Florida Senate - 2019                                    SB 7078
       
       
        
       By the Committee on Health Policy
       
       
       
       
       
       588-03183-19                                          20197078__
    1                        A bill to be entitled                      
    2         An act relating to health care; amending s. 394.4615,
    3         F.S.; requiring a service provider to furnish and
    4         provide access to clinical records within a specified
    5         timeframe after receiving a request for such records;
    6         providing a conditional requirement that such records
    7         be furnished in the manner chosen by the requester;
    8         authorizing the service provider to charge a
    9         reasonable cost associated with reproducing such
   10         records; providing for a special service charge under
   11         specified conditions; amending s. 395.3025, F.S.;
   12         requiring a licensed facility to furnish and provide
   13         access to patient records within a specified timeframe
   14         after receiving a request for such records; providing
   15         a conditional requirement that such records be
   16         furnished in the manner chosen by the requester;
   17         authorizing the licensed facility to charge a
   18         reasonable cost associated with reproducing such
   19         records; providing for a special service charge under
   20         specified conditions; revising provisions relating to
   21         the appropriate disclosure of patient records without
   22         consent; amending s. 397.501, F.S.; requiring a
   23         service provider to furnish and provide access to
   24         records within a specified timeframe after receiving a
   25         request from an individual or an individual’s legal
   26         representative; defining the term “legal
   27         representative”; providing a conditional requirement
   28         that such records be furnished in the manner chosen by
   29         the requester; authorizing the service provider to
   30         charge a reasonable cost associated with reproducing
   31         such records; providing for a special service charge
   32         under specified conditions; amending s. 400.145, F.S.;
   33         requiring a nursing home facility to furnish and
   34         provide access to records within a specified timeframe
   35         after receiving a request; providing a conditional
   36         requirement that such records be furnished in the
   37         manner chosen by the requester; authorizing the
   38         nursing home facility to charge a reasonable cost
   39         associated with reproducing such records; providing
   40         for a special service charge under specified
   41         conditions; amending s. 456.057, F.S.; requiring
   42         certain licensed health care practitioners to furnish
   43         and provide access to copies of reports and records
   44         within a specified timeframe after receiving a request
   45         from a patient or a patient’s legal representative;
   46         authorizing such licensed health care practitioners to
   47         impose reasonable terms necessary to preserve such
   48         reports and records; defining the term “legal
   49         representative”; authorizing such licensed health care
   50         practitioners to charge a reasonable cost associated
   51         with reproducing such reports and records; providing
   52         for a special service charge under specified
   53         conditions; amending s. 395.1012, F.S.; requiring a
   54         licensed hospital to provide specified information and
   55         data relating to patient safety and quality measures
   56         to a patient under certain circumstances or to any
   57         person upon request; creating s. 395.1052, F.S.;
   58         requiring a hospital to notify a patient’s primary
   59         care provider within a specified timeframe after the
   60         patient’s admission; requiring a hospital to inform a
   61         patient, upon admission, of the option to request
   62         consultation between the hospital’s treating physician
   63         and the patient’s primary care provider or specialist
   64         provider; requiring a hospital to notify a patient’s
   65         primary care provider of the patient’s discharge and
   66         provide specified information and records to the
   67         primary care provider within a specified timeframe
   68         after discharge; amending s. 395.301, F.S.; requiring
   69         a licensed facility, upon placing a patient on
   70         observation status, to immediately notify the patient
   71         of such status using a specified form; requiring that
   72         such notification be documented in the patient’s
   73         medical records and discharge papers; amending s.
   74         624.27, F.S.; expanding the scope of direct primary
   75         care agreements, which are renamed “direct health care
   76         agreements”; conforming provisions to changes made by
   77         the act; creating s. 627.42393, F.S.; prohibiting
   78         certain health insurers from employing step-therapy
   79         protocols under certain circumstances; defining the
   80         term “health coverage plan”; amending s. 641.31, F.S.;
   81         prohibiting certain health maintenance organizations
   82         from employing step-therapy protocols under certain
   83         circumstances; defining the term “health coverage
   84         plan”; amending s. 409.973, F.S.; prohibiting Medicaid
   85         managed care plans from employing step-therapy
   86         protocols under certain circumstances; creating s.
   87         627.4303, F.S.; defining the term “health insurer”;
   88         prohibiting limitations on price transparency with
   89         patients in contracts between health insurers and
   90         health care providers; prohibiting a health insurer
   91         from requiring an insured to make a certain payment
   92         for a covered service under certain circumstances;
   93         creating s. 456.4501, F.S.; implementing the
   94         Interstate Medical Licensure Compact in this state;
   95         providing for an interstate medical licensure process;
   96         providing requirements for multistate practice and
   97         telemedicine practice; providing effective dates.
   98          
   99  Be It Enacted by the Legislature of the State of Florida:
  100  
  101         Section 1. Present subsections (3) through (11) of section
  102  394.4615, Florida Statutes, are redesignated as subsections (5)
  103  through (13), respectively, and new subsections (3) and (4) are
  104  added to that section, to read:
  105         394.4615 Clinical records; confidentiality.—
  106         (3)(a)Within 14 working days after receiving a request
  107  made in accordance with paragraphs (2)(a), (b), or (c), a
  108  service provider must furnish applicable clinical records in its
  109  possession.
  110         (b)If a service provider maintains a system of electronic
  111  health records as defined in s. 408.051, the service provider
  112  shall furnish the requested records in the manner chosen by the
  113  requester, which may include paper documents, electronic format,
  114  access through a web-based patient portal, or submission through
  115  a patient’s electronic personal health record.
  116         (4)The service provider may charge a requester no more
  117  than the reasonable costs of reproducing the clinical records,
  118  including reasonable staff time.
  119         (a)The reasonable costs of reproducing paper copies of
  120  written or typed documents or reports may not exceed $1 per page
  121  for the first 25 pages and 25 cents per page for all pages
  122  thereafter.
  123         (b)The reasonable costs of reproducing X-rays and other
  124  forms of images shall be the actual costs. Actual costs shall be
  125  the sum of the cost of the material and supplies used to
  126  duplicate the record and the labor and overhead costs associated
  127  with the duplication.
  128         (c) If the nature or volume of the clinical records
  129  requested to be copied requires extensive use of information
  130  technology resources or extensive clerical or supervisory
  131  assistance by personnel of the service provider, or both, the
  132  service provider may charge, in addition to the charges imposed
  133  under paragraphs (a) and (b), a special service charge, which
  134  shall be reasonable and shall be based on the cost incurred for
  135  such extensive use of information technology resources or the
  136  labor cost of the personnel providing the service which is
  137  actually incurred by the service provider or attributable to the
  138  service provider for the clerical and supervisory assistance
  139  required, or both.
  140         (d) The charges established in this subsection apply to all
  141  records furnished, whether directly from a service provider or
  142  from a copy service acting on behalf of the service provider.
  143  However, a patient whose records are copied or searched for the
  144  purpose of continuing to receive care is not required to pay a
  145  charge for copying or for the search.
  146         Section 2. Subsection (1) and paragraph (e) of subsection
  147  (4) of section 395.3025, Florida Statutes, are amended to read:
  148         395.3025 Patient and personnel records; copies;
  149  examination.—
  150         (1)(a) Any licensed facility shall, upon written request,
  151  and only after discharge of the patient, furnish, in a timely
  152  manner as provided in paragraph (b), without delays for legal
  153  review, to any person admitted therein for care and treatment or
  154  treated thereat, or to any such person’s guardian, curator, or
  155  personal representative, or in the absence of one of those
  156  persons, to the next of kin of a decedent or the parent of a
  157  minor, or to anyone designated by such person in writing, a true
  158  and correct copy of all patient records, including X rays, and
  159  insurance information concerning such person, which records are
  160  in the possession of the licensed facility, provided the person
  161  requesting such records agrees to pay a charge as provided in
  162  paragraph (d).
  163         (b)Within 14 working days after receiving a request made
  164  in accordance with paragraph (a), a licensed facility must
  165  furnish applicable patient records in its possession.
  166         (c)If a licensed facility maintains a system of electronic
  167  health records as defined in s. 408.051, the licensed facility
  168  shall furnish the requested records in the manner chosen by the
  169  requester, which may include paper documents, electronic format,
  170  access through a web-based patient portal, or submission through
  171  a patient’s electronic personal health record.
  172         (d)The licensed facility may charge a requester no more
  173  than the reasonable costs of reproducing the patient records,
  174  including reasonable staff time.
  175         1.The reasonable costs of reproducing paper copies of
  176  written or typed documents or reports may not exceed $1 per page
  177  for the first 25 pages and 25 cents per page for all pages
  178  thereafter.
  179         2.The reasonable costs of reproducing X-rays and other
  180  forms of images shall be the actual costs. Actual costs shall be
  181  the sum of the cost of the material and supplies used to
  182  duplicate the record and the labor and overhead costs associated
  183  with the duplication.
