Florida Senate - 2016                        COMMITTEE AMENDMENT
       Bill No. CS for SB 212
       
       
       
       
       
       
                                Ì317634.Î317634                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  02/26/2016           .                                
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       The Committee on Appropriations (Gaetz) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 381.4019, Florida Statutes, is created
    6  to read:
    7         381.4019 Dental care access accounts.—Subject to the
    8  availability of funds, the Legislature establishes a joint local
    9  and state dental care access account initiative and authorizes
   10  the creation of dental care access accounts to promote economic
   11  development by supporting qualified dentists who practice in
   12  dental health professional shortage areas or medically
   13  underserved areas or who treat a medically underserved
   14  population. The Legislature recognizes that maintaining good
   15  oral health is integral to overall health status and that the
   16  good health of residents of this state is an important
   17  contributing factor in economic development. Better health,
   18  including better oral health, enables workers to be more
   19  productive, reduces the burden of health care costs, and enables
   20  children to improve in cognitive development.
   21         (1) As used in this section, the term:
   22         (a) “Dental health professional shortage area” means a
   23  geographic area so designated by the Health Resources and
   24  Services Administration of the United States Department of
   25  Health and Human Services.
   26         (b) “Department” means the Department of Health.
   27         (c) “Medically underserved area” means a geographic area so
   28  designated by the Health Resources and Services Administration
   29  of the United States Department of Health and Human Services.
   30         (d) “Public health program” means a county health
   31  department, the Children’s Medical Services Network, a federally
   32  qualified community health center, a federally funded migrant
   33  health center, or other publicly funded or nonprofit health care
   34  program as designated by the department.
   35         (2The department shall develop and implement a dental
   36  care access account initiative to benefit dentists licensed to
   37  practice in this state who demonstrate, as required by the
   38  department by rule:
   39         (a)Active employment by a public health program located in
   40  a dental health professional shortage area or a medically
   41  underserved area; or
   42         (b)A commitment to opening a private practice in a dental
   43  health professional shortage area or a medically underserved
   44  area, as demonstrated by the dentist residing in the designated
   45  area, maintaining an active Medicaid provider agreement,
   46  enrolling in one or more Medicaid managed care plans, expending
   47  sufficient capital to make substantial progress in opening a
   48  dental practice that is capable of serving at least 1,200
   49  patients, and obtaining financial support from the local
   50  community in which the dentist is practicing or intending to
   51  open a practice.
   52         (3) The department shall establish dental care access
   53  accounts as individual benefit accounts for each dentist who
   54  satisfies the requirements of subsection (2) and is selected by
   55  the department for participation. The department shall implement
   56  an electronic benefit transfer system that enables each dentist
   57  to spend funds from his or her account for the purposes
   58  described in subsection (4).
   59         (4Funds contributed from state and local sources to a
   60  dental care access account may be used for one or more of the
   61  following purposes:
   62         (a) Repayment of dental school student loans.
   63         (b) Investment in property, facilities, or equipment
   64  necessary to establish and operate a dental office consisting of
   65  no fewer than two operatories.
   66         (c) Payment of transitional expenses related to the
   67  relocation or opening of a dental practice which are
   68  specifically approved by the department.
   69         (5Subject to legislative appropriation, the department
   70  shall distribute state funds as an award to each dental care
   71  access account. An individual award must be in an amount not
   72  more than $100,000 and not less than $10,000, except that a
   73  state award may not exceed 3 times the amount contributed to an
   74  account in the same year from local sources. If a dentist
   75  qualifies for a dental care access account under paragraph
   76  (2)(a), the dentist’s salary and associated employer
   77  expenditures constitute a local match and qualify the account
   78  for a state award if the salary and associated expenditures do
   79  not come from state funds. State funds may not be included in a
   80  determination of the amount contributed to an account from local
   81  sources.
   82         (6) The department may accept contributions of funds from a
   83  local source for deposit in the account of a dentist designated
   84  by the donor.
   85         (7) The department shall close an account no later than 5
   86  years after the first deposit of state or local funds into that
   87  account or immediately upon the occurrence of any of the
   88  following:
   89         (a) Termination of the dentist’s employment with a public
   90  health program, unless, within 30 days after such termination,
   91  the dentist opens a private practice in a dental health
   92  professional shortage area or medically underserved area.
   93         (b) Termination of the dentist’s practice in a designated
   94  dental health professional shortage area or medically
   95  underserved area.
   96         (c) Termination of the dentist’s participation in the
   97  Florida Medicaid program.
   98         (d) Participation by the dentist in any fraudulent
   99  activity.
  100         (8) Any state funds remaining in a closed account may be
  101  awarded and transferred to another account concurrent with the
  102  distribution of funds under the next legislative appropriation
  103  for the initiative. The department shall return to the donor on
  104  a pro rata basis unspent funds from local sources which remain
  105  in a closed account.
  106         (9) If the department determines that a dentist has
  107  withdrawn account funds after the occurrence of an event
  108  specified in subsection (7), has used funds for purposes not
  109  authorized in subsection (4), or has not remained eligible for a
  110  dental care access account for a minimum of 2 years, the dentist
  111  shall repay the funds to his or her account. The department may
  112  recover the withdrawn funds through disciplinary enforcement
  113  actions and other methods authorized by law.
