CS for CS for CS for SB 752 First Engrossed
2010752e1
1 A bill to be entitled
2 An act relating to health care; amending s. 400.471,
3 F.S.; prohibiting the Agency for Health Care
4 Administration from issuing an initial license to a
5 home health agency for the purpose of opening a new
6 home health agency under certain conditions until a
7 specified date; prohibiting the agency from issuing a
8 change-of-ownership license to a home health agency
9 under certain conditions until a specified date;
10 providing an exception; amending s. 400.474, F.S.;
11 authorizing the agency to revoke a home health agency
12 license if the applicant or any controlling interest
13 has been sanctioned for acts specified under s.
14 400.471(10), F.S.; amending s. 400.9905, F.S.;
15 specifying that certain licensure requirements do not
16 apply to certain pediatric cardiological or
17 perinatological clinical facilities; providing that
18 part X of ch. 400, F.S., the Health Care Clinic Act,
19 does not apply to entities owned by a corporation that
20 has a specified amount of annual sales of health care
21 services under certain circumstances; amending s.
22 408.815, F.S.; revising the grounds upon which the
23 agency may deny or revoke an application for an
24 initial license, a change-of-ownership license, or a
25 licensure renewal for certain health care entities
26 listed in s. 408.802, F.S.; amending s. 408.910, F.S.;
27 revising the list of employers who are eligible to
28 enroll in the Florida Health Choices Program; revising
29 the membership of the board of directors of the
30 Florida Health Choices, Inc.; requiring the President
31 of the Senate and the Speaker of the House of
32 Representatives to initially appoint members to the
33 board of directors for staggered terms; requiring that
34 the members of the board appoint new members to the
35 board of directors after a specified date, subject to
36 Senate confirmation; deleting a provision that
37 prohibits board members from serving for more than a
38 certain number of consecutive years; amending s.
39 409.907, F.S.; extending the number of years that
40 Medicaid providers must retain Medicaid recipient
41 records; adding additional requirements to the
42 Medicaid provider agreement; revising applicability of
43 screening requirements; revising conditions under
44 which the agency is authorized to deny a Medicaid
45 provider application; amending s. 409.912, F.S.;
46 revising requirements for Medicaid prepaid, fixed-sum,
47 and managed care contracts; revising requirements for
48 Medicaid durable medical equipment providers;
49 repealing s. 409.9122(13), F.S., relating to the
50 enrollee assignment process of Medicaid managed
51 prepaid health plans for those Medicaid managed
52 prepaid health plans operating in Miami-Dade County;
53 amending s. 409.913, F.S.; removing a required element
54 from the joint Medicaid fraud and abuse report
55 submitted by the agency and the Medicaid Fraud Control
56 Unit of the Department of Legal Affairs; extending the
57 number of years that Medicaid providers must retain
58 Medicaid recipient records; authorizing the Medicaid
59 program integrity staff to immediately suspend or
60 terminate a Medicaid provider for engaging in
61 specified conduct; removing a requirement for the
62 agency to hold suspended Medicaid payments in a
63 separate account; authorizing the agency to deny
64 payment or require repayment to Medicaid providers
65 convicted of certain crimes; authorizing the agency to
66 terminate a Medicaid provider if the provider fails to
67 reimburse a fine determined by a final order;
68 authorizing the agency to withhold Medicaid
69 reimbursement to a Medicaid provider that fails to pay
70 a fine determined by a final order, fails to enter
71 into a repayment plan, or fails to comply with a
72 repayment plan or settlement agreement; requiring the
73 biennial review of Medicaid fraud and abuse by the
74 Office of Program Policy Analysis and Government
75 Accountability to include a report on the Medicaid
76 Fraud Control Unit within the Department of Legal
77 Affairs; amending s. 409.9203, F.S.; providing that
78 certain state employees are ineligible from receiving
79 a reward for reporting Medicaid fraud; amending s.
80 456.001, F.S.; defining the term “affiliate” or
81 “affiliated person” as it relates to health
82 professions and occupations; amending s. 456.041,
83 F.S.; requiring the Department of Health to include
84 administrative complaints and any conviction
85 information relating to the practitioner’s profile;
86 providing a disclaimer; amending s. 456.0635, F.S.;
87 revising the grounds under which the Department of
88 Health or corresponding board is required to refuse to
89 admit a candidate to an examination and refuse to
90 issue or renew a license, certificate, or registration
91 of a health care practitioner; providing an exception;
92 amending s. 456.072, F.S.; clarifying a ground under
93 which disciplinary actions may be taken; amending s.
94 456.073, F.S.; revising applicability of
95 investigations and administrative complaints to
96 include Medicaid fraud; amending s. 456.074, F.S.;
97 authorizing the Department of Health to issue an
98 emergency order suspending the license of any person
99 licensed under ch. 456, F.S., who engages in specified
100 criminal conduct; amending s. 499.01, F.S.; exempting
101 certain persons from requirements for medical device
102 manufacturer permits; providing an effective date.
103
104 Be It Enacted by the Legislature of the State of Florida:
105
106 Section 1. Subsection (11) of section 400.471, Florida
107 Statutes, is amended to read:
108 400.471 Application for license; fee.—
109 (11)(a) The agency may not issue an initial license to a
110 home health agency under part II of chapter 408 or this part for
111 the purpose of opening a new home health agency until July 1,
112 2012 2010, in any county that has at least one actively licensed
113 home health agency and a population of persons 65 years of age
114 or older, as indicated in the most recent population estimates
115 published by the Executive Office of the Governor, of fewer than
116 1,200 per home health agency. In such counties, for any
117 application received by the agency prior to July 1, 2009, which
118 has been deemed by the agency to be complete except for proof of
119 accreditation, the agency may issue an initial ownership license
120 only if the applicant has applied for accreditation before May
121 1, 2009, from an accrediting organization that is recognized by
122 the agency.
123 (b) Effective October 1, 2009, the agency may not issue a
124 change of ownership license to a home health agency under part
125 II of chapter 408 or this part until July 1, 2012 2010, in any
126 county that has at least one actively licensed home health
127 agency and a population of persons 65 years of age or older, as
128 indicated in the most recent population estimates published by
129 the Executive Office of the Governor, of fewer than 1,200 per
130 home health agency. In such counties, for any application
131 received by the agency before prior to October 1, 2009, which
132 has been deemed by the agency to be complete except for proof of
133 accreditation, the agency may issue a change of ownership
134 license only if the applicant has applied for accreditation
135 before August 1, 2009, from an accrediting organization that is
136 recognized by the agency. This paragraph does not apply to an
137 application for a change in ownership from an existing home
138 health agency that is accredited, has been licensed by the state
139 at least 5 years, and is in good standing with the agency.
140 Section 2. Subsection (8) is added to section 400.474,
141 Florida Statutes, to read:
142 400.474 Administrative penalties.—
143 (8) The agency may revoke the license of a home health
144 agency that is not eligible for licensure renewal under s.
145 400.471(10).
146 Section 3. Paragraph (l) of subsection (4) of section
147 400.9905, Florida Statutes, is amended, and paragraph (m) is
148 added to that subsection, to read:
149 400.9905 Definitions.—
150 (4) “Clinic” means an entity at which health care services
151 are provided to individuals and which tenders charges for
152 reimbursement for such services, including a mobile clinic and a
153 portable equipment provider. For purposes of this part, the term
154 does not include and the licensure requirements of this part do
155 not apply to:
156 (l) Orthotic, or prosthetic, pediatric cardiological, or
157 perinatological clinical facilities that are a publicly traded
158 corporation or that are wholly owned, directly or indirectly, by
159 a publicly traded corporation. As used in this paragraph, a
160 publicly traded corporation is a corporation that issues
161 securities traded on an exchange registered with the United
162 States Securities and Exchange Commission as a national
163 securities exchange.
164 (m) Entities that are owned by a corporation that has $250
165 million or more in total annual sales of health care services
166 provided by licensed health care practitioners if one or more of
167 the owners of the entity is a health care practitioner who is
168 licensed in this state, is responsible for supervising the
169 business activities of the entity, and is legally responsible
170 for the entity’s compliance with state law for purposes of this
171 section.
172 Section 4. Subsections (1) and (4) of section 408.815,
173 Florida Statutes, are amended, and subsection (5) is added to
174 that section, to read:
175 408.815 License or application denial; revocation.—
176 (1) In addition to the grounds provided in authorizing
177 statutes, grounds that may be used by the agency for denying and
178 revoking a license or change of ownership application include
179 any of the following actions by a controlling interest:
180 (a) False representation of a material fact in the license
181 application or omission of any material fact from the
182 application.
183 (b) An intentional or negligent act materially affecting
184 the health or safety of a client of the provider.
185 (c) A violation of this part, authorizing statutes, or
186 applicable rules.
187 (d) A demonstrated pattern of deficient performance.
188 (e) The applicant, licensee, or controlling interest has
189 been or is currently excluded, suspended, or terminated from
190 participation in the state Medicaid program, the Medicaid
191 program of any other state, or the Medicare program.
192 (f) The applicant, licensee, or controlling interest is or
193 was an administrator or controlling interest in a facility or
194 entity during the period an event that caused or contributed to
195 the facility or entity being excluded, suspended, or terminated
196 from participation in the state Medicaid program, the Medicaid
197 program of any other state, or the Medicare program.
198 (4) In addition to the grounds provided in authorizing
199 statutes, the agency shall deny an application for an initial a
200 license or a change-of-ownership license renewal if the
201 applicant or a person having a controlling interest in the an
202 applicant has been:
203 (a) Has been convicted of, or entered enters a plea of
204 guilty or nolo contendere to, regardless of adjudication, a
205 felony under chapter 409, chapter 817, chapter 893, or a similar
206 felony offense committed in another state or jurisdiction 21
207 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the
208 sentence and any subsequent period of probation for such
209 conviction convictions or plea ended more than 15 years before
210 prior to the date of the application;
211 (b) Has been convicted of, or entered a plea of guilty or
212 nolo contendere to, regardless of adjudication, a felony under
213 21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the
214 sentence and any subsequent period of probation for such
215 conviction or plea ended more than 15 years before the date of
216 the application;
217 (c)(b) Has been terminated for cause from the Florida
218 Medicaid program pursuant to s. 409.913, unless the applicant
219 has been in good standing with the Florida Medicaid program for
220 the most recent 5 years; or
221 (d)(c) Has been terminated for cause, pursuant to the
222 appeals procedures established by the state, or Federal
223 Government, from the federal Medicare program or from any other
224 state Medicaid program, unless the applicant has been in good
225 standing with a state Medicaid program or the federal Medicare
226 program for the most recent 5 years and the termination occurred
227 at least 20 years before prior to the date of the application;
228 or.
