Florida Senate - 2019                          SENATOR AMENDMENT
       Bill No. CS for HB 843
       
       
       
       
       
       
                                Ì623018ÈÎ623018                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                Floor: 1/RE/2R         .                                
             04/26/2019 04:19 PM       .                                
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       Senator Harrell moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. It is the intent of the Legislature to promote
    6  programs and initiatives that help make available preventive and
    7  educational dental services for the residents of the state, as
    8  well as provide quality dental treatment services. The
    9  geographic characteristics among the residents of the state are
   10  distinctive and vary from region to region, with such residents
   11  having unique needs regarding access to dental care. The
   12  Legislature recognizes that maintaining good oral health is
   13  integral to the overall health status of individuals and that
   14  the good health of the residents of this state is an important
   15  contributing factor in economic development. Better health,
   16  including better oral health, increases workplace productivity,
   17  reduces the burden of health care costs, and improves the
   18  cognitive development of children, resulting in a reduction of
   19  missed school days.
   20         Section 2. Section 381.4019, Florida Statutes, is created
   21  to read:
   22         381.4019Dental Student Loan Repayment Program.—The Dental
   23  Student Loan Repayment Program is established to promote access
   24  to dental care by supporting qualified dentists who treat
   25  medically underserved populations in dental health professional
   26  shortage areas or medically underserved areas.
   27         (1)As used in this section, the term:
   28         (a)“Dental health professional shortage area” means a
   29  geographic area designated as such by the Health Resources and
   30  Services Administration of the United States Department of
   31  Health and Human Services.
   32         (b)“Department” means the Department of Health.
   33         (c)“Loan program” means the Dental Student Loan Repayment
   34  Program.
   35         (d)“Medically underserved area” means a geographic area,
   36  an area having a special population, or a facility which is
   37  designated by department rule as a health professional shortage
   38  area as defined by federal regulation and which has a shortage
   39  of dental health professionals who serve Medicaid recipients and
   40  other low-income patients.
   41         (e)“Public health program” means a county health
   42  department, the Children’s Medical Services program, a federally
   43  funded community health center, a federally funded migrant
   44  health center, or other publicly funded or nonprofit health care
   45  program designated by the department.
   46         (2)The department shall establish a dental student loan
   47  repayment program to benefit Florida-licensed dentists who
   48  demonstrate, as required by department rule, active employment
   49  in a public health program that serves Medicaid recipients and
   50  other low-income patients and is located in a dental health
   51  professional shortage area or a medically underserved area.
   52         (3)The department shall award funds from the loan program
   53  to repay the student loans of a dentist who meets the
   54  requirements of subsection (2).
   55         (a)An award may not exceed $50,000 per year per eligible
   56  dentist.
   57         (b)Only loans to pay the costs of tuition, books, dental
   58  equipment and supplies, uniforms, and living expenses may be
   59  covered.
   60         (c)All repayments are contingent upon continued proof of
   61  eligibility and must be made directly to the holder of the loan.
   62  The state bears no responsibility for the collection of any
   63  interest charges or other remaining balances.
   64         (d)A dentist may receive funds under the loan program for
   65  at least 1 year, up to a maximum of 5 years.
   66         (e)The department shall limit the number of new dentists
   67  participating in the loan program to not more than 10 per fiscal
   68  year.
   69         (4)A dentist is no longer eligible to receive funds under
   70  the loan program if the dentist:
   71         (a)Is no longer employed by a public health program that
   72  meets the requirements of subsection (2).
   73         (b)Ceases to participate in the Florida Medicaid program.
   74         (c)Has disciplinary action taken against his or her
   75  license by the Board of Dentistry for a violation of s. 466.028.
   76         (5)The department shall adopt rules to administer the loan
   77  program.
   78         (6) Implementation of the loan program is subject to
   79  legislative appropriation.
   80         Section 3. Section 381.40195, Florida Statutes, is created
   81  to read:
   82         381.40195Donated Dental Services Program.—
   83         (1)This act may be cited as the “Donated Dental Services
   84  Act.”
   85         (2)As used in this section, the term:
   86         (a)“Department” means the Department of Health.
   87         (b)“Program” means the Donated Dental Services Program as
   88  established pursuant to subsection (3).
   89         (3)The department shall establish the Donated Dental
   90  Services Program for the purpose of providing comprehensive
   91  dental care through a network of volunteer dentists and other
   92  dental providers to needy, disabled, elderly, and medically
   93  compromised individuals who cannot afford necessary treatment
   94  but are ineligible for public assistance. An eligible individual
   95  may receive treatment in a volunteer dentist’s or participating
   96  dental provider’s private office or at any other suitable
   97  location. An eligible individual is not required to pay any fee
   98  or cost associated with the treatment he or she receives.
   99         (4)The department shall establish the program. The
  100  department shall contract with a nonprofit organization that has
  101  experience in providing similar services or administering
  102  similar programs. The contract must specify the responsibilities
  103  of the nonprofit organization, which may include, but are not
  104  limited to:
  105         (a)Maintaining a network of volunteer dentists and other
  106  dental providers, including, but not limited to, dental
  107  specialists and dental laboratories, to provide comprehensive
  108  dental services to eligible individuals.
  109         (b)Maintaining a system to refer eligible individuals to
  110  the appropriate volunteer dentist or participating dental
  111  provider.
