Amendment

Bill No. 1062

Amendment No. 441253

CHAMBER ACTION
Senate		House
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1	Representative Farkas offered the following:
2
3	Amendment to Amendment (964733) (with title amendment)
4	Between lines 544 and 545 insert:
5	Section 12.  Subsections (3) and (4) of section 400.9905,
6	Florida Statutes, are renumbered as subsections (4) and (5),
7	respectively, and amended, and new subsections (3), (6), and (7)
8	are added to said section, to read:
9	400.9905  Definitions.--
10	(3)  "Chief financial officer" means an individual who has
11	a bachelor's degree from an accredited university in accounting
12	or finance, or a related field, and who is the person
13	responsible for the preparation of a clinic's billing.
14	(4)(3)  "Clinic" means an entity at which health care
15	services are provided to individuals and which tenders charges
16	for reimbursement for such services, including a mobile clinic
17	and a portable equipment provider. For purposes of this part,
18	the term does not include and the licensure requirements of this
19	part do not apply to:
20	(a)  Entities licensed or registered by the state under
21	chapter 395; or entities licensed or registered by the state and
22	providing only health care services within the scope of services
23	authorized under their respective licenses granted under s.
24	383.30-383.335, chapter 390, chapter 394, chapter 395, chapter
25	397, this chapter except part XIII, chapter 463, chapter 465,
26	chapter 466, chapter 478, part I of chapter 483 chapter 480,
27	chapter 484, or chapter 651; end-stage renal disease providers
28	authorized under 42 C.F.R. part 405, subpart U; or providers
29	certified under 42 C.F.R. part 485, subpart B or subpart H, or
30	any entity that provides neonatal or pediatric hospital-based
31	healthcare services by licensed practitioners solely within a
32	hospital licensed under chapter 395.
33	(b)  Entities that own, directly or indirectly, entities
34	licensed or registered by the state pursuant to chapter 395; or
35	entities that own, directly or indirectly, entities licensed or
36	registered by the state and providing only health care services
37	within the scope of services authorized pursuant to their
38	respective licenses granted under s. 383.30-383.335, chapter
39	390, chapter 394, chapter 395, chapter 397, this chapter except
40	part XIII, chapter 463, chapter 465, chapter 466, chapter 478,
41	part I of chapter 483 chapter 480, chapter 484, or chapter 651,
42	end-stage renal disease providers authorized under 42 C.F.R.
43	part 405, subpart U, or providers certified under 42 C.F.R. part
44	485, subpart B or subpart H, or any entity that provides
45	neonatal or pediatric hospital-based healthcare services by
46	licensed practitioners solely within a hospital licensed under
47	chapter 395.
48	(c)  Entities that are owned, directly or indirectly, by an
49	entity licensed or registered by the state pursuant to chapter
50	395; or entities that are owned, directly or indirectly, by an
51	entity licensed or registered by the state and providing only
52	health care services within the scope of services authorized
53	pursuant to their respective licenses granted under s. 383.30-
54	383.335, chapter 390, chapter 394, chapter 395, chapter 397,
55	this chapter except part XIII, chapter 463, chapter 465, chapter
56	466, chapter 478, part I of chapter 483 chapter 480, chapter
57	484, or chapter 651; end-stage renal disease providers
58	authorized under 42 C.F.R. part 405, subpart U; or providers
59	certified under 42 C.F.R. part 485, subpart B or subpart H, or
60	any entity that provides neonatal or pediatric hospital-based
61	healthcare services by licensed practitioners solely within a
62	hospital under chapter 395.
63	(d)  Entities that are under common ownership, directly or
64	indirectly, with an entity licensed or registered by the state
65	pursuant to chapter 395; or entities that are under common
66	ownership, directly or indirectly, with an entity licensed or
67	registered by the state and providing only health care services
68	within the scope of services authorized pursuant to their
69	respective licenses granted under s. 383.30-383.335, chapter
70	390, chapter 394, chapter 395, chapter 397, this chapter except
71	part XIII, chapter 463, chapter 465, chapter 466, chapter 478,
72	part I of chapter 483 480, chapter 484, or chapter 651; end-
73	stage renal disease providers authorized under 42 C.F.R. part
74	405, subpart U; or providers certified under 42 C.F.R. part 485,
75	subpart B or subpart H or any entity that provides neonatal or
76	pediatric hospital-based healthcare services by licensed
77	practitioners solely within a hospital licensed under chapter
78	395.
