Florida Senate - 2019                          SENATOR AMENDMENT
       Bill No. CS for HB 843
       
       
       
       
       
       
                                Ì565298ZÎ565298                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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                Floor: 1/AE/2R         .                                
             04/26/2019 04:19 PM       .                                
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       Senator Harrell moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. It is the intent of the Legislature to promote
    6  programs and initiatives that help make available preventive and
    7  educational dental services for the residents of the state, as
    8  well as provide quality dental treatment services. The
    9  geographic characteristics among the residents of the state are
   10  distinctive and vary from region to region, with such residents
   11  having unique needs regarding access to dental care. The
   12  Legislature recognizes that maintaining good oral health is
   13  integral to the overall health status of individuals and that
   14  the good health of the residents of this state is an important
   15  contributing factor in economic development. Better health,
   16  including better oral health, increases workplace productivity,
   17  reduces the burden of health care costs, and improves the
   18  cognitive development of children, resulting in a reduction of
   19  missed school days.
   20         Section 2. Section 381.4019, Florida Statutes, is created
   21  to read:
   22         381.4019Dental Student Loan Repayment Program.—The Dental
   23  Student Loan Repayment Program is established to promote access
   24  to dental care by supporting qualified dentists who treat
   25  medically underserved populations in dental health professional
   26  shortage areas or medically underserved areas.
   27         (1)As used in this section, the term:
   28         (a)“Dental health professional shortage area” means a
   29  geographic area designated as such by the Health Resources and
   30  Services Administration of the United States Department of
   31  Health and Human Services.
   32         (b)“Department” means the Department of Health.
   33         (c)“Loan program” means the Dental Student Loan Repayment
   34  Program.
   35         (d)“Medically underserved area” means a geographic area,
   36  an area having a special population, or a facility which is
   37  designated by department rule as a health professional shortage
   38  area as defined by federal regulation and which has a shortage
   39  of dental health professionals who serve Medicaid recipients and
   40  other low-income patients.
   41         (e)“Public health program” means a county health
   42  department, the Children’s Medical Services program, a federally
   43  funded community health center, a federally funded migrant
   44  health center, or other publicly funded or nonprofit health care
   45  program designated by the department.
   46         (2)The department shall establish a dental student loan
   47  repayment program to benefit Florida-licensed dentists who
   48  demonstrate, as required by department rule, active employment
   49  in a public health program that serves Medicaid recipients and
   50  other low-income patients and is located in a dental health
   51  professional shortage area or a medically underserved area.
   52         (3)The department shall award funds from the loan program
   53  to repay the student loans of a dentist who meets the
   54  requirements of subsection (2).
   55         (a)An award may not exceed $50,000 per year per eligible
   56  dentist.
   57         (b)Only loans to pay the costs of tuition, books, dental
   58  equipment and supplies, uniforms, and living expenses may be
   59  covered.
   60         (c)All repayments are contingent upon continued proof of
   61  eligibility and must be made directly to the holder of the loan.
   62  The state bears no responsibility for the collection of any
   63  interest charges or other remaining balances.
   64         (d)A dentist may receive funds under the loan program for
   65  at least 1 year, up to a maximum of 5 years.
   66         (e)The department shall limit the number of new dentists
   67  participating in the loan program to not more than 10 per fiscal
   68  year.
   69         (4)A dentist is no longer eligible to receive funds under
   70  the loan program if the dentist:
   71         (a)Is no longer employed by a public health program that
   72  meets the requirements of subsection (2).
   73         (b)Ceases to participate in the Florida Medicaid program.
   74         (c)Has disciplinary action taken against his or her
   75  license by the Board of Dentistry for a violation of s. 466.028.
   76         (5)The department shall adopt rules to administer the loan
   77  program.
   78         (6) Implementation of the loan program is subject to
   79  legislative appropriation.
   80         Section 3. Section 381.40195, Florida Statutes, is created
   81  to read:
   82         381.40195Donated Dental Services Program.—
   83         (1)This act may be cited as the “Donated Dental Services
   84  Act.”
   85         (2)As used in this section, the term:
   86         (a)“Department” means the Department of Health.
   87         (b)“Program” means the Donated Dental Services Program as
   88  established pursuant to subsection (3).