  112         (c)Developing a public awareness and marketing campaign to
  113  promote the program and educate eligible individuals about its
  114  availability and services.
  115         (d)Providing the necessary administrative and technical
  116  support to administer the program.
  117         (e)Submitting an annual report to the department which
  118  must include, at a minimum:
  119         1.Financial data relating to administering the program.
  120         2.Demographic data and other information relating to the
  121  eligible individuals who are referred to and receive treatment
  122  through the program.
  123         3.Demographic data and other information relating to the
  124  volunteer dentists and participating dental providers who
  125  provide dental services through the program.
  126         4.Any other data or information that the department may
  127  require.
  128         (f)Performing any other program-related duties and
  129  responsibilities as required by the department.
  130         (5)The department shall adopt rules to administer the
  131  program.
  132         (6) Implementation of the program is subject to legislative
  133  appropriation.
  134         Section 4. Subsection (3) is added to section 395.1012,
  135  Florida Statutes, to read:
  136         395.1012 Patient safety.—
  137         (3)(a)Each hospital shall provide to any patient upon
  138  admission, upon scheduling of nonemergency care, or before
  139  treatment, written information on a form created by the agency
  140  which contains the following information available for the
  141  hospital for the most recent year and the statewide average for
  142  all hospitals related to the following quality measures:
  143         1.The rate of hospital-acquired infections;
  144         2.The overall rating of the Hospital Consumer Assessment
  145  of Healthcare Providers and Systems survey; and
  146         3.The 15-day readmission rate.
  147         (b)A hospital shall also provide to any person, upon
  148  request, the written information specified in paragraph (a).
  149         (c)The information required by this subsection must be
  150  presented in a manner that is easily understandable and
  151  accessible to the patient and must also include an explanation
  152  of the quality measures and the relationship between patient
  153  safety and the hospital’s data for the quality measures.
  154         Section 5. Section 395.1052, Florida Statutes, is created
  155  to read:
  156         395.1052 Patient access to primary care and specialty
  157  providers; notification.—A hospital shall:
  158         (1) Notify each patient’s primary care provider, if any,
  159  within 24 hours after the patient’s admission to the hospital.
  160         (2) Inform the patient immediately upon admission that he
  161  or she may request to have the hospital’s treating physician
  162  consult with the patient’s primary care provider or specialist
  163  provider, if any, when developing the patient’s plan of care.
  164  Upon the patient’s request, the hospital’s treating physician
  165  shall make reasonable efforts to consult with the patient’s
  166  primary care provider or specialist provider when developing the
  167  patient’s plan of care.
  168         (3) Notify the patient’s primary care provider, if any, of
  169  the patient’s discharge from the hospital within 24 hours after
  170  the discharge.
  171         (4) Provide the discharge summary and any related
  172  information or records to the patient’s primary care provider,
  173  if any, within 14 days after the patient’s discharge summary has
  174  been completed.
  175         Section 6. Subsection (3) of section 395.002, Florida
  176  Statutes, is amended to read:
  177         395.002 Definitions.—As used in this chapter:
  178         (3) “Ambulatory surgical center” means a facility the
  179  primary purpose of which is to provide elective surgical care,
  180  in which the patient is admitted to and discharged from such
  181  facility within 24 hours the same working day and is not
  182  permitted to stay overnight, and which is not part of a
  183  hospital. However, a facility existing for the primary purpose
  184  of performing terminations of pregnancy, an office maintained by
  185  a physician for the practice of medicine, or an office
  186  maintained for the practice of dentistry may not be construed to
  187  be an ambulatory surgical center, provided that any facility or
  188  office which is certified or seeks certification as a Medicare
  189  ambulatory surgical center shall be licensed as an ambulatory
  190  surgical center pursuant to s. 395.003.
  191         Section 7. Section 395.1055, Florida Statutes, is amended
  192  to read:
  193         395.1055 Rules and enforcement.—
  194         (1) The agency shall adopt rules pursuant to ss. 120.536(1)
  195  and 120.54 to implement the provisions of this part, which shall
  196  include reasonable and fair minimum standards for ensuring that:
  197         (a) Sufficient numbers and qualified types of personnel and
  198  occupational disciplines are on duty and available at all times
  199  to provide necessary and adequate patient care and safety.
  200         (b) Infection control, housekeeping, sanitary conditions,
  201  and medical record procedures that will adequately protect
  202  patient care and safety are established and implemented.
  203         (c) A comprehensive emergency management plan is prepared
  204  and updated annually. Such standards must be included in the
  205  rules adopted by the agency after consulting with the Division
  206  of Emergency Management. At a minimum, the rules must provide
  207  for plan components that address emergency evacuation
  208  transportation; adequate sheltering arrangements; postdisaster
  209  activities, including emergency power, food, and water;
  210  postdisaster transportation; supplies; staffing; emergency
  211  equipment; individual identification of residents and transfer
  212  of records, and responding to family inquiries. The
  213  comprehensive emergency management plan is subject to review and
  214  approval by the local emergency management agency. During its
  215  review, the local emergency management agency shall ensure that
  216  the following agencies, at a minimum, are given the opportunity
  217  to review the plan: the Department of Elderly Affairs, the
  218  Department of Health, the Agency for Health Care Administration,
  219  and the Division of Emergency Management. Also, appropriate
  220  volunteer organizations must be given the opportunity to review
  221  the plan. The local emergency management agency shall complete
  222  its review within 60 days and either approve the plan or advise
  223  the facility of necessary revisions.
