CS/CS/HB 1503

1	A bill to be entitled
2	An act relating to health care; amending s. 112.0455,
3	F.S., and repealing paragraph (10)(e), relating to a
4	prohibition against applying the Drug-Free Workplace Act
5	retroactively; conforming a cross-reference; amending s.
6	381.00315, F.S.; directing the Department of Health to
7	accept funds from counties, municipalities, and certain
8	other entities for the purchase of certain products made
9	available under a contract with the United States
10	Department of Health and Human Services for the
11	manufacture and delivery of such products in response to a
12	public health emergency; amending s. 381.932, F.S.;
13	revising certain criteria of the breast cancer early
14	detection and treatment referral program by requiring that
15	the public education and outreach initiative and
16	professional education programs use guidelines currently
17	employed by the United States Centers for Disease Control
18	and Prevention rather than the United States Preventive
19	Services Task Force; amending s. 381.06015, F.S.;
20	requiring the State Surgeon General to make certain
21	resources and materials relating to umbilical cord blood
22	available on the Internet website of the Department of
23	Health; requiring the Department of Health to encourage
24	certain health care professionals to make specified
25	information available to patients; repealing s. 383.325,
26	F.S., relating to the requirement of a licensed facility
27	under s. 383.305, F.S., to maintain inspection reports;
28	amending s. 395.1055, F.S., requiring Agency for Health
29	Care Administration rules related to infection control to
30	include a requirement that hospitals establish a
31	comprehensive plan to reduce health care associated
32	infections; establishing components for the plan;
33	repealing s. 395.1046, F.S., relating to the investigation
34	of complaints regarding hospitals; repealing s. 395.3037,
35	F.S.; deleting definitions relating to obsolete provisions
36	governing primary and comprehensive stroke centers;
37	amending s. 400.0239, F.S.; deleting an obsolete
38	provision; repealing s. 400.147(10), F.S., relating to a
39	requirement that a nursing home facility report any notice
40	of a filing of a claim for a violation of a resident's
41	rights or a claim of negligence; repealing s. 400.148,
42	F.S., relating to the Medicaid "Up-or-Out" Quality of Care
43	Contract Management Program; repealing s. 400.195, F.S.,
44	relating to reporting requirements for the Agency for
45	Health Care Administration; amending s. 400.476, F.S.;
46	providing requirements for an alternate administrator of a
47	home health agency; revising the duties of the
48	administrator; revising the requirements for a director of
49	nursing for a specified number of home health agencies;
50	prohibiting a home health agency from using an individual
51	as a home health aide unless the person has completed
52	training and an evaluation program; requiring a home
53	health aide to meet certain standards in order to be
54	competent in performing certain tasks; requiring a home
55	health agency and staff to comply with accepted
56	professional standards; providing certain requirements for
57	a written contract between certain personnel and the
58	agency; requiring a home health agency to provide certain
59	services through its employees; authorizing a home health
60	agency to provide additional services with another
61	organization; providing responsibilities of a home health
62	agency when it provides home health aide services through
63	another organization; requiring the home health agency to
64	coordinate personnel who provide home health services;
65	requiring personnel to communicate with the home health
66	agency; amending s. 400.487, F.S.; requiring a home health
67	agency to provide a patient or the patient's legal
68	representative a copy of the agreement between the agency
69	and the patient which specifies the home health services
70	to be provided; providing the rights that are protected by
71	the home health agency; requiring the home health agency
72	to furnish nursing services by or under the supervision of
73	a registered nurse; requiring the home health agency to
74	provide therapy services through a qualified therapist or
75	therapy assistant; providing the duties and qualifications
76	of a therapist and therapy assistant; requiring
77	supervision by a physical therapist or occupational
78	therapist of a physical therapist assistant or
79	occupational therapy assistant; providing duties of a
80	physical therapist assistant or occupational therapy
81	assistant; providing for speech therapy services to be
82	provided by a qualified speech-language pathologist or
83	audiologist; providing for a plan of care; providing that
84	only the staff of a home health agency may administer
85	drugs and treatments as ordered by certain health
86	professionals; providing requirements for verbal orders;
87	providing duties of a registered nurse, licensed practical
88	nurse, home health aide, and certified nursing assistant
89	who work for a home health agency; providing for
90	supervisory visits of services provided by a home health
91	agency; amending s. 400.9905, F.S.; revising the
92	definition of the term "clinic" applicable to the Health
93	Care Clinic Act; providing exemptions from licensure
94	requirements for certain legal entities that provide
95	health care services; repealing s. 408.802(11), F.S.,
96	relating to the applicability of the Health Care Licensing
97	Procedures Act to private review agents; repealing s.
98	409.912(15)(e), (f), and (g), F.S., relating to a
99	requirement for the Agency for Health Care Administration
100	to submit a report to the Legislature regarding the
101	operations of the CARE program; repealing s. 409.9122(13),
102	F.S., relating to Medicaid managed prepaid plan minimum
103	enrollment levels for plans operating in Miami-Dade
104	County; amending s. 409.91255, F.S.; transferring
105	administrative responsibility for the application
106	procedure for federally qualified health centers from the
107	Department of Health to the Agency for Health Care
108	Administration; requiring the Florida Association of
109	Community Health Centers, Inc., to provide support and
110	assume administrative costs for the program; amending s.
111	429.075, F.S.; requiring certain assisted living
112	facilities to maintain certain security services;
113	repealing s. 429.12(2), F.S., relating to the sale or
114	transfer of ownership of an assisted living facility;
115	repealing s. 429.23(5), F.S., relating to each assisted
116	living facility's requirement to submit a report to the
117	agency regarding liability claims filed against it;
118	repealing s. 429.911(2)(a), F.S., relating to an
119	intentional or negligent act materially affecting the
120	health or safety of center participants as grounds for
121	which the agency may take action against the owner of an
122	adult day care center or its operator or employee;
123	requiring persons who apply for licensure renewal as a
124	dentist or dental hygienist to furnish certain information
125	to the Department of Health in a dental workforce survey;
126	requiring the Board of Dentistry to issue a
127	nondisciplinary citation and a notice for failure to
128	complete the survey within a specified time; providing
129	notification requirements for the citation; requiring the
130	department to serve as the coordinating body for the
131	purpose of collecting, disseminating, and updating dental
132	workforce data; requiring the department to maintain a
133	database regarding the state's dental workforce; requiring
134	the department to develop strategies to maximize federal
135	and state programs and to work with an advisory body to
136	address matters relating to the state's dental workforce;
137	providing membership of the advisory body; providing for
138	members of the advisory body to serve without
139	compensation; requiring the department to act as a
140	clearinghouse for collecting and disseminating information
141	regarding the dental workforce; requiring the department
142	and the board to adopt rules; providing legislative intent
143	regarding implementation of the act within existing
144	resources; amending s. 499.01, F.S.; exempting certain
145	persons from requirements for medical device manufacturer
146	permits; authorizing certain business entities to pay for
147	prescription drugs obtained by practitioners licensed
148	under ch. 466, F.S.; amending s. 499.003, F.S.; defining
149	the term "medical convenience kit" for purposes of the
150	Florida Drug and Cosmetic Act; conforming cross-
151	references; amending ss. 409.9201, 465.0265, 499.0121,
152	499.01211, 499.03, 499.05, and 794.075, F.S.; conforming
153	cross-references; amending s. 624.91, F.S.; revising the
154	membership of the board of directors of the Florida
155	Healthy Kids Corporation to include a member nominated by
156	the Florida Dental Association and appointed by the
157	Governor; amending s. 381.0403, F.S.; deleting provisions
158	relating to the program for graduate medical education
159	innovations and the graduate medical education committee
160	and report; conforming cross-references; amending s.
161	381.4018, F.S.; providing definitions; requiring the
162	Department of Health to coordinate and enhance activities
163	regarding the reentry of retired military and other
164	physicians into the physician workforce; revising the list
165	of governmental stakeholders that the department is
166	required to work with regarding the state strategic plan
167	and in assessing the state's physician workforce; creating
168	the Physician Workforce Advisory Council; providing
169	membership of the council; providing for appointments to
170	the council; providing terms of membership; providing for
171	removal of a council member; providing for a chair and
172	vice chair of the council; providing that council members
173	are not entitled to receive compensation or reimbursement
174	for per diem or travel expenses; providing the duties of
175	the council; establishing the physician workforce graduate
176	medical education innovation pilot projects under the
177	department; providing the purposes of the pilot projects;
178	providing for the appropriation of state funds for the
179	pilot projects; requiring the pilot projects to meet
180	certain policy needs of the physician workforce in this
181	state; providing criteria for prioritizing proposals for
182	pilot projects; requiring the department to adopt by rule
183	appropriate performance measures; requiring participating
184	pilot projects to submit an annual report to the
185	department; requiring state funds to be used to supplement
186	funds from other sources; requiring the department to
187	adopt rules; amending s. 400.9905, F.S.; revising the
188	definition of the term "clinic"; amending ss. 458.3192 and
189	459.0082, F.S.; requiring the department to determine by
190	geographic area and specialty the number of physicians and
191	osteopathic physicians who plan to relocate outside the
192	state, practice medicine in this state, and reduce or
193	modify the scope of their practice; authorizing the
194	department to report additional information in its
195	findings to the Governor and the Legislature; amending s.
196	458.315, F.S.; revising the standards for the Board of
197	Medicine to issue a temporary certificate to a certain
198	physicians to practice medicine in areas of critical need;
199	authorizing the State Surgeon General to designate areas
200	of critical need; creating s. 459.0076, F.S.; authorizing
201	the Board of Osteopathic Medicine to issue temporary
202	certificates to osteopathic physicians who meet certain
203	requirements to practice osteopathic medicine in areas of
204	critical need; providing restrictions for issuance of a
205	temporary certificate; authorizing the State Surgeon
206	General to designate areas of critical need; authorizing
207	the Board of Osteopathic Medicine to waive the application
208	fee and licensure fees for obtaining temporary
209	certificates for certain purposes; amending s. 499.01212,
210	F.S.; exempting prescription drugs contained in sealed
211	medical convenience kits from the pedigree paper
212	requirements under specified circumstances; reenacting s.
213	465.0251, F.S., to require the Board of Pharmacy and the
214	Board of Medicine to remove certain drugs from the
215	negative formulary for generic and brand-name drugs based
216	on current references published by the United States Food
217	and Drug Administration; providing an effective date.
218
219	Be It Enacted by the Legislature of the State of Florida:
220
221	Section 1.  Paragraph (e) of subsection (10) of section
222	112.0455, Florida Statutes, is repealed, and paragraph (e) of
223	subsection (14) of that section is amended to read:
224	112.0455  Drug-Free Workplace Act.-
225	(14)  DISCIPLINE REMEDIES.-
226	(e)  Upon resolving an appeal filed pursuant to paragraph
227	(c), and finding a violation of this section, the commission may
228	order the following relief:
229	1.  Rescind the disciplinary action, expunge related
230	records from the personnel file of the employee or job applicant
231	and reinstate the employee.
232	2.  Order compliance with paragraph (10)(f)(g).
233	3.  Award back pay and benefits.
234	4.  Award the prevailing employee or job applicant the
235	necessary costs of the appeal, reasonable attorney's fees, and
236	expert witness fees.
237	Section 2.  Subsection (3) is added to section 381.00315,
238	Florida Statutes, to read:
239	381.00315  Public health advisories; public health
240	emergencies.-The State Health Officer is responsible for
241	declaring public health emergencies and issuing public health
242	advisories.
243	(3)  To facilitate effective emergency management, when the
244	United States Department of Health and Human Services contracts
245	for the manufacture and delivery of licensable products in
246	response to a public health emergency and the terms of those
247	contracts are made available to the states, the department shall
248	accept funds provided by cities, counties, and other entities
249	designated in the state emergency management plan required under
250	s. 252.35(2)(a) for the purpose of participation in those
251	contracts. The department shall deposit those funds in the
252	Grants and Donations Trust Fund and expend those funds on behalf
253	of the donor city, county, or other entity for the purchase of
254	the licensable products made available under the contract.
255	Section 3.  Paragraphs (a) and (b) of subsection (3) of
256	section 381.932, Florida Statutes, are amended to read:
257	381.932  Breast cancer early detection and treatment
258	referral program.-
259	(3)  The program shall include, but not be limited to, the:
260	(a)  Establishment of a public education and outreach
261	initiative to publicize breast cancer early detection services,
262	the benefits of early detection of breast cancer, and the
263	recommended frequency for receiving screening services,
264	including clinical breast examinations and mammography
265	guidelines currently employed established by the United States
266	Centers for Disease Control and Prevention Preventive Services
267	Task Force.
268	(b)  Development of professional education programs that
269	include information regarding the benefits of the early
270	detection of breast cancer and the recommended frequency for
271	receiving a mammogram, as recommended in the most current breast
272	cancer screening guidelines currently employed established by
273	the United States Centers for Disease Control and Prevention
274	Preventive Services Task Force.
275	Section 4.  Subsection (2) of section 381.06015, Florida
276	Statutes, is amended, and subsection (8) is added to that
277	section, to read:
278	381.06015  Public Cord Blood Tissue Bank.-
279	(2)(a)  The Agency for Health Care Administration and the
280	Department of Health shall encourage health care providers,
281	including, but not limited to, hospitals, birthing facilities,
282	county health departments, physicians, midwives, and nurses, to
283	disseminate information about the Public Cord Blood Tissue Bank.
