to:
   87         (c) Developing a 4-year marketing plan.
   88         1. At a minimum, the marketing plan shall discuss the
   89  following:
   90         a. Continuation of overall tourism growth in this state.
   91         b. Expansion to new or under-represented tourist markets.
   92         c. Maintenance of traditional and loyal tourist markets.
   93         d. Coordination of efforts with county destination
   94  marketing organizations, other local government marketing
   95  groups, privately owned attractions and destinations, and other
   96  private sector partners to create a seamless, four-season
   97  advertising campaign for the state and its regions.
   98         e. Development of innovative techniques or promotions to
   99  build repeat visitation by targeted segments of the tourist
  100  population.
  101         f. Consideration of innovative sources of state funding for
  102  tourism marketing.
  103         g. Promotion of nature-based tourism and heritage tourism.
  104         h. Promotion of medical tourism for quality health care
  105  services, as provided under s. 288.924.
  106         i.h. Development of a component to address emergency
  107  response to natural and manmade disasters from a marketing
  108  standpoint.
  109         2. The plan shall be annual in construction and ongoing in
  110  nature. Any annual revisions of the plan shall carry forward the
  111  concepts of the remaining 3-year portion of the plan and
  112  consider a continuum portion to preserve the 4-year timeframe of
  113  the plan. The plan also shall include recommendations for
  114  specific performance standards and measurable outcomes for the
  115  division and direct-support organization. The department, in
  116  consultation with the board of directors of Enterprise Florida,
  117  Inc., shall base the actual performance metrics on these
  118  recommendations.
  119         3. The 4-year marketing plan shall be developed in
  120  collaboration with the Florida Tourism Industry Marketing
  121  Corporation. The plan shall be annually reviewed and approved by
  122  the board of directors of Enterprise Florida, Inc.
  123         Section 4. Section 288.924, Florida Statutes, is created to
  124  read:
  125         288.924 Medical tourism for quality health care services;
  126  medical tourism marketing plan.—The Division of Tourism
  127  Marketing shall include within the 4-year marketing plan
  128  required under s. 288.923(4) specific initiatives to advance
  129  this state as a destination for quality bundled health care
  130  services. The plan must:
  131         (1) Promote national and international awareness of the
  132  qualifications, scope of services, and specialized expertise of
  133  health care providers throughout this state;
  134         (2) Promote national and international awareness of
  135  medical-related conferences, training, or business opportunities
  136  to attract practitioners from the medical field to destinations
  137  in this state; and
  138         (3) Include an initiative that showcases selected,
  139  qualified providers offering bundled packages of health care and
  140  support services. The selection of providers to be showcased
  141  must be conducted through a solicitation of proposals from
  142  Florida hospitals and other licensed providers for plans that
  143  describe available services, provider qualifications, and
  144  special arrangements for food, lodging, transportation, or other
  145  support services and amenities that may be provided to visiting
  146  patients and their families. A single health care provider may
  147  submit a proposal describing the available health care services
  148  offered through a network of multiple providers and explaining
  149  support services and other amenities associated with the care.
  150  The Florida Tourism Industry Marketing Corporation shall assess
  151  the qualifications and credentials of providers submitting
  152  proposals. To be qualified for selection, a health care provider
  153  must:
  154         (a) Have a full, active, and unencumbered Florida license
  155  and ensure that all health care providers participating in the
  156  proposal have full, active, and unencumbered Florida licenses;
  157         (b) Have a current accreditation that is not conditional or
  158  provisional from a nationally recognized accrediting body;
  159         (c) Be a recipient of the Cancer Center of Excellence
  160  Award, as described in s. 381.925, within the recognized 3-year
  161  period of the award, or have a current national or international
  162  recognition given through a specific qualifying process in
  163  another specialty area; and
  164         (d) Meet other criteria as determined by the Florida
  165  Tourism Industry Marketing Corporation in collaboration with the
  166  Agency for Health Care Administration and the Department of
  167  Health.
  168         Section 5. Paragraphs (a) and (d) of subsection (3) and
  169  subsections (4) and (5) of section 766.1115, Florida Statutes,
  170  are amended to read:
  171         766.1115 Health care providers; creation of agency
  172  relationship with governmental contractors.—
  173         (3) DEFINITIONS.—As used in this section, the term:
  174         (a) “Contract” means an agreement executed in compliance
  175  with this section between a health care provider and a
  176  governmental contractor which allows the health care provider,
  177  or any employee or agent of the health care provider, to deliver
  178  health care services to low-income recipients as an agent of the
  179  governmental contractor. The contract must be for volunteer,
  180  uncompensated services, except as provided in paragraph (4)(g).
