Senate Bill 2034c1

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    Florida Senate - 2000                           CS for SB 2034

    By the Committee on Health, Aging and Long-Term Care; and
    Senator Clary




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  1                      A bill to be entitled

  2         An act relating to the Department of Health;

  3         amending s. 20.43, F.S.; requiring the

  4         department to include certain assessments,

  5         projections, and recommendations in the

  6         department's strategic plan rather than in the

  7         state health plan; amending s. 39.303, F.S.;

  8         providing duties of the Children's Medical

  9         Services Program within the department with

10         respect to child protection teams; amending s.

11         120.80, F.S.; revising procedures for hearings

12         conducted with respect to the Brain and Spinal

13         Cord Injury Program; amending s. 154.011, F.S.;

14         revising duties of the department with respect

15         to monitoring and administering certain primary

16         care programs; amending s. 215.5602, F.S.;

17         revising the goals of and expenditures for the

18         Florida Biomedical Research Program within the

19         Lawton Chiles Endowment Fund; amending s.

20         381.0011, F.S.; providing requirements for the

21         department's strategic plan; amending s.

22         381.003, F.S.; requiring the department to

23         develop an immunization registry; requiring

24         that the registry include all children born in

25         this state; providing procedures under which a

26         parent or guardian may elect not to participate

27         in the immunization registry; providing for the

28         electronic transfer of records between health

29         care professionals and other agencies;

30         authorizing the department to adopt rules for

31         administering the registry; amending s.

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  1         381.0031, F.S.; authorizing the department to

  2         obtain and inspect copies of certain medical

  3         records and information, notwithstanding laws

  4         governing the confidentiality of patient

  5         records; exempting health care practitioners,

  6         health care facilities, and agents and

  7         employees thereof from liability for the

  8         authorized release of patient records; amending

  9         s. 381.004, F.S.; revising requirements for the

10         release of certain preliminary test results for

11         human immunodeficiency virus; revising the

12         definition of the term "medical personnel" to

13         include additional personnel; amending s.

14         381.0059, F.S.; defining the term "person who

15         provides services under a school health

16         services plan" for purposes of background

17         screening requirements for school health

18         services personnel; amending s. 381.0101, F.S.;

19         revising certification requirements for certain

20         environmental health professionals; amending s.

21         381.731, F.S.; requiring that the department

22         include certain strategies in the department's

23         strategic plan rather than in the Healthy

24         Communities, Healthy People Plan; amending s.

25         381.734, F.S.; revising the requirements of the

26         Healthy Communities, Healthy People Program;

27         transferring, renumbering, and amending s.

28         413.46, F.S.; revising legislative intent with

29         respect to the brain and spinal cord injury

30         program; creating s. 381.745, F.S.; providing

31         definitions for purposes of the Charlie Mack

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  1         Overstreet Brain or Spinal Cord Injuries Act;

  2         amending s. 381.75, F.S., relating to duties of

  3         the department under the brain and spinal cord

  4         injury program; conforming provisions to

  5         changes made by the act; creating s. 381.755,

  6         F.S.; providing that the right to benefits

  7         under the program is not assignable; amending

  8         s. 381.76, F.S.; revising eligibility

  9         requirements for the brain and spinal cord

10         injury program; creating s. 381.765, F.S.;

11         authorizing the department to retain title to

12         property and equipment and to dispose of

13         surplus equipment; authorizing the department

14         to adopt rules; creating s. 381.775, F.S.;

15         continuing the confidentiality provided for

16         records and information that pertains to

17         applicants for and recipients of services under

18         the brain and spinal cord injury program;

19         specifying circumstances under which the

20         department may release such records or

21         information; amending s. 381.78, F.S., relating

22         to the advisory council on brain and spinal

23         cord injuries; authorizing reimbursement for

24         per diem and travel expenses for members of the

25         council; prohibiting a council member from

26         voting on matters that provide a financial

27         benefit or create a conflict of interest;

28         providing for removal of members for cause;

29         creating s. 381.785, F.S.; authorizing the

30         department to recover third-party payments for

31         funded services; providing for the enforcement

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  1         of such right to recovery pursuant to a lien;

  2         requiring the department to adopt rules

  3         governing the recovery of payments; amending s.

  4         381.79, F.S., relating to the Brain and Spinal

  5         Cord Injury Rehabilitation Trust Fund;

  6         redesignating the fund as the "Brain and Spinal

  7         Cord Injury Program Trust Fund"; providing

  8         additional purposes for which moneys in the

  9         trust fund may be used; authorizing the

10         department to accept certain gifts; amending s.

11         385.103, F.S.; providing for the department to

12         operate community intervention programs rather

13         than comprehensive health improvement projects;

14         revising definitions; revising duties of the

15         department in operating such services;

16         requiring the department to adopt rules

17         governing the operation of community

18         intervention programs; amending s. 385.207,

19         F.S., relating to programs in epilepsy control;

20         conforming a cross-reference; amending s.

21         402.181, F.S.; providing for certain damages

22         and injuries caused by patients of institutions

23         under the Department of Health and specified

24         other state agencies to be reimbursed under the

25         State Institutions Claims Program; amending s.

26         514.021, F.S.; requiring the department to

27         review rules; providing an effective date.

28

29  Be It Enacted by the Legislature of the State of Florida:

30

31

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  1         Section 1.  Paragraph (l) of subsection (1) of section

  2  20.43, Florida Statutes, is amended to read:

  3         20.43  Department of Health.--There is created a

  4  Department of Health.

  5         (1)  The purpose of the Department of Health is to

  6  promote and protect the health of all residents and visitors

  7  in the state through organized state and community efforts,

  8  including cooperative agreements with counties.  The

  9  department shall:

10         (l)  Include in the department's strategic plan

11  developed under s. 186.021 an assessment of Biennially

12  publish, and annually update, a state health plan that

13  assesses current health programs, systems, and costs; makes

14  projections of future problems and opportunities; and

15  recommended recommends changes that are needed in the health

16  care system to improve the public health.

17         Section 2.  Section 39.303, Florida Statutes, is

18  amended to read:

19         39.303  Child protection teams; services; eligible

20  cases.--The Children's Medical Services Program in the

21  Department of Health shall develop, maintain, and coordinate

22  the services of one or more multidisciplinary child protection

23  teams in each of the service districts of the Department of

24  Children and Family Services.  Such teams may be composed of

25  appropriate representatives of school districts and

26  appropriate health, mental health, social service, legal

27  service, and law enforcement agencies. The Legislature finds

28  that optimal coordination of child protection teams and sexual

29  abuse treatment programs requires collaboration between the

30  Department of Health and the Department of Children and Family

31  Services. The two departments shall maintain an interagency

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  1  agreement that establishes protocols for oversight and

  2  operations of child protection teams and sexual abuse

  3  treatment programs. The Secretary of Health and the Deputy

  4  Secretary director of Children's Medical Services, in

  5  consultation with the Secretary of Children and Family

  6  Services, shall maintain the responsibility for the screening,

  7  employment, and, if necessary, the termination of child

  8  protection team medical directors, at headquarters and in the

  9  15 districts. Child protection team medical directors shall be

10  responsible for oversight of the teams in the districts.

11         (1)  The Department of Health shall utilize and convene

12  the teams to supplement the assessment and protective

13  supervision activities of the family safety and preservation

14  program of the Department of Children and Family Services.

15  Nothing in this section shall be construed to remove or reduce

16  the duty and responsibility of any person to report pursuant

17  to this chapter all suspected or actual cases of child abuse,

18  abandonment, or neglect or sexual abuse of a child.  The role

19  of the teams shall be to support activities of the program and

20  to provide services deemed by the teams to be necessary and

21  appropriate to abused, abandoned, and neglected children upon

22  referral.  The specialized diagnostic assessment, evaluation,

23  coordination, consultation, and other supportive services that

24  a child protection team shall be capable of providing include,

25  but are not limited to, the following:

26         (a)  Medical diagnosis and evaluation services,

27  including provision or interpretation of X rays and laboratory

28  tests, and related services, as needed, and documentation of

29  findings relative thereto.

30         (b)  Telephone consultation services in emergencies and

31  in other situations.

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  1         (c)  Medical evaluation related to abuse, abandonment,

  2  or neglect, as defined by policy or rule of the Department of

  3  Health.

  4         (d)  Such psychological and psychiatric diagnosis and

  5  evaluation services for the child or the child's parent or

  6  parents, legal custodian or custodians, or other caregivers,

  7  or any other individual involved in a child abuse,

  8  abandonment, or neglect case, as the team may determine to be

  9  needed.

10         (e)  Expert medical, psychological, and related

11  professional testimony in court cases.

12         (f)  Case staffings to develop treatment plans for

13  children whose cases have been referred to the team.  A child

14  protection team may provide consultation with respect to a

15  child who is alleged or is shown to be abused, abandoned, or

16  neglected, which consultation shall be provided at the request

17  of a representative of the family safety and preservation

18  program or at the request of any other professional involved

19  with a child or the child's parent or parents, legal custodian

20  or custodians, or other caregivers.  In every such child

21  protection team case staffing, consultation, or staff activity

22  involving a child, a family safety and preservation program

23  representative shall attend and participate.

24         (g)  Case service coordination and assistance,

25  including the location of services available from other public

26  and private agencies in the community.