284	(b)  The State Surgeon General shall make publicly
285	available, by posting on the Internet website of the Department
286	of Health, resources and an Internet website link to materials
287	relating to umbilical cord blood that have been developed by the
288	Parent's Guide to Cord Blood Foundation.
289	(8)  Beginning October 1, 2010, the Department of Health
290	shall encourage health care professionals who provide health
291	care services that are directly related to a woman's pregnancy
292	to make available to the patient before her third trimester of
293	pregnancy, or, if later, at the first visit of such pregnant
294	woman to the provider, information developed under paragraph
295	(2)(b) relating to the woman's options with respect to umbilical
296	cord blood banking.
297	Section 5.  Section 383.325, Florida Statutes, is repealed.
298	Section 6.  Paragraph (b) of subsection (1) of section
299	395.1055, Florida Statutes, is amended to read:
300	395.1055  Rules and enforcement.-
301	(1)  The agency shall adopt rules pursuant to ss.
302	120.536(1) and 120.54 to implement the provisions of this part,
303	which shall include reasonable and fair minimum standards for
304	ensuring that:
305	(b)  Infection control, housekeeping, sanitary conditions,
306	and medical record procedures that will adequately protect
307	patient care and safety are established and implemented.
308	Infection control rules shall include a requirement to establish
309	and implement a comprehensive plan to reduce health care
310	associated infections. The plan must include all of the
311	following components:
312	1.  A baseline measurement of health care associated
313	infections in the hospital that uses the National Healthcare
314	Safety Network and Centers for Disease Control and Prevention
315	surveillance definitions and reports the number of infections in
316	each category relative to the volume of possible cases in the
317	hospital.
318	2.  A goal for reducing the incidence of infections by a
319	specific amount within a defined period of time. The hospital's
320	goal for reduction of infections must be commensurate with the
321	national goal for reducing each type of health care associated
322	infection.
323	3.  An action plan for reducing each type of health care
324	associated infection, including the use of real-time infection
325	surveillance technology or automated infection control or
326	prevention technology.
327	4.  Methods for making information available to patients
328	and the public regarding baseline measurements and periodic
329	reports on the hospital's progress in improving measures
330	designed to reduce health care associated infections.
331	Section 7.  Section 395.1046, Florida Statutes, is
332	repealed.
333	Section 8.  Section 395.3037, Florida Statutes, is
334	repealed.
335	Section 9.  Paragraph (g) of subsection (2) of section
336	400.0239, Florida Statutes, is amended to read:
337	400.0239  Quality of Long-Term Care Facility Improvement
338	Trust Fund.-
339	(2)  Expenditures from the trust fund shall be allowable
340	for direct support of the following:
341	(g)  Other initiatives authorized by the Centers for
342	Medicare and Medicaid Services for the use of federal civil
343	monetary penalties, including projects recommended through the
344	Medicaid "Up-or-Out" Quality of Care Contract Management Program
345	pursuant to s. 400.148.
346	Section 10.  Subsection (10) of section 400.147, Florida
347	Statutes, is repealed.
348	Section 11.  Section 400.148, Florida Statutes, is
349	repealed.
350	Section 12.  Section 400.195, Florida Statutes, is
351	repealed.
352	Section 13.  Section 400.476, Florida Statutes, is amended
353	to read:
354	400.476  Staffing requirements; notifications; limitations
355	on staffing services.-
356	(1)  ADMINISTRATOR.-
357	(a)  An administrator may manage only one home health
358	agency, except that an administrator may manage up to five home
359	health agencies if all five home health agencies have identical
360	controlling interests as defined in s. 408.803 and are located
361	within one agency geographic service area or within an
362	immediately contiguous county. If the home health agency is
363	licensed under this chapter and is part of a retirement
364	community that provides multiple levels of care, an employee of
365	the retirement community may administer the home health agency
366	and up to a maximum of four entities licensed under this chapter
367	or chapter 429 which all have identical controlling interests as
368	defined in s. 408.803. An administrator shall designate, in
369	writing, for each licensed entity, a qualified alternate
370	administrator to serve during the administrator's absence. An
371	alternate administrator must meet the requirements in this
372	paragraph and s. 400.462(1).
373	(b)  An administrator of a home health agency who is a
374	licensed physician, physician assistant, or registered nurse
375	licensed to practice in this state may also be the director of
376	nursing for a home health agency. An administrator may serve as
377	a director of nursing for up to the number of entities
378	authorized in subsection (2) only if there are 10 or fewer full-
379	time equivalent employees and contracted personnel in each home
380	health agency.
381	(c)  The administrator shall organize and direct the
382	agency's ongoing functions, maintain an ongoing liaison with the
383	board members and the staff, employ qualified personnel and
384	ensure adequate staff education and evaluations, ensure the
385	accuracy of public informational materials and activities,
386	implement an effective budgeting and accounting system, and
387	ensure that the home health agency operates in compliance with
388	this part and part II of chapter 408 and rules adopted for these
389	laws.
390	(d)  The administrator shall clearly set forth in writing
391	the organizational chart, services furnished, administrative
392	control authority, and lines of authority for the delegation of
393	responsibilities for patient care. These responsibilities must
394	be readily identifiable. Administrative and supervisory
395	functions may not be delegated to another agency or
396	organization, and the primary home health agency shall monitor
397	and control all services that are not furnished directly,
398	including services provided through contracts.
399	(2)  DIRECTOR OF NURSING.-
400	(a)  A director of nursing may be the director of nursing
401	for:
402	1.  Up to two licensed home health agencies if the agencies
403	have identical controlling interests as defined in s. 408.803
404	and are located within one agency geographic service area or
405	within an immediately contiguous county; or
406	2.  Up to five licensed home health agencies if:
407	a.  All of the home health agencies have identical
408	controlling interests as defined in s. 408.803;
409	b.  All of the home health agencies are located within one
410	agency geographic service area or within an immediately
411	contiguous county; and
412	c.  Each home health agency has a registered nurse who
413	meets the qualifications of a director of nursing and who has a
414	written delegation from the director of nursing to serve as the
415	director of nursing for that home health agency when the
416	director of nursing is not present; and.
417	d.  This person, or a similarly qualified alternate, is
418	available at all times by telecommunications during operating
419	hours and participates.
420
421	If a home health agency licensed under this chapter is part of a
422	retirement community that provides multiple levels of care, an
423	employee of the retirement community may serve as the director
424	of nursing of the home health agency and up to a maximum of four
425	entities, other than home health agencies, licensed under this
426	chapter or chapter 429 which all have identical controlling
427	interests as defined in s. 408.803.
428	(b)  A home health agency that provides skilled nursing
429	care may not operate for more than 30 calendar days without a
430	director of nursing. A home health agency that provides skilled
431	nursing care and the director of nursing of a home health agency
432	must notify the agency within 10 business days after termination
433	of the services of the director of nursing for the home health
434	agency. A home health agency that provides skilled nursing care
435	must notify the agency of the identity and qualifications of the
436	new director of nursing within 10 days after the new director is
437	hired. If a home health agency that provides skilled nursing
438	care operates for more than 30 calendar days without a director
439	of nursing, the home health agency commits a class II
440	deficiency. In addition to the fine for a class II deficiency,
441	the agency may issue a moratorium in accordance with s. 408.814
442	or revoke the license. The agency shall fine a home health
443	agency that fails to notify the agency as required in this
444	paragraph $1,000 for the first violation and $2,000 for a repeat
445	violation. The agency may not take administrative action against
446	a home health agency if the director of nursing fails to notify
447	the department upon termination of services as the director of
448	nursing for the home health agency.
449	(c)  A home health agency that is not Medicare or Medicaid
450	certified and does not provide skilled care or provides only
451	physical, occupational, or speech therapy is not required to
452	have a director of nursing and is exempt from paragraph (b).
453	(3)  TRAINING.-A home health agency shall ensure that each
454	certified nursing assistant employed by or under contract with
455	the home health agency and each home health aide employed by or
456	under contract with the home health agency is adequately trained
457	to perform the tasks of a home health aide in the home setting.
458	(a)  The home health agency may not use as a home health
459	aide on a full-time, temporary, per diem, or other basis any
460	individual to provide services unless the individual has
461	completed a training and competency evaluation program, or a
462	competency evaluation program, as permitted in s. 400.497, which
463	meets the minimum standards established by the agency in state
464	rules.
465	(b)  A home health aide is not competent in any task for
466	which he or she is evaluated as "unsatisfactory." The aide must
467	perform any such task only under direct supervision by a
468	licensed nurse until he or she receives training in the task and
469	satisfactorily passes a subsequent evaluation in performing the
470	task. A home health aide has not successfully passed a
471	competency evaluation if the aide does not have a passing score
472	on the test as specified by agency rule.
473	(4)  STAFFING.-Staffing services may be provided anywhere
474	within the state.
475	(5)  PERSONNEL.-
476	(a)  The home health agency and its staff must comply with
477	accepted professional standards and principles that apply to
478	professionals, including, but not limited to, the state practice
479	acts and the home health agency's policies and procedures.
480	(b)  Except for direct employees of the home health agency,
481	if personnel under hourly or per-visit contracts are used by the
482	home health agency, there must be a written contract between
483	those personnel and the agency which specifies the following
484	requirements:
485	1.  Acceptance for care only of patients by the primary
486	home health agency.
487	2.  The services to be furnished.
488	3.  The necessity to conform to all applicable agency
489	policies, including personnel qualifications.
490	4.  The responsibility for participating in developing
491	plans of care.
492	5.  The manner in which services are controlled,
493	coordinated, and evaluated by the primary home health agency.
494	6.  The procedures for submitting clinical and progress
495	notes, scheduling visits, and providing periodic patient
496	evaluations.
497	7.  The procedures for payment for services furnished under
498	the contract.
499	(c)  A home health agency shall directly provide at least
500	one of the types of authorized services through home health
501	agency employees, but may provide additional services under
502	arrangements with another agency or organization. Services
503	furnished under such arrangements must have a written contract
504	conforming to the requirements specified in paragraph (b).
505	(d)  If home health aide services are provided by an
506	individual who is not employed directly by the home health
507	agency, the services of the home health aide must be provided
508	under arrangements as stated in paragraphs (b) and (c). If the
509	home health agency chooses to provide home health aide services
510	under arrangements with another organization, the
511	responsibilities of the home health agency include, but are not
512	limited to:
513	1.  Ensuring the overall quality of the care provided by
514	the aide.
515	2.  Supervising the aide's services as described in s.
516	400.487.
517	3.  Ensuring that each home health aide providing services
518	under arrangements with another organization has met the
519	training requirements or competency evaluation requirements of
520	s. 400.497.
521	(e)  The home health agency shall coordinate the efforts of
522	all personnel furnishing services, and the personnel shall
523	maintain communication with the home health agency to ensure
524	that personnel efforts support the objectives outlined in the
525	plan of care. The clinical record or minutes of case conferences
526	shall ensure that effective interchange, reporting, and
527	coordination of patient care occurs.
528	Section 14.  Section 400.487, Florida Statutes, is amended
529	to read:
530	400.487  Home health service agreements; physician's,
531	physician assistant's, and advanced registered nurse
532	practitioner's treatment orders; patient assessment;
533	establishment and review of plan of care; provision of services;
534	orders not to resuscitate.-
535	(1)  Services provided by a home health agency must be
536	covered by an agreement between the home health agency and the
537	patient or the patient's legal representative specifying the
538	home health services to be provided, the rates or charges for
539	services paid with private funds, and the sources of payment,
540	which may include Medicare, Medicaid, private insurance,
541	personal funds, or a combination thereof. The home health agency
542	shall provide a copy of the agreement to the patient or the
543	patient's legal representative. A home health agency providing
544	skilled care must make an assessment of the patient's needs
545	within 48 hours after the start of services.
546	(2)  When required by the provisions of chapter 464; part
547	I, part III, or part V of chapter 468; or chapter 486, the
548	attending physician, physician assistant, or advanced registered
549	nurse practitioner, acting within his or her respective scope of
550	practice, shall establish treatment orders for a patient who is
551	to receive skilled care. The treatment orders must be signed by
552	the physician, physician assistant, or advanced registered nurse
553	practitioner before a claim for payment for the skilled services
554	is submitted by the home health agency. If the claim is
555	submitted to a managed care organization, the treatment orders
556	must be signed within the time allowed under the provider
557	agreement. The treatment orders shall be reviewed, as frequently
558	as the patient's illness requires, by the physician, physician
559	assistant, or advanced registered nurse practitioner in
560	consultation with the home health agency.
561	(3)  A home health agency shall arrange for supervisory
562	visits by a registered nurse to the home of a patient receiving
563	home health aide services as specified in subsection (9) in
564	accordance with the patient's direction, approval, and agreement
565	to pay the charge for the visits.
566	(4)  The home health agency shall protect and promote the
567	rights of each individual under its care, including each of the
568	following rights:
569	(a)  Notice of rights.-The home health agency shall provide
570	the patient with a written notice of the patient's rights in
571	advance of furnishing care to the patient or during the initial
572	evaluation visit before the initiation of treatment. The home
573	health agency must maintain documentation showing that it has
574	complied with the requirements of this section.
