CS/HB 7131

1	A bill to be entitled
2	An act relating to health care; providing legislative
3	findings; designating Miami-Dade County as a health care
4	fraud crisis area of concern; amending s. 68.085, F.S.;
5	allocating certain funds recovered under the Florida False
6	Claims Act to fund rewards for persons who report and
7	provide information relating to Medicaid fraud; amending
8	s. 68.086, F.S.; providing that a defendant who prevails
9	in an action under the Florida False Claims Act may be
10	awarded attorney's fees and costs against the person
11	bringing the action under certain circumstances; repealing
12	s. 395.0199, F.S., relating to private utilization review
13	of health care services; amending ss. 395.405, 400.0077,
14	400.0712, 430.608, and 430.80, F.S.; conforming cross-
15	references to changes made by the act; amending s.
16	400.118, F.S.; removing provisions requiring quality-of-
17	care monitors for nursing facilities in Agency for Health
18	Care Administration district offices; amending s. 400.141,
19	F.S.; revising reporting requirements for facility staff-
20	to-resident ratios; amending s. 400.147, F.S.; revising
21	reporting requirements under facility internal risk
22	management and quality assurance programs; revising the
23	definition of the term "adverse incident" for reporting
24	purposes; requiring abuse, neglect, and exploitation to be
25	reported to the agency and the Department of Children and
26	Family Services; deleting a requirement that the agency
27	submit an annual report on nursing home adverse incidents
28	to the Legislature; amending s. 400.162, F.S.; revising
29	provisions relating to procedures and policies regarding
30	the safekeeping of nursing home residents' property;
31	amending s. 400.179, F.S.; revising payments by nursing
32	homes to the agency; amending s. 400.191, F.S.;
33	eliminating requirements for the agency to publish the
34	Nursing Home Guide annually in printed form; revising
35	information provided on the agency's Internet website;
36	amending s. 400.195, F.S.; conforming a cross-reference;
37	amending s. 400.23, F.S.; deleting provisions relating to
38	minimum staffing requirements for nursing homes; amending
39	s. 400.471, F.S.; prohibiting the Agency for Health Care
40	Administration from renewing a license of a home health
41	agency in certain counties if the agency has been
42	sanctioned for certain misconduct; amending s. 400.474,
43	F.S.; providing that specified provisions relating to
44	remuneration do not apply to or preclude certain payment
45	practices permitted under specified federal laws or
46	regulations; requiring the agency to fine and authorizing
47	the agency to deny, revoke, or suspend the license of or
48	fine a home health agency that provides remuneration to
49	certain facilities or bills the Medicaid program for
50	medically unnecessary services; providing applicability;
51	amending s. 400.506, F.S.; exempting nurse registries not
52	participating in the Medicaid or Medicare program from
53	certain disciplinary actions for paying remuneration to
54	certain entities in exchange for patient referrals;
55	amending s. 400.9905, F.S.; revising the definition of the
56	term "clinic" to provide that pt. X of ch. 400, F.S., the
57	Health Care Clinic Act, does not apply to entities that do
58	not seek reimbursement from insurance companies for
59	medical services paid pursuant to certain personal injury
60	protection coverage bodily liability coverage, personal
61	umbrella liability coverage, or uninsured motorist
62	coverage; amending s. 400.9935, F.S.; revising
63	accreditation requirements for clinics providing magnetic
64	resonance imaging services; amending s. 400.995, F.S.;
65	revising agency responsibilities with respect to personnel
66	and operations in certain injunctive proceedings; amending
67	s. 408.803, F.S.; revising definitions applicable to pt.
68	II of ch. 408, F.S., the "Health Care Licensing Procedures
69	Act"; amending s. 408.806, F.S.; revising contents of and
70	procedures relating to health care provider applications
71	for licensure; providing an exception from certain
72	licensure inspections for adult family-care homes;
73	authorizing the agency to provide electronic access to
74	certain information and documents; creating s. 408.8065,
75	F.S.; providing additional licensure requirements for home
76	health agencies, home medical equipment providers, and
77	health care clinics; requiring the posting of a surety
78	bond in a specified minimum amount under certain
79	circumstances; imposing criminal penalties for certain
80	unlicensed activities; imposing criminal penalties against
81	a person who knowingly submits misleading information to
82	the Agency for Health Care Administration in connection
83	with applications for certain licenses; amending s.
84	408.808, F.S.; providing for a provisional license to be
85	issued to applicants applying for a change of ownership;
86	providing a time limit on provisional licenses; amending
87	s. 408.809, F.S.; revising provisions relating to
88	background screening of specified employees; exempting
89	certain persons from rescreening; permitting certain
90	persons to apply for an exemption from disqualification
91	under certain circumstances; requiring health care
92	providers to submit to the agency an affidavit of
93	compliance with background screening requirements at the
94	time of license renewal; deleting a provision to conform
95	to changes made by the act; amending s. 408.810, F.S.;
96	revising provisions relating to information required for
97	licensure; requiring certain licensees to provide clients
98	with a description of Medicaid fraud and the statewide
99	toll-free telephone number for the central Medicaid fraud
100	hotline; amending s. 408.811, F.S.; providing for certain
101	inspections to be accepted in lieu of complete licensure
102	inspections; granting agency access to records requested
103	during an offsite review; providing timeframes for
104	correction of certain deficiencies and submission of plans
105	to correct such deficiencies; amending s. 408.813, F.S.;
106	providing classifications of violations of pt. II of ch.
107	408, F.S.; providing for fines; amending s. 408.815, F.S.;
108	providing additional grounds to deny an application for a
109	license; amending s. 408.820, F.S.; revising applicability
110	of exemptions from specified requirements of pt. II of ch.
111	408, F.S.; conforming references; creating s. 408.821,
112	F.S.; requiring entities regulated or licensed by the
113	agency to designate a safety liaison for emergency
114	operations; providing that entities regulated or licensed
115	by the agency may temporarily exceed their licensed
116	capacity to act as receiving providers under specified
117	circumstances; providing requirements while such entities
118	are in an overcapacity status; providing for issuance of
119	an inactive license to such licensees under specified
120	conditions; providing requirements and procedures with
121	respect to the issuance and reactivation of an inactive
122	license; authorizing the agency to adopt rules; requiring
123	licensees providing certain services to use an online
124	database approved by the agency for reporting certain
125	information relating to providers; amending s. 408.831,
126	F.S.; deleting provisions relating to authorization for
127	entities regulated or licensed by the agency to exceed
128	their licensed capacity to act as receiving facilities and
129	issuance and reactivation of inactive licenses; amending
130	s. 408.918, F.S.; requiring accreditation by the National
131	Alliance of Information and Referral Services for
132	participation in the Florida 211 Network; eliminating the
133	requirement that the agency seek certain assistance and
134	guidance in resolving certain disputes; removing certain
135	agency obligations relating to the Florida 211 Network;
136	requiring the Florida Alliance of Information and Referral
137	Services to perform certain functions related to the
138	Florida 211 Network; amending s. 409.221, F.S.; conforming
139	a cross-reference; amending s. 409.901, F.S.; revising a
140	definition applicable to Medicaid providers; amending s.
141	409.905, F.S.; authorizing the Agency for Health Care
142	Administration to require prior authorization of care
143	based on billing rates; requiring a home health agency to
144	submit a plan of care and documentation of a recipient's
145	medical condition to the Agency for Health Care
146	Administration when requesting prior authorization;
147	prohibiting the Agency for Health Care Administration from
148	paying for home health services unless specified
149	requirements are satisfied; amending s. 409.907, F.S.;
150	providing for certain out-of-state providers to enroll as
151	Medicaid providers; requiring Medicaid provider agreements
152	to require full compliance with the Agency for Health Care
153	Administration's medical encounter data system and report
154	actions that provide incentives for healthy behaviors;
155	providing that a managed care plan shall not be sanctioned
156	or precluded from operating in a new service area when it
157	fails to execute a contract with at least one essential
158	provider under certain circumstances; requiring a managed
159	care plan to include any willing, qualified provider in
160	its network under certain circumstances; requiring the
161	managed care plan to offer at least the county billing
162	rate to such provider; requiring the agency to submit an
163	annual report to the Governor and Legislature that
164	summarizes data regarding the agency's medical encounter
165	data system; amending s. 409.908, F.S.; requiring the
166	agency to adjust alternative health plan, health
167	maintenance organization, and prepaid health plan
168	capitation rates based on aggregate risk scores; providing
169	a limitation on risk score variance for a specified time
170	period; requiring the agency to phase in risk-adjusted
171	capitation rates; providing for a technical advisory panel
172	to advise the agency during the transition to risk-
173	adjusted capitation rates; amending s. 409.912, F.S.;
174	authorizing the agency to contract with certain health
175	centers that are federally qualified or supported to
176	provide comprehensive behavioral health care services
177	through a capitated, prepaid arrangement; requiring the
178	agency to integrate acute care and behavioral health
179	services in the public-hospital-operated managed care
180	model; requiring an entity contracting on a prepaid or
181	fixed-sum basis to meet the surplus requirements of health
182	maintenance organizations; specifying the rate paid under
183	certain circumstances to a physician or hospital by an
184	entity that contracts with the agency on a prepaid or
185	fixed-sum basis; requiring the Agency for Health Care
186	Administration to eliminate utilization of medically
187	unnecessary Medicaid services using certain methods;
188	requiring the agency to include a report on the agency's
189	activities to eliminate the use of medically unnecessary
190	Medicaid services in the annual report required by s.
191	409.913; creating a pilot project to monitor and verify
192	the delivery of home health services and provide for
193	electronic claims for home health services; requiring the
194	Agency for Health Care Administration to issue a report
195	evaluating the pilot project; creating a pilot project for
196	home health care management; authorizing the agency to
197	enter into certain contracts and to seek amendments to the
198	state plan and waivers; requiring the Department of Health
199	to employ a competitive sealed bid process to procure
200	certain prescriptive assistive devices; requiring the
201	Department of Management Services to administer the
202	selection and procurement of the devices; creating s.
203	409.91207, F.S.; requiring the agency to establish a
204	medical home pilot project in Alachua and Hillsborough
205	Counties; requiring each county to be served by at least
206	one medical home network consisting of specified entities;
207	authorizing managed care organizations to seek designation
208	as a medical home network; requiring each medical home
209	network to provide specified services and comply with
210	specified principles of operation; specifying procedures
211	for enrollment of Medicaid recipients in a medical home
212	network; requiring a medical home network to document
213	capacity for coordinated systems of care; requiring
214	medical home network services to be reimbursed based on
215	Medicaid fee-for-service claims; authorizing specified
216	enhanced benefits for entities participating in a medical
217	home network; specifying that a medical home network is
218	eligible for shared savings under certain circumstances;
219	requiring a medical home network to maintain certain
220	medical records and clinical data; requiring the agency to
221	contract with the University of Florida for initial and
222	final evaluations of the pilot project; requiring the
223	agency to submit reports on medical home network
224	performance to the Governor and Legislature; creating s.
225	409.91208, F.S.; providing legislative findings; requiring
226	the agency to seek federal approval to implement an
227	alternative payment methodology for medical school
228	faculty; amending s. 409.91211, F.S.; requiring a Medicaid
229	provider who receives low-income pool funds to serve
230	Medicaid recipients regardless of the recipient's county
231	of residence; extending the phasing in of risk-adjusted
232	capitated rates for provider service networks; amending s.
233	409.9122, F.S.; specifying that individuals currently
234	enrolled in a disease management or specialized HIV/AIDS
235	plan stay in their plan unless they opt out; providing for
236	mandatory assignment of certain Medicaid recipients to a
237	medical home network in Alachua and Hillsborough Counties
238	who are eligible for managed care plan enrollment;
239	providing a definition; requiring the agency to convene a
240	workgroup to evaluate the status and future viability of
241	Medicaid managed care; requiring the workgroup to produce
242	a report; requiring the agency to collect encounter data
243	for services provided to patients enrolled in managed care
244	plans; amending s. 409.9124, F.S.; requiring managed care
245	rates to be based on a risk-adjusted methodology;
246	requiring the agency to submit an annual report to the
247	Governor and Legislature regarding the financial condition
248	and trends affecting Medicaid managed care plans; amending
249	s. 409.9128; requiring a managed care plan to reimburse a
250	provider at a specified rate under specific circumstances;
251	amending s. 409.913, F.S.; requiring that the annual
252	report submitted by the Agency for Health Care
253	Administration and the Medicaid Fraud Control Unit of the
254	Department of Legal Affairs recommend changes necessary to
255	prevent and detect Medicaid fraud; requiring the Agency
256	for Health Care Administration to monitor billing patterns
257	for Medicaid services; requiring the agency to deny
258	payment or require repayment for Medicaid services under
259	certain circumstances; requiring the Agency for Health
260	Care Administration to immediately terminate a Medicaid
261	provider's participation in the Medicaid program as a
262	result of certain adjudications against the provider or
263	certain affiliated persons; requiring the Agency for
264	Health Care Administration to suspend or terminate a
265	Medicaid provider's participation in the Medicaid program
266	if the provider or certain affiliated persons
267	participating in the Medicaid program have been suspended
268	or terminated by the Federal Government or another state;
269	providing that a provider is subject to sanctions for
270	violations of law as the result of actions or inactions of
271	the provider or certain affiliated persons; requiring that
272	the agency provide notice of certain administrative
273	sanctions to other regulatory agencies within a specified
274	period; requiring the Agency for Health Care
275	Administration to withhold or deny Medicaid payments under
276	certain circumstances; requiring the agency to terminate a
277	provider's participation in the Medicaid program if the
278	provider fails to repay certain overpayments from the
279	Medicaid program; requiring the agency to provide the
280	explanation of benefits letter three times a year;
281	requiring the agency to provide at least annually
282	information on Medicaid fraud in an explanation of
283	benefits letter; requiring the Agency for Health Care
284	Administration to post a list on its website of Medicaid
285	providers and affiliated persons of providers who have
286	been terminated or sanctioned; requiring the agency to
287	take certain actions to improve the prevention and
288	detection of health care fraud through the use of
289	technology; amending s. 409.920, F.S.; defining the term
290	"managed care organization"; providing criminal penalties
291	and fines for Medicaid fraud; granting civil immunity to
292	certain persons who report suspected Medicaid fraud;
293	creating s. 409.9203, F.S.; authorizing the payment of
294	rewards to persons who report and provide information
295	relating to Medicaid fraud; repealing s. 429.071, F.S.,
296	relating to the intergenerational respite care assisted
297	living facility pilot program; amending s. 429.08, F.S.;
298	authorizing the agency to provide information regarding
299	licensed assisted living facilities electronically or on
300	its Internet website; abolishing local coordinating
301	workgroups established by agency field offices; deleting a
302	fine; deleting provisions requiring the agency to provide
303	certain information and notice to service providers;
304	amending s. 429.14, F.S.; conforming a reference; amending
305	s. 429.19, F.S.; revising agency procedures for imposition
306	of fines for violations of pt. I of ch. 429, F.S., the
307	"Assisted Living Facilities Act"; providing for the
308	posting of certain information electronically or on the
309	agency's Internet website; amending s. 429.23, F.S.;
310	revising the definition of the term "adverse incident" for
311	reporting purposes; requiring abuse, neglect, and
312	exploitation to be reported to the agency and the
313	Department of Children and Family Services; deleting a
314	requirement that the agency submit an annual report on
315	assisted living facility adverse incidents to the
316	Legislature; amending s. 429.26, F.S.; removing
317	requirement for a resident of an assisted living facility
318	to undergo examinations and evaluations under certain
319	circumstances; amending ss. 435.04 and 435.05, F.S.;
320	requiring employers of certain employees to submit an
321	affidavit of compliance with level 2 screening
322	requirements at the time of license renewal; amending s.
323	456.004, F.S.; requiring the Department of Health to work
324	cooperatively with the Agency for Health Care
325	Administration and the judicial system to recover
326	overpayments by the Medicaid program; amending s. 456.053,
327	F.S.; including referrals a health care provider for
328	sleep-related testing in the definition of "referral";
329	amending s. 456.041, F.S.; requiring the Department of
330	Health to include a statement in the practitioner profile
331	if a practitioner has been terminated from participating
332	in the Medicaid program; creating s. 456.0635, F.S.;
333	prohibiting Medicaid fraud in the practice of health care
334	professions; requiring the Department of Health or boards
335	within the department to refuse to admit to exams and to
336	deny licenses, permits, or certificates to certain persons
337	who have engaged in certain acts; requiring health care
338	practitioners to report allegations of Medicaid fraud;
339	specifying that acceptance of the relinquishment of a
340	license in anticipation of charges relating to Medicaid
341	fraud constitutes permanent revocation of a license;
342	amending s. 456.072, F.S.; creating additional grounds for
343	disciplinary action by the department against certain
344	applicants or licensees for misconduct relating to a
345	Medicaid program or to health care fraud; amending s.
346	456.074, F.S.; requiring the Department of Health to issue
347	an emergency order suspending the license of a person who
348	engages in certain criminal conduct relating to the
349	Medicaid program; amending s. 456.42, F.S.; revising
350	provisions specifying the information required to be
351	included in written prescriptions for medicinal drugs;
352	amending s. 465.022, F.S.; authorizing partnerships and
353	corporations to obtain pharmacy permits; requiring
354	applicants or certain persons affiliated with an applicant
355	for a pharmacy permit to submit a set of fingerprints for
356	a criminal history records check and pay the costs of the
357	criminal history records check; requiring the Department
358	of Health or Board of Pharmacy to deny an application for
359	a pharmacy permit for certain misconduct by the applicant;
360	or persons affiliated with the applicant; amending s.
361	465.023, F.S.; authorizing the Department of Health or the
362	Board of Pharmacy to take disciplinary action against a
363	permitee for certain misconduct by the permitee, or
364	persons affiliated with the permitee; amending s. 483.031,
365	F.S.; conforming a reference; amending s. 483.041, F.S.;
366	revising a definition applicable to pt. I of ch. 483,
367	F.S., the "Florida Clinical Laboratory Law"; repealing s.
368	483.106, F.S., relating to applications for certificates
369	of exemption by clinical laboratories that perform certain
370	tests; amending s. 483.172, F.S.; conforming a reference;
371	amending s. 627.4239, F.S.; revising the definition of the
372	term "standard reference compendium" for purposes of
373	regulating the insurance coverage of drugs used in the
374	treatment of cancer; amending s. 651.118, F.S.; conforming
375	a cross-reference; amending s. 825.103, F.S.; revising the
376	term "exploitation of an elderly person or disabled
377	adult"; amending s. 893.04, F.S.; authorizing a pharmacist
378	to dispense a controlled substance and require
379	photographic identification without documenting certain
380	information; authorizing a pharmacist to dispense a
381	controlled substance without verification of certain
382	information by the prescriber under certain circumstances;
383	amending s. 921.0022, F.S.; revising the severity level
384	ranking of Medicaid fraud under the Criminal Punishment
385	Code; providing an effective date.
386
387	Be It Enacted by the Legislature of the State of Florida:
388
389	Section 1.  The Legislature finds that:
390	(1)  Immediate and proactive measures are necessary to
391	prevent, reduce, and mitigate health care fraud, waste, and
392	abuse and are essential to maintaining the integrity and
393	financial viability of health care delivery systems, including
394	those funded in whole or in part by the Medicare and Medicaid
395	trust funds. Without these measures, health care delivery
396	systems in this state will be depleted of necessary funds to
397	deliver patient care, and taxpayers' dollars will be devalued
398	and not used for their intended purposes.
399	(2)  Sufficient justification exists for increased
400	oversight of health care clinics, home health agencies,
401	providers of home medical equipment, and other health care
402	providers throughout the state, and in particular, in Miami-Dade
403	County.
404	(3)  The state's best interest is served by deterring
405	health care fraud, abuse, and waste and identifying patterns of
406	fraudulent or abusive Medicare and Medicaid activity early,
407	especially in high-risk localities, such as Miami-Dade County,
408	in order to prevent inappropriate expenditures of public funds
409	and harm to the state's residents.
410	(4)  The Legislature designates Miami-Dade County as a
411	health care fraud crisis area for purposes of implementing
412	increased scrutiny of home health agencies, home medical
413	equipment providers, health care clinics, and other health care
414	providers in Miami-Dade County in order to assist the state's
415	efforts to prevent Medicaid fraud, waste, and abuse in the
416	county and throughout the state.
417	Section 2.  Section 68.085, Florida Statutes, is amended to
418	read:
419	68.085  Awards to plaintiffs bringing action.--
420	(1)  If the department proceeds with and prevails in an
421	action brought by a person under this act, except as provided in
422	subsection (2), the court shall order the distribution to the
423	person of at least 15 percent but not more than 25 percent of
424	the proceeds recovered under any judgment obtained by the
425	department in an action under s. 68.082 or of the proceeds of
426	any settlement of the claim, depending upon the extent to which
427	the person substantially contributed to the prosecution of the
428	action.
429	(2)  If the department proceeds with an action which the
430	court finds to be based primarily on disclosures of specific
431	information, other than that provided by the person bringing the
432	action, relating to allegations or transactions in a criminal,
433	civil, or administrative hearing; a legislative, administrative,
434	inspector general, or auditor general report, hearing, audit, or
435	investigation; or from the news media, the court may award such
436	sums as it considers appropriate, but in no case more than 10
437	percent of the proceeds recovered under a judgment or received
438	in settlement of a claim under this act, taking into account the
439	significance of the information and the role of the person
440	bringing the action in advancing the case to litigation.
441	(3)  If the department does not proceed with an action
442	under this section, the person bringing the action or settling
443	the claim shall receive an amount which the court decides is
444	reasonable for collecting the civil penalty and damages. The
445	amount shall be not less than 25 percent and not more than 30
446	percent of the proceeds recovered under a judgment rendered in
447	an action under this act or in settlement of a claim under this
448	act.
449	(4)  Following any distributions under subsection (1),
450	subsection (2), or subsection (3), the agency injured by the
451	submission of a false or fraudulent claim shall be awarded an
452	amount not to exceed its compensatory damages. If the action was
453	based on a claim of funds from the state Medicaid program, 10
454	percent of any remaining proceeds shall be deposited into the
455	Legal Affairs Revolving Trust Fund to fund rewards for persons
456	who report and provide information relating to Medicaid fraud
457	pursuant to s. 409.9203. Any remaining proceeds, including civil
458	penalties awarded under s. 68.082, shall be deposited in the
459	General Revenue Fund.
460	(5)  Any payment under this section to the person bringing
461	the action shall be paid only out of the proceeds recovered from
462	the defendant.
463	(6)  Whether or not the department proceeds with the
464	action, if the court finds that the action was brought by a
465	person who planned and initiated the violation of s. 68.082 upon
466	which the action was brought, the court may, to the extent the
467	court considers appropriate, reduce the share of the proceeds of
468	the action which the person would otherwise receive under this
469	section, taking into account the role of the person in advancing
470	the case to litigation and any relevant circumstances pertaining
471	to the violation. If the person bringing the action is convicted
472	of criminal conduct arising from his or her role in the
473	violation of s. 68.082, the person shall be dismissed from the
474	civil action and shall not receive any share of the proceeds of
475	the action. Such dismissal shall not prejudice the right of the
476	department to continue the action.
477	Section 3.  Section 68.086, Florida Statutes, is amended to
478	read:
479	68.086  Expenses; attorney's fees and costs.--
480	(1)  If the department initiates an action under this act
481	or assumes control of an action brought by a person under this
482	act, the department shall be awarded its reasonable attorney's
483	fees, expenses, and costs.
484	(2)  If the court awards the person bringing the action
485	proceeds under this act, the person shall also be awarded an
486	amount for reasonable attorney's fees and costs. Payment for
487	reasonable attorney's fees and costs shall be made from the
488	recovered proceeds before the distribution of any award.
489	(3)  If the department does not proceed with an action
490	under this act and the person bringing the action conducts the
491	action defendant is the prevailing party, the court may shall
492	award to the defendant its reasonable attorney's fees and costs
493	if the defendant prevails in the action and the court finds that
494	the claim of against the person bringing the action was clearly
495	frivolous, clearly vexatious, or brought primarily for purposes
496	of harassment.
497	(4)  No liability shall be incurred by the state
498	government, the affected agency, or the department for any
499	expenses, attorney's fees, or other costs incurred by any person
500	in bringing or defending an action under this act.
501	Section 4.  Section 395.0199, Florida Statutes, is
502	repealed.
503	Section 5.  Section 395.405, Florida Statutes, is amended
504	to read:
505	395.405  Rulemaking.--The department shall adopt and
506	enforce all rules necessary to administer ss. 395.0199, 395.401,
507	395.4015, 395.402, 395.4025, 395.403, 395.404, and 395.4045.
508	Section 6.  Subsection (6) of section 400.0077, Florida
509	Statutes, is amended to read:
510	400.0077  Confidentiality.--
511	(6)  This section does not limit the subpoena power of the
512	Attorney General pursuant to s. 409.920(10)(b) s. 409.920(9)(b).
513	Section 7.  Subsection (1) of section 400.0712, Florida
514	Statutes, is amended to read:
515	400.0712  Application for inactive license.--
516	(1)  As specified in s. 408.831(4) and this section, the
517	agency may issue an inactive license to a nursing home facility
518	for all or a portion of its beds. Any request by a licensee that
519	a nursing home or portion of a nursing home become inactive must
520	be submitted to the agency in the approved format. The facility
521	may not initiate any suspension of services, notify residents,
522	or initiate inactivity before receiving approval from the
523	agency; and a licensee that violates this provision may not be
524	issued an inactive license.
525	Section 8.  Subsection (3) of section 400.118, Florida
526	Statutes, is renumbered as subsection (2), and present
527	subsection (2) of that section is amended to read:
528	400.118  Quality assurance; early warning system;
529	monitoring; rapid response teams.--
530	(2)(a)  The agency shall establish within each district
531	office one or more quality-of-care monitors, based on the number
532	of nursing facilities in the district, to monitor all nursing
533	facilities in the district on a regular, unannounced, aperiodic
534	basis, including nights, evenings, weekends, and holidays.
535	Quality-of-care monitors shall visit each nursing facility at
536	least quarterly. Priority for additional monitoring visits shall
537	be given to nursing facilities with a history of resident care
538	deficiencies. Quality-of-care monitors shall be registered
539	nurses who are trained and experienced in nursing facility
540	regulation, standards of practice in long-term care, and
541	evaluation of patient care. Individuals in these positions shall
542	not be deployed by the agency as a part of the district survey
543	team in the conduct of routine, scheduled surveys, but shall
544	function solely and independently as quality-of-care monitors.
545	Quality-of-care monitors shall assess the overall quality of
546	life in the nursing facility and shall assess specific
547	conditions in the facility directly related to resident care,
548	including the operations of internal quality improvement and
549	risk management programs and adverse incident reports. The
550	quality-of-care monitor shall include in an assessment visit
551	observation of the care and services rendered to residents and
552	formal and informal interviews with residents, family members,
553	facility staff, resident guests, volunteers, other regulatory
554	staff, and representatives of a long-term care ombudsman council
555	or Florida advocacy council.
556	(b)  Findings of a monitoring visit, both positive and
557	negative, shall be provided orally and in writing to the
558	facility administrator or, in the absence of the facility
559	administrator, to the administrator on duty or the director of
560	nursing. The quality-of-care monitor may recommend to the
561	facility administrator procedural and policy changes and staff
562	training, as needed, to improve the care or quality of life of
563	facility residents. Conditions observed by the quality-of-care
564	monitor which threaten the health or safety of a resident shall
565	be reported immediately to the agency area office supervisor for
566	appropriate regulatory action and, as appropriate or as required
567	by law, to law enforcement, adult protective services, or other
568	responsible agencies.
569	(c)  Any record, whether written or oral, or any written or
570	oral communication generated pursuant to paragraph (a) or
571	paragraph (b) shall not be subject to discovery or introduction
572	into evidence in any civil or administrative action against a
573	nursing facility arising out of matters which are the subject of
574	quality-of-care monitoring, and a person who was in attendance
575	at a monitoring visit or evaluation may not be permitted or
576	required to testify in any such civil or administrative action
577	as to any evidence or other matters produced or presented during
578	the monitoring visits or evaluations. However, information,
579	documents, or records otherwise available from original sources
580	are not to be construed as immune from discovery or use in any
581	such civil or administrative action merely because they were
582	presented during monitoring visits or evaluations, and any
583	person who participates in such activities may not be prevented
584	from testifying as to matters within his or her knowledge, but
585	such witness may not be asked about his or her participation in
586	such activities. The exclusion from the discovery or
587	introduction of evidence in any civil or administrative action
588	provided for herein shall not apply when the quality-of-care
589	monitor makes a report to the appropriate authorities regarding
590	a threat to the health or safety of a resident.
591	Section 9.  Section 400.141, Florida Statutes, is amended
592	to read:
593	400.141  Administration and management of nursing home
594	facilities.--
595	(1)  Every licensed facility shall comply with all
596	applicable standards and rules of the agency and shall:
597	(a)(1)  Be under the administrative direction and charge of
598	a licensed administrator.
599	(b)(2)  Appoint a medical director licensed pursuant to
600	chapter 458 or chapter 459. The agency may establish by rule
601	more specific criteria for the appointment of a medical
602	director.
603	(c)(3)  Have available the regular, consultative, and
604	emergency services of physicians licensed by the state.
605	(d)(4)  Provide for resident use of a community pharmacy as
606	specified in s. 400.022(1)(q). Any other law to the contrary
607	notwithstanding, a registered pharmacist licensed in Florida,
608	that is under contract with a facility licensed under this
609	chapter or chapter 429, shall repackage a nursing facility
610	resident's bulk prescription medication which has been packaged
611	by another pharmacist licensed in any state in the United States
612	into a unit dose system compatible with the system used by the
613	nursing facility, if the pharmacist is requested to offer such
614	service. In order to be eligible for the repackaging, a resident
615	or the resident's spouse must receive prescription medication
616	benefits provided through a former employer as part of his or
617	her retirement benefits, a qualified pension plan as specified
618	in s. 4972 of the Internal Revenue Code, a federal retirement
619	program as specified under 5 C.F.R. s. 831, or a long-term care
620	policy as defined in s. 627.9404(1). A pharmacist who correctly
621	repackages and relabels the medication and the nursing facility
622	which correctly administers such repackaged medication under the
623	provisions of this paragraph may subsection shall not be held
624	liable in any civil or administrative action arising from the
625	repackaging. In order to be eligible for the repackaging, a
626	nursing facility resident for whom the medication is to be
627	repackaged shall sign an informed consent form provided by the
628	facility which includes an explanation of the repackaging
629	process and which notifies the resident of the immunities from
630	liability provided in this paragraph herein. A pharmacist who
631	repackages and relabels prescription medications, as authorized
632	under this paragraph subsection, may charge a reasonable fee for
633	costs resulting from the implementation of this provision.