  224         (d) Licensed facilities are established, organized, and
  225  operated consistent with established standards and rules.
  226         (e) Licensed facility beds conform to minimum space,
  227  equipment, and furnishings standards as specified by the
  228  department.
  229         (f) All hospitals submit such data as necessary to conduct
  230  certificate-of-need reviews required under part I of chapter
  231  408. Such data shall include, but shall not be limited to,
  232  patient origin data, hospital utilization data, type of service
  233  reporting, and facility staffing data. The agency may not
  234  collect data that identifies or could disclose the identity of
  235  individual patients. The agency shall utilize existing uniform
  236  statewide data sources when available and shall minimize
  237  reporting costs to hospitals.
  238         (g) Each hospital has a quality improvement program
  239  designed according to standards established by their current
  240  accrediting organization. This program will enhance quality of
  241  care and emphasize quality patient outcomes, corrective action
  242  for problems, governing board review, and reporting to the
  243  agency of standardized data elements necessary to analyze
  244  quality of care outcomes. The agency shall use existing data,
  245  when available, and shall not duplicate the efforts of other
  246  state agencies in order to obtain such data.
  247         (h) Licensed facilities make available on their Internet
  248  websites, no later than October 1, 2004, and in a hard copy
  249  format upon request, a description of and a link to the patient
  250  charge and performance outcome data collected from licensed
  251  facilities pursuant to s. 408.061.
  252         (i) All hospitals providing organ transplantation, neonatal
  253  intensive care services, inpatient psychiatric services,
  254  inpatient substance abuse services, or comprehensive medical
  255  rehabilitation meet the minimum licensure requirements adopted
  256  by the agency. Such licensure requirements must include quality
  257  of care, nurse staffing, physician staffing, physical plant,
  258  equipment, emergency transportation, and data reporting
  259  standards.
  260         (2) Separate standards may be provided for general and
  261  specialty hospitals, ambulatory surgical centers, and statutory
  262  rural hospitals as defined in s. 395.602.
  263         (3)The agency shall adopt rules that establish minimum
  264  standards for pediatric patient care in ambulatory surgical
  265  centers to ensure the safe and effective delivery of surgical
  266  care to children in ambulatory surgical centers. Such standards
  267  must include quality of care, nurse staffing, physician
  268  staffing, and equipment standards. Ambulatory surgical centers
  269  may not provide operative procedures to children under 18 years
  270  of age which require a length of stay past midnight until such
  271  standards are established by rule.
  272         (4)(3) The agency shall adopt rules with respect to the
  273  care and treatment of patients residing in distinct part nursing
  274  units of hospitals which are certified for participation in
  275  Title XVIII (Medicare) and Title XIX (Medicaid) of the Social
  276  Security Act skilled nursing facility program. Such rules shall
  277  take into account the types of patients treated in hospital
  278  skilled nursing units, including typical patient acuity levels
  279  and the average length of stay in such units, and shall be
  280  limited to the appropriate portions of the Omnibus Budget
  281  Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,
  282  1987), Title IV (Medicare, Medicaid, and Other Health-Related
  283  Programs), Subtitle C (Nursing Home Reform), as amended. The
  284  agency shall require level 2 background screening as specified
  285  in s. 408.809(1)(e) pursuant to s. 408.809 and chapter 435 for
  286  personnel of distinct part nursing units.
  287         (5)(4) The agency shall adopt rules with respect to the
  288  care and treatment of clients in intensive residential treatment
  289  programs for children and adolescents and with respect to the
  290  safe and healthful development, operation, and maintenance of
  291  such programs.
  292         (6)(5) The agency shall enforce the provisions of part I of
  293  chapter 394, and rules adopted thereunder, with respect to the
  294  rights, standards of care, and examination and placement
  295  procedures applicable to patients voluntarily or involuntarily
  296  admitted to hospitals providing psychiatric observation,
  297  evaluation, diagnosis, or treatment.
  298         (7)(6) No rule shall be adopted under this part by the
  299  agency which would have the effect of denying a license to a
  300  facility required to be licensed under this part, solely by
  301  reason of the school or system of practice employed or permitted
  302  to be employed by physicians therein, provided that such school
  303  or system of practice is recognized by the laws of this state.
  304  However, nothing in this subsection shall be construed to limit
  305  the powers of the agency to provide and require minimum
  306  standards for the maintenance and operation of, and for the
  307  treatment of patients in, those licensed facilities which
  308  receive federal aid, in order to meet minimum standards related
  309  to such matters in such licensed facilities which may now or
  310  hereafter be required by appropriate federal officers or
  311  agencies in pursuance of federal law or promulgated in pursuance
  312  of federal law.
  313         (8)(7) Any licensed facility which is in operation at the
  314  time of promulgation of any applicable rules under this part
  315  shall be given a reasonable time, under the particular
  316  circumstances, but not to exceed 1 year from the date of such
  317  promulgation, within which to comply with such rules.
  318         (9)(8) The agency may not adopt any rule governing the
  319  design, construction, erection, alteration, modification,
  320  repair, or demolition of any public or private hospital,
  321  intermediate residential treatment facility, or ambulatory
  322  surgical center. It is the intent of the Legislature to preempt
  323  that function to the Florida Building Commission and the State
  324  Fire Marshal through adoption and maintenance of the Florida
  325  Building Code and the Florida Fire Prevention Code. However, the
  326  agency shall provide technical assistance to the commission and
  327  the State Fire Marshal in updating the construction standards of
  328  the Florida Building Code and the Florida Fire Prevention Code
  329  which govern hospitals, intermediate residential treatment
  330  facilities, and ambulatory surgical centers.
