Florida Senate - 2019                        COMMITTEE AMENDMENT
       Bill No. SB 732
       
       
       
       
       
       
                                Ì859422(Î859422                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  03/13/2019           .                                
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       The Committee on Health Policy (Flores) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsection (4) of section 400.9905, Florida
    6  Statutes, is amended to read:
    7         400.9905 Definitions.—
    8         (4) “Clinic” means an entity that provides where health
    9  care services are provided to individuals and that receives
   10  compensation and which tenders charges for reimbursement for
   11  those such services, including a mobile clinic and a portable
   12  equipment provider. As used in this part, the term does not
   13  include and the licensure requirements of this part do not apply
   14  to:
   15         (a) Entities licensed or registered by the state under
   16  chapter 395; entities licensed or registered by the state and
   17  providing only health care services within the scope of services
   18  authorized under their respective licenses under ss. 383.30
   19  383.332, chapter 390, chapter 394, chapter 397, this chapter
   20  except part X, chapter 429, chapter 463, chapter 465, chapter
   21  466, chapter 478, chapter 484, or chapter 651; end-stage renal
   22  disease providers authorized under 42 C.F.R. part 405, subpart
   23  U; providers certified under 42 C.F.R. part 485, subpart B or
   24  subpart H; or any entity that provides neonatal or pediatric
   25  hospital-based health care services or other health care
   26  services by licensed practitioners solely within a hospital
   27  licensed under chapter 395.
   28         (b) Entities that own, directly or indirectly, entities
   29  licensed or registered by the state pursuant to chapter 395;
   30  entities that own, directly or indirectly, entities licensed or
   31  registered by the state and providing only health care services
   32  within the scope of services authorized pursuant to their
   33  respective licenses under ss. 383.30-383.332, chapter 390,
   34  chapter 394, chapter 397, this chapter except part X, chapter
   35  429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
   36  484, or chapter 651; end-stage renal disease providers
   37  authorized under 42 C.F.R. part 405, subpart U; providers
   38  certified under 42 C.F.R. part 485, subpart B or subpart H; or
   39  any entity that provides neonatal or pediatric hospital-based
   40  health care services by licensed practitioners solely within a
   41  hospital licensed under chapter 395.
   42         (c) Entities that are owned, directly or indirectly, by an
   43  entity licensed or registered by the state pursuant to chapter
   44  395; entities that are owned, directly or indirectly, by an
   45  entity licensed or registered by the state and providing only
   46  health care services within the scope of services authorized
   47  pursuant to their respective licenses under ss. 383.30-383.332,
   48  chapter 390, chapter 394, chapter 397, this chapter except part
   49  X, chapter 429, chapter 463, chapter 465, chapter 466, chapter
   50  478, chapter 484, or chapter 651; end-stage renal disease
   51  providers authorized under 42 C.F.R. part 405, subpart U;
   52  providers certified under 42 C.F.R. part 485, subpart B or
   53  subpart H; or any entity that provides neonatal or pediatric
   54  hospital-based health care services by licensed practitioners
   55  solely within a hospital under chapter 395.
   56         (d) Entities that are under common ownership, directly or
   57  indirectly, with an entity licensed or registered by the state
   58  pursuant to chapter 395; entities that are under common
   59  ownership, directly or indirectly, with an entity licensed or
   60  registered by the state and providing only health care services
   61  within the scope of services authorized pursuant to their
   62  respective licenses under ss. 383.30-383.332, chapter 390,
   63  chapter 394, chapter 397, this chapter except part X, chapter
   64  429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
   65  484, or chapter 651; end-stage renal disease providers
   66  authorized under 42 C.F.R. part 405, subpart U; providers
   67  certified under 42 C.F.R. part 485, subpart B or subpart H; or
   68  any entity that provides neonatal or pediatric hospital-based
   69  health care services by licensed practitioners solely within a
   70  hospital licensed under chapter 395.
   71         (e) An entity that is exempt from federal taxation under 26
   72  U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
   73  under 26 U.S.C. s. 409 that has a board of trustees at least
   74  two-thirds of which are Florida-licensed health care
   75  practitioners and provides only physical therapy services under
   76  physician orders, any community college or university clinic,
   77  and any entity owned or operated by the federal or state
   78  government, including agencies, subdivisions, or municipalities
   79  thereof.
