Florida Senate - 2016 COMMITTEE AMENDMENT
Bill No. CS for SB 212
Ì317634.Î317634
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
02/26/2016 .
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The Committee on Appropriations (Gaetz) recommended the
following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Section 381.4019, Florida Statutes, is created
6 to read:
7 381.4019 Dental care access accounts.—Subject to the
8 availability of funds, the Legislature establishes a joint local
9 and state dental care access account initiative and authorizes
10 the creation of dental care access accounts to promote economic
11 development by supporting qualified dentists who practice in
12 dental health professional shortage areas or medically
13 underserved areas or who treat a medically underserved
14 population. The Legislature recognizes that maintaining good
15 oral health is integral to overall health status and that the
16 good health of residents of this state is an important
17 contributing factor in economic development. Better health,
18 including better oral health, enables workers to be more
19 productive, reduces the burden of health care costs, and enables
20 children to improve in cognitive development.
21 (1) As used in this section, the term:
22 (a) “Dental health professional shortage area” means a
23 geographic area so designated by the Health Resources and
24 Services Administration of the United States Department of
25 Health and Human Services.
26 (b) “Department” means the Department of Health.
27 (c) “Medically underserved area” means a geographic area so
28 designated by the Health Resources and Services Administration
29 of the United States Department of Health and Human Services.
30 (d) “Public health program” means a county health
31 department, the Children’s Medical Services Network, a federally
32 qualified community health center, a federally funded migrant
33 health center, or other publicly funded or nonprofit health care
34 program as designated by the department.
35 (2) The department shall develop and implement a dental
36 care access account initiative to benefit dentists licensed to
37 practice in this state who demonstrate, as required by the
38 department by rule:
39 (a) Active employment by a public health program located in
40 a dental health professional shortage area or a medically
41 underserved area; or
42 (b) A commitment to opening a private practice in a dental
43 health professional shortage area or a medically underserved
44 area, as demonstrated by the dentist residing in the designated
45 area, maintaining an active Medicaid provider agreement,
46 enrolling in one or more Medicaid managed care plans, expending
47 sufficient capital to make substantial progress in opening a
48 dental practice that is capable of serving at least 1,200
49 patients, and obtaining financial support from the local
50 community in which the dentist is practicing or intending to
51 open a practice.
52 (3) The department shall establish dental care access
53 accounts as individual benefit accounts for each dentist who
54 satisfies the requirements of subsection (2) and is selected by
55 the department for participation. The department shall implement
56 an electronic benefit transfer system that enables each dentist
57 to spend funds from his or her account for the purposes
58 described in subsection (4).
59 (4) Funds contributed from state and local sources to a
60 dental care access account may be used for one or more of the
61 following purposes:
62 (a) Repayment of dental school student loans.
63 (b) Investment in property, facilities, or equipment
64 necessary to establish and operate a dental office consisting of
65 no fewer than two operatories.
66 (c) Payment of transitional expenses related to the
67 relocation or opening of a dental practice which are
68 specifically approved by the department.
69 (5) Subject to legislative appropriation, the department
70 shall distribute state funds as an award to each dental care
71 access account. An individual award must be in an amount not
72 more than $100,000 and not less than $10,000, except that a
73 state award may not exceed 3 times the amount contributed to an
74 account in the same year from local sources. If a dentist
75 qualifies for a dental care access account under paragraph
76 (2)(a), the dentist’s salary and associated employer
77 expenditures constitute a local match and qualify the account
78 for a state award if the salary and associated expenditures do
79 not come from state funds. State funds may not be included in a
80 determination of the amount contributed to an account from local
81 sources.
82 (6) The department may accept contributions of funds from a
83 local source for deposit in the account of a dentist designated
84 by the donor.
85 (7) The department shall close an account no later than 5
86 years after the first deposit of state or local funds into that
87 account or immediately upon the occurrence of any of the
88 following:
89 (a) Termination of the dentist’s employment with a public
90 health program, unless, within 30 days after such termination,
91 the dentist opens a private practice in a dental health
92 professional shortage area or medically underserved area.
93 (b) Termination of the dentist’s practice in a designated
94 dental health professional shortage area or medically
95 underserved area.
96 (c) Termination of the dentist’s participation in the
97 Florida Medicaid program.
98 (d) Participation by the dentist in any fraudulent
99 activity.
100 (8) Any state funds remaining in a closed account may be
101 awarded and transferred to another account concurrent with the
102 distribution of funds under the next legislative appropriation
103 for the initiative. The department shall return to the donor on
104 a pro rata basis unspent funds from local sources which remain
105 in a closed account.
106 (9) If the department determines that a dentist has
107 withdrawn account funds after the occurrence of an event
108 specified in subsection (7), has used funds for purposes not
109 authorized in subsection (4), or has not remained eligible for a
110 dental care access account for a minimum of 2 years, the dentist
111 shall repay the funds to his or her account. The department may
112 recover the withdrawn funds through disciplinary enforcement
113 actions and other methods authorized by law.