634	(e)(5)  Provide for the access of the facility residents to
635	dental and other health-related services, recreational services,
636	rehabilitative services, and social work services appropriate to
637	their needs and conditions and not directly furnished by the
638	licensee. When a geriatric outpatient nurse clinic is conducted
639	in accordance with rules adopted by the agency, outpatients
640	attending such clinic shall not be counted as part of the
641	general resident population of the nursing home facility, nor
642	shall the nursing staff of the geriatric outpatient clinic be
643	counted as part of the nursing staff of the facility, until the
644	outpatient clinic load exceeds 15 a day.
645	(f)(6)  Be allowed and encouraged by the agency to provide
646	other needed services under certain conditions. If the facility
647	has a standard licensure status, and has had no class I or class
648	II deficiencies during the past 2 years or has been awarded a
649	Gold Seal under the program established in s. 400.235, it may be
650	encouraged by the agency to provide services, including, but not
651	limited to, respite and adult day services, which enable
652	individuals to move in and out of the facility. A facility is
653	not subject to any additional licensure requirements for
654	providing these services. Respite care may be offered to persons
655	in need of short-term or temporary nursing home services.
656	Respite care must be provided in accordance with this part and
657	rules adopted by the agency. However, the agency shall, by rule,
658	adopt modified requirements for resident assessment, resident
659	care plans, resident contracts, physician orders, and other
660	provisions, as appropriate, for short-term or temporary nursing
661	home services. The agency shall allow for shared programming and
662	staff in a facility which meets minimum standards and offers
663	services pursuant to this paragraph subsection, but, if the
664	facility is cited for deficiencies in patient care, may require
665	additional staff and programs appropriate to the needs of
666	service recipients. A person who receives respite care may not
667	be counted as a resident of the facility for purposes of the
668	facility's licensed capacity unless that person receives 24-hour
669	respite care. A person receiving either respite care for 24
670	hours or longer or adult day services must be included when
671	calculating minimum staffing for the facility. Any costs and
672	revenues generated by a nursing home facility from
673	nonresidential programs or services shall be excluded from the
674	calculations of Medicaid per diems for nursing home
675	institutional care reimbursement.
676	(g)(7)  If the facility has a standard license or is a Gold
677	Seal facility, exceeds the minimum required hours of licensed
678	nursing and certified nursing assistant direct care per resident
679	per day, and is part of a continuing care facility licensed
680	under chapter 651 or a retirement community that offers other
681	services pursuant to part III of this chapter or part I or part
682	III of chapter 429 on a single campus, be allowed to share
683	programming and staff. At the time of inspection and in the
684	semiannual report required pursuant to paragraph (o) subsection
685	(15), a continuing care facility or retirement community that
686	uses this option must demonstrate through staffing records that
687	minimum staffing requirements for the facility were met.
688	Licensed nurses and certified nursing assistants who work in the
689	nursing home facility may be used to provide services elsewhere
690	on campus if the facility exceeds the minimum number of direct
691	care hours required per resident per day and the total number of
692	residents receiving direct care services from a licensed nurse
693	or a certified nursing assistant does not cause the facility to
694	violate the staffing ratios required under s. 400.23(3)(a).
695	Compliance with the minimum staffing ratios shall be based on
696	total number of residents receiving direct care services,
697	regardless of where they reside on campus. If the facility
698	receives a conditional license, it may not share staff until the
699	conditional license status ends. This paragraph subsection does
700	not restrict the agency's authority under federal or state law
701	to require additional staff if a facility is cited for
702	deficiencies in care which are caused by an insufficient number
703	of certified nursing assistants or licensed nurses. The agency
704	may adopt rules for the documentation necessary to determine
705	compliance with this provision.
706	(h)(8)  Maintain the facility premises and equipment and
707	conduct its operations in a safe and sanitary manner.
708	(i)(9)  If the licensee furnishes food service, provide a
709	wholesome and nourishing diet sufficient to meet generally
710	accepted standards of proper nutrition for its residents and
711	provide such therapeutic diets as may be prescribed by attending
712	physicians. In making rules to implement this paragraph
713	subsection, the agency shall be guided by standards recommended
714	by nationally recognized professional groups and associations
715	with knowledge of dietetics.
716	(j)(10)  Keep full records of resident admissions and
717	discharges; medical and general health status, including medical
718	records, personal and social history, and identity and address
719	of next of kin or other persons who may have responsibility for
720	the affairs of the residents; and individual resident care plans
721	including, but not limited to, prescribed services, service
722	frequency and duration, and service goals. The records shall be
723	open to inspection by the agency.
724	(k)(11)  Keep such fiscal records of its operations and
725	conditions as may be necessary to provide information pursuant
726	to this part.
727	(l)(12)  Furnish copies of personnel records for employees
728	affiliated with such facility, to any other facility licensed by
729	this state requesting this information pursuant to this part.
730	Such information contained in the records may include, but is
731	not limited to, disciplinary matters and any reason for
732	termination. Any facility releasing such records pursuant to
733	this part shall be considered to be acting in good faith and may
734	not be held liable for information contained in such records,
735	absent a showing that the facility maliciously falsified such
736	records.
737	(m)(13)  Publicly display a poster provided by the agency
738	containing the names, addresses, and telephone numbers for the
739	state's abuse hotline, the State Long-Term Care Ombudsman, the
740	Agency for Health Care Administration consumer hotline, the
741	Advocacy Center for Persons with Disabilities, the Florida
742	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
743	with a clear description of the assistance to be expected from
744	each.
745	(n)(14)  Submit to the agency the information specified in
746	s. 400.071(1)(b) for a management company within 30 days after
747	the effective date of the management agreement.
748	(o)1.(15)  Submit semiannually to the agency, or more
749	frequently if requested by the agency, information regarding
750	facility staff-to-resident ratios, staff turnover, and staff
751	stability, including information regarding certified nursing
752	assistants, licensed nurses, the director of nursing, and the
753	facility administrator. For purposes of this reporting:
754	a.(a)  Staff-to-resident ratios must be reported in the
755	categories specified in s. 400.23(3)(a) and applicable rules.
756	The ratio must be reported as an average for the most recent
757	calendar quarter.
758	b.(b)  Staff turnover must be reported for the most recent
759	12-month period ending on the last workday of the most recent
760	calendar quarter prior to the date the information is submitted.
761	The turnover rate must be computed quarterly, with the annual
762	rate being the cumulative sum of the quarterly rates. The
763	turnover rate is the total number of terminations or separations
764	experienced during the quarter, excluding any employee
765	terminated during a probationary period of 3 months or less,
766	divided by the total number of staff employed at the end of the
767	period for which the rate is computed, and expressed as a
768	percentage.
769	c.(c)  The formula for determining staff stability is the
770	total number of employees that have been employed for more than
771	12 months, divided by the total number of employees employed at
772	the end of the most recent calendar quarter, and expressed as a
773	percentage.
774	d.(d)  A nursing facility that has failed to comply with
775	state minimum-staffing requirements for 2 consecutive days is
776	prohibited from accepting new admissions until the facility has
777	achieved the minimum-staffing requirements for a period of 6
778	consecutive days. For the purposes of this sub-subparagraph
779	paragraph, any person who was a resident of the facility and was
780	absent from the facility for the purpose of receiving medical
781	care at a separate location or was on a leave of absence is not
782	considered a new admission. Failure to impose such an admissions
783	moratorium constitutes a class II deficiency.
784	e.(e)  A nursing facility which does not have a conditional
785	license may be cited for failure to comply with the standards in
786	s. 400.23(3)(a)1.a. only if it has failed to meet those
787	standards on 2 consecutive days or if it has failed to meet at
788	least 97 percent of those standards on any one day.
789	f.(f)  A facility which has a conditional license must be
790	in compliance with the standards in s. 400.23(3)(a) at all
791	times.
792	2.  Nothing in This paragraph does not section shall limit
793	the agency's ability to impose a deficiency or take other
794	actions if a facility does not have enough staff to meet the
795	residents' needs.
796	(16)  Report monthly the number of vacant beds in the
797	facility which are available for resident occupancy on the day
798	the information is reported.
799	(p)(17)  Notify a licensed physician when a resident
800	exhibits signs of dementia or cognitive impairment or has a
801	change of condition in order to rule out the presence of an
802	underlying physiological condition that may be contributing to
803	such dementia or impairment. The notification must occur within
804	30 days after the acknowledgment of such signs by facility
805	staff. If an underlying condition is determined to exist, the
806	facility shall arrange, with the appropriate health care
807	provider, the necessary care and services to treat the
808	condition.
809	(q)(18)  If the facility implements a dining and
810	hospitality attendant program, ensure that the program is
811	developed and implemented under the supervision of the facility
812	director of nursing. A licensed nurse, licensed speech or
813	occupational therapist, or a registered dietitian must conduct
814	training of dining and hospitality attendants. A person employed
815	by a facility as a dining and hospitality attendant must perform
816	tasks under the direct supervision of a licensed nurse.
817	(r)(19)  Report to the agency any filing for bankruptcy
818	protection by the facility or its parent corporation,
819	divestiture or spin-off of its assets, or corporate
820	reorganization within 30 days after the completion of such
821	activity.
822	(s)(20)  Maintain general and professional liability
823	insurance coverage that is in force at all times. In lieu of
824	general and professional liability insurance coverage, a state-
825	designated teaching nursing home and its affiliated assisted
826	living facilities created under s. 430.80 may demonstrate proof
827	of financial responsibility as provided in s. 430.80(3)(h).
828	(t)(21)  Maintain in the medical record for each resident a
829	daily chart of certified nursing assistant services provided to
830	the resident. The certified nursing assistant who is caring for
831	the resident must complete this record by the end of his or her
832	shift. This record must indicate assistance with activities of
833	daily living, assistance with eating, and assistance with
834	drinking, and must record each offering of nutrition and
835	hydration for those residents whose plan of care or assessment
836	indicates a risk for malnutrition or dehydration.
837	(u)(22)  Before November 30 of each year, subject to the
838	availability of an adequate supply of the necessary vaccine,
839	provide for immunizations against influenza viruses to all its
840	consenting residents in accordance with the recommendations of
841	the United States Centers for Disease Control and Prevention,
842	subject to exemptions for medical contraindications and
843	religious or personal beliefs. Subject to these exemptions, any
844	consenting person who becomes a resident of the facility after
845	November 30 but before March 31 of the following year must be
846	immunized within 5 working days after becoming a resident.
847	Immunization shall not be provided to any resident who provides
848	documentation that he or she has been immunized as required by
849	this paragraph subsection. This paragraph subsection does not
850	prohibit a resident from receiving the immunization from his or
851	her personal physician if he or she so chooses. A resident who
852	chooses to receive the immunization from his or her personal
853	physician shall provide proof of immunization to the facility.
854	The agency may adopt and enforce any rules necessary to comply
855	with or implement this paragraph subsection.
856	(v)(23)  Assess all residents for eligibility for
857	pneumococcal polysaccharide vaccination (PPV) and vaccinate
858	residents when indicated within 60 days after the effective date
859	of this act in accordance with the recommendations of the United
860	States Centers for Disease Control and Prevention, subject to
861	exemptions for medical contraindications and religious or
862	personal beliefs. Residents admitted after the effective date of
863	this act shall be assessed within 5 working days of admission
864	and, when indicated, vaccinated within 60 days in accordance
865	with the recommendations of the United States Centers for
866	Disease Control and Prevention, subject to exemptions for
867	medical contraindications and religious or personal beliefs.
868	Immunization shall not be provided to any resident who provides
869	documentation that he or she has been immunized as required by
870	this paragraph subsection. This paragraph subsection does not
871	prohibit a resident from receiving the immunization from his or
872	her personal physician if he or she so chooses. A resident who
873	chooses to receive the immunization from his or her personal
874	physician shall provide proof of immunization to the facility.
875	The agency may adopt and enforce any rules necessary to comply
876	with or implement this paragraph subsection.
877	(w)(24)  Annually encourage and promote to its employees
878	the benefits associated with immunizations against influenza
879	viruses in accordance with the recommendations of the United
880	States Centers for Disease Control and Prevention. The agency
881	may adopt and enforce any rules necessary to comply with or
882	implement this paragraph subsection.
883	(2)  Facilities that have been awarded a Gold Seal under
884	the program established in s. 400.235 may develop a plan to
885	provide certified nursing assistant training as prescribed by
886	federal regulations and state rules and may apply to the agency
887	for approval of their program.
888	Section 10.  Present subsections (9) through (13) of
889	section 400.147, Florida Statutes, are renumbered as subsections
890	(10) through (14), respectively, subsection (5) and present
891	subsection (14) are amended, and a new subsection (9) is added
892	to that section, to read:
893	400.147  Internal risk management and quality assurance
894	program.--
895	(5)  For purposes of reporting to the agency under this
896	section, the term "adverse incident" means:
897	(a)  An event over which facility personnel could exercise
898	control and which is associated in whole or in part with the
899	facility's intervention, rather than the condition for which
900	such intervention occurred, and which results in one of the
901	following:
902	1.  Death;
903	2.  Brain or spinal damage;
904	3.  Permanent disfigurement;
905	4.  Fracture or dislocation of bones or joints;
906	5.  A limitation of neurological, physical, or sensory
907	function;
908	6.  Any condition that required medical attention to which
909	the resident has not given his or her informed consent,
910	including failure to honor advanced directives; or
911	7.  Any condition that required the transfer of the
912	resident, within or outside the facility, to a unit providing a
913	more acute level of care due to the adverse incident, rather
914	than the resident's condition prior to the adverse incident; or
915	8.  An event that is reported to law enforcement or its
916	personnel for investigation; or
917	(b)  Abuse, neglect, or exploitation as defined in s.
918	415.102;
919	(c)  Abuse, neglect and harm as defined in s. 39.01;
920	(b)(d)  Resident elopement, if the elopement places the
921	resident at risk of harm or injury.; or
922	(e)  An event that is reported to law enforcement.
923	(9)  Abuse, neglect, or exploitation must be reported to
924	the agency as required by 42 C.F.R. s. 483.13(c) and to the
925	department as required by chapters 39 and 415.
926	(14)  The agency shall annually submit to the Legislature a
927	report on nursing home adverse incidents. The report must
928	include the following information arranged by county:
929	(a)  The total number of adverse incidents.
930	(b)  A listing, by category, of the types of adverse
931	incidents, the number of incidents occurring within each
932	category, and the type of staff involved.
933	(c)  A listing, by category, of the types of injury caused
934	and the number of injuries occurring within each category.
935	(d)  Types of liability claims filed based on an adverse
936	incident or reportable injury.
937	(e)  Disciplinary action taken against staff, categorized
938	by type of staff involved.
939	Section 11.  Subsection (3) of section 400.162, Florida
940	Statutes, is amended to read:
941	400.162  Property and personal affairs of residents.--
942	(3)  A licensee shall provide for the safekeeping of
943	personal effects, funds, and other property of the resident in
944	the facility. Whenever necessary for the protection of
945	valuables, or in order to avoid unreasonable responsibility
946	therefor, the licensee may require that such valuables be
947	excluded or removed from the facility and kept at some place not
948	subject to the control of the licensee. At the request of a
949	resident, the facility shall mark the resident's personal
950	property with the resident's name or another type of
951	identification, without defacing the property. Any theft or loss
952	of a resident's personal property shall be documented by the
953	facility. The facility shall develop policies and procedures to
954	minimize the risk of theft or loss of the personal property of
955	residents. A copy of the policy shall be provided to every
956	employee and to each resident and resident's representative, if
957	appropriate, at admission and when revised. Facility policies
958	must include provisions related to reporting theft or loss of a
959	resident's property to law enforcement and any facility waiver
960	of liability for loss or theft. The facility shall post notice
961	of these policies and procedures, and any revision thereof, in
962	places accessible to residents.
963	Section 12.  Subsection (3) is added to section 400.179,
964	Florida Statutes, to read:
965	400.179  Liability for Medicaid underpayments and
966	overpayments.--
967	(3)  The requirements of paragraph (2)(d) to acquire and
968	maintain a bond or alternative shall be waived for license
969	renewals on or after July 1, 2009, as long as the fund balance
970	related to such payments held in the Grants and Donations Trust
971	Fund exceeds 50 percent of the balance on June 30, 2009. The
972	agency may impose the requirements of paragraph (2)(d) for
973	license renewals occurring on or after the balance in the Grants
974	and Donations Trust Fund related to such payments and
975	withdrawals is less than 50 percent of the balance on June 30,
976	2009.
977	Section 13.  Subsection (2) of section 400.191, Florida
978	Statutes, is amended to read:
979	400.191  Availability, distribution, and posting of reports
980	and records.--
981	(2)  The agency shall publish the Nursing Home Guide
982	annually in consumer-friendly printed form and quarterly in
983	electronic form to assist consumers and their families in
984	comparing and evaluating nursing home facilities.
985	(a)  The agency shall provide an Internet site which shall
986	include at least the following information either directly or
987	indirectly through a link to another established site or sites
988	of the agency's choosing:
989	1.  A section entitled "Have you considered programs that
990	provide alternatives to nursing home care?" which shall be the
991	first section of the Nursing Home Guide and which shall
992	prominently display information about available alternatives to
993	nursing homes and how to obtain additional information regarding
994	these alternatives. The Nursing Home Guide shall explain that
995	this state offers alternative programs that permit qualified
996	elderly persons to stay in their homes instead of being placed
997	in nursing homes and shall encourage interested persons to call
998	the Comprehensive Assessment Review and Evaluation for Long-Term
999	Care Services (CARES) Program to inquire if they qualify. The
1000	Nursing Home Guide shall list available home and community-based
1001	programs which shall clearly state the services that are
1002	provided and indicate whether nursing home services are included
1003	if needed.
1004	2.  A list by name and address of all nursing home
1005	facilities in this state, including any prior name by which a
1006	facility was known during the previous 24-month period.
1007	3.  Whether such nursing home facilities are proprietary or
1008	nonproprietary.
1009	4.  The current owner of the facility's license and the
1010	year that that entity became the owner of the license.
1011	5.  The name of the owner or owners of each facility and
1012	whether the facility is affiliated with a company or other
1013	organization owning or managing more than one nursing facility
1014	in this state.
1015	6.  The total number of beds in each facility and the most
1016	recently available occupancy levels.
1017	7.  The number of private and semiprivate rooms in each
1018	facility.
1019	8.  The religious affiliation, if any, of each facility.
1020	9.  The languages spoken by the administrator and staff of
1021	each facility.
1022	10.  Whether or not each facility accepts Medicare or
1023	Medicaid recipients or insurance, health maintenance
1024	organization, Veterans Administration, CHAMPUS program, or
1025	workers' compensation coverage.
1026	11.  Recreational and other programs available at each
1027	facility.
1028	12.  Special care units or programs offered at each
1029	facility.
1030	13.  Whether the facility is a part of a retirement
1031	community that offers other services pursuant to part III of
1032	this chapter or part I or part III of chapter 429.
1033	14.  Survey and deficiency information, including all
1034	federal and state recertification, licensure, revisit, and
1035	complaint survey information, for each facility for the past 30
1036	months. For noncertified nursing homes, state survey and
1037	deficiency information, including licensure, revisit, and
1038	complaint survey information for the past 30 months shall be
1039	provided.
1040	15.  A summary of the deficiency data for each facility
1041	over the past 30 months. The summary may include a score,
1042	rating, or comparison ranking with respect to other facilities
1043	based on the number of citations received by the facility on
1044	recertification, licensure, revisit, and complaint surveys; the
1045	severity and scope of the citations; and the number of
1046	recertification surveys the facility has had during the past 30
1047	months. The score, rating, or comparison ranking may be
1048	presented in either numeric or symbolic form for the intended
1049	consumer audience.
1050	(b)  The agency shall provide the following information in
1051	printed form:
1052	1.  A section entitled "Have you considered programs that
1053	provide alternatives to nursing home care?" which shall be the
1054	first section of the Nursing Home Guide and which shall
1055	prominently display information about available alternatives to
1056	nursing homes and how to obtain additional information regarding
1057	these alternatives. The Nursing Home Guide shall explain that
1058	this state offers alternative programs that permit qualified
1059	elderly persons to stay in their homes instead of being placed
1060	in nursing homes and shall encourage interested persons to call
1061	the Comprehensive Assessment Review and Evaluation for Long-Term
1062	Care Services (CARES) Program to inquire if they qualify. The
1063	Nursing Home Guide shall list available home and community-based
1064	programs which shall clearly state the services that are
1065	provided and indicate whether nursing home services are included
1066	if needed.
1067	2.  A list by name and address of all nursing home
1068	facilities in this state.
1069	3.  Whether the nursing home facilities are proprietary or
1070	nonproprietary.
1071	4.  The current owner or owners of the facility's license
1072	and the year that entity became the owner of the license.
1073	5.  The total number of beds, and of private and
1074	semiprivate rooms, in each facility.
1075	6.  The religious affiliation, if any, of each facility.
1076	7.  The name of the owner of each facility and whether the
1077	facility is affiliated with a company or other organization
1078	owning or managing more than one nursing facility in this state.
1079	8.  The languages spoken by the administrator and staff of
1080	each facility.
1081	9.  Whether or not each facility accepts Medicare or
1082	Medicaid recipients or insurance, health maintenance
1083	organization, Veterans Administration, CHAMPUS program, or
1084	workers' compensation coverage.
1085	10.  Recreational programs, special care units, and other
1086	programs available at each facility.
1087	11.  The Internet address for the site where more detailed
1088	information can be seen.
1089	12.  A statement advising consumers that each facility will
1090	have its own policies and procedures related to protecting
1091	resident property.
1092	13.  A summary of the deficiency data for each facility
1093	over the past 30 months. The summary may include a score,
1094	rating, or comparison ranking with respect to other facilities
1095	based on the number of citations received by the facility on
1096	recertification, licensure, revisit, and complaint surveys; the
1097	severity and scope of the citations; the number of citations;
1098	and the number of recertification surveys the facility has had
1099	during the past 30 months. The score, rating, or comparison
1100	ranking may be presented in either numeric or symbolic form for
1101	the intended consumer audience.
1102	(b)(c)  The agency may provide the following additional
1103	information on an Internet site or in printed form as the
1104	information becomes available:
1105	1.  The licensure status history of each facility.
1106	2.  The rating history of each facility.
1107	3.  The regulatory history of each facility, which may
1108	include federal sanctions, state sanctions, federal fines, state
1109	fines, and other actions.
1110	4.  Whether the facility currently possesses the Gold Seal
1111	designation awarded pursuant to s. 400.235.
1112	5.  Internet links to the Internet sites of the facilities
1113	or their affiliates.
1114	Section 14.  Paragraph (d) of subsection (1) of section
1115	400.195, Florida Statutes, is amended to read:
1116	400.195  Agency reporting requirements.--
1117	(1)  For the period beginning June 30, 2001, and ending
1118	June 30, 2005, the Agency for Health Care Administration shall
1119	provide a report to the Governor, the President of the Senate,
1120	and the Speaker of the House of Representatives with respect to
1121	nursing homes. The first report shall be submitted no later than
1122	December 30, 2002, and subsequent reports shall be submitted
1123	every 6 months thereafter. The report shall identify facilities
1124	based on their ownership characteristics, size, business
1125	structure, for-profit or not-for-profit status, and any other
1126	characteristics the agency determines useful in analyzing the
1127	varied segments of the nursing home industry and shall report:
1128	(d)  Information regarding deficiencies cited, including
1129	information used to develop the Nursing Home Guide WATCH LIST
1130	pursuant to s. 400.191, and applicable rules, a summary of data
1131	generated on nursing homes by Centers for Medicare and Medicaid
1132	Services Nursing Home Quality Information Project, and
1133	information collected pursuant to s. 400.147(10)(9), relating to
1134	litigation.
1135	Section 15.  Paragraph (b) of subsection (3) of section
1136	400.23, Florida Statutes, is amended to read:
1137	400.23  Rules; evaluation and deficiencies; licensure
1138	status.--
1139	(3)
1140	(b)  The agency shall adopt rules to allow properly trained
1141	staff of a nursing facility, in addition to certified nursing
1142	assistants and licensed nurses, to assist residents with eating.
1143	The rules shall specify the minimum training requirements and
1144	shall specify the physiological conditions or disorders of
1145	residents which would necessitate that the eating assistance be
1146	provided by nursing personnel of the facility. Nonnursing staff
1147	providing eating assistance to residents under the provisions of
1148	this subsection shall not count toward compliance with minimum
1149	staffing standards.
1150	Section 16.  Subsection (10) is added to section 400.471,
1151	Florida Statutes, to read:
1152	400.471  Application for license; fee.--
1153	(10)  The agency may not issue a renewal license for a home
1154	health agency in any county having at least one licensed home
1155	health agency and that has more than one home health agency per
1156	5,000 persons, as indicated by the most recent population
1157	estimates published by the Office of Economic and Demographic
1158	Research, if the applicant or any controlling interest has been
1159	administratively sanctioned by the agency since the last
1160	licensure renewal application for one or more of the following
1161	acts:
1162	(a)  An intentional or negligent act that materially
1163	affects the health or safety of a client of the provider;
1164	(b)  Knowingly providing home health services in an
1165	unlicensed assisted living facility or unlicensed adult family-
1166	care home, unless the home health agency or employee reports the
1167	unlicensed facility or home to the agency within 72 hours after
1168	providing the services;
1169	(c)  Preparing or maintaining fraudulent patient records,
1170	such as, but not limited to, charting ahead, recording vital
1171	signs or symptoms that were not personally obtained or observed
1172	by the home health agency's staff at the time indicated,
1173	borrowing patients or patient records from other home health
1174	agencies to pass a survey or inspection, or falsifying
1175	signatures;
1176	(d)  Failing to provide at least one service directly to a
1177	patient for a period of 60 days;
1178	(e)  Demonstrating a pattern of falsifying documents
1179	relating to the training of home health aides or certified
1180	nursing assistants or demonstrating a pattern of falsifying
1181	health statements for staff who provide direct care to patients.
1182	A pattern may be demonstrated by a showing of at least three
1183	fraudulent entries or documents;
1184	(f)  Demonstrating a pattern of billing any payor for
1185	services not provided. A pattern may be demonstrated by a
1186	showing of at least three billings for services not provided
1187	within a 12-month period;
1188	(g)  Demonstrating a pattern of failing to provide a
1189	service specified in the home health agency's written agreement
1190	with a patient or the patient's legal representative, or the
1191	plan of care for that patient, unless a reduction in service is
1192	mandated by Medicare, Medicaid, or a state program or as
1193	provided in s. 400.492(3). A pattern may be demonstrated by a
1194	showing of at least three incidents, regardless of the patient
1195	or service, in which the home health agency did not provide a
1196	service specified in a written agreement or plan of care during
1197	a 3-month period;
1198	(h)  Giving remuneration to a case manager, discharge
1199	planner, facility-based staff member, or third-party vendor who
1200	is involved in the discharge planning process of a facility
1201	licensed under chapter 395, chapter 429, or this chapter from
1202	whom the home health agency receives referrals or gives
1203	remuneration as prohibited in s. 400.474(6)(a);
1204	(i)  Giving cash, or its equivalent, to a Medicare or
1205	Medicaid beneficiary;
1206	(j)  Demonstrating a pattern of billing the Medicaid
1207	program for services to Medicaid recipients which are medically
1208	unnecessary. A pattern may be demonstrated by a showing of at
1209	least two fraudulent entries or documents;
1210	(k)  Providing services to residents in an assisted living
1211	facility for which the home health agency does not receive fair
1212	market value remuneration; or
1213	(l)  Providing staffing to an assisted living facility for
1214	which the home health agency does not receive fair market value
1215	remuneration.
1216	Section 17.  Subsection (6) of section 400.474, Florida
1217	Statutes, is amended to read:
1218	400.474  Administrative penalties.--
1219	(6)  The agency may deny, revoke, or suspend the license of
1220	a home health agency and shall impose a fine of $5,000 against a
1221	home health agency that:
1222	(a)  Gives remuneration for staffing services to:
1223	1.  Another home health agency with which it has formal or
1224	informal patient-referral transactions or arrangements; or
1225	2.  A health services pool with which it has formal or
1226	informal patient-referral transactions or arrangements,
1227
1228	unless the home health agency has activated its comprehensive
1229	emergency management plan in accordance with s. 400.492. This
1230	paragraph does not apply to a Medicare-certified home health
1231	agency that provides fair market value remuneration for staffing
1232	services to a non-Medicare-certified home health agency that is
1233	part of a continuing care facility licensed under chapter 651
1234	for providing services to its own residents if each resident
1235	receiving home health services pursuant to this arrangement
1236	attests in writing that he or she made a decision without
1237	influence from staff of the facility to select, from a list of
1238	Medicare-certified home health agencies provided by the
1239	facility, that Medicare-certified home health agency to provide
1240	the services.
1241	(b)  Provides services to residents in an assisted living
1242	facility for which the home health agency does not receive fair
1243	market value remuneration.
1244	(c)  Provides staffing to an assisted living facility for
1245	which the home health agency does not receive fair market value
1246	remuneration.
1247	(d)  Fails to provide the agency, upon request, with copies
1248	of all contracts with assisted living facilities which were
1249	executed within 5 years before the request.
1250	(e)  Gives remuneration to a case manager, discharge
1251	planner, facility-based staff member, or third-party vendor who
1252	is involved in the discharge planning process of a facility
1253	licensed under chapter 395, chapter 429, or this chapter from
1254	whom the home health agency receives referrals.
1255	(f)  Fails to submit to the agency, within 15 days after
1256	the end of each calendar quarter, a written report that includes
1257	the following data based on data as it existed on the last day
1258	of the quarter:
1259	1.  The number of insulin-dependent diabetic patients
1260	receiving insulin-injection services from the home health
1261	agency;
1262	2.  The number of patients receiving both home health
1263	services from the home health agency and hospice services;
1264	3.  The number of patients receiving home health services
1265	from that home health agency; and
1266	4.  The names and license numbers of nurses whose primary
1267	job responsibility is to provide home health services to
1268	patients and who received remuneration from the home health
1269	agency in excess of $25,000 during the calendar quarter.
1270	(g)  Gives cash, or its equivalent, to a Medicare or
1271	Medicaid beneficiary.
1272	(h)  Has more than one medical director contract in effect
1273	at one time or more than one medical director contract and one
1274	contract with a physician-specialist whose services are mandated
1275	for the home health agency in order to qualify to participate in
1276	a federal or state health care program at one time.
1277	(i)  Gives remuneration to a physician without a medical
1278	director contract being in effect. The contract must:
1279	1.  Be in writing and signed by both parties;
1280	2.  Provide for remuneration that is at fair market value
1281	for an hourly rate, which must be supported by invoices
1282	submitted by the medical director describing the work performed,
1283	the dates on which that work was performed, and the duration of
1284	that work; and
1285	3.  Be for a term of at least 1 year.
1286
1287	The hourly rate specified in the contract may not be increased
1288	during the term of the contract. The home health agency may not
1289	execute a subsequent contract with that physician which has an
1290	increased hourly rate and covers any portion of the term that
1291	was in the original contract.
