Florida Senate - 2017                                    SB 1760
       
       
        
       By Senator Grimsley
       
       
       
       
       
       26-00433-17                                           20171760__
    1                        A bill to be entitled                      
    2         An act relating to health care facility regulation;
    3         amending ss. 381.0031, 381.004, 384.31, 395.009, and
    4         409.905, F.S.; eliminating state licensure
    5         requirements for clinical laboratories; requiring
    6         clinical laboratories to be federally certified;
    7         amending s. 383.313, F.S.; revising requirements for a
    8         birth center to perform certain laboratory tests;
    9         repealing s. 383.335, F.S., relating to partial
   10         exemptions from licensure requirements for certain
   11         facilities that provide obstetrical and gynecological
   12         surgical services; amending s. 395.002, F.S.; revising
   13         and deleting definitions; creating s. 395.0091, F.S.;
   14         authorizing the Agency for Health Care Administration
   15         to adopt rules establishing criteria for alternate
   16         site laboratory testing; defining the term “alternate
   17         site testing”; amending ss. 395.0161 and 395.0163,
   18         F.S.; deleting licensure and inspection requirements
   19         for mobile surgical facilities to conform to changes
   20         made by the act; amending s. 395.0197, F.S.; requiring
   21         the manager of a hospital or ambulatory surgical
   22         center internal risk management program to demonstrate
   23         competence in certain administrative and health care
   24         service areas; conforming references; repealing s.
   25         395.1046, F.S., relating to hospital complaint
   26         investigation procedures; amending s. 395.1055, F.S.;
   27         requiring hospitals providing specified services to
   28         meet agency licensure requirements; conforming a
   29         reference; repealing ss. 395.10971 and 395.10972,
   30         F.S., relating to the purpose and establishment of the
   31         Health Care Risk Manager Advisory Council; amending s.
   32         395.10973, F.S.; deleting duties of the agency
   33         relating to health care risk managers; repealing s.
   34         395.10974, F.S., relating to licensure of health care
   35         risk managers; repealing s. 395.10975, F.S., relating
   36         to grounds for denial, suspension, or revocation of a
   37         health care risk manager’s license; amending s.
   38         395.602, F.S.; deleting definitions; amending s.
   39         395.603, F.S.; deleting provisions relating to
   40         deactivation of general hospital beds by certain rural
   41         and emergency care hospitals; repealing s. 395.604,
   42         F.S., relating to other rural hospital programs;
   43         repealing s. 395.605, F.S., relating to emergency care
   44         hospitals; amending s. 395.701, F.S.; revising the
   45         definition of the term “hospital” to exclude hospitals
   46         operated by state agencies; amending s. 400.464, F.S.;
   47         revising licensure requirements for a home health
   48         agency; providing conditions for advertising certain
   49         services that require licensure; providing for a fine;
   50         providing conditions for application for a certificate
   51         of exemption from licensure as a home health agency;
   52         specifying the duration of the certificate of
   53         exemption; authorizing a fee; amending s. 400.471,
   54         F.S.; revising home health agency licensure
   55         requirements; providing requirements for proof of
   56         accreditation for home health agencies applying for
   57         change of ownership or addition of skilled care
   58         services; amending s. 400.474, F.S.; revising
   59         conditions for the imposition of a fine against a home
   60         health agency; amending s. 400.476, F.S.; requiring a
   61         home health agency providing skilled nursing care to
   62         have a director of nursing; amending s. 400.484, F.S.;
   63         providing for the imposition of administrative fines
   64         on home health agencies for specified classes of
   65         violations; amending s. 400.497, F.S.; authorizing the
   66         agency to adopt rules establishing standards for
   67         certificate of exemption applications; amending s.
   68         400.506, F.S.; revising penalties for a nurse registry
   69         directed by the agency to cease operation; providing
   70         that registered nurses, licensed practical nurses,
   71         certified nursing assistants, companions or
   72         homemakers, and home health aides are independent
   73         contractors and not employees of the nurse registries
   74         that referred them; requiring a nurse registry to
   75         inform the patient, the patient’s family, or a person
   76         acting on behalf of the patient that the referred
   77         caregiver is an independent contractor and that the
   78         nurse registry is not permitted to monitor, supervise,
   79         manage, or train the referred caregiver; revising
   80         provisions relating to activities for which the agency
   81         is authorized to deny, suspend, or revoke a nurse
   82         registry license and impose fines; providing that a
   83         nurse registry is not permitted to review or act upon
   84         certain records except under certain circumstances;
   85         amending s. 400.606, F.S.; revising content
   86         requirements of the plan accompanying an initial or
   87         change of ownership application for a hospice;
   88         amending s. 400.925, F.S.; revising the definition of
   89         the term “home medical equipment”; amending s.
   90         400.931, F.S.; providing a timeframe for a home
   91         medical equipment provider to notify the agency of
   92         certain personnel changes; amending s. 400.933, F.S.;
   93         authorizing the agency to accept certain medical
   94         oxygen permits issued by the Department of Business
   95         and Professional Regulation in lieu of agency
   96         licensure inspections; amending s. 400.980, F.S.;
   97         revising timeframe requirements for change of
   98         registration information submitted to the agency by a
   99         health care services pool; amending s. 408.061, F.S.;
  100         excluding hospitals operated by state agencies from
  101         certain financial reporting requirements; conforming a
  102         cross-reference; amending s. 408.07, F.S.; deleting
  103         the definition of the term “clinical laboratory”;
  104         amending s. 408.20, F.S.; exempting hospitals operated
  105         by state agencies from assessments against the Health
  106         Care Trust Fund to fund certain agency activities;
  107         repealing s. 408.7056, F.S., relating to the
  108         Subscriber Assistance Program; amending s. 408.803,
  109         F.S.; defining the term “relative” for the Health Care
  110         Licensing Procedures Act; amending s. 408.806, F.S.;
  111         requiring additional information on a licensure
  112         application; authorizing the agency to issue licenses
  113         with an abbreviated licensure period and prorated fee
  114         for alignment of multiple provider license expiration
  115         dates; amending s. 408.810, F.S.; exempting an
  116         applicant for change of ownership from furnishing
  117         proof of ability to operate under certain conditions;
  118         authorizing the agency to adopt rules governing
  119         circumstances under which a controlling interest may
  120         act in certain legal capacities on behalf of a patient
  121         or client; amending s. 408.812, F.S.; citing failure
  122         to discharge residents by the license expiration date
  123         as unlicensed activity; providing that certain
  124         unlicensed activity by a provider constitutes abuse
  125         and neglect; requiring the agency to refer certain
  126         findings to the state attorney; requiring the agency
  127         to impose a fine under certain circumstances; amending
  128         s. 429.02, F.S.; revising definitions; amending s.
  129         429.04, F.S.; providing additional exemptions from
  130         licensure as an assisted living facility; imposing a
  131         burden of proof on the person or entity asserting the
  132         exemption; providing applicability; amending s.
  133         429.08, F.S.; providing criminal penalties and fines
  134         for ownership, rental, or maintenance of a real
  135         property used as an unlicensed assisted living
  136         facility; providing that engaging a third party to
  137         provide certain services at an unlicensed location
  138         constitutes unlicensed activity; amending s. 429.176,
  139         F.S.; prohibiting an assisted living facility from
  140         operating beyond a specified period without an
  141         administrator who has completed certain educational
  142         requirements; amending s. 429.41, F.S.; prohibiting an
  143         assisted living facility from providing personal
  144         services to nonresidents; repealing part I of ch. 483,
  145         F.S., relating to clinical laboratories; amending s.
  146         483.294, F.S.; revising agency inspection schedules
  147         for multiphasic health testing centers; amending s.
  148         483.801, F.S.; revising an exemption from regulation
  149         for persons employed by certain laboratories; amending
  150         s. 483.803, F.S.; deleting definitions; conforming
  151         provisions to changes made by the act; amending s.
  152         641.511, F.S.; revising health maintenance
  153         organization subscriber grievance reporting
  154         requirements; repealing s. 641.60, F.S., relating to
  155         the Statewide Managed Care Ombudsman Committee;
  156         amending s. 945.36, F.S.; authorizing law enforcement
  157         personnel to conduct drug tests on certain inmates and
  158         releasees; amending ss. 20.43, 220.1845, 376.30781,
  159         376.86, 381.0034, 385.211, 394.4787, 395.001, 395.003,
  160         395.7015, 400.0625, 400.9905, 408.033, 408.036,
  161         408.802, 408.820, 409.9116, 409.975, 456.001, 456.057,
  162         458.307, 458.345, 483.813, 491.003, 627.351, 627.602,
  163         627.64194, 627.6513, 641.185, 641.312, 641.3154,
  164         641.51, 641.515, 641.55, 641.70, 641.75, 766.118,
  165         766.202, and 1009.65, F.S.; conforming provisions to
  166         changes made by the act; providing effective dates.
  167          
  168  Be It Enacted by the Legislature of the State of Florida:
  169  
  170         Section 1. Paragraph (g) of subsection (3) of section
  171  20.43, Florida Statutes, is amended to read:
  172         20.43 Department of Health.—There is created a Department
  173  of Health.
  174         (3) The following divisions of the Department of Health are
  175  established:
  176         (g) Division of Medical Quality Assurance, which is
  177  responsible for the following boards and professions established
  178  within the division:
  179         1. The Board of Acupuncture, created under chapter 457.
  180         2. The Board of Medicine, created under chapter 458.
  181         3. The Board of Osteopathic Medicine, created under chapter
  182  459.
  183         4. The Board of Chiropractic Medicine, created under
  184  chapter 460.
  185         5. The Board of Podiatric Medicine, created under chapter
  186  461.
  187         6. Naturopathy, as provided under chapter 462.
  188         7. The Board of Optometry, created under chapter 463.
  189         8. The Board of Nursing, created under part I of chapter
  190  464.
  191         9. Nursing assistants, as provided under part II of chapter
  192  464.
  193         10. The Board of Pharmacy, created under chapter 465.
  194         11. The Board of Dentistry, created under chapter 466.
  195         12. Midwifery, as provided under chapter 467.
  196         13. The Board of Speech-Language Pathology and Audiology,
  197  created under part I of chapter 468.
  198         14. The Board of Nursing Home Administrators, created under
  199  part II of chapter 468.
  200         15. The Board of Occupational Therapy, created under part
  201  III of chapter 468.
  202         16. Respiratory therapy, as provided under part V of
  203  chapter 468.
  204         17. Dietetics and nutrition practice, as provided under
  205  part X of chapter 468.
  206         18. The Board of Athletic Training, created under part XIII
  207  of chapter 468.
  208         19. The Board of Orthotists and Prosthetists, created under
  209  part XIV of chapter 468.
  210         20. Electrolysis, as provided under chapter 478.
  211         21. The Board of Massage Therapy, created under chapter
  212  480.
  213         22.The Board of Clinical Laboratory Personnel, created
  214  under part III of chapter 483.
  215         22.23. Medical physicists, as provided under part III IV of
  216  chapter 483.
  217         23.24. The Board of Opticianry, created under part I of
  218  chapter 484.
  219         24.25. The Board of Hearing Aid Specialists, created under
  220  part II of chapter 484.
  221         25.26. The Board of Physical Therapy Practice, created
  222  under chapter 486.
  223         26.27. The Board of Psychology, created under chapter 490.
  224         27.28. School psychologists, as provided under chapter 490.
  225         28.29. The Board of Clinical Social Work, Marriage and
  226  Family Therapy, and Mental Health Counseling, created under
  227  chapter 491.
  228         29.30. Emergency medical technicians and paramedics, as
  229  provided under part III of chapter 401.
  230         Section 2. Paragraph (k) of subsection (2) of section
  231  220.1845, Florida Statutes, is amended to read:
  232         220.1845 Contaminated site rehabilitation tax credit.—
  233         (2) AUTHORIZATION FOR TAX CREDIT; LIMITATIONS.—
  234         (k) In order to encourage the construction and operation of
  235  a new health care facility as defined in s. 408.032 or s.
  236  408.07, or a health care provider as defined in s. 408.07 or s.
  237  408.7056, on a brownfield site, an applicant for a tax credit
  238  may claim an additional 25 percent of the total site
  239  rehabilitation costs, not to exceed $500,000, if the applicant
  240  meets the requirements of this paragraph. In order to receive
  241  this additional tax credit, the applicant must provide
  242  documentation indicating that the construction of the health
  243  care facility or health care provider by the applicant on the
  244  brownfield site has received a certificate of occupancy or a
  245  license or certificate has been issued for the operation of the
  246  health care facility or health care provider.
  247         Section 3. Paragraph (f) of subsection (3) of section
  248  376.30781, Florida Statutes, is amended to read:
  249         376.30781 Tax credits for rehabilitation of drycleaning
  250  solvent-contaminated sites and brownfield sites in designated
  251  brownfield areas; application process; rulemaking authority;
  252  revocation authority.—
  253         (3)
  254         (f) In order to encourage the construction and operation of
  255  a new health care facility or a health care provider, as defined
  256  in s. 408.032 or, s. 408.07, or s. 408.7056, on a brownfield
  257  site, an applicant for a tax credit may claim an additional 25
  258  percent of the total site rehabilitation costs, not to exceed
  259  $500,000, if the applicant meets the requirements of this
  260  paragraph. In order to receive this additional tax credit, the
  261  applicant must provide documentation indicating that the
  262  construction of the health care facility or health care provider
  263  by the applicant on the brownfield site has received a
  264  certificate of occupancy or a license or certificate has been
  265  issued for the operation of the health care facility or health
  266  care provider.
  267         Section 4. Subsection (1) of section 376.86, Florida
  268  Statutes, is amended to read:
  269         376.86 Brownfield Areas Loan Guarantee Program.—
  270         (1) The Brownfield Areas Loan Guarantee Council is created
  271  to review and approve or deny, by a majority vote of its
  272  membership, the situations and circumstances for participation
  273  in partnerships by agreements with local governments, financial
  274  institutions, and others associated with the redevelopment of
  275  brownfield areas pursuant to the Brownfields Redevelopment Act
  276  for a limited state guaranty of up to 5 years of loan guarantees
  277  or loan loss reserves issued pursuant to law. The limited state
  278  loan guaranty applies only to 50 percent of the primary lenders
  279  loans for redevelopment projects in brownfield areas. If the
  280  redevelopment project is for affordable housing, as defined in
  281  s. 420.0004, in a brownfield area, the limited state loan
  282  guaranty applies to 75 percent of the primary lender’s loan. If
  283  the redevelopment project includes the construction and
  284  operation of a new health care facility or a health care
  285  provider, as defined in s. 408.032 or, s. 408.07, or s.
  286  408.7056, on a brownfield site and the applicant has obtained
  287  documentation in accordance with s. 376.30781 indicating that
  288  the construction of the health care facility or health care
  289  provider by the applicant on the brownfield site has received a
  290  certificate of occupancy or a license or certificate has been
  291  issued for the operation of the health care facility or health
  292  care provider, the limited state loan guaranty applies to 75
  293  percent of the primary lender’s loan. A limited state guaranty
  294  of private loans or a loan loss reserve is authorized for
  295  lenders licensed to operate in the state upon a determination by
  296  the council that such an arrangement would be in the public
  297  interest and the likelihood of the success of the loan is great.
  298         Section 5. Subsection (2) of section 381.0031, Florida
  299  Statutes, is amended to read:
  300         381.0031 Epidemiological research; report of diseases of
  301  public health significance to department.—
  302         (2) Any practitioner licensed in this state to practice
  303  medicine, osteopathic medicine, chiropractic medicine,
  304  naturopathy, or veterinary medicine; any hospital licensed under
  305  part I of chapter 395; or any laboratory appropriately certified
  306  by the Centers for Medicare and Medicaid Services (CMS) under
  307  the federal Clinical Laboratory Improvement Amendments of 1988
  308  licensed under chapter 483 that diagnoses or suspects the
  309  existence of a disease of public health significance shall
  310  immediately report the fact to the Department of Health.
  311         Section 6. Subsection (3) of section 381.0034, Florida
  312  Statutes, is amended to read:
  313         381.0034 Requirement for instruction on HIV and AIDS.—
  314         (3) The department shall require, as a condition of
  315  granting a license under chapter 467 or part II III of chapter
  316  483, that an applicant making initial application for licensure
  317  complete an educational course acceptable to the department on
  318  human immunodeficiency virus and acquired immune deficiency
  319  syndrome. Upon submission of an affidavit showing good cause, an
  320  applicant who has not taken a course at the time of licensure
  321  shall be allowed 6 months to complete this requirement.
  322         Section 7. Paragraph (c) of subsection (4) of section
  323  381.004, Florida Statutes, is amended to read:
  324         381.004 HIV testing.—
  325         (4) HUMAN IMMUNODEFICIENCY VIRUS TESTING REQUIREMENTS;
  326  REGISTRATION WITH THE DEPARTMENT OF HEALTH; EXEMPTIONS FROM
  327  REGISTRATION.—No county health department and no other person in
  328  this state shall conduct or hold themselves out to the public as
  329  conducting a testing program for acquired immune deficiency
  330  syndrome or human immunodeficiency virus status without first
  331  registering with the Department of Health, reregistering each
  332  year, complying with all other applicable provisions of state
  333  law, and meeting the following requirements:
  334         (c) The program shall have all laboratory procedures
  335  performed in a laboratory appropriately certified by the Centers
  336  for Medicare and Medicaid Services (CMS) under the federal
  337  Clinical Laboratory Improvement Amendments of 1988 licensed
  338  under the provisions of chapter 483.
  339         Section 8. Subsection (1) of section 383.313, Florida
  340  Statutes, is amended to read:
  341         383.313 Performance of laboratory and surgical services;
  342  use of anesthetic and chemical agents.—
  343         (1) LABORATORY SERVICES.—A birth center may collect
  344  specimens for those tests that are requested under protocol. A
  345  birth center may perform simple laboratory tests, as defined by
  346  rule of the agency, and is exempt from the requirements of
  347  chapter 483, provided no more than five physicians are employed
  348  by the birth center and testing is conducted exclusively in
  349  connection with the diagnosis and treatment of clients of the
  350  birth center.
