Florida Senate - 2020 CS for CS for SB 1726
By the Committees on Appropriations; and Health Policy; and
1 A bill to be entitled
2 An act relating to the Agency for Health Care
3 Administration; amending s. 383.327, F.S.; requiring
4 birth centers to report certain deaths and stillbirths
5 to the agency; revising the frequency with which a
6 certain report must be submitted to the agency;
7 authorizing the agency to prescribe by rule the
8 frequency with which such report is submitted;
9 amending s. 395.003, F.S.; removing a requirement that
10 specified information be listed on licenses for
11 certain facilities; amending s. 395.1055, F.S.;
12 requiring the agency to adopt specified rules related
13 to ongoing quality improvement programs for certain
14 cardiac programs; amending s. 395.602, F.S.; revising
15 the definition of the term “rural hospital”; repealing
16 s. 395.7015, F.S., relating to an annual assessment on
17 health care entities; amending s. 395.7016, F.S.;
18 conforming a provision to changes made by the act;
19 amending s. 400.19, F.S.; revising provisions
20 requiring the agency to conduct licensure inspections
21 of nursing homes; requiring the agency to conduct
22 additional licensure surveys under certain
23 circumstances; requiring the agency to assess a
24 specified fine for such surveys; amending s. 400.462,
25 F.S.; revising definitions; amending s. 400.464, F.S.;
26 revising exemptions from licensure requirements for
27 home health agencies; amending s. 400.471, F.S.;
28 revising provisions related to certain application
29 requirements for home health agencies; amending s.
30 400.492, F.S.; revising provisions related to services
31 provided by home health agencies during an emergency;
32 amending s. 400.506, F.S.; revising provisions related
33 to licensure requirements for nurse registries;
34 amending s. 400.509, F.S.; revising provisions related
35 to the registration of certain service providers;
36 amending s. 400.605, F.S.; removing a requirement that
37 the agency conduct specified inspections of certain
38 licensees; amending s. 400.60501, F.S.; deleting an
39 obsolete date; removing a requirement that the agency
40 develop a specified annual report; amending s.
41 400.9905, F.S.; revising the definition of the term
42 “clinic”; amending s. 400.991, F.S.; removing the
43 option for health care clinics to file a surety bond
44 under certain circumstances; amending s. 400.9935,
45 F.S.; revising provisions related to the schedule of
46 charges published and posted by certain clinics;
47 specifying that urgent care centers are subject to
48 such requirements; amending s. 408.033, F.S.;
49 conforming a provision to changes made by the act;
50 amending s. 408.05, F.S.; requiring the agency to
51 publish by a specified date an annual report
52 identifying certain health care services; amending s.
53 408.061, F.S.; revising provisions requiring health
54 care facilities to submit specified data to the
55 agency; amending s. 408.0611, F.S.; removing a
56 requirement that the agency annually report to the
57 Governor and the Legislature by a specified date on
58 the progress of implementation of electronic
59 prescribing and, instead, requiring the agency to
60 annually publish such information on its website;
61 amending s. 408.062, F.S.; removing requirements that
62 the agency annually report specified information to
63 the Governor and Legislature by a specified date and,
64 instead, requiring the agency to annually publish such
65 information on its website; amending s. 408.063, F.S.;
66 removing a requirement that the agency publish certain
67 annual reports; amending s. 408.802, F.S.; conforming
68 provisions to changes made by the act; amending s.
69 408.803, F.S.; conforming a definition to changes made
70 by the act; defining the term “low-risk provider”;
71 amending s. 408.806, F.S.; exempting certain providers
72 from a specified inspection; amending s. 408.808,
73 F.S.; authorizing the issuance of a provisional
74 license to certain applicants; amending s. 408.809,
75 F.S.; revising background screening requirements for
76 certain licensees and providers; amending s. 408.811,
77 F.S.; authorizing the agency to grant certain
78 providers an exemption from a specified inspection
79 under certain circumstances; authorizing the agency to
80 adopt rules to grant waivers of certain inspections
81 and allow for extended inspection periods under
82 certain circumstances; requiring the agency to conduct
83 unannounced licensure inspections of certain providers
84 during a specified time period; providing that the
85 agency may conduct regulatory compliance inspections
86 of providers at any time; amending s. 408.820, F.S.;
87 conforming a provision to changes made by the act;
88 amending s. 408.821, F.S.; revising provisions
89 requiring licensees to have a specified plan;
90 providing requirements for the submission of such
91 plan; amending ss. 408.831 and 408.832, F.S.;
92 conforming provisions to changes made by the act;
93 amending s. 408.909, F.S.; removing a requirement that
94 the agency and the Office of Insurance Regulation
95 evaluate a specified program; amending s. 408.9091,
96 F.S.; deleting a requirement that the agency and
97 office submit a specified joint annual report to the
98 Governor and the Legislature; amending s. 409.905,
99 F.S.; providing construction for a provision that
100 requires the agency to discontinue its hospital
101 retrospective review program under certain
102 circumstances; providing legislative intent; amending
103 s. 409.907, F.S.; requiring that a specified
104 background screening be conducted through the agency
105 on certain persons and entities; repealing s. 19 of
106 chapter 2019-116, Laws of Florida, relating to the
107 abrogation of the scheduled expiration of an amendment
108 to s. 409.908(23), F.S., and the scheduled reversion
109 of the text of that subsection; amending 409.908,
110 F.S.; revising provisions related to the prospective
111 payment methodology for certain Medicaid provider
112 reimbursements; reenacting s. 409.908(23), relating to
113 reimbursement of Medicaid providers for certain
114 services; amending s. 409.913, F.S.; revising the due
115 date for a certain annual report; deleting the
116 requirement that certain agencies submit their annual
117 reports jointly; providing that the agency or its
118 contractor is entitled to recover certain costs and
119 attorney fees related to audits, investigations, or
120 enforcement actions conducted by the agency or its
121 contractor; amending s. 409.920, F.S.; revising
122 provisions related to prohibited referral practices in
123 the Medicaid program; amending ss. 409.967 and
124 409.973, F.S.; revising the length of managed care
125 plan contracts procured by the agency beginning during
126 a specified timeframe; requiring the agency to extend
127 the term of certain existing managed care plan
128 contracts until a specified date; amending s. 429.11,
129 F.S.; removing an authorization for the issuance of a
130 provisional license to certain facilities; amending s.
131 429.19, F.S.; removing requirements that the agency
132 develop and disseminate a specified list and the
133 Department of Children and Families disseminate such
134 list to certain providers; amending ss. 429.35 and
135 429.905, F.S.; revising provisions requiring a
136 biennial inspection cycle for specified facilities;
137 amending s. 429.929, F.S.; revising provisions
138 requiring a biennial inspection cycle for adult day
139 care centers; amending ss. 627.6387, 627.6648, and
140 641.31076, F.S.; revising the definition of the term
141 “shoppable health care service”; revising the duties
142 of certain health insurers and health maintenance
143 organizations; repealing part I of ch. 483, F.S.,
144 relating to the Florida Multiphasic Health Testing
145 Center Law; redesignating parts II and III of ch. 483,
146 F.S., as parts I and II, respectively; amending ss.
147 20.43, 381.0034, 456.001, 456.057, 456.076, and
148 456.47, F.S.; conforming cross-references; providing
149 effective dates.
151 Be It Enacted by the Legislature of the State of Florida:
153 Section 1. Subsections (2) and (4) of section 383.327,
154 Florida Statutes, are amended to read:
155 383.327 Birth and death records; reports.—
156 (2) Each maternal death, newborn death, and stillbirth
157 shall be reported immediately to the medical examiner and the
159 (4) A report shall be submitted
annually to the agency. The
160 contents of the report and the frequency with which it is
161 submitted shall be prescribed by rule of the agency.
162 Section 2. Subsection (4) of section 395.003, Florida
163 Statutes, is amended to read:
164 395.003 Licensure; denial, suspension, and revocation.—
165 (4) The agency shall issue a license that which specifies
166 the service categories and the number of hospital beds in each
167 bed category for which a license is received. Such information
168 shall be listed on the face of the license. All beds which are
169 not covered by any specialty-bed-need methodology shall be
170 specified as general beds. A licensed facility shall not operate
171 a number of hospital beds greater than the number indicated by
172 the agency on the face of the license without approval from the
173 agency under conditions established by rule.
174 Section 3. Paragraph (g) is added to subsection (18) of
175 section 395.1055, Florida Statutes, to read:
176 395.1055 Rules and enforcement.—
177 (18) In establishing rules for adult cardiovascular
178 services, the agency shall include provisions that allow for:
179 (g) The requirement that hospitals licensed for adult
180 diagnostic cardiac catheterization, Level I or Level II adult
181 cardiovascular services participate in the American College of
182 Cardiology – National Cardiovascular Data Registry or the
183 American Heart Association’s Get with the Guidelines – Coronary
184 Artery Disease program registry and document an ongoing quality
185 improvement plan to ensure these licensed programs meet or
186 exceed national quality and outcome benchmarks reported by the
187 registry in which they participate. Hospitals licensed for Level
188 II adult cardiovascular services must also participate in the
189 clinical outcome reporting systems operated by the Society for
190 Thoracic Surgeons.
191 Section 4. Paragraph (b) of subsection (2) of section
192 395.602, Florida Statutes, is amended to read:
193 395.602 Rural hospitals.—
194 (2) DEFINITIONS.—As used in this part, the term:
195 (b) “Rural hospital” means an acute care hospital licensed
196 under this chapter, having 100 or fewer licensed beds and an
197 emergency room, which is:
198 1. The sole provider within a county with a population
199 density of up to 100 persons per square mile;
200 2. An acute care hospital, in a county with a population
201 density of up to 100 persons per square mile, which is at least
202 30 minutes of travel time, on normally traveled roads under
203 normal traffic conditions, from any other acute care hospital
204 within the same county;
205 3. A hospital supported by a tax district or subdistrict
206 whose boundaries encompass a population of up to 100 persons per
207 square mile;
208 4. A hospital classified as a sole community hospital under
209 42 C.F.R. s. 412.92, regardless of the number of licensed beds;
210 5. A hospital with a service area that has a population of
211 up to 100 persons per square mile. As used in this subparagraph,
212 the term “service area” means the fewest number of zip codes
213 that account for 75 percent of the hospital’s discharges for the
214 most recent 5-year period, based on information available from
215 the hospital inpatient discharge database in the Florida Center
216 for Health Information and Transparency at the agency; or
217 6. A hospital designated as a critical access hospital, as
218 defined in s. 408.07.
220 Population densities used in this paragraph must be based upon
221 the most recently completed United States census. A hospital
222 that received funds under s. 409.9116 for a quarter beginning no
223 later than July 1, 2002, is deemed to have been and shall
224 continue to be a rural hospital from that date through June 30,
225 2021, if the hospital continues to have up to 100 licensed beds
226 and an emergency room. An acute care hospital that has not
227 previously been designated as a rural hospital and that meets
228 the criteria of this paragraph shall be granted such designation
229 upon application, including supporting documentation, to the
230 agency. A hospital that was licensed as a rural hospital during
231 the 2010-2011 or 2011-2012 fiscal year shall continue to be a
232 rural hospital from the date of designation through June 30,
233 2025 2021, if the hospital continues to have up to 100 licensed
234 beds and an emergency room.
235 Section 5. Section 395.7015, Florida Statutes, is repealed.
236 Section 6. Section 395.7016, Florida Statutes, is amended
237 to read:
238 395.7016 Annual appropriation.—The Legislature shall
239 appropriate each fiscal year from either the General Revenue
240 Fund or the Agency for Health Care Administration Tobacco
241 Settlement Trust Fund an amount sufficient to replace the funds
242 lost due to reduction by chapter 2000-256, Laws of Florida, of
243 the assessment on other health care entities under s. 395.7015,
244 and the reduction by chapter 2000-256, Laws of Florida, in the
245 assessment on hospitals under s. 395.701 , and to maintain
246 federal approval of the reduced amount of funds deposited into
247 the Public Medical Assistance Trust Fund under s. 395.701 , as
248 state match for the state’s Medicaid program.
249 Section 7. Subsection (3) of section 400.19, Florida
250 Statutes, is amended to read:
251 400.19 Right of entry and inspection.—
252 (3) The agency shall conduct periodic, every 15 months
253 conduct at least one unannounced licensure inspections
254 inspection to determine compliance by the licensee with
255 statutes, and with rules adopted promulgated under the
256 provisions of those statutes, governing minimum standards of
257 construction, quality and adequacy of care, and rights of
258 residents. The survey shall be conducted every 6 months for the
259 next 2-year period If the facility has been cited for a class I
260 deficiency or , has been cited for two or more class II
261 deficiencies arising from separate surveys or investigations
262 within a 60-day period, the agency shall conduct licensure
263 surveys every 6 months until the facility has two consecutive
264 licensure surveys without a citation for a class I or a class II
265 deficiency or has had three or more substantiated complaints
266 within a 6-month period, each resulting in at least one class I
267 or class II deficiency. In addition to any other fees or fines
268 in this part, the agency shall assess a fine of for each
269 facility that is subject to the 6-month survey cycle . The fine
270 for the 2-year period shall be $6,000 for the additional 6-month
271 licensure surveys , one-half to be paid at the completion of each
272 survey. The agency may adjust such this fine by the change in
273 the Consumer Price Index, based on the 12 months immediately
274 preceding the increase, to cover the cost of the additional
275 surveys. The agency shall verify through subsequent inspection
276 that any deficiency identified during inspection is corrected.
277 However, the agency may verify the correction of a class III or
278 class IV deficiency unrelated to resident rights or resident
279 care without reinspecting the facility if adequate written
280 documentation has been received from the facility, which
281 provides assurance that the deficiency has been corrected. The
282 giving or causing to be given of advance notice of such
283 unannounced inspections by an employee of the agency to any
284 unauthorized person shall constitute cause for suspension of not
285 fewer than 5 working days according to the provisions of chapter
287 Section 8. Subsections (12), (14), (17), (21), and (22) of
288 section 400.462, Florida Statutes, are amended to read:
289 400.462 Definitions.—As used in this part, the term:
290 (12) “Home health agency” means a person who an
291 organization that provides one or more home health services and
292 staffing services.
293 (14) “Home health services” means health and medical
294 services and medical supplies furnished by an organization to an
295 individual in the individual’s home or place of residence. The
296 term includes organizations that provide one or more of the
298 (a) Nursing care.
299 (b) Physical, occupational, respiratory, or speech therapy.
300 (c) Home health aide services.
301 (d) Dietetics and nutrition practice and nutrition
303 (e) Medical supplies, restricted to drugs and biologicals
304 prescribed by a physician.
305 (17) “Home infusion therapy provider” means a person who an
306 organization that employs, contracts with, or refers a licensed
307 professional who has received advanced training and experience
308 in intravenous infusion therapy and who administers infusion
309 therapy to a patient in the patient’s home or place of
311 (21) “Nurse registry” means any person who that procures,
312 offers, promises, or attempts to secure health-care-related
313 contracts for registered nurses, licensed practical nurses,
314 certified nursing assistants, home health aides, companions, or
315 homemakers, who are compensated by fees as independent
316 contractors, including, but not limited to, contracts for the
317 provision of services to patients and contracts to provide
318 private duty or staffing services to health care facilities
319 licensed under chapter 395, this chapter, or chapter 429 or
320 other business entities.
321 (22) “Organization” means a corporation, government or
322 governmental subdivision or agency, partnership or association,
323 or any other legal or commercial entity, any of which involve
324 more than one health care professional discipline; a health care
325 professional and a home health aide or certified nursing
326 assistant; more than one home health aide; more than one
327 certified nursing assistant; or a home health aide and a
328 certified nursing assistant. The term does not include an entity
329 that provides services using only volunteers or only individuals
330 related by blood or marriage to the patient or client.
331 Section 9. Subsection (1), paragraph (a) of subsection (4),
332 and subsection (5) of section 400.464, Florida Statutes, are
333 amended to read:
334 400.464 Home health agencies to be licensed; expiration of
335 license; exemptions; unlawful acts; penalties.—
336 (1) The requirements of part II of chapter 408 apply to the
337 provision of services that require licensure pursuant to this
338 part and part II of chapter 408 and entities licensed or
339 registered by or applying for such licensure or registration
340 from the Agency for Health Care Administration pursuant to this
341 part. A license issued by the agency is required in order to
342 operate a home health agency in this state. A license issued on
343 or after July 1, 2018, must specify the home health services the
344 licensee organization is authorized to perform and indicate
345 whether such specified services are considered skilled care. The
346 provision or advertising of services that require licensure
347 pursuant to this part without such services being specified on
348 the face of the license issued on or after July 1, 2018,
349 constitutes unlicensed activity as prohibited under s. 408.812.
