Florida Senate - 2016 SENATOR AMENDMENT
Bill No. HB 85
Ì7255900Î725590
LEGISLATIVE ACTION
Senate . House
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Floor: 1/RE/2R .
03/08/2016 07:02 PM .
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Senator Gaetz moved 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. Ambulatory surgical centers shall report the same
203 financial, patient, postoperative surgical infection, and other
204 data pursuant to s. 408.061 as reported by hospitals to the
205 Agency for Health Care Administration or otherwise published by
206 the agency. For the purposes of this subsection, “charity care”
207 means uncompensated care delivered to uninsured patients with
208 incomes at or below 200 percent of the federal poverty level
209 when such services are preauthorized by the licensee and not
210 subject to collection procedures. An ambulatory surgical center
211 that keeps patients later than midnight on the day of the
212 procedure must comply with the same building codes and
213 lifesafety codes as a hospital.
214 (10)(9) A hospital licensed as of June 1, 2004, shall be
215 exempt from subsection (9) subsection (8) as long as the
216 hospital maintains the same ownership, facility street address,
217 and range of services that were in existence on June 1, 2004.
218 Any transfer of beds, or other agreements that result in the
219 establishment of a hospital or hospital services within the
220 intent of this section, shall be subject to subsection (9)
221 subsection (8). Unless the hospital is otherwise exempt under
222 subsection (9) subsection (8), the agency shall deny or revoke
223 the license of a hospital that violates any of the criteria set
224 forth in that subsection.
225 (11)(10) The agency may adopt rules implementing the
226 licensure requirements set forth in subsection (9) subsection
227 (8). Within 14 days after rendering its decision on a license
228 application or revocation, the agency shall publish its proposed
229 decision in the Florida Administrative Register. Within 21 days
230 after publication of the agency’s decision, any authorized
231 person may file a request for an administrative hearing. In
232 administrative proceedings challenging the approval, denial, or
233 revocation of a license pursuant to subsection (9) subsection
234 (8), the hearing must be based on the facts and law existing at
235 the time of the agency’s proposed agency action. Existing
236 hospitals may initiate or intervene in an administrative hearing
237 to approve, deny, or revoke licensure under subsection (9)
238 subsection (8) based upon a showing that an established program
239 will be substantially affected by the issuance or renewal of a
240 license to a hospital within the same district or service area.
241 Section 4. Section 624.27, Florida Statutes, is created to
242 read:
243 624.27 Application of code as to direct primary care
244 agreements.—
245 (1) As used in this section, the term:
246 (a) “Direct primary care agreement” means a contract
247 between a primary care provider and a patient, the patient’s
248 legal representative, or an employer which meets the
249 requirements specified under subsection (4) and does not
250 indemnify for services provided by a third party.
251 (b) “Primary care provider” means a health care
252 practitioner licensed under chapter 458, chapter 459, chapter
253 460, or chapter 464, or a primary care group practice that
254 provides medical services to patients which are commonly
255 provided without referral from another health care provider.
256 (c) “Primary care service” means the screening, assessment,
257 diagnosis, and treatment of a patient for the purpose of
258 promoting health or detecting and managing disease or injury
259 within the competency and training of the primary care provider.
260 (2) A direct primary care agreement does not constitute
261 insurance and is not subject to chapter 636 or any other chapter
262 of the Florida Insurance Code. The act of entering into a direct
263 primary care agreement does not constitute the business of
264 insurance and is not subject to chapter 636 or any other chapter
265 of the Florida Insurance Code.
266 (3) A primary care provider or an agent of a primary care
267 provider is not required to obtain a certificate of authority or
268 license under chapter 636 or any other chapter of the Florida
269 Insurance Code to market, sell, or offer to sell a direct
270 primary care agreement.
271 (4) For purposes of this section, a direct primary care
272 agreement must:
273 (a) Be in writing.
274 (b) Be signed by the primary care provider or an agent of
275 the primary care provider and the patient, the patient’s legal
276 representative, or an employer.
277 (c) Allow a party to terminate the agreement by giving the
278 other party at least 30 days’ advance written notice. The
279 agreement may provide for immediate termination due to a
280 violation of the physician-patient relationship or a breach of
281 the terms of the agreement.
282 (d) Describe the scope of primary care services that are
283 covered by the monthly fee.
