Florida Senate - 2016 SB 178
By Senator Bean
1 A bill to be entitled
2 An act relating to quality health care services;
3 amending s. 288.0001, F.S.; requiring the Office of
4 Economic and Demographic Research and the Office of
5 Program Policy Analysis and Government Accountability
6 to complete a periodic analysis of the medical tourism
7 marketing plan; amending s. 288.901, F.S.; requiring
8 Enterprise Florida, Inc., to market this state as a
9 health care destination in collaboration with the
10 Department of Economic Opportunity; amending s.
11 288.923, F.S.; requiring the Division of Tourism
12 Marketing of Enterprise Florida, Inc., to include a
13 discussion of the promotion of medical tourism for
14 quality health care services in its 4-year marketing
15 plan; creating s. 288.924, F.S.; providing criteria
16 for the medical tourism initiatives to be included in
17 the division’s marketing plan; creating s. 624.27,
18 F.S.; defining terms; specifying that a direct primary
19 care agreement does not constitute insurance and is
20 not subject to the Florida Insurance Code; specifying
21 that entering into a direct primary care agreement
22 does not constitute the business of insurance and is
23 not subject to the code; providing that a health care
24 provider is not required to obtain a certificate of
25 authority or license to market, sell, or offer to sell
26 a direct primary care agreement; specifying criteria
27 for a direct primary care agreement; amending s.
28 766.1115, F.S.; redefining terms relating to agency
29 relationships with governmental health care
30 contractors; deleting an obsolete date; extending
31 sovereign immunity to include employees or agents of a
32 health care provider that executes a contract with a
33 governmental contractor; clarifying that a receipt of
34 specified notice must be acknowledged by a patient or
35 the patient’s representative at the initial visit;
36 requiring the posting of notice that a specified
37 health care provider is an agent of a governmental
38 contractor; amending s. 768.28, F.S.; redefining the
39 term “officer, employee, or agent” to include
40 employees or agents of a health care provider to
41 conform to changes made by the act; providing an
42 effective date.
44 Be It Enacted by the Legislature of the State of Florida:
46 Section 1. Paragraph (b) of subsection (2) of section
47 288.0001, Florida Statutes, is amended to read:
48 288.0001 Economic Development Programs Evaluation.—The
49 Office of Economic and Demographic Research and the Office of
50 Program Policy Analysis and Government Accountability (OPPAGA)
51 shall develop and present to the Governor, the President of the
52 Senate, the Speaker of the House of Representatives, and the
53 chairs of the legislative appropriations committees the Economic
54 Development Programs Evaluation.
55 (2) The Office of Economic and Demographic Research and
56 OPPAGA shall provide a detailed analysis of economic development
57 programs as provided in the following schedule:
58 (b) By January 1, 2015, and every 3 years thereafter, an
59 analysis of the following:
60 1. The entertainment industry financial incentive program
61 established under s. 288.1254.
62 2. The entertainment industry sales tax exemption program
63 established under s. 288.1258.
64 3. VISIT Florida and its programs established or funded
65 under ss. 288.122, 288.1226, 288.12265,
and 288.124, and
67 4. The Florida Sports Foundation and related programs
68 established under ss. 288.1162, 288.11621, 288.1166, 288.1167,
69 288.1168, 288.1169, and 288.1171.
70 Section 2. Subsection (2) of section 288.901, Florida
71 Statutes, is amended to read:
72 288.901 Enterprise Florida, Inc.—
73 (2) PURPOSES.—Enterprise Florida, Inc., shall act as the
74 economic development organization for the state, using utilizing
75 private sector and public sector expertise in collaboration with
76 the department to:
77 (a) Increase private investment in Florida;
78 (b) Advance international and domestic trade opportunities;
79 (c) Market the state both as a probusiness location for new
80 investment and as an unparalleled tourist destination;
81 (d) Revitalize Florida’s space and aerospace industries,
82 and promote emerging complementary industries;
83 (e) Promote opportunities for minority-owned businesses;
84 (f) Assist and market professional and amateur sport teams
85 and sporting events in Florida; and
86 (g) Assist, promote, and enhance economic opportunities in
87 this state’s rural and urban communities; and
88 (h) Market the state as a health care destination by using
89 the medical tourism initiatives as described in s. 288.924 to
90 promote quality health care services in this state.
91 Section 3. Paragraph (c) of subsection (4) of section
92 288.923, Florida Statutes, is amended to read:
93 288.923 Division of Tourism Marketing; definitions;
95 (4) The division’s responsibilities and duties include, but
96 are not limited to:
97 (c) Developing a 4-year marketing plan.
98 1. At a minimum, the marketing plan shall discuss the
100 a. Continuation of overall tourism growth in this state.