1292	(j)  Gives remuneration to:
1293	1.  A physician, and the home health agency is in violation
1294	of paragraph (h) or paragraph (i);
1295	2.  A member of the physician's office staff; or
1296	3.  An immediate family member of the physician,
1297
1298	if the home health agency has received a patient referral in the
1299	preceding 12 months from that physician or physician's office
1300	staff.
1301	(k)  Fails to provide to the agency, upon request, copies
1302	of all contracts with a medical director which were executed
1303	within 5 years before the request.
1304	(l)  Demonstrates a pattern of billing the Medicaid program
1305	for services to Medicaid recipients which are medically
1306	unnecessary as determined by a final order. A pattern may be
1307	demonstrated by a showing of at least two such medically
1308	unnecessary services within one Medicaid program integrity audit
1309	period.
1310
1311	Nothing in paragraph (e) or paragraph (j) shall be interpreted
1312	as applying to or precluding any discount, compensation, waiver
1313	of payment, or payment practice permitted by 42 U.S.C. s. 1320a-
1314	7b(b) or regulations adopted thereunder, including 42 C.F.R. s.
1315	1001.952, or by 42 U.S.C. s. 1395nn or regulations adopted
1316	thereunder.
1317	Section 18.  Paragraph (a) of subsection (15) of section
1318	400.506, Florida Statutes, is amended to read:
1319	400.506  Licensure of nurse registries; requirements;
1320	penalties.--
1321	(15)(a)  The agency may deny, suspend, or revoke the
1322	license of a nurse registry and shall impose a fine of $5,000
1323	against a nurse registry that:
1324	1.  Provides services to residents in an assisted living
1325	facility for which the nurse registry does not receive fair
1326	market value remuneration.
1327	2.  Provides staffing to an assisted living facility for
1328	which the nurse registry does not receive fair market value
1329	remuneration.
1330	3.  Fails to provide the agency, upon request, with copies
1331	of all contracts with assisted living facilities which were
1332	executed within the last 5 years.
1333	4.  Gives remuneration to a case manager, discharge
1334	planner, facility-based staff member, or third-party vendor who
1335	is involved in the discharge planning process of a facility
1336	licensed under chapter 395 or this chapter and from whom the
1337	nurse registry receives referrals. This subparagraph does not
1338	apply to a nurse registry that does not participate in the
1339	Medicaid or Medicare programs.
1340	5.  Gives remuneration to a physician, a member of the
1341	physician's office staff, or an immediate family member of the
1342	physician, and the nurse registry received a patient referral in
1343	the last 12 months from that physician or the physician's office
1344	staff. This subparagraph does not apply to a nurse registry that
1345	does not participate in the Medicaid or Medicare programs.
1346	Section 19.  Paragraph (m) is added to subsection (4) of
1347	section 400.9905, Florida Statutes, to read:
1348	400.9905  Definitions.--
1349	(4)  "Clinic" means an entity at which health care services
1350	are provided to individuals and which tenders charges for
1351	reimbursement for such services, including a mobile clinic and a
1352	portable equipment provider. For purposes of this part, the term
1353	does not include and the licensure requirements of this part do
1354	not apply to:
1355	(m)  Entities that do not seek reimbursement from insurance
1356	companies for medical services paid pursuant to personal injury
1357	protection coverage required by s. 627.736, bodily liability
1358	coverage, uninsured motorist coverage, or personal umbrella
1359	liability coverage.
1360	Section 20.  Paragraph (a) of subsection (7) of section
1361	400.9935, Florida Statutes, is amended to read:
1362	400.9935  Clinic responsibilities.--
1363	(7)(a)  Each clinic engaged in magnetic resonance imaging
1364	services must be accredited by the Joint Commission on
1365	Accreditation of Healthcare Organizations, the American College
1366	of Radiology, or the Accreditation Association for Ambulatory
1367	Health Care, within 1 year after licensure. A clinic that is
1368	accredited by the American College of Radiology or is within the
1369	original 1-year period after licensure and replaces its core
1370	magnetic resonance imaging equipment shall be given 1 year after
1371	the date upon which the equipment is replaced to attain
1372	accreditation. However, a clinic may request a single, 6-month
1373	extension if it provides evidence to the agency establishing
1374	that, for good cause shown, such clinic cannot can not be
1375	accredited within 1 year after licensure, and that such
1376	accreditation will be completed within the 6-month extension.
1377	After obtaining accreditation as required by this subsection,
1378	each such clinic must maintain accreditation as a condition of
1379	renewal of its license. A clinic that files a change of
1380	ownership application must comply with the original
1381	accreditation timeframe requirements of the transferor. The
1382	agency shall deny a change of ownership application if the
1383	clinic is not in compliance with the accreditation requirements.
1384	When a clinic adds, replaces, or modifies magnetic resonance
1385	imaging equipment and the accrediting organization requires new
1386	accreditation, the clinic must be accredited within 1 year after
1387	the date of the addition, replacement, or modification but may
1388	request a single, 6-month extension if the clinic provides
1389	evidence of good cause to the agency.
1390	Section 21.  Subsection (6) of section 400.995, Florida
1391	Statutes, is amended to read:
1392	400.995  Agency administrative penalties.--
1393	(6)  During an inspection, the agency, as an alternative to
1394	or in conjunction with an administrative action against a clinic
1395	for violations of this part and adopted rules, shall make a
1396	reasonable attempt to discuss each violation and recommended
1397	corrective action with the owner, medical director, or clinic
1398	director of the clinic, prior to written notification. The
1399	agency, instead of fixing a period within which the clinic shall
1400	enter into compliance with standards, may request a plan of
1401	corrective action from the clinic which demonstrates a good
1402	faith effort to remedy each violation by a specific date,
1403	subject to the approval of the agency.
1404	Section 22.  Subsections (5), (9), and (13) of section
1405	408.803, Florida Statutes, are amended to read:
1406	408.803  Definitions.--As used in this part, the term:
1407	(5)  "Change of ownership" means:
1408	(a)  An event in which the licensee sells or otherwise
1409	transfers its ownership changes to a different individual or
1410	legal entity, as evidenced by a change in federal employer
1411	identification number or taxpayer identification number; or
1412	(b)  An event in which 51 45 percent or more of the
1413	ownership, voting shares, membership, or controlling interest of
1414	a licensee is in any manner transferred or otherwise assigned.
1415	This paragraph does not apply to a licensee that is publicly
1416	traded on a recognized stock exchange. In a corporation whose
1417	shares are not publicly traded on a recognized stock exchange is
1418	transferred or assigned, including the final transfer or
1419	assignment of multiple transfers or assignments over a 2-year
1420	period that cumulatively total 45 percent or greater.
1421
1422	A change solely in the management company or board of directors
1423	is not a change of ownership.
1424	(9)  "Licensee" means an individual, corporation,
1425	partnership, firm, association, or governmental entity, or other
1426	entity that is issued a permit, registration, certificate, or
1427	license by the agency. The licensee is legally responsible for
1428	all aspects of the provider operation.
1429	(13)  "Voluntary board member" means a board member of a
1430	not-for-profit corporation or organization who serves solely in
1431	a voluntary capacity, does not receive any remuneration for his
1432	or her services on the board of directors, and has no financial
1433	interest in the corporation or organization. The agency shall
1434	recognize a person as a voluntary board member following
1435	submission of a statement to the agency by the board member and
1436	the not-for-profit corporation or organization that affirms that
1437	the board member conforms to this definition. The statement
1438	affirming the status of the board member must be submitted to
1439	the agency on a form provided by the agency.
1440	Section 23.  Paragraph (a) of subsection (1), subsection
1441	(2), paragraph (c) of subsection (7), and subsection (8) of
1442	section 408.806, Florida Statutes, are amended to read:
1443	408.806  License application process.--
1444	(1)  An application for licensure must be made to the
1445	agency on forms furnished by the agency, submitted under oath,
1446	and accompanied by the appropriate fee in order to be accepted
1447	and considered timely. The application must contain information
1448	required by authorizing statutes and applicable rules and must
1449	include:
1450	(a)  The name, address, and social security number of:
1451	1.  The applicant;
1452	2.  The administrator or a similarly titled person who is
1453	responsible for the day-to-day operation of the provider;
1454	3.  The financial officer or similarly titled person who is
1455	responsible for the financial operation of the licensee or
1456	provider; and
1457	4.  Each controlling interest if the applicant or
1458	controlling interest is an individual.
1459	(2)(a)  The applicant for a renewal license must submit an
1460	application that must be received by the agency at least 60 days
1461	but no more than 120 days prior to the expiration of the current
1462	license. An application received more than 120 days prior to the
1463	expiration of the current license shall be returned to the
1464	applicant. If the renewal application and fee are received prior
1465	to the license expiration date, the license shall not be deemed
1466	to have expired if the license expiration date occurs during the
1467	agency's review of the renewal application.
1468	(b)  The applicant for initial licensure due to a change of
1469	ownership must submit an application that must be received by
1470	the agency at least 60 days prior to the date of change of
1471	ownership.
1472	(c)  For any other application or request, the applicant
1473	must submit an application or request that must be received by
1474	the agency at least 60 days but no more than 120 days prior to
1475	the requested effective date, unless otherwise specified in
1476	authorizing statutes or applicable rules. An application
1477	received more than 120 days prior to the requested effective
1478	date shall be returned to the applicant.
1479	(d)  The agency shall notify the licensee by mail or
1480	electronically at least 90 days prior to the expiration of a
1481	license that a renewal license is necessary to continue
1482	operation. The failure to timely submit a renewal application
1483	and license fee shall result in a $50 per day late fee charged
1484	to the licensee by the agency; however, the aggregate amount of
1485	the late fee may not exceed 50 percent of the licensure fee or
1486	$500, whichever is less. If an application is received after the
1487	required filing date and exhibits a hand-canceled postmark
1488	obtained from a United States post office dated on or before the
1489	required filing date, no fine will be levied.
1490	(7)
1491	(c)  If an inspection is required by the authorizing
1492	statute for a license application other than an initial
1493	application, the inspection must be unannounced. This paragraph
1494	does not apply to inspections required pursuant to ss. 383.324,
1495	395.0161(4), 429.67(6), and 483.061(2).
1496	(8)  The agency may establish procedures for the electronic
1497	notification and submission of required information, including,
1498	but not limited to:
1499	(a)  Licensure applications.
1500	(b)  Required signatures.
1501	(c)  Payment of fees.
1502	(d)  Notarization of applications.
1503
1504	Requirements for electronic submission of any documents required
1505	by this part or authorizing statutes may be established by rule.
1506	As an alternative to sending documents as required by
1507	authorizing statutes, the agency may provide electronic access
1508	to information or documents.
1509	Section 24.  Section 408.8065, Florida Statutes, is created
1510	to read:
1511	408.8065  Additional licensure requirements for home health
1512	agencies, home medical equipment providers, and health care
1513	clinics.--
1514	(1)  An applicant for initial licensure, or initial
1515	licensure due to a change of ownership, as a home health agency,
1516	home medical equipment provider, or health care clinic shall:
1517	(a)  Demonstrate financial ability to operate, as required
1518	under s. 408.810(8).
1519	(b)  Submit pro forma financial statements, including a
1520	balance sheet, income and expense statement, and a statement of
1521	cash flows for the first 2 years of operation which provide
1522	evidence that the applicant has sufficient assets, credit, and
1523	projected revenues to cover liabilities and expenses.
1524	(c)  Submit a statement of the applicant's estimated
1525	startup costs and sources of funds through the break-even point
1526	in operations demonstrating that the applicant has the ability
1527	to fund all startup costs, working capital, and contingency
1528	financing. The statement must show that the applicant has at a
1529	minimum 3 months of average projected expenses to cover startup
1530	costs, working capital, and contingency financing. The minimum
1531	amount for contingency funding may not be less than 1 month of
1532	average projected expenses.
1533	(d)  Demonstrate the financial ability to operate if the
1534	applicant's assets, credit, and projected revenues meet or
1535	exceed projected liabilities and expenses, and provide
1536	independent evidence that the funds necessary for startup costs,
1537	working capital, and contingency financing exist and will be
1538	available as needed.
1539
1540	All documents required under this subsection must be prepared in
1541	accordance with generally accepted accounting principles and may
1542	be in a compilation form. The financial statements must be
1543	signed by a certified public accountant.
1544	(2)  For initial, renewal, or change of ownership licenses
1545	for a home health agency, a home medical equipment provider, or
1546	a health care clinic, applicants and controlling interests who
1547	are nonimmigrant aliens, as described in 8 U.S.C. 1101, must
1548	file a surety bond of at least $500,000, payable to the agency,
1549	which guarantees that the home health agency, home medical
1550	equipment provider, or health care clinic will act in full
1551	conformity with all legal requirements for operation.
1552	(3)  In addition to the penalties provided in s. 408.812,
1553	any person who offers services that require licensure under part
1554	VII or part X of chapter 400, or who offers skilled services
1555	that require licensure under part III of chapter 400, without
1556	obtaining a valid license; any person who knowingly files a
1557	false or misleading license or license renewal application or
1558	who submits false or misleading information related to such
1559	application; and any person who violates or conspires to violate
1560	this section, commits a felony of the third degree, punishable
1561	as provided in s. 775.082, s. 775.083, or s. 775.084.
1562	Section 25.  Subsection (2) of section 408.808, Florida
1563	Statutes, is amended to read:
1564	408.808  License categories.--
1565	(2)  PROVISIONAL LICENSE.--A provisional license may be
1566	issued to an applicant pursuant to s. 408.809(3). An applicant
1567	against whom a proceeding denying or revoking a license is
1568	pending at the time of license renewal may be issued a
1569	provisional license effective until final action not subject to
1570	further appeal. A provisional license may also be issued to an
1571	applicant applying for a change of ownership. A provisional
1572	license shall be limited in duration to a specific period of
1573	time, not to exceed 12 months, as determined by the agency.
1574	Section 26.  Subsection (5) of section 408.809, Florida
1575	Statutes, is amended, and new subsections (5) and (6) are added
1576	to that section, to read:
1577	408.809  Background screening; prohibited offenses.--
1578	(5)  Effective October 1, 2009, in addition to the offenses
1579	listed in ss. 435.03 and 435.04, all persons required to undergo
1580	background screening pursuant to this part or authorizing
1581	statutes must not have been found guilty of, regardless of
1582	adjudication, or entered a plea of nolo contendere or guilty to,
1583	any of the following offenses or any similar offense of another
1584	jurisdiction:
1585	(a)  A violation of any authorizing statutes, if the
1586	offense was a felony.
1587	(b)  A violation of this chapter, if the offense was a
1588	felony.
1589	(c)  A violation of s. 409.920, relating to Medicaid
1590	provider fraud, if the offense was a felony.
1591	(d)  A violation of s. 409.9201, relating to Medicaid
1592	fraud, if the offense was a felony.
1593	(e)  A violation of s. 741.28, relating to domestic
1594	violence.
1595	(f)  A violation of chapter 784, relating to assault,
1596	battery, and culpable negligence, if the offense was a felony.
1597	(g)  A violation of s. 810.02, relating to burglary.
1598	(h)  A violation of s. 817.034, relating to fraudulent acts
1599	through mail, wire, radio, electromagnetic, photoelectronic, or
1600	photooptical systems.
1601	(i)  A violation of s. 817.234, relating to false and
1602	fraudulent insurance claims.
1603	(j)  A violation of s. 817.505, relating to patient
1604	brokering.
1605	(k)  A violation of s. 817.568, relating to criminal use of
1606	personal identification information.
1607	(l)  A violation of s. 817.60, relating to obtaining a
1608	credit card through fraudulent means.
1609	(m)  A violation of s. 817.61, relating to fraudulent use
1610	of credit cards, if the offense was a felony.
1611	(n)  A violation of s. 831.01, relating to forgery.
1612	(o)  A violation of s. 831.02, relating to uttering forged
1613	instruments.
1614	(p)  A violation of s. 831.07, relating to forging bank
1615	bills, checks, drafts, or promissory notes.
1616	(q)  A violation of s. 831.09, relating to uttering forged
1617	bank bills, checks, drafts, or promissory notes.
1618	(r)  A violation of s. 831.30, relating to fraud in
1619	obtaining medicinal drugs.
1620	(s)  A violation of s. 831.31, relating to the sale,
1621	manufacture, delivery, or possession with the intent to sell,
1622	manufacture, or deliver any counterfeit controlled substance, if
1623	the offense was a felony.
1624
1625	A person who serves as a controlling interest of or is employed
1626	by a licensee on September 30, 2009, shall not be required by
1627	law to submit to rescreening if that licensee has in its
1628	possession written evidence that the person has been screened
1629	and qualified according to the standards specified in s. 435.03
1630	or s. 435.04. However, if such person has been convicted of a
1631	disqualifying offense listed in this subsection, he or she may
1632	apply for an exemption from the appropriate licensing agency
1633	before September 30, 2009, and if agreed to by the employer, may
1634	continue to perform his or her duties until the licensing agency
1635	renders a decision on the application for exemption for an
1636	offense listed in this subsection. Exemptions from
1637	disqualification may be granted pursuant to s. 435.07.
1638	(6)  The attestations required under ss. 435.04(5) and
1639	435.05(3) must be submitted at the time of license renewal,
1640	notwithstanding the provisions of ss. 435.04(5) and 435.05(3)
1641	which require annual submission of an affidavit of compliance
1642	with background screening requirements.
1643	(5)  Background screening is not required to obtain a
1644	certificate of exemption issued under s. 483.106.
1645	Section 27.  Subsection (3) and paragraph (a) of subsection
1646	(5) of section 408.810, Florida Statutes, are amended to read:
1647	408.810  Minimum licensure requirements.--In addition to
1648	the licensure requirements specified in this part, authorizing
1649	statutes, and applicable rules, each applicant and licensee must
1650	comply with the requirements of this section in order to obtain
1651	and maintain a license.
1652	(3)  Unless otherwise specified in this part, authorizing
1653	statutes, or applicable rules, any information required to be
1654	reported to the agency must be submitted within 21 calendar days
1655	after the report period or effective date of the information,
1656	whichever is earlier, including, but not limited to, any change
1657	of:
1658	(a)  Information contained in the most recent application
1659	for licensure.
1660	(b)  Required insurance or bonds.
1661	(5)(a)  On or before the first day services are provided to
1662	a client, a licensee must inform the client and his or her
1663	immediate family or representative, if appropriate, of the right
1664	to report:
1665	1.  Complaints. The statewide toll-free telephone number
1666	for reporting complaints to the agency must be provided to
1667	clients in a manner that is clearly legible and must include the
1668	words: "To report a complaint regarding the services you
1669	receive, please call toll-free (phone number)."
1670	2.  Abusive, neglectful, or exploitative practices. The
1671	statewide toll-free telephone number for the central abuse
1672	hotline must be provided to clients in a manner that is clearly
1673	legible and must include the words: "To report abuse, neglect,
1674	or exploitation, please call toll-free (phone number)."
1675	3.  Medicaid fraud. An agency-written description of
1676	Medicaid fraud and the statewide toll-free telephone number for
1677	the central Medicaid fraud hotline must be provided to clients
1678	in a manner that is clearly legible and must include the
1679	following statement: "To report suspected Medicaid fraud, please
1680	call toll-free (phone number)."
1681
1682	The agency shall publish a minimum of a 90-day advance notice of
1683	a change in the toll-free telephone numbers.
1684	Section 28.  Present subsection (4) of section 408.811,
1685	Florida Statutes, is renumbered as subsection (6), subsections
1686	(2) and (3) are amended, and new subsections (4) and (5) are
1687	added to that section, to read:
1688	408.811  Right of inspection; copies; inspection reports;
1689	plan for correction of deficiencies.--
1690	(2)  Inspections conducted in conjunction with
1691	certification, comparable licensure requirements, or a
1692	recognized or approved accreditation organization may be
1693	accepted in lieu of a complete licensure inspection. However, a
1694	licensure inspection may also be conducted to review any
1695	licensure requirements that are not also requirements for
1696	certification.
1697	(3)  The agency shall have access to and the licensee shall
1698	provide, or if requested send, copies of all provider records
1699	required during an inspection or other review at no cost to the
1700	agency, including records requested during an offsite review.
1701	(4)  Deficiencies must be corrected within 30 calendar days
1702	after the provider is notified of inspection results unless an
1703	alternative timeframe is required or approved by the agency.
1704	(5)  The agency may require an applicant or licensee to
1705	submit a plan of correction for deficiencies. If required, the
1706	plan of correction must be filed with the agency within 10
1707	calendar days after notification unless an alternative timeframe
1708	is required.
1709	Section 29.  Section 408.813, Florida Statutes, is amended
1710	to read:
1711	408.813  Administrative fines; violations.--As a penalty
1712	for any violation of this part, authorizing statutes, or
1713	applicable rules, the agency may impose an administrative fine.
1714	(1)  Unless the amount or aggregate limitation of the fine
1715	is prescribed by authorizing statutes or applicable rules, the
1716	agency may establish criteria by rule for the amount or
1717	aggregate limitation of administrative fines applicable to this
1718	part, authorizing statutes, and applicable rules. Each day of
1719	violation constitutes a separate violation and is subject to a
1720	separate fine, unless a per-violation fine is prescribed by law.
1721	For fines imposed by final order of the agency and not subject
1722	to further appeal, the violator shall pay the fine plus interest
1723	at the rate specified in s. 55.03 for each day beyond the date
1724	set by the agency for payment of the fine.
1725	(2)  Violations of this part, authorizing statutes, or
1726	applicable rules shall be classified according to the nature of
1727	the violation and the gravity of its probable effect on clients.
1728	The scope of a violation may be cited as an isolated, patterned,
1729	or widespread deficiency. An isolated deficiency is a deficiency
1730	affecting one or a very limited number of clients, or involving
1731	one or a very limited number of staff, or a situation that
1732	occurred only occasionally or occurred in a very limited number
1733	of locations. A patterned deficiency is a deficiency in which
1734	more than a very limited number of clients are affected, or more
1735	than a very limited number of staff are involved, or the
1736	situation has occurred in several locations, or the same client
1737	or clients have been affected by repeated occurrences of the
1738	same deficient practice but the effect of the deficient practice
1739	is not found to be pervasive throughout the provider. A
1740	widespread deficiency is a deficiency in which the problems
1741	causing the deficiency are pervasive in the provider or
1742	represent systemic failure that has affected or has the
1743	potential to affect a large portion of the provider's clients.
1744	This subsection does not affect the legislative determination of
1745	the amount of a fine imposed under authorizing statutes.
1746	Violations shall be classified on the written notice as follows:
1747	(a)  Class I violations are those conditions or occurrences
1748	related to the operation and maintenance of a provider or to the
1749	care of clients which the agency determines present an imminent
1750	danger to the clients of the provider or a substantial
1751	probability that death or serious physical or emotional harm
1752	would result therefrom. The condition or practice constituting a
1753	class I violation shall be abated or eliminated within 24 hours,
1754	unless a fixed period, as determined by the agency, is required
1755	for correction. The agency shall impose an administrative fine
1756	as provided by law for a cited class I violation. A fine shall
1757	be levied notwithstanding the correction of the violation.
1758	(b)  Class II violations are those conditions or
1759	occurrences related to the operation and maintenance of a
1760	provider or to the care of clients which the agency determines
1761	directly threaten the physical or emotional health, safety, or
1762	security of the clients, other than class I violations. The
1763	agency shall impose an administrative fine as provided by law
1764	for a cited class II violation. A fine shall be levied
1765	notwithstanding the correction of the violation.
1766	(c)  Class III violations are those conditions or
1767	occurrences related to the operation and maintenance of a
1768	provider or to the care of clients which the agency determines
1769	indirectly or potentially threaten the physical or emotional
1770	health, safety, or security of clients, other than class I or
1771	class II violations. The agency shall impose an administrative
1772	fine as provided by law for a cited class III violation. A
1773	citation for a class III violation must specify the time within
1774	which the violation is required to be corrected. If a class III
1775	violation is corrected within the time specified, a fine may not
1776	be imposed.
1777	(d)  Class IV violations are those conditions or
1778	occurrences related to the operation and maintenance of a
1779	provider or to required reports, forms, or documents that do not
1780	have the potential of negatively affecting clients. These
1781	violations are of a type that the agency determines do not
1782	threaten the health, safety, or security of clients. The agency
1783	shall impose an administrative fine as provided by law for a
1784	cited class IV violation. A citation for a class IV violation
1785	must specify the time within which the violation is required to
1786	be corrected. If a class IV violation is corrected within the
1787	time specified, a fine may not be imposed.
1788	Section 30.  Subsection (4) is added to section 408.815,
1789	Florida Statutes, to read:
1790	408.815  License or application denial; revocation.--
1791	(4)  In addition to the grounds provided in authorizing
1792	statutes, the agency shall deny an application for a license or
1793	license renewal if the applicant or a person having a
1794	controlling interest in an applicant has been:
1795	(a)  Convicted of, or entered a plea of guilty or nolo
1796	contendere to, regardless of adjudication, a felony under
1797	chapter 409, chapter 817, chapter 893, 21 U.S.C. ss. 801-970, or
1798	42 U.S.C. ss. 1395-1396, unless the sentence and any subsequent
1799	period of probation for such conviction or plea ended more than
1800	15 years prior to the date of the application;
1801	(b)  Terminated for cause from the Florida Medicaid program
1802	pursuant to s. 409.913, unless the applicant has been in good
1803	standing with the Florida Medicaid program for the most recent 5
1804	years; or
1805	(c)  Terminated for cause, pursuant to the appeals
1806	procedures established by the state or Federal Government, from
1807	the federal Medicare program or from any other state Medicaid
1808	program, unless the applicant has been in good standing with a
1809	state Medicaid program or the federal Medicare program for the
1810	most recent 5 years and the termination occurred more than 19
1811	years prior to the date of the application.
1812	Section 31.  Subsections (12) through (29) of section
1813	408.820, Florida Statutes, are renumbered as subsections (11)
1814	through (28), respectively, and present subsections (11), (12),
1815	(13), (21), and (26) of that section are amended to read:
1816	408.820  Exemptions.--Except as prescribed in authorizing
1817	statutes, the following exemptions shall apply to specified
1818	requirements of this part:
1819	(11)  Private review agents, as provided under part I of
1820	chapter 395, are exempt from ss. 408.806(7), 408.810, and
1821	408.811.
1822	(11)(12)  Health care risk managers, as provided under part
1823	I of chapter 395, are exempt from ss. 408.806(7), 408.810(4)-
1824	(10), and 408.811.
1825	(12)(13)  Nursing homes, as provided under part II of
1826	chapter 400, are exempt from ss. s. 408.810(7) and 408.813(2).
1827	(20)(21)  Transitional living facilities, as provided under
1828	part V of chapter 400, are exempt from s. 408.810(7)-(10).
1829	(25)(26)  Health care clinics, as provided under part X of
1830	chapter 400, are exempt from s. ss. 408.809 and 408.810(1), (6),
1831	(7), and (10).
1832	Section 32.  Section 408.821, Florida Statutes, is created
1833	to read:
1834	408.821  Emergency management planning; emergency
1835	operations; inactive license.--
1836	(1)  Licensees required by authorizing statutes to have an
1837	emergency operations plan must designate a safety liaison to
1838	serve as the primary contact for emergency operations.
1839	(2)  An entity subject to this part may temporarily exceed
1840	its licensed capacity to act as a receiving provider in
1841	accordance with an approved emergency operations plan for up to
1842	15 days. While in an overcapacity status, each provider must
1843	furnish or arrange for appropriate care and services to all
1844	clients. In addition, the agency may approve requests for
1845	overcapacity in excess of 15 days, which approvals may be based
1846	upon satisfactory justification and need as provided by the
1847	receiving and sending providers.
1848	(3)(a)  An inactive license may be issued to a licensee
1849	subject to this section when the provider is located in a
1850	geographic area in which a state of emergency was declared by
1851	the Governor if the provider:
1852	1.  Suffered damage to its operation during the state of
1853	emergency.
1854	2.  Is currently licensed.
1855	3.  Does not have a provisional license.
1856	4.  Will be temporarily unable to provide services but is
1857	reasonably expected to resume services within 12 months.
1858	(b)  An inactive license may be issued for a period not to
1859	exceed 12 months but may be renewed by the agency for up to 12
1860	additional months upon demonstration to the agency of progress
1861	toward reopening. A request by a licensee for an inactive
1862	license or to extend the previously approved inactive period
1863	must be submitted in writing to the agency, accompanied by
1864	written justification for the inactive license, which states the
1865	beginning and ending dates of inactivity and includes a plan for
1866	the transfer of any clients to other providers and appropriate
1867	licensure fees. Upon agency approval, the licensee shall notify
1868	clients of any necessary discharge or transfer as required by
1869	authorizing statutes or applicable rules. The beginning of the
1870	inactive licensure period shall be the date the provider ceases
1871	operations. The end of the inactive period shall become the
1872	license expiration date, and all licensure fees must be current,
1873	must be paid in full, and may be prorated. Reactivation of an
1874	inactive license requires the prior approval by the agency of a
1875	renewal application, including payment of licensure fees and
1876	agency inspections indicating compliance with all requirements
1877	of this part and applicable rules and statutes.
1878	(4)  The agency may adopt rules relating to emergency
1879	management planning, communications, and operations. Licensees
1880	providing residential or inpatient services must use an online
1881	database approved by the agency to report information to the
1882	agency regarding the provider's emergency status, planning, or
1883	operations.
1884	Section 33.  Subsections (3), (4), and (5) of section
1885	408.831, Florida Statutes, are amended to read:
1886	408.831  Denial, suspension, or revocation of a license,
1887	registration, certificate, or application.--
1888	(3)  An entity subject to this section may exceed its
1889	licensed capacity to act as a receiving facility in accordance
1890	with an emergency operations plan for clients of evacuating
1891	providers from a geographic area where an evacuation order has
1892	been issued by a local authority having jurisdiction. While in
1893	an overcapacity status, each provider must furnish or arrange
1894	for appropriate care and services to all clients. In addition,
1895	the agency may approve requests for overcapacity beyond 15 days,
1896	which approvals may be based upon satisfactory justification and
1897	need as provided by the receiving and sending facilities.
1898	(4)(a)  An inactive license may be issued to a licensee
1899	subject to this section when the provider is located in a
1900	geographic area where a state of emergency was declared by the
1901	Governor if the provider:
1902	1.  Suffered damage to its operation during that state of
1903	emergency.
1904	2.  Is currently licensed.
1905	3.  Does not have a provisional license.
1906	4.  Will be temporarily unable to provide services but is
1907	reasonably expected to resume services within 12 months.