284 (e) Specify the monthly fee and any fees for primary care
285 services not covered by the monthly fee.
286 (f) Specify the duration of the agreement and any automatic
287 renewal provisions.
288 (g) Offer a refund to the patient of monthly fees paid in
289 advance if the primary care provider ceases to offer primary
290 care services for any reason.
291 (h) Contain in contrasting color and in not less than 12
292 point type the following statements on the same page as the
293 applicant’s signature:
294 1. The agreement is not health insurance and the primary
295 care provider will not file any claims against the patient’s
296 health insurance policy or plan for reimbursement of any primary
297 care services covered by the agreement.
298 2. The agreement does not qualify as minimum essential
299 coverage to satisfy the individual shared responsibility
300 provision of the Patient Protection and Affordable Care Act, 26
301 U.S.C. s. 5000A.
302 Section 5. The sections created and amendments made by this
303 act to ss. 409.967, 627.42392, 641.31, and 641.394, Florida
304 Statutes, may be known as the “Right Medicine Right Time Act.”
305 Section 6. Effective January 1, 2017, paragraph (c) of
306 subsection (2) of section 409.967, Florida Statutes, is amended
307 to read:
308 409.967 Managed care plan accountability.—
309 (2) The agency shall establish such contract requirements
310 as are necessary for the operation of the statewide managed care
311 program. In addition to any other provisions the agency may deem
312 necessary, the contract must require:
313 (c) Access.—
314 1. The agency shall establish specific standards for the
315 number, type, and regional distribution of providers in managed
316 care plan networks to ensure access to care for both adults and
317 children. Each plan must maintain a regionwide network of
318 providers in sufficient numbers to meet the access standards for
319 specific medical services for all recipients enrolled in the
320 plan. The exclusive use of mail-order pharmacies may not be
321 sufficient to meet network access standards. Consistent with the
322 standards established by the agency, provider networks may
323 include providers located outside the region. A plan may
324 contract with a new hospital facility before the date the
325 hospital becomes operational if the hospital has commenced
326 construction, will be licensed and operational by January 1,
327 2013, and a final order has issued in any civil or
328 administrative challenge. Each plan shall establish and maintain
329 an accurate and complete electronic database of contracted
330 providers, including information about licensure or
331 registration, locations and hours of operation, specialty
332 credentials and other certifications, specific performance
333 indicators, and such other information as the agency deems
334 necessary. The database must be available online to both the
335 agency and the public and have the capability to compare the
336 availability of providers to network adequacy standards and to
337 accept and display feedback from each provider’s patients. Each
338 plan shall submit quarterly reports to the agency identifying
339 the number of enrollees assigned to each primary care provider.
340 2.a. Each managed care plan must publish any prescribed
341 drug formulary or preferred drug list on the plan’s website in a
342 manner that is accessible to and searchable by enrollees and
343 providers. The plan must update the list within 24 hours after
344 making a change. Each plan must ensure that the prior
345 authorization process for prescribed drugs is readily accessible
346 to health care providers, including posting appropriate contact
347 information on its website and providing timely responses to
348 providers. For Medicaid recipients diagnosed with hemophilia who
349 have been prescribed anti-hemophilic-factor replacement
350 products, the agency shall provide for those products and
351 hemophilia overlay services through the agency’s hemophilia
352 disease management program.
353 b. If a managed care plan restricts the use of prescribed
354 drugs through a fail-first protocol, it must establish a clear
355 and convenient process that a prescribing physician may use to
356 request an override of the restriction from the managed care
357 plan. The managed care plan shall grant an override of the
358 protocol within 24 hours if:
359 (I) Based on sound clinical evidence, the prescribing
360 provider concludes that the preferred treatment required under
361 the fail-first protocol has been ineffective in the treatment of
362 the enrollee’s disease or medical condition; or
363 (II) Based on sound clinical evidence or medical and
364 scientific evidence, the prescribing provider believes that the
365 preferred treatment required under the fail-first protocol:
366 (A) Is likely to be ineffective given the known relevant
367 physical or mental characteristics and medical history of the
368 enrollee and the known characteristics of the drug regimen; or
369 (B) Will cause or is likely to cause an adverse reaction or
370 other physical harm to the enrollee.
