Florida Senate - 2016                                    SB 1722
       By Senator Stargel
       15-01209E-16                                          20161722__
    1                        A bill to be entitled                      
    2         An act relating to termination of pregnancies;
    3         amending s. 390.011, F.S.; defining the term
    4         “gestation” and revising the term “third trimester”;
    5         amending s. 390.0111, F.S.; revising the requirements
    6         for disposal of fetal remains; revising the criminal
    7         punishment for failure to properly dispose of fetal
    8         remains; prohibiting state agencies, local
    9         governmental entities, and Medicaid managed care plans
   10         from expending or paying funds to or initiating or
   11         renewing contracts under certain circumstances with
   12         certain organizations that perform abortions;
   13         providing exceptions; amending s. 390.0112, F.S.;
   14         requiring directors of certain hospitals and
   15         physicians’ offices and licensed abortion clinics to
   16         submit monthly reports to the Agency for Health Care
   17         Administration on a specified form; prohibiting the
   18         report from including personal identifying
   19         information; requiring the agency to submit certain
   20         data to the Centers for Disease Control and Prevention
   21         on a quarterly basis; amending s. 390.012, F.S.;
   22         requiring the agency to develop and enforce rules
   23         relating to license inspections and investigations of
   24         certain clinics; requiring the agency to adopt rules
   25         that require certain clinics to have written
   26         agreements with local hospitals for certain
   27         contingencies; specifying that the rules must require
   28         physicians who perform abortions at a clinic that
   29         performs abortions in the first trimester of pregnancy
   30         to have admitting privileges at a hospital within
   31         reasonable proximity to the clinic; revising
   32         requirements for rules that prescribe minimum recovery
   33         room standards; revising requirements for the disposal
   34         of fetal remains; requiring the agency to submit an
   35         annual report to the Legislature; amending s. 390.014,
   36         F.S.; providing a different limitation on the amount
   37         of a fee; amending s. 390.025, F.S.; requiring certain
   38         organizations that provide abortion referral services
   39         or abortion counseling services to register with the
   40         agency, pay a specified fee, and include certain
   41         information in advertisements; requiring biennial
   42         renewal of a registration; providing exemptions from
   43         the registration requirement; requiring the agency to
   44         adopt rules; providing for the assessment of costs in
   45         certain circumstances; amending s. 873.05, F.S.;
   46         prohibiting an offer to purchase, sell, donate, or
   47         transfer fetal remains obtained from an abortion and
   48         the purchase, sale, donation, or transfer of such
   49         remains, excluding costs associated with certain
   50         transportation of remains; providing effective dates.
   52  Be It Enacted by the Legislature of the State of Florida:
   54         Section 1. Present subsections (6) through (12) of section
   55  390.011, Florida Statutes, are redesignated as subsections (7)
   56  through (13), respectively, a new subsection (6) is added to
   57  that section, and present subsection (11) of that section is
   58  amended, to read:
   59         390.011 Definitions.—As used in this chapter, the term:
   60         (6) “Gestation” means the development of a human embryo or
   61  fetus between fertilization and birth.
   62         (12)(11) “Third Trimester” means one of the following three
   63  distinct periods of time in the duration of a pregnancy:
   64         (a) “First trimester,” which is the period of time from
   65  fertilization through the end of the 11th week of gestation.
   66         (b) “Second trimester,” which is the period of time from
   67  the beginning of the 12th week of gestation through the end of
   68  the 23rd week of gestation.
   69         (c) “Third trimester,” which is the period of time from the
   70  beginning of the 24th week of gestation through birth the weeks
   71  of pregnancy after the 24th week of pregnancy.
   72         Section 2. Subsection (7) of section 390.0111, Florida
   73  Statutes, is amended, and subsection (15) is added to that
   74  section, to read:
   75         390.0111 Termination of pregnancies.—
   76         (7) FETAL REMAINS.—Fetal remains shall be disposed of in a
   77  sanitary and appropriate manner pursuant to s. 381.0098 and
   78  rules adopted thereunder and in accordance with standard health
   79  practices, as provided by rule of the Department of Health.
   80  Failure to dispose of fetal remains in accordance with this
   81  subsection department rules is a misdemeanor of the first second
   82  degree, punishable as provided in s. 775.082 or s. 775.083.
