Florida Senate - 2019 COMMITTEE AMENDMENT
Bill No. SB 732
Ì859422(Î859422
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
03/13/2019 .
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The Committee on Health Policy (Flores) recommended the
following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Subsection (4) of section 400.9905, Florida
6 Statutes, is amended to read:
7 400.9905 Definitions.—
8 (4) “Clinic” means an entity that provides where health
9 care services are provided to individuals and that receives
10 compensation and which tenders charges for reimbursement for
11 those such services, including a mobile clinic and a portable
12 equipment provider. As used in this part, the term does not
13 include and the licensure requirements of this part do not apply
14 to:
15 (a) Entities licensed or registered by the state under
16 chapter 395; entities licensed or registered by the state and
17 providing only health care services within the scope of services
18 authorized under their respective licenses under ss. 383.30
19 383.332, chapter 390, chapter 394, chapter 397, this chapter
20 except part X, chapter 429, chapter 463, chapter 465, chapter
21 466, chapter 478, chapter 484, or chapter 651; end-stage renal
22 disease providers authorized under 42 C.F.R. part 405, subpart
23 U; providers certified under 42 C.F.R. part 485, subpart B or
24 subpart H; or any entity that provides neonatal or pediatric
25 hospital-based health care services or other health care
26 services by licensed practitioners solely within a hospital
27 licensed under chapter 395.
28 (b) Entities that own, directly or indirectly, entities
29 licensed or registered by the state pursuant to chapter 395;
30 entities that own, directly or indirectly, entities licensed or
31 registered by the state and providing only health care services
32 within the scope of services authorized pursuant to their
33 respective licenses under ss. 383.30-383.332, chapter 390,
34 chapter 394, chapter 397, this chapter except part X, chapter
35 429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
36 484, or chapter 651; end-stage renal disease providers
37 authorized under 42 C.F.R. part 405, subpart U; providers
38 certified under 42 C.F.R. part 485, subpart B or subpart H; or
39 any entity that provides neonatal or pediatric hospital-based
40 health care services by licensed practitioners solely within a
41 hospital licensed under chapter 395.
42 (c) Entities that are owned, directly or indirectly, by an
43 entity licensed or registered by the state pursuant to chapter
44 395; entities that are owned, directly or indirectly, by an
45 entity licensed or registered by the state and providing only
46 health care services within the scope of services authorized
47 pursuant to their respective licenses under ss. 383.30-383.332,
48 chapter 390, chapter 394, chapter 397, this chapter except part
49 X, chapter 429, chapter 463, chapter 465, chapter 466, chapter
50 478, chapter 484, or chapter 651; end-stage renal disease
51 providers authorized under 42 C.F.R. part 405, subpart U;
52 providers certified under 42 C.F.R. part 485, subpart B or
53 subpart H; or any entity that provides neonatal or pediatric
54 hospital-based health care services by licensed practitioners
55 solely within a hospital under chapter 395.
56 (d) Entities that are under common ownership, directly or
57 indirectly, with an entity licensed or registered by the state
58 pursuant to chapter 395; entities that are under common
59 ownership, directly or indirectly, with an entity licensed or
60 registered by the state and providing only health care services
61 within the scope of services authorized pursuant to their
62 respective licenses under ss. 383.30-383.332, chapter 390,
63 chapter 394, chapter 397, this chapter except part X, chapter
64 429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
65 484, or chapter 651; end-stage renal disease providers
66 authorized under 42 C.F.R. part 405, subpart U; providers
67 certified under 42 C.F.R. part 485, subpart B or subpart H; or
68 any entity that provides neonatal or pediatric hospital-based
69 health care services by licensed practitioners solely within a
70 hospital licensed under chapter 395.
71 (e) An entity that is exempt from federal taxation under 26
72 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
73 under 26 U.S.C. s. 409 that has a board of trustees at least
74 two-thirds of which are Florida-licensed health care
75 practitioners and provides only physical therapy services under
76 physician orders, any community college or university clinic,
77 and any entity owned or operated by the federal or state
78 government, including agencies, subdivisions, or municipalities
79 thereof.