229 (e) Is currently listed on the United States Department of
230 Health and Human Services Office of Inspector General’s List of
231 Excluded Individuals and Entities.
232 (5) In addition to the grounds provided in authorizing
233 statutes, the agency shall deny an application for licensure
234 renewal if the applicant or a person having a controlling
235 interest in the applicant:
236 (a) Has been convicted of, or entered a plea of guilty or
237 nolo contendere to, regardless of adjudication, a felony under
238 chapter 409, chapter 817, chapter 893, or a similar felony
239 offense committed in another state or jurisdiction since July 1,
240 2009;
241 (b) Has been convicted of, or entered a plea of guilty or
242 nolo contendere to, regardless of adjudication, a felony under
243 21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396 since July 1,
244 2009;
245 (c) Has been terminated for cause from the Florida Medicaid
246 program pursuant to s. 409.913, unless the applicant has been in
247 good standing with the Florida Medicaid program for the most
248 recent 5 years;
249 (d) Has been terminated for cause, pursuant to the appeals
250 procedures established by the state, from any other state
251 Medicaid program, unless the applicant has been in good standing
252 with a state Medicaid program for the most recent 5 years and
253 the termination occurred at least 20 years before the date of
254 the application; or
255 (e) Is currently listed on the United States Department of
256 Health and Human Services Office of Inspector General’s List of
257 Excluded Individuals and Entities.
258 Section 5. Paragraph (a) of subsection (4) and subsection
259 (11) of section 408.910, Florida Statutes, are amended to read:
260 408.910 Florida Health Choices Program.—
261 (4) ELIGIBILITY AND PARTICIPATION.—Participation in the
262 program is voluntary and shall be available to employers,
263 individuals, vendors, and health insurance agents as specified
264 in this subsection.
265 (a) Employers eligible to enroll in the program include:
266 1. Employers that have 1 to 50 employees.
267 2. Fiscally constrained counties described in s. 218.67.
268 3. Municipalities having populations of fewer than 50,000
269 residents.
270 4. School districts in fiscally constrained counties.
271 5. State universities and community colleges.
272 (11) CORPORATION.—There is created the Florida Health
273 Choices, Inc., which shall be registered, incorporated,
274 organized, and operated in compliance with part III of chapter
275 112 and chapters 119, 286, and 617. The purpose of the
276 corporation is to administer the program created in this section
277 and to conduct such other business as may further the
278 administration of the program.
279 (a)1. The corporation shall be governed by a five-member
280 15-member board of directors consisting of:
281 1. Three ex officio, nonvoting members to include:
282 a. The Secretary of Health Care Administration or a
283 designee with expertise in health care services.
284 b. The Secretary of Management Services or a designee with
285 expertise in state employee benefits.
286 c. The commissioner of the Office of Insurance Regulation
287 or a designee with expertise in insurance regulation.
288 a.2. One member Four members appointed by and serving at
289 the pleasure of the Governor.
290 b.3. Two Four members appointed by and serving at the
291 pleasure of the President of the Senate.
292 c.4. Two Four members appointed by and serving at the
293 pleasure of the Speaker of the House of Representatives.
294 2.5. Board members may not include insurers, health
295 insurance agents or brokers, health care providers, health
296 maintenance organizations, prepaid service providers, or any
297 other entity, affiliate or subsidiary of eligible vendors.
298 (b)1. Members shall be appointed for terms of up to 4 3
299 years. In order to establish staggered terms, for the initial
300 appointments the President of the Senate and the Speaker of the
301 House of Representatives shall each appoint one member to a 2
302 year term and one member to a 4-year term. Any member is
303 eligible for reappointment. A vacancy on the board shall be
304 filled for the unexpired portion of the term in the same manner
305 as the original appointment.
306 2. Beginning July 1, 2011, the members of the board of
307 directors shall appoint new members to the board of directors,
308 subject to confirmation by the Senate.
309 (c) The board shall select a chief executive officer for
310 the corporation who shall be responsible for the selection of
311 such other staff as may be authorized by the corporation’s
312 operating budget as adopted by the board.
313 (d) Board members are entitled to receive, from funds of
314 the corporation, reimbursement for per diem and travel expenses
315 as provided by s. 112.061. No other compensation is authorized.
316 (e) There is no liability on the part of, and no cause of
317 action shall arise against, any member of the board or its
318 employees or agents for any action taken by them in the
319 performance of their powers and duties under this section.
320 (f) The board shall develop and adopt bylaws and other
321 corporate procedures as necessary for the operation of the
322 corporation and carrying out the purposes of this section. The
323 bylaws shall:
324 1. Specify procedures for selection of officers and
325 qualifications for reappointment, provided that no board member
326 shall serve more than 9 consecutive years.
327 2. Require an annual membership meeting that provides an
328 opportunity for input and interaction with individual
329 participants in the program.
330 3. Specify policies and procedures regarding conflicts of
331 interest, including the provisions of part III of chapter 112,
332 which prohibit a member from participating in any decision that
333 would inure to the benefit of the member or the organization
334 that employs the member. The policies and procedures shall also
335 require public disclosure of the interest that prevents the
336 member from participating in a decision on a particular matter.
337 (g) The corporation may exercise all powers granted to it
338 under chapter 617 necessary to carry out the purposes of this
339 section, including, but not limited to, the power to receive and
340 accept grants, loans, or advances of funds from any public or
341 private agency and to receive and accept from any source
342 contributions of money, property, labor, or any other thing of
343 value to be held, used, and applied for the purposes of this
344 section.
345 (h) The corporation may establish technical advisory panels
346 consisting of interested parties, including consumers, health
347 care providers, individuals with expertise in insurance
348 regulation, and insurers.
349 (i) The corporation shall:
350 1. Determine eligibility of employers, vendors,
351 individuals, and agents in accordance with subsection (4).
352 2. Establish procedures necessary for the operation of the
353 program, including, but not limited to, procedures for
354 application, enrollment, risk assessment, risk adjustment, plan
355 administration, performance monitoring, and consumer education.
356 3. Arrange for collection of contributions from
357 participating employers and individuals.
358 4. Arrange for payment of premiums and other appropriate
359 disbursements based on the selections of products and services
360 by the individual participants.
361 5. Establish criteria for disenrollment of participating
362 individuals based on failure to pay the individual’s share of
363 any contribution required to maintain enrollment in selected
364 products.
365 6. Establish criteria for exclusion of vendors pursuant to
366 paragraph (4)(d).
367 7. Develop and implement a plan for promoting public
368 awareness of and participation in the program.
369 8. Secure staff and consultant services necessary to the
370 operation of the program.
371 9. Establish policies and procedures regarding
372 participation in the program for individuals, vendors, health
373 insurance agents, and employers.
374 10. Develop a plan, in coordination with the Department of
375 Revenue, to establish tax credits or refunds for employers that
376 participate in the program. The corporation shall submit the
377 plan to the Governor, the President of the Senate, and the
378 Speaker of the House of Representatives by January 1, 2009.
379 Section 6. Paragraph (c) of subsection (3) of section
380 409.907, Florida Statutes, is amended, paragraph (k) is added to
381 that subsection, and subsection (8), paragraph (b) of subsection
382 (9), and subsection (10) of that section are amended, to read:
383 409.907 Medicaid provider agreements.—The agency may make
384 payments for medical assistance and related services rendered to
385 Medicaid recipients only to an individual or entity who has a
386 provider agreement in effect with the agency, who is performing
387 services or supplying goods in accordance with federal, state,
388 and local law, and who agrees that no person shall, on the
389 grounds of handicap, race, color, or national origin, or for any
390 other reason, be subjected to discrimination under any program
391 or activity for which the provider receives payment from the
392 agency.
393 (3) The provider agreement developed by the agency, in
394 addition to the requirements specified in subsections (1) and
395 (2), shall require the provider to:
396 (c) Retain all medical and Medicaid-related records for a
397 period of 6 5 years to satisfy all necessary inquiries by the
398 agency.
399 (k) Report any change of any principal of the provider,
400 including any officer, director, agent, managing employee, or
401 affiliated person, or any partner or shareholder who has an
402 ownership interest equal to 5 percent or more in the provider.
403 The provider must report changes to the agency no later than 30
404 days after the change occurs. Reporting changes in controlling
405 interests to the agency pursuant to s. 408.810(3) shall serve as
406 compliance with this paragraph for hospitals licensed under
407 chapter 395 and nursing homes licensed under chapter 400.
408 (8)(a) Each provider, or each principal of the provider if
409 the provider is a corporation, partnership, association, or
410 other entity, seeking to participate in the Medicaid program
411 must submit a complete set of his or her fingerprints to the
412 agency for the purpose of conducting a criminal history record
413 check. Principals of the provider include any officer, director,
414 billing agent, managing employee, or affiliated person, or any
415 partner or shareholder who has an ownership interest equal to 5
416 percent or more in the provider. However, for hospitals licensed
417 under chapter 395 and nursing homes licensed under chapter 400,
418 principals of the provider are those who meet the definition of
419 a controlling interest in s. 408.803(7). A director of a not
420 for-profit corporation or organization is not a principal for
421 purposes of a background investigation as required by this
422 section if the director: serves solely in a voluntary capacity
423 for the corporation or organization, does not regularly take
424 part in the day-to-day operational decisions of the corporation
425 or organization, receives no remuneration from the not-for
426 profit corporation or organization for his or her service on the
427 board of directors, has no financial interest in the not-for
428 profit corporation or organization, and has no family members
429 with a financial interest in the not-for-profit corporation or
430 organization; and if the director submits an affidavit, under
431 penalty of perjury, to this effect to the agency and the not
432 for-profit corporation or organization submits an affidavit,
433 under penalty of perjury, to this effect to the agency as part
434 of the corporation’s or organization’s Medicaid provider
435 agreement application. Notwithstanding the above, the agency may
436 require a background check for any person reasonably suspected
437 by the agency to have been convicted of a crime. This subsection
438 does shall not apply to:
439 1. A hospital licensed under chapter 395;
440 2. A nursing home licensed under chapter 400;
441 3. A hospice licensed under chapter 400;
442 4. An assisted living facility licensed under chapter 429;
443 1.5. A unit of local government, except that requirements
444 of this subsection apply to nongovernmental providers and
445 entities when contracting with the local government to provide
446 Medicaid services. The actual cost of the state and national
447 criminal history record checks must be borne by the
448 nongovernmental provider or entity; or
449 2.6. Any business that derives more than 50 percent of its
450 revenue from the sale of goods to the final consumer, and the
451 business or its controlling parent either is required to file a
452 form 10-K or other similar statement with the Securities and
453 Exchange Commission or has a net worth of $50 million or more.
454 (b) Background screening shall be conducted in accordance
455 with chapter 435 and s. 408.809. The agency shall submit the
456 fingerprints to the Department of Law Enforcement. The
457 department shall conduct a state criminal-background
458 investigation and forward the fingerprints to the Federal Bureau
459 of Investigation for a national criminal-history record check.