27         (h)  Such training services for program and other

28  employees of the Department of Children and Family Services,

29  employees of the Department of Health, and other medical

30  professionals as is deemed appropriate to enable them to

31

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  1  develop and maintain their professional skills and abilities

  2  in handling child abuse, abandonment, and neglect cases.

  3         (i)  Educational and community awareness campaigns on

  4  child abuse, abandonment, and neglect in an effort to enable

  5  citizens more successfully to prevent, identify, and treat

  6  child abuse, abandonment, and neglect in the community.

  7         (2)  The child abuse, abandonment, and neglect reports

  8  that must be referred by the Department of Children and Family

  9  Services to child protection teams of the Department of Health

10  for medical evaluation and available support services as set

11  forth in subsection (1) must include cases involving:

12         (a)  Bruises, burns, or fractures in a child of any

13  age.

14         (b)  Sexual abuse of a child in which vaginal or anal

15  penetration is alleged or in which other unlawful sexual

16  conduct has been determined to have occurred.

17         (c)  Venereal disease, or any other sexually

18  transmitted disease, in a prepubescent child.

19         (d)  Reported malnutrition of a child and failure of a

20  child to thrive.

21         (e)  Reported medical, physical, or emotional neglect

22  of a child.

23         (f)  Any family in which one or more children have been

24  pronounced dead on arrival at a hospital or other health care

25  facility, or have been injured and later died, as a result of

26  suspected abuse, abandonment, or neglect, when any sibling or

27  other child remains in the home.

28         (g)  Symptoms of serious emotional problems in a child

29  when emotional or other abuse, abandonment, or neglect is

30  suspected.

31         (h)  Injuries to a child's head.

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  1         (3)  All abuse and neglect cases transmitted for

  2  investigation to a district by the hotline must be

  3  simultaneously transmitted to the Department of Health child

  4  protection team for review. All cases transmitted to the child

  5  protection team which meet the criteria in subsection (2) must

  6  be timely reviewed by a board-certified pediatrician or

  7  registered nurse practitioner under the supervision of such

  8  pediatrician for the purpose of determining whether a

  9  face-to-face medical evaluation by a child protection team is

10  necessary.  Such face-to-face medical evaluation is not

11  necessary only if it is determined that the child was examined

12  by a physician for the alleged abuse or neglect, and a

13  consultation between the child protection team board-certified

14  pediatrician or nurse practitioner and the examining physician

15  concludes that a further medical evaluation is unnecessary.

16         (4)  In all instances in which a child protection team

17  is providing certain services to abused, abandoned, or

18  neglected children, other offices and units of the Department

19  of Health, and offices and units of the Department of Children

20  and Family Services, shall avoid duplicating the provision of

21  those services.

22         Section 3.  Subsection (15) of section 120.80, Florida

23  Statutes, is amended to read:

24         120.80  Exceptions and special requirements;

25  agencies.--

26         (15)  DEPARTMENT OF HEALTH.--Notwithstanding s.

27  120.57(1)(a), formal hearings may not be conducted by the

28  Secretary of Health, the director of the Agency for Health

29  Care Administration, or a board or member of a board within

30  the Department of Health or the Agency for Health Care

31  Administration for matters relating to the regulation of

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  1  professions, as defined by part II of chapter 455.

  2  Notwithstanding s. 120.57(1)(a), hearings conducted within the

  3  Department of Health in execution of the Special Supplemental

  4  Nutrition Program for Women, Infants, and Children; Child Care

  5  Food Program; Children's Medical Services Program; the Brain

  6  and Spinal Cord Injury Program; and the exemption from

  7  disqualification reviews for certified nurse assistants

  8  program need not be conducted by an administrative law judge

  9  assigned by the division. The Department of Health may

10  contract with the Department of Children and Family Services

11  for a hearing officer in these matters.

12         Section 4.  Subsections (2) and (5) of section 154.011,

13  Florida Statutes, are amended to read:

14         154.011  Primary care services.--

15         (2)  The department shall monitor, measure, and

16  evaluate be responsible for monitoring, measuring, and

17  evaluating the quality of care, cost-effectiveness, services,

18  and geographic accessibility provided by each primary care

19  program and shall utilize the resulting data when

20  renegotiating contracts with counties.

21         (5)  The department shall adopt rules to govern the

22  operation of primary care programs authorized by this section.

23  Such rules shall include, but not be limited to, quality of

24  care, case management, a definition of income used to

25  determine eligibility or sliding fees, and Medicaid

26  participation and shall be developed by the State Health

27  Officer. Rules governing services to clients under 21 years of

28  age shall be developed in conjunction with children's medical

29  services and shall at a minimum include preventive services as

30  set forth in s. 627.6579.

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  1         Section 5.  Paragraphs (a) and (b) of subsection (1)

  2  and subsection (2) of section 215.5602, Florida Statutes, are

  3  amended to read:

  4         215.5602  Florida Biomedical Research Program.--

  5         (1)  There is established within the Lawton Chiles

  6  Endowment Fund the Florida Biomedical Research Program to

  7  support research initiatives that address the health care

  8  problems of Floridians in the areas of cancer, cardiovascular

  9  disease, stroke, and pulmonary disease. The long-term goals of

10  the program are to:

11         (a)  Improve the health of Floridians by researching

12  better prevention, diagnoses, and treatments for cancer,

13  cardiovascular disease, stroke, and pulmonary disease.

14         (b)  Expand the foundation of biomedical knowledge

15  relating to the prevention, diagnosis, and treatment of

16  diseases related to tobacco use, including cancer,

17  cardiovascular disease, stroke, and pulmonary disease.

18         (2)  Funds appropriated from the Lawton Chiles

19  Endowment Fund to the Department of Health for the purposes of

20  this section shall be used exclusively for the award of grants

21  and fellowships under the program established in this section;

22  for research relating to the prevention, diagnosis, and

23  treatment of diseases related to tobacco use, including

24  cancer, cardiovascular disease, stroke, and pulmonary disease;

25  and for expenses incurred in the administration of this

26  section.

27         Section 6.  Subsection (3) of section 381.0011, Florida

28  Statutes, is amended to read:

29         381.0011  Duties and powers of the Department of

30  Health.--It is the duty of the Department of Health to:

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  1         (3)  Include in the department's strategic plan

  2  developed under s. 186.021 a summary of Develop a

  3  comprehensive public health plan that addresses all aspects of

  4  the public health mission and establishes health status

  5  objectives to direct the use of public health resources with

  6  an emphasis on prevention.

  7         Section 7.  Paragraph (e) of subsection (1) and

  8  subsection (2) of section 381.003, Florida Statutes, is

  9  amended to read:

10         381.003  Communicable disease and acquired immune

11  deficiency syndrome prevention and control.--

12         (1)  The department shall conduct a communicable

13  disease prevention and control program as part of fulfilling

14  its public health mission. A communicable disease is any

15  disease caused by transmission of a specific infectious agent,

16  or its toxic products, from an infected person, an infected

17  animal, or the environment to a susceptible host, either

18  directly or indirectly. The communicable disease program must

19  include, but need not be limited to:

20         (e)  Programs for the prevention and control of

21  vaccine-preventable diseases, including programs to immunize

22  school children as required by s. 232.032 and the development

23  of an automated, electronic, and centralized database or

24  registry of immunizations. The department shall ensure that

25  all children in this state are immunized against

26  vaccine-preventable diseases. The immunization registry shall

27  allow the department to enhance current immunization

28  activities for the purpose of improving the immunization of

29  all children in this state.

30         1.  Except as provided in subparagraph 2., the

31  department shall include all children born in this state in

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  1  the immunization registry by using the birth records from the

  2  Office of Vital Statistics. The department shall add other

  3  children to the registry as immunization services are

  4  provided.

  5         2.  The parent or guardian of a child may refuse to

  6  participate in the immunization registry by signing a form

  7  obtained from the department, or from the health care

  8  practitioner or entity that provides the immunization, which

  9  indicates that the parent or guardian does not wish to

10  participate in the immunization registry. The decision to not

11  participate in the immunization registry must be noted in the

12  registry.

13         3.  The immunization registry shall allow for

14  immunization records to be electronically transferred to

15  entities that are required by law to have such records,

16  including schools, licensed child care facilities, and any

17  other entity that is required by law to obtain proof of a

18  child's immunizations.

19         4.  Any health care practitioner licensed under chapter

20  458, chapter 459, or chapter 464 in this state who complies

21  with rules adopted by the department to access the

22  immunization registry may, through the immunization registry,

23  directly access immunization records and update a child's

24  immunization history or exchange immunization information with

25  another authorized practitioner, entity, or agency involved in

26  a child's care. The information included in the immunization

27  registry must include the child's name, date of birth,

28  address, and any other unique identifier necessary to

29  correctly identify the child; the immunization record,

30  including the date, type of administered vaccine, and vaccine

31  lot number; and the presence or absence of any adverse

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  1  reaction or contraindication related to the immunization.

  2  Information received by the department for the immunization

  3  registry retains its status as confidential medical

  4  information and the department must maintain the

  5  confidentiality of that information as otherwise required by

  6  law. A health care practitioner or other agency that obtains

  7  information from the immunization registry must maintain the

  8  confidentiality of any medical records in accordance with s.

  9  455.667 or as otherwise required by law.

