Florida Senate - 2015                   (PROPOSED BILL) SPB 7084
       
       
        
       FOR CONSIDERATION By the Committee on Health Policy
       
       
       
       
       
       588-03391A-15                                         20157084pb
    1                        A bill to be entitled                      
    2         An act relating to quality health care services;
    3         creating s. 624.27, F.S.; providing definitions;
    4         specifying that a direct primary care agreement does
    5         not constitute insurance and is not subject to the
    6         Florida Insurance Code; specifying that entering into
    7         a direct primary care agreement does not constitute
    8         the business of insurance and is not subject to the
    9         code; providing that a health care provider is not
   10         required to obtain a certificate of authority to
   11         market, sell, or offer to sell a direct primary care
   12         agreement; specifying criteria for a direct primary
   13         care agreement; amending s. 288.0001. F.S.; requiring
   14         an analysis of medical tourism for quality health care
   15         services in the Economic Development Programs
   16         Evaluation; amending s. 288.901, F.S.; requiring
   17         Enterprise Florida, Inc., to collaborate with the
   18         Department of Economic Opportunity to market this
   19         state as a health care destination; amending s.
   20         288.923, F.S.; requiring the Division of Tourism
   21         Marketing to include in its 4-year plan a discussion
   22         of the promotion of medical tourism for quality health
   23         care services; creating s. 288.924, F.S.; creating a
   24         marketing plan to promote national and international
   25         awareness of the qualifications, scope of services,
   26         and specialized expertise of health care providers in
   27         this state, to promote national and international
   28         awareness of certain business opportunities to attract
   29         practitioners to destinations in this state, and to
   30         include an initiative to showcase qualified health
   31         care providers; specifying qualifications for
   32         participating providers; amending s. 766.1115, F.S.;
   33         redefining terms relating to agency relationships with
   34         governmental health care contractors; deleting an
   35         obsolete date; extending sovereign immunity to
   36         employees or agents of a health care provider that
   37         executes a contract with a governmental contractor;
   38         clarifying that a receipt of specified notice must be
   39         acknowledged by a patient or the patient’s
   40         representative at the initial visit; requiring the
   41         posting of notice that a specified health care
   42         provider is an agent of a governmental contractor;
   43         amending s. 768.28, F.S.; redefining the term
   44         “officer, employee, or agent” to include employees or
   45         agents of a health care provider; providing an
   46         effective date.
   47          
   48  Be It Enacted by the Legislature of the State of Florida:
   49  
   50         Section 1. Section 624.27, Florida Statutes, is created to
   51  read:
   52         624.27 Application of code as to direct primary care
   53  agreements.—
   54         (1) As used in this section, the term:
   55         (a) “Direct primary care agreement” means a contract
   56  between a primary care provider or primary care group practice
   57  and a patient, the patient’s legal representative, or an
   58  employer which must satisfy the criteria in subsection (4) and
   59  does not indemnify for services provided by a third party.
   60         (b) “Primary care provider” means a health care provider
   61  licensed under chapter 458, chapter 459, or chapter 464 who
   62  provides medical services to patients which are commonly
   63  provided without referral from another health care provider.
   64         (c) “Primary care service” means the screening, assessment,
   65  diagnosis, and treatment of a patient for the purpose of
   66  promoting health or detecting and managing disease or injury
   67  within the competency and training of the primary care provider.
   68         (2) A direct primary care agreement does not constitute
   69  insurance and is not subject to this code. The act of entering
   70  into a direct primary care agreement does not constitute the
   71  business of insurance and is not subject to this code.
   72         (3) A primary care provider or an agent of a primary care
   73  provider is not required to obtain a certificate of authority or
   74  license under this code to market, sell, or offer to sell a
   75  direct primary care agreement.
   76         (4) For purposes of this section, a direct primary care
   77  agreement must:
   78         (a) Be in writing.
   79         (b) Be signed by the primary care provider or an agent of
   80  the primary care provider and the patient or the patient’s legal
   81  representative.
   82         (c) Allow a party to terminate the agreement by written
   83  notice to the other party after a period specified in the
   84  agreement.