80 (f) A sole proprietorship, group practice, partnership, or
81 corporation that provides health care services by physicians
82 covered by s. 627.419, that is directly supervised by one or
83 more of such physicians, and that is wholly owned by one or more
84 of those physicians or by a physician and the spouse, parent,
85 child, or sibling of that physician.
86 (g) A sole proprietorship, group practice, partnership, or
87 corporation that provides health care services by licensed
88 health care practitioners under chapter 457, chapter 458,
89 chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
90 chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
91 chapter 490, chapter 491, or part I, part III, part X, part
92 XIII, or part XIV of chapter 468, or s. 464.012, and that is
93 wholly owned by one or more licensed health care practitioners,
94 or the licensed health care practitioners set forth in this
95 paragraph and the spouse, parent, child, or sibling of a
96 licensed health care practitioner if one of the owners who is a
97 licensed health care practitioner is supervising the business
98 activities and is legally responsible for the entity’s
99 compliance with all federal and state laws. However, a health
100 care practitioner may not supervise services beyond the scope of
101 the practitioner’s license, except that, for the purposes of
102 this part, a clinic owned by a licensee in s. 456.053(3)(b)
103 which provides only services authorized pursuant to s.
104 456.053(3)(b) may be supervised by a licensee specified in s.
105 456.053(3)(b).
106 (h) Clinical facilities affiliated with an accredited
107 medical school at which training is provided for medical
108 students, residents, or fellows.
109 (i) Entities that provide only oncology or radiation
110 therapy services by physicians licensed under chapter 458 or
111 chapter 459 or entities that provide oncology or radiation
112 therapy services by physicians licensed under chapter 458 or
113 chapter 459 which are owned by a corporation whose shares are
114 publicly traded on a recognized stock exchange.
115 (j) Clinical facilities affiliated with a college of
116 chiropractic accredited by the Council on Chiropractic Education
117 at which training is provided for chiropractic students.
118 (k) Entities that provide licensed practitioners to staff
119 emergency departments or to deliver anesthesia services in
120 facilities licensed under chapter 395 and that derive at least
121 90 percent of their gross annual revenues from the provision of
122 such services. Entities claiming an exemption from licensure
123 under this paragraph must provide documentation demonstrating
124 compliance.
125 (l) Orthotic, prosthetic, pediatric cardiology, or
126 perinatology clinical facilities or anesthesia clinical
127 facilities that are not otherwise exempt under paragraph (a) or
128 paragraph (k) and that are a publicly traded corporation or are
129 wholly owned, directly or indirectly, by a publicly traded
130 corporation. As used in this paragraph, a publicly traded
131 corporation is a corporation that issues securities traded on an
132 exchange registered with the United States Securities and
133 Exchange Commission as a national securities exchange.
134 (m) Entities that are owned by a corporation that has $250
135 million or more in total annual sales of health care services
136 provided by licensed health care practitioners where one or more
137 of the persons responsible for the operations of the entity is a
138 health care practitioner who is licensed in this state and who
139 is responsible for supervising the business activities of the
140 entity and is responsible for the entity’s compliance with state
141 law for purposes of this part.
142 (n) Entities that employ 50 or more licensed health care
143 practitioners licensed under chapter 458 or chapter 459 where
144 the billing for medical services is under a single tax
145 identification number. The application for exemption under this
146 subsection shall contain information that includes: the name,
147 residence, and business address and phone number of the entity
148 that owns the practice; a complete list of the names and contact
149 information of all the officers and directors of the
150 corporation; the name, residence address, business address, and
151 medical license number of each licensed Florida health care
152 practitioner employed by the entity; the corporate tax
153 identification number of the entity seeking an exemption; a
154 listing of health care services to be provided by the entity at
155 the health care clinics owned or operated by the entity and a
156 certified statement prepared by an independent certified public
157 accountant which states that the entity and the health care
158 clinics owned or operated by the entity have not received
159 payment for health care services under personal injury
160 protection insurance coverage for the preceding year. If the
161 agency determines that an entity which is exempt under this
162 subsection has received payments for medical services under
163 personal injury protection insurance coverage, the agency may
164 deny or revoke the exemption from licensure under this
165 subsection.
166
167 Notwithstanding this subsection, an entity shall be deemed a
168 clinic and must be licensed under this part in order to receive
169 reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
170 627.730-627.7405, unless exempted under s. 627.736(5)(h).