   89         (3)The department shall establish the Donated Dental
   90  Services Program for the purpose of providing comprehensive
   91  dental care through a network of volunteer dentists and other
   92  dental providers to needy, disabled, elderly, and medically
   93  compromised individuals who cannot afford necessary treatment
   94  but are ineligible for public assistance. An eligible individual
   95  may receive treatment in a volunteer dentist’s or participating
   96  dental provider’s private office or at any other suitable
   97  location. An eligible individual is not required to pay any fee
   98  or cost associated with the treatment he or she receives.
   99         (4)The department shall establish the program. The
  100  department shall contract with a nonprofit organization that has
  101  experience in providing similar services or administering
  102  similar programs. The contract must specify the responsibilities
  103  of the nonprofit organization, which may include, but are not
  104  limited to:
  105         (a)Maintaining a network of volunteer dentists and other
  106  dental providers, including, but not limited to, dental
  107  specialists and dental laboratories, to provide comprehensive
  108  dental services to eligible individuals.
  109         (b)Maintaining a system to refer eligible individuals to
  110  the appropriate volunteer dentist or participating dental
  111  provider.
  112         (c)Developing a public awareness and marketing campaign to
  113  promote the program and educate eligible individuals about its
  114  availability and services.
  115         (d)Providing the necessary administrative and technical
  116  support to administer the program.
  117         (e)Submitting an annual report to the department which
  118  must include, at a minimum:
  119         1.Financial data relating to administering the program.
  120         2.Demographic data and other information relating to the
  121  eligible individuals who are referred to and receive treatment
  122  through the program.
  123         3.Demographic data and other information relating to the
  124  volunteer dentists and participating dental providers who
  125  provide dental services through the program.
  126         4.Any other data or information that the department may
  127  require.
  128         (f)Performing any other program-related duties and
  129  responsibilities as required by the department.
  130         (5)The department shall adopt rules to administer the
  131  program.
  132         (6) Implementation of the program is subject to legislative
  133  appropriation.
  134         Section 4. Subsection (3) is added to section 395.1012,
  135  Florida Statutes, to read:
  136         395.1012 Patient safety.—
  137         (3)(a) Each hospital shall provide to any patient or
  138  patient’s representative identified pursuant to s. 765.401(1)
  139  upon scheduling of nonemergency care, or to any other stabilized
  140  patient or patient’s representative identified pursuant to s.
  141  765.401(1) within 24 hours of the patient being stabilized or at
  142  the time of discharge, whichever comes first, written
  143  information on a form created by the agency which contains the
  144  following information available for the hospital for the most
  145  recent year and the statewide average for all hospitals related
  146  to the following quality measures:
  147         1.The rate of hospital-acquired infections;
  148         2.The overall rating of the Hospital Consumer Assessment
  149  of Healthcare Providers and Systems survey; and
  150         3.The 15-day readmission rate.
  151         (b)A hospital shall also provide to any person, upon
  152  request, the written information specified in paragraph (a).
  153         (c)The information required by this subsection must be
  154  presented in a manner that is easily understandable and
  155  accessible to the patient and must also include an explanation
  156  of the quality measures and the relationship between patient
  157  safety and the hospital’s data for the quality measures.
  158         Section 5. Section 395.1052, Florida Statutes, is created
  159  to read:
  160         395.1052 Patient access to primary care and specialty
  161  providers; notification.—A hospital shall:
  162         (1) Notify each patient’s primary care provider, if any,
  163  within 24 hours after the patient’s admission to the hospital.
  164         (2) Inform the patient immediately upon admission that he
  165  or she may request to have the hospital’s treating physician
  166  consult with the patient’s primary care provider or specialist
  167  provider, if any, when developing the patient’s plan of care.
  168  Upon the patient’s request, the hospital’s treating physician
  169  shall make reasonable efforts to consult with the patient’s
  170  primary care provider or specialist provider when developing the
  171  patient’s plan of care.
  172         (3) Notify the patient’s primary care provider, if any, of
  173  the patient’s discharge from the hospital within 24 hours after
  174  the discharge.
  175         (4) Provide the discharge summary and any related
  176  information or records to the patient’s primary care provider,
  177  if any, within 14 days after the patient’s discharge summary has
  178  been completed.