   83         (15) USE OF PUBLIC FUNDS RESTRICTED.—A state agency, a
   84  local governmental entity, or a managed care plan providing
   85  services under part IV of chapter 409 may not expend funds for
   86  the benefit of, pay funds to, or initiate or renew a contract
   87  with an organization that owns, operates, or is affiliated with
   88  one or more clinics that are licensed under this chapter and
   89  perform abortions unless one or more of the following applies:
   90         (a) All abortions performed by such clinics are:
   91         1. On fetuses that are conceived through rape or incest; or
   92         2. Are medically necessary to preserve the life of the
   93  pregnant woman or to avert a serious risk of substantial and
   94  irreversible physical impairment of a major bodily function of
   95  the pregnant woman, other than a psychological condition.
   96         (b) The funds must be expended to fulfill the terms of a
   97  contract entered into before July 1, 2016.
   98         (c) The funds must be expended as reimbursement for
   99  Medicaid services provided on a fee-for-service basis.
  100         Section 3. Subsection (1) of section 390.0112, Florida
  101  Statutes, is amended, present subsections (2), (3), and (4) of
  102  that section are redesignated as subsections (3), (4), and (5),
  103  respectively, and a new subsection (2) is added to that section,
  104  to read:
  105         390.0112 Termination of pregnancies; reporting.—
  106         (1) The director of any medical facility in which abortions
  107  are performed, including a physician’s office, any pregnancy is
  108  terminated shall submit a monthly report each month to the
  109  agency. The report may be submitted electronically, may not
  110  include personal identifying information, and must include:
  111         (a) Until the agency begins collecting data under paragraph
  112  (e), the number of abortions performed.
  113         (b) The reasons such abortions were performed.
  114         (c) For each abortion, the period of gestation at the time
  115  the abortion was performed.
  116         (d)which contains the number of procedures performed, the
  117  reason for same, the period of gestation at the time such
  118  procedures were performed, and The number of infants born alive
  119  or alive during or immediately after an attempted abortion.
  120         (e) Beginning no later than January 1, 2017, information
  121  consistent with the United States Standard Report of Induced
  122  Termination of Pregnancy adopted by the Centers for Disease
  123  Control and Prevention.
  124         (2) The agency shall keep be responsible for keeping such
  125  reports in a central location for the purpose of compiling and
  126  analyzing place from which statistical data and shall submit
  127  data reported pursuant to paragraph (1)(e) to the Division of
  128  Reproductive Health within the Centers for Disease Control and
  129  Prevention, as requested by the Centers for Disease Control and
  130  Prevention analysis can be made.
  131         Section 4. Paragraph (c) of subsection (1), subsection (2),
  132  and paragraphs (c) and (f) of subsection (3) of section 390.012,
  133  Florida Statutes, are amended, present paragraphs (g) and (h) of
  134  subsection (3) are redesignated as paragraphs (h) and (i),
  135  respectively, a new paragraph (g) is added to that subsection,
  136  subsection (7) of that section is amended, and subsection (8) is
  137  added to that section, to read:
  138         390.012 Powers of agency; rules; disposal of fetal
  139  remains.—
  140         (1) The agency may develop and enforce rules pursuant to
  141  ss. 390.011-390.018 and part II of chapter 408 for the health,
  142  care, and treatment of persons in abortion clinics and for the
  143  safe operation of such clinics.
  144         (c) The rules shall provide for:
  145         1. The performance of pregnancy termination procedures only
  146  by a licensed physician.
  147         2. The making, protection, and preservation of patient
  148  records, which shall be treated as medical records under chapter
  149  458. When performing a license inspection of a clinic, the
  150  agency shall inspect at least 50 percent of patient records
  151  generated since the clinic’s last license inspection.
  152         3. Annual inspections by the agency of all clinics licensed
  153  under this chapter to ensure that such clinics are in compliance
  154  with this chapter and agency rule.
  155         4. The prompt investigation of credible allegations of
  156  abortions being performed at a clinic that is not licensed to
  157  perform such procedures.
  158         (2) For clinics that perform abortions in the first
  159  trimester of pregnancy only, these rules must shall be
  160  comparable to rules that apply to all surgical procedures
  161  requiring approximately the same degree of skill and care as the
  162  performance of first trimester abortions and must require:
  163         (a) Clinics to have a written patient transfer agreement
  164  with a hospital within reasonable proximity to the clinic which
  165  includes the transfer of the patient’s medical records held by
  166  the clinic and the treating physician to the licensed hospital;
  167  or
  168         (b) Physicians who perform abortions at the clinic to have
  169  admitting privileges at a hospital within reasonable proximity
  170  to the clinic.