171 Section 2. Subsection (4) of section 400.991, Florida
172 Statutes, is amended to read:
173 400.991 License requirements; background screenings;
174 prohibitions.—
175 (4) In addition to the requirements of part II of chapter
176 408, the applicant must file with the application satisfactory
177 proof that the clinic is in compliance with this part and
178 applicable rules, including:
179 (a) A listing of services to be provided either directly by
180 the applicant or through contractual arrangements with existing
181 providers;
182 (b) The number and discipline of each professional staff
183 member to be employed; and
184 (c) Proof of financial ability to operate as required under
185 s. 408.810(8). As an alternative to submitting proof of
186 financial ability to operate as required under s. 408.810(8),
187 the applicant may file a surety bond of at least $500,000 which
188 guarantees that the clinic will act in full conformity with all
189 legal requirements for operating a clinic, payable to the
190 agency. The agency may adopt rules to specify related
191 requirements for such surety bond; and
192 (d) Proof that the clinic maintains the financial
193 responsibility in the manner set forth in s. 458.320(2) or s.
194 459.0085(2), as applicable, to pay claims and costs ancillary
195 thereto arising out of the rendering of or the failure to render
196 medical care and services, for physicians and osteopathic
197 physicians who perform liposuction procedures in which more than
198 1,000 cubic centimeters of supernatant fat is removed, Level II
199 office surgery, or Level III office surgery as those terms are
200 defined in ss. 458.305(8) and 459.003(9), in an office setting.
201 Section 3. Paragraph (j) is added to subsection (1) of
202 section 400.9935, Florida Statutes, to read:
203 400.9935 Clinic responsibilities.—
204 (1) Each clinic shall appoint a medical director or clinic
205 director who shall agree in writing to accept legal
206 responsibility for the following activities on behalf of the
207 clinic. The medical director or the clinic director shall:
208 (j) If the clinic is registered with the department to
209 perform office surgery, ensure that the clinic complies with the
210 standards of practice for office surgery adopted by rule under
211 ss. 458.309(4) and 459.005(3).
212 Section 4. Subsection (4) of section 400.995, Florida
213 Statutes, is amended to read:
214 400.995 Agency administrative penalties.—
215 (4) Any licensed clinic whose owner, medical director, or
216 clinic director concurrently operates an unlicensed clinic or a
217 clinic that is not registered with the department where any
218 liposuction procedure in which more than 1,000 cubic centimeters
219 of supernatant fat is removed or where any Level II office
220 surgery or Level III office surgery, as those terms are defined
221 in ss. 458.305(8) and 459.003(9), is performed, is shall be
222 subject to an administrative fine of $5,000 per day.
223 Section 5. Subsection (12) is added to section 456.004,
224 Florida Statutes, to read:
225 456.004 Department; powers and duties.—The department, for
226 the professions under its jurisdiction, shall:
227 (12) Deny or revoke the registration of, or impose any
228 penalty set forth in s. 456.072(2) against, any facility where
229 office surgery, as defined in ss. 458.305(8) and 459.003(9), is
230 performed for failure of any of its physicians, owners, or
231 operators to comply with rules adopted under ss. 458.309(3) and
232 459.005(2). Section 456.073 applies to enforcement actions
233 brought against such facilities. If a facility’s registration is
234 revoked, the department may deny any person named in the
235 registration documents of the facility, including the persons
236 who own or operate the facility, individually or as part of a
237 group, from registering a facility to perform surgical
238 procedures pursuant to s. 458.309(3) or s. 459.005(2) for 5
239 years after the revocation date.
240 Section 6. Subsection (6) is added to section 456.074,
241 Florida Statutes, to read:
242 456.074 Certain health care practitioners; immediate
243 suspension of license.—
244 (6) The department may issue an emergency order suspending
245 or restricting the registration of a facility in which
246 liposuction procedures in which more than 1,000 cubic
247 centimeters of supernatant fat is removed, Level II office
248 surgery, or Level III office surgery as those terms are defined
249 in ss. 458.305(8) and 459.003(9), are performed upon a finding
250 of probable cause that the facility or its surgeons are not in
251 compliance with the standards of practice for office surgery
252 adopted by the boards pursuant to s. 458.309(4) or s.