575	(b)  Exercise of rights and respect for property and
576	person.-
577	1.  The patient has the right to exercise his or her rights
578	as a patient of the home health agency.
579	2.  The patient has the right to have his or her property
580	treated with respect.
581	3.  The patient has the right to voice grievances regarding
582	treatment or care that is or fails to be furnished, or regarding
583	the lack of respect for property by anyone who is furnishing
584	services on behalf of the home health agency, and not be
585	subjected to discrimination or reprisal for doing so.
586	4.  The home health agency must investigate complaints made
587	by a patient or the patient's family or guardian regarding
588	treatment or care that is or fails to be furnished or regarding
589	the lack of respect for the patient's property by anyone
590	furnishing services on behalf of the home health agency. The
591	home health agency shall document the existence of the complaint
592	and its resolution.
593	5.  The patient and his or her immediate family or
594	representative must be informed of the right to report
595	complaints via the statewide toll-free telephone number to the
596	agency as required in s. 408.810.
597	(c)  Right to be informed and to participate in planning
598	care and treatment.-
599	1.  The patient has the right to be informed, in advance,
600	about the care to be furnished and of any changes in the care to
601	be furnished. The home health agency shall advise the patient in
602	advance of which disciplines will furnish care and the frequency
603	of visits proposed to be furnished. The home health agency must
604	advise the patient in advance of any change in the plan of care
605	before the change is made.
606	2.  The patient has the right to participate in the
607	planning of the care. The home health agency must advise the
608	patient in advance of the right to participate in planning the
609	care or treatment and in planning changes in the care or
610	treatment. Each patient has the right to be informed of and to
611	participate in the planning of his or her care. Each patient
612	must be provided, upon request, a copy of the plan of care
613	established and maintained for that patient by the home health
614	agency.
615	(5)  When nursing services are ordered, the home health
616	agency to which a patient has been admitted for care must
617	provide the initial admission visit, all service evaluation
618	visits, and the discharge visit by a direct employee. Services
619	provided by others under contractual arrangements to a home
620	health agency must be monitored and managed by the admitting
621	home health agency. The admitting home health agency is fully
622	responsible for ensuring that all care provided through its
623	employees or contract staff is delivered in accordance with this
624	part and applicable rules.
625	(6)  The skilled care services provided by a home health
626	agency, directly or under contract, must be supervised and
627	coordinated in accordance with the plan of care. The home health
628	agency shall furnish skilled nursing services by or under the
629	supervision of a registered nurse and in accordance with the
630	plan of care. Any therapy services offered directly or under
631	arrangement by the home health agency must be provided by a
632	qualified therapist or by a qualified therapy assistant under
633	the supervision of a qualified therapist and in accordance with
634	the plan of care.
635	(a)  Physical therapy services.-Physical therapy services
636	shall be furnished only by or under the supervision of a
637	licensed physical therapist or licensed physical therapist
638	assistant as required under chapter 486 and related applicable
639	rules. A physical therapist assistant shall perform services
640	planned, delegated, and supervised by the physical therapist,
641	assist in preparing clinical notes and progress reports,
642	participate in educating the patient and his or her family, and
643	participate in in-service programs. This paragraph does not
644	limit the services provided by a physician licensed under
645	chapter 458 or chapter 459.
646	(b)  Occupational therapy services.-Occupational therapy
647	services shall be furnished only by or under the supervision of
648	a licensed occupational therapist or occupational therapy
649	assistant as provided under part III of chapter 468 and related
650	applicable rules. An occupational therapy assistant shall
651	perform any services planned, delegated, and supervised by an
652	occupational therapist, assist in preparing clinical notes and
653	progress reports, participate in educating the patient and his
654	or her family, and participate in in-service programs. This
655	paragraph does not limit the services provided by a physician
656	licensed under chapter 458 or chapter 459.
657	(c)  Speech therapy services.-Speech therapy services shall
658	be furnished only by or under supervision of a qualified speech-
659	language pathologist or audiologist as required in part I of
660	chapter 468 and applicable rules.
661	(d)  Care follows a written plan of care.-The plan of care
662	shall be reviewed by the physician or health professional who
663	provided the treatment orders pursuant to subsection (2) and
664	home health agency personnel as often as the severity of the
665	patient's condition requires, but at least once every 60 days or
666	more when there is a patient-elected transfer, a significant
667	change in condition, or a discharge and return to the same home
668	health agency during the 60-day episode. Professional staff of a
669	home health agency shall promptly alert the physician or other
670	health professional who provided the treatment orders of any
671	change that suggests a need to alter the plan of care.
672	(e)  Administration of drugs and treatment.-Only
673	professional staff of a home health agency may administer drugs
674	and treatments as ordered by the physician or health
675	professional pursuant to subsection (2), with the exception of
676	influenza and pneumococcal polysaccharide vaccines, which may be
677	administered according to the policy of the home health agency
678	developed in consultation with a physician and after an
679	assessment for contraindications. Verbal orders shall be in
680	writing and signed and dated with the date of receipt by the
681	registered nurse or qualified therapist who is responsible for
682	furnishing or supervising the ordered service. A verbal order
683	may be accepted only by personnel who are authorized to do so by
684	applicable state laws, rules, and internal policies of the home
685	health agency.
686	(7)  A registered nurse shall conduct the initial
687	evaluation visit, regularly reevaluate the patient's nursing
688	needs, initiate the plan of care and necessary revisions,
689	furnish those services requiring substantial and specialized
690	nursing skill, initiate appropriate preventive and
691	rehabilitative nursing procedures, prepare clinical and progress
692	notes, coordinate services, inform the physician and other
693	personnel of changes in the patient's condition and needs,
694	counsel the patient and his or her family in meeting nursing and
695	related needs, participate in in-service programs, and supervise
696	and teach other nursing personnel, unless the home health agency
697	providing the home health aide services is not Medicare-
698	certified or Medicaid-certified and does not provide skilled
699	care or the patient is not receiving skilled care.
700	(8)  A licensed practical nurse shall furnish services in
701	accordance with agency policies, prepare clinical and progress
702	notes, assist the physician and registered nurse in performing
703	specialized procedures, prepare equipment and materials for
704	treatments observing aseptic technique as required, and assist
705	the patient in learning appropriate self-care techniques.
706	(9)  A home health aide and certified nursing assistant
707	shall provide services that are in the service provision plan
708	provided in s. 400.491 and other services that the home health
709	aide or certified nursing assistant is permitted to perform
710	under state law. The duties of a home health aide or certified
711	nursing assistant include the provision of hands-on personal
712	care, performance of simple procedures as an extension of
713	therapy or nursing services, assistance in ambulation or
714	exercises, and assistance in administering medications that are
715	ordinarily self-administered and are specified in agency rules.
716	Any services by a home health aide which are offered by a home
717	health agency must be provided by a qualified home health aide
718	or certified nursing assistant.
719	(a)  Assignment and duties.-A home health aide or certified
720	nursing assistant shall be assigned to a specific patient by a
721	registered nurse, unless the home health agency providing the
722	home health aide services is not Medicare-certified or Medicaid-
723	certified and does not provide skilled care or the patient is
724	not receiving skilled care. Written patient care instructions
725	for the home health aide and certified nursing assistant must be
726	prepared by the registered nurse or other appropriate
727	professional who is responsible for the supervision of the home
728	health aide and certified nursing assistant as stated in this
729	section.
730	(b)  Supervision.-If a patient receives skilled nursing
731	care, the registered nurse shall perform the supervisory visit.
732	If the patient is not receiving skilled nursing care but is
733	receiving physical therapy, occupational therapy, or speech-
734	language pathology services, the appropriate therapist may
735	provide the supervision. A registered nurse or other
736	professional must make an onsite visit to the patient's home at
737	least once every 2 weeks. The visit is not required while the
738	aide is providing care.
739	(c)  Supervisory visits.-If home health aide services are
740	provided to a patient who is not receiving skilled nursing care,
741	physical or occupational therapy, or speech-language pathology
742	services, a registered nurse must make a supervisory visit to
743	the patient's home at least once every 60 days, unless the home
744	health agency providing the home health aide services is not
745	Medicare-certified or Medicaid-certified and does not provide
746	skilled care, either directly or through contracts. The
747	registered nurse shall ensure that the aide is properly caring
748	for the patient and each supervisory visit must occur while the
749	home health aide is providing patient care. In addition to the
750	requirements in this subsection, a home health agency shall
751	arrange for additional supervisory visits by a registered nurse
752	to the home of a patient receiving home health aide services in
753	accordance with the patient's direction, approval, and agreement
754	to pay the charge for the visits.
755	(10)(7)  Home health agency personnel may withhold or
756	withdraw cardiopulmonary resuscitation if presented with an
757	order not to resuscitate executed pursuant to s. 401.45. The
758	agency shall adopt rules providing for the implementation of
759	such orders. Home health personnel and agencies shall not be
760	subject to criminal prosecution or civil liability, nor be
761	considered to have engaged in negligent or unprofessional
762	conduct, for withholding or withdrawing cardiopulmonary
763	resuscitation pursuant to such an order and rules adopted by the
764	agency.
765	Section 15.  Paragraphs (f) and (g) of subsection (4) of
766	section 400.9905, Florida Statutes, are amended to read:
767	400.9905  Definitions.-
768	(4)  "Clinic" means an entity at which health care services
769	are provided to individuals and which tenders charges for
770	reimbursement for such services, including a mobile clinic and a
771	portable equipment provider. For purposes of this part, the term
772	does not include and the licensure requirements of this part do
773	not apply to:
774	(f)  A sole proprietorship, group practice, partnership, or
775	corporation, or other legal entity that provides health care
776	services by practitioners licensed under chapter 458, chapter
777	459, chapter 461, chapter 466, or chapter 460 and subject to the
778	limitations of s. 460.4167 physicians covered by s. 627.419,
779	that is directly supervised by one or more of such physicians or
780	physician assistants, and that is wholly owned by one or more of
781	those physicians or physician assistants or by a physician or
782	physician assistant or and the spouse, parent, child, or sibling
783	of that physician or physician assistant. A certificate of
784	exemption is valid only for the entity, persons, and location
785	for which it was originally issued.
786	1.  An individual who is not a medical professional or
787	family member listed in this paragraph may own up to 30 percent
788	of a health care clinic entity that is exempt under this
789	paragraph if the individual obtains prior approval from the
790	agency for ownership of a percentage of a health care clinic.
791	Such an individual is considered an "applicant" under s.
792	400.991(5) and must meet all the requirements of that section
793	and the level 2 background screening requirements of s. 408.809
794	before being approved by the agency for ownership of a minority
795	interest in a health care clinic.
796	2.  If an individual who is not a medical professional or
797	family member listed in this paragraph assumes ownership of an
798	investment interest in a health care clinic without the prior
799	approval of the agency, the health care clinic shall lose its
800	exemption from licensure under this paragraph.
801	3.  Ownership of a health care clinic by an individual
802	other than the physician or physician assistant, or by the
803	spouse, parent, child, or sibling of the physician or physician
804	assistant to whom the exemption was granted, may not exceed 30
805	percent.
806	(g)  A sole proprietorship, group practice, partnership, or
807	corporation that provides health care services by licensed
808	health care practitioners under chapter 457, chapter 458,
809	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
810	chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
811	chapter 490, chapter 491, or part I, part III, part X, part
812	XIII, or part XIV of chapter 468, or s. 464.012, which are
813	wholly owned by one or more licensed health care practitioners,
814	or the licensed health care practitioners set forth in this
815	paragraph and the spouse, parent, child, or sibling of a
816	licensed health care practitioner, so long as one of the owners
817	who is a licensed health care practitioner is directly
818	supervising health care services the business activities and is
819	legally responsible for the entity's compliance with all federal
820	and state laws. However, a health care practitioner who is a
821	supervising owner may not supervise services beyond the scope of
822	the practitioner's license, except that, for the purposes of
823	this part, a clinic owned by a licensee in s. 456.053(3)(b) that
824	provides only services authorized pursuant to s. 456.053(3)(b)
825	may be supervised by a licensee specified in s. 456.053(3)(b). A
826	certificate of exemption is valid only for the entity, persons,
827	and location for which it was originally issued.
828	Section 16.  Subsection (11) of section 408.802, Florida
829	Statutes, is repealed.
830	Section 17.  Paragraphs (e), (f), and (g) of subsection
831	(15) of section 409.912, Florida Statutes, are repealed.
832	Section 18.  Subsection (13) of section 409.9122, Florida
833	Statutes, is repealed.
834	Section 19.  Section 409.91255, Florida Statutes, is
835	amended to read:
836	409.91255  Federally qualified health center access
837	program.-
838	(1)  SHORT TITLE.-This section may be cited as the
839	"Community Health Center Access Program Act."
840	(2)  LEGISLATIVE FINDINGS AND INTENT.-
841	(a)  The Legislature finds that, despite significant
842	investments in health care programs, nearly 6 more than 2
843	million low-income Floridians, primarily the working poor and
844	minority populations, continue to lack access to basic health
845	care services. Further, the Legislature recognizes that
846	federally qualified health centers have a proven record of
847	providing cost-effective, comprehensive primary and preventive
848	health care and are uniquely qualified to address the lack of
849	adequate health care services for the uninsured.