  331         (10)(9) The agency shall establish a pediatric cardiac
  332  technical advisory panel, pursuant to s. 20.052, to develop
  333  procedures and standards for measuring outcomes of pediatric
  334  cardiac catheterization programs and pediatric cardiovascular
  335  surgery programs.
  336         (a) Members of the panel must have technical expertise in
  337  pediatric cardiac medicine, shall serve without compensation,
  338  and may not be reimbursed for per diem and travel expenses.
  339         (b) Voting members of the panel shall include: 3 at-large
  340  members, and 3 alternate at-large members with different program
  341  affiliations, including 1 cardiologist who is board certified in
  342  caring for adults with congenital heart disease and 2 board
  343  certified pediatric cardiologists, neither of whom may be
  344  employed by any of the hospitals specified in subparagraphs 1.
  345  10. or their affiliates, each of whom is appointed by the
  346  Secretary of Health Care Administration, and 10 members, and an
  347  alternate for each member, each of whom is a pediatric
  348  cardiologist or a pediatric cardiovascular surgeon, each
  349  appointed by the chief executive officer of the following
  350  hospitals:
  351         1. Johns Hopkins All Children’s Hospital in St. Petersburg.
  352         2. Arnold Palmer Hospital for Children in Orlando.
  353         3. Joe DiMaggio Children’s Hospital in Hollywood.
  354         4. Nicklaus Children’s Hospital in Miami.
  355         5. St. Joseph’s Children’s Hospital in Tampa.
  356         6. University of Florida Health Shands Hospital in
  357  Gainesville.
  358         7. University of Miami Holtz Children’s Hospital in Miami.
  359         8. Wolfson Children’s Hospital in Jacksonville.
  360         9. Florida Hospital for Children in Orlando.
  361         10. Nemours Children’s Hospital in Orlando.
  362  
  363  Appointments made under subparagraphs 1.-10. are contingent upon
  364  the hospital’s maintenance of pediatric certificates of need and
  365  the hospital’s compliance with this section and rules adopted
  366  thereunder, as determined by the Secretary of Health Care
  367  Administration. A member appointed under subparagraphs 1.-10.
  368  whose hospital fails to maintain such certificates or comply
  369  with standards may serve only as a nonvoting member until the
  370  hospital restores such certificates or complies with such
  371  standards. A voting member may serve a maximum of two 2-year
  372  terms and may be reappointed to the panel after being retired
  373  from the panel for a full 2-year term.
  374         (c) The Secretary of Health Care Administration may appoint
  375  nonvoting members to the panel. Nonvoting members may include:
  376         1. The Secretary of Health Care Administration.
  377         2. The Surgeon General.
  378         3. The Deputy Secretary of Children’s Medical Services.
  379         4. Any current or past Division Director of Children’s
  380  Medical Services.
  381         5. A parent of a child with congenital heart disease.
  382         6. An adult with congenital heart disease.
  383         7. A representative from each of the following
  384  organizations: the Florida Chapter of the American Academy of
  385  Pediatrics, the Florida Chapter of the American College of
  386  Cardiology, the Greater Southeast Affiliate of the American
  387  Heart Association, the Adult Congenital Heart Association, the
  388  March of Dimes, the Florida Association of Children’s Hospitals,
  389  and the Florida Society of Thoracic and Cardiovascular Surgeons.
  390         (d) The panel shall meet biannually, or more frequently
  391  upon the call of the Secretary of Health Care Administration.
  392  Such meetings may be conducted telephonically, or by other
  393  electronic means.
  394         (e) The duties of the panel include recommending to the
  395  agency standards for quality of care, personnel, physical plant,
  396  equipment, emergency transportation, and data reporting for
  397  hospitals that provide pediatric cardiac services.
  398         (f) Beginning on January 1, 2020, and annually thereafter,
  399  the panel shall submit a report to the Governor, the President
  400  of the Senate, the Speaker of the House of Representatives, the
  401  Secretary of Health Care Administration, and the State Surgeon
  402  General. The report must summarize the panel’s activities during
  403  the preceding fiscal year and include data and performance
  404  measures on surgical morbidity and mortality for all pediatric
  405  cardiac programs.
  406         (g) Panel members are agents of the state for purposes of
  407  s. 768.28 throughout the good faith performance of the duties
  408  assigned to them by the Secretary of Health Care Administration.
  409         (11) The Secretary of Health Care Administration shall
  410  consult the pediatric cardiac technical advisory panel for an
  411  advisory recommendation on any certificate of need applications
  412  to establish pediatric cardiac surgical centers.
  413         (12)(10) Based on the recommendations of the pediatric
  414  cardiac technical advisory panel in subsection (9), the agency
  415  shall adopt rules for pediatric cardiac programs which, at a
  416  minimum, include:
  417         (a) Standards for pediatric cardiac catheterization
  418  services and pediatric cardiovascular surgery including quality
  419  of care, personnel, physical plant, equipment, emergency
  420  transportation, data reporting, and appropriate operating hours
  421  and timeframes for mobilization for emergency procedures.