114 (10) The department shall establish by rule:
115 (a) Application procedures for dentists who wish to apply
116 for a dental care access account. An applicant may demonstrate
117 that he or she has expended sufficient capital to make
118 substantial progress in opening a dental practice that is
119 capable of serving at least 1,200 patients by documenting
120 contracts for the purchase or lease of a practice location and
121 providing executed obligations for the purchase or other
122 acquisition of at least 30 percent of the value of equipment or
123 supplies necessary to operate a dental practice. The department
124 may limit the number of applicants selected and shall give
125 priority to those applicants practicing in the areas receiving
126 higher rankings pursuant to subsection (11). The department may
127 establish additional criteria for selection which recognize an
128 applicant’s active engagement with and commitment to the
129 community providing a local match.
130 (b) A process to verify that funds withdrawn from a dental
131 care access account have been used solely for the purposes
132 described in subsection (4).
133 (11) The Department of Economic Opportunity shall rank the
134 dental health professional shortage areas and medically
135 underserved areas of the state based on the extent to which
136 limited access to dental care is impeding the areas’ economic
137 development, with a higher ranking indicating a greater
138 impediment to development.
139 (12) The department shall develop a marketing plan for the
140 dental care access account initiative in cooperation with the
141 University of Florida College of Dentistry, the Nova
142 Southeastern University College of Dental Medicine, the Lake
143 Erie College of Osteopathic Medicine School of Dental Medicine,
144 and the Florida Dental Association.
145 (13)(a) By January 1 of each year, beginning in 2018, the
146 department shall issue a report to the Governor, the President
147 of the Senate, and the Speaker of the House of Representatives
148 which must include:
149 1. The number of patients served by dentists receiving
150 funding under this section.
151 2. The number of Medicaid recipients served by dentists
152 receiving funding under this section.
153 3. The average number of hours worked and patients served
154 in a week by dentists receiving funding under this section.
155 4. The number of dentists in each dental health
156 professional shortage area or medically underserved area
157 receiving funding under this section.
158 5. The amount and source of local matching funds received
159 by the department.
160 6. The amount of state funds awarded to dentists under this
161 section.
162 7. A complete accounting of the use of funds by categories
163 identified by the department, including, but not limited to,
164 loans, supplies, equipment, rental property payments, real
165 property purchases, and salary and wages.
166 (b) The department shall adopt rules to require dentists to
167 report information to the department which is necessary for the
168 department to fulfill its reporting requirement under this
169 subsection.
170 Section 2. Subsection (3) of section 395.002, Florida
171 Statutes, is amended to read:
172 395.002 Definitions.—As used in this chapter:
173 (3) “Ambulatory surgical center” or “mobile surgical
174 facility” means a facility the primary purpose of which is to
175 provide elective surgical care, in which the patient is admitted
176 to and discharged from such facility within 24 hours the same
177 working day and is not permitted to stay overnight, and which is
178 not part of a hospital. However, a facility existing for the
179 primary purpose of performing terminations of pregnancy, an
180 office maintained by a physician for the practice of medicine,
181 or an office maintained for the practice of dentistry shall not
182 be construed to be an ambulatory surgical center, provided that
183 any facility or office which is certified or seeks certification
184 as a Medicare ambulatory surgical center shall be licensed as an
185 ambulatory surgical center pursuant to s. 395.003. Any structure
186 or vehicle in which a physician maintains an office and
187 practices surgery, and which can appear to the public to be a
188 mobile office because the structure or vehicle operates at more
189 than one address, shall be construed to be a mobile surgical
190 facility.
191 Section 3. Present subsections (6) through (10) of section
192 395.003, Florida Statutes, are redesignated as subsections (7)
193 through (11), respectively, a new subsection (6) is added to
194 that section, and present subsections (9) and (10) of that
195 section are amended, to read:
196 395.003 Licensure; denial, suspension, and revocation.—
197 (6) An ambulatory surgical center, as a condition of
198 initial licensure and license renewal, must provide services to
199 Medicare patients, Medicaid patients, and patients who qualify
200 for charity care in an amount equal to or greater than the
201 applicable district average among licensed providers of similar
202 services. For the purposes of this subsection, “charity care”
203 means uncompensated care delivered to uninsured patients with
204 incomes at or below 200 percent of the federal poverty level
205 when such services are preauthorized by the licensee and not
206 subject to collection procedures.
207 (10)(9) A hospital licensed as of June 1, 2004, shall be
208 exempt from subsection (9) subsection (8) as long as the
209 hospital maintains the same ownership, facility street address,
210 and range of services that were in existence on June 1, 2004.