350 (4)(a) A licensee An organization that offers or advertises
351 to the public any service for which licensure or registration is
352 required under this part must include in the advertisement the
353 license number or registration number issued to the licensee
354 organization by the agency. The agency shall assess a fine of
355 not less than $100 to any licensee or registrant who fails to
356 include the license or registration number when submitting the
357 advertisement for publication, broadcast, or printing. The fine
358 for a second or subsequent offense is $500. The holder of a
359 license issued under this part may not advertise or indicate to
360 the public that it holds a home health agency or nurse registry
361 license other than the one it has been issued.
362 (5) The following are exempt from the licensure as a home
363 health agency under requirements of this part:
364 (a) A home health agency operated by the Federal
366 (b) Home health services provided by a state agency, either
367 directly or through a contractor with:
368 1. The Department of Elderly Affairs.
369 2. The Department of Health, a community health center, or
370 a rural health network that furnishes home visits for the
371 purpose of providing environmental assessments, case management,
372 health education, personal care services, family planning, or
373 followup treatment, or for the purpose of monitoring and
374 tracking disease.
375 3. Services provided to persons with developmental
376 disabilities, as defined in s. 393.063.
377 4. Companion and sitter organizations that were registered
378 under s. 400.509(1) on January 1, 1999, and were authorized to
379 provide personal services under a developmental services
380 provider certificate on January 1, 1999, may continue to provide
381 such services to past, present, and future clients of the
382 organization who need such services, notwithstanding the
383 provisions of this act.
384 5. The Department of Children and Families.
385 (c) A health care professional, whether or not
386 incorporated, who is licensed under chapter 457; chapter 458;
387 chapter 459; part I of chapter 464; chapter 467; part I, part
388 III, part V, or part X of chapter 468; chapter 480; chapter 486;
389 chapter 490; or chapter 491; and who is acting alone within the
390 scope of his or her professional license to provide care to
391 patients in their homes.
392 (d) A home health aide or certified nursing assistant who
393 is acting in his or her individual capacity, within the
394 definitions and standards of his or her occupation, and who
395 provides hands-on care to patients in their homes.
396 (e) An individual who acts alone, in his or her individual
397 capacity, and who is not employed by or affiliated with a
398 licensed home health agency or registered with a licensed nurse
399 registry. This exemption does not entitle an individual to
400 perform home health services without the required professional
402 (f) The delivery of instructional services in home dialysis
403 and home dialysis supplies and equipment.
404 (g) The delivery of nursing home services for which the
405 nursing home is licensed under part II of this chapter, to serve
406 its residents in its facility.
407 (h) The delivery of assisted living facility services for
408 which the assisted living facility is licensed under part I of
409 chapter 429, to serve its residents in its facility.
410 (i) The delivery of hospice services for which the hospice
411 is licensed under part IV of this chapter, to serve hospice
412 patients admitted to its service.
413 (j) A hospital that provides services for which it is
414 licensed under chapter 395.
415 (k) The delivery of community residential services for
416 which the community residential home is licensed under chapter
417 419, to serve the residents in its facility.
418 (l) A not-for-profit, community-based agency that provides
419 early intervention services to infants and toddlers.
420 (m) Certified rehabilitation agencies and comprehensive
421 outpatient rehabilitation facilities that are certified under
422 Title 18 of the Social Security Act.
423 (n) The delivery of adult family-care home services for
424 which the adult family-care home is licensed under part II of
425 chapter 429, to serve the residents in its facility.
426 (o) A person who provides skilled care by health care
427 professionals licensed solely under part I of chapter 464; part
428 I, part III, or part V of chapter 468; or chapter 486. This
429 exemption does not authorize an individual to perform home
430 health services without the required professional license.
431 (p) A person or entity that provides services using only
432 volunteers or only individuals related by blood or marriage to
433 the patient or client.
434 Section 10. Paragraph (g) of subsection (2) of section
435 400.471, Florida Statutes, is amended to read:
436 400.471 Application for license; fee.—
437 (2) In addition to the requirements of part II of chapter
438 408, the initial applicant, the applicant for a change of
439 ownership, and the applicant for the addition of skilled care
440 services must file with the application satisfactory proof that
441 the home health agency is in compliance with this part and
442 applicable rules, including:
443 (g) In the case of an application for initial licensure, an
444 application for a change of ownership, or an application for the
445 addition of skilled care services, documentation of
446 accreditation, or an application for accreditation, from an
447 accrediting organization that is recognized by the agency as
448 having standards comparable to those required by this part and
449 part II of chapter 408. A home health agency that does not
450 provide skilled care is exempt from this paragraph.
451 Notwithstanding s. 408.806, the an initial applicant must
452 provide proof of accreditation that is not conditional or
453 provisional and a survey demonstrating compliance with the
454 requirements of this part, part II of chapter 408, and
455 applicable rules from an accrediting organization that is
456 recognized by the agency as having standards comparable to those
457 required by this part and part II of chapter 408 within 120 days
458 after the date of the agency’s receipt of the application for
459 licensure. Such accreditation must be continuously maintained by
460 the home health agency to maintain licensure. The agency shall
461 accept, in lieu of its own periodic licensure survey, the
462 submission of the survey of an accrediting organization that is
463 recognized by the agency if the accreditation of the licensed
464 home health agency is not provisional and if the licensed home
465 health agency authorizes release of, and the agency receives the
466 report of, the accrediting organization.
467 Section 11. Section 400.492, Florida Statutes, is amended
468 to read:
469 400.492 Provision of services during an emergency.—Each
470 home health agency shall prepare and maintain a comprehensive
471 emergency management plan that is consistent with the standards
472 adopted by national or state accreditation organizations and
473 consistent with the local special needs plan. The plan shall be
474 updated annually and shall provide for continuing home health
475 services during an emergency that interrupts patient care or
476 services in the patient’s home. The plan shall include the means
477 by which the home health agency will continue to provide staff
478 to perform the same type and quantity of services to their
479 patients who evacuate to special needs shelters that were being
480 provided to those patients prior to evacuation. The plan shall
481 describe how the home health agency establishes and maintains an
482 effective response to emergencies and disasters, including:
483 notifying staff when emergency response measures are initiated;
484 providing for communication between staff members, county health
485 departments, and local emergency management agencies, including
486 a backup system; identifying resources necessary to continue
487 essential care or services or referrals to other health care
488 providers organizations subject to written agreement; and
489 prioritizing and contacting patients who need continued care or
491 (1) Each patient record for patients who are listed in the
492 registry established pursuant to s. 252.355 shall include a
493 description of how care or services will be continued in the
494 event of an emergency or disaster. The home health agency shall
495 discuss the emergency provisions with the patient and the
496 patient’s caregivers, including where and how the patient is to
497 evacuate, procedures for notifying the home health agency in the
498 event that the patient evacuates to a location other than the
499 shelter identified in the patient record, and a list of
500 medications and equipment which must either accompany the
501 patient or will be needed by the patient in the event of an
503 (2) Each home health agency shall maintain a current
504 prioritized list of patients who need continued services during
505 an emergency. The list shall indicate how services shall be
506 continued in the event of an emergency or disaster for each
507 patient and if the patient is to be transported to a special
508 needs shelter, and shall indicate if the patient is receiving
509 skilled nursing services and the patient’s medication and
510 equipment needs. The list shall be furnished to county health
511 departments and to local emergency management agencies, upon
513 (3) Home health agencies shall not be required to continue
514 to provide care to patients in emergency situations that are
515 beyond their control and that make it impossible to provide
516 services, such as when roads are impassable or when patients do
517 not go to the location specified in their patient records. Home
518 health agencies may establish links to local emergency
519 operations centers to determine a mechanism by which to approach
520 specific areas within a disaster area in order for the agency to
521 reach its clients. Home health agencies shall demonstrate a good
522 faith effort to comply with the requirements of this subsection
523 by documenting attempts of staff to follow procedures outlined
524 in the home health agency’s comprehensive emergency management
525 plan, and by the patient’s record, which support a finding that
526 the provision of continuing care has been attempted for those
527 patients who have been identified as needing care by the home
528 health agency and registered under s. 252.355, in the event of
529 an emergency or disaster under subsection (1).
530 (4) Notwithstanding the provisions of s. 400.464(2) or any
531 other provision of law to the contrary, a home health agency may
532 provide services in a special needs shelter located in any
534 Section 12. Subsection (4) and paragraph (a) of subsection
535 (5) of section 400.506, Florida Statutes, are amended to read:
536 400.506 Licensure of nurse registries; requirements;
538 (4) A licensee who person that provides, offers, or
539 advertises to the public any service for which licensure is
540 required under this section must include in such advertisement
541 the license number issued to the licensee it by the Agency for
542 Health Care Administration. The agency shall assess a fine of
543 not less than $100 against any licensee who fails to include the
544 license number when submitting the advertisement for
545 publication, broadcast, or printing. The fine for a second or
546 subsequent offense is $500.
547 (5)(a) In addition to the requirements of s. 408.812, any
548 person or entity that who owns, operates, or maintains an
549 unlicensed nurse registry and who, after receiving notification
550 from the agency, fails to cease operation and apply for a
551 license under this part commits a misdemeanor of the second
552 degree, punishable as provided in s. 775.082 or s. 775.083. Each
553 day of continued operation is a separate offense.
554 Section 13. Subsections (1), (2), (4), and (5) of section
555 400.509, Florida Statutes, are amended to read:
556 400.509 Registration of particular service providers exempt
557 from licensure; certificate of registration; regulation of
559 (1) Any person who organization that provides companion
560 services or homemaker services and does not provide a home
561 health service to a person is exempt from licensure under this
562 part. However, any person who organization that provides
563 companion services or homemaker services must register with the
564 agency. A person An organization under contract with the Agency
565 for Persons with Disabilities who which provides companion
566 services only for persons with a developmental disability, as
567 defined in s. 393.063, is exempt from registration.
568 (2) The requirements of part II of chapter 408 apply to the
569 provision of services that require registration or licensure
570 pursuant to this section and part II of chapter 408 and entities
571 registered by or applying for such registration from the Agency
572 for Health Care Administration pursuant to this section. Each
573 applicant for registration and each registrant must comply with
574 all provisions of part II of chapter 408. Registration or a
575 license issued by the agency is required for a person to provide
576 the operation of an organization that provides companion
577 services or homemaker services.
578 (4) Each registrant must obtain the employment or contract
579 history of persons who are employed by or under contract with
580 the person organization and who will have contact at any time
581 with patients or clients in their homes by:
582 (a) Requiring such persons to submit an employment or
583 contractual history to the registrant; and
584 (b) Verifying the employment or contractual history, unless
585 through diligent efforts such verification is not possible. The
586 agency shall prescribe by rule the minimum requirements for
587 establishing that diligent efforts have been made.
589 There is no monetary liability on the part of, and no cause of
590 action for damages arises against, a former employer of a
591 prospective employee of or prospective independent contractor
592 with a registrant who reasonably and in good faith communicates
593 his or her honest opinions about the former employee’s or
594 contractor’s job performance. This subsection does not affect
595 the official immunity of an officer or employee of a public
597 (5) A person who that offers or advertises to the public a
598 service for which registration is required must include in its
599 advertisement the registration number issued by the Agency for
600 Health Care Administration.
601 Section 14. Subsection (3) of section 400.605, Florida
602 Statutes, is amended to read:
603 400.605 Administration; forms; fees; rules; inspections;
605 (3) In accordance with s. 408.811, the agency shall conduct
606 annual inspections of all licensees, except that licensure
607 inspections may be conducted biennially for hospices having a 3
608 year record of substantial compliance. The agency shall conduct
609 such inspections and investigations as are necessary in order to
610 determine the state of compliance with the provisions of this
611 part, part II of chapter 408, and applicable rules.
612 Section 15. Section 400.60501, Florida Statutes, is amended
613 to read:
614 400.60501 Outcome measures; adoption of federal quality
615 measures; public reporting ; annual report.—
616 (1) No later than December 31, 2019, The agency shall adopt
617 the national hospice outcome measures and survey data in 42
618 C.F.R. part 418 to determine the quality and effectiveness of
619 hospice care for hospices licensed in the state.
620 (2) The agency shall :
621 (a) make available to the public the national hospice
622 outcome measures and survey data in a format that is
623 comprehensible by a layperson and that allows a consumer to
624 compare such measures of one or more hospices.
625 (b) Develop an annual report that analyzes and evaluates
626 the information collected under this act and any other data
627 collection or reporting provisions of law.
628 Section 16. Subsection (4) of section 400.9905, Florida
629 Statutes, is amended to read:
630 400.9905 Definitions.—
631 (4) “Clinic” means an entity where health care services are
632 provided to individuals and which tenders charges for
633 reimbursement for such services, including a mobile clinic and a
634 portable equipment provider. As used in this part, the term does
635 not include and the licensure requirements of this part do not
636 apply to:
637 (a) Entities licensed or registered by the state under
638 chapter 395; entities licensed or registered by the state and
639 providing only health care services within the scope of services
640 authorized under their respective licenses under ss. 383.30
641 383.332, chapter 390, chapter 394, chapter 397, this chapter
642 except part X, chapter 429, chapter 463, chapter 465, chapter
643 466, chapter 478, chapter 484, or chapter 651; end-stage renal
644 disease providers authorized under 42 C.F.R. part 405, subpart
645 U; providers certified and providing only health care services
646 within the scope of services authorized under their respective
647 certifications under 42 C.F.R. part 485, subpart B, or subpart
648 H, or subpart J; providers certified and providing only health
649 care services within the scope of services authorized under
650 their respective certifications under 42 C.F.R. part 486,
651 subpart C; providers certified and providing only health care
652 services within the scope of services authorized under their
653 respective certifications under 42 C.F.R. part 491, subpart A;
654 providers certified by the Centers for Medicare and Medicaid
655 Services under the federal Clinical Laboratory Improvement
656 Amendments and the federal rules adopted thereunder; or any
657 entity that provides neonatal or pediatric hospital-based health
658 care services or other health care services by licensed
659 practitioners solely within a hospital licensed under chapter
661 (b) Entities that own, directly or indirectly, entities
662 licensed or registered by the state pursuant to chapter 395;
663 entities that own, directly or indirectly, entities licensed or
664 registered by the state and providing only health care services
665 within the scope of services authorized pursuant to their
666 respective licenses under ss. 383.30-383.332, chapter 390,
667 chapter 394, chapter 397, this chapter except part X, chapter
668 429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
669 484, or chapter 651; end-stage renal disease providers
670 authorized under 42 C.F.R. part 405, subpart U; providers
671 certified and providing only health care services within the
672 scope of services authorized under their respective
673 certifications under 42 C.F.R. part 485, subpart B, or subpart
674 H, or subpart J; providers certified and providing only health
675 care services within the scope of services authorized under
676 their respective certifications under 42 C.F.R. part 486,
677 subpart C; providers certified and providing only health care
678 services within the scope of services authorized under their
679 respective certifications under 42 C.F.R. part 491, subpart A;
680 providers certified by the Centers for Medicare and Medicaid
681 Services under the federal Clinical Laboratory Improvement
682 Amendments and the federal rules adopted thereunder; or any
683 entity that provides neonatal or pediatric hospital-based health
684 care services by licensed practitioners solely within a hospital
685 licensed under chapter 395.
686 (c) Entities that are owned, directly or indirectly, by an
687 entity licensed or registered by the state pursuant to chapter
688 395; entities that are owned, directly or indirectly, by an
689 entity licensed or registered by the state and providing only
690 health care services within the scope of services authorized
691 pursuant to their respective licenses under ss. 383.30-383.332,
692 chapter 390, chapter 394, chapter 397, this chapter except part
693 X, chapter 429, chapter 463, chapter 465, chapter 466, chapter
694 478, chapter 484, or chapter 651; end-stage renal disease
695 providers authorized under 42 C.F.R. part 405, subpart U;
696 providers certified and providing only health care services
697 within the scope of services authorized under their respective
698 certifications under 42 C.F.R. part 485, subpart B, or subpart
699 H, or subpart J; providers certified and providing only health
700 care services within the scope of services authorized under
701 their respective certifications under 42 C.F.R. part 486,
702 subpart C; providers certified and providing only health care
703 services within the scope of services authorized under their
704 respective certifications under 42 C.F.R. part 491, subpart A;
705 providers certified by the Centers for Medicare and Medicaid
706 Services under the federal Clinical Laboratory Improvement
707 Amendments and the federal rules adopted thereunder; or any
708 entity that provides neonatal or pediatric hospital-based health
709 care services by licensed practitioners solely within a hospital
710 under chapter 395.
