Florida Senate - 2019 CS for SB 7078
By the Committees on Appropriations; and Health Policy
1 A bill to be entitled
2 An act relating to health care; providing legislative
3 intent; creating s. 381.4019, F.S.; establishing the
4 Dental Student Loan Repayment Program to support
5 dentists who practice in public health programs
6 located in certain underserved areas; providing
7 definitions; requiring the Department of Health to
8 establish a dental student loan repayment program for
9 specified purposes; providing for the award of funds;
10 providing the maximum number of years for which funds
11 may be awarded; providing eligibility requirements;
12 requiring the department to adopt rules; specifying
13 that implementation of the program is subject to
14 legislative appropriation; creating s. 381.40195,
15 F.S.; providing a short title; providing definitions;
16 requiring the Department of Health to establish the
17 Donated Dental Services Program to provide
18 comprehensive dental care to certain eligible
19 individuals; requiring the department to contract with
20 a nonprofit organization to implement and administer
21 the program; specifying minimum contractual
22 responsibilities; requiring the department to adopt
23 rules; specifying that implementation of the program
24 is subject to legislative appropriation; amending s.
25 395.1012, F.S.; requiring a licensed hospital to
26 provide specified information and data relating to
27 patient safety and quality measures to a patient under
28 certain circumstances or to any person upon request;
29 creating s. 395.1052, F.S.; requiring a hospital to
30 notify a patient’s primary care provider within a
31 specified timeframe after the patient’s admission;
32 requiring a hospital to inform a patient, upon
33 admission, of the option to request consultation
34 between the hospital’s treating physician and the
35 patient’s primary care provider or specialist
36 provider; requiring a hospital to notify a patient’s
37 primary care provider of the patient’s discharge and
38 provide specified information and records to the
39 primary care provider within a specified timeframe
40 after discharge; amending s. 395.002, F.S.; revising
41 the definition of the term “ambulatory surgical
42 center”; amending s. 395.1055, F.S.; requiring the
43 Agency for Health Care Administration, in consultation
44 with the Board of Medicine and the Board of
45 Osteopathic Medicine, to adopt rules that establish
46 requirements related to the delivery of surgical care
47 to children in ambulatory surgical centers, in
48 accordance with specified standards; specifying that
49 ambulatory surgical centers may provide certain
50 procedures only if authorized by agency rule;
51 authorizing the reimbursement of per diem and travel
52 expenses to members of the pediatric cardiac technical
53 advisory panel, established within the Agency for
54 Health Care Administration; revising panel membership
55 to include certain alternate at-large members;
56 providing term limits for voting members; providing
57 that members of the panel under certain circumstances
58 are agents of the state for a specified purpose;
59 requiring the Secretary of Health Care Administration
60 to consult the panel for advisory recommendations on
61 certain certificate of need applications; authorizing
62 the secretary to request announced or unannounced site
63 visits to any existing pediatric cardiac surgical
64 center or facility seeking licensure as a pediatric
65 cardiac surgical center through the certificate of
66 need process; providing a process for the appointment
67 of physician experts to a site visit team; requiring
68 each member of a site visit team to submit a report to
69 the panel; requiring the panel to discuss such reports
70 and present an advisory opinion to the secretary;
71 providing requirements for an on-site inspection;
72 requiring the Surgeon General of the Department of
73 Health to provide specified reports to the secretary;
74 395.301, F.S.; requiring a licensed facility, upon
75 placing a patient on observation status, to
76 immediately notify the patient of such status using a
77 specified form; requiring that such notification be
78 documented in the patient’s medical records and
79 discharge papers; creating s. 542.336, F.S.;
80 specifying that certain restrictive covenants entered
81 into with certain physicians are not supported by
82 legitimate business interests; providing legislative
83 findings; providing that such restrictive covenants
84 are void and remain void and unenforceable for a
85 specified period; amending s. 624.27, F.S.; expanding
86 the scope of direct primary care agreements, which are
87 renamed “direct health care agreements”; conforming
88 provisions to changes made by the act; creating s.
89 627.42393, F.S.; prohibiting certain health insurers
90 from employing step-therapy protocols under certain
91 circumstances; defining the term “health coverage
92 plan”; clarifying that a health insurer is not
93 required to take specific actions regarding
94 prescription drugs; amending s. 641.31, F.S.;
95 prohibiting certain health maintenance organizations
96 from employing step-therapy protocols under certain
97 circumstances; defining the term “health coverage
98 plan”; clarifying that a health maintenance
99 organization is not required to take specific actions
100 regarding prescription drugs; requiring the Office of
101 Program Policy Analysis and Government Accountability
102 to submit by a specified date a report and
103 recommendations to the Governor and the Legislature
104 which addresses this state’s prospective entrance into
105 the Interstate Medical Licensure Compact as a member
106 state; providing parameters for the report; providing
107 effective dates.
