Florida Senate - 2018 PROPOSED COMMITTEE SUBSTITUTE
Bill No. SB 622
Ì452688YÎ452688
576-02006A-18
Proposed Committee Substitute by the Committee on Appropriations
(Appropriations Subcommittee on Health and Human Services)
1 A bill to be entitled
2 An act relating to health care facility regulation;
3 creating s. 154.13, F.S.; providing that a designated
4 facility owned or operated by a public health trust
5 and located within the boundaries of a municipality is
6 under the exclusive jurisdiction of the county
7 creating the public health trust; amending ss.
8 381.0031, 381.004, 384.31, 395.009, 400.0625, and
9 409.905, F.S.; eliminating state licensure
10 requirements for clinical laboratories; requiring
11 clinical laboratories to be federally certified;
12 amending s. 383.313, F.S.; requiring a birth center to
13 be federally certified and meet specified requirements
14 to perform certain laboratory tests; repealing s.
15 383.335, F.S., relating to partial exemptions from
16 licensure requirements for certain facilities that
17 provide obstetrical and gynecological surgical
18 services; amending s. 395.002, F.S.; revising and
19 deleting definitions to remove the term “mobile
20 surgical facility”; conforming a cross-reference;
21 creating s. 395.0091, F.S.; requiring the Agency for
22 Health Care Administration, in consultation with the
23 Board of Clinical Laboratory Personnel, to adopt rules
24 establishing criteria for alternate-site laboratory
25 testing; requiring specifications to be included in
26 the criteria; defining the term “alternate-site
27 testing”; amending ss. 395.0161 and 395.0163, F.S.;
28 deleting licensure and inspection requirements for
29 mobile surgical facilities to conform to changes made
30 by the act; amending s. 395.0197, F.S.; requiring the
31 manager of a hospital or ambulatory surgical center
32 internal risk management program to demonstrate
33 competence in specified administrative and health care
34 service areas; conforming provisions to changes made
35 by the act; repealing s. 395.1046, F.S., relating to
36 hospital complaint investigation procedures; amending
37 s. 395.1055, F.S.; requiring hospitals that provide
38 specified services to meet agency licensure
39 requirements; providing standards to be included in
40 licensure requirements; conforming a provision to
41 changes made by the act; requiring a level 2
42 background screening for personnel of distinct part
43 nursing units; repealing ss. 395.10971 and 395.10972,
44 F.S., relating to the purpose and the establishment of
45 the Health Care Risk Manager Advisory Council,
46 respectively; amending s. 395.10973, F.S.; removing
47 requirements relating to agency standards for health
48 care risk managers to conform provisions to changes
49 made by the act; repealing s. 395.10974, F.S.,
50 relating to licensure of health care risk managers,
51 qualifications, licensure, and fees; repealing s.
52 395.10975, F.S., relating to grounds for denial,
53 suspension, or revocation of a health care risk
54 manager’s license and an administrative fine; amending
55 s. 395.602, F.S.; deleting definitions for the terms
56 “emergency care hospital”, “essential access community
57 hospital,” “inactive rural hospital bed”, and “rural
58 primary care hospital”; amending s. 395.603, F.S.;
59 deleting provisions relating to deactivation of
60 general hospital beds by certain rural and emergency
61 care hospitals; repealing s. 395.604, F.S., relating
62 to other rural hospital programs; repealing s.
63 395.605, F.S., relating to emergency care hospitals;
64 amending s. 395.701, F.S.; revising the definition of
65 the term “hospital” to exclude hospitals operated by a
66 state agency; amending s. 400.191, F.S.; removing the
67 30-month reporting timeframe for the Nursing Home
68 Guide; amending s. 400.464, F.S.; requiring that a
69 license issued to a home health agency on or after a
70 specified date specify the services the organization
71 is authorized to perform and whether the services
72 constitute skilled care; providing that the provision
73 or advertising of certain services constitutes
74 unlicensed activity under certain circumstances;
75 authorizing certain persons, entities or organizations
76 providing home health services to voluntarily apply
77 for a certificate of exemption from licensure by
78 providing certain information to the agency; providing
79 that the certificate is valid for a specified time and
80 is nontransferable; authorizing the agency to charge a
81 fee for the certificate; amending s. 400.471, F.S.;
82 revising home health agency licensure requirements;
83 providing requirements for proof of accreditation for
84 home health agencies applying for change of ownership
85 or the addition of skilled care services; removing a
86 provision prohibiting the agency from issuing a
87 license to a home health agency that fails to satisfy
88 the requirements of a Medicare certification survey
89 from the agency; amending s. 400.474, F.S.; revising
90 conditions for the imposition of a fine against a home
91 health agency; amending s. 400.476, F.S.; requiring a
92 home health agency providing skilled nursing care to
93 have a director of nursing; amending s. 400.484, F.S.;
94 imposing administrative fines on home health agencies
95 for specified classes of violations; amending s.
96 400.497, F.S.; requiring the agency to adopt, publish,
97 and enforce rules establishing standards for
98 certificates of exemption; amending s. 400.506, F.S.;
99 specifying a criminal penalty for any person who owns,
100 operates, or maintains an unlicensed nurse registry
101 that fails to cease operation immediately and apply
102 for a license after notification from the agency;
103 revising provisions authorizing the agency to impose a
104 fine on a nurse registry that fails to cease operation
105 after agency notification; revising circumstances
106 under which the agency is authorized to deny, suspend,
107 or revoke a license or impose a fine on a nurse
108 registry; prohibiting a nurse registry from
109 monitoring, supervising, managing, or training a
110 certain caregiver who is an independent contractor;
111 amending s. 400.606, F.S.; removing a requirement that
112 an existing licensed health care provider’s hospice
113 licensure application be accompanied by a copy of the
114 most recent profit-loss statement and licensure
115 inspection report; amending s. 400.925, F.S.; revising
116 the definition of the term “home medical equipment”;
117 amending s. 400.931, F.S.; requiring a home medical
118 equipment provider to notify the agency of certain
119 personnel changes within a specified timeframe;
120 amending s. 400.933, F.S.; requiring the agency to
121 accept the submission of a valid medical oxygen retail
122 establishment permit issued by the Department of
123 Business and Professional Regulation in lieu of an
124 agency inspection for licensure; amending s. 400.980,
125 F.S.; revising the timeframe within which a health
126 care services pool registrant must provide the agency
127 with certain changes of information; amending s.
128 400.9935, F.S.; specifying that a voluntary
129 certificate of exemption may be valid for up to 2
130 years; amending s. 408.036, F.S.; conforming
131 provisions to changes made by the act; deleting
132 obsolete provisions relating to certificate of need
133 requirements for specified services; amending s.
134 408.0361, F.S.; providing an exception for a hospital
135 to become a Level I Adult Cardiovascular provider if
136 certain requirements are met; amending s. 408.061,
137 F.S.; excluding hospitals operated by state agencies
138 from certain financial reporting requirements;
139 conforming a cross-reference; amending s. 408.07,
140 F.S.; deleting the definition for the term “clinical
141 laboratory”; amending s. 408.20, F.S.; exempting
142 hospitals operated by any state agency from
143 assessments against the Health Care Trust Fund to fund
144 certain agency activities; repealing s. 408.7056,
145 F.S., relating to the Subscriber Assistance Program;
146 amending s. 408.803, F.S.; defining the term
147 “relative” for purposes of the Health Care Licensing
148 Procedures Act; amending s. 408.806, F.S.; authorizing
149 licensees who hold licenses for multiple providers to
150 request that the agency align related license
151 expiration dates; authorizing the agency to issue
152 licenses for an abbreviated licensure period and to
153 charge a prorated licensure fee; amending s. 408.809,
154 F.S.; expanding the scope of persons subject to a
155 level 2 background screening to include any employee
156 of a licensee who is a controlling interest and
157 certain part-time contractors; amending s. 408.810,
158 F.S.; providing that an applicant for change of
159 ownership licensure is exempt from furnishing proof of
160 financial ability to operate if certain conditions are
161 met; authorizing the agency to adopt rules governing
162 circumstances under which a controlling interest may
163 act in certain legal capacities on behalf of a patient
164 or client; requiring a licensee to ensure that certain
165 persons do not hold an ownership interest if the
166 licensee is not organized as or owned by a publicly
167 traded corporation; defining the term “publicly traded
168 corporation”; amending s. 408.812, F.S.; providing
169 that certain unlicensed activity by a provider
170 constitutes abuse and neglect; clarifying that the
171 agency may impose a fine or penalty, as prescribed in
172 an authorizing statute, if an unlicensed provider who
173 has received notification fails to cease operation;
174 authorizing the agency to revoke all licenses and
175 impose a fine or penalties upon a controlling interest
176 or licensee who has an interest in more than one
177 provider and who fails to license a provider rendering
178 services that require licensure in certain
179 circumstances; amending s. 408.820, F.S.; deleting
180 certain exemptions from part II of ch. 408, F.S., for
181 specified providers to conform provisions to changes
182 made by the act; amending s. 409.907, F.S.; removing
183 the agency’s authority to consider certain factors in
184 determining whether to enter into, and in maintaining,
185 a Medicaid provider agreement; amending s. 429.02,
186 F.S.; revising definitions of the terms “assisted
187 living facility” and “personal services”; amending s.
188 429.04, F.S.; providing additional exemptions from
189 licensure as an assisted living facility; requiring a
190 person or entity asserting the exemption to provide
191 documentation that substantiates the claim upon agency
192 investigation of unlicensed activity; amending s.
193 429.08, F.S.; providing criminal penalties and fines
194 for a person who rents or otherwise maintains a
195 building or property used as an unlicensed assisted
196 living facility; providing criminal penalties and
197 fines for a person who owns, operates, or maintains an
198 unlicensed assisted living facility after receiving
199 notice from the agency; amending s. 429.176, F.S.;
200 prohibiting an assisted living facility from operating
201 for more than a specified time without an
202 administrator who has completed certain educational
203 requirements; amending s. 429.24, F.S.; providing that
204 30-day written notice of rate increase for residency
205 in an assisted living facility is not required in
206 certain situations; amending s. 429.28, F.S.; revising
207 the assisted living facility resident bill of rights
208 to include assistance with obtaining access to
209 adequate and appropriate health care; defining the
210 term “adequate and appropriate health care”; deleting
211 a requirement that the agency conduct at least one
212 monitoring visit under certain circumstances; deleting
213 provisions authorizing the agency to conduct periodic
214 followup inspections and complaint investigations
215 under certain circumstances; amending s. 429.294,
216 F.S.; deleting the specified timeframe within which an
217 assisted living facility must provide complete copies
218 of a resident’s records in an investigation of
219 resident’s rights; amending s. 429.34, F.S.;
220 authorizing the agency to inspect and investigate
221 assisted living facilities as necessary to determine
222 compliance with certain laws; removing a provision
223 requiring the agency to inspect each licensed assisted
224 living facility at least biennially; authorizing the
225 agency to conduct monitoring visits of each facility
226 cited for prior violations under certain
227 circumstances; amending s. 429.52, F.S.; requiring an
228 assisted living facility administrator to complete
229 required training and education within a specified
230 timeframe; amending s. 435.04, F.S.; providing that
231 security background investigations must ensure that a
232 person has not been arrested for, and is not awaiting
233 final disposition of, certain offenses; requiring that
234 security background investigations for purposes of
235 participation in the Medicaid program screen for
236 violations of federal or state law, rule, or
237 regulation governing any state Medicaid program, the
238 Medicare program, or any other publicly funded federal
239 or state health care or health insurance program;
240 specifying offenses under federal law or any state law
241 that the security background investigations must
242 screen for; amending s. 456.054, F.S.; prohibiting any
243 person or entity from paying or receiving a kickback
244 for referring patients to a clinical laboratory;
245 prohibiting a clinical laboratory from providing
246 personnel to perform certain functions or duties in a
247 health care practitioner’s office or dialysis
248 facility; providing an exception; prohibiting a
249 clinical laboratory from leasing space in any part of
250 a health care practitioner’s office or dialysis
251 facility; repealing part I of ch. 483, F.S., relating
252 to clinical laboratories; amending s. 483.294, F.S.;
253 removing a requirement that the agency inspect
254 multiphasic health testing centers at least once
255 annually; amending s. 483.801, F.S.; providing an
256 exemption from regulation for certain persons employed
257 by certain laboratories; amending s. 483.803, F.S.;
258 revising definitions of the terms “clinical
259 laboratory”, and “clinical laboratory examination”;
260 removing a cross-reference; amending s. 641.511, F.S.;
261 revising health maintenance organization subscriber
262 grievance reporting requirements; repealing s. 641.60,
263 F.S., relating to the Statewide Managed Care Ombudsman
264 Committee; repealing s. 641.65, F.S., relating to
265 district managed care ombudsman committees; repealing
266 s. 641.67, F.S., relating to a district managed care
267 ombudsman committee, exemption from public records
268 requirements, and exceptions; repealing s. 641.68,
269 F.S., relating to a district managed care ombudsman
270 committee and exemption from public meeting
271 requirements; repealing s. 641.70, F.S., relating to
272 agency duties relating to the Statewide Managed Care
273 Ombudsman Committee and the district managed care
274 ombudsman committees; repealing s. 641.75, F.S.,
275 relating to immunity from liability and limitation on
276 testimony; amending s. 945.36, F.S.; authorizing law
277 enforcement personnel to conduct drug tests on certain
278 inmates and releasees; amending ss. 20.43, 220.1845,
279 376.30781, 376.86, 381.0034, 381.0405, 383.14, 383.30,
280 383.301, 383.302, 383.305, 383.309, 383.33, 385.211,
281 394.4787, 395.001, 395.003, 395.7015, 400.9905,
282 408.033, 408.802, 409.9116, 409.975, 429.19, 456.001,
283 456.057, 456.076, 458.307, 458.345, 459.021, 483.813,
284 483.823, 491.003, 627.351, 627.602, 627.6406,
285 627.64194, 627.6513, 627.6574, 641.185, 641.31,
286 641.312, 641.3154, 641.51, 641.515, 641.55, 766.118,
287 766.202, 1009.65, and 1011.52, F.S.; conforming
288 provisions to changes made by the act; providing an
289 effective date.
290
291 Be It Enacted by the Legislature of the State of Florida:
292
293 Section 1. Paragraph (g) of subsection (3) of section
294 20.43, Florida Statutes, is amended to read:
295 20.43 Department of Health.—There is created a Department
296 of Health.
297 (3) The following divisions of the Department of Health are
298 established:
299 (g) Division of Medical Quality Assurance, which is
300 responsible for the following boards and professions established
301 within the division:
302 1. The Board of Acupuncture, created under chapter 457.
303 2. The Board of Medicine, created under chapter 458.
304 3. The Board of Osteopathic Medicine, created under chapter
305 459.
306 4. The Board of Chiropractic Medicine, created under
307 chapter 460.
308 5. The Board of Podiatric Medicine, created under chapter
309 461.
310 6. Naturopathy, as provided under chapter 462.
311 7. The Board of Optometry, created under chapter 463.
312 8. The Board of Nursing, created under part I of chapter
313 464.
314 9. Nursing assistants, as provided under part II of chapter
315 464.
316 10. The Board of Pharmacy, created under chapter 465.
317 11. The Board of Dentistry, created under chapter 466.
318 12. Midwifery, as provided under chapter 467.
319 13. The Board of Speech-Language Pathology and Audiology,
320 created under part I of chapter 468.
321 14. The Board of Nursing Home Administrators, created under
322 part II of chapter 468.
323 15. The Board of Occupational Therapy, created under part
324 III of chapter 468.
325 16. Respiratory therapy, as provided under part V of
326 chapter 468.
327 17. Dietetics and nutrition practice, as provided under
328 part X of chapter 468.
329 18. The Board of Athletic Training, created under part XIII
330 of chapter 468.
331 19. The Board of Orthotists and Prosthetists, created under
332 part XIV of chapter 468.
333 20. Electrolysis, as provided under chapter 478.
334 21. The Board of Massage Therapy, created under chapter
335 480.
336 22. The Board of Clinical Laboratory Personnel, created
337 under part II III of chapter 483.
338 23. Medical physicists, as provided under part IV of
339 chapter 483.
340 24. The Board of Opticianry, created under part I of
341 chapter 484.
342 25. The Board of Hearing Aid Specialists, created under
343 part II of chapter 484.
344 26. The Board of Physical Therapy Practice, created under
345 chapter 486.
346 27. The Board of Psychology, created under chapter 490.
347 28. School psychologists, as provided under chapter 490.
348 29. The Board of Clinical Social Work, Marriage and Family
349 Therapy, and Mental Health Counseling, created under chapter
350 491.
351 30. Emergency medical technicians and paramedics, as
352 provided under part III of chapter 401.
353 Section 2. Section 154.13, Florida Statutes, is created to
354 read:
355 154.13 Designated facilities; jurisdiction.—Any designated
356 facility owned or operated by a public health trust and located
357 within the boundaries of a municipality is under the exclusive
358 jurisdiction of the county creating the public health trust and
359 is not within the jurisdiction of the municipality.
360 Section 3. Paragraph (k) of subsection (2) of section
361 220.1845, Florida Statutes, is amended to read:
362 220.1845 Contaminated site rehabilitation tax credit.—
363 (2) AUTHORIZATION FOR TAX CREDIT; LIMITATIONS.—
364 (k) In order to encourage the construction and operation of
365 a new health care facility as defined in s. 408.032 or s.
366 408.07, or a health care provider as defined in s. 408.07 or s.
367 408.7056, on a brownfield site, an applicant for a tax credit
368 may claim an additional 25 percent of the total site
369 rehabilitation costs, not to exceed $500,000, if the applicant
370 meets the requirements of this paragraph. In order to receive
371 this additional tax credit, the applicant must provide
372 documentation indicating that the construction of the health
373 care facility or health care provider by the applicant on the
374 brownfield site has received a certificate of occupancy or a
375 license or certificate has been issued for the operation of the
376 health care facility or health care provider.
377 Section 4. Paragraph (f) of subsection (3) of section
378 376.30781, Florida Statutes, is amended to read:
379 376.30781 Tax credits for rehabilitation of drycleaning
380 solvent-contaminated sites and brownfield sites in designated
381 brownfield areas; application process; rulemaking authority;
382 revocation authority.—
383 (3)(f) In order to encourage the construction and operation
384 of a new health care facility or a health care provider, as
385 defined in s. 408.032 or, s. 408.07, or s. 408.7056, on a
386 brownfield site, an applicant for a tax credit may claim an
387 additional 25 percent of the total site rehabilitation costs,
388 not to exceed $500,000, if the applicant meets the requirements
389 of this paragraph. In order to receive this additional tax
390 credit, the applicant must provide documentation indicating that
391 the construction of the health care facility or health care
392 provider by the applicant on the brownfield site has received a
393 certificate of occupancy or a license or certificate has been
394 issued for the operation of the health care facility or health
395 care provider.
396 Section 5. Subsection (1) of section 376.86, Florida
397 Statutes, is amended to read:
398 376.86 Brownfield Areas Loan Guarantee Program.—
399 (1) The Brownfield Areas Loan Guarantee Council is created
400 to review and approve or deny, by a majority vote of its
401 membership, the situations and circumstances for participation
402 in partnerships by agreements with local governments, financial
403 institutions, and others associated with the redevelopment of
404 brownfield areas pursuant to the Brownfields Redevelopment Act
405 for a limited state guaranty of up to 5 years of loan guarantees
406 or loan loss reserves issued pursuant to law. The limited state
407 loan guaranty applies only to 50 percent of the primary lenders
408 loans for redevelopment projects in brownfield areas. If the
409 redevelopment project is for affordable housing, as defined in
410 s. 420.0004, in a brownfield area, the limited state loan
411 guaranty applies to 75 percent of the primary lender’s loan. If
412 the redevelopment project includes the construction and
413 operation of a new health care facility or a health care
414 provider, as defined in s. 408.032 or, s. 408.07, or s.
415 408.7056, on a brownfield site and the applicant has obtained
416 documentation in accordance with s. 376.30781 indicating that
417 the construction of the health care facility or health care
418 provider by the applicant on the brownfield site has received a
419 certificate of occupancy or a license or certificate has been
420 issued for the operation of the health care facility or health
421 care provider, the limited state loan guaranty applies to 75
422 percent of the primary lender’s loan. A limited state guaranty
423 of private loans or a loan loss reserve is authorized for
424 lenders licensed to operate in the state upon a determination by
425 the council that such an arrangement would be in the public
426 interest and the likelihood of the success of the loan is great.
427 Section 6. Subsection (2) of section 381.0031, Florida
428 Statutes, is amended to read:
429 381.0031 Epidemiological research; report of diseases of
430 public health significance to department.—
431 (2) Any practitioner licensed in this state to practice
432 medicine, osteopathic medicine, chiropractic medicine,
433 naturopathy, or veterinary medicine; any hospital licensed under
434 part I of chapter 395; or any laboratory appropriately certified
435 by the Centers for Medicare and Medicaid Services under the
436 federal Clinical Laboratory Improvement Amendments and the
437 federal rules adopted thereunder which licensed under chapter
438 483 that diagnoses or suspects the existence of a disease of
439 public health significance shall immediately report the fact to
440 the Department of Health.
441 Section 7. Subsection (3) of section 381.0034, Florida
442 Statutes, is amended to read:
443 381.0034 Requirement for instruction on HIV and AIDS.—
444 (3) The department shall require, as a condition of
445 granting a license under chapter 467 or part II III of chapter
446 483, that an applicant making initial application for licensure
447 complete an educational course acceptable to the department on
448 human immunodeficiency virus and acquired immune deficiency
449 syndrome. Upon submission of an affidavit showing good cause, an
450 applicant who has not taken a course at the time of licensure
451 shall be allowed 6 months to complete this requirement.
452 Section 8. Paragraph (c) of subsection (4) of section
453 381.004, Florida Statutes, is amended to read:
454 381.004 HIV testing.—
455 (4) HUMAN IMMUNODEFICIENCY VIRUS TESTING REQUIREMENTS;
456 REGISTRATION WITH THE DEPARTMENT OF HEALTH; EXEMPTIONS FROM
457 REGISTRATION.—No county health department and no other person in
458 this state shall conduct or hold themselves out to the public as
459 conducting a testing program for acquired immune deficiency
460 syndrome or human immunodeficiency virus status without first
461 registering with the Department of Health, reregistering each
462 year, complying with all other applicable provisions of state
463 law, and meeting the following requirements:
464 (c) The program shall have all laboratory procedures
465 performed in a laboratory appropriately certified by the Centers
466 for Medicare and Medicaid Services under the federal Clinical
467 Laboratory Improvement Amendments and the federal rules adopted
468 thereunder licensed under the provisions of chapter 483.