253 459.005(3), as applicable, or are in violation of s.
254 458.331(1)(v) or s. 459.015(1)(z) and that such noncompliance
255 constitutes an immediate danger to the public.
256 Section 7. Section 458.305, Florida Statutes, is amended to
257 read:
258 458.305 Definitions.—As used in this chapter, the term:
259 (1) “Board” means the Board of Medicine.
260 (2) “Deep sedation and analgesia” means a drug-induced
261 depression of consciousness during which all of the following
262 apply:
263 (a) The patient cannot be easily aroused but responds by
264 purposefully following repeated or painful stimulation.
265 (b) The patient’s ability to independently maintain
266 ventilatory function may be impaired.
267 (c) The patient may require assistance in maintaining a
268 patent airway, and spontaneous ventilation may be inadequate.
269 (d) The patient’s cardiovascular function is usually
270 maintained.
271 (e) The patient’s reflex withdrawal from painful stimulus
272 is not considered a purposeful response.
273 (3)(2) “Department” means the Department of Health.
274 (4) “Epidural anesthesia” means anesthesia produced by the
275 injection of an anesthetic agent into the space on or around the
276 dura mater of the spinal cord.
277 (5) “General anesthesia” means a drug-induced loss of
278 consciousness administered by a qualified general anesthesia
279 provider during which all of the following apply:
280 (a) The patient is not able to be aroused, even by painful
281 stimulation.
282 (b) The patient’s ability to independently maintain
283 ventilatory function is often impaired.
284 (c) The patient has a level of depressed neuromuscular
285 function.
286 (d) The patient may require assistance in maintaining a
287 patent airway, and positive pressure ventilation may be
288 required.
289 (e) The patient’s cardiovascular function may be impaired.
290 (6) “Minimal sedation” means a drug-induced state during
291 which patients respond normally to verbal commands. Although
292 cognitive function and physical coordination may be impaired,
293 airway reflexes and respiratory and cardiovascular functions are
294 unaffected.
295 (7) “Moderate sedation and analgesia” or “conscious
296 sedation” means drug-induced depression of consciousness and a
297 state of consciousness during which all of the following apply:
298 (a) The patient responds purposefully to verbal commands,
299 either alone or accompanied by light tactile stimulation.
300 (b) Interventions are not required to maintain a patent
301 airway, and spontaneous ventilation is adequate.
302 (c) Cardiovascular function is maintained.
303 (d) Reflex withdrawal from a painful stimulus is not
304 considered a purposeful response.
305 (8) “Office surgery” means a surgery that is performed in a
306 physician’s office or any facility that is not licensed under
307 chapter 390 or chapter 395.
308 (a) “Level I office surgery” includes any surgery that
309 consists of only minor procedures and in which anesthesia is
310 limited to minimal sedation.
311 (b) “Level II office surgery” includes any surgery in which
312 the patient’s level of sedation is that of moderate sedation and
313 analgesia or conscious sedation.
314 (c) ”Level III office surgery” includes any surgery in
315 which the patient’s level of sedation is that of deep sedation
316 and analgesia or general anesthesia. The term includes any
317 surgery that includes the use of spinal anesthesia or epidural
318 anesthesia.
319 (10)(3) “Practice of medicine” means the diagnosis,
320 treatment, operation, or prescription for any human disease,
321 pain, injury, deformity, or other physical or mental condition.
322 (11) “Spinal anesthesia” means anesthesia produced by the
323 injection of an anesthetic agent into the subarachnoid space of
324 the spinal cord.
325 (12) “Surgeon” means a physician who performs surgery.
326 (13) “Surgery” means any manual or operative procedure,
327 including the use of lasers, performed upon the body of a living
328 human being for the purposes of preserving health, diagnosing or
329 curing disease, repairing injury, correcting deformity or
330 defects, prolonging life, or relieving suffering or any elective
331 procedure for aesthetic, reconstructive, or cosmetic purposes,
332 including, but not limited to: incision or curettage of tissue
333 or an organ; suture or other repair of tissue or organ,
334 including a closed as well as an open reduction of a fracture;
335 extraction of tissue including premature extraction of the
336 products of conception from the uterus; insertion of natural or
337 artificial implants; or an endoscopic procedure with use of
338 local or general anesthetic.