109 Be It Enacted by the Legislature of the State of Florida:
111 Section 1. It is the intent of the Legislature to promote
112 programs and initiatives that help make available preventive and
113 educational dental services for the residents of the state, as
114 well as provide quality dental treatment services. The
115 geographic characteristics among the residents of the state are
116 distinctive and vary from region to region, with such residents
117 having unique needs regarding access to dental care. The
118 Legislature recognizes that maintaining good oral health is
119 integral to the overall health status of individuals and that
120 the good health of the residents of this state is an important
121 contributing factor in economic development. Better health,
122 including better oral health, increases workplace productivity,
123 reduces the burden of health care costs, and improves the
124 cognitive development of children, resulting in a reduction of
125 missed school days.
126 Section 2. Section 381.4019, Florida Statutes, is created
127 to read:
128 381.4019 Dental Student Loan Repayment Program.—The Dental
129 Student Loan Repayment Program is established to promote access
130 to dental care by supporting qualified dentists who treat
131 medically underserved populations in dental health professional
132 shortage areas or medically underserved areas.
133 (1) As used in this section, the term:
134 (a) “Dental health professional shortage area” means a
135 geographic area designated as such by the Health Resources and
136 Services Administration of the United States Department of
137 Health and Human Services.
138 (b) “Department” means the Department of Health.
139 (c) “Loan program” means the Dental Student Loan Repayment
141 (d) “Medically underserved area” means a geographic area,
142 an area having a special population, or a facility which is
143 designated by department rule as a health professional shortage
144 area as defined by federal regulation and which has a shortage
145 of dental health professionals who serve Medicaid recipients and
146 other low-income patients.
147 (e) “Public health program” means a county health
148 department, the Children’s Medical Services program, a federally
149 funded community health center, a federally funded migrant
150 health center, or other publicly funded or nonprofit health care
151 program designated by the department.
152 (2) The department shall establish a dental student loan
153 repayment program to benefit Florida-licensed dentists who
154 demonstrate, as required by department rule, active employment
155 in a public health program that serves Medicaid recipients and
156 other low-income patients and is located in a dental health
157 professional shortage area or a medically underserved area.
158 (3) The department shall award funds from the loan program
159 to repay the student loans of a dentist who meets the
160 requirements of subsection (2).
161 (a) An award may not exceed $50,000 per year per eligible
163 (b) Only loans to pay the costs of tuition, books, dental
164 equipment and supplies, uniforms, and living expenses may be
166 (c) All repayments are contingent upon continued proof of
167 eligibility and must be made directly to the holder of the loan.
168 The state bears no responsibility for the collection of any
169 interest charges or other remaining balances.
170 (d) A dentist may receive funds under the loan program for
171 at least 1 year, up to a maximum of 5 years.
172 (e) The department shall limit the number of new dentists
173 participating in the loan program to not more than 10 per fiscal
175 (4) A dentist is no longer eligible to receive funds under
176 the loan program if the dentist:
177 (a) Is no longer employed by a public health program that
178 meets the requirements of subsection (2).
179 (b) Ceases to participate in the Florida Medicaid program.
180 (c) Has disciplinary action taken against his or her
181 license by the Board of Dentistry for a violation of s. 466.028.
182 (5) The department shall adopt rules to administer the loan
184 (6) Implementation of the loan program is subject to
185 legislative appropriation.
186 Section 3. Section 381.40195, Florida Statutes, is created
187 to read:
188 381.40195 Donated Dental Services Program.—
189 (1) This act may be cited as the “Donated Dental Services
191 (2) As used in this section, the term:
192 (a) “Department” means the Department of Health.
193 (b) “Program” means the Donated Dental Services Program as
194 established pursuant to subsection (3).
195 (3) The department shall establish the Donated Dental
196 Services Program for the purpose of providing comprehensive
197 dental care through a network of volunteer dentists and other
198 dental providers to needy, disabled, elderly, and medically
199 compromised individuals who cannot afford necessary treatment
200 but are ineligible for public assistance. An eligible individual
201 may receive treatment in a volunteer dentist’s or participating
202 dental provider’s private office or at any other suitable
203 location. An eligible individual is not required to pay any fee
204 or cost associated with the treatment he or she receives.
