Florida Senate - 2019                        COMMITTEE AMENDMENT
       Bill No. PCS (192902) for SB 7078
       
       
       
       
       
       
                                Ì520116rÎ520116                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/19/2019           .                                
                                       .                                
                                       .                                
                                       .                                
       —————————————————————————————————————————————————————————————————




       —————————————————————————————————————————————————————————————————
       The Committee on Appropriations (Harrell) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsection (3) is added to section 395.1012,
    6  Florida Statutes, to read:
    7         395.1012 Patient safety.—
    8         (3)(a)Each hospital shall provide to any patient upon
    9  admission, upon scheduling of nonemergency care, or before
   10  treatment, written information on a form created by the agency
   11  that contains the following information available for the
   12  hospital for the most recent year and the statewide average for
   13  all hospitals related to the following quality measures:
   14         1.The rate of hospital-acquired infections;
   15         2.The overall rating of the Hospital Consumer Assessment
   16  of Healthcare Providers and Systems survey; and
   17         3.The 15-day readmission rate.
   18         (b)A hospital shall also provide to any person, upon
   19  request, the written information specified in paragraph (a).
   20         (c)The information required by this subsection must be
   21  presented in a manner that is easily understandable and
   22  accessible to the patient and must also include an explanation
   23  of the quality measures and the relationship between patient
   24  safety and the hospital’s data for the quality measures.
   25         Section 2. Section 395.1052, Florida Statutes, is created
   26  to read:
   27         395.1052 Patient access to primary care and specialty
   28  providers; notification.—A hospital shall:
   29         (1) Notify each patient’s primary care provider, if any,
   30  within 24 hours after the patient’s admission to the hospital.
   31         (2) Inform the patient immediately upon admission that he
   32  or she may request to have the hospital’s treating physician
   33  consult with the patient’s primary care provider or specialist
   34  provider, if any, when developing the patient’s plan of care.
   35  Upon the patient’s request, the hospital’s treating physician
   36  shall make reasonable efforts to consult with the patient’s
   37  primary care provider or specialist provider when developing the
   38  patient’s plan of care.
   39         (3) Notify the patient’s primary care provider, if any, of
   40  the patient’s discharge from the hospital within 24 hours after
   41  the discharge.
   42         (4) Provide the discharge summary and any related
   43  information or records to the patient’s primary care provider,
   44  if any, within 14 days after the patient’s discharge from the
   45  hospital.
   46         Section 3.  Subsection (9) and present subsections
   47  (10),(11), and (12) of section 395.1055 ,Florida Statutes, are
   48  amended, and a new subsection (10) and subsections (13) and (14)
   49  are added to that section; to read:
   50         395.1055 Rules and enforcement.—
   51         (9) The agency shall establish a pediatric cardiac
   52  technical advisory panel, pursuant to s. 20.052, to develop
   53  procedures and standards for measuring outcomes of pediatric
   54  cardiac catheterization programs and pediatric cardiovascular
   55  surgery programs.
   56         (a) Members of the panel must have technical expertise in
   57  pediatric cardiac medicine, shall serve without compensation,
   58  and may not be reimbursed for per diem and travel expenses.
   59         (b) Voting members of the panel shall include: 3 at-large
   60  members, and 3 alternate at-large members with different program
   61  affiliations, including 1 cardiologist who is board certified in
   62  caring for adults with congenital heart disease and 2 board
   63  certified pediatric cardiologists, neither of whom may be
   64  employed by any of the hospitals specified in subparagraphs 1.
   65  10. or their affiliates, each of whom is appointed by the
   66  Secretary of Health Care Administration, and 10 members, and an
   67  alternate for each member, each of whom is a pediatric
   68  cardiologist or a pediatric cardiovascular surgeon, each
   69  appointed by the chief executive officer of the following
   70  hospitals:
   71         1. Johns Hopkins All Children’s Hospital in St. Petersburg.
   72         2. Arnold Palmer Hospital for Children in Orlando.
   73         3. Joe DiMaggio Children’s Hospital in Hollywood.
   74         4. Nicklaus Children’s Hospital in Miami.
   75         5. St. Joseph’s Children’s Hospital in Tampa.
   76         6. University of Florida Health Shands Hospital in
   77  Gainesville.
   78         7. University of Miami Holtz Children’s Hospital in Miami.
   79         8. Wolfson Children’s Hospital in Jacksonville.