   80         (f) A sole proprietorship, group practice, partnership, or
   81  corporation that provides health care services by physicians
   82  covered by s. 627.419, that is directly supervised by one or
   83  more of such physicians, and that is wholly owned by one or more
   84  of those physicians or by a physician and the spouse, parent,
   85  child, or sibling of that physician.
   86         (g) A sole proprietorship, group practice, partnership, or
   87  corporation that provides health care services by licensed
   88  health care practitioners under chapter 457, chapter 458,
   89  chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
   90  chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
   91  chapter 490, chapter 491, or part I, part III, part X, part
   92  XIII, or part XIV of chapter 468, or s. 464.012, and that is
   93  wholly owned by one or more licensed health care practitioners,
   94  or the licensed health care practitioners set forth in this
   95  paragraph and the spouse, parent, child, or sibling of a
   96  licensed health care practitioner if one of the owners who is a
   97  licensed health care practitioner is supervising the business
   98  activities and is legally responsible for the entity’s
   99  compliance with all federal and state laws. However, a health
  100  care practitioner may not supervise services beyond the scope of
  101  the practitioner’s license, except that, for the purposes of
  102  this part, a clinic owned by a licensee in s. 456.053(3)(b)
  103  which provides only services authorized pursuant to s.
  104  456.053(3)(b) may be supervised by a licensee specified in s.
  105  456.053(3)(b).
  106         (h) Clinical facilities affiliated with an accredited
  107  medical school at which training is provided for medical
  108  students, residents, or fellows.
  109         (i) Entities that provide only oncology or radiation
  110  therapy services by physicians licensed under chapter 458 or
  111  chapter 459 or entities that provide oncology or radiation
  112  therapy services by physicians licensed under chapter 458 or
  113  chapter 459 which are owned by a corporation whose shares are
  114  publicly traded on a recognized stock exchange.
  115         (j) Clinical facilities affiliated with a college of
  116  chiropractic accredited by the Council on Chiropractic Education
  117  at which training is provided for chiropractic students.
  118         (k) Entities that provide licensed practitioners to staff
  119  emergency departments or to deliver anesthesia services in
  120  facilities licensed under chapter 395 and that derive at least
  121  90 percent of their gross annual revenues from the provision of
  122  such services. Entities claiming an exemption from licensure
  123  under this paragraph must provide documentation demonstrating
  124  compliance.
  125         (l) Orthotic, prosthetic, pediatric cardiology, or
  126  perinatology clinical facilities or anesthesia clinical
  127  facilities that are not otherwise exempt under paragraph (a) or
  128  paragraph (k) and that are a publicly traded corporation or are
  129  wholly owned, directly or indirectly, by a publicly traded
  130  corporation. As used in this paragraph, a publicly traded
  131  corporation is a corporation that issues securities traded on an
  132  exchange registered with the United States Securities and
  133  Exchange Commission as a national securities exchange.
  134         (m) Entities that are owned by a corporation that has $250
  135  million or more in total annual sales of health care services
  136  provided by licensed health care practitioners where one or more
  137  of the persons responsible for the operations of the entity is a
  138  health care practitioner who is licensed in this state and who
  139  is responsible for supervising the business activities of the
  140  entity and is responsible for the entity’s compliance with state
  141  law for purposes of this part.
  142         (n) Entities that employ 50 or more licensed health care
  143  practitioners licensed under chapter 458 or chapter 459 where
  144  the billing for medical services is under a single tax
  145  identification number. The application for exemption under this
  146  subsection shall contain information that includes: the name,
  147  residence, and business address and phone number of the entity
  148  that owns the practice; a complete list of the names and contact
  149  information of all the officers and directors of the
  150  corporation; the name, residence address, business address, and
  151  medical license number of each licensed Florida health care
  152  practitioner employed by the entity; the corporate tax
  153  identification number of the entity seeking an exemption; a
  154  listing of health care services to be provided by the entity at
  155  the health care clinics owned or operated by the entity and a
  156  certified statement prepared by an independent certified public
  157  accountant which states that the entity and the health care
  158  clinics owned or operated by the entity have not received
  159  payment for health care services under personal injury
  160  protection insurance coverage for the preceding year. If the
  161  agency determines that an entity which is exempt under this
  162  subsection has received payments for medical services under
  163  personal injury protection insurance coverage, the agency may
  164  deny or revoke the exemption from licensure under this
  165  subsection.
  166  
  167  Notwithstanding this subsection, an entity shall be deemed a
  168  clinic and must be licensed under this part in order to receive
  169  reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
  170  627.730-627.7405, unless exempted under s. 627.736(5)(h).
