Florida Senate - 2020 COMMITTEE AMENDMENT
Bill No. CS for SB 1726
Ì441796QÎ441796
LEGISLATIVE ACTION
Senate . House
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Appropriations Subcommittee on Health and Human Services (Bean)
recommended the following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Subsections (2) and (4) of section 383.327,
6 Florida Statutes, are amended to read:
7 383.327 Birth and death records; reports.—
8 (2) Each maternal death, newborn death, and stillbirth
9 shall be reported immediately to the medical examiner and the
10 agency.
11 (4) A report shall be submitted annually to the agency. The
12 contents of the report and the frequency with which it is
13 submitted shall be prescribed by rule of the agency.
14 Section 2. Subsection (4) of section 395.003, Florida
15 Statutes, is amended to read:
16 395.003 Licensure; denial, suspension, and revocation.—
17 (4) The agency shall issue a license that which specifies
18 the service categories and the number of hospital beds in each
19 bed category for which a license is received. Such information
20 shall be listed on the face of the license. All beds which are
21 not covered by any specialty-bed-need methodology shall be
22 specified as general beds. A licensed facility shall not operate
23 a number of hospital beds greater than the number indicated by
24 the agency on the face of the license without approval from the
25 agency under conditions established by rule.
26 Section 3. Paragraph (g) is added to subsection (18) of
27 section 395.1055, Florida Statutes, to read:
28 395.1055 Rules and enforcement.—
29 (18) In establishing rules for adult cardiovascular
30 services, the agency shall include provisions that allow for:
31 (g) The requirement that hospitals licensed for adult
32 diagnostic cardiac catheterization, Level I or Level II adult
33 cardiovascular services participate in the American College of
34 Cardiology – National Cardiovascular Data Registry or the
35 American Heart Association’s Get with the Guidelines – Coronary
36 Artery Disease program registry and document an ongoing quality
37 improvement plan to ensure these licensed programs meet or
38 exceed national quality and outcome benchmarks reported by the
39 registry in which they participate. Hospitals licensed for Level
40 II adult cardiovascular services must also participate in the
41 clinical outcome reporting systems operated by the Society for
42 Thoracic Surgeons.
43 Section 4. Paragraph (b) of subsection (2) of section
44 395.602, Florida Statutes, is amended to read:
45 395.602 Rural hospitals.—
46 (2) DEFINITIONS.—As used in this part, the term:
47 (b) “Rural hospital” means an acute care hospital licensed
48 under this chapter, having 100 or fewer licensed beds and an
49 emergency room, which is:
50 1. The sole provider within a county with a population
51 density of up to 100 persons per square mile;
52 2. An acute care hospital, in a county with a population
53 density of up to 100 persons per square mile, which is at least
54 30 minutes of travel time, on normally traveled roads under
55 normal traffic conditions, from any other acute care hospital
56 within the same county;
57 3. A hospital supported by a tax district or subdistrict
58 whose boundaries encompass a population of up to 100 persons per
59 square mile;
60 4. A hospital classified as a sole community hospital under
61 42 C.F.R. s. 412.92, regardless of the number of licensed beds;
62 5. A hospital with a service area that has a population of
63 up to 100 persons per square mile. As used in this subparagraph,
64 the term “service area” means the fewest number of zip codes
65 that account for 75 percent of the hospital’s discharges for the
66 most recent 5-year period, based on information available from
67 the hospital inpatient discharge database in the Florida Center
68 for Health Information and Transparency at the agency; or
69 6. A hospital designated as a critical access hospital, as
70 defined in s. 408.07.
71
72 Population densities used in this paragraph must be based upon
73 the most recently completed United States census. A hospital
74 that received funds under s. 409.9116 for a quarter beginning no
75 later than July 1, 2002, is deemed to have been and shall
76 continue to be a rural hospital from that date through June 30,
77 2021, if the hospital continues to have up to 100 licensed beds
78 and an emergency room. An acute care hospital that has not
79 previously been designated as a rural hospital and that meets
80 the criteria of this paragraph shall be granted such designation
81 upon application, including supporting documentation, to the
82 agency. A hospital that was licensed as a rural hospital during
83 the 2010-2011 or 2011-2012 fiscal year shall continue to be a
84 rural hospital from the date of designation through June 30,
85 2025 2021 , if the hospital continues to have up to 100 licensed
86 beds and an emergency room.
87 Section 5. Section 395.7015, Florida Statutes, is repealed.
88 Section 6. Section 395.7016, Florida Statutes, is amended
89 to read:
90 395.7016 Annual appropriation.—The Legislature shall
91 appropriate each fiscal year from either the General Revenue
92 Fund or the Agency for Health Care Administration Tobacco
93 Settlement Trust Fund an amount sufficient to replace the funds
94 lost due to reduction by chapter 2000-256, Laws of Florida, of
95 the assessment on other health care entities under s. 395.7015,
96 and the reduction by chapter 2000-256, Laws of Florida, in the
97 assessment on hospitals under s. 395.701, and to maintain
98 federal approval of the reduced amount of funds deposited into
99 the Public Medical Assistance Trust Fund under s. 395.701, as
100 state match for the state’s Medicaid program.
101 Section 7. Subsection (3) of section 400.19, Florida
102 Statutes, is amended to read:
103 400.19 Right of entry and inspection.—
104 (3) The agency shall conduct periodic, every 15 months
105 conduct at least one unannounced licensure inspections
106 inspection to determine compliance by the licensee with
107 statutes, and with rules adopted promulgated under the
108 provisions of those statutes, governing minimum standards of
109 construction, quality and adequacy of care, and rights of
110 residents. The survey shall be conducted every 6 months for the
111 next 2-year period If the facility has been cited for a class I
112 deficiency or, has been cited for two or more class II
113 deficiencies arising from separate surveys or investigations
114 within a 60-day period, the agency shall conduct licensure
115 surveys every 6 months until the facility has two consecutive
116 licensure surveys without a citation for a class I or a class II
117 deficiency or has had three or more substantiated complaints
118 within a 6-month period, each resulting in at least one class I
119 or class II deficiency. In addition to any other fees or fines
120 in this part, the agency shall assess a fine of for each
121 facility that is subject to the 6-month survey cycle. The fine
122 for the 2-year period shall be $6,000 for the additional 6-month
123 licensure surveys, one-half to be paid at the completion of each
124 survey. The agency may adjust such this fine by the change in
125 the Consumer Price Index, based on the 12 months immediately
126 preceding the increase, to cover the cost of the additional
127 surveys. The agency shall verify through subsequent inspection
128 that any deficiency identified during inspection is corrected.
129 However, the agency may verify the correction of a class III or
130 class IV deficiency unrelated to resident rights or resident
131 care without reinspecting the facility if adequate written
132 documentation has been received from the facility, which
133 provides assurance that the deficiency has been corrected. The
134 giving or causing to be given of advance notice of such
135 unannounced inspections by an employee of the agency to any
136 unauthorized person shall constitute cause for suspension of not
137 fewer than 5 working days according to the provisions of chapter
138 110.
139 Section 8. Subsections (12), (14), (17), (21), and (22) of
140 section 400.462, Florida Statutes, are amended to read:
141 400.462 Definitions.—As used in this part, the term:
142 (12) “Home health agency” means a person who an
143 organization that provides one or more home health services and
144 staffing services.
145 (14) “Home health services” means health and medical
146 services and medical supplies furnished by an organization to an
147 individual in the individual’s home or place of residence. The
148 term includes organizations that provide one or more of the
149 following:
150 (a) Nursing care.
151 (b) Physical, occupational, respiratory, or speech therapy.
152 (c) Home health aide services.
153 (d) Dietetics and nutrition practice and nutrition
154 counseling.
155 (e) Medical supplies, restricted to drugs and biologicals
156 prescribed by a physician.
157 (17) “Home infusion therapy provider” means a person who an
158 organization that employs, contracts with, or refers a licensed
159 professional who has received advanced training and experience
160 in intravenous infusion therapy and who administers infusion
161 therapy to a patient in the patient’s home or place of
162 residence.
163 (21) “Nurse registry” means any person who that procures,
164 offers, promises, or attempts to secure health-care-related
165 contracts for registered nurses, licensed practical nurses,
166 certified nursing assistants, home health aides, companions, or
167 homemakers, who are compensated by fees as independent
168 contractors, including, but not limited to, contracts for the
169 provision of services to patients and contracts to provide
170 private duty or staffing services to health care facilities
171 licensed under chapter 395, this chapter, or chapter 429 or
172 other business entities.
173 (22) “Organization” means a corporation, government or
174 governmental subdivision or agency, partnership or association,
175 or any other legal or commercial entity, any of which involve
176 more than one health care professional discipline; a health care
177 professional and a home health aide or certified nursing
178 assistant; more than one home health aide; more than one
179 certified nursing assistant; or a home health aide and a
180 certified nursing assistant. The term does not include an entity
181 that provides services using only volunteers or only individuals
182 related by blood or marriage to the patient or client.
183 Section 9. Subsection (1), paragraph (a) of subsection (4),
184 and subsection (5) of section 400.464, Florida Statutes, are
185 amended to read:
186 400.464 Home health agencies to be licensed; expiration of
187 license; exemptions; unlawful acts; penalties.—
188 (1) The requirements of part II of chapter 408 apply to the
189 provision of services that require licensure pursuant to this
190 part and part II of chapter 408 and entities licensed or
191 registered by or applying for such licensure or registration
192 from the Agency for Health Care Administration pursuant to this
193 part. A license issued by the agency is required in order to
194 operate a home health agency in this state. A license issued on
195 or after July 1, 2018, must specify the home health services the
196 licensee organization is authorized to perform and indicate
197 whether such specified services are considered skilled care. The
198 provision or advertising of services that require licensure
199 pursuant to this part without such services being specified on
200 the face of the license issued on or after July 1, 2018,
201 constitutes unlicensed activity as prohibited under s. 408.812.
202 (4)(a) A licensee An organization that offers or advertises
203 to the public any service for which licensure or registration is
204 required under this part must include in the advertisement the
205 license number or registration number issued to the licensee
206 organization by the agency. The agency shall assess a fine of
207 not less than $100 to any licensee or registrant who fails to
208 include the license or registration number when submitting the
209 advertisement for publication, broadcast, or printing. The fine
210 for a second or subsequent offense is $500. The holder of a
211 license issued under this part may not advertise or indicate to
212 the public that it holds a home health agency or nurse registry
213 license other than the one it has been issued.
214 (5) The following are exempt from the licensure as a home
215 health agency under requirements of this part:
216 (a) A home health agency operated by the Federal
217 Government.
218 (b) Home health services provided by a state agency, either
219 directly or through a contractor with:
220 1. The Department of Elderly Affairs.
221 2. The Department of Health, a community health center, or
222 a rural health network that furnishes home visits for the
223 purpose of providing environmental assessments, case management,
224 health education, personal care services, family planning, or
225 followup treatment, or for the purpose of monitoring and
226 tracking disease.
227 3. Services provided to persons with developmental
228 disabilities, as defined in s. 393.063.
229 4. Companion and sitter organizations that were registered
230 under s. 400.509(1) on January 1, 1999, and were authorized to
231 provide personal services under a developmental services
232 provider certificate on January 1, 1999, may continue to provide
233 such services to past, present, and future clients of the
234 organization who need such services, notwithstanding the
235 provisions of this act.
236 5. The Department of Children and Families.
237 (c) A health care professional, whether or not
238 incorporated, who is licensed under chapter 457; chapter 458;
239 chapter 459; part I of chapter 464; chapter 467; part I, part
240 III, part V, or part X of chapter 468; chapter 480; chapter 486;
241 chapter 490; or chapter 491; and who is acting alone within the
242 scope of his or her professional license to provide care to
243 patients in their homes.
244 (d) A home health aide or certified nursing assistant who
245 is acting in his or her individual capacity, within the
246 definitions and standards of his or her occupation, and who
247 provides hands-on care to patients in their homes.
248 (e) An individual who acts alone, in his or her individual
249 capacity, and who is not employed by or affiliated with a
250 licensed home health agency or registered with a licensed nurse
251 registry. This exemption does not entitle an individual to
252 perform home health services without the required professional
253 license.
254 (f) The delivery of instructional services in home dialysis
255 and home dialysis supplies and equipment.
256 (g) The delivery of nursing home services for which the
257 nursing home is licensed under part II of this chapter, to serve
258 its residents in its facility.
259 (h) The delivery of assisted living facility services for
260 which the assisted living facility is licensed under part I of
261 chapter 429, to serve its residents in its facility.
262 (i) The delivery of hospice services for which the hospice
263 is licensed under part IV of this chapter, to serve hospice
264 patients admitted to its service.
265 (j) A hospital that provides services for which it is
266 licensed under chapter 395.
267 (k) The delivery of community residential services for
268 which the community residential home is licensed under chapter
269 419, to serve the residents in its facility.
270 (l) A not-for-profit, community-based agency that provides
271 early intervention services to infants and toddlers.
272 (m) Certified rehabilitation agencies and comprehensive
273 outpatient rehabilitation facilities that are certified under
274 Title 18 of the Social Security Act.
275 (n) The delivery of adult family-care home services for
276 which the adult family-care home is licensed under part II of
277 chapter 429, to serve the residents in its facility.
278 (o) A person who provides skilled care by health care
279 professionals licensed solely under part I of chapter 464; part
280 I, part III, or part V of chapter 468; or chapter 486. This
281 exemption does not authorize an individual to perform home
282 health services without the required professional license.
283 (p) A person or entity that provides services using only
284 volunteers or only individuals related by blood or marriage to
285 the patient or client.
286 Section 10. Paragraph (g) of subsection (2) of section
287 400.471, Florida Statutes, is amended to read:
288 400.471 Application for license; fee.—
289 (2) In addition to the requirements of part II of chapter
290 408, the initial applicant, the applicant for a change of
291 ownership, and the applicant for the addition of skilled care
292 services must file with the application satisfactory proof that
293 the home health agency is in compliance with this part and
294 applicable rules, including:
295 (g) In the case of an application for initial licensure, an
296 application for a change of ownership, or an application for the
297 addition of skilled care services, documentation of
298 accreditation, or an application for accreditation, from an
299 accrediting organization that is recognized by the agency as
300 having standards comparable to those required by this part and
301 part II of chapter 408. A home health agency that does not
302 provide skilled care is exempt from this paragraph.
303 Notwithstanding s. 408.806, the an initial applicant must
304 provide proof of accreditation that is not conditional or
305 provisional and a survey demonstrating compliance with the
306 requirements of this part, part II of chapter 408, and
307 applicable rules from an accrediting organization that is
308 recognized by the agency as having standards comparable to those
309 required by this part and part II of chapter 408 within 120 days
310 after the date of the agency’s receipt of the application for
311 licensure. Such accreditation must be continuously maintained by
312 the home health agency to maintain licensure. The agency shall
313 accept, in lieu of its own periodic licensure survey, the
314 submission of the survey of an accrediting organization that is
315 recognized by the agency if the accreditation of the licensed
316 home health agency is not provisional and if the licensed home
317 health agency authorizes release of, and the agency receives the
318 report of, the accrediting organization.
319 Section 11. Section 400.492, Florida Statutes, is amended
320 to read:
321 400.492 Provision of services during an emergency.—Each
322 home health agency shall prepare and maintain a comprehensive
323 emergency management plan that is consistent with the standards
324 adopted by national or state accreditation organizations and
325 consistent with the local special needs plan. The plan shall be
326 updated annually and shall provide for continuing home health
327 services during an emergency that interrupts patient care or
328 services in the patient’s home. The plan shall include the means
329 by which the home health agency will continue to provide staff
330 to perform the same type and quantity of services to their
331 patients who evacuate to special needs shelters that were being
332 provided to those patients prior to evacuation. The plan shall
333 describe how the home health agency establishes and maintains an
334 effective response to emergencies and disasters, including:
335 notifying staff when emergency response measures are initiated;
336 providing for communication between staff members, county health
337 departments, and local emergency management agencies, including
338 a backup system; identifying resources necessary to continue
339 essential care or services or referrals to other health care
340 providers organizations subject to written agreement; and
341 prioritizing and contacting patients who need continued care or
342 services.
343 (1) Each patient record for patients who are listed in the
344 registry established pursuant to s. 252.355 shall include a
345 description of how care or services will be continued in the
346 event of an emergency or disaster. The home health agency shall
347 discuss the emergency provisions with the patient and the
348 patient’s caregivers, including where and how the patient is to
349 evacuate, procedures for notifying the home health agency in the
350 event that the patient evacuates to a location other than the
351 shelter identified in the patient record, and a list of
352 medications and equipment which must either accompany the
353 patient or will be needed by the patient in the event of an
354 evacuation.
