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         154.13Designated 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         395.0091Alternate-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 districts
 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.