   80         9. Florida Hospital for Children in Orlando.
   81         10. Nemours Children’s Hospital in Orlando.
   82  
   83  Appointments made under subparagraphs 1.-10. are contingent upon
   84  the hospital’s maintenance of pediatric certificates of need and
   85  the hospital’s compliance with this section and rules adopted
   86  thereunder, as determined by the Secretary of Health Care
   87  Administration. A member appointed under subparagraphs 1.-10.
   88  whose hospital fails to maintain such certificates or comply
   89  with standards may serve only as a nonvoting member until the
   90  hospital restores such certificates or complies with such
   91  standards. A voting member may serve a maximum of two 2-year
   92  terms and may be reappointed to the panel after being retired
   93  from the panel for a full 2-year term.
   94         (c) The Secretary of Health Care Administration may appoint
   95  nonvoting members to the panel. Nonvoting members may include:
   96         1. The Secretary of Health Care Administration.
   97         2. The Surgeon General.
   98         3. The Deputy Secretary of Children’s Medical Services.
   99         4. Any current or past Division Director of Children’s
  100  Medical Services.
  101         5. A parent of a child with congenital heart disease.
  102         6. An adult with congenital heart disease.
  103         7. A representative from each of the following
  104  organizations: the Florida Chapter of the American Academy of
  105  Pediatrics, the Florida Chapter of the American College of
  106  Cardiology, the Greater Southeast Affiliate of the American
  107  Heart Association, the Adult Congenital Heart Association, the
  108  March of Dimes, the Florida Association of Children’s Hospitals,
  109  and the Florida Society of Thoracic and Cardiovascular Surgeons.
  110         (d) The panel shall meet biannually, or more frequently
  111  upon the call of the Secretary of Health Care Administration.
  112  Such meetings may be conducted telephonically, or by other
  113  electronic means.
  114         (e) The duties of the panel include recommending to the
  115  agency standards for quality of care, personnel, physical plant,
  116  equipment, emergency transportation, and data reporting for
  117  hospitals that provide pediatric cardiac services.
  118         (f) Beginning on January 1, 2020, and annually thereafter,
  119  the panel shall submit a report to the Governor, the President
  120  of the Senate, the Speaker of the House of Representatives, the
  121  Secretary of Health Care Administration, and the State Surgeon
  122  General. The report must summarize the panel’s activities during
  123  the preceding fiscal year and include data and performance
  124  measures on surgical morbidity and mortality for all pediatric
  125  cardiac programs.
  126         (g) Panel members are agents of the state for purposes of
  127  s. 768.28 throughout the good faith performance of the duties
  128  assigned to them by the Secretary of Health Care Administration.
  129         (10) The Secretary of Health Care Administration shall
  130  consult the pediatric cardiac technical advisory panel for an
  131  advisory recommendation on all certificate of need applications
  132  to establish pediatric cardiac surgical centers.
  133         (11)(10) Based on the recommendations of the pediatric
  134  cardiac technical advisory panel in subsection (9), the agency
  135  shall adopt rules for pediatric cardiac programs which, at a
  136  minimum, include:
  137         (a) Standards for pediatric cardiac catheterization
  138  services and pediatric cardiovascular surgery including quality
  139  of care, personnel, physical plant, equipment, emergency
  140  transportation, data reporting, and appropriate operating hours
  141  and timeframes for mobilization for emergency procedures.
  142         (b) Outcome standards consistent with nationally
  143  established levels of performance in pediatric cardiac programs.
  144         (c) Specific steps to be taken by the agency and licensed
  145  facilities when the facilities do not meet the outcome standards
  146  within a specified time, including time required for detailed
  147  case reviews and the development and implementation of
  148  corrective action plans.
  149         (12)(11) A pediatric cardiac program shall:
  150         (a) Have a pediatric cardiology clinic affiliated with a
  151  hospital licensed under this chapter.
  152         (b) Have a pediatric cardiac catheterization laboratory and
  153  a pediatric cardiovascular surgical program located in the
  154  hospital.
  155         (c) Have a risk adjustment surgical procedure protocol
  156  following the guidelines established by the Society of Thoracic
  157  Surgeons.
  158         (d) Have quality assurance and quality improvement
  159  processes in place to enhance clinical operation and patient
  160  satisfaction with services.