101 b. Expansion to new or under-represented tourist markets.
102 c. Maintenance of traditional and loyal tourist markets.
103 d. Coordination of efforts with county destination
104 marketing organizations, other local government marketing
105 groups, privately owned attractions and destinations, and other
106 private sector partners to create a seamless, four-season
107 advertising campaign for the state and its regions.
108 e. Development of innovative techniques or promotions to
109 build repeat visitation by targeted segments of the tourist
111 f. Consideration of innovative sources of state funding for
112 tourism marketing.
113 g. Promotion of nature-based tourism and heritage tourism.
114 h. Promotion of medical tourism for quality health care
115 services, as provided under s. 288.924.
116 i. h. Development of a component to address emergency
117 response to natural and manmade disasters from a marketing
119 2. The plan shall be annual in construction and ongoing in
120 nature. Any annual revisions of the plan shall carry forward the
121 concepts of the remaining 3-year portion of the plan and
122 consider a continuum portion to preserve the 4-year timeframe of
123 the plan. The plan also shall include recommendations for
124 specific performance standards and measurable outcomes for the
125 division and direct-support organization. The department, in
126 consultation with the board of directors of Enterprise Florida,
127 Inc., shall base the actual performance metrics on these
129 3. The 4-year marketing plan shall be developed in
130 collaboration with the Florida Tourism Industry Marketing
131 Corporation. The plan shall be annually reviewed and approved by
132 the board of directors of Enterprise Florida, Inc.
133 Section 4. Section 288.924, Florida Statutes, is created to
135 288.924 Medical tourism for quality health care services;
136 medical tourism marketing plan.—The Division of Tourism
137 Marketing shall include within the 4-year marketing plan
138 required under s. 288.923(4) specific initiatives to advance
139 this state as a destination for quality bundled health care
140 services. The plan must:
141 (1) Promote national and international awareness of the
142 qualifications, scope of services, and specialized expertise of
143 health care providers throughout this state;
144 (2) Promote national and international awareness of
145 medical-related conferences, training, or business opportunities
146 to attract practitioners from the medical field to destinations
147 in this state; and
148 (3) Include an initiative that showcases selected,
149 qualified providers offering bundled packages of health care and
150 support services. The selection of providers to be showcased
151 must be conducted through a solicitation of proposals from
152 Florida hospitals and other licensed providers for plans that
153 describe available services, provider qualifications, and
154 special arrangements for food, lodging, transportation, or other
155 support services and amenities that may be provided to visiting
156 patients and their families. A single health care provider may
157 submit a proposal describing the available health care services
158 offered through a network of multiple providers and explaining
159 support services and other amenities associated with the care.
160 The Florida Tourism Industry Marketing Corporation shall assess
161 the qualifications and credentials of providers submitting
162 proposals. To be qualified for selection, a health care provider
164 (a) Have a full, active, and unencumbered Florida license
165 and ensure that all health care providers participating in the
166 proposal have full, active, and unencumbered Florida licenses;
167 (b) Have a current accreditation that is not conditional or
168 provisional from a nationally recognized accrediting body;
169 (c) Be a recipient of the Cancer Center of Excellence
170 Award, as described in s. 381.925, within the recognized 3-year
171 period of the award, or have a current national or international
172 recognition given through a specific qualifying process in
173 another specialty area; and
174 (d) Meet other criteria as determined by the Florida
175 Tourism Industry Marketing Corporation in collaboration with the
176 Agency for Health Care Administration and the Department of
178 Section 5. Section 624.27, Florida Statutes, is created to
180 624.27 Application of code as to direct primary care
182 (1) As used in this section, the term:
183 (a) “Direct primary care agreement” means a contract
184 between a primary care provider or primary care group practice
185 and a patient, the patient’s legal representative, or an
186 employer which meets the requirements specified under subsection
187 (4) and does not indemnify for services provided by a third
189 (b) “Primary care provider” means a health care provider
190 licensed under chapter 458, chapter 459, or chapter 464 that
191 provides medical services to patients which are commonly
192 provided without referral from another health care provider.
193 (c) “Primary care service” means the screening, assessment,
194 diagnosis, and treatment of a patient for the purpose of
195 promoting health or detecting and managing disease or injury
196 within the competency and training of the primary care provider.
197 (2) A direct primary care agreement does not constitute
198 insurance and is not subject to this code. The act of entering
199 into a direct primary care agreement does not constitute the
200 business of insurance and is not subject to this code.
201 (3) A primary care provider or an agent of a primary care
202 provider is not required to obtain a certificate of authority or
203 license under this code to market, sell, or offer to sell a
204 direct primary care agreement.
205 (4) For purposes of this section, a direct primary care
206 agreement must:
207 (a) Be in writing.