205 (4) The department shall establish the program. The
206 department shall contract with a nonprofit organization that has
207 experience in providing similar services or administering
208 similar programs. The contract must specify the responsibilities
209 of the nonprofit organization, which may include, but are not
210 limited to:
211 (a) Maintaining a network of volunteer dentists and other
212 dental providers, including, but not limited to, dental
213 specialists and dental laboratories, to provide comprehensive
214 dental services to eligible individuals.
215 (b) Maintaining a system to refer eligible individuals to
216 the appropriate volunteer dentist or participating dental
218 (c) Developing a public awareness and marketing campaign to
219 promote the program and educate eligible individuals about its
220 availability and services.
221 (d) Providing the necessary administrative and technical
222 support to administer the program.
223 (e) Submitting an annual report to the department which
224 must include, at a minimum:
225 1. Financial data relating to administering the program.
226 2. Demographic data and other information relating to the
227 eligible individuals who are referred to and receive treatment
228 through the program.
229 3. Demographic data and other information relating to the
230 volunteer dentists and participating dental providers who
231 provide dental services through the program.
232 4. Any other data or information that the department may
234 (f) Performing any other program-related duties and
235 responsibilities as required by the department.
236 (5) The department shall adopt rules to administer the
238 (6) Implementation of the program is subject to legislative
240 Section 4. Subsection (3) is added to section 395.1012,
241 Florida Statutes, to read:
242 395.1012 Patient safety.—
243 (3)(a) Each hospital shall provide to any patient upon
244 admission, upon scheduling of nonemergency care, or before
245 treatment, written information on a form created by the agency
246 which contains the following information available for the
247 hospital for the most recent year and the statewide average for
248 all hospitals related to the following quality measures:
249 1. The rate of hospital-acquired infections;
250 2. The overall rating of the Hospital Consumer Assessment
251 of Healthcare Providers and Systems survey; and
252 3. The 15-day readmission rate.
253 (b) A hospital shall also provide to any person, upon
254 request, the written information specified in paragraph (a).
255 (c) The information required by this subsection must be
256 presented in a manner that is easily understandable and
257 accessible to the patient and must also include an explanation
258 of the quality measures and the relationship between patient
259 safety and the hospital’s data for the quality measures.
260 Section 5. Section 395.1052, Florida Statutes, is created
261 to read:
262 395.1052 Patient access to primary care and specialty
263 providers; notification.—A hospital shall:
264 (1) Notify each patient’s primary care provider, if any,
265 within 24 hours after the patient’s admission to the hospital.
266 (2) Inform the patient immediately upon admission that he
267 or she may request to have the hospital’s treating physician
268 consult with the patient’s primary care provider or specialist
269 provider, if any, when developing the patient’s plan of care.
270 Upon the patient’s request, the hospital’s treating physician
271 shall make reasonable efforts to consult with the patient’s
272 primary care provider or specialist provider when developing the
273 patient’s plan of care.
274 (3) Notify the patient’s primary care provider, if any, of
275 the patient’s discharge from the hospital within 24 hours after
276 the discharge.
277 (4) Provide the discharge summary and any related
278 information or records to the patient’s primary care provider,
279 if any, within 14 days after the patient’s discharge from the
281 Section 6. Subsection (3) of section 395.002, Florida
282 Statutes, is amended to read:
283 395.002 Definitions.—As used in this chapter:
284 (3) “Ambulatory surgical center” means a facility the
285 primary purpose of which is to provide elective surgical care,
286 in which the patient is admitted to and discharged from such
287 facility within 24 hours
the same working day and is not
288 permitted to stay overnight, and which is not part of a
289 hospital. However, a facility existing for the primary purpose
290 of performing terminations of pregnancy, an office maintained by
291 a physician for the practice of medicine, or an office
292 maintained for the practice of dentistry may not be construed to
293 be an ambulatory surgical center, provided that any facility or
294 office which is certified or seeks certification as a Medicare
295 ambulatory surgical center shall be licensed as an ambulatory
296 surgical center pursuant to s. 395.003.
297 Section 7. Section 395.1055, Florida Statutes, is amended
298 to read:
299 395.1055 Rules and enforcement.—
300 (1) The agency shall adopt rules pursuant to ss. 120.536(1)
301 and 120.54 to implement the provisions of this part, which shall
302 include reasonable and fair minimum standards for ensuring that:
303 (a) Sufficient numbers and qualified types of personnel and
304 occupational disciplines are on duty and available at all times
305 to provide necessary and adequate patient care and safety.