  161         (e) Participate in the clinical outcome reporting systems
  162  operated by the Society of Thoracic Surgeons and the American
  163  College of Cardiology.
  164         (13)(a) The Secretary of Health Care Administration may
  165  request announced or unannounced site visits to any existing
  166  pediatric cardiac surgical center or facility seeking licensure
  167  as a pediatric cardiac surgical center through the certificate
  168  of need process, to ensure compliance with this section and
  169  rules adopted hereunder.
  170         (b) At the request of the Secretary of Health Care
  171  Administration, the pediatric cardiac technical advisory panel
  172  shall recommend in-state physician experts to conduct an on-site
  173  visit. The Secretary may also appoint up to two out-of-state
  174  physician experts.
  175         (c) A site visit team shall conduct an on-site inspection
  176  of the designated hospital’s pediatric medical and surgical
  177  programs, and each member shall submit a written report of his
  178  or her findings to the panel. The panel shall discuss the
  179  written reports and present an advisory opinion to the Secretary
  180  of Health Care Administration which includes recommendations and
  181  any suggested actions for correction.
  182         (d) Each on-site inspection must include all of the
  183  following:
  184         1. An inspection of the program’s physical facilities,
  185  clinics, and laboratories.
  186         2. Interviews with support staff and hospital
  187  administrators.
  188         3.A review of:
  189         a. Randomly selected medical records and reports,
  190  including, but not limited to, advanced cardiac imaging,
  191  computed tomography, magnetic resonance imaging, cardiac
  192  ultrasound, cardiac catheterization, and surgical operative
  193  notes.
  194         b.The program’s clinical outcome data submitted to the
  195  Society of Thoracic Surgeons and the American College of
  196  Cardiology pursuant to s. 408.05(3)(k).
  197         c.Mortality reports from cardiac-related deaths that
  198  occurred in the previous year.
  199         d. Program volume data from the preceding year for
  200  interventional and electrophysiology catheterizations and
  201  surgical procedures.
  202         (14) The Surgeon General shall provide quarterly reports to
  203  the Secretary of Health Care Administration consisting of data
  204  from the Children’s Medical Services critical congenital heart
  205  disease screening program for review by the advisory panel.
  206         (15)(12) The agency may adopt rules to administer the
  207  requirements of part II of chapter 408.
  208         Section 4. Subsection (3) of section 395.301, Florida
  209  Statutes, is amended to read:
  210         395.301 Price transparency; itemized patient statement or
  211  bill; patient admission status notification.—
  212         (3) If a licensed facility places a patient on observation
  213  status rather than inpatient status, the licensed facility must
  214  immediately notify the patient of such status using the form
  215  adopted under 42 C.F.R. s. 489.20 for Medicare patients or a
  216  form adopted by agency rule for non-Medicare patients. Such
  217  notification must observation services shall be documented in
  218  the patient’s medical records and discharge papers. The patient
  219  or the patient’s survivor or legal guardian must shall be
  220  notified of observation services through discharge papers, which
  221  may also include brochures, signage, or other forms of
  222  communication for this purpose.
  223         Section 5. Section 624.27, Florida Statutes, is amended to
  224  read:
  225         624.27 Direct health primary care agreements; exemption
  226  from code.—
  227         (1) As used in this section, the term:
  228         (a) “Direct health primary care agreement” means a contract
  229  between a health primary care provider and a patient, a
  230  patient’s legal representative, or a patient’s employer, which
  231  meets the requirements of subsection (4) and does not indemnify
  232  for services provided by a third party.
  233         (b) “Health Primary care provider” means a health care
  234  provider licensed under chapter 458, chapter 459, chapter 460,
  235  or chapter 464, or chapter 466, or a health primary care group
  236  practice, who provides health primary care services to patients.
  237         (c) “Health Primary care services” means the screening,
  238  assessment, diagnosis, and treatment of a patient conducted
  239  within the competency and training of the health primary care
  240  provider for the purpose of promoting health or detecting and
  241  managing disease or injury.
  242         (2) A direct health primary care agreement does not
  243  constitute insurance and is not subject to the Florida Insurance
  244  Code. The act of entering into a direct health primary care
  245  agreement does not constitute the business of insurance and is
  246  not subject to the Florida Insurance Code.
  247         (3) A health primary care provider or an agent of a health
  248  primary care provider is not required to obtain a certificate of
  249  authority or license under the Florida Insurance Code to market,
  250  sell, or offer to sell a direct health primary care agreement.
  251         (4) For purposes of this section, a direct health primary
  252  care agreement must:
  253         (a) Be in writing.