355 (2) Each home health agency shall maintain a current
356 prioritized list of patients who need continued services during
357 an emergency. The list shall indicate how services shall be
358 continued in the event of an emergency or disaster for each
359 patient and if the patient is to be transported to a special
360 needs shelter, and shall indicate if the patient is receiving
361 skilled nursing services and the patient’s medication and
362 equipment needs. The list shall be furnished to county health
363 departments and to local emergency management agencies, upon
364 request.
365 (3) Home health agencies shall not be required to continue
366 to provide care to patients in emergency situations that are
367 beyond their control and that make it impossible to provide
368 services, such as when roads are impassable or when patients do
369 not go to the location specified in their patient records. Home
370 health agencies may establish links to local emergency
371 operations centers to determine a mechanism by which to approach
372 specific areas within a disaster area in order for the agency to
373 reach its clients. Home health agencies shall demonstrate a good
374 faith effort to comply with the requirements of this subsection
375 by documenting attempts of staff to follow procedures outlined
376 in the home health agency’s comprehensive emergency management
377 plan, and by the patient’s record, which support a finding that
378 the provision of continuing care has been attempted for those
379 patients who have been identified as needing care by the home
380 health agency and registered under s. 252.355, in the event of
381 an emergency or disaster under subsection (1).
382 (4) Notwithstanding the provisions of s. 400.464(2) or any
383 other provision of law to the contrary, a home health agency may
384 provide services in a special needs shelter located in any
385 county.
386 Section 12. Subsection (4) and paragraph (a) of subsection
387 (5) of section 400.506, Florida Statutes, are amended to read:
388 400.506 Licensure of nurse registries; requirements;
389 penalties.—
390 (4) A licensee who person that provides, offers, or
391 advertises to the public any service for which licensure is
392 required under this section must include in such advertisement
393 the license number issued to the licensee it by the Agency for
394 Health Care Administration. The agency shall assess a fine of
395 not less than $100 against any licensee who fails to include the
396 license number when submitting the advertisement for
397 publication, broadcast, or printing. The fine for a second or
398 subsequent offense is $500.
399 (5)(a) In addition to the requirements of s. 408.812, any
400 person or entity that who owns, operates, or maintains an
401 unlicensed nurse registry and who, after receiving notification
402 from the agency, fails to cease operation and apply for a
403 license under this part commits a misdemeanor of the second
404 degree, punishable as provided in s. 775.082 or s. 775.083. Each
405 day of continued operation is a separate offense.
406 Section 13. Subsections (1), (2), (4), and (5) of section
407 400.509, Florida Statutes, are amended to read:
408 400.509 Registration of particular service providers exempt
409 from licensure; certificate of registration; regulation of
410 registrants.—
411 (1) Any person who organization that provides companion
412 services or homemaker services and does not provide a home
413 health service to a person is exempt from licensure under this
414 part. However, any person who organization that provides
415 companion services or homemaker services must register with the
416 agency. A person An organization under contract with the Agency
417 for Persons with Disabilities who which provides companion
418 services only for persons with a developmental disability, as
419 defined in s. 393.063, is exempt from registration.
420 (2) The requirements of part II of chapter 408 apply to the
421 provision of services that require registration or licensure
422 pursuant to this section and part II of chapter 408 and entities
423 registered by or applying for such registration from the Agency
424 for Health Care Administration pursuant to this section. Each
425 applicant for registration and each registrant must comply with
426 all provisions of part II of chapter 408. Registration or a
427 license issued by the agency is required for a person to provide
428 the operation of an organization that provides companion
429 services or homemaker services.
430 (4) Each registrant must obtain the employment or contract
431 history of persons who are employed by or under contract with
432 the person organization and who will have contact at any time
433 with patients or clients in their homes by:
434 (a) Requiring such persons to submit an employment or
435 contractual history to the registrant; and
436 (b) Verifying the employment or contractual history, unless
437 through diligent efforts such verification is not possible. The
438 agency shall prescribe by rule the minimum requirements for
439 establishing that diligent efforts have been made.
440
441 There is no monetary liability on the part of, and no cause of
442 action for damages arises against, a former employer of a
443 prospective employee of or prospective independent contractor
444 with a registrant who reasonably and in good faith communicates
445 his or her honest opinions about the former employee’s or
446 contractor’s job performance. This subsection does not affect
447 the official immunity of an officer or employee of a public
448 corporation.
449 (5) A person who that offers or advertises to the public a
450 service for which registration is required must include in its
451 advertisement the registration number issued by the Agency for
452 Health Care Administration.
453 Section 14. Subsection (3) of section 400.605, Florida
454 Statutes, is amended to read:
455 400.605 Administration; forms; fees; rules; inspections;
456 fines.—
457 (3) In accordance with s. 408.811, the agency shall conduct
458 annual inspections of all licensees, except that licensure
459 inspections may be conducted biennially for hospices having a 3
460 year record of substantial compliance. The agency shall conduct
461 such inspections and investigations as are necessary in order to
462 determine the state of compliance with the provisions of this
463 part, part II of chapter 408, and applicable rules.
464 Section 15. Section 400.60501, Florida Statutes, is amended
465 to read:
466 400.60501 Outcome measures; adoption of federal quality
467 measures; public reporting; annual report.—
468 (1) No later than December 31, 2019, The agency shall adopt
469 the national hospice outcome measures and survey data in 42
470 C.F.R. part 418 to determine the quality and effectiveness of
471 hospice care for hospices licensed in the state.
472 (2) The agency shall:
473 (a) make available to the public the national hospice
474 outcome measures and survey data in a format that is
475 comprehensible by a layperson and that allows a consumer to
476 compare such measures of one or more hospices.
477 (b) Develop an annual report that analyzes and evaluates
478 the information collected under this act and any other data
479 collection or reporting provisions of law.
480 Section 16. Subsection (4) of section 400.9905, Florida
481 Statutes, is amended to read:
482 400.9905 Definitions.—
483 (4) “Clinic” means an entity where health care services are
484 provided to individuals and which tenders charges for
485 reimbursement for such services, including a mobile clinic and a
486 portable equipment provider. As used in this part, the term does
487 not include and the licensure requirements of this part do not
488 apply to:
489 (a) Entities licensed or registered by the state under
490 chapter 395; entities licensed or registered by the state and
491 providing only health care services within the scope of services
492 authorized under their respective licenses under ss. 383.30
493 383.332, chapter 390, chapter 394, chapter 397, this chapter
494 except part X, chapter 429, chapter 463, chapter 465, chapter
495 466, chapter 478, chapter 484, or chapter 651; end-stage renal
496 disease providers authorized under 42 C.F.R. part 405, subpart
497 U; providers certified and providing only health care services
498 within the scope of services authorized under their respective
499 certifications under 42 C.F.R. part 485, subpart B, or subpart
500 H, or subpart J; providers certified and providing only health
501 care services within the scope of services authorized under
502 their respective certifications under 42 C.F.R. part 486,
503 subpart C; providers certified and providing only health care
504 services within the scope of services authorized under their
505 respective certifications under 42 C.F.R. part 491, subpart A;
506 providers certified by the Centers for Medicare and Medicaid
507 services under the federal Clinical Laboratory Improvement
508 Amendments and the federal rules adopted thereunder; or any
509 entity that provides neonatal or pediatric hospital-based health
510 care services or other health care services by licensed
511 practitioners solely within a hospital licensed under chapter
512 395.
513 (b) Entities that own, directly or indirectly, entities
514 licensed or registered by the state pursuant to chapter 395;
515 entities that own, directly or indirectly, entities licensed or
516 registered by the state and providing only health care services
517 within the scope of services authorized pursuant to their
518 respective licenses under ss. 383.30-383.332, chapter 390,
519 chapter 394, chapter 397, this chapter except part X, chapter
520 429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
521 484, or chapter 651; end-stage renal disease providers
522 authorized under 42 C.F.R. part 405, subpart U; providers
523 certified and providing only health care services within the
524 scope of services authorized under their respective
525 certifications under 42 C.F.R. part 485, subpart B, or subpart
526 H, or subpart J; providers certified and providing only health
527 care services within the scope of services authorized under
528 their respective certifications under 42 C.F.R. part 486,
529 subpart C; providers certified and providing only health care
530 services within the scope of services authorized under their
531 respective certifications under 42 C.F.R. part 491, subpart A;
532 providers certified by the Centers for Medicare and Medicaid
533 services under the federal Clinical Laboratory Improvement
534 Amendments and the federal rules adopted thereunder; or any
535 entity that provides neonatal or pediatric hospital-based health
536 care services by licensed practitioners solely within a hospital
537 licensed under chapter 395.
538 (c) Entities that are owned, directly or indirectly, by an
539 entity licensed or registered by the state pursuant to chapter
540 395; entities that are owned, directly or indirectly, by an
541 entity licensed or registered by the state and providing only
542 health care services within the scope of services authorized
543 pursuant to their respective licenses under ss. 383.30-383.332,
544 chapter 390, chapter 394, chapter 397, this chapter except part
545 X, chapter 429, chapter 463, chapter 465, chapter 466, chapter
546 478, chapter 484, or chapter 651; end-stage renal disease
547 providers authorized under 42 C.F.R. part 405, subpart U;
548 providers certified and providing only health care services
549 within the scope of services authorized under their respective
550 certifications under 42 C.F.R. part 485, subpart B, or subpart
551 H, or subpart J; providers certified and providing only health
552 care services within the scope of services authorized under
553 their respective certifications under 42 C.F.R. part 486,
554 subpart C; providers certified and providing only health care
555 services within the scope of services authorized under their
556 respective certifications under 42 C.F.R. part 491, subpart A;
557 providers certified by the Centers for Medicare and Medicaid
558 services under the federal Clinical Laboratory Improvement
559 Amendments and the federal rules adopted thereunder; or any
560 entity that provides neonatal or pediatric hospital-based health
561 care services by licensed practitioners solely within a hospital
562 under chapter 395.
563 (d) Entities that are under common ownership, directly or
564 indirectly, with an entity licensed or registered by the state
565 pursuant to chapter 395; entities that are under common
566 ownership, directly or indirectly, with an entity licensed or
567 registered by the state and providing only health care services
568 within the scope of services authorized pursuant to their
569 respective licenses under ss. 383.30-383.332, chapter 390,
570 chapter 394, chapter 397, this chapter except part X, chapter
571 429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
572 484, or chapter 651; end-stage renal disease providers
573 authorized under 42 C.F.R. part 405, subpart U; providers
574 certified and providing only health care services within the
575 scope of services authorized under their respective
576 certifications under 42 C.F.R. part 485, subpart B, or subpart
577 H, or subpart J; providers certified and providing only health
578 care services within the scope of services authorized under
579 their respective certifications under 42 C.F.R. part 486,
580 subpart C; providers certified and providing only health care
581 services within the scope of services authorized under their
582 respective certifications under 42 C.F.R. part 491, subpart A;
583 providers certified by the Centers for Medicare and Medicaid
584 services under the federal Clinical Laboratory Improvement
585 Amendments and the federal rules adopted thereunder; or any
586 entity that provides neonatal or pediatric hospital-based health
587 care services by licensed practitioners solely within a hospital
588 licensed under chapter 395.
589 (e) An entity that is exempt from federal taxation under 26
590 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
591 under 26 U.S.C. s. 409 that has a board of trustees at least
592 two-thirds of which are Florida-licensed health care
593 practitioners and provides only physical therapy services under
594 physician orders, any community college or university clinic,
595 and any entity owned or operated by the federal or state
596 government, including agencies, subdivisions, or municipalities
597 thereof.
598 (f) A sole proprietorship, group practice, partnership, or
599 corporation that provides health care services by physicians
600 covered by s. 627.419, that is directly supervised by one or
601 more of such physicians, and that is wholly owned by one or more
602 of those physicians or by a physician and the spouse, parent,
603 child, or sibling of that physician.
604 (g) A sole proprietorship, group practice, partnership, or
605 corporation that provides health care services by licensed
606 health care practitioners under chapter 457, chapter 458,
607 chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
608 chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
609 chapter 490, chapter 491, or part I, part III, part X, part
610 XIII, or part XIV of chapter 468, or s. 464.012, and that is
611 wholly owned by one or more licensed health care practitioners,
612 or the licensed health care practitioners set forth in this
613 paragraph and the spouse, parent, child, or sibling of a
614 licensed health care practitioner if one of the owners who is a
615 licensed health care practitioner is supervising the business
616 activities and is legally responsible for the entity’s
617 compliance with all federal and state laws. However, a health
618 care practitioner may not supervise services beyond the scope of
619 the practitioner’s license, except that, for the purposes of
620 this part, a clinic owned by a licensee in s. 456.053(3)(b)
621 which provides only services authorized pursuant to s.
622 456.053(3)(b) may be supervised by a licensee specified in s.
623 456.053(3)(b).
624 (h) Clinical facilities affiliated with an accredited
625 medical school at which training is provided for medical
626 students, residents, or fellows.
627 (i) Entities that provide only oncology or radiation
628 therapy services by physicians licensed under chapter 458 or
629 chapter 459 or entities that provide oncology or radiation
630 therapy services by physicians licensed under chapter 458 or
631 chapter 459 which are owned by a corporation whose shares are
632 publicly traded on a recognized stock exchange.
633 (j) Clinical facilities affiliated with a college of
634 chiropractic accredited by the Council on Chiropractic Education
635 at which training is provided for chiropractic students.
636 (k) Entities that provide licensed practitioners to staff
637 emergency departments or to deliver anesthesia services in
638 facilities licensed under chapter 395 and that derive at least
639 90 percent of their gross annual revenues from the provision of
640 such services. Entities claiming an exemption from licensure
641 under this paragraph must provide documentation demonstrating
642 compliance.
643 (l) Orthotic, prosthetic, pediatric cardiology, or
644 perinatology clinical facilities or anesthesia clinical
645 facilities that are not otherwise exempt under paragraph (a) or
646 paragraph (k) and that are a publicly traded corporation or are
647 wholly owned, directly or indirectly, by a publicly traded
648 corporation. As used in this paragraph, a publicly traded
649 corporation is a corporation that issues securities traded on an
650 exchange registered with the United States Securities and
651 Exchange Commission as a national securities exchange.
652 (m) Entities that are owned by a corporation that has $250
653 million or more in total annual sales of health care services
654 provided by licensed health care practitioners where one or more
655 of the persons responsible for the operations of the entity is a
656 health care practitioner who is licensed in this state and who
657 is responsible for supervising the business activities of the
658 entity and is responsible for the entity’s compliance with state
659 law for purposes of this part.
660 (n) Entities that employ 50 or more licensed health care
661 practitioners licensed under chapter 458 or chapter 459 where
662 the billing for medical services is under a single tax
663 identification number. The application for exemption under this
664 subsection shall contain information that includes: the name,
665 residence, and business address and phone number of the entity
666 that owns the practice; a complete list of the names and contact
667 information of all the officers and directors of the
668 corporation; the name, residence address, business address, and
669 medical license number of each licensed Florida health care
670 practitioner employed by the entity; the corporate tax
671 identification number of the entity seeking an exemption; a
672 listing of health care services to be provided by the entity at
673 the health care clinics owned or operated by the entity and a
674 certified statement prepared by an independent certified public
675 accountant which states that the entity and the health care
676 clinics owned or operated by the entity have not received
677 payment for health care services under personal injury
678 protection insurance coverage for the preceding year. If the
679 agency determines that an entity which is exempt under this
680 subsection has received payments for medical services under
681 personal injury protection insurance coverage, the agency may
682 deny or revoke the exemption from licensure under this
683 subsection.
684 (o) Entities that are, directly or indirectly, under the
685 common ownership of or that are subject to common control by a
686 mutual insurance holding company, as defined in s. 628.703, with
687 an entity licensed or certified under chapter 627 or chapter 641
688 which has $1 billion or more in total annual sales in this
689 state.
690 (p) Entities that are owned by an entity that is a
691 behavioral health service provider in at least 5 states other
692 than Florida and that, together with its affiliates, has $90
693 million or more in total annual revenues associated with the
694 provision of behavioral health services and where one or more of
695 the persons responsible for the operations of the entity is a
696 health care practitioner who is licensed in this state and who
697 is responsible for supervising the business activities of the
698 entity and for the entity’s compliance with state law for
699 purposes of this part.
700 (q) Medicaid providers.
701
702 Notwithstanding this subsection, an entity shall be deemed a
703 clinic and must be licensed under this part in order to receive
704 reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
705 627.730-627.7405, unless exempted under s. 627.736(5)(h).