711 (d) Entities that are under common ownership, directly or
712 indirectly, with an entity licensed or registered by the state
713 pursuant to chapter 395; entities that are under common
714 ownership, directly or indirectly, with an entity licensed or
715 registered by the state and providing only health care services
716 within the scope of services authorized pursuant to their
717 respective licenses under ss. 383.30-383.332, chapter 390,
718 chapter 394, chapter 397, this chapter except part X, chapter
719 429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
720 484, or chapter 651; end-stage renal disease providers
721 authorized under 42 C.F.R. part 405, subpart U; providers
722 certified and providing only health care services within the
723 scope of services authorized under their respective
724 certifications under 42 C.F.R. part 485, subpart B, or subpart
725 H, or subpart J; providers certified and providing only health
726 care services within the scope of services authorized under
727 their respective certifications under 42 C.F.R. part 486,
728 subpart C; providers certified and providing only health care
729 services within the scope of services authorized under their
730 respective certifications under 42 C.F.R. part 491, subpart A;
731 providers certified by the Centers for Medicare and Medicaid
732 Services under the federal Clinical Laboratory Improvement
733 Amendments and the federal rules adopted thereunder; or any
734 entity that provides neonatal or pediatric hospital-based health
735 care services by licensed practitioners solely within a hospital
736 licensed under chapter 395.
737 (e) An entity that is exempt from federal taxation under 26
738 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
739 under 26 U.S.C. s. 409 that has a board of trustees at least
740 two-thirds of which are Florida-licensed health care
741 practitioners and provides only physical therapy services under
742 physician orders, any community college or university clinic,
743 and any entity owned or operated by the federal or state
744 government, including agencies, subdivisions, or municipalities
746 (f) A sole proprietorship, group practice, partnership, or
747 corporation that provides health care services by physicians
748 covered by s. 627.419, that is directly supervised by one or
749 more of such physicians, and that is wholly owned by one or more
750 of those physicians or by a physician and the spouse, parent,
751 child, or sibling of that physician.
752 (g) A sole proprietorship, group practice, partnership, or
753 corporation that provides health care services by licensed
754 health care practitioners under chapter 457, chapter 458,
755 chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
756 chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
757 chapter 490, chapter 491, or part I, part III, part X, part
758 XIII, or part XIV of chapter 468, or s. 464.012, and that is
759 wholly owned by one or more licensed health care practitioners,
760 or the licensed health care practitioners set forth in this
761 paragraph and the spouse, parent, child, or sibling of a
762 licensed health care practitioner if one of the owners who is a
763 licensed health care practitioner is supervising the business
764 activities and is legally responsible for the entity’s
765 compliance with all federal and state laws. However, a health
766 care practitioner may not supervise services beyond the scope of
767 the practitioner’s license, except that, for the purposes of
768 this part, a clinic owned by a licensee in s. 456.053(3)(b)
769 which provides only services authorized pursuant to s.
770 456.053(3)(b) may be supervised by a licensee specified in s.
772 (h) Clinical facilities affiliated with an accredited
773 medical school at which training is provided for medical
774 students, residents, or fellows.
775 (i) Entities that provide only oncology or radiation
776 therapy services by physicians licensed under chapter 458 or
777 chapter 459 or entities that provide oncology or radiation
778 therapy services by physicians licensed under chapter 458 or
779 chapter 459 which are owned by a corporation whose shares are
780 publicly traded on a recognized stock exchange.
781 (j) Clinical facilities affiliated with a college of
782 chiropractic accredited by the Council on Chiropractic Education
783 at which training is provided for chiropractic students.
784 (k) Entities that provide licensed practitioners to staff
785 emergency departments or to deliver anesthesia services in
786 facilities licensed under chapter 395 and that derive at least
787 90 percent of their gross annual revenues from the provision of
788 such services. Entities claiming an exemption from licensure
789 under this paragraph must provide documentation demonstrating
791 (l) Orthotic, prosthetic, pediatric cardiology, or
792 perinatology clinical facilities or anesthesia clinical
793 facilities that are not otherwise exempt under paragraph (a) or
794 paragraph (k) and that are a publicly traded corporation or are
795 wholly owned, directly or indirectly, by a publicly traded
796 corporation. As used in this paragraph, a publicly traded
797 corporation is a corporation that issues securities traded on an
798 exchange registered with the United States Securities and
799 Exchange Commission as a national securities exchange.
800 (m) Entities that are owned by a corporation that has $250
801 million or more in total annual sales of health care services
802 provided by licensed health care practitioners where one or more
803 of the persons responsible for the operations of the entity is a
804 health care practitioner who is licensed in this state and who
805 is responsible for supervising the business activities of the
806 entity and is responsible for the entity’s compliance with state
807 law for purposes of this part.
808 (n) Entities that employ 50 or more licensed health care
809 practitioners licensed under chapter 458 or chapter 459 where
810 the billing for medical services is under a single tax
811 identification number. The application for exemption under this
812 subsection shall contain information that includes: the name,
813 residence, and business address and phone number of the entity
814 that owns the practice; a complete list of the names and contact
815 information of all the officers and directors of the
816 corporation; the name, residence address, business address, and
817 medical license number of each licensed Florida health care
818 practitioner employed by the entity; the corporate tax
819 identification number of the entity seeking an exemption; a
820 listing of health care services to be provided by the entity at
821 the health care clinics owned or operated by the entity and a
822 certified statement prepared by an independent certified public
823 accountant which states that the entity and the health care
824 clinics owned or operated by the entity have not received
825 payment for health care services under personal injury
826 protection insurance coverage for the preceding year. If the
827 agency determines that an entity which is exempt under this
828 subsection has received payments for medical services under
829 personal injury protection insurance coverage, the agency may
830 deny or revoke the exemption from licensure under this
832 (o) Entities that are, directly or indirectly, under the
833 common ownership of or that are subject to common control by a
834 mutual insurance holding company, as defined in s. 628.703, with
835 an entity licensed or certified under chapter 627 or chapter 641
836 which has $1 billion or more in total annual sales in this
838 (p) Entities that are owned by an entity that is a
839 behavioral health service provider in at least 5 states other
840 than Florida and that, together with its affiliates, has $90
841 million or more in total annual revenues associated with the
842 provision of behavioral health services and where one or more of
843 the persons responsible for the operations of the entity is a
844 health care practitioner who is licensed in this state and who
845 is responsible for supervising the business activities of the
846 entity and for the entity’s compliance with state law for
847 purposes of this part.
848 (q) Medicaid providers.
850 Notwithstanding this subsection, an entity shall be deemed a
851 clinic and must be licensed under this part in order to receive
852 reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
853 627.730-627.7405, unless exempted under s. 627.736(5)(h).
854 Section 17. Paragraph (c) of subsection (3) of section
855 400.991, Florida Statutes, is amended to read:
856 400.991 License requirements; background screenings;
858 (3) In addition to the requirements of part II of chapter
859 408, the applicant must file with the application satisfactory
860 proof that the clinic is in compliance with this part and
861 applicable rules, including:
862 (c) Proof of financial ability to operate as required under
863 ss. 408.8065(1) and 408.810(8) s. 408.810(8). As an alternative
864 to submitting proof of financial ability to operate as required
865 under s. 408.810(8), the applicant may file a surety bond of at
866 least $500,000 which guarantees that the clinic will act in full
867 conformity with all legal requirements for operating a clinic,
868 payable to the agency. The agency may adopt rules to specify
869 related requirements for such surety bond.
870 Section 18. Paragraph (i) of subsection (1) of section
871 400.9935, Florida Statutes, is amended to read:
872 400.9935 Clinic responsibilities.—
873 (1) Each clinic shall appoint a medical director or clinic
874 director who shall agree in writing to accept legal
875 responsibility for the following activities on behalf of the
876 clinic. The medical director or the clinic director shall:
877 (i) Ensure that the clinic publishes a schedule of charges
878 for the medical services offered to patients. The schedule must
879 include the prices charged to an uninsured person paying for
880 such services by cash, check, credit card, or debit card. The
881 schedule may group services by price levels, listing services in
882 each price level. The schedule must be posted in a conspicuous
883 place in the reception area of any clinic that is an the urgent
884 care center as defined in s. 395.002(29)(b) and must include,
885 but is not limited to, the 50 services most frequently provided
886 by the clinic. The schedule may group services by three price
887 levels, listing services in each price level. The posting may be
888 a sign that must be at least 15 square feet in size or through
889 an electronic messaging board that is at least 3 square feet in
890 size. The failure of a clinic, including a clinic that is an
891 urgent care center, to publish and post a schedule of charges as
892 required by this section shall result in a fine of not more than
893 $1,000, per day, until the schedule is published and posted.
894 Section 19. Paragraph (a) of subsection (2) of section
895 408.033, Florida Statutes, is amended to read:
896 408.033 Local and state health planning.—
897 (2) FUNDING.—
898 (a) The Legislature intends that the cost of local health
899 councils be borne by assessments on selected health care
900 facilities subject to facility licensure by the Agency for
901 Health Care Administration, including abortion clinics, assisted
902 living facilities, ambulatory surgical centers, birth centers,
903 home health agencies, hospices, hospitals, intermediate care
904 facilities for the developmentally disabled, nursing homes, and
905 health care clinics, and multiphasic testing centers and by
906 assessments on organizations subject to certification by the
907 agency pursuant to chapter 641, part III, including health
908 maintenance organizations and prepaid health clinics. Fees
909 assessed may be collected prospectively at the time of licensure
910 renewal and prorated for the licensure period.
911 Section 20. Effective January 1, 2021, paragraph (l) is
912 added to subsection (3) of section 408.05, Florida Statutes, to
914 408.05 Florida Center for Health Information and
916 (3) HEALTH INFORMATION TRANSPARENCY.—In order to
917 disseminate and facilitate the availability of comparable and
918 uniform health information, the agency shall perform the
919 following functions:
920 (l) By July 1 of each year, publish a report identifying
921 the health care services with the most significant price
922 variation both statewide and regionally.
923 Section 21. Paragraph (a) of subsection (1) of section
924 408.061, Florida Statutes, is amended to read:
925 408.061 Data collection; uniform systems of financial
926 reporting; information relating to physician charges;
927 confidential information; immunity.—
928 (1) The agency shall require the submission by health care
929 facilities, health care providers, and health insurers of data
930 necessary to carry out the agency’s duties and to facilitate
931 transparency in health care pricing data and quality measures.
932 Specifications for data to be collected under this section shall
933 be developed by the agency and applicable contract vendors, with
934 the assistance of technical advisory panels including
935 representatives of affected entities, consumers, purchasers, and
936 such other interested parties as may be determined by the
938 (a) Data submitted by health care facilities, including the
939 facilities as defined in chapter 395, shall include, but are not
940 limited to, : case-mix data, patient admission and discharge
941 data, hospital emergency department data which shall include the
942 number of patients treated in the emergency department of a
943 licensed hospital reported by patient acuity level, data on
944 hospital-acquired infections as specified by rule, data on
945 complications as specified by rule, data on readmissions as
946 specified by rule, including patient- with patient and provider
947 specific identifiers included, actual charge data by diagnostic
948 groups or other bundled groupings as specified by rule,
949 financial data, accounting data, operating expenses, expenses
950 incurred for rendering services to patients who cannot or do not
951 pay, interest charges, depreciation expenses based on the
952 expected useful life of the property and equipment involved, and
953 demographic data. The agency shall adopt nationally recognized
954 risk adjustment methodologies or software consistent with the
955 standards of the Agency for Healthcare Research and Quality and
956 as selected by the agency for all data submitted as required by
957 this section. Data may be obtained from documents including such
958 as, but not limited to, : leases, contracts, debt instruments,
959 itemized patient statements or bills, medical record abstracts,
960 and related diagnostic information. Reported Data elements shall
961 be reported electronically in accordance with the inpatient data
962 reporting instructions as prescribed by agency rule 59E-7.012,
963 Florida Administrative Code. Data submitted shall be certified
964 by the chief executive officer or an appropriate and duly
965 authorized representative or employee of the licensed facility
966 that the information submitted is true and accurate.
967 Section 22. Subsection (4) of section 408.0611, Florida
968 Statutes, is amended to read:
969 408.0611 Electronic prescribing clearinghouse.—
970 (4) Pursuant to s. 408.061, the agency shall monitor the
971 implementation of electronic prescribing by health care
972 practitioners, health care facilities, and pharmacies. By
973 January 31 of each year, The agency shall report annually on its
974 website on the progress of implementation of electronic
975 prescribing to the Governor and the Legislature. Information
976 reported pursuant to this subsection must shall include federal
977 and private sector electronic prescribing initiatives and, to
978 the extent that data is readily available from organizations
979 that operate electronic prescribing networks, the number of
980 health care practitioners using electronic prescribing and the
981 number of prescriptions electronically transmitted.
982 Section 23. Paragraphs (i) and (j) of subsection (1) of
983 section 408.062, Florida Statutes, are amended to read:
984 408.062 Research, analyses, studies, and reports.—
985 (1) The agency shall conduct research, analyses, and
986 studies relating to health care costs and access to and quality
987 of health care services as access and quality are affected by
988 changes in health care costs. Such research, analyses, and
989 studies shall include, but not be limited to:
990 (i) The use of emergency department services by patient
991 acuity level and the implication of increasing hospital cost by
992 providing nonurgent care in emergency departments. The agency
993 shall annually publish on its website information submit an
994 annual report based on this monitoring and assessment to the
995 Governor, the Speaker of the House of Representatives, the
996 President of the Senate, and the substantive legislative
997 committees, due January 1.
998 (j) The making available on its Internet website, and in a
999 hard-copy format upon request, of patient charge, volumes,
1000 length of stay, and performance indicators collected from health
1001 care facilities pursuant to s. 408.061(1)(a) for specific
1002 medical conditions, surgeries, and procedures provided in
1003 inpatient and outpatient facilities as determined by the agency.
1004 In making the determination of specific medical conditions,
1005 surgeries, and procedures to include, the agency shall consider
1006 such factors as volume, severity of the illness, urgency of
1007 admission, individual and societal costs, and whether the
1008 condition is acute or chronic. Performance outcome indicators
1009 shall be risk adjusted or severity adjusted, as applicable,
1010 using nationally recognized risk adjustment methodologies or
1011 software consistent with the standards of the Agency for
1012 Healthcare Research and Quality and as selected by the agency.
1013 The website shall also provide an interactive search that allows
1014 consumers to view and compare the information for specific
1015 facilities, a map that allows consumers to select a county or
1016 region, definitions of all of the data, descriptions of each
1017 procedure, and an explanation about why the data may differ from
1018 facility to facility. Such public data shall be updated
1019 quarterly. The agency shall annually publish on its website
1020 information submit an annual status report on the collection of
1021 data and publication of health care quality measures to the
1022 Governor, the Speaker of the House of Representatives, the
1023 President of the Senate, and the substantive legislative
1024 committees, due January 1.
1025 Section 24. Subsection (5) of section 408.063, Florida
1026 Statutes, is amended to read:
1027 408.063 Dissemination of health care information.—
1028 (5) The agency shall publish annually a comprehensive
1029 report of state health expenditures. The report shall identify:
1030 (a) The contribution of health care dollars made by all
1032 (b) The dollars expended by type of health care service in
1034 Section 25. Section 408.802, Florida Statutes, is amended
1035 to read:
1036 408.802 Applicability.— The provisions of This part applies
1037 apply to the provision of services that require licensure as
1038 defined in this part and to the following entities licensed,
1039 registered, or certified by the agency, as described in chapters
1040 112, 383, 390, 394, 395, 400, 429, 440, 483, and 765:
1041 (1) Laboratories authorized to perform testing under the
1042 Drug-Free Workplace Act, as provided under ss. 112.0455 and
1044 (2) Birth centers, as provided under chapter 383.
1045 (3) Abortion clinics, as provided under chapter 390.
1046 (4) Crisis stabilization units, as provided under parts I
1047 and IV of chapter 394.
1048 (5) Short-term residential treatment facilities, as
1049 provided under parts I and IV of chapter 394.
1050 (6) Residential treatment facilities, as provided under
1051 part IV of chapter 394.
1052 (7) Residential treatment centers for children and
1053 adolescents, as provided under part IV of chapter 394.
1054 (8) Hospitals, as provided under part I of chapter 395.
1055 (9) Ambulatory surgical centers, as provided under part I
1056 of chapter 395.
1057 (10) Nursing homes, as provided under part II of chapter
1059 (11) Assisted living facilities, as provided under part I
1060 of chapter 429.
1061 (12) Home health agencies, as provided under part III of
1062 chapter 400.