850	(b)  It is the intent of the Legislature to recognize the
851	significance of increased federal investments in federally
852	qualified health centers and to leverage that investment through
853	the creation of a program to provide for the expansion of the
854	primary and preventive health care services offered by federally
855	qualified health centers. Further, such a program will support
856	the coordination of federal, state, and local resources to
857	assist such health centers in developing an expanded community-
858	based primary care delivery system.
859	(3)  ASSISTANCE TO FEDERALLY QUALIFIED HEALTH CENTERS.-The
860	agency shall administer Department of Health shall develop a
861	program for the expansion of federally qualified health centers
862	for the purpose of providing comprehensive primary and
863	preventive health care and urgent care services that may reduce
864	the morbidity, mortality, and cost of care among the uninsured
865	population of the state. The program shall provide for
866	distribution of financial assistance to federally qualified
867	health centers that apply and demonstrate a need for such
868	assistance in order to sustain or expand the delivery of primary
869	and preventive health care services. In selecting centers to
870	receive this financial assistance, the program:
871	(a)  Shall give preference to communities that have few or
872	no community-based primary care services or in which the current
873	services are unable to meet the community's needs. To assist in
874	the assessment and identification of areas of critical need, a
875	federally qualified health-center-based statewide assessment and
876	strategic plan shall be developed by the Florida Association of
877	Community Health Centers, Inc., every 5 years, beginning January
878	1, 2011.
879	(b)  Shall require that primary care services be provided
880	to the medically indigent using a sliding fee schedule based on
881	income.
882	(c)  Shall promote allow innovative and creative uses of
883	federal, state, and local health care resources.
884	(d)  Shall require that the funds provided be used to pay
885	for operating costs of a projected expansion in patient
886	caseloads or services or for capital improvement projects.
887	Capital improvement projects may include renovations to existing
888	facilities or construction of new facilities, provided that an
889	expansion in patient caseloads or services to a new patient
890	population will occur as a result of the capital expenditures.
891	The agency department shall include in its standard contract
892	document a requirement that any state funds provided for the
893	purchase of or improvements to real property are contingent upon
894	the contractor granting to the state a security interest in the
895	property at least to the amount of the state funds provided for
896	at least 5 years from the date of purchase or the completion of
897	the improvements or as further required by law. The contract
898	must include a provision that, as a condition of receipt of
899	state funding for this purpose, the contractor agrees that, if
900	it disposes of the property before the agency's department's
901	interest is vacated, the contractor will refund the
902	proportionate share of the state's initial investment, as
903	adjusted by depreciation.
904	(e)  Shall May require in-kind support from other sources.
905	(f)  Shall promote May encourage coordination among
906	federally qualified health centers, other private sector
907	providers, and publicly supported programs.
908	(g)  Shall promote allow the development of community
909	emergency room diversion programs in conjunction with local
910	resources, providing extended hours of operation to urgent care
911	patients. Diversion programs shall include case management for
912	emergency room followup care.
913	(4)  EVALUATION OF APPLICATIONS.-A review panel shall be
914	established, consisting of four persons appointed by the
915	Secretary of Health Care Administration State Surgeon General
916	and three persons appointed by the chief executive officer of
917	the Florida Association of Community Health Centers, Inc., to
918	review all applications for financial assistance under the
919	program. Applicants shall specify in the application whether the
920	program funds will be used for the expansion of patient
921	caseloads or services or for capital improvement projects to
922	expand and improve patient facilities. The panel shall use the
923	following elements in reviewing application proposals and shall
924	determine the relative weight for scoring and evaluating these
925	elements:
926	(a)  The target population to be served.
927	(b)  The health benefits to be provided.
928	(c)  The methods that will be used to measure cost-
929	effectiveness.
930	(d)  How patient satisfaction will be measured.
931	(e)  The proposed internal quality assurance process.
932	(f)  Projected health status outcomes.
933	(g)  How data will be collected to measure cost-
934	effectiveness, health status outcomes, and overall achievement
935	of the goals of the proposal.
936	(h)  All resources, including cash, in-kind, voluntary, or
937	other resources that will be dedicated to the proposal.
938	(5)  ADMINISTRATION AND TECHNICAL ASSISTANCE.-The agency
939	shall Department of Health may contract with the Florida
940	Association of Community Health Centers, Inc., to develop and
941	coordinate administer the program and provide technical
942	assistance to the federally qualified health centers selected to
943	receive financial assistance. The contracted entity shall be
944	responsible for program support and assume all costs related to
945	administration of this program.
946	Section 20.  Subsection (2) of section 429.075, Florida
947	Statutes, is amended to read:
948	429.075  Limited mental health license.-An assisted living
949	facility that serves three or more mental health residents must
950	obtain a limited mental health license.
951	(2)  Facilities licensed to provide services to mental
952	health residents shall provide appropriate supervision and
953	staffing to provide for the health, safety, and welfare of such
954	residents. Assisted living facilities within an area zoned for
955	residential use in a municipality having a population of more
956	than 400,000, which house persons identified as being part of a
957	priority population that includes adult and adolescent residents
958	who have severe and persistent mental illness, as described in
959	s. 394.674, must maintain 24-hour security services provided by
960	uniformed security personnel licensed under part III of chapter
961	493.
962	Section 21.  Subsection (2) of section 429.12, Florida
963	Statutes, is repealed.
964	Section 22.  Subsection (5) of section 429.23, Florida
965	Statutes, is repealed.
966	Section 23.  Paragraph (a) of subsection (2) of section
967	429.911, Florida Statutes, is repealed.
968	Section 24.  Dental workforce survey.-
969	(1)  Beginning in 2012, each person who applies for
970	licensure renewal as a dentist or dental hygienist under chapter
971	466, Florida Statutes, must, in conjunction with the renewal of
972	such license under procedures and forms adopted by the Board of
973	Dentistry and in addition to any other information that may be
974	required from the applicant, furnish the following information
975	to the Department of Health, working in conjunction with the
976	board, in a dental workforce survey:
977	(a)  Licensee information, including, but not limited to:
978	1.  The name of the dental school or dental hygiene program
979	that the dentist or dental hygienist graduated from and the year
980	of graduation.
981	2.  The year that the dentist or dental hygienist began
982	practicing or working in this state.
983	3.  The geographic location of the dentist's or dental
984	hygienist's practice or address within the state.
985	4.  For a dentist in private practice:
986	a.  The number of full-time dental hygienists employed by
987	the dentist during the reporting period.
988	b.  The number of full-time dental assistants employed by
989	the dentist during the reporting period.
990	c.  The average number of patients treated per week by the
991	dentist during the reporting period.
992	d.  The settings where the dental care was delivered.
993	5.  Anticipated plans of the dentist to change the status
994	of his or her license or practice.
995	6.  The dentist's areas of specialty or certification.
996	7.  The year that the dentist completed a specialty program
997	recognized by the American Dental Association.
998	8.  For a hygienist:
999	a.  The average number of patients treated per week by the
1000	hygienist during the reporting period.
1001	b.  The settings where the dental care was delivered.
1002	9.  The dentist's memberships in professional
1003	organizations.
1004	10.  The number of pro bono hours provided by the dentist
1005	or dental hygienist during the last biennium.
1006	(b)  Information concerning the availability and trends
1007	relating to critically needed services, including, but not
1008	limited to, the following types of care provided by the dentist
1009	or dental hygienist:
1010	1.  Dental care to children having special needs.
1011	2.  Geriatric dental care.
1012	3.  Dental services in emergency departments.
1013	4.  Medicaid services.
1014	5.  Other critically needed specialty areas, as determined
1015	by the advisory body.
1016	(2)  In addition to the completed survey, the dentist or
1017	dental hygienist must submit a statement that the information
1018	provided is true and accurate to the best of his or her
1019	knowledge and belief.
1020	(3)  Beginning in 2012, renewal of a license by a dentist
1021	or dental hygienist licensed under chapter 466, Florida
1022	Statutes, is not contingent upon the completion and submission
1023	of the dental workforce survey; however, for any subsequent
1024	license renewal, the board may not renew the license of any
1025	dentist or dental hygienist until the survey required under this
1026	section is completed and submitted by the licensee.
1027	(4)(a)  Beginning in 2012, the Board of Dentistry shall
1028	issue a nondisciplinary citation to any dentist or dental
1029	hygienist licensed under chapter 466, Florida Statutes, who
1030	fails to complete the survey within 90 days after the renewal of
1031	his or her license to practice as a dentist or dental hygienist.
1032	(b)  The citation must notify a dentist or dental hygienist
1033	who fails to complete the survey required by this section that
1034	his or her license will not be renewed for any subsequent
1035	license renewal unless the dentist or dental hygienist completes
1036	the survey.
1037	(c)  In conjunction with issuing the license renewal notice
1038	required by s. 456.038, Florida Statutes, the board shall notify
1039	each dentist or dental hygienist licensed under chapter 466,
1040	Florida Statutes, who fails to complete the survey that the
1041	survey must be completed before the subsequent license renewal.
1042	Section 25.  (1)  The Department of Health shall serve as
1043	the coordinating body for the purpose of collecting and
1044	regularly updating and disseminating dental workforce data. The
1045	department shall work with multiple stakeholders, including the
1046	Florida Dental Association and the Florida Dental Hygiene
1047	Association, to assess and share with all communities of
1048	interest all data collected in a timely fashion.
1049	(2)  The Department of Health shall maintain a current
1050	database to serve as a statewide source of data concerning the
1051	dental workforce. The department, in conjunction with the Board
1052	of Dentistry, shall also:
1053	(a)  Develop strategies to maximize federal and state
1054	programs that provide incentives for dentists to practice in
1055	shortage areas that are federally designated. Strategies shall
1056	include programs such as the Florida Health Services Corps
1057	established under s. 381.0302, Florida Statutes.
1058	(b)  Work in conjunction with an advisory body to address
1059	matters relating to the state's dental workforce. The advisory
1060	body shall provide input on developing questions for the dentist
1061	workforce survey. The advisory body shall include, but need not
1062	be limited to, the State Surgeon General or his or her designee,
1063	the dean of each dental school accredited in the United States
1064	and based in this state or his or her designee, a representative
1065	from the Florida Dental Association, a representative from the
1066	Florida Dental Hygiene Association, a representative from the
1067	Board of Dentistry, and a dentist from each of the dental
1068	specialties recognized by the American Dental Association's
1069	Commission on Dental Accreditation. Members of the advisory body
1070	shall serve without compensation.
1071	(c)  Act as a clearinghouse for collecting and
1072	disseminating information concerning the dental workforce.
1073	(3)  The Department of Health and the Board of Dentistry
1074	shall adopt rules necessary to administer this section.
1075	Section 26.  It is the intent of the Legislature that the
1076	Department of Health and the Board of Dentistry implement the
1077	provisions of sections 16 through 20 of this act within existing
1078	resources.
1079	Section 27.  Paragraphs (q) and (t) of subsection (2) of
1080	section 499.01, Florida Statutes, are amended to read:
1081	499.01  Permits.-
1082	(2)  The following permits are established:
1083	(q)  Device manufacturer permit.-
1084	1.  A device manufacturer permit is required for any person
1085	that engages in the manufacture, repackaging, or assembly of
1086	medical devices for human use in this state, except that a
1087	permit is not required if:
1088	a.  The person manufactures, repackages, or assembles only
1089	those medical devices or components for such devices which are
1090	exempt from registration pursuant to s. 499.015(8); or
1091	b.  The person is engaged only in manufacturing,
1092	repackaging, or assembling a medical device pursuant to a
1093	practitioner's order for a specific patient.
1094	2.1.  A manufacturer or repackager of medical devices in
1095	this state must comply with all appropriate state and federal
1096	good manufacturing practices and quality system rules.
1097	3.2.  The department shall adopt rules related to storage,
1098	handling, and recordkeeping requirements for manufacturers of
1099	medical devices for human use.
1100	(t)  Health care clinic establishment permit.-Effective
1101	January 1, 2009, a health care clinic establishment permit is
1102	required for the purchase of a prescription drug by a place of
1103	business at one general physical location that provides health
1104	care or veterinary services, which is owned and operated by a
1105	business entity that has been issued a federal employer tax
1106	identification number. For the purpose of this paragraph, the
1107	term "qualifying practitioner" means a licensed health care
1108	practitioner defined in s. 456.001, or a veterinarian licensed
1109	under chapter 474, who is authorized under the appropriate
1110	practice act to prescribe and administer a prescription drug.
1111	1.  An establishment must provide, as part of the
1112	application required under s. 499.012, designation of a
1113	qualifying practitioner who will be responsible for complying
1114	with all legal and regulatory requirements related to the
1115	purchase, recordkeeping, storage, and handling of the
1116	prescription drugs. In addition, the designated qualifying
1117	practitioner shall be the practitioner whose name, establishment
1118	address, and license number is used on all distribution
1119	documents for prescription drugs purchased or returned by the
1120	health care clinic establishment. Upon initial appointment of a
1121	qualifying practitioner, the qualifying practitioner and the
1122	health care clinic establishment shall notify the department on
1123	a form furnished by the department within 10 days after such
1124	employment. In addition, the qualifying practitioner and health
1125	care clinic establishment shall notify the department within 10
1126	days after any subsequent change.