  114         (10) The department shall establish by rule:
  115         (a) Application procedures for dentists who wish to apply
  116  for a dental care access account. An applicant may demonstrate
  117  that he or she has expended sufficient capital to make
  118  substantial progress in opening a dental practice that is
  119  capable of serving at least 1,200 patients by documenting
  120  contracts for the purchase or lease of a practice location and
  121  providing executed obligations for the purchase or other
  122  acquisition of at least 30 percent of the value of equipment or
  123  supplies necessary to operate a dental practice. The department
  124  may limit the number of applicants selected and shall give
  125  priority to those applicants practicing in the areas receiving
  126  higher rankings pursuant to subsection (11). The department may
  127  establish additional criteria for selection which recognize an
  128  applicant’s active engagement with and commitment to the
  129  community providing a local match.
  130         (b)A process to verify that funds withdrawn from a dental
  131  care access account have been used solely for the purposes
  132  described in subsection (4).
  133         (11) The Department of Economic Opportunity shall rank the
  134  dental health professional shortage areas and medically
  135  underserved areas of the state based on the extent to which
  136  limited access to dental care is impeding the areas’ economic
  137  development, with a higher ranking indicating a greater
  138  impediment to development.
  139         (12) The department shall develop a marketing plan for the
  140  dental care access account initiative in cooperation with the
  141  University of Florida College of Dentistry, the Nova
  142  Southeastern University College of Dental Medicine, the Lake
  143  Erie College of Osteopathic Medicine School of Dental Medicine,
  144  and the Florida Dental Association.
  145         (13)(a) By January 1 of each year, beginning in 2018, the
  146  department shall issue a report to the Governor, the President
  147  of the Senate, and the Speaker of the House of Representatives
  148  which must include:
  149         1. The number of patients served by dentists receiving
  150  funding under this section.
  151         2. The number of Medicaid recipients served by dentists
  152  receiving funding under this section.
  153         3. The average number of hours worked and patients served
  154  in a week by dentists receiving funding under this section.
  155         4. The number of dentists in each dental health
  156  professional shortage area or medically underserved area
  157  receiving funding under this section.
  158         5. The amount and source of local matching funds received
  159  by the department.
  160         6. The amount of state funds awarded to dentists under this
  161  section.
  162         7. A complete accounting of the use of funds by categories
  163  identified by the department, including, but not limited to,
  164  loans, supplies, equipment, rental property payments, real
  165  property purchases, and salary and wages.
  166         (b) The department shall adopt rules to require dentists to
  167  report information to the department which is necessary for the
  168  department to fulfill its reporting requirement under this
  169  subsection.
  170         Section 2. Subsection (3) of section 395.002, Florida
  171  Statutes, is amended to read:
  172         395.002 Definitions.—As used in this chapter:
  173         (3) “Ambulatory surgical center” or “mobile surgical
  174  facility” means a facility the primary purpose of which is to
  175  provide elective surgical care, in which the patient is admitted
  176  to and discharged from such facility within 24 hours the same
  177  working day and is not permitted to stay overnight, and which is
  178  not part of a hospital. However, a facility existing for the
  179  primary purpose of performing terminations of pregnancy, an
  180  office maintained by a physician for the practice of medicine,
  181  or an office maintained for the practice of dentistry shall not
  182  be construed to be an ambulatory surgical center, provided that
  183  any facility or office which is certified or seeks certification
  184  as a Medicare ambulatory surgical center shall be licensed as an
  185  ambulatory surgical center pursuant to s. 395.003. Any structure
  186  or vehicle in which a physician maintains an office and
  187  practices surgery, and which can appear to the public to be a
  188  mobile office because the structure or vehicle operates at more
  189  than one address, shall be construed to be a mobile surgical
  190  facility.
  191         Section 3. Present subsections (6) through (10) of section
  192  395.003, Florida Statutes, are redesignated as subsections (7)
  193  through (11), respectively, a new subsection (6) is added to
  194  that section, and present subsections (9) and (10) of that
  195  section are amended, to read:
  196         395.003 Licensure; denial, suspension, and revocation.—
  197         (6) An ambulatory surgical center, as a condition of
  198  initial licensure and license renewal, must provide services to
  199  Medicare patients, Medicaid patients, and patients who qualify
  200  for charity care in an amount equal to or greater than the
  201  applicable district average among licensed providers of similar
  202  services. For the purposes of this subsection, “charity care”
  203  means uncompensated care delivered to uninsured patients with
  204  incomes at or below 200 percent of the federal poverty level
  205  when such services are preauthorized by the licensee and not
  206  subject to collection procedures.
  207         (10)(9) A hospital licensed as of June 1, 2004, shall be
  208  exempt from subsection (9) subsection (8) as long as the
  209  hospital maintains the same ownership, facility street address,
  210  and range of services that were in existence on June 1, 2004.