1908	(b)  An inactive license may be issued for a period not to
1909	exceed 12 months but may be renewed by the agency for up to 12
1910	additional months upon demonstration to the agency of progress
1911	toward reopening. A request by a licensee for an inactive
1912	license or to extend the previously approved inactive period
1913	must be submitted in writing to the agency, accompanied by
1914	written justification for the inactive license, which states the
1915	beginning and ending dates of inactivity and includes a plan for
1916	the transfer of any clients to other providers and appropriate
1917	licensure fees. Upon agency approval, the licensee shall notify
1918	clients of any necessary discharge or transfer as required by
1919	authorizing statutes or applicable rules. The beginning of the
1920	inactive licensure period shall be the date the provider ceases
1921	operations. The end of the inactive period shall become the
1922	licensee expiration date, and all licensure fees must be
1923	current, paid in full, and may be prorated. Reactivation of an
1924	inactive license requires the prior approval by the agency of a
1925	renewal application, including payment of licensure fees and
1926	agency inspections indicating compliance with all requirements
1927	of this part and applicable rules and statutes.
1928	(3)(5)  This section provides standards of enforcement
1929	applicable to all entities licensed or regulated by the Agency
1930	for Health Care Administration. This section controls over any
1931	conflicting provisions of chapters 39, 383, 390, 391, 394, 395,
1932	400, 408, 429, 468, 483, and 765 or rules adopted pursuant to
1933	those chapters.
1934	Section 34.  Subsection (2) of section 408.918, Florida
1935	Statutes, is amended, and subsection (3) is added to that
1936	section, to read:
1937	408.918  Florida 211 Network; uniform certification
1938	requirements.--
1939	(2)  In order to participate in the Florida 211 Network, a
1940	211 provider must be fully accredited by the National certified
1941	by the Agency for Health Care Administration. The agency shall
1942	develop criteria for certification, as recommended by the
1943	Florida Alliance of Information and Referral Services or have
1944	received approval to operate, pending accreditation, from its
1945	affiliate, the Florida Alliance of Information and Referral
1946	Services, and shall adopt the criteria as administrative rules.
1947	(a)  If any provider of information and referral services
1948	or other entity leases a 211 number from a local exchange
1949	company and is not authorized as described in this section,
1950	certified by the agency, the agency shall, after consultation
1951	with the local exchange company and the Public Service
1952	Commission shall, request that the Federal Communications
1953	Commission direct the local exchange company to revoke the use
1954	of the 211 number.
1955	(b)  The agency shall seek the assistance and guidance of
1956	the Public Service Commission and the Federal Communications
1957	Commission in resolving any disputes arising over jurisdiction
1958	related to 211 numbers.
1959	(3)  The Florida Alliance of Information and Referral
1960	Services is the 211 collaborative organization for the state
1961	that is responsible for studying, designing, implementing,
1962	supporting, and coordinating the Florida 211 Network and
1963	receiving federal grants.
1964	Section 35.  Paragraph (e) of subsection (4) of section
1965	409.221, Florida Statutes, is amended to read:
1966	409.221  Consumer-directed care program.--
1967	(4)  CONSUMER-DIRECTED CARE.--
1968	(e)  Services.--Consumers shall use the budget allowance
1969	only to pay for home and community-based services that meet the
1970	consumer's long-term care needs and are a cost-efficient use of
1971	funds. Such services may include, but are not limited to, the
1972	following:
1973	1.  Personal care.
1974	2.  Homemaking and chores, including housework, meals,
1975	shopping, and transportation.
1976	3.  Home modifications and assistive devices which may
1977	increase the consumer's independence or make it possible to
1978	avoid institutional placement.
1979	4.  Assistance in taking self-administered medication.
1980	5.  Day care and respite care services, including those
1981	provided by nursing home facilities pursuant to s.
1982	400.141(1)(f)(6) or by adult day care facilities licensed
1983	pursuant to s. 429.907.
1984	6.  Personal care and support services provided in an
1985	assisted living facility.
1986	Section 36.  Subsection (5) of section 409.901, Florida
1987	Statutes, is amended to read:
1988	409.901  Definitions; ss. 409.901-409.920.--As used in ss.
1989	409.901-409.920, except as otherwise specifically provided, the
1990	term:
1991	(5)  "Change of ownership" means:
1992	(a)  An event in which the provider ownership changes to a
1993	different individual legal entity, as evidenced by a change in
1994	federal employer identification number or taxpayer
1995	identification number; or
1996	(b)  An event in which 51 45 percent or more of the
1997	ownership, voting shares, membership, or controlling interest of
1998	a provider is in any manner transferred or otherwise assigned.
1999	This paragraph does not apply to a licensee that is publicly
2000	traded on a recognized stock exchange; or
2001	(c)  When the provider is licensed or registered by the
2002	agency, an event considered a change of ownership for licensure
2003	as defined in s. 408.803 in a corporation whose shares are not
2004	publicly traded on a recognized stock exchange is transferred or
2005	assigned, including the final transfer or assignment of multiple
2006	transfers or assignments over a 2-year period that cumulatively
2007	total 45 percent or more.
2008
2009	A change solely in the management company or board of directors
2010	is not a change of ownership.
2011	Section 37.  Subsection (4) of section 409.905, Florida
2012	Statutes, is amended to read:
2013	409.905  Mandatory Medicaid services.--The agency may make
2014	payments for the following services, which are required of the
2015	state by Title XIX of the Social Security Act, furnished by
2016	Medicaid providers to recipients who are determined to be
2017	eligible on the dates on which the services were provided. Any
2018	service under this section shall be provided only when medically
2019	necessary and in accordance with state and federal law.
2020	Mandatory services rendered by providers in mobile units to
2021	Medicaid recipients may be restricted by the agency. Nothing in
2022	this section shall be construed to prevent or limit the agency
2023	from adjusting fees, reimbursement rates, lengths of stay,
2024	number of visits, number of services, or any other adjustments
2025	necessary to comply with the availability of moneys and any
2026	limitations or directions provided for in the General
2027	Appropriations Act or chapter 216.
2028	(4)  HOME HEALTH CARE SERVICES.--The agency shall pay for
2029	nursing and home health aide services, supplies, appliances, and
2030	durable medical equipment, necessary to assist a recipient
2031	living at home. An entity that provides services pursuant to
2032	this subsection shall be licensed under part III of chapter 400.
2033	These services, equipment, and supplies, or reimbursement
2034	therefor, may be limited as provided in the General
2035	Appropriations Act and do not include services, equipment, or
2036	supplies provided to a person residing in a hospital or nursing
2037	facility.
2038	(a)  In providing home health care services, the agency may
2039	require prior authorization of care based on diagnosis or
2040	utilization or billing rates. The agency shall require prior
2041	authorization for visits for home health services that are not
2042	associated with a skilled nursing visit when the home health
2043	agency billing rates exceed the state average by 50 percent or
2044	more. The home health agency must submit the recipient's plan of
2045	care and documentation that supports the recipient's diagnosis
2046	to the agency when requesting prior authorization.
2047	(b)  The agency shall implement a comprehensive utilization
2048	management program that requires prior authorization of all
2049	private duty nursing services, an individualized treatment plan
2050	that includes information about medication and treatment orders,
2051	treatment goals, methods of care to be used, and plans for care
2052	coordination by nurses and other health professionals. The
2053	utilization management program shall also include a process for
2054	periodically reviewing the ongoing use of private duty nursing
2055	services. The assessment of need shall be based on a child's
2056	condition, family support and care supplements, a family's
2057	ability to provide care, and a family's and child's schedule
2058	regarding work, school, sleep, and care for other family
2059	dependents. When implemented, the private duty nursing
2060	utilization management program shall replace the current
2061	authorization program used by the Agency for Health Care
2062	Administration and the Children's Medical Services program of
2063	the Department of Health. The agency may competitively bid on a
2064	contract to select a qualified organization to provide
2065	utilization management of private duty nursing services. The
2066	agency is authorized to seek federal waivers to implement this
2067	initiative.
2068	(c)  The agency may not pay for home health services unless
2069	the services are medically necessary and:
2070	1.  The services are ordered by a physician.
2071	2.  The written prescription for the services is signed and
2072	dated by the recipient's physician before the development of a
2073	plan of care and before any request requiring prior
2074	authorization.
2075	3.  The physician ordering the services is not employed,
2076	under contract with, or otherwise affiliated with the home
2077	health agency rendering the services. However, this subparagraph
2078	does not apply to a home health agency affiliated with a
2079	retirement community, of which the parent corporation or a
2080	related legal entity owns a rural health clinic certified under
2081	42 C.F.R. part 491, subpart A, ss. 1-11, a nursing home licensed
2082	under part II of chapter 400, or an apartment or single-family
2083	home for independent living.
2084	4.  The physician ordering the services has examined the
2085	recipient within the 30 days preceding the initial request for
2086	the services and biannually thereafter.
2087	5.  The written prescription for the services includes the
2088	recipient's acute or chronic medical condition or diagnosis, the
2089	home health service required, and, for skilled nursing services,
2090	the frequency and duration of the services.
2091	6.  The national provider identifier, Medicaid
2092	identification number, or medical practitioner license number of
2093	the physician ordering the services is listed on the written
2094	prescription for the services, the claim for home health
2095	reimbursement, and the prior authorization request.
2096	Section 38.  Paragraphs (k) and (l) are added to subsection
2097	(3) of section 409.907, Florida Statutes, subsection (9) is
2098	amended, subsection (12) is renumbered as subsection (13) and
2099	amended, and new subsections (12) and (14) are added to that
2100	section, to read:
2101	409.907  Medicaid provider agreements.--The agency may make
2102	payments for medical assistance and related services rendered to
2103	Medicaid recipients only to an individual or entity who has a
2104	provider agreement in effect with the agency, who is performing
2105	services or supplying goods in accordance with federal, state,
2106	and local law, and who agrees that no person shall, on the
2107	grounds of handicap, race, color, or national origin, or for any
2108	other reason, be subjected to discrimination under any program
2109	or activity for which the provider receives payment from the
2110	agency.
2111	(3)  The provider agreement developed by the agency, in
2112	addition to the requirements specified in subsections (1) and
2113	(2), shall require the provider to:
2114	(k)  Fully comply with the agency's medical encounter data
2115	system.
2116	(l)  Report specific actions by the managed care plan to
2117	provide incentives for healthy behaviors.
2118	(9)  Upon receipt of a completed, signed, and dated
2119	application, and completion of any necessary background
2120	investigation and criminal history record check, the agency must
2121	either:
2122	(a)  Enroll the applicant as a Medicaid provider upon
2123	approval of the provider application. The enrollment effective
2124	date shall be the date the agency receives the provider
2125	application. With respect to a provider that requires a Medicare
2126	certification survey, the enrollment effective date is the date
2127	the certification is awarded. With respect to a provider that
2128	completes a change of ownership, the effective date is the date
2129	the agency received the application, the date the change of
2130	ownership was complete, or the date the applicant became
2131	eligible to provide services under Medicaid, whichever date is
2132	later. With respect to a provider of emergency medical services
2133	transportation or emergency services and care, the effective
2134	date is the date the services were rendered. Payment for any
2135	claims for services provided to Medicaid recipients between the
2136	date of receipt of the application and the date of approval is
2137	contingent on applying any and all applicable audits and edits
2138	contained in the agency's claims adjudication and payment
2139	processing systems. The agency may enroll a provider located
2140	outside the state if the provider's location is no more than 50
2141	miles from the Florida state line, and the agency determines a
2142	need for that provider type to ensure adequate access to care;
2143	or
2144	(b)  Deny the application if the agency finds that it is in
2145	the best interest of the Medicaid program to do so. The agency
2146	may consider the factors listed in subsection (10), as well as
2147	any other factor that could affect the effective and efficient
2148	administration of the program, including, but not limited to,
2149	the applicant's demonstrated ability to provide services,
2150	conduct business, and operate a financially viable concern; the
2151	current availability of medical care, services, or supplies to
2152	recipients, taking into account geographic location and
2153	reasonable travel time; the number of providers of the same type
2154	already enrolled in the same geographic area; and the
2155	credentials, experience, success, and patient outcomes of the
2156	provider for the services that it is making application to
2157	provide in the Medicaid program. The agency shall deny the
2158	application if the agency finds that a provider; any officer,
2159	director, agent, managing employee, or affiliated person; or any
2160	partner or shareholder having an ownership interest equal to 5
2161	percent or greater in the provider if the provider is a
2162	corporation, partnership, or other business entity, has failed
2163	to pay all outstanding fines or overpayments assessed by final
2164	order of the agency or final order of the Centers for Medicare
2165	and Medicaid Services, not subject to further appeal, unless the
2166	provider agrees to a repayment plan that includes withholding
2167	Medicaid reimbursement until the amount due is paid in full.
2168	(12)  A managed care plan that has the capacity to provide
2169	covered services to all enrollees in compliance with agency
2170	requirements, with the exception of at least one essential
2171	provider despite a good faith effort to execute a contract with
2172	that provider, shall not be sanctioned or precluded from
2173	operating in a new service area by the agency as long as the
2174	managed care plan demonstrates its ability to provide services
2175	within a reasonable travel time and distance or arranges for
2176	single case coverage and negotiates in good faith to execute a
2177	contract with the provider. For purposes of this subsection,
2178	"good faith effort" means the managed care plan:
2179	(a)  Offers a rate equivalent to, or greater than, the rate
2180	specified in s. 409.9128(5)(d).
2181	(b)  Does not engage in a pattern of unfair business
2182	practices, including unreasonable claims denials, payment
2183	delays, or referral patterns.
2184	(13)(12)  Licensed, certified, or otherwise qualified
2185	providers are not entitled to enrollment in a Medicaid provider
2186	network. However, a managed care plan that is relying on
2187	subsection (12) to meet agency requirements for a specific
2188	service area shall include any willing, qualified provider
2189	located in that area in the managed care plan's network and
2190	offer a rate equivalent to, or greater than, the Medicaid fee
2191	schedule or county billing rate specified in s. 409.915.
2192	(14)  By January 1, 2010, and annually thereafter until
2193	full compliance is reached, the agency shall submit to the
2194	Governor, the President of the Senate, and the Speaker of the
2195	House of Representatives a report that summarizes data regarding
2196	the agency's medical encounter data system, including the number
2197	of participating plans, the level of compliance of each plan,
2198	and specific problem areas. The report shall include issues and
2199	recommendations developed by the technical assistance panel
2200	created in s. 409.908(4)(b).
2201	Section 39.  Subsection (4) of section 409.908, Florida
2202	Statutes, is amended to read:
2203	409.908  Reimbursement of Medicaid providers.--Subject to
2204	specific appropriations, the agency shall reimburse Medicaid
2205	providers, in accordance with state and federal law, according
2206	to methodologies set forth in the rules of the agency and in
2207	policy manuals and handbooks incorporated by reference therein.
2208	These methodologies may include fee schedules, reimbursement
2209	methods based on cost reporting, negotiated fees, competitive
2210	bidding pursuant to s. 287.057, and other mechanisms the agency
2211	considers efficient and effective for purchasing services or
2212	goods on behalf of recipients. If a provider is reimbursed based
2213	on cost reporting and submits a cost report late and that cost
2214	report would have been used to set a lower reimbursement rate
2215	for a rate semester, then the provider's rate for that semester
2216	shall be retroactively calculated using the new cost report, and
2217	full payment at the recalculated rate shall be effected
2218	retroactively. Medicare-granted extensions for filing cost
2219	reports, if applicable, shall also apply to Medicaid cost
2220	reports. Payment for Medicaid compensable services made on
2221	behalf of Medicaid eligible persons is subject to the
2222	availability of moneys and any limitations or directions
2223	provided for in the General Appropriations Act or chapter 216.
2224	Further, nothing in this section shall be construed to prevent
2225	or limit the agency from adjusting fees, reimbursement rates,
2226	lengths of stay, number of visits, or number of services, or
2227	making any other adjustments necessary to comply with the
2228	availability of moneys and any limitations or directions
2229	provided for in the General Appropriations Act, provided the
2230	adjustment is consistent with legislative intent.
2231	(4)  Subject to any limitations or directions provided for
2232	in the General Appropriations Act, alternative health plans,
2233	health maintenance organizations, and prepaid health plans shall
2234	be reimbursed a fixed, prepaid amount negotiated, or
2235	competitively bid pursuant to s. 287.057, by the agency and
2236	prospectively paid to the provider monthly for each Medicaid
2237	recipient enrolled. The amount may not exceed the average amount
2238	the agency determines it would have paid, based on claims
2239	experience, for recipients in the same or similar category of
2240	eligibility. The agency shall calculate capitation rates on a
2241	regional basis and, beginning September 1, 1995, shall include
2242	age-band differentials in such calculations.
2243	(a)  As of September 1, 2011, or the date the agency
2244	determines that its encounter data is complete, valid, and
2245	tested through a simulated rate-setting process, whichever is
2246	later, the agency shall begin a budget-neutral adjustment of
2247	capitation rates based on aggregate risk scores for each plan's
2248	enrollees. During the first 2 years of the adjustment, the
2249	agency shall ensure that no plan has an aggregate risk score
2250	that varies by more than 10 percent from the aggregate weighted
2251	average for all plans. The risk-adjusted capitation rates shall
2252	be phased in as follows:
2253	1.  In the first fiscal year, 75 percent of the capitation
2254	rate shall be based on the current methodology and 25 percent
2255	shall be based on the risk-adjusted capitation rate methodology.
2256	2.  In the second fiscal year, 50 percent of the capitation
2257	rate shall be based on the current methodology and 50 percent
2258	shall be based on the risk-adjusted rate methodology.
2259	3.  In the third fiscal year, the risk-adjusted capitation
2260	methodology shall be fully implemented.
2261	(b)  The secretary of the agency shall convene a technical
2262	advisory panel to advise the agency in the area of risk-adjusted
2263	rate-setting during the transition to risk-adjusted capitation
2264	rates described in paragraph (a). The panel shall include
2265	representatives of prepaid plans in counties not included in the
2266	demonstration sites established under s. 409.91211(1). The panel
2267	shall advise the agency regarding:
2268	1.  The selection of a base year of encounter data to be
2269	used to set risk-adjusted rates.
2270	2.  The completeness and accuracy of the encounter data.
2271	3.  The effect of risk-adjusted rates on prepaid plans
2272	based on a review of a simulated rate-setting process.
2273	Section 40.  Paragraph (b) of subsection (4) and
2274	subsections (14), (17), and (19) of section 409.912, Florida
2275	Statutes, are amended, and subsections (54) and (55) are added
2276	to that section, to read:
2277	409.912  Cost-effective purchasing of health care.--The
2278	agency shall purchase goods and services for Medicaid recipients
2279	in the most cost-effective manner consistent with the delivery
2280	of quality medical care. To ensure that medical services are
2281	effectively utilized, the agency may, in any case, require a
2282	confirmation or second physician's opinion of the correct
2283	diagnosis for purposes of authorizing future services under the
2284	Medicaid program. This section does not restrict access to
2285	emergency services or poststabilization care services as defined
2286	in 42 C.F.R. part 438.114. Such confirmation or second opinion
2287	shall be rendered in a manner approved by the agency. The agency
2288	shall maximize the use of prepaid per capita and prepaid
2289	aggregate fixed-sum basis services when appropriate and other
2290	alternative service delivery and reimbursement methodologies,
2291	including competitive bidding pursuant to s. 287.057, designed
2292	to facilitate the cost-effective purchase of a case-managed
2293	continuum of care. The agency shall also require providers to
2294	minimize the exposure of recipients to the need for acute
2295	inpatient, custodial, and other institutional care and the
2296	inappropriate or unnecessary use of high-cost services. The
2297	agency shall contract with a vendor to monitor and evaluate the
2298	clinical practice patterns of providers in order to identify
2299	trends that are outside the normal practice patterns of a
2300	provider's professional peers or the national guidelines of a
2301	provider's professional association. The vendor must be able to
2302	provide information and counseling to a provider whose practice
2303	patterns are outside the norms, in consultation with the agency,
2304	to improve patient care and reduce inappropriate utilization.
2305	The agency may mandate prior authorization, drug therapy
2306	management, or disease management participation for certain
2307	populations of Medicaid beneficiaries, certain drug classes, or
2308	particular drugs to prevent fraud, abuse, overuse, and possible
2309	dangerous drug interactions. The Pharmaceutical and Therapeutics
2310	Committee shall make recommendations to the agency on drugs for
2311	which prior authorization is required. The agency shall inform
2312	the Pharmaceutical and Therapeutics Committee of its decisions
2313	regarding drugs subject to prior authorization. The agency is
2314	authorized to limit the entities it contracts with or enrolls as
2315	Medicaid providers by developing a provider network through
2316	provider credentialing. The agency may competitively bid single-
2317	source-provider contracts if procurement of goods or services
2318	results in demonstrated cost savings to the state without
2319	limiting access to care. The agency may limit its network based
2320	on the assessment of beneficiary access to care, provider
2321	availability, provider quality standards, time and distance
2322	standards for access to care, the cultural competence of the
2323	provider network, demographic characteristics of Medicaid
2324	beneficiaries, practice and provider-to-beneficiary standards,
2325	appointment wait times, beneficiary use of services, provider
2326	turnover, provider profiling, provider licensure history,
2327	previous program integrity investigations and findings, peer
2328	review, provider Medicaid policy and billing compliance records,
2329	clinical and medical record audits, and other factors. Providers
2330	shall not be entitled to enrollment in the Medicaid provider
2331	network. The agency shall determine instances in which allowing
2332	Medicaid beneficiaries to purchase durable medical equipment and
2333	other goods is less expensive to the Medicaid program than long-
2334	term rental of the equipment or goods. The agency may establish
2335	rules to facilitate purchases in lieu of long-term rentals in
2336	order to protect against fraud and abuse in the Medicaid program
2337	as defined in s. 409.913. The agency may seek federal waivers
2338	necessary to administer these policies.
2339	(4)  The agency may contract with:
2340	(b)  An entity that is providing comprehensive behavioral
2341	health care services to certain Medicaid recipients through a
2342	capitated, prepaid arrangement pursuant to the federal waiver
2343	provided for by s. 409.905(5). Such an entity must be licensed
2344	under chapter 624, chapter 636, or chapter 641, or authorized
2345	under paragraph (c), and must possess the clinical systems and
2346	operational competence to manage risk and provide comprehensive
2347	behavioral health care to Medicaid recipients. As used in this
2348	paragraph, the term "comprehensive behavioral health care
2349	services" means covered mental health and substance abuse
2350	treatment services that are available to Medicaid recipients.
2351	The secretary of the Department of Children and Family Services
2352	shall approve provisions of procurements related to children in
2353	the department's care or custody prior to enrolling such
2354	children in a prepaid behavioral health plan. Any contract
2355	awarded under this paragraph must be competitively procured. In
2356	developing the behavioral health care prepaid plan procurement
2357	document, the agency shall ensure that the procurement document
2358	requires the contractor to develop and implement a plan to
2359	ensure compliance with s. 394.4574 related to services provided
2360	to residents of licensed assisted living facilities that hold a
2361	limited mental health license. Except as provided in
2362	subparagraph 8., and except in counties where the Medicaid
2363	managed care pilot program is authorized pursuant to s.
2364	409.91211, the agency shall seek federal approval to contract
2365	with a single entity meeting these requirements to provide
2366	comprehensive behavioral health care services to all Medicaid
2367	recipients not enrolled in a Medicaid managed care plan
2368	authorized under s. 409.91211 or a Medicaid health maintenance
2369	organization in an AHCA area. In an AHCA area where the Medicaid
2370	managed care pilot program is authorized pursuant to s.
2371	409.91211 in one or more counties, the agency may procure a
2372	contract with a single entity to serve the remaining counties as
2373	an AHCA area or the remaining counties may be included with an
2374	adjacent AHCA area and shall be subject to this paragraph. Each
2375	entity must offer sufficient choice of providers in its network
2376	to ensure recipient access to care and the opportunity to select
2377	a provider with whom they are satisfied. The network shall
2378	include all public mental health hospitals. To ensure unimpaired
2379	access to behavioral health care services by Medicaid
2380	recipients, all contracts issued pursuant to this paragraph
2381	shall require 80 percent of the capitation paid to the managed
2382	care plan, including health maintenance organizations, to be
2383	expended for the provision of behavioral health care services.
2384	In the event the managed care plan expends less than 80 percent
2385	of the capitation paid pursuant to this paragraph for the
2386	provision of behavioral health care services, the difference
2387	shall be returned to the agency. The agency shall provide the
2388	managed care plan with a certification letter indicating the
2389	amount of capitation paid during each calendar year for the
2390	provision of behavioral health care services pursuant to this
2391	section. The agency may reimburse for substance abuse treatment
2392	services on a fee-for-service basis until the agency finds that
2393	adequate funds are available for capitated, prepaid
2394	arrangements.
2395	1.  By January 1, 2001, the agency shall modify the
2396	contracts with the entities providing comprehensive inpatient
2397	and outpatient mental health care services to Medicaid
2398	recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
2399	Counties, to include substance abuse treatment services.
2400	2.  By July 1, 2003, the agency and the Department of
2401	Children and Family Services shall execute a written agreement
2402	that requires collaboration and joint development of all policy,
2403	budgets, procurement documents, contracts, and monitoring plans
2404	that have an impact on the state and Medicaid community mental
2405	health and targeted case management programs.
2406	3.  Except as provided in subparagraph 8., by July 1, 2006,
2407	the agency and the Department of Children and Family Services
2408	shall contract with managed care entities in each AHCA area
2409	except area 6 or arrange to provide comprehensive inpatient and
2410	outpatient mental health and substance abuse services through
2411	capitated prepaid arrangements to all Medicaid recipients who
2412	are eligible to participate in such plans under federal law and
2413	regulation. In AHCA areas where eligible individuals number less
2414	than 150,000, the agency shall contract with a single managed
2415	care plan to provide comprehensive behavioral health services to
2416	all recipients who are not enrolled in a Medicaid health
2417	maintenance organization or a Medicaid capitated managed care
2418	plan authorized under s. 409.91211. The agency may contract with
2419	more than one comprehensive behavioral health provider to
2420	provide care to recipients who are not enrolled in a Medicaid
2421	capitated managed care plan authorized under s. 409.91211 or a
2422	Medicaid health maintenance organization in AHCA areas where the
2423	eligible population exceeds 150,000. In an AHCA area where the
2424	Medicaid managed care pilot program is authorized pursuant to s.
2425	409.91211 in one or more counties, the agency may procure a
2426	contract with a single entity to serve the remaining counties as
2427	an AHCA area or the remaining counties may be included with an
2428	adjacent AHCA area and shall be subject to this paragraph.
2429	Contracts for comprehensive behavioral health providers awarded
2430	pursuant to this section shall be competitively procured. Both
2431	for-profit and not-for-profit corporations shall be eligible to
2432	compete. Managed care plans contracting with the agency under
2433	subsection (3) shall provide and receive payment for the same
2434	comprehensive behavioral health benefits as provided in AHCA
2435	rules, including handbooks incorporated by reference. In AHCA
2436	area 11, the agency shall contract with at least two
2437	comprehensive behavioral health care providers to provide
2438	behavioral health care to recipients in that area who are
2439	enrolled in, or assigned to, the MediPass program. One of the
2440	behavioral health care contracts shall be with the existing
2441	provider service network pilot project, as described in
2442	paragraph (d), for the purpose of demonstrating the cost-
2443	effectiveness of the provision of quality mental health services
2444	through a public hospital-operated managed care model. The
2445	agency is directed to integrate the provision of acute care and
2446	behavioral health services in the public hospital-operated
2447	managed care model to the extent feasible and consistent with
2448	continuity of care and patient choice. Payment shall be at an
2449	agreed-upon capitated rate to ensure cost savings. Of the
2450	recipients in area 11 who are assigned to MediPass under the
2451	provisions of s. 409.9122(2)(k), a minimum of 50,000 of those
2452	MediPass-enrolled recipients shall be assigned to the existing
2453	provider service network in area 11 for their behavioral care.
2454	4.  By October 1, 2003, the agency and the department shall
2455	submit a plan to the Governor, the President of the Senate, and
2456	the Speaker of the House of Representatives which provides for
2457	the full implementation of capitated prepaid behavioral health
2458	care in all areas of the state.
2459	a.  Implementation shall begin in 2003 in those AHCA areas
2460	of the state where the agency is able to establish sufficient
2461	capitation rates.
2462	b.  If the agency determines that the proposed capitation
2463	rate in any area is insufficient to provide appropriate
2464	services, the agency may adjust the capitation rate to ensure
2465	that care will be available. The agency and the department may
2466	use existing general revenue to address any additional required
2467	match but may not over-obligate existing funds on an annualized
2468	basis.
2469	c.  Subject to any limitations provided for in the General
2470	Appropriations Act, the agency, in compliance with appropriate
2471	federal authorization, shall develop policies and procedures
2472	that allow for certification of local and state funds.
2473	5.  Children residing in a statewide inpatient psychiatric
2474	program, or in a Department of Juvenile Justice or a Department
2475	of Children and Family Services residential program approved as
2476	a Medicaid behavioral health overlay services provider shall not
2477	be included in a behavioral health care prepaid health plan or
2478	any other Medicaid managed care plan pursuant to this paragraph.
2479	6.  In converting to a prepaid system of delivery, the
2480	agency shall in its procurement document require an entity
2481	providing only comprehensive behavioral health care services to
2482	prevent the displacement of indigent care patients by enrollees
2483	in the Medicaid prepaid health plan providing behavioral health
2484	care services from facilities receiving state funding to provide
2485	indigent behavioral health care, to facilities licensed under
2486	chapter 395 which do not receive state funding for indigent
2487	behavioral health care, or reimburse the unsubsidized facility
2488	for the cost of behavioral health care provided to the displaced
2489	indigent care patient.
2490	7.  Traditional community mental health providers under
2491	contract with the Department of Children and Family Services
2492	pursuant to part IV of chapter 394, child welfare providers
2493	under contract with the Department of Children and Family
2494	Services in areas 1 and 6, and inpatient mental health providers
2495	licensed pursuant to chapter 395 must be offered an opportunity
2496	to accept or decline a contract to participate in any provider
2497	network for prepaid behavioral health services.
2498	8.  All Medicaid-eligible children, except children in area
2499	1 and children in Highlands County, Hardee County, Polk County,
2500	or Manatee County of area 6, who are open for child welfare
2501	services in the HomeSafeNet system, shall receive their
2502	behavioral health care services through a specialty prepaid plan
2503	operated by community-based lead agencies either through a
2504	single agency or formal agreements among several agencies. The
2505	specialty prepaid plan must result in savings to the state
2506	comparable to savings achieved in other Medicaid managed care
2507	and prepaid programs. Such plan must provide mechanisms to
2508	maximize state and local revenues. The specialty prepaid plan
2509	shall be developed by the agency and the Department of Children
2510	and Family Services. The agency is authorized to seek any
2511	federal waivers to implement this initiative. Medicaid-eligible
2512	children whose cases are open for child welfare services in the
2513	HomeSafeNet system and who reside in AHCA area 10 are exempt
2514	from the specialty prepaid plan upon the development of a
2515	service delivery mechanism for children who reside in area 10 as
2516	specified in s. 409.91211(3)(dd).