10         (2)  The department may adopt, repeal, and amend rules

11  related to the prevention and control of communicable diseases

12  and the administration of the immunization registry. Such

13  rules may include, including procedures for investigating

14  disease, timeframes for reporting disease, requirements for

15  followup reports of known or suspected exposure to disease,

16  and procedures for providing access to confidential

17  information necessary for disease investigations. For purposes

18  of the immunization registry, the rules may include procedures

19  for a health care practitioner to obtain authorization to use

20  the immunization registry, methods for a parent or guardian to

21  elect not to participate in the immunization registry, and

22  procedures for a health care practitioner licensed under

23  chapter 458, chapter 459, or chapter 464 to access and share

24  electronic immunization records with other entities allowed by

25  law to have access to the records.

26         Section 8.  Section 381.0031, Florida Statutes, is

27  amended to read:

28         381.0031  Report of diseases of public health

29  significance to department.--

30         (1)  Any practitioner licensed in this state to

31  practice medicine, osteopathic medicine, chiropractic

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  1  medicine, naturopathy, or veterinary medicine; any hospital

  2  licensed under part I of chapter 395; or any laboratory

  3  licensed under chapter 483 that diagnoses or suspects the

  4  existence of a disease of public health significance shall

  5  immediately report the fact to the Department of Health.

  6         (2)  Periodically the department shall issue a list of

  7  infectious or noninfectious diseases determined by it to be a

  8  threat to public health and therefore of significance to

  9  public health and shall furnish a copy of the list to the

10  practitioners listed in subsection (1).

11         (3)  Reports required by this section must be in

12  accordance with methods specified by rule of the department.

13         (4)  Information submitted in reports required by this

14  section is confidential, exempt from the provisions of s.

15  119.07(1), and is to be made public only when necessary to

16  public health. A report so submitted is not a violation of the

17  confidential relationship between practitioner and patient.

18         (5)  The department may obtain and inspect copies of

19  medical records, records of laboratory tests, and other

20  medical-related information for reported cases of diseases of

21  public health significance described in subsection (2). The

22  department shall examine the records of a person who has a

23  disease of public health significance only for purposes of

24  preventing and eliminating outbreaks of disease and making

25  epidemiological investigations of reported cases of diseases

26  of public health significance, notwithstanding any other law

27  to the contrary. Health care practitioners, licensed health

28  care facilities, and laboratories shall allow the department

29  to inspect and obtain copies of such medical records and

30  medical-related information, notwithstanding any other law to

31  the contrary. Release of medical records and medical-related

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  1  information to the department by a health care practitioner,

  2  licensed health care facility, or laboratory, or by an

  3  authorized employee or agent thereof, does not constitute a

  4  violation of the confidentiality of patient records. A health

  5  care practitioner, health care facility, or laboratory, or any

  6  employee or agent thereof, may not be held liable in any

  7  manner for damages and is not subject to criminal penalties

  8  for providing patient records to the department as authorized

  9  by this section.

10         (6)(5)  The department may adopt rules related to

11  reporting diseases of significance to public health, which

12  must specify the information to be included in the report, who

13  is required to report, the method and time period for

14  reporting, requirements for enforcement, and required followup

15  activities by the department which are necessary to protect

16  public health.

17

18  This section does not affect s. 384.25.

19         Section 9.  Paragraphs (d) and (h) of subsection (3) of

20  section 381.004, Florida Statutes, are amended to read:

21         381.004  Testing for human immunodeficiency virus.--

22         (3)  HUMAN IMMUNODEFICIENCY VIRUS TESTING; INFORMED

23  CONSENT; RESULTS; COUNSELING; CONFIDENTIALITY.--

24         (d)  No test result shall be determined as positive,

25  and no positive test result shall be revealed to any person,

26  without corroborating or confirmatory tests being conducted

27  except in the following situations:

28         1.  Preliminary test results may be released to

29  licensed physicians or the medical or nonmedical personnel

30  subject to the significant exposure for purposes of

31  subparagraphs (h)10., 11., and 12.

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  1         2.  Preliminary test results may be released to health

  2  care providers and to the person tested when decisions about

  3  medical care or treatment of, or recommendation to, the person

  4  tested and, in the case of an intrapartum or postpartum woman,

  5  when care, treatment, or recommendations regarding her

  6  newborn, cannot await the results of confirmatory testing.

  7  Positive preliminary HIV test results shall not be

  8  characterized to the patient as a diagnosis of HIV infection.

  9  Justification for the use of preliminary test results must be

10  documented in the medical record by the health care provider

11  who ordered the test.  This subparagraph does not authorize

12  the release of preliminary test results for the purpose of

13  routine identification of HIV-infected individuals or when HIV

14  testing is incidental to the preliminary diagnosis or care of

15  a patient.  Corroborating or confirmatory testing must be

16  conducted as followup to a positive preliminary test.  Results

17  shall be communicated to the patient according to statute

18  regardless of the outcome. Except as provided in this section,

19  test results are confidential and exempt from the provisions

20  of s. 119.07(1).

21         (h)  Notwithstanding the provisions of paragraph (a),

22  informed consent is not required:

23         1.  When testing for sexually transmissible diseases is

24  required by state or federal law, or by rule including the

25  following situations:

26         a.  HIV testing pursuant to s. 796.08 of persons

27  convicted of prostitution or of procuring another to commit

28  prostitution.

29         b.  Testing for HIV by a medical examiner in accordance

30  with s. 406.11.

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  1         2.  Those exceptions provided for blood, plasma,

  2  organs, skin, semen, or other human tissue pursuant to s.

  3  381.0041.

  4         3.  For the performance of an HIV-related test by

  5  licensed medical personnel in bona fide medical emergencies

  6  when the test results are necessary for medical diagnostic

  7  purposes to provide appropriate emergency care or treatment to

  8  the person being tested and the patient is unable to consent,

  9  as supported by documentation in the medical record.

10  Notification of test results in accordance with paragraph (c)

11  is required.

12         4.  For the performance of an HIV-related test by

13  licensed medical personnel for medical diagnosis of acute

14  illness where, in the opinion of the attending physician,

15  obtaining informed consent would be detrimental to the

16  patient, as supported by documentation in the medical record,

17  and the test results are necessary for medical diagnostic

18  purposes to provide appropriate care or treatment to the

19  person being tested. Notification of test results in

20  accordance with paragraph (c) is required if it would not be

21  detrimental to the patient.  This subparagraph does not

22  authorize the routine testing of patients for HIV infection

23  without informed consent.

24         5.  When HIV testing is performed as part of an autopsy

25  for which consent was obtained pursuant to s. 872.04.

26         6.  For the performance of an HIV test upon a defendant

27  pursuant to the victim's request in a prosecution for any type

28  of sexual battery where a blood sample is taken from the

29  defendant voluntarily, pursuant to court order for any

30  purpose, or pursuant to the provisions of s. 775.0877, s.

31  951.27, or s. 960.003; however, the results of any HIV test

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  1  performed shall be disclosed solely to the victim and the

  2  defendant, except as provided in ss. 775.0877, 951.27, and

  3  960.003.

  4         7.  When an HIV test is mandated by court order.

  5         8.  For epidemiological research pursuant to s.

  6  381.0032, for research consistent with institutional review

  7  boards created by 45 C.F.R. part 46, or for the performance of

  8  an HIV-related test for the purpose of research, if the

  9  testing is performed in a manner by which the identity of the

10  test subject is not known and may not be retrieved by the

11  researcher.

12         9.  When human tissue is collected lawfully without the

13  consent of the donor for corneal removal as authorized by s.

14  732.9185 or enucleation of the eyes as authorized by s.

15  732.919.

16         10.  For the performance of an HIV test upon an

17  individual who comes into contact with medical personnel in

18  such a way that a significant exposure has occurred during the

19  course of employment or within the scope of practice and where

20  a blood sample is available that was taken from that

21  individual voluntarily by medical personnel for other

22  purposes.  The term "medical personnel" includes a licensed or

23  certified health care professional; an employee of a health

24  care professional or, health care facility; employees of a

25  laboratory licensed under chapter 483; personnel of a, or

26  blood bank or plasma center; a medical student or other

27  student who is receiving training as a health care

28  professional at a health care facility; and a paramedic or

29  emergency medical technician certified by the department to

30  perform life-support procedures under as defined in s. 401.23.

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  1         a.  Prior to performance of an HIV test on a

  2  voluntarily obtained blood sample, the individual from whom

  3  the blood was obtained shall be requested to consent to the

  4  performance of the test and to the release of the results.

  5  The individual's refusal to consent and all information

  6  concerning the performance of an HIV test and any HIV test

  7  result shall be documented only in the medical personnel's

  8  record unless the individual gives written consent to entering

  9  this information on the individual's medical record.

10         b.  Reasonable attempts to locate the individual and to

11  obtain consent shall be made and all attempts must be

12  documented. If the individual cannot be found, an HIV test may

13  be conducted on the available blood sample. If the individual

14  does not voluntarily consent to the performance of an HIV

15  test, the individual shall be informed that an HIV test will

16  be performed, and counseling shall be furnished as provided in

17  this section.  However, HIV testing shall be conducted only

18  after a licensed physician documents, in the medical record of

19  the medical personnel, that there has been a significant

20  exposure and that, in the physician's medical judgment, the

21  information is medically necessary to determine the course of

22  treatment for the medical personnel.

23         c.  Costs of any HIV test of a blood sample performed

24  with or without the consent of the individual, as provided in

25  this subparagraph, shall be borne by the medical personnel or

26  the employer of the medical personnel. However, costs of

27  testing or treatment not directly related to the initial HIV

28  tests or costs of subsequent testing or treatment shall not be

29  borne by the medical personnel or the employer of the medical

30  personnel.