  179         Section 6. Subsection (3) of section 395.002, Florida
  180  Statutes, is amended to read:
  181         395.002 Definitions.—As used in this chapter:
  182         (3) “Ambulatory surgical center” means a facility the
  183  primary purpose of which is to provide elective surgical care,
  184  in which the patient is admitted to and discharged from such
  185  facility within 24 hours the same working day and is not
  186  permitted to stay overnight, and which is not part of a
  187  hospital. However, a facility existing for the primary purpose
  188  of performing terminations of pregnancy, an office maintained by
  189  a physician for the practice of medicine, or an office
  190  maintained for the practice of dentistry may not be construed to
  191  be an ambulatory surgical center, provided that any facility or
  192  office which is certified or seeks certification as a Medicare
  193  ambulatory surgical center shall be licensed as an ambulatory
  194  surgical center pursuant to s. 395.003.
  195         Section 7. Section 395.1055, Florida Statutes, is amended
  196  to read:
  197         395.1055 Rules and enforcement.—
  198         (1) The agency shall adopt rules pursuant to ss. 120.536(1)
  199  and 120.54 to implement the provisions of this part, which shall
  200  include reasonable and fair minimum standards for ensuring that:
  201         (a) Sufficient numbers and qualified types of personnel and
  202  occupational disciplines are on duty and available at all times
  203  to provide necessary and adequate patient care and safety.
  204         (b) Infection control, housekeeping, sanitary conditions,
  205  and medical record procedures that will adequately protect
  206  patient care and safety are established and implemented.
  207         (c) A comprehensive emergency management plan is prepared
  208  and updated annually. Such standards must be included in the
  209  rules adopted by the agency after consulting with the Division
  210  of Emergency Management. At a minimum, the rules must provide
  211  for plan components that address emergency evacuation
  212  transportation; adequate sheltering arrangements; postdisaster
  213  activities, including emergency power, food, and water;
  214  postdisaster transportation; supplies; staffing; emergency
  215  equipment; individual identification of residents and transfer
  216  of records, and responding to family inquiries. The
  217  comprehensive emergency management plan is subject to review and
  218  approval by the local emergency management agency. During its
  219  review, the local emergency management agency shall ensure that
  220  the following agencies, at a minimum, are given the opportunity
  221  to review the plan: the Department of Elderly Affairs, the
  222  Department of Health, the Agency for Health Care Administration,
  223  and the Division of Emergency Management. Also, appropriate
  224  volunteer organizations must be given the opportunity to review
  225  the plan. The local emergency management agency shall complete
  226  its review within 60 days and either approve the plan or advise
  227  the facility of necessary revisions.
  228         (d) Licensed facilities are established, organized, and
  229  operated consistent with established standards and rules.
  230         (e) Licensed facility beds conform to minimum space,
  231  equipment, and furnishings standards as specified by the
  232  department.
  233         (f) All hospitals submit such data as necessary to conduct
  234  certificate-of-need reviews required under part I of chapter
  235  408. Such data shall include, but shall not be limited to,
  236  patient origin data, hospital utilization data, type of service
  237  reporting, and facility staffing data. The agency may not
  238  collect data that identifies or could disclose the identity of
  239  individual patients. The agency shall utilize existing uniform
  240  statewide data sources when available and shall minimize
  241  reporting costs to hospitals.
  242         (g) Each hospital has a quality improvement program
  243  designed according to standards established by their current
  244  accrediting organization. This program will enhance quality of
  245  care and emphasize quality patient outcomes, corrective action
  246  for problems, governing board review, and reporting to the
  247  agency of standardized data elements necessary to analyze
  248  quality of care outcomes. The agency shall use existing data,
  249  when available, and shall not duplicate the efforts of other
  250  state agencies in order to obtain such data.
  251         (h) Licensed facilities make available on their Internet
  252  websites, no later than October 1, 2004, and in a hard copy
  253  format upon request, a description of and a link to the patient
  254  charge and performance outcome data collected from licensed
  255  facilities pursuant to s. 408.061.
  256         (i) All hospitals providing organ transplantation, neonatal
  257  intensive care services, inpatient psychiatric services,
  258  inpatient substance abuse services, or comprehensive medical
  259  rehabilitation meet the minimum licensure requirements adopted
  260  by the agency. Such licensure requirements must include quality
  261  of care, nurse staffing, physician staffing, physical plant,
  262  equipment, emergency transportation, and data reporting
  263  standards.