2517	(c)  A federally qualified health center or an entity owned
2518	by one or more federally qualified health centers or an entity
2519	owned by other migrant and community health centers receiving
2520	non-Medicaid financial support from the Federal Government to
2521	provide health care services on a prepaid or fixed-sum basis to
2522	recipients. A federally qualified health center or an entity
2523	that is owned by one or more federally qualified health centers
2524	and is reimbursed by the agency on a prepaid basis is exempt
2525	from parts I and III of chapter 641, but must comply with the
2526	solvency requirements in s. 641.2261(2) and meet the appropriate
2527	requirements governing financial reserve, quality assurance, and
2528	patients' rights established by the agency.
2529	(14)(a)  The agency shall operate or contract for the
2530	operation of utilization management and incentive systems
2531	designed to encourage cost-effective use of services and to
2532	eliminate services that are medically unnecessary. The agency
2533	shall track Medicaid provider prescription and billing patterns
2534	and evaluate them against Medicaid medical necessity criteria as
2535	provided in agency rules. Medical necessity determination
2536	requires that service be consistent with symptoms or confirmed
2537	diagnosis of illness or injury under treatment and not in excess
2538	of the patient's needs. The agency shall conduct reviews of
2539	provider exceptions to peer group norms and shall, using
2540	statistical methodologies, provider profiling, and analysis of
2541	billing patterns, detect and investigate abnormal or unusual
2542	increases in billing or payment of claims for Medicaid services
2543	and medically unnecessary provision of services. Providers that
2544	demonstrate a pattern of submitting claims for medically
2545	unnecessary services shall be referred to the Medicaid program
2546	integrity unit for investigation. The agency shall report on its
2547	efforts to eliminate medically necessary services in the annual
2548	report required by s. 409.913.
2549	(b)  The agency shall develop a procedure for determining
2550	whether health care providers and service vendors can provide
2551	the Medicaid program using a business case that demonstrates
2552	whether a particular good or service can offset the cost of
2553	providing the good or service in an alternative setting or
2554	through other means and therefore should receive a higher
2555	reimbursement. The business case must include, but need not be
2556	limited to:
2557	1.  A detailed description of the good or service to be
2558	provided, a description and analysis of the agency's current
2559	performance of the service, and a rationale documenting how
2560	providing the service in an alternative setting would be in the
2561	best interest of the state, the agency, and its clients.
2562	2.  A cost-benefit analysis documenting the estimated
2563	specific direct and indirect costs, savings, performance
2564	improvements, risks, and qualitative and quantitative benefits
2565	involved in or resulting from providing the service. The cost-
2566	benefit analysis must include a detailed plan and timeline
2567	identifying all actions that must be implemented to realize
2568	expected benefits. The Secretary of Health Care Administration
2569	shall verify that all costs, savings, and benefits are valid and
2570	achievable.
2571	(c)  If the agency determines that the increased
2572	reimbursement is cost-effective, the agency shall recommend a
2573	change in the reimbursement schedule for that particular good or
2574	service. If, within 12 months after implementing any rate change
2575	under this procedure, the agency determines that costs were not
2576	offset by the increased reimbursement schedule, the agency may
2577	revert to the former reimbursement schedule for the particular
2578	good or service.
2579	(17)  An entity contracting on a prepaid or fixed-sum basis
2580	shall meet the, in addition to meeting any applicable statutory
2581	surplus requirements of s. 641.225, also maintain at all times
2582	in the form of cash, investments that mature in less than 180
2583	days allowable as admitted assets by the Office of Insurance
2584	Regulation, and restricted funds or deposits controlled by the
2585	agency or the Office of Insurance Regulation, a surplus amount
2586	equal to one-and-one-half times the entity's monthly Medicaid
2587	prepaid revenues. As used in this subsection, the term "surplus"
2588	means the entity's total assets minus total liabilities. If an
2589	entity's surplus falls below an amount equal to the surplus
2590	requirements of s. 641.225 one-and-one-half times the entity's
2591	monthly Medicaid prepaid revenues, the agency shall prohibit the
2592	entity from engaging in marketing and preenrollment activities,
2593	shall cease to process new enrollments, and shall not renew the
2594	entity's contract until the required balance is achieved. The
2595	requirements of this subsection do not apply:
2596	(a)  Where a public entity agrees to fund any deficit
2597	incurred by the contracting entity; or
2598	(b)  Where the entity's performance and obligations are
2599	guaranteed in writing by a guaranteeing organization which:
2600	1.  Has been in operation for at least 5 years and has
2601	assets in excess of $50 million; or
2602	2.  Submits a written guarantee acceptable to the agency
2603	which is irrevocable during the term of the contracting entity's
2604	contract with the agency and, upon termination of the contract,
2605	until the agency receives proof of satisfaction of all
2606	outstanding obligations incurred under the contract.
2607	(19)  For services provided on or after July 1, 2009, an
2608	entity that contracts with the agency on a prepaid or fixed-sum
2609	basis for the provision of Medicaid services shall reimburse any
2610	hospital or physician that is outside the entity's authorized
2611	geographic service area as specified in its contract with the
2612	agency, and that provides services authorized by the entity to
2613	its members, at a rate negotiated with the hospital or physician
2614	for the provision of services or according to the lesser of the
2615	following:
2616	(a)  The usual and customary charges made to the general
2617	public by the hospital or physician; or
2618	(b)  The Florida Medicaid fee-for-service reimbursement
2619	rate that would have been paid to the hospital or physician by
2620	the agency if the enrollee had been a MediPass recipient
2621	established for the hospital or physician.
2622	(54)  The agency shall develop and implement a home health
2623	agency monitoring pilot project in Miami-Dade County by January
2624	1, 2010. The agency shall contract with a vendor to verify the
2625	use and delivery of home health services and provide an
2626	electronic billing interface for home health services. The
2627	contract must require the creation of a program to submit claims
2628	electronically for the delivery of home health services. The
2629	program must verify telephonically visits for the delivery of
2630	home health services using voice biometrics. The agency may seek
2631	amendments to the Medicaid state plan and waivers of federal
2632	laws, as necessary, to implement the pilot project.
2633	Notwithstanding s. 287.057(5)(f), the agency must award the
2634	contract through the competitive solicitation process. The
2635	agency shall submit a report to the Governor, the President of
2636	the Senate, and the Speaker of the House of Representatives
2637	evaluating the pilot project by February 1, 2011.
2638	(55)  The agency shall implement a comprehensive care
2639	management pilot project for home health services by January 1,
2640	2010, which includes face-to-face assessments by a nurse
2641	licensed pursuant to chapter 464, consultation with physicians
2642	ordering services to substantiate the medical necessity for
2643	services, and on-site or desk reviews of recipients' medical
2644	records in Miami-Dade County. The agency may enter into a
2645	contract with a qualified organization to implement the pilot
2646	project. The agency may seek amendments to the Medicaid state
2647	plan and waivers of federal laws, as necessary, to implement the
2648	pilot project.
2649	Section 41.  Section 409.91207, Florida Statutes, is
2650	created to read:
2651	409.91207  Medical Home Pilot Projects.--
2652	(1)  PURPOSE.--The agency shall establish pilot projects in
2653	Alachua and Hillsborough Counties to test the potential for
2654	coordinated and cost-effective care in a fee-for-service
2655	environment and to compare performance of these pilot projects
2656	with other managed care models, including, but not limited to,
2657	primary care case management.
2658	(2)  ORGANIZATION.--
2659	(a)  Each county in the pilot project shall be served by at
2660	least one medical home network. A medical home network shall
2661	consist of:
2662	1.  Primary care providers who also provide disease
2663	management. Eligible primary care providers include physicians,
2664	federally qualified health centers, medical schools, teaching
2665	hospitals, or programs serving children with special health care
2666	needs currently authorized as a network under an existing
2667	Medicaid waiver.
2668	2.  Specialty care providers who are employed by or under
2669	contract with a medical school or programs that serve children
2670	with special health care needs currently authorized as a network
2671	under an existing Medicaid waiver.
2672	3.  One or more hospitals.
2673	(b)  A medical home network shall coordinate with other
2674	providers, as necessary, to ensure that Medicaid participants
2675	receive efficient and effective access to services, consistent
2676	with the scope of services provided to MediPass recipients.
2677	(c)  A managed care organization may seek designation by
2678	the agency as a medical home network by documenting policies and
2679	procedures consistent with the principles provided in subsection
2680	(4).
2681	(3)  SERVICE CAPABILITIES.--A medical home network shall
2682	provide primary care, coordinated services to control chronic
2683	illnesses, pharmacy services, outpatient specialty physician
2684	services, and inpatient services.
2685	(4)  PRINCIPLES.--A medical home network shall modify the
2686	processes and patterns of health care service delivery by
2687	applying the following principles:
2688	(a)  A personal medical provider shall lead an
2689	interdisciplinary team of professionals who share the
2690	responsibility for ongoing care to a specific panel of patients.
2691	(b)  The personal medical provider shall identify the
2692	patient's health care needs and respond to those needs either
2693	through direct care or arrangements with other qualified
2694	providers.
2695	(c)  Care shall be coordinated or integrated across all
2696	areas of health service delivery.
2697	(d)  Information technology shall be integrated into
2698	delivery systems to enhance clinical performance and monitor
2699	patient outcomes.
2700	(5)  ENROLLMENT.--Each MediPass recipient receiving primary
2701	care at a participating federally qualified health center or
2702	primary care clinic owned and operated by a medical school or
2703	teaching hospital shall be enrolled in the program if the
2704	recipient does not opt out of enrollment pursuant to s.
2705	409.9122. Other Medicaid recipients shall be enrolled consistent
2706	with s. 409.9122(2)(e)1.
2707	(6)  ACCESS STANDARDS AND NETWORK ADEQUACY.--A medical home
2708	network shall document the capacity for coordinated systems of
2709	care through written agreements between providers that establish
2710	arrangements for referral, access to medical records, and
2711	followup care.
2712	(7)  FINANCING.--Services provided by a medical home
2713	network shall be reimbursed based on claims filed for Medicaid
2714	fee-for-service payments. A managed care organization designated
2715	as a medical home network shall receive capitated rates that
2716	reflect enhanced payments to fee-for-service medical home
2717	networks, as authorized in the General Appropriations Act. In
2718	addition, the following entities that participate in a medical
2719	home network shall be eligible to receive an enhanced payment,
2720	as authorized in the General Appropriations Act:
2721	(a)  A primary care physician, federally qualified health
2722	center, or primary care clinic owned and operated by a medical
2723	school or teaching hospital shall be eligible to receive
2724	enhanced primary care case management fees.
2725	(b)  A medical school shall be eligible to receive enhanced
2726	payments through the supplemental physician payment program
2727	using such certified funds.
2728	(c)  An outpatient specialty clinic operated by a medical
2729	school shall be eligible to bill Medicaid for facility costs, in
2730	addition to professional services.
2731	(d)  A hospital shall be eligible to receive supplemental
2732	Medicaid payments and exempt rates.
2733	(8)  SHARED SAVINGS.--The agency shall analyze spending for
2734	enrolled medical home network patients compared to capitation
2735	rates that would have been paid for the same population in the
2736	same region during the same year. The agency shall report the
2737	results of this comparison as part of the Social Services
2738	Estimating Conference. Each medical home network that achieves
2739	savings equal to the prepaid health plan area discount factor is
2740	eligible for an appropriation of the shared savings. When the
2741	savings exceed the area discount factor, the medical home
2742	network shall be eligible for an appropriation of the full
2743	amount of the excess savings. To the extent possible, savings
2744	shared with the medical home network shall be distributed as
2745	bonus payments for quality performance.
2746	(9)  QUALITY ASSURANCE AND ACCOUNTABILITY.--A medical home
2747	network shall maintain medical records and clinical data as
2748	necessary to assess the utilization, cost, and outcome of
2749	services provided to enrollees.
2750	(10)  EVALUATION.--The agency shall report medical home
2751	network performance on a quarterly basis. The agency shall
2752	contract with the University of Florida to comprehensively
2753	evaluate the pilot projects created under this section,
2754	including a comparison of the medical home network to other
2755	models of managed care. An initial evaluation shall cover a 24-
2756	month period beginning with the implementation of the pilot
2757	projects in all pilot project counties. A final evaluation shall
2758	cover a 60-month period beginning with the implementation of the
2759	pilot projects in all pilot project counties. The initial
2760	evaluation shall be submitted to the Governor, the President of
2761	the Senate, and the Speaker of the House of Representatives by
2762	June 30, 2012. The final evaluation shall be submitted to the
2763	Governor, the President of the Senate, and the Speaker of the
2764	House of Representatives by June 30, 2015. The final evaluation
2765	shall include the following:
2766	(a)  Quality of care indicators, including, but not limited
2767	to, hospital admission rates for preventable and chronic
2768	diseases; emergency department utilization rates; hospital
2769	readmission rates; and specific performance indicators related
2770	to diabetes, hypertension, obesity, and tobacco use prevention
2771	and cessation.
2772	(b)  Financial performance compared to expenditures for
2773	similar patients enrolled in MediPass and compared to the
2774	capitation rates that would have been paid if the medical home
2775	enrollees were in prepaid plans.
2776	(11)  AUTHORITY.--The agency shall seek any federal waivers
2777	or amend the Medicaid state plan as necessary to implement the
2778	provisions of this subsection.
2779	Section 42.  Section 409.91208, Florida Statutes, is
2780	created to read:
2781	409.91208  Reimbursement for services provided by medical
2782	schools.--
2783	(1)  FINDINGS AND INTENT.--
2784	(a)  The Legislature finds that there is a critical
2785	shortage of physicians that threatens access to health care.
2786	(b)  The Legislature further finds that the physician
2787	workforce shortage is likely to become worse in the future due
2788	to an aging physician population.
2789	(c)  The Legislature further finds that one of the primary
2790	reasons for the physician workforce shortage is the failure to
2791	adequately provide for graduate medical education in this state.
2792	(d)  The Legislature further finds a nexus between the
2793	infrastructure for graduate medical education and the goal of
2794	providing access to services for Medicaid patients.
2795	(e)  The Legislature further finds that managed care is a
2796	responsible and valuable tool for ensuring a sustainable
2797	Medicaid program.
2798	(f)  Finally, the Legislature finds that federal
2799	regulations create a barrier to simultaneously supporting
2800	graduate medical education and maintaining cost-effective
2801	purchasing of services in the Medicaid program through managed
2802	care.
2803	(2)  ALTERNATIVE PAYMENT METHOD.--The agency shall seek
2804	federal approval to implement an alternative payment methodology
2805	for medical school faculty who provide services in the Medicaid
2806	program so that direct payments may be made to physicians
2807	employed by or under contract with the state's medical schools
2808	for costs associated with graduate medical education. The agency
2809	shall amend its Medicaid policies as necessary to implement the
2810	provisions of this subsection.
2811	Section 43.  Paragraph (b) of subsection (1) and paragraph
2812	(e) of subsection (3) of section 409.91211, Florida Statutes,
2813	are amended to read:
2814	409.91211  Medicaid managed care pilot program.--
2815	(1)
2816	(b)  This waiver authority is contingent upon federal
2817	approval to preserve the upper-payment-limit funding mechanism
2818	for hospitals, including a guarantee of a reasonable growth
2819	factor, a methodology to allow the use of a portion of these
2820	funds to serve as a risk pool for demonstration sites,
2821	provisions to preserve the state's ability to use
2822	intergovernmental transfers, and provisions to protect the
2823	disproportionate share program authorized pursuant to this
2824	chapter. Upon completion of the evaluation conducted under s. 3,
2825	ch. 2005-133, Laws of Florida, the agency may request statewide
2826	expansion of the demonstration projects. Statewide phase-in to
2827	additional counties shall be contingent upon review and approval
2828	by the Legislature. Under the upper-payment-limit program, or
2829	the low-income pool as implemented by the Agency for Health Care
2830	Administration pursuant to federal waiver, the state matching
2831	funds required for the program shall be provided by local
2832	governmental entities through intergovernmental transfers in
2833	accordance with published federal statutes and regulations. The
2834	Agency for Health Care Administration shall distribute upper-
2835	payment-limit, disproportionate share hospital, and low-income
2836	pool funds according to published federal statutes, regulations,
2837	and waivers and the low-income pool methodology approved by the
2838	federal Centers for Medicare and Medicaid Services. A provider
2839	who receives supplemental payments shall serve Medicaid
2840	recipients regardless of their county of residence in this state
2841	and may not restrict access to care based on residency in a
2842	county in this state other than the one in which the provider is
2843	located.
2844	(3)  The agency shall have the following powers, duties,
2845	and responsibilities with respect to the pilot program:
2846	(e)  To implement policies and guidelines for phasing in
2847	financial risk for approved provider service networks over a 5-
2848	year 3-year period. These policies and guidelines must include
2849	an option for a provider service network to be paid fee-for-
2850	service rates. For any provider service network established in a
2851	managed care pilot area, the option to be paid fee-for-service
2852	rates shall include a savings-settlement mechanism that is
2853	consistent with s. 409.912(44). This model shall be converted to
2854	a risk-adjusted capitated rate no later than the beginning of
2855	the sixth fourth year of operation, and may be converted earlier
2856	at the option of the provider service network. Federally
2857	qualified health centers may be offered an opportunity to accept
2858	or decline a contract to participate in any provider network for
2859	prepaid primary care services.
2860	Section 44.  Paragraph (e) of subsection (2) and subsection
2861	(7) of section 409.9122, Florida Statutes, are amended, and
2862	subsection (15) is added to that section, to read:
2863	409.9122  Mandatory Medicaid managed care enrollment;
2864	programs and procedures.--
2865	(2)
2866	(e)  Medicaid recipients who are already enrolled in a
2867	managed care plan or MediPass shall be offered the opportunity
2868	to change managed care plans or MediPass providers on a
2869	staggered basis, as defined by the agency. All Medicaid
2870	recipients shall have 30 days in which to make a choice of
2871	managed care plans or MediPass providers. Enrolled Medicaid
2872	recipients who have a known diagnosis consistent with HIV/AIDS
2873	shall be offered the opportunity to change plans on a staggered
2874	basis; however, these individuals shall remain in their current
2875	disease management or specialized HIV/AIDS plan unless they
2876	actively choose to opt out of that plan. In counties that have
2877	two or more managed care plans, a recipient already enrolled in
2878	MediPass who fails to make a choice during the annual period
2879	shall be assigned to a managed care plan if he or she is
2880	eligible for enrollment in the managed care plan. The agency
2881	shall apply for a state plan amendment or federal waiver
2882	authority, if necessary, to implement the provisions of this
2883	paragraph. All newly eligible Medicaid recipients shall have 30
2884	days in which to make a choice of managed care plans or MediPass
2885	providers. Those Medicaid recipients who do not make a choice
2886	shall be assigned in accordance with paragraph (f). To
2887	facilitate continuity of care, for a Medicaid recipient who is
2888	also a recipient of Supplemental Security Income (SSI), prior to
2889	assigning the SSI recipient to a managed care plan or MediPass,
2890	the agency shall determine whether the SSI recipient has an
2891	ongoing relationship with a MediPass provider or managed care
2892	plan. If the SSI recipient has an ongoing relationship with a
2893	managed care plan, the agency shall assign the recipient to that
2894	managed care plan. Those SSI recipients who do not have such a
2895	provider relationship shall be assigned to a managed care plan
2896	or MediPass provider in accordance with paragraph (f).
2897	1.  Notwithstanding this paragraph and paragraphs (f) and
2898	(k), a Medicaid recipient who resides in Alachua County or
2899	Hillsborough County who would otherwise be subject to mandatory
2900	assignment because the recipient failed to make a choice shall
2901	be assigned by the agency to a medical home network operated
2902	pursuant to s. 409.91207 using a method that enrolls 35 percent
2903	of those recipients in medical home networks and 65 percent in
2904	managed care plans. In making these assignments, the agency
2905	shall consider the capability of the networks to meet patient
2906	needs.
2907	2.  For purposes of subparagraph 1., the term "managed care
2908	plans" includes health maintenance organizations, exclusive
2909	provider organizations, provider service networks, minority
2910	physician networks, the Children's Medical Services Network, and
2911	pediatric emergency department diversion programs authorized by
2912	this chapter or the General Appropriations Act.
2913	(7)  The agency shall convene a workgroup to evaluate the
2914	current status and future viability of Medicaid managed care.
2915	The workgroup shall complete a report by January 1, 2010, that
2916	considers the following issues investigate the feasibility of
2917	developing managed care plan and MediPass options for the
2918	following groups of Medicaid recipients:
2919	(a)  The performance of managed care plans in achieving
2920	access to care, quality services, and cost containment. Pregnant
2921	women and infants.
2922	(b)  The effect of recent changes to payment rates for
2923	managed care plans. Elderly and disabled recipients, especially
2924	those who are at risk of nursing home placement.
2925	(c)  The status of contractual relationships between
2926	managed care plans and providers, especially providers
2927	critically necessary for compliance with network adequacy
2928	standards. Persons with developmental disabilities.
2929	(d)  The availability of other models for managed care that
2930	may improve performance, ensure stability, and contain costs in
2931	the future. Qualified Medicare beneficiaries.
2932	(e)  Adults who have chronic, high-cost medical conditions.
2933	(f)  Adults and children who have mental health problems.
2934	(g)  Other recipients for whom managed care plans and
2935	MediPass offer the opportunity of more cost-effective care and
2936	greater access to qualified providers.
2937	(15)  The agency shall collect encounter data in conformity
2938	with s. 409.91211(3)(p)4. on services provided to patients
2939	enrolled in managed care plans. The agency shall collect
2940	financial and utilization encounter data in a uniform manner
2941	based on common definitions delineated by category of service
2942	and eligibility group.
2943	Section 45.  Subsection (4) of section 409.9124, Florida
2944	Statutes, is amended, and paragraph (d) is added to subsection
2945	(1) of that section, to read:
2946	409.9124  Managed care reimbursement.--The agency shall
2947	develop and adopt by rule a methodology for reimbursing managed
2948	care plans.
2949	(1)  Final managed care rates shall be published annually
2950	prior to September 1 of each year, based on methodology that:
2951	(d)  Is risk adjusted in accordance with s. 409.908(4).
2952	(4)  The agency shall quarterly examine the financial
2953	condition of each managed care plan, and its performance in
2954	serving Medicaid patients, and shall utilize examinations
2955	performed by the Office of Insurance Regulation wherever
2956	possible. No later than January 1, 2010, and at least annually
2957	thereafter, the agency shall submit a report to the Governor,
2958	the President of the Senate, and the Speaker of the House of
2959	Representatives regarding the financial condition and trends
2960	affecting Medicaid managed care plans in order to assess the
2961	viability of these plans, identify any specific risks to future
2962	performance, assess overall rate adequacy, and recommend any
2963	changes necessary to ensure a resilient and effective managed
2964	care program that meets the needs of Medicaid participants.
2965	Section 46.  Subsection (5) of section 409.9128, Florida
2966	Statutes, is amended to read:
2967	409.9128  Requirements for providing emergency services and
2968	care.--
2969	(5)  Reimbursement for services provided to an enrollee of
2970	a managed care plan under this section on or after July 1, 2009,
2971	by a provider who does not have a contract with the managed care
2972	plan shall be the lesser of:
2973	(a)  The provider's charges;
2974	(b)  The usual and customary provider charges for similar
2975	services in the community where the services were provided;
2976	(c)  The charge mutually agreed to by the entity and the
2977	provider within 60 days after submittal of the claim; or
2978	(d)  The Medicaid fee-for-service rate that would have been
2979	paid to the provider by the agency if the enrollee had been a
2980	MediPass recipient.
2981	Section 47.  Section 409.913, Florida Statutes, is amended
2982	to read:
2983	409.913  Oversight of the integrity of the Medicaid
2984	program.--The agency shall operate a program to oversee the
2985	activities of Florida Medicaid recipients, and providers and
2986	their representatives, to ensure that fraudulent and abusive
2987	behavior and neglect of recipients occur to the minimum extent
2988	possible, and to recover overpayments and impose sanctions as
2989	appropriate. Beginning January 1, 2003, and each year
2990	thereafter, the agency and the Medicaid Fraud Control Unit of
2991	the Department of Legal Affairs shall submit a joint report to
2992	the Legislature documenting the effectiveness of the state's
2993	efforts to control Medicaid fraud and abuse and to recover
2994	Medicaid overpayments during the previous fiscal year. The
2995	report must describe the number of cases opened and investigated
2996	each year; the sources of the cases opened; the disposition of
2997	the cases closed each year; the amount of overpayments alleged
2998	in preliminary and final audit letters; the number and amount of
2999	fines or penalties imposed; any reductions in overpayment
3000	amounts negotiated in settlement agreements or by other means;
3001	the amount of final agency determinations of overpayments; the
3002	amount deducted from federal claiming as a result of
3003	overpayments; the amount of overpayments recovered each year;
3004	the amount of cost of investigation recovered each year; the
3005	average length of time to collect from the time the case was
3006	opened until the overpayment is paid in full; the amount
3007	determined as uncollectible and the portion of the uncollectible
3008	amount subsequently reclaimed from the Federal Government; the
3009	number of providers, by type, that are terminated from
3010	participation in the Medicaid program as a result of fraud and
3011	abuse; and all costs associated with discovering and prosecuting
3012	cases of Medicaid overpayments and making recoveries in such
3013	cases. The report must also document actions taken to prevent
3014	overpayments and the number of providers prevented from
3015	enrolling in or reenrolling in the Medicaid program as a result
3016	of documented Medicaid fraud and abuse and must include policy
3017	recommendations recommend changes necessary to prevent or
3018	recover overpayments and changes necessary to prevent and detect
3019	Medicaid fraud. All policy recommendations in the report must
3020	include a detailed fiscal analysis, including, but not limited
3021	to, implementation costs, estimated savings to the Medicaid
3022	program, and the return on investment. The agency must submit
3023	the policy recommendations and fiscal analyses in the report to
3024	the appropriate estimating conference, pursuant to s. 216.137,
3025	by February 15 of each year. The agency and the Medicaid Fraud
3026	Control Unit of the Department of Legal Affairs each must
3027	include detailed unit-specific performance standards,
3028	benchmarks, and metrics in the report, including projected cost
3029	savings to the state Medicaid program during the following
3030	fiscal year.
3031	(1)  For the purposes of this section, the term:
3032	(a)  "Abuse" means:
3033	1.  Provider practices that are inconsistent with generally
3034	accepted business or medical practices and that result in an
3035	unnecessary cost to the Medicaid program or in reimbursement for
3036	goods or services that are not medically necessary or that fail
3037	to meet professionally recognized standards for health care.
3038	2.  Recipient practices that result in unnecessary cost to
3039	the Medicaid program.
3040	(b)  "Complaint" means an allegation that fraud, abuse, or
3041	an overpayment has occurred.
3042	(c)  "Fraud" means an intentional deception or
3043	misrepresentation made by a person with the knowledge that the
3044	deception results in unauthorized benefit to herself or himself
3045	or another person. The term includes any act that constitutes
3046	fraud under applicable federal or state law.
3047	(d)  "Medical necessity" or "medically necessary" means any
3048	goods or services necessary to palliate the effects of a
3049	terminal condition, or to prevent, diagnose, correct, cure,
3050	alleviate, or preclude deterioration of a condition that
3051	threatens life, causes pain or suffering, or results in illness
3052	or infirmity, which goods or services are provided in accordance
3053	with generally accepted standards of medical practice. For
3054	purposes of determining Medicaid reimbursement, the agency is
3055	the final arbiter of medical necessity. Determinations of
3056	medical necessity must be made by a licensed physician employed
3057	by or under contract with the agency and must be based upon
3058	information available at the time the goods or services are
3059	provided.
3060	(e)  "Overpayment" includes any amount that is not
3061	authorized to be paid by the Medicaid program whether paid as a
3062	result of inaccurate or improper cost reporting, improper
3063	claiming, unacceptable practices, fraud, abuse, or mistake.
3064	(f)  "Person" means any natural person, corporation,
3065	partnership, association, clinic, group, or other entity,
3066	whether or not such person is enrolled in the Medicaid program
3067	or is a provider of health care.
3068	(2)  The agency shall conduct, or cause to be conducted by
3069	contract or otherwise, reviews, investigations, analyses,
3070	audits, or any combination thereof, to determine possible fraud,
3071	abuse, overpayment, or recipient neglect in the Medicaid program
3072	and shall report the findings of any overpayments in audit
3073	reports as appropriate. At least 5 percent of all audits shall
3074	be conducted on a random basis. As part of its ongoing fraud
3075	detection activities, the agency shall identify and monitor, by
3076	contract or otherwise, patterns of overutilization of Medicaid
3077	services based on state averages. The agency shall track
3078	Medicaid provider prescription and billing patterns and evaluate
3079	them against Medicaid medical necessity criteria and coverage
3080	and limitation guidelines adopted by rule. Medical necessity
3081	determination requires that service be consistent with symptoms
3082	or confirmed diagnosis of illness or injury under treatment and
3083	not in excess of the patient's needs. The agency shall conduct
3084	reviews of provider exceptions to peer group norms and shall,
3085	using statistical methodologies, provider profiling, and
3086	analysis of billing patterns, detect and investigate abnormal or
3087	unusual increases in billing or payment of claims for Medicaid
3088	services and medically unnecessary provision of services.
3089	(3)  The agency may conduct, or may contract for,
3090	prepayment review of provider claims to ensure cost-effective
3091	purchasing; to ensure that billing by a provider to the agency
3092	is in accordance with applicable provisions of all Medicaid
3093	rules, regulations, handbooks, and policies and in accordance
3094	with federal, state, and local law; and to ensure that
3095	appropriate care is rendered to Medicaid recipients. Such
3096	prepayment reviews may be conducted as determined appropriate by
3097	the agency, without any suspicion or allegation of fraud, abuse,
3098	or neglect, and may last for up to 1 year. Unless the agency has
3099	reliable evidence of fraud, misrepresentation, abuse, or
3100	neglect, claims shall be adjudicated for denial or payment
3101	within 90 days after receipt of complete documentation by the
3102	agency for review. If there is reliable evidence of fraud,
3103	misrepresentation, abuse, or neglect, claims shall be
3104	adjudicated for denial of payment within 180 days after receipt
3105	of complete documentation by the agency for review.
3106	(4)  Any suspected criminal violation identified by the
3107	agency must be referred to the Medicaid Fraud Control Unit of
3108	the Office of the Attorney General for investigation. The agency
3109	and the Attorney General shall enter into a memorandum of
3110	understanding, which must include, but need not be limited to, a
3111	protocol for regularly sharing information and coordinating
3112	casework. The protocol must establish a procedure for the
3113	referral by the agency of cases involving suspected Medicaid
3114	fraud to the Medicaid Fraud Control Unit for investigation, and
3115	the return to the agency of those cases where investigation
3116	determines that administrative action by the agency is
3117	appropriate. Offices of the Medicaid program integrity program
3118	and the Medicaid Fraud Control Unit of the Department of Legal
3119	Affairs, shall, to the extent possible, be collocated. The
3120	agency and the Department of Legal Affairs shall periodically
3121	conduct joint training and other joint activities designed to
3122	increase communication and coordination in recovering
3123	overpayments.