  211  Any transfer of beds, or other agreements that result in the
  212  establishment of a hospital or hospital services within the
  213  intent of this section, shall be subject to subsection (9)
  214  subsection (8). Unless the hospital is otherwise exempt under
  215  subsection (9) subsection (8), the agency shall deny or revoke
  216  the license of a hospital that violates any of the criteria set
  217  forth in that subsection.
  218         (11)(10) The agency may adopt rules implementing the
  219  licensure requirements set forth in subsection (9) subsection
  220  (8). Within 14 days after rendering its decision on a license
  221  application or revocation, the agency shall publish its proposed
  222  decision in the Florida Administrative Register. Within 21 days
  223  after publication of the agency’s decision, any authorized
  224  person may file a request for an administrative hearing. In
  225  administrative proceedings challenging the approval, denial, or
  226  revocation of a license pursuant to subsection (9) subsection
  227  (8), the hearing must be based on the facts and law existing at
  228  the time of the agency’s proposed agency action. Existing
  229  hospitals may initiate or intervene in an administrative hearing
  230  to approve, deny, or revoke licensure under subsection (9)
  231  subsection (8) based upon a showing that an established program
  232  will be substantially affected by the issuance or renewal of a
  233  license to a hospital within the same district or service area.
  234         Section 4. Section 624.27, Florida Statutes, is created to
  235  read:
  236         624.27 Application of code as to direct primary care
  237  agreements.—
  238         (1) As used in this section, the term:
  239         (a) “Direct primary care agreement” means a contract
  240  between a primary care provider and a patient, the patient’s
  241  legal representative, or an employer which meets the
  242  requirements specified under subsection (4) and does not
  243  indemnify for services provided by a third party.
  244         (b) “Primary care provider” means a health care
  245  practitioner licensed under chapter 458, chapter 459, chapter
  246  460, or chapter 464, or a primary care group practice that
  247  provides medical services to patients which are commonly
  248  provided without referral from another health care provider.
  249         (c) “Primary care service” means the screening, assessment,
  250  diagnosis, and treatment of a patient for the purpose of
  251  promoting health or detecting and managing disease or injury
  252  within the competency and training of the primary care provider.
  253         (2) A direct primary care agreement does not constitute
  254  insurance and is not subject to chapter 636 or any other chapter
  255  of the Florida Insurance Code. The act of entering into a direct
  256  primary care agreement does not constitute the business of
  257  insurance and is not subject to chapter 636 or any other chapter
  258  of the Florida Insurance Code.
  259         (3) A primary care provider or an agent of a primary care
  260  provider is not required to obtain a certificate of authority or
  261  license under chapter 636 or any other chapter of the Florida
  262  Insurance Code to market, sell, or offer to sell a direct
  263  primary care agreement.
  264         (4) For purposes of this section, a direct primary care
  265  agreement must:
  266         (a) Be in writing.
  267         (b) Be signed by the primary care provider or an agent of
  268  the primary care provider and the patient, the patient’s legal
  269  representative, or an employer.
  270         (c) Allow a party to terminate the agreement by giving the
  271  other party at least 30 days’ advance written notice. The
  272  agreement may provide for immediate termination due to a
  273  violation of the physician-patient relationship or a breach of
  274  the terms of the agreement.
  275         (d) Describe the scope of primary care services that are
  276  covered by the monthly fee.
  277         (e) Specify the monthly fee and any fees for primary care
  278  services not covered by the monthly fee.
  279         (f) Specify the duration of the agreement and any automatic
  280  renewal provisions.
  281         (g) Offer a refund to the patient of monthly fees paid in
  282  advance if the primary care provider ceases to offer primary
  283  care services for any reason.
  284         (h) Contain in contrasting color and in not less than 12
  285  point type the following statements on the same page as the
  286  applicant’s signature:
  287         1. The agreement is not health insurance and the primary
  288  care provider will not file any claims against the patient’s
  289  health insurance policy or plan for reimbursement of any primary
  290  care services covered by the agreement.
  291         2. The agreement does not qualify as minimum essential
  292  coverage to satisfy the individual shared responsibility
  293  provision of the Patient Protection and Affordable Care Act, 26
  294  U.S.C. s. 5000A.
  295         Section 5. The amendments made by this act to ss. 409.967,
  296  627.42392, 641.31, and 641.394, Florida Statutes, may be known
  297  as the “Right Medicine Right Time Act.”