371
372 If the prescribing provider follows the fail-first protocol
373 recommended by the managed care plan for an enrollee, the
374 duration of treatment under the fail-first protocol may not
375 exceed a period deemed appropriate by the prescribing provider.
376 Following such period, if the prescribing provider deems the
377 treatment provided under the protocol clinically ineffective,
378 the enrollee is entitled to receive the course of therapy that
379 the prescribing provider recommends, and the provider is not
380 required to seek approval of an override of the fail-first
381 protocol. As used in this subparagraph, the term “fail-first
382 protocol” means a prescription practice that begins medication
383 for a medical condition with the most cost-effective drug
384 therapy and progresses to other more costly or risky therapies
385 only if necessary.
386 3. Managed care plans, and their fiscal agents or
387 intermediaries, must accept prior authorization requests for any
388 service electronically.
389 4. Managed care plans serving children in the care and
390 custody of the Department of Children and Families shall must
391 maintain complete medical, dental, and behavioral health
392 encounter information and participate in making such information
393 available to the department or the applicable contracted
394 community-based care lead agency for use in providing
395 comprehensive and coordinated case management. The agency and
396 the department shall establish an interagency agreement to
397 provide guidance for the format, confidentiality, recipient,
398 scope, and method of information to be made available and the
399 deadlines for submission of the data. The scope of information
400 available to the department are shall be the data that managed
401 care plans are required to submit to the agency. The agency
402 shall determine the plan’s compliance with standards for access
403 to medical, dental, and behavioral health services; the use of
404 medications; and followup on all medically necessary services
405 recommended as a result of early and periodic screening,
406 diagnosis, and treatment.
407 Section 7. Effective January 1, 2017, section 627.42392,
408 Florida Statutes, is created to read:
409 627.42392 Fail-first protocols.—If an insurer restricts the
410 use of prescribed drugs through a fail-first protocol, it must
411 establish a clear and convenient process that a prescribing
412 physician may use to request an override of the restriction from
413 the insurer. The insurer shall grant an override of the protocol
414 within 24 hours if:
415 (1) Based on sound clinical evidence, the prescribing
416 provider concludes that the preferred treatment required under
417 the fail-first protocol has been ineffective in the treatment of
418 the insured’s disease or medical condition; or
419 (2) Based on sound clinical evidence or medical and
420 scientific evidence, the prescribing provider believes that the
421 preferred treatment required under the fail-first protocol:
422 (a) Is likely to be ineffective given the known relevant
423 physical or mental characteristics and medical history of the
424 insured and the known characteristics of the drug regimen; or
425 (b) Will cause or is likely to cause an adverse reaction or
426 other physical harm to the insured.
427
428 If the prescribing provider follows the fail-first protocol
429 recommended by the insurer for an insured, the duration of
430 treatment under the fail-first protocol may not exceed a period
431 deemed appropriate by the prescribing provider. Following such
432 period, if the prescribing provider deems the treatment provided
433 under the protocol clinically ineffective, the insured is
434 entitled to receive the course of therapy that the prescribing
435 provider recommends, and the provider is not required to seek
436 approval of an override of the fail-first protocol. As used in
437 this section, the term “fail-first protocol” means a
438 prescription practice that begins medication for a medical
439 condition with the most cost-effective drug therapy and
440 progresses to other more costly or risky therapies only if
441 necessary.
442 Section 8. Effective January 1, 2017, subsection (44) is
443 added to section 641.31, Florida Statutes, to read:
444 641.31 Health maintenance contracts.—
445 (44) A health maintenance organization may not require a
446 health care provider, by contract with another health care
447 provider, a patient, or another individual or entity, to use a
448 clinical decision support system or a laboratory benefits
449 management program before the provider may order clinical
450 laboratory services or in an attempt to direct or limit the
451 provider’s medical decisionmaking relating to the use of such
452 services. This subsection may not be construed to prohibit any
453 prior authorization requirements that the health maintenance
454 organization may have regarding the provision of clinical
455 laboratory services. As used in this subsection, the term:
456 (a) “Clinical decision support system” means software
457 designed to direct or assist clinical decisionmaking by matching
458 the characteristics of an individual patient to a computerized
459 clinical knowledge base and providing patient-specific
460 assessments or recommendations based on the match.