1063 (13) Nurse registries, as provided under part III of
1064 chapter 400.
1065 (14) Companion services or homemaker services providers, as
1066 provided under part III of chapter 400.
1067 (15) Adult day care centers, as provided under part III of
1068 chapter 429.
1069 (16) Hospices, as provided under part IV of chapter 400.
1070 (17) Adult family-care homes, as provided under part II of
1071 chapter 429.
1072 (18) Homes for special services, as provided under part V
1073 of chapter 400.
1074 (19) Transitional living facilities, as provided under part
1075 XI of chapter 400.
1076 (20) Prescribed pediatric extended care centers, as
1077 provided under part VI of chapter 400.
1078 (21) Home medical equipment providers, as provided under
1079 part VII of chapter 400.
1080 (22) Intermediate care facilities for persons with
1081 developmental disabilities, as provided under part VIII of
1082 chapter 400.
1083 (23) Health care services pools, as provided under part IX
1084 of chapter 400.
1085 (24) Health care clinics, as provided under part X of
1086 chapter 400.
1087 (25) Multiphasic health testing centers, as provided under
1088 part I of chapter 483.
1089 (25) (26) Organ, tissue, and eye procurement organizations,
1090 as provided under part V of chapter 765.
1091 Section 26. Present subsections (10) through (14) of
1092 section 408.803, Florida Statutes, are redesignated as
1093 subsections (11) through (15), respectively, a new subsection
1094 (10) is added to that section, and subsection (3) of that
1095 section is amended, to read:
1096 408.803 Definitions.—As used in this part, the term:
1097 (3) “Authorizing statute” means the statute authorizing the
1098 licensed operation of a provider listed in s. 408.802 and
1099 includes chapters 112, 383, 390, 394, 395, 400, 429, 440, 483,
1100 and 765.
1101 (10) “Low-risk provider” means nurse registries, home
1102 medical equipment providers, and health care clinics.
1103 Section 27. Paragraph (b) of subsection (7) of section
1104 408.806, Florida Statutes, is amended to read:
1105 408.806 License application process.—
1107 (b) An initial inspection is not required for companion
1108 services or homemaker services providers , as provided under part
1109 III of chapter 400, or for health care services pools , as
1110 provided under part IX of chapter 400, or for low-risk providers
1111 as provided under s. 408.811.
1112 Section 28. Subsection (2) of section 408.808, Florida
1113 Statutes, is amended to read:
1114 408.808 License categories.—
1115 (2) PROVISIONAL LICENSE.—An applicant against whom a
1116 proceeding denying or revoking a license is pending at the time
1117 of license renewal may be issued a provisional license effective
1118 until final action not subject to further appeal. A provisional
1119 license may also be issued to an applicant for initial licensure
1120 or an applicant applying for a change of ownership. A
1121 provisional license must be limited in duration to a specific
1122 period of time, up to 12 months, as determined by the agency.
1123 Section 29. Subsections (2) and (5) of section 408.809,
1124 Florida Statutes, are amended to read:
1125 408.809 Background screening; prohibited offenses.—
1126 (2) Every 5 years following his or her licensure,
1127 employment, or entry into a contract in a capacity that under
1128 subsection (1) would require level 2 background screening under
1129 chapter 435, each such person must submit to level 2 background
1130 rescreening as a condition of retaining such license or
1131 continuing in such employment or contractual status. For any
1132 such rescreening, the agency shall request the Department of Law
1133 Enforcement to forward the person’s fingerprints to the Federal
1134 Bureau of Investigation for a national criminal history record
1135 check unless the person’s fingerprints are enrolled in the
1136 Federal Bureau of Investigation’s national retained print arrest
1137 notification program. If the fingerprints of such a person are
1138 not retained by the Department of Law Enforcement under s.
1139 943.05(2)(g) and (h), the person must submit fingerprints
1140 electronically to the Department of Law Enforcement for state
1141 processing, and the Department of Law Enforcement shall forward
1142 the fingerprints to the Federal Bureau of Investigation for a
1143 national criminal history record check. The fingerprints shall
1144 be retained by the Department of Law Enforcement under s.
1145 943.05(2)(g) and (h) and enrolled in the national retained print
1146 arrest notification program when the Department of Law
1147 Enforcement begins participation in the program. The cost of the
1148 state and national criminal history records checks required by
1149 level 2 screening may be borne by the licensee or the person
1150 fingerprinted. Until a specified agency is fully implemented in
1151 the clearinghouse created under s. 435.12, The agency may accept
1152 as satisfying the requirements of this section proof of
1153 compliance with level 2 screening standards submitted within the
1154 previous 5 years to meet any provider or professional licensure
1155 requirements of the agency, the Department of Health, the
1156 Department of Elderly Affairs, the Agency for Persons with
1157 Disabilities, the Department of Children and Families, or the
1158 Department of Financial Services for an applicant for a
1159 certificate of authority or provisional certificate of authority
1160 to operate a continuing care retirement community under chapter
1161 651, provided that:
1162 (a) The screening standards and disqualifying offenses for
1163 the prior screening are equivalent to those specified in s.
1164 435.04 and this section;
1165 (b) The person subject to screening has not had a break in
1166 service from a position that requires level 2 screening for more
1167 than 90 days; and
1168 (c) Such proof is accompanied, under penalty of perjury, by
1169 an attestation of compliance with chapter 435 and this section
1170 using forms provided by the agency.
1171 (5) A person who serves as a controlling interest of, is
1172 employed by, or contracts with a licensee on July 31, 2010, who
1173 has been screened and qualified according to standards specified
1174 in s. 435.03 or s. 435.04 must be rescreened by July 31, 2015,
1175 in compliance with the following schedule. If, upon rescreening,
1176 such person has a disqualifying offense that was not a
1177 disqualifying offense at the time of the last screening, but is
1178 a current disqualifying offense and was committed before the
1179 last screening, he or she may apply for an exemption from the
1180 appropriate licensing agency and, if agreed to by the employer,
1181 may continue to perform his or her duties until the licensing
1182 agency renders a decision on the application for exemption if
1183 the person is eligible to apply for an exemption and the
1184 exemption request is received by the agency within 30 days after
1185 receipt of the rescreening results by the person. The
1186 rescreening schedule shall be:
1187 (a) Individuals for whom the last screening was conducted
1188 on or before December 31, 2004, must be rescreened by July 31,
1190 (b) Individuals for whom the last screening conducted was
1191 between January 1, 2005, and December 31, 2008, must be
1192 rescreened by July 31, 2014.
1193 (c) Individuals for whom the last screening conducted was
1194 between January 1, 2009, through July 31, 2011, must be
1195 rescreened by July 31, 2015.
1196 Section 30. Subsection (1) of section 408.811, Florida
1197 Statutes, is amended to read:
1198 408.811 Right of inspection; copies; inspection reports;
1199 plan for correction of deficiencies.—
1200 (1) An authorized officer or employee of the agency may
1201 make or cause to be made any inspection or investigation deemed
1202 necessary by the agency to determine the state of compliance
1203 with this part, authorizing statutes, and applicable rules. The
1204 right of inspection extends to any business that the agency has
1205 reason to believe is being operated as a provider without a
1206 license, but inspection of any business suspected of being
1207 operated without the appropriate license may not be made without
1208 the permission of the owner or person in charge unless a warrant
1209 is first obtained from a circuit court. Any application for a
1210 license issued under this part, authorizing statutes, or
1211 applicable rules constitutes permission for an appropriate
1212 inspection to verify the information submitted on or in
1213 connection with the application.
1214 (a) All inspections shall be unannounced, except as
1215 specified in s. 408.806.
1216 (b) Inspections for relicensure shall be conducted
1217 biennially unless otherwise specified by this section,
1218 authorizing statutes, or applicable rules.
1219 (c) The agency may exempt a low-risk provider from
1220 licensure inspection if the provider or controlling interest has
1221 an excellent regulatory history with regard to deficiencies,
1222 sanctions, complaints, and other regulatory actions, as defined
1223 by rule. The agency shall continue to conduct unannounced
1224 licensure inspections for at least 10 percent of exempt low-risk
1225 providers to verify compliance.
1226 (d) The agency may adopt rules to waive a routine
1227 inspection, including inspection for relicensure, or allow for
1228 an extended period between relicensure inspections for specific
1229 providers based upon all of the following:
1230 1. A favorable regulatory history with regard to
1231 deficiencies, sanctions, complaints, and other regulatory
1233 2. Outcome measures that demonstrate quality performance.
1234 3. Successful participation in a recognized quality
1235 assurance program.
1236 4. Accreditation status.
1237 5. Other measures reflective of quality and safety.
1238 6. The length of time between inspections.
1240 The agency shall continue to conduct unannounced licensure
1241 inspections for at least 10 percent of providers that qualify
1242 for a waiver or extended period between relicensure inspections.
1243 (e) The agency maintains the authority to conduct an
1244 inspection of any provider at any time to determine regulatory
1246 Section 31. Subsection (24) of section 408.820, Florida
1247 Statutes, is amended to read:
1248 408.820 Exemptions.—Except as prescribed in authorizing
1249 statutes, the following exemptions shall apply to specified
1250 requirements of this part:
1251 (24) Multiphasic health testing centers, as provided under
1252 part I of chapter 483, are exempt from s. 408.810(5)-(10).
1253 Section 32. Subsections (1) and (2) of section 408.821,
1254 Florida Statutes, are amended to read:
1255 408.821 Emergency management planning; emergency
1256 operations; inactive license.—
1257 (1) A licensee required by authorizing statutes and agency
1258 rule to have a comprehensive an emergency management operations
1259 plan must designate a safety liaison to serve as the primary
1260 contact for emergency operations. Such licensee shall submit its
1261 comprehensive emergency management plan to the local emergency
1262 management agency, the county health department, or the
1263 Department of Health as follows:
1264 (a) Submit the plan within 30 days after initial licensure
1265 and change of ownership, and notify the agency within 30 days
1266 after submission of the plan.
1267 (b) Submit the plan annually and within 30 days after any
1268 significant modification, as defined by agency rule, to a
1269 previously approved plan.
1270 (c) Respond with necessary plan revisions within 30 days
1271 after notification that plan revisions are required.
1272 (d) Notify the agency within 30 days after approval of its
1273 plan by the local emergency management agency, county health
1274 department, or Department of Health.
1275 (2) An entity subject to this part may temporarily exceed
1276 its licensed capacity to act as a receiving provider in
1277 accordance with an approved comprehensive emergency management
1278 operations plan for up to 15 days. While in an overcapacity
1279 status, each provider must furnish or arrange for appropriate
1280 care and services to all clients. In addition, the agency may
1281 approve requests for overcapacity in excess of 15 days, which
1282 approvals may be based upon satisfactory justification and need
1283 as provided by the receiving and sending providers.
1284 Section 33. Subsection (3) of section 408.831, Florida
1285 Statutes, is amended to read:
1286 408.831 Denial, suspension, or revocation of a license,
1287 registration, certificate, or application.—
1288 (3) This section provides standards of enforcement
1289 applicable to all entities licensed or regulated by the Agency
1290 for Health Care Administration. This section controls over any
1291 conflicting provisions of chapters 39, 383, 390, 391, 394, 395,
1292 400, 408, 429, 468, 483, and 765 or rules adopted pursuant to
1293 those chapters.
1294 Section 34. Section 408.832, Florida Statutes, is amended
1295 to read:
1296 408.832 Conflicts.—In case of conflict between the
1297 provisions of this part and the authorizing statutes governing
1298 the licensure of health care providers by the Agency for Health
1299 Care Administration found in s. 112.0455 and chapters 383, 390,
1300 394, 395, 400, 429, 440, 483, and 765, the provisions of this
1301 part shall prevail.
1302 Section 35. Subsection (9) of section 408.909, Florida
1303 Statutes, is amended to read:
1304 408.909 Health flex plans.—
1305 (9) PROGRAM EVALUATION.—The agency and the office shall
1306 evaluate the pilot program and its effect on the entities that
1307 seek approval as health flex plans, on the number of enrollees,
1308 and on the scope of the health care coverage offered under a
1309 health flex plan; shall provide an assessment of the health flex
1310 plans and their potential applicability in other settings; shall
1311 use health flex plans to gather more information to evaluate
1312 low-income consumer driven benefit packages; and shall, by
1313 January 15, 2016, and annually thereafter, jointly submit a
1314 report to the Governor, the President of the Senate, and the
1315 Speaker of the House of Representatives.
1316 Section 36. Paragraph (d) of subsection (10) of section
1317 408.9091, Florida Statutes, is amended to read:
1318 408.9091 Cover Florida Health Care Access Program.—
1319 (10) PROGRAM EVALUATION.—The agency and the office shall:
1320 (d) Jointly submit by March 1, annually, a report to the
1321 Governor, the President of the Senate, and the Speaker of the
1322 House of Representatives which provides the information
1323 specified in paragraphs (a)-(c) and recommendations relating to
1324 the successful implementation and administration of the program.
1325 Section 37. Effective upon becoming a law, paragraph (a) of
1326 subsection (5) of section 409.905, Florida Statutes, is amended
1327 to read:
1328 409.905 Mandatory Medicaid services.—The agency may make
1329 payments for the following services, which are required of the
1330 state by Title XIX of the Social Security Act, furnished by
1331 Medicaid providers to recipients who are determined to be
1332 eligible on the dates on which the services were provided. Any
1333 service under this section shall be provided only when medically
1334 necessary and in accordance with state and federal law.
1335 Mandatory services rendered by providers in mobile units to
1336 Medicaid recipients may be restricted by the agency. Nothing in
1337 this section shall be construed to prevent or limit the agency
1338 from adjusting fees, reimbursement rates, lengths of stay,
1339 number of visits, number of services, or any other adjustments
1340 necessary to comply with the availability of moneys and any
1341 limitations or directions provided for in the General
1342 Appropriations Act or chapter 216.
1343 (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
1344 all covered services provided for the medical care and treatment
1345 of a recipient who is admitted as an inpatient by a licensed
1346 physician or dentist to a hospital licensed under part I of
1347 chapter 395. However, the agency shall limit the payment for
1348 inpatient hospital services for a Medicaid recipient 21 years of
1349 age or older to 45 days or the number of days necessary to
1350 comply with the General Appropriations Act.
1351 (a)1. The agency may implement reimbursement and
1352 utilization management reforms in order to comply with any
1353 limitations or directions in the General Appropriations Act,
1354 which may include, but are not limited to: prior authorization
1355 for inpatient psychiatric days; prior authorization for
1356 nonemergency hospital inpatient admissions for individuals 21
1357 years of age and older; authorization of emergency and urgent
1358 care admissions within 24 hours after admission; enhanced
1359 utilization and concurrent review programs for highly utilized
1360 services; reduction or elimination of covered days of service;
1361 adjusting reimbursement ceilings for variable costs; adjusting
1362 reimbursement ceilings for fixed and property costs; and
1363 implementing target rates of increase.
1364 2. The agency may limit prior authorization for hospital
1365 inpatient services to selected diagnosis-related groups, based
1366 on an analysis of the cost and potential for unnecessary
1367 hospitalizations represented by certain diagnoses. Admissions
1368 for normal delivery and newborns are exempt from requirements
1369 for prior authorization.
1370 3. In implementing the provisions of this section related
1371 to prior authorization, the agency shall ensure that the process
1372 for authorization is accessible 24 hours per day, 7 days per
1373 week and authorization is automatically granted when not denied
1374 within 4 hours after the request. Authorization procedures must
1375 include steps for review of denials.
1376 4. Upon implementing the prior authorization program for
1377 hospital inpatient services, the agency shall discontinue its
1378 hospital retrospective review program. However, this
1379 subparagraph may not be construed to prevent the agency from
1380 conducting retrospective reviews under s. 409.913, including,
1381 but not limited to, reviews in which an overpayment is suspected
1382 due to a mistake or submission of an improper claim or for other
1383 reasons that do not rise to the level of fraud or abuse.
1384 Section 38. It is the intent of the Legislature that
1385 section 409.905(5)(a), Florida Statutes, as amended by this act,
1386 confirms and clarifies existing law. This section shall take
1387 effect upon becoming a law.