706 Section 17. Paragraph (c) of subsection (3) of section
707 400.991, Florida Statutes, is amended to read:
708 400.991 License requirements; background screenings;
709 prohibitions.—
710 (3) In addition to the requirements of part II of chapter
711 408, the applicant must file with the application satisfactory
712 proof that the clinic is in compliance with this part and
713 applicable rules, including:
714 (c) Proof of financial ability to operate as required under
715 ss. 408.8065(1) and 408.810(8) s. 408.810(8). As an alternative
716 to submitting proof of financial ability to operate as required
717 under s. 408.810(8), the applicant may file a surety bond of at
718 least $500,000 which guarantees that the clinic will act in full
719 conformity with all legal requirements for operating a clinic,
720 payable to the agency. The agency may adopt rules to specify
721 related requirements for such surety bond.
722 Section 18. Paragraph (i) of subsection (1) of section
723 400.9935, Florida Statutes, is amended to read:
724 400.9935 Clinic responsibilities.—
725 (1) Each clinic shall appoint a medical director or clinic
726 director who shall agree in writing to accept legal
727 responsibility for the following activities on behalf of the
728 clinic. The medical director or the clinic director shall:
729 (i) Ensure that the clinic publishes a schedule of charges
730 for the medical services offered to patients. The schedule must
731 include the prices charged to an uninsured person paying for
732 such services by cash, check, credit card, or debit card. The
733 schedule may group services by price levels, listing services in
734 each price level. The schedule must be posted in a conspicuous
735 place in the reception area of any clinic that is an the urgent
736 care center as defined in s. 395.002(29)(b) and must include,
737 but is not limited to, the 50 services most frequently provided
738 by the clinic. The schedule may group services by three price
739 levels, listing services in each price level. The posting may be
740 a sign that must be at least 15 square feet in size or through
741 an electronic messaging board that is at least 3 square feet in
742 size. The failure of a clinic, including a clinic that is an
743 urgent care center, to publish and post a schedule of charges as
744 required by this section shall result in a fine of not more than
745 $1,000, per day, until the schedule is published and posted.
746 Section 19. Paragraph (a) of subsection (2) of section
747 408.033, Florida Statutes, is amended to read:
748 408.033 Local and state health planning.—
749 (2) FUNDING.—
750 (a) The Legislature intends that the cost of local health
751 councils be borne by assessments on selected health care
752 facilities subject to facility licensure by the Agency for
753 Health Care Administration, including abortion clinics, assisted
754 living facilities, ambulatory surgical centers, birth centers,
755 home health agencies, hospices, hospitals, intermediate care
756 facilities for the developmentally disabled, nursing homes, and
757 health care clinics, and multiphasic testing centers and by
758 assessments on organizations subject to certification by the
759 agency pursuant to chapter 641, part III, including health
760 maintenance organizations and prepaid health clinics. Fees
761 assessed may be collected prospectively at the time of licensure
762 renewal and prorated for the licensure period.
763 Section 20. Effective January 1, 2021, paragraph (l) is
764 added to subsection (3) of section 408.05, Florida Statutes, to
765 read:
766 408.05 Florida Center for Health Information and
767 Transparency.—
768 (3) HEALTH INFORMATION TRANSPARENCY.—In order to
769 disseminate and facilitate the availability of comparable and
770 uniform health information, the agency shall perform the
771 following functions:
772 (l) By July 1 of each year, publish a report identifying
773 the health care services with the most significant price
774 variation both statewide and regionally.
775 Section 21. Paragraph (a) of subsection (1) of section
776 408.061, Florida Statutes, is amended to read:
777 408.061 Data collection; uniform systems of financial
778 reporting; information relating to physician charges;
779 confidential information; immunity.—
780 (1) The agency shall require the submission by health care
781 facilities, health care providers, and health insurers of data
782 necessary to carry out the agency’s duties and to facilitate
783 transparency in health care pricing data and quality measures.
784 Specifications for data to be collected under this section shall
785 be developed by the agency and applicable contract vendors, with
786 the assistance of technical advisory panels including
787 representatives of affected entities, consumers, purchasers, and
788 such other interested parties as may be determined by the
789 agency.
790 (a) Data submitted by health care facilities, including the
791 facilities as defined in chapter 395, shall include, but are not
792 limited to,: case-mix data, patient admission and discharge
793 data, hospital emergency department data which shall include the
794 number of patients treated in the emergency department of a
795 licensed hospital reported by patient acuity level, data on
796 hospital-acquired infections as specified by rule, data on
797 complications as specified by rule, data on readmissions as
798 specified by rule, including patient- with patient and provider
799 specific identifiers included, actual charge data by diagnostic
800 groups or other bundled groupings as specified by rule,
801 financial data, accounting data, operating expenses, expenses
802 incurred for rendering services to patients who cannot or do not
803 pay, interest charges, depreciation expenses based on the
804 expected useful life of the property and equipment involved, and
805 demographic data. The agency shall adopt nationally recognized
806 risk adjustment methodologies or software consistent with the
807 standards of the Agency for Healthcare Research and Quality and
808 as selected by the agency for all data submitted as required by
809 this section. Data may be obtained from documents including such
810 as, but not limited to,: leases, contracts, debt instruments,
811 itemized patient statements or bills, medical record abstracts,
812 and related diagnostic information. Reported Data elements shall
813 be reported electronically in accordance with the inpatient data
814 reporting instructions as prescribed by agency rule 59E-7.012,
815 Florida Administrative Code. Data submitted shall be certified
816 by the chief executive officer or an appropriate and duly
817 authorized representative or employee of the licensed facility
818 that the information submitted is true and accurate.
819 Section 22. Subsection (4) of section 408.0611, Florida
820 Statutes, is amended to read:
821 408.0611 Electronic prescribing clearinghouse.—
822 (4) Pursuant to s. 408.061, the agency shall monitor the
823 implementation of electronic prescribing by health care
824 practitioners, health care facilities, and pharmacies. By
825 January 31 of each year, The agency shall report annually on its
826 website on the progress of implementation of electronic
827 prescribing to the Governor and the Legislature. Information
828 reported pursuant to this subsection must shall include federal
829 and private sector electronic prescribing initiatives and, to
830 the extent that data is readily available from organizations
831 that operate electronic prescribing networks, the number of
832 health care practitioners using electronic prescribing and the
833 number of prescriptions electronically transmitted.
834 Section 23. Paragraphs (i) and (j) of subsection (1) of
835 section 408.062, Florida Statutes, are amended to read:
836 408.062 Research, analyses, studies, and reports.—
837 (1) The agency shall conduct research, analyses, and
838 studies relating to health care costs and access to and quality
839 of health care services as access and quality are affected by
840 changes in health care costs. Such research, analyses, and
841 studies shall include, but not be limited to:
842 (i) The use of emergency department services by patient
843 acuity level and the implication of increasing hospital cost by
844 providing nonurgent care in emergency departments. The agency
845 shall annually publish on its website information submit an
846 annual report based on this monitoring and assessment to the
847 Governor, the Speaker of the House of Representatives, the
848 President of the Senate, and the substantive legislative
849 committees, due January 1.
850 (j) The making available on its Internet website, and in a
851 hard-copy format upon request, of patient charge, volumes,
852 length of stay, and performance indicators collected from health
853 care facilities pursuant to s. 408.061(1)(a) for specific
854 medical conditions, surgeries, and procedures provided in
855 inpatient and outpatient facilities as determined by the agency.
856 In making the determination of specific medical conditions,
857 surgeries, and procedures to include, the agency shall consider
858 such factors as volume, severity of the illness, urgency of
859 admission, individual and societal costs, and whether the
860 condition is acute or chronic. Performance outcome indicators
861 shall be risk adjusted or severity adjusted, as applicable,
862 using nationally recognized risk adjustment methodologies or
863 software consistent with the standards of the Agency for
864 Healthcare Research and Quality and as selected by the agency.
865 The website shall also provide an interactive search that allows
866 consumers to view and compare the information for specific
867 facilities, a map that allows consumers to select a county or
868 region, definitions of all of the data, descriptions of each
869 procedure, and an explanation about why the data may differ from
870 facility to facility. Such public data shall be updated
871 quarterly. The agency shall annually publish on its website
872 information submit an annual status report on the collection of
873 data and publication of health care quality measures to the
874 Governor, the Speaker of the House of Representatives, the
875 President of the Senate, and the substantive legislative
876 committees, due January 1.
877 Section 24. Subsection (5) of section 408.063, Florida
878 Statutes, is amended to read:
879 408.063 Dissemination of health care information.—
880 (5) The agency shall publish annually a comprehensive
881 report of state health expenditures. The report shall identify:
882 (a) The contribution of health care dollars made by all
883 payors.
884 (b) The dollars expended by type of health care service in
885 Florida.
886 Section 25. Section 408.802, Florida Statutes, is amended
887 to read:
888 408.802 Applicability.—The provisions of This part applies
889 apply to the provision of services that require licensure as
890 defined in this part and to the following entities licensed,
891 registered, or certified by the agency, as described in chapters
892 112, 383, 390, 394, 395, 400, 429, 440, 483, and 765:
893 (1) Laboratories authorized to perform testing under the
894 Drug-Free Workplace Act, as provided under ss. 112.0455 and
895 440.102.
896 (2) Birth centers, as provided under chapter 383.
897 (3) Abortion clinics, as provided under chapter 390.
898 (4) Crisis stabilization units, as provided under parts I
899 and IV of chapter 394.
900 (5) Short-term residential treatment facilities, as
901 provided under parts I and IV of chapter 394.
902 (6) Residential treatment facilities, as provided under
903 part IV of chapter 394.
904 (7) Residential treatment centers for children and
905 adolescents, as provided under part IV of chapter 394.
906 (8) Hospitals, as provided under part I of chapter 395.
907 (9) Ambulatory surgical centers, as provided under part I
908 of chapter 395.
909 (10) Nursing homes, as provided under part II of chapter
910 400.
911 (11) Assisted living facilities, as provided under part I
912 of chapter 429.
913 (12) Home health agencies, as provided under part III of
914 chapter 400.
915 (13) Nurse registries, as provided under part III of
916 chapter 400.
917 (14) Companion services or homemaker services providers, as
918 provided under part III of chapter 400.
919 (15) Adult day care centers, as provided under part III of
920 chapter 429.
921 (16) Hospices, as provided under part IV of chapter 400.
922 (17) Adult family-care homes, as provided under part II of
923 chapter 429.
924 (18) Homes for special services, as provided under part V
925 of chapter 400.
926 (19) Transitional living facilities, as provided under part
927 XI of chapter 400.
928 (20) Prescribed pediatric extended care centers, as
929 provided under part VI of chapter 400.
930 (21) Home medical equipment providers, as provided under
931 part VII of chapter 400.
932 (22) Intermediate care facilities for persons with
933 developmental disabilities, as provided under part VIII of
934 chapter 400.
935 (23) Health care services pools, as provided under part IX
936 of chapter 400.
937 (24) Health care clinics, as provided under part X of
938 chapter 400.
939 (25) Multiphasic health testing centers, as provided under
940 part I of chapter 483.
941 (25)(26) Organ, tissue, and eye procurement organizations,
942 as provided under part V of chapter 765.
943 Section 26. Present subsections (10) through (14) of
944 section 408.803, Florida Statutes, are redesignated as
945 subsections (11) through (15), respectively, a new subsection
946 (10) is added to that section, and subsection (3) of that
947 section is amended, to read:
948 408.803 Definitions.—As used in this part, the term:
949 (3) “Authorizing statute” means the statute authorizing the
950 licensed operation of a provider listed in s. 408.802 and
951 includes chapters 112, 383, 390, 394, 395, 400, 429, 440, 483,
952 and 765.
953 (10) “Low-risk provider” means nurse registries, home
954 medical equipment providers, and health care clinics.
955 Section 27. Paragraph (b) of subsection (7) of section
956 408.806, Florida Statutes, is amended to read:
957 408.806 License application process.—
958 (7)
959 (b) An initial inspection is not required for companion
960 services or homemaker services providers, as provided under part
961 III of chapter 400, or for health care services pools, as
962 provided under part IX of chapter 400, or for low-risk providers
963 as provided under s. 408.811.
964 Section 28. Subsection (2) of section 408.808, Florida
965 Statutes, is amended to read:
966 408.808 License categories.—
967 (2) PROVISIONAL LICENSE.—An applicant against whom a
968 proceeding denying or revoking a license is pending at the time
969 of license renewal may be issued a provisional license effective
970 until final action not subject to further appeal. A provisional
971 license may also be issued to an applicant for initial licensure
972 or an applicant applying for a change of ownership. A
973 provisional license must be limited in duration to a specific
974 period of time, up to 12 months, as determined by the agency.
975 Section 29. Subsections (2) and (5) of section 408.809,
976 Florida Statutes, are amended to read:
977 408.809 Background screening; prohibited offenses.—
978 (2) Every 5 years following his or her licensure,
979 employment, or entry into a contract in a capacity that under
980 subsection (1) would require level 2 background screening under
981 chapter 435, each such person must submit to level 2 background
982 rescreening as a condition of retaining such license or
983 continuing in such employment or contractual status. For any
984 such rescreening, the agency shall request the Department of Law
985 Enforcement to forward the person’s fingerprints to the Federal
986 Bureau of Investigation for a national criminal history record
987 check unless the person’s fingerprints are enrolled in the
988 Federal Bureau of Investigation’s national retained print arrest
989 notification program. If the fingerprints of such a person are
990 not retained by the Department of Law Enforcement under s.
991 943.05(2)(g) and (h), the person must submit fingerprints
992 electronically to the Department of Law Enforcement for state
993 processing, and the Department of Law Enforcement shall forward
994 the fingerprints to the Federal Bureau of Investigation for a
995 national criminal history record check. The fingerprints shall
996 be retained by the Department of Law Enforcement under s.
997 943.05(2)(g) and (h) and enrolled in the national retained print
998 arrest notification program when the Department of Law
999 Enforcement begins participation in the program. The cost of the
1000 state and national criminal history records checks required by
1001 level 2 screening may be borne by the licensee or the person
1002 fingerprinted. Until a specified agency is fully implemented in
1003 the clearinghouse created under s. 435.12, The agency may accept
1004 as satisfying the requirements of this section proof of
1005 compliance with level 2 screening standards submitted within the
1006 previous 5 years to meet any provider or professional licensure
1007 requirements of the agency, the Department of Health, the
1008 Department of Elderly Affairs, the Agency for Persons with
1009 Disabilities, the Department of Children and Families, or the
1010 Department of Financial Services for an applicant for a
1011 certificate of authority or provisional certificate of authority
1012 to operate a continuing care retirement community under chapter
1013 651, provided that:
1014 (a) The screening standards and disqualifying offenses for
1015 the prior screening are equivalent to those specified in s.
1016 435.04 and this section;
1017 (b) The person subject to screening has not had a break in
1018 service from a position that requires level 2 screening for more
1019 than 90 days; and
1020 (c) Such proof is accompanied, under penalty of perjury, by
1021 an attestation of compliance with chapter 435 and this section
1022 using forms provided by the agency.
1023 (5) A person who serves as a controlling interest of, is
1024 employed by, or contracts with a licensee on July 31, 2010, who
1025 has been screened and qualified according to standards specified
1026 in s. 435.03 or s. 435.04 must be rescreened by July 31, 2015,
1027 in compliance with the following schedule. If, upon rescreening,
1028 such person has a disqualifying offense that was not a
1029 disqualifying offense at the time of the last screening, but is
1030 a current disqualifying offense and was committed before the
1031 last screening, he or she may apply for an exemption from the
1032 appropriate licensing agency and, if agreed to by the employer,
1033 may continue to perform his or her duties until the licensing
1034 agency renders a decision on the application for exemption if
1035 the person is eligible to apply for an exemption and the
1036 exemption request is received by the agency within 30 days after
1037 receipt of the rescreening results by the person. The
1038 rescreening schedule shall be:
1039 (a) Individuals for whom the last screening was conducted
1040 on or before December 31, 2004, must be rescreened by July 31,
1041 2013.
1042 (b) Individuals for whom the last screening conducted was
1043 between January 1, 2005, and December 31, 2008, must be
1044 rescreened by July 31, 2014.
1045 (c) Individuals for whom the last screening conducted was
1046 between January 1, 2009, through July 31, 2011, must be
1047 rescreened by July 31, 2015.