211 Any transfer of beds, or other agreements that result in the
212 establishment of a hospital or hospital services within the
213 intent of this section, shall be subject to subsection (9)
214 subsection (8). Unless the hospital is otherwise exempt under
215 subsection (9) subsection (8), the agency shall deny or revoke
216 the license of a hospital that violates any of the criteria set
217 forth in that subsection.
218 (11)(10) The agency may adopt rules implementing the
219 licensure requirements set forth in subsection (9) subsection
220 (8). Within 14 days after rendering its decision on a license
221 application or revocation, the agency shall publish its proposed
222 decision in the Florida Administrative Register. Within 21 days
223 after publication of the agency’s decision, any authorized
224 person may file a request for an administrative hearing. In
225 administrative proceedings challenging the approval, denial, or
226 revocation of a license pursuant to subsection (9) subsection
227 (8), the hearing must be based on the facts and law existing at
228 the time of the agency’s proposed agency action. Existing
229 hospitals may initiate or intervene in an administrative hearing
230 to approve, deny, or revoke licensure under subsection (9)
231 subsection (8) based upon a showing that an established program
232 will be substantially affected by the issuance or renewal of a
233 license to a hospital within the same district or service area.
234 Section 4. Section 624.27, Florida Statutes, is created to
235 read:
236 624.27 Application of code as to direct primary care
237 agreements.—
238 (1) As used in this section, the term:
239 (a) “Direct primary care agreement” means a contract
240 between a primary care provider and a patient, the patient’s
241 legal representative, or an employer which meets the
242 requirements specified under subsection (4) and does not
243 indemnify for services provided by a third party.
244 (b) “Primary care provider” means a health care
245 practitioner licensed under chapter 458, chapter 459, chapter
246 460, or chapter 464, or a primary care group practice that
247 provides medical services to patients which are commonly
248 provided without referral from another health care provider.
249 (c) “Primary care service” means the screening, assessment,
250 diagnosis, and treatment of a patient for the purpose of
251 promoting health or detecting and managing disease or injury
252 within the competency and training of the primary care provider.
253 (2) A direct primary care agreement does not constitute
254 insurance and is not subject to chapter 636 or any other chapter
255 of the Florida Insurance Code. The act of entering into a direct
256 primary care agreement does not constitute the business of
257 insurance and is not subject to chapter 636 or any other chapter
258 of the Florida Insurance Code.
259 (3) A primary care provider or an agent of a primary care
260 provider is not required to obtain a certificate of authority or
261 license under chapter 636 or any other chapter of the Florida
262 Insurance Code to market, sell, or offer to sell a direct
263 primary care agreement.
264 (4) For purposes of this section, a direct primary care
265 agreement must:
266 (a) Be in writing.
267 (b) Be signed by the primary care provider or an agent of
268 the primary care provider and the patient, the patient’s legal
269 representative, or an employer.
270 (c) Allow a party to terminate the agreement by giving the
271 other party at least 30 days’ advance written notice. The
272 agreement may provide for immediate termination due to a
273 violation of the physician-patient relationship or a breach of
274 the terms of the agreement.
275 (d) Describe the scope of primary care services that are
276 covered by the monthly fee.
277 (e) Specify the monthly fee and any fees for primary care
278 services not covered by the monthly fee.
279 (f) Specify the duration of the agreement and any automatic
280 renewal provisions.
281 (g) Offer a refund to the patient of monthly fees paid in
282 advance if the primary care provider ceases to offer primary
283 care services for any reason.
284 (h) Contain in contrasting color and in not less than 12
285 point type the following statements on the same page as the
286 applicant’s signature:
287 1. The agreement is not health insurance and the primary
288 care provider will not file any claims against the patient’s
289 health insurance policy or plan for reimbursement of any primary
290 care services covered by the agreement.
291 2. The agreement does not qualify as minimum essential
292 coverage to satisfy the individual shared responsibility
293 provision of the Patient Protection and Affordable Care Act, 26
294 U.S.C. s. 5000A.
295 Section 5. The amendments made by this act to ss. 409.967,
296 627.42392, 641.31, and 641.394, Florida Statutes, may be known
297 as the “Right Medicine Right Time Act.”