461 (b) “Clinical laboratory services” means the examination of
462 fluids or other materials taken from the human body, which
463 examination is ordered by a health care provider for use in the
464 diagnosis, prevention, or treatment of a disease or in the
465 identification or assessment of a medical or physical condition.
466 (c) “Laboratory benefits management program” means a health
467 maintenance organization protocol that dictates or limits health
468 care provider decisionmaking relating to the use of clinical
469 laboratory services.
470 Section 9. Effective January 1, 2017, section 641.394,
471 Florida Statutes, is created to read:
472 641.394 Fail-first protocols.—If a health maintenance
473 organization restricts the use of prescribed drugs through a
474 fail-first protocol, it must establish a clear and convenient
475 process that a prescribing physician may use to request an
476 override of the restriction from the health maintenance
477 organization. The health maintenance organization shall grant an
478 override of the protocol within 24 hours if:
479 (1) Based on sound clinical evidence, the prescribing
480 provider concludes that the preferred treatment required under
481 the fail-first protocol has been ineffective in the treatment of
482 the subscriber’s disease or medical condition; or
483 (2) Based on sound clinical evidence or medical and
484 scientific evidence, the prescribing provider believes that the
485 preferred treatment required under the fail-first protocol:
486 (a) Is likely to be ineffective given the known relevant
487 physical or mental characteristics and medical history of the
488 subscriber and the known characteristics of the drug regimen; or
489 (b) Will cause or is likely to cause an adverse reaction or
490 other physical harm to the subscriber.
491
492 If the prescribing provider follows the fail-first protocol
493 recommended by the health maintenance organization for a
494 subscriber, the duration of treatment under the fail-first
495 protocol may not exceed a period deemed appropriate by the
496 prescribing provider. Following such period, if the prescribing
497 provider deems the treatment provided under the protocol
498 clinically ineffective, the subscriber is entitled to receive
499 the course of therapy that the prescribing provider recommends,
500 and the provider is not required to seek approval of an override
501 of the fail-first protocol. As used in this section, the term
502 “fail-first protocol” means a prescription practice that begins
503 medication for a medical condition with the most cost-effective
504 drug therapy and progresses to other more costly or risky
505 therapies only if necessary.
506 Section 10. Paragraphs (a) and (d) of subsection (3) and
507 subsections (4) and (5) of section 766.1115, Florida Statutes,
508 are amended to read:
509 766.1115 Health care providers; creation of agency
510 relationship with governmental contractors.—
511 (3) DEFINITIONS.—As used in this section, the term:
512 (a) “Contract” means an agreement executed in compliance
513 with this section between a health care provider and a
514 governmental contractor for volunteer, uncompensated services
515 which allows the health care provider to deliver health care
516 services to low-income recipients as an agent of the
517 governmental contractor. The contract must be for volunteer,
518 uncompensated services, except as provided in paragraph (4)(g).
519 For services to qualify as volunteer, uncompensated services
520 under this section, the health care provider, or any employee or
521 agent of the health care provider, must receive no compensation
522 from the governmental contractor for any services provided under
523 the contract and must not bill or accept compensation from the
524 recipient, or a public or private third-party payor, for the
525 specific services provided to the low-income recipients covered
526 by the contract, except as provided in paragraph (4)(g). A free
527 clinic as described in subparagraph (d)14. may receive a
528 legislative appropriation, a grant through a legislative
529 appropriation, or a grant from a governmental entity or
530 nonprofit corporation to support the delivery of contracted
531 services by volunteer health care providers, including the
532 employment of health care providers to supplement, coordinate,
533 or support the delivery of such services. The appropriation or
534 grant for the free clinic does not constitute compensation under
535 this paragraph from the governmental contractor for services
536 provided under the contract, nor does receipt or use of the
537 appropriation or grant constitute the acceptance of compensation
538 under this paragraph for the specific services provided to the
539 low-income recipients covered by the contract.
540 (d) “Health care provider” or “provider” means:
541 1. A birth center licensed under chapter 383.
542 2. An ambulatory surgical center licensed under chapter
543 395.
544 3. A hospital licensed under chapter 395.
545 4. A physician or physician assistant licensed under
546 chapter 458.
547 5. An osteopathic physician or osteopathic physician
548 assistant licensed under chapter 459.
549 6. A chiropractic physician licensed under chapter 460.
550 7. A podiatric physician licensed under chapter 461.