  181  For services to qualify as volunteer, uncompensated services
  182  under this section, the health care provider must receive no
  183  compensation from the governmental contractor for any services
  184  provided under the contract and must not bill or accept
  185  compensation from the recipient, or a public or private third
  186  party payor, for the specific services provided to the low
  187  income recipients covered by the contract, except as provided in
  188  paragraph (4)(g). A free clinic as described in subparagraph
  189  (3)(d)14. may receive a legislative appropriation, a grant
  190  through a legislative appropriation, or a grant from a
  191  governmental entity or nonprofit corporation to support the
  192  delivery of such contracted services by volunteer health care
  193  providers, including the employment of health care providers to
  194  supplement, coordinate, or support the delivery of services by
  195  volunteer health care providers. Such an appropriation or grant
  196  does not constitute compensation under this paragraph from the
  197  governmental contractor for services provided under the
  198  contract, nor does receipt and use of the appropriation or grant
  199  constitute the acceptance of compensation under this paragraph
  200  for the specific services provided to the low-income recipients
  201  covered by the contract.
  202         (d) “Health care provider” or “provider” means:
  203         1. A birth center licensed under chapter 383.
  204         2. An ambulatory surgical center licensed under chapter
  205  395.
  206         3. A hospital licensed under chapter 395.
  207         4. A physician or physician assistant licensed under
  208  chapter 458.
  209         5. An osteopathic physician or osteopathic physician
  210  assistant licensed under chapter 459.
  211         6. A chiropractic physician licensed under chapter 460.
  212         7. A podiatric physician licensed under chapter 461.
  213         8. A registered nurse, nurse midwife, licensed practical
  214  nurse, or advanced registered nurse practitioner licensed or
  215  registered under part I of chapter 464 or any facility which
  216  employs nurses licensed or registered under part I of chapter
  217  464 to supply all or part of the care delivered under this
  218  section.
  219         9. A midwife licensed under chapter 467.
  220         10. A health maintenance organization certificated under
  221  part I of chapter 641.
  222         11. A health care professional association and its
  223  employees or a corporate medical group and its employees.
  224         12. Any other medical facility the primary purpose of which
  225  is to deliver human medical diagnostic services or which
  226  delivers nonsurgical human medical treatment, and which includes
  227  an office maintained by a provider.
  228         13. A dentist or dental hygienist licensed under chapter
  229  466.
  230         14. A free clinic that delivers only medical diagnostic
  231  services or nonsurgical medical treatment free of charge to all
  232  low-income recipients.
  233         15. Any other health care professional, practitioner,
  234  provider, or facility under contract with a governmental
  235  contractor, including a student enrolled in an accredited
  236  program that prepares the student for licensure as any one of
  237  the professionals listed in subparagraphs 4.-9.
  239  The term includes any nonprofit corporation qualified as exempt
  240  from federal income taxation under s. 501(a) of the Internal
  241  Revenue Code, and described in s. 501(c) of the Internal Revenue
  242  Code, which delivers health care services provided by licensed
  243  professionals listed in this paragraph, any federally funded
  244  community health center, and any volunteer corporation or
  245  volunteer health care provider that delivers health care
  246  services.
  247         (4) CONTRACT REQUIREMENTS.—A health care provider that
  248  executes a contract with a governmental contractor to deliver
  249  health care services on or after April 17, 1992, as an agent of
  250  the governmental contractor, or any employee or agent of such
  251  health care provider, is an agent for purposes of s. 768.28(9),
  252  while acting within the scope of duties under the contract, if
  253  the contract complies with the requirements of this section and
  254  regardless of whether the individual treated is later found to
  255  be ineligible. A health care provider, or any employee or agent
  256  of the health care provider, shall continue to be an agent for
  257  purposes of s. 768.28(9) for 30 days after a determination of
  258  ineligibility to allow for treatment until the individual
  259  transitions to treatment by another health care provider. A
  260  health care provider under contract with the state, or any
  261  employee or agent of such health care provider, may not be named
  262  as a defendant in any action arising out of medical care or
  263  treatment provided on or after April 17, 1992, under contracts
  264  entered into under this section. The contract must provide that:
  265         (a) The right of dismissal or termination of any health
  266  care provider delivering services under the contract is retained
  267  by the governmental contractor.