298 Section 6. Effective January 1, 2017, paragraph (c) of
299 subsection (2) of section 409.967, Florida Statutes, is amended
300 to read:
301 409.967 Managed care plan accountability.—
302 (2) The agency shall establish such contract requirements
303 as are necessary for the operation of the statewide managed care
304 program. In addition to any other provisions the agency may deem
305 necessary, the contract must require:
306 (c) Access.—
307 1. The agency shall establish specific standards for the
308 number, type, and regional distribution of providers in managed
309 care plan networks to ensure access to care for both adults and
310 children. Each plan must maintain a regionwide network of
311 providers in sufficient numbers to meet the access standards for
312 specific medical services for all recipients enrolled in the
313 plan. The exclusive use of mail-order pharmacies may not be
314 sufficient to meet network access standards. Consistent with the
315 standards established by the agency, provider networks may
316 include providers located outside the region. A plan may
317 contract with a new hospital facility before the date the
318 hospital becomes operational if the hospital has commenced
319 construction, will be licensed and operational by January 1,
320 2013, and a final order has issued in any civil or
321 administrative challenge. Each plan shall establish and maintain
322 an accurate and complete electronic database of contracted
323 providers, including information about licensure or
324 registration, locations and hours of operation, specialty
325 credentials and other certifications, specific performance
326 indicators, and such other information as the agency deems
327 necessary. The database must be available online to both the
328 agency and the public and have the capability to compare the
329 availability of providers to network adequacy standards and to
330 accept and display feedback from each provider’s patients. Each
331 plan shall submit quarterly reports to the agency identifying
332 the number of enrollees assigned to each primary care provider.
333 2.a. Each managed care plan must publish any prescribed
334 drug formulary or preferred drug list on the plan’s website in a
335 manner that is accessible to and searchable by enrollees and
336 providers. The plan must update the list within 24 hours after
337 making a change. Each plan must ensure that the prior
338 authorization process for prescribed drugs is readily accessible
339 to health care providers, including posting appropriate contact
340 information on its website and providing timely responses to
341 providers. For Medicaid recipients diagnosed with hemophilia who
342 have been prescribed anti-hemophilic-factor replacement
343 products, the agency shall provide for those products and
344 hemophilia overlay services through the agency’s hemophilia
345 disease management program.
346 b. If a managed care plan restricts the use of prescribed
347 drugs through a fail-first protocol, it must establish a clear
348 and convenient process that a prescribing physician may use to
349 request an override of the restriction from the managed care
350 plan. The managed care plan shall grant an override of the
351 protocol within 24 hours if:
352 (I) Based on sound clinical evidence, the prescribing
353 provider concludes that the preferred treatment required under
354 the fail-first protocol has been ineffective in the treatment of
355 the enrollee’s disease or medical condition; or
356 (II) Based on sound clinical evidence or medical and
357 scientific evidence, the prescribing provider believes that the
358 preferred treatment required under the fail-first protocol:
359 (A) Is likely to be ineffective given the known relevant
360 physical or mental characteristics and medical history of the
361 enrollee and the known characteristics of the drug regimen; or
362 (B) Will cause or is likely to cause an adverse reaction or
363 other physical harm to the enrollee.
364
365 If the prescribing provider follows the fail-first protocol
366 recommended by the managed care plan for an enrollee, the
367 duration of treatment under the fail-first protocol may not
368 exceed a period deemed appropriate by the prescribing provider.
369 Following such period, if the prescribing provider deems the
370 treatment provided under the protocol clinically ineffective,
371 the enrollee is entitled to receive the course of therapy that
372 the prescribing provider recommends, and the provider is not
373 required to seek approval of an override of the fail-first
374 protocol. As used in this subparagraph, the term “fail-first
375 protocol” means a prescription practice that begins medication
376 for a medical condition with the most cost-effective drug
377 therapy and progresses to other more costly or risky therapies
378 only if necessary.
379 3. Managed care plans, and their fiscal agents or
380 intermediaries, must accept prior authorization requests for any
381 service electronically.
382 4. Managed care plans serving children in the care and
383 custody of the Department of Children and Families shall must
384 maintain complete medical, dental, and behavioral health
385 encounter information and participate in making such information
386 available to the department or the applicable contracted
387 community-based care lead agency for use in providing
388 comprehensive and coordinated case management. The agency and
389 the department shall establish an interagency agreement to
390 provide guidance for the format, confidentiality, recipient,
391 scope, and method of information to be made available and the
392 deadlines for submission of the data. The scope of information
393 available to the department are shall be the data that managed
394 care plans are required to submit to the agency. The agency
395 shall determine the plan’s compliance with standards for access
396 to medical, dental, and behavioral health services; the use of
397 medications; and followup on all medically necessary services
398 recommended as a result of early and periodic screening,
399 diagnosis, and treatment.
400 Section 7. Effective January 1, 2017, section 627.42392,
401 Florida Statutes, is created to read:
402 627.42392 Fail-first protocols.—If an insurer restricts the
403 use of prescribed drugs through a fail-first protocol, it must
404 establish a clear and convenient process that a prescribing
405 physician may use to request an override of the restriction from
406 the insurer. The insurer shall grant an override of the protocol
407 within 24 hours if:
408 (1) Based on sound clinical evidence, the prescribing
409 provider concludes that the preferred treatment required under
410 the fail-first protocol has been ineffective in the treatment of
411 the insured’s disease or medical condition; or
412 (2) Based on sound clinical evidence or medical and
413 scientific evidence, the prescribing provider believes that the
414 preferred treatment required under the fail-first protocol:
415 (a) Is likely to be ineffective given the known relevant
416 physical or mental characteristics and medical history of the
417 insured and the known characteristics of the drug regimen; or
418 (b) Will cause or is likely to cause an adverse reaction or
419 other physical harm to the insured.