339 (9)(4) “Physician” means a person who is licensed to
340 practice medicine in this state.
341 Section 8. Subsection (3) of section 458.309, Florida
342 Statutes, is amended and subsection (4) is added to that
343 section, to read:
344 458.309 Rulemaking authority.—
345 (3) A physician who performs any liposuction procedure
346 procedures in which more than 1,000 cubic centimeters of
347 supernatant fat is removed, any Level II office surgery level 2
348 procedures lasting more than 5 minutes, or any Level III office
349 surgery and all level 3 surgical procedures in an office setting
350 must register the office with the department unless that office
351 is licensed as a facility under chapter 395. The department
352 shall inspect the physician’s office annually unless the office
353 is accredited by a nationally recognized accrediting agency or
354 an accrediting organization subsequently approved by the Board
355 of Medicine. The actual costs for registration and inspection or
356 accreditation shall be paid by the person seeking to register
357 and operate the office setting in which office surgery is
358 performed. As a condition of registration, a physician who
359 performs such surgical procedures in an office setting, and the
360 office itself if it is a separate legal entity from the
361 physician, must maintain the same levels of financial
362 responsibility required in s. 458.320.
363 (4) The department may adopt rules to administer the
364 registration, inspection, and safety of offices in which a
365 physician performs office surgery. The board shall adopt by rule
366 standards of practice for physicians who perform office surgery.
367 The board shall impose a fine of $5,000 per day on a physician
368 who performs a surgical procedure identified in subsection (3)
369 in an office that is not registered with the department.
370 Section 9. Paragraph (vv) is added to subsection (1) of
371 section 458.331, Florida Statutes, to read:
372 458.331 Grounds for disciplinary action; action by the
373 board and department.—
374 (1) The following acts constitute grounds for denial of a
375 license or disciplinary action, as specified in s. 456.072(2):
376 (vv) Performing a liposuction procedure in which more than
377 1,000 cubic centimeters of supernatant fat is removed, a Level
378 II office surgery, or a Level III office surgery in an office
379 that is not registered with the department pursuant to s.
380 458.309(3).
381 Section 10. Section 459.003, Florida Statutes, is amended
382 to read:
383 459.003 Definitions.—As used in this chapter, the term:
384 (1) “Board” means the Board of Osteopathic Medicine.
385 (2) “Deep sedation and analgesia” means a drug-induced
386 depression of consciousness during which all of the following
387 apply:
388 (a) The patient cannot be easily aroused but responds by
389 purposefully following repeated or painful stimulation.
390 (b) The patient’s ability to independently maintain
391 ventilatory function may be impaired.
392 (c) The patient may require assistance in maintaining a
393 patent airway, and spontaneous ventilation may be inadequate.
394 (d) The patient’s cardiovascular function is usually
395 maintained.
396 (e) The patient’s reflex withdrawal from painful stimulus
397 is not considered a purposeful response.
398 (3)(2) “Department” means the Department of Health.
399 (5) “Epidural anesthesia” means anesthesia produced by the
400 injection of an anesthetic agent into the space on or around the
401 dura mater of the spinal cord.
402 (6) “General anesthesia” means a drug-induced loss of
403 consciousness administered by a qualified general anesthesia
404 provider during which all of the following apply:
405 (a) The patient is not able to be aroused, even by painful
406 stimulation.
407 (b) The patient’s ability to independently maintain
408 ventilatory function is often impaired.
409 (c) The patient has a level of depressed neuromuscular
410 function.
411 (d) The patient may require assistance in maintaining a
412 patent airway, and positive pressure ventilation may be
413 required.
414 (e) The patient’s cardiovascular function may be impaired.
415 (7) “Minimal sedation” means a drug-induced state during
416 which patients respond normally to verbal commands. Although
417 cognitive function and physical coordination may be impaired,
418 airway reflexes, and respiratory and cardiovascular functions
419 are unaffected.
420 (8) “Moderate sedation and analgesia” or “conscious
421 sedation” means drug-induced depression of consciousness and a
422 state of consciousness during which all of the following apply:
423 (a) The patient responds purposefully to verbal commands,
424 either alone or accompanied by light tactile stimulation.
425 (b) Interventions are not required to maintain a patent
426 airway, and spontaneous ventilation is adequate.