306 (b) Infection control, housekeeping, sanitary conditions,
307 and medical record procedures that will adequately protect
308 patient care and safety are established and implemented.
309 (c) A comprehensive emergency management plan is prepared
310 and updated annually. Such standards must be included in the
311 rules adopted by the agency after consulting with the Division
312 of Emergency Management. At a minimum, the rules must provide
313 for plan components that address emergency evacuation
314 transportation; adequate sheltering arrangements; postdisaster
315 activities, including emergency power, food, and water;
316 postdisaster transportation; supplies; staffing; emergency
317 equipment; individual identification of residents and transfer
318 of records, and responding to family inquiries. The
319 comprehensive emergency management plan is subject to review and
320 approval by the local emergency management agency. During its
321 review, the local emergency management agency shall ensure that
322 the following agencies, at a minimum, are given the opportunity
323 to review the plan: the Department of Elderly Affairs, the
324 Department of Health, the Agency for Health Care Administration,
325 and the Division of Emergency Management. Also, appropriate
326 volunteer organizations must be given the opportunity to review
327 the plan. The local emergency management agency shall complete
328 its review within 60 days and either approve the plan or advise
329 the facility of necessary revisions.
330 (d) Licensed facilities are established, organized, and
331 operated consistent with established standards and rules.
332 (e) Licensed facility beds conform to minimum space,
333 equipment, and furnishings standards as specified by the
335 (f) All hospitals submit such data as necessary to conduct
336 certificate-of-need reviews required under part I of chapter
337 408. Such data shall include, but shall not be limited to,
338 patient origin data, hospital utilization data, type of service
339 reporting, and facility staffing data. The agency may not
340 collect data that identifies or could disclose the identity of
341 individual patients. The agency shall utilize existing uniform
342 statewide data sources when available and shall minimize
343 reporting costs to hospitals.
344 (g) Each hospital has a quality improvement program
345 designed according to standards established by their current
346 accrediting organization. This program will enhance quality of
347 care and emphasize quality patient outcomes, corrective action
348 for problems, governing board review, and reporting to the
349 agency of standardized data elements necessary to analyze
350 quality of care outcomes. The agency shall use existing data,
351 when available, and shall not duplicate the efforts of other
352 state agencies in order to obtain such data.
353 (h) Licensed facilities make available on their Internet
354 websites, no later than October 1, 2004, and in a hard copy
355 format upon request, a description of and a link to the patient
356 charge and performance outcome data collected from licensed
357 facilities pursuant to s. 408.061.
358 (i) All hospitals providing organ transplantation, neonatal
359 intensive care services, inpatient psychiatric services,
360 inpatient substance abuse services, or comprehensive medical
361 rehabilitation meet the minimum licensure requirements adopted
362 by the agency. Such licensure requirements must include quality
363 of care, nurse staffing, physician staffing, physical plant,
364 equipment, emergency transportation, and data reporting
366 (2) Separate standards may be provided for general and
367 specialty hospitals, ambulatory surgical centers, and statutory
368 rural hospitals as defined in s. 395.602.
369 (3)(a) The agency, in consultation with the Board of
370 Medicine and the Board of Osteopathic Medicine, shall adopt
371 rules that establish requirements to ensure the safe and
372 effective delivery of surgical care to children kept past
373 midnight in ambulatory surgical centers. The rules must be
374 consistent with the American College of Surgeons’ 2015 standards
375 document entitled “Optimal Resources for Children’s Surgical
376 Care” and must establish minimum standards for pediatric patient
377 care in ambulatory surgical centers.
378 (b) Ambulatory surgical centers may provide operative
379 procedures that require a length of stay past midnight on the
380 day of surgery for children younger than 18 years of age only if
381 the agency authorizes the performance of such procedures by
383 (4) (3) The agency shall adopt rules with respect to the
384 care and treatment of patients residing in distinct part nursing
385 units of hospitals which are certified for participation in
386 Title XVIII (Medicare) and Title XIX (Medicaid) of the Social
387 Security Act skilled nursing facility program. Such rules shall
388 take into account the types of patients treated in hospital
389 skilled nursing units, including typical patient acuity levels
390 and the average length of stay in such units, and shall be
391 limited to the appropriate portions of the Omnibus Budget
392 Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,
393 1987), Title IV (Medicare, Medicaid, and Other Health-Related
394 Programs), Subtitle C (Nursing Home Reform), as amended. The
395 agency shall require level 2 background screening as specified
396 in s. 408.809(1)(e) pursuant to s. 408.809 and chapter 435 for
397 personnel of distinct part nursing units.