460 The cost of the state and national criminal record check shall
461 be borne by the provider.
462 (c) The agency may permit a provider to participate in the
463 Medicaid program pending the results of the criminal record
464 check. However, such permission is fully revocable if the record
465 check reveals any crime-related history as provided in
466 subsection (10).
467 (c)(d) Proof of compliance with the requirements of level 2
468 screening under s. 435.04 conducted within 12 months prior to
469 the date that the Medicaid provider application is submitted to
470 the agency shall fulfill the requirements of this subsection.
471 Proof of compliance with the requirements of level 1 screening
472 under s. 435.03 conducted within 12 months prior to the date
473 that the Medicaid provider application is submitted to the
474 agency shall meet the requirement that the Department of Law
475 Enforcement conduct a state criminal history record check.
476 (9) Upon receipt of a completed, signed, and dated
477 application, and completion of any necessary background
478 investigation and criminal history record check, the agency must
479 either:
480 (b) Deny the application if the agency finds that it is in
481 the best interest of the Medicaid program to do so. The agency
482 may consider any the factors listed in subsection (10), as well
483 as any other factor that could affect the effective and
484 efficient administration of the program, including, but not
485 limited to, the applicant’s demonstrated ability to provide
486 services, conduct business, and operate a financially viable
487 concern; the current availability of medical care, services, or
488 supplies to recipients, taking into account geographic location
489 and reasonable travel time; the number of providers of the same
490 type already enrolled in the same geographic area; and the
491 credentials, experience, success, and patient outcomes of the
492 provider for the services that it is making application to
493 provide in the Medicaid program. The agency shall deny the
494 application if the agency finds that a provider; any officer,
495 director, agent, managing employee, or affiliated person; or any
496 principal, partner, or shareholder having an ownership interest
497 equal to 5 percent or greater in the provider if the provider is
498 a corporation, partnership, or other business entity, has failed
499 to pay all outstanding fines or overpayments assessed by final
500 order of the agency or final order of the Centers for Medicare
501 and Medicaid Services, not subject to further appeal, unless the
502 provider agrees to a repayment plan that includes withholding
503 Medicaid reimbursement until the amount due is paid in full.
504 (10) The agency shall deny the application if may consider
505 whether the provider, or any officer, director, agent, managing
506 employee, or affiliated person, or any principal, partner, or
507 shareholder having an ownership interest equal to 5 percent or
508 greater in the provider if the provider is a corporation,
509 partnership, or other business entity, has committed an offense
510 listed in s. 409.913(13), and may deny the application if one of
511 these persons has:
512 (a) Made a false representation or omission of any material
513 fact in making the application, including the submission of an
514 application that conceals the controlling or ownership interest
515 of any officer, director, agent, managing employee, affiliated
516 person, or principal, partner, or shareholder who may not be
517 eligible to participate;
518 (b) Been or is currently excluded, suspended, terminated
519 from, or has involuntarily withdrawn from participation in,
520 Florida’s Medicaid program or any other state’s Medicaid
521 program, or from participation in any other governmental or
522 private health care or health insurance program;
523 (c) Been convicted of a criminal offense relating to the
524 delivery of any goods or services under Medicaid or Medicare or
525 any other public or private health care or health insurance
526 program including the performance of management or
527 administrative services relating to the delivery of goods or
528 services under any such program;
529 (d) Been convicted under federal or state law of a criminal
530 offense related to the neglect or abuse of a patient in
531 connection with the delivery of any health care goods or
532 services;
533 (c)(e) Been convicted under federal or state law of a
534 criminal offense relating to the unlawful manufacture,
535 distribution, prescription, or dispensing of a controlled
536 substance;
537 (d)(f) Been convicted of any criminal offense relating to
538 fraud, theft, embezzlement, breach of fiduciary responsibility,
539 or other financial misconduct;
540 (e)(g) Been convicted under federal or state law of a crime
541 punishable by imprisonment of a year or more which involves
542 moral turpitude;
543 (f)(h) Been convicted in connection with the interference
544 or obstruction of any investigation into any criminal offense
545 listed in this subsection;
546 (g)(i) Been found to have violated federal or state laws,
547 rules, or regulations governing Florida’s Medicaid program or
548 any other state’s Medicaid program, the Medicare program, or any
549 other publicly funded federal or state health care or health
550 insurance program, and been sanctioned accordingly;
551 (h)(j) Been previously found by a licensing, certifying, or
552 professional standards board or agency to have violated the
553 standards or conditions relating to licensure or certification
554 or the quality of services provided; or
555 (i)(k) Failed to pay any fine or overpayment properly
556 assessed under the Medicaid program in which no appeal is
557 pending or after resolution of the proceeding by stipulation or
558 agreement, unless the agency has issued a specific letter of
559 forgiveness or has approved a repayment schedule to which the
560 provider agrees to adhere.
561
562 If the agency determines a provider did not participate or
563 acquiesce in an offense specified in s. 409.913(13), the agency
564 is not required to deny the provider application.
565 Section 7. Subsections (10), (32), and (48) of section
566 409.912, Florida Statutes, are amended to read:
567 409.912 Cost-effective purchasing of health care.—The
568 agency shall purchase goods and services for Medicaid recipients
569 in the most cost-effective manner consistent with the delivery
570 of quality medical care. To ensure that medical services are
571 effectively utilized, the agency may, in any case, require a
572 confirmation or second physician’s opinion of the correct
573 diagnosis for purposes of authorizing future services under the
574 Medicaid program. This section does not restrict access to
575 emergency services or poststabilization care services as defined
576 in 42 C.F.R. part 438.114. Such confirmation or second opinion
577 shall be rendered in a manner approved by the agency. The agency
578 shall maximize the use of prepaid per capita and prepaid
579 aggregate fixed-sum basis services when appropriate and other
580 alternative service delivery and reimbursement methodologies,
581 including competitive bidding pursuant to s. 287.057, designed
582 to facilitate the cost-effective purchase of a case-managed
583 continuum of care. The agency shall also require providers to
584 minimize the exposure of recipients to the need for acute
585 inpatient, custodial, and other institutional care and the
586 inappropriate or unnecessary use of high-cost services. The
587 agency shall contract with a vendor to monitor and evaluate the
588 clinical practice patterns of providers in order to identify
589 trends that are outside the normal practice patterns of a
590 provider’s professional peers or the national guidelines of a
591 provider’s professional association. The vendor must be able to
592 provide information and counseling to a provider whose practice
593 patterns are outside the norms, in consultation with the agency,
594 to improve patient care and reduce inappropriate utilization.
595 The agency may mandate prior authorization, drug therapy
596 management, or disease management participation for certain
597 populations of Medicaid beneficiaries, certain drug classes, or
598 particular drugs to prevent fraud, abuse, overuse, and possible
599 dangerous drug interactions. The Pharmaceutical and Therapeutics
600 Committee shall make recommendations to the agency on drugs for
601 which prior authorization is required. The agency shall inform
602 the Pharmaceutical and Therapeutics Committee of its decisions
603 regarding drugs subject to prior authorization. The agency is
604 authorized to limit the entities it contracts with or enrolls as
605 Medicaid providers by developing a provider network through
606 provider credentialing. The agency may competitively bid single
607 source-provider contracts if procurement of goods or services
608 results in demonstrated cost savings to the state without
609 limiting access to care. The agency may limit its network based
610 on the assessment of beneficiary access to care, provider
611 availability, provider quality standards, time and distance
612 standards for access to care, the cultural competence of the
613 provider network, demographic characteristics of Medicaid
614 beneficiaries, practice and provider-to-beneficiary standards,
615 appointment wait times, beneficiary use of services, provider
616 turnover, provider profiling, provider licensure history,
617 previous program integrity investigations and findings, peer
618 review, provider Medicaid policy and billing compliance records,
619 clinical and medical record audits, and other factors. Providers
620 shall not be entitled to enrollment in the Medicaid provider
621 network. The agency shall determine instances in which allowing
622 Medicaid beneficiaries to purchase durable medical equipment and
623 other goods is less expensive to the Medicaid program than long
624 term rental of the equipment or goods. The agency may establish
625 rules to facilitate purchases in lieu of long-term rentals in
626 order to protect against fraud and abuse in the Medicaid program
627 as defined in s. 409.913. The agency may seek federal waivers
628 necessary to administer these policies.
629 (10) The agency shall not contract on a prepaid or fixed
630 sum basis for Medicaid services with an entity which knows or
631 reasonably should know that any principal, officer, director,
632 agent, managing employee, or owner of stock or beneficial
633 interest in excess of 5 percent common or preferred stock, or
634 the entity itself, has been found guilty of, regardless of
635 adjudication, or entered a plea of nolo contendere, or guilty,
636 to:
637 (a) An offense listed in s. 408.809, s. 409.913(13), or s.
638 435.04 Fraud;
639 (b) Violation of federal or state antitrust statutes,
640 including those proscribing price fixing between competitors and
641 the allocation of customers among competitors;
642 (c) Commission of a felony involving embezzlement, theft,
643 forgery, income tax evasion, bribery, falsification or
644 destruction of records, making false statements, receiving
645 stolen property, making false claims, or obstruction of justice;
646 or
647 (d) Any crime in any jurisdiction which directly relates to
648 the provision of health services on a prepaid or fixed-sum
649 basis.
650 (32) Each managed care plan that is under contract with the
651 agency to provide health care services to Medicaid recipients
652 shall annually conduct a background check with the Florida
653 Department of Law Enforcement of all persons with ownership
654 interest of 5 percent or more or executive management
655 responsibility for the managed care plan and shall submit to the
656 agency information concerning any such person who has been found
657 guilty of, regardless of adjudication, or has entered a plea of
658 nolo contendere or guilty to, any of the offenses listed in s.
659 408.809, s. 409.913(13), or s. 435.04 s. 435.03.
660 (48)(a) A provider is not entitled to enrollment in the
661 Medicaid provider network. The agency may implement a Medicaid
662 fee-for-service provider network controls, including, but not
663 limited to, competitive procurement and provider credentialing.
664 If a credentialing process is used, the agency may limit its
665 provider network based upon the following considerations:
666 beneficiary access to care, provider availability, provider
667 quality standards and quality assurance processes, cultural
668 competency, demographic characteristics of beneficiaries,
669 practice standards, service wait times, provider turnover,
670 provider licensure and accreditation history, program integrity
671 history, peer review, Medicaid policy and billing compliance
672 records, clinical and medical record audit findings, and such
673 other areas that are considered necessary by the agency to
674 ensure the integrity of the program.
675 (b) The agency shall limit its network of durable medical
676 equipment and medical supply providers. For dates of service
677 after January 1, 2009, the agency shall limit payment for
678 durable medical equipment and supplies to providers that meet
679 all the requirements of this paragraph.