3124	(5)  A Medicaid provider is subject to having goods and
3125	services that are paid for by the Medicaid program reviewed by
3126	an appropriate peer-review organization designated by the
3127	agency. The written findings of the applicable peer-review
3128	organization are admissible in any court or administrative
3129	proceeding as evidence of medical necessity or the lack thereof.
3130	(6)  Any notice required to be given to a provider under
3131	this section is presumed to be sufficient notice if sent to the
3132	address last shown on the provider enrollment file. It is the
3133	responsibility of the provider to furnish and keep the agency
3134	informed of the provider's current address. United States Postal
3135	Service proof of mailing or certified or registered mailing of
3136	such notice to the provider at the address shown on the provider
3137	enrollment file constitutes sufficient proof of notice. Any
3138	notice required to be given to the agency by this section must
3139	be sent to the agency at an address designated by rule.
3140	(7)  When presenting a claim for payment under the Medicaid
3141	program, a provider has an affirmative duty to supervise the
3142	provision of, and be responsible for, goods and services claimed
3143	to have been provided, to supervise and be responsible for
3144	preparation and submission of the claim, and to present a claim
3145	that is true and accurate and that is for goods and services
3146	that:
3147	(a)  Have actually been furnished to the recipient by the
3148	provider prior to submitting the claim.
3149	(b)  Are Medicaid-covered goods or services that are
3150	medically necessary.
3151	(c)  Are of a quality comparable to those furnished to the
3152	general public by the provider's peers.
3153	(d)  Have not been billed in whole or in part to a
3154	recipient or a recipient's responsible party, except for such
3155	copayments, coinsurance, or deductibles as are authorized by the
3156	agency.
3157	(e)  Are provided in accord with applicable provisions of
3158	all Medicaid rules, regulations, handbooks, and policies and in
3159	accordance with federal, state, and local law.
3160	(f)  Are documented by records made at the time the goods
3161	or services were provided, demonstrating the medical necessity
3162	for the goods or services rendered. Medicaid goods or services
3163	are excessive or not medically necessary unless both the medical
3164	basis and the specific need for them are fully and properly
3165	documented in the recipient's medical record.
3166
3167	The agency shall may deny payment or require repayment for goods
3168	or services that are not presented as required in this
3169	subsection.
3170	(8)  The agency shall not reimburse any person or entity
3171	for any prescription for medications, medical supplies, or
3172	medical services if the prescription was written by a physician
3173	or other prescribing practitioner who is not enrolled in the
3174	Medicaid program. This section does not apply:
3175	(a)  In instances involving bona fide emergency medical
3176	conditions as determined by the agency;
3177	(b)  To a provider of medical services to a patient in a
3178	hospital emergency department, hospital inpatient or outpatient
3179	setting, or nursing home;
3180	(c)  To bona fide pro bono services by preapproved non-
3181	Medicaid providers as determined by the agency;
3182	(d)  To prescribing physicians who are board-certified
3183	specialists treating Medicaid recipients referred for treatment
3184	by a treating physician who is enrolled in the Medicaid program;
3185	(e)  To prescriptions written for dually eligible Medicare
3186	beneficiaries by an authorized Medicare provider who is not
3187	enrolled in the Medicaid program;
3188	(f)  To other physicians who are not enrolled in the
3189	Medicaid program but who provide a medically necessary service
3190	or prescription not otherwise reasonably available from a
3191	Medicaid-enrolled physician; or
3192	(9)  A Medicaid provider shall retain medical,
3193	professional, financial, and business records pertaining to
3194	services and goods furnished to a Medicaid recipient and billed
3195	to Medicaid for a period of 5 years after the date of furnishing
3196	such services or goods. The agency may investigate, review, or
3197	analyze such records, which must be made available during normal
3198	business hours. However, 24-hour notice must be provided if
3199	patient treatment would be disrupted. The provider is
3200	responsible for furnishing to the agency, and keeping the agency
3201	informed of the location of, the provider's Medicaid-related
3202	records. The authority of the agency to obtain Medicaid-related
3203	records from a provider is neither curtailed nor limited during
3204	a period of litigation between the agency and the provider.
3205	(10)  Payments for the services of billing agents or
3206	persons participating in the preparation of a Medicaid claim
3207	shall not be based on amounts for which they bill nor based on
3208	the amount a provider receives from the Medicaid program.
3209	(11)  The agency shall may deny payment or require
3210	repayment for inappropriate, medically unnecessary, or excessive
3211	goods or services from the person furnishing them, the person
3212	under whose supervision they were furnished, or the person
3213	causing them to be furnished.
3214	(12)  The complaint and all information obtained pursuant
3215	to an investigation of a Medicaid provider, or the authorized
3216	representative or agent of a provider, relating to an allegation
3217	of fraud, abuse, or neglect are confidential and exempt from the
3218	provisions of s. 119.07(1):
3219	(a)  Until the agency takes final agency action with
3220	respect to the provider and requires repayment of any
3221	overpayment, or imposes an administrative sanction;
3222	(b)  Until the Attorney General refers the case for
3223	criminal prosecution;
3224	(c)  Until 10 days after the complaint is determined
3225	without merit; or
3226	(d)  At all times if the complaint or information is
3227	otherwise protected by law.
3228	(13)  The agency shall immediately may terminate
3229	participation of a Medicaid provider in the Medicaid program and
3230	may seek civil remedies or impose other administrative sanctions
3231	against a Medicaid provider, if the provider or any principal,
3232	officer, director, agent, managing employee, or affiliated
3233	person of the provider, or any partner or shareholder having an
3234	ownership interest in the provider equal to 5 percent or
3235	greater, has been:
3236	(a)  Convicted of a criminal offense related to the
3237	delivery of any health care goods or services, including the
3238	performance of management or administrative functions relating
3239	to the delivery of health care goods or services;
3240	(b)  Convicted of a criminal offense under federal law or
3241	the law of any state relating to the practice of the provider's
3242	profession; or
3243	(c)  Found by a court of competent jurisdiction to have
3244	neglected or physically abused a patient in connection with the
3245	delivery of health care goods or services.
3246
3247	If the agency determines a provider did not participate or
3248	acquiesce in an offense specified in paragraph (a), paragraph
3249	(b), or paragraph (c), termination will not be imposed. If the
3250	agency effects a termination under this subsection, the agency
3251	shall issue an immediate final order pursuant to s.
3252	120.569(2)(n).
3253	(14)  If the provider has been suspended or terminated for
3254	cause, pursuant to the appeals procedures established by the
3255	state or Federal Government, from participation in any other
3256	state the Medicaid program or the federal Medicare program by
3257	the Federal Government or any state, the agency must immediately
3258	suspend or terminate, as appropriate, the provider's
3259	participation in this state's the Florida Medicaid program for a
3260	period no less than that imposed by the Federal Government or
3261	any other state, and may not enroll such provider in this
3262	state's the Florida Medicaid program while such foreign
3263	suspension or termination remains in effect. The agency shall
3264	also immediately suspend or terminate, as appropriate, a
3265	provider's participation in this state's Medicaid program if the
3266	provider participated or acquiesced in any action for which any
3267	principal, officer, director, agent, managing employee, or
3268	affiliated person of the provider, or any partner or shareholder
3269	having an ownership interest in the provider equal to 5 percent
3270	or greater, was suspended or terminated for cause, pursuant to
3271	the appeals procedures established by the state or Federal
3272	Government, from any other state Medicaid program or the federal
3273	Medicare program. This sanction is in addition to all other
3274	remedies provided by law.
3275	(15)  The agency shall may seek a any remedy provided by
3276	law, including, but not limited to, any remedy the remedies
3277	provided in subsections (13) and (16) and s. 812.035, if:
3278	(a)  The provider's license has not been renewed, or has
3279	been revoked, suspended, or terminated, for cause, by the
3280	licensing agency of any state;
3281	(b)  The provider has failed to make available or has
3282	refused access to Medicaid-related records to an auditor,
3283	investigator, or other authorized employee or agent of the
3284	agency, the Attorney General, a state attorney, or the Federal
3285	Government;
3286	(c)  The provider has not furnished or has failed to make
3287	available such Medicaid-related records as the agency has found
3288	necessary to determine whether Medicaid payments are or were due
3289	and the amounts thereof;
3290	(d)  The provider has failed to maintain medical records
3291	made at the time of service, or prior to service if prior
3292	authorization is required, demonstrating the necessity and
3293	appropriateness of the goods or services rendered;
3294	(e)  The provider is not in compliance with provisions of
3295	Medicaid provider publications that have been adopted by
3296	reference as rules in the Florida Administrative Code; with
3297	provisions of state or federal laws, rules, or regulations; with
3298	provisions of the provider agreement between the agency and the
3299	provider; or with certifications found on claim forms or on
3300	transmittal forms for electronically submitted claims that are
3301	submitted by the provider or authorized representative, as such
3302	provisions apply to the Medicaid program;
3303	(f)  The provider or person who ordered or prescribed the
3304	care, services, or supplies has furnished, or ordered the
3305	furnishing of, goods or services to a recipient which are
3306	inappropriate, unnecessary, excessive, or harmful to the
3307	recipient or are of inferior quality;
3308	(g)  The provider has demonstrated a pattern of failure to
3309	provide goods or services that are medically necessary;
3310	(h)  The provider or an authorized representative of the
3311	provider, or a person who ordered or prescribed the goods or
3312	services, has submitted or caused to be submitted false or a
3313	pattern of erroneous Medicaid claims;
3314	(i)  The provider or an authorized representative of the
3315	provider, or a person who has ordered or prescribed the goods or
3316	services, has submitted or caused to be submitted a Medicaid
3317	provider enrollment application, a request for prior
3318	authorization for Medicaid services, a drug exception request,
3319	or a Medicaid cost report that contains materially false or
3320	incorrect information;
3321	(j)  The provider or an authorized representative of the
3322	provider has collected from or billed a recipient or a
3323	recipient's responsible party improperly for amounts that should
3324	not have been so collected or billed by reason of the provider's
3325	billing the Medicaid program for the same service;
3326	(k)  The provider or an authorized representative of the
3327	provider has included in a cost report costs that are not
3328	allowable under a Florida Title XIX reimbursement plan, after
3329	the provider or authorized representative had been advised in an
3330	audit exit conference or audit report that the costs were not
3331	allowable;
3332	(l)  The provider is charged by information or indictment
3333	with fraudulent billing practices. The sanction applied for this
3334	reason is limited to suspension of the provider's participation
3335	in the Medicaid program for the duration of the indictment
3336	unless the provider is found guilty pursuant to the information
3337	or indictment;
3338	(m)  The provider or a person who has ordered, or
3339	prescribed the goods or services is found liable for negligent
3340	practice resulting in death or injury to the provider's patient;
3341	(n)  The provider fails to demonstrate that it had
3342	available during a specific audit or review period sufficient
3343	quantities of goods, or sufficient time in the case of services,
3344	to support the provider's billings to the Medicaid program;
3345	(o)  The provider has failed to comply with the notice and
3346	reporting requirements of s. 409.907;
3347	(p)  The agency has received reliable information of
3348	patient abuse or neglect or of any act prohibited by s. 409.920;
3349	or
3350	(q)  The provider has failed to comply with an agreed-upon
3351	repayment schedule.
3352
3353	A provider is subject to sanctions for violations of this
3354	subsection as the result of actions or inactions of the
3355	provider, or actions or inactions of any principal, officer,
3356	director, agent, managing employee, or affiliated person of the
3357	provider, or any partner or shareholder having an ownership
3358	interest in the provider equal to 5 percent or greater, in which
3359	the provider participated or acquiesced.
3360	(16)  The agency shall impose any of the following
3361	sanctions or disincentives on a provider or a person for any of
3362	the acts described in subsection (15):
3363	(a)  Suspension for a specific period of time of not more
3364	than 1 year. Suspension shall preclude participation in the
3365	Medicaid program, which includes any action that results in a
3366	claim for payment to the Medicaid program as a result of
3367	furnishing, supervising a person who is furnishing, or causing a
3368	person to furnish goods or services.
3369	(b)  Termination for a specific period of time of from more
3370	than 1 year to 20 years. Termination shall preclude
3371	participation in the Medicaid program, which includes any action
3372	that results in a claim for payment to the Medicaid program as a
3373	result of furnishing, supervising a person who is furnishing, or
3374	causing a person to furnish goods or services.
3375	(c)  Imposition of a fine of up to $5,000 for each
3376	violation. Each day that an ongoing violation continues, such as
3377	refusing to furnish Medicaid-related records or refusing access
3378	to records, is considered, for the purposes of this section, to
3379	be a separate violation. Each instance of improper billing of a
3380	Medicaid recipient; each instance of including an unallowable
3381	cost on a hospital or nursing home Medicaid cost report after
3382	the provider or authorized representative has been advised in an
3383	audit exit conference or previous audit report of the cost
3384	unallowability; each instance of furnishing a Medicaid recipient
3385	goods or professional services that are inappropriate or of
3386	inferior quality as determined by competent peer judgment; each
3387	instance of knowingly submitting a materially false or erroneous
3388	Medicaid provider enrollment application, request for prior
3389	authorization for Medicaid services, drug exception request, or
3390	cost report; each instance of inappropriate prescribing of drugs
3391	for a Medicaid recipient as determined by competent peer
3392	judgment; and each false or erroneous Medicaid claim leading to
3393	an overpayment to a provider is considered, for the purposes of
3394	this section, to be a separate violation.
3395	(d)  Immediate suspension, if the agency has received
3396	information of patient abuse or neglect or of any act prohibited
3397	by s. 409.920. Upon suspension, the agency must issue an
3398	immediate final order under s. 120.569(2)(n).
3399	(e)  A fine, not to exceed $10,000, for a violation of
3400	paragraph (15)(i).
3401	(f)  Imposition of liens against provider assets,
3402	including, but not limited to, financial assets and real
3403	property, not to exceed the amount of fines or recoveries
3404	sought, upon entry of an order determining that such moneys are
3405	due or recoverable.
3406	(g)  Prepayment reviews of claims for a specified period of
3407	time.
3408	(h)  Comprehensive followup reviews of providers every 6
3409	months to ensure that they are billing Medicaid correctly.
3410	(i)  Corrective-action plans that would remain in effect
3411	for providers for up to 3 years and that would be monitored by
3412	the agency every 6 months while in effect.
3413	(j)  Other remedies as permitted by law to effect the
3414	recovery of a fine or overpayment.
3415
3416	The Secretary of Health Care Administration may make a
3417	determination that imposition of a sanction or disincentive is
3418	not in the best interest of the Medicaid program, in which case
3419	a sanction or disincentive shall not be imposed.
3420	(17)  In determining the appropriate administrative
3421	sanction to be applied, or the duration of any suspension or
3422	termination, the agency shall consider:
3423	(a)  The seriousness and extent of the violation or
3424	violations.
3425	(b)  Any prior history of violations by the provider
3426	relating to the delivery of health care programs which resulted
3427	in either a criminal conviction or in administrative sanction or
3428	penalty.
3429	(c)  Evidence of continued violation within the provider's
3430	management control of Medicaid statutes, rules, regulations, or
3431	policies after written notification to the provider of improper
3432	practice or instance of violation.
3433	(d)  The effect, if any, on the quality of medical care
3434	provided to Medicaid recipients as a result of the acts of the
3435	provider.
3436	(e)  Any action by a licensing agency respecting the
3437	provider in any state in which the provider operates or has
3438	operated.
3439	(f)  The apparent impact on access by recipients to
3440	Medicaid services if the provider is suspended or terminated, in
3441	the best judgment of the agency.
3442
3443	The agency shall document the basis for all sanctioning actions
3444	and recommendations.
3445	(18)  The agency may take action to sanction, suspend, or
3446	terminate a particular provider working for a group provider,
3447	and may suspend or terminate Medicaid participation at a
3448	specific location, rather than or in addition to taking action
3449	against an entire group.
3450	(19)  The agency shall establish a process for conducting
3451	followup reviews of a sampling of providers who have a history
3452	of overpayment under the Medicaid program. This process must
3453	consider the magnitude of previous fraud or abuse and the
3454	potential effect of continued fraud or abuse on Medicaid costs.
3455	(20)  In making a determination of overpayment to a
3456	provider, the agency must use accepted and valid auditing,
3457	accounting, analytical, statistical, or peer-review methods, or
3458	combinations thereof. Appropriate statistical methods may
3459	include, but are not limited to, sampling and extension to the
3460	population, parametric and nonparametric statistics, tests of
3461	hypotheses, and other generally accepted statistical methods.
3462	Appropriate analytical methods may include, but are not limited
3463	to, reviews to determine variances between the quantities of
3464	products that a provider had on hand and available to be
3465	purveyed to Medicaid recipients during the review period and the
3466	quantities of the same products paid for by the Medicaid program
3467	for the same period, taking into appropriate consideration sales
3468	of the same products to non-Medicaid customers during the same
3469	period. In meeting its burden of proof in any administrative or
3470	court proceeding, the agency may introduce the results of such
3471	statistical methods as evidence of overpayment.
3472	(21)  When making a determination that an overpayment has
3473	occurred, the agency shall prepare and issue an audit report to
3474	the provider showing the calculation of overpayments.
3475	(22)  The audit report, supported by agency work papers,
3476	showing an overpayment to a provider constitutes evidence of the
3477	overpayment. A provider may not present or elicit testimony,
3478	either on direct examination or cross-examination in any court
3479	or administrative proceeding, regarding the purchase or
3480	acquisition by any means of drugs, goods, or supplies; sales or
3481	divestment by any means of drugs, goods, or supplies; or
3482	inventory of drugs, goods, or supplies, unless such acquisition,
3483	sales, divestment, or inventory is documented by written
3484	invoices, written inventory records, or other competent written
3485	documentary evidence maintained in the normal course of the
3486	provider's business. Notwithstanding the applicable rules of
3487	discovery, all documentation that will be offered as evidence at
3488	an administrative hearing on a Medicaid overpayment must be
3489	exchanged by all parties at least 14 days before the
3490	administrative hearing or must be excluded from consideration.
3491	(23)(a)  In an audit or investigation of a violation
3492	committed by a provider which is conducted pursuant to this
3493	section, the agency is entitled to recover all investigative,
3494	legal, and expert witness costs if the agency's findings were
3495	not contested by the provider or, if contested, the agency
3496	ultimately prevailed.
3497	(b)  The agency has the burden of documenting the costs,
3498	which include salaries and employee benefits and out-of-pocket
3499	expenses. The amount of costs that may be recovered must be
3500	reasonable in relation to the seriousness of the violation and
3501	must be set taking into consideration the financial resources,
3502	earning ability, and needs of the provider, who has the burden
3503	of demonstrating such factors.
3504	(c)  The provider may pay the costs over a period to be
3505	determined by the agency if the agency determines that an
3506	extreme hardship would result to the provider from immediate
3507	full payment. Any default in payment of costs may be collected
3508	by any means authorized by law.
3509	(24)  If the agency imposes an administrative sanction
3510	pursuant to subsection (13), subsection (14), or subsection
3511	(15), except paragraphs (15)(e) and (o), upon any provider or
3512	any principal, officer, director, agent, managing employee, or
3513	affiliated person of the provider other person who is regulated
3514	by another state entity, the agency shall notify that other
3515	entity of the imposition of the sanction within 5 business days.
3516	Such notification must include the provider's or person's name
3517	and license number and the specific reasons for sanction.
3518	(25)(a)  The agency shall may withhold Medicaid payments,
3519	in whole or in part, to a provider upon receipt of reliable
3520	evidence that the circumstances giving rise to the need for a
3521	withholding of payments involve fraud, willful
3522	misrepresentation, or abuse under the Medicaid program, or a
3523	crime committed while rendering goods or services to Medicaid
3524	recipients. If it is determined that fraud, willful
3525	misrepresentation, abuse, or a crime did not occur, the payments
3526	withheld must be paid to the provider within 14 days after such
3527	determination with interest at the rate of 10 percent a year.
3528	Any money withheld in accordance with this paragraph shall be
3529	placed in a suspended account, readily accessible to the agency,
3530	so that any payment ultimately due the provider shall be made
3531	within 14 days.
3532	(b)  The agency shall may deny payment, or require
3533	repayment, if the goods or services were furnished, supervised,
3534	or caused to be furnished by a person who has been suspended or
3535	terminated from the Medicaid program or Medicare program by the
3536	Federal Government or any state.
3537	(c)  Overpayments owed to the agency bear interest at the
3538	rate of 10 percent per year from the date of determination of
3539	the overpayment by the agency, and payment arrangements must be
3540	made at the conclusion of legal proceedings. A provider who does
3541	not enter into or adhere to an agreed-upon repayment schedule
3542	may be terminated by the agency for nonpayment or partial
3543	payment.
3544	(d)  The agency, upon entry of a final agency order, a
3545	judgment or order of a court of competent jurisdiction, or a
3546	stipulation or settlement, may collect the moneys owed by all
3547	means allowable by law, including, but not limited to, notifying
3548	any fiscal intermediary of Medicare benefits that the state has
3549	a superior right of payment. Upon receipt of such written
3550	notification, the Medicare fiscal intermediary shall remit to
3551	the state the sum claimed.
3552	(e)  The agency may institute amnesty programs to allow
3553	Medicaid providers the opportunity to voluntarily repay
3554	overpayments. The agency may adopt rules to administer such
3555	programs.
3556	(26)  The agency may impose administrative sanctions
3557	against a Medicaid recipient, or the agency may seek any other
3558	remedy provided by law, including, but not limited to, the
3559	remedies provided in s. 812.035, if the agency finds that a
3560	recipient has engaged in solicitation in violation of s. 409.920
3561	or that the recipient has otherwise abused the Medicaid program.
3562	(27)  When the Agency for Health Care Administration has
3563	made a probable cause determination and alleged that an
3564	overpayment to a Medicaid provider has occurred, the agency,
3565	after notice to the provider, shall may:
3566	(a)  Withhold, and continue to withhold during the pendency
3567	of an administrative hearing pursuant to chapter 120, any
3568	medical assistance reimbursement payments until such time as the
3569	overpayment is recovered, unless within 30 days after receiving
3570	notice thereof the provider:
3571	1.  Makes repayment in full; or
3572	2.  Establishes a repayment plan that is satisfactory to
3573	the Agency for Health Care Administration.
3574	(b)  Withhold, and continue to withhold during the pendency
3575	of an administrative hearing pursuant to chapter 120, medical
3576	assistance reimbursement payments if the terms of a repayment
3577	plan are not adhered to by the provider.
3578	(28)  Venue for all Medicaid program integrity overpayment
3579	cases shall lie in Leon County, at the discretion of the agency.
3580	(29)  Notwithstanding other provisions of law, the agency
3581	and the Medicaid Fraud Control Unit of the Department of Legal
3582	Affairs may review a provider's Medicaid-related and non-
3583	Medicaid-related records in order to determine the total output
3584	of a provider's practice to reconcile quantities of goods or
3585	services billed to Medicaid with quantities of goods or services
3586	used in the provider's total practice.
3587	(30)  The agency shall may terminate a provider's
3588	participation in the Medicaid program if the provider fails to
3589	reimburse an overpayment that has been determined by final
3590	order, not subject to further appeal, within 35 days after the
3591	date of the final order, unless the provider and the agency have
3592	entered into a repayment agreement.
3593	(31)  If a provider requests an administrative hearing
3594	pursuant to chapter 120, such hearing must be conducted within
3595	90 days following assignment of an administrative law judge,
3596	absent exceptionally good cause shown as determined by the
3597	administrative law judge or hearing officer. Upon issuance of a
3598	final order, the outstanding balance of the amount determined to
3599	constitute the overpayment shall become due. If a provider fails
3600	to make payments in full, fails to enter into a satisfactory
3601	repayment plan, or fails to comply with the terms of a repayment
3602	plan or settlement agreement, the agency shall may withhold
3603	medical assistance reimbursement payments until the amount due
3604	is paid in full.
3605	(32)  Duly authorized agents and employees of the agency
3606	shall have the power to inspect, during normal business hours,
3607	the records of any pharmacy, wholesale establishment, or
3608	manufacturer, or any other place in which drugs and medical
3609	supplies are manufactured, packed, packaged, made, stored, sold,
3610	or kept for sale, for the purpose of verifying the amount of
3611	drugs and medical supplies ordered, delivered, or purchased by a
3612	provider. The agency shall provide at least 2 business days'
3613	prior notice of any such inspection. The notice must identify
3614	the provider whose records will be inspected, and the inspection
3615	shall include only records specifically related to that
3616	provider.
3617	(33)  In accordance with federal law, Medicaid recipients
3618	convicted of a crime pursuant to 42 U.S.C. s. 1320a-7b may be
3619	limited, restricted, or suspended from Medicaid eligibility for
3620	a period not to exceed 1 year, as determined by the agency head
3621	or designee.
3622	(34)  To deter fraud and abuse in the Medicaid program, the
3623	agency may limit the number of Schedule II and Schedule III
3624	refill prescription claims submitted from a pharmacy provider.
3625	The agency shall limit the allowable amount of reimbursement of
3626	prescription refill claims for Schedule II and Schedule III
3627	pharmaceuticals if the agency or the Medicaid Fraud Control Unit
3628	determines that the specific prescription refill was not
3629	requested by the Medicaid recipient or authorized representative
3630	for whom the refill claim is submitted or was not prescribed by
3631	the recipient's medical provider or physician. Any such refill
3632	request must be consistent with the original prescription.
3633	(35)  The Office of Program Policy Analysis and Government
3634	Accountability shall provide a report to the President of the
3635	Senate and the Speaker of the House of Representatives on a
3636	biennial basis, beginning January 31, 2006, on the agency's
3637	efforts to prevent, detect, and deter, as well as recover funds
3638	lost to, fraud and abuse in the Medicaid program.
3639	(36)  At least three times a year, the agency shall provide
3640	to each Medicaid recipient or his or her representative an
3641	explanation of benefits in the form of a letter that is mailed
3642	to the most recent address of the recipient on the record with
3643	the Department of Children and Family Services. The explanation
3644	of benefits must include the patient's name, the name of the
3645	health care provider and the address of the location where the
3646	service was provided, a description of all services billed to
3647	Medicaid in terminology that should be understood by a
3648	reasonable person, and information on how to report
3649	inappropriate or incorrect billing to the agency or other law
3650	enforcement entities for review or investigation. At least once
3651	a year, the letter also must include information on how to
3652	report criminal Medicaid fraud, the Medicaid Fraud Control
3653	Unit's toll-free hotline number, and information about the
3654	rewards available under s. 409.9203. The explanation of benefits
3655	may not be mailed for Medicaid independent laboratory services
3656	as described in s. 409.905(7) or for Medicaid certified match
3657	services as described in ss. 409.9071 and 1011.70.
3658	(37)  The agency shall post on its website a current list
3659	of each Medicaid provider, including any principal, officer,
3660	director, agent, managing employee, or affiliated person of the
3661	provider, or any partner or shareholder having an ownership
3662	interest in the provider equal to 5 percent or greater, who has
3663	been sanctioned by or terminated for cause from the Medicaid
3664	program pursuant to this section. The list must be searchable by
3665	a variety of search parameters and provide for the creation of
3666	formatted lists that may be printed or imported into other
3667	applications, including spreadsheets. The agency shall update
3668	the list at least monthly.
3669	(38)  In order to improve the detection of health care
3670	fraud, use technology to prevent and detect fraud, and maximize
3671	the electronic exchange of health care fraud information, the
3672	agency shall:
3673	(a)  Compile, maintain, and publish on its website a
3674	detailed list of all state and federal databases that contain
3675	health care fraud information and update the list at least
3676	biannually;
3677	(b)  Develop a strategic plan to connect all databases that
3678	contain health care fraud information to facilitate the
3679	electronic exchange of health information between the agency,
3680	the Department of Health, the Department of Law Enforcement, and
3681	the Attorney General's Office. The plan must include recommended
3682	standard data formats, fraud-identification strategies, and
3683	specifications for the technical interface between state and
3684	federal health care fraud databases;
3685	(c)  Monitor innovations in health information technology,
3686	specifically as it pertains to Medicaid fraud prevention and
3687	detection; and
3688	(d)  Periodically publish policy briefs that highlight
3689	available new technology to prevent or detect health care fraud
3690	and projects implemented by other states, the private sector, or
3691	the Federal Government which use technology to prevent or detect
3692	health care fraud.
3693	Section 48.  Subsections (1) and (2) of section 409.920,
3694	Florida Statutes, are amended, present subsections (8) and (9)
3695	of that section are renumbered as subsections (9) and (10),
3696	respectively, and a new subsection (8) is added to that section,
3697	to read:
3698	409.920  Medicaid provider fraud.--
3699	(1)  For the purposes of this section, the term:
3700	(a)  "Agency" means the Agency for Health Care
3701	Administration.
3702	(b)  "Fiscal agent" means any individual, firm,
3703	corporation, partnership, organization, or other legal entity
3704	that has contracted with the agency to receive, process, and
3705	adjudicate claims under the Medicaid program.
3706	(c)  "Item or service" includes:
3707	1.  Any particular item, device, medical supply, or service
3708	claimed to have been provided to a recipient and listed in an
3709	itemized claim for payment; or
3710	2.  In the case of a claim based on costs, any entry in the
3711	cost report, books of account, or other documents supporting
3712	such claim.
3713	(d)  "Knowingly" means that the act was done voluntarily
3714	and intentionally and not because of mistake or accident. As
3715	used in this section, the term "knowingly" also includes the
3716	word "willfully" or "willful" which, as used in this section,
3717	means that an act was committed voluntarily and purposely, with
3718	the specific intent to do something that the law forbids, and
3719	that the act was committed with bad purpose, either to disobey
3720	or disregard the law.
3721	(e)  "Managed care plan" means a health insurer authorized
3722	under chapter 624, an exclusive provider organization authorized
3723	under chapter 627, a health maintenance organization authorized
3724	under chapter 641, the Children's Medical Services Network
3725	authorized under chapter 391, a prepaid health plan authorized
3726	under chapter 409, a provider service network authorized under
3727	chapter 409, a minority physician network authorized under
3728	chapter 409, and emergency department diversion programs
3729	authorized under chapter 409 or the General Appropriations Act,
3730	providing health care services pursuant to a contract with the
3731	Medicaid program
3732	(2)(a)  A person may not It is unlawful to:
3733	1.(a)  Knowingly make, cause to be made, or aid and abet in
3734	the making of any false statement or false representation of a
3735	material fact, by commission or omission, in any claim submitted
3736	to the agency or its fiscal agent or a managed care plan for
3737	payment.
3738	2.(b)  Knowingly make, cause to be made, or aid and abet in
3739	the making of a claim for items or services that are not
3740	authorized to be reimbursed by the Medicaid program.
3741	3.(c)  Knowingly charge, solicit, accept, or receive
3742	anything of value, other than an authorized copayment from a
3743	Medicaid recipient, from any source in addition to the amount
3744	legally payable for an item or service provided to a Medicaid
3745	recipient under the Medicaid program or knowingly fail to credit
3746	the agency or its fiscal agent for any payment received from a
3747	third-party source.
