Florida Senate - 2016                        COMMITTEE AMENDMENT
       Bill No. SB 108
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: WD            .                                
                  11/13/2015           .                                

       The Committee on Health Policy (Grimsley) recommended the
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Paragraphs (c), (k), and (o) of subsection (3)
    6  of section 456.053, Florida Statutes, are amended to read:
    7         456.053 Financial arrangements between referring health
    8  care providers and providers of health care services.—
    9         (3) DEFINITIONS.—For the purpose of this section, the word,
   10  phrase, or term:
   11         (c) “Designated health services” means, for purposes of
   12  this section, clinical laboratory services, other than clinical
   13  laboratory services incidental to renal dialysis, physical
   14  therapy services, comprehensive rehabilitative services,
   15  diagnostic-imaging services, and radiation therapy services.
   16         (k) “Investment interest” means equities an equity or debt
   17  securities security issued by an entity, including, without
   18  limitation, shares of stock in a corporation, units or other
   19  interests in a partnership, bonds, debentures, notes, or other
   20  equity interests or debt instruments. The following investment
   21  interests are shall be excepted from this definition:
   22         1. An investment interest in an entity that is the sole
   23  provider of designated health services or clinical laboratory
   24  services incidental to renal dialysis in a rural area.;
   25         2. An investment interest in notes, bonds, debentures, or
   26  other debt instruments issued by an entity that which provides
   27  designated health services, as an integral part of a plan by the
   28  such entity to acquire such investor’s equity investment
   29  interest in the entity, provided that the interest rate is
   30  consistent with fair market value, and that the maturity date of
   31  the notes, bonds, debentures, or other debt instruments issued
   32  by the entity to the investor is not later than October 1, 1996.
   33         3. An investment interest in real property which results
   34  resulting in a landlord-tenant relationship between the health
   35  care provider and the entity in which the equity interest is
   36  held, unless the rent is determined, in whole or in part, by the
   37  business volume or profitability of the tenant or exceeds fair
   38  market value.; or
   39         4. An investment interest in an entity that which owns or
   40  leases and operates a hospital licensed under chapter 395 or a
   41  nursing home facility licensed under chapter 400.
   42         (o) “Referral” means any referral of a patient by a health
   43  care provider for health care services, including, without
   44  limitation,:
   45         1. the forwarding of a patient by a health care provider to
   46  another health care provider or to an entity that which provides
   47  or supplies designated health services or any other health care
   48  item or service; or
   49         2. the request or establishment of a plan of care by a
   50  health care provider, which includes the provision of designated
   51  health services or other health care items or services. An
   52  order, a recommendation, or a plan of care for the services or
   53  supplies listed in the following subparagraphs does item or
   54  service.
   55         3. The following orders, recommendations, or plans of care
   56  shall not constitute a referral if it is issued or made by the a
   57  health care provider designated in the applicable subparagraph:
   58         1.a.By a radiologist for Diagnostic-imaging services, if
   59  issued or made by a radiologist or.
   60         b.by a physician specializing in the provision of
   61  radiation therapy services for such diagnostic-imaging services.
   62         2.c.By a medical oncologist for Drugs and solutions to be
   63  prepared and administered intravenously to a such oncologist’s
   64  patient, and as well as for the supplies and equipment used in
   65  connection with the preparation and intravenous administration
   66  of such drugs and solutions, therewith to treat the such patient
   67  for cancer and related the complications, if issued or made by a
   68  medical oncologist thereof.
   69         3.d.By a cardiologist for Cardiac catheterization
   70  services, if issued or made by a cardiologist.
   71         4.e.By a pathologist for Diagnostic clinical laboratory
   72  tests and pathological examination services, if issued or made
   73  by a pathologist and the tests or services are furnished by or
   74  under the supervision of the such pathologist pursuant to a
   75  consultation requested by another physician.
   76         5.f.All services and supplies for which an order,
   77  recommendation, or plan of care is issued or made by a health
   78  care provider who is the sole provider or member of a group
   79  practice for designated health services or other health care
   80  items or services that are prescribed or provided solely for
   81  such referring health care provider’s or group practice’s own
   82  patients, and that are provided or performed by or under the
   83  direct supervision of such referring health care provider or
   84  group practice.; provided, However, that effective July 1, 1999,
   85  a physician licensed under pursuant to chapter 458, chapter 459,
   86  chapter 460, or chapter 461 may refer a patient to a sole
   87  provider or group practice for diagnostic imaging services,
   88  excluding radiation therapy services, for which the sole
   89  provider or group practice billed both the technical and the
   90  professional fee for or on behalf of the patient, if the
   91  referring physician has no investment interest in the practice.
   92  The diagnostic imaging service referred to a group practice or
   93  sole provider must be a diagnostic imaging service normally
   94  provided within the scope of practice to the patients of the
   95  group practice or sole provider. The group practice or sole
   96  provider may accept no more than 15 percent of its their
   97  patients receiving diagnostic imaging services from outside
   98  referrals, excluding radiation therapy services.
   99         6.g.By a health care provider for Services provided at by
  100  an ambulatory surgical center licensed under chapter 395, or
  101  services related to sleep-related testing, if issued or made by
  102  any health care provider licensed in this state.
  103         7.h.By a urologist for Lithotripsy services, if issued or
  104  made by a urologist.
  105         8.i.By a dentist for Dental services performed by an
  106  employee of or a health care provider or an employee of a health
  107  care provider who is an independent contractor of a with the
  108  dentist or group practice of which the dentist is a member, if
  109  issued or made by the dentist.
  110         9.j.By a physician for Infusion therapy services for to a
  111  patient of a that physician or a member of the that physician’s
  112  group practice, if issued or made by the physician.
  113         10.k.By a nephrologist for Renal dialysis services,
  114  including clinical laboratory services incidental to renal
  115  dialysis, and supplies, if issued or made by a nephrologist
  116  except laboratory services.
  117         11.l.All services and supplies for which an order,
  118  recommendation, or plan of care is issued or made by a health
  119  care provider whose principal professional practice consists of
  120  treating patients in their private residences for services to be
  121  rendered in such private residences, excluding except for
  122  services rendered by a home health agency licensed under chapter
  123  400. For purposes of this subparagraph sub-subparagraph, the
  124  term “private residences” includes patients’ private homes,
  125  independent living centers, and assisted living facilities, but
  126  does not include skilled nursing facilities.
  127         m.By a health care provider For Sleep-related testing.
  128         Section 2. This act shall take effect July 1, 2016.
  130  ================= T I T L E  A M E N D M E N T ================
  131  And the title is amended as follows:
  132         Delete everything before the enacting clause
  133  and insert:
  134                        A bill to be entitled                      
  135         An act relating to financial arrangements between
  136         referring health care providers and providers of
  137         health care services; amending s. 456.053, F.S.;
  138         exempting clinical laboratory services incidental to
  139         renal dialysis from the definition of “designated
  140         health services”; providing that the definition of
  141         “investment interest” does not include investment
  142         interests in an entity that is the sole provider of
  143         clinical laboratory services incidental to renal
  144         dialysis in a rural area; excluding orders,
  145         recommendations, or plans of care by a nephrologist
  146         for clinical laboratory services incidental to renal
  147         dialysis from the definition of “referral”; providing
  148         an effective date.