  422         (b) Outcome standards consistent with nationally
  423  established levels of performance in pediatric cardiac programs.
  424         (c) Specific steps to be taken by the agency and licensed
  425  facilities when the facilities do not meet the outcome standards
  426  within a specified time, including time required for detailed
  427  case reviews and the development and implementation of
  428  corrective action plans.
  429         (13)(11) A pediatric cardiac program shall:
  430         (a) Have a pediatric cardiology clinic affiliated with a
  431  hospital licensed under this chapter.
  432         (b) Have a pediatric cardiac catheterization laboratory and
  433  a pediatric cardiovascular surgical program located in the
  434  hospital.
  435         (c) Have a risk adjustment surgical procedure protocol
  436  following the guidelines established by the Society of Thoracic
  437  Surgeons.
  438         (d) Have quality assurance and quality improvement
  439  processes in place to enhance clinical operation and patient
  440  satisfaction with services.
  441         (e) Participate in the clinical outcome reporting systems
  442  operated by the Society of Thoracic Surgeons and the American
  443  College of Cardiology.
  444         (14)(a) The Secretary of Health Care Administration may
  445  request announced or unannounced site visits to any existing
  446  pediatric cardiac surgical center or facility seeking licensure
  447  as a pediatric cardiac surgical center through the certificate
  448  of need process, to ensure compliance with this section and
  449  rules adopted hereunder.
  450         (b) At the request of the Secretary of Health Care
  451  Administration, the pediatric cardiac technical advisory panel
  452  shall recommend in-state physician experts to conduct an on-site
  453  visit. The Secretary may also appoint up to two out-of-state
  454  physician experts.
  455         (c) A site visit team shall conduct an on-site inspection
  456  of the designated hospital’s pediatric medical and surgical
  457  programs, and each member shall submit a written report of his
  458  or her findings to the panel. The panel shall discuss the
  459  written reports and present an advisory opinion to the Secretary
  460  of Health Care Administration which includes recommendations and
  461  any suggested actions for correction.
  462         (d) Each on-site inspection must include all of the
  463  following:
  464         1. An inspection of the program’s physical facilities,
  465  clinics, and laboratories.
  466         2. Interviews with support staff and hospital
  467  administrators.
  468         3.A review of:
  469         a. Randomly selected medical records and reports,
  470  including, but not limited to, advanced cardiac imaging,
  471  computed tomography, magnetic resonance imaging, cardiac
  472  ultrasound, cardiac catheterization, and surgical operative
  473  notes.
  474         b.The program’s clinical outcome data submitted to the
  475  Society of Thoracic Surgeons and the American College of
  476  Cardiology pursuant to s. 408.05(3)(k).
  477         c.Mortality reports from cardiac-related deaths that
  478  occurred in the previous year.
  479         d. Program volume data from the preceding year for
  480  interventional and electrophysiology catheterizations and
  481  surgical procedures.
  482         (15) The Surgeon General shall provide quarterly reports to
  483  the Secretary of Health Care Administration consisting of data
  484  from the Children’s Medical Services critical congenital heart
  485  disease screening program for review by the advisory panel.
  486         (16)(12) The agency may adopt rules to administer the
  487  requirements of part II of chapter 408.
  488         Section 8. Subsection (3) of section 395.301, Florida
  489  Statutes, is amended to read:
  490         395.301 Price transparency; itemized patient statement or
  491  bill; patient admission status notification.—
  492         (3) If a licensed facility places a patient on observation
  493  status rather than inpatient status, the licensed facility must
  494  immediately notify the patient of such status using the form
  495  adopted under 42 C.F.R. s. 489.20 for Medicare patients or a
  496  form adopted by agency rule for non-Medicare patients. Such
  497  notification must observation services shall be documented in
  498  the patient’s medical records and discharge papers. The patient
  499  or the patient’s survivor or legal guardian must shall be
  500  notified of observation services through discharge papers, which
  501  may also include brochures, signage, or other forms of
  502  communication for this purpose.
  503         Section 9. Paragraphs (a), (b), (c), and (d) of subsection
  504  (4) of section 400.9905, Florida Statutes, are amended to read:
  505         400.9905 Definitions.—
  506         (4) “Clinic” means an entity where health care services are
  507  provided to individuals and which tenders charges for
  508  reimbursement for such services, including a mobile clinic and a
  509  portable equipment provider. As used in this part, the term does
  510  not include and the licensure requirements of this part do not
  511  apply to:
  512         (a) Entities licensed or registered by the state under
  513  chapter 395; entities licensed or registered by the state and
  514  providing only health care services within the scope of services
  515  authorized under their respective licenses under ss. 383.30
  516  383.332, chapter 390, chapter 394, chapter 397, this chapter
  517  except part X, chapter 429, chapter 463, chapter 465, chapter
  518  466, chapter 478, chapter 484, or chapter 651; end-stage renal
  519  disease providers authorized under 42 C.F.R. part 405, subpart
  520  U; providers certified under 42 C.F.R. part 485, subpart B or
  521  subpart H; providers certified by the Centers for Medicare and
  522  Medicaid services under the federal Clinical Laboratory
  523  Improvement Amendments and the federal rules adopted thereunder;
  524  or any entity that provides neonatal or pediatric hospital-based
  525  health care services or other health care services by licensed
  526  practitioners solely within a hospital licensed under chapter
  527  395.