1127	2.  The health care clinic establishment must employ a
1128	qualifying practitioner at each establishment.
1129	3.  In addition to the remedies and penalties provided in
1130	this part, a violation of this chapter by the health care clinic
1131	establishment or qualifying practitioner constitutes grounds for
1132	discipline of the qualifying practitioner by the appropriate
1133	regulatory board.
1134	4.  The purchase of prescription drugs by the health care
1135	clinic establishment is prohibited during any period of time
1136	when the establishment does not comply with this paragraph.
1137	5.  A health care clinic establishment permit is not a
1138	pharmacy permit or otherwise subject to chapter 465. A health
1139	care clinic establishment that meets the criteria of a modified
1140	Class II institutional pharmacy under s. 465.019 is not eligible
1141	to be permitted under this paragraph.
1142	6.  This paragraph does not apply to the purchase of a
1143	prescription drug by a licensed practitioner under his or her
1144	license. A professional corporation or limited liability company
1145	composed of dentists and operating as authorized in s. 466.0285
1146	may pay for prescription drugs obtained by a practitioner
1147	licensed under chapter 466, and the licensed practitioner is
1148	deemed the purchaser and owner of the prescription drugs.
1149	Section 28.  Subsections (32) through (54) of section
1150	499.003, Florida Statutes, are renumbered as subsections (33)
1151	through (55), respectively, present subsection (42) is amended,
1152	and a new subsection (32) is added to that section, to read:
1153	499.003  Definitions of terms used in this part.-As used in
1154	this part, the term:
1155	(32)  "Medical convenience kit" means a package or unit
1156	that contains combination products as described in 21 C.F.R. s.
1157	3.2(e)(2).
1158	(43)(42)  "Prescription drug" means a prescription,
1159	medicinal, or legend drug, including, but not limited to,
1160	finished dosage forms or active ingredients subject to, defined
1161	by, or described by s. 503(b) of the Federal Food, Drug, and
1162	Cosmetic Act or s. 465.003(8), s. 499.007(13), or subsection
1163	(11), subsection (46) (45), or subsection (53) (52).
1164	Section 29.  Paragraph (a) of subsection (1) of section
1165	409.9201, Florida Statutes, is amended to read:
1166	409.9201  Medicaid fraud.-
1167	(1)  As used in this section, the term:
1168	(a)  "Prescription drug" means any drug, including, but not
1169	limited to, finished dosage forms or active ingredients that are
1170	subject to, defined by, or described by s. 503(b) of the Federal
1171	Food, Drug, and Cosmetic Act or by s. 465.003(8), s.
1172	499.003(45)(45) or (53) (52), or s. 499.007(13).
1173
1174	The value of individual items of the legend drugs or goods or
1175	services involved in distinct transactions committed during a
1176	single scheme or course of conduct, whether involving a single
1177	person or several persons, may be aggregated when determining
1178	the punishment for the offense.
1179	Section 30.  Subsection (3) of section 465.0265, Florida
1180	Statutes, is amended to read:
1181	465.0265  Centralized prescription filling.-
1182	(3)  The filling, delivery, and return of a prescription by
1183	one pharmacy for another pursuant to this section shall not be
1184	construed as the filling of a transferred prescription as set
1185	forth in s. 465.026 or as a wholesale distribution as set forth
1186	in s. 499.003(54)(53).
1187	Section 31.  Paragraph (d) of subsection (4) of section
1188	499.0121, Florida Statutes, is amended to read:
1189	499.0121  Storage and handling of prescription drugs;
1190	recordkeeping.-The department shall adopt rules to implement
1191	this section as necessary to protect the public health, safety,
1192	and welfare. Such rules shall include, but not be limited to,
1193	requirements for the storage and handling of prescription drugs
1194	and for the establishment and maintenance of prescription drug
1195	distribution records.
1196	(4)  EXAMINATION OF MATERIALS AND RECORDS.-
1197	(d)  Upon receipt, a wholesale distributor must review
1198	records required under this section for the acquisition of
1199	prescription drugs for accuracy and completeness, considering
1200	the total facts and circumstances surrounding the transactions
1201	and the wholesale distributors involved. This includes
1202	authenticating each transaction listed on a pedigree paper, as
1203	defined in s. 499.003(37)(36).
1204	Section 32.  Paragraphs (a) and (b) of subsection (2) of
1205	section 499.01211, Florida Statutes, are amended to read:
1206	499.01211  Drug Wholesale Distributor Advisory Council.-
1207	(2)  The State Surgeon General, or his or her designee, and
1208	the Secretary of Health Care Administration, or her or his
1209	designee, shall be members of the council. The State Surgeon
1210	General shall appoint nine additional members to the council who
1211	shall be appointed to a term of 4 years each, as follows:
1212	(a)  Three different persons each of whom is employed by a
1213	different prescription drug wholesale distributor licensed under
1214	this part which operates nationally and is a primary wholesale
1215	distributor, as defined in s. 499.003(47)(46).
1216	(b)  One person employed by a prescription drug wholesale
1217	distributor licensed under this part which is a secondary
1218	wholesale distributor, as defined in s. 499.003(52)(51).
1219	Section 33.  Subsection (1) of section 499.03, Florida
1220	Statutes, is amended to read:
1221	499.03  Possession of certain drugs without prescriptions
1222	unlawful; exemptions and exceptions.-
1223	(1)  A person may not possess, or possess with intent to
1224	sell, dispense, or deliver, any habit-forming, toxic, harmful,
1225	or new drug subject to s. 499.003(33)(32), or prescription drug
1226	as defined in s. 499.003(43)(42), unless the possession of the
1227	drug has been obtained by a valid prescription of a practitioner
1228	licensed by law to prescribe the drug. However, this section
1229	does not apply to the delivery of such drugs to persons included
1230	in any of the classes named in this subsection, or to the agents
1231	or employees of such persons, for use in the usual course of
1232	their businesses or practices or in the performance of their
1233	official duties, as the case may be; nor does this section apply
1234	to the possession of such drugs by those persons or their agents
1235	or employees for such use:
1236	(a)  A licensed pharmacist or any person under the licensed
1237	pharmacist's supervision while acting within the scope of the
1238	licensed pharmacist's practice;
1239	(b)  A licensed practitioner authorized by law to prescribe
1240	prescription drugs or any person under the licensed
1241	practitioner's supervision while acting within the scope of the
1242	licensed practitioner's practice;
1243	(c)  A qualified person who uses prescription drugs for
1244	lawful research, teaching, or testing, and not for resale;
1245	(d)  A licensed hospital or other institution that procures
1246	such drugs for lawful administration or dispensing by
1247	practitioners;
1248	(e)  An officer or employee of a federal, state, or local
1249	government; or
1250	(f)  A person that holds a valid permit issued by the
1251	department pursuant to this part which authorizes that person to
1252	possess prescription drugs.
1253	Section 34.  Paragraphs (i) and (m) of subsection (1) of
1254	section 499.05, Florida Statutes, are amended to read:
1255	499.05  Rules.-
1256	(1)  The department shall adopt rules to implement and
1257	enforce this part with respect to:
1258	(i)  Additional conditions that qualify as an emergency
1259	medical reason under s. 499.003(54)(53)(b)2.
1260	(m)  The recordkeeping, storage, and handling with respect
1261	to each of the distributions of prescription drugs specified in
1262	s. 499.003(54)(53)(a)-(d).
1263	Section 35.  Subsection (1) of section 794.075, Florida
1264	Statutes, is amended to read:
1265	794.075  Sexual predators; erectile dysfunction drugs.-
1266	(1)  A person may not possess a prescription drug, as
1267	defined in s. 499.003(43)(42), for the purpose of treating
1268	erectile dysfunction if the person is designated as a sexual
1269	predator under s. 775.21.
1270	Section 36.  Paragraph (a) of subsection (6) of section
1271	624.91, Florida Statutes, is amended to read:
1272	624.91  The Florida Healthy Kids Corporation Act.-
1273	(6)  BOARD OF DIRECTORS.-
1274	(a)  The Florida Healthy Kids Corporation shall operate
1275	subject to the supervision and approval of a board of directors
1276	chaired by the Chief Financial Officer or her or his designee,
1277	and composed of 12 11 other members selected for 3-year terms of
1278	office as follows:
1279	1.  The Secretary of Health Care Administration, or his or
1280	her designee.
1281	2.  One member appointed by the Commissioner of Education
1282	from the Office of School Health Programs of the Florida
1283	Department of Education.
1284	3.  One member appointed by the Chief Financial Officer
1285	from among three members nominated by the Florida Pediatric
1286	Society.
1287	4.  One member, appointed by the Governor, who represents
1288	the Children's Medical Services Program.
1289	5.  One member appointed by the Chief Financial Officer
1290	from among three members nominated by the Florida Hospital
1291	Association.
1292	6.  One member, appointed by the Governor, who is an expert
1293	on child health policy.
1294	7.  One member, appointed by the Chief Financial Officer,
1295	from among three members nominated by the Florida Academy of
1296	Family Physicians.
1297	8.  One member, appointed by the Governor, who represents
1298	the state Medicaid program.
1299	9.  One member, appointed by the Chief Financial Officer,
1300	from among three members nominated by the Florida Association of
1301	Counties.
1302	10.  The State Health Officer or her or his designee.
1303	11.  The Secretary of Children and Family Services, or his
1304	or her designee.
1305	12.  One member, appointed by the Governor, from among
1306	three members nominated by the Florida Dental Association.
1307	Section 37.  Section 381.0403, Florida Statutes, is amended
1308	to read:
1309	381.0403  The Community Hospital Education Act.-
1310	(1)  SHORT TITLE.-This section shall be known and cited as
1311	"The Community Hospital Education Act."
1312	(2)  LEGISLATIVE INTENT.-
1313	(a)  It is the intent of the Legislature that health care
1314	services for the citizens of this state be upgraded and that a
1315	program for continuing these services be maintained through a
1316	plan for community medical education. The program is intended to
1317	provide additional outpatient and inpatient services, a
1318	continuing supply of highly trained physicians, and graduate
1319	medical education.
1320	(b)  The Legislature further acknowledges the critical need
1321	for increased numbers of primary care physicians to provide the
1322	necessary current and projected health and medical services. In
1323	order to meet both present and anticipated needs, the
1324	Legislature supports an expansion in the number of family
1325	practice residency positions. The Legislature intends that the
1326	funding for graduate education in family practice be maintained
1327	and that funding for all primary care specialties be provided at
1328	a minimum of $10,000 per resident per year. Should funding for
1329	this act remain constant or be reduced, it is intended that all
1330	programs funded by this act be maintained or reduced
1331	proportionately.
1332	(3)  PROGRAM FOR COMMUNITY HOSPITAL EDUCATION; STATE AND
1333	LOCAL PLANNING.-
1334	(a)  There is established under the Department of Health a
1335	program for statewide graduate medical education. It is intended
1336	that continuing graduate medical education programs for interns
1337	and residents be established on a statewide basis. The program
1338	shall provide financial support for primary care specialty
1339	interns and residents based on policies recommended and approved
1340	by the Community Hospital Education Council, herein established,
1341	and the Department of Health. Only those programs with at least
1342	three residents or interns in each year of the training program
1343	are qualified to apply for financial support. Programs with
1344	fewer than three residents or interns per training year are
1345	qualified to apply for financial support, but only if the
1346	appropriate accrediting entity for the particular specialty has
1347	approved the program for fewer positions. Programs added after
1348	fiscal year 1997-1998 shall have 5 years to attain the requisite
1349	number of residents or interns. When feasible and to the extent
1350	allowed through the General Appropriations Act, state funds
1351	shall be used to generate federal matching funds under Medicaid,
1352	or other federal programs, and the resulting combined state and
1353	federal funds shall be allocated to participating hospitals for
1354	the support of graduate medical education. The department may
1355	spend up to $75,000 of the state appropriation for
1356	administrative costs associated with the production of the
1357	annual report as specified in subsection (9), and for
1358	administration of the program.
1359	(b)  For the purposes of this section, primary care
1360	specialties include emergency medicine, family practice,
1361	internal medicine, pediatrics, psychiatry,
1362	obstetrics/gynecology, and combined pediatrics and internal
1363	medicine, and other primary care specialties as may be included
1364	by the council and Department of Health.
1365	(c)  Medical institutions throughout the state may apply to
1366	the Community Hospital Education Council for grants-in-aid for
1367	financial support of their approved programs. Recommendations
1368	for funding of approved programs shall be forwarded to the
1369	Department of Health.
1370	(d)  The program shall provide a plan for community
1371	clinical teaching and training with the cooperation of the
1372	medical profession, hospitals, and clinics. The plan shall also
1373	include formal teaching opportunities for intern and resident
1374	training. In addition, the plan shall establish an off-campus
1375	medical faculty with university faculty review to be located
1376	throughout the state in local communities.
1377	(4)  PROGRAM FOR GRADUATE MEDICAL EDUCATION INNOVATIONS.-
1378	(a)  There is established under the Department of Health a
1379	program for fostering graduate medical education innovations.