1388 Section 39. Subsection (8) of section 409.907, Florida
1389 Statutes, is amended to read:
1390 409.907 Medicaid provider agreements.—The agency may make
1391 payments for medical assistance and related services rendered to
1392 Medicaid recipients only to an individual or entity who has a
1393 provider agreement in effect with the agency, who is performing
1394 services or supplying goods in accordance with federal, state,
1395 and local law, and who agrees that no person shall, on the
1396 grounds of handicap, race, color, or national origin, or for any
1397 other reason, be subjected to discrimination under any program
1398 or activity for which the provider receives payment from the
1400 (8)(a) A level 2 background screening pursuant to chapter
1401 435 must be conducted through the agency on each of the
1403 1. The Each provider, or each principal of the provider if
1404 the provider is a corporation, partnership, association, or
1405 other entity , seeking to participate in the Medicaid program
1406 must submit a complete set of his or her fingerprints to the
1407 agency for the purpose of conducting a criminal history record
1409 2. Principals of the provider, who include any officer,
1410 director, billing agent, managing employee, or affiliated
1411 person, or any partner or shareholder who has an ownership
1412 interest equal to 5 percent or more in the provider. However,
1413 for a hospital licensed under chapter 395 or a nursing home
1414 licensed under chapter 400, principals of the provider are those
1415 who meet the definition of a controlling interest under s.
1416 408.803. A director of a not-for-profit corporation or
1417 organization is not a principal for purposes of a background
1418 investigation required by this section if the director: serves
1419 solely in a voluntary capacity for the corporation or
1420 organization, does not regularly take part in the day-to-day
1421 operational decisions of the corporation or organization,
1422 receives no remuneration from the not-for-profit corporation or
1423 organization for his or her service on the board of directors,
1424 has no financial interest in the not-for-profit corporation or
1425 organization, and has no family members with a financial
1426 interest in the not-for-profit corporation or organization; and
1427 if the director submits an affidavit, under penalty of perjury,
1428 to this effect to the agency and the not-for-profit corporation
1429 or organization submits an affidavit, under penalty of perjury,
1430 to this effect to the agency as part of the corporation’s or
1431 organization’s Medicaid provider agreement application.
1432 3. Any person who participates or seeks to participate in
1433 the Florida Medicaid program by way of rendering services to
1434 Medicaid recipients or having direct access to Medicaid
1435 recipients, recipient living areas, or the financial, medical,
1436 or service records of a Medicaid recipient or who supervises the
1437 delivery of goods or services to a Medicaid recipient. This
1438 subparagraph does not impose additional screening requirements
1439 on any providers licensed under part II of chapter 408 or
1440 transportation service providers contracted with a
1441 transportation broker subject to this paragraph while
1442 administering the Medicaid transportation benefit.
1443 (b) Notwithstanding paragraph (a) the above, the agency may
1444 require a background check for any person reasonably suspected
1445 by the agency to have been convicted of a crime.
1446 (c) (a) Paragraph (a) This subsection does not apply to:
1447 1. A unit of local government, except that requirements of
1448 this subsection apply to nongovernmental providers and entities
1449 contracting with the local government to provide Medicaid
1450 services. The actual cost of the state and national criminal
1451 history record checks must be borne by the nongovernmental
1452 provider or entity; or
1453 2. Any business that derives more than 50 percent of its
1454 revenue from the sale of goods to the final consumer, and the
1455 business or its controlling parent is required to file a form
1456 10-K or other similar statement with the Securities and Exchange
1457 Commission or has a net worth of $50 million or more.
1458 (d) (b) Background screening shall be conducted in
1459 accordance with chapter 435 and s. 408.809. The cost of the
1460 state and national criminal record check shall be borne by the
1462 Section 40. Effective June 30, 2020, section 19 of chapter
1463 2019-116, Laws of Florida, is repealed.
1464 Section 41. Paragraph (a) of subsection (1) of section
1465 409.908, Florida Statutes, is amended, and subsection (23) of
1466 that section is reenacted, to read:
1467 409.908 Reimbursement of Medicaid providers.—Subject to
1468 specific appropriations, the agency shall reimburse Medicaid
1469 providers, in accordance with state and federal law, according
1470 to methodologies set forth in the rules of the agency and in
1471 policy manuals and handbooks incorporated by reference therein.
1472 These methodologies may include fee schedules, reimbursement
1473 methods based on cost reporting, negotiated fees, competitive
1474 bidding pursuant to s. 287.057, and other mechanisms the agency
1475 considers efficient and effective for purchasing services or
1476 goods on behalf of recipients. If a provider is reimbursed based
1477 on cost reporting and submits a cost report late and that cost
1478 report would have been used to set a lower reimbursement rate
1479 for a rate semester, then the provider’s rate for that semester
1480 shall be retroactively calculated using the new cost report, and
1481 full payment at the recalculated rate shall be effected
1482 retroactively. Medicare-granted extensions for filing cost
1483 reports, if applicable, shall also apply to Medicaid cost
1484 reports. Payment for Medicaid compensable services made on
1485 behalf of Medicaid eligible persons is subject to the
1486 availability of moneys and any limitations or directions
1487 provided for in the General Appropriations Act or chapter 216.
1488 Further, nothing in this section shall be construed to prevent
1489 or limit the agency from adjusting fees, reimbursement rates,
1490 lengths of stay, number of visits, or number of services, or
1491 making any other adjustments necessary to comply with the
1492 availability of moneys and any limitations or directions
1493 provided for in the General Appropriations Act, provided the
1494 adjustment is consistent with legislative intent.
1495 (1) Reimbursement to hospitals licensed under part I of
1496 chapter 395 must be made prospectively or on the basis of
1498 (a) Reimbursement for inpatient care is limited as provided
1499 in s. 409.905(5), except as otherwise provided in this
1501 1. If authorized by the General Appropriations Act, the
1502 agency may modify reimbursement for specific types of services
1503 or diagnoses, recipient ages, and hospital provider types.
1504 2. The agency may establish an alternative methodology to
1505 the DRG-based prospective payment system to set reimbursement
1506 rates for:
1507 a. State-owned psychiatric hospitals.
1508 b. Newborn hearing screening services.
1509 c. Transplant services for which the agency has established
1510 a global fee.
1511 d. Recipients who have tuberculosis that is resistant to
1512 therapy who are in need of long-term, hospital-based treatment
1513 pursuant to s. 392.62.
1514 e. Class III psychiatric hospitals.
1515 3. The agency shall modify reimbursement according to other
1516 methodologies recognized in the General Appropriations Act.
1518 The agency may receive funds from state entities, including, but
1519 not limited to, the Department of Health, local governments, and
1520 other local political subdivisions, for the purpose of making
1521 special exception payments, including federal matching funds,
1522 through the Medicaid inpatient reimbursement methodologies.
1523 Funds received for this purpose shall be separately accounted
1524 for and may not be commingled with other state or local funds in
1525 any manner. The agency may certify all local governmental funds
1526 used as state match under Title XIX of the Social Security Act,
1527 to the extent and in the manner authorized under the General
1528 Appropriations Act and pursuant to an agreement between the
1529 agency and the local governmental entity. In order for the
1530 agency to certify such local governmental funds, a local
1531 governmental entity must submit a final, executed letter of
1532 agreement to the agency, which must be received by October 1 of
1533 each fiscal year and provide the total amount of local
1534 governmental funds authorized by the entity for that fiscal year
1535 under this paragraph, paragraph (b), or the General
1536 Appropriations Act. The local governmental entity shall use a
1537 certification form prescribed by the agency. At a minimum, the
1538 certification form must identify the amount being certified and
1539 describe the relationship between the certifying local
1540 governmental entity and the local health care provider. The
1541 agency shall prepare an annual statement of impact which
1542 documents the specific activities undertaken during the previous
1543 fiscal year pursuant to this paragraph, to be submitted to the
1544 Legislature annually by January 1.
1545 (23)(a) The agency shall establish rates at a level that
1546 ensures no increase in statewide expenditures resulting from a
1547 change in unit costs for county health departments effective
1548 July 1, 2011. Reimbursement rates shall be as provided in the
1549 General Appropriations Act.
1550 (b)1. Base rate reimbursement for inpatient services under
1551 a diagnosis-related group payment methodology shall be provided
1552 in the General Appropriations Act.
1553 2. Base rate reimbursement for outpatient services under an
1554 enhanced ambulatory payment group methodology shall be provided
1555 in the General Appropriations Act.
1556 3. Prospective payment system reimbursement for nursing
1557 home services shall be as provided in subsection (2) and in the
1558 General Appropriations Act.
1559 Section 42. Section 409.913, Florida Statutes, is amended
1560 to read:
1561 409.913 Oversight of the integrity of the Medicaid
1562 program.—The agency shall operate a program to oversee the
1563 activities of Florida Medicaid recipients, and providers and
1564 their representatives, to ensure that fraudulent and abusive
1565 behavior and neglect of recipients occur to the minimum extent
1566 possible, and to recover overpayments and impose sanctions as
1567 appropriate. Each January 15 January 1, the agency and the
1568 Medicaid Fraud Control Unit of the Department of Legal Affairs
1569 shall submit reports a joint report to the Legislature
1570 documenting the effectiveness of the state’s efforts to control
1571 Medicaid fraud and abuse and to recover Medicaid overpayments
1572 during the previous fiscal year. The report must describe the
1573 number of cases opened and investigated each year; the sources
1574 of the cases opened; the disposition of the cases closed each
1575 year; the amount of overpayments alleged in preliminary and
1576 final audit letters; the number and amount of fines or penalties
1577 imposed; any reductions in overpayment amounts negotiated in
1578 settlement agreements or by other means; the amount of final
1579 agency determinations of overpayments; the amount deducted from
1580 federal claiming as a result of overpayments; the amount of
1581 overpayments recovered each year; the amount of cost of
1582 investigation recovered each year; the average length of time to
1583 collect from the time the case was opened until the overpayment
1584 is paid in full; the amount determined as uncollectible and the
1585 portion of the uncollectible amount subsequently reclaimed from
1586 the Federal Government; the number of providers, by type, that
1587 are terminated from participation in the Medicaid program as a
1588 result of fraud and abuse; and all costs associated with
1589 discovering and prosecuting cases of Medicaid overpayments and
1590 making recoveries in such cases. The report must also document
1591 actions taken to prevent overpayments and the number of
1592 providers prevented from enrolling in or reenrolling in the
1593 Medicaid program as a result of documented Medicaid fraud and
1594 abuse and must include policy recommendations necessary to
1595 prevent or recover overpayments and changes necessary to prevent
1596 and detect Medicaid fraud. All policy recommendations in the
1597 report must include a detailed fiscal analysis, including, but
1598 not limited to, implementation costs, estimated savings to the
1599 Medicaid program, and the return on investment. The agency must
1600 submit the policy recommendations and fiscal analyses in the
1601 report to the appropriate estimating conference, pursuant to s.
1602 216.137, by February 15 of each year. The agency and the
1603 Medicaid Fraud Control Unit of the Department of Legal Affairs
1604 each must include detailed unit-specific performance standards,
1605 benchmarks, and metrics in the report, including projected cost
1606 savings to the state Medicaid program during the following
1607 fiscal year.
1608 (1) For the purposes of this section, the term:
1609 (a) “Abuse” means:
1610 1. Provider practices that are inconsistent with generally
1611 accepted business or medical practices and that result in an
1612 unnecessary cost to the Medicaid program or in reimbursement for
1613 goods or services that are not medically necessary or that fail
1614 to meet professionally recognized standards for health care.
1615 2. Recipient practices that result in unnecessary cost to
1616 the Medicaid program.
1617 (b) “Complaint” means an allegation that fraud, abuse, or
1618 an overpayment has occurred.
1619 (c) “Fraud” means an intentional deception or
1620 misrepresentation made by a person with the knowledge that the
1621 deception results in unauthorized benefit to herself or himself
1622 or another person. The term includes any act that constitutes
1623 fraud under applicable federal or state law.
1624 (d) “Medical necessity” or “medically necessary” means any
1625 goods or services necessary to palliate the effects of a
1626 terminal condition, or to prevent, diagnose, correct, cure,
1627 alleviate, or preclude deterioration of a condition that
1628 threatens life, causes pain or suffering, or results in illness
1629 or infirmity, which goods or services are provided in accordance
1630 with generally accepted standards of medical practice. For
1631 purposes of determining Medicaid reimbursement, the agency is
1632 the final arbiter of medical necessity. Determinations of
1633 medical necessity must be made by a licensed physician employed
1634 by or under contract with the agency and must be based upon
1635 information available at the time the goods or services are
1637 (e) “Overpayment” includes any amount that is not
1638 authorized to be paid by the Medicaid program whether paid as a
1639 result of inaccurate or improper cost reporting, improper
1640 claiming, unacceptable practices, fraud, abuse, or mistake.
1641 (f) “Person” means any natural person, corporation,
1642 partnership, association, clinic, group, or other entity,
1643 whether or not such person is enrolled in the Medicaid program
1644 or is a provider of health care.
1645 (2) The agency shall conduct, or cause to be conducted by
1646 contract or otherwise, reviews, investigations, analyses,
1647 audits, or any combination thereof, to determine possible fraud,
1648 abuse, overpayment, or recipient neglect in the Medicaid program
1649 and shall report the findings of any overpayments in audit
1650 reports as appropriate. At least 5 percent of all audits shall
1651 be conducted on a random basis. As part of its ongoing fraud
1652 detection activities, the agency shall identify and monitor, by
1653 contract or otherwise, patterns of overutilization of Medicaid
1654 services based on state averages. The agency shall track
1655 Medicaid provider prescription and billing patterns and evaluate
1656 them against Medicaid medical necessity criteria and coverage
1657 and limitation guidelines adopted by rule. Medical necessity
1658 determination requires that service be consistent with symptoms
1659 or confirmed diagnosis of illness or injury under treatment and
1660 not in excess of the patient’s needs. The agency shall conduct
1661 reviews of provider exceptions to peer group norms and shall,
1662 using statistical methodologies, provider profiling, and
1663 analysis of billing patterns, detect and investigate abnormal or
1664 unusual increases in billing or payment of claims for Medicaid
1665 services and medically unnecessary provision of services.
1666 (3) The agency may conduct, or may contract for, prepayment
1667 review of provider claims to ensure cost-effective purchasing;
1668 to ensure that billing by a provider to the agency is in
1669 accordance with applicable provisions of all Medicaid rules,
1670 regulations, handbooks, and policies and in accordance with
1671 federal, state, and local law; and to ensure that appropriate
1672 care is rendered to Medicaid recipients. Such prepayment reviews
1673 may be conducted as determined appropriate by the agency,
1674 without any suspicion or allegation of fraud, abuse, or neglect,
1675 and may last for up to 1 year. Unless the agency has reliable
1676 evidence of fraud, misrepresentation, abuse, or neglect, claims
1677 shall be adjudicated for denial or payment within 90 days after
1678 receipt of complete documentation by the agency for review. If
1679 there is reliable evidence of fraud, misrepresentation, abuse,
1680 or neglect, claims shall be adjudicated for denial of payment
1681 within 180 days after receipt of complete documentation by the
1682 agency for review.
1683 (4) Any suspected criminal violation identified by the
1684 agency must be referred to the Medicaid Fraud Control Unit of
1685 the Office of the Attorney General for investigation. The agency
1686 and the Attorney General shall enter into a memorandum of
1687 understanding, which must include, but need not be limited to, a
1688 protocol for regularly sharing information and coordinating
1689 casework. The protocol must establish a procedure for the
1690 referral by the agency of cases involving suspected Medicaid
1691 fraud to the Medicaid Fraud Control Unit for investigation, and
1692 the return to the agency of those cases where investigation
1693 determines that administrative action by the agency is
1694 appropriate. Offices of the Medicaid program integrity program
1695 and the Medicaid Fraud Control Unit of the Department of Legal
1696 Affairs, shall, to the extent possible, be collocated. The
1697 agency and the Department of Legal Affairs shall periodically
1698 conduct joint training and other joint activities designed to
1699 increase communication and coordination in recovering
1701 (5) A Medicaid provider is subject to having goods and
1702 services that are paid for by the Medicaid program reviewed by
1703 an appropriate peer-review organization designated by the
1704 agency. The written findings of the applicable peer-review
1705 organization are admissible in any court or administrative
1706 proceeding as evidence of medical necessity or the lack thereof.
1707 (6) Any notice required to be given to a provider under
1708 this section is presumed to be sufficient notice if sent to the
1709 address last shown on the provider enrollment file. It is the
1710 responsibility of the provider to furnish and keep the agency
1711 informed of the provider’s current address. United States Postal
1712 Service proof of mailing or certified or registered mailing of
1713 such notice to the provider at the address shown on the provider
1714 enrollment file constitutes sufficient proof of notice. Any
1715 notice required to be given to the agency by this section must
1716 be sent to the agency at an address designated by rule.
1717 (7) When presenting a claim for payment under the Medicaid
1718 program, a provider has an affirmative duty to supervise the
1719 provision of, and be responsible for, goods and services claimed
1720 to have been provided, to supervise and be responsible for
1721 preparation and submission of the claim, and to present a claim
1722 that is true and accurate and that is for goods and services
1724 (a) Have actually been furnished to the recipient by the
1725 provider prior to submitting the claim.