680 1. Providers must be accredited by a Centers for Medicare
681 and Medicaid Services deemed accreditation organization for
682 suppliers of durable medical equipment, prosthetics, orthotics,
683 and supplies. The provider must maintain accreditation and is
684 subject to unannounced reviews by the accrediting organization.
685 2. Providers must provide the services or supplies directly
686 to the Medicaid recipient or caregiver at the provider location
687 or recipient’s residence or send the supplies directly to the
688 recipient’s residence with receipt of mailed delivery.
689 Subcontracting or consignment of the service or supply to a
690 third party is prohibited.
691 3. Notwithstanding subparagraph 2., a durable medical
692 equipment provider may store nebulizers at a physician’s office
693 for the purpose of having the physician’s staff issue the
694 equipment if it meets all of the following conditions:
695 a. The physician must document the medical necessity and
696 need to prevent further deterioration of the patient’s
697 respiratory status by the timely delivery of the nebulizer in
698 the physician’s office.
699 b. The durable medical equipment provider must have written
700 documentation of the competency and training by a Florida
701 licensed registered respiratory therapist of any durable medical
702 equipment staff who participate in the training of physician
703 office staff for the use of nebulizers, including cleaning,
704 warranty, and special needs of patients.
705 c. The physician’s office must have documented the training
706 and competency of any staff member who initiates the delivery of
707 nebulizers to patients. The durable medical equipment provider
708 must maintain copies of all physician office training.
709 d. The physician’s office must maintain inventory records
710 of stored nebulizers, including documentation of the durable
711 medical equipment provider source.
712 e. A physician contracted with a Medicaid durable medical
713 equipment provider may not have a financial relationship with
714 that provider or receive any financial gain from the delivery of
715 nebulizers to patients.
716 4. Providers must have a physical business location and a
717 functional landline business phone. The location must be within
718 the state or not more than 50 miles from the Florida state line.
719 The agency may make exceptions for providers of durable medical
720 equipment or supplies not otherwise available from other
721 enrolled providers located within the state.
722 5. Physical business locations must be clearly identified
723 as a business that furnishes durable medical equipment or
724 medical supplies by signage that can be read from 20 feet away.
725 The location must be readily accessible to the public during
726 normal, posted business hours and must operate no less than 5
727 hours per day and no less than 5 days per week, with the
728 exception of scheduled and posted holidays. The location may not
729 be located within or at the same numbered street address as
730 another enrolled Medicaid durable medical equipment or medical
731 supply provider or as an enrolled Medicaid pharmacy that is also
732 enrolled as a durable medical equipment provider. A licensed
733 orthotist or prosthetist that provides only orthotic or
734 prosthetic devices as a Medicaid durable medical equipment
735 provider is exempt from the provisions in this paragraph.
736 6. Providers must maintain a stock of durable medical
737 equipment and medical supplies on site that is readily available
738 to meet the needs of the durable medical equipment business
739 location’s customers.
740 7. Providers must provide a surety bond of $50,000 for each
741 provider location, up to a maximum of 5 bonds statewide or an
742 aggregate bond of $250,000 statewide, as identified by Federal
743 Employer Identification Number. Providers who post a statewide
744 or an aggregate bond must identify all of their locations in any
745 Medicaid durable medical equipment and medical supply provider
746 enrollment application or bond renewal. Each provider location’s
747 surety bond must be renewed annually and the provider must
748 submit proof of renewal even if the original bond is a
749 continuous bond. A licensed orthotist or prosthetist that
750 provides only orthotic or prosthetic devices as a Medicaid
751 durable medical equipment provider is exempt from the provisions
752 in this paragraph.
753 8. Providers must obtain a level 2 background screening, in
754 accordance with chapter 435 and s. 408.809 as provided under s.
755 435.04, for each provider employee in direct contact with or
756 providing direct services to recipients of durable medical
757 equipment and medical supplies in their homes. This requirement
758 includes, but is not limited to, repair and service technicians,
759 fitters, and delivery staff. The provider shall pay for the cost
760 of the background screening.
761 9. The following providers are exempt from the requirements
762 of subparagraphs 1. and 7.:
763 a. Durable medical equipment providers owned and operated
764 by a government entity.
765 b. Durable medical equipment providers that are operating
766 within a pharmacy that is currently enrolled as a Medicaid
767 pharmacy provider.
768 c. Active, Medicaid-enrolled orthopedic physician groups,
769 primarily owned by physicians, which provide only orthotic and
770 prosthetic devices.
771 Section 8. Subsection (13) of section 409.9122, Florida
772 Statutes, is repealed.
773 Section 9. Section 409.913, Florida Statutes, is amended to
774 read:
775 409.913 Oversight of the integrity of the Medicaid
776 program.—The agency shall operate a program to oversee the
777 activities of Florida Medicaid recipients, and providers and
778 their representatives, to ensure that fraudulent and abusive
779 behavior and neglect of recipients occur to the minimum extent
780 possible, and to recover overpayments and impose sanctions as
781 appropriate. Beginning January 1, 2003, and each year
782 thereafter, the agency and the Medicaid Fraud Control Unit of
783 the Department of Legal Affairs shall submit a joint report to
784 the Legislature documenting the effectiveness of the state’s
785 efforts to control Medicaid fraud and abuse and to recover
786 Medicaid overpayments during the previous fiscal year. The
787 report must describe the number of cases opened and investigated
788 each year; the sources of the cases opened; the disposition of
789 the cases closed each year; the amount of overpayments alleged
790 in preliminary and final audit letters; the number and amount of
791 fines or penalties imposed; any reductions in overpayment
792 amounts negotiated in settlement agreements or by other means;
793 the amount of final agency determinations of overpayments; the
794 amount deducted from federal claiming as a result of
795 overpayments; the amount of overpayments recovered each year;
796 the amount of cost of investigation recovered each year; the
797 average length of time to collect from the time the case was
798 opened until the overpayment is paid in full; the amount
799 determined as uncollectible and the portion of the uncollectible
800 amount subsequently reclaimed from the Federal Government; the
801 number of providers, by type, that are terminated from
802 participation in the Medicaid program as a result of fraud and
803 abuse; and all costs associated with discovering and prosecuting
804 cases of Medicaid overpayments and making recoveries in such
805 cases. The report must also document actions taken to prevent
806 overpayments and the number of providers prevented from
807 enrolling in or reenrolling in the Medicaid program as a result
808 of documented Medicaid fraud and abuse and must include policy
809 recommendations necessary to prevent or recover overpayments and
810 changes necessary to prevent and detect Medicaid fraud. All
811 policy recommendations in the report must include a detailed
812 fiscal analysis, including, but not limited to, implementation
813 costs, estimated savings to the Medicaid program, and the return
814 on investment. The agency must submit the policy recommendations
815 and fiscal analyses in the report to the appropriate estimating
816 conference, pursuant to s. 216.137, by February 15 of each year.
817 The agency and the Medicaid Fraud Control Unit of the Department
818 of Legal Affairs each must include detailed unit-specific
819 performance standards, benchmarks, and metrics in the report,
820 including projected cost savings to the state Medicaid program
821 during the following fiscal year.
822 (1) For the purposes of this section, the term:
823 (a) “Abuse” means:
824 1. Provider practices that are inconsistent with generally
825 accepted business or medical practices and that result in an
826 unnecessary cost to the Medicaid program or in reimbursement for
827 goods or services that are not medically necessary or that fail
828 to meet professionally recognized standards for health care.
829 2. Recipient practices that result in unnecessary cost to
830 the Medicaid program.
831 (b) “Complaint” means an allegation that fraud, abuse, or
832 an overpayment has occurred.
833 (c) “Fraud” means an intentional deception or
834 misrepresentation made by a person with the knowledge that the
835 deception results in unauthorized benefit to herself or himself
836 or another person. The term includes any act that constitutes
837 fraud under applicable federal or state law.
838 (d) “Medical necessity” or “medically necessary” means any
839 goods or services necessary to palliate the effects of a
840 terminal condition, or to prevent, diagnose, correct, cure,
841 alleviate, or preclude deterioration of a condition that
842 threatens life, causes pain or suffering, or results in illness
843 or infirmity, which goods or services are provided in accordance
844 with generally accepted standards of medical practice. For
845 purposes of determining Medicaid reimbursement, the agency is
846 the final arbiter of medical necessity. Determinations of
847 medical necessity must be made by a licensed physician employed
848 by or under contract with the agency and must be based upon
849 information available at the time the goods or services are
850 provided.
851 (e) “Overpayment” includes any amount that is not
852 authorized to be paid by the Medicaid program whether paid as a
853 result of inaccurate or improper cost reporting, improper
854 claiming, unacceptable practices, fraud, abuse, or mistake.
855 (f) “Person” means any natural person, corporation,
856 partnership, association, clinic, group, or other entity,
857 whether or not such person is enrolled in the Medicaid program
858 or is a provider of health care.
859 (2) The agency shall conduct, or cause to be conducted by
860 contract or otherwise, reviews, investigations, analyses,
861 audits, or any combination thereof, to determine possible fraud,
862 abuse, overpayment, or recipient neglect in the Medicaid program
863 and shall report the findings of any overpayments in audit
864 reports as appropriate. At least 5 percent of all audits shall
865 be conducted on a random basis. As part of its ongoing fraud
866 detection activities, the agency shall identify and monitor, by
867 contract or otherwise, patterns of overutilization of Medicaid
868 services based on state averages. The agency shall track
869 Medicaid provider prescription and billing patterns and evaluate
870 them against Medicaid medical necessity criteria and coverage
871 and limitation guidelines adopted by rule. Medical necessity
872 determination requires that service be consistent with symptoms
873 or confirmed diagnosis of illness or injury under treatment and
874 not in excess of the patient’s needs. The agency shall conduct
875 reviews of provider exceptions to peer group norms and shall,
876 using statistical methodologies, provider profiling, and
877 analysis of billing patterns, detect and investigate abnormal or
878 unusual increases in billing or payment of claims for Medicaid
879 services and medically unnecessary provision of services.
880 (3) The agency may conduct, or may contract for, prepayment
881 review of provider claims to ensure cost-effective purchasing;
882 to ensure that billing by a provider to the agency is in
883 accordance with applicable provisions of all Medicaid rules,
884 regulations, handbooks, and policies and in accordance with
885 federal, state, and local law; and to ensure that appropriate
886 care is rendered to Medicaid recipients. Such prepayment reviews
887 may be conducted as determined appropriate by the agency,
888 without any suspicion or allegation of fraud, abuse, or neglect,
889 and may last for up to 1 year. Unless the agency has reliable
890 evidence of fraud, misrepresentation, abuse, or neglect, claims
891 shall be adjudicated for denial or payment within 90 days after
892 receipt of complete documentation by the agency for review. If
893 there is reliable evidence of fraud, misrepresentation, abuse,
894 or neglect, claims shall be adjudicated for denial of payment
895 within 180 days after receipt of complete documentation by the
896 agency for review.