1048 Section 30. Subsection (1) of section 408.811, Florida
1049 Statutes, is amended to read:
1050 408.811 Right of inspection; copies; inspection reports;
1051 plan for correction of deficiencies.—
1052 (1) An authorized officer or employee of the agency may
1053 make or cause to be made any inspection or investigation deemed
1054 necessary by the agency to determine the state of compliance
1055 with this part, authorizing statutes, and applicable rules. The
1056 right of inspection extends to any business that the agency has
1057 reason to believe is being operated as a provider without a
1058 license, but inspection of any business suspected of being
1059 operated without the appropriate license may not be made without
1060 the permission of the owner or person in charge unless a warrant
1061 is first obtained from a circuit court. Any application for a
1062 license issued under this part, authorizing statutes, or
1063 applicable rules constitutes permission for an appropriate
1064 inspection to verify the information submitted on or in
1065 connection with the application.
1066 (a) All inspections shall be unannounced, except as
1067 specified in s. 408.806.
1068 (b) Inspections for relicensure shall be conducted
1069 biennially unless otherwise specified by this section,
1070 authorizing statutes, or applicable rules.
1071 (c) The agency may exempt a low-risk provider from
1072 licensure inspection if the provider or controlling interest has
1073 an excellent regulatory history with regard to deficiencies,
1074 sanctions, complaints, and other regulatory actions, as defined
1075 by rule. The agency shall continue to conduct unannounced
1076 licensure inspections for at least 10 percent of exempt low-risk
1077 providers to verify compliance.
1078 (d) The agency may adopt rules to waive a routine
1079 inspection, including inspection for relicensure, or allow for
1080 an extended period between relicensure inspections for specific
1081 providers based upon all of the following:
1082 1. A favorable regulatory history with regard to
1083 deficiencies, sanctions, complaints, and other regulatory
1084 measures.
1085 2. Outcome measures that demonstrate quality performance.
1086 3. Successful participation in a recognized quality
1087 assurance program.
1088 4. Accreditation status.
1089 5. Other measures reflective of quality and safety.
1090 6. The length of time between inspections.
1091
1092 The agency shall continue to conduct unannounced licensure
1093 inspections for at least 10 percent of providers that qualify
1094 for a waiver or extended period between relicensure inspections.
1095 (e) The agency maintains the authority to conduct an
1096 inspection of any provider at any time to determine regulatory
1097 compliance.
1098 Section 31. Subsection (24) of section 408.820, Florida
1099 Statutes, is amended to read:
1100 408.820 Exemptions.—Except as prescribed in authorizing
1101 statutes, the following exemptions shall apply to specified
1102 requirements of this part:
1103 (24) Multiphasic health testing centers, as provided under
1104 part I of chapter 483, are exempt from s. 408.810(5)-(10).
1105 Section 32. Subsections (1) and (2) of section 408.821,
1106 Florida Statutes, are amended to read:
1107 408.821 Emergency management planning; emergency
1108 operations; inactive license.—
1109 (1) A licensee required by authorizing statutes and agency
1110 rule to have a comprehensive an emergency management operations
1111 plan must designate a safety liaison to serve as the primary
1112 contact for emergency operations. Such licensee shall submit its
1113 comprehensive emergency management plan to the local emergency
1114 management agency, county health department, or Department of
1115 Health as follows:
1116 (a) Submit the plan within 30 days after initial licensure
1117 and change of ownership, and notify the agency within 30 days
1118 after submission of the plan.
1119 (b) Submit the plan annually and within 30 days after any
1120 significant modification, as defined by agency rule, to a
1121 previously approved plan.
1122 (c) Respond with necessary plan revisions within 30 days
1123 after notification that plan revisions are required.
1124 (d) Notify the agency within 30 days after approval of its
1125 plan by the local emergency management agency, county health
1126 department, or Department of Health.
1127 (2) An entity subject to this part may temporarily exceed
1128 its licensed capacity to act as a receiving provider in
1129 accordance with an approved comprehensive emergency management
1130 operations plan for up to 15 days. While in an overcapacity
1131 status, each provider must furnish or arrange for appropriate
1132 care and services to all clients. In addition, the agency may
1133 approve requests for overcapacity in excess of 15 days, which
1134 approvals may be based upon satisfactory justification and need
1135 as provided by the receiving and sending providers.
1136 Section 33. Subsection (3) of section 408.831, Florida
1137 Statutes, is amended to read:
1138 408.831 Denial, suspension, or revocation of a license,
1139 registration, certificate, or application.—
1140 (3) This section provides standards of enforcement
1141 applicable to all entities licensed or regulated by the Agency
1142 for Health Care Administration. This section controls over any
1143 conflicting provisions of chapters 39, 383, 390, 391, 394, 395,
1144 400, 408, 429, 468, 483, and 765 or rules adopted pursuant to
1145 those chapters.
1146 Section 34. Section 408.832, Florida Statutes, is amended
1147 to read:
1148 408.832 Conflicts.—In case of conflict between the
1149 provisions of this part and the authorizing statutes governing
1150 the licensure of health care providers by the Agency for Health
1151 Care Administration found in s. 112.0455 and chapters 383, 390,
1152 394, 395, 400, 429, 440, 483, and 765, the provisions of this
1153 part shall prevail.
1154 Section 35. Subsection (9) of section 408.909, Florida
1155 Statutes, is amended to read:
1156 408.909 Health flex plans.—
1157 (9) PROGRAM EVALUATION.—The agency and the office shall
1158 evaluate the pilot program and its effect on the entities that
1159 seek approval as health flex plans, on the number of enrollees,
1160 and on the scope of the health care coverage offered under a
1161 health flex plan; shall provide an assessment of the health flex
1162 plans and their potential applicability in other settings; shall
1163 use health flex plans to gather more information to evaluate
1164 low-income consumer driven benefit packages; and shall, by
1165 January 15, 2016, and annually thereafter, jointly submit a
1166 report to the Governor, the President of the Senate, and the
1167 Speaker of the House of Representatives.
1168 Section 36. Paragraph (d) of subsection (10) of section
1169 408.9091, Florida Statutes, is amended to read:
1170 408.9091 Cover Florida Health Care Access Program.—
1171 (10) PROGRAM EVALUATION.—The agency and the office shall:
1172 (d) Jointly submit by March 1, annually, a report to the
1173 Governor, the President of the Senate, and the Speaker of the
1174 House of Representatives which provides the information
1175 specified in paragraphs (a)-(c) and recommendations relating to
1176 the successful implementation and administration of the program.
1177 Section 37. Effective upon becoming a law, paragraph (a) of
1178 subsection (5) of section 409.905, Florida Statutes, is amended
1179 to read:
1180 409.905 Mandatory Medicaid services.—The agency may make
1181 payments for the following services, which are required of the
1182 state by Title XIX of the Social Security Act, furnished by
1183 Medicaid providers to recipients who are determined to be
1184 eligible on the dates on which the services were provided. Any
1185 service under this section shall be provided only when medically
1186 necessary and in accordance with state and federal law.
1187 Mandatory services rendered by providers in mobile units to
1188 Medicaid recipients may be restricted by the agency. Nothing in
1189 this section shall be construed to prevent or limit the agency
1190 from adjusting fees, reimbursement rates, lengths of stay,
1191 number of visits, number of services, or any other adjustments
1192 necessary to comply with the availability of moneys and any
1193 limitations or directions provided for in the General
1194 Appropriations Act or chapter 216.
1195 (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
1196 all covered services provided for the medical care and treatment
1197 of a recipient who is admitted as an inpatient by a licensed
1198 physician or dentist to a hospital licensed under part I of
1199 chapter 395. However, the agency shall limit the payment for
1200 inpatient hospital services for a Medicaid recipient 21 years of
1201 age or older to 45 days or the number of days necessary to
1202 comply with the General Appropriations Act.
1203 (a)1. The agency may implement reimbursement and
1204 utilization management reforms in order to comply with any
1205 limitations or directions in the General Appropriations Act,
1206 which may include, but are not limited to: prior authorization
1207 for inpatient psychiatric days; prior authorization for
1208 nonemergency hospital inpatient admissions for individuals 21
1209 years of age and older; authorization of emergency and urgent
1210 care admissions within 24 hours after admission; enhanced
1211 utilization and concurrent review programs for highly utilized
1212 services; reduction or elimination of covered days of service;
1213 adjusting reimbursement ceilings for variable costs; adjusting
1214 reimbursement ceilings for fixed and property costs; and
1215 implementing target rates of increase.
1216 2. The agency may limit prior authorization for hospital
1217 inpatient services to selected diagnosis-related groups, based
1218 on an analysis of the cost and potential for unnecessary
1219 hospitalizations represented by certain diagnoses. Admissions
1220 for normal delivery and newborns are exempt from requirements
1221 for prior authorization.
1222 3. In implementing the provisions of this section related
1223 to prior authorization, the agency shall ensure that the process
1224 for authorization is accessible 24 hours per day, 7 days per
1225 week and authorization is automatically granted when not denied
1226 within 4 hours after the request. Authorization procedures must
1227 include steps for review of denials.
1228 4. Upon implementing the prior authorization program for
1229 hospital inpatient services, the agency shall discontinue its
1230 hospital retrospective review program. However, this
1231 subparagraph may not be construed to prevent the agency from
1232 conducting retrospective reviews under s. 409.913, including,
1233 but not limited to, reviews in which an overpayment is suspected
1234 due to a mistake or submission of an improper claim or for other
1235 reasons that do not rise to the level of fraud or abuse.
1236 Section 38. It is the intent of the Legislature that
1237 section 409.905(5)(a), Florida Statutes, as amended by this act,
1238 confirms and clarifies existing law. This section shall take
1239 effect upon becoming a law.
1240 Section 39. Subsection (8) of section 409.907, Florida
1241 Statutes, is amended to read:
1242 409.907 Medicaid provider agreements.—The agency may make
1243 payments for medical assistance and related services rendered to
1244 Medicaid recipients only to an individual or entity who has a
1245 provider agreement in effect with the agency, who is performing
1246 services or supplying goods in accordance with federal, state,
1247 and local law, and who agrees that no person shall, on the
1248 grounds of handicap, race, color, or national origin, or for any
1249 other reason, be subjected to discrimination under any program
1250 or activity for which the provider receives payment from the
1251 agency.
1252 (8)(a) A level 2 background screening pursuant to chapter
1253 435 must be conducted through the agency on each of the
1254 following:
1255 1. The Each provider, or each principal of the provider if
1256 the provider is a corporation, partnership, association, or
1257 other entity, seeking to participate in the Medicaid program
1258 must submit a complete set of his or her fingerprints to the
1259 agency for the purpose of conducting a criminal history record
1260 check.
1261 2. Principals of the provider, who include any officer,
1262 director, billing agent, managing employee, or affiliated
1263 person, or any partner or shareholder who has an ownership
1264 interest equal to 5 percent or more in the provider. However,
1265 for a hospital licensed under chapter 395 or a nursing home
1266 licensed under chapter 400, principals of the provider are those
1267 who meet the definition of a controlling interest under s.
1268 408.803. A director of a not-for-profit corporation or
1269 organization is not a principal for purposes of a background
1270 investigation required by this section if the director: serves
1271 solely in a voluntary capacity for the corporation or
1272 organization, does not regularly take part in the day-to-day
1273 operational decisions of the corporation or organization,
1274 receives no remuneration from the not-for-profit corporation or
1275 organization for his or her service on the board of directors,
1276 has no financial interest in the not-for-profit corporation or
1277 organization, and has no family members with a financial
1278 interest in the not-for-profit corporation or organization; and
1279 if the director submits an affidavit, under penalty of perjury,
1280 to this effect to the agency and the not-for-profit corporation
1281 or organization submits an affidavit, under penalty of perjury,
1282 to this effect to the agency as part of the corporation’s or
1283 organization’s Medicaid provider agreement application.
1284 3. Any person who participates or seeks to participate in
1285 the Florida Medicaid program by way of rendering services to
1286 Medicaid recipients or having direct access to Medicaid
1287 recipients, recipient living areas, or the financial, medical,
1288 or service records of a Medicaid recipient or who supervises the
1289 delivery of goods or services to a Medicaid recipient. This
1290 subparagraph does not impose additional screening requirements
1291 on any providers licensed under part II of chapter 408 or
1292 transportation service providers contracted with a
1293 transportation broker subject to this paragraph while
1294 administering the Medicaid transportation benefit.
1295 (b) Notwithstanding paragraph (a) the above, the agency may
1296 require a background check for any person reasonably suspected
1297 by the agency to have been convicted of a crime.
1298 (c)(a) Paragraph (a) This subsection does not apply to:
1299 1. A unit of local government, except that requirements of
1300 this subsection apply to nongovernmental providers and entities
1301 contracting with the local government to provide Medicaid
1302 services. The actual cost of the state and national criminal
1303 history record checks must be borne by the nongovernmental
1304 provider or entity; or
1305 2. Any business that derives more than 50 percent of its
1306 revenue from the sale of goods to the final consumer, and the
1307 business or its controlling parent is required to file a form
1308 10-K or other similar statement with the Securities and Exchange
1309 Commission or has a net worth of $50 million or more.
1310 (d)(b) Background screening shall be conducted in
1311 accordance with chapter 435 and s. 408.809. The cost of the
1312 state and national criminal record check shall be borne by the
1313 provider.
1314 Section 40. Paragraph (a) of subsection (1) of section
1315 409.908, Florida Statutes, is amended to read:
1316 409.908 Reimbursement of Medicaid providers.—Subject to
1317 specific appropriations, the agency shall reimburse Medicaid
1318 providers, in accordance with state and federal law, according
1319 to methodologies set forth in the rules of the agency and in
1320 policy manuals and handbooks incorporated by reference therein.
1321 These methodologies may include fee schedules, reimbursement
1322 methods based on cost reporting, negotiated fees, competitive
1323 bidding pursuant to s. 287.057, and other mechanisms the agency
1324 considers efficient and effective for purchasing services or
1325 goods on behalf of recipients. If a provider is reimbursed based
1326 on cost reporting and submits a cost report late and that cost
1327 report would have been used to set a lower reimbursement rate
1328 for a rate semester, then the provider’s rate for that semester
1329 shall be retroactively calculated using the new cost report, and
1330 full payment at the recalculated rate shall be effected
1331 retroactively. Medicare-granted extensions for filing cost
1332 reports, if applicable, shall also apply to Medicaid cost
1333 reports. Payment for Medicaid compensable services made on
1334 behalf of Medicaid eligible persons is subject to the
1335 availability of moneys and any limitations or directions
1336 provided for in the General Appropriations Act or chapter 216.
1337 Further, nothing in this section shall be construed to prevent
1338 or limit the agency from adjusting fees, reimbursement rates,
1339 lengths of stay, number of visits, or number of services, or
1340 making any other adjustments necessary to comply with the
1341 availability of moneys and any limitations or directions
1342 provided for in the General Appropriations Act, provided the
1343 adjustment is consistent with legislative intent.
1344 (1) Reimbursement to hospitals licensed under part I of
1345 chapter 395 must be made prospectively or on the basis of
1346 negotiation.
1347 (a) Reimbursement for inpatient care is limited as provided
1348 in s. 409.905(5), except as otherwise provided in this
1349 subsection.
1350 1. If authorized by the General Appropriations Act, the
1351 agency may modify reimbursement for specific types of services
1352 or diagnoses, recipient ages, and hospital provider types.
1353 2. The agency may establish an alternative methodology to
1354 the DRG-based prospective payment system to set reimbursement
1355 rates for:
1356 a. State-owned psychiatric hospitals.
1357 b. Newborn hearing screening services.
1358 c. Transplant services for which the agency has established
1359 a global fee.
1360 d. Recipients who have tuberculosis that is resistant to
1361 therapy who are in need of long-term, hospital-based treatment
1362 pursuant to s. 392.62.
1363 e. Class III psychiatric hospitals.
1364 3. The agency shall modify reimbursement according to other
1365 methodologies recognized in the General Appropriations Act.
1366
1367 The agency may receive funds from state entities, including, but
1368 not limited to, the Department of Health, local governments, and
1369 other local political subdivisions, for the purpose of making
1370 special exception payments, including federal matching funds,
1371 through the Medicaid inpatient reimbursement methodologies.
1372 Funds received for this purpose shall be separately accounted
1373 for and may not be commingled with other state or local funds in
1374 any manner. The agency may certify all local governmental funds
1375 used as state match under Title XIX of the Social Security Act,
1376 to the extent and in the manner authorized under the General
1377 Appropriations Act and pursuant to an agreement between the
1378 agency and the local governmental entity. In order for the
1379 agency to certify such local governmental funds, a local
1380 governmental entity must submit a final, executed letter of
1381 agreement to the agency, which must be received by October 1 of
1382 each fiscal year and provide the total amount of local
1383 governmental funds authorized by the entity for that fiscal year
1384 under this paragraph, paragraph (b), or the General
1385 Appropriations Act. The local governmental entity shall use a
1386 certification form prescribed by the agency. At a minimum, the
1387 certification form must identify the amount being certified and
1388 describe the relationship between the certifying local
1389 governmental entity and the local health care provider. The
1390 agency shall prepare an annual statement of impact which
1391 documents the specific activities undertaken during the previous
1392 fiscal year pursuant to this paragraph, to be submitted to the
1393 Legislature annually by January 1.
1394 Section 41. Effective June 30, 2020, section 19 of chapter
1395 2019-116, Laws of Florida, is repealed.