  254         (b) Be signed by the health primary care provider or an
  255  agent of the health primary care provider and the patient, the
  256  patient’s legal representative, or the patient’s employer.
  257         (c) Allow a party to terminate the agreement by giving the
  258  other party at least 30 days’ advance written notice. The
  259  agreement may provide for immediate termination due to a
  260  violation of the physician-patient relationship or a breach of
  261  the terms of the agreement.
  262         (d) Describe the scope of health primary care services that
  263  are covered by the monthly fee.
  264         (e) Specify the monthly fee and any fees for health primary
  265  care services not covered by the monthly fee.
  266         (f) Specify the duration of the agreement and any automatic
  267  renewal provisions.
  268         (g) Offer a refund to the patient, the patient’s legal
  269  representative, or the patient’s employer of monthly fees paid
  270  in advance if the health primary care provider ceases to offer
  271  health primary care services for any reason.
  272         (h) Contain, in contrasting color and in at least 12-point
  273  type, the following statement on the signature page: “This
  274  agreement is not health insurance and the health primary care
  275  provider will not file any claims against the patient’s health
  276  insurance policy or plan for reimbursement of any health primary
  277  care services covered by the agreement. This agreement does not
  278  qualify as minimum essential coverage to satisfy the individual
  279  shared responsibility provision of the Patient Protection and
  280  Affordable Care Act, 26 U.S.C. s. 5000A. This agreement is not
  281  workers’ compensation insurance and does not replace an
  282  employer’s obligations under chapter 440.”
  283         Section 6. Effective January 1, 2020, section 627.42393,
  284  Florida Statutes, is created to read:
  285         627.42393 Step-therapy protocol.—
  286         (1) A health insurer issuing a major medical individual or
  287  group policy may not require a step-therapy protocol under the
  288  policy for a covered prescription drug requested by an insured
  289  if:
  290         (a) The insured has previously been approved to receive the
  291  prescription drug through the completion of a step-therapy
  292  protocol required by a separate health coverage plan; and
  293         (b) The insured provides documentation originating from the
  294  health coverage plan that approved the prescription drug as
  295  described in paragraph (a) indicating that the health coverage
  296  plan paid for the drug on the insured’s behalf during the 90
  297  days immediately before the request.
  298         (2) As used in this section, the term “health coverage
  299  plan” means any of the following which is currently or was
  300  previously providing major medical or similar comprehensive
  301  coverage or benefits to the insured:
  302         (a) A health insurer or health maintenance organization.
  303         (b)A plan established or maintained by an individual
  304  employer as provided by the Employee Retirement Income Security
  305  Act of 1974, Pub. L. No. 93-406.
  306         (c) A multiple-employer welfare arrangement as defined in
  307  s. 624.437.
  308         (d) A governmental entity providing a plan of self
  309  insurance.
  310         (3) This section does not require a health insurer to add a
  311  drug to its prescription drug formulary or to cover a
  312  prescription drug that the insurer does not otherwise cover.
  313         Section 7. Effective January 1, 2020, subsection (45) is
  314  added to section 641.31, Florida Statutes, to read:
  315         641.31 Health maintenance contracts.—
  316         (45)(a) A health maintenance organization issuing major
  317  medical coverage through an individual or group contract may not
  318  require a step-therapy protocol under the contract for a covered
  319  prescription drug requested by a subscriber if:
  320         1. The subscriber has previously been approved to receive
  321  the prescription drug through the completion of a step-therapy
  322  protocol required by a separate health coverage plan; and
  323         2. The subscriber provides documentation originating from
  324  the health coverage plan that approved the prescription drug as
  325  described in subparagraph 1. indicating that the health coverage
  326  plan paid for the drug on the subscriber’s behalf during the 90
  327  days immediately before the request.
  328         (b) As used in this subsection, the term “health coverage
  329  plan” means any of the following which previously provided or is
  330  currently providing major medical or similar comprehensive
  331  coverage or benefits to the subscriber:
  332         1. A health insurer or health maintenance organization;
  333         2.A plan established or maintained by an individual
  334  employer as provided by the Employee Retirement Income Security
  335  Act of 1974, Pub. L. No. 93-406;
  336         3. A multiple-employer welfare arrangement as defined in s.
  337  624.437; or
  338         4. A governmental entity providing a plan of self
  339  insurance.