469 Section 9. Paragraph (f) of subsection (4) of section
470 381.0405, Florida Statutes, is amended to read:
471 381.0405 Office of Rural Health.—
472 (4) COORDINATION.—The office shall:
473 (f) Assume responsibility for state coordination of the
474 Rural Hospital Transition Grant Program, the Essential Access
475 Community Hospital Program, and other federal rural health care
476 programs.
477 Section 10. Paragraph (a) of subsection (2) of section
478 383.14, Florida Statutes, is amended to read:
479 383.14 Screening for metabolic disorders, other hereditary
480 and congenital disorders, and environmental risk factors.—
481 (2) RULES.—
482 (a) After consultation with the Genetics and Newborn
483 Screening Advisory Council, the department shall adopt and
484 enforce rules requiring that every newborn in this state shall:
485 1. Before becoming 1 week of age, be subjected to a test
486 for phenylketonuria;
487 2. Be tested for any condition included on the federal
488 Recommended Uniform Screening Panel which the council advises
489 the department should be included under the state’s screening
490 program. After the council recommends that a condition be
491 included, the department shall submit a legislative budget
492 request to seek an appropriation to add testing of the condition
493 to the newborn screening program. The department shall expand
494 statewide screening of newborns to include screening for such
495 conditions within 18 months after the council renders such
496 advice, if a test approved by the United States Food and Drug
497 Administration or a test offered by an alternative vendor which
498 is compatible with the clinical standards established under part
499 I of chapter 483 is available. If such a test is not available
500 within 18 months after the council makes its recommendation, the
501 department shall implement such screening as soon as a test
502 offered by the United States Food and Drug Administration or by
503 an alternative vendor is available; and
504 3. At the appropriate age, be tested for such other
505 metabolic diseases and hereditary or congenital disorders as the
506 department may deem necessary from time to time.
507 Section 11. Section 383.30, Florida Statutes, is amended to
508 read:
509 383.30 Birth Center Licensure Act; short title.—Sections
510 383.30-383.332 383.30-383.335 shall be known and may be cited as
511 the “Birth Center Licensure Act.”
512 Section 12. Section 383.301, Florida Statutes, is amended
513 to read:
514 383.301 Licensure and regulation of birth centers;
515 legislative intent.—It is the intent of the Legislature to
516 provide for the protection of public health and safety in the
517 establishment, maintenance, and operation of birth centers by
518 providing for licensure of birth centers and for the
519 development, establishment, and enforcement of minimum standards
520 with respect to birth centers. The requirements of part II of
521 chapter 408 shall apply to the provision of services that
522 require licensure pursuant to ss. 383.30-383.332 383.30-383.335
523 and part II of chapter 408 and to entities licensed by or
524 applying for such licensure from the Agency for Health Care
525 Administration pursuant to ss. 383.30-383.332 383.30-383.335. A
526 license issued by the agency is required in order to operate a
527 birth center in this state.
528 Section 13. Section 383.302, Florida Statutes, is amended
529 to read:
530 383.302 Definitions of terms used in ss. 383.30-383.332
531 383.30-383.335.—As used in ss. 383.30-383.332 383.30-383.335,
532 the term:
533 (1) “Agency” means the Agency for Health Care
534 Administration.
535 (2) “Birth center” means any facility, institution, or
536 place, which is not an ambulatory surgical center or a hospital
537 or in a hospital, in which births are planned to occur away from
538 the mother’s usual residence following a normal, uncomplicated,
539 low-risk pregnancy.
540 (3) “Clinical staff” means individuals employed full time
541 or part time by a birth center who are licensed or certified to
542 provide care at childbirth.
543 (4) “Consultant” means a physician licensed pursuant to
544 chapter 458 or chapter 459 who agrees to provide advice and
545 services to a birth center and who either:
546 (a) Is certified or eligible for certification by the
547 American Board of Obstetrics and Gynecology, or
548 (b) Has hospital obstetrical privileges.
549 (5) “Governing body” means any individual, group,
550 corporation, or institution which is responsible for the overall
551 operation and maintenance of a birth center.
552 (6) “Governmental unit” means the state or any county,
553 municipality, or other political subdivision or any department,
554 division, board, or other agency of any of the foregoing.
555 (7) “Licensed facility” means a facility licensed in
556 accordance with s. 383.305.
557 (8) “Low-risk pregnancy” means a pregnancy which is
558 expected to result in an uncomplicated birth, as determined
559 through risk criteria developed by rule of the department, and
560 which is accompanied by adequate prenatal care.
561 (9) “Person” means any individual, firm, partnership,
562 corporation, company, association, institution, or joint stock
563 association and means any legal successor of any of the
564 foregoing.
565 (10) “Premises” means those buildings, beds, and facilities
566 located at the main address of the licensee and all other
567 buildings, beds, and facilities for the provision of maternity
568 care located in such reasonable proximity to the main address of
569 the licensee as to appear to the public to be under the dominion
570 and control of the licensee.
571 Section 14. Subsection (1) of section 383.305, Florida
572 Statutes, is amended to read:
573 383.305 Licensure; fees.—
574 (1) In accordance with s. 408.805, an applicant or a
575 licensee shall pay a fee for each license application submitted
576 under ss. 383.30-383.332 383.30-383.335 and part II of chapter
577 408. The amount of the fee shall be established by rule.
578 Section 15. Subsection (1) of section 383.309, Florida
579 Statutes, is amended to read:
580 383.309 Minimum standards for birth centers; rules and
581 enforcement.—
582 (1) The agency shall adopt and enforce rules to administer
583 ss. 383.30-383.332 383.30-383.335 and part II of chapter 408,
584 which rules shall include, but are not limited to, reasonable
585 and fair minimum standards for ensuring that:
586 (a) Sufficient numbers and qualified types of personnel and
587 occupational disciplines are available at all times to provide
588 necessary and adequate patient care and safety.
589 (b) Infection control, housekeeping, sanitary conditions,
590 disaster plan, and medical record procedures that will
591 adequately protect patient care and provide safety are
592 established and implemented.
593 (c) Licensed facilities are established, organized, and
594 operated consistent with established programmatic standards.
595 Section 16. Subsection (1) of section 383.313, Florida
596 Statutes, is amended to read:
597 383.313 Performance of laboratory and surgical services;
598 use of anesthetic and chemical agents.—
599 (1) LABORATORY SERVICES.—A birth center may collect
600 specimens for those tests that are requested under protocol. A
601 birth center must obtain and continuously maintain certification
602 by the Centers for Medicare and Medicaid Services under the
603 federal Clinical Laboratory Improvement Amendments and the
604 federal rules adopted thereunder in order to may perform simple
605 laboratory tests specified, as defined by rule of the agency,
606 and which are appropriate to meet the needs of the patient is
607 exempt from the requirements of chapter 483, provided no more
608 than five physicians are employed by the birth center and
609 testing is conducted exclusively in connection with the
610 diagnosis and treatment of clients of the birth center.
611 Section 17. Subsection (1) and paragraph (a) of subsection
612 (2) of section 383.33, Florida Statutes, are amended to read:
613 383.33 Administrative penalties; moratorium on admissions.—
614 (1) In addition to the requirements of part II of chapter
615 408, the agency may impose an administrative fine not to exceed
616 $500 per violation per day for the violation of any provision of
617 ss. 383.30-383.332 383.30-383.335, part II of chapter 408, or
618 applicable rules.
619 (2) In determining the amount of the fine to be levied for
620 a violation, as provided in this section, the following factors
621 shall be considered:
622 (a) The severity of the violation, including the
623 probability that death or serious harm to the health or safety
624 of any person will result or has resulted; the severity of the
625 actual or potential harm; and the extent to which the provisions
626 of ss. 383.30-383.332 383.30-383.335, part II of chapter 408, or
627 applicable rules were violated.
628 Section 18. Section 383.335, Florida Statutes, is repealed.
629 Section 19. Section 384.31, Florida Statutes, is amended to
630 read:
631 384.31 Testing of pregnant women; duty of the attendant.
632 Every person, including every physician licensed under chapter
633 458 or chapter 459 or midwife licensed under part I of chapter
634 464 or chapter 467, attending a pregnant woman for conditions
635 relating to pregnancy during the period of gestation and
636 delivery shall cause the woman to be tested for sexually
637 transmissible diseases, including HIV, as specified by
638 department rule. Testing shall be performed by a laboratory
639 appropriately certified by the Centers for Medicare and Medicaid
640 Services under the federal Clinical Laboratory Improvement
641 Amendments and the federal rules adopted thereunder approved for
642 such purposes under part I of chapter 483. The woman shall be
643 informed of the tests that will be conducted and of her right to
644 refuse testing. If a woman objects to testing, a written
645 statement of objection, signed by the woman, shall be placed in
646 the woman’s medical record and no testing shall occur.
647 Section 20. Subsection (2) of section 385.211, Florida
648 Statutes, is amended to read:
649 385.211 Refractory and intractable epilepsy treatment and
650 research at recognized medical centers.—
651 (2) Notwithstanding chapter 893, medical centers recognized
652 pursuant to s. 381.925, or an academic medical research
653 institution legally affiliated with a licensed children’s
654 specialty hospital as defined in s. 395.002(27) s. 395.002(28)
655 that contracts with the Department of Health, may conduct
656 research on cannabidiol and low-THC cannabis. This research may
657 include, but is not limited to, the agricultural development,
658 production, clinical research, and use of liquid medical
659 derivatives of cannabidiol and low-THC cannabis for the
660 treatment for refractory or intractable epilepsy. The authority
661 for recognized medical centers to conduct this research is
662 derived from 21 C.F.R. parts 312 and 316. Current state or
663 privately obtained research funds may be used to support the
664 activities described in this section.
665 Section 21. Subsection (7) of section 394.4787, Florida
666 Statutes, is amended to read:
667 394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and
668 394.4789.—As used in this section and ss. 394.4786, 394.4788,
669 and 394.4789:
670 (7) “Specialty psychiatric hospital” means a hospital
671 licensed by the agency pursuant to s. 395.002(27) s. 395.002(28)
672 and part II of chapter 408 as a specialty psychiatric hospital.
673 Section 22. Section 395.001, Florida Statutes, is amended
674 to read:
675 395.001 Legislative intent.—It is the intent of the
676 Legislature to provide for the protection of public health and
677 safety in the establishment, construction, maintenance, and
678 operation of hospitals and, ambulatory surgical centers, and
679 mobile surgical facilities by providing for licensure of same
680 and for the development, establishment, and enforcement of
681 minimum standards with respect thereto.
682 Section 23. Present subsections (22) through (33) of
683 section 395.002, Florida Statutes, are redesignated as
684 subsections (21) through (32), respectively, and subsections (3)
685 and (16) of that section and present subsections (21) and (23)
686 of that section are amended, to read:
687 395.002 Definitions.—As used in this chapter:
688 (3) “Ambulatory surgical center” or “mobile surgical
689 facility” means a facility the primary purpose of which is to
690 provide elective surgical care, in which the patient is admitted
691 to and discharged from such facility within the same working day
692 and is not permitted to stay overnight, and which is not part of
693 a hospital. However, a facility existing for the primary purpose
694 of performing terminations of pregnancy, an office maintained by
695 a physician for the practice of medicine, or an office
696 maintained for the practice of dentistry may shall not be
697 construed to be an ambulatory surgical center, provided that any
698 facility or office which is certified or seeks certification as
699 a Medicare ambulatory surgical center shall be licensed as an
700 ambulatory surgical center pursuant to s. 395.003. Any structure
701 or vehicle in which a physician maintains an office and
702 practices surgery, and which can appear to the public to be a
703 mobile office because the structure or vehicle operates at more
704 than one address, shall be construed to be a mobile surgical
705 facility.
706 (16) “Licensed facility” means a hospital or, ambulatory
707 surgical center, or mobile surgical facility licensed in
708 accordance with this chapter.
709 (21) “Mobile surgical facility” is a mobile facility in
710 which licensed health care professionals provide elective
711 surgical care under contract with the Department of Corrections
712 or a private correctional facility operating pursuant to chapter
713 957 and in which inmate patients are admitted to and discharged
714 from said facility within the same working day and are not
715 permitted to stay overnight. However, mobile surgical facilities
716 may only provide health care services to the inmate patients of
717 the Department of Corrections, or inmate patients of a private
718 correctional facility operating pursuant to chapter 957, and not
719 to the general public.
720 (22)(23) “Premises” means those buildings, beds, and
721 equipment located at the address of the licensed facility and
722 all other buildings, beds, and equipment for the provision of
723 hospital or, ambulatory surgical, or mobile surgical care
724 located in such reasonable proximity to the address of the
725 licensed facility as to appear to the public to be under the
726 dominion and control of the licensee. For any licensee that is a
727 teaching hospital as defined in s. 408.07 s. 408.07(45),
728 reasonable proximity includes any buildings, beds, services,
729 programs, and equipment under the dominion and control of the
730 licensee that are located at a site with a main address that is
731 within 1 mile of the main address of the licensed facility; and
732 all such buildings, beds, and equipment may, at the request of a
733 licensee or applicant, be included on the facility license as a
734 single premises.
735 Section 24. Paragraphs (a) and (b) of subsection (1) and
736 paragraph (b) of subsection (2) of section 395.003, Florida
737 Statutes, are amended to read:
738 395.003 Licensure; denial, suspension, and revocation.—
739 (1)(a) The requirements of part II of chapter 408 apply to
740 the provision of services that require licensure pursuant to ss.
741 395.001-395.1065 and part II of chapter 408 and to entities
742 licensed by or applying for such licensure from the Agency for
743 Health Care Administration pursuant to ss. 395.001-395.1065. A
744 license issued by the agency is required in order to operate a
745 hospital or, ambulatory surgical center, or mobile surgical
746 facility in this state.
747 (b)1. It is unlawful for a person to use or advertise to
748 the public, in any way or by any medium whatsoever, any facility
749 as a “hospital,” or “ambulatory surgical center,” or “mobile
750 surgical facility” unless such facility has first secured a
751 license under the provisions of this part.
752 2. This part does not apply to veterinary hospitals or to
753 commercial business establishments using the word “hospital,” or
754 “ambulatory surgical center,” or “mobile surgical facility” as a
755 part of a trade name if no treatment of human beings is
756 performed on the premises of such establishments.
757 (2)(b) The agency shall, at the request of a licensee that
758 is a teaching hospital as defined in s. 408.07 s. 408.07(45),
759 issue a single license to a licensee for facilities that have
760 been previously licensed as separate premises, provided such
761 separately licensed facilities, taken together, constitute the
762 same premises as defined in s. 395.002 s. 395.002(23). Such
763 license for the single premises shall include all of the beds,
764 services, and programs that were previously included on the
765 licenses for the separate premises. The granting of a single
766 license under this paragraph may shall not in any manner reduce
767 the number of beds, services, or programs operated by the
768 licensee.
769 Section 25. Subsection (1) of section 395.009, Florida
770 Statutes, is amended to read:
771 395.009 Minimum standards for clinical laboratory test
772 results and diagnostic X-ray results; prerequisite for issuance
773 or renewal of license.—
774 (1) As a requirement for issuance or renewal of its
775 license, each licensed facility shall require that all clinical
776 laboratory tests performed by or for the licensed facility be
777 performed by a clinical laboratory appropriately certified by
778 the Centers for Medicare and Medicaid Services under the federal
779 Clinical Laboratory Improvement Amendments and the federal rules
780 adopted thereunder licensed under the provisions of chapter 483.
781 Section 26. Section 395.0091, Florida Statutes, is created
782 to read:
783 395.0091 Alternate-site testing.—The agency, in
784 consultation with the Board of Clinical Laboratory Personnel,
785 shall adopt by rule the criteria for alternate-site testing to
786 be performed under the supervision of a clinical laboratory
787 director. At a minimum, the criteria must address hospital
788 internal needs assessment; a protocol for implementation,
789 including the identification of tests to be performed and who
790 will perform them; selection of the method of testing to be used
791 for alternate-site testing; minimum training and education
792 requirements for those who will perform alternate-site testing,
793 such as documented training, licensure, certification, or other
794 medical professional background not limited to laboratory
795 professionals; documented inservice training and initial and
796 ongoing competency validation; an appropriate internal and
797 external quality control protocol; an internal mechanism for the
798 central laboratory to identify and track alternate-site testing;
799 and recordkeeping requirements. Alternate-site testing locations
800 must register when the hospital applies to renew its license.
801 For purposes of this section, the term “alternate-site testing”
802 includes any laboratory testing done under the administrative
803 control of a hospital, but performed out of the physical or
804 administrative confines of the central laboratory.
805 Section 27. Paragraph (f) of subsection (1) of section
806 395.0161, Florida Statutes, is amended to read:
807 395.0161 Licensure inspection.—
808 (1) In addition to the requirement of s. 408.811, the
809 agency shall make or cause to be made such inspections and
810 investigations as it deems necessary, including:
811 (f) Inspections of mobile surgical facilities at each time
812 a facility establishes a new location, prior to the admission of
813 patients. However, such inspections shall not be required when a
814 mobile surgical facility is moved temporarily to a location
815 where medical treatment will not be provided.
816 Section 28. Subsection (3) of section 395.0163, Florida
817 Statutes, is amended to read:
818 395.0163 Construction inspections; plan submission and
819 approval; fees.—
820 (3) In addition to the requirements of s. 408.811, the
821 agency shall inspect a mobile surgical facility at initial
822 licensure and at each time the facility establishes a new
823 location, prior to admission of patients. However, such
824 inspections shall not be required when a mobile surgical
825 facility is moved temporarily to a location where medical
826 treatment will not be provided.
827 Section 29. Subsection (2), paragraph (c) of subsection
828 (6), and subsections (16) and (17) of section 395.0197, Florida
829 Statutes, are amended to read:
830 395.0197 Internal risk management program.—
831 (2) The internal risk management program is the
832 responsibility of the governing board of the health care
833 facility. Each licensed facility shall hire a risk manager,
834 licensed under s. 395.10974, who is responsible for
835 implementation and oversight of the such facility’s internal
836 risk management program and who demonstrates competence, through
837 education or experience, in all of the following areas:
838 (a) Applicable standards of health care risk management.
839 (b) Applicable federal, state, and local health and safety
840 laws and rules.
841 (c) General risk management administration.
842 (d) Patient care.
843 (e) Medical care.
844 (f) Personal and social care.
845 (g) Accident prevention.
846 (h) Departmental organization and management.
847 (i) Community interrelationships.
848 (j) Medical terminology as required by this section. A risk
849 manager must not be made responsible for more than four internal
850 risk management programs in separate licensed facilities, unless
851 the facilities are under one corporate ownership or the risk
852 management programs are in rural hospitals.
853 (6)(c) The report submitted to the agency must shall also
854 contain the name and license number of the risk manager of the
855 licensed facility, a copy of its policy and procedures which
856 govern the measures taken by the facility and its risk manager
857 to reduce the risk of injuries and adverse incidents, and the
858 results of such measures. The annual report is confidential and
859 is not available to the public pursuant to s. 119.07(1) or any
860 other law providing access to public records. The annual report
861 is not discoverable or admissible in any civil or administrative
862 action, except in disciplinary proceedings by the agency or the
863 appropriate regulatory board. The annual report is not available
864 to the public as part of the record of investigation for and
865 prosecution in disciplinary proceedings made available to the
866 public by the agency or the appropriate regulatory board.
867 However, the agency or the appropriate regulatory board shall
868 make available, upon written request by a health care
869 professional against whom probable cause has been found, any
870 such records which form the basis of the determination of
871 probable cause.
872 (16) There shall be no monetary liability on the part of,
873 and no cause of action for damages shall arise against, any risk
874 manager, licensed under s. 395.10974, for the implementation and
875 oversight of the internal risk management program in a facility
876 licensed under this chapter or chapter 390 as required by this
877 section, for any act or proceeding undertaken or performed
878 within the scope of the functions of such internal risk
879 management program if the risk manager acts without intentional
880 fraud.
881 (17) A privilege against civil liability is hereby granted
882 to any licensed risk manager or licensed facility with regard to
883 information furnished pursuant to this chapter, unless the
884 licensed risk manager or facility acted in bad faith or with
885 malice in providing such information.
886 Section 30. Section 395.1046, Florida Statutes, is
887 repealed.
888 Section 31. Subsections (2) and (3) of section 395.1055,
889 Florida Statutes, are amended, and paragraph (i) is added to
890 subsection (1), to read:
891 395.1055 Rules and enforcement.—
892 (1) The agency shall adopt rules pursuant to ss. 120.536(1)
893 and 120.54 to implement the provisions of this part, which shall
894 include reasonable and fair minimum standards for ensuring that:
895 (i) All hospitals providing organ transplantation, neonatal
896 intensive care services, inpatient psychiatric services,
897 inpatient substance abuse services, or comprehensive medical
898 rehabilitation meet the minimum licensure requirements adopted
899 by the agency. Such licensure requirements must include quality
900 of care, nurse staffing, physician staffing, physical plant,
901 equipment, emergency transportation, and data reporting
902 standards.
903 (2) Separate standards may be provided for general and
904 specialty hospitals, ambulatory surgical centers, mobile
905 surgical facilities, and statutory rural hospitals as defined in
906 s. 395.602.
907 (3) The agency shall adopt rules with respect to the care
908 and treatment of patients residing in distinct part nursing
909 units of hospitals which are certified for participation in
910 Title XVIII (Medicare) and Title XIX (Medicaid) of the Social
911 Security Act skilled nursing facility program. Such rules shall
912 take into account the types of patients treated in hospital
913 skilled nursing units, including typical patient acuity levels
914 and the average length of stay in such units, and shall be
915 limited to the appropriate portions of the Omnibus Budget
916 Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,
917 1987), Title IV (Medicare, Medicaid, and Other Health-Related
918 Programs), Subtitle C (Nursing Home Reform), as amended. The
919 agency shall require level 2 background screening as specified
920 in s. 408.809(1)(e) pursuant to s. 408.809 and chapter 435 for
921 personnel of distinct part nursing units.
922 Section 32. Section 395.10971, Florida Statutes, is
923 repealed.
924 Section 33. Section 395.10972, Florida Statutes, is
925 repealed.
926 Section 34. Section 395.10973, Florida Statutes, is amended
927 to read:
928 395.10973 Powers and duties of the agency.—It is the
929 function of the agency to:
930 (1) Adopt rules pursuant to ss. 120.536(1) and 120.54 to
931 implement the provisions of this part and part II of chapter 408
932 conferring duties upon it.