79	(e)  An entity that is exempt from federal taxation under
80	26 U.S.C. s. 501(c)(3) or s. 501(c)(4) and any community college
81	or university clinic, and any entity owned or operated by
82	federal or state government, including agencies, subdivisions,
83	or municipalities thereof.
84	(f) A sole proprietorship, group practice, partnership, or
85	corporation that provides health care services by physicians
86	covered by s. 627.419, that is directly supervised by one or
87	more of such physicians, and that is wholly owned by one or more
88	of those physicians or by a physician and the spouse, child, or
89	sibling of that physician.
90	(g)(f)  A sole proprietorship, group practice, partnership,
91	or corporation that provides health care services by licensed
92	health care practitioners under chapter 457, chapter 458,
93	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
94	chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
95	chapter 490, chapter 491, or part I, part III, part X, part
96	XIII, or part XIV of chapter 468, or s. 464.012, which are
97	wholly owned by one or more a licensed health care practitioners
98	practitioner, or the licensed health care practitioners set
99	forth in this paragraph practitioner and the spouse, parent, or
100	child, or sibling of a licensed health care practitioner, so
101	long as one of the owners who is a licensed health care
102	practitioner is supervising the business activities services
103	performed therein and is legally responsible for the entity's
104	compliance with all federal and state laws. However, a health
105	care practitioner may not supervise services beyond the scope of
106	the practitioner's license, except that, for the purposes of
107	this part, a clinic owned by a licensee in s. 456.053(3)(b) that
108	provides only services authorized pursuant to s. 456.053(3)(b)
109	may be supervised by a licensee specified in s. 456.053(3)(b).
110	(h)(g)  Clinical facilities affiliated with an accredited
111	medical school at which training is provided for medical
112	students, residents, or fellows.
113	(i)  Entities that provide only oncology or radiation
114	therapy services by physicians licensed under chapter 458 or
115	chapter 459.
116	(5)(4)  "Medical director" means a physician who is
117	employed or under contract with a clinic and who maintains a
118	full and unencumbered physician license in accordance with
119	chapter 458, chapter 459, chapter 460, or chapter 461. However,
120	if the clinic does not provide services pursuant to the
121	respective physician practices acts listed in this subsection,
122	it is limited to providing health care services pursuant to
123	chapter 457, chapter 484, chapter 486, chapter 490, or chapter
124	491 or part I, part III, part X, part XIII, or part XIV of
125	chapter 468, the clinic may appoint a Florida-licensed health
126	care practitioner who does not provide services pursuant to the
127	respective physician practices acts listed in this subsection
128	licensed under that chapter to serve as a clinic director who is
129	responsible for the clinic's activities. A health care
130	practitioner may not serve as the clinic director if the
131	services provided at the clinic are beyond the scope of that
132	practitioner's license, except that a licensee specified in s.
133	456.053(3)(b) who provides only services authorized pursuant to
134	s. 456.053(3)(b) may serve as clinic director of an entity
135	providing services as specified in s. 456.053(3)(b).
136	(6)  "Mobile clinic" means a movable or detached self-
137	contained health care unit within or from which direct health
138	care services are provided to individuals and which otherwise
139	meets the definition of a clinic in subsection (4).
140	(7)  "Portable equipment provider" means an entity that
141	contracts with or employs persons to provide portable equipment
142	to multiple locations performing treatment or diagnostic testing
143	of individuals, that bills third-party payors for those
144	services, and that otherwise meets the definition of a clinic in
145	subsection (4).
146	Section 13.  The creation of s. 400.9905(4)(i), Florida
147	Statutes, by this act is intended to clarify the legislative
148	intent of this provision as it existed at the time the
149	provisions initially took effect as ss. 456.0375(1)(b) and
150	400.9905(4)(i), Florida Statutes, as created by this act, shall
151	operate retroactively to October 1, 2001. Nothing in this
152	section shall be construed as amending, modifying, limiting, or
153	otherwise affecting in any way the legislative intent, scope,
154	terms, prohibition, or requirements of s. 456.053, Florida
155	Statutes.
156	Section 14.  Effective upon this act becoming a law and
157	applicable retroactively to March 1, 2004, subsections (1), (2),
158	and (3) and paragraphs (a) and (b) of subsection (7) of section
159	400.991, Florida Statutes, are amended to read:
160	400.991  License requirements; background screenings;
161	prohibitions.--
162	(1)(a)  Each clinic, as defined in s. 400.9905, must be
163	licensed and shall at all times maintain a valid license with
164	the agency. Each clinic location shall be licensed separately
165	regardless of whether the clinic is operated under the same
166	business name or management as another clinic.