  184         3. If the nature or volume of the patient records requested
  185  to be copied requires extensive use of information technology
  186  resources or extensive clerical or supervisory assistance by
  187  personnel of the licensed facility, or both, the licensed
  188  facility may charge, in addition to the charges imposed under
  189  subparagraphs 1. and 2., a special service charge, which shall
  190  be reasonable and shall be based on the cost incurred for such
  191  extensive use of information technology resources or the labor
  192  cost of the personnel providing the service which is actually
  193  incurred by the licensed facility or attributable to the
  194  licensed facility for the clerical and supervisory assistance
  195  required, or both.
  196         4. The charges established in this paragraph The exclusive
  197  charge for copies of patient records may include sales tax and
  198  actual postage, and, except for nonpaper records that are
  199  subject to a charge not to exceed $2, may not exceed $1 per
  200  page. A fee of up to $1 may be charged for each year of records
  201  requested. These charges shall apply to all records furnished,
  202  whether directly from the facility or from a copy service acting
  203  providing these services on behalf of the facility. However, a
  204  patient whose records are copied or searched for the purpose of
  205  continuing to receive medical care is not required to pay a
  206  charge for copying or for the search.
  207         (e) If a person authorized to receive copies of patient
  208  records under paragraph (a) requests to examine the licensed
  209  facility’s original records pertaining to the patient, the
  210  licensed facility shall, within 10 working days after receiving
  211  such a request, provide such person with access to examine such
  212  original records, microforms, or other suitable reproductions of
  213  such records in its possession. A licensed facility may impose
  214  any reasonable terms necessary to ensure further allow any such
  215  person to examine the original records in its possession, or
  216  microforms or other suitable reproductions of the records, upon
  217  such reasonable terms as shall be imposed to assure that the
  218  records will not be damaged, destroyed, or altered.
  219         (4) Patient records are confidential and may must not be
  220  disclosed without the consent of the patient or his or her legal
  221  representative; however, but appropriate disclosure may be made
  222  without such consent to:
  223         (e) The department agency upon subpoena issued pursuant to
  224  s. 456.071, but the records obtained thereby must be used solely
  225  for the purpose of the department agency and the appropriate
  226  professional board in its investigation, prosecution, and appeal
  227  of disciplinary proceedings. If the department agency requests
  228  copies of the records, the facility shall charge no more than
  229  its actual copying costs, including reasonable staff time. The
  230  records must be sealed and must not be available to the public
  231  pursuant to s. 119.07(1) or any other statute providing access
  232  to records, nor may they be available to the public as part of
  233  the record of investigation for and prosecution in disciplinary
  234  proceedings made available to the public by the department
  235  agency or the appropriate regulatory board. However, the
  236  department agency must make available, upon written request by a
  237  practitioner against whom probable cause has been found, any
  238  such records that form the basis of the determination of
  239  probable cause.
  240         Section 3. Present paragraphs (a) through (j) of subsection
  241  (7) of section 397.501, Florida Statutes, are redesignated as
  242  paragraphs (d) through (m), respectively, and new paragraphs
  243  (a), (b), and (c) are added to that subsection, to read:
  244         397.501 Rights of individuals.—Individuals receiving
  245  substance abuse services from any service provider are
  246  guaranteed protection of the rights specified in this section,
  247  unless otherwise expressly provided, and service providers must
  248  ensure the protection of such rights.
  249         (7) RIGHT TO ACCESS TO AND CONFIDENTIALITY OF INDIVIDUAL
  250  RECORDS.—
  251         (a)1.Within 14 working days after receiving a written
  252  request from an individual or an individual’s legal
  253  representative, a service provider shall furnish a true and
  254  correct copy of all records pertaining to that individual in the
  255  possession of the service provider.
  256         2. For the purpose of this subsection, the term “legal
  257  representative” means an individual’s legal guardian or, if the
  258  individual is younger than 18 years old, the individual’s parent
  259  or legal guardian.
  260         3. If a service provider maintains a system of electronic
  261  health records as defined in s. 408.051, the service provider
  262  shall furnish the requested records in the manner chosen by the
  263  requester, which may include paper documents, electronic format,
  264  access through a web-based patient portal, or submission through
  265  an individual’s electronic personal health record.
  266         (b)A service provider may charge the requester no more
  267  than the reasonable costs of reproducing the records, including
  268  reasonable staff time.
  269         1.The reasonable costs of reproducing paper copies of
  270  written or typed documents or reports may not exceed $1 per page
  271  for the first 25 pages and 25 cents per page for all pages
  272  thereafter.
  273         2.The reasonable costs of reproducing X-rays and such
  274  other kinds of records shall be the actual costs. Actual costs
  275  are the sum of the cost of the material and supplies used to
  276  duplicate the records and the labor and overhead costs
  277  associated with the duplication.
  278         3.If the nature or volume of the records requested to be
  279  copied requires extensive use of information technology
  280  resources or extensive clerical or supervisory assistance by
  281  personnel of the service provider, or both, the service provider
  282  may charge, in addition to the charges imposed under
  283  subparagraphs 1. and 2., a special service charge, which shall
  284  be reasonable and shall be based on the cost incurred for such
  285  extensive use of information technology resources or the labor
  286  cost of the personnel providing the service which is actually
  287  incurred by the service provider or attributable to the service
  288  provider for the clerical and supervisory assistance required,
  289  or both.
  290         4. The charges established in this paragraph apply to all
  291  records furnished, whether directly from a service provider or
  292  from a copy service acting on behalf of the service provider.
  293  However, an individual whose records are copied or searched for
  294  the purpose of continuing to receive care is not required to pay
  295  a charge for copying or for the search.
  296         (c)Within 10 working days after receiving a request from
  297  an individual or an individual’s legal representative to examine
  298  the service providers original records pertaining to that
  299  individual, a service provider shall provide access to examine
  300  such original records, microforms, or other suitable
  301  reproductions of such records in its possession. A service
  302  provider may impose any reasonable terms necessary to ensure
  303  that the records will not be damaged, destroyed, or altered.
  304         Section 4. Subsection (4) of section 400.145, Florida
  305  Statutes, is amended to read:
  306         400.145 Copies of records of care and treatment of
  307  resident.—
  308         (4)(a) Within 14 working days after receiving a request
  309  made in accordance with subsections (1)-(3), a nursing home
  310  facility must furnish applicable resident records in its
  311  possession in accordance with this subsection.
  312         (b)If a nursing home facility maintains a system of
  313  electronic health records as defined in s. 408.051, the facility
  314  shall furnish the requested records in the manner chosen by the
  315  requester, which may include paper documents, electronic format,
  316  or access through a web-based portal.
  317         (c)The nursing home facility may charge a requester no
  318  more than the reasonable costs of reproducing the records,
  319  including reasonable staff time.
  320         1.The reasonable costs of reproducing paper copies of
  321  written or typed documents or reports may not exceed $1 per page
  322  for the first 25 pages and 25 cents per page for all pages
  323  thereafter.
  324         2.The reasonable costs of reproducing X-rays and other
  325  forms of images shall be the actual costs. Actual costs shall be
  326  the sum of the cost of the material and supplies used to
  327  duplicate the record and the labor and overhead costs associated
  328  with the duplication.
  329         3. If the nature or volume of the records requested to be
  330  copied requires extensive use of information technology
  331  resources or extensive clerical or supervisory assistance by
  332  personnel of the nursing home facility, or both, the facility
  333  may charge, in addition to the charges imposed under
  334  subparagraphs 1. and 2., a special service charge, which shall
  335  be reasonable and shall be based on the cost incurred for such
  336  extensive use of information technology resources or the labor
  337  cost of the personnel providing the service which is actually
  338  incurred by the facility or attributable to the facility for the
  339  clerical and supervisory assistance required, or both.
  340         4. The charges established in this paragraph apply to all
  341  records furnished, whether directly from a nursing home facility
  342  or from a copy service acting on behalf of the facility.
  343  However, a resident whose records are copied or searched for the
  344  purpose of continuing to receive care is not required to pay a
  345  charge for copying or for the search
  346         (d)Within 10 working days after receiving a request from a
  347  person who is authorized to act on behalf of a resident to
  348  examine the nursing home facility’s original records pertaining
  349  to the resident, the facility shall provide access to examine
  350  such original records, microforms, or other suitable
  351  reproductions of such records in its possession. A facility may
  352  impose any reasonable terms necessary A nursing home facility
  353  may charge a reasonable fee for the copying of resident records.
  354  Such fee may not exceed $1 per page for the first 25 pages and
  355  25 cents per page for each additional page. The facility shall
  356  allow a person who is authorized to act on behalf of the
  357  resident to examine the original records, microfilms, or other
  358  suitable reproductions of the records in its possession upon any
  359  reasonable terms imposed by the facility to ensure that the
  360  records are not damaged, destroyed, or altered.