933 (2) Develop, impose, and enforce specific standards within
934 the scope of the general qualifications established by this part
935 which must be met by individuals in order to receive licenses as
936 health care risk managers. These standards shall be designed to
937 ensure that health care risk managers are individuals of good
938 character and otherwise suitable and, by training or experience
939 in the field of health care risk management, qualified in
940 accordance with the provisions of this part to serve as health
941 care risk managers, within statutory requirements.
942 (3) Develop a method for determining whether an individual
943 meets the standards set forth in s. 395.10974.
944 (4) Issue licenses to qualified individuals meeting the
945 standards set forth in s. 395.10974.
946 (5) Receive, investigate, and take appropriate action with
947 respect to any charge or complaint filed with the agency to the
948 effect that a certified health care risk manager has failed to
949 comply with the requirements or standards adopted by rule by the
950 agency or to comply with the provisions of this part.
951 (6) Establish procedures for providing periodic reports on
952 persons certified or disciplined by the agency under this part.
953 (2)(7) Develop a model risk management program for health
954 care facilities which will satisfy the requirements of s.
955 395.0197.
956 (3)(8) Enforce the special-occupancy provisions of the
957 Florida Building Code which apply to hospitals, intermediate
958 residential treatment facilities, and ambulatory surgical
959 centers in conducting any inspection authorized by this chapter
960 and part II of chapter 408.
961 Section 35. Section 395.10974, Florida Statutes, is
962 repealed.
963 Section 36. Section 395.10975, Florida Statutes, is
964 repealed.
965 Section 37. Subsection (2) of section 395.602, Florida
966 Statutes, is amended to read:
967 395.602 Rural hospitals.—
968 (2) DEFINITIONS.—As used in this part, the term:
969 (a) “Emergency care hospital” means a medical facility
970 which provides:
971 1. Emergency medical treatment; and
972 2. Inpatient care to ill or injured persons prior to their
973 transportation to another hospital or provides inpatient medical
974 care to persons needing care for a period of up to 96 hours. The
975 96-hour limitation on inpatient care does not apply to respite,
976 skilled nursing, hospice, or other nonacute care patients.
977 (b) “Essential access community hospital” means any
978 facility which:
979 1. Has at least 100 beds;
980 2. Is located more than 35 miles from any other essential
981 access community hospital, rural referral center, or urban
982 hospital meeting criteria for classification as a regional
983 referral center;
984 3. Is part of a network that includes rural primary care
985 hospitals;
986 4. Provides emergency and medical backup services to rural
987 primary care hospitals in its rural health network;
988 5. Extends staff privileges to rural primary care hospital
989 physicians in its network; and
990 6. Accepts patients transferred from rural primary care
991 hospitals in its network.
992 (c) “Inactive rural hospital bed” means a licensed acute
993 care hospital bed, as defined in s. 395.002(13), that is
994 inactive in that it cannot be occupied by acute care inpatients.
995 (a)(d) “Rural area health education center” means an area
996 health education center (AHEC), as authorized by Pub. L. No. 94
997 484, which provides services in a county with a population
998 density of up to no greater than 100 persons per square mile.
999 (b)(e) “Rural hospital” means an acute care hospital
1000 licensed under this chapter, having 100 or fewer licensed beds
1001 and an emergency room, which is:
1002 1. The sole provider within a county with a population
1003 density of up to 100 persons per square mile;
1004 2. An acute care hospital, in a county with a population
1005 density of up to 100 persons per square mile, which is at least
1006 30 minutes of travel time, on normally traveled roads under
1007 normal traffic conditions, from any other acute care hospital
1008 within the same county;
1009 3. A hospital supported by a tax district or subdistrict
1010 whose boundaries encompass a population of up to 100 persons per
1011 square mile;
1012 4. A hospital classified as a sole community hospital under
1013 42 C.F.R. s. 412.92 which has up to 175, regardless of the
1014 number of licensed beds;
1015 5. A hospital with a service area that has a population of
1016 up to 100 persons per square mile. As used in this subparagraph,
1017 the term “service area” means the fewest number of zip codes
1018 that account for 75 percent of the hospital’s discharges for the
1019 most recent 5-year period, based on information available from
1020 the hospital inpatient discharge database in the Florida Center
1021 for Health Information and Transparency at the agency; or
1022 6. A hospital designated as a critical access hospital, as
1023 defined in s. 408.07.
1024
1025 Population densities used in this paragraph must be based upon
1026 the most recently completed United States census. A hospital
1027 that received funds under s. 409.9116 for a quarter beginning no
1028 later than July 1, 2002, is deemed to have been and shall
1029 continue to be a rural hospital from that date through June 30,
1030 2021, if the hospital continues to have up to 100 licensed beds
1031 and an emergency room. An acute care hospital that has not
1032 previously been designated as a rural hospital and that meets
1033 the criteria of this paragraph shall be granted such designation
1034 upon application, including supporting documentation, to the
1035 agency. A hospital that was licensed as a rural hospital during
1036 the 2010-2011 or 2011-2012 fiscal year shall continue to be a
1037 rural hospital from the date of designation through June 30,
1038 2021, if the hospital continues to have up to 100 licensed beds
1039 and an emergency room.
1040 (f) “Rural primary care hospital” means any facility
1041 meeting the criteria in paragraph (e) or s. 395.605 which
1042 provides:
1043 1. Twenty-four-hour emergency medical care;
1044 2. Temporary inpatient care for periods of 72 hours or less
1045 to patients requiring stabilization before discharge or transfer
1046 to another hospital. The 72-hour limitation does not apply to
1047 respite, skilled nursing, hospice, or other nonacute care
1048 patients; and
1049 3. Has no more than six licensed acute care inpatient beds.
1050 (c)(g) “Swing-bed” means a bed which can be used
1051 interchangeably as either a hospital, skilled nursing facility
1052 (SNF), or intermediate care facility (ICF) bed pursuant to 42
1053 C.F.R. parts 405, 435, 440, 442, and 447.
1054 Section 38. Section 395.603, Florida Statutes, is amended
1055 to read:
1056 395.603 Deactivation of general hospital beds; Rural
1057 hospital impact statement.—
1058 (1) The agency shall establish, by rule, a process by which
1059 a rural hospital, as defined in s. 395.602, that seeks licensure
1060 as a rural primary care hospital or as an emergency care
1061 hospital, or becomes a certified rural health clinic as defined
1062 in Pub. L. No. 95-210, or becomes a primary care program such as
1063 a county health department, community health center, or other
1064 similar outpatient program that provides preventive and curative
1065 services, may deactivate general hospital beds. Rural primary
1066 care hospitals and emergency care hospitals shall maintain the
1067 number of actively licensed general hospital beds necessary for
1068 the facility to be certified for Medicare reimbursement.
1069 Hospitals that discontinue inpatient care to become rural health
1070 care clinics or primary care programs shall deactivate all
1071 licensed general hospital beds. All hospitals, clinics, and
1072 programs with inactive beds shall provide 24-hour emergency
1073 medical care by staffing an emergency room. Providers with
1074 inactive beds shall be subject to the criteria in s. 395.1041.
1075 The agency shall specify in rule requirements for making 24-hour
1076 emergency care available. Inactive general hospital beds shall
1077 be included in the acute care bed inventory, maintained by the
1078 agency for certificate-of-need purposes, for 10 years from the
1079 date of deactivation of the beds. After 10 years have elapsed,
1080 inactive beds shall be excluded from the inventory. The agency
1081 shall, at the request of the licensee, reactivate the inactive
1082 general beds upon a showing by the licensee that licensure
1083 requirements for the inactive general beds are met.
1084 (2) In formulating and implementing policies and rules that
1085 may have significant impact on the ability of rural hospitals to
1086 continue to provide health care services in rural communities,
1087 the agency, the department, or the respective regulatory board
1088 adopting policies or rules regarding the licensure or
1089 certification of health care professionals shall provide a rural
1090 hospital impact statement. The rural hospital impact statement
1091 shall assess the proposed action in light of the following
1092 questions:
1093 (1)(a) Do the health personnel affected by the proposed
1094 action currently practice in rural hospitals or are they likely
1095 to in the near future?
1096 (2)(b) What are the current numbers of the affected health
1097 personnel in this state, their geographic distribution, and the
1098 number practicing in rural hospitals?
1099 (3)(c) What are the functions presently performed by the
1100 affected health personnel, and are such functions presently
1101 performed in rural hospitals?
1102 (4)(d) What impact will the proposed action have on the
1103 ability of rural hospitals to recruit the affected personnel to
1104 practice in their facilities?
1105 (5)(e) What impact will the proposed action have on the
1106 limited financial resources of rural hospitals through increased
1107 salaries and benefits necessary to recruit or retain such health
1108 personnel?
1109 (6)(f) Is there a less stringent requirement which could
1110 apply to practice in rural hospitals?
1111 (7)(g) Will this action create staffing shortages, which
1112 could result in a loss to the public of health care services in
1113 rural hospitals or result in closure of any rural hospitals?
1114 Section 39. Section 395.604, Florida Statutes, is repealed.
1115 Section 40. Section 395.605, Florida Statutes, is repealed.
1116 Section 41. Paragraph (c) of subsection (1) of section
1117 395.701, Florida Statutes, is amended to read:
1118 395.701 Annual assessments on net operating revenues for
1119 inpatient and outpatient services to fund public medical
1120 assistance; administrative fines for failure to pay assessments
1121 when due; exemption.—
1122 (1) For the purposes of this section, the term:
1123 (c) “Hospital” means a health care institution as defined
1124 in s. 395.002(12), but does not include any hospital operated by
1125 a state the agency or the Department of Corrections.
1126 Section 42. Paragraph (b) of subsection (2) of section
1127 395.7015, Florida Statutes, is amended to read:
1128 395.7015 Annual assessment on health care entities.—
1129 (2) There is imposed an annual assessment against certain
1130 health care entities as described in this section:
1131 (b) For the purpose of this section, “health care entities”
1132 include the following:
1133 1. Ambulatory surgical centers and mobile surgical
1134 facilities licensed under s. 395.003. This subsection shall only
1135 apply to mobile surgical facilities operating under contracts
1136 entered into on or after July 1, 1998.
1137 2. Clinical laboratories licensed under s. 483.091,
1138 excluding any hospital laboratory defined under s. 483.041(6),
1139 any clinical laboratory operated by the state or a political
1140 subdivision of the state, any clinical laboratory which
1141 qualifies as an exempt organization under s. 501(c)(3) of the
1142 Internal Revenue Code of 1986, as amended, and which receives 70
1143 percent or more of its gross revenues from services to charity
1144 patients or Medicaid patients, and any blood, plasma, or tissue
1145 bank procuring, storing, or distributing blood, plasma, or
1146 tissue either for future manufacture or research or distributed
1147 on a nonprofit basis, and further excluding any clinical
1148 laboratory which is wholly owned and operated by 6 or fewer
1149 physicians who are licensed pursuant to chapter 458 or chapter
1150 459 and who practice in the same group practice, and at which no
1151 clinical laboratory work is performed for patients referred by
1152 any health care provider who is not a member of the same group.
1153 2.3. Diagnostic-imaging centers that are freestanding
1154 outpatient facilities that provide specialized services for the
1155 identification or determination of a disease through examination
1156 and also provide sophisticated radiological services, and in
1157 which services are rendered by a physician licensed by the Board
1158 of Medicine under s. 458.311, s. 458.313, or s. 458.317, or by
1159 an osteopathic physician licensed by the Board of Osteopathic
1160 Medicine under s. 459.0055 or s. 459.0075. For purposes of this
1161 paragraph, “sophisticated radiological services” means the
1162 following: magnetic resonance imaging; nuclear medicine;
1163 angiography; arteriography; computed tomography; positron
1164 emission tomography; digital vascular imaging; bronchography;
1165 lymphangiography; splenography; ultrasound, excluding ultrasound
1166 providers that are part of a private physician’s office practice
1167 or when ultrasound is provided by two or more physicians
1168 licensed under chapter 458 or chapter 459 who are members of the
1169 same professional association and who practice in the same
1170 medical specialties; and such other sophisticated radiological
1171 services, excluding mammography, as adopted in rule by the
1172 board.
1173 Section 43. Subsection (1) of section 400.0625, Florida
1174 Statutes, is amended to read:
1175 400.0625 Minimum standards for clinical laboratory test
1176 results and diagnostic X-ray results.—
1177 (1) Each nursing home, as a requirement for issuance or
1178 renewal of its license, shall require that all clinical
1179 laboratory tests performed for the nursing home be performed by
1180 a clinical laboratory appropriately certified by the Centers for
1181 Medicare and Medicaid Services under the federal Clinical
1182 Laboratory Improvement Amendments and the federal rules adopted
1183 thereunder licensed under the provisions of chapter 483, except
1184 for such self-testing procedures as are approved by the agency
1185 by rule. Results of clinical laboratory tests performed prior to
1186 admission which meet the minimum standards provided in s.
1187 483.181(3) shall be accepted in lieu of routine examinations
1188 required upon admission and clinical laboratory tests which may
1189 be ordered by a physician for residents of the nursing home.
1190 Section 44. Paragraph (a) of subsection (2) of section
1191 400.191, Florida Statutes, is amended to read:
1192 400.191 Availability, distribution, and posting of reports
1193 and records.—
1194 (2) The agency shall publish the Nursing Home Guide
1195 quarterly in electronic form to assist consumers and their
1196 families in comparing and evaluating nursing home facilities.
1197 (a) The agency shall provide an Internet site which shall
1198 include at least the following information either directly or
1199 indirectly through a link to another established site or sites
1200 of the agency’s choosing:
1201 1. A section entitled “Have you considered programs that
1202 provide alternatives to nursing home care?” which shall be the
1203 first section of the Nursing Home Guide and which shall
1204 prominently display information about available alternatives to
1205 nursing homes and how to obtain additional information regarding
1206 these alternatives. The Nursing Home Guide shall explain that
1207 this state offers alternative programs that permit qualified
1208 elderly persons to stay in their homes instead of being placed
1209 in nursing homes and shall encourage interested persons to call
1210 the Comprehensive Assessment Review and Evaluation for Long-Term
1211 Care Services (CARES) Program to inquire if they qualify. The
1212 Nursing Home Guide shall list available home and community-based
1213 programs which shall clearly state the services that are
1214 provided and indicate whether nursing home services are included
1215 if needed.
1216 2. A list by name and address of all nursing home
1217 facilities in this state, including any prior name by which a
1218 facility was known during the previous 24-month period.
1219 3. Whether such nursing home facilities are proprietary or
1220 nonproprietary.
1221 4. The current owner of the facility’s license and the year
1222 that that entity became the owner of the license.
1223 5. The name of the owner or owners of each facility and
1224 whether the facility is affiliated with a company or other
1225 organization owning or managing more than one nursing facility
1226 in this state.
1227 6. The total number of beds in each facility and the most
1228 recently available occupancy levels.
1229 7. The number of private and semiprivate rooms in each
1230 facility.
1231 8. The religious affiliation, if any, of each facility.
1232 9. The languages spoken by the administrator and staff of
1233 each facility.
1234 10. Whether or not each facility accepts Medicare or
1235 Medicaid recipients or insurance, health maintenance
1236 organization, Veterans Administration, CHAMPUS program, or
1237 workers’ compensation coverage.
1238 11. Recreational and other programs available at each
1239 facility.
1240 12. Special care units or programs offered at each
1241 facility.
1242 13. Whether the facility is a part of a retirement
1243 community that offers other services pursuant to part III of
1244 this chapter or part I or part III of chapter 429.
1245 14. Survey and deficiency information, including all
1246 federal and state recertification, licensure, revisit, and
1247 complaint survey information, for each facility for the past 30
1248 months. For noncertified nursing homes, state survey and
1249 deficiency information, including licensure, revisit, and
1250 complaint survey information for the past 30 months shall be
1251 provided.
1252 Section 45. Subsection (1) and paragraphs (b), (e), and (f)
1253 of subsection (4) of section 400.464, Florida Statutes, are
1254 amended, and subsection (6) is added to that section, to read:
1255 400.464 Home health agencies to be licensed; expiration of
1256 license; exemptions; unlawful acts; penalties.—
1257 (1) The requirements of part II of chapter 408 apply to the
1258 provision of services that require licensure pursuant to this
1259 part and part II of chapter 408 and entities licensed or
1260 registered by or applying for such licensure or registration
1261 from the Agency for Health Care Administration pursuant to this
1262 part. A license issued by the agency is required in order to
1263 operate a home health agency in this state. A license issued on
1264 or after July 1, 2018, must specify the home health services the
1265 organization is authorized to perform and indicate whether such
1266 specified services are considered skilled care. The provision or
1267 advertising of services that require licensure pursuant to this
1268 part without such services being specified on the face of the
1269 license issued on or after July 1, 2018, constitutes unlicensed
1270 activity as prohibited under s. 408.812.
1271 (4)(b) The operation or maintenance of an unlicensed home
1272 health agency or the performance of any home health services in
1273 violation of this part is declared a nuisance, inimical to the
1274 public health, welfare, and safety. The agency or any state
1275 attorney may, in addition to other remedies provided in this
1276 part, bring an action for an injunction to restrain such
1277 violation, or to enjoin the future operation or maintenance of
1278 the home health agency or the provision of home health services
1279 in violation of this part or part II of chapter 408, until
1280 compliance with this part or the rules adopted under this part
1281 has been demonstrated to the satisfaction of the agency.
1282 (e) Any person who owns, operates, or maintains an
1283 unlicensed home health agency and who, within 10 working days
1284 after receiving notification from the agency, fails to cease
1285 operation and apply for a license under this part commits a
1286 misdemeanor of the second degree, punishable as provided in s.
1287 775.082 or s. 775.083. Each day of continued operation is a
1288 separate offense.
1289 (f) Any home health agency that fails to cease operation
1290 after agency notification may be fined in accordance with s.
1291 408.812 $500 for each day of noncompliance.
1292 (6) Any person, entity, or organization providing home
1293 health services which is exempt from licensure under subsection
1294 (5) may voluntarily apply for a certificate of exemption from
1295 licensure under its exempt status with the agency on a form that
1296 specifies its name or names and addresses, a statement of the
1297 reasons why it is exempt from licensure as a home health agency,
1298 and other information deemed necessary by the agency. A
1299 certificate of exemption is valid for a period of not more than
1300 2 years and is not transferable. The agency may charge an
1301 applicant $100 for a certificate of exemption or charge the
1302 actual cost of processing the certificate.
1303 Section 46. Subsections (6) through (9) of section 400.471,
1304 Florida Statutes, are redesignated as subsections (5) through
1305 (8), respectively, and present subsections (2),(6), and (9) of
1306 that section are amended, to read:
1307 400.471 Application for license; fee.—
1308 (2) In addition to the requirements of part II of chapter
1309 408, the initial applicant, the applicant for a change of
1310 ownership, and the applicant for the addition of skilled care
1311 services must file with the application satisfactory proof that
1312 the home health agency is in compliance with this part and
1313 applicable rules, including:
1314 (a) A listing of services to be provided, either directly
1315 by the applicant or through contractual arrangements with
1316 existing providers.
1317 (b) The number and discipline of professional staff to be
1318 employed.
1319 (c) Completion of questions concerning volume data on the
1320 renewal application as determined by rule.
1321 (c)(d) A business plan, signed by the applicant, which
1322 details the home health agency’s methods to obtain patients and
1323 its plan to recruit and maintain staff.
1324 (d)(e) Evidence of contingency funding as required under s.
1325 408.8065 equal to 1 month’s average operating expenses during
1326 the first year of operation.
1327 (e)(f) A balance sheet, income and expense statement, and
1328 statement of cash flows for the first 2 years of operation which
1329 provide evidence of having sufficient assets, credit, and
1330 projected revenues to cover liabilities and expenses. The
1331 applicant has demonstrated financial ability to operate if the
1332 applicant’s assets, credit, and projected revenues meet or
1333 exceed projected liabilities and expenses. An applicant may not
1334 project an operating margin of 15 percent or greater for any
1335 month in the first year of operation. All documents required
1336 under this paragraph must be prepared in accordance with
1337 generally accepted accounting principles and compiled and signed
1338 by a certified public accountant.
1339 (f)(g) All other ownership interests in health care
1340 entities for each controlling interest, as defined in part II of
1341 chapter 408.
1342 (g)(h) In the case of an application for initial licensure,
1343 an application for a change of ownership, or an application for
1344 the addition of skilled care services, documentation of
1345 accreditation, or an application for accreditation, from an
1346 accrediting organization that is recognized by the agency as
1347 having standards comparable to those required by this part and
1348 part II of chapter 408. A home health agency that is not
1349 Medicare or Medicaid certified and does not provide skilled care
1350 is exempt from this paragraph. Notwithstanding s. 408.806, an
1351 initial applicant that has applied for accreditation must
1352 provide proof of accreditation that is not conditional or
1353 provisional and a survey demonstrating compliance with the
1354 requirements of this part, part II of chapter 408, and
1355 applicable rules from an accrediting organization that is
1356 recognized by the agency as having standards comparable to those
1357 required by this part and part II of chapter 408 within 120 days
1358 after the date of the agency’s receipt of the application for
1359 licensure or the application shall be withdrawn from further
1360 consideration. Such accreditation must be continuously
1361 maintained by the home health agency to maintain licensure. The
1362 agency shall accept, in lieu of its own periodic licensure
1363 survey, the submission of the survey of an accrediting
1364 organization that is recognized by the agency if the
1365 accreditation of the licensed home health agency is not
1366 provisional and if the licensed home health agency authorizes
1367 releases of, and the agency receives the report of, the
1368 accrediting organization.
1369 (6) The agency may not issue a license designated as
1370 certified to a home health agency that fails to satisfy the
1371 requirements of a Medicare certification survey from the agency.
1372 (8)(9) The agency may not issue a renewal license for a
1373 home health agency in any county having at least one licensed
1374 home health agency and that has more than one home health agency
1375 per 5,000 persons, as indicated by the most recent population
1376 estimates published by the Legislature’s Office of Economic and
1377 Demographic Research, if the applicant or any controlling
1378 interest has been administratively sanctioned by the agency
1379 during the 2 years prior to the submission of the licensure
1380 renewal application for one or more of the following acts:
1381 (a) An intentional or negligent act that materially affects
1382 the health or safety of a client of the provider;
1383 (b) Knowingly providing home health services in an
1384 unlicensed assisted living facility or unlicensed adult family
1385 care home, unless the home health agency or employee reports the
1386 unlicensed facility or home to the agency within 72 hours after
1387 providing the services;
1388 (c) Preparing or maintaining fraudulent patient records,
1389 such as, but not limited to, charting ahead, recording vital
1390 signs or symptoms which were not personally obtained or observed
1391 by the home health agency’s staff at the time indicated,
1392 borrowing patients or patient records from other home health
1393 agencies to pass a survey or inspection, or falsifying
1394 signatures;
1395 (d) Failing to provide at least one service directly to a
1396 patient for a period of 60 days;
1397 (e) Demonstrating a pattern of falsifying documents
1398 relating to the training of home health aides or certified
1399 nursing assistants or demonstrating a pattern of falsifying
1400 health statements for staff who provide direct care to patients.