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  1         d.  In order to utilize the provisions of this

  2  subparagraph, the medical personnel must either be tested for

  3  HIV pursuant to this section or provide the results of an HIV

  4  test taken within 6 months prior to the significant exposure

  5  if such test results are negative.

  6         e.  A person who receives the results of an HIV test

  7  pursuant to this subparagraph shall maintain the

  8  confidentiality of the information received and of the persons

  9  tested.  Such confidential information is exempt from s.

10  119.07(1).

11         f.  If the source of the exposure will not voluntarily

12  submit to HIV testing and a blood sample is not available, the

13  medical personnel or the employer of such person acting on

14  behalf of the employee may seek a court order directing the

15  source of the exposure to submit to HIV testing.  A sworn

16  statement by a physician licensed under chapter 458 or chapter

17  459 that a significant exposure has occurred and that, in the

18  physician's medical judgment, testing is medically necessary

19  to determine the course of treatment constitutes probable

20  cause for the issuance of an order by the court.  The results

21  of the test shall be released to the source of the exposure

22  and to the person who experienced the exposure.

23         11.  For the performance of an HIV test upon an

24  individual who comes into contact with medical personnel in

25  such a way that a significant exposure has occurred during the

26  course of employment or within the scope of practice of the

27  medical personnel while the medical personnel provides

28  emergency medical treatment to the individual; or who comes

29  into contact with nonmedical personnel in such a way that a

30  significant exposure has occurred while the nonmedical

31  personnel provides emergency medical assistance during a

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  1  medical emergency.  For the purposes of this subparagraph, a

  2  medical emergency means an emergency medical condition outside

  3  of a hospital or health care facility that provides physician

  4  care. The test may be performed only during the course of

  5  treatment for the medical emergency.

  6         a.  An individual who is capable of providing consent

  7  shall be requested to consent to an HIV test prior to the

  8  testing. The individual's refusal to consent, and all

  9  information concerning the performance of an HIV test and its

10  result, shall be documented only in the medical personnel's

11  record unless the individual gives written consent to entering

12  this information on the individual's medical record.

13         b.  HIV testing shall be conducted only after a

14  licensed physician documents, in the medical record of the

15  medical personnel or nonmedical personnel, that there has been

16  a significant exposure and that, in the physician's medical

17  judgment, the information is medically necessary to determine

18  the course of treatment for the medical personnel or

19  nonmedical personnel.

20         c.  Costs of any HIV test performed with or without the

21  consent of the individual, as provided in this subparagraph,

22  shall be borne by the medical personnel or the employer of the

23  medical personnel or nonmedical personnel. However, costs of

24  testing or treatment not directly related to the initial HIV

25  tests or costs of subsequent testing or treatment shall not be

26  borne by the medical personnel or the employer of the medical

27  personnel or nonmedical personnel.

28         d.  In order to utilize the provisions of this

29  subparagraph, the medical personnel or nonmedical personnel

30  shall be tested for HIV pursuant to this section or shall

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  1  provide the results of an HIV test taken within 6 months prior

  2  to the significant exposure if such test results are negative.

  3         e.  A person who receives the results of an HIV test

  4  pursuant to this subparagraph shall maintain the

  5  confidentiality of the information received and of the persons

  6  tested.  Such confidential information is exempt from s.

  7  119.07(1).

  8         f.  If the source of the exposure will not voluntarily

  9  submit to HIV testing and a blood sample was not obtained

10  during treatment for the medical emergency, the medical

11  personnel, the employer of the medical personnel acting on

12  behalf of the employee, or the nonmedical personnel may seek a

13  court order directing the source of the exposure to submit to

14  HIV testing.  A sworn statement by a physician licensed under

15  chapter 458 or chapter 459 that a significant exposure has

16  occurred and that, in the physician's medical judgment,

17  testing is medically necessary to determine the course of

18  treatment constitutes probable cause for the issuance of an

19  order by the court.  The results of the test shall be released

20  to the source of the exposure and to the person who

21  experienced the exposure.

22         12.  For the performance of an HIV test by the medical

23  examiner or attending physician upon an individual who expired

24  or could not be resuscitated while receiving emergency medical

25  assistance or care and who was the source of a significant

26  exposure to medical or nonmedical personnel providing such

27  assistance or care.

28         a.  HIV testing may be conducted only after a licensed

29  physician documents in the medical record of the medical

30  personnel or nonmedical personnel that there has been a

31  significant exposure and that, in the physician's medical

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  1  judgment, the information is medically necessary to determine

  2  the course of treatment for the medical personnel or

  3  nonmedical personnel.

  4         b.  Costs of any HIV test performed under this

  5  subparagraph may not be charged to the deceased or to the

  6  family of the deceased person.

  7         c.  For the provisions of this subparagraph to be

  8  applicable, the medical personnel or nonmedical personnel must

  9  be tested for HIV under this section or must provide the

10  results of an HIV test taken within 6 months before the

11  significant exposure if such test results are negative.

12         d.  A person who receives the results of an HIV test

13  pursuant to this subparagraph shall comply with paragraph (e).

14         13.  For the performance of an HIV-related test

15  medically indicated by licensed medical personnel for medical

16  diagnosis of a hospitalized infant as necessary to provide

17  appropriate care and treatment of the infant when, after a

18  reasonable attempt, a parent cannot be contacted to provide

19  consent. The medical records of the infant shall reflect the

20  reason consent of the parent was not initially obtained.  Test

21  results shall be provided to the parent when the parent is

22  located.

23         14.  For the performance of HIV testing conducted to

24  monitor the clinical progress of a patient previously

25  diagnosed to be HIV positive.

26         15.  For the performance of repeated HIV testing

27  conducted to monitor possible conversion from a significant

28  exposure.

29         Section 10.  Section 381.0059, Florida Statutes, is

30  amended to read:

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  1         381.0059  Background screening requirements for school

  2  health services personnel.--

  3         (1)(a)  Any person who provides services under a school

  4  health services plan pursuant to s. 381.0056 must complete

  5  level 2 screening as provided in chapter 435. A person may

  6  satisfy the requirements of this subsection by submitting

  7  proof of compliance with the requirements of level 2 screening

  8  under s. 435.04, conducted within 12 months before the date

  9  that person initially provides services under a school health

10  services plan pursuant to s. 381.0056. Any person who provides

11  services under a school health services plan pursuant to s.

12  381.0056 shall be on probationary status pending the results

13  of the level 2 screening.

14         (b)  In order to conduct level 2 screening, any person

15  who provides services under a school health services plan

16  pursuant to s. 381.0056 must furnish to the Department of

17  Health a full set of fingerprints to enable the department to

18  conduct a criminal background investigation. Each person who

19  provides services under a school health services plan pursuant

20  to s. 381.0056 must file a complete set of fingerprints taken

21  by an authorized law enforcement officer and must provide

22  sufficient information for a statewide criminal records

23  correspondence check through the Florida Department of Law

24  Enforcement. The Department of Health shall submit the

25  fingerprints to the Florida Department of Law Enforcement for

26  a statewide criminal history check, and the Florida Department

27  of Law Enforcement shall forward the fingerprints to the

28  Federal Bureau of Investigation for a national criminal

29  history check.

30         (c)  The person subject to the required background

31  screening or his or her employer must pay the fees required to

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  1  obtain the background screening. Payment for the screening and

  2  the abuse registry check must be submitted to the Department

  3  of Health. The Florida Department of Law Enforcement shall

  4  charge the Department of Health for a level 2 screening at a

  5  rate sufficient to cover the costs of such screening pursuant

  6  to s. 943.053(3). The Department of Health shall establish a

  7  schedule of fees to cover the costs of the level 2 screening

  8  and the abuse registry check. The applicant or his or her

  9  employer who pays for the required screening may be reimbursed

10  by the Department of Health from funds designated for this

11  purpose.

12         (2)(a)  When the Department of Health has reasonable

13  cause to believe that grounds exist for the disqualification

14  of any person providing services under a school health

15  services plan pursuant to s. 381.0056, as a result of

16  background screening, it shall notify the person in writing,

17  stating the specific record that indicates noncompliance with

18  the level 2 screening standards. The Department of Health must

19  disqualify any person from providing services under a school

20  health services plan pursuant to s. 381.0056 if the department

21  finds that the person is not in compliance with the level 2

22  screening standards. A person who provides services under a

23  school health plan pursuant to s. 381.0056 on a probationary

24  status and who is disqualified because of the results of his

25  or her background screening may contest that disqualification.

26         (b)  As provided in s. 435.07, the Department of Health

27  may grant an exemption from disqualification to a person

28  providing services under a school health services plan

29  pursuant to s. 381.0056 who has not received a professional

30  license or certification from the Department of Health.

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  1         (c)  As provided in s. 435.07, the Department of Health

  2  may grant an exemption from disqualification to a person

  3  providing services under a school health services plan

  4  pursuant to s. 381.0056 who has received a professional

  5  license or certification from the Department of Health.

  6         (3)  Any person who is required to undergo the

  7  background screening to provide services under a school health

  8  plan pursuant to s. 381.0056 who refuses to cooperate in such

  9  screening or refuses to submit the information necessary to

10  complete the screening, including fingerprints, shall be

11  disqualified for employment or volunteering in such position

12  or, if employed, shall be dismissed.