  361         Section 5. Subsections (6) and (17) of section 456.057,
  362  Florida Statutes, are amended to read:
  363         456.057 Ownership and control of patient records; report or
  364  copies of records to be furnished; disclosure of information.—
  365         (6)(a) Any health care practitioner licensed by the
  366  department or a board within the department who makes a physical
  367  or mental examination of, or administers treatment or dispenses
  368  legend drugs to, any person shall, upon written request of such
  369  person or the person’s legal representative, furnish, within 14
  370  working days after such request in a timely manner, without
  371  delays for legal review, copies of all reports and records
  372  relating to such examination or treatment, including X-rays X
  373  rays and insurance information. If the health care practitioner
  374  maintains a system of electronic health records as defined in s.
  375  408.051, the health care practitioner shall furnish the
  376  requested records in the manner chosen by the requester, which
  377  may include paper documents, electronic format, access through a
  378  web-based patient portal, or submission through a patient’s
  379  electronic personal health record.
  380         (b)Within 10 working days after receiving a written
  381  request by a patient or the patient’s legal representative to
  382  examine the health care practitioners original reports and
  383  records pertaining to the patient, a health care practitioner
  384  must provide access to examine such original reports and
  385  records, or microforms or other suitable reproductions of the
  386  reports and records in the health care practitioner’s
  387  possession. The health care practitioner may impose any
  388  reasonable terms necessary to ensure that the reports and
  389  records will not be damaged, destroyed, or altered.
  390         (c) For the purposes of this subsection, the term “legal
  391  representative” means a patient’s legal guardian or, if the
  392  patient is younger than 18 years old, the patient’s parent or
  393  legal guardian.
  394         (d)However, When a patient’s psychiatric, chapter 490
  395  psychological, or chapter 491 psychotherapeutic records are
  396  requested by the patient or the patient’s legal representative,
  397  the health care practitioner may provide a report of examination
  398  and treatment in lieu of copies of records. Upon a patient’s
  399  written request, complete copies of the patient’s psychiatric
  400  records shall be provided directly to a subsequent treating
  401  psychiatrist. The furnishing of such report or copies may shall
  402  not be conditioned upon payment of a fee for services rendered.
  403         (17) A licensed health care practitioner may charge the
  404  requester no more than the reasonable costs of reproducing the
  405  reports and records, including reasonable staff time.
  406         (a)The reasonable costs of reproducing paper copies of
  407  written or typed documents or reports may not exceed $1 per page
  408  for the first 25 pages and 25 cents per page for all pages
  409  thereafter.
  410         (b)The reasonable costs of reproducing X-rays and such
  411  other kinds of records shall be the actual costs. Actual costs
  412  are the sum of the cost of the material and supplies used to
  413  duplicate the record and the labor and overhead costs associated
  414  with the duplication.
  415         (c)If the nature or volume of the records requested to be
  416  copied requires extensive use of information technology
  417  resources or extensive clerical or supervisory assistance by
  418  personnel of the health care practitioner, or both, the health
  419  care practitioner may charge, in addition to the charges imposed
  420  under paragraphs (a) and (b), a special service charge, which
  421  shall be reasonable and shall be based on the cost incurred for
  422  such extensive use of information technology resources or the
  423  labor cost of the personnel providing the service which is
  424  actually incurred by the health care practitioner or
  425  attributable to the health care practitioner for the clerical
  426  and supervisory assistance required, or both.
  427         (d) The charges established in this subsection apply to all
  428  reports and records furnished, whether directly from a health
  429  care practitioner or from a copy service providing such services
  430  on behalf of the health care practitioner. However, a patient
  431  whose reports and records are copied or searched for the purpose
  432  of continuing to receive medical care is not required to pay a
  433  charge for copying or for the search A health care practitioner
  434  or records owner furnishing copies of reports or records or
  435  making the reports or records available for digital scanning
  436  pursuant to this section shall charge no more than the actual
  437  cost of copying, including reasonable staff time, or the amount
  438  specified in administrative rule by the appropriate board, or
  439  the department when there is no board.
  440         Section 6. Subsection (3) is added to section 395.1012,
  441  Florida Statutes, to read:
  442         395.1012 Patient safety.—
  443         (3)(a)Each hospital shall provide to any patient upon
  444  admission, upon scheduling of nonemergency care, or prior to
  445  treatment, written information on a form created by the agency
  446  that contains the following information available for the
  447  hospital for the most recent year and the statewide average for
  448  all hospitals related to the following quality measures:
  449         1.The rate of hospital-acquired infections;
  450         2.The overall rating of the Hospital Consumer Assessment
  451  of Healthcare Providers and Systems survey; and
  452         3.The 15-day readmission rate.
  453         (b)A hospital must also provide the written information
  454  specified in paragraph (a) to any person upon request.
  455         (c)The information required by this subsection must be
  456  presented in a manner that is easily understandable and
  457  accessible to the patient and must also include an explanation
  458  of the quality measures and the relationship between patient
  459  safety and the hospital’s data for the quality measures.
  460         Section 7. Section 395.1052, Florida Statutes, is created
  461  to read:
  462         395.1052 Patient access to primary care and specialty
  463  providers; notification.—A hospital shall:
  464         (1) Notify each patient’s primary care provider, if any,
  465  within 24 hours after the patient’s admission to the hospital.
  466         (2) Inform a patient immediately upon admission that he or
  467  she may request to have the hospital’s treating physician
  468  consult with the patient’s primary care provider or specialist
  469  provider, if any, when developing the patient’s plan of care.
  470  Upon the patient’s request, the hospital’s treating physician
  471  shall make reasonable efforts to consult with the patient’s
  472  primary care provider or specialist provider when developing the
  473  patient’s plan of care.
  474         (3) Notify the patient’s primary care provider, if any, of
  475  the patient’s discharge from the hospital within 24 hours after
  476  discharge.
  477         (4) Provide the discharge summary and any related
  478  information or records to the patient’s primary care provider,
  479  if any, within 7 days after the patient’s discharge from the
  480  hospital.
  481         Section 8. Subsection (3) of section 395.301, Florida
  482  Statutes, is amended to read:
  483         395.301 Price transparency; itemized patient statement or
  484  bill; patient admission status notification.—
  485         (3) If a licensed facility places a patient on observation
  486  status rather than inpatient status, the licensed facility must
  487  immediately notify the patient of such status using the form
  488  adopted under 42 C.F.R. s. 489.20 for Medicare patients or a
  489  form adopted by agency rule for non-Medicare patients. Such
  490  notification must observation services shall be documented in
  491  the patient’s medical records and discharge papers. The patient
  492  or the patient’s survivor or legal guardian must shall be
  493  notified of observation services through discharge papers, which
  494  may also include brochures, signage, or other forms of
  495  communication for this purpose.
  496         Section 9. Section 624.27, Florida Statutes, is amended to
  497  read:
  498         624.27 Direct health primary care agreements; exemption
  499  from code.—
  500         (1) As used in this section, the term:
  501         (a) “Direct health primary care agreement” means a contract
  502  between a health primary care provider and a patient, a
  503  patient’s legal representative, or a patient’s employer, which
  504  meets the requirements of subsection (4) and does not indemnify
  505  for services provided by a third party.
  506         (b) “Health Primary care provider” means a health care
  507  provider licensed under chapter 458, chapter 459, chapter 460,
  508  or chapter 464, or chapter 466, or a health primary care group
  509  practice, who provides health primary care services to patients.
  510         (c) “Health Primary care services” means the screening,
  511  assessment, diagnosis, and treatment of a patient conducted
  512  within the competency and training of the health primary care
  513  provider for the purpose of promoting health or detecting and
  514  managing disease or injury.
  515         (2) A direct health primary care agreement does not
  516  constitute insurance and is not subject to the Florida Insurance
  517  Code. The act of entering into a direct health primary care
  518  agreement does not constitute the business of insurance and is
  519  not subject to the Florida Insurance Code.
  520         (3) A health primary care provider or an agent of a health
  521  primary care provider is not required to obtain a certificate of
  522  authority or license under the Florida Insurance Code to market,
  523  sell, or offer to sell a direct health primary care agreement.
  524         (4) For purposes of this section, a direct health primary
  525  care agreement must:
  526         (a) Be in writing.
  527         (b) Be signed by the health primary care provider or an
  528  agent of the health primary care provider and the patient, the
  529  patient’s legal representative, or the patient’s employer.
  530         (c) Allow a party to terminate the agreement by giving the
  531  other party at least 30 days’ advance written notice. The
  532  agreement may provide for immediate termination due to a
  533  violation of the physician-patient relationship or a breach of
  534  the terms of the agreement.
  535         (d) Describe the scope of health primary care services that
  536  are covered by the monthly fee.
  537         (e) Specify the monthly fee and any fees for health primary
  538  care services not covered by the monthly fee.
  539         (f) Specify the duration of the agreement and any automatic
  540  renewal provisions.