1401 A pattern may be demonstrated by a showing of at least three
1402 fraudulent entries or documents;
1403 (f) Demonstrating a pattern of billing any payor for
1404 services not provided. A pattern may be demonstrated by a
1405 showing of at least three billings for services not provided
1406 within a 12-month period;
1407 (g) Demonstrating a pattern of failing to provide a service
1408 specified in the home health agency’s written agreement with a
1409 patient or the patient’s legal representative, or the plan of
1410 care for that patient, except unless a reduction in service is
1411 mandated by Medicare, Medicaid, or a state program or as
1412 provided in s. 400.492(3). A pattern may be demonstrated by a
1413 showing of at least three incidents, regardless of the patient
1414 or service, in which the home health agency did not provide a
1415 service specified in a written agreement or plan of care during
1416 a 3-month period;
1417 (h) Giving remuneration to a case manager, discharge
1418 planner, facility-based staff member, or third-party vendor who
1419 is involved in the discharge planning process of a facility
1420 licensed under chapter 395, chapter 429, or this chapter from
1421 whom the home health agency receives referrals or gives
1422 remuneration as prohibited in s. 400.474(6)(a);
1423 (i) Giving cash, or its equivalent, to a Medicare or
1424 Medicaid beneficiary;
1425 (j) Demonstrating a pattern of billing the Medicaid program
1426 for services to Medicaid recipients which are medically
1427 unnecessary as determined by a final order. A pattern may be
1428 demonstrated by a showing of at least two such medically
1429 unnecessary services within one Medicaid program integrity audit
1430 period;
1431 (k) Providing services to residents in an assisted living
1432 facility for which the home health agency does not receive fair
1433 market value remuneration; or
1434 (l) Providing staffing to an assisted living facility for
1435 which the home health agency does not receive fair market value
1436 remuneration.
1437 Section 47. Subsection (5) of section 400.474, Florida
1438 Statutes, is amended to read:
1439 400.474 Administrative penalties.—
1440 (5) The agency shall impose a fine of $5,000 against a home
1441 health agency that demonstrates a pattern of failing to provide
1442 a service specified in the home health agency’s written
1443 agreement with a patient or the patient’s legal representative,
1444 or the plan of care for that patient, except unless a reduction
1445 in service is mandated by Medicare, Medicaid, or a state program
1446 or as provided in s. 400.492(3). A pattern may be demonstrated
1447 by a showing of at least three incidences, regardless of the
1448 patient or service, where the home health agency did not provide
1449 a service specified in a written agreement or plan of care
1450 during a 3-month period. The agency shall impose the fine for
1451 each occurrence. The agency may also impose additional
1452 administrative fines under s. 400.484 for the direct or indirect
1453 harm to a patient, or deny, revoke, or suspend the license of
1454 the home health agency for a pattern of failing to provide a
1455 service specified in the home health agency’s written agreement
1456 with a patient or the plan of care for that patient.
1457 Section 48. Paragraph (c) of subsection (2) of section
1458 400.476, Florida Statutes, is amended to read:
1459 400.476 Staffing requirements; notifications; limitations
1460 on staffing services.—
1461 (2) DIRECTOR OF NURSING.—
1462 (c) A home health agency that provides skilled nursing care
1463 must is not Medicare or Medicaid certified and does not provide
1464 skilled care or provides only physical, occupational, or speech
1465 therapy is not required to have a director of nursing and is
1466 exempt from paragraph (b).
1467 Section 49. Section 400.484, Florida Statutes, is amended
1468 to read:
1469 400.484 Right of inspection; violations deficiencies;
1470 fines.—
1471 (1) In addition to the requirements of s. 408.811, the
1472 agency may make such inspections and investigations as are
1473 necessary in order to determine the state of compliance with
1474 this part, part II of chapter 408, and applicable rules.
1475 (2) The agency shall impose fines for various classes of
1476 violations deficiencies in accordance with the following
1477 schedule:
1478 (a) Class I violations are as provided in s. 408.813 A
1479 class I deficiency is any act, omission, or practice that
1480 results in a patient’s death, disablement, or permanent injury,
1481 or places a patient at imminent risk of death, disablement, or
1482 permanent injury. Upon finding a class I violation deficiency,
1483 the agency shall impose an administrative fine in the amount of
1484 $15,000 for each occurrence and each day that the violation
1485 deficiency exists.
1486 (b) Class II violations are as provided in s. 408.813 A
1487 class II deficiency is any act, omission, or practice that has a
1488 direct adverse effect on the health, safety, or security of a
1489 patient. Upon finding a class II violation deficiency, the
1490 agency shall impose an administrative fine in the amount of
1491 $5,000 for each occurrence and each day that the violation
1492 deficiency exists.
1493 (c) Class III violations are as provided in s. 408.813 A
1494 class III deficiency is any act, omission, or practice that has
1495 an indirect, adverse effect on the health, safety, or security
1496 of a patient. Upon finding an uncorrected or repeated class III
1497 violation deficiency, the agency shall impose an administrative
1498 fine not to exceed $1,000 for each occurrence and each day that
1499 the uncorrected or repeated violation deficiency exists.
1500 (d) Class IV violations are as provided in s. 408.813 A
1501 class IV deficiency is any act, omission, or practice related to
1502 required reports, forms, or documents which does not have the
1503 potential of negatively affecting patients. These violations are
1504 of a type that the agency determines do not threaten the health,
1505 safety, or security of patients. Upon finding an uncorrected or
1506 repeated class IV violation deficiency, the agency shall impose
1507 an administrative fine not to exceed $500 for each occurrence
1508 and each day that the uncorrected or repeated violation
1509 deficiency exists.
1510 (3) In addition to any other penalties imposed pursuant to
1511 this section or part, the agency may assess costs related to an
1512 investigation that results in a successful prosecution,
1513 excluding costs associated with an attorney’s time.
1514 Section 50. Subsection (4) of section 400.497, Florida
1515 Statutes, is amended to read:
1516 400.497 Rules establishing minimum standards.—The agency
1517 shall adopt, publish, and enforce rules to implement part II of
1518 chapter 408 and this part, including, as applicable, ss. 400.506
1519 and 400.509, which must provide reasonable and fair minimum
1520 standards relating to:
1521 (4) Licensure application and renewal and certificates of
1522 exemption.
1523 Section 51. Subsection (5), paragraph (e) of subsection
1524 (6), paragraph (a) of subsection (15), and subsection (19) of
1525 section 400.506, Florida Statutes, are amended to read:
1526 400.506 Licensure of nurse registries; requirements;
1527 penalties.—
1528 (5)(a) In addition to the requirements of s. 408.812, any
1529 person who owns, operates, or maintains an unlicensed nurse
1530 registry and who, within 10 working days after receiving
1531 notification from the agency, fails to cease operation and apply
1532 for a license under this part commits a misdemeanor of the
1533 second degree, punishable as provided in s. 775.082 or s.
1534 775.083. Each day of continued operation is a separate offense.
1535 (b) If a nurse registry fails to cease operation after
1536 agency notification, the agency may impose a fine pursuant to s.
1537 408.812 of $500 for each day of noncompliance.
1538 (6)
1539 (e) Upon referral of a registered nurse, licensed practical
1540 nurse, certified nursing assistant, companion or homemaker, or
1541 home health aide for contract in a private residence or
1542 facility, the nurse registry shall advise the patient, the
1543 patient’s family, or any other person acting on behalf of the
1544 patient, at the time of the contract for services, that the
1545 caregiver referred by the nurse registry is an independent
1546 contractor and that the it is not the obligation of a nurse
1547 registry may not to monitor, supervise, manage, or train a
1548 caregiver referred for contract under this chapter.
1549 (15)(a) The agency may deny, suspend, or revoke the license
1550 of a nurse registry and shall impose a fine of $5,000 against a
1551 nurse registry that:
1552 1. Provides services to residents in an assisted living
1553 facility for which the nurse registry does not receive fair
1554 market value remuneration.
1555 2. Provides staffing to an assisted living facility for
1556 which the nurse registry does not receive fair market value
1557 remuneration.
1558 3. Fails to provide the agency, upon request, with copies
1559 of all contracts with assisted living facilities which were
1560 executed within the last 5 years.
1561 4. Gives remuneration to a case manager, discharge planner,
1562 facility-based staff member, or third-party vendor who is
1563 involved in the discharge planning process of a facility
1564 licensed under chapter 395 or this chapter and from whom the
1565 nurse registry receives referrals. A nurse registry is exempt
1566 from this subparagraph if it does not bill the Florida Medicaid
1567 program or the Medicare program or share a controlling interest
1568 with any entity licensed, registered, or certified under part II
1569 of chapter 408 that bills the Florida Medicaid program or the
1570 Medicare program.
1571 5. Gives remuneration to a physician, a member of the
1572 physician’s office staff, or an immediate family member of the
1573 physician, and the nurse registry received a patient referral in
1574 the last 12 months from that physician or the physician’s office
1575 staff. A nurse registry is exempt from this subparagraph if it
1576 does not bill the Florida Medicaid program or the Medicare
1577 program or share a controlling interest with any entity
1578 licensed, registered, or certified under part II of chapter 408
1579 that bills the Florida Medicaid program or the Medicare program.
1580 (19) It is not the obligation of A nurse registry may not
1581 to monitor, supervise, manage, or train a registered nurse,
1582 licensed practical nurse, certified nursing assistant, companion
1583 or homemaker, or home health aide referred for contract under
1584 this chapter. In the event of a violation of this chapter or a
1585 violation of any other law of this state by a referred
1586 registered nurse, licensed practical nurse, certified nursing
1587 assistant, companion or homemaker, or home health aide, or a
1588 deficiency in credentials which comes to the attention of the
1589 nurse registry, the nurse registry shall advise the patient to
1590 terminate the referred person’s contract, providing the reason
1591 for the suggested termination; cease referring the person to
1592 other patients or facilities; and, if practice violations are
1593 involved, notify the licensing board. This section does not
1594 affect or negate any other obligations imposed on a nurse
1595 registry under chapter 408.
1596 Section 52. Subsection (1) of section 400.606, Florida
1597 Statutes, is amended to read:
1598 400.606 License; application; renewal; conditional license
1599 or permit; certificate of need.—
1600 (1) In addition to the requirements of part II of chapter
1601 408, the initial application and change of ownership application
1602 must be accompanied by a plan for the delivery of home,
1603 residential, and homelike inpatient hospice services to
1604 terminally ill persons and their families. Such plan must
1605 contain, but need not be limited to:
1606 (a) The estimated average number of terminally ill persons
1607 to be served monthly.
1608 (b) The geographic area in which hospice services will be
1609 available.
1610 (c) A listing of services which are or will be provided,
1611 either directly by the applicant or through contractual
1612 arrangements with existing providers.
1613 (d) Provisions for the implementation of hospice home care
1614 within 3 months after licensure.
1615 (e) Provisions for the implementation of hospice homelike
1616 inpatient care within 12 months after licensure.
1617 (f) The number and disciplines of professional staff to be
1618 employed.
1619 (g) The name and qualifications of any existing or
1620 potential contractee.
1621 (h) A plan for attracting and training volunteers.
1622
1623 If the applicant is an existing licensed health care provider,
1624 the application must be accompanied by a copy of the most recent
1625 profit-loss statement and, if applicable, the most recent
1626 licensure inspection report.
1627 Section 53. Subsection (6) of section 400.925, Florida
1628 Statutes, is amended to read:
1629 400.925 Definitions.—As used in this part, the term:
1630 (6) “Home medical equipment” includes any product as
1631 defined by the Food and Drug Administration’s Federal Food,
1632 Drug, and Cosmetic Act, any products reimbursed under the
1633 Medicare Part B Durable Medical Equipment benefits, or any
1634 products reimbursed under the Florida Medicaid durable medical
1635 equipment program. Home medical equipment includes:
1636 (a) Oxygen and related respiratory equipment; manual,
1637 motorized, or customized wheelchairs and related seating and
1638 positioning, but does not include prosthetics or orthotics or
1639 any splints, braces, or aids custom fabricated by a licensed
1640 health care practitioner;
1641 (b) Motorized scooters;
1642 (c) Personal transfer systems; and
1643 (d) Specialty beds, for use by a person with a medical
1644 need; and
1645 (e) Manual, motorized, or customized wheelchairs and
1646 related seating and positioning, but does not include
1647 prosthetics or orthotics or any splints, braces, or aids custom
1648 fabricated by a licensed health care practitioner.
1649 Section 54. Subsection (4) of section 400.931, Florida
1650 Statutes, is amended to read:
1651 400.931 Application for license; fee.—
1652 (4) When a change of the general manager of a home medical
1653 equipment provider occurs, the licensee must notify the agency
1654 of the change within the timeframes established in part II of
1655 chapter 408 and applicable rules 45 days.
1656 Section 55. Subsection (2) of section 400.933, Florida
1657 Statutes, is amended to read:
1658 400.933 Licensure inspections and investigations.—
1659 (2) The agency shall accept, in lieu of its own periodic
1660 inspections for licensure, submission of the following:
1661 (a) The survey or inspection of an accrediting
1662 organization, provided the accreditation of the licensed home
1663 medical equipment provider is not provisional and provided the
1664 licensed home medical equipment provider authorizes release of,
1665 and the agency receives the report of, the accrediting
1666 organization; or
1667 (b) A copy of a valid medical oxygen retail establishment
1668 permit issued by the Department of Business and Professional
1669 Regulation Health, pursuant to chapter 499.
1670 Section 56. Subsection (2) of section 400.980, Florida
1671 Statutes, is amended to read:
1672 400.980 Health care services pools.—
1673 (2) The requirements of part II of chapter 408 apply to the
1674 provision of services that require licensure or registration
1675 pursuant to this part and part II of chapter 408 and to entities
1676 registered by or applying for such registration from the agency
1677 pursuant to this part. Registration or a license issued by the
1678 agency is required for the operation of a health care services
1679 pool in this state. In accordance with s. 408.805, an applicant
1680 or licensee shall pay a fee for each license application
1681 submitted using this part, part II of chapter 408, and
1682 applicable rules. The agency shall adopt rules and provide forms
1683 required for such registration and shall impose a registration
1684 fee in an amount sufficient to cover the cost of administering
1685 this part and part II of chapter 408. In addition to the
1686 requirements in part II of chapter 408, the registrant must
1687 provide the agency with any change of information contained on
1688 the original registration application within the timeframes
1689 established in this part, part II of chapter 408, and applicable
1690 rules 14 days prior to the change.
1691 Section 57. Paragraphs (a) through (d) of subsection (4) of
1692 section 400.9905, Florida Statutes, are amended to read:
1693 400.9905 Definitions.—
1694 (4) “Clinic” means an entity where health care services are
1695 provided to individuals and which tenders charges for
1696 reimbursement for such services, including a mobile clinic and a
1697 portable equipment provider. As used in this part, the term does
1698 not include and the licensure requirements of this part do not
1699 apply to:
1700 (a) Entities licensed or registered by the state under
1701 chapter 395; entities licensed or registered by the state and
1702 providing only health care services within the scope of services
1703 authorized under their respective licenses under ss. 383.30
1704 383.332 383.30-383.335, chapter 390, chapter 394, chapter 397,
1705 this chapter except part X, chapter 429, chapter 463, chapter
1706 465, chapter 466, chapter 478, part I of chapter 483, chapter
1707 484, or chapter 651; end-stage renal disease providers
1708 authorized under 42 C.F.R. part 405, subpart U; providers
1709 certified under 42 C.F.R. part 485, subpart B or subpart H; or
1710 any entity that provides neonatal or pediatric hospital-based
1711 health care services or other health care services by licensed
1712 practitioners solely within a hospital licensed under chapter
1713 395.
1714 (b) Entities that own, directly or indirectly, entities
1715 licensed or registered by the state pursuant to chapter 395;
1716 entities that own, directly or indirectly, entities licensed or
1717 registered by the state and providing only health care services
1718 within the scope of services authorized pursuant to their
1719 respective licenses under ss. 383.30-383.332 383.30-383.335,
1720 chapter 390, chapter 394, chapter 397, this chapter except part
1721 X, chapter 429, chapter 463, chapter 465, chapter 466, chapter
1722 478, part I of chapter 483, chapter 484, or chapter 651; end
1723 stage renal disease providers authorized under 42 C.F.R. part
1724 405, subpart U; providers certified under 42 C.F.R. part 485,
1725 subpart B or subpart H; or any entity that provides neonatal or
1726 pediatric hospital-based health care services by licensed
1727 practitioners solely within a hospital licensed under chapter
1728 395.
1729 (c) Entities that are owned, directly or indirectly, by an
1730 entity licensed or registered by the state pursuant to chapter
1731 395; entities that are owned, directly or indirectly, by an
1732 entity licensed or registered by the state and providing only
1733 health care services within the scope of services authorized
1734 pursuant to their respective licenses under ss. 383.30-383.332
1735 383.30-383.335, chapter 390, chapter 394, chapter 397, this
1736 chapter except part X, chapter 429, chapter 463, chapter 465,
1737 chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1738 chapter 651; end-stage renal disease providers authorized under
1739 42 C.F.R. part 405, subpart U; providers certified under 42
1740 C.F.R. part 485, subpart B or subpart H; or any entity that
1741 provides neonatal or pediatric hospital-based health care
1742 services by licensed practitioners solely within a hospital
1743 under chapter 395.
1744 (d) Entities that are under common ownership, directly or
1745 indirectly, with an entity licensed or registered by the state
1746 pursuant to chapter 395; entities that are under common
1747 ownership, directly or indirectly, with an entity licensed or
1748 registered by the state and providing only health care services
1749 within the scope of services authorized pursuant to their
1750 respective licenses under ss. 383.30-383.332 383.30-383.335,
1751 chapter 390, chapter 394, chapter 397, this chapter except part
1752 X, chapter 429, chapter 463, chapter 465, chapter 466, chapter
1753 478, part I of chapter 483, chapter 484, or chapter 651; end
1754 stage renal disease providers authorized under 42 C.F.R. part
1755 405, subpart U; providers certified under 42 C.F.R. part 485,
1756 subpart B or subpart H; or any entity that provides neonatal or
1757 pediatric hospital-based health care services by licensed
1758 practitioners solely within a hospital licensed under chapter
1759 395.
1760
1761 Notwithstanding this subsection, an entity shall be deemed a
1762 clinic and must be licensed under this part in order to receive
1763 reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
1764 627.730-627.7405, unless exempted under s. 627.736(5)(h).
1765 Section 58. Subsection (6) of section 400.9935, Florida
1766 Statutes, is amended to read:
1767 400.9935 Clinic responsibilities.—
1768 (6) Any person or entity providing health care services
1769 which is not a clinic, as defined under s. 400.9905, may
1770 voluntarily apply for a certificate of exemption from licensure
1771 under its exempt status with the agency on a form that sets
1772 forth its name or names and addresses, a statement of the
1773 reasons why it cannot be defined as a clinic, and other
1774 information deemed necessary by the agency. An exemption may be
1775 valid for up to 2 years and is not transferable. The agency may
1776 charge an applicant for a certificate of exemption in an amount
1777 equal to $100 or the actual cost of processing the certificate,
1778 whichever is less. An entity seeking a certificate of exemption
1779 must publish and maintain a schedule of charges for the medical
1780 services offered to patients. The schedule must include the
1781 prices charged to an uninsured person paying for such services
1782 by cash, check, credit card, or debit card. The schedule must be
1783 posted in a conspicuous place in the reception area of the
1784 entity and must include, but is not limited to, the 50 services
1785 most frequently provided by the entity. The schedule may group
1786 services by three price levels, listing services in each price
1787 level. The posting must be at least 15 square feet in size. As a
1788 condition precedent to receiving a certificate of exemption, an
1789 applicant must provide to the agency documentation of compliance
1790 with these requirements.
1791 Section 59. Paragraph (a) of subsection (2) of section
1792 408.033, Florida Statutes, is amended to read:
1793 408.033 Local and state health planning.—
1794 (2) FUNDING.—
1795 (a) The Legislature intends that the cost of local health
1796 councils be borne by assessments on selected health care
1797 facilities subject to facility licensure by the Agency for
1798 Health Care Administration, including abortion clinics, assisted
1799 living facilities, ambulatory surgical centers, birth birthing
1800 centers, clinical laboratories except community nonprofit blood
1801 banks and clinical laboratories operated by practitioners for
1802 exclusive use regulated under s. 483.035, home health agencies,
1803 hospices, hospitals, intermediate care facilities for the
1804 developmentally disabled, nursing homes, health care clinics,
1805 and multiphasic testing centers and by assessments on
1806 organizations subject to certification by the agency pursuant to
1807 chapter 641, part III, including health maintenance
1808 organizations and prepaid health clinics. Fees assessed may be
1809 collected prospectively at the time of licensure renewal and
1810 prorated for the licensure period.
1811 Section 60. Present paragraphs (f) through (l) of
1812 subsection (3) of section 408.036, Florida Statutes, are
1813 redesignated as paragraphs (e) through (k), respectively,
1814 present paragraphs (o) through (t) of that subsection are
1815 redesignated as paragraphs (l) through (q), respectively, and
1816 present paragraphs (e), (m), (n), and (p) of that subsection are
1817 amended, to read:
1818 408.036 Projects subject to review; exemptions.—
1819 (3) EXEMPTIONS.—Upon request, the following projects are
1820 subject to exemption from the provisions of subsection (1):
1821 (e) For mobile surgical facilities and related health care
1822 services provided under contract with the Department of
1823 Corrections or a private correctional facility operating
1824 pursuant to chapter 957.
1825 (m)1. For the provision of adult open-heart services in a
1826 hospital located within the boundaries of a health service
1827 planning district, as defined in s. 408.032(5), which has
1828 experienced an annual net out-migration of at least 600 open
1829 heart-surgery cases for 3 consecutive years according to the
1830 most recent data reported to the agency, and the district’s
1831 population per licensed and operational open-heart programs
1832 exceeds the state average of population per licensed and
1833 operational open-heart programs by at least 25 percent. All
1834 hospitals within a health service planning district which meet
1835 the criteria reference in sub-subparagraphs 2.a.-h. shall be
1836 eligible for this exemption on July 1, 2004, and shall receive
1837 the exemption upon filing for it and subject to the following:
1838 a. A hospital that has received a notice of intent to grant
1839 a certificate of need or a final order of the agency granting a
1840 certificate of need for the establishment of an open-heart
1841 surgery program is entitled to receive a letter of exemption for
1842 the establishment of an adult open-heart-surgery program upon
1843 filing a request for exemption and complying with the criteria
1844 enumerated in sub-subparagraphs 2.a.-h., and is entitled to
1845 immediately commence operation of the program.