  171         (3) For clinics that perform or claim to perform abortions
  172  after the first trimester of pregnancy, the agency shall adopt
  173  rules pursuant to ss. 120.536(1) and 120.54 to implement the
  174  provisions of this chapter, including the following:
  175         (c) Rules relating to abortion clinic personnel. At a
  176  minimum, these rules shall require that:
  177         1. The abortion clinic designate a medical director who is
  178  licensed to practice medicine in this state, and all physicians
  179  who perform abortions in the clinic have who has admitting
  180  privileges at a licensed hospital in this state within
  181  reasonable proximity to the clinic or has a transfer agreement
  182  with a licensed hospital within reasonable proximity of the
  183  clinic.
  184         2. If a physician is not present after an abortion is
  185  performed, a registered nurse, licensed practical nurse,
  186  advanced registered nurse practitioner, or physician assistant
  187  shall be present and remain at the clinic to provide
  188  postoperative monitoring and care until the patient is
  189  discharged.
  190         3. Surgical assistants receive training in counseling,
  191  patient advocacy, and the specific responsibilities associated
  192  with the services the surgical assistants provide.
  193         4. Volunteers receive training in the specific
  194  responsibilities associated with the services the volunteers
  195  provide, including counseling and patient advocacy as provided
  196  in the rules adopted by the director for different types of
  197  volunteers based on their responsibilities.
  198         (f) Rules that prescribe minimum recovery room standards.
  199  At a minimum, these rules must shall require that:
  200         1. Postprocedure recovery rooms be are supervised and
  201  staffed to meet the patients’ needs.
  202         2. Immediate postprocedure care consist consists of
  203  observation in a supervised recovery room for as long as the
  204  patient’s condition warrants.
  205         3. The clinic arranges hospitalization if any complication
  206  beyond the medical capability of the staff occurs or is
  207  suspected.
  208         4. A registered nurse, licensed practical nurse, advanced
  209  registered nurse practitioner, or physician assistant who is
  210  trained in the management of the recovery area and is capable of
  211  providing basic cardiopulmonary resuscitation and related
  212  emergency procedures remain remains on the premises of the
  213  abortion clinic until all patients are discharged.
  214         4.5. A physician shall sign the discharge order and be
  215  readily accessible and available until the last patient is
  216  discharged to facilitate the transfer of emergency cases if
  217  hospitalization of the patient or viable fetus is necessary.
  218         5.6. A physician discuss discusses Rho(D) immune globulin
  219  with each patient for whom it is indicated and ensure ensures
  220  that it is offered to the patient in the immediate postoperative
  221  period or that it will be available to her within 72 hours after
  222  completion of the abortion procedure. If the patient refuses the
  223  Rho(D) immune globulin, she and a witness must sign a refusal
  224  form approved by the agency which must be shall be signed by the
  225  patient and a witness and included in the medical record.
  226         6.7. Written instructions with regard to postabortion
  227  coitus, signs of possible problems, and general aftercare which
  228  are specific to the patient be are given to each patient. The
  229  instructions must include information Each patient shall have
  230  specific written instructions regarding access to medical care
  231  for complications, including a telephone number for use in the
  232  event of a to call for medical emergency emergencies.
  233         7.8.There is A specified minimum length of time be
  234  specified, by type of abortion procedure and duration of
  235  gestation, during which that a patient must remain remains in
  236  the recovery room by type of abortion procedure and duration of
  237  gestation.
  238         8.9. The physician ensure ensures that, with the patient’s
  239  consent, a registered nurse, licensed practical nurse, advanced
  240  registered nurse practitioner, or physician assistant from the
  241  abortion clinic makes a good faith effort to contact the patient
  242  by telephone, with the patient’s consent, within 24 hours after
  243  surgery to assess the patient’s recovery.
  244         9.10. Equipment and services be are readily accessible to
  245  provide appropriate emergency resuscitative and life support
  246  procedures pending the transfer of the patient or viable fetus
  247  to the hospital.
  248         (g) Rules that require clinics to have a written patient
  249  transfer agreement with a hospital within reasonable proximity
  250  to the clinic which includes the transfer of the patient’s
  251  medical records held by both the clinic and the treating
  252  physician.