  528         (b) Entities that own, directly or indirectly, entities
  529  licensed or registered by the state pursuant to chapter 395;
  530  entities that own, directly or indirectly, entities licensed or
  531  registered by the state and providing only health care services
  532  within the scope of services authorized pursuant to their
  533  respective licenses under ss. 383.30-383.332, chapter 390,
  534  chapter 394, chapter 397, this chapter except part X, chapter
  535  429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
  536  484, or chapter 651; end-stage renal disease providers
  537  authorized under 42 C.F.R. part 405, subpart U; providers
  538  certified under 42 C.F.R. part 485, subpart B or subpart H;
  539  providers certified by the Centers for Medicare and Medicaid
  540  services under the federal Clinical Laboratory Improvement
  541  Amendments and the federal rules adopted thereunder; or any
  542  entity that provides neonatal or pediatric hospital-based health
  543  care services by licensed practitioners solely within a hospital
  544  licensed under chapter 395.
  545         (c) Entities that are owned, directly or indirectly, by an
  546  entity licensed or registered by the state pursuant to chapter
  547  395; entities that are owned, directly or indirectly, by an
  548  entity licensed or registered by the state and providing only
  549  health care services within the scope of services authorized
  550  pursuant to their respective licenses under ss. 383.30-383.332,
  551  chapter 390, chapter 394, chapter 397, this chapter except part
  552  X, chapter 429, chapter 463, chapter 465, chapter 466, chapter
  553  478, chapter 484, or chapter 651; end-stage renal disease
  554  providers authorized under 42 C.F.R. part 405, subpart U;
  555  providers certified under 42 C.F.R. part 485, subpart B or
  556  subpart H; providers certified by the Centers for Medicare and
  557  Medicaid services under the federal Clinical Laboratory
  558  Improvement Amendments and the federal rules adopted thereunder;
  559  or any entity that provides neonatal or pediatric hospital-based
  560  health care services by licensed practitioners solely within a
  561  hospital under chapter 395.
  562         (d) Entities that are under common ownership, directly or
  563  indirectly, with an entity licensed or registered by the state
  564  pursuant to chapter 395; entities that are under common
  565  ownership, directly or indirectly, with an entity licensed or
  566  registered by the state and providing only health care services
  567  within the scope of services authorized pursuant to their
  568  respective licenses under ss. 383.30-383.332, chapter 390,
  569  chapter 394, chapter 397, this chapter except part X, chapter
  570  429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
  571  484, or chapter 651; end-stage renal disease providers
  572  authorized under 42 C.F.R. part 405, subpart U; providers
  573  certified under 42 C.F.R. part 485, subpart B or subpart H;
  574  providers certified by the Centers for Medicare and Medicaid
  575  services under the federal Clinical Laboratory Improvement
  576  Amendments and the federal rules adopted thereunder; or any
  577  entity that provides neonatal or pediatric hospital-based health
  578  care services by licensed practitioners solely within a hospital
  579  licensed under chapter 395.
  580  
  581  Notwithstanding this subsection, an entity shall be deemed a
  582  clinic and must be licensed under this part in order to receive
  583  reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
  584  627.730-627.7405, unless exempted under s. 627.736(5)(h).
  585         Section 10. Section 542.336, Florida Statutes, is created
  586  to read:
  587         542.336 Invalid restrictive covenants.—A restrictive
  588  covenant entered into with a physician who is licensed under
  589  chapter 458 or chapter 459 and who practices a medical specialty
  590  in a county wherein one entity employs or contracts with, either
  591  directly or through related or affiliated entities, all
  592  physicians who practice such specialty in that county is not
  593  supported by a legitimate business interest. The Legislature
  594  finds that such covenants restrict patient access to physicians,
  595  increase costs, and are void and unenforceable under current
  596  law. Such restrictive covenants shall remain void and
  597  unenforceable for 3 years after the date on which a second
  598  entity that employs or contracts with, either directly or
  599  through related or affiliated entities, one or more physicians
  600  who practice such specialty begins offering such specialty
  601  services in that county.
  602         Section 11. Section 624.27, Florida Statutes, is amended to
  603  read:
  604         624.27 Direct health primary care agreements; exemption
  605  from code.—
  606         (1) As used in this section, the term:
  607         (a) “Direct health primary care agreement” means a contract
  608  between a health primary care provider and a patient, a
  609  patient’s legal representative, or a patient’s employer, which
  610  meets the requirements of subsection (4) and does not indemnify
  611  for services provided by a third party.
  612         (b) “Health Primary care provider” means a health care
  613  provider licensed under chapter 458, chapter 459, chapter 460,
  614  or chapter 464, or chapter 466, or a health primary care group
  615  practice, who provides health primary care services to patients.
  616         (c) “Health Primary care services” means the screening,
  617  assessment, diagnosis, and treatment of a patient conducted
  618  within the competency and training of the health primary care
  619  provider for the purpose of promoting health or detecting and
  620  managing disease or injury.
  621         (2) A direct health primary care agreement does not
  622  constitute insurance and is not subject to the Florida Insurance
  623  Code. The act of entering into a direct health primary care
  624  agreement does not constitute the business of insurance and is
  625  not subject to the Florida Insurance Code.
  626         (3) A health primary care provider or an agent of a health
  627  primary care provider is not required to obtain a certificate of
  628  authority or license under the Florida Insurance Code to market,
  629  sell, or offer to sell a direct health primary care agreement.