  268         (b) The governmental contractor has access to the patient
  269  records of any health care provider delivering services under
  270  the contract.
  271         (c) Adverse incidents and information on treatment outcomes
  272  must be reported by any health care provider to the governmental
  273  contractor if the incidents and information pertain to a patient
  274  treated under the contract. The health care provider shall
  275  submit the reports required by s. 395.0197. If an incident
  276  involves a professional licensed by the Department of Health or
  277  a facility licensed by the Agency for Health Care
  278  Administration, the governmental contractor shall submit such
  279  incident reports to the appropriate department or agency, which
  280  shall review each incident and determine whether it involves
  281  conduct by the licensee that is subject to disciplinary action.
  282  All patient medical records and any identifying information
  283  contained in adverse incident reports and treatment outcomes
  284  which are obtained by governmental entities under this paragraph
  285  are confidential and exempt from the provisions of s. 119.07(1)
  286  and s. 24(a), Art. I of the State Constitution.
  287         (d) Patient selection and initial referral must be made by
  288  the governmental contractor or the provider. Patients may not be
  289  transferred to the provider based on a violation of the
  290  antidumping provisions of the Omnibus Budget Reconciliation Act
  291  of 1989, the Omnibus Budget Reconciliation Act of 1990, or
  292  chapter 395.
  293         (e) If emergency care is required, the patient need not be
  294  referred before receiving treatment, but must be referred within
  295  48 hours after treatment is commenced or within 48 hours after
  296  the patient has the mental capacity to consent to treatment,
  297  whichever occurs later.
  298         (f) The provider is subject to supervision and regular
  299  inspection by the governmental contractor.
  300         (g) As an agent of the governmental contractor for purposes
  301  of s. 768.28(9), while acting within the scope of duties under
  302  the contract, A health care provider licensed under chapter 466,
  303  as an agent of the governmental contractor for purposes of s.
  304  768.28(9), may allow a patient, or a parent or guardian of the
  305  patient, to voluntarily contribute a monetary amount to cover
  306  costs of dental laboratory work related to the services provided
  307  to the patient within the scope of duties under the contract.
  308  This contribution may not exceed the actual cost of the dental
  309  laboratory charges.
  311  A governmental contractor that is also a health care provider is
  312  not required to enter into a contract under this section with
  313  respect to the health care services delivered by its employees.
  314         (5) NOTICE OF AGENCY RELATIONSHIP.—The governmental
  315  contractor must provide written notice to each patient, or the
  316  patient’s legal representative, receipt of which must be
  317  acknowledged in writing at the initial visit, that the provider
  318  is an agent of the governmental contractor and that the
  319  exclusive remedy for injury or damage suffered as the result of
  320  any act or omission of the provider or of any employee or agent
  321  thereof acting within the scope of duties pursuant to the
  322  contract is by commencement of an action pursuant to the
  323  provisions of s. 768.28. Thereafter, and with respect to any
  324  federally funded community health center, the notice
  325  requirements may be met by posting in a place conspicuous to all
  326  persons a notice that the health care provider federally funded
  327  community health center is an agent of the governmental
  328  contractor and that the exclusive remedy for injury or damage
  329  suffered as the result of any act or omission of the provider or
  330  of any employee or agent thereof acting within the scope of
  331  duties pursuant to the contract is by commencement of an action
  332  pursuant to the provisions of s. 768.28.
  333         Section 6. Paragraph (b) of subsection (9) of section
  334  768.28, Florida Statutes, is amended to read:
  335         768.28 Waiver of sovereign immunity in tort actions;
  336  recovery limits; limitation on attorney fees; statute of
  337  limitations; exclusions; indemnification; risk management
  338  programs.—
  339         (9)
  340         (b) As used in this subsection, the term:
  341         1. “Employee” includes any volunteer firefighter.
  342         2. “Officer, employee, or agent” includes, but is not
  343  limited to, any health care provider, and its employees or
  344  agents, when providing services pursuant to s. 766.1115; any
  345  nonprofit independent college or university located and
  346  chartered in this state which owns or operates an accredited
  347  medical school, and its employees or agents, when providing
  348  patient services pursuant to paragraph (10)(f); and any public
  349  defender or her or his employee or agent, including, among
  350  others, an assistant public defender and an investigator.
  351         Section 7. This act shall take effect July 1, 2016.