  298         Section 6. Effective January 1, 2017, paragraph (c) of
  299  subsection (2) of section 409.967, Florida Statutes, is amended
  300  to read:
  301         409.967 Managed care plan accountability.—
  302         (2) The agency shall establish such contract requirements
  303  as are necessary for the operation of the statewide managed care
  304  program. In addition to any other provisions the agency may deem
  305  necessary, the contract must require:
  306         (c) Access.—
  307         1. The agency shall establish specific standards for the
  308  number, type, and regional distribution of providers in managed
  309  care plan networks to ensure access to care for both adults and
  310  children. Each plan must maintain a regionwide network of
  311  providers in sufficient numbers to meet the access standards for
  312  specific medical services for all recipients enrolled in the
  313  plan. The exclusive use of mail-order pharmacies may not be
  314  sufficient to meet network access standards. Consistent with the
  315  standards established by the agency, provider networks may
  316  include providers located outside the region. A plan may
  317  contract with a new hospital facility before the date the
  318  hospital becomes operational if the hospital has commenced
  319  construction, will be licensed and operational by January 1,
  320  2013, and a final order has issued in any civil or
  321  administrative challenge. Each plan shall establish and maintain
  322  an accurate and complete electronic database of contracted
  323  providers, including information about licensure or
  324  registration, locations and hours of operation, specialty
  325  credentials and other certifications, specific performance
  326  indicators, and such other information as the agency deems
  327  necessary. The database must be available online to both the
  328  agency and the public and have the capability to compare the
  329  availability of providers to network adequacy standards and to
  330  accept and display feedback from each provider’s patients. Each
  331  plan shall submit quarterly reports to the agency identifying
  332  the number of enrollees assigned to each primary care provider.
  333         2.a. Each managed care plan must publish any prescribed
  334  drug formulary or preferred drug list on the plan’s website in a
  335  manner that is accessible to and searchable by enrollees and
  336  providers. The plan must update the list within 24 hours after
  337  making a change. Each plan must ensure that the prior
  338  authorization process for prescribed drugs is readily accessible
  339  to health care providers, including posting appropriate contact
  340  information on its website and providing timely responses to
  341  providers. For Medicaid recipients diagnosed with hemophilia who
  342  have been prescribed anti-hemophilic-factor replacement
  343  products, the agency shall provide for those products and
  344  hemophilia overlay services through the agency’s hemophilia
  345  disease management program.
  346         b. If a managed care plan restricts the use of prescribed
  347  drugs through a fail-first protocol, it must establish a clear
  348  and convenient process that a prescribing physician may use to
  349  request an override of the restriction from the managed care
  350  plan. The managed care plan shall grant an override of the
  351  protocol within 24 hours if:
  352         (I) Based on sound clinical evidence, the prescribing
  353  provider concludes that the preferred treatment required under
  354  the fail-first protocol has been ineffective in the treatment of
  355  the enrollee’s disease or medical condition; or
  356         (II) Based on sound clinical evidence or medical and
  357  scientific evidence, the prescribing provider believes that the
  358  preferred treatment required under the fail-first protocol:
  359         (A) Is likely to be ineffective given the known relevant
  360  physical or mental characteristics and medical history of the
  361  enrollee and the known characteristics of the drug regimen; or
  362         (B) Will cause or is likely to cause an adverse reaction or
  363  other physical harm to the enrollee.
  364  
  365  If the prescribing provider follows the fail-first protocol
  366  recommended by the managed care plan for an enrollee, the
  367  duration of treatment under the fail-first protocol may not
  368  exceed a period deemed appropriate by the prescribing provider.
  369  Following such period, if the prescribing provider deems the
  370  treatment provided under the protocol clinically ineffective,
  371  the enrollee is entitled to receive the course of therapy that
  372  the prescribing provider recommends, and the provider is not
  373  required to seek approval of an override of the fail-first
  374  protocol. As used in this subparagraph, the term “fail-first
  375  protocol” means a prescription practice that begins medication
  376  for a medical condition with the most cost-effective drug
  377  therapy and progresses to other more costly or risky therapies
  378  only if necessary.
  379         3. Managed care plans, and their fiscal agents or
  380  intermediaries, must accept prior authorization requests for any
  381  service electronically.
  382         4. Managed care plans serving children in the care and
  383  custody of the Department of Children and Families shall must
  384  maintain complete medical, dental, and behavioral health
  385  encounter information and participate in making such information
  386  available to the department or the applicable contracted
  387  community-based care lead agency for use in providing
  388  comprehensive and coordinated case management. The agency and
  389  the department shall establish an interagency agreement to
  390  provide guidance for the format, confidentiality, recipient,
  391  scope, and method of information to be made available and the
  392  deadlines for submission of the data. The scope of information
  393  available to the department are shall be the data that managed
  394  care plans are required to submit to the agency. The agency
  395  shall determine the plan’s compliance with standards for access
  396  to medical, dental, and behavioral health services; the use of
  397  medications; and followup on all medically necessary services
  398  recommended as a result of early and periodic screening,
  399  diagnosis, and treatment.
  400         Section 7. Effective January 1, 2017, section 627.42392,
  401  Florida Statutes, is created to read:
  402         627.42392Fail-first protocols.—If an insurer restricts the
  403  use of prescribed drugs through a fail-first protocol, it must
  404  establish a clear and convenient process that a prescribing
  405  physician may use to request an override of the restriction from
  406  the insurer. The insurer shall grant an override of the protocol
  407  within 24 hours if:
  408         (1) Based on sound clinical evidence, the prescribing
  409  provider concludes that the preferred treatment required under
  410  the fail-first protocol has been ineffective in the treatment of
  411  the insured’s disease or medical condition; or
  412         (2) Based on sound clinical evidence or medical and
  413  scientific evidence, the prescribing provider believes that the
  414  preferred treatment required under the fail-first protocol:
  415         (a) Is likely to be ineffective given the known relevant
  416  physical or mental characteristics and medical history of the
  417  insured and the known characteristics of the drug regimen; or
  418         (b) Will cause or is likely to cause an adverse reaction or
  419  other physical harm to the insured.