398 (5) (4) The agency shall adopt rules with respect to the
399 care and treatment of clients in intensive residential treatment
400 programs for children and adolescents and with respect to the
401 safe and healthful development, operation, and maintenance of
402 such programs.
403 (6) (5) The agency shall enforce the provisions of part I of
404 chapter 394, and rules adopted thereunder, with respect to the
405 rights, standards of care, and examination and placement
406 procedures applicable to patients voluntarily or involuntarily
407 admitted to hospitals providing psychiatric observation,
408 evaluation, diagnosis, or treatment.
409 (7) (6) No rule shall be adopted under this part by the
410 agency which would have the effect of denying a license to a
411 facility required to be licensed under this part, solely by
412 reason of the school or system of practice employed or permitted
413 to be employed by physicians therein, provided that such school
414 or system of practice is recognized by the laws of this state.
415 However, nothing in this subsection shall be construed to limit
416 the powers of the agency to provide and require minimum
417 standards for the maintenance and operation of, and for the
418 treatment of patients in, those licensed facilities which
419 receive federal aid, in order to meet minimum standards related
420 to such matters in such licensed facilities which may now or
421 hereafter be required by appropriate federal officers or
422 agencies in pursuance of federal law or promulgated in pursuance
423 of federal law.
424 (8) (7) Any licensed facility which is in operation at the
425 time of promulgation of any applicable rules under this part
426 shall be given a reasonable time, under the particular
427 circumstances, but not to exceed 1 year from the date of such
428 promulgation, within which to comply with such rules.
429 (9) (8) The agency may not adopt any rule governing the
430 design, construction, erection, alteration, modification,
431 repair, or demolition of any public or private hospital,
432 intermediate residential treatment facility, or ambulatory
433 surgical center. It is the intent of the Legislature to preempt
434 that function to the Florida Building Commission and the State
435 Fire Marshal through adoption and maintenance of the Florida
436 Building Code and the Florida Fire Prevention Code. However, the
437 agency shall provide technical assistance to the commission and
438 the State Fire Marshal in updating the construction standards of
439 the Florida Building Code and the Florida Fire Prevention Code
440 which govern hospitals, intermediate residential treatment
441 facilities, and ambulatory surgical centers.
442 (10) (9) The agency shall establish a pediatric cardiac
443 technical advisory panel, pursuant to s. 20.052, to develop
444 procedures and standards for measuring outcomes of pediatric
445 cardiac catheterization programs and pediatric cardiovascular
446 surgery programs.
447 (a) Members of the panel must have technical expertise in
448 pediatric cardiac medicine, shall serve without compensation,
449 and may not be reimbursed for per diem and travel expenses.
450 (b) Voting members of the panel shall include: 3 at-large
451 members, and 3 alternate at-large members with different program
452 affiliations, including 1 cardiologist who is board certified in
453 caring for adults with congenital heart disease and 2 board
454 certified pediatric cardiologists, neither of whom may be
455 employed by any of the hospitals specified in subparagraphs 1.
456 10. or their affiliates, each of whom is appointed by the
457 Secretary of Health Care Administration, and 10 members, and an
458 alternate for each member, each of whom is a pediatric
459 cardiologist or a pediatric cardiovascular surgeon, each
460 appointed by the chief executive officer of the following
462 1. Johns Hopkins All Children’s Hospital in St. Petersburg.
463 2. Arnold Palmer Hospital for Children in Orlando.
464 3. Joe DiMaggio Children’s Hospital in Hollywood.
465 4. Nicklaus Children’s Hospital in Miami.
466 5. St. Joseph’s Children’s Hospital in Tampa.
467 6. University of Florida Health Shands Hospital in
469 7. University of Miami Holtz Children’s Hospital in Miami.
470 8. Wolfson Children’s Hospital in Jacksonville.
471 9. Florida Hospital for Children in Orlando.
472 10. Nemours Children’s Hospital in Orlando.
474 Appointments made under subparagraphs 1.-10. are contingent upon
475 the hospital’s maintenance of pediatric certificates of need and
476 the hospital’s compliance with this section and rules adopted
477 thereunder, as determined by the Secretary of Health Care
478 Administration. A member appointed under subparagraphs 1.-10.
479 whose hospital fails to maintain such certificates or comply
480 with standards may serve only as a nonvoting member until the
481 hospital restores such certificates or complies with such
482 standards. A voting member may serve a maximum of two 2-year
483 terms and may be reappointed to the panel after being retired
484 from the panel for a full 2-year term.