  630         (4) For purposes of this section, a direct health primary
  631  care agreement must:
  632         (a) Be in writing.
  633         (b) Be signed by the health primary care provider or an
  634  agent of the health primary care provider and the patient, the
  635  patient’s legal representative, or the patient’s employer.
  636         (c) Allow a party to terminate the agreement by giving the
  637  other party at least 30 days’ advance written notice. The
  638  agreement may provide for immediate termination due to a
  639  violation of the physician-patient relationship or a breach of
  640  the terms of the agreement.
  641         (d) Describe the scope of health primary care services that
  642  are covered by the monthly fee.
  643         (e) Specify the monthly fee and any fees for health primary
  644  care services not covered by the monthly fee.
  645         (f) Specify the duration of the agreement and any automatic
  646  renewal provisions.
  647         (g) Offer a refund to the patient, the patient’s legal
  648  representative, or the patient’s employer of monthly fees paid
  649  in advance if the health primary care provider ceases to offer
  650  health primary care services for any reason.
  651         (h) Contain, in contrasting color and in at least 12-point
  652  type, the following statement on the signature page: “This
  653  agreement is not health insurance and the health primary care
  654  provider will not file any claims against the patient’s health
  655  insurance policy or plan for reimbursement of any health primary
  656  care services covered by the agreement. This agreement does not
  657  qualify as minimum essential coverage to satisfy the individual
  658  shared responsibility provision of the Patient Protection and
  659  Affordable Care Act, 26 U.S.C. s. 5000A. This agreement is not
  660  workers’ compensation insurance and does not replace an
  661  employer’s obligations under chapter 440.”
  662         Section 12. Effective January 1, 2020, section 627.42393,
  663  Florida Statutes, is created to read:
  664         627.42393 Step-therapy protocol.—
  665         (1) A health insurer issuing a major medical individual or
  666  group policy may not require a step-therapy protocol under the
  667  policy for a covered prescription drug requested by an insured
  668  if:
  669         (a) The insured has previously been approved to receive the
  670  prescription drug through the completion of a step-therapy
  671  protocol required by a separate health coverage plan; and
  672         (b) The insured provides documentation originating from the
  673  health coverage plan that approved the prescription drug as
  674  described in paragraph (a) indicating that the health coverage
  675  plan paid for the drug on the insured’s behalf during the 90
  676  days immediately before the request.
  677         (2) As used in this section, the term “health coverage
  678  plan” means any of the following which is currently or was
  679  previously providing major medical or similar comprehensive
  680  coverage or benefits to the insured:
  681         (a) A health insurer or health maintenance organization.
  682         (b)A plan established or maintained by an individual
  683  employer as provided by the Employee Retirement Income Security
  684  Act of 1974, Pub. L. No. 93-406.
  685         (c) A multiple-employer welfare arrangement as defined in
  686  s. 624.437.
  687         (d) A governmental entity providing a plan of self
  688  insurance.
  689         (3) This section does not require a health insurer to add a
  690  drug to its prescription drug formulary or to cover a
  691  prescription drug that the insurer does not otherwise cover.
  692         Section 13. Effective January 1, 2020, subsection (45) is
  693  added to section 641.31, Florida Statutes, to read:
  694         641.31 Health maintenance contracts.—
  695         (45)(a) A health maintenance organization issuing major
  696  medical coverage through an individual or group contract may not
  697  require a step-therapy protocol under the contract for a covered
  698  prescription drug requested by a subscriber if:
  699         1. The subscriber has previously been approved to receive
  700  the prescription drug through the completion of a step-therapy
  701  protocol required by a separate health coverage plan; and
  702         2. The subscriber provides documentation originating from
  703  the health coverage plan that approved the prescription drug as
  704  described in subparagraph 1. indicating that the health coverage
  705  plan paid for the drug on the subscriber’s behalf during the 90
  706  days immediately before the request.
  707         (b) As used in this subsection, the term “health coverage
  708  plan” means any of the following which previously provided or is
  709  currently providing major medical or similar comprehensive
  710  coverage or benefits to the subscriber:
  711         1. A health insurer or health maintenance organization;
  712         2.A plan established or maintained by an individual
  713  employer as provided by the Employee Retirement Income Security
  714  Act of 1974, Pub. L. No. 93-406;
  715         3. A multiple-employer welfare arrangement as defined in s.
  716  624.437; or
  717         4. A governmental entity providing a plan of self
  718  insurance.
  719         (c) This subsection does not require a health maintenance
  720  organization to add a drug to its prescription drug formulary or
  721  to cover a prescription drug that the health maintenance
  722  organization does not otherwise cover.
  723         Section 14. The Office of Program Policy Analysis and
  724  Government Accountability shall research and analyze the
  725  Interstate Medical Licensure Compact and the relevant
  726  requirements and provisions of general law and the State
  727  Constitution and shall develop a report and recommendations
  728  addressing this state’s prospective entrance into the compact as
  729  a member state while remaining consistent with those
  730  requirements and provisions. In conducting such research and
  731  analysis, the office may consult with the executive director,
  732  other executive staff, or the executive committee of the
  733  Interstate Medical Licensure Compact Commission. The office
  734  shall submit the report and recommendations to the Governor, the
  735  President of the Senate, and the Speaker of the House of
  736  Representatives by not later than October 1, 2019.
  737         Section 15. Except as otherwise expressly provided in this
  738  act, this act shall take effect July 1, 2019.