1726 (b) Are Medicaid-covered goods or services that are
1727 medically necessary.
1728 (c) Are of a quality comparable to those furnished to the
1729 general public by the provider’s peers.
1730 (d) Have not been billed in whole or in part to a recipient
1731 or a recipient’s responsible party, except for such copayments,
1732 coinsurance, or deductibles as are authorized by the agency.
1733 (e) Are provided in accord with applicable provisions of
1734 all Medicaid rules, regulations, handbooks, and policies and in
1735 accordance with federal, state, and local law.
1736 (f) Are documented by records made at the time the goods or
1737 services were provided, demonstrating the medical necessity for
1738 the goods or services rendered. Medicaid goods or services are
1739 excessive or not medically necessary unless both the medical
1740 basis and the specific need for them are fully and properly
1741 documented in the recipient’s medical record.
1743 The agency shall deny payment or require repayment for goods or
1744 services that are not presented as required in this subsection.
1745 (8) The agency shall not reimburse any person or entity for
1746 any prescription for medications, medical supplies, or medical
1747 services if the prescription was written by a physician or other
1748 prescribing practitioner who is not enrolled in the Medicaid
1749 program. This section does not apply:
1750 (a) In instances involving bona fide emergency medical
1751 conditions as determined by the agency;
1752 (b) To a provider of medical services to a patient in a
1753 hospital emergency department, hospital inpatient or outpatient
1754 setting, or nursing home;
1755 (c) To bona fide pro bono services by preapproved non
1756 Medicaid providers as determined by the agency;
1757 (d) To prescribing physicians who are board-certified
1758 specialists treating Medicaid recipients referred for treatment
1759 by a treating physician who is enrolled in the Medicaid program;
1760 (e) To prescriptions written for dually eligible Medicare
1761 beneficiaries by an authorized Medicare provider who is not
1762 enrolled in the Medicaid program; or
1763 (f) To other physicians who are not enrolled in the
1764 Medicaid program but who provide a medically necessary service
1765 or prescription not otherwise reasonably available from a
1766 Medicaid-enrolled physician. ; or
1767 (9) A Medicaid provider shall retain medical, professional,
1768 financial, and business records pertaining to services and goods
1769 furnished to a Medicaid recipient and billed to Medicaid for a
1770 period of 5 years after the date of furnishing such services or
1771 goods. The agency may investigate, review, or analyze such
1772 records, which must be made available during normal business
1773 hours. However, 24-hour notice must be provided if patient
1774 treatment would be disrupted. The provider must keep the agency
1775 informed of the location of the provider’s Medicaid-related
1776 records. The authority of the agency to obtain Medicaid-related
1777 records from a provider is neither curtailed nor limited during
1778 a period of litigation between the agency and the provider.
1779 (10) Payments for the services of billing agents or persons
1780 participating in the preparation of a Medicaid claim shall not
1781 be based on amounts for which they bill nor based on the amount
1782 a provider receives from the Medicaid program.
1783 (11) The agency shall deny payment or require repayment for
1784 inappropriate, medically unnecessary, or excessive goods or
1785 services from the person furnishing them, the person under whose
1786 supervision they were furnished, or the person causing them to
1787 be furnished.
1788 (12) The complaint and all information obtained pursuant to
1789 an investigation of a Medicaid provider, or the authorized
1790 representative or agent of a provider, relating to an allegation
1791 of fraud, abuse, or neglect are confidential and exempt from the
1792 provisions of s. 119.07(1):
1793 (a) Until the agency takes final agency action with respect
1794 to the provider and requires repayment of any overpayment, or
1795 imposes an administrative sanction;
1796 (b) Until the Attorney General refers the case for criminal
1798 (c) Until 10 days after the complaint is determined without
1799 merit; or
1800 (d) At all times if the complaint or information is
1801 otherwise protected by law.
1802 (13) The agency shall terminate participation of a Medicaid
1803 provider in the Medicaid program and may seek civil remedies or
1804 impose other administrative sanctions against a Medicaid
1805 provider, if the provider or any principal, officer, director,
1806 agent, managing employee, or affiliated person of the provider,
1807 or any partner or shareholder having an ownership interest in
1808 the provider equal to 5 percent or greater, has been convicted
1809 of a criminal offense under federal law or the law of any state
1810 relating to the practice of the provider’s profession, or a
1811 criminal offense listed under s. 408.809(4), s. 409.907(10), or
1812 s. 435.04(2). If the agency determines that the provider did not
1813 participate or acquiesce in the offense, termination will not be
1814 imposed. If the agency effects a termination under this
1815 subsection, the agency shall take final agency action.
1816 (14) If the provider has been suspended or terminated from
1817 participation in the Medicaid program or the Medicare program by
1818 the Federal Government or any state, the agency must immediately
1819 suspend or terminate, as appropriate, the provider’s
1820 participation in this state’s Medicaid program for a period no
1821 less than that imposed by the Federal Government or any other
1822 state, and may not enroll such provider in this state’s Medicaid
1823 program while such foreign suspension or termination remains in
1824 effect. The agency shall also immediately suspend or terminate,
1825 as appropriate, a provider’s participation in this state’s
1826 Medicaid program if the provider participated or acquiesced in
1827 any action for which any principal, officer, director, agent,
1828 managing employee, or affiliated person of the provider, or any
1829 partner or shareholder having an ownership interest in the
1830 provider equal to 5 percent or greater, was suspended or
1831 terminated from participating in the Medicaid program or the
1832 Medicare program by the Federal Government or any state. This
1833 sanction is in addition to all other remedies provided by law.
1834 (15) The agency shall seek a remedy provided by law,
1835 including, but not limited to, any remedy provided in
1836 subsections (13) and (16) and s. 812.035, if:
1837 (a) The provider’s license has not been renewed, or has
1838 been revoked, suspended, or terminated, for cause, by the
1839 licensing agency of any state;
1840 (b) The provider has failed to make available or has
1841 refused access to Medicaid-related records to an auditor,
1842 investigator, or other authorized employee or agent of the
1843 agency, the Attorney General, a state attorney, or the Federal
1845 (c) The provider has not furnished or has failed to make
1846 available such Medicaid-related records as the agency has found
1847 necessary to determine whether Medicaid payments are or were due
1848 and the amounts thereof;
1849 (d) The provider has failed to maintain medical records
1850 made at the time of service, or prior to service if prior
1851 authorization is required, demonstrating the necessity and
1852 appropriateness of the goods or services rendered;
1853 (e) The provider is not in compliance with provisions of
1854 Medicaid provider publications that have been adopted by
1855 reference as rules in the Florida Administrative Code; with
1856 provisions of state or federal laws, rules, or regulations; with
1857 provisions of the provider agreement between the agency and the
1858 provider; or with certifications found on claim forms or on
1859 transmittal forms for electronically submitted claims that are
1860 submitted by the provider or authorized representative, as such
1861 provisions apply to the Medicaid program;
1862 (f) The provider or person who ordered, authorized, or
1863 prescribed the care, services, or supplies has furnished, or
1864 ordered or authorized the furnishing of, goods or services to a
1865 recipient which are inappropriate, unnecessary, excessive, or
1866 harmful to the recipient or are of inferior quality;
1867 (g) The provider has demonstrated a pattern of failure to
1868 provide goods or services that are medically necessary;
1869 (h) The provider or an authorized representative of the
1870 provider, or a person who ordered, authorized, or prescribed the
1871 goods or services, has submitted or caused to be submitted false
1872 or a pattern of erroneous Medicaid claims;
1873 (i) The provider or an authorized representative of the
1874 provider, or a person who has ordered, authorized, or prescribed
1875 the goods or services, has submitted or caused to be submitted a
1876 Medicaid provider enrollment application, a request for prior
1877 authorization for Medicaid services, a drug exception request,
1878 or a Medicaid cost report that contains materially false or
1879 incorrect information;
1880 (j) The provider or an authorized representative of the
1881 provider has collected from or billed a recipient or a
1882 recipient’s responsible party improperly for amounts that should
1883 not have been so collected or billed by reason of the provider’s
1884 billing the Medicaid program for the same service;
1885 (k) The provider or an authorized representative of the
1886 provider has included in a cost report costs that are not
1887 allowable under a Florida Title XIX reimbursement plan after the
1888 provider or authorized representative had been advised in an
1889 audit exit conference or audit report that the costs were not
1891 (l) The provider is charged by information or indictment
1892 with fraudulent billing practices or an offense referenced in
1893 subsection (13). The sanction applied for this reason is limited
1894 to suspension of the provider’s participation in the Medicaid
1895 program for the duration of the indictment unless the provider
1896 is found guilty pursuant to the information or indictment;
1897 (m) The provider or a person who ordered, authorized, or
1898 prescribed the goods or services is found liable for negligent
1899 practice resulting in death or injury to the provider’s patient;
1900 (n) The provider fails to demonstrate that it had available
1901 during a specific audit or review period sufficient quantities
1902 of goods, or sufficient time in the case of services, to support
1903 the provider’s billings to the Medicaid program;
1904 (o) The provider has failed to comply with the notice and
1905 reporting requirements of s. 409.907;
1906 (p) The agency has received reliable information of patient
1907 abuse or neglect or of any act prohibited by s. 409.920; or
1908 (q) The provider has failed to comply with an agreed-upon
1909 repayment schedule.
1911 A provider is subject to sanctions for violations of this
1912 subsection as the result of actions or inactions of the
1913 provider, or actions or inactions of any principal, officer,
1914 director, agent, managing employee, or affiliated person of the
1915 provider, or any partner or shareholder having an ownership
1916 interest in the provider equal to 5 percent or greater, in which
1917 the provider participated or acquiesced.
1918 (16) The agency shall impose any of the following sanctions
1919 or disincentives on a provider or a person for any of the acts
1920 described in subsection (15):
1921 (a) Suspension for a specific period of time of not more
1922 than 1 year. Suspension precludes participation in the Medicaid
1923 program, which includes any action that results in a claim for
1924 payment to the Medicaid program for furnishing, supervising a
1925 person who is furnishing, or causing a person to furnish goods
1926 or services.
1927 (b) Termination for a specific period of time ranging from
1928 more than 1 year to 20 years. Termination precludes
1929 participation in the Medicaid program, which includes any action
1930 that results in a claim for payment to the Medicaid program for
1931 furnishing, supervising a person who is furnishing, or causing a
1932 person to furnish goods or services.
1933 (c) Imposition of a fine of up to $5,000 for each
1934 violation. Each day that an ongoing violation continues, such as
1935 refusing to furnish Medicaid-related records or refusing access
1936 to records, is considered a separate violation. Each instance of
1937 improper billing of a Medicaid recipient; each instance of
1938 including an unallowable cost on a hospital or nursing home
1939 Medicaid cost report after the provider or authorized
1940 representative has been advised in an audit exit conference or
1941 previous audit report of the cost unallowability; each instance
1942 of furnishing a Medicaid recipient goods or professional
1943 services that are inappropriate or of inferior quality as
1944 determined by competent peer judgment; each instance of
1945 knowingly submitting a materially false or erroneous Medicaid
1946 provider enrollment application, request for prior authorization
1947 for Medicaid services, drug exception request, or cost report;
1948 each instance of inappropriate prescribing of drugs for a
1949 Medicaid recipient as determined by competent peer judgment; and
1950 each false or erroneous Medicaid claim leading to an overpayment
1951 to a provider is considered a separate violation.
1952 (d) Immediate suspension, if the agency has received
1953 information of patient abuse or neglect or of any act prohibited
1954 by s. 409.920. Upon suspension, the agency must issue an
1955 immediate final order under s. 120.569(2)(n).
1956 (e) A fine, not to exceed $10,000, for a violation of
1957 paragraph (15)(i).
1958 (f) Imposition of liens against provider assets, including,
1959 but not limited to, financial assets and real property, not to
1960 exceed the amount of fines or recoveries sought, upon entry of
1961 an order determining that such moneys are due or recoverable.
1962 (g) Prepayment reviews of claims for a specified period of
1964 (h) Comprehensive followup reviews of providers every 6
1965 months to ensure that they are billing Medicaid correctly.
1966 (i) Corrective-action plans that remain in effect for up to
1967 3 years and that are monitored by the agency every 6 months
1968 while in effect.
1969 (j) Other remedies as permitted by law to effect the
1970 recovery of a fine or overpayment.
1972 If a provider voluntarily relinquishes its Medicaid provider
1973 number or an associated license, or allows the associated
1974 licensure to expire after receiving written notice that the
1975 agency is conducting, or has conducted, an audit, survey,
1976 inspection, or investigation and that a sanction of suspension
1977 or termination will or would be imposed for noncompliance
1978 discovered as a result of the audit, survey, inspection, or
1979 investigation, the agency shall impose the sanction of
1980 termination for cause against the provider. The agency’s
1981 termination with cause is subject to hearing rights as may be
1982 provided under chapter 120. The Secretary of Health Care
1983 Administration may make a determination that imposition of a
1984 sanction or disincentive is not in the best interest of the
1985 Medicaid program, in which case a sanction or disincentive may
1986 not be imposed.
1987 (17) In determining the appropriate administrative sanction
1988 to be applied, or the duration of any suspension or termination,
1989 the agency shall consider:
1990 (a) The seriousness and extent of the violation or
1992 (b) Any prior history of violations by the provider
1993 relating to the delivery of health care programs which resulted
1994 in either a criminal conviction or in administrative sanction or
1996 (c) Evidence of continued violation within the provider’s
1997 management control of Medicaid statutes, rules, regulations, or
1998 policies after written notification to the provider of improper
1999 practice or instance of violation.
2000 (d) The effect, if any, on the quality of medical care
2001 provided to Medicaid recipients as a result of the acts of the
2003 (e) Any action by a licensing agency respecting the
2004 provider in any state in which the provider operates or has
2006 (f) The apparent impact on access by recipients to Medicaid
2007 services if the provider is suspended or terminated, in the best
2008 judgment of the agency.
2010 The agency shall document the basis for all sanctioning actions
2011 and recommendations.
2012 (18) The agency may take action to sanction, suspend, or
2013 terminate a particular provider working for a group provider,
2014 and may suspend or terminate Medicaid participation at a
2015 specific location, rather than or in addition to taking action
2016 against an entire group.
2017 (19) The agency shall establish a process for conducting
2018 followup reviews of a sampling of providers who have a history
2019 of overpayment under the Medicaid program. This process must
2020 consider the magnitude of previous fraud or abuse and the
2021 potential effect of continued fraud or abuse on Medicaid costs.
2022 (20) In making a determination of overpayment to a
2023 provider, the agency must use accepted and valid auditing,
2024 accounting, analytical, statistical, or peer-review methods, or
2025 combinations thereof. Appropriate statistical methods may
2026 include, but are not limited to, sampling and extension to the
2027 population, parametric and nonparametric statistics, tests of
2028 hypotheses, and other generally accepted statistical methods.
2029 Appropriate analytical methods may include, but are not limited
2030 to, reviews to determine variances between the quantities of
2031 products that a provider had on hand and available to be
2032 purveyed to Medicaid recipients during the review period and the
2033 quantities of the same products paid for by the Medicaid program
2034 for the same period, taking into appropriate consideration sales
2035 of the same products to non-Medicaid customers during the same
2036 period. In meeting its burden of proof in any administrative or
2037 court proceeding, the agency may introduce the results of such
2038 statistical methods as evidence of overpayment.
2039 (21) When making a determination that an overpayment has
2040 occurred, the agency shall prepare and issue an audit report to
2041 the provider showing the calculation of overpayments. The
2042 agency’s determination must be based solely upon information
2043 available to it before issuance of the audit report and, in the
2044 case of documentation obtained to substantiate claims for
2045 Medicaid reimbursement, based solely upon contemporaneous
2046 records. The agency may consider addenda or modifications to a
2047 note that was made contemporaneously with the patient care
2048 episode if the addenda or modifications are germane to the note.
2049 (22) The audit report, supported by agency work papers,
2050 showing an overpayment to a provider constitutes evidence of the
2051 overpayment. A provider may not present or elicit testimony on
2052 direct examination or cross-examination in any court or
2053 administrative proceeding, regarding the purchase or acquisition
2054 by any means of drugs, goods, or supplies; sales or divestment
2055 by any means of drugs, goods, or supplies; or inventory of
2056 drugs, goods, or supplies, unless such acquisition, sales,
2057 divestment, or inventory is documented by written invoices,
2058 written inventory records, or other competent written
2059 documentary evidence maintained in the normal course of the
2060 provider’s business. A provider may not present records to
2061 contest an overpayment or sanction unless such records are
2062 contemporaneous and, if requested during the audit process, were
2063 furnished to the agency or its agent upon request. This
2064 limitation does not apply to Medicaid cost report audits. This
2065 limitation does not preclude consideration by the agency of
2066 addenda or modifications to a note if the addenda or
2067 modifications are made before notification of the audit, the
2068 addenda or modifications are germane to the note, and the note
2069 was made contemporaneously with a patient care episode.