1846 b. An otherwise eligible hospital that has not received a
1847 notice of intent to grant a certificate of need or a final order
1848 of the agency granting a certificate of need for the
1849 establishment of an open-heart-surgery program is entitled to
1850 immediately receive a letter of exemption for the establishment
1851 of an adult open-heart-surgery program upon filing a request for
1852 exemption and complying with the criteria enumerated in sub
1853 subparagraphs 2.a.-h., but is not entitled to commence operation
1854 of its program until December 31, 2006.
1855 2. A hospital shall be exempt from the certificate-of-need
1856 review for the establishment of an open-heart-surgery program
1857 when the application for exemption submitted under this
1858 paragraph complies with the following criteria:
1859 a. The applicant must certify that it will meet and
1860 continuously maintain the minimum licensure requirements adopted
1861 by the agency governing adult open-heart programs, including the
1862 most current guidelines of the American College of Cardiology
1863 and American Heart Association Guidelines for Adult Open Heart
1864 Programs.
1865 b. The applicant must certify that it will maintain
1866 sufficient appropriate equipment and health personnel to ensure
1867 quality and safety.
1868 c. The applicant must certify that it will maintain
1869 appropriate times of operation and protocols to ensure
1870 availability and appropriate referrals in the event of
1871 emergencies.
1872 d. The applicant can demonstrate that it has discharged at
1873 least 300 inpatients with a principal diagnosis of ischemic
1874 heart disease for the most recent 12-month period as reported to
1875 the agency.
1876 e. The applicant is a general acute care hospital that is
1877 in operation for 3 years or more.
1878 f. The applicant is performing more than 300 diagnostic
1879 cardiac catheterization procedures per year, combined inpatient
1880 and outpatient.
1881 g. The applicant’s payor mix at a minimum reflects the
1882 community average for Medicaid, charity care, and self-pay
1883 patients or the applicant must certify that it will provide a
1884 minimum of 5 percent of Medicaid, charity care, and self-pay to
1885 open-heart-surgery patients.
1886 h. If the applicant fails to meet the established criteria
1887 for open-heart programs or fails to reach 300 surgeries per year
1888 by the end of its third year of operation, it must show cause
1889 why its exemption should not be revoked.
1890 3. By December 31, 2004, and annually thereafter, the
1891 agency shall submit a report to the Legislature providing
1892 information concerning the number of requests for exemption it
1893 has received under this paragraph during the calendar year and
1894 the number of exemptions it has granted or denied during the
1895 calendar year.
1896 (n) For the provision of percutaneous coronary intervention
1897 for patients presenting with emergency myocardial infarctions in
1898 a hospital without an approved adult open-heart-surgery program.
1899 In addition to any other documentation required by the agency, a
1900 request for an exemption submitted under this paragraph must
1901 comply with the following:
1902 1. The applicant must certify that it will meet and
1903 continuously maintain the requirements adopted by the agency for
1904 the provision of these services. These licensure requirements
1905 shall be adopted by rule and must be consistent with the
1906 guidelines published by the American College of Cardiology and
1907 the American Heart Association for the provision of percutaneous
1908 coronary interventions in hospitals without adult open-heart
1909 services. At a minimum, the rules must require the following:
1910 a. Cardiologists must be experienced interventionalists who
1911 have performed a minimum of 75 interventions within the previous
1912 12 months.
1913 b. The hospital must provide a minimum of 36 emergency
1914 interventions annually in order to continue to provide the
1915 service.
1916 c. The hospital must offer sufficient physician, nursing,
1917 and laboratory staff to provide the services 24 hours a day, 7
1918 days a week.
1919 d. Nursing and technical staff must have demonstrated
1920 experience in handling acutely ill patients requiring
1921 intervention based on previous experience in dedicated
1922 interventional laboratories or surgical centers.
1923 e. Cardiac care nursing staff must be adept in hemodynamic
1924 monitoring and Intra-aortic Balloon Pump (IABP) management.
1925 f. Formalized written transfer agreements must be developed
1926 with a hospital with an adult open-heart-surgery program, and
1927 written transport protocols must be in place to ensure safe and
1928 efficient transfer of a patient within 60 minutes. Transfer and
1929 transport agreements must be reviewed and tested, with
1930 appropriate documentation maintained at least every 3 months.
1931 However, a hospital located more than 100 road miles from the
1932 closest Level II adult cardiovascular services program does not
1933 need to meet the 60-minute transfer time protocol if the
1934 hospital demonstrates that it has a formalized, written transfer
1935 agreement with a hospital that has a Level II program. The
1936 agreement must include written transport protocols that ensure
1937 the safe and efficient transfer of a patient, taking into
1938 consideration the patient’s clinical and physical
1939 characteristics, road and weather conditions, and viability of
1940 ground and air ambulance service to transfer the patient.
1941 g. Hospitals implementing the service must first undertake
1942 a training program of 3 to 6 months’ duration, which includes
1943 establishing standards and testing logistics, creating quality
1944 assessment and error management practices, and formalizing
1945 patient-selection criteria.
1946 2. The applicant must certify that it will use at all times
1947 the patient-selection criteria for the performance of primary
1948 angioplasty at hospitals without adult open-heart-surgery
1949 programs issued by the American College of Cardiology and the
1950 American Heart Association. At a minimum, these criteria would
1951 provide for the following:
1952 a. Avoidance of interventions in hemodynamically stable
1953 patients who have identified symptoms or medical histories.
1954 b. Transfer of patients who have a history of coronary
1955 disease and clinical presentation of hemodynamic instability.
1956 3. The applicant must agree to submit a quarterly report to
1957 the agency detailing patient characteristics, treatment, and
1958 outcomes for all patients receiving emergency percutaneous
1959 coronary interventions pursuant to this paragraph. This report
1960 must be submitted within 15 days after the close of each
1961 calendar quarter.
1962 4. The exemption provided by this paragraph does not apply
1963 unless the agency determines that the hospital has taken all
1964 necessary steps to be in compliance with all requirements of
1965 this paragraph, including the training program required under
1966 sub-subparagraph 1.g.
1967 5. Failure of the hospital to continuously comply with the
1968 requirements of sub-subparagraphs 1.c.-f. and subparagraphs 2.
1969 and 3. will result in the immediate expiration of this
1970 exemption.
1971 6. Failure of the hospital to meet the volume requirements
1972 of sub-subparagraphs 1.a. and b. within 18 months after the
1973 program begins offering the service will result in the immediate
1974 expiration of the exemption.
1975
1976 If the exemption for this service expires under subparagraph 5.
1977 or subparagraph 6., the agency may not grant another exemption
1978 for this service to the same hospital for 2 years and then only
1979 upon a showing that the hospital will remain in compliance with
1980 the requirements of this paragraph through a demonstration of
1981 corrections to the deficiencies that caused expiration of the
1982 exemption. Compliance with the requirements of this paragraph
1983 includes compliance with the rules adopted pursuant to this
1984 paragraph.
1985 (m)(p) For replacement of a licensed nursing home on the
1986 same site, or within 5 miles of the same site if within the same
1987 subdistrict, if the number of licensed beds does not increase
1988 except as permitted under paragraph (e) (f).
1989 Section 61. Paragraph (b) of subsection (3) of section
1990 408.0361, Florida Statutes, is amended to read:
1991 408.0361 Cardiovascular services and burn unit licensure.—
1992 (3) In establishing rules for adult cardiovascular
1993 services, the agency shall include provisions that allow for:
1994 (b)1. For a hospital seeking a Level I program,
1995 demonstration that, for the most recent 12-month period as
1996 reported to the agency, it has provided a minimum of 300 adult
1997 inpatient and outpatient diagnostic cardiac catheterizations or,
1998 for the most recent 12-month period, has discharged or
1999 transferred at least 300 patients inpatients with the principal
2000 diagnosis of ischemic heart disease and that it has a
2001 formalized, written transfer agreement with a hospital that has
2002 a Level II program, including written transport protocols to
2003 ensure safe and efficient transfer of a patient within 60
2004 minutes.
2005 2.a. A hospital located more than 100 road miles from the
2006 closest Level II adult cardiovascular services program does not
2007 need to meet the diagnostic cardiac catheterization volume and
2008 ischemic heart disease diagnosis volume requirements in
2009 subparagraph 1., if the hospital demonstrates that it has, for
2010 the most recent 12-month period as reported to the agency,
2011 provided a minimum of 100 adult inpatient and outpatient
2012 diagnostic cardiac catheterizations or that, for the most recent
2013 12-month period, it has discharged or transferred at least 300
2014 patients with the principal diagnosis of ischemic heart disease.
2015 b. However, A hospital located more than 100 road miles
2016 from the closest Level II adult cardiovascular services program
2017 does not need to meet the 60-minute transfer time protocol
2018 requirement in subparagraph 1., if the hospital demonstrates
2019 that it has a formalized, written transfer agreement with a
2020 hospital that has a Level II program. The agreement must include
2021 written transport protocols to ensure the safe and efficient
2022 transfer of a patient, taking into consideration the patient’s
2023 clinical and physical characteristics, road and weather
2024 conditions, and viability of ground and air ambulance service to
2025 transfer the patient.
2026 3. At a minimum, the rules for adult cardiovascular
2027 services must require nursing and technical staff to have
2028 demonstrated experience in handling acutely ill patients
2029 requiring intervention, based on the staff member’s previous
2030 experience in dedicated cardiac interventional laboratories or
2031 surgical centers. If a staff member’s previous experience is in
2032 a dedicated cardiac interventional laboratory at a hospital that
2033 does not have an approved adult open-heart-surgery program, the
2034 staff member’s previous experience qualifies only if, at the
2035 time the staff member acquired his or her experience, the
2036 dedicated cardiac interventional laboratory:
2037 a. Had an annual volume of 500 or more percutaneous cardiac
2038 intervention procedures;
2039 b. Achieved a demonstrated success rate of 95 percent or
2040 greater for percutaneous cardiac intervention procedures;
2041 c. Experienced a complication rate of less than 5 percent
2042 for percutaneous cardiac intervention procedures; and
2043 d. Performed diverse cardiac procedures, including, but not
2044 limited to, balloon angioplasty and stenting, rotational
2045 atherectomy, cutting balloon atheroma remodeling, and procedures
2046 relating to left ventricular support capability.
2047 Section 62. Subsection (4) of section 408.061, Florida
2048 Statutes, is amended to read:
2049 408.061 Data collection; uniform systems of financial
2050 reporting; information relating to physician charges;
2051 confidential information; immunity.—
2052 (4) Within 120 days after the end of its fiscal year, each
2053 health care facility, excluding continuing care facilities,
2054 hospitals operated by state agencies, and nursing homes as those
2055 terms are defined in s. 408.07 s. 408.07(14) and (37), shall
2056 file with the agency, on forms adopted by the agency and based
2057 on the uniform system of financial reporting, its actual
2058 financial experience for that fiscal year, including
2059 expenditures, revenues, and statistical measures. Such data may
2060 be based on internal financial reports which are certified to be
2061 complete and accurate by the provider. However, hospitals’
2062 actual financial experience shall be their audited actual
2063 experience. Every nursing home shall submit to the agency, in a
2064 format designated by the agency, a statistical profile of the
2065 nursing home residents. The agency, in conjunction with the
2066 Department of Elderly Affairs and the Department of Health,
2067 shall review these statistical profiles and develop
2068 recommendations for the types of residents who might more
2069 appropriately be placed in their homes or other noninstitutional
2070 settings.
2071 Section 63. Subsection (11) of section 408.07, Florida
2072 Statutes, is amended to read:
2073 408.07 Definitions.—As used in this chapter, with the
2074 exception of ss. 408.031-408.045, the term:
2075 (11) “Clinical laboratory” means a facility licensed under
2076 s. 483.091, excluding: any hospital laboratory defined under s.
2077 483.041(6); any clinical laboratory operated by the state or a
2078 political subdivision of the state; any blood or tissue bank
2079 where the majority of revenues are received from the sale of
2080 blood or tissue and where blood, plasma, or tissue is procured
2081 from volunteer donors and donated, processed, stored, or
2082 distributed on a nonprofit basis; and any clinical laboratory
2083 which is wholly owned and operated by physicians who are
2084 licensed pursuant to chapter 458 or chapter 459 and who practice
2085 in the same group practice, and at which no clinical laboratory
2086 work is performed for patients referred by any health care
2087 provider who is not a member of that same group practice.
2088 Section 64. Subsection (4) of section 408.20, Florida
2089 Statutes, is amended to read:
2090 408.20 Assessments; Health Care Trust Fund.—
2091 (4) Hospitals operated by a state agency the Department of
2092 Children and Families, the Department of Health, or the
2093 Department of Corrections are exempt from the assessments
2094 required under this section.
2095 Section 65. Section 408.7056, Florida Statutes, is
2096 repealed.
2097 Section 66. Subsections (10), (11), and (27) of section
2098 408.802, Florida Statutes, are amended to read:
2099 408.802 Applicability.—The provisions of this part apply to
2100 the provision of services that require licensure as defined in
2101 this part and to the following entities licensed, registered, or
2102 certified by the agency, as described in chapters 112, 383, 390,
2103 394, 395, 400, 429, 440, 483, and 765:
2104 (10) Mobile surgical facilities, as provided under part I
2105 of chapter 395.
2106 (11) Health care risk managers, as provided under part I of
2107 chapter 395.
2108 (27) Clinical laboratories, as provided under part I of
2109 chapter 483.
2110 Section 67. Subsections (12) and (13) of section 408.803,
2111 Florida Statutes, are redesignated as subsections (13) and (14),
2112 respectively, and a new subsection (12) is added to that
2113 section, to read:
2114 408.803 Definitions.—As used in this part, the term:
2115 (12) “Relative” means an individual who is the father,
2116 mother, stepfather, stepmother, son, daughter, brother, sister,
2117 grandmother, grandfather, great-grandmother, great-grandfather,
2118 grandson, granddaughter, uncle, aunt, first cousin, nephew,
2119 niece, husband, wife, father-in-law, mother-in-law, son-in-law,
2120 daughter-in-law, brother-in-law, sister-in-law, stepson,
2121 stepdaughter, stepbrother, stepsister, half-brother, or half
2122 sister of a patient or client.
2123 Section 68. Paragraph (c) of subsection (7) of section
2124 408.806, Florida Statutes, is amended, and subsection (9) is
2125 added to that section, to read:
2126 408.806 License application process.—
2127 (7)(c) If an inspection is required by the authorizing
2128 statute for a license application other than an initial
2129 application, the inspection must be unannounced. This paragraph
2130 does not apply to inspections required pursuant to ss. 383.324,
2131 395.0161(4) and, 429.67(6), and 483.061(2).
2132 (9) A licensee that holds a license for multiple providers
2133 licensed by the agency may request that all related license
2134 expiration dates be aligned. Upon such request, the agency may
2135 issue a license for an abbreviated licensure period with a
2136 prorated licensure fee.
2137 Section 69. Paragraphs (d) and (e) of subsection (1) of
2138 section 408.809, Florida Statutes, are amended to read:
2139 408.809 Background screening; prohibited offenses.—
2140 (1) Level 2 background screening pursuant to chapter 435
2141 must be conducted through the agency on each of the following
2142 persons, who are considered employees for the purposes of
2143 conducting screening under chapter 435:
2144 (d) Any person who is a controlling interest if the agency
2145 has reason to believe that such person has been convicted of any
2146 offense prohibited by s. 435.04. For each controlling interest
2147 who has been convicted of any such offense, the licensee shall
2148 submit to the agency a description and explanation of the
2149 conviction at the time of license application.
2150 (e) Any person, as required by authorizing statutes,
2151 seeking employment with a licensee or provider who is expected
2152 to, or whose responsibilities may require him or her to, provide
2153 personal care or services directly to clients or have access to
2154 client funds, personal property, or living areas; and any
2155 person, as required by authorizing statutes, contracting with a
2156 licensee or provider whose responsibilities require him or her
2157 to provide personal care or personal services directly to
2158 clients, or contracting with a licensee or provider to work 20
2159 hours a week or more who will have access to client funds,
2160 personal property, or living areas. Evidence of contractor
2161 screening may be retained by the contractor’s employer or the
2162 licensee.
2163 Section 70. Subsection (8) of section 408.810, Florida
2164 Statutes, is amended, and subsections (11), (12), and (13) are
2165 added to that section, to read:
2166 408.810 Minimum licensure requirements.—In addition to the
2167 licensure requirements specified in this part, authorizing
2168 statutes, and applicable rules, each applicant and licensee must
2169 comply with the requirements of this section in order to obtain
2170 and maintain a license.
2171 (8) Upon application for initial licensure or change of
2172 ownership licensure, the applicant shall furnish satisfactory
2173 proof of the applicant’s financial ability to operate in
2174 accordance with the requirements of this part, authorizing
2175 statutes, and applicable rules. The agency shall establish
2176 standards for this purpose, including information concerning the
2177 applicant’s controlling interests. The agency shall also
2178 establish documentation requirements, to be completed by each
2179 applicant, that show anticipated provider revenues and
2180 expenditures, the basis for financing the anticipated cash-flow
2181 requirements of the provider, and an applicant’s access to
2182 contingency financing. A current certificate of authority,
2183 pursuant to chapter 651, may be provided as proof of financial
2184 ability to operate. The agency may require a licensee to provide
2185 proof of financial ability to operate at any time if there is
2186 evidence of financial instability, including, but not limited
2187 to, unpaid expenses necessary for the basic operations of the
2188 provider. An applicant applying for change of ownership
2189 licensure is exempt from furnishing proof of financial ability
2190 to operate if the provider has been licensed for at least 5
2191 years, and:
2192 (a) The ownership change is a result of a corporate
2193 reorganization under which the controlling interest is unchanged
2194 and the applicant submits organizational charts that represent
2195 the current and proposed structure of the reorganized
2196 corporation; or
2197 (b) The ownership change is due solely to the death of a
2198 person holding a controlling interest, and the surviving
2199 controlling interests continue to hold at least 51 percent of
2200 ownership after the change of ownership.
2201 (11) The agency may adopt rules that govern the
2202 circumstances under which a controlling interest, an
2203 administrator, an employee, or a contractor, or a representative
2204 thereof, who is not a relative of the client may act as an agent
2205 of the client in authorizing consent for medical treatment,
2206 assignment of benefits, and release of information. Such rules
2207 may include requirements related to disclosure, bonding,
2208 restrictions, and client protections.
2209 (12) The licensee shall ensure that no person holds any
2210 ownership interest, either directly or indirectly, regardless of
2211 ownership structure, who:
2212 (a) Has a disqualifying offense pursuant to s. 408.809; or
2213 (b) Holds or has held any ownership interest, either
2214 directly or indirectly, regardless of ownership structure, in a
2215 provider that had a license revoked or an application denied
2216 pursuant to s. 408.815.
2217 (13) If the licensee is a publicly traded corporation or is
2218 wholly owned, directly or indirectly, by a publicly traded
2219 corporation, subsection (12) does not apply to those persons
2220 whose sole relationship with the corporation is as a shareholder
2221 of publicly traded shares. As used in this subsection, a
2222 “publicly traded corporation” is a corporation that issues
2223 securities traded on an exchange registered with the United
2224 States Securities and Exchange Commission as a national
2225 securities exchange.
2226 Section 71. Section 408.812, Florida Statutes, is amended
2227 to read:
2228 408.812 Unlicensed activity.—
2229 (1) A person or entity may not offer or advertise services
2230 that require licensure as defined by this part, authorizing
2231 statutes, or applicable rules to the public without obtaining a
2232 valid license from the agency. A licenseholder may not advertise
2233 or hold out to the public that he or she holds a license for
2234 other than that for which he or she actually holds the license.
2235 (2) The operation or maintenance of an unlicensed provider
2236 or the performance of any services that require licensure
2237 without proper licensure is a violation of this part and
2238 authorizing statutes. Unlicensed activity constitutes harm that
2239 materially affects the health, safety, and welfare of clients,
2240 and constitutes abuse and neglect, as defined in s. 415.102. The
2241 agency or any state attorney may, in addition to other remedies
2242 provided in this part, bring an action for an injunction to
2243 restrain such violation, or to enjoin the future operation or
2244 maintenance of the unlicensed provider or the performance of any
2245 services in violation of this part and authorizing statutes,
2246 until compliance with this part, authorizing statutes, and
2247 agency rules has been demonstrated to the satisfaction of the
2248 agency.
2249 (3) It is unlawful for any person or entity to own,
2250 operate, or maintain an unlicensed provider. If after receiving
2251 notification from the agency, such person or entity fails to
2252 cease operation and apply for a license under this part and
2253 authorizing statutes, the person or entity is shall be subject
2254 to penalties as prescribed by authorizing statutes and
2255 applicable rules. Each day of continued operation is a separate
2256 offense.
2257 (4) Any person or entity that fails to cease operation
2258 after agency notification may be fined $1,000 for each day of
2259 noncompliance.
2260 (5) When a controlling interest or licensee has an interest
2261 in more than one provider and fails to license a provider
2262 rendering services that require licensure, the agency may revoke
2263 all licenses, and impose actions under s. 408.814, and
2264 regardless of correction, impose a fine of $1,000 per day,
2265 unless otherwise specified by authorizing statutes, against each
2266 licensee until such time as the appropriate license is obtained
2267 or the unlicensed activity ceases for the unlicensed operation.
2268 (6) In addition to granting injunctive relief pursuant to
2269 subsection (2), if the agency determines that a person or entity
2270 is operating or maintaining a provider without obtaining a
2271 license and determines that a condition exists that poses a
2272 threat to the health, safety, or welfare of a client of the
2273 provider, the person or entity is subject to the same actions
2274 and fines imposed against a licensee as specified in this part,
2275 authorizing statutes, and agency rules.
2276 (7) Any person aware of the operation of an unlicensed
2277 provider must report that provider to the agency.
2278 Section 72. Subsections (10), (11) and (26) of section
2279 408.820, Florida Statutes, are amended, and subsections (12)
2280 through (25) and (27) and (28) are redesignated as subsections
2281 (10) through (23) and (24) and (25), respectively, to read:
2282 408.820 Exemptions.—Except as prescribed in authorizing
2283 statutes, the following exemptions shall apply to specified
2284 requirements of this part:
2285 (10) Mobile surgical facilities, as provided under part I
2286 of chapter 395, are exempt from s. 408.810(7)-(10).