  340         (c) This subsection does not require a health maintenance
  341  organization to add a drug to its prescription drug formulary or
  342  to cover a prescription drug that the health maintenance
  343  organization does not otherwise cover.
  344         Section 8. The Office of Program Policy Analysis and
  345  Government Accountability shall research and analyze the
  346  Interstate Medical Licensure Compact and the relevant
  347  requirements and provisions of general law and the State
  348  Constitution and shall develop a report and recommendations
  349  addressing this state’s prospective entrance into the compact as
  350  a member state while remaining consistent with those
  351  requirements and provisions. In conducting such research and
  352  analysis, the office may consult with the executive director,
  353  other executive staff, or the executive committee of the
  354  Interstate Medical Licensure Compact Commission. The office
  355  shall submit the report and recommendations to the Governor, the
  356  President of the Senate, and the Speaker of the House of
  357  Representatives by not later than October 1, 2019.
  358         Section 9. Except as otherwise expressly provided in this
  359  act, this act shall take effect July 1, 2019.
  360  
  361  ================= T I T L E  A M E N D M E N T ================
  362  And the title is amended as follows:
  363         Delete everything before the enacting clause
  364  and insert:
  365                        A bill to be entitled                      
  366         An act relating to health care; amending s. 395.1012,
  367         F.S.; requiring a licensed hospital to provide
  368         specified information and data relating to patient
  369         safety and quality measures to a patient under certain
  370         circumstances or to any person upon request; creating
  371         s. 395.1052, F.S.; requiring a hospital to notify a
  372         patient’s primary care provider within a specified
  373         timeframe after the patient’s admission; requiring a
  374         hospital to inform a patient, upon admission, of the
  375         option to request consultation between the hospital’s
  376         treating physician and the patient’s primary care
  377         provider or specialist provider; requiring a hospital
  378         to notify a patient’s primary care provider of the
  379         patient’s discharge and provide specified information
  380         and records to the primary care provider within a
  381         specified timeframe after discharge; amending s.
  382         amending s. 395.1055, F.S.; authorizing the
  383         reimbursement of per diem and travel expenses to
  384         members of the pediatric cardiac technical advisory
  385         panel, established within the Agency for Health Care
  386         Administration; revising panel membership to include
  387         certain alternate at-large members; providing term
  388         limits for voting members; providing that members of
  389         the panel under certain circumstances are agents of
  390         the state for a specified purpose; requiring the
  391         Secretary of Health Care Administration to consult the
  392         panel for advisory recommendations on certain
  393         certificate of need applications; authorizing the
  394         secretary to request announced or unannounced site
  395         visits to any existing pediatric cardiac surgical
  396         centers or facilities seeking licensure as a pediatric
  397         cardiac surgical center through the certificate of
  398         need process; providing a process for the appointment
  399         of physician experts to a site visit team; requiring
  400         each member of a site visit team to submit a report to
  401         the panel; requiring the panel to discuss such reports
  402         and present an advisory opinion to the secretary;
  403         providing requirements for an on-site inspection;
  404         requiring the Surgeon General of the Department of
  405         Health to provide specified reports to the secretary;
  406         395.301, F.S.; requiring a licensed facility, upon
  407         placing a patient on observation status, to
  408         immediately notify the patient of such status using a
  409         specified form; requiring that such notification be
  410         documented in the patient’s medical records and
  411         discharge papers; amending s. 624.27, F.S.; expanding
  412         the scope of direct primary care agreements, which are
  413         renamed “direct health care agreements”; conforming
  414         provisions to changes made by the act; creating s.
  415         627.42393, F.S.; prohibiting certain health insurers
  416         from employing step-therapy protocols under certain
  417         circumstances; defining the term “health coverage
  418         plan”; clarifying that a health insurer is not
  419         required to take specific actions regarding
  420         prescription drugs; amending s. 641.31, F.S.;
  421         prohibiting certain health maintenance organizations
  422         from employing step-therapy protocols under certain
  423         circumstances; defining the term “health coverage
  424         plan”; clarifying that a health maintenance
  425         organization is not required to take specific actions
  426         regarding prescription drugs; requiring the Office of
  427         Program Policy Analysis and Government Accountability
  428         to submit by a specified date a report and
  429         recommendations to the Governor and the Legislature
  430         which addresses this state’s prospective entrance into
  431         the Interstate Medical Licensure Compact as a member
  432         state; providing parameters for the report; providing
  433         effective dates.