   85         (d) Describe the scope of the primary care services that
   86  are covered by the monthly fee.
   87         (e) Specify the monthly fee and any fees for primary care
   88  services not covered by the monthly fee.
   89         (f) Specify the duration of the agreement and any automatic
   90  renewal provisions.
   91         (g) Offer a refund to the patient of monthly fees paid in
   92  advance if the primary care provider ceases to offer primary
   93  care services for any reason.
   94         (h) State that the agreement is not health insurance.
   95         Section 2. Paragraph (b) of subsection (2) of section
   96  288.0001, Florida Statutes, is amended to read:
   97         288.0001 Economic Development Programs Evaluation.—The
   98  Office of Economic and Demographic Research and the Office of
   99  Program Policy Analysis and Government Accountability (OPPAGA)
  100  shall develop and present to the Governor, the President of the
  101  Senate, the Speaker of the House of Representatives, and the
  102  chairs of the legislative appropriations committees the Economic
  103  Development Programs Evaluation.
  104         (2) The Office of Economic and Demographic Research and
  105  OPPAGA shall provide a detailed analysis of economic development
  106  programs as provided in the following schedule:
  107         (b) By January 1, 2015, and every 3 years thereafter, an
  108  analysis of the following:
  109         1. The entertainment industry financial incentive program
  110  established under s. 288.1254.
  111         2. The entertainment industry sales tax exemption program
  112  established under s. 288.1258.
  113         3. VISIT Florida and its programs established or funded
  114  under ss. 288.122, 288.1226, 288.12265, and 288.124, and
  115  288.924.
  116         4. The Florida Sports Foundation and related programs
  117  established under ss. 288.1162, 288.11621, 288.1166, 288.1167,
  118  288.1168, 288.1169, and 288.1171.
  119         Section 3. Subsection (2) of section 288.901, Florida
  120  Statutes, is amended to read:
  121         288.901 Enterprise Florida, Inc.—
  122         (2) PURPOSES.—Enterprise Florida, Inc., shall act as the
  123  economic development organization for the state, using utilizing
  124  private sector and public sector expertise in collaboration with
  125  the department to:
  126         (a) Increase private investment in Florida;
  127         (b) Advance international and domestic trade opportunities;
  128         (c) Market the state both as a probusiness location for new
  129  investment and as an unparalleled tourist destination;
  130         (d) Revitalize Florida’s space and aerospace industries,
  131  and promote emerging complementary industries;
  132         (e) Promote opportunities for minority-owned businesses;
  133         (f) Assist and market professional and amateur sport teams
  134  and sporting events in Florida; and
  135         (g) Assist, promote, and enhance economic opportunities in
  136  this state’s rural and urban communities; and.
  137         (h) Market the state as a health care destination by using
  138  the medical tourism initiatives as described in s. 288.924 to
  139  promote quality health care services in this state.
  140         Section 4. Paragraph (c) of subsection (4) of section
  141  288.923, Florida Statutes, is amended to read:
  142         288.923 Division of Tourism Marketing; definitions;
  143  responsibilities.—
  144         (4) The division’s responsibilities and duties include, but
  145  are not limited to:
  146         (c) Developing a 4-year marketing plan.
  147         1. At a minimum, the marketing plan shall discuss the
  148  following:
  149         a. Continuation of overall tourism growth in this state.
  150         b. Expansion to new or under-represented tourist markets.
  151         c. Maintenance of traditional and loyal tourist markets.
  152         d. Coordination of efforts with county destination
  153  marketing organizations, other local government marketing
  154  groups, privately owned attractions and destinations, and other
  155  private sector partners to create a seamless, four-season
  156  advertising campaign for the state and its regions.
  157         e. Development of innovative techniques or promotions to
  158  build repeat visitation by targeted segments of the tourist
  159  population.
  160         f. Consideration of innovative sources of state funding for
  161  tourism marketing.
  162         g. Promotion of nature-based tourism and heritage tourism.
  163         h. Promotion of medical tourism for quality health care
  164  services, as provided under s. 288.924.
  165         i.h. Development of a component to address emergency
  166  response to natural and manmade disasters from a marketing
  167  standpoint.
