Florida Senate - 2023                                     SB 768
       By Senator Martin
       33-00843-23                                            2023768__
    1                        A bill to be entitled                      
    2         An act relating to referral of patients by health care
    3         providers; amending s. 456.053, F.S.; deleting the
    4         definitions of the terms “direct supervision” and
    5         “present in the office suite”; revising the definition
    6         of the term “referral” to remove reference to direct
    7         physician supervision and to require compliance with
    8         certain Medicare payment and coverage rules; amending
    9         s. 641.316, F.S.; conforming cross-references;
   10         providing an effective date.
   12  Be It Enacted by the Legislature of the State of Florida:
   14         Section 1. Paragraphs (e) and (o) and present paragraph (p)
   15  of subsection (3) of section 456.053, Florida Statutes, are
   16  amended to read:
   17         456.053 Financial arrangements between referring health
   18  care providers and providers of health care services.—
   19         (3) DEFINITIONS.—For the purpose of this section, the word,
   20  phrase, or term:
   21         (e)“Direct supervision” means supervision by a physician
   22  who is present in the office suite and immediately available to
   23  provide assistance and direction throughout the time services
   24  are being performed.
   25         (o)“Present in the office suite” means that the physician
   26  is actually physically present; provided, however, that the
   27  health care provider is considered physically present during
   28  brief unexpected absences as well as during routine absences of
   29  a short duration if the absences occur during time periods in
   30  which the health care provider is otherwise scheduled and
   31  ordinarily expected to be present and the absences do not
   32  conflict with any other requirement in the Medicare program for
   33  a particular level of health care provider supervision.
   34         (n)(p) “Referral” means any referral of a patient by a
   35  health care provider for health care services, including,
   36  without limitation:
   37         1. The forwarding of a patient by a health care provider to
   38  another health care provider or to an entity which provides or
   39  supplies designated health services or any other health care
   40  item or service; or
   41         2. The request or establishment of a plan of care by a
   42  health care provider, which includes the provision of designated
   43  health services or other health care item or service.
   44         3. The following orders, recommendations, or plans of care
   45  shall not constitute a referral by a health care provider:
   46         a. By a radiologist for diagnostic-imaging services.
   47         b. By a physician specializing in the provision of
   48  radiation therapy services for such services.
   49         c. By a medical oncologist for drugs and solutions to be
   50  prepared and administered intravenously to such oncologist’s
   51  patient, as well as for the supplies and equipment used in
   52  connection therewith to treat such patient for cancer and the
   53  complications thereof.
   54         d. By a cardiologist for cardiac catheterization services.
   55         e. By a pathologist for diagnostic clinical laboratory
   56  tests and pathological examination services, if furnished by or
   57  under the supervision of such pathologist pursuant to a
   58  consultation requested by another physician.
   59         f. By a health care provider who is the sole provider or
   60  member of a group practice for designated health services or
   61  other health care items or services that are prescribed or
   62  provided solely for such referring health care provider’s or
   63  group practice’s own patients, and that are provided or
   64  performed by or under the direct supervision of such referring
   65  health care provider or group practice if such supervision
   66  complies with all applicable Medicare payment and coverage rules
   67  for services; provided, however, a physician licensed pursuant
   68  to chapter 458, chapter 459, chapter 460, or chapter 461 or an
   69  advanced practice registered nurse registered under s. 464.0123
   70  may refer a patient to a sole provider or group practice for
   71  diagnostic imaging services, excluding radiation therapy
   72  services, for which the sole provider or group practice billed
   73  both the technical and the professional fee for or on behalf of
   74  the patient, if the referring physician or advanced practice
   75  registered nurse registered under s. 464.0123 has no investment
   76  interest in the practice. The diagnostic imaging service
   77  referred to a group practice or sole provider must be a
   78  diagnostic imaging service normally provided within the scope of
   79  practice to the patients of the group practice or sole provider.
   80  The group practice or sole provider may accept no more than 15
   81  percent of their patients receiving diagnostic imaging services
   82  from outside referrals, excluding radiation therapy services.
   83  However, the 15 percent limitation of this sub-subparagraph and
   84  the requirements of subparagraph (4)(a)2. do not apply to a
   85  group practice entity that owns an accountable care organization
   86  or an entity operating under an advanced alternative payment
   87  model according to federal regulations if such entity provides
   88  diagnostic imaging services and has more than 30,000 patients
   89  enrolled per year.
   90         g. By a health care provider for services provided by an
   91  ambulatory surgical center licensed under chapter 395.
   92         h. By a urologist for lithotripsy services.
   93         i. By a dentist for dental services performed by an
   94  employee of or health care provider who is an independent
   95  contractor with the dentist or group practice of which the
   96  dentist is a member.
   97         j. By a physician for infusion therapy services to a
   98  patient of that physician or a member of that physician’s group
   99  practice.
  100         k. By a nephrologist for renal dialysis services and
  101  supplies, except laboratory services.
  102         l. By a health care provider whose principal professional
  103  practice consists of treating patients in their private
  104  residences for services to be rendered in such private
  105  residences, except for services rendered by a home health agency
  106  licensed under chapter 400. For purposes of this sub
  107  subparagraph, the term “private residences” includes patients’
  108  private homes, independent living centers, and assisted living
  109  facilities, but does not include skilled nursing facilities.
  110         m. By a health care provider for sleep-related testing.
  111         Section 2. Paragraph (b) of subsection (2) and subsection
  112  (6) of section 641.316, Florida Statutes, are amended to read:
  113         641.316 Fiscal intermediary services.—
  114         (2)
  115         (b) The term “fiscal intermediary services organization”
  116  means a person or entity that performs fiduciary or fiscal
  117  intermediary services to health care professionals who contract
  118  with health maintenance organizations other than a hospital
  119  licensed under chapter 395, an insurer licensed under chapter
  120  624, a third-party administrator licensed under chapter 626, a
  121  prepaid limited health service organization licensed under
  122  chapter 636, a health maintenance organization licensed under
  123  this chapter, or a physician group practice as defined in s.
  124  456.053(3) s. 456.053(3)(h) which provides services under the
  125  scope of licenses of the members of the group practice.
  126         (6) Any fiscal intermediary services organization, other
  127  than a hospital licensed under chapter 395, an insurer licensed
  128  under chapter 624, a third-party administrator licensed under
  129  chapter 626, a prepaid limited health service organization
  130  licensed under chapter 636, a health maintenance organization
  131  licensed under this chapter, a not-for-profit corporation that
  132  provides health care services directly to patients through
  133  employed, salaried physicians and that is affiliated with an
  134  accredited hospital licensed in this state, or a physician group
  135  practice as defined in s. 456.053(3) s. 456.053(3)(h) which
  136  provides services under the scope of licenses of the members of
  137  the group practice, must register with the office and meet the
  138  requirements of this section. In order to register as a fiscal
  139  intermediary services organization, the organization must comply
  140  with ss. 641.21(1)(c), (d), and (j), 641.22(6), and 641.27. The
  141  fiscal intermediary services organization must also comply with
  142  the provisions of ss. 641.3155, 641.3156, and 641.51(4). Should
  143  the office determine that the fiscal intermediary services
  144  organization does not meet the requirements of this section, the
  145  registration shall be denied. If the registrant fails to
  146  maintain compliance with this section, the office may revoke or
  147  suspend the registration. In lieu of revocation or suspension of
  148  the registration, the office may levy an administrative penalty
  149  in accordance with s. 641.25.
  150         Section 3. This act shall take effect July 1, 2023.