2070 Notwithstanding the applicable rules of discovery, all
2071 documentation to be offered as evidence at an administrative
2072 hearing on a Medicaid overpayment or an administrative sanction
2073 must be exchanged by all parties at least 14 days before the
2074 administrative hearing or be excluded from consideration.
2075 (23)(a) In an audit, or investigation, or enforcement
2076 action taken for of a violation committed by a provider which is
2077 conducted pursuant to this section, the agency is entitled to
2078 recover all investigative and , legal costs incurred as a result
2079 of such audit, investigation, or enforcement action. The costs
2080 associated with an investigation, audit, or enforcement action
2081 may include, but are not limited to, salaries and benefits of
2082 personnel, costs related to the time spent by an attorney and
2083 other personnel working on the case, and any other expenses
2084 incurred by the agency or contractor which are associated with
2085 the case, including any , and expert witness costs and attorney
2086 fees incurred on behalf of the agency or contractor if the
2087 agency’s findings were not contested by the provider or, if
2088 contested, the agency ultimately prevailed.
2089 (b) The agency has the burden of documenting the costs,
2090 which include salaries and employee benefits and out-of-pocket
2091 expenses. The amount of costs that may be recovered must be
2092 reasonable in relation to the seriousness of the violation and
2093 must be set taking into consideration the financial resources,
2094 earning ability, and needs of the provider, who has the burden
2095 of demonstrating such factors.
2096 (c) The provider may pay the costs over a period to be
2097 determined by the agency if the agency determines that an
2098 extreme hardship would result to the provider from immediate
2099 full payment. Any default in payment of costs may be collected
2100 by any means authorized by law.
2101 (24) If the agency imposes an administrative sanction
2102 pursuant to subsection (13), subsection (14), or subsection
2103 (15), except paragraphs (15)(e) and (o), upon any provider or
2104 any principal, officer, director, agent, managing employee, or
2105 affiliated person of the provider who is regulated by another
2106 state entity, the agency shall notify that other entity of the
2107 imposition of the sanction within 5 business days. Such
2108 notification must include the provider’s or person’s name and
2109 license number and the specific reasons for sanction.
2110 (25)(a) The agency shall withhold Medicaid payments, in
2111 whole or in part, to a provider upon receipt of reliable
2112 evidence that the circumstances giving rise to the need for a
2113 withholding of payments involve fraud, willful
2114 misrepresentation, or abuse under the Medicaid program, or a
2115 crime committed while rendering goods or services to Medicaid
2116 recipients. If it is determined that fraud, willful
2117 misrepresentation, abuse, or a crime did not occur, the payments
2118 withheld must be paid to the provider within 14 days after such
2119 determination. Amounts not paid within 14 days accrue interest
2120 at the rate of 10 percent per year, beginning after the 14th
2122 (b) The agency shall deny payment, or require repayment, if
2123 the goods or services were furnished, supervised, or caused to
2124 be furnished by a person who has been suspended or terminated
2125 from the Medicaid program or Medicare program by the Federal
2126 Government or any state.
2127 (c) Overpayments owed to the agency bear interest at the
2128 rate of 10 percent per year from the date of final determination
2129 of the overpayment by the agency, and payment arrangements must
2130 be made within 30 days after the date of the final order, which
2131 is not subject to further appeal.
2132 (d) The agency, upon entry of a final agency order, a
2133 judgment or order of a court of competent jurisdiction, or a
2134 stipulation or settlement, may collect the moneys owed by all
2135 means allowable by law, including, but not limited to, notifying
2136 any fiscal intermediary of Medicare benefits that the state has
2137 a superior right of payment. Upon receipt of such written
2138 notification, the Medicare fiscal intermediary shall remit to
2139 the state the sum claimed.
2140 (e) The agency may institute amnesty programs to allow
2141 Medicaid providers the opportunity to voluntarily repay
2142 overpayments. The agency may adopt rules to administer such
2144 (26) The agency may impose administrative sanctions against
2145 a Medicaid recipient, or the agency may seek any other remedy
2146 provided by law, including, but not limited to, the remedies
2147 provided in s. 812.035, if the agency finds that a recipient has
2148 engaged in solicitation in violation of s. 409.920 or that the
2149 recipient has otherwise abused the Medicaid program.
2150 (27) When the Agency for Health Care Administration has
2151 made a probable cause determination and alleged that an
2152 overpayment to a Medicaid provider has occurred, the agency,
2153 after notice to the provider, shall:
2154 (a) Withhold, and continue to withhold during the pendency
2155 of an administrative hearing pursuant to chapter 120, any
2156 medical assistance reimbursement payments until such time as the
2157 overpayment is recovered, unless within 30 days after receiving
2158 notice thereof the provider:
2159 1. Makes repayment in full; or
2160 2. Establishes a repayment plan that is satisfactory to the
2161 Agency for Health Care Administration.
2162 (b) Withhold, and continue to withhold during the pendency
2163 of an administrative hearing pursuant to chapter 120, medical
2164 assistance reimbursement payments if the terms of a repayment
2165 plan are not adhered to by the provider.
2166 (28) Venue for all Medicaid program integrity cases lies in
2167 Leon County, at the discretion of the agency.
2168 (29) Notwithstanding other provisions of law, the agency
2169 and the Medicaid Fraud Control Unit of the Department of Legal
2170 Affairs may review a provider’s Medicaid-related and non
2171 Medicaid-related records in order to determine the total output
2172 of a provider’s practice to reconcile quantities of goods or
2173 services billed to Medicaid with quantities of goods or services
2174 used in the provider’s total practice.
2175 (30) The agency shall terminate a provider’s participation
2176 in the Medicaid program if the provider fails to reimburse an
2177 overpayment or pay an agency-imposed fine that has been
2178 determined by final order, not subject to further appeal, within
2179 30 days after the date of the final order, unless the provider
2180 and the agency have entered into a repayment agreement.
2181 (31) If a provider requests an administrative hearing
2182 pursuant to chapter 120, such hearing must be conducted within
2183 90 days following assignment of an administrative law judge,
2184 absent exceptionally good cause shown as determined by the
2185 administrative law judge or hearing officer. Upon issuance of a
2186 final order, the outstanding balance of the amount determined to
2187 constitute the overpayment and fines is due. If a provider fails
2188 to make payments in full, fails to enter into a satisfactory
2189 repayment plan, or fails to comply with the terms of a repayment
2190 plan or settlement agreement, the agency shall withhold
2191 reimbursement payments for Medicaid services until the amount
2192 due is paid in full.
2193 (32) Duly authorized agents and employees of the agency
2194 shall have the power to inspect, during normal business hours,
2195 the records of any pharmacy, wholesale establishment, or
2196 manufacturer, or any other place in which drugs and medical
2197 supplies are manufactured, packed, packaged, made, stored, sold,
2198 or kept for sale, for the purpose of verifying the amount of
2199 drugs and medical supplies ordered, delivered, or purchased by a
2200 provider. The agency shall provide at least 2 business days’
2201 prior notice of any such inspection. The notice must identify
2202 the provider whose records will be inspected, and the inspection
2203 shall include only records specifically related to that
2205 (33) In accordance with federal law, Medicaid recipients
2206 convicted of a crime pursuant to 42 U.S.C. s. 1320a-7b may be
2207 limited, restricted, or suspended from Medicaid eligibility for
2208 a period not to exceed 1 year, as determined by the agency head
2209 or designee.
2210 (34) To deter fraud and abuse in the Medicaid program, the
2211 agency may limit the number of Schedule II and Schedule III
2212 refill prescription claims submitted from a pharmacy provider.
2213 The agency shall limit the allowable amount of reimbursement of
2214 prescription refill claims for Schedule II and Schedule III
2215 pharmaceuticals if the agency or the Medicaid Fraud Control Unit
2216 determines that the specific prescription refill was not
2217 requested by the Medicaid recipient or authorized representative
2218 for whom the refill claim is submitted or was not prescribed by
2219 the recipient’s medical provider or physician. Any such refill
2220 request must be consistent with the original prescription.
2221 (35) The Office of Program Policy Analysis and Government
2222 Accountability shall provide a report to the President of the
2223 Senate and the Speaker of the House of Representatives on a
2224 biennial basis, beginning January 31, 2006, on the agency’s
2225 efforts to prevent, detect, and deter, as well as recover funds
2226 lost to, fraud and abuse in the Medicaid program.
2227 (36) The agency may provide to a sample of Medicaid
2228 recipients or their representatives through the distribution of
2229 explanations of benefits information about services reimbursed
2230 by the Medicaid program for goods and services to such
2231 recipients, including information on how to report inappropriate
2232 or incorrect billing to the agency or other law enforcement
2233 entities for review or investigation, information on how to
2234 report criminal Medicaid fraud to the Medicaid Fraud Control
2235 Unit’s toll-free hotline number, and information about the
2236 rewards available under s. 409.9203. The explanation of benefits
2237 may not be mailed for Medicaid independent laboratory services
2238 as described in s. 409.905(7) or for Medicaid certified match
2239 services as described in ss. 409.9071 and 1011.70.
2240 (37) The agency shall post on its website a current list of
2241 each Medicaid provider, including any principal, officer,
2242 director, agent, managing employee, or affiliated person of the
2243 provider, or any partner or shareholder having an ownership
2244 interest in the provider equal to 5 percent or greater, who has
2245 been terminated for cause from the Medicaid program or
2246 sanctioned under this section. The list must be searchable by a
2247 variety of search parameters and provide for the creation of
2248 formatted lists that may be printed or imported into other
2249 applications, including spreadsheets. The agency shall update
2250 the list at least monthly.
2251 (38) In order to improve the detection of health care
2252 fraud, use technology to prevent and detect fraud, and maximize
2253 the electronic exchange of health care fraud information, the
2254 agency shall:
2255 (a) Compile, maintain, and publish on its website a
2256 detailed list of all state and federal databases that contain
2257 health care fraud information and update the list at least
2259 (b) Develop a strategic plan to connect all databases that
2260 contain health care fraud information to facilitate the
2261 electronic exchange of health information between the agency,
2262 the Department of Health, the Department of Law Enforcement, and
2263 the Attorney General’s Office. The plan must include recommended
2264 standard data formats, fraud identification strategies, and
2265 specifications for the technical interface between state and
2266 federal health care fraud databases;
2267 (c) Monitor innovations in health information technology,
2268 specifically as it pertains to Medicaid fraud prevention and
2269 detection; and
2270 (d) Periodically publish policy briefs that highlight
2271 available new technology to prevent or detect health care fraud
2272 and projects implemented by other states, the private sector, or
2273 the Federal Government which use technology to prevent or detect
2274 health care fraud.
2275 Section 43. Paragraph (a) of subsection (2) of section
2276 409.920, Florida Statutes, is amended to read:
2277 409.920 Medicaid provider fraud.—
2278 (2)(a) A person may not:
2279 1. Knowingly make, cause to be made, or aid and abet in the
2280 making of any false statement or false representation of a
2281 material fact, by commission or omission, in any claim submitted
2282 to the agency or its fiscal agent or a managed care plan for
2284 2. Knowingly make, cause to be made, or aid and abet in the
2285 making of a claim for items or services that are not authorized
2286 to be reimbursed by the Medicaid program.
2287 3. Knowingly charge, solicit, accept, or receive anything
2288 of value, other than an authorized copayment from a Medicaid
2289 recipient, from any source in addition to the amount legally
2290 payable for an item or service provided to a Medicaid recipient
2291 under the Medicaid program or knowingly fail to credit the
2292 agency or its fiscal agent for any payment received from a
2293 third-party source.
2294 4. Knowingly make or in any way cause to be made any false
2295 statement or false representation of a material fact, by
2296 commission or omission, in any document containing items of
2297 income and expense that is or may be used by the agency to
2298 determine a general or specific rate of payment for an item or
2299 service provided by a provider.
2300 5. Knowingly solicit, offer, pay, or receive any
2301 remuneration, including any kickback, bribe, or rebate, directly
2302 or indirectly, overtly or covertly, in cash or in kind, in
2303 return for referring an individual to a person for the
2304 furnishing or arranging for the furnishing of any item or
2305 service for which payment may be made, in whole or in part,
2306 under the Medicaid program, or in return for obtaining,
2307 purchasing, leasing, ordering, or arranging for or recommending,
2308 obtaining, purchasing, leasing, or ordering any goods, facility,
2309 item, or service, for which payment may be made, in whole or in
2310 part, under the Medicaid program. This subparagraph does not
2311 apply to any discount, payment, waiver of payment, or payment
2312 practice not prohibited by 42 U.S.C. s. 1320a-7b(b) or
2313 regulations adopted thereunder.
2314 6. Knowingly submit false or misleading information or
2315 statements to the Medicaid program for the purpose of being
2316 accepted as a Medicaid provider.
2317 7. Knowingly use or endeavor to use a Medicaid provider’s
2318 identification number or a Medicaid recipient’s identification
2319 number to make, cause to be made, or aid and abet in the making
2320 of a claim for items or services that are not authorized to be
2321 reimbursed by the Medicaid program.
2322 Section 44. Subsection (1) of section 409.967, Florida
2323 Statutes, is amended to read:
2324 409.967 Managed care plan accountability.—
2325 (1) Beginning with the contract procurement process
2326 initiated during the 2023 calendar year, the agency shall
2327 establish a 6-year 5-year contract with each managed care plan
2328 selected through the procurement process described in s.
2329 409.966. A plan contract may not be renewed; however, the agency
2330 may extend the term of a plan contract to cover any delays
2331 during the transition to a new plan. The agency shall extend
2332 until December 31, 2024, the term of existing plan contracts
2333 awarded pursuant to the invitation to negotiate published in
2334 July 2017.
2335 Section 45. Paragraph (b) of subsection (5) of section
2336 409.973, Florida Statutes, is amended to read:
2337 409.973 Benefits.—
2338 (5) PROVISION OF DENTAL SERVICES.—
2339 (b) In the event the Legislature takes no action before
2340 July 1, 2017, with respect to the report findings required under
2341 subparagraph (a)2., the agency shall implement a statewide
2342 Medicaid prepaid dental health program for children and adults
2343 with a choice of at least two licensed dental managed care
2344 providers who must have substantial experience in providing
2345 dental care to Medicaid enrollees and children eligible for
2346 medical assistance under Title XXI of the Social Security Act
2347 and who meet all agency standards and requirements. To qualify
2348 as a provider under the prepaid dental health program, the
2349 entity must be licensed as a prepaid limited health service
2350 organization under part I of chapter 636 or as a health
2351 maintenance organization under part I of chapter 641. The
2352 contracts for program providers shall be awarded through a
2353 competitive procurement process. Beginning with the contract
2354 procurement process initiated during the 2023 calendar year, the
2355 contracts must be for 6 5 years and may not be renewed; however,
2356 the agency may extend the term of a plan contract to cover
2357 delays during a transition to a new plan provider. The agency
2358 shall include in the contracts a medical loss ratio provision
2359 consistent with s. 409.967(4). The agency is authorized to seek
2360 any necessary state plan amendment or federal waiver to commence
2361 enrollment in the Medicaid prepaid dental health program no
2362 later than March 1, 2019. The agency shall extend until December
2363 31, 2024, the term of existing plan contracts awarded pursuant
2364 to the invitation to negotiate published in October 2017.
2365 Section 46. Subsection (6) of section 429.11, Florida
2366 Statutes, is amended to read:
2367 429.11 Initial application for license; provisional
2369 (6) In addition to the license categories available in s.
2370 408.808, a provisional license may be issued to an applicant
2371 making initial application for licensure or making application
2372 for a change of ownership. A provisional license shall be
2373 limited in duration to a specific period of time not to exceed 6
2374 months, as determined by the agency.