897 (4) Any suspected criminal violation identified by the
898 agency must be referred to the Medicaid Fraud Control Unit of
899 the Office of the Attorney General for investigation. The agency
900 and the Attorney General shall enter into a memorandum of
901 understanding, which must include, but need not be limited to, a
902 protocol for regularly sharing information and coordinating
903 casework. The protocol must establish a procedure for the
904 referral by the agency of cases involving suspected Medicaid
905 fraud to the Medicaid Fraud Control Unit for investigation, and
906 the return to the agency of those cases where investigation
907 determines that administrative action by the agency is
908 appropriate. Offices of the Medicaid program integrity program
909 and the Medicaid Fraud Control Unit of the Department of Legal
910 Affairs, shall, to the extent possible, be collocated. The
911 agency and the Department of Legal Affairs shall periodically
912 conduct joint training and other joint activities designed to
913 increase communication and coordination in recovering
914 overpayments.
915 (5) A Medicaid provider is subject to having goods and
916 services that are paid for by the Medicaid program reviewed by
917 an appropriate peer-review organization designated by the
918 agency. The written findings of the applicable peer-review
919 organization are admissible in any court or administrative
920 proceeding as evidence of medical necessity or the lack thereof.
921 (6) Any notice required to be given to a provider under
922 this section is presumed to be sufficient notice if sent to the
923 address last shown on the provider enrollment file. It is the
924 responsibility of the provider to furnish and keep the agency
925 informed of the provider’s current address. United States Postal
926 Service proof of mailing or certified or registered mailing of
927 such notice to the provider at the address shown on the provider
928 enrollment file constitutes sufficient proof of notice. Any
929 notice required to be given to the agency by this section must
930 be sent to the agency at an address designated by rule.
931 (7) When presenting a claim for payment under the Medicaid
932 program, a provider has an affirmative duty to supervise the
933 provision of, and be responsible for, goods and services claimed
934 to have been provided, to supervise and be responsible for
935 preparation and submission of the claim, and to present a claim
936 that is true and accurate and that is for goods and services
937 that:
938 (a) Have actually been furnished to the recipient by the
939 provider prior to submitting the claim.
940 (b) Are Medicaid-covered goods or services that are
941 medically necessary.
942 (c) Are of a quality comparable to those furnished to the
943 general public by the provider’s peers.
944 (d) Have not been billed in whole or in part to a recipient
945 or a recipient’s responsible party, except for such copayments,
946 coinsurance, or deductibles as are authorized by the agency.
947 (e) Are provided in accord with applicable provisions of
948 all Medicaid rules, regulations, handbooks, and policies and in
949 accordance with federal, state, and local law.
950 (f) Are documented by records made at the time the goods or
951 services were provided, demonstrating the medical necessity for
952 the goods or services rendered. Medicaid goods or services are
953 excessive or not medically necessary unless both the medical
954 basis and the specific need for them are fully and properly
955 documented in the recipient’s medical record.
956
957 The agency shall deny payment or require repayment for goods or
958 services that are not presented as required in this subsection.
959 (8) The agency shall not reimburse any person or entity for
960 any prescription for medications, medical supplies, or medical
961 services if the prescription was written by a physician or other
962 prescribing practitioner who is not enrolled in the Medicaid
963 program. This section does not apply:
964 (a) In instances involving bona fide emergency medical
965 conditions as determined by the agency;
966 (b) To a provider of medical services to a patient in a
967 hospital emergency department, hospital inpatient or outpatient
968 setting, or nursing home;
969 (c) To bona fide pro bono services by preapproved non
970 Medicaid providers as determined by the agency;
971 (d) To prescribing physicians who are board-certified
972 specialists treating Medicaid recipients referred for treatment
973 by a treating physician who is enrolled in the Medicaid program;
974 (e) To prescriptions written for dually eligible Medicare
975 beneficiaries by an authorized Medicare provider who is not
976 enrolled in the Medicaid program;
977 (f) To other physicians who are not enrolled in the
978 Medicaid program but who provide a medically necessary service
979 or prescription not otherwise reasonably available from a
980 Medicaid-enrolled physician; or
981 (9) A Medicaid provider shall retain medical, professional,
982 financial, and business records pertaining to services and goods
983 furnished to a Medicaid recipient and billed to Medicaid for a
984 period of 6 5 years after the date of furnishing such services
985 or goods. The agency may investigate, review, or analyze such
986 records, which must be made available during normal business
987 hours. However, 24-hour notice must be provided if patient
988 treatment would be disrupted. The provider is responsible for
989 furnishing to the agency, and keeping the agency informed of the
990 location of, the provider’s Medicaid-related records. The
991 authority of the agency to obtain Medicaid-related records from
992 a provider is neither curtailed nor limited during a period of
993 litigation between the agency and the provider.
994 (10) Payments for the services of billing agents or persons
995 participating in the preparation of a Medicaid claim shall not
996 be based on amounts for which they bill nor based on the amount
997 a provider receives from the Medicaid program.
998 (11) The agency shall deny payment or require repayment for
999 inappropriate, medically unnecessary, or excessive goods or
1000 services from the person furnishing them, the person under whose
1001 supervision they were furnished, or the person causing them to
1002 be furnished.
1003 (12) The complaint and all information obtained pursuant to
1004 an investigation of a Medicaid provider, or the authorized
1005 representative or agent of a provider, relating to an allegation
1006 of fraud, abuse, or neglect are confidential and exempt from the
1007 provisions of s. 119.07(1):
1008 (a) Until the agency takes final agency action with respect
1009 to the provider and requires repayment of any overpayment, or
1010 imposes an administrative sanction;
1011 (b) Until the Attorney General refers the case for criminal
1012 prosecution;
1013 (c) Until 10 days after the complaint is determined without
1014 merit; or
1015 (d) At all times if the complaint or information is
1016 otherwise protected by law.
1017 (13) The agency shall immediately terminate participation
1018 of a Medicaid provider in the Medicaid program and may seek
1019 civil remedies or impose other administrative sanctions against
1020 a Medicaid provider, if the provider or any principal, officer,
1021 director, agent, managing employee, or affiliated person of the
1022 provider, or any partner or shareholder having an ownership
1023 interest in the provider equal to 5 percent or greater, has
1024 been:
1025 (a) Convicted of a criminal offense related to the delivery
1026 of any health care goods or services, including the performance
1027 of management or administrative functions relating to the
1028 delivery of health care goods or services;
1029 (b) Convicted of a criminal offense under federal law or
1030 the law of any state relating to the practice of the provider’s
1031 profession; or
1032 (c) Found by a court of competent jurisdiction to have
1033 neglected or physically abused a patient in connection with the
1034 delivery of health care goods or services.
1035
1036 If the agency determines a provider did not participate or
1037 acquiesce in an offense specified in paragraph (a), paragraph
1038 (b), or paragraph (c), termination will not be imposed. If the
1039 agency effects a termination under this subsection, the agency
1040 shall issue an immediate termination final order as provided in
1041 subsection (16) pursuant to s. 120.569(2)(n).
1042 (14) If the provider has been suspended or terminated from
1043 participation in the Medicaid program or the Medicare program by
1044 the Federal Government or any state, the agency must immediately
1045 suspend or terminate, as appropriate, the provider’s
1046 participation in this state’s Medicaid program for a period no
1047 less than that imposed by the Federal Government or any other
1048 state, and may not enroll such provider in this state’s Medicaid
1049 program while such foreign suspension or termination remains in
1050 effect. The agency shall also immediately suspend or terminate,
1051 as appropriate, a provider’s participation in this state’s
1052 Medicaid program if the provider participated or acquiesced in
1053 any action for which any principal, officer, director, agent,
1054 managing employee, or affiliated person of the provider, or any
1055 partner or shareholder having an ownership interest in the
1056 provider equal to 5 percent or greater, was suspended or
1057 terminated from participating in the Medicaid program or the
1058 Medicare program by the Federal Government or any state. This
1059 sanction is in addition to all other remedies provided by law.
1060 If the agency suspends or terminates a provider’s participation
1061 in the state’s Medicaid program under this subsection, the
1062 agency shall issue an immediate suspension or immediate
1063 termination order as provided in subsection (16).
1064 (15) The agency shall seek a remedy provided by law,
1065 including, but not limited to, any remedy provided in
1066 subsections (13) and (16) and s. 812.035, if:
1067 (a) The provider’s license has not been renewed, or has
1068 been revoked, suspended, or terminated, for cause, by the
1069 licensing agency of any state;
1070 (b) The provider has failed to make available or has
1071 refused access to Medicaid-related records to an auditor,
1072 investigator, or other authorized employee or agent of the
1073 agency, the Attorney General, a state attorney, or the Federal
1074 Government;
1075 (c) The provider has not furnished or has failed to make
1076 available such Medicaid-related records as the agency has found
1077 necessary to determine whether Medicaid payments are or were due
1078 and the amounts thereof;
1079 (d) The provider has failed to maintain medical records
1080 made at the time of service, or prior to service if prior
1081 authorization is required, demonstrating the necessity and
1082 appropriateness of the goods or services rendered;
1083 (e) The provider is not in compliance with provisions of
1084 Medicaid provider publications that have been adopted by
1085 reference as rules in the Florida Administrative Code; with
1086 provisions of state or federal laws, rules, or regulations; with
1087 provisions of the provider agreement between the agency and the
1088 provider; or with certifications found on claim forms or on
1089 transmittal forms for electronically submitted claims that are
1090 submitted by the provider or authorized representative, as such
1091 provisions apply to the Medicaid program;
1092 (f) The provider or person who ordered or prescribed the
1093 care, services, or supplies has furnished, or ordered the
1094 furnishing of, goods or services to a recipient which are
1095 inappropriate, unnecessary, excessive, or harmful to the
1096 recipient or are of inferior quality;
1097 (g) The provider has demonstrated a pattern of failure to
1098 provide goods or services that are medically necessary;
1099 (h) The provider or an authorized representative of the
1100 provider, or a person who ordered or prescribed the goods or
1101 services, has submitted or caused to be submitted false or a
1102 pattern of erroneous Medicaid claims;
1103 (i) The provider or an authorized representative of the
1104 provider, or a person who has ordered or prescribed the goods or
1105 services, has submitted or caused to be submitted a Medicaid
1106 provider enrollment application, a request for prior
1107 authorization for Medicaid services, a drug exception request,
1108 or a Medicaid cost report that contains materially false or
1109 incorrect information;
1110 (j) The provider or an authorized representative of the
1111 provider has collected from or billed a recipient or a
1112 recipient’s responsible party improperly for amounts that should
1113 not have been so collected or billed by reason of the provider’s
1114 billing the Medicaid program for the same service;
1115 (k) The provider or an authorized representative of the
1116 provider has included in a cost report costs that are not
1117 allowable under a Florida Title XIX reimbursement plan, after
1118 the provider or authorized representative had been advised in an
1119 audit exit conference or audit report that the costs were not
1120 allowable;
1121 (l) The provider is charged by information or indictment
1122 with fraudulent billing practices or an offense under subsection
1123 (13). The sanction applied for this reason is limited to
1124 suspension of the provider’s participation in the Medicaid
1125 program for the duration of the indictment unless the provider
1126 is found guilty pursuant to the information or indictment;
1127 (m) The provider or a person who has ordered or prescribed
1128 the goods or services is found liable for negligent practice
1129 resulting in death or injury to the provider’s patient;
1130 (n) The provider fails to demonstrate that it had available
1131 during a specific audit or review period sufficient quantities
1132 of goods, or sufficient time in the case of services, to support
1133 the provider’s billings to the Medicaid program;
1134 (o) The provider has failed to comply with the notice and
1135 reporting requirements of s. 409.907;
1136 (p) The agency has received reliable information of patient
1137 abuse or neglect or of any act prohibited by s. 409.920; or
1138 (q) The provider has failed to comply with an agreed-upon
1139 repayment schedule.