13         (4)  Under penalty of perjury, each person who provides

14  services under a school health plan pursuant to s. 381.0056

15  must attest to meeting the level 2 screening requirements for

16  participation under the plan and agree to inform the

17  Department of Health immediately if convicted of any

18  disqualifying offense while providing services under a school

19  health services plan pursuant to s. 381.0056.

20         (5)  As used in this section, the term "person who

21  provides services under a school health services plan" does

22  not include an unpaid volunteer who lectures students in group

23  settings on health education topics.

24         Section 11.  Paragraphs (a) and (d) of subsection (5)

25  of section 381.0101, Florida Statutes, are amended to read:

26         381.0101  Environmental health professionals.--

27         (5)  STANDARDS FOR CERTIFICATION.--The department shall

28  adopt rules that establish minimum standards of education,

29  training, or experience for those persons subject to this

30  section. The rules shall also address the process for

31  application, examination, issuance, expiration, and renewal of

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  1  certification and ethical standards of practice for the

  2  profession.

  3         (a)  Persons employed as environmental health

  4  professionals shall exhibit a knowledge of rules and

  5  principles of environmental and public health law in Florida

  6  through examination.  A person may not conduct environmental

  7  health evaluations in a primary program area unless he or she

  8  is currently certified in that program area or works under the

  9  direct supervision of a certified environmental health

10  professional.

11         1.  All persons who begin employment in a primary

12  environmental health program on or after September 21, 1994,

13  must be certified in that program within 6 months after

14  employment.

15         2.  Persons employed in the a primary environmental

16  health program of a food protection program or an onsite

17  sewage treatment and disposal system prior to September 21,

18  1994, shall be considered certified while employed in that

19  position and shall be required to adhere to any professional

20  standards established by the department pursuant to paragraph

21  (b), complete any continuing education requirements imposed

22  under paragraph (d), and pay the certificate renewal fee

23  imposed under subsection (7).

24         3.  Persons employed in the a primary environmental

25  health program of a food protection program or an onsite

26  sewage treatment and disposal system prior to September 21,

27  1994, who change positions or program areas and transfer into

28  another primary environmental health program area on or after

29  September 21, 1994, must be certified in that program within 6

30  months after such transfer, except that they will not be

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  1  required to possess the college degree required under

  2  paragraph (e).

  3         4.  Registered sanitarians shall be considered

  4  certified and shall be required to adhere to any professional

  5  standards established by the department pursuant to paragraph

  6  (b).

  7         (d)  Persons who are certified shall renew their

  8  certification biennially by completing not less than 24

  9  contact hours of continuing education for each program area in

10  which they maintain certification, subject to a maximum of 48

11  hours for multiprogram certification.

12         Section 12.  Section 381.731, Florida Statutes, is

13  amended to read:

14         381.731  Strategic planning Healthy Communities,

15  Healthy People Plan.--

16         (1)  The Department of Health shall include

17  population-based health-promotion strategies in the

18  department's strategic plan developed under s. 186.021 develop

19  a biennial Healthy Communities, Healthy People Plan that shall

20  be submitted to the Governor, the President of the Senate, and

21  the Speaker of the House of Representatives by December 31 of

22  each even-numbered year.

23         (2)  The strategic plan must include data on the health

24  status of the state's population, health status objectives and

25  outcome measures, and public health strategies, including

26  health promotion strategies.  The strategic plan must also

27  provide an overall conceptual framework for the state's health

28  promotion programs that considers available information on

29  mortality, morbidity, disability, and behavioral risk factors

30  associated with chronic diseases and conditions; proposals for

31  public and private health insurance reforms needed to fully

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  1  implement the state's health promotion initiative; the best

  2  health promotion practices of the county health departments

  3  and other states; and proposed educational reforms needed to

  4  promote healthy behaviors among the state's school-age

  5  children.

  6         Section 13.  Section 381.734, Florida Statutes, is

  7  amended to read:

  8         381.734  Healthy Communities, Healthy People Program.--

  9         (1)  The department shall develop and implement the

10  Healthy Communities, Healthy People Program, a comprehensive

11  and community-based health promotion and wellness program.

12  The program shall be designed to reduce major behavioral risk

13  factors associated with chronic diseases, including those

14  chronic diseases identified in chapter 385, and injuries and

15  accidents, by enhancing the knowledge, skills, motivation, and

16  opportunities for individuals, organizations, and communities

17  to develop and maintain healthy lifestyles.

18         (2)  The department shall consolidate and use existing

19  resources, programs, and program data to develop this program,

20  to avoid duplication of efforts or services.  Such resources,

21  programs, and program data shall include the community

22  intervention programs operated, but not be limited to, s.

23  381.103, the comprehensive health improvement project under s.

24  385.103, and the comprehensive public health plan, public

25  information, and statewide injury control plan under s.

26  381.0011(3), (8), and (12).

27         (3)  The program shall include:

28         (a)  Biennial Statewide assessments of specific,

29  causal, and behavioral risk factors that affect the health of

30  residents of the state.

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  1         (b)  The development of community-based health

  2  promotion programs, incorporating health promotion and

  3  preventive care practices supported in scientific and medical

  4  literature.

  5         (c)  The development and implementation of statewide

  6  age-specific, disease-specific, and community-specific health

  7  promotion and preventive care strategies using primary,

  8  secondary, and tertiary prevention interventions.

  9         (d)  The development and implementation of models for

10  testing statewide health promotion of community-based

11  health-promotion model programs that meet specific criteria

12  and address major risk factors in the state and motivate

13  individuals to permanently adopt healthy behaviors, enhance

14  self-esteem, and increase social and personal

15  responsibilities.

16         (e)  The enhancement of the department's State Health

17  Office's special initiatives to develop the mental, emotional,

18  and social competencies of children and adolescents, using

19  innovative school-based and neighborhood-based approaches to

20  build self-esteem and prevent later problems such as drug

21  abuse, poor school performance, criminal behavior, and other

22  behavioral problems.

23         (f)  The development and implementation of a statewide

24  health education program to educate the public and communities

25  about health risks and assist them in modifying unhealthy

26  behaviors.

27         (g)  The establishment of a comprehensive program to

28  inform the public, health care professionals, and communities

29  about the prevalence of chronic diseases in the state; known

30  and potential risks, including social and behavioral risks;

31  and behavior changes that would reduce risks.

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  1         (h)  The development and implementation of a program

  2  for enhancing self-help organizations and volunteer programs

  3  that enlist the support of volunteers in health promotion

  4  activities, particularly persons who serve as role models

  5  because of their public visibility or because of their

  6  recovery from or skill in coping with disease.

  7         (i)  The development of policies that encourage the use

  8  of alternative community delivery sites for health promotion

  9  and preventive care programs and promote the use of

10  neighborhood delivery sites that are close to work, home, and

11  school.

12         (j)  An emphasis on the importance of a physically

13  active lifestyle to build self-esteem, reduce morbidity and

14  mortality associated with chronic disease, and reduce obesity.

15         Section 14.  Section 413.46, Florida Statutes, is

16  transferred, renumbered as section 381.7395, Florida Statutes,

17  and amended to read:

18         381.7395 413.46  Legislative intent.--It is the intent

19  of the Legislature to ensure the referral of individuals

20  persons who have moderate-to-severe brain or spinal cord

21  injuries to the brain and spinal cord injury program, a

22  coordinated rehabilitation program developed and administered

23  by the department division. The program shall provide eligible

24  persons, as defined in s. 381.76 s. 413.507, the opportunity

25  to obtain the necessary rehabilitative services enabling them

26  to be referred to a vocational rehabilitation program or to

27  return to an appropriate level of functioning in their

28  community. Further, it is intended that permanent disability

29  be avoided, whenever possible, through prevention, early

30  identification, skilled emergency medical services and

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  1  transport evacuation procedures, and proper medical and

  2  rehabilitative treatment.

  3         Section 15.  Section 381.745, Florida Statutes, is

  4  created to read:

  5         381.745  Definitions.--As used in ss. 381.739-381.79,

  6  the term:

  7         (1)  "Activity of daily living" means an activity

  8  required on a frequent basis which permits an individual to

  9  secure or maintain independence. Such activities include, but

10  are not limited to, personal home care, transportation,

11  personal-assistance services, housekeeping, shopping,

12  attending school, communication, and employment.

13         (2)  "Brain or spinal cord injury" means:

14         (a)  A lesion to the spinal cord or cauda equina,

15  resulting from external trauma, with evidence of significant

16  involvement of two of the following deficits or dysfunctions:

17         1.  Motor deficit.

18         2.  Sensory deficit.

19         3.  Bowel and bladder dysfunction.

20         (b)  An insult to the skull, brain, or its covering,

21  resulting from external trauma that produces an altered state

22  of consciousness or anatomic motor, sensory, cognitive, or

23  behavioral deficits.

24         (3)  "Emergency medical evacuation system" means a

25  department-approved transportation system that provides timely

26  and skilled emergency care and movement of individuals

27  believed to have sustained a brain or spinal cord injury.

28         (4)  "Personal-assistance services" means a range of

29  services, provided by one or more individuals, which are

30  designed to assist an individual who has a disability to

31  perform activities of daily living.

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  1         (5)  "Funded services" means services paid for through

  2  the brain and spinal cord injury program.

  3         (6)  "Designated facility" means a facility approved by

  4  the brain and spinal cord injury program which meets the

  5  criteria and standards of care of the brain and spinal cord

  6  injury program for individuals who have sustained a brain or

  7  spinal cord injury.