  253         (7) If an any owner, operator, or employee of an abortion
  254  clinic fails to dispose of fetal remains and tissue in a
  255  sanitary manner pursuant to s. 381.0098, rules adopted
  256  thereunder, and rules adopted by the agency pursuant to this
  257  section consistent with the disposal of other human tissue in a
  258  competent professional manner, the license of such clinic may be
  259  suspended or revoked, and such person commits is guilty of a
  260  misdemeanor of the first degree, punishable as provided in s.
  261  775.082 or s. 775.083.
  262         (8) Beginning February 1, 2017, and annually thereafter,
  263  the agency shall submit a report to the President of the Senate
  264  and the Speaker of the House of Representatives which summarizes
  265  all regulatory actions taken during the prior year by the agency
  266  under this chapter.
  267         Section 5. Subsection (3) of section 390.014, Florida
  268  Statutes, is amended to read:
  269         390.014 Licenses; fees.—
  270         (3) In accordance with s. 408.805, an applicant or licensee
  271  shall pay a fee for each license application submitted under
  272  this chapter and part II of chapter 408. The amount of the fee
  273  shall be established by rule and may not be more than required
  274  to pay for the costs incurred by the agency in administering
  275  this chapter less than $70 or more than $500.
  276         Section 6. Effective January 1, 2017, present subsection
  277  (3) of section 390.025, Florida Statutes, is amended, and new
  278  subsections (3), (4), and (5) are added to that section, to
  279  read:
  280         390.025 Abortion referral or counseling agencies;
  281  penalties.—
  282         (3) An abortion referral or counseling agency, as defined
  283  in subsection (1), shall register with the Agency for Health
  284  Care Administration. To register or renew a registration an
  285  applicant must pay an initial or renewal registration fee
  286  established by rule, which must not exceed the costs incurred by
  287  the agency in administering this section. Registrants must
  288  include in any advertising materials the registration number
  289  issued by the agency and must renew their registration
  290  biennially.
  291         (4) The following are exempt from the requirement to
  292  register pursuant to subsection (3):
  293         (a) Facilities licensed pursuant to chapter 390, chapter
  294  395, chapter 400, or chapter 408;
  295         (b) Facilities that are exempt from licensure as a clinic
  296  under s. 400.9905(4) and that refer five or fewer patients for
  297  abortions per month; and
  298         (c) Health care practitioners, as defined in s. 456.001,
  299  who, in the course of their practice outside of a facility
  300  licensed pursuant to chapter 390, chapter 395, chapter 400, or
  301  chapter 408, refer five or fewer patients for abortions each
  302  month.
  303         (5) The agency shall adopt rules to administer this section
  304  and part II of chapter 408.
  305         (6)(3) Any person who violates the provisions of subsection
  306  (2) this section is guilty of a misdemeanor of the first degree,
  307  punishable as provided in s. 775.082 or s. 775.083. In addition
  308  to any other penalties imposed pursuant to this chapter, the
  309  Agency for Health Care Administration may assess costs related
  310  to an investigation of violations of this section which results
  311  in a successful prosecution. Such costs may not include attorney
  312  fees.
  313         Section 7. Section 873.05, Florida Statutes, is amended to
  314  read:
  315         873.05 Advertising, purchase, or sale, or transfer of human
  316  embryos or fetal remains prohibited.—
  317         (1) A No person may not shall knowingly advertise or offer
  318  to purchase or sell, or purchase, sell, or otherwise transfer, a
  319  any human embryo for valuable consideration.
  320         (2) As used in this subsection section, the term “valuable
  321  consideration” does not include the reasonable costs associated
  322  with the removal, storage, and transportation of a human embryo.
  323         (2) A person may not advertise or offer to purchase, sell,
  324  donate, or transfer, or purchase, sell, donate, or transfer,
  325  fetal remains obtained from an abortion, as defined in s.
  326  390.011. This subsection does not prohibit the transportation or
  327  transfer of fetal remains for disposal pursuant to s. 381.0098
  328  or rules adopted thereunder.
  329         (3) A person who violates the provisions of this section is
  330  guilty of a felony of the second degree, punishable as provided
  331  in s. 775.082, s. 775.083, or s. 775.084.
  332         Section 8. Except as otherwise expressly provided in this
  333  act, this act shall take effect July 1, 2016.