Amendment

Bill No. 2380

Amendment No. 985271

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

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