  420  
  421  If the prescribing provider follows the fail-first protocol
  422  recommended by the insurer for an insured, the duration of
  423  treatment under the fail-first protocol may not exceed a period
  424  deemed appropriate by the prescribing provider. Following such
  425  period, if the prescribing provider deems the treatment provided
  426  under the protocol clinically ineffective, the insured is
  427  entitled to receive the course of therapy that the prescribing
  428  provider recommends, and the provider is not required to seek
  429  approval of an override of the fail-first protocol. As used in
  430  this section, the term “fail-first protocol” means a
  431  prescription practice that begins medication for a medical
  432  condition with the most cost-effective drug therapy and
  433  progresses to other more costly or risky therapies only if
  434  necessary.
  435         Section 8. Effective January 1, 2017, subsection (44) is
  436  added to section 641.31, Florida Statutes, to read:
  437         641.31 Health maintenance contracts.—
  438         (44) A health maintenance organization may not require a
  439  health care provider, by contract with another health care
  440  provider, a patient, or another individual or entity, to use a
  441  clinical decision support system or a laboratory benefits
  442  management program before the provider may order clinical
  443  laboratory services or in an attempt to direct or limit the
  444  provider’s medical decisionmaking relating to the use of such
  445  services. This subsection may not be construed to prohibit any
  446  prior authorization requirements that the health maintenance
  447  organization may have regarding the provision of clinical
  448  laboratory services. As used in this subsection, the term:
  449         (a) “Clinical decision support system” means software
  450  designed to direct or assist clinical decisionmaking by matching
  451  the characteristics of an individual patient to a computerized
  452  clinical knowledge base and providing patient-specific
  453  assessments or recommendations based on the match.
  454         (b) “Clinical laboratory services” means the examination of
  455  fluids or other materials taken from the human body, which
  456  examination is ordered by a health care provider for use in the
  457  diagnosis, prevention, or treatment of a disease or in the
  458  identification or assessment of a medical or physical condition.
  459         (c) “Laboratory benefits management program” means a health
  460  maintenance organization protocol that dictates or limits health
  461  care provider decisionmaking relating to the use of clinical
  462  laboratory services.
  463         Section 9. Effective January 1, 2017, section 641.394,
  464  Florida Statutes, is created to read:
  465         641.394 Fail-first protocols.—If a health maintenance
  466  organization restricts the use of prescribed drugs through a
  467  fail-first protocol, it must establish a clear and convenient
  468  process that a prescribing physician may use to request an
  469  override of the restriction from the health maintenance
  470  organization. The health maintenance organization shall grant an
  471  override of the protocol within 24 hours if:
  472         (1) Based on sound clinical evidence, the prescribing
  473  provider concludes that the preferred treatment required under
  474  the fail-first protocol has been ineffective in the treatment of
  475  the subscriber’s disease or medical condition; or
  476         (2) Based on sound clinical evidence or medical and
  477  scientific evidence, the prescribing provider believes that the
  478  preferred treatment required under the fail-first protocol:
  479         (a) Is likely to be ineffective given the known relevant
  480  physical or mental characteristics and medical history of the
  481  subscriber and the known characteristics of the drug regimen; or
  482         (b) Will cause or is likely to cause an adverse reaction or
  483  other physical harm to the subscriber.
  484  
  485  If the prescribing provider follows the fail-first protocol
  486  recommended by the health maintenance organization for a
  487  subscriber, the duration of treatment under the fail-first
  488  protocol may not exceed a period deemed appropriate by the
  489  prescribing provider. Following such period, if the prescribing
  490  provider deems the treatment provided under the protocol
  491  clinically ineffective, the subscriber is entitled to receive
  492  the course of therapy that the prescribing provider recommends,
  493  and the provider is not required to seek approval of an override
  494  of the fail-first protocol. As used in this section, the term
  495  “fail-first protocol” means a prescription practice that begins
  496  medication for a medical condition with the most cost-effective
  497  drug therapy and progresses to other more costly or risky
  498  therapies only if necessary.
  499         Section 10. Paragraphs (a) and (d) of subsection (3) and
  500  subsections (4) and (5) of section 766.1115, Florida Statutes,
  501  are amended to read:
  502         766.1115 Health care providers; creation of agency
  503  relationship with governmental contractors.—
  504         (3) DEFINITIONS.—As used in this section, the term:
  505         (a) “Contract” means an agreement executed in compliance
  506  with this section between a health care provider and a
  507  governmental contractor for volunteer, uncompensated services
  508  which allows the health care provider to deliver health care
  509  services to low-income recipients as an agent of the
  510  governmental contractor. The contract must be for volunteer,
  511  uncompensated services, except as provided in paragraph (4)(g).