  171         Section 2. Subsection (4) of section 400.991, Florida
  172  Statutes, is amended to read:
  173         400.991 License requirements; background screenings;
  174  prohibitions.—
  175         (4) In addition to the requirements of part II of chapter
  176  408, the applicant must file with the application satisfactory
  177  proof that the clinic is in compliance with this part and
  178  applicable rules, including:
  179         (a) A listing of services to be provided either directly by
  180  the applicant or through contractual arrangements with existing
  181  providers;
  182         (b) The number and discipline of each professional staff
  183  member to be employed; and
  184         (c) Proof of financial ability to operate as required under
  185  s. 408.810(8). As an alternative to submitting proof of
  186  financial ability to operate as required under s. 408.810(8),
  187  the applicant may file a surety bond of at least $500,000 which
  188  guarantees that the clinic will act in full conformity with all
  189  legal requirements for operating a clinic, payable to the
  190  agency. The agency may adopt rules to specify related
  191  requirements for such surety bond; and
  192         (d) Proof that the clinic maintains the financial
  193  responsibility in the manner set forth in s. 458.320(2) or s.
  194  459.0085(2), as applicable, to pay claims and costs ancillary
  195  thereto arising out of the rendering of or the failure to render
  196  medical care and services, for physicians and osteopathic
  197  physicians who perform liposuction procedures in which more than
  198  1,000 cubic centimeters of supernatant fat is removed, Level II
  199  office surgery, or Level III office surgery as those terms are
  200  defined in ss. 458.305(8) and 459.003(9), in an office setting.
  201         Section 3. Paragraph (j) is added to subsection (1) of
  202  section 400.9935, Florida Statutes, to read:
  203         400.9935 Clinic responsibilities.—
  204         (1) Each clinic shall appoint a medical director or clinic
  205  director who shall agree in writing to accept legal
  206  responsibility for the following activities on behalf of the
  207  clinic. The medical director or the clinic director shall:
  208         (j) If the clinic is registered with the department to
  209  perform office surgery, ensure that the clinic complies with the
  210  standards of practice for office surgery adopted by rule under
  211  ss. 458.309(4) and 459.005(3).
  212         Section 4. Subsection (4) of section 400.995, Florida
  213  Statutes, is amended to read:
  214         400.995 Agency administrative penalties.—
  215         (4) Any licensed clinic whose owner, medical director, or
  216  clinic director concurrently operates an unlicensed clinic or a
  217  clinic that is not registered with the department where any
  218  liposuction procedure in which more than 1,000 cubic centimeters
  219  of supernatant fat is removed or where any Level II office
  220  surgery or Level III office surgery, as those terms are defined
  221  in ss. 458.305(8) and 459.003(9), is performed, is shall be
  222  subject to an administrative fine of $5,000 per day.
  223         Section 5. Subsection (12) is added to section 456.004,
  224  Florida Statutes, to read:
  225         456.004 Department; powers and duties.—The department, for
  226  the professions under its jurisdiction, shall:
  227         (12) Deny or revoke the registration of, or impose any
  228  penalty set forth in s. 456.072(2) against, any facility where
  229  office surgery, as defined in ss. 458.305(8) and 459.003(9), is
  230  performed for failure of any of its physicians, owners, or
  231  operators to comply with rules adopted under ss. 458.309(3) and
  232  459.005(2). Section 456.073 applies to enforcement actions
  233  brought against such facilities. If a facility’s registration is
  234  revoked, the department may deny any person named in the
  235  registration documents of the facility, including the persons
  236  who own or operate the facility, individually or as part of a
  237  group, from registering a facility to perform surgical
  238  procedures pursuant to s. 458.309(3) or s. 459.005(2) for 5
  239  years after the revocation date.
  240         Section 6. Subsection (6) is added to section 456.074,
  241  Florida Statutes, to read:
  242         456.074 Certain health care practitioners; immediate
  243  suspension of license.—
  244         (6) The department may issue an emergency order suspending
  245  or restricting the registration of a facility in which
  246  liposuction procedures in which more than 1,000 cubic
  247  centimeters of supernatant fat is removed, Level II office
  248  surgery, or Level III office surgery as those terms are defined
  249  in ss. 458.305(8) and 459.003(9), are performed upon a finding
  250  of probable cause that the facility or its surgeons are not in
  251  compliance with the standards of practice for office surgery
  252  adopted by the boards pursuant to s. 458.309(4) or s.