  8         (7)  "Third-party coverage" means any claim for, right

  9  to receive payment for, or any coverage for the payment of any

10  services under the brain and spinal cord injury program.

11         (8)  "Third-party payment" means any and all payments

12  received or due as a result of any third-party obligation

13  created by gift, coverage or other contract, settlement or

14  judicial decision, or action of law.

15         (9)  "Transitional living facility" means a

16  state-approved facility, as defined and licensed under chapter

17  400, or a facility approved by the brain and spinal cord

18  injury program in accordance with this chapter.

19         (10)  "Trauma center" means a department-approved acute

20  care facility that provides diagnosis and treatment of

21  individuals who have sustained a brain or spinal cord injury.

22         Section 16.  Section 381.75, Florida Statutes, is

23  amended to read:

24         381.75  Duties and responsibilities of the department,

25  of transitional living facilities, and of

26  residents.--Consistent with the mandate of s. 381.7395 s.

27  413.46, the department shall develop and administer a

28  multilevel treatment program for individuals persons who

29  sustain have brain or spinal cord injuries and who are

30  referred to the brain and spinal cord injury program.

31

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  1         (1)  Within 15 days after any report of an individual a

  2  person who has sustained a brain or spinal cord injury, the

  3  department shall notify the individual or the most immediate

  4  available family members of their right to assistance from the

  5  state, the services available, and the eligibility

  6  requirements.

  7         (2)  The department shall refer individuals persons who

  8  have brain or spinal cord injuries to other state agencies to

  9  assure that rehabilitative services, if desired, are obtained

10  by that individual person.

11         (3)  The department, in consultation with emergency

12  medical service, shall develop standards for an emergency

13  medical evacuation system that will ensure that all

14  individuals persons who sustain traumatic brain or spinal cord

15  injuries are transported to a department-approved trauma

16  center that meets the standards and criteria established by

17  the emergency medical service and the acute-care standards of

18  the brain and spinal cord injury program.

19         (4)  The department shall develop standards for

20  designation of rehabilitation centers to provide

21  rehabilitation services for individuals persons who have brain

22  or spinal cord injuries.

23         (5)  The department shall determine the appropriate

24  number of designated acute-care facilities, inpatient

25  rehabilitation centers, and outpatient rehabilitation centers,

26  needed based on incidence, volume of admissions, and other

27  appropriate criteria.

28         (6)  The department shall develop standards for

29  designation of transitional living facilities to provide

30  individuals the opportunity to adjust to their disabilities

31

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  1  and to develop physical and functional skills in a supported

  2  living environment.

  3         (a)  The Agency for Health Care Administration, in

  4  consultation with the department, shall develop rules for the

  5  licensure of transitional living facilities for individuals

  6  persons who have brain or spinal cord injuries.

  7         (b)  The goal of a transitional living program for

  8  individuals persons who have brain or spinal cord injuries is

  9  to assist each individual person who has such a disability to

10  achieve a higher level of independent functioning and to

11  enable that person to reenter the community. The program shall

12  be focused on preparing participants to return to community

13  living.

14         (c)  A transitional living facility for an individual a

15  person who has a brain or spinal cord injury shall provide to

16  such individual person, in a residential setting, a

17  goal-oriented treatment program designed to improve the

18  individual's person's physical, cognitive, communicative,

19  behavioral, psychological, and social functioning, as well as

20  to provide necessary support and supervision. A transitional

21  living facility shall offer at least the following therapies:

22  physical, occupational, speech, neuropsychology, independent

23  living skills training, behavior analysis for programs serving

24  brain-injured individuals persons, health education, and

25  recreation.

26         (d)  All residents shall use the transitional living

27  facility as a temporary measure and not as a permanent home or

28  domicile. The transitional living facility shall develop an

29  initial treatment plan for each resident within 3 days after

30  the resident's admission. The transitional living facility

31  shall develop a comprehensive plan of treatment and a

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  1  discharge plan for each resident as soon as practical, but no

  2  later than 30 days after the resident's admission. Each

  3  comprehensive treatment plan and discharge plan must be

  4  reviewed and updated as necessary, but no less often than

  5  quarterly. This subsection does not require the discharge of

  6  an individual who continues to require any of the specialized

  7  services described in paragraph (c) or who is making

  8  measurable progress in accordance with that individual's

  9  comprehensive treatment plan. The transitional living facility

10  shall discharge any individual who has an appropriate

11  discharge site and who has achieved the goals of his or her

12  discharge plan or who is no longer making progress toward the

13  goals established in the comprehensive treatment plan and the

14  discharge plan. The discharge location must be the least

15  restrictive environment in which an individual's health,

16  well-being, and safety is preserved.

17         (7)  Recipients of services, under this section, from

18  any of the facilities referred to in this section shall pay a

19  fee based on ability to pay.

20         Section 17.  Section 381.755, Florida Statutes, is

21  created to read:

22         381.755  Benefits not assignable.--The right of an

23  eligible individual to any services provided by the brain and

24  spinal cord injury program is not transferable or assignable,

25  and any benefits, including money, goods, or chattels,

26  received as services under the brain and spinal cord injury

27  program are exempt from all state, county, and municipal taxes

28  and from sale under the process of any court, except for

29  obligations contracted for the purchase of such property.

30         Section 18.  Section 381.76, Florida Statutes, is

31  amended to read:

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  1         381.76  Eligibility for the brain and spinal cord

  2  injury program.--

  3         (1)  An individual shall be accepted as eligible for

  4  the brain and spinal cord injury program following

  5  certification by the department that the individual:

  6         (a)  Has been referred to the central registry pursuant

  7  to s. 381.74; s. 413.48.

  8         (b)  Is a legal resident of this state at the time of

  9  application for services;.

10         (c)  Has sustained a brain or spinal cord suffered a

11  traumatic injury; as defined in s. 413.20.

12         (d)  Is medically stable; and as defined by rules of

13  the department.

14         (e)  Is reasonably expected to achieve reintegration

15  into the community through rehabilitative services provided by

16  the brain and spinal cord injury program.

17         (2)  If In the event the department is unable to

18  provide services to all eligible individuals, the department

19  may establish an order of selection.

20         Section 19.  Section 381.765, Florida Statutes, is

21  created to read:

22         381.765  Retention of title to and disposal of

23  equipment.--

24         (1)  The department may retain title to any property,

25  tools, instruments, training supplies, equipment, or other

26  items of value acquired for services provided under the brain

27  and spinal cord injury program or for personnel employed in

28  operating the brain and spinal cord injury program, and may

29  repossess or transfer such property, tools, instruments,

30  supplies, equipment, or other items of value.

31

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  1         (2)  The department may offer for sale any surplus

  2  items acquired in operating the brain and spinal cord injury

  3  program when they are no longer necessary or exchange them for

  4  necessary items that may be used to greater advantage. When

  5  any such surplus equipment is sold or exchanged, a receipt for

  6  the equipment shall be taken from the purchaser showing the

  7  consideration given for such equipment and forwarded to the

  8  Treasurer, and any funds received by the brain and spinal cord

  9  injury program pursuant to any such transaction shall be

10  deposited in the Brain and Spinal Cord Injury Rehabilitation

11  Trust Fund and shall be available for expenditure for any

12  purpose consistent with this part.

13         (3)  The department may adopt rules relating to records

14  and recordkeeping for department-owned property referenced in

15  subsections (1) and (2).

16         Section 20.  Section 381.775, Florida Statutes, is

17  created to read:

18         381.775  Applicant and recipient records; confidential

19  and privileged.--

20         (1)  All oral and written records, information,

21  letters, and reports received, made, or maintained by the

22  department relative to any applicant for or recipient of

23  services under the brain and spinal cord injury program are

24  privileged, confidential, and exempt from s. 119.07(1). Any

25  person who discloses or releases such records, information, or

26  communications in violation of this section commits a

27  misdemeanor of the second degree, punishable as provided in s.

28  775.082 or s. 775.083. Such records may not be released,

29  except that:

30         (a)  Records may be released to the applicant or

31  recipient, or his or her representative, upon receipt of a

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  1  written waiver from the applicant or recipient. Medical,

  2  psychological, or other information that the department

  3  believes may be harmful to an applicant or recipient may not

  4  be released directly to him or her, but must be provided

  5  through a licensed health care professional designated by the

  6  applicant or recipient.

  7         (b)  Records that do not identify applicants or

  8  recipients may be released for the purpose of research, when

  9  the research is approved by the department.

10         (c)  Records used in administering the brain and spinal

11  cord injury program may be released as required to administer

12  the program or as required by an agency or political

13  subdivision of the state in the performance of its duties. Any

14  agency or political subdivision to which records are released

15  under this paragraph may not disclose the records to third

16  parties.

17         (d)  Records may be released upon the order of an

18  administrative law judge, a hearing officer, a judge of

19  compensation claims, an agency head exercising quasi-judicial

20  authority, or a judge of a court of competent jurisdiction

21  following a finding in an in camera proceeding that the

22  records are relevant to the inquiry before the court and

23  should be released. The in camera proceeding and all records

24  relating thereto are confidential and exempt from s.

25  119.07(1).

26         (e)  Whenever an applicant for or recipient of services

27  under the brain and spinal cord injury program has declared

28  any intention to harm other persons or property, such

29  declaration may be disclosed.