420
421 If the prescribing provider follows the fail-first protocol
422 recommended by the insurer for an insured, the duration of
423 treatment under the fail-first protocol may not exceed a period
424 deemed appropriate by the prescribing provider. Following such
425 period, if the prescribing provider deems the treatment provided
426 under the protocol clinically ineffective, the insured is
427 entitled to receive the course of therapy that the prescribing
428 provider recommends, and the provider is not required to seek
429 approval of an override of the fail-first protocol. As used in
430 this section, the term “fail-first protocol” means a
431 prescription practice that begins medication for a medical
432 condition with the most cost-effective drug therapy and
433 progresses to other more costly or risky therapies only if
434 necessary.
435 Section 8. Effective January 1, 2017, subsection (44) is
436 added to section 641.31, Florida Statutes, to read:
437 641.31 Health maintenance contracts.—
438 (44) A health maintenance organization may not require a
439 health care provider, by contract with another health care
440 provider, a patient, or another individual or entity, to use a
441 clinical decision support system or a laboratory benefits
442 management program before the provider may order clinical
443 laboratory services or in an attempt to direct or limit the
444 provider’s medical decisionmaking relating to the use of such
445 services. This subsection may not be construed to prohibit any
446 prior authorization requirements that the health maintenance
447 organization may have regarding the provision of clinical
448 laboratory services. As used in this subsection, the term:
449 (a) “Clinical decision support system” means software
450 designed to direct or assist clinical decisionmaking by matching
451 the characteristics of an individual patient to a computerized
452 clinical knowledge base and providing patient-specific
453 assessments or recommendations based on the match.
454 (b) “Clinical laboratory services” means the examination of
455 fluids or other materials taken from the human body, which
456 examination is ordered by a health care provider for use in the
457 diagnosis, prevention, or treatment of a disease or in the
458 identification or assessment of a medical or physical condition.
459 (c) “Laboratory benefits management program” means a health
460 maintenance organization protocol that dictates or limits health
461 care provider decisionmaking relating to the use of clinical
462 laboratory services.
463 Section 9. Effective January 1, 2017, section 641.394,
464 Florida Statutes, is created to read:
465 641.394 Fail-first protocols.—If a health maintenance
466 organization restricts the use of prescribed drugs through a
467 fail-first protocol, it must establish a clear and convenient
468 process that a prescribing physician may use to request an
469 override of the restriction from the health maintenance
470 organization. The health maintenance organization shall grant an
471 override of the protocol within 24 hours if:
472 (1) Based on sound clinical evidence, the prescribing
473 provider concludes that the preferred treatment required under
474 the fail-first protocol has been ineffective in the treatment of
475 the subscriber’s disease or medical condition; or
476 (2) Based on sound clinical evidence or medical and
477 scientific evidence, the prescribing provider believes that the
478 preferred treatment required under the fail-first protocol:
479 (a) Is likely to be ineffective given the known relevant
480 physical or mental characteristics and medical history of the
481 subscriber and the known characteristics of the drug regimen; or
482 (b) Will cause or is likely to cause an adverse reaction or
483 other physical harm to the subscriber.
484
485 If the prescribing provider follows the fail-first protocol
486 recommended by the health maintenance organization for a
487 subscriber, the duration of treatment under the fail-first
488 protocol may not exceed a period deemed appropriate by the
489 prescribing provider. Following such period, if the prescribing
490 provider deems the treatment provided under the protocol
491 clinically ineffective, the subscriber is entitled to receive
492 the course of therapy that the prescribing provider recommends,
493 and the provider is not required to seek approval of an override
494 of the fail-first protocol. As used in this section, the term
495 “fail-first protocol” means a prescription practice that begins
496 medication for a medical condition with the most cost-effective
497 drug therapy and progresses to other more costly or risky
498 therapies only if necessary.
499 Section 10. Paragraphs (a) and (d) of subsection (3) and
500 subsections (4) and (5) of section 766.1115, Florida Statutes,
501 are amended to read:
502 766.1115 Health care providers; creation of agency
503 relationship with governmental contractors.—
504 (3) DEFINITIONS.—As used in this section, the term:
505 (a) “Contract” means an agreement executed in compliance
506 with this section between a health care provider and a
507 governmental contractor for volunteer, uncompensated services
508 which allows the health care provider to deliver health care
509 services to low-income recipients as an agent of the
510 governmental contractor. The contract must be for volunteer,
511 uncompensated services, except as provided in paragraph (4)(g).