2287 (11) Health care risk managers, as provided under part I of
2288 chapter 395, are exempt from ss. 408.806(7), 408.810(4)-(10),
2289 and 408.811.
2290 (26) Clinical laboratories, as provided under part I of
2291 chapter 483, are exempt from s. 408.810(5)-(10).
2292 Section 73. Subsection (7) of section 409.905, Florida
2293 Statutes, is amended to read:
2294 409.905 Mandatory Medicaid services.—The agency may make
2295 payments for the following services, which are required of the
2296 state by Title XIX of the Social Security Act, furnished by
2297 Medicaid providers to recipients who are determined to be
2298 eligible on the dates on which the services were provided. Any
2299 service under this section shall be provided only when medically
2300 necessary and in accordance with state and federal law.
2301 Mandatory services rendered by providers in mobile units to
2302 Medicaid recipients may be restricted by the agency. Nothing in
2303 this section shall be construed to prevent or limit the agency
2304 from adjusting fees, reimbursement rates, lengths of stay,
2305 number of visits, number of services, or any other adjustments
2306 necessary to comply with the availability of moneys and any
2307 limitations or directions provided for in the General
2308 Appropriations Act or chapter 216.
2309 (7) INDEPENDENT LABORATORY SERVICES.—The agency shall pay
2310 for medically necessary diagnostic laboratory procedures ordered
2311 by a licensed physician or other licensed practitioner of the
2312 healing arts which are provided for a recipient in a laboratory
2313 that meets the requirements for Medicare participation and is
2314 appropriately certified by the Centers for Medicare and Medicaid
2315 Services under the federal Clinical Laboratory Improvement
2316 Amendments and the federal rules adopted thereunder licensed
2317 under chapter 483, if required.
2318 Section 74. Subsection (10) of section 409.907, Florida
2319 Statutes, is amended to read:
2320 409.907 Medicaid provider agreements.—The agency may make
2321 payments for medical assistance and related services rendered to
2322 Medicaid recipients only to an individual or entity who has a
2323 provider agreement in effect with the agency, who is performing
2324 services or supplying goods in accordance with federal, state,
2325 and local law, and who agrees that no person shall, on the
2326 grounds of handicap, race, color, or national origin, or for any
2327 other reason, be subjected to discrimination under any program
2328 or activity for which the provider receives payment from the
2329 agency.
2330 (10) The agency may consider whether the provider, or any
2331 officer, director, agent, managing employee, or affiliated
2332 person, or any partner or shareholder having an ownership
2333 interest equal to 5 percent or greater in the provider if the
2334 provider is a corporation, partnership, or other business
2335 entity, has:
2336 (a) Made a false representation or omission of any material
2337 fact in making the application, including the submission of an
2338 application that conceals the controlling or ownership interest
2339 of any officer, director, agent, managing employee, affiliated
2340 person, or partner or shareholder who may not be eligible to
2341 participate;
2342 (b) Been or is currently excluded, suspended, terminated
2343 from, or has involuntarily withdrawn from participation in,
2344 Florida’s Medicaid program or any other state’s Medicaid
2345 program, or from participation in any other governmental or
2346 private health care or health insurance program;
2347 (c) Been convicted of a criminal offense relating to the
2348 delivery of any goods or services under Medicaid or Medicare or
2349 any other public or private health care or health insurance
2350 program including the performance of management or
2351 administrative services relating to the delivery of goods or
2352 services under any such program;
2353 (d) Been convicted under federal or state law of a criminal
2354 offense related to the neglect or abuse of a patient in
2355 connection with the delivery of any health care goods or
2356 services;
2357 (e) Been convicted under federal or state law of a criminal
2358 offense relating to the unlawful manufacture, distribution,
2359 prescription, or dispensing of a controlled substance;
2360 (f) Been convicted of any criminal offense relating to
2361 fraud, theft, embezzlement, breach of fiduciary responsibility,
2362 or other financial misconduct;
2363 (g) Been convicted under federal or state law of a crime
2364 punishable by imprisonment of a year or more which involves
2365 moral turpitude;
2366 (h) Been convicted in connection with the interference or
2367 obstruction of any investigation into any criminal offense
2368 listed in this subsection;
2369 (i) Been found to have violated federal or state laws,
2370 rules, or regulations governing Florida’s Medicaid program or
2371 any other state’s Medicaid program, the Medicare program, or any
2372 other publicly funded federal or state health care or health
2373 insurance program, and been sanctioned accordingly;
2374 (c)(j) Been previously found by a licensing, certifying, or
2375 professional standards board or agency to have violated the
2376 standards or conditions relating to licensure or certification
2377 or the quality of services provided; or
2378 (d)(k) Failed to pay any fine or overpayment properly
2379 assessed under the Medicaid program in which no appeal is
2380 pending or after resolution of the proceeding by stipulation or
2381 agreement, unless the agency has issued a specific letter of
2382 forgiveness or has approved a repayment schedule to which the
2383 provider agrees to adhere.
2384 Section 75. Subsection (6) of section 409.9116, Florida
2385 Statutes, is amended to read:
2386 409.9116 Disproportionate share/financial assistance
2387 program for rural hospitals.—In addition to the payments made
2388 under s. 409.911, the Agency for Health Care Administration
2389 shall administer a federally matched disproportionate share
2390 program and a state-funded financial assistance program for
2391 statutory rural hospitals. The agency shall make
2392 disproportionate share payments to statutory rural hospitals
2393 that qualify for such payments and financial assistance payments
2394 to statutory rural hospitals that do not qualify for
2395 disproportionate share payments. The disproportionate share
2396 program payments shall be limited by and conform with federal
2397 requirements. Funds shall be distributed quarterly in each
2398 fiscal year for which an appropriation is made. Notwithstanding
2399 the provisions of s. 409.915, counties are exempt from
2400 contributing toward the cost of this special reimbursement for
2401 hospitals serving a disproportionate share of low-income
2402 patients.
2403 (6) This section applies only to hospitals that were
2404 defined as statutory rural hospitals, or their successor-in
2405 interest hospital, prior to January 1, 2001. Any additional
2406 hospital that is defined as a statutory rural hospital, or its
2407 successor-in-interest hospital, on or after January 1, 2001, is
2408 not eligible for programs under this section unless additional
2409 funds are appropriated each fiscal year specifically to the
2410 rural hospital disproportionate share and financial assistance
2411 programs in an amount necessary to prevent any hospital, or its
2412 successor-in-interest hospital, eligible for the programs prior
2413 to January 1, 2001, from incurring a reduction in payments
2414 because of the eligibility of an additional hospital to
2415 participate in the programs. A hospital, or its successor-in
2416 interest hospital, which received funds pursuant to this section
2417 before January 1, 2001, and which qualifies under s.
2418 395.602(2)(b) s. 395.602(2)(e), shall be included in the
2419 programs under this section and is not required to seek
2420 additional appropriations under this subsection.
2421 Section 76. Paragraphs (a) and (b) of subsection (1) of
2422 section 409.975, Florida Statutes, are amended to read:
2423 409.975 Managed care plan accountability.—In addition to
2424 the requirements of s. 409.967, plans and providers
2425 participating in the managed medical assistance program shall
2426 comply with the requirements of this section.
2427 (1) PROVIDER NETWORKS.—Managed care plans must develop and
2428 maintain provider networks that meet the medical needs of their
2429 enrollees in accordance with standards established pursuant to
2430 s. 409.967(2)(c). Except as provided in this section, managed
2431 care plans may limit the providers in their networks based on
2432 credentials, quality indicators, and price.
2433 (a) Plans must include all providers in the region that are
2434 classified by the agency as essential Medicaid providers, unless
2435 the agency approves, in writing, an alternative arrangement for
2436 securing the types of services offered by the essential
2437 providers. Providers are essential for serving Medicaid
2438 enrollees if they offer services that are not available from any
2439 other provider within a reasonable access standard, or if they
2440 provided a substantial share of the total units of a particular
2441 service used by Medicaid patients within the region during the
2442 last 3 years and the combined capacity of other service
2443 providers in the region is insufficient to meet the total needs
2444 of the Medicaid patients. The agency may not classify physicians
2445 and other practitioners as essential providers. The agency, at a
2446 minimum, shall determine which providers in the following
2447 categories are essential Medicaid providers:
2448 1. Federally qualified health centers.
2449 2. Statutory teaching hospitals as defined in s. 408.07(44)
2450 s. 408.07(45).
2451 3. Hospitals that are trauma centers as defined in s.
2452 395.4001(14).
2453 4. Hospitals located at least 25 miles from any other
2454 hospital with similar services.
2455
2456 Managed care plans that have not contracted with all essential
2457 providers in the region as of the first date of recipient
2458 enrollment, or with whom an essential provider has terminated
2459 its contract, must negotiate in good faith with such essential
2460 providers for 1 year or until an agreement is reached, whichever
2461 is first. Payments for services rendered by a nonparticipating
2462 essential provider shall be made at the applicable Medicaid rate
2463 as of the first day of the contract between the agency and the
2464 plan. A rate schedule for all essential providers shall be
2465 attached to the contract between the agency and the plan. After
2466 1 year, managed care plans that are unable to contract with
2467 essential providers shall notify the agency and propose an
2468 alternative arrangement for securing the essential services for
2469 Medicaid enrollees. The arrangement must rely on contracts with
2470 other participating providers, regardless of whether those
2471 providers are located within the same region as the
2472 nonparticipating essential service provider. If the alternative
2473 arrangement is approved by the agency, payments to
2474 nonparticipating essential providers after the date of the
2475 agency’s approval shall equal 90 percent of the applicable
2476 Medicaid rate. Except for payment for emergency services, if the
2477 alternative arrangement is not approved by the agency, payment
2478 to nonparticipating essential providers shall equal 110 percent
2479 of the applicable Medicaid rate.
2480 (b) Certain providers are statewide resources and essential
2481 providers for all managed care plans in all regions. All managed
2482 care plans must include these essential providers in their
2483 networks. Statewide essential providers include:
2484 1. Faculty plans of Florida medical schools.
2485 2. Regional perinatal intensive care centers as defined in
2486 s. 383.16(2).
2487 3. Hospitals licensed as specialty children’s hospitals as
2488 defined in s. 395.002(27) s. 395.002(28).
2489 4. Accredited and integrated systems serving medically
2490 complex children which comprise separately licensed, but
2491 commonly owned, health care providers delivering at least the
2492 following services: medical group home, in-home and outpatient
2493 nursing care and therapies, pharmacy services, durable medical
2494 equipment, and Prescribed Pediatric Extended Care.
2495
2496 Managed care plans that have not contracted with all statewide
2497 essential providers in all regions as of the first date of
2498 recipient enrollment must continue to negotiate in good faith.
2499 Payments to physicians on the faculty of nonparticipating
2500 Florida medical schools shall be made at the applicable Medicaid
2501 rate. Payments for services rendered by regional perinatal
2502 intensive care centers shall be made at the applicable Medicaid
2503 rate as of the first day of the contract between the agency and
2504 the plan. Except for payments for emergency services, payments
2505 to nonparticipating specialty children’s hospitals shall equal
2506 the highest rate established by contract between that provider
2507 and any other Medicaid managed care plan.
2508 Section 77. Subsections (5) and (17) of section 429.02,
2509 Florida Statutes, are amended to read:
2510 429.02 Definitions.—When used in this part, the term:
2511 (5) “Assisted living facility” means any building or
2512 buildings, section or distinct part of a building, private home,
2513 boarding home, home for the aged, or other residential facility,
2514 regardless of whether operated for profit or not, which
2515 undertakes through its ownership or management provides to
2516 provide housing, meals, and one or more personal services for a
2517 period exceeding 24 hours to one or more adults who are not
2518 relatives of the owner or administrator.
2519 (17) “Personal services” means direct physical assistance
2520 with or supervision of the activities of daily living, and the
2521 self-administration of medication, or and other similar services
2522 which the department may define by rule. The term may “Personal
2523 services” shall not be construed to mean the provision of
2524 medical, nursing, dental, or mental health services.
2525 Section 78. Paragraphs (b) and (d) of subsection (2) of
2526 section 429.04, Florida Statutes, are amended, and subsection
2527 (3) is added that section, to read:
2528 429.04 Facilities to be licensed; exemptions.—
2529 (2) The following are exempt from licensure under this
2530 part:
2531 (b) Any facility or part of a facility licensed by the
2532 Agency for Persons with Disabilities under chapter 393, a mental
2533 health facility licensed under or chapter 394, a hospital
2534 licensed under chapter 395, a nursing home licensed under part
2535 II of chapter 400, an inpatient hospice licensed under part IV
2536 of chapter 400, a home for special services licensed under part
2537 V of chapter 400, an intermediate care facility licensed under
2538 part VIII of chapter 400, or a transitional living facility
2539 licensed under part XI of chapter 400.
2540 (d) Any person who provides housing, meals, and one or more
2541 personal services on a 24-hour basis in the person’s own home to
2542 not more than two adults who do not receive optional state
2543 supplementation. The person who provides the housing, meals, and
2544 personal services must own or rent the home and must have
2545 established the home as his or her permanent residence. For
2546 purposes of this paragraph, any person holding a homestead
2547 exemption at an address other than that at which the person
2548 asserts this exemption is presumed to not have established
2549 permanent residence reside therein. This exemption does not
2550 apply to a person or entity that previously held a license
2551 issued by the agency which was revoked or for which renewal was
2552 denied by final order of the agency, or when the person or
2553 entity voluntarily relinquished the license during agency
2554 enforcement proceedings.
2555 (3) Upon agency investigation of unlicensed activity, any
2556 person or entity that claims that it is exempt under this
2557 section must provide documentation substantiating entitlement to
2558 the exemption.
2559 Section 79. Paragraphs (b) and (d) of subsection (1) of
2560 section 429.08, Florida Statutes, are amended to read:
2561 429.08 Unlicensed facilities; referral of person for
2562 residency to unlicensed facility; penalties.—
2563 (1)(b) Except as provided under paragraph (d), Any person
2564 who owns, rents, or otherwise maintains a building or property
2565 used as operates, or maintains an unlicensed assisted living
2566 facility commits a felony of the third degree, punishable as
2567 provided in s. 775.082, s. 775.083, or s. 775.084. Each day of
2568 continued operation is a separate offense.
2569 (d) In addition to the requirements of s. 408.812, any
2570 person who owns, operates, or maintains an unlicensed assisted
2571 living facility after receiving notice from the agency due to a
2572 change in this part or a modification in rule within 6 months
2573 after the effective date of such change and who, within 10
2574 working days after receiving notification from the agency, fails
2575 to cease operation or apply for a license under this part
2576 commits a felony of the third degree, punishable as provided in
2577 s. 775.082, s. 775.083, or s. 775.084. Each day of continued
2578 operation is a separate offense.
2579 Section 80. Section 429.176, Florida Statutes, is amended
2580 to read:
2581 429.176 Notice of change of administrator.—If, during the
2582 period for which a license is issued, the owner changes
2583 administrators, the owner must notify the agency of the change
2584 within 10 days and provide documentation within 90 days that the
2585 new administrator has completed the applicable core educational
2586 requirements under s. 429.52. A facility may not be operated for
2587 more than 120 consecutive days without an administrator who has
2588 completed the core educational requirements.
2589 Section 81. Subsection(7) of section 429.19, Florida
2590 Statutes, is amended to read:
2591 429.19 Violations; imposition of administrative fines;
2592 grounds.—
2593 (7) In addition to any administrative fines imposed, the
2594 agency may assess a survey fee, equal to the lesser of one half
2595 of the facility’s biennial license and bed fee or $500, to cover
2596 the cost of conducting initial complaint investigations that
2597 result in the finding of a violation that was the subject of the
2598 complaint or monitoring visits conducted under s. 429.28(3)(c)
2599 to verify the correction of the violations.
2600 Section 82. Subsection (2) of section 429.24, Florida
2601 Statutes, is amended to read:
2602 429.24 Contracts.—
2603 (2) Each contract must contain express provisions
2604 specifically setting forth the services and accommodations to be
2605 provided by the facility; the rates or charges; provision for at
2606 least 30 days’ written notice of a rate increase; the rights,
2607 duties, and obligations of the residents, other than those
2608 specified in s. 429.28; and other matters that the parties deem
2609 appropriate. A new service or accommodation added to, or
2610 implemented in, a resident’s contract for which the resident was
2611 not previously charged does not require a 30-day written notice
2612 of a rate increase. Whenever money is deposited or advanced by a
2613 resident in a contract as security for performance of the
2614 contract agreement or as advance rent for other than the next
2615 immediate rental period:
2616 (a) Such funds shall be deposited in a banking institution
2617 in this state that is located, if possible, in the same
2618 community in which the facility is located; shall be kept
2619 separate from the funds and property of the facility; may not be
2620 represented as part of the assets of the facility on financial
2621 statements; and shall be used, or otherwise expended, only for
2622 the account of the resident.
2623 (b) The licensee shall, within 30 days of receipt of
2624 advance rent or a security deposit, notify the resident or
2625 residents in writing of the manner in which the licensee is
2626 holding the advance rent or security deposit and state the name
2627 and address of the depository where the moneys are being held.
2628 The licensee shall notify residents of the facility’s policy on
2629 advance deposits.
2630 Section 83. Paragraphs (e) and (j) of subsection (1) and
2631 paragraphs (c), (d), and (e) of subsection (3) of section
2632 429.28, Florida Statutes, are amended to read:
2633 429.28 Resident bill of rights.—
2634 (1) No resident of a facility shall be deprived of any
2635 civil or legal rights, benefits, or privileges guaranteed by
2636 law, the Constitution of the State of Florida, or the
2637 Constitution of the United States as a resident of a facility.
2638 Every resident of a facility shall have the right to:
2639 (e) Freedom to participate in and benefit from community
2640 services and activities and to pursue achieve the highest
2641 possible level of independence, autonomy, and interaction within
2642 the community.
2643 (j) Assistance with obtaining access to adequate and
2644 appropriate health care. For purposes of this paragraph, the
2645 term “adequate and appropriate health care” means the management
2646 of medications, assistance in making appointments for health
2647 care services, the provision of or arrangement of transportation
2648 to health care appointments, and the performance of health care
2649 services in accordance with s. 429.255 which are consistent with
2650 established and recognized standards within the community.
2651 (3)(c) During any calendar year in which no survey is
2652 conducted, the agency shall conduct at least one monitoring
2653 visit of each facility cited in the previous year for a class I
2654 or class II violation, or more than three uncorrected class III
2655 violations.
2656 (d) The agency may conduct periodic followup inspections as
2657 necessary to monitor the compliance of facilities with a history
2658 of any class I, class II, or class III violations that threaten
2659 the health, safety, or security of residents.
2660 (e) The agency may conduct complaint investigations as
2661 warranted to investigate any allegations of noncompliance with
2662 requirements required under this part or rules adopted under
2663 this part.
2664 Section 84. Subsection (1) of section 429.294, Florida
2665 Statutes, is amended to read:
2666 429.294 Availability of facility records for investigation
2667 of resident’s rights violations and defenses; penalty.—
2668 (1) Failure to provide complete copies of a resident’s
2669 records, including, but not limited to, all medical records and
2670 the resident’s chart, within the control or possession of the
2671 facility within 10 days, in accordance with the provisions of s.
2672 400.145, shall constitute evidence of failure of that party to
2673 comply with good faith discovery requirements and shall waive
2674 the good faith certificate and presuit notice requirements under
2675 this part by the requesting party.
2676 Section 85. Subsection (2) of section 429.34, Florida
2677 Statutes, is amended to read:
2678 429.34 Right of entry and inspection.—
2679 (2)(a) In addition to the requirements of s. 408.811, the
2680 agency may inspect and investigate facilities as necessary to
2681 determine compliance with this part, part II of chapter 408, and
2682 rules adopted thereunder. The agency shall inspect each licensed
2683 assisted living facility at least once every 24 months to
2684 determine compliance with this chapter and related rules. If an
2685 assisted living facility is cited for a class I violation or
2686 three or more class II violations arising from separate surveys
2687 within a 60-day period or due to unrelated circumstances during
2688 the same survey, the agency must conduct an additional licensure
2689 inspection within 6 months.
2690 (b) During any calendar year in which a survey is not
2691 conducted, the agency may conduct monitoring visits of each
2692 facility cited in the previous year for a class I or class II
2693 violation or for more than three uncorrected class III
2694 violations.
2695 Section 86. Subsection (4) of section 429.52, Florida
2696 Statutes, is amended to read:
2697 429.52 Staff training and educational programs; core
2698 educational requirement.—
2699 (4) Effective January 1, 2004, a new facility administrator
2700 must complete the required training and education, including the
2701 competency test, within 90 days after date of employment a
2702 reasonable time after being employed as an administrator, as
2703 determined by the department. Failure to do so is a violation of
2704 this part and subjects the violator to an administrative fine as
2705 prescribed in s. 429.19. Administrators licensed in accordance
2706 with part II of chapter 468 are exempt from this requirement.
2707 Other licensed professionals may be exempted, as determined by
2708 the department by rule.
2709 Section 87. Subsection (3) of section 435.04, Florida
2710 Statutes, is amended, and subsection (4) is added to that
2711 section, to read:
2712 435.04 Level 2 screening standards.—
2713 (3) The security background investigations under this
2714 section must ensure that no person subject to this section has
2715 been arrested for and is awaiting final disposition of, been
2716 found guilty of, regardless of adjudication, or entered a plea
2717 of nolo contendere or guilty to, any offense that constitutes
2718 domestic violence as defined in s. 741.28, whether such act was
2719 committed in this state or in another jurisdiction.
2720 (4) For the purpose of screening applicability to
2721 participate in the Medicaid program, the security background
2722 investigations under this section must ensure that a person
2723 subject to screening under this section has not been arrested
2724 for and is not awaiting final disposition of; has not been found
2725 guilty of, regardless of adjudication, or entered a plea of nolo
2726 contendere or guilty to; and has not been adjudicated delinquent
2727 and the record sealed or expunged for, any of the following
2728 offenses:
2729 (a) Violation of a federal law or a law in any state which
2730 creates a criminal offense relating to:
2731 1. The delivery of any goods or services under Medicaid or
2732 Medicare or any other public or private health care or health
2733 insurance program, including the performance of management or
2734 administrative services relating to the delivery of goods or
2735 services under any such program;
2736 2. Neglect or abuse of a patient in connection with the
2737 delivery of any health care good or service;
2738 3. Unlawful manufacture, distribution, prescription, or
2739 dispensing of a controlled substance;
2740 4. Fraud, theft, embezzlement, breach of fiduciary
2741 responsibility, or other financial misconduct; or
2742 5. Moral turpitude, if punishable by imprisonment of a year
2743 or more.