1396 Section 42. Section 409.913, Florida Statutes, is amended
1397 to read:
1398 409.913 Oversight of the integrity of the Medicaid
1399 program.—The agency shall operate a program to oversee the
1400 activities of Florida Medicaid recipients, and providers and
1401 their representatives, to ensure that fraudulent and abusive
1402 behavior and neglect of recipients occur to the minimum extent
1403 possible, and to recover overpayments and impose sanctions as
1404 appropriate. Each January 15 January 1, the agency and the
1405 Medicaid Fraud Control Unit of the Department of Legal Affairs
1406 shall submit reports a joint report to the Legislature
1407 documenting the effectiveness of the state’s efforts to control
1408 Medicaid fraud and abuse and to recover Medicaid overpayments
1409 during the previous fiscal year. The report must describe the
1410 number of cases opened and investigated each year; the sources
1411 of the cases opened; the disposition of the cases closed each
1412 year; the amount of overpayments alleged in preliminary and
1413 final audit letters; the number and amount of fines or penalties
1414 imposed; any reductions in overpayment amounts negotiated in
1415 settlement agreements or by other means; the amount of final
1416 agency determinations of overpayments; the amount deducted from
1417 federal claiming as a result of overpayments; the amount of
1418 overpayments recovered each year; the amount of cost of
1419 investigation recovered each year; the average length of time to
1420 collect from the time the case was opened until the overpayment
1421 is paid in full; the amount determined as uncollectible and the
1422 portion of the uncollectible amount subsequently reclaimed from
1423 the Federal Government; the number of providers, by type, that
1424 are terminated from participation in the Medicaid program as a
1425 result of fraud and abuse; and all costs associated with
1426 discovering and prosecuting cases of Medicaid overpayments and
1427 making recoveries in such cases. The report must also document
1428 actions taken to prevent overpayments and the number of
1429 providers prevented from enrolling in or reenrolling in the
1430 Medicaid program as a result of documented Medicaid fraud and
1431 abuse and must include policy recommendations necessary to
1432 prevent or recover overpayments and changes necessary to prevent
1433 and detect Medicaid fraud. All policy recommendations in the
1434 report must include a detailed fiscal analysis, including, but
1435 not limited to, implementation costs, estimated savings to the
1436 Medicaid program, and the return on investment. The agency must
1437 submit the policy recommendations and fiscal analyses in the
1438 report to the appropriate estimating conference, pursuant to s.
1439 216.137, by February 15 of each year. The agency and the
1440 Medicaid Fraud Control Unit of the Department of Legal Affairs
1441 each must include detailed unit-specific performance standards,
1442 benchmarks, and metrics in the report, including projected cost
1443 savings to the state Medicaid program during the following
1444 fiscal year.
1445 (1) For the purposes of this section, the term:
1446 (a) “Abuse” means:
1447 1. Provider practices that are inconsistent with generally
1448 accepted business or medical practices and that result in an
1449 unnecessary cost to the Medicaid program or in reimbursement for
1450 goods or services that are not medically necessary or that fail
1451 to meet professionally recognized standards for health care.
1452 2. Recipient practices that result in unnecessary cost to
1453 the Medicaid program.
1454 (b) “Complaint” means an allegation that fraud, abuse, or
1455 an overpayment has occurred.
1456 (c) “Fraud” means an intentional deception or
1457 misrepresentation made by a person with the knowledge that the
1458 deception results in unauthorized benefit to herself or himself
1459 or another person. The term includes any act that constitutes
1460 fraud under applicable federal or state law.
1461 (d) “Medical necessity” or “medically necessary” means any
1462 goods or services necessary to palliate the effects of a
1463 terminal condition, or to prevent, diagnose, correct, cure,
1464 alleviate, or preclude deterioration of a condition that
1465 threatens life, causes pain or suffering, or results in illness
1466 or infirmity, which goods or services are provided in accordance
1467 with generally accepted standards of medical practice. For
1468 purposes of determining Medicaid reimbursement, the agency is
1469 the final arbiter of medical necessity. Determinations of
1470 medical necessity must be made by a licensed physician employed
1471 by or under contract with the agency and must be based upon
1472 information available at the time the goods or services are
1473 provided.
1474 (e) “Overpayment” includes any amount that is not
1475 authorized to be paid by the Medicaid program whether paid as a
1476 result of inaccurate or improper cost reporting, improper
1477 claiming, unacceptable practices, fraud, abuse, or mistake.
1478 (f) “Person” means any natural person, corporation,
1479 partnership, association, clinic, group, or other entity,
1480 whether or not such person is enrolled in the Medicaid program
1481 or is a provider of health care.
1482 (2) The agency shall conduct, or cause to be conducted by
1483 contract or otherwise, reviews, investigations, analyses,
1484 audits, or any combination thereof, to determine possible fraud,
1485 abuse, overpayment, or recipient neglect in the Medicaid program
1486 and shall report the findings of any overpayments in audit
1487 reports as appropriate. At least 5 percent of all audits shall
1488 be conducted on a random basis. As part of its ongoing fraud
1489 detection activities, the agency shall identify and monitor, by
1490 contract or otherwise, patterns of overutilization of Medicaid
1491 services based on state averages. The agency shall track
1492 Medicaid provider prescription and billing patterns and evaluate
1493 them against Medicaid medical necessity criteria and coverage
1494 and limitation guidelines adopted by rule. Medical necessity
1495 determination requires that service be consistent with symptoms
1496 or confirmed diagnosis of illness or injury under treatment and
1497 not in excess of the patient’s needs. The agency shall conduct
1498 reviews of provider exceptions to peer group norms and shall,
1499 using statistical methodologies, provider profiling, and
1500 analysis of billing patterns, detect and investigate abnormal or
1501 unusual increases in billing or payment of claims for Medicaid
1502 services and medically unnecessary provision of services.
1503 (3) The agency may conduct, or may contract for, prepayment
1504 review of provider claims to ensure cost-effective purchasing;
1505 to ensure that billing by a provider to the agency is in
1506 accordance with applicable provisions of all Medicaid rules,
1507 regulations, handbooks, and policies and in accordance with
1508 federal, state, and local law; and to ensure that appropriate
1509 care is rendered to Medicaid recipients. Such prepayment reviews
1510 may be conducted as determined appropriate by the agency,
1511 without any suspicion or allegation of fraud, abuse, or neglect,
1512 and may last for up to 1 year. Unless the agency has reliable
1513 evidence of fraud, misrepresentation, abuse, or neglect, claims
1514 shall be adjudicated for denial or payment within 90 days after
1515 receipt of complete documentation by the agency for review. If
1516 there is reliable evidence of fraud, misrepresentation, abuse,
1517 or neglect, claims shall be adjudicated for denial of payment
1518 within 180 days after receipt of complete documentation by the
1519 agency for review.
1520 (4) Any suspected criminal violation identified by the
1521 agency must be referred to the Medicaid Fraud Control Unit of
1522 the Office of the Attorney General for investigation. The agency
1523 and the Attorney General shall enter into a memorandum of
1524 understanding, which must include, but need not be limited to, a
1525 protocol for regularly sharing information and coordinating
1526 casework. The protocol must establish a procedure for the
1527 referral by the agency of cases involving suspected Medicaid
1528 fraud to the Medicaid Fraud Control Unit for investigation, and
1529 the return to the agency of those cases where investigation
1530 determines that administrative action by the agency is
1531 appropriate. Offices of the Medicaid program integrity program
1532 and the Medicaid Fraud Control Unit of the Department of Legal
1533 Affairs, shall, to the extent possible, be collocated. The
1534 agency and the Department of Legal Affairs shall periodically
1535 conduct joint training and other joint activities designed to
1536 increase communication and coordination in recovering
1537 overpayments.
1538 (5) A Medicaid provider is subject to having goods and
1539 services that are paid for by the Medicaid program reviewed by
1540 an appropriate peer-review organization designated by the
1541 agency. The written findings of the applicable peer-review
1542 organization are admissible in any court or administrative
1543 proceeding as evidence of medical necessity or the lack thereof.
1544 (6) Any notice required to be given to a provider under
1545 this section is presumed to be sufficient notice if sent to the
1546 address last shown on the provider enrollment file. It is the
1547 responsibility of the provider to furnish and keep the agency
1548 informed of the provider’s current address. United States Postal
1549 Service proof of mailing or certified or registered mailing of
1550 such notice to the provider at the address shown on the provider
1551 enrollment file constitutes sufficient proof of notice. Any
1552 notice required to be given to the agency by this section must
1553 be sent to the agency at an address designated by rule.
1554 (7) When presenting a claim for payment under the Medicaid
1555 program, a provider has an affirmative duty to supervise the
1556 provision of, and be responsible for, goods and services claimed
1557 to have been provided, to supervise and be responsible for
1558 preparation and submission of the claim, and to present a claim
1559 that is true and accurate and that is for goods and services
1560 that:
1561 (a) Have actually been furnished to the recipient by the
1562 provider prior to submitting the claim.
1563 (b) Are Medicaid-covered goods or services that are
1564 medically necessary.
1565 (c) Are of a quality comparable to those furnished to the
1566 general public by the provider’s peers.
1567 (d) Have not been billed in whole or in part to a recipient
1568 or a recipient’s responsible party, except for such copayments,
1569 coinsurance, or deductibles as are authorized by the agency.
1570 (e) Are provided in accord with applicable provisions of
1571 all Medicaid rules, regulations, handbooks, and policies and in
1572 accordance with federal, state, and local law.
1573 (f) Are documented by records made at the time the goods or
1574 services were provided, demonstrating the medical necessity for
1575 the goods or services rendered. Medicaid goods or services are
1576 excessive or not medically necessary unless both the medical
1577 basis and the specific need for them are fully and properly
1578 documented in the recipient’s medical record.
1579
1580 The agency shall deny payment or require repayment for goods or
1581 services that are not presented as required in this subsection.
1582 (8) The agency shall not reimburse any person or entity for
1583 any prescription for medications, medical supplies, or medical
1584 services if the prescription was written by a physician or other
1585 prescribing practitioner who is not enrolled in the Medicaid
1586 program. This section does not apply:
1587 (a) In instances involving bona fide emergency medical
1588 conditions as determined by the agency;
1589 (b) To a provider of medical services to a patient in a
1590 hospital emergency department, hospital inpatient or outpatient
1591 setting, or nursing home;
1592 (c) To bona fide pro bono services by preapproved non
1593 Medicaid providers as determined by the agency;
1594 (d) To prescribing physicians who are board-certified
1595 specialists treating Medicaid recipients referred for treatment
1596 by a treating physician who is enrolled in the Medicaid program;
1597 (e) To prescriptions written for dually eligible Medicare
1598 beneficiaries by an authorized Medicare provider who is not
1599 enrolled in the Medicaid program;
1600 (f) To other physicians who are not enrolled in the
1601 Medicaid program but who provide a medically necessary service
1602 or prescription not otherwise reasonably available from a
1603 Medicaid-enrolled physician; or
1604 (9) A Medicaid provider shall retain medical, professional,
1605 financial, and business records pertaining to services and goods
1606 furnished to a Medicaid recipient and billed to Medicaid for a
1607 period of 5 years after the date of furnishing such services or
1608 goods. The agency may investigate, review, or analyze such
1609 records, which must be made available during normal business
1610 hours. However, 24-hour notice must be provided if patient
1611 treatment would be disrupted. The provider must keep the agency
1612 informed of the location of the provider’s Medicaid-related
1613 records. The authority of the agency to obtain Medicaid-related
1614 records from a provider is neither curtailed nor limited during
1615 a period of litigation between the agency and the provider.
1616 (10) Payments for the services of billing agents or persons
1617 participating in the preparation of a Medicaid claim shall not
1618 be based on amounts for which they bill nor based on the amount
1619 a provider receives from the Medicaid program.
1620 (11) The agency shall deny payment or require repayment for
1621 inappropriate, medically unnecessary, or excessive goods or
1622 services from the person furnishing them, the person under whose
1623 supervision they were furnished, or the person causing them to
1624 be furnished.
1625 (12) The complaint and all information obtained pursuant to
1626 an investigation of a Medicaid provider, or the authorized
1627 representative or agent of a provider, relating to an allegation
1628 of fraud, abuse, or neglect are confidential and exempt from the
1629 provisions of s. 119.07(1):
1630 (a) Until the agency takes final agency action with respect
1631 to the provider and requires repayment of any overpayment, or
1632 imposes an administrative sanction;
1633 (b) Until the Attorney General refers the case for criminal
1634 prosecution;
1635 (c) Until 10 days after the complaint is determined without
1636 merit; or
1637 (d) At all times if the complaint or information is
1638 otherwise protected by law.
1639 (13) The agency shall terminate participation of a Medicaid
1640 provider in the Medicaid program and may seek civil remedies or
1641 impose other administrative sanctions against a Medicaid
1642 provider, if the provider or any principal, officer, director,
1643 agent, managing employee, or affiliated person of the provider,
1644 or any partner or shareholder having an ownership interest in
1645 the provider equal to 5 percent or greater, has been convicted
1646 of a criminal offense under federal law or the law of any state
1647 relating to the practice of the provider’s profession, or a
1648 criminal offense listed under s. 408.809(4), s. 409.907(10), or
1649 s. 435.04(2). If the agency determines that the provider did not
1650 participate or acquiesce in the offense, termination will not be
1651 imposed. If the agency effects a termination under this
1652 subsection, the agency shall take final agency action.
1653 (14) If the provider has been suspended or terminated from
1654 participation in the Medicaid program or the Medicare program by
1655 the Federal Government or any state, the agency must immediately
1656 suspend or terminate, as appropriate, the provider’s
1657 participation in this state’s Medicaid program for a period no
1658 less than that imposed by the Federal Government or any other
1659 state, and may not enroll such provider in this state’s Medicaid
1660 program while such foreign suspension or termination remains in
1661 effect. The agency shall also immediately suspend or terminate,
1662 as appropriate, a provider’s participation in this state’s
1663 Medicaid program if the provider participated or acquiesced in
1664 any action for which any principal, officer, director, agent,
1665 managing employee, or affiliated person of the provider, or any
1666 partner or shareholder having an ownership interest in the
1667 provider equal to 5 percent or greater, was suspended or
1668 terminated from participating in the Medicaid program or the
1669 Medicare program by the Federal Government or any state. This
1670 sanction is in addition to all other remedies provided by law.
1671 (15) The agency shall seek a remedy provided by law,
1672 including, but not limited to, any remedy provided in
1673 subsections (13) and (16) and s. 812.035, if:
1674 (a) The provider’s license has not been renewed, or has
1675 been revoked, suspended, or terminated, for cause, by the
1676 licensing agency of any state;
1677 (b) The provider has failed to make available or has
1678 refused access to Medicaid-related records to an auditor,
1679 investigator, or other authorized employee or agent of the
1680 agency, the Attorney General, a state attorney, or the Federal
1681 Government;
1682 (c) The provider has not furnished or has failed to make
1683 available such Medicaid-related records as the agency has found
1684 necessary to determine whether Medicaid payments are or were due
1685 and the amounts thereof;
1686 (d) The provider has failed to maintain medical records
1687 made at the time of service, or prior to service if prior
1688 authorization is required, demonstrating the necessity and
1689 appropriateness of the goods or services rendered;
1690 (e) The provider is not in compliance with provisions of
1691 Medicaid provider publications that have been adopted by
1692 reference as rules in the Florida Administrative Code; with
1693 provisions of state or federal laws, rules, or regulations; with
1694 provisions of the provider agreement between the agency and the
1695 provider; or with certifications found on claim forms or on
1696 transmittal forms for electronically submitted claims that are
1697 submitted by the provider or authorized representative, as such
1698 provisions apply to the Medicaid program;
1699 (f) The provider or person who ordered, authorized, or
1700 prescribed the care, services, or supplies has furnished, or
1701 ordered or authorized the furnishing of, goods or services to a
1702 recipient which are inappropriate, unnecessary, excessive, or
1703 harmful to the recipient or are of inferior quality;
1704 (g) The provider has demonstrated a pattern of failure to
1705 provide goods or services that are medically necessary;
1706 (h) The provider or an authorized representative of the
1707 provider, or a person who ordered, authorized, or prescribed the
1708 goods or services, has submitted or caused to be submitted false
1709 or a pattern of erroneous Medicaid claims;
1710 (i) The provider or an authorized representative of the
1711 provider, or a person who has ordered, authorized, or prescribed
1712 the goods or services, has submitted or caused to be submitted a
1713 Medicaid provider enrollment application, a request for prior
1714 authorization for Medicaid services, a drug exception request,
1715 or a Medicaid cost report that contains materially false or
1716 incorrect information;
1717 (j) The provider or an authorized representative of the
1718 provider has collected from or billed a recipient or a
1719 recipient’s responsible party improperly for amounts that should
1720 not have been so collected or billed by reason of the provider’s
1721 billing the Medicaid program for the same service;
1722 (k) The provider or an authorized representative of the
1723 provider has included in a cost report costs that are not
1724 allowable under a Florida Title XIX reimbursement plan after the
1725 provider or authorized representative had been advised in an
1726 audit exit conference or audit report that the costs were not
1727 allowable;
1728 (l) The provider is charged by information or indictment
1729 with fraudulent billing practices or an offense referenced in
1730 subsection (13). The sanction applied for this reason is limited
1731 to suspension of the provider’s participation in the Medicaid
1732 program for the duration of the indictment unless the provider
1733 is found guilty pursuant to the information or indictment;
1734 (m) The provider or a person who ordered, authorized, or
1735 prescribed the goods or services is found liable for negligent
1736 practice resulting in death or injury to the provider’s patient;
1737 (n) The provider fails to demonstrate that it had available
1738 during a specific audit or review period sufficient quantities
1739 of goods, or sufficient time in the case of services, to support
1740 the provider’s billings to the Medicaid program;
1741 (o) The provider has failed to comply with the notice and
1742 reporting requirements of s. 409.907;
1743 (p) The agency has received reliable information of patient
1744 abuse or neglect or of any act prohibited by s. 409.920; or
1745 (q) The provider has failed to comply with an agreed-upon
1746 repayment schedule.