512 For services to qualify as volunteer, uncompensated services
513 under this section, the health care provider, or any employee or
514 agent of the health care provider, must receive no compensation
515 from the governmental contractor for any services provided under
516 the contract and must not bill or accept compensation from the
517 recipient, or a public or private third-party payor, for the
518 specific services provided to the low-income recipients covered
519 by the contract, except as provided in paragraph (4)(g). A free
520 clinic as described in subparagraph (d)14. may receive a
521 legislative appropriation, a grant through a legislative
522 appropriation, or a grant from a governmental entity or
523 nonprofit corporation to support the delivery of contracted
524 services by volunteer health care providers, including the
525 employment of health care providers to supplement, coordinate,
526 or support the delivery of such services. The appropriation or
527 grant for the free clinic does not constitute compensation under
528 this paragraph from the governmental contractor for services
529 provided under the contract, nor does receipt or use of the
530 appropriation or grant constitute the acceptance of compensation
531 under this paragraph for the specific services provided to the
532 low-income recipients covered by the contract.
533 (d) “Health care provider” or “provider” means:
534 1. A birth center licensed under chapter 383.
535 2. An ambulatory surgical center licensed under chapter
536 395.
537 3. A hospital licensed under chapter 395.
538 4. A physician or physician assistant licensed under
539 chapter 458.
540 5. An osteopathic physician or osteopathic physician
541 assistant licensed under chapter 459.
542 6. A chiropractic physician licensed under chapter 460.
543 7. A podiatric physician licensed under chapter 461.
544 8. A registered nurse, nurse midwife, licensed practical
545 nurse, or advanced registered nurse practitioner licensed or
546 registered under part I of chapter 464 or any facility which
547 employs nurses licensed or registered under part I of chapter
548 464 to supply all or part of the care delivered under this
549 section.
550 9. A midwife licensed under chapter 467.
551 10. A health maintenance organization certificated under
552 part I of chapter 641.
553 11. A health care professional association and its
554 employees or a corporate medical group and its employees.
555 12. Any other medical facility the primary purpose of which
556 is to deliver human medical diagnostic services or which
557 delivers nonsurgical human medical treatment, and which includes
558 an office maintained by a provider.
559 13. A dentist or dental hygienist licensed under chapter
560 466.
561 14. A free clinic that delivers only medical diagnostic
562 services or nonsurgical medical treatment free of charge to all
563 low-income recipients.
564 15. A pharmacy or pharmacist licensed under chapter 465.
565 16.15. Any other health care professional, practitioner,
566 provider, or facility under contract with a governmental
567 contractor, including a student enrolled in an accredited
568 program that prepares the student for licensure as any one of
569 the professionals listed in subparagraphs 4.-9.
570
571 The term includes any nonprofit corporation qualified as exempt
572 from federal income taxation under s. 501(a) of the Internal
573 Revenue Code, and described in s. 501(c) of the Internal Revenue
574 Code, which delivers health care services provided by licensed
575 professionals listed in this paragraph, any federally funded
576 community health center, and any volunteer corporation or
577 volunteer health care provider that delivers health care
578 services.
579 (4) CONTRACT REQUIREMENTS.—A health care provider that
580 executes a contract with a governmental contractor to deliver
581 health care services on or after April 17, 1992, as an agent of
582 the governmental contractor, or any employee or agent of such
583 health care provider, is an agent for purposes of s. 768.28(9),
584 while acting within the scope of duties under the contract, if
585 the contract complies with the requirements of this section and
586 regardless of whether the individual treated is later found to
587 be ineligible. A health care provider, or any employee or agent
588 of such health care provider, shall continue to be an agent for
589 purposes of s. 768.28(9) for 30 days after a determination of
590 ineligibility to allow for treatment until the individual
591 transitions to treatment by another health care provider. A
592 health care provider, or any employee or agent of such health
593 care provider, under contract with the state may not be named as
594 a defendant in any action arising out of medical care or
595 treatment provided on or after April 17, 1992, under contracts
596 entered into under this section. The contract must provide that:
597 (a) The right of dismissal or termination of any health
598 care provider delivering services under the contract is retained
599 by the governmental contractor.
600 (b) The governmental contractor has access to the patient
601 records of any health care provider delivering services under
602 the contract.
603 (c) Adverse incidents and information on treatment outcomes
604 must be reported by any health care provider to the governmental
605 contractor if the incidents and information pertain to a patient
606 treated under the contract. The health care provider shall
607 submit the reports required by s. 395.0197. If an incident
608 involves a professional licensed by the Department of Health or
609 a facility licensed by the Agency for Health Care
610 Administration, the governmental contractor shall submit such
611 incident reports to the appropriate department or agency, which
612 shall review each incident and determine whether it involves
613 conduct by the licensee that is subject to disciplinary action.