551 8. A registered nurse, nurse midwife, licensed practical
552 nurse, or advanced registered nurse practitioner licensed or
553 registered under part I of chapter 464 or any facility which
554 employs nurses licensed or registered under part I of chapter
555 464 to supply all or part of the care delivered under this
556 section.
557 9. A midwife licensed under chapter 467.
558 10. A health maintenance organization certificated under
559 part I of chapter 641.
560 11. A health care professional association and its
561 employees or a corporate medical group and its employees.
562 12. Any other medical facility the primary purpose of which
563 is to deliver human medical diagnostic services or which
564 delivers nonsurgical human medical treatment, and which includes
565 an office maintained by a provider.
566 13. A dentist or dental hygienist licensed under chapter
567 466.
568 14. A free clinic that delivers only medical diagnostic
569 services or nonsurgical medical treatment free of charge to all
570 low-income recipients.
571 15. A pharmacy or pharmacist licensed under chapter 465.
572 16.15. Any other health care professional, practitioner,
573 provider, or facility under contract with a governmental
574 contractor, including a student enrolled in an accredited
575 program that prepares the student for licensure as any one of
576 the professionals listed in subparagraphs 4.-9.
577
578 The term includes any nonprofit corporation qualified as exempt
579 from federal income taxation under s. 501(a) of the Internal
580 Revenue Code, and described in s. 501(c) of the Internal Revenue
581 Code, which delivers health care services provided by licensed
582 professionals listed in this paragraph, any federally funded
583 community health center, and any volunteer corporation or
584 volunteer health care provider that delivers health care
585 services.
586 (4) CONTRACT REQUIREMENTS.—A health care provider that
587 executes a contract with a governmental contractor to deliver
588 health care services on or after April 17, 1992, as an agent of
589 the governmental contractor, or any employee or agent of such
590 health care provider, is an agent for purposes of s. 768.28(9),
591 while acting within the scope of duties under the contract, if
592 the contract complies with the requirements of this section and
593 regardless of whether the individual treated is later found to
594 be ineligible. A health care provider, or any employee or agent
595 of such health care provider, shall continue to be an agent for
596 purposes of s. 768.28(9) for 30 days after a determination of
597 ineligibility to allow for treatment until the individual
598 transitions to treatment by another health care provider. A
599 health care provider, or any employee or agent of such health
600 care provider, under contract with the state may not be named as
601 a defendant in any action arising out of medical care or
602 treatment provided on or after April 17, 1992, under contracts
603 entered into under this section. The contract must provide that:
604 (a) The right of dismissal or termination of any health
605 care provider delivering services under the contract is retained
606 by the governmental contractor.
607 (b) The governmental contractor has access to the patient
608 records of any health care provider delivering services under
609 the contract.
610 (c) Adverse incidents and information on treatment outcomes
611 must be reported by any health care provider to the governmental
612 contractor if the incidents and information pertain to a patient
613 treated under the contract. The health care provider shall
614 submit the reports required by s. 395.0197. If an incident
615 involves a professional licensed by the Department of Health or
616 a facility licensed by the Agency for Health Care
617 Administration, the governmental contractor shall submit such
618 incident reports to the appropriate department or agency, which
619 shall review each incident and determine whether it involves
620 conduct by the licensee that is subject to disciplinary action.
621 All patient medical records and any identifying information
622 contained in adverse incident reports and treatment outcomes
623 which are obtained by governmental entities under this paragraph
624 are confidential and exempt from the provisions of s. 119.07(1)
625 and s. 24(a), Art. I of the State Constitution.
626 (d) Patient selection and initial referral must be made by
627 the governmental contractor or the provider. Patients may not be
628 transferred to the provider based on a violation of the
629 antidumping provisions of the Omnibus Budget Reconciliation Act
630 of 1989, the Omnibus Budget Reconciliation Act of 1990, or
631 chapter 395.
632 (e) If emergency care is required, the patient need not be
633 referred before receiving treatment, but must be referred within
634 48 hours after treatment is commenced or within 48 hours after
635 the patient has the mental capacity to consent to treatment,
636 whichever occurs later.
637 (f) The provider is subject to supervision and regular
638 inspection by the governmental contractor.
639 (g) As an agent of the governmental contractor for purposes
640 of s. 768.28(9), while acting within the scope of duties under
641 the contract, A health care provider licensed under chapter 466,
642 as an agent of the governmental contractor for purposes of s.