  739  
  740  ================= T I T L E  A M E N D M E N T ================
  741  And the title is amended as follows:
  742         Delete everything before the enacting clause
  743  and insert:
  744                        A bill to be entitled                      
  745         An act relating to health care; providing legislative
  746         intent; creating s. 381.4019, F.S.; establishing the
  747         Dental Student Loan Repayment Program to support
  748         dentists who practice in public health programs
  749         located in certain underserved areas; providing
  750         definitions; requiring the Department of Health to
  751         establish a dental student loan repayment program for
  752         specified purposes; providing for the award of funds;
  753         providing the maximum number of years for which funds
  754         may be awarded; providing eligibility requirements;
  755         requiring the department to adopt rules; specifying
  756         that implementation of the program is subject to
  757         legislative appropriation; creating s. 381.40195,
  758         F.S.; providing a short title; providing definitions;
  759         requiring the Department of Health to establish the
  760         Donated Dental Services Program to provide
  761         comprehensive dental care to certain eligible
  762         individuals; requiring the department to contract with
  763         a nonprofit organization to implement and administer
  764         the program; specifying minimum contractual
  765         responsibilities; requiring the department to adopt
  766         rules; specifying that implementation of the program
  767         is subject to legislative appropriation; amending s.
  768         395.1012, F.S.; requiring a licensed hospital to
  769         provide specified information and data relating to
  770         patient safety and quality measures to a patient under
  771         certain circumstances or to any person upon request;
  772         creating s. 395.1052, F.S.; requiring a hospital to
  773         notify a patient’s primary care provider within a
  774         specified timeframe after the patient’s admission;
  775         requiring a hospital to inform a patient, upon
  776         admission, of the option to request consultation
  777         between the hospital’s treating physician and the
  778         patient’s primary care provider or specialist
  779         provider; requiring a hospital to notify a patient’s
  780         primary care provider of the patient’s discharge
  781         within a specified timeframe after discharge;
  782         requiring a hospital to provide specified information
  783         and records to the primary care provider within a
  784         specified timeframe after completion of the patient’s
  785         discharge summary; amending s. 395.002, F.S.; revising
  786         the definition of the term “ambulatory surgical
  787         center”; amending s. 395.1055, F.S.; requiring the
  788         Agency for Health Care Administration to adopt rules
  789         that establish standards related to the delivery of
  790         surgical care to children in ambulatory surgical
  791         center; specifying that ambulatory surgical centers
  792         may provide certain procedures only if authorized by
  793         agency rule; authorizing the reimbursement of per diem
  794         and travel expenses to members of the pediatric
  795         cardiac technical advisory panel, established within
  796         the Agency for Health Care Administration; revising
  797         panel membership to include certain alternate at-large
  798         members; providing term limits for voting members;
  799         providing that members of the panel under certain
  800         circumstances are agents of the state for a specified
  801         purpose; requiring the Secretary of Health Care
  802         Administration to consult the panel for advisory
  803         recommendations on certain certificate of need
  804         applications; authorizing the secretary to request
  805         announced or unannounced site visits to any existing
  806         pediatric cardiac surgical center or facility seeking
  807         licensure as a pediatric cardiac surgical center
  808         through the certificate of need process; providing a
  809         process for the appointment of physician experts to a
  810         site visit team; requiring each member of a site visit
  811         team to submit a report to the panel; requiring the
  812         panel to discuss such reports and present an advisory
  813         opinion to the secretary; providing requirements for
  814         an on-site inspection; requiring the Surgeon General
  815         of the Department of Health to provide specified
  816         reports to the secretary; 395.301, F.S.; requiring a
  817         licensed facility, upon placing a patient on
  818         observation status, to immediately notify the patient
  819         of such status using a specified form; requiring that
  820         such notification be documented in the patient’s
  821         medical records and discharge papers; amending s.
  822         400.9905, F.S.; revising the definition of the term
  823         “clinic” to exclude certain entities; creating s.
  824         542.336, F.S.; specifying that certain restrictive
  825         covenants entered into with certain physicians are not
  826         supported by legitimate business interests; providing
  827         legislative findings; providing that such restrictive
  828         covenants are void and remain void and unenforceable
  829         for a specified period; amending s. 624.27, F.S.;
  830         expanding the scope of direct primary care agreements,
  831         which are renamed “direct health care agreements”;
  832         conforming provisions to changes made by the act;
  833         creating s. 627.42393, F.S.; prohibiting certain
  834         health insurers from employing step-therapy protocols
  835         under certain circumstances; defining the term “health
  836         coverage plan”; clarifying that a health insurer is
  837         not required to take specific actions regarding
  838         prescription drugs; amending s. 641.31, F.S.;
  839         prohibiting certain health maintenance organizations
  840         from employing step-therapy protocols under certain
  841         circumstances; defining the term “health coverage
  842         plan”; clarifying that a health maintenance
  843         organization is not required to take specific actions
  844         regarding prescription drugs; requiring the Office of
  845         Program Policy Analysis and Government Accountability
  846         to submit by a specified date a report and
  847         recommendations to the Governor and the Legislature
  848         which addresses this state’s prospective entrance into
  849         the Interstate Medical Licensure Compact as a member
  850         state; providing parameters for the report; providing
  851         effective dates.