427 (c) Cardiovascular function is maintained.
428 (d) Reflex withdrawal from a painful stimulus is not
429 considered a purposeful response.
430 (9) “Office surgery” means a surgery that is performed in a
431 physician’s office or any facility that is not licensed under
432 chapter 390 or chapter 395.
433 (a) “Level I office surgery” includes any surgery that
434 consists of only minor procedures and in which anesthesia is
435 limited to minimal sedation.
436 (b) “Level II office surgery” includes any surgery in which
437 the patient’s level of sedation is that of moderate sedation and
438 analgesia or conscious sedation.
439 (c) ”Level III office surgery” includes any surgery in
440 which the patient’s level of sedation is that of deep sedation
441 and analgesia or general anesthesia. The term includes any
442 surgery that includes the use of spinal anesthesia or epidural
443 anesthesia.
444 (11)(3) “Practice of osteopathic medicine” means the
445 diagnosis, treatment, operation, or prescription for any human
446 disease, pain, injury, deformity, or other physical or mental
447 condition, which practice is based in part upon educational
448 standards and requirements which emphasize the importance of the
449 musculoskeletal structure and manipulative therapy in the
450 maintenance and restoration of health.
451 (12) “Spinal anesthesia” means anesthesia produced by the
452 injection of an anesthetic agent into the subarachnoid space of
453 the spinal cord.
454 (13) “Surgeon” means a physician who performs surgery.
455 (14) “Surgery” means any manual or operative procedure,
456 including the use of lasers, performed upon the body of a living
457 human being for the purposes of preserving health, diagnosing or
458 curing disease, repairing injury, correcting deformity or
459 defects, prolonging life, or relieving suffering or any elective
460 procedure for aesthetic, reconstructive, or cosmetic purposes,
461 including, but not limited to: incision or curettage of tissue
462 or an organ; suture or other repair of tissue or organ,
463 including a closed as well as an open reduction of a fracture;
464 extraction of tissue including premature extraction of the
465 products of conception from the uterus; insertion of natural or
466 artificial implants; or an endoscopic procedure with use of
467 local or general anesthetic.
468 (10)(4) “Osteopathic physician” means a person who is
469 licensed to practice osteopathic medicine in this state.
470 (4)(5) “Doctor of Osteopathy” and “Doctor of Osteopathic
471 Medicine,” when referring to degrees, shall be construed to be
472 equivalent and equal degrees.
473 Section 11. Subsection (2) of section 459.005, Florida
474 Statutes, is amended and subsection (3) is added to that
475 section, to read:
476 459.005 Rulemaking authority.—
477 (2) A physician who performs any liposuction procedure
478 procedures in which more than 1,000 cubic centimeters of
479 supernatant fat is removed, any Level II office surgery level 2
480 procedures lasting more than 5 minutes, or any Level III office
481 surgery and all level 3 surgical procedures in an office setting
482 must register the office with the department unless that office
483 is licensed as a facility under chapter 395. The department
484 shall inspect the physician’s office annually unless the office
485 is accredited by a nationally recognized accrediting agency or
486 an accrediting organization subsequently approved by the Board
487 of Osteopathic Medicine. The actual costs for registration and
488 inspection or accreditation shall be paid by the person seeking
489 to register and operate the office setting in which office
490 surgery is performed. As a condition of registration, a
491 physician who performs such surgical procedures in an office
492 setting, and the office itself if it is a separate legal entity
493 from the physician, must maintain the same levels of financial
494 responsibility required in s. 459.0085.
495 (3) The department may adopt rules to administer the
496 registration, inspection, and safety of offices in which a
497 physician performs office surgery. The board shall adopt by rule
498 standards of practice for physicians who perform office surgery.
499 The board shall impose a fine of $5,000 per day on a physician
500 who performs a surgical procedure identified in subsection (2)
501 in an office that is not registered with the department.
502 Section 12. Paragraph (xx) is added to subsection (1) of
503 section 459.015, Florida Statutes, to read:
504 459.015 Grounds for disciplinary action; action by the
505 board and department.—
506 (1) The following acts constitute grounds for denial of a
507 license or disciplinary action, as specified in s. 456.072(2):
508 (xx) Performing a liposuction procedure in which more than
509 1,000 cubic centimeters of supernatant fat is removed, a Level
510 II office surgery, or a Level III office surgery in an office
511 that is not registered with the department pursuant to s.