30         (f)  The department may release personal information

31  about an applicant for or recipient of services under the

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  1  brain and spinal cord injury program in order to protect him

  2  or her or others when the applicant or recipient poses a

  3  threat to his or her own safety or to the safety of others and

  4  shall, upon official request, release such information to law

  5  enforcement agencies investigating the commission of a crime.

  6         (2)  Records that come into the possession of the

  7  department relative to any applicant for or receipt of

  8  services under the brain and spinal cord injury program and

  9  that are confidential by other provisions of law are

10  confidential and exempt from s. 119.07(1), and may not be

11  released by the department, except as provided in this

12  section.

13         Section 21.  Section 381.78, Florida Statutes, is

14  amended to read:

15         381.78  Advisory council on brain and spinal cord

16  injuries.--

17         (1)  There is created within the department a 16-member

18  advisory council on brain and spinal cord injuries. The

19  council shall be composed of a minimum of four individuals

20  persons who have brain injuries or are family members of

21  individuals persons who have brain injuries, a minimum of four

22  individuals persons who have spinal cord injuries or are

23  family members of individuals persons who have spinal cord

24  injuries, and a minimum of two individuals persons who

25  represent the special needs of children who have brain or

26  spinal cord injuries. The balance of the council members shall

27  be physicians, other allied health professionals,

28  administrators of brain and spinal cord injury programs, and

29  representatives from support groups that have expertise in

30  areas related to the rehabilitation of individuals persons who

31  have brain or spinal cord injuries.

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  1         (2)  Members of the council shall be appointed to serve

  2  by the Secretary of Health. All members' terms shall be for 4

  3  years. An individual may not serve more than two terms.

  4         (a)  Eight members of the first appointed council shall

  5  serve an initial term of 2 years. This group shall include two

  6  persons who have brain injuries or are family members of

  7  persons who have brain injuries, two persons who have spinal

  8  cord injuries or are family members of persons who have spinal

  9  cord injuries, and four other persons from the previous

10  council.

11         (b)  The remaining members of the first appointed

12  council shall serve an initial term of 4 years. Thereafter all

13  members' terms shall be for 4 years.

14         (c)  Any council member who is unwilling or unable to

15  properly fulfill the duties of the office shall be succeeded

16  by an individual a person chosen by the secretary to serve out

17  the unexpired balance of the replaced council member's term.

18  If the unexpired balance of the replaced council member's term

19  is less than 18 months, then, notwithstanding the provisions

20  of this subsection, the succeeding council member may be

21  reappointed by the secretary twice.

22         (3)  The council shall meet at least two times

23  annually.

24         (4)  The council shall:

25         (a)  Provide advice and expertise to the department

26  division in the preparation, implementation, and periodic

27  review of the brain and spinal cord injury program as

28  referenced in s. 413.49.

29         (b)  Annually appoint a five-member committee composed

30  of one individual person who has a brain injury or has a

31  family member with a brain injury, one individual person who

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  1  has a spinal cord injury or has a family member with a spinal

  2  cord injury, and three members who shall be chosen from among

  3  these representative groups: physicians, other allied health

  4  professionals, administrators of brain and spinal cord injury

  5  programs, and representatives from support groups with

  6  expertise in areas related to the rehabilitation of

  7  individuals persons who have brain or spinal cord injuries,

  8  except that one and only one member of the committee shall be

  9  an administrator of a transitional living facility. Membership

10  on the council is not a prerequisite for membership on this

11  committee.

12         1.  The committee shall perform onsite visits to those

13  transitional living facilities identified by the Agency for

14  Health Care Administration as being in possible violation of

15  the statutes and rules regulating such facilities. The

16  committee members have the same rights of entry and inspection

17  granted under s. 400.805(7) to designated representatives of

18  the agency.

19         2.  Factual findings of the committee resulting from an

20  onsite investigation of a facility pursuant to subparagraph 1.

21  shall be adopted by the agency in developing its

22  administrative response regarding enforcement of statutes and

23  rules regulating the operation of the facility.

24         3.  Onsite investigations by the committee shall be

25  funded by the Health Care Trust Fund.

26         4.  Travel expenses for committee members shall be

27  reimbursed in accordance with s. 112.061.

28         5.  Members of the committee shall recuse themselves

29  from participating in any investigation that would create a

30  conflict of interest under state law, and the council shall

31  replace the member, either temporarily or permanently.

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  1         (5)  Members of the advisory council are entitled to

  2  reimbursement for per diem and travel expenses for required

  3  attendance at council meetings in accordance with s. 112.061.

  4  Reasonable expenses for personal-assistance services and

  5  interpreters needed by members during required attendance at

  6  council meetings shall be reimbursed. A member may not receive

  7  any compensation for performing duties specified in, or

  8  arising out of, her or his duties as a council member under

  9  this part, except as otherwise specified in this part.

10         (6)  A member of the advisory council may not cast a

11  vote on any matter that would provide direct financial benefit

12  to the member or create a conflict of interest under state

13  law.

14         (7)  A member of the advisory council may be removed

15  from office by the Secretary of Health for malfeasance,

16  misfeasance, neglect of duty, incompetence, or permanent

17  inability to perform official duties or for pleading nolo

18  contendere to, or being found guilty of, a crime. Malfeasance

19  includes, but is not limited to, a violation of any specific

20  prohibition within this part.

21         Section 22.  Section 381.785, Florida Statutes, is

22  created to read:

23         381.785  Recovery of third-party payments for funded

24  services.--

25         (1)  Third-party coverage for funded services

26  constitutes primary coverage.

27         (2)  An applicant for or recipient of services funded

28  under the brain and spinal cord injury program must inform the

29  brain and spinal cord injury program of any rights she or he

30  has to third-party payments for such services, and the brain

31  and spinal cord injury program shall be subrogated to her or

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  1  his rights to such third-party payments. The brain and spinal

  2  cord injury program may recover directly from:

  3         (a)  Any third party that is liable to make a benefit

  4  payment to the provider of the recipient's funded services or

  5  to the recipient under the terms of any contract, settlement,

  6  or award;

  7         (b)  The recipient, if she or he has received a

  8  third-party payment for funded services provided to her or

  9  him; or

10         (c)  The provider of the recipient's funded services,

11  if third-party payment for such services has been recovered by

12  the provider.

13         (3)  An applicant for or a recipient of funded services

14  is deemed to have assigned to the brain and spinal cord injury

15  program her or his rights to any payments for such services

16  from a third party and to have authorized the brain and spinal

17  cord injury program to release information with respect to

18  such services for the sole purpose of obtaining reimbursement.

19         (4)  The brain and spinal cord injury program may, in

20  order to enforce its rights under this section, institute,

21  intervene in, or join any legal proceeding against a third

22  party against whom recovery rights arise. Action taken by the

23  brain and spinal cord injury program does not preclude the

24  recipient's recovery for that portion of her or his damages

25  not subrogated to the brain and spinal cord injury program,

26  and action taken by the recipient does not prejudice the

27  rights of the brain and spinal cord injury program.

28         (5)  When the brain and spinal cord injury program

29  provides, pays for, or becomes liable for funded services, it

30  has a lien for the amount of such services upon all causes of

31  action that accrue to the recipient or to her or his legal

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  1  representatives as a result of sickness, injury, disease,

  2  disability, or death due to the liability of a third party

  3  which necessitated funded services. To perfect such lien, a

  4  notice of lien must be filed with the clerk of the circuit

  5  court in the recipient's county of residence. The notice of

  6  lien must contain the name and address of the person to whom

  7  services were furnished and the name, address, and telephone

  8  number of a person at the brain and spinal cord injury program

  9  from whom information regarding the lien can be obtained.

10  Failure of the brain and spinal cord injury program to file a

11  notice of lien does not affect the program's other rights

12  provided in this section. Any notice of lien filed as provided

13  under this subsection is valid for 5 years after filing, and

14  may be extended for an additional 5-year period by filing a

15  new notice of lien at any time prior to the expiration of the

16  original notice of lien.

17         (6)  In recovering any payments in accordance with this

18  section, the brain and spinal cord injury program may make

19  appropriate settlements.

20         (7)  Notwithstanding any other law to the contrary,

21  payments made for funded services are neither collateral

22  payments nor collateral sources within the meaning of chapter

23  86-160, Laws of Florida, or chapter 88-1, Laws of Florida.

24         (8)  Notwithstanding any other law to the contrary, the

25  brain and spinal cord injury program retains all rights and

26  remedies granted under this section as against moneys paid

27  under chapter 440.

28         (9)  The department shall adopt rules to administer

29  this section.

30         Section 23.  Section 381.79, Florida Statutes, is

31  amended to read:

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  1         381.79  Brain and Spinal Cord Injury Program

  2  Rehabilitation Trust Fund.--

  3         (1)  There is created in the State Treasury the Brain

  4  and Spinal Cord Injury Program Rehabilitation Trust Fund.

  5  Moneys in the fund shall be appropriated to the department for

  6  the purpose of providing the cost of care for brain or spinal

  7  cord injuries as a payor of last resort to residents of this

  8  state, for multilevel programs of care established pursuant to

  9  s. 381.75 s. 413.49.

10         (a)  Authorization of expenditures for brain or spinal

11  cord injury care shall be made only by the department.

12         (b)  Authorized expenditures include acute care,

13  rehabilitation, transitional living, equipment, and supplies

14  necessary for activities of daily living, public information,

15  prevention, education, and research. In addition, the

16  department may provide matching funds for public or private

17  assistance provided under the brain and spinal cord injury

18  program and may provide funds for any approved expansion of

19  services for treating individuals who have sustained a brain

20  or spinal cord injury.