208 (b) Be signed by the primary care provider or an agent of
209 the primary care provider and the patient or the patient’s legal
211 (c) Allow a party to terminate the agreement by written
212 notice to the other party after a period specified in the
214 (d) Describe the scope of the primary care services that
215 are covered by the monthly fee.
216 (e) Specify the monthly fee and any fees for primary care
217 services not covered by the monthly fee.
218 (f) Specify the duration of the agreement and any automatic
219 renewal provisions.
220 (g) Offer a refund to the patient of monthly fees paid in
221 advance if the primary care provider ceases to offer primary
222 care services for any reason.
223 (h) State that the agreement is not health insurance.
224 Section 6. Paragraphs (a) and (d) of subsection (3) and
225 subsections (4) and (5) of section 766.1115, Florida Statutes,
226 are amended to read:
227 766.1115 Health care providers; creation of agency
228 relationship with governmental contractors.—
229 (3) DEFINITIONS.—As used in this section, the term:
230 (a) “Contract” means an agreement executed in compliance
231 with this section between a health care provider and a
232 governmental contractor which allows the health care provider,
233 or any employee or agent of the health care provider, to deliver
234 health care services to low-income recipients as an agent of the
235 governmental contractor. The contract must be for volunteer,
236 uncompensated services , except as provided in paragraph (4)(g).
237 For services to qualify as volunteer, uncompensated services
238 under this section, the health care provider must receive no
239 compensation from the governmental contractor for any services
240 provided under the contract and must not bill or accept
241 compensation from the recipient, or a public or private third
242 party payor, for the specific services provided to the low
243 income recipients covered by the contract, except as provided in
244 paragraph (4)(g). A free clinic as described in subparagraph
245 (3)(d)14. may receive a legislative appropriation, a grant
246 through a legislative appropriation, or a grant from a
247 governmental entity or nonprofit corporation to support the
248 delivery of such contracted services by volunteer health care
249 providers, including the employment of health care providers to
250 supplement, coordinate, or support the delivery of services by
251 volunteer health care providers. Such an appropriation or grant
252 does not constitute compensation under this paragraph from the
253 governmental contractor for services provided under the
254 contract, nor does receipt and use of the appropriation or grant
255 constitute the acceptance of compensation under this paragraph
256 for the specific services provided to the low-income recipients
257 covered by the contract.
258 (d) “Health care provider” or “provider” means:
259 1. A birth center licensed under chapter 383.
260 2. An ambulatory surgical center licensed under chapter
262 3. A hospital licensed under chapter 395.
263 4. A physician or physician assistant licensed under
264 chapter 458.
265 5. An osteopathic physician or osteopathic physician
266 assistant licensed under chapter 459.
267 6. A chiropractic physician licensed under chapter 460.
268 7. A podiatric physician licensed under chapter 461.
269 8. A registered nurse, nurse midwife, licensed practical
270 nurse, or advanced registered nurse practitioner licensed or
271 registered under part I of chapter 464 or any facility which
272 employs nurses licensed or registered under part I of chapter
273 464 to supply all or part of the care delivered under this
275 9. A midwife licensed under chapter 467.
276 10. A health maintenance organization certificated under
277 part I of chapter 641.
278 11. A health care professional association and its
279 employees or a corporate medical group and its employees.
280 12. Any other medical facility the primary purpose of which
281 is to deliver human medical diagnostic services or which
282 delivers nonsurgical human medical treatment, and which includes
283 an office maintained by a provider.
284 13. A dentist or dental hygienist licensed under chapter
286 14. A free clinic that delivers only medical diagnostic
287 services or nonsurgical medical treatment free of charge to all
288 low-income recipients.
289 15. Any other health care professional, practitioner,
290 provider, or facility under contract with a governmental
291 contractor, including a student enrolled in an accredited
292 program that prepares the student for licensure as any one of
293 the professionals listed in subparagraphs 4.-9.
295 The term includes any nonprofit corporation qualified as exempt
296 from federal income taxation under s. 501(a) of the Internal
297 Revenue Code, and described in s. 501(c) of the Internal Revenue
298 Code, which delivers health care services provided by licensed
299 professionals listed in this paragraph, any federally funded
300 community health center, and any volunteer corporation or
301 volunteer health care provider that delivers health care
303 (4) CONTRACT REQUIREMENTS.—A health care provider that
304 executes a contract with a governmental contractor to deliver
305 health care services on or after April 17, 1992, as an agent of
306 the governmental contractor, or any employee or agent of such
307 health care provider, is an agent for purposes of s. 768.28(9),
308 while acting within the scope of duties under the contract, if
309 the contract complies with the requirements of this section and
310 regardless of whether the individual treated is later found to
311 be ineligible. A health care provider, or any employee or agent
312 of the health care provider, shall continue to be an agent for
313 purposes of s. 768.28(9) for 30 days after a determination of
314 ineligibility to allow for treatment until the individual
315 transitions to treatment by another health care provider. A
316 health care provider under contract with the state, or any
317 employee or agent of such health care provider, may not be named
318 as a defendant in any action arising out of medical care or
319 treatment provided on or after April 17, 1992, under contracts
320 entered into under this section. The contract must provide that:
321 (a) The right of dismissal or termination of any health
322 care provider delivering services under the contract is retained
323 by the governmental contractor.