512 459.005(2).
513 Section 13. Paragraph (b) of subsection (4) of section
514 464.012, Florida Statutes, is amended to read:
515 464.012 Licensure of advanced practice registered nurses;
516 fees; controlled substance prescribing.—
517 (4) In addition to the general functions specified in
518 subsection (3), an advanced practice registered nurse may
519 perform the following acts within his or her specialty:
520 (b) The certified registered nurse anesthetist may, to the
521 extent authorized by established protocol approved by the
522 medical staff of the facility in which the anesthetic service is
523 performed, perform any or all of the following:
524 1. Determine the health status of the patient as it relates
525 to the risk factors and to the anesthetic management of the
526 patient through the performance of the general functions.
527 2. Based on history, physical assessment, and supplemental
528 laboratory results, determine, with the consent of the
529 responsible physician, the appropriate type of anesthesia within
530 the framework of the protocol.
531 3. Order under the protocol preanesthetic medication.
532 4. Perform under the protocol procedures commonly used to
533 render the patient insensible to pain during the performance of
534 surgical, obstetrical, therapeutic, or diagnostic clinical
535 procedures. These procedures include ordering and administering
536 regional, spinal, and general anesthesia; inhalation agents and
537 techniques; intravenous agents and techniques; and techniques of
538 hypnosis.
539 5. Order or perform monitoring procedures indicated as
540 pertinent to the anesthetic health care management of the
541 patient.
542 6. Support life functions during anesthesia health care,
543 including induction and intubation procedures, the use of
544 appropriate mechanical supportive devices, and the management of
545 fluid, electrolyte, and blood component balances.
546 7. Recognize and take appropriate corrective action for
547 abnormal patient responses to anesthesia, adjunctive medication,
548 or other forms of therapy.
549 8. Recognize and treat a cardiac arrhythmia while the
550 patient is under anesthetic care.
551 9. Participate in management of the patient while in the
552 postanesthesia recovery area, including ordering the
553 administration of fluids and drugs.
554 10. Place special peripheral and central venous and
555 arterial lines for blood sampling and monitoring as appropriate.
556 11. Provide the services identified in subsections 1.-10.
557 in an office registered to perform office surgery pursuant to s.
558 458.309(3) or s. 459.005(2) within the framework of an
559 established protocol with an anesthesiologist licensed under
560 chapter 458 or chapter 459.
561 Section 14. Paragraph (a) of subsection (1) of section
562 766.101, Florida Statutes, is amended to read:
563 766.101 Medical review committee, immunity from liability.—
564 (1) As used in this section:
565 (a) The term “medical review committee” or “committee”
566 means:
567 1.a. A committee of a hospital or ambulatory surgical
568 center licensed under chapter 395 or a health maintenance
569 organization certificated under part I of chapter 641;
570 b. A committee of a physician-hospital organization, a
571 provider-sponsored organization, or an integrated delivery
572 system;
573 c. A committee of a state or local professional society of
574 health care providers;
575 d. A committee of a medical staff of a licensed hospital or
576 nursing home, provided the medical staff operates pursuant to
577 written bylaws that have been approved by the governing board of
578 the hospital or nursing home;
579 e. A committee of the Department of Corrections or the
580 Correctional Medical Authority as created under s. 945.602, or
581 employees, agents, or consultants of either the department or
582 the authority or both;
583 f. A committee of a professional service corporation formed
584 under chapter 621 or a corporation organized under part I of
585 chapter 607 or chapter 617, which is formed and operated for the
586 practice of medicine as defined in s. 458.305 s. 458.305(3), and
587 which has at least 25 health care providers who routinely
588 provide health care services directly to patients;
589 g. A committee of the Department of Children and Families
590 which includes employees, agents, or consultants to the
591 department as deemed necessary to provide peer review,
592 utilization review, and mortality review of treatment services
593 provided pursuant to chapters 394, 397, and 916;
594 h. A committee of a mental health treatment facility
595 licensed under chapter 394 or a community mental health center
596 as defined in s. 394.907, provided the quality assurance program
597 operates pursuant to the guidelines that have been approved by
598 the governing board of the agency;
599 i. A committee of a substance abuse treatment and education
600 prevention program licensed under chapter 397 provided the
601 quality assurance program operates pursuant to the guidelines
602 that have been approved by the governing board of the agency;
603 j. A peer review or utilization review committee organized
604 under chapter 440;
605 k. A committee of the Department of Health, a county health
606 department, healthy start coalition, or certified rural health
607 network, when reviewing quality of care, or employees of these
608 entities when reviewing mortality records; or
609 l. A continuous quality improvement committee of a pharmacy
610 licensed pursuant to chapter 465,
611
612 which committee is formed to evaluate and improve the quality of
613 health care rendered by providers of health service, to
614 determine that health services rendered were professionally
615 indicated or were performed in compliance with the applicable
616 standard of care, or that the cost of health care rendered was
617 considered reasonable by the providers of professional health
618 services in the area; or
619 2. A committee of an insurer, self-insurer, or joint
620 underwriting association of medical malpractice insurance, or
621 other persons conducting review under s. 766.106.