3748	4.(d)  Knowingly make or in any way cause to be made any
3749	false statement or false representation of a material fact, by
3750	commission or omission, in any document containing items of
3751	income and expense that is or may be used by the agency to
3752	determine a general or specific rate of payment for an item or
3753	service provided by a provider.
3754	5.(e)  Knowingly solicit, offer, pay, or receive any
3755	remuneration, including any kickback, bribe, or rebate, directly
3756	or indirectly, overtly or covertly, in cash or in kind, in
3757	return for referring an individual to a person for the
3758	furnishing or arranging for the furnishing of any item or
3759	service for which payment may be made, in whole or in part,
3760	under the Medicaid program, or in return for obtaining,
3761	purchasing, leasing, ordering, or arranging for or recommending,
3762	obtaining, purchasing, leasing, or ordering any goods, facility,
3763	item, or service, for which payment may be made, in whole or in
3764	part, under the Medicaid program.
3765	6.(f)  Knowingly submit false or misleading information or
3766	statements to the Medicaid program for the purpose of being
3767	accepted as a Medicaid provider.
3768	7.(g)  Knowingly use or endeavor to use a Medicaid
3769	provider's identification number or a Medicaid recipient's
3770	identification number to make, cause to be made, or aid and abet
3771	in the making of a claim for items or services that are not
3772	authorized to be reimbursed by the Medicaid program.
3773	(b)1.  A person who violates this subsection and receives
3774	or endeavors to receive anything of value of:
3775	a.  Ten thousand dollars or less commits a felony of the
3776	third degree, punishable as provided in s. 775.082, s. 775.083,
3777	or s. 775.084.
3778	b.  More than $10,000, but less than $50,000, commits a
3779	felony of the second degree, punishable as provided in s.
3780	775.082, s. 775.083, or s. 775.084.
3781	c.  Fifty thousand dollars or more commits a felony of the
3782	first degree, punishable as provided in s. 775.082, s. 775.083,
3783	or s. 775.084.
3784	2.  The value of separate funds, goods, or services that a
3785	person received or attempted to receive pursuant to a scheme or
3786	course of conduct may be aggregated in determining the degree of
3787	the offense.
3788	3.  In addition to the sentence authorized by law, a person
3789	who is convicted of a violation of this subsection shall pay a
3790	fine in an amount equal to five times the pecuniary gain
3791	unlawfully received or the loss incurred by the Medicaid program
3792	or managed care organization, whichever is greater.
3793	(8)  A person who provides the state, any state agency, any
3794	of the state's political subdivisions, or any agency of the
3795	state's political subdivisions with information about fraud or
3796	suspected fraud by a Medicaid provider, including a managed care
3797	organization, is immune from civil liability for providing the
3798	information unless the person acted with knowledge that the
3799	information was false or acted with reckless disregard for the
3800	truth or falsity of the information.
3801	Section 49.  Section 409.9203, Florida Statutes, is created
3802	to read:
3803	409.9203  Rewards for reporting Medicaid fraud.--
3804	(1)  The Department of Law Enforcement or director of the
3805	Medicaid Fraud Control Unit shall, subject to availability of
3806	funds, pay a reward to a person who furnishes original
3807	information relating to and reports a violation of the state's
3808	Medicaid fraud laws, unless the person declines the reward, if
3809	the information and report:
3810	(a)  Is made to the Office of the Attorney General, the
3811	Agency for Health Care Administration, the Department of Health,
3812	or the Department of Law Enforcement;
3813	(b)  Relates to criminal fraud upon Medicaid funds or a
3814	criminal violation of Medicaid laws by another person; and
3815	(c)  Leads to a recovery of a fine, penalty, or forfeiture
3816	of property.
3817	(2)  The reward may not exceed the lesser of 25 percent of
3818	the amount recovered or $500,000 in a single case.
3819	(3)  The reward shall be paid from the Legal Affairs
3820	Revolving Trust Fund from moneys collected pursuant to s.
3821	68.085.
3822	(4)  A person who receives a reward pursuant to this
3823	section is not eligible to receive any funds pursuant to the
3824	Florida False Claims Act for Medicaid fraud for which a reward
3825	is received pursuant to this section.
3826	Section 50.  Section 429.071, Florida Statutes, is
3827	repealed.
3828	Section 51.  Paragraph (e) of subsection (1) and
3829	subsections (2) and (3) of section 429.08, Florida Statutes, are
3830	amended to read:
3831	429.08  Unlicensed facilities; referral of person for
3832	residency to unlicensed facility; penalties; verification of
3833	licensure status.--
3834	(1)
3835	(e)  The agency shall publish provide to the department's
3836	elder information and referral providers a list, by county, of
3837	licensed assisted living facilities, to assist persons who are
3838	considering an assisted living facility placement in locating a
3839	licensed facility. This information may be provided
3840	electronically or on the agency's Internet website.
3841	(2)  Each field office of the Agency for Health Care
3842	Administration shall establish a local coordinating workgroup
3843	which includes representatives of local law enforcement
3844	agencies, state attorneys, the Medicaid Fraud Control Unit of
3845	the Department of Legal Affairs, local fire authorities, the
3846	Department of Children and Family Services, the district long-
3847	term care ombudsman council, and the district human rights
3848	advocacy committee to assist in identifying the operation of
3849	unlicensed facilities and to develop and implement a plan to
3850	ensure effective enforcement of state laws relating to such
3851	facilities. The workgroup shall report its findings, actions,
3852	and recommendations semiannually to the Director of Health
3853	Quality Assurance of the agency.
3854	(2)(3)  It is unlawful to knowingly refer a person for
3855	residency to an unlicensed assisted living facility; to an
3856	assisted living facility the license of which is under denial or
3857	has been suspended or revoked; or to an assisted living facility
3858	that has a moratorium pursuant to part II of chapter 408. Any
3859	person who violates this subsection commits a noncriminal
3860	violation, punishable by a fine not exceeding $500 as provided
3861	in s. 775.083.
3862	(a)  Any health care practitioner, as defined in s.
3863	456.001, who is aware of the operation of an unlicensed facility
3864	shall report that facility to the agency. Failure to report a
3865	facility that the practitioner knows or has reasonable cause to
3866	suspect is unlicensed shall be reported to the practitioner's
3867	licensing board.
3868	(b)  Any provider as defined in s. 408.803 that hospital or
3869	community mental health center licensed under chapter 395 or
3870	chapter 394 which knowingly discharges a patient or client to an
3871	unlicensed facility is subject to sanction by the agency.
3872	(c)  Any employee of the agency or department, or the
3873	Department of Children and Family Services, who knowingly refers
3874	a person for residency to an unlicensed facility; to a facility
3875	the license of which is under denial or has been suspended or
3876	revoked; or to a facility that has a moratorium pursuant to part
3877	II of chapter 408 is subject to disciplinary action by the
3878	agency or department, or the Department of Children and Family
3879	Services.
3880	(d)  The employer of any person who is under contract with
3881	the agency or department, or the Department of Children and
3882	Family Services, and who knowingly refers a person for residency
3883	to an unlicensed facility; to a facility the license of which is
3884	under denial or has been suspended or revoked; or to a facility
3885	that has a moratorium pursuant to part II of chapter 408 shall
3886	be fined and required to prepare a corrective action plan
3887	designed to prevent such referrals.
3888	(e)  The agency shall provide the department and the
3889	Department of Children and Family Services with a list of
3890	licensed facilities within each county and shall update the list
3891	at least quarterly.
3892	(f)  At least annually, the agency shall notify, in
3893	appropriate trade publications, physicians licensed under
3894	chapter 458 or chapter 459, hospitals licensed under chapter
3895	395, nursing home facilities licensed under part II of chapter
3896	400, and employees of the agency or the department, or the
3897	Department of Children and Family Services, who are responsible
3898	for referring persons for residency, that it is unlawful to
3899	knowingly refer a person for residency to an unlicensed assisted
3900	living facility and shall notify them of the penalty for
3901	violating such prohibition. The department and the Department of
3902	Children and Family Services shall, in turn, notify service
3903	providers under contract to the respective departments who have
3904	responsibility for resident referrals to facilities. Further,
3905	the notice must direct each noticed facility and individual to
3906	contact the appropriate agency office in order to verify the
3907	licensure status of any facility prior to referring any person
3908	for residency. Each notice must include the name, telephone
3909	number, and mailing address of the appropriate office to
3910	contact.
3911	Section 52.  Paragraph (e) of subsection (1) of section
3912	429.14, Florida Statutes, is amended to read:
3913	429.14  Administrative penalties.--
3914	(1)  In addition to the requirements of part II of chapter
3915	408, the agency may deny, revoke, and suspend any license issued
3916	under this part and impose an administrative fine in the manner
3917	provided in chapter 120 against a licensee of an assisted living
3918	facility for a violation of any provision of this part, part II
3919	of chapter 408, or applicable rules, or for any of the following
3920	actions by a licensee of an assisted living facility, for the
3921	actions of any person subject to level 2 background screening
3922	under s. 408.809, or for the actions of any facility employee:
3923	(e)  A citation of any of the following deficiencies as
3924	specified defined in s. 429.19:
3925	1.  One or more cited class I deficiencies.
3926	2.  Three or more cited class II deficiencies.
3927	3.  Five or more cited class III deficiencies that have
3928	been cited on a single survey and have not been corrected within
3929	the times specified.
3930	Section 53.  Subsections (2), (8), and (9) of section
3931	429.19, Florida Statutes, are amended to read:
3932	429.19  Violations; imposition of administrative fines;
3933	grounds.--
3934	(2)  Each violation of this part and adopted rules shall be
3935	classified according to the nature of the violation and the
3936	gravity of its probable effect on facility residents. The agency
3937	shall indicate the classification on the written notice of the
3938	violation as follows:
3939	(a)  Class "I" violations are defined in s. 408.813 those
3940	conditions or occurrences related to the operation and
3941	maintenance of a facility or to the personal care of residents
3942	which the agency determines present an imminent danger to the
3943	residents or guests of the facility or a substantial probability
3944	that death or serious physical or emotional harm would result
3945	therefrom. The condition or practice constituting a class I
3946	violation shall be abated or eliminated within 24 hours, unless
3947	a fixed period, as determined by the agency, is required for
3948	correction. The agency shall impose an administrative fine for a
3949	cited class I violation in an amount not less than $5,000 and
3950	not exceeding $10,000 for each violation. A fine may be levied
3951	notwithstanding the correction of the violation.
3952	(b)  Class "II" violations are defined in s. 408.813 those
3953	conditions or occurrences related to the operation and
3954	maintenance of a facility or to the personal care of residents
3955	which the agency determines directly threaten the physical or
3956	emotional health, safety, or security of the facility residents,
3957	other than class I violations. The agency shall impose an
3958	administrative fine for a cited class II violation in an amount
3959	not less than $1,000 and not exceeding $5,000 for each
3960	violation. A fine shall be levied notwithstanding the correction
3961	of the violation.
3962	(c)  Class "III" violations are defined in s. 408.813 those
3963	conditions or occurrences related to the operation and
3964	maintenance of a facility or to the personal care of residents
3965	which the agency determines indirectly or potentially threaten
3966	the physical or emotional health, safety, or security of
3967	facility residents, other than class I or class II violations.
3968	The agency shall impose an administrative fine for a cited class
3969	III violation in an amount not less than $500 and not exceeding
3970	$1,000 for each violation. A citation for a class III violation
3971	must specify the time within which the violation is required to
3972	be corrected. If a class III violation is corrected within the
3973	time specified, no fine may be imposed, unless it is a repeated
3974	offense.
3975	(d)  Class "IV" violations are defined in s. 408.813 those
3976	conditions or occurrences related to the operation and
3977	maintenance of a building or to required reports, forms, or
3978	documents that do not have the potential of negatively affecting
3979	residents. These violations are of a type that the agency
3980	determines do not threaten the health, safety, or security of
3981	residents of the facility. The agency shall impose an
3982	administrative fine for a cited class IV violation in an amount
3983	not less than $100 and not exceeding $200 for each violation. A
3984	citation for a class IV violation must specify the time within
3985	which the violation is required to be corrected. If a class IV
3986	violation is corrected within the time specified, no fine shall
3987	be imposed. Any class IV violation that is corrected during the
3988	time an agency survey is being conducted will be identified as
3989	an agency finding and not as a violation.
3990	(8)  During an inspection, the agency, as an alternative to
3991	or in conjunction with an administrative action against a
3992	facility for violations of this part and adopted rules, shall
3993	make a reasonable attempt to discuss each violation and
3994	recommended corrective action with the owner or administrator of
3995	the facility, prior to written notification. The agency, instead
3996	of fixing a period within which the facility shall enter into
3997	compliance with standards, may request a plan of corrective
3998	action from the facility which demonstrates a good faith effort
3999	to remedy each violation by a specific date, subject to the
4000	approval of the agency.
4001	(9)  The agency shall develop and disseminate an annual
4002	list of all facilities sanctioned or fined $5,000 or more for
4003	violations of state standards, the number and class of
4004	violations involved, the penalties imposed, and the current
4005	status of cases. The list shall be disseminated, at no charge,
4006	to the Department of Elderly Affairs, the Department of Health,
4007	the Department of Children and Family Services, the Agency for
4008	Persons with Disabilities, the area agencies on aging, the
4009	Florida Statewide Advocacy Council, and the state and local
4010	ombudsman councils. The Department of Children and Family
4011	Services shall disseminate the list to service providers under
4012	contract to the department who are responsible for referring
4013	persons to a facility for residency. The agency may charge a fee
4014	commensurate with the cost of printing and postage to other
4015	interested parties requesting a copy of this list. This
4016	information may be provided electronically or on the agency's
4017	Internet website.
4018	Section 54.  Subsections (2) and (6) of section 429.23,
4019	Florida Statutes, are amended to read:
4020	429.23  Internal risk management and quality assurance
4021	program; adverse incidents and reporting requirements.--
4022	(2)  Every facility licensed under this part is required to
4023	maintain adverse incident reports. For purposes of this section,
4024	the term, "adverse incident" means:
4025	(a)  An event over which facility personnel could exercise
4026	control rather than as a result of the resident's condition and
4027	results in:
4028	1.  Death;
4029	2.  Brain or spinal damage;
4030	3.  Permanent disfigurement;
4031	4.  Fracture or dislocation of bones or joints;
4032	5.  Any condition that required medical attention to which
4033	the resident has not given his or her consent, including failure
4034	to honor advanced directives;
4035	6.  Any condition that requires the transfer of the
4036	resident from the facility to a unit providing more acute care
4037	due to the incident rather than the resident's condition before
4038	the incident; or.
4039	7.  An event that is reported to law enforcement or its
4040	personnel for investigation; or
4041	(b)  Abuse, neglect, or exploitation as defined in s.
4042	415.102;
4043	(c)  Events reported to law enforcement; or
4044	(b)(d)  Resident elopement, if the elopement places the
4045	resident at risk of harm or injury.
4046	(6)  Abuse, neglect, or exploitation must be reported to
4047	the Department of Children and Family Services as required under
4048	chapter 415. The agency shall annually submit to the Legislature
4049	a report on assisted living facility adverse incident reports.
4050	The report must include the following information arranged by
4051	county:
4052	(a)  A total number of adverse incidents;
4053	(b)  A listing, by category, of the type of adverse
4054	incidents occurring within each category and the type of staff
4055	involved;
4056	(c)  A listing, by category, of the types of injuries, if
4057	any, and the number of injuries occurring within each category;
4058	(d)  Types of liability claims filed based on an adverse
4059	incident report or reportable injury; and
4060	(e)  Disciplinary action taken against staff, categorized
4061	by the type of staff involved.
4062	Section 55.  Subsections (10) through (12) of section
4063	429.26, Florida Statutes, are renumbered as subsections (9)
4064	through (11), respectively, and present subsection (9) of that
4065	section is amended to read:
4066	429.26  Appropriateness of placements; examinations of
4067	residents.--
4068	(9)  If, at any time after admission to a facility, a
4069	resident appears to need care beyond that which the facility is
4070	licensed to provide, the agency shall require the resident to be
4071	physically examined by a licensed physician, physician
4072	assistant, or licensed nurse practitioner. This examination
4073	shall, to the extent possible, be performed by the resident's
4074	preferred physician or nurse practitioner and shall be paid for
4075	by the resident with personal funds, except as provided in s.
4076	429.18(2). Following this examination, the examining physician,
4077	physician assistant, or licensed nurse practitioner shall
4078	complete and sign a medical form provided by the agency. The
4079	completed medical form shall be submitted to the agency within
4080	30 days after the date the facility owner or administrator is
4081	notified by the agency that the physical examination is
4082	required. After consultation with the physician, physician
4083	assistant, or licensed nurse practitioner who performed the
4084	examination, a medical review team designated by the agency
4085	shall then determine whether the resident is appropriately
4086	residing in the facility. The medical review team shall base its
4087	decision on a comprehensive review of the resident's physical
4088	and functional status, including the resident's preferences, and
4089	not on an isolated health-related problem. In the case of a
4090	mental health resident, if the resident appears to have needs in
4091	addition to those identified in the community living support
4092	plan, the agency may require an evaluation by a mental health
4093	professional, as determined by the Department of Children and
4094	Family Services. A facility may not be required to retain a
4095	resident who requires more services or care than the facility is
4096	able to provide in accordance with its policies and criteria for
4097	admission and continued residency. Members of the medical review
4098	team making the final determination may not include the agency
4099	personnel who initially questioned the appropriateness of a
4100	resident's placement. Such determination is final and binding
4101	upon the facility and the resident. Any resident who is
4102	determined by the medical review team to be inappropriately
4103	residing in a facility shall be given 30 days' written notice to
4104	relocate by the owner or administrator, unless the resident's
4105	continued residence in the facility presents an imminent danger
4106	to the health, safety, or welfare of the resident or a
4107	substantial probability exists that death or serious physical
4108	harm would result to the resident if allowed to remain in the
4109	facility.
4110	Section 56.  Subsection (2) of section 430.608, Florida
4111	Statutes, is amended to read:
4112	430.608  Confidentiality of information.--
4113	(2)  This section does not, however, limit the subpoena
4114	authority of the Medicaid Fraud Control Unit of the Department
4115	of Legal Affairs pursuant to s. 409.920(10)(b) s. 409.920(9)(b).
4116	Section 57.  Paragraph (h) of subsection (3) of section
4117	430.80, Florida Statutes, is amended to read:
4118	430.80  Implementation of a teaching nursing home pilot
4119	project.--
4120	(3)  To be designated as a teaching nursing home, a nursing
4121	home licensee must, at a minimum:
4122	(h)  Maintain insurance coverage pursuant to s.
4123	400.141(1)(s)(20) or proof of financial responsibility in a
4124	minimum amount of $750,000. Such proof of financial
4125	responsibility may include:
4126	1.  Maintaining an escrow account consisting of cash or
4127	assets eligible for deposit in accordance with s. 625.52; or
4128	2.  Obtaining and maintaining pursuant to chapter 675 an
4129	unexpired, irrevocable, nontransferable and nonassignable letter
4130	of credit issued by any bank or savings association organized
4131	and existing under the laws of this state or any bank or savings
4132	association organized under the laws of the United States that
4133	has its principal place of business in this state or has a
4134	branch office which is authorized to receive deposits in this
4135	state. The letter of credit shall be used to satisfy the
4136	obligation of the facility to the claimant upon presentment of a
4137	final judgment indicating liability and awarding damages to be
4138	paid by the facility or upon presentment of a settlement
4139	agreement signed by all parties to the agreement when such final
4140	judgment or settlement is a result of a liability claim against
4141	the facility.
4142	Section 58.  Subsection (5) of section 435.04, Florida
4143	Statutes, is amended to read:
4144	435.04  Level 2 screening standards.--
4145	(5)  Under penalty of perjury, all employees in such
4146	positions of trust or responsibility shall attest to meeting the
4147	requirements for qualifying for employment and agreeing to
4148	inform the employer immediately if convicted of any of the
4149	disqualifying offenses while employed by the employer. Each
4150	employer of employees in such positions of trust or
4151	responsibilities which is licensed or registered by a state
4152	agency shall submit to the licensing agency annually or at the
4153	time of license renewal, under penalty of perjury, an affidavit
4154	of compliance with the provisions of this section.
4155	Section 59.  Subsection (3) of section 435.05, Florida
4156	Statutes, is amended to read:
4157	435.05  Requirements for covered employees.--Except as
4158	otherwise provided by law, the following requirements shall
4159	apply to covered employees:
4160	(3)  Each employer required to conduct level 2 background
4161	screening must sign an affidavit annually or at the time of
4162	license renewal, under penalty of perjury, stating that all
4163	covered employees have been screened or are newly hired and are
4164	awaiting the results of the required screening checks.
4165	Section 60.  Subsection (11) is added to section 456.004,
4166	Florida Statutes, to read:
4167	456.004  Department; powers and duties.--The department,
4168	for the professions under its jurisdiction, shall:
4169	(11)  Work cooperatively with the Agency for Health Care
4170	Administration and the judicial system to recover Medicaid
4171	overpayments by the Medicaid program. The department shall
4172	investigate and prosecute health care practitioners who have not
4173	remitted amounts owed to the state for an overpayment from the
4174	Medicaid program pursuant to a final order, judgment, or
4175	stipulation or settlement.
4176	Section 61.  Present subsections (6) through (10) of
4177	section 456.041, Florida Statutes, are renumbered as subsections
4178	(7) through (11), respectively, and a new subsection (6) is
4179	added to that section, to read:
4180	456.041  Practitioner profile; creation.--
4181	(6)  The Department of Health shall provide in each
4182	practitioner profile for every physician or advanced registered
4183	nurse practitioner terminated for cause from participating in
4184	the Medicaid program, pursuant to s. 409.913, or sanctioned by
4185	the Medicaid program, a statement that the practitioner has been
4186	terminated from participating in the Florida Medicaid program or
4187	sanctioned by the Medicaid program.
4188	Section 62.  Paragraph (o) of subsection (3) of section
4189	456.053, Florida Statutes, is amended to read:
4190	(3)  DEFINITIONS.--For the purpose of this section, the
4191	word, phrase, or term:
4192	(o)  "Referral" means any referral of a patient by a health
4193	care provider for health care services, including, without
4194	limitation:
4195	1.  The forwarding of a patient by a health care provider
4196	to another health care provider or to an entity which provides
4197	or supplies designated health services or any other health care
4198	item or service; or
4199	2.  The request or establishment of a plan of care by a
4200	health care provider, which includes the provision of designated
4201	health services or other health care item or service.
4202	3.  The following orders, recommendations, or plans of care
4203	shall not constitute a referral by a health care provider:
4204	a.  By a radiologist for diagnostic-imaging services.
4205	b.  By a physician specializing in the provision of
4206	radiation therapy services for such services.
4207	c.  By a medical oncologist for drugs and solutions to be
4208	prepared and administered intravenously to such oncologist's
4209	patient, as well as for the supplies and equipment used in
4210	connection therewith to treat such patient for cancer and the
4211	complications thereof.
4212	d.  By a cardiologist for cardiac catheterization services.
4213	e.  By a pathologist for diagnostic clinical laboratory
4214	tests and pathological examination services, if furnished by or
4215	under the supervision of such pathologist pursuant to a
4216	consultation requested by another physician.
4217	f.  By a health care provider who is the sole provider or
4218	member of a group practice for designated health services or
4219	other health care items or services that are prescribed or
4220	provided solely for such referring health care provider's or
4221	group practice's own patients, and that are provided or
4222	performed by or under the direct supervision of such referring
4223	health care provider or group practice; provided, however, that
4224	effective July 1, 1999, a physician licensed pursuant to chapter
4225	458, chapter 459, chapter 460, or chapter 461 may refer a
4226	patient to a sole provider or group practice for diagnostic
4227	imaging services, excluding radiation therapy services, for
4228	which the sole provider or group practice billed both the
4229	technical and the professional fee for or on behalf of the
4230	patient, if the referring physician has no investment interest
4231	in the practice. The diagnostic imaging service referred to a
4232	group practice or sole provider must be a diagnostic imaging
4233	service normally provided within the scope of practice to the
4234	patients of the group practice or sole provider. The group
4235	practice or sole provider may accept no more than 15 percent of
4236	their patients receiving diagnostic imaging services from
4237	outside referrals, excluding radiation therapy services.
4238	g.  By a health care provider for services provided by an
4239	ambulatory surgical center licensed under chapter 395.
4240	h.  By a urologist for lithotripsy services.
4241	i.  By a dentist for dental services performed by an
4242	employee of or health care provider who is an independent
4243	contractor with the dentist or group practice of which the
4244	dentist is a member.
4245	j.  By a physician for infusion therapy services to a
4246	patient of that physician or a member of that physician's group
4247	practice.
4248	k.  By a nephrologist for renal dialysis services and
4249	supplies, except laboratory services.
4250	l.  By a health care provider whose principal professional
4251	practice consists of treating patients in their private
4252	residences for services to be rendered in such private
4253	residences, except for services rendered by a home health agency
4254	licensed under chapter 400. For purposes of this sub-
4255	subparagraph, the term "private residences" includes patient's
4256	private homes, independent living centers, and assisted living
4257	facilities, but does not include skilled nursing facilities.
4258	m.  By a health care provider for sleep-related testing.
4259	Section 63.  Section 456.0635, Florida Statutes, is created
4260	to read:
4261	456.0635  Medicaid fraud; disqualification for license,
4262	certificate, or registration.--
4263	(1)  Medicaid fraud in the practice of a health care
4264	profession is prohibited.
4265	(2)  Each board within the jurisdiction of the department,
4266	or the department if there is no board, shall refuse to admit a
4267	candidate to any examination and refuse to issue or renew a
4268	license, certificate, or registration to any applicant if the
4269	candidate or applicant or any principle, officer, agent,
4270	managing employee, or affiliated person of the applicant, has
4271	been:
4272	(a)  Convicted of, or entered a plea of guilty or nolo
4273	contendere to, regardless of adjudication, a felony under
4274	chapter 409, chapter 817, chapter 893, 21 U.S.C. ss. 801-970, or
4275	42 U.S.C. ss. 1395-1396, unless the sentence and any subsequent
4276	period of probation for such conviction or plea ended more than
4277	15 years prior to the date of the application;
4278	(b)  Terminated for cause from the Florida Medicaid program
4279	pursuant to s. 409.913, unless the applicant has been in good
4280	standing with the Florida Medicaid program for the most recent 5
4281	years; or
4282	(c)  Terminated for cause, pursuant to the appeals
4283	procedures established by the state or Federal Government, from
4284	the federal Medicare program or from any other state Medicaid
4285	program, unless the applicant has been in good standing with a
4286	state Medicaid program or the federal Medicare program for the
4287	most recent 5 years and the termination occurred more than 19
4288	years prior to the date of the application.
4289	(3)  Licensed health care practitioners shall report
4290	allegations of Medicaid fraud to the department, regardless of
4291	the practice setting in which the alleged Medicaid fraud
4292	occurred.
4293	(4)  The acceptance by a licensing authority of a
4294	candidate's relinquishment of a license which is offered in
4295	response to or anticipation of the filing of administrative
4296	charges alleging Medicaid fraud or similar charges constitutes
4297	the permanent revocation of the license.
4298	Section 64.  Paragraphs (ii), (jj), (kk), and (ll) are
4299	added to subsection (1) of section 456.072, Florida Statutes, to
4300	read:
4301	456.072  Grounds for discipline; penalties; enforcement.--
4302	(1)  The following acts shall constitute grounds for which
4303	the disciplinary actions specified in subsection (2) may be
4304	taken:
4305	(ii)  Being convicted of, or entering a plea of guilty or
4306	nolo contendere to, any misdemeanor or felony, regardless of
4307	adjudication, under 18 U.S.C. s. 669, ss. 285-287, s. 371, s.
4308	1001, s. 1035, s. 1341, s. 1343, s. 1347, s. 1349, or s. 1518,
4309	or 42 U.S.C. ss. 1320a-7b, relating to the Medicaid program.
4310	(jj)  Failing to remit the sum owed to the state for an
4311	overpayment from the Medicaid program pursuant to a final order,
4312	judgment, or stipulation or settlement.
4313	(kk)  Being terminated for cause from the state Medicaid
4314	program pursuant to s. 409.913, or being terminated for cause,
4315	pursuant to the appeals procedures established by the state or
4316	Federal Government, the federal Medicare program, unless
4317	eligibility to participate in that program has been restored, or
4318	from any other state Medicaid program.
4319	(ll)  Being convicted of, or entering a plea of guilty or
4320	nolo contendere to, any misdemeanor or felony, regardless of
4321	adjudication, a crime in any jurisdiction which relates to
4322	health care fraud.
4323	Section 65.  Subsection (1) of section 456.074, Florida
4324	Statutes, is amended to read:
4325	456.074  Certain health care practitioners; immediate
4326	suspension of license.--
4327	(1)  The department shall issue an emergency order
4328	suspending the license of any person licensed under chapter 458,
4329	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
4330	chapter 464, chapter 465, chapter 466, or chapter 484 who pleads
4331	guilty to, is convicted or found guilty of, or who enters a plea
4332	of nolo contendere to, regardless of adjudication, to:
4333	(a)  A felony under chapter 409, chapter 817, or chapter
4334	893 or under 21 U.S.C. ss. 801-970 or under 42 U.S.C. ss. 1395-
4335	1396; or.
4336	(b)  A misdemeanor or felony under 18 U.S.C. s. 669, ss.
4337	285-287, s. 371, s. 1001, s. 1035, s. 1341, s. 1343, s. 1347, s.
4338	1349, or s. 1518 or 42 U.S.C. ss. 1320a-7b, relating to the
4339	Medicaid program.
4340	Section 66.  Section 456.42, Florida Statutes, is amended
4341	to read:
4342	456.42  Written prescriptions for medicinal drugs.--A
4343	written prescription for a medicinal drug issued by a health
4344	care practitioner licensed by law to prescribe such drug must be
4345	legibly printed or typed so as to be capable of being understood
4346	by the pharmacist filling the prescription; must contain the
4347	name of the prescribing practitioner, the name and strength of
4348	the drug prescribed, the quantity of the drug prescribed in both
4349	textual and numerical formats, and the directions for use of the
4350	drug; must be dated with the month written out in textual
4351	letters; and must be signed by the prescribing practitioner on
4352	the day when issued. A written prescription for a controlled
4353	substance listed in chapter 893 must have the quantity of the
4354	drug prescribed in both textual and numerical formats and must
4355	be dated with the abbreviated month written out on the face of
4356	the prescription. However, a prescription that is electronically
4357	generated and transmitted must contain the name of the
4358	prescribing practitioner, the name and strength of the drug
4359	prescribed, the quantity of the drug prescribed in numerical
4360	format, and the directions for use of the drug and must be dated
4361	and signed by the prescribing practitioner only on the day
4362	issued, which signature may be in an electronic format as
4363	defined in s. 668.003(4).