485 (c) The Secretary of Health Care Administration may appoint
486 nonvoting members to the panel. Nonvoting members may include:
487 1. The Secretary of Health Care Administration.
488 2. The Surgeon General.
489 3. The Deputy Secretary of Children’s Medical Services.
490 4. Any current or past Division Director of Children’s
491 Medical Services.
492 5. A parent of a child with congenital heart disease.
493 6. An adult with congenital heart disease.
494 7. A representative from each of the following
495 organizations: the Florida Chapter of the American Academy of
496 Pediatrics, the Florida Chapter of the American College of
497 Cardiology, the Greater Southeast Affiliate of the American
498 Heart Association, the Adult Congenital Heart Association, the
499 March of Dimes, the Florida Association of Children’s Hospitals,
500 and the Florida Society of Thoracic and Cardiovascular Surgeons.
501 (d) The panel shall meet biannually, or more frequently
502 upon the call of the Secretary of Health Care Administration.
503 Such meetings may be conducted telephonically, or by other
504 electronic means.
505 (e) The duties of the panel include recommending to the
506 agency standards for quality of care, personnel, physical plant,
507 equipment, emergency transportation, and data reporting for
508 hospitals that provide pediatric cardiac services.
509 (f) Beginning on January 1, 2020, and annually thereafter,
510 the panel shall submit a report to the Governor, the President
511 of the Senate, the Speaker of the House of Representatives, the
512 Secretary of Health Care Administration, and the State Surgeon
513 General. The report must summarize the panel’s activities during
514 the preceding fiscal year and include data and performance
515 measures on surgical morbidity and mortality for all pediatric
516 cardiac programs.
517 (g) Panel members are agents of the state for purposes of
518 s. 768.28 throughout the good faith performance of the duties
519 assigned to them by the Secretary of Health Care Administration.
520 (11) The Secretary of Health Care Administration shall
521 consult the pediatric cardiac technical advisory panel for an
522 advisory recommendation on all certificate of need applications
523 to establish pediatric cardiac surgical centers.
524 (12) (10) Based on the recommendations of the pediatric
525 cardiac technical advisory panel in subsection (9), the agency
526 shall adopt rules for pediatric cardiac programs which, at a
527 minimum, include:
528 (a) Standards for pediatric cardiac catheterization
529 services and pediatric cardiovascular surgery including quality
530 of care, personnel, physical plant, equipment, emergency
531 transportation, data reporting, and appropriate operating hours
532 and timeframes for mobilization for emergency procedures.
533 (b) Outcome standards consistent with nationally
534 established levels of performance in pediatric cardiac programs.
535 (c) Specific steps to be taken by the agency and licensed
536 facilities when the facilities do not meet the outcome standards
537 within a specified time, including time required for detailed
538 case reviews and the development and implementation of
539 corrective action plans.
540 (13) (11) A pediatric cardiac program shall:
541 (a) Have a pediatric cardiology clinic affiliated with a
542 hospital licensed under this chapter.
543 (b) Have a pediatric cardiac catheterization laboratory and
544 a pediatric cardiovascular surgical program located in the
546 (c) Have a risk adjustment surgical procedure protocol
547 following the guidelines established by the Society of Thoracic
549 (d) Have quality assurance and quality improvement
550 processes in place to enhance clinical operation and patient
551 satisfaction with services.
552 (e) Participate in the clinical outcome reporting systems
553 operated by the Society of Thoracic Surgeons and the American
554 College of Cardiology.
555 (14)(a) The Secretary of Health Care Administration may
556 request announced or unannounced site visits to any existing
557 pediatric cardiac surgical center or facility seeking licensure
558 as a pediatric cardiac surgical center through the certificate
559 of need process, to ensure compliance with this section and
560 rules adopted hereunder.
561 (b) At the request of the Secretary of Health Care
562 Administration, the pediatric cardiac technical advisory panel
563 shall recommend in-state physician experts to conduct an on-site
564 visit. The Secretary may also appoint up to two out-of-state
565 physician experts.
566 (c) A site visit team shall conduct an on-site inspection
567 of the designated hospital’s pediatric medical and surgical
568 programs, and each member shall submit a written report of his
569 or her findings to the panel. The panel shall discuss the
570 written reports and present an advisory opinion to the Secretary
571 of Health Care Administration which includes recommendations and
572 any suggested actions for correction.