1140
1141 A provider is subject to sanctions for violations of this
1142 subsection as the result of actions or inactions of the
1143 provider, or actions or inactions of any principal, officer,
1144 director, agent, managing employee, or affiliated person of the
1145 provider, or any partner or shareholder having an ownership
1146 interest in the provider equal to 5 percent or greater, in which
1147 the provider participated or acquiesced. If the agency
1148 immediately suspends or immediately terminates a provider under
1149 this subsection, the agency shall issue an immediate suspension
1150 or immediate termination order as provided in subsection (16).
1151 (16) The agency shall impose any of the following sanctions
1152 or disincentives on a provider or a person for any of the acts
1153 described in subsection (15):
1154 (a) Suspension for a specific period of time of not more
1155 than 1 year. Suspension shall preclude participation in the
1156 Medicaid program, which includes any action that results in a
1157 claim for payment to the Medicaid program as a result of
1158 furnishing, supervising a person who is furnishing, or causing a
1159 person to furnish goods or services.
1160 (b) Termination for a specific period of time of from more
1161 than 1 year to 20 years. Termination shall preclude
1162 participation in the Medicaid program, which includes any action
1163 that results in a claim for payment to the Medicaid program as a
1164 result of furnishing, supervising a person who is furnishing, or
1165 causing a person to furnish goods or services.
1166 (c) Imposition of a fine of up to $5,000 for each
1167 violation. Each day that an ongoing violation continues, such as
1168 refusing to furnish Medicaid-related records or refusing access
1169 to records, is considered, for the purposes of this section, to
1170 be a separate violation. Each instance of improper billing of a
1171 Medicaid recipient; each instance of including an unallowable
1172 cost on a hospital or nursing home Medicaid cost report after
1173 the provider or authorized representative has been advised in an
1174 audit exit conference or previous audit report of the cost
1175 unallowability; each instance of furnishing a Medicaid recipient
1176 goods or professional services that are inappropriate or of
1177 inferior quality as determined by competent peer judgment; each
1178 instance of knowingly submitting a materially false or erroneous
1179 Medicaid provider enrollment application, request for prior
1180 authorization for Medicaid services, drug exception request, or
1181 cost report; each instance of inappropriate prescribing of drugs
1182 for a Medicaid recipient as determined by competent peer
1183 judgment; and each false or erroneous Medicaid claim leading to
1184 an overpayment to a provider is considered, for the purposes of
1185 this section, to be a separate violation.
1186 (d) Immediate suspension, if the agency has received
1187 information of patient abuse or neglect, or of any act
1188 prohibited by s. 409.920, or any conduct listed in subsection
1189 (13) or subsection (14). Upon suspension, the agency must issue
1190 an immediate suspension final order, which shall state that the
1191 agency has reasonable cause to believe that the provider,
1192 person, or entity named is engaging in or has engaged in patient
1193 abuse or neglect, any act prohibited by s. 409.920, or any
1194 conduct listed in subsection (13) or subsection (14). The order
1195 shall provide notice of administrative hearing rights under ss.
1196 120.569 and 120.57 and is effective immediately upon notice to
1197 the provider, person, or entity under s. 120.569(2)(n).
1198 (e) Immediate termination, if the agency has received
1199 information of a conviction based on patient abuse or neglect,
1200 any act prohibited by s. 409.920, or any conduct listed in
1201 subsection (13) or subsection (14). Upon termination, the agency
1202 must issue an immediate termination order, which shall state
1203 that the agency has reasonable cause to believe that the
1204 provider, person, or entity named has been convicted of patient
1205 abuse or neglect, any act prohibited by s. 409.920, or any
1206 conduct listed in subsection (13) or subsection (14). The
1207 termination order shall provide notice of administrative hearing
1208 rights under ss. 120.569 and 120.57 and is effective immediately
1209 upon notice to the provider, person, or entity.
1210 (f)(e) A fine, not to exceed $10,000, for a violation of
1211 paragraph (15)(i).
1212 (g)(f) Imposition of liens against provider assets,
1213 including, but not limited to, financial assets and real
1214 property, not to exceed the amount of fines or recoveries
1215 sought, upon entry of an order determining that such moneys are
1216 due or recoverable.
1217 (h)(g) Prepayment reviews of claims for a specified period
1218 of time.
1219 (i)(h) Comprehensive followup reviews of providers every 6
1220 months to ensure that they are billing Medicaid correctly.
1221 (j)(i) Corrective-action plans that would remain in effect
1222 for providers for up to 3 years and that would be monitored by
1223 the agency every 6 months while in effect.
1224 (k)(j) Other remedies as permitted by law to effect the
1225 recovery of a fine or overpayment.
1226
1227 The Secretary of Health Care Administration may make a
1228 determination that imposition of a sanction or disincentive is
1229 not in the best interest of the Medicaid program, in which case
1230 a sanction or disincentive shall not be imposed.
1231 (17) In determining the appropriate administrative sanction
1232 to be applied, or the duration of any suspension or termination,
1233 the agency shall consider:
1234 (a) The seriousness and extent of the violation or
1235 violations.
1236 (b) Any prior history of violations by the provider
1237 relating to the delivery of health care programs which resulted
1238 in either a criminal conviction or in administrative sanction or
1239 penalty.
1240 (c) Evidence of continued violation within the provider’s
1241 management control of Medicaid statutes, rules, regulations, or
1242 policies after written notification to the provider of improper
1243 practice or instance of violation.
1244 (d) The effect, if any, on the quality of medical care
1245 provided to Medicaid recipients as a result of the acts of the
1246 provider.
1247 (e) Any action by a licensing agency respecting the
1248 provider in any state in which the provider operates or has
1249 operated.
1250 (f) The apparent impact on access by recipients to Medicaid
1251 services if the provider is suspended or terminated, in the best
1252 judgment of the agency.
1253
1254 The agency shall document the basis for all sanctioning actions
1255 and recommendations.
1256 (18) The agency may take action to sanction, suspend, or
1257 terminate a particular provider working for a group provider,
1258 and may suspend or terminate Medicaid participation at a
1259 specific location, rather than or in addition to taking action
1260 against an entire group.
1261 (19) The agency shall establish a process for conducting
1262 followup reviews of a sampling of providers who have a history
1263 of overpayment under the Medicaid program. This process must
1264 consider the magnitude of previous fraud or abuse and the
1265 potential effect of continued fraud or abuse on Medicaid costs.
1266 (20) In making a determination of overpayment to a
1267 provider, the agency must use accepted and valid auditing,
1268 accounting, analytical, statistical, or peer-review methods, or
1269 combinations thereof. Appropriate statistical methods may
1270 include, but are not limited to, sampling and extension to the
1271 population, parametric and nonparametric statistics, tests of
1272 hypotheses, and other generally accepted statistical methods.
1273 Appropriate analytical methods may include, but are not limited
1274 to, reviews to determine variances between the quantities of
1275 products that a provider had on hand and available to be
1276 purveyed to Medicaid recipients during the review period and the
1277 quantities of the same products paid for by the Medicaid program
1278 for the same period, taking into appropriate consideration sales
1279 of the same products to non-Medicaid customers during the same
1280 period. In meeting its burden of proof in any administrative or
1281 court proceeding, the agency may introduce the results of such
1282 statistical methods as evidence of overpayment.
1283 (21) When making a determination that an overpayment has
1284 occurred, the agency shall prepare and issue an audit report to
1285 the provider showing the calculation of overpayments.
1286 (22) The audit report, supported by agency work papers,
1287 showing an overpayment to a provider constitutes evidence of the
1288 overpayment. A provider may not present or elicit testimony,
1289 either on direct examination or cross-examination in any court
1290 or administrative proceeding, regarding the purchase or
1291 acquisition by any means of drugs, goods, or supplies; sales or
1292 divestment by any means of drugs, goods, or supplies; or
1293 inventory of drugs, goods, or supplies, unless such acquisition,
1294 sales, divestment, or inventory is documented by written
1295 invoices, written inventory records, or other competent written
1296 documentary evidence maintained in the normal course of the
1297 provider’s business. Notwithstanding the applicable rules of
1298 discovery, all documentation that will be offered as evidence at
1299 an administrative hearing on a Medicaid overpayment must be
1300 exchanged by all parties at least 14 days before the
1301 administrative hearing or must be excluded from consideration.
1302 (23)(a) In an audit or investigation of a violation
1303 committed by a provider which is conducted pursuant to this
1304 section, the agency is entitled to recover all investigative,
1305 legal, and expert witness costs if the agency’s findings were
1306 not contested by the provider or, if contested, the agency
1307 ultimately prevailed.
1308 (b) The agency has the burden of documenting the costs,
1309 which include salaries and employee benefits and out-of-pocket
1310 expenses. The amount of costs that may be recovered must be
1311 reasonable in relation to the seriousness of the violation and
1312 must be set taking into consideration the financial resources,
1313 earning ability, and needs of the provider, who has the burden
1314 of demonstrating such factors.
1315 (c) The provider may pay the costs over a period to be
1316 determined by the agency if the agency determines that an
1317 extreme hardship would result to the provider from immediate
1318 full payment. Any default in payment of costs may be collected
1319 by any means authorized by law.