  168         2. The plan shall be annual in construction and ongoing in
  169  nature. Any annual revisions of the plan shall carry forward the
  170  concepts of the remaining 3-year portion of the plan and
  171  consider a continuum portion to preserve the 4-year timeframe of
  172  the plan. The plan also shall include recommendations for
  173  specific performance standards and measurable outcomes for the
  174  division and direct-support organization. The department, in
  175  consultation with the board of directors of Enterprise Florida,
  176  Inc., shall base the actual performance metrics on these
  177  recommendations.
  178         3. The 4-year marketing plan shall be developed in
  179  collaboration with the Florida Tourism Industry Marketing
  180  Corporation. The plan shall be annually reviewed and approved by
  181  the board of directors of Enterprise Florida, Inc.
  182         Section 5. Section 288.924, Florida Statutes, is created to
  183  read:
  184         288.924 Medical tourism for quality health care services;
  185  medical tourism marketing plan.—The Division of Tourism
  186  Marketing shall include within the 4-year marketing plan
  187  required under s. 288.923(4) specific initiatives to advance
  188  this state as a destination for quality bundled health care
  189  services. The plan must:
  190         (1) Promote national and international awareness of the
  191  qualifications, scope of services, and specialized expertise of
  192  health care providers throughout this state;
  193         (2) Promote national and international awareness of
  194  medical-related conferences, training, or business opportunities
  195  to attract practitioners from the medical field to destinations
  196  in this state; and
  197         (3) Include an initiative that showcases selected,
  198  qualified providers offering bundled packages of health care and
  199  support services. The selection of providers to be showcased
  200  must be conducted through a solicitation of proposals from
  201  Florida hospitals and other licensed providers for plans that
  202  describe available services, provider qualifications, and
  203  special arrangements for food, lodging, transportation, or other
  204  support services and amenities that may be provided to visiting
  205  patients and their families. A single health care provider may
  206  submit a proposal describing the available health care services
  207  offered through a network of multiple providers and explaining
  208  support services and other amenities associated with the care.
  209  The Florida Tourism Industry Marketing Corporation shall assess
  210  the qualifications and credentials of providers submitting
  211  proposals. To be qualified for selection, a health care provider
  212  must:
  213         (a) Have a full, active, and unencumbered Florida license
  214  and ensure that all health care providers participating in the
  215  proposal have full, active, and unencumbered Florida licenses;
  216         (b) Have a current accreditation that is not conditional or
  217  provisional from a nationally recognized accrediting body;
  218         (c) Be a recipient of the Cancer Center of Excellence
  219  Award, as described in s. 381.925, within the recognized 3-year
  220  period of the award, or have a current national or international
  221  recognition given through a specific qualifying process in
  222  another specialty area; and
  223         (d) Meet other criteria as determined by the Florida
  224  Tourism Industry Marketing Corporation in collaboration with the
  225  Agency for Health Care Administration and the Department of
  226  Health.
  227         Section 6. Paragraphs (a) and (d) of subsection (3) and
  228  subsections (4) and (5) of section 766.1115, Florida Statutes,
  229  are amended to read:
  230         766.1115 Health care providers; creation of agency
  231  relationship with governmental contractors.—
  232         (3) DEFINITIONS.—As used in this section, the term:
  233         (a) “Contract” means an agreement executed in compliance
  234  with this section between a health care provider and a
  235  governmental contractor which allows the health care provider,
  236  or any employee or agent of the health care provider, to deliver
  237  health care services to low-income recipients as an agent of the
  238  governmental contractor. The contract must be for volunteer,
  239  uncompensated services, except as provided in paragraph (4)(g).