614 All patient medical records and any identifying information
615 contained in adverse incident reports and treatment outcomes
616 which are obtained by governmental entities under this paragraph
617 are confidential and exempt from the provisions of s. 119.07(1)
618 and s. 24(a), Art. I of the State Constitution.
619 (d) Patient selection and initial referral must be made by
620 the governmental contractor or the provider. Patients may not be
621 transferred to the provider based on a violation of the
622 antidumping provisions of the Omnibus Budget Reconciliation Act
623 of 1989, the Omnibus Budget Reconciliation Act of 1990, or
624 chapter 395.
625 (e) If emergency care is required, the patient need not be
626 referred before receiving treatment, but must be referred within
627 48 hours after treatment is commenced or within 48 hours after
628 the patient has the mental capacity to consent to treatment,
629 whichever occurs later.
630 (f) The provider is subject to supervision and regular
631 inspection by the governmental contractor.
632 (g) As an agent of the governmental contractor for purposes
633 of s. 768.28(9), while acting within the scope of duties under
634 the contract, A health care provider licensed under chapter 466,
635 as an agent of the governmental contractor for purposes of s.
636 768.28(9), may allow a patient, or a parent or guardian of the
637 patient, to voluntarily contribute a monetary amount to cover
638 costs of dental laboratory work related to the services provided
639 to the patient within the scope of duties under the contract.
640 This contribution may not exceed the actual cost of the dental
641 laboratory charges.
642
643 A governmental contractor that is also a health care provider is
644 not required to enter into a contract under this section with
645 respect to the health care services delivered by its employees.
646 (5) NOTICE OF AGENCY RELATIONSHIP.—The governmental
647 contractor must provide written notice to each patient, or the
648 patient’s legal representative, receipt of which must be
649 acknowledged in writing at the initial visit, that the provider
650 is an agent of the governmental contractor and that the
651 exclusive remedy for injury or damage suffered as the result of
652 any act or omission of the provider or of any employee or agent
653 thereof acting within the scope of duties pursuant to the
654 contract is by commencement of an action pursuant to the
655 provisions of s. 768.28. Thereafter, or with respect to any
656 federally funded community health center, the notice
657 requirements may be met by posting in a place conspicuous to all
658 persons a notice that the health care provider, or federally
659 funded community health center, is an agent of the governmental
660 contractor and that the exclusive remedy for injury or damage
661 suffered as the result of any act or omission of the provider or
662 of any employee or agent thereof acting within the scope of
663 duties pursuant to the contract is by commencement of an action
664 pursuant to the provisions of s. 768.28.
665 Section 11. Paragraphs (a) and (b) of subsection (9) of
666 section 768.28, Florida Statutes, is amended to read:
667 768.28 Waiver of sovereign immunity in tort actions;
668 recovery limits; limitation on attorney fees; statute of
669 limitations; exclusions; indemnification; risk management
670 programs.—
671 (9)(a) An No officer, employee, or agent of the state or of
672 any of its subdivisions may not shall be held personally liable
673 in tort or named as a party defendant in any action for any
674 injury or damage suffered as a result of any act, event, or
675 omission of action in the scope of her or his employment or
676 function, unless such officer, employee, or agent acted in bad
677 faith or with malicious purpose or in a manner exhibiting wanton
678 and willful disregard of human rights, safety, or property.
679 However, such officer, employee, or agent shall be considered an
680 adverse witness in a tort action for any injury or damage
681 suffered as a result of any act, event, or omission of action in
682 the scope of her or his employment or function. The exclusive
683 remedy for injury or damage suffered as a result of an act,
684 event, or omission of an officer, employee, or agent of the
685 state or any of its subdivisions or constitutional officers is
686 shall be by action against the governmental entity, or the head
687 of such entity in her or his official capacity, or the
688 constitutional officer of which the officer, employee, or agent
689 is an employee, unless such act or omission was committed in bad
690 faith or with malicious purpose or in a manner exhibiting wanton
691 and willful disregard of human rights, safety, or property. The
692 state or its subdivisions are shall not be liable in tort for
693 the acts or omissions of an officer, employee, or agent
694 committed while acting outside the course and scope of her or
695 his employment or committed in bad faith or with malicious
696 purpose or in a manner exhibiting wanton and willful disregard
697 of human rights, safety, or property.
698 (b) As used in this subsection, the term:
699 1. “Employee” includes any volunteer firefighter.
700 2. “Officer, employee, or agent” includes, but is not
701 limited to, any health care provider, and its employees or
702 agents, when providing services pursuant to s. 766.1115; any
703 nonprofit independent college or university located and
704 chartered in this state which owns or operates an accredited
705 medical school, and its employees or agents, when providing
706 patient services pursuant to paragraph (10)(f); and any public
707 defender or her or his employee or agent, including, among
708 others, an assistant public defender or and an investigator; and
709 any physician licensed in this state who is a medical director
710 for or member of a child protection team, as defined in s.