1320 (24) If the agency imposes an administrative sanction
1321 pursuant to subsection (13), subsection (14), or subsection
1322 (15), except paragraphs (15)(e) and (o), upon any provider or
1323 any principal, officer, director, agent, managing employee, or
1324 affiliated person of the provider who is regulated by another
1325 state entity, the agency shall notify that other entity of the
1326 imposition of the sanction within 5 business days. Such
1327 notification must include the provider’s or person’s name and
1328 license number and the specific reasons for sanction.
1329 (25)(a) The agency shall withhold Medicaid payments, in
1330 whole or in part, to a provider upon receipt of reliable
1331 evidence that the circumstances giving rise to the need for a
1332 withholding of payments involve fraud, willful
1333 misrepresentation, or abuse under the Medicaid program, or a
1334 crime committed while rendering goods or services to Medicaid
1335 recipients. If the provider is not paid within 14 days after the
1336 agency receives evidence it is determined that fraud, willful
1337 misrepresentation, abuse, or a crime did not occur, interest
1338 shall accrue at a rate of 10 percent a year the payments
1339 withheld must be paid to the provider within 14 days after such
1340 determination with interest at the rate of 10 percent a year.
1341 Any money withheld in accordance with this paragraph shall be
1342 placed in a suspended account, readily accessible to the agency,
1343 so that any payment ultimately due the provider shall be made
1344 within 14 days.
1345 (b) The agency shall deny payment, or require repayment, if
1346 the goods or services were furnished, supervised, or caused to
1347 be furnished by a person who has been convicted of a crime under
1348 subsection (13) or who has been suspended or terminated from the
1349 Medicaid program or Medicare program by the Federal Government
1350 or any state.
1351 (c) Overpayments owed to the agency bear interest at the
1352 rate of 10 percent per year from the date of determination of
1353 the overpayment by the agency, and payment arrangements for
1354 overpayments and fines must be made within 35 days after the
1355 date of the final order at the conclusion of legal proceedings.
1356 A provider who does not enter into or adhere to an agreed-upon
1357 repayment schedule may be terminated by the agency for
1358 nonpayment or partial payment.
1359 (d) The agency, upon entry of a final agency order, a
1360 judgment or order of a court of competent jurisdiction, or a
1361 stipulation or settlement, may collect the moneys owed by all
1362 means allowable by law, including, but not limited to, notifying
1363 any fiscal intermediary of Medicare benefits that the state has
1364 a superior right of payment. Upon receipt of such written
1365 notification, the Medicare fiscal intermediary shall remit to
1366 the state the sum claimed.
1367 (e) The agency may institute amnesty programs to allow
1368 Medicaid providers the opportunity to voluntarily repay
1369 overpayments. The agency may adopt rules to administer such
1370 programs.
1371 (26) The agency may impose administrative sanctions against
1372 a Medicaid recipient, or the agency may seek any other remedy
1373 provided by law, including, but not limited to, the remedies
1374 provided in s. 812.035, if the agency finds that a recipient has
1375 engaged in solicitation in violation of s. 409.920 or that the
1376 recipient has otherwise abused the Medicaid program.
1377 (27) When the Agency for Health Care Administration has
1378 made a probable cause determination and alleged that an
1379 overpayment to a Medicaid provider has occurred, the agency,
1380 after notice to the provider, shall:
1381 (a) Withhold, and continue to withhold during the pendency
1382 of an administrative hearing pursuant to chapter 120, any
1383 medical assistance reimbursement payments until such time as the
1384 overpayment is recovered, unless within 30 days after receiving
1385 notice thereof the provider:
1386 1. Makes repayment in full; or
1387 2. Establishes a repayment plan that is satisfactory to the
1388 Agency for Health Care Administration.
1389 (b) Withhold, and continue to withhold during the pendency
1390 of an administrative hearing pursuant to chapter 120, medical
1391 assistance reimbursement payments if the terms of a repayment
1392 plan are not adhered to by the provider.
1393 (28) Venue for all Medicaid program integrity overpayment
1394 cases shall lie in Leon County, at the discretion of the agency.
1395 (29) Notwithstanding other provisions of law, the agency
1396 and the Medicaid Fraud Control Unit of the Department of Legal
1397 Affairs may review a provider’s Medicaid-related and non
1398 Medicaid-related records in order to determine the total output
1399 of a provider’s practice to reconcile quantities of goods or
1400 services billed to Medicaid with quantities of goods or services
1401 used in the provider’s total practice.
1402 (30) The agency shall terminate a provider’s participation
1403 in the Medicaid program if the provider fails to reimburse an
1404 overpayment or fine that has been determined by final order, not
1405 subject to further appeal, within 35 days after the date of the
1406 final order, unless the provider and the agency have entered
1407 into a repayment agreement.
1408 (31) If a provider requests an administrative hearing
1409 pursuant to chapter 120, such hearing must be conducted within
1410 90 days following assignment of an administrative law judge,
1411 absent exceptionally good cause shown as determined by the
1412 administrative law judge or hearing officer. Upon issuance of a
1413 final order, the outstanding balance of the amount determined to
1414 constitute the overpayment or fine shall become due. If a
1415 provider fails to make payments in full, fails to enter into a
1416 satisfactory repayment plan, or fails to comply with the terms
1417 of a repayment plan or settlement agreement, the agency shall
1418 withhold medical assistance reimbursement payments until the
1419 amount due is paid in full.
1420 (32) Duly authorized agents and employees of the agency
1421 shall have the power to inspect, during normal business hours,
1422 the records of any pharmacy, wholesale establishment, or
1423 manufacturer, or any other place in which drugs and medical
1424 supplies are manufactured, packed, packaged, made, stored, sold,
1425 or kept for sale, for the purpose of verifying the amount of
1426 drugs and medical supplies ordered, delivered, or purchased by a
1427 provider. The agency shall provide at least 2 business days’
1428 prior notice of any such inspection. The notice must identify
1429 the provider whose records will be inspected, and the inspection
1430 shall include only records specifically related to that
1431 provider.
1432 (33) In accordance with federal law, Medicaid recipients
1433 convicted of a crime pursuant to 42 U.S.C. s. 1320a-7b may be
1434 limited, restricted, or suspended from Medicaid eligibility for
1435 a period not to exceed 1 year, as determined by the agency head
1436 or designee.
1437 (34) To deter fraud and abuse in the Medicaid program, the
1438 agency may limit the number of Schedule II and Schedule III
1439 refill prescription claims submitted from a pharmacy provider.
1440 The agency shall limit the allowable amount of reimbursement of
1441 prescription refill claims for Schedule II and Schedule III
1442 pharmaceuticals if the agency or the Medicaid Fraud Control Unit
1443 determines that the specific prescription refill was not
1444 requested by the Medicaid recipient or authorized representative
1445 for whom the refill claim is submitted or was not prescribed by
1446 the recipient’s medical provider or physician. Any such refill
1447 request must be consistent with the original prescription.
1448 (35) The Office of Program Policy Analysis and Government
1449 Accountability shall provide a report to the President of the
1450 Senate and the Speaker of the House of Representatives on a
1451 biennial basis, beginning January 31, 2006, on the agency’s and
1452 the Medicaid Fraud Control Unit’s efforts to prevent, detect,
1453 and deter, as well as recover funds lost to, fraud and abuse in
1454 the Medicaid program.
1455 (36) At least three times a year, the agency shall provide
1456 to each Medicaid recipient or his or her representative an
1457 explanation of benefits in the form of a letter that is mailed
1458 to the most recent address of the recipient on the record with
1459 the Department of Children and Family Services. The explanation
1460 of benefits must include the patient’s name, the name of the
1461 health care provider and the address of the location where the
1462 service was provided, a description of all services billed to
1463 Medicaid in terminology that should be understood by a
1464 reasonable person, and information on how to report
1465 inappropriate or incorrect billing to the agency or other law
1466 enforcement entities for review or investigation. At least once
1467 a year, the letter also must include information on how to
1468 report criminal Medicaid fraud, the Medicaid Fraud Control
1469 Unit’s toll-free hotline number, and information about the
1470 rewards available under s. 409.9203. The explanation of benefits
1471 may not be mailed for Medicaid independent laboratory services
1472 as described in s. 409.905(7) or for Medicaid certified match
1473 services as described in ss. 409.9071 and 1011.70.
1474 (37) The agency shall post on its website a current list of
1475 each Medicaid provider, including any principal, officer,
1476 director, agent, managing employee, or affiliated person of the
1477 provider, or any partner or shareholder having an ownership
1478 interest in the provider equal to 5 percent or greater, who has
1479 been terminated for cause from the Medicaid program or
1480 sanctioned under this section. The list must be searchable by a
1481 variety of search parameters and provide for the creation of
1482 formatted lists that may be printed or imported into other
1483 applications, including spreadsheets. The agency shall update
1484 the list at least monthly.
1485 (38) In order to improve the detection of health care
1486 fraud, use technology to prevent and detect fraud, and maximize
1487 the electronic exchange of health care fraud information, the
1488 agency shall:
1489 (a) Compile, maintain, and publish on its website a
1490 detailed list of all state and federal databases that contain
1491 health care fraud information and update the list at least
1492 biannually;
1493 (b) Develop a strategic plan to connect all databases that
1494 contain health care fraud information to facilitate the
1495 electronic exchange of health information between the agency,
1496 the Department of Health, the Department of Law Enforcement, and
1497 the Attorney General’s Office. The plan must include recommended
1498 standard data formats, fraud identification strategies, and
1499 specifications for the technical interface between state and
1500 federal health care fraud databases;
1501 (c) Monitor innovations in health information technology,
1502 specifically as it pertains to Medicaid fraud prevention and
1503 detection; and
1504 (d) Periodically publish policy briefs that highlight
1505 available new technology to prevent or detect health care fraud
1506 and projects implemented by other states, the private sector, or
1507 the Federal Government which use technology to prevent or detect
1508 health care fraud.
1509 Section 10. Subsection (5) is added to section 409.9203,
1510 Florida Statutes, to read:
1511 409.9203 Rewards for reporting Medicaid fraud.—
1512 (5) An employee of the Agency for Health Care
1513 Administration, the Department of Legal Affairs, the Department
1514 of Health, or the Department of Law Enforcement whose job
1515 responsibilities include the prevention, detection, and
1516 prosecution of Medicaid fraud is not eligible to receive a
1517 reward under this section.
1518 Section 11. Subsection (8) is added to section 456.001,
1519 Florida Statutes, to read:
1520 456.001 Definitions.—As used in this chapter, the term:
1521 (8) “Affiliate” or “affiliated person” means any person who
1522 directly or indirectly manages, controls, or oversees the
1523 operation of a corporation or other business entity, regardless
1524 of whether such person is a partner, shareholder, owner,
1525 officer, director, or agent of the entity.
1526 Section 12. Paragraph (c) of subsection (1) and subsections
1527 (2) and (3) of section 456.041, Florida Statutes, are amended to
1528 read:
1529 456.041 Practitioner profile; creation.—
1530 (1)
1531 (c) Within 30 calendar days after receiving an update of
1532 information required for the practitioner’s profile, the
1533 department shall update the practitioner’s profile in accordance
1534 with the requirements of subsection (8) (7).