  541         (g) Offer a refund to the patient, the patient’s legal
  542  representative, or the patient’s employer of monthly fees paid
  543  in advance if the health primary care provider ceases to offer
  544  health primary care services for any reason.
  545         (h) Contain, in contrasting color and in at least 12-point
  546  type, the following statement on the signature page: “This
  547  agreement is not health insurance and the health primary care
  548  provider will not file any claims against the patient’s health
  549  insurance policy or plan for reimbursement of any health primary
  550  care services covered by the agreement. This agreement does not
  551  qualify as minimum essential coverage to satisfy the individual
  552  shared responsibility provision of the Patient Protection and
  553  Affordable Care Act, 26 U.S.C. s. 5000A. This agreement is not
  554  workers’ compensation insurance and does not replace an
  555  employer’s obligations under chapter 440.”
  556         Section 10. Effective January 1, 2020, section 627.42393,
  557  Florida Statutes, is created to read:
  558         627.42393 Step-therapy protocol.—
  559         (1) A health insurer issuing a major medical individual or
  560  group policy may not require a step-therapy protocol under the
  561  policy for a covered prescription drug requested by an insured
  562  if:
  563         (a) The insured has previously been approved to receive the
  564  prescription drug through the completion of a step-therapy
  565  protocol required by a separate health coverage plan; and
  566         (b) The insured provides documentation originating from the
  567  health coverage plan that approved the prescription drug as
  568  described in paragraph (a) indicating that the health coverage
  569  plan paid for the drug on the insured’s behalf during the 180
  570  days immediately prior to the request.
  571         (2) As used in this section, the term “health coverage
  572  plan” means any of the following which previously provided or is
  573  currently providing major medical or similar comprehensive
  574  coverage or benefits to the insured:
  575         (a) A health insurer or health maintenance organization.
  576         (b)A plan established or maintained by an individual
  577  employer as provided by the Employee Retirement Income Security
  578  Act of 1974, Pub. L. No. 93-406.
  579         (c) A multiple-employer welfare arrangement as defined in
  580  s. 624.437.
  581         (d) A governmental entity providing a plan of self
  582  insurance.
  583         Section 11. Effective January 1, 2020, subsection (45) is
  584  added to section 641.31, Florida Statutes, to read:
  585         641.31 Health maintenance contracts.—
  586         (45)(a) A health maintenance organization issuing major
  587  medical coverage through an individual or group contract may not
  588  require a step-therapy protocol under the contract for a covered
  589  prescription drug requested by a subscriber if:
  590         1. The subscriber has previously been approved to receive
  591  the prescription drug through the completion of a step-therapy
  592  protocol required by a separate health coverage plan; and
  593         2. The subscriber provides documentation originating from
  594  the health coverage plan that approved the prescription drug as
  595  described in subparagraph 1. indicating that the health coverage
  596  plan paid for the drug on the subscriber’s behalf during the 180
  597  days immediately prior to the request.
  598         (b) As used in this subsection, the term “health coverage
  599  plan” means any of the following which previously provided or is
  600  currently providing major medical or similar comprehensive
  601  coverage or benefits to the subscriber:
  602         1. A health insurer or health maintenance organization;
  603         2.A plan established or maintained by an individual
  604  employer as provided by the Employee Retirement Income Security
  605  Act of 1974, Pub. L. No. 93-406;
  606         3. A multiple-employer welfare arrangement as defined in s.
  607  624.437; or
  608         4. A governmental entity providing a plan of self
  609  insurance.
  610         Section 12. Present subsection (6) of section 409.973,
  611  Florida Statutes, is redesignated as subsection (7), and a new
  612  subsection (6) is added to that section, to read:
  613         409.973 Benefits.—
  614         (6) PROVISION OF PRESCRIPTION DRUG SERVICES.—
  615         (a) A managed care plan may not require a step-therapy
  616  approval process for a covered prescription drug requested by an
  617  enrolled recipient if:
  618         1. The recipient has been approved to receive the
  619  prescription drug through the completion of a step-therapy
  620  approval process required by a managed care plan in which the
  621  recipient was previously enrolled under this part; and
  622         2. The managed care plan in which the recipient was
  623  previously enrolled has paid for the drug on the recipients
  624  behalf during the 180 days immediately before the request.
  625         (b) The agency shall implement paragraph (a) by amending
  626  managed care plan contracts concurrent with the start of a new
  627  capitation cycle.
  628         Section 13. Section 627.4303, Florida Statutes, is created
  629  to read:
  630         627.4303 Price transparency in contracts between health
  631  insurers and health care providers.—
  632         (1) As used in this section, the term “health insurer”
  633  means a health insurer issuing major medical coverage through an
  634  individual or group policy or a health maintenance organization
  635  issuing major medical coverage through an individual or group
  636  contract.
  637         (2) A health insurer may not limit a provider’s ability to
  638  disclose whether a patient’s cost-sharing obligation exceeds the
  639  cash price for a covered service in the absence of health
  640  insurance coverage or the availability of a more affordable
  641  service.
  642         (3) A health insurer may not require an insured to make a
  643  payment for a covered service in an amount that exceeds the cash
  644  price of the service in the absence of health insurance
  645  coverage.
  646         Section 14. Section 456.4501, Florida Statutes, is created
  647  to read:
  648         456.4501 Interstate Medical Licensure Compact.—The
  649  Interstate Medical Licensure Compact is hereby enacted into law
  650  and entered into by this state with all other jurisdictions
  651  legally joining therein in the form substantially as follows:
  652  
  653                              SECTION 1                            
  654                               PURPOSE                             
  655  
  656         In order to strengthen access to health care, and in
  657  recognition of the advances in the delivery of health care, the
  658  member states of the Interstate Medical Licensure Compact have
  659  allied in common purpose to develop a comprehensive process that
  660  complements the existing licensing and regulatory authority of
  661  state medical boards, provides a streamlined process that allows
  662  physicians to become licensed in multiple states, thereby
  663  enhancing the portability of a medical license and ensuring the
  664  safety of patients. The Compact creates another pathway for
  665  licensure and does not otherwise change a states existing
  666  Medical Practice Act. The Compact also adopts the prevailing
  667  standard for licensure and affirms that the practice of medicine
  668  occurs where the patient is located at the time of the
  669  physician-patient encounter, and therefore, requires the
  670  physician to be under the jurisdiction of the state medical
  671  board where the patient is located. State medical boards that
  672  participate in the Compact retain the jurisdiction to impose an
  673  adverse action against a license to practice medicine in that
  674  state issued to a physician through the procedures in the
  675  Compact.
  676  
  677                              SECTION 2                            
  678                             DEFINITIONS                           
  679  
  680         In this compact:
  681         (a)“Bylaws” means those bylaws established by the
  682  Interstate Commission pursuant to Section 11 for its governance,
  683  or for directing and controlling its actions and conduct.
  684         (b)“Commissioner” means the voting representative
  685  appointed by each member board pursuant to Section 11.
  686         (c)“Conviction” means a finding by a court that an
  687  individual is guilty of a criminal offense through adjudication,
  688  or entry of a plea of guilt or no contest to the charge by the
  689  offender. Evidence of an entry of a conviction of a criminal
  690  offense by the court shall be considered final for purposes of
  691  disciplinary action by a member board.
  692         (d)“Expedited License” means a full and unrestricted
  693  medical license granted by a member state to an eligible
  694  physician through the process set forth in the Compact.
  695         (e)“Interstate Commission” means the interstate commission
  696  created pursuant to Section 11.
  697         (f)“License” means authorization by a state for a
  698  physician to engage in the practice of medicine, which would be
  699  unlawful without the authorization.
  700         (g)“Medical Practice Act” means laws and regulations
  701  governing the practice of allopathic and osteopathic medicine
  702  within a member state.
  703         (h)“Member Board” means a state agency in a member state
  704  that acts in the sovereign interests of the state by protecting
  705  the public through licensure, regulation, and education of
  706  physicians as directed by the state government.
  707         (i)“Member State” means a state that has enacted the
  708  Compact.
  709         (j)“Practice of medicine” means the diagnosis, treatment,
  710  prevention, cure, or relieving of a human disease, ailment,
  711  defect, complaint, or other physical or mental condition, by
  712  attendance, advice, device, diagnostic test, or other means, or
  713  offering, undertaking, attempting to do, or holding oneself out
  714  as able to do, any of these acts.