  512  For services to qualify as volunteer, uncompensated services
  513  under this section, the health care provider, or any employee or
  514  agent of the health care provider, must receive no compensation
  515  from the governmental contractor for any services provided under
  516  the contract and must not bill or accept compensation from the
  517  recipient, or a public or private third-party payor, for the
  518  specific services provided to the low-income recipients covered
  519  by the contract, except as provided in paragraph (4)(g). A free
  520  clinic as described in subparagraph (d)14. may receive a
  521  legislative appropriation, a grant through a legislative
  522  appropriation, or a grant from a governmental entity or
  523  nonprofit corporation to support the delivery of contracted
  524  services by volunteer health care providers, including the
  525  employment of health care providers to supplement, coordinate,
  526  or support the delivery of such services. The appropriation or
  527  grant for the free clinic does not constitute compensation under
  528  this paragraph from the governmental contractor for services
  529  provided under the contract, nor does receipt or use of the
  530  appropriation or grant constitute the acceptance of compensation
  531  under this paragraph for the specific services provided to the
  532  low-income recipients covered by the contract.
  533         (d) “Health care provider” or “provider” means:
  534         1. A birth center licensed under chapter 383.
  535         2. An ambulatory surgical center licensed under chapter
  536  395.
  537         3. A hospital licensed under chapter 395.
  538         4. A physician or physician assistant licensed under
  539  chapter 458.
  540         5. An osteopathic physician or osteopathic physician
  541  assistant licensed under chapter 459.
  542         6. A chiropractic physician licensed under chapter 460.
  543         7. A podiatric physician licensed under chapter 461.
  544         8. A registered nurse, nurse midwife, licensed practical
  545  nurse, or advanced registered nurse practitioner licensed or
  546  registered under part I of chapter 464 or any facility which
  547  employs nurses licensed or registered under part I of chapter
  548  464 to supply all or part of the care delivered under this
  549  section.
  550         9. A midwife licensed under chapter 467.
  551         10. A health maintenance organization certificated under
  552  part I of chapter 641.
  553         11. A health care professional association and its
  554  employees or a corporate medical group and its employees.
  555         12. Any other medical facility the primary purpose of which
  556  is to deliver human medical diagnostic services or which
  557  delivers nonsurgical human medical treatment, and which includes
  558  an office maintained by a provider.
  559         13. A dentist or dental hygienist licensed under chapter
  560  466.
  561         14. A free clinic that delivers only medical diagnostic
  562  services or nonsurgical medical treatment free of charge to all
  563  low-income recipients.
  564         15. A pharmacy or pharmacist licensed under chapter 465.
  565         16.15. Any other health care professional, practitioner,
  566         provider, or facility under contract with a governmental
  567  contractor, including a student enrolled in an accredited
  568  program that prepares the student for licensure as any one of
  569  the professionals listed in subparagraphs 4.-9.
  570  
  571  The term includes any nonprofit corporation qualified as exempt
  572  from federal income taxation under s. 501(a) of the Internal
  573  Revenue Code, and described in s. 501(c) of the Internal Revenue
  574  Code, which delivers health care services provided by licensed
  575  professionals listed in this paragraph, any federally funded
  576  community health center, and any volunteer corporation or
  577  volunteer health care provider that delivers health care
  578  services.
  579         (4) CONTRACT REQUIREMENTS.—A health care provider that
  580  executes a contract with a governmental contractor to deliver
  581  health care services on or after April 17, 1992, as an agent of
  582  the governmental contractor, or any employee or agent of such
  583  health care provider, is an agent for purposes of s. 768.28(9),
  584  while acting within the scope of duties under the contract, if
  585  the contract complies with the requirements of this section and
  586  regardless of whether the individual treated is later found to
  587  be ineligible. A health care provider, or any employee or agent
  588  of such health care provider, shall continue to be an agent for
  589  purposes of s. 768.28(9) for 30 days after a determination of
  590  ineligibility to allow for treatment until the individual
  591  transitions to treatment by another health care provider. A
  592  health care provider, or any employee or agent of such health
  593  care provider, under contract with the state may not be named as
  594  a defendant in any action arising out of medical care or
  595  treatment provided on or after April 17, 1992, under contracts
  596  entered into under this section. The contract must provide that:
  597         (a) The right of dismissal or termination of any health
  598  care provider delivering services under the contract is retained
  599  by the governmental contractor.
  600         (b) The governmental contractor has access to the patient
  601  records of any health care provider delivering services under
  602  the contract.
  603         (c) Adverse incidents and information on treatment outcomes
  604  must be reported by any health care provider to the governmental
  605  contractor if the incidents and information pertain to a patient
  606  treated under the contract. The health care provider shall
  607  submit the reports required by s. 395.0197. If an incident
  608  involves a professional licensed by the Department of Health or
  609  a facility licensed by the Agency for Health Care
  610  Administration, the governmental contractor shall submit such
  611  incident reports to the appropriate department or agency, which
  612  shall review each incident and determine whether it involves
  613  conduct by the licensee that is subject to disciplinary action.