  351         Section 9. Section 383.335, Florida Statutes, is repealed.
  352         Section 10. Section 384.31, Florida Statutes, is amended to
  353  read:
  354         384.31 Testing of pregnant women; duty of the attendant.
  355  Every person, including every physician licensed under chapter
  356  458 or chapter 459 or midwife licensed under part I of chapter
  357  464 or chapter 467, attending a pregnant woman for conditions
  358  relating to pregnancy during the period of gestation and
  359  delivery shall cause the woman to be tested for sexually
  360  transmissible diseases, including HIV, as specified by
  361  department rule. Testing shall be performed by a laboratory
  362  appropriately certified by the Centers for Medicare and Medicaid
  363  Services (CMS) under the federal Clinical Laboratory Improvement
  364  Amendments of 1988 approved for such purposes under part I of
  365  chapter 483. The woman shall be informed of the tests that will
  366  be conducted and of her right to refuse testing. If a woman
  367  objects to testing, a written statement of objection, signed by
  368  the woman, shall be placed in the woman’s medical record and no
  369  testing shall occur.
  370         Section 11. Subsection (2) of section 385.211, Florida
  371  Statutes, is amended to read:
  372         385.211 Refractory and intractable epilepsy treatment and
  373  research at recognized medical centers.—
  374         (2) Notwithstanding chapter 893, medical centers recognized
  375  pursuant to s. 381.925, or an academic medical research
  376  institution legally affiliated with a licensed children’s
  377  specialty hospital as defined in s. 395.002(27) 395.002(28) that
  378  contracts with the Department of Health, may conduct research on
  379  cannabidiol and low-THC cannabis. This research may include, but
  380  is not limited to, the agricultural development, production,
  381  clinical research, and use of liquid medical derivatives of
  382  cannabidiol and low-THC cannabis for the treatment for
  383  refractory or intractable epilepsy. The authority for recognized
  384  medical centers to conduct this research is derived from 21
  385  C.F.R. parts 312 and 316. Current state or privately obtained
  386  research funds may be used to support the activities described
  387  in this section.
  388         Section 12. Subsection (7) of section 394.4787, Florida
  389  Statutes, is amended to read:
  390         394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and
  391  394.4789.—As used in this section and ss. 394.4786, 394.4788,
  392  and 394.4789:
  393         (7) “Specialty psychiatric hospital” means a hospital
  394  licensed by the agency pursuant to s. 395.002(27) 395.002(28)
  395  and part II of chapter 408 as a specialty psychiatric hospital.
  396         Section 13. Section 395.001, Florida Statutes, is amended
  397  to read:
  398         395.001 Legislative intent.—It is the intent of the
  399  Legislature to provide for the protection of public health and
  400  safety in the establishment, construction, maintenance, and
  401  operation of hospitals and, ambulatory surgical centers, and
  402  mobile surgical facilities by providing for licensure of same
  403  and for the development, establishment, and enforcement of
  404  minimum standards with respect thereto.
  405         Section 14. Present subsections (22) through (33) of
  406  section 395.002, Florida Statutes, are renumbered as subsections
  407  (21) through (32), respectively, and subsections (3) and (16)
  408  and present subsections (21) and (23) of that section are
  409  amended, to read:
  410         395.002 Definitions.—As used in this chapter:
  411         (3) “Ambulatory surgical center” or “mobile surgical
  412  facility” means a facility the primary purpose of which is to
  413  provide elective surgical care, in which the patient is admitted
  414  to and discharged from such facility within the same working day
  415  and is not permitted to stay overnight, and which is not part of
  416  a hospital. However, a facility existing for the primary purpose
  417  of performing terminations of pregnancy, an office maintained by
  418  a physician for the practice of medicine, or an office
  419  maintained for the practice of dentistry shall not be construed
  420  to be an ambulatory surgical center, provided that any facility
  421  or office which is certified or seeks certification as a
  422  Medicare ambulatory surgical center shall be licensed as an
  423  ambulatory surgical center pursuant to s. 395.003. Any structure
  424  or vehicle in which a physician maintains an office and
  425  practices surgery, and which can appear to the public to be a
  426  mobile office because the structure or vehicle operates at more
  427  than one address, shall be construed to be a mobile surgical
  428  facility.
  429         (16) “Licensed facility” means a hospital or, ambulatory
  430  surgical center, or mobile surgical facility licensed in
  431  accordance with this chapter.
  432         (21)“Mobile surgical facility” is a mobile facility in
  433  which licensed health care professionals provide elective
  434  surgical care under contract with the Department of Corrections
  435  or a private correctional facility operating pursuant to chapter
  436  957 and in which inmate patients are admitted to and discharged
  437  from said facility within the same working day and are not
  438  permitted to stay overnight. However, mobile surgical facilities
  439  may only provide health care services to the inmate patients of
  440  the Department of Corrections, or inmate patients of a private
  441  correctional facility operating pursuant to chapter 957, and not
  442  to the general public.
  443         (22)(23) “Premises” means those buildings, beds, and
  444  equipment located at the address of the licensed facility and
  445  all other buildings, beds, and equipment for the provision of
  446  hospital or, ambulatory surgical, or mobile surgical care
  447  located in such reasonable proximity to the address of the
  448  licensed facility as to appear to the public to be under the
  449  dominion and control of the licensee. For any licensee that is a
  450  teaching hospital as defined in s. 408.07(44) 408.07(45),
  451  reasonable proximity includes any buildings, beds, services,
  452  programs, and equipment under the dominion and control of the
  453  licensee that are located at a site with a main address that is
  454  within 1 mile of the main address of the licensed facility; and
  455  all such buildings, beds, and equipment may, at the request of a
  456  licensee or applicant, be included on the facility license as a
  457  single premises.
  458         Section 15. Paragraphs (a) and (b) of subsection (1) and
  459  paragraph (b) of subsection (2) of section 395.003, Florida
  460  Statutes, are amended to read:
  461         395.003 Licensure; denial, suspension, and revocation.—
  462         (1)(a) The requirements of part II of chapter 408 apply to
  463  the provision of services that require licensure pursuant to ss.
  464  395.001-395.1065 and part II of chapter 408 and to entities
  465  licensed by or applying for such licensure from the Agency for
  466  Health Care Administration pursuant to ss. 395.001-395.1065. A
  467  license issued by the agency is required in order to operate a
  468  hospital or, ambulatory surgical center, or mobile surgical
  469  facility in this state.
  470         (b)1. It is unlawful for a person to use or advertise to
  471  the public, in any way or by any medium whatsoever, any facility
  472  as a “hospital,or “ambulatory surgical center,or “mobile
  473  surgical facility” unless such facility has first secured a
  474  license under the provisions of this part.
  475         2. This part does not apply to veterinary hospitals or to
  476  commercial business establishments using the word “hospital,or
  477  “ambulatory surgical center,or “mobile surgical facility” as a
  478  part of a trade name if no treatment of human beings is
  479  performed on the premises of such establishments.
  480         (2)
  481         (b) The agency shall, at the request of a licensee that is
  482  a teaching hospital as defined in s. 408.07(44) 408.07(45),
  483  issue a single license to a licensee for facilities that have
  484  been previously licensed as separate premises, provided such
  485  separately licensed facilities, taken together, constitute the
  486  same premises as defined in s. 395.002(22) 395.002(23). Such
  487  license for the single premises shall include all of the beds,
  488  services, and programs that were previously included on the
  489  licenses for the separate premises. The granting of a single
  490  license under this paragraph shall not in any manner reduce the
  491  number of beds, services, or programs operated by the licensee.
  492         Section 16. Subsection (1) of section 395.009, Florida
  493  Statutes, is amended to read:
  494         395.009 Minimum standards for clinical laboratory test
  495  results and diagnostic X-ray results; prerequisite for issuance
  496  or renewal of license.—
  497         (1) As a requirement for issuance or renewal of its
  498  license, each licensed facility shall require that all clinical
  499  laboratory tests performed by or for the licensed facility be
  500  performed by a clinical laboratory appropriately certified by
  501  the Centers for Medicare and Medicaid Services (CMS) under the
  502  federal Clinical Laboratory Improvement Amendments of 1988
  503  licensed under the provisions of chapter 483.
  504         Section 17. Section 395.0091, Florida Statutes, is created
  505  to read:
  506         395.0091Alternate-site testing.—The agency, in
  507  consultation with the Board of Clinical Laboratory Personnel,
  508  shall adopt by rule the criteria for alternate-site testing to
  509  be performed under the supervision of a clinical laboratory
  510  director. The elements to be addressed in the rule include, but
  511  are not limited to: a hospital internal needs assessment; a
  512  protocol of implementation, including tests to be performed and
  513  who will perform the tests; criteria to be used in selecting the
  514  method of testing to be used for alternate-site testing; minimum
  515  training and education requirements for those who will perform
  516  alternate-site testing, such as documented training, licensure,
  517  certification, or other medical professional backgrounds not
  518  limited to laboratory professionals; documented inservice
  519  training as well as initial and ongoing competency validation;
  520  an appropriate internal and external quality control protocol;
  521  an internal mechanism for identifying and tracking alternate
  522  site testing by the central laboratory; and recordkeeping
  523  requirements. Alternate-site testing locations must register
  524  when the hospital applies to renew its license. For purposes of
  525  this section, the term “alternate-site testing” means any
  526  laboratory testing done under the administrative control of a
  527  hospital but performed out of the physical or administrative
  528  confines of the central laboratory.
  529         Section 18. Paragraph (f) of subsection (1) of section
  530  395.0161, Florida Statutes, is amended to read:
  531         395.0161 Licensure inspection.—
  532         (1) In addition to the requirement of s. 408.811, the
  533  agency shall make or cause to be made such inspections and
  534  investigations as it deems necessary, including:
  535         (f)Inspections of mobile surgical facilities at each time
  536  a facility establishes a new location, prior to the admission of
  537  patients. However, such inspections shall not be required when a
  538  mobile surgical facility is moved temporarily to a location
  539  where medical treatment will not be provided.
  540         Section 19. Subsection (3) of section 395.0163, Florida
  541  Statutes, is amended to read:
  542         395.0163 Construction inspections; plan submission and
  543  approval; fees.—
  544         (3)In addition to the requirements of s. 408.811, the
  545  agency shall inspect a mobile surgical facility at initial
  546  licensure and at each time the facility establishes a new
  547  location, prior to admission of patients. However, such
  548  inspections shall not be required when a mobile surgical
  549  facility is moved temporarily to a location where medical
  550  treatment will not be provided.
  551         Section 20. Subsection (2), paragraph (c) of subsection
  552  (6), and subsections (16) and (17) of section 395.0197, Florida
  553  Statutes, are amended to read:
  554         395.0197 Internal risk management program.—
  555         (2) The internal risk management program is the
  556  responsibility of the governing board of the health care
  557  facility. Each licensed facility shall hire a risk manager,
  558  licensed under s. 395.10974, who is responsible for
  559  implementation and oversight of such facility’s internal risk
  560  management program and who demonstrates competence, by education
  561  or experience, in the following areas: as required by this
  562  section. A risk manager must not be made responsible for more
  563  than four internal risk management programs in separate licensed
  564  facilities, unless the facilities are under one corporate
  565  ownership or the risk management programs are in rural
  566  hospitals.
  567         (a)Applicable standards of health care risk management.
  568         (b)Applicable federal, state, and local health and safety
  569  laws and rules.
  570         (c)General risk management administration.
  571         (d)Patient care.
  572         (e)Medical care.
  573         (f)Personal and social care.
  574         (g)Accident prevention.
  575         (h)Departmental organization and management.
  576         (i)Community interrelationships.
  577         (j)Medical terminology.
  578         (6)
  579         (c) The report submitted to the agency shall also contain
  580  the name and license number of the risk manager of the licensed
  581  facility, a copy of its policy and procedures which govern the
  582  measures taken by the facility and its risk manager to reduce
  583  the risk of injuries and adverse incidents, and the results of
  584  such measures. The annual report is confidential and is not
  585  available to the public pursuant to s. 119.07(1) or any other
  586  law providing access to public records. The annual report is not
  587  discoverable or admissible in any civil or administrative
  588  action, except in disciplinary proceedings by the agency or the
  589  appropriate regulatory board. The annual report is not available
  590  to the public as part of the record of investigation for and
  591  prosecution in disciplinary proceedings made available to the
  592  public by the agency or the appropriate regulatory board.
  593  However, the agency or the appropriate regulatory board shall
  594  make available, upon written request by a health care
  595  professional against whom probable cause has been found, any
  596  such records which form the basis of the determination of
  597  probable cause.
  598         (16) There shall be no monetary liability on the part of,
  599  and no cause of action for damages shall arise against, any risk
  600  manager, licensed under s. 395.10974, for the implementation and
  601  oversight of the internal risk management program in a facility
  602  licensed under this chapter or chapter 390 as required by this
  603  section, for any act or proceeding undertaken or performed
  604  within the scope of the functions of such internal risk
  605  management program if the risk manager acts without intentional
  606  fraud.
  607         (17) A privilege against civil liability is hereby granted
  608  to any licensed risk manager or licensed facility with regard to
  609  information furnished pursuant to this chapter, unless the
  610  licensed risk manager or facility acted in bad faith or with
  611  malice in providing such information.
  612         Section 21. Section 395.1046, Florida Statutes, is
  613  repealed.
  614         Section 22. Subsection (2) of section 395.1055, Florida
  615  Statutes, is amended, and paragraph (i) is added to subsection
  616  (1), to read:
  617         395.1055 Rules and enforcement.—
  618         (1) The agency shall adopt rules pursuant to ss. 120.536(1)
  619  and 120.54 to implement the provisions of this part, which shall
  620  include reasonable and fair minimum standards for ensuring that:
  621         (i)All hospitals providing pediatric cardiac
  622  catheterization, pediatric open-heart surgery, organ
  623  transplantation, neonatal intensive care services, psychiatric
  624  services, or comprehensive medical rehabilitation meet the
  625  minimum licensure requirements adopted by the agency. Such
  626  licensure requirements shall include quality of care, nurse
  627  staffing, physician staffing, physical plant, equipment,
  628  emergency transportation, and data reporting standards.
  629         (2) Separate standards may be provided for general and
  630  specialty hospitals, ambulatory surgical centers, mobile
  631  surgical facilities, and statutory rural hospitals as defined in
  632  s. 395.602.
  633         Section 23. Section 395.10971, Florida Statutes, is
  634  repealed.
  635         Section 24. Section 395.10972, Florida Statutes, is
  636  repealed.
  637         Section 25. Section 395.10973, Florida Statutes, is amended
  638  to read:
  639         395.10973 Powers and duties of the agency.—It is the
  640  function of the agency to:
  641         (1) Adopt rules pursuant to ss. 120.536(1) and 120.54 to
  642  implement the provisions of this part and part II of chapter 408
  643  conferring duties upon it.
  644         (2)Develop, impose, and enforce specific standards within
  645  the scope of the general qualifications established by this part
  646  which must be met by individuals in order to receive licenses as
  647  health care risk managers. These standards shall be designed to
  648  ensure that health care risk managers are individuals of good
  649  character and otherwise suitable and, by training or experience
  650  in the field of health care risk management, qualified in
  651  accordance with the provisions of this part to serve as health
  652  care risk managers, within statutory requirements.
  653         (3)Develop a method for determining whether an individual
  654  meets the standards set forth in s. 395.10974.
  655         (4)Issue licenses to qualified individuals meeting the
  656  standards set forth in s. 395.10974.
  657         (5)Receive, investigate, and take appropriate action with
  658  respect to any charge or complaint filed with the agency to the
  659  effect that a certified health care risk manager has failed to
  660  comply with the requirements or standards adopted by rule by the
  661  agency or to comply with the provisions of this part.
  662         (6)Establish procedures for providing periodic reports on
  663  persons certified or disciplined by the agency under this part.
  664         (2)(7) Develop a model risk management program for health
  665  care facilities which will satisfy the requirements of s.
  666  395.0197.
  667         (3)(8) Enforce the special-occupancy provisions of the
  668  Florida Building Code which apply to hospitals, intermediate
  669  residential treatment facilities, and ambulatory surgical
  670  centers in conducting any inspection authorized by this chapter
  671  and part II of chapter 408.
  672         Section 26. Section 395.10974, Florida Statutes, is
  673  repealed.
  674         Section 27. Section 395.10975, Florida Statutes, is
  675  repealed.
  676         Section 28. Subsection (2) of section 395.602, Florida
  677  Statutes, is amended to read:
  678         395.602 Rural hospitals.—
  679         (2) DEFINITIONS.—As used in this part, the term:
  680         (a)“Emergency care hospital” means a medical facility
  681  which provides:
  682         1.Emergency medical treatment; and
  683         2.Inpatient care to ill or injured persons prior to their
  684  transportation to another hospital or provides inpatient medical
  685  care to persons needing care for a period of up to 96 hours. The
  686  96-hour limitation on inpatient care does not apply to respite,
  687  skilled nursing, hospice, or other nonacute care patients.
  688         (b)“Essential access community hospital” means any
  689  facility which:
  690         1.Has at least 100 beds;
  691         2.Is located more than 35 miles from any other essential
  692  access community hospital, rural referral center, or urban
  693  hospital meeting criteria for classification as a regional
  694  referral center;
  695         3.Is part of a network that includes rural primary care
  696  hospitals;
  697         4.Provides emergency and medical backup services to rural
  698  primary care hospitals in its rural health network;
  699         5.Extends staff privileges to rural primary care hospital
  700  physicians in its network; and
  701         6.Accepts patients transferred from rural primary care
  702  hospitals in its network.