1380	Funds appropriated annually by the Legislature for this purpose
1381	shall be distributed to participating hospitals or consortia of
1382	participating hospitals and Florida medical schools or to a
1383	Florida medical school for the direct costs of providing
1384	graduate medical education in community-based clinical settings
1385	on a competitive grant or formula basis to achieve state health
1386	care workforce policy objectives, including, but not limited to:
1387	1.  Increasing the number of residents in primary care and
1388	other high demand specialties or fellowships;
1389	2.  Enhancing retention of primary care physicians in
1390	Florida practice;
1391	3.  Promoting practice in medically underserved areas of
1392	the state;
1393	4.  Encouraging racial and ethnic diversity within the
1394	state's physician workforce; and
1395	5.  Encouraging increased production of geriatricians.
1396	(b)  Participating hospitals or consortia of participating
1397	hospitals and Florida medical schools or a Florida medical
1398	school providing graduate medical education in community-based
1399	clinical settings may apply to the Community Hospital Education
1400	Council for funding under this innovations program, except when
1401	such innovations directly compete with services or programs
1402	provided by participating hospitals or consortia of
1403	participating hospitals, or by both hospitals and consortia.
1404	Innovations program funding shall provide funding based on
1405	policies recommended and approved by the Community Hospital
1406	Education Council and the Department of Health.
1407	(c)  Participating hospitals or consortia of participating
1408	hospitals and Florida medical schools or Florida medical schools
1409	awarded an innovations grant shall provide the Community
1410	Hospital Education Council and Department of Health with an
1411	annual report on their project.
1412	(4)(5)  FAMILY PRACTICE RESIDENCIES.-In addition to the
1413	programs established in subsection (3), the Community Hospital
1414	Education Council and the Department of Health shall establish
1415	an ongoing statewide program of family practice residencies. The
1416	administration of this program shall be in the manner described
1417	in this section.
1418	(5)(6)  COUNCIL AND DIRECTOR.-
1419	(a)  There is established the Community Hospital Education
1420	Council, hereinafter referred to as the council, which shall
1421	consist of 11 members, as follows:
1422	1.  Seven members must be program directors of accredited
1423	graduate medical education programs or practicing physicians who
1424	have faculty appointments in accredited graduate medical
1425	education programs. Six of these members must be board certified
1426	or board eligible in family practice, internal medicine,
1427	pediatrics, emergency medicine, obstetrics-gynecology, and
1428	psychiatry, respectively, and licensed pursuant to chapter 458.
1429	No more than one of these members may be appointed from any one
1430	specialty. One member must be licensed pursuant to chapter 459.
1431	2.  One member must be a representative of the
1432	administration of a hospital with an approved community hospital
1433	medical education program;
1434	3.  One member must be the dean of a medical school in this
1435	state; and
1436	4.  Two members must be consumer representatives.
1437
1438	All of the members shall be appointed by the Governor for terms
1439	of 4 years each.
1440	(b)  Council membership shall cease when a member's
1441	representative status no longer exists. Members of similar
1442	representative status shall be appointed to replace retiring or
1443	resigning members of the council.
1444	(c)  The State Surgeon General shall designate an
1445	administrator to serve as staff director. The council shall
1446	elect a chair from among its membership. Such other personnel as
1447	may be necessary to carry out the program shall be employed as
1448	authorized by the Department of Health.
1449	(6)(7)  DEPARTMENT OF HEALTH; STANDARDS.-
1450	(a)  The Department of Health, with recommendations from
1451	the council, shall establish standards and policies for the use
1452	and expenditure of graduate medical education funds appropriated
1453	pursuant to subsection (7) (8) for a program of community
1454	hospital education. The Department of Health shall establish
1455	requirements for hospitals to be qualified for participation in
1456	the program which shall include, but not be limited to:
1457	1.  Submission of an educational plan and a training
1458	schedule.
1459	2.  A determination by the council to ascertain that each
1460	portion of the program of the hospital provides a high degree of
1461	academic excellence and is accredited by the Accreditation
1462	Council for Graduate Medical Education of the American Medical
1463	Association or is accredited by the American Osteopathic
1464	Association.
1465	3.  Supervision of the educational program of the hospital
1466	by a physician who is not the hospital administrator.
1467	(b)  The Department of Health shall periodically review the
1468	educational program provided by a participating hospital to
1469	assure that the program includes a reasonable amount of both
1470	formal and practical training and that the formal sessions are
1471	presented as scheduled in the plan submitted by each hospital.
1472	(c)  In years that funds are transferred to the Agency for
1473	Health Care Administration, the Department of Health shall
1474	certify to the Agency for Health Care Administration on a
1475	quarterly basis the number of primary care specialty residents
1476	and interns at each of the participating hospitals for which the
1477	Community Hospital Education Council and the department
1478	recommends funding.
1479	(7)(8)  MATCHING FUNDS.-State funds shall be used to match
1480	funds from any local governmental or hospital source. The state
1481	shall provide up to 50 percent of the funds, and the community
1482	hospital medical education program shall provide the remainder.
1483	However, except for fixed capital outlay, the provisions of this
1484	subsection shall not apply to any program authorized under the
1485	provisions of subsection (5) for the first 3 years after such
1486	program is in operation.
1487	(9)  ANNUAL REPORT ON GRADUATE MEDICAL EDUCATION;
1488	COMMITTEE.-The Executive Office of the Governor, the Department
1489	of Health, and the Agency for Health Care Administration shall
1490	collaborate to establish a committee that shall produce an
1491	annual report on graduate medical education. The committee shall
1492	be comprised of 11 members: five members shall be deans of the
1493	medical schools or their designees; the Governor shall appoint
1494	two members, one of whom must be a representative of the Florida
1495	Medical Association who has supervised or currently supervises
1496	residents or interns and one of whom must be a representative of
1497	the Florida Hospital Association; the Secretary of Health Care
1498	Administration shall appoint two members, one of whom must be a
1499	representative of a statutory teaching hospital and one of whom
1500	must be a physician who has supervised or is currently
1501	supervising residents or interns; and the State Surgeon General
1502	shall appoint two members, one of whom must be a representative
1503	of a statutory family practice teaching hospital and one of whom
1504	must be a physician who has supervised or is currently
1505	supervising residents or interns. With the exception of the
1506	deans, members shall serve 4-year terms. In order to stagger the
1507	terms, the Governor's appointees shall serve initial terms of 4
1508	years, the State Surgeon General's appointees shall serve
1509	initial terms of 3 years, and the Secretary of Health Care
1510	Administration's appointees shall serve initial terms of 2
1511	years. A member's term shall be deemed terminated when the
1512	member's representative status no longer exists. Once the
1513	committee is appointed, it shall elect a chair to serve for a 1-
1514	year term. The report shall be provided to the Governor, the
1515	President of the Senate, and the Speaker of the House of
1516	Representatives by January 15 annually. Committee members shall
1517	serve without compensation. The report shall address the
1518	following:
1519	(a)  The role of residents and medical faculty in the
1520	provision of health care.
1521	(b)  The relationship of graduate medical education to the
1522	state's physician workforce.
1523	(c)  The costs of training medical residents for hospitals,
1524	medical schools, teaching hospitals, including all hospital-
1525	medical affiliations, practice plans at all of the medical
1526	schools, and municipalities.
1527	(d)  The availability and adequacy of all sources of
1528	revenue to support graduate medical education and recommend
1529	alternative sources of funding for graduate medical education.
1530	(e)  The use of state and federal appropriated funds for
1531	graduate medical education by hospitals receiving such funds.
1532	(9)(10)  RULEMAKING.-The department has authority to adopt
1533	rules pursuant to ss. 120.536(1) and 120.54 to implement the
1534	provisions of this section.
1535	Section 38.  Section 381.4018, Florida Statutes, is amended
1536	to read:
1537	381.4018  Physician workforce assessment and development.-
1538	(1)  DEFINITIONS.-As used in this section, the term:
1539	(a)  "Consortium" or "consortia" means a combination of
1540	statutory teaching hospitals, specialty children's hospitals,
1541	statutory rural hospitals, other hospitals, accredited medical
1542	schools, clinics operated by the department, clinics operated by
1543	the Department of Veterans' Affairs, area health education
1544	centers, community health centers, federally qualified health
1545	centers, prison clinics, local community clinics, or other
1546	programs. At least one member of the consortium shall be a
1547	sponsoring institution accredited or currently seeking
1548	accreditation by the Accreditation Council for Graduate Medical
1549	Education or the American Osteopathic Association.
1550	(b)  "Council" means the Physician Workforce Advisory
1551	Council.
1552	(c)  "Department" means the Department of Health.
1553	(d)  "Graduate medical education program" means a program
1554	accredited by the Accreditation Council for Graduate Medical
1555	Education or the American Osteopathic Association.
1556	(e)  "Primary care specialty" means emergency medicine,
1557	family practice, internal medicine, pediatrics, psychiatry,
1558	geriatrics, general surgery, obstetrics and gynecology, and
1559	combined pediatrics and internal medicine and other specialties
1560	as determined by the Physician Workforce Advisory Council or the
1561	Department of Health.
1562	(2)(1)  LEGISLATIVE INTENT.-The Legislature recognizes that
1563	physician workforce planning is an essential component of
1564	ensuring that there is an adequate and appropriate supply of
1565	well-trained physicians to meet this state's future health care
1566	service needs as the general population and elderly population
1567	of the state increase. The Legislature finds that items to
1568	consider relative to assessing the physician workforce may
1569	include physician practice status; specialty mix; geographic
1570	distribution; demographic information, including, but not
1571	limited to, age, gender, race, and cultural considerations; and
1572	needs of current or projected medically underserved areas in the
1573	state. Long-term strategic planning is essential as the period
1574	from the time a medical student enters medical school to
1575	completion of graduate medical education may range from 7 to 10
1576	years or longer. The Legislature recognizes that strategies to
1577	provide for a well-trained supply of physicians must include
1578	ensuring the availability and capacity of quality graduate
1579	medical schools and graduate medical education programs in this
1580	state, as well as using new or existing state and federal
1581	programs providing incentives for physicians to practice in
1582	needed specialties and in underserved areas in a manner that
1583	addresses projected needs for physician manpower.
1584	(3)(2)  PURPOSE.-The department of Health shall serve as a
1585	coordinating and strategic planning body to actively assess the
1586	state's current and future physician workforce needs and work
1587	with multiple stakeholders to develop strategies and
1588	alternatives to address current and projected physician
1589	workforce needs.
1590	(4)(3)  GENERAL FUNCTIONS.-The department shall maximize
1591	the use of existing programs under the jurisdiction of the
1592	department and other state agencies and coordinate governmental
1593	and nongovernmental stakeholders and resources in order to
1594	develop a state strategic plan and assess the implementation of
1595	such strategic plan. In developing the state strategic plan, the
1596	department shall:
1597	(a)  Monitor, evaluate, and report on the supply and
1598	distribution of physicians licensed under chapter 458 or chapter
1599	459. The department shall maintain a database to serve as a
1600	statewide source of data concerning the physician workforce.
1601	(b)  Develop a model and quantify, on an ongoing basis, the
1602	adequacy of the state's current and future physician workforce
1603	as reliable data becomes available. Such model must take into
1604	account demographics, physician practice status, place of
1605	education and training, generational changes, population growth,
1606	economic indicators, and issues concerning the "pipeline" into
1607	medical education.
1608	(c)  Develop and recommend strategies to determine whether
1609	the number of qualified medical school applicants who might
1610	become competent, practicing physicians in this state will be
1611	sufficient to meet the capacity of the state's medical schools.
1612	If appropriate, the department shall, working with
1613	representatives of appropriate governmental and nongovernmental
1614	entities, develop strategies and recommendations and identify
1615	best practice programs that introduce health care as a
1616	profession and strengthen skills needed for medical school
1617	admission for elementary, middle, and high school students, and
1618	improve premedical education at the precollege and college level
1619	in order to increase this state's potential pool of medical
1620	students.
1621	(d)  Develop strategies to ensure that the number of
1622	graduates from the state's public and private allopathic and
1623	osteopathic medical schools is are adequate to meet physician
1624	workforce needs, based on the analysis of the physician
1625	workforce data, so as to provide a high-quality medical
1626	education to students in a manner that recognizes the uniqueness
1627	of each new and existing medical school in this state.
1628	(e)  Pursue strategies and policies to create, expand, and
1629	maintain graduate medical education positions in the state based
1630	on the analysis of the physician workforce data. Such strategies
1631	and policies must take into account the effect of federal
1632	funding limitations on the expansion and creation of positions
1633	in graduate medical education. The department shall develop
1634	options to address such federal funding limitations. The
1635	department shall consider options to provide direct state
1636	funding for graduate medical education positions in a manner
1637	that addresses requirements and needs relative to accreditation
1638	of graduate medical education programs. The department shall
1639	consider funding residency positions as a means of addressing
1640	needed physician specialty areas, rural areas having a shortage
1641	of physicians, and areas of ongoing critical need, and as a
1642	means of addressing the state's physician workforce needs based
1643	on an ongoing analysis of physician workforce data.
1644	(f)  Develop strategies to maximize federal and state
1645	programs that provide for the use of incentives to attract
1646	physicians to this state or retain physicians within the state.