643 768.28(9), may allow a patient, or a parent or guardian of the
644 patient, to voluntarily contribute a monetary amount to cover
645 costs of dental laboratory work related to the services provided
646 to the patient within the scope of duties under the contract.
647 This contribution may not exceed the actual cost of the dental
648 laboratory charges.
649
650 A governmental contractor that is also a health care provider is
651 not required to enter into a contract under this section with
652 respect to the health care services delivered by its employees.
653 (5) NOTICE OF AGENCY RELATIONSHIP.—The governmental
654 contractor must provide written notice to each patient, or the
655 patient’s legal representative, receipt of which must be
656 acknowledged in writing at the initial visit, that the provider
657 is an agent of the governmental contractor and that the
658 exclusive remedy for injury or damage suffered as the result of
659 any act or omission of the provider or of any employee or agent
660 thereof acting within the scope of duties pursuant to the
661 contract is by commencement of an action pursuant to the
662 provisions of s. 768.28. Thereafter, or with respect to any
663 federally funded community health center, the notice
664 requirements may be met by posting in a place conspicuous to all
665 persons a notice that the health care provider, or federally
666 funded community health center, is an agent of the governmental
667 contractor and that the exclusive remedy for injury or damage
668 suffered as the result of any act or omission of the provider or
669 of any employee or agent thereof acting within the scope of
670 duties pursuant to the contract is by commencement of an action
671 pursuant to the provisions of s. 768.28.
672 Section 11. Paragraphs (a) and (b) of subsection (9) of
673 section 768.28, Florida Statutes, are amended to read:
674 768.28 Waiver of sovereign immunity in tort actions;
675 recovery limits; limitation on attorney fees; statute of
676 limitations; exclusions; indemnification; risk management
677 programs.—
678 (9)(a) An No officer, employee, or agent of the state or of
679 any of its subdivisions may not shall be held personally liable
680 in tort or named as a party defendant in any action for any
681 injury or damage suffered as a result of any act, event, or
682 omission of action in the scope of her or his employment or
683 function, unless such officer, employee, or agent acted in bad
684 faith or with malicious purpose or in a manner exhibiting wanton
685 and willful disregard of human rights, safety, or property.
686 However, such officer, employee, or agent shall be considered an
687 adverse witness in a tort action for any injury or damage
688 suffered as a result of any act, event, or omission of action in
689 the scope of her or his employment or function. The exclusive
690 remedy for injury or damage suffered as a result of an act,
691 event, or omission of an officer, employee, or agent of the
692 state or any of its subdivisions or constitutional officers is
693 shall be by action against the governmental entity, or the head
694 of such entity in her or his official capacity, or the
695 constitutional officer of which the officer, employee, or agent
696 is an employee, unless such act or omission was committed in bad
697 faith or with malicious purpose or in a manner exhibiting wanton
698 and willful disregard of human rights, safety, or property. The
699 state or its subdivisions are shall not be liable in tort for
700 the acts or omissions of an officer, employee, or agent
701 committed while acting outside the course and scope of her or
702 his employment or committed in bad faith or with malicious
703 purpose or in a manner exhibiting wanton and willful disregard
704 of human rights, safety, or property.
705 (b) As used in this subsection, the term:
706 1. “Employee” includes any volunteer firefighter.
707 2. “Officer, employee, or agent” includes, but is not
708 limited to, any health care provider, and its employees or
709 agents, when providing services pursuant to s. 766.1115; any
710 nonprofit independent college or university located and
711 chartered in this state which owns or operates an accredited
712 medical school, and its employees or agents, when providing
713 patient services pursuant to paragraph (10)(f); and any public
714 defender or her or his employee or agent, including, among
715 others, an assistant public defender or and an investigator.
716 Section 12. Except as otherwise expressly provided in this
717 act, this act shall take effect July 1, 2016.