  703         (c)“Inactive rural hospital bed” means a licensed acute
  704  care hospital bed, as defined in s. 395.002(13), that is
  705  inactive in that it cannot be occupied by acute care inpatients.
  706         (a)(d) “Rural area health education center” means an area
  707  health education center (AHEC), as authorized by Pub. L. No. 94
  708  484, which provides services in a county with a population
  709  density of up to no greater than 100 persons per square mile.
  710         (b)(e) “Rural hospital” means an acute care hospital
  711  licensed under this chapter, having 100 or fewer licensed beds
  712  and an emergency room, which is:
  713         1. The sole provider within a county with a population
  714  density of up to 100 persons per square mile;
  715         2. An acute care hospital, in a county with a population
  716  density of up to 100 persons per square mile, which is at least
  717  30 minutes of travel time, on normally traveled roads under
  718  normal traffic conditions, from any other acute care hospital
  719  within the same county;
  720         3. A hospital supported by a tax district or subdistrict
  721  whose boundaries encompass a population of up to 100 persons per
  722  square mile;
  723         4. A hospital classified as a sole community hospital under
  724  42 C.F.R. s. 412.92 which has up to 175 licensed beds;
  725         5. A hospital with a service area that has a population of
  726  up to 100 persons per square mile. As used in this subparagraph,
  727  the term “service area” means the fewest number of zip codes
  728  that account for 75 percent of the hospital’s discharges for the
  729  most recent 5-year period, based on information available from
  730  the hospital inpatient discharge database in the Florida Center
  731  for Health Information and Transparency at the agency; or
  732         6. A hospital designated as a critical access hospital, as
  733  defined in s. 408.07.
  734  
  735  Population densities used in this paragraph must be based upon
  736  the most recently completed United States census. A hospital
  737  that received funds under s. 409.9116 for a quarter beginning no
  738  later than July 1, 2002, is deemed to have been and shall
  739  continue to be a rural hospital from that date through June 30,
  740  2021, if the hospital continues to have up to 100 licensed beds
  741  and an emergency room. An acute care hospital that has not
  742  previously been designated as a rural hospital and that meets
  743  the criteria of this paragraph shall be granted such designation
  744  upon application, including supporting documentation, to the
  745  agency. A hospital that was licensed as a rural hospital during
  746  the 2010-2011 or 2011-2012 fiscal year shall continue to be a
  747  rural hospital from the date of designation through June 30,
  748  2021, if the hospital continues to have up to 100 licensed beds
  749  and an emergency room.
  750         (f)“Rural primary care hospital” means any facility
  751  meeting the criteria in paragraph (e) or s. 395.605 which
  752  provides:
  753         1.Twenty-four-hour emergency medical care;
  754         2.Temporary inpatient care for periods of 72 hours or less
  755  to patients requiring stabilization before discharge or transfer
  756  to another hospital. The 72-hour limitation does not apply to
  757  respite, skilled nursing, hospice, or other nonacute care
  758  patients; and
  759         3.Has no more than six licensed acute care inpatient beds.
  760         (c)(g) “Swing-bed” means a bed which can be used
  761  interchangeably as either a hospital, skilled nursing facility
  762  (SNF), or intermediate care facility (ICF) bed pursuant to 42
  763  C.F.R. parts 405, 435, 440, 442, and 447.
  764         Section 29. Section 395.603, Florida Statutes, is amended
  765  to read:
  766         395.603 Deactivation of general hospital beds; Rural
  767  hospital impact statement.—
  768         (1)The agency shall establish, by rule, a process by which
  769  a rural hospital, as defined in s. 395.602, that seeks licensure
  770  as a rural primary care hospital or as an emergency care
  771  hospital, or becomes a certified rural health clinic as defined
  772  in Pub. L. No. 95-210, or becomes a primary care program such as
  773  a county health department, community health center, or other
  774  similar outpatient program that provides preventive and curative
  775  services, may deactivate general hospital beds. Rural primary
  776  care hospitals and emergency care hospitals shall maintain the
  777  number of actively licensed general hospital beds necessary for
  778  the facility to be certified for Medicare reimbursement.
  779  Hospitals that discontinue inpatient care to become rural health
  780  care clinics or primary care programs shall deactivate all
  781  licensed general hospital beds. All hospitals, clinics, and
  782  programs with inactive beds shall provide 24-hour emergency
  783  medical care by staffing an emergency room. Providers with
  784  inactive beds shall be subject to the criteria in s. 395.1041.
  785  The agency shall specify in rule requirements for making 24-hour
  786  emergency care available. Inactive general hospital beds shall
  787  be included in the acute care bed inventory, maintained by the
  788  agency for certificate-of-need purposes, for 10 years from the
  789  date of deactivation of the beds. After 10 years have elapsed,
  790  inactive beds shall be excluded from the inventory. The agency
  791  shall, at the request of the licensee, reactivate the inactive
  792  general beds upon a showing by the licensee that licensure
  793  requirements for the inactive general beds are met.
  794         (2) In formulating and implementing policies and rules that
  795  may have significant impact on the ability of rural hospitals to
  796  continue to provide health care services in rural communities,
  797  the agency, the department, or the respective regulatory board
  798  adopting policies or rules regarding the licensure or
  799  certification of health care professionals shall provide a rural
  800  hospital impact statement. The rural hospital impact statement
  801  shall assess the proposed action in light of the following
  802  questions:
  803         (1)(a) Do the health personnel affected by the proposed
  804  action currently practice in rural hospitals or are they likely
  805  to in the near future?
  806         (2)(b) What are the current numbers of the affected health
  807  personnel in this state, their geographic distribution, and the
  808  number practicing in rural hospitals?
  809         (3)(c) What are the functions presently performed by the
  810  affected health personnel, and are such functions presently
  811  performed in rural hospitals?
  812         (4)(d) What impact will the proposed action have on the
  813  ability of rural hospitals to recruit the affected personnel to
  814  practice in their facilities?
  815         (5)(e) What impact will the proposed action have on the
  816  limited financial resources of rural hospitals through increased
  817  salaries and benefits necessary to recruit or retain such health
  818  personnel?
  819         (6)(f) Is there a less stringent requirement which could
  820  apply to practice in rural hospitals?
  821         (7)(g) Will this action create staffing shortages, which
  822  could result in a loss to the public of health care services in
  823  rural hospitals or result in closure of any rural hospitals?
  824         Section 30. Section 395.604, Florida Statutes, is repealed.
  825         Section 31. Section 395.605, Florida Statutes, is repealed.
  826         Section 32. Paragraph (c) of subsection (1) of section
  827  395.701, Florida Statutes, is amended to read:
  828         395.701 Annual assessments on net operating revenues for
  829  inpatient and outpatient services to fund public medical
  830  assistance; administrative fines for failure to pay assessments
  831  when due; exemption.—
  832         (1) For the purposes of this section, the term:
  833         (c) “Hospital” means a health care institution as defined
  834  in s. 395.002(12), but does not include any hospital operated by
  835  a state the agency or the Department of Corrections.
  836         Section 33. Paragraph (b) of subsection (2) of section
  837  395.7015, Florida Statutes, is amended to read:
  838         395.7015 Annual assessment on health care entities.—
  839         (2) There is imposed an annual assessment against certain
  840  health care entities as described in this section:
  841         (b) For the purpose of this section, “health care entities”
  842  include the following:
  843         1. Ambulatory surgical centers and mobile surgical
  844  facilities licensed under s. 395.003. This subsection shall only
  845  apply to mobile surgical facilities operating under contracts
  846  entered into on or after July 1, 1998.
  847         2.Clinical laboratories licensed under s. 483.091,
  848  excluding any hospital laboratory defined under s. 483.041(6),
  849  any clinical laboratory operated by the state or a political
  850  subdivision of the state, any clinical laboratory which
  851  qualifies as an exempt organization under s. 501(c)(3) of the
  852  Internal Revenue Code of 1986, as amended, and which receives 70
  853  percent or more of its gross revenues from services to charity
  854  patients or Medicaid patients, and any blood, plasma, or tissue
  855  bank procuring, storing, or distributing blood, plasma, or
  856  tissue either for future manufacture or research or distributed
  857  on a nonprofit basis, and further excluding any clinical
  858  laboratory which is wholly owned and operated by 6 or fewer
  859  physicians who are licensed pursuant to chapter 458 or chapter
  860  459 and who practice in the same group practice, and at which no
  861  clinical laboratory work is performed for patients referred by
  862  any health care provider who is not a member of the same group.
  863         2.3. Diagnostic-imaging centers that are freestanding
  864  outpatient facilities that provide specialized services for the
  865  identification or determination of a disease through examination
  866  and also provide sophisticated radiological services, and in
  867  which services are rendered by a physician licensed by the Board
  868  of Medicine under s. 458.311, s. 458.313, or s. 458.317, or by
  869  an osteopathic physician licensed by the Board of Osteopathic
  870  Medicine under s. 459.0055 or s. 459.0075. For purposes of this
  871  paragraph, “sophisticated radiological services” means the
  872  following: magnetic resonance imaging; nuclear medicine;
  873  angiography; arteriography; computed tomography; positron
  874  emission tomography; digital vascular imaging; bronchography;
  875  lymphangiography; splenography; ultrasound, excluding ultrasound
  876  providers that are part of a private physician’s office practice
  877  or when ultrasound is provided by two or more physicians
  878  licensed under chapter 458 or chapter 459 who are members of the
  879  same professional association and who practice in the same
  880  medical specialties; and such other sophisticated radiological
  881  services, excluding mammography, as adopted in rule by the
  882  board.
  883         Section 34. Subsection (1) of section 400.0625, Florida
  884  Statutes, is amended to read:
  885         400.0625 Minimum standards for clinical laboratory test
  886  results and diagnostic X-ray results.—
  887         (1) Each nursing home, as a requirement for issuance or
  888  renewal of its license, shall require that all clinical
  889  laboratory tests performed for the nursing home be performed by
  890  a licensed clinical laboratory licensed under the provisions of
  891  chapter 483, except for such self-testing procedures as are
  892  approved by the agency by rule. Results of clinical laboratory
  893  tests performed prior to admission which meet the minimum
  894  standards provided in s. 483.181(3) shall be accepted in lieu of
  895  routine examinations required upon admission and clinical
  896  laboratory tests which may be ordered by a physician for
  897  residents of the nursing home.
  898         Section 35. Subsection (1) and paragraphs (b), (e), and (f)
  899  of subsection (4) of section 400.464, Florida Statutes, are
  900  amended, and subsection (6) is added to that section, to read:
  901         400.464 Home health agencies to be licensed; expiration of
  902  license; exemptions; unlawful acts; penalties.—
  903         (1) The requirements of part II of chapter 408 apply to the
  904  provision of services that require licensure pursuant to this
  905  part and part II of chapter 408 and entities licensed or
  906  registered by or applying for such licensure or registration
  907  from the Agency for Health Care Administration pursuant to this
  908  part. A license issued by the agency is required in order to
  909  operate a home health agency in this state. A license issued
  910  after June 30, 2017, must specify the home health services that
  911  the organization is authorized to perform and indicate whether
  912  such specified services are considered skilled care. The
  913  provision or advertising of services which require licensure
  914  pursuant to this part without such services being specified on
  915  the face of the license issued after June 30, 2017, constitutes
  916  unlicensed activity as prohibited under s. 408.812.
  917         (4)
  918         (b) The operation or maintenance of an unlicensed home
  919  health agency or the performance of any home health services in
  920  violation of this part is declared a nuisance, inimical to the
  921  public health, welfare, and safety. The agency or any state
  922  attorney may, in addition to other remedies provided in this
  923  part, bring an action for an injunction to restrain such
  924  violation, or to enjoin the future operation or maintenance of
  925  the home health agency or the provision of home health services
  926  in violation of this part or part II of chapter 408, until
  927  compliance with this part or the rules adopted under this part
  928  has been demonstrated to the satisfaction of the agency.
  929         (e) Any person who owns, operates, or maintains an
  930  unlicensed home health agency and who, within 10 working days
  931  after receiving notification from the agency, fails to cease
  932  operation and apply for a license under this part commits a
  933  misdemeanor of the second degree, punishable as provided in s.
  934  775.082 or s. 775.083. Each day of continued operation is a
  935  separate offense.
  936         (f) Any home health agency that fails to cease operation
  937  after agency notification may be fined in accordance with s.
  938  408.812 $500 for each day of noncompliance.
  939         (6)Any person, entity, or organization providing home
  940  health services which is exempt from licensure under subsection
  941  (5) may voluntarily apply for a certificate of exemption from
  942  licensure under its exempt status with the agency on a form that
  943  sets forth its name or names and addresses, a statement of the
  944  reasons why it is exempt from licensure as a home health agency,
  945  and other information deemed necessary by the agency. A
  946  certificate of exemption is valid for a period of not more than
  947  2 years and is not transferable. The agency may charge an
  948  applicant for a certificate of exemption in an amount equal to
  949  $100 or the actual cost of processing the certificate.
  950         Section 36. Present subsections (7), (8), and (9) of
  951  section 400.471, Florida Statutes, are renumbered as subsections
  952  (6), (7), and (8), respectively, and subsection (2), present
  953  subsection (6), and paragraph (g) of subsection (10) are
  954  amended, to read:
  955         400.471 Application for license; fee.—
  956         (2) In addition to the requirements of part II of chapter
  957  408, the initial applicant, the applicant for a change of
  958  ownership, and the applicant for the addition of skilled care
  959  services, must file with the application satisfactory proof that
  960  the home health agency is in compliance with this part and
  961  applicable rules, including:
  962         (a) A listing of services to be provided, either directly
  963  by the applicant or through contractual arrangements with
  964  existing providers.
  965         (b) The number and discipline of professional staff to be
  966  employed.
  967         (c)Completion of questions concerning volume data on the
  968  renewal application as determined by rule.
  969         (c)(d) A business plan, signed by the applicant, which
  970  details the home health agency’s methods to obtain patients and
  971  its plan to recruit and maintain staff.
  972         (d)(e) Evidence of contingency funding as required under s.
  973  408.8065 equal to 1 month’s average operating expenses during
  974  the first year of operation.
  975         (e)(f) A balance sheet, income and expense statement, and
  976  statement of cash flows for the first 2 years of operation which
  977  provide evidence of having sufficient assets, credit, and
  978  projected revenues to cover liabilities and expenses. The
  979  applicant has demonstrated financial ability to operate if the
  980  applicant’s assets, credit, and projected revenues meet or
  981  exceed projected liabilities and expenses. An applicant may not
  982  project an operating margin of 15 percent or greater for any
  983  month in the first year of operation. All documents required
  984  under this paragraph must be prepared in accordance with
  985  generally accepted accounting principles and compiled and signed
  986  by a certified public accountant.
  987         (f)(g) All other ownership interests in health care
  988  entities for each controlling interest, as defined in part II of
  989  chapter 408.
  990         (g)(h) In the case of an application for initial licensure,
  991  an application for a change of ownership, or an application for
  992  the addition of skilled care services, documentation of
  993  accreditation, or an application for accreditation, from an
  994  accrediting organization that is recognized by the agency as
  995  having standards comparable to those required by this part and
  996  part II of chapter 408. A home health agency that is not
  997  Medicare or Medicaid certified and does not provide skilled care
  998  is exempt from this paragraph. Notwithstanding s. 408.806, an
  999  initial applicant that has applied for accreditation must
 1000  provide proof of accreditation that is not conditional or
 1001  provisional and submit a survey demonstrating compliance with
 1002  the requirements of this part, part II of chapter 408, and
 1003  applicable rules from an accrediting organization that is
 1004  recognized by the agency as having standards comparable to those
 1005  required by this part and part II of chapter 408 within 120 days
 1006  after the date of the agency’s receipt of the application for
 1007  licensure or the application shall be withdrawn from further
 1008  consideration. Such accreditation must be continuously
 1009  maintained by the home health agency to maintain licensure. The
 1010  agency shall accept, in lieu of its own periodic licensure
 1011  survey, the submission of the survey of an accrediting
 1012  organization that is recognized by the agency if the
 1013  accreditation of the licensed home health agency is not
 1014  provisional and if the licensed home health agency authorizes
 1015  releases of, and the agency receives the report of, the
 1016  accrediting organization.
 1017         (6)The agency may not issue a license designated as
 1018  certified to a home health agency that fails to satisfy the
 1019  requirements of a Medicare certification survey from the agency.
 1020         (9)(10) The agency may not issue a renewal license for a
 1021  home health agency in any county having at least one licensed
 1022  home health agency and that has more than one home health agency
 1023  per 5,000 persons, as indicated by the most recent population
 1024  estimates published by the Legislature’s Office of Economic and
 1025  Demographic Research, if the applicant or any controlling
 1026  interest has been administratively sanctioned by the agency
 1027  during the 2 years prior to the submission of the licensure
 1028  renewal application for one or more of the following acts:
 1029         (g) Demonstrating a pattern of failing to provide a service
 1030  specified in the home health agency’s written agreement with a
 1031  patient or the patient’s legal representative, or the plan of
 1032  care for that patient, except unless a reduction in service is
 1033  mandated by Medicare, Medicaid, or a state program or as
 1034  provided in s. 400.492(3). A pattern may be demonstrated by a
 1035  showing of at least three incidents, regardless of the patient
 1036  or service, in which the home health agency did not provide a
 1037  service specified in a written agreement or plan of care during
 1038  a 3-month period;
 1039         Section 37. Subsection (5) of section 400.474, Florida
 1040  Statutes, is amended to read:
 1041         400.474 Administrative penalties.—
 1042         (5) The agency shall impose a fine of $5,000 against a home
 1043  health agency that demonstrates a pattern of failing to provide
 1044  a service specified in the home health agency’s written
 1045  agreement with a patient or the patient’s legal representative,
 1046  or the plan of care for that patient, except unless a reduction
 1047  in service is mandated by Medicare, Medicaid, or a state program
 1048  or as provided in s. 400.492(3). A pattern may be demonstrated
 1049  by a showing of at least three incidences, regardless of the
 1050  patient or service, where the home health agency did not provide
 1051  a service specified in a written agreement or plan of care
 1052  during a 3-month period. The agency shall impose the fine for
 1053  each occurrence. The agency may also impose additional
 1054  administrative fines under s. 400.484 for the direct or indirect
 1055  harm to a patient, or deny, revoke, or suspend the license of
 1056  the home health agency for a pattern of failing to provide a
 1057  service specified in the home health agency’s written agreement
 1058  with a patient or the plan of care for that patient.