1747
1748 A provider is subject to sanctions for violations of this
1749 subsection as the result of actions or inactions of the
1750 provider, or actions or inactions of any principal, officer,
1751 director, agent, managing employee, or affiliated person of the
1752 provider, or any partner or shareholder having an ownership
1753 interest in the provider equal to 5 percent or greater, in which
1754 the provider participated or acquiesced.
1755 (16) The agency shall impose any of the following sanctions
1756 or disincentives on a provider or a person for any of the acts
1757 described in subsection (15):
1758 (a) Suspension for a specific period of time of not more
1759 than 1 year. Suspension precludes participation in the Medicaid
1760 program, which includes any action that results in a claim for
1761 payment to the Medicaid program for furnishing, supervising a
1762 person who is furnishing, or causing a person to furnish goods
1763 or services.
1764 (b) Termination for a specific period of time ranging from
1765 more than 1 year to 20 years. Termination precludes
1766 participation in the Medicaid program, which includes any action
1767 that results in a claim for payment to the Medicaid program for
1768 furnishing, supervising a person who is furnishing, or causing a
1769 person to furnish goods or services.
1770 (c) Imposition of a fine of up to $5,000 for each
1771 violation. Each day that an ongoing violation continues, such as
1772 refusing to furnish Medicaid-related records or refusing access
1773 to records, is considered a separate violation. Each instance of
1774 improper billing of a Medicaid recipient; each instance of
1775 including an unallowable cost on a hospital or nursing home
1776 Medicaid cost report after the provider or authorized
1777 representative has been advised in an audit exit conference or
1778 previous audit report of the cost unallowability; each instance
1779 of furnishing a Medicaid recipient goods or professional
1780 services that are inappropriate or of inferior quality as
1781 determined by competent peer judgment; each instance of
1782 knowingly submitting a materially false or erroneous Medicaid
1783 provider enrollment application, request for prior authorization
1784 for Medicaid services, drug exception request, or cost report;
1785 each instance of inappropriate prescribing of drugs for a
1786 Medicaid recipient as determined by competent peer judgment; and
1787 each false or erroneous Medicaid claim leading to an overpayment
1788 to a provider is considered a separate violation.
1789 (d) Immediate suspension, if the agency has received
1790 information of patient abuse or neglect or of any act prohibited
1791 by s. 409.920. Upon suspension, the agency must issue an
1792 immediate final order under s. 120.569(2)(n).
1793 (e) A fine, not to exceed $10,000, for a violation of
1794 paragraph (15)(i).
1795 (f) Imposition of liens against provider assets, including,
1796 but not limited to, financial assets and real property, not to
1797 exceed the amount of fines or recoveries sought, upon entry of
1798 an order determining that such moneys are due or recoverable.
1799 (g) Prepayment reviews of claims for a specified period of
1800 time.
1801 (h) Comprehensive followup reviews of providers every 6
1802 months to ensure that they are billing Medicaid correctly.
1803 (i) Corrective-action plans that remain in effect for up to
1804 3 years and that are monitored by the agency every 6 months
1805 while in effect.
1806 (j) Other remedies as permitted by law to effect the
1807 recovery of a fine or overpayment.
1808
1809 If a provider voluntarily relinquishes its Medicaid provider
1810 number or an associated license, or allows the associated
1811 licensure to expire after receiving written notice that the
1812 agency is conducting, or has conducted, an audit, survey,
1813 inspection, or investigation and that a sanction of suspension
1814 or termination will or would be imposed for noncompliance
1815 discovered as a result of the audit, survey, inspection, or
1816 investigation, the agency shall impose the sanction of
1817 termination for cause against the provider. The agency’s
1818 termination with cause is subject to hearing rights as may be
1819 provided under chapter 120. The Secretary of Health Care
1820 Administration may make a determination that imposition of a
1821 sanction or disincentive is not in the best interest of the
1822 Medicaid program, in which case a sanction or disincentive may
1823 not be imposed.
1824 (17) In determining the appropriate administrative sanction
1825 to be applied, or the duration of any suspension or termination,
1826 the agency shall consider:
1827 (a) The seriousness and extent of the violation or
1828 violations.
1829 (b) Any prior history of violations by the provider
1830 relating to the delivery of health care programs which resulted
1831 in either a criminal conviction or in administrative sanction or
1832 penalty.
1833 (c) Evidence of continued violation within the provider’s
1834 management control of Medicaid statutes, rules, regulations, or
1835 policies after written notification to the provider of improper
1836 practice or instance of violation.
1837 (d) The effect, if any, on the quality of medical care
1838 provided to Medicaid recipients as a result of the acts of the
1839 provider.
1840 (e) Any action by a licensing agency respecting the
1841 provider in any state in which the provider operates or has
1842 operated.
1843 (f) The apparent impact on access by recipients to Medicaid
1844 services if the provider is suspended or terminated, in the best
1845 judgment of the agency.
1846
1847 The agency shall document the basis for all sanctioning actions
1848 and recommendations.
1849 (18) The agency may take action to sanction, suspend, or
1850 terminate a particular provider working for a group provider,
1851 and may suspend or terminate Medicaid participation at a
1852 specific location, rather than or in addition to taking action
1853 against an entire group.
1854 (19) The agency shall establish a process for conducting
1855 followup reviews of a sampling of providers who have a history
1856 of overpayment under the Medicaid program. This process must
1857 consider the magnitude of previous fraud or abuse and the
1858 potential effect of continued fraud or abuse on Medicaid costs.
1859 (20) In making a determination of overpayment to a
1860 provider, the agency must use accepted and valid auditing,
1861 accounting, analytical, statistical, or peer-review methods, or
1862 combinations thereof. Appropriate statistical methods may
1863 include, but are not limited to, sampling and extension to the
1864 population, parametric and nonparametric statistics, tests of
1865 hypotheses, and other generally accepted statistical methods.
1866 Appropriate analytical methods may include, but are not limited
1867 to, reviews to determine variances between the quantities of
1868 products that a provider had on hand and available to be
1869 purveyed to Medicaid recipients during the review period and the
1870 quantities of the same products paid for by the Medicaid program
1871 for the same period, taking into appropriate consideration sales
1872 of the same products to non-Medicaid customers during the same
1873 period. In meeting its burden of proof in any administrative or
1874 court proceeding, the agency may introduce the results of such
1875 statistical methods as evidence of overpayment.
1876 (21) When making a determination that an overpayment has
1877 occurred, the agency shall prepare and issue an audit report to
1878 the provider showing the calculation of overpayments. The
1879 agency’s determination must be based solely upon information
1880 available to it before issuance of the audit report and, in the
1881 case of documentation obtained to substantiate claims for
1882 Medicaid reimbursement, based solely upon contemporaneous
1883 records. The agency may consider addenda or modifications to a
1884 note that was made contemporaneously with the patient care
1885 episode if the addenda or modifications are germane to the note.
1886 (22) The audit report, supported by agency work papers,
1887 showing an overpayment to a provider constitutes evidence of the
1888 overpayment. A provider may not present or elicit testimony on
1889 direct examination or cross-examination in any court or
1890 administrative proceeding, regarding the purchase or acquisition
1891 by any means of drugs, goods, or supplies; sales or divestment
1892 by any means of drugs, goods, or supplies; or inventory of
1893 drugs, goods, or supplies, unless such acquisition, sales,
1894 divestment, or inventory is documented by written invoices,
1895 written inventory records, or other competent written
1896 documentary evidence maintained in the normal course of the
1897 provider’s business. A provider may not present records to
1898 contest an overpayment or sanction unless such records are
1899 contemporaneous and, if requested during the audit process, were
1900 furnished to the agency or its agent upon request. This
1901 limitation does not apply to Medicaid cost report audits. This
1902 limitation does not preclude consideration by the agency of
1903 addenda or modifications to a note if the addenda or
1904 modifications are made before notification of the audit, the
1905 addenda or modifications are germane to the note, and the note
1906 was made contemporaneously with a patient care episode.
1907 Notwithstanding the applicable rules of discovery, all
1908 documentation to be offered as evidence at an administrative
1909 hearing on a Medicaid overpayment or an administrative sanction
1910 must be exchanged by all parties at least 14 days before the
1911 administrative hearing or be excluded from consideration.
1912 (23)(a) In an audit, or investigation, or enforcement
1913 action taken for of a violation committed by a provider which is
1914 conducted pursuant to this section, the agency is entitled to
1915 recover all investigative and, legal costs incurred as a result
1916 of such audit, investigation, or enforcement action. The costs
1917 associated with an investigation, audit, or enforcement action
1918 may include, but are not limited to, salaries and benefits of
1919 personnel, costs related to the time spent by an attorney and
1920 other personnel working on the case, and any other expenses
1921 incurred by the agency or contractor which are associated with
1922 the case, including any, and expert witness costs and attorney
1923 fees incurred on behalf of the agency or contractor if the
1924 agency’s findings were not contested by the provider or, if
1925 contested, the agency ultimately prevailed.
1926 (b) The agency has the burden of documenting the costs,
1927 which include salaries and employee benefits and out-of-pocket
1928 expenses. The amount of costs that may be recovered must be
1929 reasonable in relation to the seriousness of the violation and
1930 must be set taking into consideration the financial resources,
1931 earning ability, and needs of the provider, who has the burden
1932 of demonstrating such factors.
1933 (c) The provider may pay the costs over a period to be
1934 determined by the agency if the agency determines that an
1935 extreme hardship would result to the provider from immediate
1936 full payment. Any default in payment of costs may be collected
1937 by any means authorized by law.
1938 (24) If the agency imposes an administrative sanction
1939 pursuant to subsection (13), subsection (14), or subsection
1940 (15), except paragraphs (15)(e) and (o), upon any provider or
1941 any principal, officer, director, agent, managing employee, or
1942 affiliated person of the provider who is regulated by another
1943 state entity, the agency shall notify that other entity of the
1944 imposition of the sanction within 5 business days. Such
1945 notification must include the provider’s or person’s name and
1946 license number and the specific reasons for sanction.
1947 (25)(a) The agency shall withhold Medicaid payments, in
1948 whole or in part, to a provider upon receipt of reliable
1949 evidence that the circumstances giving rise to the need for a
1950 withholding of payments involve fraud, willful
1951 misrepresentation, or abuse under the Medicaid program, or a
1952 crime committed while rendering goods or services to Medicaid
1953 recipients. If it is determined that fraud, willful
1954 misrepresentation, abuse, or a crime did not occur, the payments
1955 withheld must be paid to the provider within 14 days after such
1956 determination. Amounts not paid within 14 days accrue interest
1957 at the rate of 10 percent per year, beginning after the 14th
1958 day.
1959 (b) The agency shall deny payment, or require repayment, if
1960 the goods or services were furnished, supervised, or caused to
1961 be furnished by a person who has been suspended or terminated
1962 from the Medicaid program or Medicare program by the Federal
1963 Government or any state.
1964 (c) Overpayments owed to the agency bear interest at the
1965 rate of 10 percent per year from the date of final determination
1966 of the overpayment by the agency, and payment arrangements must
1967 be made within 30 days after the date of the final order, which
1968 is not subject to further appeal.
1969 (d) The agency, upon entry of a final agency order, a
1970 judgment or order of a court of competent jurisdiction, or a
1971 stipulation or settlement, may collect the moneys owed by all
1972 means allowable by law, including, but not limited to, notifying
1973 any fiscal intermediary of Medicare benefits that the state has
1974 a superior right of payment. Upon receipt of such written
1975 notification, the Medicare fiscal intermediary shall remit to
1976 the state the sum claimed.
1977 (e) The agency may institute amnesty programs to allow
1978 Medicaid providers the opportunity to voluntarily repay
1979 overpayments. The agency may adopt rules to administer such
1980 programs.
1981 (26) The agency may impose administrative sanctions against
1982 a Medicaid recipient, or the agency may seek any other remedy
1983 provided by law, including, but not limited to, the remedies
1984 provided in s. 812.035, if the agency finds that a recipient has
1985 engaged in solicitation in violation of s. 409.920 or that the
1986 recipient has otherwise abused the Medicaid program.
1987 (27) When the Agency for Health Care Administration has
1988 made a probable cause determination and alleged that an
1989 overpayment to a Medicaid provider has occurred, the agency,
1990 after notice to the provider, shall:
1991 (a) Withhold, and continue to withhold during the pendency
1992 of an administrative hearing pursuant to chapter 120, any
1993 medical assistance reimbursement payments until such time as the
1994 overpayment is recovered, unless within 30 days after receiving
1995 notice thereof the provider:
1996 1. Makes repayment in full; or
1997 2. Establishes a repayment plan that is satisfactory to the
1998 Agency for Health Care Administration.
1999 (b) Withhold, and continue to withhold during the pendency
2000 of an administrative hearing pursuant to chapter 120, medical
2001 assistance reimbursement payments if the terms of a repayment
2002 plan are not adhered to by the provider.
2003 (28) Venue for all Medicaid program integrity cases lies in
2004 Leon County, at the discretion of the agency.
2005 (29) Notwithstanding other provisions of law, the agency
2006 and the Medicaid Fraud Control Unit of the Department of Legal
2007 Affairs may review a provider’s Medicaid-related and non
2008 Medicaid-related records in order to determine the total output
2009 of a provider’s practice to reconcile quantities of goods or
2010 services billed to Medicaid with quantities of goods or services
2011 used in the provider’s total practice.
2012 (30) The agency shall terminate a provider’s participation
2013 in the Medicaid program if the provider fails to reimburse an
2014 overpayment or pay an agency-imposed fine that has been
2015 determined by final order, not subject to further appeal, within
2016 30 days after the date of the final order, unless the provider
2017 and the agency have entered into a repayment agreement.
2018 (31) If a provider requests an administrative hearing
2019 pursuant to chapter 120, such hearing must be conducted within
2020 90 days following assignment of an administrative law judge,
2021 absent exceptionally good cause shown as determined by the
2022 administrative law judge or hearing officer. Upon issuance of a
2023 final order, the outstanding balance of the amount determined to
2024 constitute the overpayment and fines is due. If a provider fails
2025 to make payments in full, fails to enter into a satisfactory
2026 repayment plan, or fails to comply with the terms of a repayment
2027 plan or settlement agreement, the agency shall withhold
2028 reimbursement payments for Medicaid services until the amount
2029 due is paid in full.
2030 (32) Duly authorized agents and employees of the agency
2031 shall have the power to inspect, during normal business hours,
2032 the records of any pharmacy, wholesale establishment, or
2033 manufacturer, or any other place in which drugs and medical
2034 supplies are manufactured, packed, packaged, made, stored, sold,
2035 or kept for sale, for the purpose of verifying the amount of
2036 drugs and medical supplies ordered, delivered, or purchased by a
2037 provider. The agency shall provide at least 2 business days’
2038 prior notice of any such inspection. The notice must identify
2039 the provider whose records will be inspected, and the inspection
2040 shall include only records specifically related to that
2041 provider.