  253  459.005(3), as applicable, or are in violation of s.
  254  458.331(1)(v) or s. 459.015(1)(z) and that such noncompliance
  255  constitutes an immediate danger to the public.
  256         Section 7. Section 458.305, Florida Statutes, is amended to
  257  read:
  258         458.305 Definitions.—As used in this chapter, the term:
  259         (1) “Board” means the Board of Medicine.
  260         (2)“Deep sedation and analgesia” means a drug-induced
  261  depression of consciousness during which all of the following
  262  apply:
  263         (a) The patient cannot be easily aroused but responds by
  264  purposefully following repeated or painful stimulation.
  265         (b) The patient’s ability to independently maintain
  266  ventilatory function may be impaired.
  267         (c) The patient may require assistance in maintaining a
  268  patent airway, and spontaneous ventilation may be inadequate.
  269         (d) The patient’s cardiovascular function is usually
  270  maintained.
  271         (e) The patient’s reflex withdrawal from painful stimulus
  272  is not considered a purposeful response.
  273         (3)(2) “Department” means the Department of Health.
  274         (4)“Epidural anesthesia” means anesthesia produced by the
  275  injection of an anesthetic agent into the space on or around the
  276  dura mater of the spinal cord.
  277         (5)“General anesthesia” means a drug-induced loss of
  278  consciousness administered by a qualified general anesthesia
  279  provider during which all of the following apply:
  280         (a) The patient is not able to be aroused, even by painful
  281  stimulation.
  282         (b) The patient’s ability to independently maintain
  283  ventilatory function is often impaired.
  284         (c) The patient has a level of depressed neuromuscular
  285  function.
  286         (d) The patient may require assistance in maintaining a
  287  patent airway, and positive pressure ventilation may be
  288  required.
  289         (e) The patient’s cardiovascular function may be impaired.
  290         (6)“Minimal sedation” means a drug-induced state during
  291  which patients respond normally to verbal commands. Although
  292  cognitive function and physical coordination may be impaired,
  293  airway reflexes and respiratory and cardiovascular functions are
  294  unaffected.
  295         (7) “Moderate sedation and analgesia” or “conscious
  296  sedation” means drug-induced depression of consciousness and a
  297  state of consciousness during which all of the following apply:
  298         (a) The patient responds purposefully to verbal commands,
  299  either alone or accompanied by light tactile stimulation.
  300         (b) Interventions are not required to maintain a patent
  301  airway, and spontaneous ventilation is adequate.
  302         (c) Cardiovascular function is maintained.
  303         (d) Reflex withdrawal from a painful stimulus is not
  304  considered a purposeful response.
  305         (8)“Office surgery” means a surgery that is performed in a
  306  physician’s office or any facility that is not licensed under
  307  chapter 390 or chapter 395.
  308         (a)“Level I office surgery” includes any surgery that
  309  consists of only minor procedures and in which anesthesia is
  310  limited to minimal sedation.
  311         (b)“Level II office surgery includes any surgery in which
  312  the patient’s level of sedation is that of moderate sedation and
  313  analgesia or conscious sedation.
  314         (c) ”Level III office surgery includes any surgery in
  315  which the patient’s level of sedation is that of deep sedation
  316  and analgesia or general anesthesia. The term includes any
  317  surgery that includes the use of spinal anesthesia or epidural
  318  anesthesia.
  319         (10)(3) “Practice of medicine” means the diagnosis,
  320  treatment, operation, or prescription for any human disease,
  321  pain, injury, deformity, or other physical or mental condition.
  322         (11)“Spinal anesthesia” means anesthesia produced by the
  323  injection of an anesthetic agent into the subarachnoid space of
  324  the spinal cord.
  325         (12)“Surgeon” means a physician who performs surgery.
  326         (13)“Surgery” means any manual or operative procedure,
  327  including the use of lasers, performed upon the body of a living
  328  human being for the purposes of preserving health, diagnosing or
  329  curing disease, repairing injury, correcting deformity or
  330  defects, prolonging life, or relieving suffering or any elective
  331  procedure for aesthetic, reconstructive, or cosmetic purposes,
  332  including, but not limited to: incision or curettage of tissue
  333  or an organ; suture or other repair of tissue or organ,
  334  including a closed as well as an open reduction of a fracture;
  335  extraction of tissue including premature extraction of the
  336  products of conception from the uterus; insertion of natural or
  337  artificial implants; or an endoscopic procedure with use of
  338  local or general anesthetic.