  715         (k)“Physician” means any person who:
  716         (1)Is a graduate of a medical school accredited by the
  717  Liaison Committee on Medical Education, the Commission on
  718  Osteopathic College Accreditation, or a medical school listed in
  719  the International Medical Education Directory or its equivalent;
  720         (2)Passed each component of the United States Medical
  721  Licensing Examination (USMLE) or the Comprehensive Osteopathic
  722  Medical Licensing Examination (COMLEX-USA) within three
  723  attempts, or any of its predecessor examinations accepted by a
  724  state medical board as an equivalent examination for licensure
  725  purposes;
  726         (3)Successfully completed graduate medical education
  727  approved by the Accreditation Council for Graduate Medical
  728  Education or the American Osteopathic Association;
  729         (4)Holds specialty certification or a time-unlimited
  730  specialty certificate recognized by the American Board of
  731  Medical Specialties or the American Osteopathic Associations
  732  Bureau of Osteopathic Specialists; however, the specialty
  733  certification or a time-unlimited specialty certificate does not
  734  have to be maintained once a physician is initially determined
  735  to be eligible for expedited licensure through the Compact;
  736         (5)Possesses a full and unrestricted license to engage in
  737  the practice of medicine issued by a member board;
  738         (6)Has never been convicted, received adjudication,
  739  deferred adjudication, community supervision, or deferred
  740  disposition for any offense by a court of appropriate
  741  jurisdiction;
  742         (7)Has never held a license authorizing the practice of
  743  medicine subjected to discipline by a licensing agency in any
  744  state, federal, or foreign jurisdiction, excluding any action
  745  related to non-payment of fees related to a license;
  746         (8)Has never had a controlled substance license or permit
  747  suspended or revoked by a state or the United States Drug
  748  Enforcement Administration; and
  749         (9)Is not under active investigation by a licensing agency
  750  or law enforcement authority in any state, federal, or foreign
  751  jurisdiction.
  752         (l)“Offense” means a felony, high court misdemeanor, or
  753  crime of moral turpitude.
  754         (m)“Rule” means a written statement by the Interstate
  755  Commission promulgated pursuant to Section 12 of the Compact
  756  that is of general applicability, implements, interprets, or
  757  prescribes a policy or provision of the Compact, or an
  758  organizational, procedural, or practice requirement of the
  759  Interstate Commission, and has the force and effect of statutory
  760  law in a member state, if the rule is not inconsistent with the
  761  laws of the member state. The term includes the amendment,
  762  repeal, or suspension of an existing rule.
  763         (n)“State” means any state, commonwealth, district, or
  764  territory of the United States.
  765         (o)“State of Principal License” means a member state where
  766  a physician holds a license to practice medicine and which has
  767  been designated as such by the physician for purposes of
  768  registration and participation in the Compact.
  769  
  770                              SECTION 3                            
  771                             ELIGIBILITY                           
  772  
  773         (a)A physician must meet the eligibility requirements as
  774  defined in Section 2(k) to receive an expedited license under
  775  the terms and provisions of the Compact.
  776         (b)A physician who does not meet the requirements of
  777  Section 2(k) may obtain a license to practice medicine in a
  778  member state if the individual complies with all laws and
  779  requirements, other than the Compact, relating to the issuance
  780  of a license to practice medicine in that state.
  781  
  782                              SECTION 4                            
  783              DESIGNATION OF STATE OF PRINCIPAL LICENSE            
  784  
  785         (a)A physician shall designate a member state as the state
  786  of principal license for purposes of registration for expedited
  787  licensure through the Compact if the physician possesses a full
  788  and unrestricted license to practice medicine in that state, and
  789  the state is:
  790         (1)the state of primary residence for the physician, or
  791         (2)the state where at least 25% of the practice of
  792  medicine occurs, or
  793         (3)the location of the physician’s employer, or
  794         (4)if no state qualifies under subsection (1), subsection
  795  (2), or subsection (3), the state designated as state of
  796  residence for purpose of federal income tax.
  797         (b)A physician may redesignate a member state as state of
  798  principal license at any time, as long as the state meets the
  799  requirements in subsection (a).
  800         (c)The Interstate Commission is authorized to develop
  801  rules to facilitate redesignation of another member state as the
  802  state of principal license.
  803  
  804                              SECTION 5                            
  805           APPLICATION AND ISSUANCE OF EXPEDITED LICENSURE         
  806  
  807         (a)A physician seeking licensure through the Compact shall
  808  file an application for an expedited license with the member
  809  board of the state selected by the physician as the state of
  810  principal license.
  811         (b)Upon receipt of an application for an expedited
  812  license, the member board within the state selected as the state
  813  of principal license shall evaluate whether the physician is
  814  eligible for expedited licensure and issue a letter of
  815  qualification, verifying or denying the physician’s eligibility,
  816  to the Interstate Commission.
  817         (i) Static qualifications, which include verification of
  818  medical education, graduate medical education, results of any
  819  medical or licensing examination, and other qualifications as
  820  determined by the Interstate Commission through rule, shall not
  821  be subject to additional primary source verification where
  822  already primary source verified by the state of principal
  823  license.
  824         (ii) The member board within the state selected as the
  825  state of principal license shall, in the course of verifying
  826  eligibility, perform a criminal background check of an
  827  applicant, including the use of the results of fingerprint or
  828  other biometric data checks compliant with the requirements of
  829  the Federal Bureau of Investigation, with the exception of
  830  federal employees who have suitability determination in
  831  accordance with U.S. 5 CFR §731.202.
  832         (iii) Appeal on the determination of eligibility shall be
  833  made to the member state where the application was filed and
  834  shall be subject to the law of that state.
  835         (c) Upon verification in subsection (b), physicians
  836  eligible for an expedited license shall complete the
  837  registration process established by the Interstate Commission to
  838  receive a license in a member state selected pursuant to
  839  subsection (a), including the payment of any applicable fees.
  840         (d) After receiving verification of eligibility under
  841  subsection (b) and any fees under subsection (c), a member board
  842  shall issue an expedited license to the physician. This license
  843  shall authorize the physician to practice medicine in the
  844  issuing state consistent with the Medical Practice Act and all
  845  applicable laws and regulations of the issuing member board and
  846  member state.
  847         (e) An expedited license shall be valid for a period
  848  consistent with the licensure period in the member state and in
  849  the same manner as required for other physicians holding a full
  850  and unrestricted license within the member state.
  851         (f) An expedited license obtained through the Compact shall
  852  be terminated if a physician fails to maintain a license in the
  853  state of principal licensure for a non-disciplinary reason,
  854  without redesignation of a new state of principal licensure.
  855         (g) The Interstate Commission is authorized to develop
  856  rules regarding the application process, including payment of
  857  any applicable fees, and the issuance of an expedited license.
  858  
  859                              SECTION 6                            
  860                    FEES FOR EXPEDITED LICENSURE                   
  861  
  862         (a) A member state issuing an expedited license authorizing
  863  the practice of medicine in that state, or the regulating
  864  authority of the member state, may impose a fee for a license
  865  issued or renewed through the Compact.
  866         (b) The Interstate Commission is authorized to develop
  867  rules regarding fees for expedited licenses. However, those
  868  rules shall not limit the authority of a member state, or the
  869  regulating authority of the member state, to impose and
  870  determine the amount of a fee under subsection (a).
  871  
  872                              SECTION 7                            
  873                 RENEWAL AND CONTINUED PARTICIPATION               
  874  
  875         (a) A physician seeking to renew an expedited license
  876  granted in a member state shall complete a renewal process with
  877  the Interstate Commission if the physician:
  878         (1) Maintains a full and unrestricted license in a state of
  879  principal license;
  880         (2) Has not been convicted, received adjudication, deferred
  881  adjudication, community supervision, or deferred disposition for
  882  any offense by a court of appropriate jurisdiction;
  883         (3) Has not had a license authorizing the practice of
  884  medicine subject to discipline by a licensing agency in any
  885  state, federal, or foreign jurisdiction, excluding any action
  886  related to non-payment of fees related to a license; and
  887         (4) Has not had a controlled substance license or permit
  888  suspended or revoked by a state or the United States Drug
  889  Enforcement Administration.
  890         (b) Physicians shall comply with all continuing
  891  professional development or continuing medical education
  892  requirements for renewal of a license issued by a member state.
  893         (c) The Interstate Commission shall collect any renewal
  894  fees charged for the renewal of a license and distribute the
  895  fees to the applicable member board.
  896         (d) Upon receipt of any renewal fees collected in
  897  subsection (c), a member board shall renew the physician’s
  898  license.
  899         (e) Physician information collected by the Interstate
  900  Commission during the renewal process will be distributed to all
  901  member boards.
  902         (f) The Interstate Commission is authorized to develop
  903  rules to address renewal of licenses obtained through the
  904  Compact.
  905  
  906                              SECTION 8                            
  907                   COORDINATED INFORMATION SYSTEM                  
  908  
  909         (a) The Interstate Commission shall establish a database of
  910  all physicians licensed, or who have applied for licensure,
  911  under Section 5.
  912         (b) Notwithstanding any other provision of law, member
  913  boards shall report to the Interstate Commission any public
  914  action or complaints against a licensed physician who has
  915  applied or received an expedited license through the Compact.
  916         (c) Member boards shall report disciplinary or
  917  investigatory information determined as necessary and proper by
  918  rule of the Interstate Commission.
  919         (d) Member boards may report any non-public complaint,
  920  disciplinary, or investigatory information not required by
  921  subsection (c) to the Interstate Commission.