  614  All patient medical records and any identifying information
  615  contained in adverse incident reports and treatment outcomes
  616  which are obtained by governmental entities under this paragraph
  617  are confidential and exempt from the provisions of s. 119.07(1)
  618  and s. 24(a), Art. I of the State Constitution.
  619         (d) Patient selection and initial referral must be made by
  620  the governmental contractor or the provider. Patients may not be
  621  transferred to the provider based on a violation of the
  622  antidumping provisions of the Omnibus Budget Reconciliation Act
  623  of 1989, the Omnibus Budget Reconciliation Act of 1990, or
  624  chapter 395.
  625         (e) If emergency care is required, the patient need not be
  626  referred before receiving treatment, but must be referred within
  627  48 hours after treatment is commenced or within 48 hours after
  628  the patient has the mental capacity to consent to treatment,
  629  whichever occurs later.
  630         (f) The provider is subject to supervision and regular
  631  inspection by the governmental contractor.
  632         (g) As an agent of the governmental contractor for purposes
  633  of s. 768.28(9), while acting within the scope of duties under
  634  the contract, A health care provider licensed under chapter 466,
  635  as an agent of the governmental contractor for purposes of s.
  636  768.28(9), may allow a patient, or a parent or guardian of the
  637  patient, to voluntarily contribute a monetary amount to cover
  638  costs of dental laboratory work related to the services provided
  639  to the patient within the scope of duties under the contract.
  640  This contribution may not exceed the actual cost of the dental
  641  laboratory charges.
  642  
  643  A governmental contractor that is also a health care provider is
  644  not required to enter into a contract under this section with
  645  respect to the health care services delivered by its employees.
  646         (5) NOTICE OF AGENCY RELATIONSHIP.—The governmental
  647  contractor must provide written notice to each patient, or the
  648  patient’s legal representative, receipt of which must be
  649  acknowledged in writing at the initial visit, that the provider
  650  is an agent of the governmental contractor and that the
  651  exclusive remedy for injury or damage suffered as the result of
  652  any act or omission of the provider or of any employee or agent
  653  thereof acting within the scope of duties pursuant to the
  654  contract is by commencement of an action pursuant to the
  655  provisions of s. 768.28. Thereafter, or with respect to any
  656  federally funded community health center, the notice
  657  requirements may be met by posting in a place conspicuous to all
  658  persons a notice that the health care provider, or federally
  659  funded community health center, is an agent of the governmental
  660  contractor and that the exclusive remedy for injury or damage
  661  suffered as the result of any act or omission of the provider or
  662  of any employee or agent thereof acting within the scope of
  663  duties pursuant to the contract is by commencement of an action
  664  pursuant to the provisions of s. 768.28.
  665         Section 11. Paragraphs (a) and (b) of subsection (9) of
  666  section 768.28, Florida Statutes, is amended to read:
  667         768.28 Waiver of sovereign immunity in tort actions;
  668  recovery limits; limitation on attorney fees; statute of
  669  limitations; exclusions; indemnification; risk management
  670  programs.—
  671         (9)(a) An No officer, employee, or agent of the state or of
  672  any of its subdivisions may not shall be held personally liable
  673  in tort or named as a party defendant in any action for any
  674  injury or damage suffered as a result of any act, event, or
  675  omission of action in the scope of her or his employment or
  676  function, unless such officer, employee, or agent acted in bad
  677  faith or with malicious purpose or in a manner exhibiting wanton
  678  and willful disregard of human rights, safety, or property.
  679  However, such officer, employee, or agent shall be considered an
  680  adverse witness in a tort action for any injury or damage
  681  suffered as a result of any act, event, or omission of action in
  682  the scope of her or his employment or function. The exclusive
  683  remedy for injury or damage suffered as a result of an act,
  684  event, or omission of an officer, employee, or agent of the
  685  state or any of its subdivisions or constitutional officers is
  686  shall be by action against the governmental entity, or the head
  687  of such entity in her or his official capacity, or the
  688  constitutional officer of which the officer, employee, or agent
  689  is an employee, unless such act or omission was committed in bad
  690  faith or with malicious purpose or in a manner exhibiting wanton
  691  and willful disregard of human rights, safety, or property. The
  692  state or its subdivisions are shall not be liable in tort for
  693  the acts or omissions of an officer, employee, or agent
  694  committed while acting outside the course and scope of her or
  695  his employment or committed in bad faith or with malicious
  696  purpose or in a manner exhibiting wanton and willful disregard
  697  of human rights, safety, or property.
  698         (b) As used in this subsection, the term:
  699         1. “Employee” includes any volunteer firefighter.
  700         2. “Officer, employee, or agent” includes, but is not
  701  limited to, any health care provider, and its employees or
  702  agents, when providing services pursuant to s. 766.1115; any
  703  nonprofit independent college or university located and
  704  chartered in this state which owns or operates an accredited
  705  medical school, and its employees or agents, when providing
  706  patient services pursuant to paragraph (10)(f); and any public
  707  defender or her or his employee or agent, including, among
  708  others, an assistant public defender or and an investigator; and
  709  any physician licensed in this state who is a medical director
  710  for or member of a child protection team, as defined in s.