  339         (9)(4) “Physician” means a person who is licensed to
  340  practice medicine in this state.
  341         Section 8. Subsection (3) of section 458.309, Florida
  342  Statutes, is amended and subsection (4) is added to that
  343  section, to read:
  344         458.309 Rulemaking authority.—
  345         (3) A physician who performs any liposuction procedure
  346  procedures in which more than 1,000 cubic centimeters of
  347  supernatant fat is removed, any Level II office surgery level 2
  348  procedures lasting more than 5 minutes, or any Level III office
  349  surgery and all level 3 surgical procedures in an office setting
  350  must register the office with the department unless that office
  351  is licensed as a facility under chapter 395. The department
  352  shall inspect the physician’s office annually unless the office
  353  is accredited by a nationally recognized accrediting agency or
  354  an accrediting organization subsequently approved by the Board
  355  of Medicine. The actual costs for registration and inspection or
  356  accreditation shall be paid by the person seeking to register
  357  and operate the office setting in which office surgery is
  358  performed. As a condition of registration, a physician who
  359  performs such surgical procedures in an office setting, and the
  360  office itself if it is a separate legal entity from the
  361  physician, must maintain the same levels of financial
  362  responsibility required in s. 458.320.
  363         (4) The department may adopt rules to administer the
  364  registration, inspection, and safety of offices in which a
  365  physician performs office surgery. The board shall adopt by rule
  366  standards of practice for physicians who perform office surgery.
  367  The board shall impose a fine of $5,000 per day on a physician
  368  who performs a surgical procedure identified in subsection (3)
  369  in an office that is not registered with the department.
  370         Section 9. Paragraph (vv) is added to subsection (1) of
  371  section 458.331, Florida Statutes, to read:
  372         458.331 Grounds for disciplinary action; action by the
  373  board and department.—
  374         (1) The following acts constitute grounds for denial of a
  375  license or disciplinary action, as specified in s. 456.072(2):
  376         (vv) Performing a liposuction procedure in which more than
  377  1,000 cubic centimeters of supernatant fat is removed, a Level
  378  II office surgery, or a Level III office surgery in an office
  379  that is not registered with the department pursuant to s.
  380  458.309(3).
  381         Section 10. Section 459.003, Florida Statutes, is amended
  382  to read:
  383         459.003 Definitions.—As used in this chapter, the term:
  384         (1) “Board” means the Board of Osteopathic Medicine.
  385         (2)“Deep sedation and analgesia” means a drug-induced
  386  depression of consciousness during which all of the following
  387  apply:
  388         (a) The patient cannot be easily aroused but responds by
  389  purposefully following repeated or painful stimulation.
  390         (b) The patient’s ability to independently maintain
  391  ventilatory function may be impaired.
  392         (c) The patient may require assistance in maintaining a
  393  patent airway, and spontaneous ventilation may be inadequate.
  394         (d) The patient’s cardiovascular function is usually
  395  maintained.
  396         (e) The patient’s reflex withdrawal from painful stimulus
  397  is not considered a purposeful response.
  398         (3)(2) “Department” means the Department of Health.
  399         (5)“Epidural anesthesia” means anesthesia produced by the
  400  injection of an anesthetic agent into the space on or around the
  401  dura mater of the spinal cord.
  402         (6)“General anesthesia” means a drug-induced loss of
  403  consciousness administered by a qualified general anesthesia
  404  provider during which all of the following apply:
  405         (a) The patient is not able to be aroused, even by painful
  406  stimulation.
  407         (b) The patient’s ability to independently maintain
  408  ventilatory function is often impaired.
  409         (c) The patient has a level of depressed neuromuscular
  410  function.
  411         (d) The patient may require assistance in maintaining a
  412  patent airway, and positive pressure ventilation may be
  413  required.
  414         (e) The patient’s cardiovascular function may be impaired.
  415         (7)“Minimal sedation” means a drug-induced state during
  416  which patients respond normally to verbal commands. Although
  417  cognitive function and physical coordination may be impaired,
  418  airway reflexes, and respiratory and cardiovascular functions
  419  are unaffected.
  420         (8) “Moderate sedation and analgesia” or “conscious
  421  sedation” means drug-induced depression of consciousness and a
  422  state of consciousness during which all of the following apply:
  423         (a) The patient responds purposefully to verbal commands,
  424  either alone or accompanied by light tactile stimulation.
  425         (b) Interventions are not required to maintain a patent
  426  airway, and spontaneous ventilation is adequate.