 1059         Section 38. Paragraph (c) of subsection (2) of section
 1060  400.476, Florida Statutes, is amended to read:
 1061         400.476 Staffing requirements; notifications; limitations
 1062  on staffing services.—
 1063         (2) DIRECTOR OF NURSING.—
 1064         (c) A home health agency that provides skilled nursing care
 1065  must is not Medicare or Medicaid certified and does not provide
 1066  skilled care or provides only physical, occupational, or speech
 1067  therapy is not required to have a director of nursing and is
 1068  exempt from paragraph (b).
 1069         Section 39. Subsection (2) of section 400.484, Florida
 1070  Statutes, is amended to read:
 1071         400.484 Right of inspection; violations deficiencies;
 1072  fines.—
 1073         (2) The agency shall impose fines for various classes of
 1074  violations deficiencies in accordance with the following
 1075  schedule:
 1076         (a) Class I violations are defined in s. 408.813 A class I
 1077  deficiency is any act, omission, or practice that results in a
 1078  patient’s death, disablement, or permanent injury, or places a
 1079  patient at imminent risk of death, disablement, or permanent
 1080  injury. Upon finding a class I violation deficiency, the agency
 1081  shall impose an administrative fine in the amount of $15,000 for
 1082  each occurrence and each day that the violation deficiency
 1083  exists.
 1084         (b) Class II violations are defined in s. 408.813 A class
 1085  II deficiency is any act, omission, or practice that has a
 1086  direct adverse effect on the health, safety, or security of a
 1087  patient. Upon finding a class II violation deficiency, the
 1088  agency shall impose an administrative fine in the amount of
 1089  $5,000 for each occurrence and each day that the violation
 1090  deficiency exists.
 1091         (c) Class III violations are defined in s. 408.813 A class
 1092  III deficiency is any act, omission, or practice that has an
 1093  indirect, adverse effect on the health, safety, or security of a
 1094  patient. Upon finding an uncorrected or repeated class III
 1095  violation deficiency, the agency shall impose an administrative
 1096  fine not to exceed $1,000 for each occurrence and each day that
 1097  the uncorrected or repeated violation deficiency exists.
 1098         (d) Class IV violations are defined in s. 408.813 A class
 1099  IV deficiency is any act, omission, or practice related to
 1100  required reports, forms, or documents which does not have the
 1101  potential of negatively affecting patients. These violations are
 1102  of a type that the agency determines do not threaten the health,
 1103  safety, or security of patients. Upon finding an uncorrected or
 1104  repeated class IV violation deficiency, the agency shall impose
 1105  an administrative fine not to exceed $500 for each occurrence
 1106  and each day that the uncorrected or repeated violation
 1107  deficiency exists.
 1108         Section 40. Subsection (4) of section 400.497, Florida
 1109  Statutes, is amended to read:
 1110         400.497 Rules establishing minimum standards.—The agency
 1111  shall adopt, publish, and enforce rules to implement part II of
 1112  chapter 408 and this part, including, as applicable, ss. 400.506
 1113  and 400.509, which must provide reasonable and fair minimum
 1114  standards relating to:
 1115         (4) Licensure and certificate of exemption application and
 1116  renewal.
 1117         Section 41. Subsection (5), paragraphs (d) and (e) of
 1118  subsection (6), paragraph (a) of subsection (15), and
 1119  subsections (19) and (20) of section 400.506, Florida Statutes,
 1120  are amended to read:
 1121         400.506 Licensure of nurse registries; requirements;
 1122  penalties.—
 1123         (5)(a) In addition to the requirements of s. 408.812, any
 1124  person who owns, operates, or maintains an unlicensed nurse
 1125  registry and who, within 10 working days after receiving
 1126  notification from the agency, fails to cease operation and apply
 1127  for a license under this part commits a misdemeanor of the
 1128  second degree, punishable as provided in s. 775.082 or s.
 1129  775.083. Each day of continued operation is a separate offense.
 1130         (b) If a nurse registry fails to cease operation after
 1131  agency notification, the agency may impose a fine in accordance
 1132  with s. 408.812 of $500 for each day of noncompliance.
 1133         (6)
 1134         (d) A registered nurse, licensed practical nurse, certified
 1135  nursing assistant, companion or homemaker, or home health aide
 1136  referred for contract under this chapter by a nurse registry is
 1137  deemed an independent contractor and not an employee of the
 1138  nurse registry under any chapter, regardless of the obligations
 1139  imposed on a nurse registry under this chapter or chapter 408.
 1140         (e) Upon referral of a registered nurse, licensed practical
 1141  nurse, certified nursing assistant, companion or homemaker, or
 1142  home health aide for contract in a private residence or
 1143  facility, the nurse registry shall advise the patient, the
 1144  patient’s family, or any other person acting on behalf of the
 1145  patient, at the time of the contract for services, that the
 1146  caregiver referred by the nurse registry is an independent
 1147  contractor and that the it is not the obligation of a nurse
 1148  registry is not permitted to monitor, supervise, manage, or
 1149  train a caregiver referred for contract under this chapter.
 1150         (15)(a) The agency may deny, suspend, or revoke the license
 1151  of a nurse registry and shall impose a fine of $5,000 against a
 1152  nurse registry that:
 1153         1. Provides services to residents in an assisted living
 1154  facility for which the nurse registry does not receive fair
 1155  market value remuneration.
 1156         2. Provides staffing to an assisted living facility for
 1157  which the nurse registry does not receive fair market value
 1158  remuneration.
 1159         3. Fails to provide the agency, upon request, with copies
 1160  of all contracts with assisted living facilities which were
 1161  executed within the last 5 years.
 1162         4.Gives remuneration to a case manager, discharge planner,
 1163  facility-based staff member, or third-party vendor who is
 1164  involved in the discharge planning process of a facility
 1165  licensed under chapter 395 or this chapter and from whom the
 1166  nurse registry receives referrals. A nurse registry is exempt
 1167  from this subparagraph if it does not bill the Florida Medicaid
 1168  program or the Medicare program or share a controlling interest
 1169  with any entity licensed, registered, or certified under part II
 1170  of chapter 408 that bills the Florida Medicaid program or the
 1171  Medicare program.
 1172         5.Gives remuneration to a physician, a member of the
 1173  physician’s office staff, or an immediate family member of the
 1174  physician, and the nurse registry received a patient referral in
 1175  the last 12 months from that physician or the physician’s office
 1176  staff. A nurse registry is exempt from this subparagraph if it
 1177  does not bill the Florida Medicaid program or the Medicare
 1178  program or share a controlling interest with any entity
 1179  licensed, registered, or certified under part II of chapter 408
 1180  that bills the Florida Medicaid program or the Medicare program.
 1181         (19) It is not the obligation of A nurse registry is not
 1182  permitted to monitor, supervise, manage, or train a registered
 1183  nurse, licensed practical nurse, certified nursing assistant,
 1184  companion or homemaker, or home health aide referred for
 1185  contract under this chapter. In the event of a violation of this
 1186  chapter or a violation of any other law of this state by a
 1187  referred registered nurse, licensed practical nurse, certified
 1188  nursing assistant, companion or homemaker, or home health aide,
 1189  or a deficiency in credentials which comes to the attention of
 1190  the nurse registry, the nurse registry shall advise the patient
 1191  to terminate the referred person’s contract, providing the
 1192  reason for the suggested termination; cease referring the person
 1193  to other patients or facilities; and, if practice violations are
 1194  involved, notify the licensing board. This section does not
 1195  affect or negate any other obligations imposed on a nurse
 1196  registry under chapter 408.
 1197         (20) Records required to be filed under this chapter with
 1198  the nurse registry as a repository of records must be kept in
 1199  accordance with rules adopted by the agency. The nurse registry
 1200  is not permitted has no obligation to review or act upon such
 1201  records except as specified in subsection (19).
 1202         Section 42. Subsection (1) of section 400.606, Florida
 1203  Statutes, is amended to read:
 1204         400.606 License; application; renewal; conditional license
 1205  or permit; certificate of need.—
 1206         (1) In addition to the requirements of part II of chapter
 1207  408, the initial application and change of ownership application
 1208  must be accompanied by a plan for the delivery of home,
 1209  residential, and homelike inpatient hospice services to
 1210  terminally ill persons and their families. Such plan must
 1211  contain, but need not be limited to:
 1212         (a) The estimated average number of terminally ill persons
 1213  to be served monthly.
 1214         (b) The geographic area in which hospice services will be
 1215  available.
 1216         (c) A listing of services which are or will be provided,
 1217  either directly by the applicant or through contractual
 1218  arrangements with existing providers.
 1219         (d) Provisions for the implementation of hospice home care
 1220  within 3 months after licensure.
 1221         (e) Provisions for the implementation of hospice homelike
 1222  inpatient care within 12 months after licensure.
 1223         (f) The number and disciplines of professional staff to be
 1224  employed.
 1225         (g) The name and qualifications of any existing or
 1226  potential contractee.
 1227         (h) A plan for attracting and training volunteers.
 1228  
 1229  If the applicant is an existing licensed health care provider,
 1230  the application must be accompanied by a copy of the most recent
 1231  profit-loss statement and, if applicable, the most recent
 1232  licensure inspection report.
 1233         Section 43. Subsection (6) of section 400.925, Florida
 1234  Statutes, is amended to read:
 1235         400.925 Definitions.—As used in this part, the term:
 1236         (6) “Home medical equipment” includes any product as
 1237  defined by the Federal Drug Administration’s Drugs, Devices and
 1238  Cosmetics Act, any products reimbursed under the Medicare Part B
 1239  Durable Medical Equipment benefits, or any products reimbursed
 1240  under the Florida Medicaid durable medical equipment program.
 1241  Home medical equipment includes:
 1242         (a) Oxygen and related respiratory equipment; manual,
 1243  motorized, or customized wheelchairs and related seating and
 1244  positioning, but does not include prosthetics or orthotics or
 1245  any splints, braces, or aids custom fabricated by a licensed
 1246  health care practitioner;
 1247         (b) Motorized scooters;
 1248         (c) Personal transfer systems; and
 1249         (d) Specialty beds, for use by a person with a medical
 1250  need; and
 1251         (e)Manual, motorized, or customized wheelchairs and
 1252  related seating and positioning, but does not include
 1253  prosthetics, orthotics, or any splints, braces, or aids custom
 1254  fabricated by a licensed health care practitioner.
 1255         Section 44. Subsection (4) of section 400.931, Florida
 1256  Statutes, is amended to read:
 1257         400.931 Application for license; fee.—
 1258         (4) When a change of the general manager of a home medical
 1259  equipment provider occurs, the licensee must notify the agency
 1260  of the change within the timeframes established in part II of
 1261  chapter 408 and applicable rules 45 days.
 1262         Section 45. Subsection (2) of section 400.933, Florida
 1263  Statutes, is amended to read:
 1264         400.933 Licensure inspections and investigations.—
 1265         (2) The agency shall accept, in lieu of its own periodic
 1266  inspections for licensure, submission of the following:
 1267         (a) The survey or inspection of an accrediting
 1268  organization, provided the accreditation of the licensed home
 1269  medical equipment provider is not provisional and provided the
 1270  licensed home medical equipment provider authorizes release of,
 1271  and the agency receives the report of, the accrediting
 1272  organization; or
 1273         (b) A copy of a valid medical oxygen retail establishment
 1274  permit issued by the Department of Business and Professional
 1275  Regulation Health, pursuant to chapter 499.
 1276         Section 46. Subsection (2) of section 400.980, Florida
 1277  Statutes, is amended to read:
 1278         400.980 Health care services pools.—
 1279         (2) The requirements of part II of chapter 408 apply to the
 1280  provision of services that require licensure or registration
 1281  pursuant to this part and part II of chapter 408 and to entities
 1282  registered by or applying for such registration from the agency
 1283  pursuant to this part. Registration or a license issued by the
 1284  agency is required for the operation of a health care services
 1285  pool in this state. In accordance with s. 408.805, an applicant
 1286  or licensee shall pay a fee for each license application
 1287  submitted using this part, part II of chapter 408, and
 1288  applicable rules. The agency shall adopt rules and provide forms
 1289  required for such registration and shall impose a registration
 1290  fee in an amount sufficient to cover the cost of administering
 1291  this part and part II of chapter 408. In addition to the
 1292  requirements in part II of chapter 408, the registrant must
 1293  provide the agency with any change of information contained on
 1294  the original registration application within the timeframes
 1295  established in this part, part II of chapter 408, and applicable
 1296  rules 14 days prior to the change.
 1297         Section 47. Paragraphs (a) through (d) of subsection (4) of
 1298  section 400.9905, Florida Statutes, are amended to read:
 1299         400.9905 Definitions.—
 1300         (4) “Clinic” means an entity where health care services are
 1301  provided to individuals and which tenders charges for
 1302  reimbursement for such services, including a mobile clinic and a
 1303  portable equipment provider. As used in this part, the term does
 1304  not include and the licensure requirements of this part do not
 1305  apply to:
 1306         (a) Entities licensed or registered by the state under
 1307  chapter 395; entities licensed or registered by the state and
 1308  providing only health care services within the scope of services
 1309  authorized under their respective licenses under ss. 383.30
 1310  383.332 ss. 383.30-383.335, chapter 390, chapter 394, chapter
 1311  397, this chapter except part X, chapter 429, chapter 463,
 1312  chapter 465, chapter 466, chapter 478, part I of chapter 483,
 1313  chapter 484, or chapter 651; end-stage renal disease providers
 1314  authorized under 42 C.F.R. part 405, subpart U; providers
 1315  certified under 42 C.F.R. part 485, subpart B or subpart H; or
 1316  any entity that provides neonatal or pediatric hospital-based
 1317  health care services or other health care services by licensed
 1318  practitioners solely within a hospital licensed under chapter
 1319  395.
 1320         (b) Entities that own, directly or indirectly, entities
 1321  licensed or registered by the state pursuant to chapter 395;
 1322  entities that own, directly or indirectly, entities licensed or
 1323  registered by the state and providing only health care services
 1324  within the scope of services authorized pursuant to their
 1325  respective licenses under ss. 383.30-383.332 ss. 383.30-383.335,
 1326  chapter 390, chapter 394, chapter 397, this chapter except part
 1327  X, chapter 429, chapter 463, chapter 465, chapter 466, chapter
 1328  478, part I of chapter 483, chapter 484, or chapter 651; end
 1329  stage renal disease providers authorized under 42 C.F.R. part
 1330  405, subpart U; providers certified under 42 C.F.R. part 485,
 1331  subpart B or subpart H; or any entity that provides neonatal or
 1332  pediatric hospital-based health care services by licensed
 1333  practitioners solely within a hospital licensed under chapter
 1334  395.
 1335         (c) Entities that are owned, directly or indirectly, by an
 1336  entity licensed or registered by the state pursuant to chapter
 1337  395; entities that are owned, directly or indirectly, by an
 1338  entity licensed or registered by the state and providing only
 1339  health care services within the scope of services authorized
 1340  pursuant to their respective licenses under ss. 383.30-383.332
 1341  ss. 383.30-383.335, chapter 390, chapter 394, chapter 397, this
 1342  chapter except part X, chapter 429, chapter 463, chapter 465,
 1343  chapter 466, chapter 478, part I of chapter 483, chapter 484, or
 1344  chapter 651; end-stage renal disease providers authorized under
 1345  42 C.F.R. part 405, subpart U; providers certified under 42
 1346  C.F.R. part 485, subpart B or subpart H; or any entity that
 1347  provides neonatal or pediatric hospital-based health care
 1348  services by licensed practitioners solely within a hospital
 1349  under chapter 395.
 1350         (d) Entities that are under common ownership, directly or
 1351  indirectly, with an entity licensed or registered by the state
 1352  pursuant to chapter 395; entities that are under common
 1353  ownership, directly or indirectly, with an entity licensed or
 1354  registered by the state and providing only health care services
 1355  within the scope of services authorized pursuant to their
 1356  respective licenses under ss. 383.30-383.332 ss. 383.30-383.335,
 1357  chapter 390, chapter 394, chapter 397, this chapter except part
 1358  X, chapter 429, chapter 463, chapter 465, chapter 466, chapter
 1359  478, part I of chapter 483, chapter 484, or chapter 651; end
 1360  stage renal disease providers authorized under 42 C.F.R. part
 1361  405, subpart U; providers certified under 42 C.F.R. part 485,
 1362  subpart B or subpart H; or any entity that provides neonatal or
 1363  pediatric hospital-based health care services by licensed
 1364  practitioners solely within a hospital licensed under chapter
 1365  395.
 1366  
 1367  Notwithstanding this subsection, an entity shall be deemed a
 1368  clinic and must be licensed under this part in order to receive
 1369  reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
 1370  627.730-627.7405, unless exempted under s. 627.736(5)(h).
 1371         Section 48. Paragraph (a) of subsection (2) of section
 1372  408.033, Florida Statutes, is amended to read:
 1373         408.033 Local and state health planning.—
 1374         (2) FUNDING.—
 1375         (a) The Legislature intends that the cost of local health
 1376  councils be borne by assessments on selected health care
 1377  facilities subject to facility licensure by the Agency for
 1378  Health Care Administration, including abortion clinics, assisted
 1379  living facilities, ambulatory surgical centers, birthing
 1380  centers, clinical laboratories except community nonprofit blood
 1381  banks and clinical laboratories operated by practitioners for
 1382  exclusive use regulated under s. 483.035, home health agencies,
 1383  hospices, hospitals, intermediate care facilities for the
 1384  developmentally disabled, nursing homes, health care clinics,
 1385  and multiphasic testing centers and by assessments on
 1386  organizations subject to certification by the agency pursuant to
 1387  chapter 641, part III, including health maintenance
 1388  organizations and prepaid health clinics. Fees assessed may be
 1389  collected prospectively at the time of licensure renewal and
 1390  prorated for the licensure period.