324 (b) The governmental contractor has access to the patient
325 records of any health care provider delivering services under
326 the contract.
327 (c) Adverse incidents and information on treatment outcomes
328 must be reported by any health care provider to the governmental
329 contractor if the incidents and information pertain to a patient
330 treated under the contract. The health care provider shall
331 submit the reports required by s. 395.0197. If an incident
332 involves a professional licensed by the Department of Health or
333 a facility licensed by the Agency for Health Care
334 Administration, the governmental contractor shall submit such
335 incident reports to the appropriate department or agency, which
336 shall review each incident and determine whether it involves
337 conduct by the licensee that is subject to disciplinary action.
338 All patient medical records and any identifying information
339 contained in adverse incident reports and treatment outcomes
340 which are obtained by governmental entities under this paragraph
341 are confidential and exempt from the provisions of s. 119.07(1)
342 and s. 24(a), Art. I of the State Constitution.
343 (d) Patient selection and initial referral must be made by
344 the governmental contractor or the provider. Patients may not be
345 transferred to the provider based on a violation of the
346 antidumping provisions of the Omnibus Budget Reconciliation Act
347 of 1989, the Omnibus Budget Reconciliation Act of 1990, or
348 chapter 395.
349 (e) If emergency care is required, the patient need not be
350 referred before receiving treatment, but must be referred within
351 48 hours after treatment is commenced or within 48 hours after
352 the patient has the mental capacity to consent to treatment,
353 whichever occurs later.
354 (f) The provider is subject to supervision and regular
355 inspection by the governmental contractor.
356 (g) As an agent of the governmental contractor for purposes
357 of s. 768.28(9), while acting within the scope of duties under
358 the contract, A health care provider licensed under chapter 466,
359 as an agent of the governmental contractor for purposes of s.
360 768.28(9), may allow a patient, or a parent or guardian of the
361 patient, to voluntarily contribute a monetary amount to cover
362 costs of dental laboratory work related to the services provided
363 to the patient within the scope of duties under the contract.
364 This contribution may not exceed the actual cost of the dental
365 laboratory charges.
367 A governmental contractor that is also a health care provider is
368 not required to enter into a contract under this section with
369 respect to the health care services delivered by its employees.
370 (5) NOTICE OF AGENCY RELATIONSHIP.—The governmental
371 contractor must provide written notice to each patient, or the
372 patient’s legal representative, receipt of which must be
373 acknowledged in writing at the initial visit, that the provider
374 is an agent of the governmental contractor and that the
375 exclusive remedy for injury or damage suffered as the result of
376 any act or omission of the provider or of any employee or agent
377 thereof acting within the scope of duties pursuant to the
378 contract is by commencement of an action pursuant to the
379 provisions of s. 768.28. Thereafter, and with respect to any
380 federally funded community health center, the notice
381 requirements may be met by posting in a place conspicuous to all
382 persons a notice that the health care provider federally funded
383 community health center is an agent of the governmental
384 contractor and that the exclusive remedy for injury or damage
385 suffered as the result of any act or omission of the provider or
386 of any employee or agent thereof acting within the scope of
387 duties pursuant to the contract is by commencement of an action
388 pursuant to the provisions of s. 768.28.
389 Section 7. Paragraph (b) of subsection (9) of section
390 768.28, Florida Statutes, is amended to read:
391 768.28 Waiver of sovereign immunity in tort actions;
392 recovery limits; limitation on attorney fees; statute of
393 limitations; exclusions; indemnification; risk management
396 (b) As used in this subsection, the term:
397 1. “Employee” includes any volunteer firefighter.
398 2. “Officer, employee, or agent” includes, but is not
399 limited to, any health care provider, and its employees or
400 agents, when providing services pursuant to s. 766.1115; any
401 nonprofit independent college or university located and
402 chartered in this state which owns or operates an accredited
403 medical school, and its employees or agents, when providing
404 patient services pursuant to paragraph (10)(f); and any public
405 defender or her or his employee or agent, including, among
406 others, an assistant public defender and an investigator.
407 Section 8. This act shall take effect July 1, 2016.