573 (d) Each on-site inspection must include all of the
575 1. An inspection of the program’s physical facilities,
576 clinics, and laboratories.
577 2. Interviews with support staff and hospital
579 3. A review of:
580 a. Randomly selected medical records and reports,
581 including, but not limited to, advanced cardiac imaging,
582 computed tomography, magnetic resonance imaging, cardiac
583 ultrasound, cardiac catheterization, and surgical operative
585 b. The program’s clinical outcome data submitted to the
586 Society of Thoracic Surgeons and the American College of
587 Cardiology pursuant to s. 408.05(3)(k).
588 c. Mortality reports from cardiac-related deaths that
589 occurred in the previous year.
590 d. Program volume data from the preceding year for
591 interventional and electrophysiology catheterizations and
592 surgical procedures.
593 (15) The Surgeon General shall provide quarterly reports to
594 the Secretary of Health Care Administration consisting of data
595 from the Children’s Medical Services’ critical congenital heart
596 disease screening program for review by the advisory panel.
597 (16) (12) The agency may adopt rules to administer the
598 requirements of part II of chapter 408.
599 Section 8. Subsection (3) of section 395.301, Florida
600 Statutes, is amended to read:
601 395.301 Price transparency; itemized patient statement or
602 bill; patient admission status notification.—
603 (3) If a licensed facility places a patient on observation
604 status rather than inpatient status, the licensed facility must
605 immediately notify the patient of such status using the form
606 adopted under 42 C.F.R. s. 489.20 for Medicare patients or a
607 form adopted by agency rule for non-Medicare patients. Such
608 notification must observation services shall be documented in
609 the patient’s medical records and discharge papers. The patient
610 or the patient’s survivor or legal guardian must shall be
611 notified of observation services through discharge papers, which
612 may also include brochures, signage, or other forms of
613 communication for this purpose.
614 Section 9. Section 542.336, Florida Statutes, is created to
616 542.336 Invalid restrictive covenants.—A restrictive
617 covenant entered into with a physician who is licensed under
618 chapter 458 or chapter 459 and who practices a medical specialty
619 in a county wherein one entity employs or contracts with, either
620 directly or through related or affiliated entities, all
621 physicians who practice such specialty in that county is not
622 supported by a legitimate business interest. The Legislature
623 finds that such covenants restrict patient access to physicians,
624 increase costs, and are void and unenforceable under current
625 law. Such restrictive covenants shall remain void and
626 unenforceable for 3 years after the date on which a second
627 entity that employs or contracts with, either directly or
628 through related or affiliated entities, one or more physicians
629 who practice such specialty begins offering such specialty
630 services in that county.
631 Section 10. Section 624.27, Florida Statutes, is amended to
633 624.27 Direct health primary care agreements; exemption
634 from code.—
635 (1) As used in this section, the term:
636 (a) “Direct health primary care agreement” means a contract
637 between a health primary care provider and a patient, a
638 patient’s legal representative, or a patient’s employer, which
639 meets the requirements of subsection (4) and does not indemnify
640 for services provided by a third party.
641 (b) “Health Primary care provider” means a health care
642 provider licensed under chapter 458, chapter 459, chapter 460,
643 or chapter 464, or chapter 466, or a health primary care group
644 practice, who provides health primary care services to patients.
645 (c) “Health Primary care services” means the screening,
646 assessment, diagnosis, and treatment of a patient conducted
647 within the competency and training of the health primary care
648 provider for the purpose of promoting health or detecting and
649 managing disease or injury.
650 (2) A direct health primary care agreement does not
651 constitute insurance and is not subject to the Florida Insurance
652 Code. The act of entering into a direct health primary care
653 agreement does not constitute the business of insurance and is
654 not subject to the Florida Insurance Code.
655 (3) A health primary care provider or an agent of a health
656 primary care provider is not required to obtain a certificate of
657 authority or license under the Florida Insurance Code to market,
658 sell, or offer to sell a direct health primary care agreement.
659 (4) For purposes of this section, a direct health primary
660 care agreement must:
661 (a) Be in writing.
662 (b) Be signed by the health primary care provider or an
663 agent of the health primary care provider and the patient, the
664 patient’s legal representative, or the patient’s employer.
665 (c) Allow a party to terminate the agreement by giving the
666 other party at least 30 days’ advance written notice. The
667 agreement may provide for immediate termination due to a
668 violation of the physician-patient relationship or a breach of
669 the terms of the agreement.
670 (d) Describe the scope of health primary care services that
671 are covered by the monthly fee.