  711  39.01, when carrying out her or his duties as a team member.
  712         Section 12. Except as otherwise expressly provided in this
  713  act, this act shall take effect July 1, 2016.
  714  
  715  ================= T I T L E  A M E N D M E N T ================
  716  And the title is amended as follows:
  717         Delete everything before the enacting clause
  718  and insert:
  719                        A bill to be entitled                      
  720         An act relating to health care; creating s. 381.4019,
  721         F.S.; establishing a joint local and state dental care
  722         access account initiative, subject to the availability
  723         of funding; authorizing the creation of dental care
  724         access accounts; specifying the purpose of the
  725         initiative; defining terms; providing criteria for the
  726         selection of dentists for participation in the
  727         initiative; providing for the establishment of
  728         accounts; requiring the Department of Health to
  729         implement an electronic benefit transfer system;
  730         providing for the use of funds deposited in the
  731         accounts; requiring the department to distribute state
  732         funds to accounts, subject to legislative
  733         appropriations; authorizing the department to accept
  734         contributions from a local source for deposit in a
  735         designated account; limiting the number of years that
  736         an account may remain open; providing for the
  737         immediate closing of accounts under certain
  738         circumstances; authorizing the department to transfer
  739         state funds remaining in a closed account at a
  740         specified time and to return unspent funds from local
  741         sources; requiring a dentist to repay funds in certain
  742         circumstances; authorizing the department to pursue
  743         disciplinary enforcement actions and to use other
  744         legal means to recover funds; requiring the department
  745         to establish by rule application procedures and a
  746         process to verify the use of funds withdrawn from a
  747         dental care access account; requiring the department
  748         to give priority to applications from dentists
  749         practicing in certain areas; requiring the Department
  750         of Economic Opportunity to rank dental health
  751         professional shortage areas and medically underserved
  752         areas; requiring the Department of Health to develop a
  753         marketing plan in cooperation with certain dental
  754         colleges and the Florida Dental Association; requiring
  755         the Department of Health to annually submit a report
  756         with certain information to the Governor and the
  757         Legislature; providing rulemaking authority to require
  758         the submission of information for such reporting;
  759         amending s. 395.002, F.S.; revising the definition of
  760         the term “ambulatory surgical center” or “mobile
  761         surgical facility”; amending s. 395.003, F.S.;
  762         requiring, as a condition of licensure and license
  763         renewal, that ambulatory surgical centers provide
  764         services to specified patients in at least a specified
  765         amount; defining a term; creating s. 624.27, F.S.;
  766         defining terms; specifying that a direct primary care
  767         agreement does not constitute insurance and is not
  768         subject to ch. 636, F.S., relating to prepaid limited
  769         health service organizations and discount medical plan
  770         organizations, or any other chapter of the Florida
  771         Insurance Code; specifying that entering into a direct
  772         primary care agreement does not constitute the
  773         business of insurance and is not subject to ch. 636,
  774         F.S., or any other chapter of the code; providing that
  775         certain certificates of authority and licenses are not
  776         required to market, sell, or offer to sell a direct
  777         primary care agreement; specifying requirements for a
  778         direct primary care agreement; providing a short
  779         title; amending s. 409.967, F.S.; requiring a managed
  780         care plan to establish a process by which a
  781         prescribing physician may request an override of
  782         certain restrictions in certain circumstances;
  783         providing the circumstances under which an override
  784         must be granted; defining the term “fail-first
  785         protocol”; creating s. 627.42392, F.S.; requiring an
  786         insurer to establish a process by which a prescribing
  787         physician may request an override of certain
  788         restrictions in certain circumstances; providing the
  789         circumstances under which an override must be granted;
  790         defining the term “fail-first protocol”; amending s.
  791         641.31, F.S.; prohibiting a health maintenance
  792         organization from requiring that a health care
  793         provider use a clinical decision support system or a
  794         laboratory benefits management program in certain
  795         circumstances; defining terms; providing for
  796         construction; creating s. 641.394, F.S.; requiring a
  797         health maintenance organization to establish a process
  798         by which a prescribing physician may request an
  799         override of certain restrictions in certain
  800         circumstances; providing the circumstances under which
  801         an override must be granted; defining the term “fail
  802         first protocol”; amending s. 766.1115, F.S.; revising
  803         the definitions of the terms “contract” and “health
  804         care provider”; deleting an obsolete date; extending
  805         sovereign immunity to employees or agents of a health
  806         care provider that executes a contract with a
  807         governmental contractor; clarifying that a receipt of
  808         specified notice must be acknowledged by a patient or
  809         the patient’s representative at the initial visit;
  810         requiring the posting of notice that a specified
  811         health care provider is an agent of a governmental
  812         contractor; amending s. 768.28, F.S.; revising the
  813         definition of the term “officer, employee, or agent”
  814         to include employees or agents of a health care
  815         provider as it applies to immunity from personal
  816         liability in certain actions, to include licensed
  817         physicians who are medical directors for or members of
  818         a child protection team, in certain circumstances;
  819         providing effective dates.