  427         (c) Cardiovascular function is maintained.
  428         (d) Reflex withdrawal from a painful stimulus is not
  429  considered a purposeful response.
  430         (9)“Office surgery” means a surgery that is performed in a
  431  physician’s office or any facility that is not licensed under
  432  chapter 390 or chapter 395.
  433         (a)“Level I office surgery” includes any surgery that
  434  consists of only minor procedures and in which anesthesia is
  435  limited to minimal sedation.
  436         (b)“Level II office surgery includes any surgery in which
  437  the patient’s level of sedation is that of moderate sedation and
  438  analgesia or conscious sedation.
  439         (c) ”Level III office surgery includes any surgery in
  440  which the patient’s level of sedation is that of deep sedation
  441  and analgesia or general anesthesia. The term includes any
  442  surgery that includes the use of spinal anesthesia or epidural
  443  anesthesia.
  444         (11)(3) “Practice of osteopathic medicine” means the
  445  diagnosis, treatment, operation, or prescription for any human
  446  disease, pain, injury, deformity, or other physical or mental
  447  condition, which practice is based in part upon educational
  448  standards and requirements which emphasize the importance of the
  449  musculoskeletal structure and manipulative therapy in the
  450  maintenance and restoration of health.
  451         (12)“Spinal anesthesia” means anesthesia produced by the
  452  injection of an anesthetic agent into the subarachnoid space of
  453  the spinal cord.
  454         (13)“Surgeon” means a physician who performs surgery.
  455         (14)“Surgery” means any manual or operative procedure,
  456  including the use of lasers, performed upon the body of a living
  457  human being for the purposes of preserving health, diagnosing or
  458  curing disease, repairing injury, correcting deformity or
  459  defects, prolonging life, or relieving suffering or any elective
  460  procedure for aesthetic, reconstructive, or cosmetic purposes,
  461  including, but not limited to: incision or curettage of tissue
  462  or an organ; suture or other repair of tissue or organ,
  463  including a closed as well as an open reduction of a fracture;
  464  extraction of tissue including premature extraction of the
  465  products of conception from the uterus; insertion of natural or
  466  artificial implants; or an endoscopic procedure with use of
  467  local or general anesthetic.
  468         (10)(4) “Osteopathic physician” means a person who is
  469  licensed to practice osteopathic medicine in this state.
  470         (4)(5) “Doctor of Osteopathy” and “Doctor of Osteopathic
  471  Medicine,” when referring to degrees, shall be construed to be
  472  equivalent and equal degrees.
  473         Section 11. Subsection (2) of section 459.005, Florida
  474  Statutes, is amended and subsection (3) is added to that
  475  section, to read:
  476         459.005 Rulemaking authority.—
  477         (2) A physician who performs any liposuction procedure
  478  procedures in which more than 1,000 cubic centimeters of
  479  supernatant fat is removed, any Level II office surgery level 2
  480  procedures lasting more than 5 minutes, or any Level III office
  481  surgery and all level 3 surgical procedures in an office setting
  482  must register the office with the department unless that office
  483  is licensed as a facility under chapter 395. The department
  484  shall inspect the physician’s office annually unless the office
  485  is accredited by a nationally recognized accrediting agency or
  486  an accrediting organization subsequently approved by the Board
  487  of Osteopathic Medicine. The actual costs for registration and
  488  inspection or accreditation shall be paid by the person seeking
  489  to register and operate the office setting in which office
  490  surgery is performed. As a condition of registration, a
  491  physician who performs such surgical procedures in an office
  492  setting, and the office itself if it is a separate legal entity
  493  from the physician, must maintain the same levels of financial
  494  responsibility required in s. 459.0085.
  495         (3) The department may adopt rules to administer the
  496  registration, inspection, and safety of offices in which a
  497  physician performs office surgery. The board shall adopt by rule
  498  standards of practice for physicians who perform office surgery.
  499  The board shall impose a fine of $5,000 per day on a physician
  500  who performs a surgical procedure identified in subsection (2)
  501  in an office that is not registered with the department.
  502         Section 12. Paragraph (xx) is added to subsection (1) of
  503  section 459.015, Florida Statutes, to read:
  504         459.015 Grounds for disciplinary action; action by the
  505  board and department.—
  506         (1) The following acts constitute grounds for denial of a
  507  license or disciplinary action, as specified in s. 456.072(2):
  508         (xx) Performing a liposuction procedure in which more than
  509  1,000 cubic centimeters of supernatant fat is removed, a Level
  510  II office surgery, or a Level III office surgery in an office
  511  that is not registered with the department pursuant to s.