2375 Section 47. Subsection (9) of section 429.19, Florida
2376 Statutes, is amended to read:
2377 429.19 Violations; imposition of administrative fines;
2379 (9) The agency shall develop and disseminate an annual list
2380 of all facilities sanctioned or fined for violations of state
2381 standards, the number and class of violations involved, the
2382 penalties imposed, and the current status of cases. The list
2383 shall be disseminated, at no charge, to the Department of
2384 Elderly Affairs, the Department of Health, the Department of
2385 Children and Families, the Agency for Persons with Disabilities,
2386 the area agencies on aging, the Florida Statewide Advocacy
2387 Council, the State Long-Term Care Ombudsman Program, and state
2388 and local ombudsman councils. The Department of Children and
2389 Families shall disseminate the list to service providers under
2390 contract to the department who are responsible for referring
2391 persons to a facility for residency. The agency may charge a fee
2392 commensurate with the cost of printing and postage to other
2393 interested parties requesting a copy of this list. This
2394 information may be provided electronically or through the
2395 agency’s Internet site.
2396 Section 48. Subsection (2) of section 429.35, Florida
2397 Statutes, is amended to read:
2398 429.35 Maintenance of records; reports.—
2399 (2) Within 60 days after the date of an the biennial
2400 inspection conducted visit required under s. 408.811 or within
2401 30 days after the date of an any interim visit, the agency shall
2402 forward the results of the inspection to the local ombudsman
2403 council in the district where the facility is located; to at
2404 least one public library or, in the absence of a public library,
2405 the county seat in the county in which the inspected assisted
2406 living facility is located; and, when appropriate, to the
2407 district Adult Services and Mental Health Program Offices.
2408 Section 49. Subsection (2) of section 429.905, Florida
2409 Statutes, is amended to read:
2410 429.905 Exemptions; monitoring of adult day care center
2411 programs colocated with assisted living facilities or licensed
2412 nursing home facilities.—
2413 (2) A licensed assisted living facility, a licensed
2414 hospital, or a licensed nursing home facility may provide
2415 services during the day which include, but are not limited to,
2416 social, health, therapeutic, recreational, nutritional, and
2417 respite services, to adults who are not residents. Such a
2418 facility need not be licensed as an adult day care center;
2419 however, the agency must monitor the facility during the regular
2420 inspection and at least biennially to ensure adequate space and
2421 sufficient staff. If an assisted living facility, a hospital, or
2422 a nursing home holds itself out to the public as an adult day
2423 care center, it must be licensed as such and meet all standards
2424 prescribed by statute and rule. For the purpose of this
2425 subsection, the term “day” means any portion of a 24-hour day.
2426 Section 50. Section 429.929, Florida Statutes, is amended
2427 to read:
2428 429.929 Rules establishing standards.—
2429 (1) The agency shall adopt rules to implement this part.
2430 The rules must include reasonable and fair standards. Any
2431 conflict between these standards and those that may be set forth
2432 in local, county, or municipal ordinances shall be resolved in
2433 favor of those having statewide effect. Such standards must
2434 relate to:
2435 (1) (a) The maintenance of adult day care centers with
2436 respect to plumbing, heating, lighting, ventilation, and other
2437 building conditions, including adequate meeting space, to ensure
2438 the health, safety, and comfort of participants and protection
2439 from fire hazard. Such standards may not conflict with chapter
2440 553 and must be based upon the size of the structure and the
2441 number of participants.
2442 (2) (b) The number and qualifications of all personnel
2443 employed by adult day care centers who have responsibilities for
2444 the care of participants.
2445 (3) (c) All sanitary conditions within adult day care
2446 centers and their surroundings, including water supply, sewage
2447 disposal, food handling, and general hygiene, and maintenance of
2448 sanitary conditions, to ensure the health and comfort of
2450 (4) (d) Basic services provided by adult day care centers.
2451 (5) (e) Supportive and optional services provided by adult
2452 day care centers.
2453 (6) (f) Data and information relative to participants and
2454 programs of adult day care centers, including, but not limited
2455 to, the physical and mental capabilities and needs of the
2456 participants, the availability, frequency, and intensity of
2457 basic services and of supportive and optional services provided,
2458 the frequency of participation, the distances traveled by
2459 participants, the hours of operation, the number of referrals to
2460 other centers or elsewhere, and the incidence of illness.
2461 (7) (g) Components of a comprehensive emergency management
2462 plan, developed in consultation with the Department of Health
2463 and the Division of Emergency Management.
2464 (2) Pursuant to this part, s. 408.811, and applicable
2465 rules, the agency may conduct an abbreviated biennial inspection
2466 of key quality-of-care standards, in lieu of a full inspection,
2467 of a center that has a record of good performance. However, the
2468 agency must conduct a full inspection of a center that has had
2469 one or more confirmed complaints within the licensure period
2470 immediately preceding the inspection or which has a serious
2471 problem identified during the abbreviated inspection. The agency
2472 shall develop the key quality-of-care standards, taking into
2473 consideration the comments and recommendations of provider
2474 groups. These standards shall be included in rules adopted by
2475 the agency.
2476 Section 51. Effective January 1, 2021, paragraph (e) of
2477 subsection (2) and paragraph (e) of subsection (3) of section
2478 627.6387, Florida Statutes, are amended to read:
2479 627.6387 Shared savings incentive program.—
2480 (2) As used in this section, the term:
2481 (e) “Shoppable health care service” means a lower-cost,
2482 high-quality nonemergency health care service for which a shared
2483 savings incentive is available for insureds under a health
2484 insurer’s shared savings incentive program. Shoppable health
2485 care services may be provided within or outside this state and
2486 include, but are not limited to:
2487 1. Clinical laboratory services.
2488 2. Infusion therapy.
2489 3. Inpatient and outpatient surgical procedures.
2490 4. Obstetrical and gynecological services.
2491 5. Inpatient and outpatient nonsurgical diagnostic tests
2492 and procedures.
2493 6. Physical and occupational therapy services.
2494 7. Radiology and imaging services.
2495 8. Prescription drugs.
2496 9. Services provided through telehealth.
2497 10. Any additional services published by the Agency for
2498 Health Care Administration which have the most significant price
2499 variation pursuant to s. 408.05(3)(l).
2500 (3) A health insurer may offer a shared savings incentive
2501 program to provide incentives to an insured when the insured
2502 obtains a shoppable health care service from the health
2503 insurer’s shared savings list. An insured may not be required to
2504 participate in a shared savings incentive program. A health
2505 insurer that offers a shared savings incentive program must:
2506 (e) At least quarterly, credit or deposit the shared
2507 savings incentive amount to the insured’s account as a return or
2508 reduction in premium, or credit the shared savings incentive
2509 amount to the insured’s flexible spending account, health
2510 savings account, or health reimbursement account, or reward the
2511 insured directly with cash or a cash equivalent such that the
2512 amount does not constitute income to the insured.
2513 Section 52. Effective January 1, 2021, paragraph (e) of
2514 subsection (2) and paragraph (e) of subsection (3) of section
2515 627.6648, Florida Statutes, are amended to read:
2516 627.6648 Shared savings incentive program.—
2517 (2) As used in this section, the term:
2518 (e) “Shoppable health care service” means a lower-cost,
2519 high-quality nonemergency health care service for which a shared
2520 savings incentive is available for insureds under a health
2521 insurer’s shared savings incentive program. Shoppable health
2522 care services may be provided within or outside this state and
2523 include, but are not limited to:
2524 1. Clinical laboratory services.
2525 2. Infusion therapy.
2526 3. Inpatient and outpatient surgical procedures.
2527 4. Obstetrical and gynecological services.
2528 5. Inpatient and outpatient nonsurgical diagnostic tests
2529 and procedures.
2530 6. Physical and occupational therapy services.
2531 7. Radiology and imaging services.
2532 8. Prescription drugs.
2533 9. Services provided through telehealth.
2534 10. Any additional services published by the Agency for
2535 Health Care Administration which have the most significant price
2536 variation pursuant to s. 408.05(3)(l).
2537 (3) A health insurer may offer a shared savings incentive
2538 program to provide incentives to an insured when the insured
2539 obtains a shoppable health care service from the health
2540 insurer’s shared savings list. An insured may not be required to
2541 participate in a shared savings incentive program. A health
2542 insurer that offers a shared savings incentive program must:
2543 (e) At least quarterly, credit or deposit the shared
2544 savings incentive amount to the insured’s account as a return or
2545 reduction in premium, or credit the shared savings incentive
2546 amount to the insured’s flexible spending account, health
2547 savings account, or health reimbursement account, or reward the
2548 insured directly with cash or a cash equivalent such that the
2549 amount does not constitute income to the insured.
2550 Section 53. Effective January 1, 2021, paragraph (e) of
2551 subsection (2) and paragraph (e) of subsection (3) of section
2552 641.31076, Florida Statutes, are amended to read:
2553 641.31076 Shared savings incentive program.—
2554 (2) As used in this section, the term:
2555 (e) “Shoppable health care service” means a lower-cost,
2556 high-quality nonemergency health care service for which a shared
2557 savings incentive is available for subscribers under a health
2558 maintenance organization’s shared savings incentive program.
2559 Shoppable health care services may be provided within or outside
2560 this state and include, but are not limited to:
2561 1. Clinical laboratory services.
2562 2. Infusion therapy.
2563 3. Inpatient and outpatient surgical procedures.
2564 4. Obstetrical and gynecological services.
2565 5. Inpatient and outpatient nonsurgical diagnostic tests
2566 and procedures.
2567 6. Physical and occupational therapy services.
2568 7. Radiology and imaging services.
2569 8. Prescription drugs.
2570 9. Services provided through telehealth.
2571 10. Any additional services published by the Agency for
2572 Health Care Administration which have the most significant price
2573 variation pursuant to s. 408.05(3)(l).
2574 (3) A health maintenance organization may offer a shared
2575 savings incentive program to provide incentives to a subscriber
2576 when the subscriber obtains a shoppable health care service from
2577 the health maintenance organization’s shared savings list. A
2578 subscriber may not be required to participate in a shared
2579 savings incentive program. A health maintenance organization
2580 that offers a shared savings incentive program must:
2581 (e) At least quarterly, credit or deposit the shared
2582 savings incentive amount to the subscriber’s account as a return
2583 or reduction in premium, or credit the shared savings incentive
2584 amount to the subscriber’s flexible spending account, health
2585 savings account, or health reimbursement account, or reward the
2586 subscriber directly with cash or a cash equivalent such that the
2587 amount does not constitute income to the subscriber.
2588 Section 54. Part I of chapter 483, Florida Statutes, is
2589 repealed, and part II and part III of that chapter are
2590 redesignated as part I and part II, respectively.
2591 Section 55. Paragraph (g) of subsection (3) of section
2592 20.43, Florida Statutes, is amended to read:
2593 20.43 Department of Health.—There is created a Department
2594 of Health.
2595 (3) The following divisions of the Department of Health are
2597 (g) Division of Medical Quality Assurance, which is
2598 responsible for the following boards and professions established
2599 within the division:
2600 1. The Board of Acupuncture, created under chapter 457.
2601 2. The Board of Medicine, created under chapter 458.
2602 3. The Board of Osteopathic Medicine, created under chapter
2604 4. The Board of Chiropractic Medicine, created under
2605 chapter 460.
2606 5. The Board of Podiatric Medicine, created under chapter
2608 6. Naturopathy, as provided under chapter 462.
2609 7. The Board of Optometry, created under chapter 463.
2610 8. The Board of Nursing, created under part I of chapter
2612 9. Nursing assistants, as provided under part II of chapter
2614 10. The Board of Pharmacy, created under chapter 465.
2615 11. The Board of Dentistry, created under chapter 466.
2616 12. Midwifery, as provided under chapter 467.
2617 13. The Board of Speech-Language Pathology and Audiology,
2618 created under part I of chapter 468.
2619 14. The Board of Nursing Home Administrators, created under
2620 part II of chapter 468.
2621 15. The Board of Occupational Therapy, created under part
2622 III of chapter 468.
2623 16. Respiratory therapy, as provided under part V of
2624 chapter 468.
2625 17. Dietetics and nutrition practice, as provided under
2626 part X of chapter 468.
2627 18. The Board of Athletic Training, created under part XIII
2628 of chapter 468.
2629 19. The Board of Orthotists and Prosthetists, created under
2630 part XIV of chapter 468.
2631 20. Electrolysis, as provided under chapter 478.
2632 21. The Board of Massage Therapy, created under chapter
2634 22. The Board of Clinical Laboratory Personnel, created
2635 under part I part II of chapter 483.
2636 23. Medical physicists, as provided under part II part III
2637 of chapter 483.
2638 24. The Board of Opticianry, created under part I of
2639 chapter 484.
2640 25. The Board of Hearing Aid Specialists, created under
2641 part II of chapter 484.
2642 26. The Board of Physical Therapy Practice, created under
2643 chapter 486.
2644 27. The Board of Psychology, created under chapter 490.
2645 28. School psychologists, as provided under chapter 490.
2646 29. The Board of Clinical Social Work, Marriage and Family
2647 Therapy, and Mental Health Counseling, created under chapter
2649 30. Emergency medical technicians and paramedics, as
2650 provided under part III of chapter 401.
2651 Section 56. Subsection (3) of section 381.0034, Florida
2652 Statutes, is amended to read:
2653 381.0034 Requirement for instruction on HIV and AIDS.—
2654 (3) The department shall require, as a condition of
2655 granting a license under chapter 467 or part I part II of
2656 chapter 483, that an applicant making initial application for
2657 licensure complete an educational course acceptable to the
2658 department on human immunodeficiency virus and acquired immune
2659 deficiency syndrome. Upon submission of an affidavit showing
2660 good cause, an applicant who has not taken a course at the time
2661 of licensure shall be allowed 6 months to complete this
2663 Section 57. Subsection (4) of section 456.001, Florida
2664 Statutes, is amended to read:
2665 456.001 Definitions.—As used in this chapter, the term:
2666 (4) “Health care practitioner” means any person licensed
2667 under chapter 457; chapter 458; chapter 459; chapter 460;
2668 chapter 461; chapter 462; chapter 463; chapter 464; chapter 465;
2669 chapter 466; chapter 467; part I, part II, part III, part V,
2670 part X, part XIII, or part XIV of chapter 468; chapter 478;
2671 chapter 480; part I or part II part II or part III of chapter
2672 483; chapter 484; chapter 486; chapter 490; or chapter 491.
2673 Section 58. Paragraphs (h) and (i) of subsection (2) of
2674 section 456.057, Florida Statutes, are amended to read:
2675 456.057 Ownership and control of patient records; report or
2676 copies of records to be furnished; disclosure of information.—
2677 (2) As used in this section, the terms “records owner,”
2678 “health care practitioner,” and “health care practitioner’s
2679 employer” do not include any of the following persons or
2680 entities; furthermore, the following persons or entities are not
2681 authorized to acquire or own medical records, but are authorized
2682 under the confidentiality and disclosure requirements of this
2683 section to maintain those documents required by the part or
2684 chapter under which they are licensed or regulated:
2685 (h) Clinical laboratory personnel licensed under part I
2686 part II of chapter 483.
2687 (i) Medical physicists licensed under part II part III of
2688 chapter 483.
2689 Section 59. Paragraph (j) of subsection (1) of section
2690 456.076, Florida Statutes, is amended to read:
2691 456.076 Impaired practitioner programs.—
2692 (1) As used in this section, the term:
2693 (j) “Practitioner” means a person licensed, registered,
2694 certified, or regulated by the department under part III of
2695 chapter 401; chapter 457; chapter 458; chapter 459; chapter 460;
2696 chapter 461; chapter 462; chapter 463; chapter 464; chapter 465;
2697 chapter 466; chapter 467; part I, part II, part III, part V,
2698 part X, part XIII, or part XIV of chapter 468; chapter 478;
2699 chapter 480; part I or part II part II or part III of chapter
2700 483; chapter 484; chapter 486; chapter 490; or chapter 491; or
2701 an applicant for a license, registration, or certification under
2702 the same laws.
2703 Section 60. Paragraph (b) of subsection (1) of section
2704 456.47, Florida Statutes, is amended to read:
2705 456.47 Use of telehealth to provide services.—
2706 (1) DEFINITIONS.—As used in this section, the term:
2707 (b) “Telehealth provider” means any individual who provides
2708 health care and related services using telehealth and who is
2709 licensed or certified under s. 393.17; part III of chapter 401;
2710 chapter 457; chapter 458; chapter 459; chapter 460; chapter 461;
2711 chapter 463; chapter 464; chapter 465; chapter 466; chapter 467;
2712 part I, part III, part IV, part V, part X, part XIII, or part
2713 XIV of chapter 468; chapter 478; chapter 480; part I or part II
2714 part II or part III of chapter 483; chapter 484; chapter 486;
2715 chapter 490; or chapter 491; who is licensed under a multistate
2716 health care licensure compact of which Florida is a member
2717 state; or who is registered under and complies with subsection
2719 Section 61. Except as otherwise expressly provided in this
2720 act and except for this section, which shall become effective
2721 upon this act becoming a law, this act shall take effect July 1,