2744 6. Interference with or obstruction of an investigation
2745 into any criminal offense identified in this subsection.
2746 (b) Violation of the following state laws or laws of
2747 another jurisdiction:
2748 1. Section 817.569, criminal use of a public record or
2749 information contained in a public record;
2750 2. Section 838.016, unlawful compensation or reward for
2751 official behavior;
2752 3. Section 838.021, corruption by threat against a public
2753 servant;
2754 4. Section 838.022, official misconduct;
2755 5. Section 838.22, bid tampering;
2756 6. Section 839.13, falsifying records;
2757 7. Section 839.26, misuse of confidential information; or
2758 (c) Violation of a federal or state law, rule, or
2759 regulation governing the Florida Medicaid program or any other
2760 state Medicaid program, the Medicare program, or any other
2761 publicly funded federal or state health care or health insurance
2762 program.
2763 Section 88. Subsection (4) of section 456.001, Florida
2764 Statutes, is amended to read:
2765 456.001 Definitions.—As used in this chapter, the term:
2766 (4) “Health care practitioner” means any person licensed
2767 under chapter 457; chapter 458; chapter 459; chapter 460;
2768 chapter 461; chapter 462; chapter 463; chapter 464; chapter 465;
2769 chapter 466; chapter 467; part I, part II, part III, part V,
2770 part X, part XIII, or part XIV of chapter 468; chapter 478;
2771 chapter 480; part II or part III or part IV of chapter 483;
2772 chapter 484; chapter 486; chapter 490; or chapter 491.
2773 Section 89. Subsection (3) of section 456.054, Florida
2774 Statutes, is redesignated as subsection (4), and a new
2775 subsection (3) is added to that section, to read:
2776 456.054 Kickbacks prohibited.—
2777 (3)(a) It is unlawful for any person or any entity to pay
2778 or receive, directly or indirectly, a commission, bonus,
2779 kickback, or rebate from, or to engage in any form of a split
2780 fee arrangement with, a dialysis facility, health care
2781 practitioner, surgeon, person, or entity for referring patients
2782 to a clinical laboratory as defined in s. 483.803.
2783 (b) It is unlawful for any clinical laboratory to:
2784 1. Provide personnel to perform any functions or duties in
2785 a health care practitioner’s office or dialysis facility for any
2786 purpose, including for the collection or handling of specimens,
2787 directly or indirectly through an employee, contractor,
2788 independent staffing company, lease agreement, or otherwise,
2789 unless the laboratory and the practitioner’s office, or dialysis
2790 facility, are wholly owned and operated by the same entity.
2791 2. Lease space within any part of a health care
2792 practitioner’s office or dialysis facility for any purpose,
2793 including for the purpose of establishing a collection station
2794 where materials or specimens are collected or drawn from
2795 patients.
2796 Section 90. Paragraphs (h) and (i) of subsection (2) of
2797 section 456.057, Florida Statutes, are amended to read:
2798 456.057 Ownership and control of patient records; report or
2799 copies of records to be furnished; disclosure of information.—
2800 (2) As used in this section, the terms “records owner,”
2801 “health care practitioner,” and “health care practitioner’s
2802 employer” do not include any of the following persons or
2803 entities; furthermore, the following persons or entities are not
2804 authorized to acquire or own medical records, but are authorized
2805 under the confidentiality and disclosure requirements of this
2806 section to maintain those documents required by the part or
2807 chapter under which they are licensed or regulated:
2808 (h) Clinical laboratory personnel licensed under part II
2809 III of chapter 483.
2810 (i) Medical physicists licensed under part III IV of
2811 chapter 483.
2812 Section 91. Paragraph (j) of subsection (1) of section
2813 456.076, Florida Statutes, is amended to read:
2814 456.076 Impaired practitioner programs.—
2815 (1) As used in this section, the term:
2816 (j) “Practitioner” means a person licensed, registered,
2817 certified, or regulated by the department under part III of
2818 chapter 401; chapter 457; chapter 458; chapter 459; chapter 460;
2819 chapter 461; chapter 462; chapter 463; chapter 464; chapter 465;
2820 chapter 466; chapter 467; part I, part II, part III, part V,
2821 part X, part XIII, or part XIV of chapter 468; chapter 478;
2822 chapter 480; part II or part III or part IV of chapter 483;
2823 chapter 484; chapter 486; chapter 490; or chapter 491; or an
2824 applicant for a license, registration, or certification under
2825 the same laws.
2826 Section 92. Subsection (2) of section 458.307, Florida
2827 Statutes, is amended to read:
2828 458.307 Board of Medicine.—
2829 (2) Twelve members of the board must be licensed physicians
2830 in good standing in this state who are residents of the state
2831 and who have been engaged in the active practice or teaching of
2832 medicine for at least 4 years immediately preceding their
2833 appointment. One of the physicians must be on the full-time
2834 faculty of a medical school in this state, and one of the
2835 physicians must be in private practice and on the full-time
2836 staff of a statutory teaching hospital in this state as defined
2837 in s. 408.07. At least one of the physicians must be a graduate
2838 of a foreign medical school. The remaining three members must be
2839 residents of the state who are not, and never have been,
2840 licensed health care practitioners. One member must be a health
2841 care risk manager licensed under s. 395.10974. At least one
2842 member of the board must be 60 years of age or older.
2843 Section 93. Subsection (1) of section 458.345, Florida
2844 Statutes, is amended to read:
2845 458.345 Registration of resident physicians, interns, and
2846 fellows; list of hospital employees; prescribing of medicinal
2847 drugs; penalty.—
2848 (1) Any person desiring to practice as a resident
2849 physician, assistant resident physician, house physician,
2850 intern, or fellow in fellowship training which leads to
2851 subspecialty board certification in this state, or any person
2852 desiring to practice as a resident physician, assistant resident
2853 physician, house physician, intern, or fellow in fellowship
2854 training in a teaching hospital in this state as defined in s.
2855 408.07 s. 408.07(45) or s. 395.805(2), who does not hold a
2856 valid, active license issued under this chapter shall apply to
2857 the department to be registered and shall remit a fee not to
2858 exceed $300 as set by the board. The department shall register
2859 any applicant the board certifies has met the following
2860 requirements:
2861 (a) Is at least 21 years of age.
2862 (b) Has not committed any act or offense within or without
2863 the state which would constitute the basis for refusal to
2864 certify an application for licensure pursuant to s. 458.331.
2865 (c) Is a graduate of a medical school or college as
2866 specified in s. 458.311(1)(f).
2867 Section 94. Subsection (1) of s. 459.021, Florida Statutes,
2868 is amended to read:
2869 459.021 Registration of resident physicians, interns, and
2870 fellows; list of hospital employees; penalty.—
2871 (1) Any person who holds a degree of Doctor of Osteopathic
2872 Medicine from a college of osteopathic medicine recognized and
2873 approved by the American Osteopathic Association who desires to
2874 practice as a resident physician, intern, or fellow in
2875 fellowship training which leads to subspecialty board
2876 certification in this state, or any person desiring to practice
2877 as a resident physician, intern, or fellow in fellowship
2878 training in a teaching hospital in this state as defined in s.
2879 408.07 s. 408.07(45) or s. 395.805(2), who does not hold an
2880 active license issued under this chapter shall apply to the
2881 department to be registered, on an application provided by the
2882 department, before commencing such a training program and shall
2883 remit a fee not to exceed $300 as set by the board.
2884 Section 95. Part I of chapter 483, Florida Statutes,
2885 consisting of sections 483.011, 483.021, 483.031, 483.035,
2886 483.041, 483.051, 483.061, 483.091, 483.101, 483.111, 483.172,
2887 483.181, 483.191, 483.201, 483.221, 483.23, 483.245, and 483.26,
2888 is repealed.
2889 Section 96. Section 483.294, Florida Statutes, is amended
2890 to read:
2891 483.294 Inspection of centers.—In accordance with s.
2892 408.811, the agency shall, at least once annually, inspect the
2893 premises and operations of all centers subject to licensure
2894 under this part.
2895 Section 97. Subsections (3) and (5) of section 483.801,
2896 Florida Statutes, are amended, and subsection (6) is added to
2897 that section, to read:
2898 483.801 Exemptions.—This part applies to all clinical
2899 laboratories and clinical laboratory personnel within this
2900 state, except:
2901 (3) Persons engaged in testing performed by laboratories
2902 that are wholly owned and operated by one or more practitioners
2903 licensed under chapter 458, chapter 459, chapter 460, chapter
2904 461, chapter 462, chapter 463, or chapter 466 who practice in
2905 the same group practice, and in which no clinical laboratory
2906 work is performed for patients referred by any health care
2907 provider who is not a member of that group practice regulated
2908 under s. 483.035(1) or exempt from regulation under s.
2909 483.031(2).
2910 (5) Advanced registered nurse practitioners licensed under
2911 part I of chapter 464 who perform provider-performed microscopy
2912 procedures (PPMP) in a an exclusive-use laboratory setting
2913 pursuant to subsection (3).
2914 (6) Persons performing laboratory testing within a
2915 physician office practice for patients referred by a health care
2916 provider who is a member of the same physician office practice,
2917 if the laboratory or entity operating the laboratory within a
2918 physician office practice is under common ownership, directly or
2919 indirectly, with an entity licensed pursuant to chapter 395.
2920 Section 98. Subsections (2), (3), and (4) of section
2921 483.803, Florida Statutes, are amended to read:
2922 483.803 Definitions.—As used in this part, the term:
2923 (2) “Clinical laboratory” means the physical location in
2924 which one or more of the following services are performed to
2925 provide information or materials for use in the diagnosis,
2926 prevention, or treatment of a disease or the identification or
2927 assessment of a medical or physical condition:
2928 (a) Clinical laboratory services, which entail the
2929 examination of fluids or other materials taken from the human
2930 body.
2931 (b) Anatomic laboratory services, which entail the
2932 examination of tissue taken from the human body.
2933 (c) Cytology laboratory services, which entail the
2934 examination of cells from individual tissues or fluid taken from
2935 the human body a clinical laboratory as defined in s. 483.041.
2936 (3) “Clinical laboratory examination” means a procedure
2937 performed to deliver the services identified in subsection (2),
2938 including the oversight or interpretation of such services
2939 clinical laboratory examination as defined in s. 483.041.
2940 (4) “Clinical laboratory personnel” includes a clinical
2941 laboratory director, supervisor, technologist, blood gas
2942 analyst, or technician who performs or is responsible for
2943 laboratory test procedures, but the term does not include
2944 trainees, persons who perform screening for blood banks or
2945 plasmapheresis centers, phlebotomists, or persons employed by a
2946 clinical laboratory to perform manual pretesting duties or
2947 clerical, personnel, or other administrative responsibilities,
2948 or persons engaged in testing performed by laboratories
2949 regulated under s. 483.035(1) or exempt from regulation under s.
2950 483.031(2).
2951 Section 99. Section 483.813, Florida Statutes, is amended
2952 to read:
2953 483.813 Clinical laboratory personnel license.—A person may
2954 not conduct a clinical laboratory examination or report the
2955 results of such examination unless such person is licensed under
2956 this part to perform such procedures. However, this provision
2957 does not apply to any practitioner of the healing arts
2958 authorized to practice in this state or to persons engaged in
2959 testing performed by laboratories regulated under s. 483.035(1)
2960 or exempt from regulation under s. 483.031(2). The department
2961 may grant a temporary license to any candidate it deems properly
2962 qualified, for a period not to exceed 1 year.
2963 Section 100. Subsection (2) of section 483.823, Florida
2964 Statutes, is amended to read:
2965 483.823 Qualifications of clinical laboratory personnel.—
2966 (2) Personnel qualifications may require appropriate
2967 education, training, or experience or the passing of an
2968 examination in appropriate subjects or any combination of these,
2969 but a no practitioner of the healing arts licensed to practice
2970 in this state is not required to obtain any license under this
2971 part or to pay any fee under this part hereunder except the fee
2972 required for clinical laboratory licensure.
2973 Section 101. Paragraph (c) of subsection (7), and
2974 subsections (8) and (9) of section 491.003, Florida Statutes,
2975 are amended to read:
2976 491.003 Definitions.—As used in this chapter:
2977 (7) The “practice of clinical social work” is defined as
2978 the use of scientific and applied knowledge, theories, and
2979 methods for the purpose of describing, preventing, evaluating,
2980 and treating individual, couple, marital, family, or group
2981 behavior, based on the person-in-situation perspective of
2982 psychosocial development, normal and abnormal behavior,
2983 psychopathology, unconscious motivation, interpersonal
2984 relationships, environmental stress, differential assessment,
2985 differential planning, and data gathering. The purpose of such
2986 services is the prevention and treatment of undesired behavior
2987 and enhancement of mental health. The practice of clinical
2988 social work includes methods of a psychological nature used to
2989 evaluate, assess, diagnose, treat, and prevent emotional and
2990 mental disorders and dysfunctions (whether cognitive, affective,
2991 or behavioral), sexual dysfunction, behavioral disorders,
2992 alcoholism, and substance abuse. The practice of clinical social
2993 work includes, but is not limited to, psychotherapy,
2994 hypnotherapy, and sex therapy. The practice of clinical social
2995 work also includes counseling, behavior modification,
2996 consultation, client-centered advocacy, crisis intervention, and
2997 the provision of needed information and education to clients,
2998 when using methods of a psychological nature to evaluate,
2999 assess, diagnose, treat, and prevent emotional and mental
3000 disorders and dysfunctions (whether cognitive, affective, or
3001 behavioral), sexual dysfunction, behavioral disorders,
3002 alcoholism, or substance abuse. The practice of clinical social
3003 work may also include clinical research into more effective
3004 psychotherapeutic modalities for the treatment and prevention of
3005 such conditions.
3006 (c) The terms “diagnose” and “treat,” as used in this
3007 chapter, when considered in isolation or in conjunction with any
3008 provision of the rules of the board, may shall not be construed
3009 to permit the performance of any act which clinical social
3010 workers are not educated and trained to perform, including, but
3011 not limited to, admitting persons to hospitals for treatment of
3012 the foregoing conditions, treating persons in hospitals without
3013 medical supervision, prescribing medicinal drugs as defined in
3014 chapter 465, authorizing clinical laboratory procedures pursuant
3015 to chapter 483, or radiological procedures, or use of
3016 electroconvulsive therapy. In addition, this definition shall
3017 may not be construed to permit any person licensed,
3018 provisionally licensed, registered, or certified pursuant to
3019 this chapter to describe or label any test, report, or procedure
3020 as “psychological,” except to relate specifically to the
3021 definition of practice authorized in this subsection.
3022 (8) The term “practice of marriage and family therapy”
3023 means is defined as the use of scientific and applied marriage
3024 and family theories, methods, and procedures for the purpose of
3025 describing, evaluating, and modifying marital, family, and
3026 individual behavior, within the context of marital and family
3027 systems, including the context of marital formation and
3028 dissolution, and is based on marriage and family systems theory,
3029 marriage and family development, human development, normal and
3030 abnormal behavior, psychopathology, human sexuality,
3031 psychotherapeutic and marriage and family therapy theories and
3032 techniques. The practice of marriage and family therapy includes
3033 methods of a psychological nature used to evaluate, assess,
3034 diagnose, treat, and prevent emotional and mental disorders or
3035 dysfunctions (whether cognitive, affective, or behavioral),
3036 sexual dysfunction, behavioral disorders, alcoholism, and
3037 substance abuse. The practice of marriage and family therapy
3038 includes, but is not limited to, marriage and family therapy,
3039 psychotherapy, including behavioral family therapy,
3040 hypnotherapy, and sex therapy. The practice of marriage and
3041 family therapy also includes counseling, behavior modification,
3042 consultation, client-centered advocacy, crisis intervention, and
3043 the provision of needed information and education to clients,
3044 when using methods of a psychological nature to evaluate,
3045 assess, diagnose, treat, and prevent emotional and mental
3046 disorders and dysfunctions (whether cognitive, affective, or
3047 behavioral), sexual dysfunction, behavioral disorders,
3048 alcoholism, or substance abuse. The practice of marriage and
3049 family therapy may also include clinical research into more
3050 effective psychotherapeutic modalities for the treatment and
3051 prevention of such conditions.
3052 (a) Marriage and family therapy may be rendered to
3053 individuals, including individuals affected by termination of
3054 marriage, to couples, whether married or unmarried, to families,
3055 or to groups.
3056 (b) The use of specific methods, techniques, or modalities
3057 within the practice of marriage and family therapy is restricted
3058 to marriage and family therapists appropriately trained in the
3059 use of such methods, techniques, or modalities.
3060 (c) The terms “diagnose” and “treat,” as used in this
3061 chapter, when considered in isolation or in conjunction with any
3062 provision of the rules of the board, may shall not be construed
3063 to permit the performance of any act that which marriage and
3064 family therapists are not educated and trained to perform,
3065 including, but not limited to, admitting persons to hospitals
3066 for treatment of the foregoing conditions, treating persons in
3067 hospitals without medical supervision, prescribing medicinal
3068 drugs as defined in chapter 465, authorizing clinical laboratory
3069 procedures pursuant to chapter 483, or radiological procedures,
3070 or the use of electroconvulsive therapy. In addition, this
3071 definition may shall not be construed to permit any person
3072 licensed, provisionally licensed, registered, or certified
3073 pursuant to this chapter to describe or label any test, report,
3074 or procedure as “psychological,” except to relate specifically
3075 to the definition of practice authorized in this subsection.
3076 (d) The definition of “marriage and family therapy”
3077 contained in this subsection includes all services offered
3078 directly to the general public or through organizations, whether
3079 public or private, and applies whether payment is requested or
3080 received for services rendered.
3081 (9) The term “practice of mental health counseling” means
3082 is defined as the use of scientific and applied behavioral
3083 science theories, methods, and techniques for the purpose of
3084 describing, preventing, and treating undesired behavior and
3085 enhancing mental health and human development and is based on
3086 the person-in-situation perspectives derived from research and
3087 theory in personality, family, group, and organizational
3088 dynamics and development, career planning, cultural diversity,
3089 human growth and development, human sexuality, normal and
3090 abnormal behavior, psychopathology, psychotherapy, and
3091 rehabilitation. The practice of mental health counseling
3092 includes methods of a psychological nature used to evaluate,
3093 assess, diagnose, and treat emotional and mental dysfunctions or
3094 disorders, (whether cognitive, affective, or behavioral),
3095 behavioral disorders, interpersonal relationships, sexual
3096 dysfunction, alcoholism, and substance abuse. The practice of
3097 mental health counseling includes, but is not limited to,
3098 psychotherapy, hypnotherapy, and sex therapy. The practice of
3099 mental health counseling also includes counseling, behavior
3100 modification, consultation, client-centered advocacy, crisis
3101 intervention, and the provision of needed information and
3102 education to clients, when using methods of a psychological
3103 nature to evaluate, assess, diagnose, treat, and prevent
3104 emotional and mental disorders and dysfunctions (whether
3105 cognitive, affective, or behavioral), behavioral disorders,
3106 sexual dysfunction, alcoholism, or substance abuse. The practice
3107 of mental health counseling may also include clinical research
3108 into more effective psychotherapeutic modalities for the
3109 treatment and prevention of such conditions.
3110 (a) Mental health counseling may be rendered to
3111 individuals, including individuals affected by the termination
3112 of marriage, and to couples, families, groups, organizations,
3113 and communities.
3114 (b) The use of specific methods, techniques, or modalities
3115 within the practice of mental health counseling is restricted to
3116 mental health counselors appropriately trained in the use of
3117 such methods, techniques, or modalities.
3118 (c) The terms “diagnose” and “treat,” as used in this
3119 chapter, when considered in isolation or in conjunction with any
3120 provision of the rules of the board, may shall not be construed
3121 to permit the performance of any act that which mental health
3122 counselors are not educated and trained to perform, including,
3123 but not limited to, admitting persons to hospitals for treatment
3124 of the foregoing conditions, treating persons in hospitals
3125 without medical supervision, prescribing medicinal drugs as
3126 defined in chapter 465, authorizing clinical laboratory
3127 procedures pursuant to chapter 483, or radiological procedures,
3128 or the use of electroconvulsive therapy. In addition, this
3129 definition may shall not be construed to permit any person
3130 licensed, provisionally licensed, registered, or certified
3131 pursuant to this chapter to describe or label any test, report,
3132 or procedure as “psychological,” except to relate specifically
3133 to the definition of practice authorized in this subsection.
3134 (d) The definition of “mental health counseling” contained
3135 in this subsection includes all services offered directly to the
3136 general public or through organizations, whether public or
3137 private, and applies whether payment is requested or received
3138 for services rendered.
3139 Section 102. Paragraph (h) of subsection (4) of section
3140 627.351, Florida Statutes, is amended to read:
3141 627.351 Insurance risk apportionment plans.—
3142 (4) MEDICAL MALPRACTICE RISK APPORTIONMENT.—
3143 (h) As used in this subsection:
3144 1. “Health care provider” means hospitals licensed under
3145 chapter 395; physicians licensed under chapter 458; osteopathic
3146 physicians licensed under chapter 459; podiatric physicians
3147 licensed under chapter 461; dentists licensed under chapter 466;
3148 chiropractic physicians licensed under chapter 460; naturopaths
3149 licensed under chapter 462; nurses licensed under part I of
3150 chapter 464; midwives licensed under chapter 467; clinical
3151 laboratories registered under chapter 483; physician assistants
3152 licensed under chapter 458 or chapter 459; physical therapists
3153 and physical therapist assistants licensed under chapter 486;
3154 health maintenance organizations certificated under part I of
3155 chapter 641; ambulatory surgical centers licensed under chapter
3156 395; other medical facilities as defined in subparagraph 2.;
3157 blood banks, plasma centers, industrial clinics, and renal
3158 dialysis facilities; or professional associations, partnerships,
3159 corporations, joint ventures, or other associations for
3160 professional activity by health care providers.
3161 2. “Other medical facility” means a facility the primary
3162 purpose of which is to provide human medical diagnostic services
3163 or a facility providing nonsurgical human medical treatment, to
3164 which facility the patient is admitted and from which facility
3165 the patient is discharged within the same working day, and which
3166 facility is not part of a hospital. However, a facility existing
3167 for the primary purpose of performing terminations of pregnancy
3168 or an office maintained by a physician or dentist for the
3169 practice of medicine may shall not be construed to be an “other
3170 medical facility.”
3171 3. “Health care facility” means any hospital licensed under
3172 chapter 395, health maintenance organization certificated under
3173 part I of chapter 641, ambulatory surgical center licensed under
3174 chapter 395, or other medical facility as defined in
3175 subparagraph 2.