  512  459.005(2).
  513         Section 13. Paragraph (b) of subsection (4) of section
  514  464.012, Florida Statutes, is amended to read:
  515         464.012 Licensure of advanced practice registered nurses;
  516  fees; controlled substance prescribing.—
  517         (4) In addition to the general functions specified in
  518  subsection (3), an advanced practice registered nurse may
  519  perform the following acts within his or her specialty:
  520         (b) The certified registered nurse anesthetist may, to the
  521  extent authorized by established protocol approved by the
  522  medical staff of the facility in which the anesthetic service is
  523  performed, perform any or all of the following:
  524         1. Determine the health status of the patient as it relates
  525  to the risk factors and to the anesthetic management of the
  526  patient through the performance of the general functions.
  527         2. Based on history, physical assessment, and supplemental
  528  laboratory results, determine, with the consent of the
  529  responsible physician, the appropriate type of anesthesia within
  530  the framework of the protocol.
  531         3. Order under the protocol preanesthetic medication.
  532         4. Perform under the protocol procedures commonly used to
  533  render the patient insensible to pain during the performance of
  534  surgical, obstetrical, therapeutic, or diagnostic clinical
  535  procedures. These procedures include ordering and administering
  536  regional, spinal, and general anesthesia; inhalation agents and
  537  techniques; intravenous agents and techniques; and techniques of
  538  hypnosis.
  539         5. Order or perform monitoring procedures indicated as
  540  pertinent to the anesthetic health care management of the
  541  patient.
  542         6. Support life functions during anesthesia health care,
  543  including induction and intubation procedures, the use of
  544  appropriate mechanical supportive devices, and the management of
  545  fluid, electrolyte, and blood component balances.
  546         7. Recognize and take appropriate corrective action for
  547  abnormal patient responses to anesthesia, adjunctive medication,
  548  or other forms of therapy.
  549         8. Recognize and treat a cardiac arrhythmia while the
  550  patient is under anesthetic care.
  551         9. Participate in management of the patient while in the
  552  postanesthesia recovery area, including ordering the
  553  administration of fluids and drugs.
  554         10. Place special peripheral and central venous and
  555  arterial lines for blood sampling and monitoring as appropriate.
  556         11. Provide the services identified in subsections 1.-10.
  557  in an office registered to perform office surgery pursuant to s.
  558  458.309(3) or s. 459.005(2) within the framework of an
  559  established protocol with an anesthesiologist licensed under
  560  chapter 458 or chapter 459.
  561         Section 14. Paragraph (a) of subsection (1) of section
  562  766.101, Florida Statutes, is amended to read:
  563         766.101 Medical review committee, immunity from liability.—
  564         (1) As used in this section:
  565         (a) The term “medical review committee” or “committee”
  566  means:
  567         1.a. A committee of a hospital or ambulatory surgical
  568  center licensed under chapter 395 or a health maintenance
  569  organization certificated under part I of chapter 641;
  570         b. A committee of a physician-hospital organization, a
  571  provider-sponsored organization, or an integrated delivery
  572  system;
  573         c. A committee of a state or local professional society of
  574  health care providers;
  575         d. A committee of a medical staff of a licensed hospital or
  576  nursing home, provided the medical staff operates pursuant to
  577  written bylaws that have been approved by the governing board of
  578  the hospital or nursing home;
  579         e. A committee of the Department of Corrections or the
  580  Correctional Medical Authority as created under s. 945.602, or
  581  employees, agents, or consultants of either the department or
  582  the authority or both;
  583         f. A committee of a professional service corporation formed
  584  under chapter 621 or a corporation organized under part I of
  585  chapter 607 or chapter 617, which is formed and operated for the
  586  practice of medicine as defined in s. 458.305 s. 458.305(3), and
  587  which has at least 25 health care providers who routinely
  588  provide health care services directly to patients;
  589         g. A committee of the Department of Children and Families
  590  which includes employees, agents, or consultants to the
  591  department as deemed necessary to provide peer review,
  592  utilization review, and mortality review of treatment services
  593  provided pursuant to chapters 394, 397, and 916;
  594         h. A committee of a mental health treatment facility
  595  licensed under chapter 394 or a community mental health center
  596  as defined in s. 394.907, provided the quality assurance program
  597  operates pursuant to the guidelines that have been approved by
  598  the governing board of the agency;
  599         i. A committee of a substance abuse treatment and education
  600  prevention program licensed under chapter 397 provided the
  601  quality assurance program operates pursuant to the guidelines
  602  that have been approved by the governing board of the agency;
  603         j. A peer review or utilization review committee organized
  604  under chapter 440;
  605         k. A committee of the Department of Health, a county health
  606  department, healthy start coalition, or certified rural health
  607  network, when reviewing quality of care, or employees of these
  608  entities when reviewing mortality records; or
  609         l. A continuous quality improvement committee of a pharmacy
  610  licensed pursuant to chapter 465,
  611  
  612  which committee is formed to evaluate and improve the quality of
  613  health care rendered by providers of health service, to
  614  determine that health services rendered were professionally
  615  indicated or were performed in compliance with the applicable
  616  standard of care, or that the cost of health care rendered was
  617  considered reasonable by the providers of professional health
  618  services in the area; or
  619         2. A committee of an insurer, self-insurer, or joint
  620  underwriting association of medical malpractice insurance, or
  621  other persons conducting review under s. 766.106.