 1391         Section 49. Paragraph (e) and present paragraph (p) of
 1392  subsection (3) of section 408.036, Florida Statutes, are amended
 1393  to read:
 1394         408.036 Projects subject to review; exemptions.—
 1395         (3) EXEMPTIONS.—Upon request, the following projects are
 1396  subject to exemption from the provisions of subsection (1):
 1397         (e)For mobile surgical facilities and related health care
 1398  services provided under contract with the Department of
 1399  Corrections or a private correctional facility operating
 1400  pursuant to chapter 957.
 1401         (o)(p) For replacement of a licensed nursing home on the
 1402  same site, or within 5 miles of the same site if within the same
 1403  subdistrict, if the number of licensed beds does not increase
 1404  except as permitted under paragraph (e) (f).
 1405         Section 50. Subsection (4) of section 408.061, Florida
 1406  Statutes, is amended to read:
 1407         408.061 Data collection; uniform systems of financial
 1408  reporting; information relating to physician charges;
 1409  confidential information; immunity.—
 1410         (4) Within 120 days after the end of its fiscal year, each
 1411  health care facility, excluding continuing care facilities as
 1412  defined in s. 408.07(13), hospitals operated by state agencies,
 1413  and nursing homes as defined in s. 408.07(36) 408.07(14) and
 1414  (37), shall file with the agency, on forms adopted by the agency
 1415  and based on the uniform system of financial reporting, its
 1416  actual financial experience for that fiscal year, including
 1417  expenditures, revenues, and statistical measures. Such data may
 1418  be based on internal financial reports which are certified to be
 1419  complete and accurate by the provider. However, hospitals’
 1420  actual financial experience shall be their audited actual
 1421  experience. Every nursing home shall submit to the agency, in a
 1422  format designated by the agency, a statistical profile of the
 1423  nursing home residents. The agency, in conjunction with the
 1424  Department of Elderly Affairs and the Department of Health,
 1425  shall review these statistical profiles and develop
 1426  recommendations for the types of residents who might more
 1427  appropriately be placed in their homes or other noninstitutional
 1428  settings.
 1429         Section 51. Subsection (11) of section 408.07, Florida
 1430  Statutes, is amended to read:
 1431         408.07 Definitions.—As used in this chapter, with the
 1432  exception of ss. 408.031-408.045, the term:
 1433         (11)“Clinical laboratory” means a facility licensed under
 1434  s. 483.091, excluding: any hospital laboratory defined under s.
 1435  483.041(6); any clinical laboratory operated by the state or a
 1436  political subdivision of the state; any blood or tissue bank
 1437  where the majority of revenues are received from the sale of
 1438  blood or tissue and where blood, plasma, or tissue is procured
 1439  from volunteer donors and donated, processed, stored, or
 1440  distributed on a nonprofit basis; and any clinical laboratory
 1441  which is wholly owned and operated by physicians who are
 1442  licensed pursuant to chapter 458 or chapter 459 and who practice
 1443  in the same group practice, and at which no clinical laboratory
 1444  work is performed for patients referred by any health care
 1445  provider who is not a member of that same group practice.
 1446         Section 52. Subsection (4) of section 408.20, Florida
 1447  Statutes, is amended to read:
 1448         408.20 Assessments; Health Care Trust Fund.—
 1449         (4) Hospitals operated by state agencies the Department of
 1450  Children and Families, the Department of Health, or the
 1451  Department of Corrections are exempt from the assessments
 1452  required under this section.
 1453         Section 53. Section 408.7056, Florida Statutes, is
 1454  repealed.
 1455         Section 54. Subsections (10), (11), and (27) of section
 1456  408.802, Florida Statutes, are amended to read:
 1457         408.802 Applicability.—The provisions of this part apply to
 1458  the provision of services that require licensure as defined in
 1459  this part and to the following entities licensed, registered, or
 1460  certified by the agency, as described in chapters 112, 383, 390,
 1461  394, 395, 400, 429, 440, 483, and 765:
 1462         (10)Mobile surgical facilities, as provided under part I
 1463  of chapter 395.
 1464         (11)Health care risk managers, as provided under part I of
 1465  chapter 395.
 1466         (27)Clinical laboratories, as provided under part I of
 1467  chapter 483.
 1468         Section 55. Present subsections (12) and (13) of section
 1469  408.803, Florida Statutes, are renumbered as subsections (13)
 1470  and (14), respectively, and a new subsection (12) is added to
 1471  that section, to read:
 1472         408.803 Definitions.—As used in this part, the term:
 1473         (12)“Relative” means an individual who is the father,
 1474  mother, stepfather, stepmother, son, daughter, brother, sister,
 1475  grandmother, grandfather, great-grandmother, great-grandfather,
 1476  grandson, granddaughter, uncle, aunt, first cousin, nephew,
 1477  niece, husband, wife, father-in-law, mother-in-law, son-in-law,
 1478  daughter-in-law, brother-in-law, sister-in-law, stepson,
 1479  stepdaughter, stepbrother, stepsister, half-brother, or half
 1480  sister of a patient or client.
 1481         Section 56. Paragraph (a) of subsection (1) and paragraph
 1482  (c) of subsection (7) of section 408.806, Florida Statutes, are
 1483  amended, and subsection (9) is added to that section, to read:
 1484         408.806 License application process.—
 1485         (1) An application for licensure must be made to the agency
 1486  on forms furnished by the agency, submitted under oath or
 1487  attestation, and accompanied by the appropriate fee in order to
 1488  be accepted and considered timely. The application must contain
 1489  information required by authorizing statutes and applicable
 1490  rules and must include:
 1491         (a) The name, address, and social security number, or
 1492  individual taxpayer identification number if a social security
 1493  number cannot legally be obtained, of:
 1494         1. The applicant;
 1495         2. The administrator or a similarly titled person who is
 1496  responsible for the day-to-day operation of the provider;
 1497         3. The financial officer or similarly titled person who is
 1498  responsible for the financial operation of the licensee or
 1499  provider; and
 1500         4. Each controlling interest if the applicant or
 1501  controlling interest is an individual.
 1502  
 1503  The licensee shall ensure that no person has any ownership
 1504  interest in the licensee, directly or indirectly, regardless of
 1505  ownership structure, who is ineligible pursuant to s.
 1506  408.809(4). The licensee shall ensure that no person holds or
 1507  has held any ownership interest, directly or indirectly,
 1508  regardless of ownership structure, in a provider that has had a
 1509  license or change of ownership application denied, revoked, or
 1510  excluded pursuant to s. 408.815.
 1511         (7)
 1512         (c) If an inspection is required by the authorizing statute
 1513  for a license application other than an initial application, the
 1514  inspection must be unannounced. This paragraph does not apply to
 1515  inspections required pursuant to ss. 383.324, 395.0161(4), and,
 1516  429.67(6), and 483.061(2).
 1517         (9)A licensee that holds a license for multiple providers
 1518  licensed by the agency may request that all related license
 1519  expiration dates be aligned. The agency may issue a license for
 1520  an abbreviated licensure period with a prorated licensure fee.
 1521         Section 57. Subsection (8) of section 408.810, Florida
 1522  Statutes, is amended, and subsection (11) is added to that
 1523  section to read:
 1524         408.810 Minimum licensure requirements.—In addition to the
 1525  licensure requirements specified in this part, authorizing
 1526  statutes, and applicable rules, each applicant and licensee must
 1527  comply with the requirements of this section in order to obtain
 1528  and maintain a license.
 1529         (8) Upon application for initial licensure or change of
 1530  ownership licensure, the applicant shall furnish satisfactory
 1531  proof of the applicant’s financial ability to operate in
 1532  accordance with the requirements of this part, authorizing
 1533  statutes, and applicable rules. The agency shall establish
 1534  standards for this purpose, including information concerning the
 1535  applicant’s controlling interests. The agency shall also
 1536  establish documentation requirements, to be completed by each
 1537  applicant, that show anticipated provider revenues and
 1538  expenditures, the basis for financing the anticipated cash-flow
 1539  requirements of the provider, and an applicant’s access to
 1540  contingency financing. A current certificate of authority,
 1541  pursuant to chapter 651, may be provided as proof of financial
 1542  ability to operate. The agency may require a licensee to provide
 1543  proof of financial ability to operate at any time if there is
 1544  evidence of financial instability, including, but not limited
 1545  to, unpaid expenses necessary for the basic operations of the
 1546  provider. An applicant applying for change of ownership
 1547  licensure is exempt from furnishing proof of the applicant’s
 1548  financial ability to operate if the provider has been licensed
 1549  for at least 5 years and:
 1550         (a)The licensee change is a result of a corporate
 1551  reorganization under which the controlling interest is unchanged
 1552  and the applicant submits organization charts that represent the
 1553  current and proposed structure of the reorganized corporation;
 1554  or
 1555         (b)The licensee change is due solely to the death of a
 1556  controlling interest, and the surviving controlling interests
 1557  continue to hold at least 51 percent of ownership after the
 1558  change of ownership.
 1559         (11)The agency may adopt rules that govern the
 1560  circumstances under which a controlling interest, an
 1561  administrator, an employee, a contractor, or a representative
 1562  thereof who is not a relative of the patient or client may act
 1563  as a legal representative, agent, health care surrogate, power
 1564  of attorney, or guardian of a patient or client. Such rules may
 1565  include requirements related to disclosure, bonding,
 1566  restrictions, and client protections.
 1567         Section 58. Section 408.812, Florida Statutes, is amended
 1568  to read:
 1569         408.812 Unlicensed activity.—
 1570         (1) A person or entity may not offer or advertise services
 1571  that require licensure as defined by this part, authorizing
 1572  statutes, or applicable rules to the public without obtaining a
 1573  valid license from the agency. A licenseholder may not advertise
 1574  or hold out to the public that he or she holds a license for
 1575  other than that for which he or she actually holds the license.
 1576         (2) The operation or maintenance of an unlicensed provider
 1577  or the performance of any services that require licensure
 1578  without proper licensure is a violation of this part and
 1579  authorizing statutes. Unlicensed activity constitutes harm that
 1580  materially affects the health, safety, and welfare of clients
 1581  and constitutes abuse and neglect as defined in s. 415.102. The
 1582  agency or any state attorney may, in addition to other remedies
 1583  provided in this part, bring an action for an injunction to
 1584  restrain such violation, or to enjoin the future operation or
 1585  maintenance of the unlicensed provider or the performance of any
 1586  services in violation of this part and authorizing statutes,
 1587  until compliance with this part, authorizing statutes, and
 1588  agency rules has been demonstrated to the satisfaction of the
 1589  agency.
 1590         (3) It is unlawful for any person or entity to own,
 1591  operate, or maintain an unlicensed provider. If after receiving
 1592  notification from the agency, such person or entity fails to
 1593  cease operation and apply for a license under this part and
 1594  authorizing statutes, the person or entity shall be subject to
 1595  penalties as prescribed by authorizing statutes and applicable
 1596  rules. Each day of continued operation is a separate offense.
 1597         (4) Any person or entity that fails to cease operation
 1598  after agency notification may be fined $1,000 for each day of
 1599  noncompliance.
 1600         (5) When a controlling interest or licensee has an interest
 1601  in more than one provider and fails to license a provider
 1602  rendering services that require licensure, the agency may revoke
 1603  all licenses and impose actions under s. 408.814 and, regardless
 1604  of correction, impose a fine of $1,000 per day, unless otherwise
 1605  specified by authorizing statutes, against each licensee until
 1606  such time as the appropriate license is obtained or the
 1607  unlicensed activity ceases for the unlicensed operation.
 1608         (6) In addition to granting injunctive relief pursuant to
 1609  subsection (2), if the agency determines that a person or entity
 1610  is operating or maintaining a provider without obtaining a
 1611  license and determines that a condition exists that poses a
 1612  threat to the health, safety, or welfare of a client of the
 1613  provider, the person or entity is subject to the same actions
 1614  and fines imposed against a licensee as specified in this part,
 1615  authorizing statutes, and agency rules.
 1616         (7) Any person aware of the operation of an unlicensed
 1617  provider must report that provider to the agency.
 1618         Section 59. Subsections (10), (11), (26), and (27) of
 1619  section 408.820, Florida Statutes, are amended to read:
 1620         408.820 Exemptions.—Except as prescribed in authorizing
 1621  statutes, the following exemptions shall apply to specified
 1622  requirements of this part:
 1623         (10)Mobile surgical facilities, as provided under part I
 1624  of chapter 395, are exempt from s. 408.810(7)-(10).
 1625         (11)Health care risk managers, as provided under part I of
 1626  chapter 395, are exempt from ss. 408.806(7), 408.810(4)-(10),
 1627  and 408.811.
 1628         (26)Clinical laboratories, as provided under part I of
 1629  chapter 483, are exempt from s. 408.810(5)-(10).
 1630         (24)(27) Multiphasic health testing centers, as provided
 1631  under part I II of chapter 483, are exempt from s. 408.810(5)
 1632  (10).
 1633         Section 60. Subsection (7) of section 409.905, Florida
 1634  Statutes, is amended to read:
 1635         409.905 Mandatory Medicaid services.—The agency may make
 1636  payments for the following services, which are required of the
 1637  state by Title XIX of the Social Security Act, furnished by
 1638  Medicaid providers to recipients who are determined to be
 1639  eligible on the dates on which the services were provided. Any
 1640  service under this section shall be provided only when medically
 1641  necessary and in accordance with state and federal law.
 1642  Mandatory services rendered by providers in mobile units to
 1643  Medicaid recipients may be restricted by the agency. Nothing in
 1644  this section shall be construed to prevent or limit the agency
 1645  from adjusting fees, reimbursement rates, lengths of stay,
 1646  number of visits, number of services, or any other adjustments
 1647  necessary to comply with the availability of moneys and any
 1648  limitations or directions provided for in the General
 1649  Appropriations Act or chapter 216.
 1650         (7) INDEPENDENT LABORATORY SERVICES.—The agency shall pay
 1651  for medically necessary diagnostic laboratory procedures ordered
 1652  by a licensed physician or other licensed practitioner of the
 1653  healing arts which are provided for a recipient in a laboratory
 1654  that meets the requirements for Medicare participation and
 1655  appropriately certified by the Centers for Medicare and Medicaid
 1656  Services (CMS) under the federal Clinical Laboratory Improvement
 1657  Amendments of 1988 is licensed under chapter 483, if required.
 1658         Section 61. Subsection (6) of section 409.9116, Florida
 1659  Statutes, is amended to read:
 1660         409.9116 Disproportionate share/financial assistance
 1661  program for rural hospitals.—In addition to the payments made
 1662  under s. 409.911, the Agency for Health Care Administration
 1663  shall administer a federally matched disproportionate share
 1664  program and a state-funded financial assistance program for
 1665  statutory rural hospitals. The agency shall make
 1666  disproportionate share payments to statutory rural hospitals
 1667  that qualify for such payments and financial assistance payments
 1668  to statutory rural hospitals that do not qualify for
 1669  disproportionate share payments. The disproportionate share
 1670  program payments shall be limited by and conform with federal
 1671  requirements. Funds shall be distributed quarterly in each
 1672  fiscal year for which an appropriation is made. Notwithstanding
 1673  the provisions of s. 409.915, counties are exempt from
 1674  contributing toward the cost of this special reimbursement for
 1675  hospitals serving a disproportionate share of low-income
 1676  patients.
 1677         (6) This section applies only to hospitals that were
 1678  defined as statutory rural hospitals, or their successor-in
 1679  interest hospital, prior to January 1, 2001. Any additional
 1680  hospital that is defined as a statutory rural hospital, or its
 1681  successor-in-interest hospital, on or after January 1, 2001, is
 1682  not eligible for programs under this section unless additional
 1683  funds are appropriated each fiscal year specifically to the
 1684  rural hospital disproportionate share and financial assistance
 1685  programs in an amount necessary to prevent any hospital, or its
 1686  successor-in-interest hospital, eligible for the programs prior
 1687  to January 1, 2001, from incurring a reduction in payments
 1688  because of the eligibility of an additional hospital to
 1689  participate in the programs. A hospital, or its successor-in
 1690  interest hospital, which received funds pursuant to this section
 1691  before January 1, 2001, and which qualifies under s.
 1692  395.602(2)(b) 395.602(2)(e), shall be included in the programs
 1693  under this section and is not required to seek additional
 1694  appropriations under this subsection.
 1695         Section 62. Paragraphs (a) and (b) of subsection (1) of
 1696  section 409.975, Florida Statutes, are amended to read:
 1697         409.975 Managed care plan accountability.—In addition to
 1698  the requirements of s. 409.967, plans and providers
 1699  participating in the managed medical assistance program shall
 1700  comply with the requirements of this section.
 1701         (1) PROVIDER NETWORKS.—Managed care plans must develop and
 1702  maintain provider networks that meet the medical needs of their
 1703  enrollees in accordance with standards established pursuant to
 1704  s. 409.967(2)(c). Except as provided in this section, managed
 1705  care plans may limit the providers in their networks based on
 1706  credentials, quality indicators, and price.
 1707         (a) Plans must include all providers in the region that are
 1708  classified by the agency as essential Medicaid providers, unless
 1709  the agency approves, in writing, an alternative arrangement for
 1710  securing the types of services offered by the essential
 1711  providers. Providers are essential for serving Medicaid
 1712  enrollees if they offer services that are not available from any
 1713  other provider within a reasonable access standard, or if they
 1714  provided a substantial share of the total units of a particular
 1715  service used by Medicaid patients within the region during the
 1716  last 3 years and the combined capacity of other service
 1717  providers in the region is insufficient to meet the total needs
 1718  of the Medicaid patients. The agency may not classify physicians
 1719  and other practitioners as essential providers. The agency, at a
 1720  minimum, shall determine which providers in the following
 1721  categories are essential Medicaid providers:
 1722         1. Federally qualified health centers.