167	(b)  Each mobile clinic must obtain a separate health care
168	clinic license and clinics must provide to the agency, at least
169	quarterly, its their projected street location locations to
170	enable the agency to locate and inspect such clinic clinics. A
171	portable equipment provider must obtain a health care clinic
172	license for a single administrative office and is not required
173	to submit quarterly projected street locations.
174	(2)  The initial clinic license application shall be filed
175	with the agency by all clinics, as defined in s. 400.9905, on or
176	before July March 1, 2004. A clinic license must be renewed
177	biennially.
178	(3)  Applicants that submit an application on or before
179	July March 1, 2004, which meets all requirements for initial
180	licensure as specified in this section shall receive a temporary
181	license until the completion of an initial inspection verifying
182	that the applicant meets all requirements in rules authorized in
183	s. 400.9925. However, a clinic engaged in magnetic resonance
184	imaging services may not receive a temporary license unless it
185	presents evidence satisfactory to the agency that such clinic is
186	making a good faith effort and substantial progress in seeking
187	accreditation required under s. 400.9935.
188	(7)  Each applicant for licensure shall comply with the
189	following requirements:
190	(a)  As used in this subsection, the term "applicant" means
191	individuals owning or controlling, directly or indirectly, 5
192	percent or more of an interest in a clinic; the medical or
193	clinic director, or a similarly titled person who is responsible
194	for the day-to-day operation of the licensed clinic; the
195	financial officer or similarly titled individual who is
196	responsible for the financial operation of the clinic; and
197	licensed health care practitioners medical providers at the
198	clinic.
199	(b)  Upon receipt of a completed, signed, and dated
200	application, the agency shall require background screening of
201	the applicant, in accordance with the level 2 standards for
202	screening set forth in chapter 435. Proof of compliance with the
203	level 2 background screening requirements of chapter 435 which
204	has been submitted within the previous 5 years in compliance
205	with any other health care licensure requirements of this state
206	is acceptable in fulfillment of this paragraph. Applicants who
207	own less than 10 percent of a health care clinic are not
208	required to submit fingerprints under this section.
209	Section 15.  Paragraph (g) of subsection (1), subsection
210	(9), and paragraph (b) of subsection (11) of section 400.9935,
211	Florida Statutes, are amended to read:
212	400.9935  Clinic responsibilities.--
213	(1)  Each clinic shall appoint a medical director or clinic
214	director who shall agree in writing to accept legal
215	responsibility for the following activities on behalf of the
216	clinic. The medical director or the clinic director shall:
217	(g)  Conduct systematic reviews of clinic billings to
218	ensure that the billings are not fraudulent or unlawful. Upon
219	discovery of an unlawful charge, the medical director or clinic
220	director shall take immediate corrective action. If the clinic
221	performs only the technical component of magnetic resonance
222	imaging, static radiographs, computed tomography, or positron
223	emission tomography and provides the professional interpretation
224	of such services, in a fixed facility that is accredited by the
225	Joint Commission on Accreditation of Healthcare Organizations or
226	the Accreditation Association for Ambulatory Health Care and the
227	American College of Radiology, and if, in the preceding quarter,
228	the percentage of scans performed by that clinic that were
229	billed to a personal injury protection insurance carrier was
230	less than 15 percent, the chief financial officer of the clinic
231	may, in a written acknowledgment provided to the agency, assume
232	the responsibility for the conduct of the systematic reviews of
233	clinic billings to ensure that the billings are not fraudulent
234	or unlawful.