3176 Section 103. Paragraph (h) of subsection (1) of section
3177 627.602, Florida Statutes, is amended to read:
3178 627.602 Scope, format of policy.—
3179 (1) Each health insurance policy delivered or issued for
3180 delivery to any person in this state must comply with all
3181 applicable provisions of this code and all of the following
3182 requirements:
3183 (h) Section 641.312 and the provisions of the Employee
3184 Retirement Income Security Act of 1974, as implemented by 29
3185 C.F.R. s. 2560.503-1, relating to internal grievances. This
3186 paragraph does not apply to a health insurance policy that is
3187 subject to the Subscriber Assistance Program under s. 408.7056
3188 or to the types of benefits or coverages provided under s.
3189 627.6513(1)-(14) issued in any market.
3190 Section 104. Subsection (1) of section 627.6406, Florida
3191 Statutes, is amended to read:
3192 627.6406 Maternity care.—
3193 (1) Any policy of health insurance which that provides
3194 coverage for maternity care must also cover the services of
3195 certified nurse-midwives and midwives licensed pursuant to
3196 chapter 467, and the services of birth centers licensed under
3197 ss. 383.30-383.332 383.30-383.335.
3198 Section 105. Paragraphs (b) and (e) of subsection (1) of
3199 section 627.64194, Florida Statutes, are amended to read:
3200 627.64194 Coverage requirements for services provided by
3201 nonparticipating providers; payment collection limitations.—
3202 (1) As used in this section, the term:
3203 (b) “Facility” means a licensed facility as defined in s.
3204 395.002(16) and an urgent care center as defined in s. 395.002
3205 s. 395.002(30).
3206 (e) “Nonparticipating provider” means a provider who is not
3207 a preferred provider as defined in s. 627.6471 or a provider who
3208 is not an exclusive provider as defined in s. 627.6472. For
3209 purposes of covered emergency services under this section, a
3210 facility licensed under chapter 395 or an urgent care center
3211 defined in s. 395.002 s. 395.002(30) is a nonparticipating
3212 provider if the facility has not contracted with an insurer to
3213 provide emergency services to its insureds at a specified rate.
3214 Section 106. Section 627.6513, Florida Statutes, is amended
3215 to read:
3216 627.6513 Scope.—Section 641.312 and the provisions of the
3217 Employee Retirement Income Security Act of 1974, as implemented
3218 by 29 C.F.R. s. 2560.503-1, relating to internal grievances,
3219 apply to all group health insurance policies issued under this
3220 part. This section does not apply to a group health insurance
3221 policy that is subject to the Subscriber Assistance Program in
3222 s. 408.7056 or to:
3223 (1) Coverage only for accident insurance, or disability
3224 income insurance, or any combination thereof.
3225 (2) Coverage issued as a supplement to liability insurance.
3226 (3) Liability insurance, including general liability
3227 insurance and automobile liability insurance.
3228 (4) Workers’ compensation or similar insurance.
3229 (5) Automobile medical payment insurance.
3230 (6) Credit-only insurance.
3231 (7) Coverage for onsite medical clinics, including prepaid
3232 health clinics under part II of chapter 641.
3233 (8) Other similar insurance coverage, specified in rules
3234 adopted by the commission, under which benefits for medical care
3235 are secondary or incidental to other insurance benefits. To the
3236 extent possible, such rules must be consistent with regulations
3237 adopted by the United States Department of Health and Human
3238 Services.
3239 (9) Limited scope dental or vision benefits, if offered
3240 separately.
3241 (10) Benefits for long-term care, nursing home care, home
3242 health care, or community-based care, or any combination
3243 thereof, if offered separately.
3244 (11) Other similar, limited benefits, if offered
3245 separately, as specified in rules adopted by the commission.
3246 (12) Coverage only for a specified disease or illness, if
3247 offered as independent, noncoordinated benefits.
3248 (13) Hospital indemnity or other fixed indemnity insurance,
3249 if offered as independent, noncoordinated benefits.
3250 (14) Benefits provided through a Medicare supplemental
3251 health insurance policy, as defined under s. 1882(g)(1) of the
3252 Social Security Act, coverage supplemental to the coverage
3253 provided under 10 U.S.C. chapter 55, and similar supplemental
3254 coverage provided to coverage under a group health plan, which
3255 are offered as a separate insurance policy and as independent,
3256 noncoordinated benefits.
3257 Section 107. Subsection (1) of section 627.6574, Florida
3258 Statutes, is amended to read:
3259 627.6574 Maternity care.—
3260 (1) Any group, blanket, or franchise policy of health
3261 insurance which that provides coverage for maternity care must
3262 also cover the services of certified nurse-midwives and midwives
3263 licensed pursuant to chapter 467, and the services of birth
3264 centers licensed under ss. 383.30-383.332 383.30-383.335.
3265 Section 108. Paragraph (j) of subsection (1) of section
3266 641.185, Florida Statutes, is amended to read:
3267 641.185 Health maintenance organization subscriber
3268 protections.—
3269 (1) With respect to the provisions of this part and part
3270 III, the principles expressed in the following statements shall
3271 serve as standards to be followed by the commission, the office,
3272 the department, and the Agency for Health Care Administration in
3273 exercising their powers and duties, in exercising administrative
3274 discretion, in administrative interpretations of the law, in
3275 enforcing its provisions, and in adopting rules:
3276 (j) A health maintenance organization should receive timely
3277 and, if necessary, urgent review by an independent state
3278 external review organization for unresolved grievances and
3279 appeals pursuant to s. 408.7056.
3280 Section 109. Paragraph (a) of subsection (18) of section
3281 641.31, Florida Statutes, is amended to read:
3282 641.31 Health maintenance contracts.—
3283 (18)(a) Health maintenance contracts that provide coverage,
3284 benefits, or services for maternity care must provide, as an
3285 option to the subscriber, the services of nurse-midwives and
3286 midwives licensed pursuant to chapter 467, and the services of
3287 birth centers licensed pursuant to ss. 383.30-383.332 383.30
3288 383.335, if such services are available within the service area.
3289 Section 110. Section 641.312, Florida Statutes, is amended
3290 to read:
3291 641.312 Scope.—The Office of Insurance Regulation may adopt
3292 rules to administer the provisions of the National Association
3293 of Insurance Commissioners’ Uniform Health Carrier External
3294 Review Model Act, issued by the National Association of
3295 Insurance Commissioners and dated April 2010. This section does
3296 not apply to a health maintenance contract that is subject to
3297 the Subscriber Assistance Program under s. 408.7056 or to the
3298 types of benefits or coverages provided under s. 627.6513(1)
3299 (14) issued in any market.
3300 Section 111. Subsection (4) of section 641.3154, Florida
3301 Statutes, is amended to read:
3302 641.3154 Organization liability; provider billing
3303 prohibited.—
3304 (4) A provider or any representative of a provider,
3305 regardless of whether the provider is under contract with the
3306 health maintenance organization, may not collect or attempt to
3307 collect money from, maintain any action at law against, or
3308 report to a credit agency a subscriber of an organization for
3309 payment of services for which the organization is liable, if the
3310 provider in good faith knows or should know that the
3311 organization is liable. This prohibition applies during the
3312 pendency of any claim for payment made by the provider to the
3313 organization for payment of the services and any legal
3314 proceedings or dispute resolution process to determine whether
3315 the organization is liable for the services if the provider is
3316 informed that such proceedings are taking place. It is presumed
3317 that a provider does not know and should not know that an
3318 organization is liable unless:
3319 (a) The provider is informed by the organization that it
3320 accepts liability;
3321 (b) A court of competent jurisdiction determines that the
3322 organization is liable; or
3323 (c) The office or agency makes a final determination that
3324 the organization is required to pay for such services subsequent
3325 to a recommendation made by the Subscriber Assistance Panel
3326 pursuant to s. 408.7056; or
3327 (c)(d) The agency issues a final order that the
3328 organization is required to pay for such services subsequent to
3329 a recommendation made by a resolution organization pursuant to
3330 s. 408.7057.
3331 Section 112. Paragraph (c) of subsection (5) of section
3332 641.51, Florida Statutes, is amended to read:
3333 641.51 Quality assurance program; second medical opinion
3334 requirement.—
3335 (5)(c) For second opinions provided by contract physicians
3336 the organization is prohibited from charging a fee to the
3337 subscriber in an amount in excess of the subscriber fees
3338 established by contract for referral contract physicians. The
3339 organization shall pay the amount of all charges, which are
3340 usual, reasonable, and customary in the community, for second
3341 opinion services performed by a physician not under contract
3342 with the organization, but may require the subscriber to be
3343 responsible for up to 40 percent of such amount. The
3344 organization may require that any tests deemed necessary by a
3345 noncontract physician shall be conducted by the organization.
3346 The organization may deny reimbursement rights granted under
3347 this section in the event the subscriber seeks in excess of
3348 three such referrals per year if such subsequent referral costs
3349 are deemed by the organization to be evidence that the
3350 subscriber has unreasonably overutilized the second opinion
3351 privilege. A subscriber thus denied reimbursement under this
3352 section has shall have recourse to grievance procedures as
3353 specified in ss. 408.7056, 641.495, and 641.511. The
3354 organization’s physician’s professional judgment concerning the
3355 treatment of a subscriber derived after review of a second
3356 opinion is shall be controlling as to the treatment obligations
3357 of the health maintenance organization. Treatment not authorized
3358 by the health maintenance organization is shall be at the
3359 subscriber’s expense.
3360 Section 113. Subsection (1), paragraph (e) of subsection
3361 (3), paragraph (d) of subsection (4), paragraphs (g) and (h) of
3362 subsection (6), and subsections (7) through (12) of section
3363 641.511, Florida Statutes, are amended to read:
3364 641.511 Subscriber grievance reporting and resolution
3365 requirements.—
3366 (1) Every organization must have a grievance procedure
3367 available to its subscribers for the purpose of addressing
3368 complaints and grievances. Every organization must notify its
3369 subscribers that a subscriber must submit a grievance within 1
3370 year after the date of occurrence of the action that initiated
3371 the grievance, and may submit the grievance for review to the
3372 Subscriber Assistance Program panel as provided in s. 408.7056
3373 after receiving a final disposition of the grievance through the
3374 organization’s grievance process. An organization shall maintain
3375 records of all grievances and shall report annually to the
3376 agency the total number of grievances handled, a categorization
3377 of the cases underlying the grievances, and the final
3378 disposition of the grievances.
3379 (3) Each organization’s grievance procedure, as required
3380 under subsection (1), must include, at a minimum:
3381 (e) A notice that a subscriber may voluntarily pursue
3382 binding arbitration in accordance with the terms of the contract
3383 if offered by the organization, after completing the
3384 organization’s grievance procedure and as an alternative to the
3385 Subscriber Assistance Program. Such notice shall include an
3386 explanation that the subscriber may incur some costs if the
3387 subscriber pursues binding arbitration, depending upon the terms
3388 of the subscriber’s contract.
3389 (4)(d) In any case when the review process does not resolve
3390 a difference of opinion between the organization and the
3391 subscriber or the provider acting on behalf of the subscriber,
3392 the subscriber or the provider acting on behalf of the
3393 subscriber may submit a written grievance to the Subscriber
3394 Assistance Program.
3395 (6)(g) In any case when the expedited review process does
3396 not resolve a difference of opinion between the organization and
3397 the subscriber or the provider acting on behalf of the
3398 subscriber, the subscriber or the provider acting on behalf of
3399 the subscriber may submit a written grievance to the Subscriber
3400 Assistance Program.
3401 (g)(h) An organization shall not provide an expedited
3402 retrospective review of an adverse determination.
3403 (7) Each organization shall send to the agency a copy of
3404 its quarterly grievance reports submitted to the office pursuant
3405 to s. 408.7056(12).
3406 (7)(8) The agency shall investigate all reports of
3407 unresolved quality of care grievances received from:
3408 (a) annual and quarterly grievance reports submitted by the
3409 organization to the office.
3410 (b) Review requests of subscribers whose grievances remain
3411 unresolved after the subscriber has followed the full grievance
3412 procedure of the organization.
3413 (9)(a) The agency shall advise subscribers with grievances
3414 to follow their organization’s formal grievance process for
3415 resolution prior to review by the Subscriber Assistance Program.
3416 The subscriber may, however, submit a copy of the grievance to
3417 the agency at any time during the process.
3418 (b) Requiring completion of the organization’s grievance
3419 process before the Subscriber Assistance Program panel’s review
3420 does not preclude the agency from investigating any complaint or
3421 grievance before the organization makes its final determination.
3422 (10) Each organization must notify the subscriber in a
3423 final decision letter that the subscriber may request review of
3424 the organization’s decision concerning the grievance by the
3425 Subscriber Assistance Program, as provided in s. 408.7056, if
3426 the grievance is not resolved to the satisfaction of the
3427 subscriber. The final decision letter must inform the subscriber
3428 that the request for review must be made within 365 days after
3429 receipt of the final decision letter, must explain how to
3430 initiate such a review, and must include the addresses and toll
3431 free telephone numbers of the agency and the Subscriber
3432 Assistance Program.
3433 (8)(11) Each organization, as part of its contract with any
3434 provider, must require the provider to post a consumer
3435 assistance notice prominently displayed in the reception area of
3436 the provider and clearly noticeable by all patients. The
3437 consumer assistance notice must state the addresses and toll
3438 free telephone numbers of the Agency for Health Care
3439 Administration, the Subscriber Assistance Program, and the
3440 Department of Financial Services. The consumer assistance notice
3441 must also clearly state that the address and toll-free telephone
3442 number of the organization’s grievance department shall be
3443 provided upon request. The agency may adopt rules to implement
3444 this section.
3445 (9)(12) The agency may impose administrative sanction, in
3446 accordance with s. 641.52, against an organization for
3447 noncompliance with this section.
3448 Section 114. Subsection (1) of section 641.515, Florida
3449 Statutes, is amended to read:
3450 641.515 Investigation by the agency.—
3451 (1) The agency shall investigate further any quality of
3452 care issue contained in recommendations and reports submitted
3453 pursuant to s. ss. 408.7056 and 641.511. The agency shall also
3454 investigate further any information that indicates that the
3455 organization does not meet accreditation standards or the
3456 standards of the review organization performing the external
3457 quality assurance assessment pursuant to reports submitted under
3458 s. 641.512. Every organization shall submit its books and
3459 records and take other appropriate action as may be necessary to
3460 facilitate an examination. The agency shall have access to the
3461 organization’s medical records of individuals and records of
3462 employed and contracted physicians, with the consent of the
3463 subscriber or by court order, as necessary to administer carry
3464 out the provisions of this part.
3465 Section 115. Subsection (2) of section 641.55, Florida
3466 Statutes, is amended to read:
3467 641.55 Internal risk management program.—
3468 (2) The risk management program shall be the responsibility
3469 of the governing authority or board of the organization. Every
3470 organization which has an annual premium volume of $10 million
3471 or more and which directly provides health care in a building
3472 owned or leased by the organization shall hire a risk manager,
3473 certified under ss. 395.10971-395.10975, who is shall be
3474 responsible for implementation of the organization’s risk
3475 management program required by this section. A part-time risk
3476 manager may shall not be responsible for risk management
3477 programs in more than four organizations or facilities. Every
3478 organization that which does not directly provide health care in
3479 a building owned or leased by the organization and every
3480 organization with an annual premium volume of less than $10
3481 million shall designate an officer or employee of the
3482 organization to serve as the risk manager.
3483
3484 The gross data compiled under this section or s. 395.0197 shall
3485 be furnished by the agency upon request to organizations to be
3486 utilized for risk management purposes. The agency shall adopt
3487 rules necessary to administer carry out the provisions of this
3488 section.
3489 Section 116. Section 641.60, Florida Statutes, is repealed.
3490 Section 117. Section 641.65, Florida Statutes, is repealed.
3491 Section 118. Section 641.67, Florida Statutes, is repealed.
3492 Section 119. Section 641.68, Florida Statutes, is repealed.
3493 Section 120. Section 641.70, Florida Statutes, is repealed.
3494 Section 121. Section 641.75, Florida Statutes, is repealed.
3495 Section 122. Paragraph (b) of subsection (6) of section
3496 766.118, Florida Statutes, is amended to read:
3497 766.118 Determination of noneconomic damages.—
3498 (6) LIMITATION ON NONECONOMIC DAMAGES FOR NEGLIGENCE OF A
3499 PRACTITIONER PROVIDING SERVICES AND CARE TO A MEDICAID
3500 RECIPIENT.—Notwithstanding subsections (2), (3), and (5), with
3501 respect to a cause of action for personal injury or wrongful
3502 death arising from medical negligence of a practitioner
3503 committed in the course of providing medical services and
3504 medical care to a Medicaid recipient, regardless of the number
3505 of such practitioner defendants providing the services and care,
3506 noneconomic damages may not exceed $300,000 per claimant, unless
3507 the claimant pleads and proves, by clear and convincing
3508 evidence, that the practitioner acted in a wrongful manner. A
3509 practitioner providing medical services and medical care to a
3510 Medicaid recipient is not liable for more than $200,000 in
3511 noneconomic damages, regardless of the number of claimants,
3512 unless the claimant pleads and proves, by clear and convincing
3513 evidence, that the practitioner acted in a wrongful manner. The
3514 fact that a claimant proves that a practitioner acted in a
3515 wrongful manner does not preclude the application of the
3516 limitation on noneconomic damages prescribed elsewhere in this
3517 section. For purposes of this subsection:
3518 (b) The term “practitioner,” in addition to the meaning
3519 prescribed in subsection (1), includes any hospital or,
3520 ambulatory surgical center, or mobile surgical facility as
3521 defined and licensed under chapter 395.
3522 Section 123. Subsection (4) of section 766.202, Florida
3523 Statutes, is amended to read:
3524 766.202 Definitions; ss. 766.201-766.212.—As used in ss.
3525 766.201-766.212, the term:
3526 (4) “Health care provider” means any hospital or,
3527 ambulatory surgical center, or mobile surgical facility as
3528 defined and licensed under chapter 395; a birth center licensed
3529 under chapter 383; any person licensed under chapter 458,
3530 chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
3531 part I of chapter 464, chapter 466, chapter 467, part XIV of
3532 chapter 468, or chapter 486; a clinical lab licensed under
3533 chapter 483; a health maintenance organization certificated
3534 under part I of chapter 641; a blood bank; a plasma center; an
3535 industrial clinic; a renal dialysis facility; or a professional
3536 association partnership, corporation, joint venture, or other
3537 association for professional activity by health care providers.
3538 Section 124. Section 945.36, Florida Statutes, is amended
3539 to read:
3540 945.36 Exemption from health testing regulations for Law
3541 enforcement personnel authorized to conduct conducting drug
3542 tests on inmates and releasees.—
3543 (1) Any law enforcement officer, state or county probation
3544 officer, employee of the Department of Corrections, or employee
3545 of a contracted community correctional center who is certified
3546 by the Department of Corrections pursuant to subsection (2) may
3547 administer, is exempt from part I of chapter 483, for the
3548 limited purpose of administering a urine screen drug test to:
3549 (a) Persons during incarceration;
3550 (b) Persons released as a condition of probation for either
3551 a felony or misdemeanor;
3552 (c) Persons released as a condition of community control;
3553 (d) Persons released as a condition of conditional release;
3554 (e) Persons released as a condition of parole;
3555 (f) Persons released as a condition of provisional release;
3556 (g) Persons released as a condition of pretrial release; or
3557 (h) Persons released as a condition of control release.
3558 (2) The Department of Corrections shall develop a procedure
3559 for certification of any law enforcement officer, state or
3560 county probation officer, employee of the Department of
3561 Corrections, or employee of a contracted community correctional
3562 center to perform a urine screen drug test on the persons
3563 specified in subsection (1).
3564 Section 125. Paragraph (b) of subsection (2) of section
3565 1009.65, Florida Statutes, is amended to read:
3566 1009.65 Medical Education Reimbursement and Loan Repayment
3567 Program.—
3568 (2) From the funds available, the Department of Health
3569 shall make payments to selected medical professionals as
3570 follows:
3571 (b) All payments are shall be contingent on continued proof
3572 of primary care practice in an area defined in s. 395.602(2)(b)
3573 s. 395.602(2)(e), or an underserved area designated by the
3574 Department of Health, provided the practitioner accepts Medicaid
3575 reimbursement if eligible for such reimbursement. Correctional
3576 facilities, state hospitals, and other state institutions that
3577 employ medical personnel shall be designated by the Department
3578 of Health as underserved locations. Locations with high
3579 incidences of infant mortality, high morbidity, or low Medicaid
3580 participation by health care professionals may be designated as
3581 underserved.
3582 Section 126. Subsection (2) of section 1011.52, Florida
3583 Statutes, is amended to read:
3584 1011.52 Appropriation to first accredited medical school.—
3585 (2) In order for a medical school to qualify under the
3586 provisions of this section and to be entitled to the benefits
3587 herein, such medical school:
3588 (a) Must be primarily operated and established to offer,
3589 afford, and render a medical education to residents of the state
3590 qualifying for admission to such institution;
3591 (b) Must be operated by a municipality or county of this
3592 state, or by a nonprofit organization heretofore or hereafter
3593 established exclusively for educational purposes;
3594 (c) Must, upon the formation and establishment of an
3595 accredited medical school, transmit and file with the Department
3596 of Education documentary proof evidencing the facts that such
3597 institution has been certified and approved by the council on
3598 medical education and hospitals of the American Medical
3599 Association and has adequately met the requirements of that
3600 council in regard to its administrative facilities,
3601 administrative plant, clinical facilities, curriculum, and all
3602 other such requirements as may be necessary to qualify with the
3603 council as a recognized, approved, and accredited medical
3604 school;
3605 (d) Must certify to the Department of Education the name,
3606 address, and educational history of each student approved and
3607 accepted for enrollment in such institution for the ensuing
3608 school year; and
3609 (e) Must have in place an operating agreement with a
3610 government-owned hospital that is located in the same county as
3611 the medical school and that is a statutory teaching hospital as
3612 defined in s. 408.07(44) s. 408.07(45). The operating agreement
3613 must shall provide for the medical school to maintain the same
3614 level of affiliation with the hospital, including the level of
3615 services to indigent and charity care patients served by the
3616 hospital, which was in place in the prior fiscal year. Each
3617 year, documentation demonstrating that an operating agreement is
3618 in effect shall be submitted jointly to the Department of
3619 Education by the hospital and the medical school prior to the
3620 payment of moneys from the annual appropriation.
3621 Section 127. This act shall take effect July 1, 2018.