  622         Section 15. This act shall take effect upon becoming a law.
  623  
  624  ================= T I T L E  A M E N D M E N T ================
  625  And the title is amended as follows:
  626         Delete everything before the enacting clause
  627  and insert:
  628                        A bill to be entitled                      
  629         An act relating to clinics and office surgery;
  630         amending s. 400.9905, F.S.; revising the definition of
  631         the term “clinic”; amending s. 400.991, F.S.;
  632         requiring a clinic to provide proof of its financial
  633         responsibility to pay certain claims and costs along
  634         with its application for licensure to the Agency for
  635         Health Care Administration; amending s. 400.9935,
  636         F.S.; requiring a medical director or a clinic
  637         director to ensure that the clinic complies with
  638         specified rules; amending s. 400.995, F.S.; requiring
  639         the agency to impose a specified administrative fine
  640         on an unregistered clinic that performs certain office
  641         surgeries; amending s. 456.004, F.S.; requiring the
  642         Department of Health to deny or revoke the
  643         registration of or impose certain penalties against a
  644         facility where certain office surgeries are performed
  645         under certain circumstances; specifying provisions
  646         that apply enforcement actions against such
  647         facilities; authorizing the department to deny certain
  648         persons associated with an office of which the
  649         registration was revoked from registering a new office
  650         to perform certain office surgery; amending s.
  651         456.074, F.S.; authorizing the department to issue an
  652         emergency order suspending or restricting the
  653         registration of a certain office if it makes certain
  654         findings; amending s. 458.305, F.S.; defining terms;
  655         amending s. 458.309, F.S.; requiring a physician who
  656         performs certain office surgery and the office in
  657         which the surgery is performed to maintain specified
  658         levels of financial responsibility; authorizing the
  659         department to adopt rules to administer the
  660         registration, inspection, and safety of offices that
  661         perform certain office surgery; requiring the Board of
  662         Medicine to adopt rules governing the standard of care
  663         for physicians practicing in such offices; requiring
  664         the board to impose a specified fine on physicians who
  665         perform certain office surgeries in an unregistered
  666         office; amending s. 458.331, F.S.; providing that a
  667         physician performing certain office surgeries in an
  668         unregistered office constitutes grounds for denial of
  669         a license or disciplinary action; amending s. 459.003,
  670         F.S.; defining terms; amending s. 459.005, F.S.;
  671         requiring a physician who performs certain office
  672         surgery and the office in which the surgery is
  673         performed to maintain specified levels of financial
  674         responsibility; authorizing the department to adopt
  675         rules to administer the registration, inspection, and
  676         safety of offices that perform certain office surgery;
  677         requiring the Board of Osteopathic Medicine to adopt
  678         rules governing the standard of care for physicians
  679         practicing in such offices; requiring the board to
  680         impose a specified fine on physicians who perform
  681         certain office surgeries in an unregistered office;
  682         amending s. 459.015, F.S.; providing that a physician
  683         performing certain office surgeries in an unregistered
  684         office constitutes grounds for denial of a license or
  685         disciplinary action; amending s. 464.012, F.S.;
  686         authorizing a certified registered nurse anesthetist
  687         to provide specified services in a an office
  688         registered to perform office surgery within the
  689         framework of an established protocol with a licensed
  690         anesthesiologist; amending s. 766.101, F.S.;
  691         conforming a cross-reference; providing an effective
  692         date.