2042 (33) In accordance with federal law, Medicaid recipients
2043 convicted of a crime pursuant to 42 U.S.C. s. 1320a-7b may be
2044 limited, restricted, or suspended from Medicaid eligibility for
2045 a period not to exceed 1 year, as determined by the agency head
2046 or designee.
2047 (34) To deter fraud and abuse in the Medicaid program, the
2048 agency may limit the number of Schedule II and Schedule III
2049 refill prescription claims submitted from a pharmacy provider.
2050 The agency shall limit the allowable amount of reimbursement of
2051 prescription refill claims for Schedule II and Schedule III
2052 pharmaceuticals if the agency or the Medicaid Fraud Control Unit
2053 determines that the specific prescription refill was not
2054 requested by the Medicaid recipient or authorized representative
2055 for whom the refill claim is submitted or was not prescribed by
2056 the recipient’s medical provider or physician. Any such refill
2057 request must be consistent with the original prescription.
2058 (35) The Office of Program Policy Analysis and Government
2059 Accountability shall provide a report to the President of the
2060 Senate and the Speaker of the House of Representatives on a
2061 biennial basis, beginning January 31, 2006, on the agency’s
2062 efforts to prevent, detect, and deter, as well as recover funds
2063 lost to, fraud and abuse in the Medicaid program.
2064 (36) The agency may provide to a sample of Medicaid
2065 recipients or their representatives through the distribution of
2066 explanations of benefits information about services reimbursed
2067 by the Medicaid program for goods and services to such
2068 recipients, including information on how to report inappropriate
2069 or incorrect billing to the agency or other law enforcement
2070 entities for review or investigation, information on how to
2071 report criminal Medicaid fraud to the Medicaid Fraud Control
2072 Unit’s toll-free hotline number, and information about the
2073 rewards available under s. 409.9203. The explanation of benefits
2074 may not be mailed for Medicaid independent laboratory services
2075 as described in s. 409.905(7) or for Medicaid certified match
2076 services as described in ss. 409.9071 and 1011.70.
2077 (37) The agency shall post on its website a current list of
2078 each Medicaid provider, including any principal, officer,
2079 director, agent, managing employee, or affiliated person of the
2080 provider, or any partner or shareholder having an ownership
2081 interest in the provider equal to 5 percent or greater, who has
2082 been terminated for cause from the Medicaid program or
2083 sanctioned under this section. The list must be searchable by a
2084 variety of search parameters and provide for the creation of
2085 formatted lists that may be printed or imported into other
2086 applications, including spreadsheets. The agency shall update
2087 the list at least monthly.
2088 (38) In order to improve the detection of health care
2089 fraud, use technology to prevent and detect fraud, and maximize
2090 the electronic exchange of health care fraud information, the
2091 agency shall:
2092 (a) Compile, maintain, and publish on its website a
2093 detailed list of all state and federal databases that contain
2094 health care fraud information and update the list at least
2095 biannually;
2096 (b) Develop a strategic plan to connect all databases that
2097 contain health care fraud information to facilitate the
2098 electronic exchange of health information between the agency,
2099 the Department of Health, the Department of Law Enforcement, and
2100 the Attorney General’s Office. The plan must include recommended
2101 standard data formats, fraud identification strategies, and
2102 specifications for the technical interface between state and
2103 federal health care fraud databases;
2104 (c) Monitor innovations in health information technology,
2105 specifically as it pertains to Medicaid fraud prevention and
2106 detection; and
2107 (d) Periodically publish policy briefs that highlight
2108 available new technology to prevent or detect health care fraud
2109 and projects implemented by other states, the private sector, or
2110 the Federal Government which use technology to prevent or detect
2111 health care fraud.
2112 Section 43. Paragraph (a) of subsection (2) of section
2113 409.920, Florida Statutes, is amended to read:
2114 409.920 Medicaid provider fraud.—
2115 (2)(a) A person may not:
2116 1. Knowingly make, cause to be made, or aid and abet in the
2117 making of any false statement or false representation of a
2118 material fact, by commission or omission, in any claim submitted
2119 to the agency or its fiscal agent or a managed care plan for
2120 payment.
2121 2. Knowingly make, cause to be made, or aid and abet in the
2122 making of a claim for items or services that are not authorized
2123 to be reimbursed by the Medicaid program.
2124 3. Knowingly charge, solicit, accept, or receive anything
2125 of value, other than an authorized copayment from a Medicaid
2126 recipient, from any source in addition to the amount legally
2127 payable for an item or service provided to a Medicaid recipient
2128 under the Medicaid program or knowingly fail to credit the
2129 agency or its fiscal agent for any payment received from a
2130 third-party source.
2131 4. Knowingly make or in any way cause to be made any false
2132 statement or false representation of a material fact, by
2133 commission or omission, in any document containing items of
2134 income and expense that is or may be used by the agency to
2135 determine a general or specific rate of payment for an item or
2136 service provided by a provider.
2137 5. Knowingly solicit, offer, pay, or receive any
2138 remuneration, including any kickback, bribe, or rebate, directly
2139 or indirectly, overtly or covertly, in cash or in kind, in
2140 return for referring an individual to a person for the
2141 furnishing or arranging for the furnishing of any item or
2142 service for which payment may be made, in whole or in part,
2143 under the Medicaid program, or in return for obtaining,
2144 purchasing, leasing, ordering, or arranging for or recommending,
2145 obtaining, purchasing, leasing, or ordering any goods, facility,
2146 item, or service, for which payment may be made, in whole or in
2147 part, under the Medicaid program. This subparagraph does not
2148 apply to any discount, payment, waiver of payment, or payment
2149 practice not prohibited by 42 U.S.C. s. 1320a-7b(b) or
2150 regulations adopted thereunder.
2151 6. Knowingly submit false or misleading information or
2152 statements to the Medicaid program for the purpose of being
2153 accepted as a Medicaid provider.
2154 7. Knowingly use or endeavor to use a Medicaid provider’s
2155 identification number or a Medicaid recipient’s identification
2156 number to make, cause to be made, or aid and abet in the making
2157 of a claim for items or services that are not authorized to be
2158 reimbursed by the Medicaid program.
2159 Section 44. Subsection (1) of section 409.967, Florida
2160 Statutes, is amended to read:
2161 409.967 Managed care plan accountability.—
2162 (1) Beginning with the contract procurement process
2163 initiated during the 2023 calendar year, the agency shall
2164 establish a 6-year 5-year contract with each managed care plan
2165 selected through the procurement process described in s.
2166 409.966. A plan contract may not be renewed; however, the agency
2167 may extend the term of a plan contract to cover any delays
2168 during the transition to a new plan. The agency shall extend
2169 until December 31, 2024, the term of existing plan contracts
2170 awarded pursuant to the invitation to negotiate published in
2171 July 2017.
2172 Section 45. Paragraph (b) of subsection (5) of section
2173 409.973, Florida Statutes, is amended to read:
2174 409.973 Benefits.—
2175 (5) PROVISION OF DENTAL SERVICES.—
2176 (b) In the event the Legislature takes no action before
2177 July 1, 2017, with respect to the report findings required under
2178 subparagraph (a)2., the agency shall implement a statewide
2179 Medicaid prepaid dental health program for children and adults
2180 with a choice of at least two licensed dental managed care
2181 providers who must have substantial experience in providing
2182 dental care to Medicaid enrollees and children eligible for
2183 medical assistance under Title XXI of the Social Security Act
2184 and who meet all agency standards and requirements. To qualify
2185 as a provider under the prepaid dental health program, the
2186 entity must be licensed as a prepaid limited health service
2187 organization under part I of chapter 636 or as a health
2188 maintenance organization under part I of chapter 641. The
2189 contracts for program providers shall be awarded through a
2190 competitive procurement process. Beginning with the contract
2191 procurement process initiated during the 2023 calendar year, the
2192 contracts must be for 6 5 years and may not be renewed; however,
2193 the agency may extend the term of a plan contract to cover
2194 delays during a transition to a new plan provider. The agency
2195 shall include in the contracts a medical loss ratio provision
2196 consistent with s. 409.967(4). The agency is authorized to seek
2197 any necessary state plan amendment or federal waiver to commence
2198 enrollment in the Medicaid prepaid dental health program no
2199 later than March 1, 2019. The agency shall extend until December
2200 31, 2024, the term of existing plan contracts awarded pursuant
2201 to the invitation to negotiate published in October 2017.
2202 Section 46. Subsection (6) of section 429.11, Florida
2203 Statutes, is amended to read:
2204 429.11 Initial application for license; provisional
2205 license.—
2206 (6) In addition to the license categories available in s.
2207 408.808, a provisional license may be issued to an applicant
2208 making initial application for licensure or making application
2209 for a change of ownership. A provisional license shall be
2210 limited in duration to a specific period of time not to exceed 6
2211 months, as determined by the agency.
2212 Section 47. Subsection (9) of section 429.19, Florida
2213 Statutes, is amended to read:
2214 429.19 Violations; imposition of administrative fines;
2215 grounds.—
2216 (9) The agency shall develop and disseminate an annual list
2217 of all facilities sanctioned or fined for violations of state
2218 standards, the number and class of violations involved, the
2219 penalties imposed, and the current status of cases. The list
2220 shall be disseminated, at no charge, to the Department of
2221 Elderly Affairs, the Department of Health, the Department of
2222 Children and Families, the Agency for Persons with Disabilities,
2223 the area agencies on aging, the Florida Statewide Advocacy
2224 Council, the State Long-Term Care Ombudsman Program, and state
2225 and local ombudsman councils. The Department of Children and
2226 Families shall disseminate the list to service providers under
2227 contract to the department who are responsible for referring
2228 persons to a facility for residency. The agency may charge a fee
2229 commensurate with the cost of printing and postage to other
2230 interested parties requesting a copy of this list. This
2231 information may be provided electronically or through the
2232 agency’s Internet site.
2233 Section 48. Subsection (2) of section 429.35, Florida
2234 Statutes, is amended to read:
2235 429.35 Maintenance of records; reports.—
2236 (2) Within 60 days after the date of an the biennial
2237 inspection conducted visit required under s. 408.811 or within
2238 30 days after the date of an any interim visit, the agency shall
2239 forward the results of the inspection to the local ombudsman
2240 council in the district where the facility is located; to at
2241 least one public library or, in the absence of a public library,
2242 the county seat in the county in which the inspected assisted
2243 living facility is located; and, when appropriate, to the
2244 district Adult Services and Mental Health Program Offices.
2245 Section 49. Subsection (2) of section 429.905, Florida
2246 Statutes, is amended to read:
2247 429.905 Exemptions; monitoring of adult day care center
2248 programs colocated with assisted living facilities or licensed
2249 nursing home facilities.—
2250 (2) A licensed assisted living facility, a licensed
2251 hospital, or a licensed nursing home facility may provide
2252 services during the day which include, but are not limited to,
2253 social, health, therapeutic, recreational, nutritional, and
2254 respite services, to adults who are not residents. Such a
2255 facility need not be licensed as an adult day care center;
2256 however, the agency must monitor the facility during the regular
2257 inspection and at least biennially to ensure adequate space and
2258 sufficient staff. If an assisted living facility, a hospital, or
2259 a nursing home holds itself out to the public as an adult day
2260 care center, it must be licensed as such and meet all standards
2261 prescribed by statute and rule. For the purpose of this
2262 subsection, the term “day” means any portion of a 24-hour day.
2263 Section 50. Section 429.929, Florida Statutes, is amended
2264 to read:
2265 429.929 Rules establishing standards.—
2266 (1) The agency shall adopt rules to implement this part.
2267 The rules must include reasonable and fair standards. Any
2268 conflict between these standards and those that may be set forth
2269 in local, county, or municipal ordinances shall be resolved in
2270 favor of those having statewide effect. Such standards must
2271 relate to:
2272 (1)(a) The maintenance of adult day care centers with
2273 respect to plumbing, heating, lighting, ventilation, and other
2274 building conditions, including adequate meeting space, to ensure
2275 the health, safety, and comfort of participants and protection
2276 from fire hazard. Such standards may not conflict with chapter
2277 553 and must be based upon the size of the structure and the
2278 number of participants.
2279 (2)(b) The number and qualifications of all personnel
2280 employed by adult day care centers who have responsibilities for
2281 the care of participants.
2282 (3)(c) All sanitary conditions within adult day care
2283 centers and their surroundings, including water supply, sewage
2284 disposal, food handling, and general hygiene, and maintenance of
2285 sanitary conditions, to ensure the health and comfort of
2286 participants.
2287 (4)(d) Basic services provided by adult day care centers.
2288 (5)(e) Supportive and optional services provided by adult
2289 day care centers.
2290 (6)(f) Data and information relative to participants and
2291 programs of adult day care centers, including, but not limited
2292 to, the physical and mental capabilities and needs of the
2293 participants, the availability, frequency, and intensity of
2294 basic services and of supportive and optional services provided,
2295 the frequency of participation, the distances traveled by
2296 participants, the hours of operation, the number of referrals to
2297 other centers or elsewhere, and the incidence of illness.
2298 (7)(g) Components of a comprehensive emergency management
2299 plan, developed in consultation with the Department of Health
2300 and the Division of Emergency Management.
2301 (2) Pursuant to this part, s. 408.811, and applicable
2302 rules, the agency may conduct an abbreviated biennial inspection
2303 of key quality-of-care standards, in lieu of a full inspection,
2304 of a center that has a record of good performance. However, the
2305 agency must conduct a full inspection of a center that has had
2306 one or more confirmed complaints within the licensure period
2307 immediately preceding the inspection or which has a serious
2308 problem identified during the abbreviated inspection. The agency
2309 shall develop the key quality-of-care standards, taking into
2310 consideration the comments and recommendations of provider
2311 groups. These standards shall be included in rules adopted by
2312 the agency.
2313 Section 51. Effective January 1, 2021, paragraph (e) of
2314 subsection (2) and paragraph (e) of subsection (3) of section
2315 627.6387, Florida Statutes, are amended to read:
2316 627.6387 Shared savings incentive program.—
2317 (2) As used in this section, the term:
2318 (e) “Shoppable health care service” means a lower-cost,
2319 high-quality nonemergency health care service for which a shared
2320 savings incentive is available for insureds under a health
2321 insurer’s shared savings incentive program. Shoppable health
2322 care services may be provided within or outside this state and
2323 include, but are not limited to:
2324 1. Clinical laboratory services.
2325 2. Infusion therapy.
2326 3. Inpatient and outpatient surgical procedures.
2327 4. Obstetrical and gynecological services.
2328 5. Inpatient and outpatient nonsurgical diagnostic tests
2329 and procedures.
2330 6. Physical and occupational therapy services.
2331 7. Radiology and imaging services.
2332 8. Prescription drugs.
2333 9. Services provided through telehealth.
2334 10. Any additional services published by the Agency for
2335 Health Care Administration that have the most significant price
2336 variation pursuant to s. 408.05(3)(l).
2337 (3) A health insurer may offer a shared savings incentive
2338 program to provide incentives to an insured when the insured
2339 obtains a shoppable health care service from the health
2340 insurer’s shared savings list. An insured may not be required to
2341 participate in a shared savings incentive program. A health
2342 insurer that offers a shared savings incentive program must:
2343 (e) At least quarterly, credit or deposit the shared
2344 savings incentive amount to the insured’s account as a return or
2345 reduction in premium, or credit the shared savings incentive
2346 amount to the insured’s flexible spending account, health
2347 savings account, or health reimbursement account, or reward the
2348 insured directly with cash or a cash equivalent such that the
2349 amount does not constitute income to the insured.
2350 Section 52. Effective January 1, 2021, paragraph (e) of
2351 subsection (2) and paragraph (e) of subsection (3) of section
2352 627.6648, Florida Statutes, are amended to read:
2353 627.6648 Shared savings incentive program.—
2354 (2) As used in this section, the term:
2355 (e) “Shoppable health care service” means a lower-cost,
2356 high-quality nonemergency health care service for which a shared
2357 savings incentive is available for insureds under a health
2358 insurer’s shared savings incentive program. Shoppable health
2359 care services may be provided within or outside this state and
2360 include, but are not limited to:
2361 1. Clinical laboratory services.
2362 2. Infusion therapy.
2363 3. Inpatient and outpatient surgical procedures.
2364 4. Obstetrical and gynecological services.
2365 5. Inpatient and outpatient nonsurgical diagnostic tests
2366 and procedures.
2367 6. Physical and occupational therapy services.
2368 7. Radiology and imaging services.
2369 8. Prescription drugs.
2370 9. Services provided through telehealth.
2371 10. Any additional services published by the Agency for
2372 Health Care Administration that have the most significant price
2373 variation pursuant to s. 408.05(3)(l).
