Florida Senate - 2016                        COMMITTEE AMENDMENT
       Bill No. SB 108
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  11/17/2015           .                                

       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 which provides or
   47  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 item or service.
   52         3. The following orders, recommendations, or plans of care
   53  shall not constitute a referral by a health care provider:
   54         a. By a radiologist for diagnostic-imaging services.
   55         b. By a physician specializing in the provision of
   56  radiation therapy services for such services.
   57         c. By a medical oncologist for drugs and solutions to be
   58  prepared and administered intravenously to such oncologist’s
   59  patient, as well as for the supplies and equipment used in
   60  connection therewith to treat such patient for cancer and the
   61  complications thereof.
   62         d. By a cardiologist for cardiac catheterization services.
   63         e. By a pathologist for diagnostic clinical laboratory
   64  tests and pathological examination services, if furnished by or
   65  under the supervision of such pathologist pursuant to a
   66  consultation requested by another physician.
   67         f. By a health care provider who is the sole provider or
   68  member of a group practice for designated health services or
   69  other health care items or services that are prescribed or
   70  provided solely for such referring health care provider’s or
   71  group practice’s own patients, and that are provided or
   72  performed by or under the direct supervision of such referring
   73  health care provider or group practice; provided, however, that
   74  effective July 1, 1999, a physician licensed pursuant to chapter
   75  458, chapter 459, chapter 460, or chapter 461 may refer a
   76  patient to a sole provider or group practice for diagnostic
   77  imaging services, excluding radiation therapy services, for
   78  which the sole provider or group practice billed both the
   79  technical and the professional fee for or on behalf of the
   80  patient, if the referring physician has no investment interest
   81  in the practice. The diagnostic imaging service referred to a
   82  group practice or sole provider must be a diagnostic imaging
   83  service normally provided within the scope of practice to the
   84  patients of the group practice or sole provider. The group
   85  practice or sole provider may accept no more than 15 percent of
   86  their patients receiving diagnostic imaging services from
   87  outside referrals, excluding radiation therapy services.
   88         g. By a health care provider for services provided by an
   89  ambulatory surgical center licensed under chapter 395.
   90         h. By a urologist for lithotripsy services.
   91         i. By a dentist for dental services performed by an
   92  employee of or health care provider who is an independent
   93  contractor with the dentist or group practice of which the
   94  dentist is a member.
   95         j. By a physician for infusion therapy services to a
   96  patient of that physician or a member of that physician’s group
   97  practice.
   98         k. By a nephrologist for renal dialysis services, and
   99  supplies, or clinical laboratory services incidental to renal
  100  dialysis except laboratory services.
  101         l. By a health care provider whose principal professional
  102  practice consists of treating patients in their private
  103  residences for services to be rendered in such private
  104  residences, except for services rendered by a home health agency
  105  licensed under chapter 400. For purposes of this sub
  106  subparagraph, the term “private residences” includes patients’
  107  private homes, independent living centers, and assisted living
  108  facilities, but does not include skilled nursing facilities.
  109         m. By a health care provider for sleep-related testing.
  110         Section 2. This act shall take effect July 1, 2016.
  112  ================= T I T L E  A M E N D M E N T ================
  113  And the title is amended as follows:
  114         Delete everything before the enacting clause
  115  and insert:
  116                        A bill to be entitled                      
  117         An act relating to financial arrangements between
  118         referring health care providers and providers of
  119         health care services; amending s. 456.053, F.S.;
  120         exempting clinical laboratory services incidental to
  121         renal dialysis from the definition of “designated
  122         health services”; providing that the definition of
  123         “investment interest” does not include investment
  124         interests in an entity that is the sole provider of
  125         clinical laboratory services incidental to renal
  126         dialysis in a rural area; excluding orders,
  127         recommendations, or plans of care by a nephrologist
  128         for clinical laboratory services incidental to renal
  129         dialysis from the definition of “referral”; providing
  130         an effective date.