 1723         2. Statutory teaching hospitals as defined in s. 408.07(44)
 1724  408.07(45).
 1725         3. Hospitals that are trauma centers as defined in s.
 1726  395.4001(14).
 1727         4. Hospitals located at least 25 miles from any other
 1728  hospital with similar services.
 1729  
 1730  Managed care plans that have not contracted with all essential
 1731  providers in the region as of the first date of recipient
 1732  enrollment, or with whom an essential provider has terminated
 1733  its contract, must negotiate in good faith with such essential
 1734  providers for 1 year or until an agreement is reached, whichever
 1735  is first. Payments for services rendered by a nonparticipating
 1736  essential provider shall be made at the applicable Medicaid rate
 1737  as of the first day of the contract between the agency and the
 1738  plan. A rate schedule for all essential providers shall be
 1739  attached to the contract between the agency and the plan. After
 1740  1 year, managed care plans that are unable to contract with
 1741  essential providers shall notify the agency and propose an
 1742  alternative arrangement for securing the essential services for
 1743  Medicaid enrollees. The arrangement must rely on contracts with
 1744  other participating providers, regardless of whether those
 1745  providers are located within the same region as the
 1746  nonparticipating essential service provider. If the alternative
 1747  arrangement is approved by the agency, payments to
 1748  nonparticipating essential providers after the date of the
 1749  agency’s approval shall equal 90 percent of the applicable
 1750  Medicaid rate. Except for payment for emergency services, if the
 1751  alternative arrangement is not approved by the agency, payment
 1752  to nonparticipating essential providers shall equal 110 percent
 1753  of the applicable Medicaid rate.
 1754         (b) Certain providers are statewide resources and essential
 1755  providers for all managed care plans in all regions. All managed
 1756  care plans must include these essential providers in their
 1757  networks. Statewide essential providers include:
 1758         1. Faculty plans of Florida medical schools.
 1759         2. Regional perinatal intensive care centers as defined in
 1760  s. 383.16(2).
 1761         3. Hospitals licensed as specialty children’s hospitals as
 1762  defined in s. 395.002(27) 395.002(28).
 1763         4. Accredited and integrated systems serving medically
 1764  complex children which comprise separately licensed, but
 1765  commonly owned, health care providers delivering at least the
 1766  following services: medical group home, in-home and outpatient
 1767  nursing care and therapies, pharmacy services, durable medical
 1768  equipment, and Prescribed Pediatric Extended Care.
 1769  
 1770  Managed care plans that have not contracted with all statewide
 1771  essential providers in all regions as of the first date of
 1772  recipient enrollment must continue to negotiate in good faith.
 1773  Payments to physicians on the faculty of nonparticipating
 1774  Florida medical schools shall be made at the applicable Medicaid
 1775  rate. Payments for services rendered by regional perinatal
 1776  intensive care centers shall be made at the applicable Medicaid
 1777  rate as of the first day of the contract between the agency and
 1778  the plan. Except for payments for emergency services, payments
 1779  to nonparticipating specialty children’s hospitals shall equal
 1780  the highest rate established by contract between that provider
 1781  and any other Medicaid managed care plan.
 1782         Section 63. Subsections (5) and (17) of section 429.02,
 1783  Florida Statutes, are amended to read:
 1784         429.02 Definitions.—When used in this part, the term:
 1785         (5) “Assisted living facility” means any building or
 1786  buildings, section or distinct part of a building, private home,
 1787  boarding home, home for the aged, or other residential facility,
 1788  whether operated for profit or not, which, undertakes through
 1789  its ownership or management, provides to provide housing, meals,
 1790  and one or more personal services for a period exceeding 24
 1791  hours to one or more adults who are not relatives of the owner
 1792  or administrator.
 1793         (17) “Personal services” means direct physical assistance
 1794  with or supervision of the activities of daily living, and the
 1795  self-administration of medication, or and other similar services
 1796  which the department may define by rule. “Personal services” may
 1797  shall not be construed to mean the provision of medical,
 1798  nursing, dental, or mental health services, or, with the
 1799  exception of authorized adult day care services provided within
 1800  a licensed assisted living facility, personal services to
 1801  individuals who are not residents of the facility.
 1802         Section 64. Paragraphs (b) and (d) of subsection (2) of
 1803  section 429.04, Florida Statutes, are amended, and subsection
 1804  (3) is added to that section, to read:
 1805         429.04 Facilities to be licensed; exemptions.—
 1806         (2) The following are exempt from licensure under this
 1807  part:
 1808         (b) Any facility or part of a facility licensed by the
 1809  Agency for Persons with Disabilities under chapter 393, a mental
 1810  health facility licensed under or chapter 394, a hospital
 1811  licensed under chapter 395, a nursing home licensed under part
 1812  II of chapter 400, an inpatient hospice licensed under part IV
 1813  of chapter 400, a home for special services licensed under part
 1814  V of chapter 400, an intermediate care facility licensed under
 1815  part VIII of chapter 400, or a transitional living facility
 1816  licensed under part XI of chapter 400.
 1817         (d) Any person who provides housing, meals, and one or more
 1818  personal services on a 24-hour basis in the person’s own home to
 1819  not more than two adults who do not receive optional state
 1820  supplementation. The person who provides the housing, meals, and
 1821  personal services must own or rent the home and must have
 1822  established the home as the person’s permanent residence. Any
 1823  person holding a homestead exemption at an address other than
 1824  that at which the person asserts this exemption shall be
 1825  presumed to not have established permanent residence under this
 1826  exemption reside therein. This exemption does not apply to a
 1827  person or entity who previously held licensure issued by the
 1828  agency and such licensure was revoked or the licensure renewal
 1829  was denied by final order of the agency, or when the person or
 1830  entity voluntarily relinquished licensure during agency
 1831  enforcement proceedings.
 1832         (3)Upon agency investigation of unlicensed activity, any
 1833  person or entity asserting an exemption pursuant to this section
 1834  shall have the burden of providing documentation substantiating
 1835  that the person or entity is entitled to the licensure
 1836  exemption.
 1837         Section 65. Paragraphs (b) and (d) of subsection (1) of
 1838  section 429.08, Florida Statutes, are amended, to read:
 1839         429.08 Unlicensed facilities; referral of person for
 1840  residency to unlicensed facility; penalties.—
 1841         (1)
 1842         (b) Except as provided under paragraph (d), Any person who
 1843  owns, rents, or otherwise maintains a building or property that
 1844  operates, or maintains an unlicensed assisted living facility
 1845  commits a felony of the third degree, punishable as provided in
 1846  s. 775.082, s. 775.083, or s. 775.084. Each day of continued
 1847  operation is a separate offense.
 1848         (d) In addition to the requirements of s. 408.812, any
 1849  person who owns, operates, or maintains an unlicensed assisted
 1850  living facility after receiving notice from the agency due to a
 1851  change in this part or a modification in rule within 6 months
 1852  after the effective date of such change and who, within 10
 1853  working days after receiving notification from the agency, fails
 1854  to cease operation or apply for a license under this part
 1855  commits a felony of the third degree, punishable as provided in
 1856  s. 775.082, s. 775.083, or s. 775.084. Each day of continued
 1857  operation is a separate offense.
 1858         Section 66. Section 429.176, Florida Statutes, is amended
 1859  to read:
 1860         429.176 Notice of change of administrator.—If, during the
 1861  period for which a license is issued, the owner changes
 1862  administrators, the owner must notify the agency of the change
 1863  within 10 days and provide documentation within 90 days that the
 1864  new administrator has completed the applicable core educational
 1865  requirements under s. 429.52. A facility may not be operated for
 1866  more than 120 consecutive days without an administrator who has
 1867  completed the core educational requirements.
 1868         Section 67. Paragraph (h) of subsection (1) of section
 1869  429.41, Florida Statutes, is amended to read:
 1870         429.41 Rules establishing standards.—
 1871         (1) It is the intent of the Legislature that rules
 1872  published and enforced pursuant to this section shall include
 1873  criteria by which a reasonable and consistent quality of
 1874  resident care and quality of life may be ensured and the results
 1875  of such resident care may be demonstrated. Such rules shall also
 1876  ensure a safe and sanitary environment that is residential and
 1877  noninstitutional in design or nature. It is further intended
 1878  that reasonable efforts be made to accommodate the needs and
 1879  preferences of residents to enhance the quality of life in a
 1880  facility. Uniform firesafety standards for assisted living
 1881  facilities shall be established by the State Fire Marshal
 1882  pursuant to s. 633.206. The agency, in consultation with the
 1883  department, may adopt rules to administer the requirements of
 1884  part II of chapter 408. In order to provide safe and sanitary
 1885  facilities and the highest quality of resident care
 1886  accommodating the needs and preferences of residents, the
 1887  department, in consultation with the agency, the Department of
 1888  Children and Families, and the Department of Health, shall adopt
 1889  rules, policies, and procedures to administer this part, which
 1890  must include reasonable and fair minimum standards in relation
 1891  to:
 1892         (h) The care and maintenance of residents, which must
 1893  include, but is not limited to:
 1894         1. The supervision of residents;
 1895         2. The provision of personal services. With the exception
 1896  of authorized adult day care services provided within a licensed
 1897  assisted living facility, an assisted living facility may not
 1898  provide personal services to individuals who are not residents
 1899  of the facility;
 1900         3. The provision of, or arrangement for, social and leisure
 1901  activities;
 1902         4. The arrangement for appointments and transportation to
 1903  appropriate medical, dental, nursing, or mental health services,
 1904  as needed by residents;
 1905         5. The management of medication;
 1906         6. The nutritional needs of residents;
 1907         7. Resident records; and
 1908         8. Internal risk management and quality assurance.
 1909         Section 68. Subsection (4) of section 456.001, Florida
 1910  Statutes, is amended to read:
 1911         456.001 Definitions.—As used in this chapter, the term:
 1912         (4) “Health care practitioner” means any person licensed
 1913  under chapter 457; chapter 458; chapter 459; chapter 460;
 1914  chapter 461; chapter 462; chapter 463; chapter 464; chapter 465;
 1915  chapter 466; chapter 467; part I, part II, part III, part V,
 1916  part X, part XIII, or part XIV of chapter 468; chapter 478;
 1917  chapter 480; part II or part III or part IV of chapter 483;
 1918  chapter 484; chapter 486; chapter 490; or chapter 491.
 1919         Section 69. Paragraphs (h) and (i) of subsection (2) of
 1920  section 456.057, Florida Statutes, are amended to read:
 1921         456.057 Ownership and control of patient records; report or
 1922  copies of records to be furnished; disclosure of information.—
 1923         (2) As used in this section, the terms “records owner,”
 1924  “health care practitioner,” and “health care practitioner’s
 1925  employer” do not include any of the following persons or
 1926  entities; furthermore, the following persons or entities are not
 1927  authorized to acquire or own medical records, but are authorized
 1928  under the confidentiality and disclosure requirements of this
 1929  section to maintain those documents required by the part or
 1930  chapter under which they are licensed or regulated:
 1931         (h) Clinical laboratory personnel licensed under part II
 1932  III of chapter 483.
 1933         (i) Medical physicists licensed under part III IV of
 1934  chapter 483.
 1935         Section 70. Subsection (2) of section 458.307, Florida
 1936  Statutes, is amended to read:
 1937         458.307 Board of Medicine.—
 1938         (2) Twelve members of the board must be licensed physicians
 1939  in good standing in this state who are residents of the state
 1940  and who have been engaged in the active practice or teaching of
 1941  medicine for at least 4 years immediately preceding their
 1942  appointment. One of the physicians must be on the full-time
 1943  faculty of a medical school in this state, and one of the
 1944  physicians must be in private practice and on the full-time
 1945  staff of a statutory teaching hospital in this state as defined
 1946  in s. 408.07. At least one of the physicians must be a graduate
 1947  of a foreign medical school. The remaining three members must be
 1948  residents of the state who are not, and never have been,
 1949  licensed health care practitioners. One member must be a health
 1950  care risk manager licensed under s. 395.10974. At least one
 1951  member of the board must be 60 years of age or older.
 1952         Section 71. Subsection (1) of section 458.345, Florida
 1953  Statutes, is amended to read:
 1954         458.345 Registration of resident physicians, interns, and
 1955  fellows; list of hospital employees; prescribing of medicinal
 1956  drugs; penalty.—
 1957         (1) Any person desiring to practice as a resident
 1958  physician, assistant resident physician, house physician,
 1959  intern, or fellow in fellowship training which leads to
 1960  subspecialty board certification in this state, or any person
 1961  desiring to practice as a resident physician, assistant resident
 1962  physician, house physician, intern, or fellow in fellowship
 1963  training in a teaching hospital in this state as defined in s.
 1964  408.07(44) 408.07(45) or s. 395.805(2), who does not hold a
 1965  valid, active license issued under this chapter shall apply to
 1966  the department to be registered and shall remit a fee not to
 1967  exceed $300 as set by the board. The department shall register
 1968  any applicant the board certifies has met the following
 1969  requirements:
 1970         (a) Is at least 21 years of age.
 1971         (b) Has not committed any act or offense within or without
 1972  the state which would constitute the basis for refusal to
 1973  certify an application for licensure pursuant to s. 458.331.
 1974         (c) Is a graduate of a medical school or college as
 1975  specified in s. 458.311(1)(f).
 1976         Section 72. Part I of chapter 483, Florida Statutes,
 1977  consisting of sections 483.011, 483.021, 483.031, 483.035,
 1978  483.041, 483.051, 483.061, 483.091, 483.101, 483.111, 483.172,
 1979  483.181, 483.191, 483.201, 483.221, 483.23, 483.245, and 483.26,
 1980  is repealed.
 1981         Section 73. Section 483.294, Florida Statutes, is amended
 1982  to read:
 1983         483.294 Inspection of centers.—In accordance with s.
 1984  408.811, the agency shall, at least once annually, inspect the
 1985  premises and operations of all centers subject to licensure
 1986  under this part.
 1987         Section 74. Subsection (3) of section 483.801, Florida
 1988  Statutes, is amended to read:
 1989         483.801 Exemptions.—This part applies to all clinical
 1990  laboratories and clinical laboratory personnel within this
 1991  state, except:
 1992         (3) Persons engaged in testing performed by laboratories
 1993  that are wholly owned and operated by one or more practitioners
 1994  who are licensed under chapter 458, chapter 459, chapter 460,
 1995  chapter 461, chapter 462, chapter 463, or chapter 466 and who
 1996  practice in the same group practice, and in which no clinical
 1997  laboratory work is performed for patients referred by any health
 1998  care provider who is not a member of the same group regulated
 1999  under s. 483.035(1) or exempt from regulation under s.
 2000  483.031(2).
 2001         Section 75. Subsections (2), (3), and (4) of section
 2002  483.803, Florida Statutes, are amended to read:
 2003         483.803 Definitions.—As used in this part, the term:
 2004         (2)“Clinical laboratory” means a clinical laboratory as
 2005  defined in s. 483.041.
 2006         (3)“Clinical laboratory examination” means a clinical
 2007  laboratory examination as defined in s. 483.041.
 2008         (2)(4) “Clinical laboratory personnel” includes a clinical
 2009  laboratory director, supervisor, technologist, blood gas
 2010  analyst, or technician who performs or is responsible for
 2011  laboratory test procedures, but the term does not include
 2012  trainees, persons who perform screening for blood banks or
 2013  plasmapheresis centers, phlebotomists, or persons employed by a
 2014  clinical laboratory to perform manual pretesting duties or
 2015  clerical, personnel, or other administrative responsibilities,
 2016  or persons engaged in testing performed by laboratories
 2017  regulated under s. 483.035(1) or exempt from regulation under s.
 2018  483.031(2).
 2019         Section 76. Section 483.813, Florida Statutes, is amended
 2020  to read:
 2021         483.813 Clinical laboratory personnel license.—A person may
 2022  not conduct a clinical laboratory examination or report the
 2023  results of such examination unless such person is licensed under
 2024  this part to perform such procedures. However, this provision
 2025  does not apply to any practitioner of the healing arts
 2026  authorized to practice in this state or to persons engaged in
 2027  testing performed by laboratories regulated under s. 483.035(1)
 2028  or exempt from regulation under s. 483.031(2). The department
 2029  may grant a temporary license to any candidate it deems properly
 2030  qualified, for a period not to exceed 1 year.
 2031         Section 77. Paragraph (c) of subsection (7), paragraph (c)
 2032  of subsection (8), and paragraph (c) of subsection (9) of
 2033  section 491.003, Florida Statutes, are amended to read:
 2034         491.003 Definitions.—As used in this chapter:
 2035         (7) The “practice of clinical social work” is defined as
 2036  the use of scientific and applied knowledge, theories, and
 2037  methods for the purpose of describing, preventing, evaluating,
 2038  and treating individual, couple, marital, family, or group
 2039  behavior, based on the person-in-situation perspective of
 2040  psychosocial development, normal and abnormal behavior,
 2041  psychopathology, unconscious motivation, interpersonal
 2042  relationships, environmental stress, differential assessment,
 2043  differential planning, and data gathering. The purpose of such
 2044  services is the prevention and treatment of undesired behavior
 2045  and enhancement of mental health. The practice of clinical
 2046  social work includes methods of a psychological nature used to
 2047  evaluate, assess, diagnose, treat, and prevent emotional and
 2048  mental disorders and dysfunctions (whether cognitive, affective,
 2049  or behavioral), sexual dysfunction, behavioral disorders,
 2050  alcoholism, and substance abuse. The practice of clinical social
 2051  work includes, but is not limited to, psychotherapy,
 2052  hypnotherapy, and sex therapy. The practice of clinical social
 2053  work also includes counseling, behavior modification,
 2054  consultation, client-centered advocacy, crisis intervention, and
 2055  the provision of needed information and education to clients,
 2056  when using methods of a psychological nature to evaluate,
 2057  assess, diagnose, treat, and prevent emotional and mental
 2058  disorders and dysfunctions (whether cognitive, affective, or
 2059  behavioral), sexual dysfunction, behavioral disorders,
 2060  alcoholism, or substance abuse. The practice of clinical social
 2061  work may also include clinical research into more effective
 2062  psychotherapeutic modalities for the treatment and prevention of
 2063  such conditions.