235	(9)  Any person or entity providing health care services
236	which is not a clinic, as defined under s. 400.9905, may
237	voluntarily apply for a certificate of exemption from licensure
238	under its exempt status with the agency on a form that sets
239	forth its name or names and addresses, a statement of the
240	reasons why it cannot be defined as a clinic, and other
241	information deemed necessary by the agency. An exemption is not
242	transferable. The agency may charge an applicant for a
243	certificate of exemption in an amount equal to $100 or the
244	actual cost of processing the certificate, whichever is less.
245	(11)
246	(b)  The agency may deny disallow the application or revoke
247	the license of any entity formed for the purpose of avoiding
248	compliance with the accreditation provisions of this subsection
249	and whose principals were previously principals of an entity
250	that was unable to meet the accreditation requirements within
251	the specified timeframes. The agency may adopt rules as to the
252	accreditation of magnetic resonance imaging clinics.
253	Section 16.  Subsections (1) and (3) of section 400.995,
254	Florida Statutes, are amended, and a new subsection (10) is
255	added to said section, to read:
256	400.995  Agency administrative penalties.--
257	(1)  The agency may deny the application for a license
258	renewal, revoke or suspend the license, and impose
259	administrative fines penalties against clinics of up to $5,000
260	per violation for violations of the requirements of this part or
261	rules of the agency. In determining if a penalty is to be
262	imposed and in fixing the amount of the fine, the agency shall
263	consider the following factors:
264	(a)  The gravity of the violation, including the
265	probability that death or serious physical or emotional harm to
266	a patient will result or has resulted, the severity of the
267	action or potential harm, and the extent to which the provisions
268	of the applicable laws or rules were violated.
269	(b)  Actions taken by the owner, medical director, or
270	clinic director to correct violations.
271	(c)  Any previous violations.
272	(d)  The financial benefit to the clinic of committing or
273	continuing the violation.
274	(3)  Any action taken to correct a violation shall be
275	documented in writing by the owner, medical director, or clinic
276	director of the clinic and verified through followup visits by
277	agency personnel. The agency may impose a fine and, in the case
278	of an owner-operated clinic, revoke or deny a clinic's license
279	when a clinic medical director or clinic director knowingly
280	fraudulently misrepresents actions taken to correct a violation.
281	(10)  If the agency issues a notice of intent to deny a
282	license application after a temporary license has been issued
283	pursuant to s. 400.991(3), the temporary license shall expire on
284	the date of the notice and may not be extended during any
285	proceeding for administrative or judicial review pursuant to
286	chapter 120.
287	Section 17.  The Agency for Health Care Administration is
288	directed to make refunds to applicants that submitted their
289	health care clinic licensure fees and applications but were
290	subsequently exempted from licensure by this act as follows:
291	(1)  Seventy-five percent of the application fee if the
292	temporary license has not been issued;
293	(2)  Fifty percent of the application fee if the temporary
294	license has been issued but the inspection has not been
295	completed; or
296	(3)  No refund if the inspection has been completed.
297	Section 18.  Any person or entity defined as a clinic under
298	s. 400.9905, Florida Statutes, shall not be in violation of part
299	XIII of chapter 400, Florida Statutes, due to failure to apply
300	for a clinic license by March 1, 2004, as previously required by
301	s. 400.991, Florida Statutes. Payment to any such person or
302	entity by an insurer or other person liable for payment to such
303	person or entity may not be denied on the grounds that the
304	person or entity failed to apply for or obtain a clinic license
305	before March 1, 2004.
306
307	================ T I T L E  A M E N D M E N T =============
308	Remove line 600 and insert:
309	facility; amending s. 400.9905, F.S.; revising and providing
310	definitions; amending s. 400.991, F.S.; revising health care
311	clinic licensing requirements; requiring separate licenses for
312	each mobile clinic; providing licensing requirements for
313	portable equipment providers; providing for retroactive effect;
314	amending s. 400.9935, F.S.; providing that a chief financial
315	officer may assume responsibility for clinic billings under
316	certain circumstances; providing that an exemption is not
317	transferable; authorizing a fee for a certificate of exemption;
318	allowing the agency to deny or revoke a license; amending s.
319	400.995, F.S.; allowing the agency to deny the renewal of a
320	license or to revoke or suspend a license; prohibiting extension
321	of a temporary license under certain circumstances; requiring
322	the Agency for Health Care Administration to refund certain
323	application fees; providing exceptions for certain late filed
324	applications; providing an effective date.

CODING: Words stricken are deletions; words underlined are additions.