  922         (e) Member boards shall share complaint or disciplinary
  923  information about a physician upon request of another member
  924  board.
  925         (f) All information provided to the Interstate Commission
  926  or distributed by member boards shall be confidential, filed
  927  under seal, and used only for investigatory or disciplinary
  928  matters.
  929         (g) The Interstate Commission is authorized to develop
  930  rules for mandated or discretionary sharing of information by
  931  member boards.
  932  
  933                              SECTION 9                            
  934                        JOINT INVESTIGATIONS                       
  935  
  936         (a) Licensure and disciplinary records of physicians are
  937  deemed investigative.
  938         (b) In addition to the authority granted to a member board
  939  by its respective Medical Practice Act or other applicable state
  940  law, a member board may participate with other member boards in
  941  joint investigations of physicians licensed by the member
  942  boards.
  943         (c) A subpoena issued by a member state shall be
  944  enforceable in other member states.
  945         (d) Member boards may share any investigative, litigation,
  946  or compliance materials in furtherance of any joint or
  947  individual investigation initiated under the Compact.
  948         (e) Any member state may investigate actual or alleged
  949  violations of the statutes authorizing the practice of medicine
  950  in any other member state in which a physician holds a license
  951  to practice medicine.
  952  
  953                             SECTION 10                            
  954                        DISCIPLINARY ACTIONS                       
  955  
  956         (a) Any disciplinary action taken by any member board
  957  against a physician licensed through the Compact shall be deemed
  958  unprofessional conduct which may be subject to discipline by
  959  other member boards, in addition to any violation of the Medical
  960  Practice Act or regulations in that state.
  961         (b) If a license granted to a physician by the member board
  962  in the state of principal license is revoked, surrendered or
  963  relinquished in lieu of discipline, or suspended, then all
  964  licenses issued to the physician by member boards shall
  965  automatically be placed, without further action necessary by any
  966  member board, on the same status. If the member board in the
  967  state of principal license subsequently reinstates the
  968  physician’s license, a license issued to the physician by any
  969  other member board shall remain encumbered until that respective
  970  member board takes action to reinstate the license in a manner
  971  consistent with the Medical Practice Act of that state.
  972         (c) If disciplinary action is taken against a physician by
  973  a member board not in the state of principal license, any other
  974  member board may deem the action conclusive as to matter of law
  975  and fact decided, and:
  976         (i) impose the same or lesser sanction(s) against the
  977  physician so long as such sanctions are consistent with the
  978  Medical Practice Act of that state;
  979         (ii) or pursue separate disciplinary action against the
  980  physician under its respective Medical Practice Act, regardless
  981  of the action taken in other member states.
  982         (d) If a license granted to a physician by a member board
  983  is revoked, surrendered or relinquished in lieu of discipline,
  984  or suspended, then any license(s) issued to the physician by any
  985  other member board(s) shall be suspended, automatically and
  986  immediately without further action necessary by the other member
  987  board(s), for ninety (90) days upon entry of the order by the
  988  disciplining board, to permit the member board(s) to investigate
  989  the basis for the action under the Medical Practice Act of that
  990  state. A member board may terminate the automatic suspension of
  991  the license it issued prior to the completion of the ninety (90)
  992  day suspension period in a manner consistent with the Medical
  993  Practice Act of that state.
  994  
  995                             SECTION 11                            
  996           INTERSTATE MEDICAL LICENSURE COMPACT COMMISSION         
  997  
  998         (a) The member states hereby create the “Interstate Medical
  999  Licensure Compact Commission”.
 1000         (b) The purpose of the Interstate Commission is the
 1001  administration of the Interstate Medical Licensure Compact,
 1002  which is a discretionary state function.
 1003         (c) The Interstate Commission shall be a body corporate and
 1004  joint agency of the member states and shall have all the
 1005  responsibilities, powers, and duties set forth in the Compact,
 1006  and such additional powers as may be conferred upon it by a
 1007  subsequent concurrent action of the respective legislatures of
 1008  the member states in accordance with the terms of the Compact.
 1009         (d) The Interstate Commission shall consist of two voting
 1010  representatives appointed by each member state who shall serve
 1011  as Commissioners. In states where allopathic and osteopathic
 1012  physicians are regulated by separate member boards, or if the
 1013  licensing and disciplinary authority is split between multiple
 1014  member boards within a member state, the member state shall
 1015  appoint one representative from each member board. A
 1016  Commissioner shall be a(n):
 1017         (1) Allopathic or osteopathic physician appointed to a
 1018  member board;
 1019         (2) Executive director, executive secretary, or similar
 1020  executive of a member board; or
 1021         (3) Member of the public appointed to a member board.
 1022         (e) The Interstate Commission shall meet at least once each
 1023  calendar year. A portion of this meeting shall be a business
 1024  meeting to address such matters as may properly come before the
 1025  Commission, including the election of officers. The chairperson
 1026  may call additional meetings and shall call for a meeting upon
 1027  the request of a majority of the member states.
 1028         (f) The bylaws may provide for meetings of the Interstate
 1029  Commission to be conducted by telecommunication or electronic
 1030  communication.
 1031         (g) Each Commissioner participating at a meeting of the
 1032  Interstate Commission is entitled to one vote. A majority of
 1033  Commissioners shall constitute a quorum for the transaction of
 1034  business, unless a larger quorum is required by the bylaws of
 1035  the Interstate Commission. A Commissioner shall not delegate a
 1036  vote to another Commissioner. In the absence of its
 1037  Commissioner, a member state may delegate voting authority for a
 1038  specified meeting to another person from that state who shall
 1039  meet the requirements of subsection (d).
 1040         (h) The Interstate Commission shall provide public notice
 1041  of all meetings and all meetings shall be open to the public.
 1042  The Interstate Commission may close a meeting, in full or in
 1043  portion, where it determines by a two-thirds vote of the
 1044  Commissioners present that an open meeting would be likely to:
 1045         (1) Relate solely to the internal personnel practices and
 1046  procedures of the Interstate Commission;
 1047         (2) Discuss matters specifically exempted from disclosure
 1048  by federal statute;
 1049         (3) Discuss trade secrets, commercial, or financial
 1050  information that is privileged or confidential;
 1051         (4) Involve accusing a person of a crime, or formally
 1052  censuring a person;
 1053         (5) Discuss information of a personal nature where
 1054  disclosure would constitute a clearly unwarranted invasion of
 1055  personal privacy;
 1056         (6) Discuss investigative records compiled for law
 1057  enforcement purposes; or
 1058         (7) Specifically relate to the participation in a civil
 1059  action or other legal proceeding.
 1060         (i) The Interstate Commission shall keep minutes which
 1061  shall fully describe all matters discussed in a meeting and
 1062  shall provide a full and accurate summary of actions taken,
 1063  including record of any roll call votes.
 1064         (j) The Interstate Commission shall make its information
 1065  and official records, to the extent not otherwise designated in
 1066  the Compact or by its rules, available to the public for
 1067  inspection.
 1068         (k) The Interstate Commission shall establish an executive
 1069  committee, which shall include officers, members, and others as
 1070  determined by the bylaws. The executive committee shall have the
 1071  power to act on behalf of the Interstate Commission, with the
 1072  exception of rulemaking, during periods when the Interstate
 1073  Commission is not in session. When acting on behalf of the
 1074  Interstate Commission, the executive committee shall oversee the
 1075  administration of the Compact including enforcement and
 1076  compliance with the provisions of the Compact, its bylaws and
 1077  rules, and other such duties as necessary.
 1078         (l) The Interstate Commission may establish other
 1079  committees for governance and administration of the Compact.