  240  For services to qualify as volunteer, uncompensated services
  241  under this section, the health care provider must receive no
  242  compensation from the governmental contractor for any services
  243  provided under the contract and must not bill or accept
  244  compensation from the recipient, or a public or private third
  245  party payor, for the specific services provided to the low
  246  income recipients covered by the contract, except as provided in
  247  paragraph (4)(g). A free clinic as described in subparagraph
  248  (3)(d)14. may receive a legislative appropriation, a grant
  249  through a legislative appropriation, or a grant from a
  250  governmental entity or nonprofit corporation to support the
  251  delivery of such contracted services by volunteer health care
  252  providers, including the employment of health care providers to
  253  supplement, coordinate, or support the delivery of services by
  254  volunteer health care providers. Such an appropriation or grant
  255  does not constitute compensation under this paragraph from the
  256  governmental contractor for services provided under the
  257  contract, nor does receipt and use of the appropriation or grant
  258  constitute the acceptance of compensation under this paragraph
  259  for the specific services provided to the low-income recipients
  260  covered by the contract.
  261         (d) “Health care provider” or “provider” means:
  262         1. A birth center licensed under chapter 383.
  263         2. An ambulatory surgical center licensed under chapter
  264  395.
  265         3. A hospital licensed under chapter 395.
  266         4. A physician or physician assistant licensed under
  267  chapter 458.
  268         5. An osteopathic physician or osteopathic physician
  269  assistant licensed under chapter 459.
  270         6. A chiropractic physician licensed under chapter 460.
  271         7. A podiatric physician licensed under chapter 461.
  272         8. A registered nurse, nurse midwife, licensed practical
  273  nurse, or advanced registered nurse practitioner licensed or
  274  registered under part I of chapter 464 or any facility which
  275  employs nurses licensed or registered under part I of chapter
  276  464 to supply all or part of the care delivered under this
  277  section.
  278         9. A midwife licensed under chapter 467.
  279         10. A health maintenance organization certificated under
  280  part I of chapter 641.
  281         11. A health care professional association and its
  282  employees or a corporate medical group and its employees.
  283         12. Any other medical facility the primary purpose of which
  284  is to deliver human medical diagnostic services or which
  285  delivers nonsurgical human medical treatment, and which includes
  286  an office maintained by a provider.
  287         13. A dentist or dental hygienist licensed under chapter
  288  466.
  289         14. A free clinic that delivers only medical diagnostic
  290  services or nonsurgical medical treatment free of charge to all
  291  low-income recipients.
  292         15. Any other health care professional, practitioner,
  293  provider, or facility under contract with a governmental
  294  contractor, including a student enrolled in an accredited
  295  program that prepares the student for licensure as any one of
  296  the professionals listed in subparagraphs 4.-9.
  297  
  298  The term includes any nonprofit corporation qualified as exempt
  299  from federal income taxation under s. 501(a) of the Internal
  300  Revenue Code, and described in s. 501(c) of the Internal Revenue
  301  Code, which delivers health care services provided by licensed
  302  professionals listed in this paragraph, any federally funded
  303  community health center, and any volunteer corporation or
  304  volunteer health care provider that delivers health care
  305  services.
  306         (4) CONTRACT REQUIREMENTS.—A health care provider that
  307  executes a contract with a governmental contractor to deliver
  308  health care services on or after April 17, 1992, as an agent of
  309  the governmental contractor, or any employee or agent of such
  310  health care provider, is an agent for purposes of s. 768.28(9),
  311  while acting within the scope of duties under the contract, if
  312  the contract complies with the requirements of this section and
  313  regardless of whether the individual treated is later found to
  314  be ineligible. A health care provider, or any employee or agent
  315  of the health care provider, shall continue to be an agent for
  316  purposes of s. 768.28(9) for 30 days after a determination of
  317  ineligibility to allow for treatment until the individual
  318  transitions to treatment by another health care provider. A
  319  health care provider under contract with the state, or any
  320  employee or agent of such health care provider, may not be named
  321  as a defendant in any action arising out of medical care or
  322  treatment provided on or after April 17, 1992, under contracts
  323  entered into under this section. The contract must provide that:
  324         (a) The right of dismissal or termination of any health
  325  care provider delivering services under the contract is retained
  326  by the governmental contractor.
  327         (b) The governmental contractor has access to the patient
  328  records of any health care provider delivering services under
  329  the contract.