1535 (2) Beginning July 1, 2010, on the profile published under
1536 subsection (1), the department shall include indicate if the
1537 information provided under s. 456.039(1)(a)7. or s.
1538 456.0391(1)(a)7. and indicate if the information is or is not
1539 corroborated by a criminal history records check conducted
1540 according to this subsection. The department must include in
1541 each practitioner’s profile the following statement: “The
1542 criminal history information, if any exists, may be incomplete.
1543 Federal criminal history information is not available to the
1544 public.” The department, or the board having regulatory
1545 authority over the practitioner acting on behalf of the
1546 department, shall investigate any information received by the
1547 department or the board.
1548 (3) Beginning July 1, 2010, the department shall include in
1549 each practitioner’s profile any open administrative complaint
1550 filed with the department against the practitioner in which
1551 probable cause has been found. The Department of Health shall
1552 include in each practitioner’s practitioner profile that
1553 criminal information that directly relates to the practitioner’s
1554 ability to competently practice his or her profession. The
1555 department must include in each practitioner’s practitioner
1556 profile the following statement: “The criminal history
1557 information, if any exists, may be incomplete; federal criminal
1558 history information is not available to the public.” The
1559 department shall provide in each practitioner profile, for every
1560 final disciplinary action taken against the practitioner, an
1561 easy-to-read narrative description that explains the
1562 administrative complaint filed against the practitioner and the
1563 final disciplinary action imposed on the practitioner. The
1564 department shall include a hyperlink to each final order listed
1565 in its website report of dispositions of recent disciplinary
1566 actions taken against practitioners.
1567 Section 13. Section 456.0635, Florida Statutes, is amended
1568 to read:
1569 456.0635 Health care Medicaid fraud; disqualification for
1570 license, certificate, or registration.—
1571 (1) Medicaid Fraud in the practice of a health care
1572 profession is prohibited.
1573 (2) Each board within the jurisdiction of the department,
1574 or the department if there is no board, shall refuse to admit a
1575 candidate to any examination and refuse to issue or renew a
1576 license, certificate, or registration to any applicant if the
1577 candidate or applicant or any principal, officer, agent,
1578 managing employee, or affiliated person of the applicant, has
1579 been:
1580 (a) Has been convicted of, or entered a plea of guilty or
1581 nolo contendere to, regardless of adjudication, a felony under
1582 chapter 409, chapter 817, chapter 893, or a similar felony
1583 offense committed in another state or jurisdiction 21 U.S.C. ss.
1584 801-970, or 42 U.S.C. ss. 1395-1396, unless the sentence and any
1585 subsequent period of probation for such conviction or plea pleas
1586 ended: more than 15 years prior to the date of the application;
1587 1. For felonies of the first or second degree more than 15
1588 years before the date of application.
1589 2. For felonies of the third degree more than 10 years
1590 before the date of application, except for felonies of the third
1591 degree under s. 893.13(6)(a).
1592 3. For felonies of the third degree under s. 893.13(6)(a),
1593 more than 5 years before the date of application.
1594 4. For felonies in which the defendant entered a plea of
1595 guilty or nolo contendere in an agreement with the court to
1596 enter a pretrial intervention or drug diversion program, the
1597 department shall not approve or deny the application for a
1598 license, certificate, or registration until the final resolution
1599 of the case.
1600 (b) Has been convicted of, or entered a plea of guilty or
1601 nolo contendere to, regardless of adjudication, a felony under
1602 21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the
1603 sentence and any subsequent period of probation for such
1604 conviction or plea ended more than 15 years before the date of
1605 the application;
1606 (c)(b) Has been terminated for cause from the Florida
1607 Medicaid program pursuant to s. 409.913, unless the applicant
1608 has been in good standing with the Florida Medicaid program for
1609 the most recent 5 years;
1610 (d)(c) Has been terminated for cause, pursuant to the
1611 appeals procedures established by the state or Federal
1612 Government, from any other state Medicaid program or the federal
1613 Medicare program, unless the applicant has been in good standing
1614 with a state Medicaid program or the federal Medicare program
1615 for the most recent 5 years and the termination occurred at
1616 least 20 years before prior to the date of the application; or.
1617 (e) Is currently listed on the United States Department of
1618 Health and Human Services Office of Inspector General’s List of
1619 Excluded Individuals and Entities.
1620 (f) This subsection does not apply to applicants for
1621 initial licensure or certification who were enrolled in an
1622 educational or training program on or before July 1, 2009, which
1623 was recognized by a board or, if there is no board, recognized
1624 by the department, and who applied for licensure after July 1,
1625 2009.
1626 (3) Each board within the jurisdiction of the department,
1627 or the department if there is no board, shall refuse to renew a
1628 license, certificate, or registration of any applicant if the
1629 candidate or applicant or any principal, officer, agent,
1630 managing employee, or affiliated person of the applicant:
1631 (a) Has been convicted of, or entered a plea of guilty or
1632 nolo contendere to, regardless of adjudication, a felony under:
1633 chapter 409, chapter 817, chapter 893, or a similar felony
1634 offense committed in another state or jurisdiction since July 1,
1635 2009.
1636 (b) Has been convicted of, or entered a plea of guilty or
1637 nolo contendere to, regardless of adjudication, a felony under
1638 21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396 since July 1,
1639 2009.
1640 (c) Has been terminated for cause from the Florida Medicaid
1641 program pursuant to s. 409.913, unless the applicant has been in
1642 good standing with the Florida Medicaid program for the most
1643 recent 5 years.
1644 (d) Has been terminated for cause, pursuant to the appeals
1645 procedures established by the state, from any other state
1646 Medicaid program, unless the applicant has been in good standing
1647 with a state Medicaid program for the most recent 5 years and
1648 the termination occurred at least 20 years before the date of
1649 the application.
1650 (e) Is currently listed on the United States Department of
1651 Health and Human Services Office of Inspector General’s List of
1652 Excluded Individuals and Entities.
1653 (f) For felonies in which the defendant entered a plea of
1654 guilty or nolo contendere in an agreement with the court to
1655 enter a pretrial intervention or drug diversion program, the
1656 department shall not approve or deny the application for a
1657 renewal of a license, certificate, or registration until the
1658 final resolution of the case.
1659 (4)(3) Licensed health care practitioners shall report
1660 allegations of Medicaid fraud to the department, regardless of
1661 the practice setting in which the alleged Medicaid fraud
1662 occurred.
1663 (5)(4) The acceptance by a licensing authority of a
1664 candidate’s relinquishment of a license which is offered in
1665 response to or anticipation of the filing of administrative
1666 charges alleging Medicaid fraud or similar charges constitutes
1667 the permanent revocation of the license.
1668 (6) The department shall adopt rules to administer the
1669 provisions of this section related to denial of licensure
1670 renewal.
1671 Section 14. Paragraph (kk) of subsection (1) of section
1672 456.072, Florida Statutes, is amended to read:
1673 456.072 Grounds for discipline; penalties; enforcement.—
1674 (1) The following acts shall constitute grounds for which
1675 the disciplinary actions specified in subsection (2) may be
1676 taken:
1677 (kk) Being terminated from the state Medicaid program
1678 pursuant to s. 409.913 or, any other state Medicaid program, or
1679 excluded from the federal Medicare program, unless eligibility
1680 to participate in the program from which the practitioner was
1681 terminated has been restored.
1682 Section 15. Subsection (13) of section 456.073, Florida
1683 Statutes, is amended to read:
1684 456.073 Disciplinary proceedings.—Disciplinary proceedings
1685 for each board shall be within the jurisdiction of the
1686 department.
1687 (13) Notwithstanding any provision of law to the contrary,
1688 an administrative complaint against a licensee shall be filed
1689 within 6 years after the time of the incident or occurrence
1690 giving rise to the complaint against the licensee. If such
1691 incident or occurrence involved fraud related to the Medicaid
1692 program, criminal actions, diversion of controlled substances,
1693 sexual misconduct, or impairment by the licensee, this
1694 subsection does not apply to bar initiation of an investigation
1695 or filing of an administrative complaint beyond the 6-year
1696 timeframe. In those cases covered by this subsection in which it
1697 can be shown that fraud, concealment, or intentional
1698 misrepresentation of fact prevented the discovery of the
1699 violation of law, the period of limitations is extended forward,
1700 but in no event to exceed 12 years after the time of the
1701 incident or occurrence.
1702 Section 16. Subsection (1) of section 456.074, Florida
1703 Statutes, is amended to read:
1704 456.074 Certain health care practitioners; immediate
1705 suspension of license.—
1706 (1) The department shall issue an emergency order
1707 suspending the license of any person licensed in a profession as
1708 defined in this chapter under chapter 458, chapter 459, chapter
1709 460, chapter 461, chapter 462, chapter 463, chapter 464, chapter
1710 465, chapter 466, or chapter 484 who pleads guilty to, is
1711 convicted or found guilty of, or who enters a plea of nolo
1712 contendere to, regardless of adjudication, to:
1713 (a) A felony under chapter 409, chapter 812, chapter 817,
1714 or chapter 893, chapter 895, chapter 896, or under 21 U.S.C. ss.
1715 801-970, or under 42 U.S.C. ss. 1395-1396; or
1716 (b) A misdemeanor or felony under 18 U.S.C. s. 669, ss.
1717 285-287, s. 371, s. 1001, s. 1035, s. 1341, s. 1343, s. 1347, s.
1718 1349, or s. 1518 or 42 U.S.C. ss. 1320a-7b, relating to the
1719 Medicaid program.
1720 Section 17. Paragraph (q) of subsection (2) of section
1721 499.01, Florida Statutes, is amended to read:
1722 499.01 Permits.—
1723 (2) The following permits are established:
1724 (q) Device manufacturer permit.—A device manufacturer
1725 permit is required for any person that engages in the
1726 manufacture, repackaging, or assembly of medical devices for
1727 human use in this state, except that a permit is not required
1728 if:
1729 1. The person does not manufacture, repackage, or assemble
1730 any medical devices or components for such devices, except those
1731 devices or components which are exempt from registration
1732 pursuant to s. 499.015(8); or
1733 2. The person is engaged only in manufacturing,
1734 repackaging, or assembling a medical device pursuant to a
1735 practitioner’s order for a specific patient.
1736 a.1. A manufacturer or repackager of medical devices in
1737 this state must comply with all appropriate state and federal
1738 good manufacturing practices and quality system rules.
1739 b.2. The department shall adopt rules related to storage,
1740 handling, and recordkeeping requirements for manufacturers of
1741 medical devices for human use.
1742 Section 18. This act shall take effect July 1, 2010.