718
719 ================= T I T L E A M E N D M E N T ================
720 And the title is amended as follows:
721 Delete everything before the enacting clause
722 and insert:
723 A bill to be entitled
724 An act relating to health care; creating s. 381.4019,
725 F.S.; establishing a joint local and state dental care
726 access account initiative, subject to the availability
727 of funding; authorizing the creation of dental care
728 access accounts; specifying the purpose of the
729 initiative; defining terms; providing criteria for the
730 selection of dentists for participation in the
731 initiative; providing for the establishment of
732 accounts; requiring the Department of Health to
733 implement an electronic benefit transfer system;
734 providing for the use of funds deposited in the
735 accounts; requiring the department to distribute state
736 funds to accounts, subject to legislative
737 appropriations; authorizing the department to accept
738 contributions from a local source for deposit in a
739 designated account; limiting the number of years that
740 an account may remain open; providing for the
741 immediate closing of accounts under certain
742 circumstances; authorizing the department to transfer
743 state funds remaining in a closed account at a
744 specified time and to return unspent funds from local
745 sources; requiring a dentist to repay funds in certain
746 circumstances; authorizing the department to pursue
747 disciplinary enforcement actions and to use other
748 legal means to recover funds; requiring the department
749 to establish by rule application procedures and a
750 process to verify the use of funds withdrawn from a
751 dental care access account; requiring the department
752 to give priority to applications from dentists
753 practicing in certain areas; requiring the Department
754 of Economic Opportunity to rank dental health
755 professional shortage areas and medically underserved
756 areas; requiring the Department of Health to develop a
757 marketing plan in cooperation with certain dental
758 colleges and the Florida Dental Association; requiring
759 the Department of Health to annually submit a report
760 with certain information to the Governor and the
761 Legislature; providing rulemaking authority to require
762 the submission of information for such reporting;
763 amending s. 395.002, F.S.; revising the definition of
764 the term “ambulatory surgical center” or “mobile
765 surgical facility”; amending s. 395.003, F.S.;
766 requiring, as a condition of licensure and license
767 renewal, that ambulatory surgical centers provide
768 services to specified patients in at least a specified
769 amount; requiring ambulatory surgical centers to
770 report certain data; defining a term; requiring
771 ambulatory surgical centers to comply with certain
772 building and lifesafety codes in certain
773 circumstances; creating s. 624.27, F.S.; defining
774 terms; specifying that a direct primary care agreement
775 does not constitute insurance and is not subject to
776 ch. 636, F.S., relating to prepaid limited health
777 service organizations and discount medical plan
778 organizations, or any other chapter of the Florida
779 Insurance Code; specifying that entering into a direct
780 primary care agreement does not constitute the
781 business of insurance and is not subject to ch. 636,
782 F.S., or any other chapter of the code; providing that
783 certain certificates of authority and licenses are not
784 required to market, sell, or offer to sell a direct
785 primary care agreement; specifying requirements for a
786 direct primary care agreement; providing a short
787 title; amending s. 409.967, F.S.; requiring a managed
788 care plan to establish a process by which a
789 prescribing physician may request an override of
790 certain restrictions in certain circumstances;
791 providing the circumstances under which an override
792 must be granted; defining the term “fail-first
793 protocol”; creating s. 627.42392, F.S.; requiring an
794 insurer to establish a process by which a prescribing
795 physician may request an override of certain
796 restrictions in certain circumstances; providing the
797 circumstances under which an override must be granted;
798 defining the term “fail-first protocol”; amending s.
799 641.31, F.S.; prohibiting a health maintenance
800 organization from requiring that a health care
801 provider use a clinical decision support system or a
802 laboratory benefits management program in certain
803 circumstances; defining terms; providing for
804 construction; creating s. 641.394, F.S.; requiring a
805 health maintenance organization to establish a process
806 by which a prescribing physician may request an
807 override of certain restrictions in certain
808 circumstances; providing the circumstances under which
809 an override must be granted; defining the term “fail
810 first protocol”; amending s. 766.1115, F.S.; revising
811 the definitions of the terms “contract” and “health
812 care provider”; deleting an obsolete date; extending
813 sovereign immunity to employees or agents of a health
814 care provider that executes a contract with a
815 governmental contractor; clarifying that a receipt of
816 specified notice must be acknowledged by a patient or
817 the patient’s representative at the initial visit;
818 requiring the posting of notice that a specified
819 health care provider is an agent of a governmental
820 contractor; amending s. 768.28, F.S.; revising the
821 definition of the term “officer, employee, or agent”
822 to include employees or agents of a health care
823 provider as it applies to immunity from personal
824 liability in certain actions; providing effective
825 dates.