1647	Such strategies should explore and maximize federal-state
1648	partnerships that provide incentives for physicians to practice
1649	in federally designated shortage areas. Strategies shall also
1650	consider the use of state programs, such as the Florida Health
1651	Service Corps established pursuant to s. 381.0302 and the
1652	Medical Education Reimbursement and Loan Repayment Program
1653	pursuant to s. 1009.65, which provide for education loan
1654	repayment or loan forgiveness and provide monetary incentives
1655	for physicians to relocate to underserved areas of the state.
1656	(g)  Coordinate and enhance activities relative to
1657	physician workforce needs, undergraduate medical education, and
1658	graduate medical education, and reentry of retired military and
1659	other physicians into the physician workforce provided by the
1660	Division of Medical Quality Assurance, the Community Hospital
1661	Education Program and the Graduate Medical Education Committee
1662	established pursuant to s. 381.0403, area health education
1663	center networks established pursuant to s. 381.0402, and other
1664	offices and programs within the department of Health as
1665	designated by the State Surgeon General.
1666	(h)  Work in conjunction with and act as a coordinating
1667	body for governmental and nongovernmental stakeholders to
1668	address matters relating to the state's physician workforce
1669	assessment and development for the purpose of ensuring an
1670	adequate supply of well-trained physicians to meet the state's
1671	future needs. Such governmental stakeholders shall include, but
1672	need not be limited to, the State Surgeon General or his or her
1673	designee, the Commissioner of Education or his or her designee,
1674	the Secretary of Health Care Administration or his or her
1675	designee, and the Chancellor of the State University System or
1676	his or her designee from the Board of Governors of the State
1677	University System, and, at the discretion of the department,
1678	other representatives of state and local agencies that are
1679	involved in assessing, educating, or training the state's
1680	current or future physicians. Other stakeholders shall include,
1681	but need not be limited to, organizations representing the
1682	state's public and private allopathic and osteopathic medical
1683	schools; organizations representing hospitals and other
1684	institutions providing health care, particularly those that
1685	currently provide or have an interest in providing accredited
1686	medical education and graduate medical education to medical
1687	students and medical residents; organizations representing
1688	allopathic and osteopathic practicing physicians; and, at the
1689	discretion of the department, representatives of other
1690	organizations or entities involved in assessing, educating, or
1691	training the state's current or future physicians.
1692	(i)  Serve as a liaison with other states and federal
1693	agencies and programs in order to enhance resources available to
1694	the state's physician workforce and medical education continuum.
1695	(j)  Act as a clearinghouse for collecting and
1696	disseminating information concerning the physician workforce and
1697	medical education continuum in this state.
1698	(5)  PHYSICIAN WORKFORCE ADVISORY COUNCIL.-There is created
1699	in the department the Physician Workforce Advisory Council, an
1700	advisory council as defined in s. 20.03. The council shall
1701	comply with the requirements of s. 20.052, except as otherwise
1702	provided in this section.
1703	(a)  The council shall consist of 19 members. Members
1704	appointed by the State Surgeon General shall include:
1705	1.  A designee from the department who is a physician
1706	licensed under chapter 458 or chapter 459 and recommended by the
1707	State Surgeon General.
1708	2.  An individual who is affiliated with the Science
1709	Students Together Reaching Instructional Diversity and
1710	Excellence program and recommended by the area health education
1711	center network.
1712	3.  Two individuals who are recommended by the Council of
1713	Florida Medical School Deans, one who represents a college of
1714	allopathic medicine and one who represents a college of
1715	osteopathic medicine.
1716	4.  One individual who is recommended by the Florida
1717	Hospital Association and represents a hospital that is licensed
1718	under chapter 395, has an accredited graduate medical education
1719	program, and is not a statutory teaching hospital.
1720	5.  One individual who represents a statutory teaching
1721	hospital as defined in s. 408.07 and is recommended by the
1722	Safety Net Hospital Alliance.
1723	6.  One individual who represents a family practice
1724	teaching hospital as defined in s. 395.805 and is recommended by
1725	the Council of Family Medicine and Community Teaching Hospitals.
1726	7.  Two individuals who are recommended by the Florida
1727	Medical Association, one who represents a primary care specialty
1728	and one who represents a nonprimary care specialty.
1729	8.  Two individuals who are recommended by the Florida
1730	Osteopathic Medical Association, one who represents a primary
1731	care specialty and one who represents a nonprimary care
1732	specialty.
1733	9.  Two individuals who are program directors of accredited
1734	graduate medical education programs, one who represents a
1735	program that is accredited by the Accreditation Council for
1736	Graduate Medical Education and one who represents a program that
1737	is accredited by the American Osteopathic Association.
1738	10.  An individual who is recommended by the Florida
1739	Association of Community Health Centers and represents a
1740	federally qualified health center located in a rural area as
1741	defined in s. 381.0406(2)(a).
1742	11.  An individual who is recommended by the Florida
1743	Academy of Family Physicians.
1744	12.  An individual who is recommended by the Florida
1745	Alliance for Health Professions Diversity.
1746	13.  The Chancellor of the State University System or his
1747	or her designee.
1748	14.  A layperson member as determined by the State Surgeon
1749	General.
1750
1751	Each entity authorized to make recommendations under this
1752	subsection shall make at least two recommendations to the State
1753	Surgeon General for each appointment to the council. The State
1754	Surgeon General shall name one appointee for each position from
1755	the recommendations made by each authorized entity.
1756	(b)  Each council member shall be appointed to a 4-year
1757	term. An individual may not serve more than two terms. Any
1758	council member may be removed from office for malfeasance,
1759	misfeasance, neglect of duty, incompetence, permanent inability
1760	to perform official duties, or pleading guilty or nolo
1761	contendere to, or being found guilty of, a felony. Any council
1762	member who meets the criteria for removal, or who is otherwise
1763	unwilling or unable to properly fulfill the duties of the
1764	office, shall be succeeded by an individual chosen by the State
1765	Surgeon General to serve out the remainder of the council
1766	member's term. If the remainder of the replaced council member's
1767	term is less than 18 months, notwithstanding the provisions of
1768	this paragraph, the succeeding council member may be reappointed
1769	twice by the State Surgeon General.
1770	(c)  The chair of the council is the State Surgeon General,
1771	who shall designate a vice chair from the membership of the
1772	council to serve in the absence of the State Surgeon General. A
1773	vacancy shall be filled for the remainder of the unexpired term
1774	in the same manner as the original appointment.
1775	(d)  Council members are not entitled to receive
1776	compensation or reimbursement for per diem or travel expenses.
1777	(e)  The council shall meet at least twice a year in person
1778	or by teleconference.
1779	(f)  The council shall:
1780	1.  Advise the State Surgeon General and the department on
1781	matters concerning current and future physician workforce needs
1782	in this state;
1783	2.  Review survey materials and the compilation of survey
1784	information;
1785	3.  Annually review the number, location, cost, and
1786	reimbursement of graduate medical education programs and
1787	positions;
1788	4.  Provide recommendations to the department regarding the
1789	survey completed by physicians licensed under chapter 458 or
1790	chapter 459;
1791	5.  Assist the department in preparing the annual report to
1792	the Legislature pursuant to ss. 458.3192 and 459.0082;
1793	6.  Assist the department in preparing an initial strategic
1794	plan, conduct ongoing strategic planning in accordance with this
1795	section, and provide ongoing advice on implementing the
1796	recommendations;
1797	7.  Monitor and provide recommendations regarding the need
1798	for an increased number of primary care or other physician
1799	specialties to provide the necessary current and projected
1800	health and medical services for the state; and
1801	8.  Monitor and make recommendations regarding the status
1802	of the needs relating to graduate medical education in this
1803	state.
1804	(6)  PHYSICIAN WORKFORCE GRADUATE MEDICAL EDUCATION
1805	INNOVATION PILOT PROJECTS.-
1806	(a)  The Legislature finds that:
1807	1.  In order to ensure a physician workforce that is
1808	adequate to meet the needs of this state's residents and its
1809	health care system, policymakers must consider the education and
1810	training of future generations of well-trained health care
1811	providers.
1812	2.  Physicians are likely to practice in the state where
1813	they complete their graduate medical education.
1814	3.  It can directly affect the makeup of the physician
1815	workforce by selectively funding graduate medical education
1816	programs to provide needed specialists in geographic areas of
1817	the state that have a deficient number of such specialists.
1818	4.  Developing additional positions in graduate medical
1819	education programs is essential to the future of this state's
1820	health care system.
1821	5.  It was necessary in 2007 to pass legislation that
1822	provided for an assessment of the status of this state's current
1823	and future physician workforce. The department is collecting and
1824	analyzing information on an ongoing basis to assess this state's
1825	physician workforce needs, and such assessment may facilitate
1826	the determination of graduate medical education needs and
1827	strategies for the state.
1828	(b)  There is established under the department a program to
1829	foster innovative graduate medical education pilot projects that
1830	are designed to promote the expansion of graduate medical
1831	education programs or positions to prepare physicians to
1832	practice in needed specialties and underserved areas or settings
1833	and to provide demographic and cultural representation in a
1834	manner that addresses current and projected needs for this
1835	state's physician workforce. Funds appropriated annually by the
1836	Legislature for this purpose shall be distributed to
1837	participating hospitals, medical schools, other sponsors of
1838	graduate medical education programs, consortia engaged in
1839	developing new graduate medical education programs or positions
1840	in those programs, or pilot projects providing innovative
1841	graduate medical education in community-based clinical settings.
1842	Pilot projects shall be selected on a competitive grant basis,
1843	subject to available funds.
1844	(c)  Pilot projects shall be designed to meet one or more
1845	of this state's physician workforce needs, as determined
1846	pursuant to this section, including, but not limited to:
1847	1.  Increasing the number of residencies or fellowships in
1848	primary care or other needed specialties.
1849	2.  Enhancing the retention of primary care physicians or
1850	other needed specialties in this state.
1851	3.  Promoting practice in rural or medically underserved
1852	areas of the state.
1853	4.  Encouraging racial and ethnic diversity within the
1854	state's physician workforce.
1855	5.  Encouraging practice in community health care or other
1856	ambulatory care settings.
1857	6.  Encouraging practice in clinics operated by the
1858	department, including, but not limited to, county health
1859	departments, clinics operated by the Department of Veterans'
1860	Affairs, prison clinics, or similar settings of need.
1861	7.  Encouraging the increased production of geriatricians.
1862	(d)  Priority shall be given to a proposal for a pilot
1863	project that:
1864	1.  Demonstrates a collaboration of federal, state, and
1865	local entities that are public or private.
1866	2.  Obtains funding from multiple sources.
1867	3.  Focuses on enhancing graduate medical education in
1868	rural or underserved areas.
1869	4.  Focuses on enhancing graduate medical education in
1870	ambulatory or community-based settings other than a hospital
1871	environment.
1872	5.  Includes the use of technology, such as electronic
1873	medical records, distance consultation, and telemedicine, to
1874	ensure that residents are better prepared to care for patients
1875	in this state, regardless of the community in which the
1876	residents practice.
1877	6.  Is designed to meet multiple policy needs as enumerated
1878	in subsection (4).
1879	7.  Uses a consortium to provide for graduate medical
1880	education experiences.
1881	(e)  The department shall adopt by rule appropriate
1882	performance measures to use in order to consistently evaluate
1883	the effectiveness, safety, and quality of the programs, as well
1884	as the impact of each program on meeting this state's physician
1885	workforce needs.
1886	(f)  Participating pilot projects shall submit to the
1887	department an annual report on the project in a manner required
1888	by the department.
1889	(g)  Funding provided to a pilot project may be used only
1890	for the direct costs of providing graduate medical education.
1891	Accounting of such costs and expenditures shall be documented in
1892	the annual report.
1893	(h)  State funds shall be used to supplement funds from any
1894	local government, community, or private source. The state may
1895	provide up to 50 percent of the funds, and local governmental
1896	grants or community or private sources shall provide the
1897	remainder of the funds.
1898	(7)  RULEMAKING.-The department shall adopt rules as
1899	necessary to administer this section.
1900	Section 39.  Paragraph (l) of subsection (4) of section
1901	400.9905, Florida Statutes, is amended to read:
1902	400.9905  Definitions.-
1903	(4)  "Clinic" means an entity at which health care services
1904	are provided to individuals and which tenders charges for
1905	reimbursement for such services, including a mobile clinic and a
1906	portable equipment provider. For purposes of this part, the term
1907	does not include and the licensure requirements of this part do
1908	not apply to:
1909	(l)  Orthotic, or prosthetic, pediatric cardiology, or
1910	perinatology clinical facilities that are a publicly traded
1911	corporation or that are wholly owned, directly or indirectly, by
1912	a publicly traded corporation. As used in this paragraph, a
1913	publicly traded corporation is a corporation that issues
1914	securities traded on an exchange registered with the United
1915	States Securities and Exchange Commission as a national
1916	securities exchange.
1917	Section 40.  Section 458.3192, Florida Statutes, is amended
1918	to read:
1919	458.3192  Analysis of survey results; report.-
1920	(1)  Each year, the Department of Health shall analyze the
1921	results of the physician survey required by s. 458.3191 and
1922	determine by geographic area and specialty the number of
1923	physicians who:
1924	(a)  Perform deliveries of children in this state Florida.