 1080  
 1081                             SECTION 12                            
 1082           POWERS AND DUTIES OF THE INTERSTATE COMMISSION          
 1083  
 1084         The Interstate Commission shall have the duty and power to:
 1085         (a) Oversee and maintain the administration of the Compact;
 1086         (b) Promulgate rules which shall be binding to the extent
 1087  and in the manner provided for in the Compact;
 1088         (c) Issue, upon the request of a member state or member
 1089  board, advisory opinions concerning the meaning or
 1090  interpretation of the Compact, its bylaws, rules, and actions;
 1091         (d) Enforce compliance with Compact provisions, the rules
 1092  promulgated by the Interstate Commission, and the bylaws, using
 1093  all necessary and proper means, including but not limited to the
 1094  use of judicial process;
 1095         (e) Establish and appoint committees including, but not
 1096  limited to, an executive committee as required by Section 11,
 1097  which shall have the power to act on behalf of the Interstate
 1098  Commission in carrying out its powers and duties;
 1099         (f) Pay, or provide for the payment of the expenses related
 1100  to the establishment, organization, and ongoing activities of
 1101  the Interstate Commission;
 1102         (g) Establish and maintain one or more offices;
 1103         (h) Borrow, accept, hire, or contract for services of
 1104  personnel;
 1105         (i) Purchase and maintain insurance and bonds;
 1106         (j) Employ an executive director who shall have such powers
 1107  to employ, select or appoint employees, agents, or consultants,
 1108  and to determine their qualifications, define their duties, and
 1109  fix their compensation;
 1110         (k) Establish personnel policies and programs relating to
 1111  conflicts of interest, rates of compensation, and qualifications
 1112  of personnel;
 1113         (l) Accept donations and grants of money, equipment,
 1114  supplies, materials and services, and to receive, utilize, and
 1115  dispose of it in a manner consistent with the conflict of
 1116  interest policies established by the Interstate Commission;
 1117         (m) Lease, purchase, accept contributions or donations of,
 1118  or otherwise to own, hold, improve or use, any property, real,
 1119  personal, or mixed;
 1120         (n) Sell, convey, mortgage, pledge, lease, exchange,
 1121  abandon, or otherwise dispose of any property, real, personal,
 1122  or mixed;
 1123         (o) Establish a budget and make expenditures;
 1124         (p) Adopt a seal and bylaws governing the management and
 1125  operation of the Interstate Commission;
 1126         (q) Report annually to the legislatures and governors of
 1127  the member states concerning the activities of the Interstate
 1128  Commission during the preceding year. Such reports shall also
 1129  include reports of financial audits and any recommendations that
 1130  may have been adopted by the Interstate Commission;
 1131         (r) Coordinate education, training, and public awareness
 1132  regarding the Compact, its implementation, and its operation;
 1133         (s) Maintain records in accordance with the bylaws;
 1134         (t) Seek and obtain trademarks, copyrights, and patents;
 1135  and
 1136         (u) Perform such functions as may be necessary or
 1137  appropriate to achieve the purposes of the Compact.
 1138  
 1139                             SECTION 13                            
 1140                           FINANCE POWERS                          
 1141  
 1142         (a) The Interstate Commission may levy on and collect an
 1143  annual assessment from each member state to cover the cost of
 1144  the operations and activities of the Interstate Commission and
 1145  its staff. The total assessment, subject to appropriation, must
 1146  be sufficient to cover the annual budget approved each year for
 1147  which revenue is not provided by other sources. The aggregate
 1148  annual assessment amount shall be allocated upon a formula to be
 1149  determined by the Interstate Commission, which shall promulgate
 1150  a rule binding upon all member states.
 1151         (b) The Interstate Commission shall not incur obligations
 1152  of any kind prior to securing the funds adequate to meet the
 1153  same.
 1154         (c) The Interstate Commission shall not pledge the credit
 1155  of any of the member states, except by, and with the authority
 1156  of, the member state.
 1157         (d) The Interstate Commission shall be subject to a yearly
 1158  financial audit conducted by a certified or licensed public
 1159  accountant and the report of the audit shall be included in the
 1160  annual report of the Interstate Commission.
 1161  
 1162                             SECTION 14                            
 1163       ORGANIZATION AND OPERATION OF THE INTERSTATE COMMISSION     
 1164  
 1165         (a) The Interstate Commission shall, by a majority of
 1166  Commissioners present and voting, adopt bylaws to govern its
 1167  conduct as may be necessary or appropriate to carry out the
 1168  purposes of the Compact within twelve (12) months of the first
 1169  Interstate Commission meeting.
 1170         (b) The Interstate Commission shall elect or appoint
 1171  annually from among its Commissioners a chairperson, a vice
 1172  chairperson, and a treasurer, each of whom shall have such
 1173  authority and duties as may be specified in the bylaws. The
 1174  chairperson, or in the chairperson’s absence or disability, the
 1175  vice-chairperson, shall preside at all meetings of the
 1176  Interstate Commission.
 1177         (c) Officers selected in subsection (b) shall serve without
 1178  remuneration from the Interstate Commission.
 1179         (d) The officers and employees of the Interstate Commission
 1180  shall be immune from suit and liability, either personally or in
 1181  their official capacity, for a claim for damage to or loss of
 1182  property or personal injury or other civil liability caused or
 1183  arising out of, or relating to, an actual or alleged act, error,
 1184  or omission that occurred, or that such person had a reasonable
 1185  basis for believing occurred, within the scope of Interstate
 1186  Commission employment, duties, or responsibilities; provided
 1187  that such person shall not be protected from suit or liability
 1188  for damage, loss, injury, or liability caused by the intentional
 1189  or willful and wanton misconduct of such person.
 1190         (1) The liability of the executive director and employees
 1191  of the Interstate Commission or representatives of the
 1192  Interstate Commission, acting within the scope of such person’s
 1193  employment or duties for acts, errors, or omissions occurring
 1194  within such person’s state, may not exceed the limits of
 1195  liability set forth under the constitution and laws of that
 1196  state for state officials, employees, and agents. The Interstate
 1197  Commission is considered to be an instrumentality of the states
 1198  for the purposes of any such action. Nothing in this subsection
 1199  shall be construed to protect such person from suit or liability
 1200  for damage, loss, injury, or liability caused by the intentional
 1201  or willful and wanton misconduct of such person.
 1202         (2) The Interstate Commission shall defend the executive
 1203  director, its employees, and subject to the approval of the
 1204  attorney general or other appropriate legal counsel of the
 1205  member state represented by an Interstate Commission
 1206  representative, shall defend such Interstate Commission
 1207  representative in any civil action seeking to impose liability
 1208  arising out of an actual or alleged act, error or omission that
 1209  occurred within the scope of Interstate Commission employment,
 1210  duties or responsibilities, or that the defendant had a
 1211  reasonable basis for believing occurred within the scope of
 1212  Interstate Commission employment, duties, or responsibilities,
 1213  provided that the actual or alleged act, error, or omission did
 1214  not result from intentional or willful and wanton misconduct on
 1215  the part of such person.
 1216         (3) To the extent not covered by the state involved, member
 1217  state, or the Interstate Commission, the representatives or
 1218  employees of the Interstate Commission shall be held harmless in
 1219  the amount of a settlement or judgment, including attorney’s
 1220  fees and costs, obtained against such persons arising out of an
 1221  actual or alleged act, error, or omission that occurred within
 1222  the scope of Interstate Commission employment, duties, or
 1223  responsibilities, or that such persons had a reasonable basis
 1224  for believing occurred within the scope of Interstate Commission
 1225  employment, duties, or responsibilities, provided that the
 1226  actual or alleged act, error, or omission did not result from
 1227  intentional or willful and wanton misconduct on the part of such
 1228  persons.
 1229  
 1230                             SECTION 15                            
 1231          RULEMAKING FUNCTIONS OF THE INTERSTATE COMMISSION        
 1232  
 1233         (a) The Interstate Commission shall promulgate reasonable
 1234  rules in order to effectively and efficiently achieve the
 1235  purposes of the Compact. Notwithstanding the foregoing, in the
 1236  event the Interstate Commission exercises its rulemaking
 1237  authority in a manner that is beyond the scope of the purposes
 1238  of the Compact, or the powers granted hereunder, then such an
 1239  action by the Interstate Commission shall be invalid and have no
 1240  force or effect.
 1241         (b) Rules deemed appropriate for the operations of the
 1242  Interstate Commission shall be made pursuant to a rulemaking
 1243  process that substantially conforms to the “Model State
 1244  Administrative Procedure Act” of 2010, and subsequent amendments
 1245  thereto.
 1246         (c) Not later than thirty (30) days after a rule is
 1247  promulgated, any person may file a petition for judicial review
 1248  of the rule in the United States District Court for the District
 1249  of Columbia or the federal district where the Interstate
 1250  Commission has its principal offices, provided that the filing
 1251  of such a petition shall not stay or otherwise prevent the rule
 1252  from becoming effective unless the court finds that the
 1253  petitioner has a substantial likelihood of success. The court
 1254  shall give deference to the actions of the Interstate Commission
 1255  consistent with applicable law and shall not find the rule to be
 1256  unlawful if the rule represents a reasonable exercise of the
 1257  authority granted to the Interstate Commission.
 1258  
 1259                             SECTION 16                            
 1260                   OVERSIGHT OF INTERSTATE COMPACT                 
 1261  
 1262         (a) The executive, legislative, and judicial branches of
 1263  state government in each member state shall enforce the Compact
 1264  and shall take all actions necessary and appropriate to
 1265  effectuate the Compact’s purposes and intent. The provisions of
 1266  the Compact and the rules promulgated hereunder shall have
 1267  standing as statutory law but shall not override existing state
 1268  authority to regulate the practice of medicine.
 1269         (b) All courts shall take judicial notice of the Compact
 1270  and the rules in any judicial or administrative proceeding in a
 1271  member state pertaining to the subject matter of the Compact
 1272  which may affect the powers, responsibilities or actions of the
 1273  Interstate Commission.
 1274         (c) The Interstate Commission shall be entitled to receive
 1275  all service of process in any such proceeding, and shall have
 1276  standing to intervene in the proceeding for all purposes.