622 Section 15. This act shall take effect upon becoming a law.
623
624 ================= T I T L E A M E N D M E N T ================
625 And the title is amended as follows:
626 Delete everything before the enacting clause
627 and insert:
628 A bill to be entitled
629 An act relating to clinics and office surgery;
630 amending s. 400.9905, F.S.; revising the definition of
631 the term “clinic”; amending s. 400.991, F.S.;
632 requiring a clinic to provide proof of its financial
633 responsibility to pay certain claims and costs along
634 with its application for licensure to the Agency for
635 Health Care Administration; amending s. 400.9935,
636 F.S.; requiring a medical director or a clinic
637 director to ensure that the clinic complies with
638 specified rules; amending s. 400.995, F.S.; requiring
639 the agency to impose a specified administrative fine
640 on an unregistered clinic that performs certain office
641 surgeries; amending s. 456.004, F.S.; requiring the
642 Department of Health to deny or revoke the
643 registration of or impose certain penalties against a
644 facility where certain office surgeries are performed
645 under certain circumstances; specifying provisions
646 that apply enforcement actions against such
647 facilities; authorizing the department to deny certain
648 persons associated with an office of which the
649 registration was revoked from registering a new office
650 to perform certain office surgery; amending s.
651 456.074, F.S.; authorizing the department to issue an
652 emergency order suspending or restricting the
653 registration of a certain office if it makes certain
654 findings; amending s. 458.305, F.S.; defining terms;
655 amending s. 458.309, F.S.; requiring a physician who
656 performs certain office surgery and the office in
657 which the surgery is performed to maintain specified
658 levels of financial responsibility; authorizing the
659 department to adopt rules to administer the
660 registration, inspection, and safety of offices that
661 perform certain office surgery; requiring the Board of
662 Medicine to adopt rules governing the standard of care
663 for physicians practicing in such offices; requiring
664 the board to impose a specified fine on physicians who
665 perform certain office surgeries in an unregistered
666 office; amending s. 458.331, F.S.; providing that a
667 physician performing certain office surgeries in an
668 unregistered office constitutes grounds for denial of
669 a license or disciplinary action; amending s. 459.003,
670 F.S.; defining terms; amending s. 459.005, F.S.;
671 requiring a physician who performs certain office
672 surgery and the office in which the surgery is
673 performed to maintain specified levels of financial
674 responsibility; authorizing the department to adopt
675 rules to administer the registration, inspection, and
676 safety of offices that perform certain office surgery;
677 requiring the Board of Osteopathic Medicine to adopt
678 rules governing the standard of care for physicians
679 practicing in such offices; requiring the board to
680 impose a specified fine on physicians who perform
681 certain office surgeries in an unregistered office;
682 amending s. 459.015, F.S.; providing that a physician
683 performing certain office surgeries in an unregistered
684 office constitutes grounds for denial of a license or
685 disciplinary action; amending s. 464.012, F.S.;
686 authorizing a certified registered nurse anesthetist
687 to provide specified services in a an office
688 registered to perform office surgery within the
689 framework of an established protocol with a licensed
690 anesthesiologist; amending s. 766.101, F.S.;
691 conforming a cross-reference; providing an effective
692 date.