2374 (3) A health insurer may offer a shared savings incentive
2375 program to provide incentives to an insured when the insured
2376 obtains a shoppable health care service from the health
2377 insurer’s shared savings list. An insured may not be required to
2378 participate in a shared savings incentive program. A health
2379 insurer that offers a shared savings incentive program must:
2380 (e) At least quarterly, credit or deposit the shared
2381 savings incentive amount to the insured’s account as a return or
2382 reduction in premium, or credit the shared savings incentive
2383 amount to the insured’s flexible spending account, health
2384 savings account, or health reimbursement account, or reward the
2385 insured directly with cash or a cash equivalent such that the
2386 amount does not constitute income to the insured.
2387 Section 53. Effective January 1, 2021, paragraph (e) of
2388 subsection (2) and paragraph (e) of subsection (3) of section
2389 641.31076, Florida Statutes, are amended to read:
2390 641.31076 Shared savings incentive program.—
2391 (2) As used in this section, the term:
2392 (e) “Shoppable health care service” means a lower-cost,
2393 high-quality nonemergency health care service for which a shared
2394 savings incentive is available for subscribers under a health
2395 maintenance organization’s shared savings incentive program.
2396 Shoppable health care services may be provided within or outside
2397 this state and include, but are not limited to:
2398 1. Clinical laboratory services.
2399 2. Infusion therapy.
2400 3. Inpatient and outpatient surgical procedures.
2401 4. Obstetrical and gynecological services.
2402 5. Inpatient and outpatient nonsurgical diagnostic tests
2403 and procedures.
2404 6. Physical and occupational therapy services.
2405 7. Radiology and imaging services.
2406 8. Prescription drugs.
2407 9. Services provided through telehealth.
2408 10. Any additional services published by the Agency for
2409 Health Care Administration that have the most significant price
2410 variation pursuant to s. 408.05(3)(l).
2411 (3) A health maintenance organization may offer a shared
2412 savings incentive program to provide incentives to a subscriber
2413 when the subscriber obtains a shoppable health care service from
2414 the health maintenance organization’s shared savings list. A
2415 subscriber may not be required to participate in a shared
2416 savings incentive program. A health maintenance organization
2417 that offers a shared savings incentive program must:
2418 (e) At least quarterly, credit or deposit the shared
2419 savings incentive amount to the subscriber’s account as a return
2420 or reduction in premium, or credit the shared savings incentive
2421 amount to the subscriber’s flexible spending account, health
2422 savings account, or health reimbursement account, or reward the
2423 subscriber directly with cash or a cash equivalent such that the
2424 amount does not constitute income to the subscriber.
2425 Section 54. Part I of chapter 483, Florida Statutes, is
2426 repealed, and part II and part III of that chapter are
2427 redesignated as part I and part II, respectively.
2428 Section 55. Paragraph (g) of subsection (3) of section
2429 20.43, Florida Statutes, is amended to read:
2430 20.43 Department of Health.—There is created a Department
2431 of Health.
2432 (3) The following divisions of the Department of Health are
2433 established:
2434 (g) Division of Medical Quality Assurance, which is
2435 responsible for the following boards and professions established
2436 within the division:
2437 1. The Board of Acupuncture, created under chapter 457.
2438 2. The Board of Medicine, created under chapter 458.
2439 3. The Board of Osteopathic Medicine, created under chapter
2440 459.
2441 4. The Board of Chiropractic Medicine, created under
2442 chapter 460.
2443 5. The Board of Podiatric Medicine, created under chapter
2444 461.
2445 6. Naturopathy, as provided under chapter 462.
2446 7. The Board of Optometry, created under chapter 463.
2447 8. The Board of Nursing, created under part I of chapter
2448 464.
2449 9. Nursing assistants, as provided under part II of chapter
2450 464.
2451 10. The Board of Pharmacy, created under chapter 465.
2452 11. The Board of Dentistry, created under chapter 466.
2453 12. Midwifery, as provided under chapter 467.
2454 13. The Board of Speech-Language Pathology and Audiology,
2455 created under part I of chapter 468.
2456 14. The Board of Nursing Home Administrators, created under
2457 part II of chapter 468.
2458 15. The Board of Occupational Therapy, created under part
2459 III of chapter 468.
2460 16. Respiratory therapy, as provided under part V of
2461 chapter 468.
2462 17. Dietetics and nutrition practice, as provided under
2463 part X of chapter 468.
2464 18. The Board of Athletic Training, created under part XIII
2465 of chapter 468.
2466 19. The Board of Orthotists and Prosthetists, created under
2467 part XIV of chapter 468.
2468 20. Electrolysis, as provided under chapter 478.
2469 21. The Board of Massage Therapy, created under chapter
2470 480.
2471 22. The Board of Clinical Laboratory Personnel, created
2472 under part I part II of chapter 483.
2473 23. Medical physicists, as provided under part II part III
2474 of chapter 483.
2475 24. The Board of Opticianry, created under part I of
2476 chapter 484.
2477 25. The Board of Hearing Aid Specialists, created under
2478 part II of chapter 484.
2479 26. The Board of Physical Therapy Practice, created under
2480 chapter 486.
2481 27. The Board of Psychology, created under chapter 490.
2482 28. School psychologists, as provided under chapter 490.
2483 29. The Board of Clinical Social Work, Marriage and Family
2484 Therapy, and Mental Health Counseling, created under chapter
2485 491.
2486 30. Emergency medical technicians and paramedics, as
2487 provided under part III of chapter 401.
2488 Section 56. Subsection (3) of section 381.0034, Florida
2489 Statutes, is amended to read:
2490 381.0034 Requirement for instruction on HIV and AIDS.—
2491 (3) The department shall require, as a condition of
2492 granting a license under chapter 467 or part I part II of
2493 chapter 483, that an applicant making initial application for
2494 licensure complete an educational course acceptable to the
2495 department on human immunodeficiency virus and acquired immune
2496 deficiency syndrome. Upon submission of an affidavit showing
2497 good cause, an applicant who has not taken a course at the time
2498 of licensure shall be allowed 6 months to complete this
2499 requirement.
2500 Section 57. Subsection (4) of section 456.001, Florida
2501 Statutes, is amended to read:
2502 456.001 Definitions.—As used in this chapter, the term:
2503 (4) “Health care practitioner” means any person licensed
2504 under chapter 457; chapter 458; chapter 459; chapter 460;
2505 chapter 461; chapter 462; chapter 463; chapter 464; chapter 465;
2506 chapter 466; chapter 467; part I, part II, part III, part V,
2507 part X, part XIII, or part XIV of chapter 468; chapter 478;
2508 chapter 480; part I or part II part II or part III of chapter
2509 483; chapter 484; chapter 486; chapter 490; or chapter 491.
2510 Section 58. Paragraphs (h) and (i) of subsection (2) of
2511 section 456.057, Florida Statutes, are amended to read:
2512 456.057 Ownership and control of patient records; report or
2513 copies of records to be furnished; disclosure of information.—
2514 (2) As used in this section, the terms “records owner,”
2515 “health care practitioner,” and “health care practitioner’s
2516 employer” do not include any of the following persons or
2517 entities; furthermore, the following persons or entities are not
2518 authorized to acquire or own medical records, but are authorized
2519 under the confidentiality and disclosure requirements of this
2520 section to maintain those documents required by the part or
2521 chapter under which they are licensed or regulated:
2522 (h) Clinical laboratory personnel licensed under part I
2523 part II of chapter 483.
2524 (i) Medical physicists licensed under part II part III of
2525 chapter 483.
2526 Section 59. Paragraph (j) of subsection (1) of section
2527 456.076, Florida Statutes, is amended to read:
2528 456.076 Impaired practitioner programs.—
2529 (1) As used in this section, the term:
2530 (j) “Practitioner” means a person licensed, registered,
2531 certified, or regulated by the department under part III of
2532 chapter 401; chapter 457; chapter 458; chapter 459; chapter 460;
2533 chapter 461; chapter 462; chapter 463; chapter 464; chapter 465;
2534 chapter 466; chapter 467; part I, part II, part III, part V,
2535 part X, part XIII, or part XIV of chapter 468; chapter 478;
2536 chapter 480; part I or part II part II or part III of chapter
2537 483; chapter 484; chapter 486; chapter 490; or chapter 491; or
2538 an applicant for a license, registration, or certification under
2539 the same laws.
2540 Section 60. Paragraph (b) of subsection (1) of section
2541 456.47, Florida Statutes, is amended to read:
2542 456.47 Use of telehealth to provide services.—
2543 (1) DEFINITIONS.—As used in this section, the term:
2544 (b) “Telehealth provider” means any individual who provides
2545 health care and related services using telehealth and who is
2546 licensed or certified under s. 393.17; part III of chapter 401;
2547 chapter 457; chapter 458; chapter 459; chapter 460; chapter 461;
2548 chapter 463; chapter 464; chapter 465; chapter 466; chapter 467;
2549 part I, part III, part IV, part V, part X, part XIII, or part
2550 XIV of chapter 468; chapter 478; chapter 480; part I or part II
2551 part II or part III of chapter 483; chapter 484; chapter 486;
2552 chapter 490; or chapter 491; who is licensed under a multistate
2553 health care licensure compact of which Florida is a member
2554 state; or who is registered under and complies with subsection
2555 (4).
2556 Section 61. Except as otherwise expressly provided in this
2557 act and except for this section, which shall become effective
2558 upon this act becoming a law, this act shall take effect July 1,
2559 2020.
2560
2561 ================= T I T L E A M E N D M E N T ================
2562 And the title is amended as follows:
2563 Delete everything before the enacting clause
2564 and insert:
2565 A bill to be entitled
2566 An act relating to the Agency for Health Care
2567 Administration; amending s. 383.327, F.S.; requiring
2568 birth centers to report certain deaths and stillbirths
2569 to the agency; revising the frequency with which a
2570 certain report must be submitted to the agency;
2571 authorizing the agency to prescribe by rule the
2572 frequency with which such report is submitted;
2573 amending s. 395.003, F.S.; removing a requirement that
2574 specified information be listed on licenses for
2575 certain facilities; amending s. 395.1055, F.S.;
2576 requiring the agency to adopt specified rules related
2577 to ongoing quality improvement programs for certain
2578 cardiac programs; amending s. 395.602, F.S.; revising
2579 the definition of the term “rural hospital”; repealing
2580 s. 395.7015, F.S., relating to an annual assessment on
2581 health care entities; amending s. 395.7016, F.S.;
2582 conforming a provision to changes made by the act;
2583 amending s. 400.19, F.S.; revising provisions
2584 requiring the agency to conduct licensure inspections
2585 of nursing homes; requiring the agency to conduct
2586 additional licensure surveys under certain
2587 circumstances; requiring the agency to assess a
2588 specified fine for such surveys; amending s. 400.462,
2589 F.S.; revising definitions; amending s. 400.464, F.S.;
2590 revising exemptions from licensure requirements for
2591 home health agencies; amending s. 400.471, F.S.;
2592 revising provisions related to certain application
2593 requirements for home health agencies; amending s.
2594 400.492, F.S.; revising provisions related to services
2595 provided by home health agencies during an emergency;
2596 amending s. 400.506, F.S.; revising provisions related
2597 to licensure requirements for nurse registries;
2598 amending s. 400.509, F.S.; revising provisions related
2599 to the registration of certain service providers;
2600 amending s. 400.605, F.S.; removing a requirement that
2601 the agency conduct specified inspections of certain
2602 licensees; amending s. 400.60501, F.S.; deleting an
2603 obsolete date; removing a requirement that the agency
2604 develop a specified annual report; amending s.
2605 400.9905, F.S.; revising the definition of the term
2606 “clinic”; amending s. 400.991, F.S.; removing the
2607 option for health care clinics to file a surety bond
2608 under certain circumstances; amending s. 400.9935,
2609 F.S.; revising provisions related to the schedule of
2610 charges published and posted by certain clinics;
2611 specifying that urgent care centers are subject to
2612 such requirements; amending s. 408.033, F.S.;
2613 conforming a provision to changes made by the act;
2614 amending s. 408.05, F.S.; requiring the agency to
2615 publish by a specified date an annual report
2616 identifying certain health care services; amending s.
2617 408.061, F.S.; revising provisions requiring health
2618 care facilities to submit specified data to the
2619 agency; amending s. 408.0611, F.S.; removing a
2620 requirement that the agency annually report to the
2621 Governor and the Legislature by a specified date on
2622 the progress of implementation of electronic
2623 prescribing, and instead, requiring the agency to
2624 annually publish such information on its website;
2625 amending s. 408.062, F.S.; removing requirements that
2626 the agency annually report specified information to
2627 the Governor and Legislature by a specified date and,
2628 instead, requiring the agency to annually publish such
2629 information on its website; amending s. 408.063, F.S.;
2630 removing a requirement that the agency publish certain
2631 annual reports; amending s. 408.803, F.S.; conforming
2632 a definition to changes made by the act; defining the
2633 term “low-risk provider”; amending ss. 408.802,
2634 408.820, 408.831, and 408.832, F.S.; conforming
2635 provisions to changes made by the act; amending s.
2636 408.806, F.S.; exempting certain providers from a
2637 specified inspection; amending s. 408.808, F.S.;
2638 authorizing the issuance of a provisional license to
2639 certain applicants; amending ss. 408.809 and 409.907,
2640 F.S.; revising background screening requirements for
2641 certain licensees and providers; amending s. 408.811,
2642 F.S.; authorizing the agency to grant certain
2643 providers an exemption from a specified inspection
2644 under certain circumstances; authorizing the agency to
2645 adopt rules to grant waivers of certain inspections
2646 and allow for extended inspection periods under
2647 certain circumstances; requiring the agency to conduct
2648 unannounced licensure inspections of certain providers
2649 during a specified time period; providing that the
2650 agency may conduct regulatory compliance inspections
2651 of providers at any time; amending s. 408.821, F.S.;
2652 revising provisions requiring licensees to have a
2653 specified plan; providing requirements for the
2654 submission of such plan; amending s. 408.909, F.S.;
2655 removing a requirement that the agency and Office of
2656 Insurance Regulation evaluate a specified program;
2657 amending s. 408.9091, F.S.; deleting a requirement
2658 that the agency and office submit a specified joint
2659 annual report to the Governor and Legislature;
2660 amending s. 409.905, F.S.; providing construction for
2661 a provision that requires the agency to discontinue
2662 its hospital retrospective review program under
2663 certain circumstances; providing legislative intent;
2664 amending 409.908, F.S.; revising provisions related to
2665 the prospective payment methodology for certain
2666 Medicaid provider reimbursements; repealing s. 19 of
2667 chapter 2019-116, Laws of Florida, relating to the
2668 abrogation of the scheduled expiration of an amendment
2669 to s. 408.908(23), F.S., and the scheduled reversion
2670 of the text of that subsection; amending s. 409.913,
2671 F.S.; revising the due date for a certain annual
2672 report; deleting the requirement that certain agencies
2673 submit their annual reports jointly; providing that
2674 the agency or its contractor is entitled to recover
2675 certain costs and attorney fees related to audits,
2676 investigations, or enforcement actions conducted by
2677 the agency or its contractor; amending s. 409.920,
2678 F.S.; revising provisions related to prohibited
2679 referral practices in the Medicaid program; amending
2680 ss. 409.967 and 409.973, F.S.; revising the length of
2681 managed care plan contracts procured by the agency
2682 beginning during a specified timeframe; requiring the
2683 agency to extend the term of certain existing managed
2684 care plan contracts until a specified date; amending
2685 s. 429.11, F.S.; removing an authorization for the
2686 issuance of a provisional license to certain
2687 facilities; amending s. 429.19, F.S.; removing
2688 requirements that the agency develop and disseminate a
2689 specified list and the Department of Children and
2690 Families disseminate such list to certain providers;
2691 amending ss. 429.35 and 429.905, F.S.; revising
2692 provisions requiring a biennial inspection cycle for
2693 specified facilities; amending s. 429.929, F.S.;
2694 revising provisions requiring a biennial inspection
2695 cycle for adult day care centers; amending ss.
2696 627.6387, 627.6648, and 641.31076, F.S.; revising the
2697 definition of the term “shoppable health care
2698 service”; revising duties of certain health insurers
2699 and health maintenance organizations; repealing part I
2700 of ch. 483, F.S., relating to the Florida Multiphasic
2701 Health Testing Center Law; redesignating parts II and
2702 III of ch. 483, F.S., as parts I and II, respectively;
2703 amending ss. 20.43, 381.0034, 456.001, 456.057,
2704 456.076, and 456.47, F.S.; conforming cross
2705 references; providing effective dates.