 1277  Failure to provide service of process to the Interstate
 1278  Commission shall render a judgment or order void as to the
 1279  Interstate Commission, the Compact, or promulgated rules.
 1280  
 1281                             SECTION 17                            
 1282                  ENFORCEMENT OF INTERSTATE COMPACT                
 1283  
 1284         (a) The Interstate Commission, in the reasonable exercise
 1285  of its discretion, shall enforce the provisions and rules of the
 1286  Compact.
 1287         (b) The Interstate Commission may, by majority vote of the
 1288  Commissioners, initiate legal action in the United States
 1289  District Court for the District of Columbia, or, at the
 1290  discretion of the Interstate Commission, in the federal district
 1291  where the Interstate Commission has its principal offices, to
 1292  enforce compliance with the provisions of the Compact, and its
 1293  promulgated rules and bylaws, against a member state in default.
 1294  The relief sought may include both injunctive relief and
 1295  damages. In the event judicial enforcement is necessary, the
 1296  prevailing party shall be awarded all costs of such litigation
 1297  including reasonable attorney’s fees.
 1298         (c) The remedies herein shall not be the exclusive remedies
 1299  of the Interstate Commission. The Interstate Commission may
 1300  avail itself of any other remedies available under state law or
 1301  the regulation of a profession.
 1302  
 1303                             SECTION 18                            
 1304                         DEFAULT PROCEDURES                        
 1305  
 1306         (a) The grounds for default include, but are not limited
 1307  to, failure of a member state to perform such obligations or
 1308  responsibilities imposed upon it by the Compact, or the rules
 1309  and bylaws of the Interstate Commission promulgated under the
 1310  Compact.
 1311         (b) If the Interstate Commission determines that a member
 1312  state has defaulted in the performance of its obligations or
 1313  responsibilities under the Compact, or the bylaws or promulgated
 1314  rules, the Interstate Commission shall:
 1315         (1) Provide written notice to the defaulting state and
 1316  other member states, of the nature of the default, the means of
 1317  curing the default, and any action taken by the Interstate
 1318  Commission. The Interstate Commission shall specify the
 1319  conditions by which the defaulting state must cure its default;
 1320  and
 1321         (2) Provide remedial training and specific technical
 1322  assistance regarding the default.
 1323         (c) If the defaulting state fails to cure the default, the
 1324  defaulting state shall be terminated from the Compact upon an
 1325  affirmative vote of a majority of the Commissioners and all
 1326  rights, privileges, and benefits conferred by the Compact shall
 1327  terminate on the effective date of termination. A cure of the
 1328  default does not relieve the offending state of obligations or
 1329  liabilities incurred during the period of the default.
 1330         (d) Termination of membership in the Compact shall be
 1331  imposed only after all other means of securing compliance have
 1332  been exhausted. Notice of intent to terminate shall be given by
 1333  the Interstate Commission to the governor, the majority and
 1334  minority leaders of the defaulting state’s legislature, and each
 1335  of the member states.
 1336         (e) The Interstate Commission shall establish rules and
 1337  procedures to address licenses and physicians that are
 1338  materially impacted by the termination of a member state, or the
 1339  withdrawal of a member state.
 1340         (f) The member state which has been terminated is
 1341  responsible for all dues, obligations, and liabilities incurred
 1342  through the effective date of termination including obligations,
 1343  the performance of which extends beyond the effective date of
 1344  termination.
 1345         (g) The Interstate Commission shall not bear any costs
 1346  relating to any state that has been found to be in default or
 1347  which has been terminated from the Compact, unless otherwise
 1348  mutually agreed upon in writing between the Interstate
 1349  Commission and the defaulting state.
 1350         (h) The defaulting state may appeal the action of the
 1351  Interstate Commission by petitioning the United States District
 1352  Court for the District of Columbia or the federal district where
 1353  the Interstate Commission has its principal offices. The
 1354  prevailing party shall be awarded all costs of such litigation
 1355  including reasonable attorney’s fees.
 1356  
 1357                             SECTION 19                            
 1358                         DISPUTE RESOLUTION                        
 1359  
 1360         (a) The Interstate Commission shall attempt, upon the
 1361  request of a member state, to resolve disputes which are subject
 1362  to the Compact and which may arise among member states or member
 1363  boards.
 1364         (b) The Interstate Commission shall promulgate rules
 1365  providing for both mediation and binding dispute resolution as
 1366  appropriate.
 1367  
 1368                             SECTION 20                            
 1369             MEMBER STATES, EFFECTIVE DATE AND AMENDMENT           
 1370  
 1371         (a) Any state is eligible to become a member state of the
 1372  Compact.
 1373         (b) The Compact shall become effective and binding upon
 1374  legislative enactment of the Compact into law by no less than
 1375  seven (7) states. Thereafter, it shall become effective and
 1376  binding on a state upon enactment of the Compact into law by
 1377  that state.
 1378         (c) The governors of non-member states, or their designees,
 1379  shall be invited to participate in the activities of the
 1380  Interstate Commission on a non-voting basis prior to adoption of
 1381  the Compact by all states.
 1382         (d) The Interstate Commission may propose amendments to the
 1383  Compact for enactment by the member states. No amendment shall
 1384  become effective and binding upon the Interstate Commission and
 1385  the member states unless and until it is enacted into law by
 1386  unanimous consent of the member states.
 1387  
 1388                             SECTION 21                            
 1389                             WITHDRAWAL                            
 1390  
 1391         (a) Once effective, the Compact shall continue in force and
 1392  remain binding upon each and every member state; provided that a
 1393  member state may withdraw from the Compact by specifically
 1394  repealing the statute which enacted the Compact into law.
 1395         (b) Withdrawal from the Compact shall be by the enactment
 1396  of a statute repealing the same, but shall not take effect until
 1397  one (1) year after the effective date of such statute and until
 1398  written notice of the withdrawal has been given by the
 1399  withdrawing state to the governor of each other member state.
 1400         (c) The withdrawing state shall immediately notify the
 1401  chairperson of the Interstate Commission in writing upon the
 1402  introduction of legislation repealing the Compact in the
 1403  withdrawing state.
 1404         (d) The Interstate Commission shall notify the other member
 1405  states of the withdrawing state’s intent to withdraw within
 1406  sixty (60) days of its receipt of notice provided under
 1407  subsection (c).
 1408         (e) The withdrawing state is responsible for all dues,
 1409  obligations and liabilities incurred through the effective date
 1410  of withdrawal, including obligations, the performance of which
 1411  extend beyond the effective date of withdrawal.
 1412         (f) Reinstatement following withdrawal of a member state
 1413  shall occur upon the withdrawing state reenacting the Compact or
 1414  upon such later date as determined by the Interstate Commission.
 1415         (g) The Interstate Commission is authorized to develop
 1416  rules to address the impact of the withdrawal of a member state
 1417  on licenses granted in other member states to physicians who
 1418  designated the withdrawing member state as the state of
 1419  principal license.
 1420  
 1421                             SECTION 22                            
 1422                             DISSOLUTION                           
 1423  
 1424         (a) The Compact shall dissolve effective upon the date of
 1425  the withdrawal or default of the member state which reduces the
 1426  membership in the Compact to one (1) member state.
 1427         (b) Upon the dissolution of the Compact, the Compact
 1428  becomes null and void and shall be of no further force or
 1429  effect, and the business and affairs of the Interstate
 1430  Commission shall be concluded and surplus funds shall be
 1431  distributed in accordance with the bylaws.
 1432  
 1433                             SECTION 23                            
 1434                    SEVERABILITY AND CONSTRUCTION                  
 1435  
 1436         (a) The provisions of the Compact shall be severable, and
 1437  if any phrase, clause, sentence, or provision is deemed
 1438  unenforceable, the remaining provisions of the Compact shall be
 1439  enforceable.
 1440         (b) The provisions of the Compact shall be liberally
 1441  construed to effectuate its purposes.
 1442         (c) Nothing in the Compact shall be construed to prohibit
 1443  the applicability of other interstate compacts to which the
 1444  states are members.
 1445  
 1446                             SECTION 24                            
 1447              BINDING EFFECT OF COMPACT AND OTHER LAWS             
 1448  
 1449         (a) Nothing herein prevents the enforcement of any other
 1450  law of a member state that is not inconsistent with the Compact.
 1451         (b) All laws in a member state in conflict with the Compact
 1452  are superseded to the extent of the conflict.
 1453         (c) All lawful actions of the Interstate Commission,
 1454  including all rules and bylaws promulgated by the Commission,
 1455  are binding upon the member states.
 1456         (d) All agreements between the Interstate Commission and
 1457  the member states are binding in accordance with their terms.
 1458         (e) In the event any provision of the Compact exceeds the
 1459  constitutional limits imposed on the legislature of any member
 1460  state, such provision shall be ineffective to the extent of the
 1461  conflict with the constitutional provision in question in that
 1462  member state.
 1463         Section 15. Except as otherwise expressly provided in this
 1464  act, this act shall take effect July 1, 2019.