4364	Section 67.  Subsections (2) and (3) of section 465.022,
4365	Florida Statutes, are amended, present subsections (4), (5),
4366	(6), and (7) of that section are renumbered as subsections (5),
4367	(6), (7), and (8), respectively, and a new subsection (4) is
4368	added to that section, to read:
4369	465.022  Pharmacies; general requirements; fees.--
4370	(2)  A pharmacy permit shall be issued only to a person who
4371	is at least 18 years of age, a partnership whose partners are
4372	all at least 18 years of age, or to a corporation that which is
4373	registered pursuant to chapter 607 or chapter 617 whose
4374	officers, directors, and shareholders are at least 18 years of
4375	age.
4376	(3)  Any person, partnership, or corporation before
4377	engaging in the operation of a pharmacy shall file with the
4378	board a sworn application on forms provided by the department.
4379	(a)  An application for a pharmacy permit must include a
4380	set of fingerprints from each person having an ownership
4381	interest of 5 percent or greater and from any person who,
4382	directly or indirectly, manages, oversees, or controls the
4383	operation of the applicant, including officers and members of
4384	the board of directors of an applicant that is a corporation.
4385	The applicant must provide payment in the application for the
4386	cost of state and national criminal history records checks.
4387	1.  For corporations having more than $100 million of
4388	business taxable assets in this state, in lieu of these
4389	fingerprint requirements, the department shall require the
4390	prescription department manager who will be directly involved in
4391	the management and operation of the pharmacy to submit a set of
4392	fingerprints.
4393	2.  A representative of a corporation described in
4394	subparagraph 1. satisfies the requirement to submit a set of his
4395	or her fingerprints if the fingerprints are on file with the
4396	department or the Agency for Health Care Administration, meet
4397	the fingerprint specifications for submission by the Department
4398	of Law Enforcement, and are available to the department.
4399	(b)  The department shall submit the fingerprints provided
4400	by the applicant to the Department of Law Enforcement for a
4401	state criminal history records check. The Department of Law
4402	Enforcement shall forward the fingerprints to the Federal Bureau
4403	of Investigation for a national criminal history records check.
4404	(4)  The department or board shall deny an application for
4405	a pharmacy permit if the applicant or an affiliated person,
4406	partner, officer, director, or prescription department manager
4407	of the applicant has:
4408	(a)  Obtained a permit by misrepresentation or fraud;
4409	(b)  Attempted to procure, or has procured, a permit for
4410	any other person by making, or causing to be made, any false
4411	representation;
4412	(c)  Been convicted of, or entered a plea of guilty or nolo
4413	contendere to, regardless of adjudication, a crime in any
4414	jurisdiction which relates to the practice of, or the ability to
4415	practice, the profession of pharmacy, unless the sentence and
4416	any subsequent period of probation for such conviction or plea
4417	ended more than 15 years prior to the date of the application;
4418	(d)  Been convicted of, or entered a plea of guilty or nolo
4419	contendere to, regardless of adjudication, a crime in any
4420	jurisdiction which relates to health care fraud, unless the
4421	sentence and any subsequent period of probation for such
4422	conviction or plea ended more than 15 years prior to the date of
4423	the application;
4424	(e)  Been terminated for cause, pursuant to the appeals
4425	procedures established by the state or Federal Government, from
4426	the federal Medicare program or from any other state Medicaid
4427	program, unless the applicant has been in good standing with a
4428	state Medicaid program or the federal Medicare program for the
4429	most recent 5 years and the termination occurred more than 19
4430	years prior to the date of the application; or
4431	(f)  Dispensed any medicinal drug based upon a
4432	communication that purports to be a prescription as defined by
4433	s. 465.003(14) or s. 893.02 when the pharmacist knows or has
4434	reason to believe that the purported prescription is not based
4435	upon a valid practitioner-patient relationship that includes a
4436	documented patient evaluation, including history and a physical
4437	examination adequate to establish the diagnosis for which any
4438	drug is prescribed and any other requirement established by
4439	board rule under chapter 458, chapter 459, chapter 461, chapter
4440	463, chapter 464, or chapter 466.
4441	Section 68.  Subsection (1) of section 465.023, Florida
4442	Statutes, is amended to read:
4443	465.023  Pharmacy permittee; disciplinary action.--
4444	(1)  The department or the board may revoke or suspend the
4445	permit of any pharmacy permittee, and may fine, place on
4446	probation, or otherwise discipline any pharmacy permittee if the
4447	permittee, or any affiliated person, partner, officer, director,
4448	or agent of the permittee, including a person fingerprinted
4449	under s. 465.022(3), who has:
4450	(a)  Obtained a permit by misrepresentation or fraud or
4451	through an error of the department or the board;
4452	(b)  Attempted to procure, or has procured, a permit for
4453	any other person by making, or causing to be made, any false
4454	representation;
4455	(c)  Violated any of the requirements of this chapter or
4456	any of the rules of the Board of Pharmacy; of chapter 499, known
4457	as the "Florida Drug and Cosmetic Act"; of 21 U.S.C. ss. 301-
4458	392, known as the "Federal Food, Drug, and Cosmetic Act"; of 21
4459	U.S.C. ss. 821 et seq., known as the Comprehensive Drug Abuse
4460	Prevention and Control Act; or of chapter 893;
4461	(d)  Been convicted or found guilty, regardless of
4462	adjudication, of a felony or any other crime involving moral
4463	turpitude in any of the courts of this state, of any other
4464	state, or of the United States; or
4465	(e)  Been convicted or disciplined by a regulatory agency
4466	of the Federal Government or a regulatory agency of another
4467	state for any offense that would constitute a violation of this
4468	chapter;
4469	(f)  Been convicted of, or entered a plea of guilty or nolo
4470	contendere to, regardless of adjudication, a crime in any
4471	jurisdiction which relates to the practice of, or the ability to
4472	practice, the profession of pharmacy;
4473	(g)  Been convicted of, or entered a plea of guilty or nolo
4474	contendere to, regardless of adjudication, a crime in any
4475	jurisdiction which relates to health care fraud; or
4476	(h)(e)  Dispensed any medicinal drug based upon a
4477	communication that purports to be a prescription as defined by
4478	s. 465.003(14) or s. 893.02 when the pharmacist knows or has
4479	reason to believe that the purported prescription is not based
4480	upon a valid practitioner-patient relationship that includes a
4481	documented patient evaluation, including history and a physical
4482	examination adequate to establish the diagnosis for which any
4483	drug is prescribed and any other requirement established by
4484	board rule under chapter 458, chapter 459, chapter 461, chapter
4485	463, chapter 464, or chapter 466.
4486	Section 69.  Subsection (2) of section 483.031, Florida
4487	Statutes, is amended to read:
4488	483.031  Application of part; exemptions.--This part
4489	applies to all clinical laboratories within this state, except:
4490	(2)  A clinical laboratory that performs only waived tests
4491	and has received a certificate of exemption from the agency
4492	under s. 483.106.
4493	Section 70.  Subsection (10) of section 483.041, Florida
4494	Statutes, is amended to read:
4495	483.041  Definitions.--As used in this part, the term:
4496	(10)  "Waived test" means a test that the federal Centers
4497	for Medicare and Medicaid Services Health Care Financing
4498	Administration has determined qualifies for a certificate of
4499	waiver under the federal Clinical Laboratory Improvement
4500	Amendments of 1988, and the federal rules adopted thereunder.
4501	Section 71.  Section 483.106, Florida Statutes, is
4502	repealed.
4503	Section 72.  Subsection (3) of section 483.172, Florida
4504	Statutes, is amended to read:
4505	483.172  License fees.--
4506	(3)  The agency shall assess a biennial fee of $100 for a
4507	certificate of exemption and a $100 biennial license fee under
4508	this section for facilities surveyed by an approved accrediting
4509	organization.
4510	Section 73.  Paragraph (b) of subsection (1) of section
4511	627.4239, Florida Statutes, is amended to read:
4512	627.4239  Coverage for use of drugs in treatment of
4513	cancer.--
4514	(1)  DEFINITIONS.--As used in this section, the term:
4515	(b)  "Standard reference compendium" means authoritative
4516	compendia identified by the Secretary of the United States
4517	Department of Health and Human Services and recognized by the
4518	federal Centers for Medicare and Medicaid Services:
4519	1.  The United States Pharmacopeia Drug Information;
4520	2.  The American Medical Association Drug Evaluations; or
4521	3.  The American Hospital Formulary Service Drug
4522	Information.
4523	Section 74.  Subsection (13) of section 651.118, Florida
4524	Statutes, is amended to read:
4525	651.118  Agency for Health Care Administration;
4526	certificates of need; sheltered beds; community beds.--
4527	(13)  Residents, as defined in this chapter, are not
4528	considered new admissions for the purpose of s.
4529	400.141(1)(o)1.d.(15)(d).
4530	Section 75.  Section 825.103, Florida Statutes, is amended
4531	to read:
4532	825.103  Exploitation of an elderly person or disabled
4533	adult; penalties.--
4534	(1)  "Exploitation of an elderly person or disabled adult"
4535	means:
4536	(a)  Knowingly, by deception or intimidation, obtaining or
4537	using, or endeavoring to obtain or use, an elderly person's or
4538	disabled adult's funds, assets, or property with the intent to
4539	temporarily or permanently deprive the elderly person or
4540	disabled adult of the use, benefit, or possession of the funds,
4541	assets, or property, or to benefit someone other than the
4542	elderly person or disabled adult, by a person who:
4543	1.  Stands in a position of trust and confidence with the
4544	elderly person or disabled adult; or
4545	2.  Has a business relationship with the elderly person or
4546	disabled adult; or
4547	(b)  Obtaining or using, endeavoring to obtain or use, or
4548	conspiring with another to obtain or use an elderly person's or
4549	disabled adult's funds, assets, or property with the intent to
4550	temporarily or permanently deprive the elderly person or
4551	disabled adult of the use, benefit, or possession of the funds,
4552	assets, or property, or to benefit someone other than the
4553	elderly person or disabled adult, by a person who knows or
4554	reasonably should know that the elderly person or disabled adult
4555	lacks the capacity to consent; or.
4556	(c)  Breach of a fiduciary duty to an elderly person or
4557	disabled adult by the person's guardian or agent under a power
4558	of attorney which results in an unauthorized appropriation,
4559	sale, or transfer of property.
4560	(2)(a)  If the funds, assets, or property involved in the
4561	exploitation of the elderly person or disabled adult is valued
4562	at $100,000 or more, the offender commits a felony of the first
4563	degree, punishable as provided in s. 775.082, s. 775.083, or s.
4564	775.084.
4565	(b)  If the funds, assets, or property involved in the
4566	exploitation of the elderly person or disabled adult is valued
4567	at $20,000 or more, but less than $100,000, the offender commits
4568	a felony of the second degree, punishable as provided in s.
4569	775.082, s. 775.083, or s. 775.084.
4570	(c)  If the funds, assets, or property involved in the
4571	exploitation of an elderly person or disabled adult is valued at
4572	less than $20,000, the offender commits a felony of the third
4573	degree, punishable as provided in s. 775.082, s. 775.083, or s.
4574	775.084.
4575	Section 76.  Paragraph (d) of subsection (2) of section
4576	893.04, Florida Statutes, is amended to read:
4577	893.04  Pharmacist and practitioner.--
4578	(2)
4579	(d)  Each written prescription prescribed by a practitioner
4580	in this state for a controlled substance listed in Schedule II,
4581	Schedule III, or Schedule IV must include both a written and a
4582	numerical notation of the quantity of the controlled substance
4583	prescribed on the face of the prescription and a notation of the
4584	date, with the abbreviated month written out on the face of the
4585	prescription. A pharmacist may, upon verification by the
4586	prescriber, document any information required by this paragraph.
4587	If the prescriber is not available to verify a prescription, the
4588	pharmacist may dispense the controlled substance but may insist
4589	that the person to whom the controlled substance is dispensed
4590	provide valid photographic identification. If a prescription
4591	includes a numerical notation of the quantity of the controlled
4592	substance or date but does not include the quantity or date
4593	written out in textual format, the pharmacist may dispense the
4594	controlled substance without verification by the prescriber of
4595	the quantity or date if the pharmacy previously dispensed
4596	another prescription for the person to whom the prescription was
4597	written.
4598	Section 77.  Paragraphs (g) and (i) of subsection (3) of
4599	section 921.0022, Florida Statutes, are amended to read:
4600	921.0022  Criminal Punishment Code; offense severity
4601	ranking chart.--
4602	(3)  OFFENSE SEVERITY RANKING CHART
4603	(g)  LEVEL 7
4604
	FloridaStatute FelonyDegree Description
4605
4606
	316.027(1)(b) 1st Accident involving death, failure to stop; leaving scene.
4607
4608
	316.193(3)(c)2. 3rd DUI resulting in serious bodily injury.
4609
4610
	316.1935(3)(b) 1st Causing serious bodily injury or death to another person; driving at high speed or with wanton disregard for safety while fleeing or attempting to elude law enforcement officer who is in a patrol vehicle with siren and lights activated.
4611
4612
	327.35(3)(c)2. 3rd Vessel BUI resulting in serious bodily injury.
4613
4614
	402.319(2) 2nd Misrepresentation and negligence or intentional act resulting in great bodily harm, permanent disfiguration, permanent disability, or death.
4615
4616
	409.920(2)(b)1.a. 3rd Medicaid provider fraud; $10,000 or less.
4617
4618
	409.920(2)(b)1.b. 2nd Medicaid provider fraud; more than $10,000, but less than $50,000.
4619
4620
	456.065(2) 3rd Practicing a health care profession without a license.
4621
4622
	456.065(2) 2nd Practicing a health care profession without a license which results in serious bodily injury.
4623
4624
	458.327(1) 3rd Practicing medicine without a license.
4625
4626
	459.013(1) 3rd Practicing osteopathic medicine without a license.
4627
4628
	460.411(1) 3rd Practicing chiropractic medicine without a license.
4629
4630
	461.012(1) 3rd Practicing podiatric medicine without a license.
4631
4632
	462.17 3rd Practicing naturopathy without a license.
4633
4634
	463.015(1) 3rd Practicing optometry without a license.
4635
4636
	464.016(1) 3rd Practicing nursing without a license.
4637
4638
	465.015(2) 3rd Practicing pharmacy without a license.
4639
4640
	466.026(1) 3rd Practicing dentistry or dental hygiene without a license.
4641
4642
	467.201 3rd Practicing midwifery without a license.
4643
4644
	468.366 3rd Delivering respiratory care services without a license.
4645
4646
	483.828(1) 3rd Practicing as clinical laboratory personnel without a license.
4647
4648
	483.901(9) 3rd Practicing medical physics without a license.
4649
4650
	484.013(1)(c) 3rd Preparing or dispensing optical devices without a prescription.
4651
4652
	484.053 3rd Dispensing hearing aids without a license.
4653
4654
	494.0018(2) 1st Conviction of any violation of ss. 494.001-494.0077 in which the total money and property unlawfully obtained exceeded $50,000 and there were five or more victims.
4655
4656
	560.123(8)(b)1. 3rd Failure to report currency or payment instruments exceeding $300 but less than $20,000 by a money services business.
4657
4658
	560.125(5)(a) 3rd Money services business by unauthorized person, currency or payment instruments exceeding $300 but less than $20,000.
4659
4660
	655.50(10)(b)1. 3rd Failure to report financial transactions exceeding $300 but less than $20,000 by financial institution.
4661
4662
	775.21(10)(a) 3rd Sexual predator; failure to register; failure to renew driver's license or identification card; other registration violations.
4663
4664
	775.21(10)(b) 3rd Sexual predator working where children regularly congregate.
4665
4666
	775.21(10)(g) 3rd Failure to report or providing false information about a sexual predator; harbor or conceal a sexual predator.
4667
4668
	782.051(3) 2nd Attempted felony murder of a person by a person other than the perpetrator or the perpetrator of an attempted felony.
4669
4670
	782.07(1) 2nd Killing of a human being by the act, procurement, or culpable negligence of another (manslaughter).
4671
4672
	782.071 2nd Killing of a human being or viable fetus by the operation of a motor vehicle in a reckless manner (vehicular homicide).
4673
4674
	782.072 2nd Killing of a human being by the operation of a vessel in a reckless manner (vessel homicide).
4675
4676
	784.045(1)(a)1. 2nd Aggravated battery; intentionally causing great bodily harm or disfigurement.
4677
4678
	784.045(1)(a)2. 2nd Aggravated battery; using deadly weapon.
4679
4680
	784.045(1)(b) 2nd Aggravated battery; perpetrator aware victim pregnant.
4681
4682
	784.048(4) 3rd Aggravated stalking; violation of injunction or court order.
4683
4684
	784.048(7) 3rd Aggravated stalking; violation of court order.
4685
4686
	784.07(2)(d) 1st Aggravated battery on law enforcement officer.
4687
4688
	784.074(1)(a) 1st Aggravated battery on sexually violent predators facility staff.
4689
4690
	784.08(2)(a) 1st Aggravated battery on a person 65 years of age or older.
4691
4692
	784.081(1) 1st Aggravated battery on specified official or employee.
4693
4694
	784.082(1) 1st Aggravated battery by detained person on visitor or other detainee.
4695
4696
	784.083(1) 1st Aggravated battery on code inspector.
4697
4698
	790.07(4) 1st Specified weapons violation subsequent to previous conviction of s. 790.07(1) or (2).
4699
4700
	790.16(1) 1st Discharge of a machine gun under specified circumstances.
4701
4702
	790.165(2) 2nd Manufacture, sell, possess, or deliver hoax bomb.
4703
4704
	790.165(3) 2nd Possessing, displaying, or threatening to use any hoax bomb while committing or attempting to commit a felony.
4705
4706
	790.166(3) 2nd Possessing, selling, using, or attempting to use a hoax weapon of mass destruction.
4707
4708
	790.166(4) 2nd Possessing, displaying, or threatening to use a hoax weapon of mass destruction while committing or attempting to commit a felony.
4709
4710
	790.23 1st,PBL Possession of a firearm by a person who qualifies for the penalty enhancements provided for in s. 874.04.
4711
4712
	794.08(4) 3rd Female genital mutilation; consent by a parent, guardian, or a person in custodial authority to a victim younger than 18 years of age.
4713
4714
	796.03 2nd Procuring any person under 16 years for prostitution.
4715
4716
	800.04(5)(c)1. 2nd Lewd or lascivious molestation; victim less than 12 years of age; offender less than 18 years.
4717
4718
	800.04(5)(c)2. 2nd Lewd or lascivious molestation; victim 12 years of age or older but less than 16 years; offender 18 years or older.
4719
4720
	806.01(2) 2nd Maliciously damage structure by fire or explosive.
4721
4722
	810.02(3)(a) 2nd Burglary of occupied dwelling; unarmed; no assault or battery.
4723
4724
	810.02(3)(b) 2nd Burglary of unoccupied dwelling; unarmed; no assault or battery.
4725
4726
	810.02(3)(d) 2nd Burglary of occupied conveyance; unarmed; no assault or battery.
4727
4728
	810.02(3)(e) 2nd Burglary of authorized emergency vehicle.
4729
4730
	812.014(2)(a)1. 1st Property stolen, valued at $100,000 or more or a semitrailer deployed by a law enforcement officer; property stolen while causing other property damage; 1st degree grand theft.
4731
4732
	812.014(2)(b)2. 2nd Property stolen, cargo valued at less than $50,000, grand theft in 2nd degree.
4733
4734
	812.014(2)(b)3. 2nd Property stolen, emergency medical equipment; 2nd degree grand theft.
4735
4736
	812.014(2)(b)4. 2nd Property stolen, law enforcement equipment from authorized emergency vehicle.
4737
4738
	812.0145(2)(a) 1st Theft from person 65 years of age or older; $50,000 or more.
4739
4740
	812.019(2) 1st Stolen property; initiates, organizes, plans, etc., the theft of property and traffics in stolen property.
4741
4742
	812.131(2)(a) 2nd Robbery by sudden snatching.
4743
4744
	812.133(2)(b) 1st Carjacking; no firearm, deadly weapon, or other weapon.
4745
4746
	817.234(8)(a) 2nd Solicitation of motor vehicle accident victims with intent to defraud.
4747
4748
	817.234(9) 2nd Organizing, planning, or participating in an intentional motor vehicle collision.
4749
4750
	817.234(11)(c) 1st Insurance fraud; property value $100,000 or more.
4751
4752
	817.2341(2)(b) & (3)(b) 1st Making false entries of material fact or false statements regarding property values relating to the solvency of an insuring entity which are a significant cause of the insolvency of that entity.
4753
4754
	825.102(3)(b) 2nd Neglecting an elderly person or disabled adult causing great bodily harm, disability, or disfigurement.
4755
4756
	825.103(2)(b) 2nd Exploiting an elderly person or disabled adult and property is valued at $20,000 or more, but less than $100,000.
4757
4758
	827.03(3)(b) 2nd Neglect of a child causing great bodily harm, disability, or disfigurement.
4759
4760
	827.04(3) 3rd Impregnation of a child under 16 years of age by person 21 years of age or older.
4761
4762
	837.05(2) 3rd Giving false information about alleged capital felony to a law enforcement officer.
4763
4764
	838.015 2nd Bribery.
4765
4766
	838.016 2nd Unlawful compensation or reward for official behavior.
4767
4768
	838.021(3)(a) 2nd Unlawful harm to a public servant.
4769
4770
	838.22 2nd Bid tampering.
4771
4772
	847.0135(3) 3rd Solicitation of a child, via a computer service, to commit an unlawful sex act.
4773
4774
	847.0135(4) 2nd Traveling to meet a minor to commit an unlawful sex act.
4775
4776
	872.06 2nd Abuse of a dead human body.
4777
4778
	874.10 1st,PBL Knowingly initiates, organizes, plans, finances, directs, manages, or supervises criminal gang-related activity.
4779
4780
	893.13(1)(c)1. 1st Sell, manufacture, or deliver cocaine (or other drug prohibited under s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4.) within 1,000 feet of a child care facility, school, or state, county, or municipal park or publicly owned recreational facility or community center.
4781
4782
	893.13(1)(e)1. 1st Sell, manufacture, or deliver cocaine or other drug prohibited under s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4., within 1,000 feet of property used for religious services or a specified business site.
4783
4784
	893.13(4)(a) 1st Deliver to minor cocaine (or other s. 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)4. drugs).
4785
4786
	893.135(1)(a)1. 1st Trafficking in cannabis, more than 25 lbs., less than 2,000 lbs.
4787
4788
	893.135(1)(b)1.a. 1st Trafficking in cocaine, more than 28 grams, less than 200 grams.
4789
4790
	893.135(1)(c)1.a. 1st Trafficking in illegal drugs, more than 4 grams, less than 14 grams.
4791
4792
	893.135(1)(d)1. 1st Trafficking in phencyclidine, more than 28 grams, less than 200 grams.
4793
4794
	893.135(1)(e)1. 1st Trafficking in methaqualone, more than 200 grams, less than 5 kilograms.
4795
4796
	893.135(1)(f)1. 1st Trafficking in amphetamine, more than 14 grams, less than 28 grams.
4797
4798
	893.135(1)(g)1.a. 1st Trafficking in flunitrazepam, 4 grams or more, less than 14 grams.
4799
4800
	893.135(1)(h)1.a. 1st Trafficking in gamma-hydroxybutyric acid (GHB), 1 kilogram or more, less than 5 kilograms.
4801
4802
	893.135(1)(j)1.a. 1st Trafficking in 1,4-Butanediol, 1 kilogram or more, less than 5 kilograms.
4803
4804
	893.135(1)(k)2.a. 1st Trafficking in Phenethylamines, 10 grams or more, less than 200 grams.
4805
4806
	893.1351(2) 2nd Possession of place for trafficking in or manufacturing of controlled substance.
4807
4808
	896.101(5)(a) 3rd Money laundering, financial transactions exceeding $300 but less than $20,000.
4809
4810
	896.104(4)(a)1. 3rd Structuring transactions to evade reporting or registration requirements, financial transactions exceeding $300 but less than $20,000.
4811
4812
	943.0435(4)(c) 2nd Sexual offender vacating permanent residence; failure to comply with reporting requirements.
4813
4814
	943.0435(8) 2nd Sexual offender; remains in state after indicating intent to leave; failure to comply with reporting requirements.
4815
4816
	943.0435(9)(a) 3rd Sexual offender; failure to comply with reporting requirements.
4817
4818
	943.0435(13) 3rd Failure to report or providing false information about a sexual offender; harbor or conceal a sexual offender.
4819
4820
	943.0435(14) 3rd Sexual offender; failure to report and reregister; failure to respond to address verification.
4821
4822
	944.607(9) 3rd Sexual offender; failure to comply with reporting requirements.
4823
4824
	944.607(10)(a) 3rd Sexual offender; failure to submit to the taking of a digitized photograph.
4825
4826
	944.607(12) 3rd Failure to report or providing false information about a sexual offender; harbor or conceal a sexual offender.
4827
4828
	944.607(13) 3rd Sexual offender; failure to report and reregister; failure to respond to address verification.
4829
4830
	985.4815(10) 3rd Sexual offender; failure to submit to the taking of a digitized photograph.
4831
4832
	985.4815(12) 3rd Failure to report or providing false information about a sexual offender; harbor or conceal a sexual offender.
4833
4834
	985.4815(13) 3rd Sexual offender; failure to report and reregister; failure to respond to address verification.
4835
4836	(i)  LEVEL 9
4837
	FloridaStatute FelonyDegree Description
4838
4839
	316.193(3)(c)3.b. 1st DUI manslaughter; failing to render aid or give information.
4840
4841
	327.35(3)(c)3.b. 1st BUI manslaughter; failing to render aid or give information.
4842
4843
	409.920(2)(b)1.c. 1st Medicaid provider fraud; $50,000 or more.
4844
4845
	499.0051(9) 1st Knowing sale or purchase of contraband prescription drugs resulting in great bodily harm.
4846
4847
	560.123(8)(b)3. 1st Failure to report currency or payment instruments totaling or exceeding $100,000 by money transmitter.
4848
4849
	560.125(5)(c) 1st Money transmitter business by unauthorized person, currency, or payment instruments totaling or exceeding $100,000.
4850
4851
	655.50(10)(b)3. 1st Failure to report financial transactions totaling or exceeding $100,000 by financial institution.
4852
4853
	775.0844 1st Aggravated white collar crime.
4854
4855
	782.04(1) 1st Attempt, conspire, or solicit to commit premeditated murder.
4856
4857
	782.04(3) 1st,PBL Accomplice to murder in connection with arson, sexual battery, robbery, burglary, and other specified felonies.
4858
4859
	782.051(1) 1st Attempted felony murder while perpetrating or attempting to perpetrate a felony enumerated in s. 782.04(3).
4860
4861
	782.07(2) 1st Aggravated manslaughter of an elderly person or disabled adult.
4862
4863
	787.01(1)(a)1. 1st,PBL Kidnapping; hold for ransom or reward or as a shield or hostage.
4864
4865
	787.01(1)(a)2. 1st,PBL Kidnapping with intent to commit or facilitate commission of any felony.
4866
4867
	787.01(1)(a)4. 1st,PBL Kidnapping with intent to interfere with performance of any governmental or political function.
4868
4869
	787.02(3)(a) 1st False imprisonment; child under age 13; perpetrator also commits aggravated child abuse, sexual battery, or lewd or lascivious battery, molestation, conduct, or exhibition.
4870
4871
	790.161 1st Attempted capital destructive device offense.
4872
4873
	790.166(2) 1st,PBL Possessing, selling, using, or attempting to use a weapon of mass destruction.
4874
4875
	794.011(2) 1st Attempted sexual battery; victim less than 12 years of age.
4876
4877
	794.011(2) Life Sexual battery; offender younger than 18 years and commits sexual battery on a person less than 12 years.
4878
4879
	794.011(4) 1st Sexual battery; victim 12 years or older, certain circumstances.
4880
4881
	794.011(8)(b) 1st Sexual battery; engage in sexual conduct with minor 12 to 18 years by person in familial or custodial authority.
4882
4883
	794.08(2) 1st Female genital mutilation; victim younger than 18 years of age.
4884
4885
	800.04(5)(b) Life Lewd or lascivious molestation; victim less than 12 years; offender 18 years or older.
4886
4887
	812.13(2)(a) 1st,PBL Robbery with firearm or other deadly weapon.
4888
4889
	812.133(2)(a) 1st,PBL Carjacking; firearm or other deadly weapon.
4890
4891
	812.135(2)(b) 1st Home-invasion robbery with weapon.
4892
4893
	817.568(7) 2nd,PBL Fraudulent use of personal identification information of an individual under the age of 18 by his or her parent, legal guardian, or person exercising custodial authority.
4894
4895
	827.03(2) 1st Aggravated child abuse.
4896
4897
	847.0145(1) 1st Selling, or otherwise transferring custody or control, of a minor.
4898
4899
	847.0145(2) 1st Purchasing, or otherwise obtaining custody or control, of a minor.
4900
4901
	859.01 1st Poisoning or introducing bacteria, radioactive materials, viruses, or chemical compounds into food, drink, medicine, or water with intent to kill or injure another person.
4902
4903
	893.135 1st Attempted capital trafficking offense.
4904
4905
	893.135(1)(a)3. 1st Trafficking in cannabis, more than 10,000 lbs.
4906
4907
	893.135(1)(b)1.c. 1st Trafficking in cocaine, more than 400 grams, less than 150 kilograms.
4908
4909
	893.135(1)(c)1.c. 1st Trafficking in illegal drugs, more than 28 grams, less than 30 kilograms.
4910
4911
	893.135(1)(d)1.c. 1st Trafficking in phencyclidine, more than 400 grams.
4912
4913
	893.135(1)(e)1.c. 1st Trafficking in methaqualone, more than 25 kilograms.
4914
4915
	893.135(1)(f)1.c. 1st Trafficking in amphetamine, more than 200 grams.
4916
4917
	893.135(1)(h)1.c. 1st Trafficking in gamma-hydroxybutyric acid (GHB), 10 kilograms or more.
4918
4919
	893.135(1)(j)1.c. 1st Trafficking in 1,4-Butanediol, 10 kilograms or more.
4920
4921
	893.135(1)(k)2.c. 1st Trafficking in Phenethylamines, 400 grams or more.
4922
4923
	896.101(5)(c) 1st Money laundering, financial instruments totaling or exceeding $100,000.
4924
4925
	896.104(4)(a)3. 1st Structuring transactions to evade reporting or registration requirements, financial transactions totaling or exceeding $100,000.
4926
4927	Section 78.  In order to identify and realize potential
4928	cost savings for prescriptive assistive devices purchased by the
4929	Department of Health, all prescriptive assistive devices
4930	procured by the department that cost more than $2,500 shall be
4931	acquired on a competitive sealed bid basis through
4932	MyFloridaMarketPlace in accordance with s. 287.057, Florida
4933	Statutes. Any deviation from these guidelines shall be in
4934	accordance with s. 287.057(5)(a), Florida Statutes. The
4935	Department of Management Services shall administer the selection
4936	and the procurement of such devices.
4937	Section 79.  This act shall take effect July 1, 2009.

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