 2064         (c) The terms “diagnose” and “treat,” as used in this
 2065  chapter, when considered in isolation or in conjunction with any
 2066  provision of the rules of the board, shall not be construed to
 2067  permit the performance of any act which clinical social workers
 2068  are not educated and trained to perform, including, but not
 2069  limited to, admitting persons to hospitals for treatment of the
 2070  foregoing conditions, treating persons in hospitals without
 2071  medical supervision, prescribing medicinal drugs as defined in
 2072  chapter 465, authorizing clinical laboratory procedures pursuant
 2073  to chapter 483, or radiological procedures, or use of
 2074  electroconvulsive therapy. In addition, this definition shall
 2075  not be construed to permit any person licensed, provisionally
 2076  licensed, registered, or certified pursuant to this chapter to
 2077  describe or label any test, report, or procedure as
 2078  “psychological,” except to relate specifically to the definition
 2079  of practice authorized in this subsection.
 2080         (8) The “practice of marriage and family therapy” is
 2081  defined as the use of scientific and applied marriage and family
 2082  theories, methods, and procedures for the purpose of describing,
 2083  evaluating, and modifying marital, family, and individual
 2084  behavior, within the context of marital and family systems,
 2085  including the context of marital formation and dissolution, and
 2086  is based on marriage and family systems theory, marriage and
 2087  family development, human development, normal and abnormal
 2088  behavior, psychopathology, human sexuality, psychotherapeutic
 2089  and marriage and family therapy theories and techniques. The
 2090  practice of marriage and family therapy includes methods of a
 2091  psychological nature used to evaluate, assess, diagnose, treat,
 2092  and prevent emotional and mental disorders or dysfunctions
 2093  (whether cognitive, affective, or behavioral), sexual
 2094  dysfunction, behavioral disorders, alcoholism, and substance
 2095  abuse. The practice of marriage and family therapy includes, but
 2096  is not limited to, marriage and family therapy, psychotherapy,
 2097  including behavioral family therapy, hypnotherapy, and sex
 2098  therapy. The practice of marriage and family therapy also
 2099  includes counseling, behavior modification, consultation,
 2100  client-centered advocacy, crisis intervention, and the provision
 2101  of needed information and education to clients, when using
 2102  methods of a psychological nature to evaluate, assess, diagnose,
 2103  treat, and prevent emotional and mental disorders and
 2104  dysfunctions (whether cognitive, affective, or behavioral),
 2105  sexual dysfunction, behavioral disorders, alcoholism, or
 2106  substance abuse. The practice of marriage and family therapy may
 2107  also include clinical research into more effective
 2108  psychotherapeutic modalities for the treatment and prevention of
 2109  such conditions.
 2110         (c) The terms “diagnose” and “treat,” as used in this
 2111  chapter, when considered in isolation or in conjunction with any
 2112  provision of the rules of the board, shall not be construed to
 2113  permit the performance of any act which marriage and family
 2114  therapists are not educated and trained to perform, including,
 2115  but not limited to, admitting persons to hospitals for treatment
 2116  of the foregoing conditions, treating persons in hospitals
 2117  without medical supervision, prescribing medicinal drugs as
 2118  defined in chapter 465, authorizing clinical laboratory
 2119  procedures pursuant to chapter 483, or radiological procedures,
 2120  or use of electroconvulsive therapy. In addition, this
 2121  definition shall not be construed to permit any person licensed,
 2122  provisionally licensed, registered, or certified pursuant to
 2123  this chapter to describe or label any test, report, or procedure
 2124  as “psychological,” except to relate specifically to the
 2125  definition of practice authorized in this subsection.
 2126         (9) The “practice of mental health counseling” is defined
 2127  as the use of scientific and applied behavioral science
 2128  theories, methods, and techniques for the purpose of describing,
 2129  preventing, and treating undesired behavior and enhancing mental
 2130  health and human development and is based on the person-in
 2131  situation perspectives derived from research and theory in
 2132  personality, family, group, and organizational dynamics and
 2133  development, career planning, cultural diversity, human growth
 2134  and development, human sexuality, normal and abnormal behavior,
 2135  psychopathology, psychotherapy, and rehabilitation. The practice
 2136  of mental health counseling includes methods of a psychological
 2137  nature used to evaluate, assess, diagnose, and treat emotional
 2138  and mental dysfunctions or disorders (whether cognitive,
 2139  affective, or behavioral), behavioral disorders, interpersonal
 2140  relationships, sexual dysfunction, alcoholism, and substance
 2141  abuse. The practice of mental health counseling includes, but is
 2142  not limited to, psychotherapy, hypnotherapy, and sex therapy.
 2143  The practice of mental health counseling also includes
 2144  counseling, behavior modification, consultation, client-centered
 2145  advocacy, crisis intervention, and the provision of needed
 2146  information and education to clients, when using methods of a
 2147  psychological nature to evaluate, assess, diagnose, treat, and
 2148  prevent emotional and mental disorders and dysfunctions (whether
 2149  cognitive, affective, or behavioral), behavioral disorders,
 2150  sexual dysfunction, alcoholism, or substance abuse. The practice
 2151  of mental health counseling may also include clinical research
 2152  into more effective psychotherapeutic modalities for the
 2153  treatment and prevention of such conditions.
 2154         (c) The terms “diagnose” and “treat,” as used in this
 2155  chapter, when considered in isolation or in conjunction with any
 2156  provision of the rules of the board, shall not be construed to
 2157  permit the performance of any act which mental health counselors
 2158  are not educated and trained to perform, including, but not
 2159  limited to, admitting persons to hospitals for treatment of the
 2160  foregoing conditions, treating persons in hospitals without
 2161  medical supervision, prescribing medicinal drugs as defined in
 2162  chapter 465, authorizing clinical laboratory procedures pursuant
 2163  to chapter 483, or radiological procedures, or use of
 2164  electroconvulsive therapy. In addition, this definition shall
 2165  not be construed to permit any person licensed, provisionally
 2166  licensed, registered, or certified pursuant to this chapter to
 2167  describe or label any test, report, or procedure as
 2168  “psychological,” except to relate specifically to the definition
 2169  of practice authorized in this subsection.
 2170         Section 78. Paragraph (h) of subsection (4) of section
 2171  627.351, Florida Statutes, is amended to read:
 2172         627.351 Insurance risk apportionment plans.—
 2173         (4) MEDICAL MALPRACTICE RISK APPORTIONMENT.—
 2174         (h) As used in this subsection:
 2175         1. “Health care provider” means hospitals licensed under
 2176  chapter 395; physicians licensed under chapter 458; osteopathic
 2177  physicians licensed under chapter 459; podiatric physicians
 2178  licensed under chapter 461; dentists licensed under chapter 466;
 2179  chiropractic physicians licensed under chapter 460; naturopaths
 2180  licensed under chapter 462; nurses licensed under part I of
 2181  chapter 464; midwives licensed under chapter 467; clinical
 2182  laboratories registered under chapter 483; physician assistants
 2183  licensed under chapter 458 or chapter 459; physical therapists
 2184  and physical therapist assistants licensed under chapter 486;
 2185  health maintenance organizations certificated under part I of
 2186  chapter 641; ambulatory surgical centers licensed under chapter
 2187  395; other medical facilities as defined in subparagraph 2.;
 2188  blood banks, plasma centers, industrial clinics, and renal
 2189  dialysis facilities; or professional associations, partnerships,
 2190  corporations, joint ventures, or other associations for
 2191  professional activity by health care providers.
 2192         2. “Other medical facility” means a facility the primary
 2193  purpose of which is to provide human medical diagnostic services
 2194  or a facility providing nonsurgical human medical treatment, to
 2195  which facility the patient is admitted and from which facility
 2196  the patient is discharged within the same working day, and which
 2197  facility is not part of a hospital. However, a facility existing
 2198  for the primary purpose of performing terminations of pregnancy
 2199  or an office maintained by a physician or dentist for the
 2200  practice of medicine shall not be construed to be an “other
 2201  medical facility.”
 2202         3. “Health care facility” means any hospital licensed under
 2203  chapter 395, health maintenance organization certificated under
 2204  part I of chapter 641, ambulatory surgical center licensed under
 2205  chapter 395, or other medical facility as defined in
 2206  subparagraph 2.
 2207         Section 79. Paragraph (h) of subsection (1) of section
 2208  627.602, Florida Statutes, is amended to read:
 2209         627.602 Scope, format of policy.—
 2210         (1) Each health insurance policy delivered or issued for
 2211  delivery to any person in this state must comply with all
 2212  applicable provisions of this code and all of the following
 2213  requirements:
 2214         (h) Section 641.312 and the provisions of the Employee
 2215  Retirement Income Security Act of 1974, as implemented by 29
 2216  C.F.R. s. 2560.503-1, relating to internal grievances. This
 2217  paragraph does not apply to a health insurance policy that is
 2218  subject to the Subscriber Assistance Program under s. 408.7056
 2219  or to the types of benefits or coverages provided under s.
 2220  627.6513(1)-(14) issued in any market.
 2221         Section 80. Paragraphs (b) and (e) of subsection (1) of
 2222  section 627.64194, Florida Statutes, are amended to read:
 2223         627.64194 Coverage requirements for services provided by
 2224  nonparticipating providers; payment collection limitations.—
 2225         (1) As used in this section, the term:
 2226         (b) “Facility” means a licensed facility as defined in s.
 2227  395.002(16) and an urgent care center as defined in s.
 2228  395.002(29) s. 395.002(30).
 2229         (e) “Nonparticipating provider” means a provider who is not
 2230  a preferred provider as defined in s. 627.6471 or a provider who
 2231  is not an exclusive provider as defined in s. 627.6472. For
 2232  purposes of covered emergency services under this section, a
 2233  facility licensed under chapter 395 or an urgent care center
 2234  defined in s. 395.002(29) 395.002(30) is a nonparticipating
 2235  provider if the facility has not contracted with an insurer to
 2236  provide emergency services to its insureds at a specified rate.
 2237         Section 81. Section 627.6513, Florida Statutes, is amended
 2238  to read:
 2239         627.6513 Scope.—Section 641.312 and the provisions of the
 2240  Employee Retirement Income Security Act of 1974, as implemented
 2241  by 29 C.F.R. s. 2560.503-1, relating to internal grievances,
 2242  apply to all group health insurance policies issued under this
 2243  part. This section does not apply to a group health insurance
 2244  policy that is subject to the Subscriber Assistance Program in
 2245  s. 408.7056 or to:
 2246         (1) Coverage only for accident insurance, or disability
 2247  income insurance, or any combination thereof.
 2248         (2) Coverage issued as a supplement to liability insurance.
 2249         (3) Liability insurance, including general liability
 2250  insurance and automobile liability insurance.
 2251         (4) Workers’ compensation or similar insurance.
 2252         (5) Automobile medical payment insurance.
 2253         (6) Credit-only insurance.
 2254         (7) Coverage for onsite medical clinics, including prepaid
 2255  health clinics under part II of chapter 641.
 2256         (8) Other similar insurance coverage, specified in rules
 2257  adopted by the commission, under which benefits for medical care
 2258  are secondary or incidental to other insurance benefits. To the
 2259  extent possible, such rules must be consistent with regulations
 2260  adopted by the United States Department of Health and Human
 2261  Services.
 2262         (9) Limited scope dental or vision benefits, if offered
 2263  separately.
 2264         (10) Benefits for long-term care, nursing home care, home
 2265  health care, or community-based care, or any combination
 2266  thereof, if offered separately.
 2267         (11) Other similar, limited benefits, if offered
 2268  separately, as specified in rules adopted by the commission.
 2269         (12) Coverage only for a specified disease or illness, if
 2270  offered as independent, noncoordinated benefits.
 2271         (13) Hospital indemnity or other fixed indemnity insurance,
 2272  if offered as independent, noncoordinated benefits.
 2273         (14) Benefits provided through a Medicare supplemental
 2274  health insurance policy, as defined under s. 1882(g)(1) of the
 2275  Social Security Act, coverage supplemental to the coverage
 2276  provided under 10 U.S.C. chapter 55, and similar supplemental
 2277  coverage provided to coverage under a group health plan, which
 2278  are offered as a separate insurance policy and as independent,
 2279  noncoordinated benefits.
 2280         Section 82. Effective January 1, 2018, paragraph (j) of
 2281  subsection (1) of section 641.185, Florida Statutes, is amended
 2282  to read:
 2283         641.185 Health maintenance organization subscriber
 2284  protections.—
 2285         (1) With respect to the provisions of this part and part
 2286  III, the principles expressed in the following statements shall
 2287  serve as standards to be followed by the commission, the office,
 2288  the department, and the Agency for Health Care Administration in
 2289  exercising their powers and duties, in exercising administrative
 2290  discretion, in administrative interpretations of the law, in
 2291  enforcing its provisions, and in adopting rules:
 2292         (j)A health maintenance organization should receive timely
 2293  and, if necessary, urgent review by an independent state
 2294  external review organization for unresolved grievances and
 2295  appeals pursuant to s. 408.7056.
 2296         Section 83. Effective January 1, 2018, section 641.312,
 2297  Florida Statutes, is amended to read:
 2298         641.312 Scope.—The Office of Insurance Regulation may adopt
 2299  rules to administer the provisions of the National Association
 2300  of Insurance Commissioners’ Uniform Health Carrier External
 2301  Review Model Act, issued by the National Association of
 2302  Insurance Commissioners and dated April 2010. This section does
 2303  not apply to a health maintenance contract that is subject to
 2304  the Subscriber Assistance Program under s. 408.7056 or to the
 2305  types of benefits or coverages provided under s. 627.6513(1)
 2306  (14) issued in any market.
 2307         Section 84. Effective January 1, 2018, subsection (4) of
 2308  section 641.3154, Florida Statutes, is amended to read:
 2309         641.3154 Organization liability; provider billing
 2310  prohibited.—
 2311         (4) A provider or any representative of a provider,
 2312  regardless of whether the provider is under contract with the
 2313  health maintenance organization, may not collect or attempt to
 2314  collect money from, maintain any action at law against, or
 2315  report to a credit agency a subscriber of an organization for
 2316  payment of services for which the organization is liable, if the
 2317  provider in good faith knows or should know that the
 2318  organization is liable. This prohibition applies during the
 2319  pendency of any claim for payment made by the provider to the
 2320  organization for payment of the services and any legal
 2321  proceedings or dispute resolution process to determine whether
 2322  the organization is liable for the services if the provider is
 2323  informed that such proceedings are taking place. It is presumed
 2324  that a provider does not know and should not know that an
 2325  organization is liable unless:
 2326         (a) The provider is informed by the organization that it
 2327  accepts liability;
 2328         (b) A court of competent jurisdiction determines that the
 2329  organization is liable; or
 2330         (c)The office or agency makes a final determination that
 2331  the organization is required to pay for such services subsequent
 2332  to a recommendation made by the Subscriber Assistance Panel
 2333  pursuant to s. 408.7056; or
 2334         (c)(d) The agency issues a final order that the
 2335  organization is required to pay for such services subsequent to
 2336  a recommendation made by a resolution organization pursuant to
 2337  s. 408.7057.
 2338         Section 85. Effective January 1, 2018, paragraph (c) of
 2339  subsection (5) of section 641.51, Florida Statutes, is amended
 2340  to read:
 2341         641.51 Quality assurance program; second medical opinion
 2342  requirement.—
 2343         (5)
 2344         (c) For second opinions provided by contract physicians the
 2345  organization is prohibited from charging a fee to the subscriber
 2346  in an amount in excess of the subscriber fees established by
 2347  contract for referral contract physicians. The organization
 2348  shall pay the amount of all charges, which are usual,
 2349  reasonable, and customary in the community, for second opinion
 2350  services performed by a physician not under contract with the
 2351  organization, but may require the subscriber to be responsible
 2352  for up to 40 percent of such amount. The organization may
 2353  require that any tests deemed necessary by a noncontract
 2354  physician shall be conducted by the organization. The
 2355  organization may deny reimbursement rights granted under this
 2356  section in the event the subscriber seeks in excess of three
 2357  such referrals per year if such subsequent referral costs are
 2358  deemed by the organization to be evidence that the subscriber
 2359  has unreasonably overutilized the second opinion privilege. A
 2360  subscriber thus denied reimbursement under this section shall
 2361  have recourse to grievance procedures as specified in ss.
 2362  408.7056, 641.495, and 641.511. The organization’s physician’s
 2363  professional judgment concerning the treatment of a subscriber
 2364  derived after review of a second opinion shall be controlling as
 2365  to the treatment obligations of the health maintenance
 2366  organization. Treatment not authorized by the health maintenance
 2367  organization shall be at the subscriber’s expense.
 2368         Section 86. Effective January 1, 2018, section 641.511,
 2369  Florida Statutes, is amended to read:
 2370         641.511 Subscriber grievance reporting and resolution
 2371  requirements.—
 2372         (1) Every organization must have a grievance procedure
 2373  available to its subscribers for the purpose of addressing
 2374  complaints and grievances. Every organization must notify its
 2375  subscribers that a subscriber must submit a grievance within 1
 2376  year after the date of occurrence of the action that initiated
 2377  the grievance, and may submit the grievance for review to the
 2378  Subscriber Assistance Program panel as provided in s. 408.7056
 2379  after receiving a final disposition of the grievance through the
 2380  organization’s grievance process. An organization shall maintain
 2381  records of all grievances and shall report annually to the
 2382  agency the total number of grievances handled, a categorization
 2383  of the cases underlying the grievances, and the final
 2384  disposition of the grievances.