21         (2)  The department shall issue a report to the

22  President of the Senate and the Speaker of the House of

23  Representatives by March 1 of each year, summarizing the

24  activities supported by the trust fund.

25         (3)  Annually, 5 percent of the revenues deposited

26  monthly in the fund pursuant to s. 318.21(2)(d) shall be

27  appropriated to the University of Florida and 5 percent to the

28  University of Miami for spinal cord injury and brain injury

29  research. The amount to be distributed to the universities

30  shall be calculated based on the deposits into the fund for

31  each quarter in the fiscal year, but may not exceed $500,000

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  1  per university per year. Funds distributed under this

  2  subsection shall be made in quarterly payments at the end of

  3  each quarter during the fiscal year.

  4         (4)  The Board of Regents shall establish a program

  5  administration process which shall include: an annual

  6  prospective program plan with goals, research design, proposed

  7  outcomes, a proposed budget, an annual report of research

  8  activities and findings, and an annual end-of-year financial

  9  statement. Prospective program plans shall be submitted to the

10  Board of Regents, and funds shall be released upon acceptance

11  of the proposed program plans. The annual report of research

12  activities and findings shall be submitted to the Board of

13  Regents, with the executive summaries submitted to the

14  President of the Senate, the Speaker of the House of

15  Representatives, and the Secretary of the Department of

16  Health.

17         (5)  Moneys received under s. 381.785 shall be

18  deposited into the trust fund and used for the purposes

19  specified in subsection (1).

20         (6)  The department may accept, deposit into the trust

21  fund, and use for carrying out the purposes of this part gifts

22  made unconditionally by will or otherwise. Any gift made under

23  conditions that, in the judgment of the department, are proper

24  and consistent with this section, the laws of the United

25  States, and the laws of this state may be accepted and shall

26  be held, invested, reinvested, and used in accordance with the

27  conditions of the gift.

28         Section 24.  Section 385.103, Florida Statutes, is

29  amended to read:

30         385.103  Community intervention programs Chronic

31  disease control program.--

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  1         (1)  DEFINITIONS.--As used in this section, the term

  2  act:

  3         (a)  "Chronic disease prevention and control program"

  4  means a program including a combination of at least the

  5  following elements:

  6         1.  Health screening;

  7         2.  Risk factor detection;

  8         3.  Appropriate intervention to enable and encourage

  9  changes in behaviors that create health risks risk factor

10  reversal; and

11         4.  Counseling in nutrition, physical activity, the

12  effects of tobacco use, hypertension, blood pressure control,

13  and diabetes control and the provision of other clinical

14  prevention services counseling.

15         (b)  "Community health education program" means a

16  program involving the planned and coordinated use of the

17  educational resources available in a community in an effort

18  to:

19         1.  Motivate and assist citizens to adopt and maintain

20  healthful practices and lifestyles;

21         2.  Make available learning opportunities which will

22  increase the ability of people to make informed decisions

23  affecting their personal, family, and community well-being and

24  which are designed to facilitate voluntary adoption of

25  behavior which will improve or maintain health;

26         3.  Reduce, through coordination among appropriate

27  agencies, duplication of health education efforts; and

28         4.  Facilitate collaboration among appropriate agencies

29  for efficient use of scarce resources.

30         (c)  "Community intervention program" "Comprehensive

31  health improvement project" means a program combining the

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  1  required elements of both a chronic disease prevention and

  2  control program and a community health education program into

  3  a unified program over which a single administrative entity

  4  has authority and responsibility.

  5         (d)  "Department" means the Department of Health.

  6         (e)  "District" means a service district of the

  7  department.

  8         (e)(f)  "Risk factor" means a factor identified during

  9  the course of an epidemiological study of a disease, which

10  factor appears to be statistically associated with a high

11  incidence of that disease.

12         (2)  OPERATION OF COMMUNITY INTERVENTION PROGRAMS

13  COMPREHENSIVE HEALTH IMPROVEMENT PROJECTS.--

14         (a)  The department shall assist the county health

15  departments in developing and operating community intervention

16  programs comprehensive health improvement projects throughout

17  the state.  At a minimum, the community intervention programs

18  comprehensive health improvement projects shall address one to

19  three of the following the chronic diseases: of cancer,

20  diabetes, heart disease, stroke, hypertension, renal disease,

21  and chronic obstructive lung disease.

22         (b)  Existing community resources, when available,

23  shall be used to support the programs. The department shall

24  seek funding for the programs from federal and state financial

25  assistance programs which presently exist or which may be

26  hereafter created. Additional services, as appropriate, may be

27  incorporated into a program to the extent that resources are

28  available.  The department may accept gifts and grants in

29  order to carry out a program.

30         (c)  Volunteers shall be used to the maximum extent

31  possible in carrying out the programs.  The department shall

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  1  contract for the necessary insurance coverage to protect

  2  volunteers from personal liability while acting within the

  3  scope of their volunteer assignments under a program.

  4         (d)  The department may contract for the provision of

  5  all or any portion of the services required by a program, and

  6  shall so contract whenever the services so provided are more

  7  cost-efficient than those provided by the department.

  8         (e)  If the department determines that it is necessary

  9  for clients to help pay for services provided by a program,

10  the department may require clients to make contribution

11  therefor in either money or personal services. The amount of

12  money or value of the personal services shall be fixed

13  according to a fee schedule established by the department or

14  by the entity developing the program.  In establishing the fee

15  schedule, the department or the entity developing the program

16  shall take into account the expenses and resources of a client

17  and his or her overall ability to pay for the services.

18         (f)  The department shall adopt rules governing the

19  operation of the community intervention programs health

20  improvement projects.  These rules shall include guidelines

21  for intake and enrollment of clients into the projects.

22         Section 25.  Subsection (3) of section 385.207, Florida

23  Statutes, is amended to read:

24         385.207  Care and assistance of persons with epilepsy;

25  establishment of programs in epilepsy control.--

26         (3)  Revenue for statewide implementation of programs

27  for epilepsy prevention and education pursuant to this section

28  shall be derived pursuant to the provisions of s. 318.21(6) s.

29  318.18(12) and shall be deposited in the Epilepsy Services

30  Trust Fund, which is hereby established to be administered by

31  the Department of Health.  All funds deposited into the trust

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  1  fund shall be invested pursuant to the provisions of s.

  2  18.125. Interest income accruing to such invested funds shall

  3  increase the total funds available under this subsection.

  4         Section 26.  Section 402.181, Florida Statutes, is

  5  amended to read:

  6         402.181  State Institutions Claims Program.--

  7         (1)  There is created a State Institutions Claims

  8  Program, for the purpose of making restitution for property

  9  damages and direct medical expenses for injuries caused by

10  shelter children or foster children, or escapees, or inmates,

11  or patients of state institutions under the Department of

12  Children and Family Services, the Department of Health, the

13  Department of Juvenile Justice, or the Department of

14  Corrections.

15         (2)  Claims for restitution may be filed with the

16  Department of Legal Affairs at its office in accordance with

17  regulations prescribed by the Department of Legal Affairs. The

18  Department of Legal Affairs shall have full power and

19  authority to hear, investigate, and determine all questions in

20  respect to such claims and is authorized, within the limits of

21  current appropriations, to pay individual claims up to $1,000

22  or, with respect to children in foster care and their

23  families, individual claims up to $1,500. Claims in excess of

24  these amounts shall continue to require legislative approval.

25         (3)(a)  The Department of Legal Affairs shall make or

26  cause to be made such investigations as it considers necessary

27  in respect to such claims. Hearings shall be held in

28  accordance with chapter 120.

29         (b)  The Department of Legal Affairs shall work with

30  the Department of Children and Family Services, the Department

31  of Health, the Department of Juvenile Justice, and the

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  1  Department of Corrections to streamline the process of

  2  investigations, hearings, and determinations with respect to

  3  claims under this section, to ensure that eligible claimants

  4  receive restitution within a reasonable time.

  5         Section 27.  Section 514.021, Florida Statutes, is

  6  amended to read:

  7         514.021  Department authorization.--The department is

  8  authorized to adopt and enforce rules to protect the health,

  9  safety, or welfare of persons using public swimming pools and

10  bathing places.  The department shall review and revise such

11  rules as necessary, but not less than biennially biannually.

12  Sanitation and safety standards shall include, but not be

13  limited to, matters relating to structure; appurtenances;

14  operation; source of water supply; bacteriological, chemical,

15  and physical quality of water in the pool or bathing area;

16  method of water purification, treatment, and disinfection;

17  lifesaving apparatus; measures to ensure safety of bathers;

18  and measures to ensure the personal cleanliness of bathers.

19         Section 28.  This act shall take effect July 1, 2000.

20

21          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
22                         Senate Bill 2034

23

24  The committee substitute revises an exception to the
    prohibition on release of HIV preliminary test results in
25  those instances where decisions about medical care or
    treatment cannot await the results of confirmatory testing to
26  clarify for whom and the circumstances under which the
    preliminary test results may be released. The bill deletes a
27  procedure for the appointment of guardian advocates for
    certain tuberculosis patients at A.G. Holley State Hospital
28  and deletes an expansion of a public records exemption that
    would have required law enforcement agencies to keep
29  confidential the name or identity of a person subject to court
    action by the Tuberculosis Control Program.
30

31

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