672 (e) Specify the monthly fee and any fees for health primary
673 care services not covered by the monthly fee.
674 (f) Specify the duration of the agreement and any automatic
675 renewal provisions.
676 (g) Offer a refund to the patient, the patient’s legal
677 representative, or the patient’s employer of monthly fees paid
678 in advance if the health primary care provider ceases to offer
679 health primary care services for any reason.
680 (h) Contain, in contrasting color and in at least 12-point
681 type, the following statement on the signature page: “This
682 agreement is not health insurance and the health primary care
683 provider will not file any claims against the patient’s health
684 insurance policy or plan for reimbursement of any health primary
685 care services covered by the agreement. This agreement does not
686 qualify as minimum essential coverage to satisfy the individual
687 shared responsibility provision of the Patient Protection and
688 Affordable Care Act, 26 U.S.C. s. 5000A. This agreement is not
689 workers’ compensation insurance and does not replace an
690 employer’s obligations under chapter 440.”
691 Section 11. Effective January 1, 2020, section 627.42393,
692 Florida Statutes, is created to read:
693 627.42393 Step-therapy protocol.—
694 (1) A health insurer issuing a major medical individual or
695 group policy may not require a step-therapy protocol under the
696 policy for a covered prescription drug requested by an insured
698 (a) The insured has previously been approved to receive the
699 prescription drug through the completion of a step-therapy
700 protocol required by a separate health coverage plan; and
701 (b) The insured provides documentation originating from the
702 health coverage plan that approved the prescription drug as
703 described in paragraph (a) indicating that the health coverage
704 plan paid for the drug on the insured’s behalf during the 90
705 days immediately before the request.
706 (2) As used in this section, the term “health coverage
707 plan” means any of the following which is currently or was
708 previously providing major medical or similar comprehensive
709 coverage or benefits to the insured:
710 (a) A health insurer or health maintenance organization.
711 (b) A plan established or maintained by an individual
712 employer as provided by the Employee Retirement Income Security
713 Act of 1974, Pub. L. No. 93-406.
714 (c) A multiple-employer welfare arrangement as defined in
715 s. 624.437.
716 (d) A governmental entity providing a plan of self
718 (3) This section does not require a health insurer to add a
719 drug to its prescription drug formulary or to cover a
720 prescription drug that the insurer does not otherwise cover.
721 Section 12. Effective January 1, 2020, subsection (45) is
722 added to section 641.31, Florida Statutes, to read:
723 641.31 Health maintenance contracts.—
724 (45)(a) A health maintenance organization issuing major
725 medical coverage through an individual or group contract may not
726 require a step-therapy protocol under the contract for a covered
727 prescription drug requested by a subscriber if:
728 1. The subscriber has previously been approved to receive
729 the prescription drug through the completion of a step-therapy
730 protocol required by a separate health coverage plan; and
731 2. The subscriber provides documentation originating from
732 the health coverage plan that approved the prescription drug as
733 described in subparagraph 1. indicating that the health coverage
734 plan paid for the drug on the subscriber’s behalf during the 90
735 days immediately before the request.
736 (b) As used in this subsection, the term “health coverage
737 plan” means any of the following which previously provided or is
738 currently providing major medical or similar comprehensive
739 coverage or benefits to the subscriber:
740 1. A health insurer or health maintenance organization;
741 2. A plan established or maintained by an individual
742 employer as provided by the Employee Retirement Income Security
743 Act of 1974, Pub. L. No. 93-406;
744 3. A multiple-employer welfare arrangement as defined in s.
745 624.437; or
746 4. A governmental entity providing a plan of self
748 (c) This subsection does not require a health maintenance
749 organization to add a drug to its prescription drug formulary or
750 to cover a prescription drug that the health maintenance
751 organization does not otherwise cover.
752 Section 13. The Office of Program Policy Analysis and
753 Government Accountability shall research and analyze the
754 Interstate Medical Licensure Compact and the relevant
755 requirements and provisions of general law and the State
756 Constitution and shall develop a report and recommendations
757 addressing this state’s prospective entrance into the compact as
758 a member state while remaining consistent with those
759 requirements and provisions. In conducting such research and
760 analysis, the office may consult with the executive director,
761 other executive staff, or the executive committee of the
762 Interstate Medical Licensure Compact Commission. The office
763 shall submit the report and recommendations to the Governor, the
764 President of the Senate, and the Speaker of the House of
765 Representatives by not later than October 1, 2019.
766 Section 14. Except as otherwise expressly provided in this
767 act, this act shall take effect July 1, 2019.