711 39.01, when carrying out her or his duties as a team member.
712 Section 12. Except as otherwise expressly provided in this
713 act, this act shall take effect July 1, 2016.
714
715 ================= T I T L E A M E N D M E N T ================
716 And the title is amended as follows:
717 Delete everything before the enacting clause
718 and insert:
719 A bill to be entitled
720 An act relating to health care; creating s. 381.4019,
721 F.S.; establishing a joint local and state dental care
722 access account initiative, subject to the availability
723 of funding; authorizing the creation of dental care
724 access accounts; specifying the purpose of the
725 initiative; defining terms; providing criteria for the
726 selection of dentists for participation in the
727 initiative; providing for the establishment of
728 accounts; requiring the Department of Health to
729 implement an electronic benefit transfer system;
730 providing for the use of funds deposited in the
731 accounts; requiring the department to distribute state
732 funds to accounts, subject to legislative
733 appropriations; authorizing the department to accept
734 contributions from a local source for deposit in a
735 designated account; limiting the number of years that
736 an account may remain open; providing for the
737 immediate closing of accounts under certain
738 circumstances; authorizing the department to transfer
739 state funds remaining in a closed account at a
740 specified time and to return unspent funds from local
741 sources; requiring a dentist to repay funds in certain
742 circumstances; authorizing the department to pursue
743 disciplinary enforcement actions and to use other
744 legal means to recover funds; requiring the department
745 to establish by rule application procedures and a
746 process to verify the use of funds withdrawn from a
747 dental care access account; requiring the department
748 to give priority to applications from dentists
749 practicing in certain areas; requiring the Department
750 of Economic Opportunity to rank dental health
751 professional shortage areas and medically underserved
752 areas; requiring the Department of Health to develop a
753 marketing plan in cooperation with certain dental
754 colleges and the Florida Dental Association; requiring
755 the Department of Health to annually submit a report
756 with certain information to the Governor and the
757 Legislature; providing rulemaking authority to require
758 the submission of information for such reporting;
759 amending s. 395.002, F.S.; revising the definition of
760 the term “ambulatory surgical center” or “mobile
761 surgical facility”; amending s. 395.003, F.S.;
762 requiring, as a condition of licensure and license
763 renewal, that ambulatory surgical centers provide
764 services to specified patients in at least a specified
765 amount; defining a term; creating s. 624.27, F.S.;
766 defining terms; specifying that a direct primary care
767 agreement does not constitute insurance and is not
768 subject to ch. 636, F.S., relating to prepaid limited
769 health service organizations and discount medical plan
770 organizations, or any other chapter of the Florida
771 Insurance Code; specifying that entering into a direct
772 primary care agreement does not constitute the
773 business of insurance and is not subject to ch. 636,
774 F.S., or any other chapter of the code; providing that
775 certain certificates of authority and licenses are not
776 required to market, sell, or offer to sell a direct
777 primary care agreement; specifying requirements for a
778 direct primary care agreement; providing a short
779 title; amending s. 409.967, F.S.; requiring a managed
780 care plan to establish a process by which a
781 prescribing physician may request an override of
782 certain restrictions in certain circumstances;
783 providing the circumstances under which an override
784 must be granted; defining the term “fail-first
785 protocol”; creating s. 627.42392, F.S.; requiring an
786 insurer to establish a process by which a prescribing
787 physician may request an override of certain
788 restrictions in certain circumstances; providing the
789 circumstances under which an override must be granted;
790 defining the term “fail-first protocol”; amending s.
791 641.31, F.S.; prohibiting a health maintenance
792 organization from requiring that a health care
793 provider use a clinical decision support system or a
794 laboratory benefits management program in certain
795 circumstances; defining terms; providing for
796 construction; creating s. 641.394, F.S.; requiring a
797 health maintenance organization to establish a process
798 by which a prescribing physician may request an
799 override of certain restrictions in certain
800 circumstances; providing the circumstances under which
801 an override must be granted; defining the term “fail
802 first protocol”; amending s. 766.1115, F.S.; revising
803 the definitions of the terms “contract” and “health
804 care provider”; deleting an obsolete date; extending
805 sovereign immunity to employees or agents of a health
806 care provider that executes a contract with a
807 governmental contractor; clarifying that a receipt of
808 specified notice must be acknowledged by a patient or
809 the patient’s representative at the initial visit;
810 requiring the posting of notice that a specified
811 health care provider is an agent of a governmental
812 contractor; amending s. 768.28, F.S.; revising the
813 definition of the term “officer, employee, or agent”
814 to include employees or agents of a health care
815 provider as it applies to immunity from personal
816 liability in certain actions, to include licensed
817 physicians who are medical directors for or members of
818 a child protection team, in certain circumstances;
819 providing effective dates.