 2385         (2) When an organization receives an initial complaint from
 2386  a subscriber, the organization must respond to the complaint
 2387  within a reasonable time after its submission. At the time of
 2388  receipt of the initial complaint, the organization shall inform
 2389  the subscriber that the subscriber has a right to file a written
 2390  grievance at any time and that assistance in preparing the
 2391  written grievance shall be provided by the organization.
 2392         (3) Each organization’s grievance procedure, as required
 2393  under subsection (1), must include, at a minimum:
 2394         (a) An explanation of how to pursue redress of a grievance.
 2395         (b) The names of the appropriate employees or a list of
 2396  grievance departments that are responsible for implementing the
 2397  organization’s grievance procedure. The list must include the
 2398  address and the toll-free telephone number of each grievance
 2399  department, the address of the agency and its toll-free
 2400  telephone hotline number, and the address of the Subscriber
 2401  Assistance Program and its toll-free telephone number.
 2402         (c) The description of the process through which a
 2403  subscriber may, at any time, contact the toll-free telephone
 2404  hotline of the agency to inform it of the unresolved grievance.
 2405         (d) A procedure for establishing methods for classifying
 2406  grievances as urgent and for establishing time limits for an
 2407  expedited review within which such grievances must be resolved.
 2408         (e) A notice that a subscriber may voluntarily pursue
 2409  binding arbitration in accordance with the terms of the contract
 2410  if offered by the organization, after completing the
 2411  organization’s grievance procedure and as an alternative to the
 2412  Subscriber Assistance Program. Such notice shall include an
 2413  explanation that the subscriber may incur some costs if the
 2414  subscriber pursues binding arbitration, depending upon the terms
 2415  of the subscriber’s contract.
 2416         (f) A process whereby the grievance manager acknowledges
 2417  the grievance and investigates the grievance in order to notify
 2418  the subscriber of a final decision in writing.
 2419         (g) A procedure for providing individuals who are unable to
 2420  submit a written grievance with access to the grievance process,
 2421  which shall include assistance by the organization in preparing
 2422  the grievance and communicating back to the subscriber.
 2423         (4)(a) With respect to a grievance concerning an adverse
 2424  determination, an organization shall make available to the
 2425  subscriber a review of the grievance by an internal review
 2426  panel; such review must be requested within 30 days after the
 2427  organization’s transmittal of the final determination notice of
 2428  an adverse determination. A majority of the panel shall be
 2429  persons who previously were not involved in the initial adverse
 2430  determination. A person who previously was involved in the
 2431  adverse determination may appear before the panel to present
 2432  information or answer questions. The panel shall have the
 2433  authority to bind the organization to the panel’s decision.
 2434         (b) An organization shall ensure that a majority of the
 2435  persons reviewing a grievance involving an adverse determination
 2436  are providers who have appropriate expertise. An organization
 2437  shall issue a copy of the written decision of the review panel
 2438  to the subscriber and to the provider, if any, who submits a
 2439  grievance on behalf of a subscriber. In cases where there has
 2440  been a denial of coverage of service, the reviewing provider
 2441  shall not be a provider previously involved with the adverse
 2442  determination.
 2443         (c) An organization shall establish written procedures for
 2444  a review of an adverse determination. Review procedures shall be
 2445  available to the subscriber and to a provider acting on behalf
 2446  of a subscriber.
 2447         (d)In any case when the review process does not resolve a
 2448  difference of opinion between the organization and the
 2449  subscriber or the provider acting on behalf of the subscriber,
 2450  the subscriber or the provider acting on behalf of the
 2451  subscriber may submit a written grievance to the Subscriber
 2452  Assistance Program.
 2453         (5) Except as provided in subsection (6), the organization
 2454  shall resolve a grievance within 60 days after receipt of the
 2455  grievance, or within a maximum of 90 days if the grievance
 2456  involves the collection of information outside the service area.
 2457  These time limitations are tolled if the organization has
 2458  notified the subscriber, in writing, that additional information
 2459  is required for proper review of the grievance and that such
 2460  time limitations are tolled until such information is provided.
 2461  After the organization receives the requested information, the
 2462  time allowed for completion of the grievance process resumes.
 2463  The Employee Retirement Income Security Act of 1974, as
 2464  implemented by 29 C.F.R. s. 2560.503-1, is adopted and
 2465  incorporated by reference as applicable to all organizations
 2466  that administer small and large group health plans that are
 2467  subject to 29 C.F.R. s. 2560.503-1. The claims procedures of the
 2468  regulations of the Employee Retirement Income Security Act of
 2469  1974, as implemented by 29 C.F.R. s. 2560.503-1, shall be the
 2470  minimum standards for grievance processes for claims for
 2471  benefits for small and large group health plans that are subject
 2472  to 29 C.F.R. s. 2560.503-1.
 2473         (6)(a) An organization shall establish written procedures
 2474  for the expedited review of an urgent grievance. A request for
 2475  an expedited review may be submitted orally or in writing and
 2476  shall be subject to the review procedures of this section, if it
 2477  meets the criteria of this section. Unless it is submitted in
 2478  writing, for purposes of the grievance reporting requirements in
 2479  subsection (1), the request shall be considered an appeal of a
 2480  utilization review decision and not a grievance. Expedited
 2481  review procedures shall be available to a subscriber and to the
 2482  provider acting on behalf of a subscriber. For purposes of this
 2483  subsection, “subscriber” includes the legal representative of a
 2484  subscriber.
 2485         (b) Expedited reviews shall be evaluated by an appropriate
 2486  clinical peer or peers. The clinical peer or peers shall not
 2487  have been involved in the initial adverse determination.
 2488         (c) In an expedited review, all necessary information,
 2489  including the organization’s decision, shall be transmitted
 2490  between the organization and the subscriber, or the provider
 2491  acting on behalf of the subscriber, by telephone, facsimile, or
 2492  the most expeditious method available.
 2493         (d) In an expedited review, an organization shall make a
 2494  decision and notify the subscriber, or the provider acting on
 2495  behalf of the subscriber, as expeditiously as the subscriber’s
 2496  medical condition requires, but in no event more than 72 hours
 2497  after receipt of the request for review. If the expedited review
 2498  is a concurrent review determination, the service shall be
 2499  continued without liability to the subscriber until the
 2500  subscriber has been notified of the determination.
 2501         (e) An organization shall provide written confirmation of
 2502  its decision concerning an expedited review within 2 working
 2503  days after providing notification of that decision, if the
 2504  initial notification was not in writing.
 2505         (f) An organization shall provide reasonable access, not to
 2506  exceed 24 hours after receiving a request for an expedited
 2507  review, to a clinical peer who can perform the expedited review.
 2508         (g)In any case when the expedited review process does not
 2509  resolve a difference of opinion between the organization and the
 2510  subscriber or the provider acting on behalf of the subscriber,
 2511  the subscriber or the provider acting on behalf of the
 2512  subscriber may submit a written grievance to the Subscriber
 2513  Assistance Program.
 2514         (g)(h) An organization shall not provide an expedited
 2515  retrospective review of an adverse determination.
 2516         (7)Each organization shall send to the agency a copy of
 2517  its quarterly grievance reports submitted to the office pursuant
 2518  to s. 408.7056(12).
 2519         (7)(8) The agency shall investigate all reports of
 2520  unresolved quality of care grievances received from:
 2521         (a) annual and quarterly grievance reports submitted by the
 2522  organization to the office.
 2523         (b)Review requests of subscribers whose grievances remain
 2524  unresolved after the subscriber has followed the full grievance
 2525  procedure of the organization.
 2526         (9)(a)The agency shall advise subscribers with grievances
 2527  to follow their organization’s formal grievance process for
 2528  resolution prior to review by the Subscriber Assistance Program.
 2529  The subscriber may, however, submit a copy of the grievance to
 2530  the agency at any time during the process.
 2531         (b)Requiring completion of the organization’s grievance
 2532  process before the Subscriber Assistance Program panel’s review
 2533  does not preclude the agency from investigating any complaint or
 2534  grievance before the organization makes its final determination.
 2535         (10)Each organization must notify the subscriber in a
 2536  final decision letter that the subscriber may request review of
 2537  the organization’s decision concerning the grievance by the
 2538  Subscriber Assistance Program, as provided in s. 408.7056, if
 2539  the grievance is not resolved to the satisfaction of the
 2540  subscriber. The final decision letter must inform the subscriber
 2541  that the request for review must be made within 365 days after
 2542  receipt of the final decision letter, must explain how to
 2543  initiate such a review, and must include the addresses and toll
 2544  free telephone numbers of the agency and the Subscriber
 2545  Assistance Program.
 2546         (8)(11) Each organization, as part of its contract with any
 2547  provider, must require the provider to post a consumer
 2548  assistance notice prominently displayed in the reception area of
 2549  the provider and clearly noticeable by all patients. The
 2550  consumer assistance notice must state the addresses and toll
 2551  free telephone numbers of the Agency for Health Care
 2552  Administration, the Subscriber Assistance Program, and the
 2553  Department of Financial Services. The consumer assistance notice
 2554  must also clearly state that the address and toll-free telephone
 2555  number of the organization’s grievance department shall be
 2556  provided upon request. The agency may adopt rules to implement
 2557  this section.
 2558         (9)(12) The agency may impose administrative sanction, in
 2559  accordance with s. 641.52, against an organization for
 2560  noncompliance with this section.
 2561         Section 87. Effective January 1, 2018, subsection (1) of
 2562  section 641.515, Florida Statutes, is amended to read:
 2563         641.515 Investigation by the agency.—
 2564         (1) The agency shall investigate further any quality of
 2565  care issue contained in recommendations and reports submitted
 2566  pursuant to ss. 408.7056 and s. 641.511. The agency shall also
 2567  investigate further any information that indicates that the
 2568  organization does not meet accreditation standards or the
 2569  standards of the review organization performing the external
 2570  quality assurance assessment pursuant to reports submitted under
 2571  s. 641.512. Every organization shall submit its books and
 2572  records and take other appropriate action as may be necessary to
 2573  facilitate an examination. The agency shall have access to the
 2574  organization’s medical records of individuals and records of
 2575  employed and contracted physicians, with the consent of the
 2576  subscriber or by court order, as necessary to carry out the
 2577  provisions of this part.
 2578         Section 88. Effective January 1, 2018, subsection (2) of
 2579  section 641.55, Florida Statutes, is amended to read:
 2580         641.55 Internal risk management program.—
 2581         (2) The risk management program shall be the responsibility
 2582  of the governing authority or board of the organization. Every
 2583  organization which has an annual premium volume of $10 million
 2584  or more and which directly provides health care in a building
 2585  owned or leased by the organization shall hire a risk manager,
 2586  certified under ss. 395.10971-395.10975, who shall be
 2587  responsible for implementation of the organization’s risk
 2588  management program required by this section. A part-time risk
 2589  manager shall not be responsible for risk management programs in
 2590  more than four organizations or facilities. Every organization
 2591  which does not directly provide health care in a building owned
 2592  or leased by the organization and every organization with an
 2593  annual premium volume of less than $10 million shall designate
 2594  an officer or employee of the organization to serve as the risk
 2595  manager.
 2596  
 2597  The gross data compiled under this section or s. 395.0197 shall
 2598  be furnished by the agency upon request to organizations to be
 2599  utilized for risk management purposes. The agency shall adopt
 2600  rules necessary to carry out the provisions of this section.
 2601         Section 89. Section 641.60, Florida Statutes, is repealed.
 2602         Section 90. Section 641.70, Florida Statutes, is amended to
 2603  read:
 2604         641.70 Agency duties relating to the Statewide Managed Care
 2605  Ombudsman Committee and the district managed care ombudsman
 2606  committees.—
 2607         (1) The agency shall adopt rules that specify:
 2608         (a) Procedures by which the statewide committee and
 2609  district committees receive reports of enrollee complaints from
 2610  the agency.
 2611         (b) Procedures by which enrollee information shall be made
 2612  available to members of the statewide committee and to the
 2613  district committees.
 2614         (c) Procedures by which recommendations made by the
 2615  committees shall be considered for incorporation into policies
 2616  and procedures of the agency.
 2617         (d)Procedures by which statewide committee members shall
 2618  be reimbursed for authorized expenditures.
 2619         (d)(e) Any other procedures that are necessary to
 2620  administer this section and ss. 641.60 and s. 641.65.
 2621         (2) The Agency for Health Care Administration shall provide
 2622  a meeting place for district committees in agency offices and
 2623  shall provide the necessary administrative support to assist the
 2624  statewide committee and district committees, within available
 2625  resources.
 2626         (3) The secretary of the agency shall ensure the full
 2627  cooperation and assistance of agency employees with members of
 2628  the statewide committee and district committees.
 2629         Section 91. Subsection (3) of section 641.75, Florida
 2630  Statutes, is amended to read:
 2631         641.75 Immunity from liability; limitation on testimony.—
 2632         (3) Members of any state or district ombudsman committee
 2633  shall not be required to testify in any court with respect to
 2634  matters held to be confidential except as may be necessary to
 2635  enforce ss. 641.61-641.75 641.60-641.75.
 2636         Section 92. Paragraph (b) of subsection (6) of section
 2637  766.118, Florida Statutes, is amended to read:
 2638         766.118 Determination of noneconomic damages.—
 2639         (6) LIMITATION ON NONECONOMIC DAMAGES FOR NEGLIGENCE OF A
 2640  PRACTITIONER PROVIDING SERVICES AND CARE TO A MEDICAID
 2641  RECIPIENT.—Notwithstanding subsections (2), (3), and (5), with
 2642  respect to a cause of action for personal injury or wrongful
 2643  death arising from medical negligence of a practitioner
 2644  committed in the course of providing medical services and
 2645  medical care to a Medicaid recipient, regardless of the number
 2646  of such practitioner defendants providing the services and care,
 2647  noneconomic damages may not exceed $300,000 per claimant, unless
 2648  the claimant pleads and proves, by clear and convincing
 2649  evidence, that the practitioner acted in a wrongful manner. A
 2650  practitioner providing medical services and medical care to a
 2651  Medicaid recipient is not liable for more than $200,000 in
 2652  noneconomic damages, regardless of the number of claimants,
 2653  unless the claimant pleads and proves, by clear and convincing
 2654  evidence, that the practitioner acted in a wrongful manner. The
 2655  fact that a claimant proves that a practitioner acted in a
 2656  wrongful manner does not preclude the application of the
 2657  limitation on noneconomic damages prescribed elsewhere in this
 2658  section. For purposes of this subsection:
 2659         (b) The term “practitioner,” in addition to the meaning
 2660  prescribed in subsection (1), includes any hospital or,
 2661  ambulatory surgical center, or mobile surgical facility as
 2662  defined and licensed under chapter 395.
 2663         Section 93. Subsection (4) of section 766.202, Florida
 2664  Statutes, is amended to read:
 2665         766.202 Definitions; ss. 766.201-766.212.—As used in ss.
 2666  766.201-766.212, the term:
 2667         (4) “Health care provider” means any hospital or,
 2668  ambulatory surgical center, or mobile surgical facility as
 2669  defined and licensed under chapter 395; a birth center licensed
 2670  under chapter 383; any person licensed under chapter 458,
 2671  chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
 2672  part I of chapter 464, chapter 466, chapter 467, part XIV of
 2673  chapter 468, or chapter 486; a clinical lab licensed under
 2674  chapter 483; a health maintenance organization certificated
 2675  under part I of chapter 641; a blood bank; a plasma center; an
 2676  industrial clinic; a renal dialysis facility; or a professional
 2677  association partnership, corporation, joint venture, or other
 2678  association for professional activity by health care providers.
 2679         Section 94. Subsection (1) of section 945.36, Florida
 2680  Statutes, is amended to read:
 2681         945.36 Exemption from health testing regulations for Law
 2682  enforcement personnel authorized to conduct conducting drug
 2683  tests on inmates and releasees.—
 2684         (1) Any law enforcement officer, state or county probation
 2685  officer, or employee of the Department of Corrections, who is
 2686  certified by the Department of Corrections pursuant to
 2687  subsection (2), may administer is exempt from part I of chapter
 2688  483, for the limited purpose of administering a urine screen
 2689  drug test to:
 2690         (a) Persons during incarceration;
 2691         (b) Persons released as a condition of probation for either
 2692  a felony or misdemeanor;
 2693         (c) Persons released as a condition of community control;
 2694         (d) Persons released as a condition of conditional release;
 2695         (e) Persons released as a condition of parole;
 2696         (f) Persons released as a condition of provisional release;
 2697         (g) Persons released as a condition of pretrial release; or
 2698         (h) Persons released as a condition of control release.
 2699         Section 95. Paragraph (b) of subsection (2) of section
 2700  1009.65, Florida Statutes, is amended to read:
 2701         1009.65 Medical Education Reimbursement and Loan Repayment
 2702  Program.—
 2703         (2) From the funds available, the Department of Health
 2704  shall make payments to selected medical professionals as
 2705  follows:
 2706         (b) All payments shall be contingent on continued proof of
 2707  primary care practice in an area defined in s. 395.602(2)(b)
 2708  395.602(2)(e), or an underserved area designated by the
 2709  Department of Health, provided the practitioner accepts Medicaid
 2710  reimbursement if eligible for such reimbursement. Correctional
 2711  facilities, state hospitals, and other state institutions that
 2712  employ medical personnel shall be designated by the Department
 2713  of Health as underserved locations. Locations with high
 2714  incidences of infant mortality, high morbidity, or low Medicaid
 2715  participation by health care professionals may be designated as
 2716  underserved.
 2717         Section 96. Except as otherwise expressly provided in this
 2718  act, this act shall take effect July 1, 2017.