1925	(b)  Read mammograms and perform breast-imaging-guided
1926	procedures in this state Florida.
1927	(c)  Perform emergency care on an on-call basis for a
1928	hospital emergency department.
1929	(d)  Plan to reduce or increase emergency on-call hours in
1930	a hospital emergency department.
1931	(e)  Plan to relocate their allopathic or osteopathic
1932	practice outside the state.
1933	(f)  Practice medicine in this state.
1934	(g)  Plan to reduce or modify the scope of their practice.
1935	(2)  The Department of Health must report its findings to
1936	the Governor, the President of the Senate, and the Speaker of
1937	the House of Representatives by November 1 each year. The
1938	department shall also include in its report findings,
1939	recommendations, and strategic planning activities as provided
1940	in s. 381.4018. The department may also include other
1941	information requested by the Physician Workforce Advisory
1942	Council.
1943	Section 41.  Section 459.0082, Florida Statutes, is amended
1944	to read:
1945	459.0082  Analysis of survey results; report.-
1946	(1)  Each year, the Department of Health shall analyze the
1947	results of the physician survey required by s. 459.0081 and
1948	determine by geographic area and specialty the number of
1949	physicians who:
1950	(a)  Perform deliveries of children in this state Florida.
1951	(b)  Read mammograms and perform breast-imaging-guided
1952	procedures in this state Florida.
1953	(c)  Perform emergency care on an on-call basis for a
1954	hospital emergency department.
1955	(d)  Plan to reduce or increase emergency on-call hours in
1956	a hospital emergency department.
1957	(e)  Plan to relocate their allopathic or osteopathic
1958	practice outside the state.
1959	(f)  Practice medicine in this state.
1960	(g)  Plan to reduce or modify the scope of their practice.
1961	(2)  The Department of Health must report its findings to
1962	the Governor, the President of the Senate, and the Speaker of
1963	the House of Representatives by November 1 each year. The
1964	department shall also include in its report findings,
1965	recommendations, and strategic planning activities as provided
1966	in s. 381.4018. The department may also include other
1967	information requested by the Physician Workforce Advisory
1968	Council.
1969	Section 42.  Section 458.315, Florida Statutes, is amended
1970	to read:
1971	458.315  Temporary certificate for practice in areas of
1972	critical need.-
1973	(1)  Any physician who:
1974	(a)  Is licensed to practice in any jurisdiction in the
1975	United States and other state, whose license is currently valid;
1976	or,
1977	(b)  Has served as a physician in the United States Armed
1978	Forces for at least 10 years and received an honorable discharge
1979	from the military;
1980
1981	and who pays an application fee of $300 may be issued a
1982	temporary certificate for to practice in areas of communities of
1983	Florida where there is a critical need for physicians.
1984	(2)  A certificate may be issued to a physician who:
1985	(a)  Practices in an area of critical need;
1986	(b)  Will be employed by or practice in a county health
1987	department, correctional facility, Department of Veterans'
1988	Affairs clinic, community health center funded by s. 329, s.
1989	330, or s. 340 of the United States Public Health Services Act,
1990	or other agency or institution that is approved by the State
1991	Surgeon General and provides health care to meet the needs of
1992	underserved populations in this state; or
1993	(c)  Will practice for a limited time to address critical
1994	physician-specialty, demographic, or geographic needs for this
1995	state's physician workforce as determined by the State Surgeon
1996	General entity that provides health care to indigents and that
1997	is approved by the State Health Officer.
1998	(3)  The Board of Medicine may issue this temporary
1999	certificate with the following restrictions:
2000	(a)(1)  The State Surgeon General board shall determine the
2001	areas of critical need, and the physician so certified may
2002	practice in any of those areas for a time to be determined by
2003	the board. Such areas shall include, but are not be limited to,
2004	health professional shortage areas designated by the United
2005	States Department of Health and Human Services.
2006	1.(a)  A recipient of a temporary certificate for practice
2007	in areas of critical need may use the certificate license to
2008	work for any approved entity employer in any area of critical
2009	need or as authorized by the State Surgeon General approved by
2010	the board.
2011	2.(b)  The recipient of a temporary certificate for
2012	practice in areas of critical need shall, within 30 days after
2013	accepting employment, notify the board of all approved
2014	institutions in which the licensee practices and of all approved
2015	institutions where practice privileges have been denied.
2016	(b)(2)  The board may administer an abbreviated oral
2017	examination to determine the physician's competency, but a no
2018	written regular examination is not required necessary. Within 60
2019	days after receipt of an application for a temporary
2020	certificate, the board shall review the application and issue
2021	the temporary certificate, or notify the applicant of denial, or
2022	notify the applicant that the board recommends additional
2023	assessment, training, education, or other requirements as a
2024	condition of certification. If the applicant has not actively
2025	practiced during the prior 3 years and the board determines that
2026	the applicant may lack clinical competency, possess diminished
2027	or inadequate skills, lack necessary medical knowledge, or
2028	exhibit patterns of deficits in clinical decisionmaking, the
2029	board may:
2030	1.  Deny the application;
2031	2.  Issue a temporary certificate with reasonable
2032	restrictions that may include, but are not limited to, a
2033	requirement for the applicant to practice under the supervision
2034	of a physician approved by the board; or
2035	3.  Issue a temporary certificate upon receipt of
2036	documentation confirming that the applicant has met any
2037	reasonable conditions of the board which may include, but are
2038	not limited to, completing continuing education or undergoing an
2039	assessment of skills and training.
2040	(c)(3)  Any certificate issued under this section is shall
2041	be valid only so long as the State Surgeon General determines
2042	that the reason area for which it was is issued remains a an
2043	area of critical need to the state. The Board of Medicine shall
2044	review each temporary certificateholder the service within said
2045	area not less than annually to ascertain that the
2046	requirements of the Medical Practice Act and its adopted the
2047	rules and regulations promulgated thereunder are being complied
2048	with. If it is determined that such minimum requirements are not
2049	being met, the board shall forthwith revoke such certificate or
2050	shall impose restrictions or conditions, or both, as a condition
2051	of continued practice under the certificate.
2052	(d)(4)  The board may shall not issue a temporary
2053	certificate for practice in an area of critical need to any
2054	physician who is under investigation in any jurisdiction in the
2055	United States another state for an act that which would
2056	constitute a violation of this chapter until such time as the
2057	investigation is complete, at which time the provisions of s.
2058	458.331 shall apply.
2059	(4)(5)  The application fee and all licensure fees,
2060	including neurological injury compensation assessments, shall be
2061	waived for those persons obtaining a temporary certificate to
2062	practice in areas of critical need for the purpose of providing
2063	volunteer, uncompensated care for low-income residents
2064	Floridians. The applicant must submit an affidavit from the
2065	employing agency or institution stating that the physician will
2066	not receive any compensation for any service involving the
2067	practice of medicine.
2068	Section 43.  Section 459.0076, Florida Statutes, is created
2069	to read:
2070	459.0076  Temporary certificate for practice in areas of
2071	critical need.-
2072	(1)  Any physician who:
2073	(a)  Is licensed to practice in any jurisdiction in the
2074	United States and whose license is currently valid; or
2075	(b)  Has served as a physician in the United States Armed
2076	Forces for at least 10 years and received an honorable discharge
2077	from the military;
2078
2079	and who pays an application fee of $300 may be issued a
2080	temporary certificate for practice in areas of critical need.
2081	(2)  A certificate may be issued to a physician who:
2082	(a)  Will practice in an area of critical need;
2083	(b)  Will be employed by or practice in a county health
2084	department, correctional facility, Department of Veterans'
2085	Affairs clinic, community health center funded by s. 329, s.
2086	330, or s. 340 of the United States Public Health Services Act,
2087	or other agency or institution that is approved by the State
2088	Surgeon General and provides health care to meet the needs of
2089	underserved populations in this state; or
2090	(c)  Will practice for a limited time to address critical
2091	physician-specialty, demographic, or geographic needs for this
2092	state's physician workforce as determined by the State Surgeon
2093	General.
2094	(3)  The Board of Osteopathic Medicine may issue this
2095	temporary certificate with the following restrictions:
2096	(a)  The State Surgeon General shall determine the areas of
2097	critical need. Such areas include, but are not limited to,
2098	health professional shortage areas designated by the United
2099	States Department of Health and Human Services.
2100	1.  A recipient of a temporary certificate for practice in
2101	areas of critical need may use the certificate to work for any
2102	approved entity in any area of critical need or as authorized by
2103	the State Surgeon General.
2104	2.  The recipient of a temporary certificate for practice
2105	in areas of critical need shall, within 30 days after accepting
2106	employment, notify the board of all approved institutions in
2107	which the licensee practices and of all approved institutions
2108	where practice privileges have been denied.
2109	(b)  The board may administer an abbreviated oral
2110	examination to determine the physician's competency, but a
2111	written regular examination is not required. Within 60 days
2112	after receipt of an application for a temporary certificate, the
2113	board shall review the application and issue the temporary
2114	certificate, notify the applicant of denial, or notify the
2115	applicant that the board recommends additional assessment,
2116	training, education, or other requirements as a condition of
2117	certification. If the applicant has not actively practiced
2118	during the prior 3 years and the board determines that the
2119	applicant may lack clinical competency, possess diminished or
2120	inadequate skills, lack necessary medical knowledge, or exhibit
2121	patterns of deficits in clinical decisionmaking, the board may:
2122	1.  Deny the application;
2123	2.  Issue a temporary certificate having reasonable
2124	restrictions that may include, but are not limited to, a
2125	requirement for the applicant to practice under the supervision
2126	of a physician approved by the board; or
2127	3.  Issue a temporary certificate upon receipt of
2128	documentation confirming that the applicant has met any
2129	reasonable conditions of the board, which may include, but are
2130	not limited to, completing continuing education or undergoing an
2131	assessment of skills and training.
2132	(c)  Any certificate issued under this section is valid
2133	only so long as the State Surgeon General determines that the
2134	reason for which it was issued remains a critical need to the
2135	state. The Board of Osteopathic Medicine shall review each
2136	temporary certificateholder not less than annually to ascertain
2137	that the minimum requirements of the Osteopathic Medical
2138	Practice Act and its adopted rules are being complied with. If
2139	it is determined that such minimum requirements are not being
2140	met, the board shall revoke such certificate or shall impose
2141	restrictions or conditions, or both, as a condition of continued
2142	practice under the certificate.
2143	(d)  The board may not issue a temporary certificate for
2144	practice in an area of critical need to any physician who is
2145	under investigation in any jurisdiction in the United States for
2146	an act that would constitute a violation of this chapter until
2147	such time as the investigation is complete, at which time the
2148	provisions of s. 459.015 apply.
2149	(4)  The application fee and all licensure fees, including
2150	neurological injury compensation assessments, shall be waived
2151	for those persons obtaining a temporary certificate to practice
2152	in areas of critical need for the purpose of providing
2153	volunteer, uncompensated care for low-income residents. The
2154	applicant must submit an affidavit from the employing agency or
2155	institution stating that the physician will not receive any
2156	compensation for any service involving the practice of medicine.
2157	Section 44.  Paragraph (i) is added to subsection (3) of
2158	section 499.01212, Florida Statutes, to read:
2159	499.01212  Pedigree paper.-
2160	(3)  EXCEPTIONS.-A pedigree paper is not required for:
2161	(i)  The wholesale distribution of prescription drugs
2162	within a medical convenience kit if:
2163	1.  The medical convenience kit is assembled in an
2164	establishment that is registered with the United States Food and
2165	Drug Administration as a medical device manufacturer;
2166	2.  The medical convenience kit manufacturer is an
2167	authorized distributor of record, as defined by 21 C.F.R. s.
2168	203.3, for the manufacturer of the specific drugs contained
2169	within the kit; and
2170	3.  The drugs contained in the medical convenience kit are:
2171	a.  Intravenous solutions intended for the replenishment of
2172	fluids and electrolytes;
2173	b.  Products intended to maintain the equilibrium of water
2174	and minerals in the body;
2175	c.  Products intended for irrigation or reconstitution;
2176	d.  Anesthetics; or
2177	e.  Anticoagulants.
2178
2179	This paragraph does not apply to a medical convenience kit
2180	containing any controlled substance that appears in any schedule
2181	contained in or subject to chapter 893 or the Federal
2182	Comprehensive Drug Abuse Prevention and Control Act of 1970.
2183	Section 45.  Subsection (1) of section 465.0251, Florida
2184	Statutes, is reenacted to read:
2185	465.0251  Generic drugs; removal from formulary under
2186	specified circumstances.-
2187	(1)  The Board of Pharmacy and the Board of Medicine shall
2188	remove any generic named drug product from the formulary
2189	established by s. 465.025(6), if every commercially marketed
2190	equivalent of that drug product is "A" rated as therapeutically
2191	equivalent to a reference listed drug or is a reference listed
2192	drug as referred to in "Approved Drug Products with Therapeutic
2193	Equivalence Evaluations" (Orange Book) published by the United
2194	States Food and Drug Administration.
2195	Section 46.  This act shall take effect July 1, 2010.

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