  330         (c) Adverse incidents and information on treatment outcomes
  331  must be reported by any health care provider to the governmental
  332  contractor if the incidents and information pertain to a patient
  333  treated under the contract. The health care provider shall
  334  submit the reports required by s. 395.0197. If an incident
  335  involves a professional licensed by the Department of Health or
  336  a facility licensed by the Agency for Health Care
  337  Administration, the governmental contractor shall submit such
  338  incident reports to the appropriate department or agency, which
  339  shall review each incident and determine whether it involves
  340  conduct by the licensee that is subject to disciplinary action.
  341  All patient medical records and any identifying information
  342  contained in adverse incident reports and treatment outcomes
  343  which are obtained by governmental entities under this paragraph
  344  are confidential and exempt from the provisions of s. 119.07(1)
  345  and s. 24(a), Art. I of the State Constitution.
  346         (d) Patient selection and initial referral must be made by
  347  the governmental contractor or the provider. Patients may not be
  348  transferred to the provider based on a violation of the
  349  antidumping provisions of the Omnibus Budget Reconciliation Act
  350  of 1989, the Omnibus Budget Reconciliation Act of 1990, or
  351  chapter 395.
  352         (e) If emergency care is required, the patient need not be
  353  referred before receiving treatment, but must be referred within
  354  48 hours after treatment is commenced or within 48 hours after
  355  the patient has the mental capacity to consent to treatment,
  356  whichever occurs later.
  357         (f) The provider is subject to supervision and regular
  358  inspection by the governmental contractor.
  359         (g) As an agent of the governmental contractor for purposes
  360  of s. 768.28(9), while acting within the scope of duties under
  361  the contract, A health care provider licensed under chapter 466,
  362  as an agent of the governmental contractor for purposes of s.
  363  768.28(9), may allow a patient, or a parent or guardian of the
  364  patient, to voluntarily contribute a monetary amount to cover
  365  costs of dental laboratory work related to the services provided
  366  to the patient within the scope of duties under the contract.
  367  This contribution may not exceed the actual cost of the dental
  368  laboratory charges.
  369  
  370  A governmental contractor that is also a health care provider is
  371  not required to enter into a contract under this section with
  372  respect to the health care services delivered by its employees.
  373         (5) NOTICE OF AGENCY RELATIONSHIP.—The governmental
  374  contractor must provide written notice to each patient, or the
  375  patient’s legal representative, receipt of which must be
  376  acknowledged in writing at the initial visit, that the provider
  377  is an agent of the governmental contractor and that the
  378  exclusive remedy for injury or damage suffered as the result of
  379  any act or omission of the provider or of any employee or agent
  380  thereof acting within the scope of duties pursuant to the
  381  contract is by commencement of an action pursuant to the
  382  provisions of s. 768.28. Thereafter, and with respect to any
  383  federally funded community health center, the notice
  384  requirements may be met by posting in a place conspicuous to all
  385  persons a notice that the health care provider federally funded
  386  community health center is an agent of the governmental
  387  contractor and that the exclusive remedy for injury or damage
  388  suffered as the result of any act or omission of the provider or
  389  of any employee or agent thereof acting within the scope of
  390  duties pursuant to the contract is by commencement of an action
  391  pursuant to the provisions of s. 768.28.
  392         Section 7. Paragraph (b) of subsection (9) of section
  393  768.28, Florida Statutes, is amended to read:
  394         768.28 Waiver of sovereign immunity in tort actions;
  395  recovery limits; limitation on attorney fees; statute of
  396  limitations; exclusions; indemnification; risk management
  397  programs.—
  398         (9)
  399         (b) As used in this subsection, the term:
  400         1. “Employee” includes any volunteer firefighter.
  401         2. “Officer, employee, or agent” includes, but is not
  402  limited to, any health care provider, and its employees or
  403  agents, when providing services pursuant to s. 766.1115; any
  404  nonprofit independent college or university located and
  405  chartered in this state which owns or operates an accredited
  406  medical school, and its employees or agents, when providing
  407  patient services pursuant to paragraph (10)(f); and any public
  408  defender or her or his employee or agent, including, among
  409  others, an assistant public defender and an investigator.
  410         Section 8. This act shall take effect July 1, 2015.