  264         (2) Separate standards may be provided for general and
  265  specialty hospitals, ambulatory surgical centers, and statutory
  266  rural hospitals as defined in s. 395.602.
  267         (3)The agency shall adopt rules that establish minimum
  268  standards for pediatric patient care in ambulatory surgical
  269  centers to ensure the safe and effective delivery of surgical
  270  care to children in ambulatory surgical centers. Such standards
  271  must include quality of care, nurse staffing, physician
  272  staffing, and equipment standards. Ambulatory surgical centers
  273  may not provide operative procedures to children under 18 years
  274  of age which require a length of stay past midnight until such
  275  standards are established by rule.
  276         (4)(3) The agency shall adopt rules with respect to the
  277  care and treatment of patients residing in distinct part nursing
  278  units of hospitals which are certified for participation in
  279  Title XVIII (Medicare) and Title XIX (Medicaid) of the Social
  280  Security Act skilled nursing facility program. Such rules shall
  281  take into account the types of patients treated in hospital
  282  skilled nursing units, including typical patient acuity levels
  283  and the average length of stay in such units, and shall be
  284  limited to the appropriate portions of the Omnibus Budget
  285  Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,
  286  1987), Title IV (Medicare, Medicaid, and Other Health-Related
  287  Programs), Subtitle C (Nursing Home Reform), as amended. The
  288  agency shall require level 2 background screening as specified
  289  in s. 408.809(1)(e) pursuant to s. 408.809 and chapter 435 for
  290  personnel of distinct part nursing units.
  291         (5)(4) The agency shall adopt rules with respect to the
  292  care and treatment of clients in intensive residential treatment
  293  programs for children and adolescents and with respect to the
  294  safe and healthful development, operation, and maintenance of
  295  such programs.
  296         (6)(5) The agency shall enforce the provisions of part I of
  297  chapter 394, and rules adopted thereunder, with respect to the
  298  rights, standards of care, and examination and placement
  299  procedures applicable to patients voluntarily or involuntarily
  300  admitted to hospitals providing psychiatric observation,
  301  evaluation, diagnosis, or treatment.
  302         (7)(6) No rule shall be adopted under this part by the
  303  agency which would have the effect of denying a license to a
  304  facility required to be licensed under this part, solely by
  305  reason of the school or system of practice employed or permitted
  306  to be employed by physicians therein, provided that such school
  307  or system of practice is recognized by the laws of this state.
  308  However, nothing in this subsection shall be construed to limit
  309  the powers of the agency to provide and require minimum
  310  standards for the maintenance and operation of, and for the
  311  treatment of patients in, those licensed facilities which
  312  receive federal aid, in order to meet minimum standards related
  313  to such matters in such licensed facilities which may now or
  314  hereafter be required by appropriate federal officers or
  315  agencies in pursuance of federal law or promulgated in pursuance
  316  of federal law.
  317         (8)(7) Any licensed facility which is in operation at the
  318  time of promulgation of any applicable rules under this part
  319  shall be given a reasonable time, under the particular
  320  circumstances, but not to exceed 1 year from the date of such
  321  promulgation, within which to comply with such rules.
  322         (9)(8) The agency may not adopt any rule governing the
  323  design, construction, erection, alteration, modification,
  324  repair, or demolition of any public or private hospital,
  325  intermediate residential treatment facility, or ambulatory
  326  surgical center. It is the intent of the Legislature to preempt
  327  that function to the Florida Building Commission and the State
  328  Fire Marshal through adoption and maintenance of the Florida
  329  Building Code and the Florida Fire Prevention Code. However, the
  330  agency shall provide technical assistance to the commission and
  331  the State Fire Marshal in updating the construction standards of
  332  the Florida Building Code and the Florida Fire Prevention Code
  333  which govern hospitals, intermediate residential treatment
  334  facilities, and ambulatory surgical centers.
  335         (10)(9) The agency shall establish a pediatric cardiac
  336  technical advisory panel, pursuant to s. 20.052, to develop
  337  procedures and standards for measuring outcomes of pediatric
  338  cardiac catheterization programs and pediatric cardiovascular
  339  surgery programs.
  340         (a) Members of the panel must have technical expertise in
  341  pediatric cardiac medicine, shall serve without compensation,
  342  and may not be reimbursed for per diem and travel expenses.
  343         (b) Voting members of the panel shall include: 3 at-large
  344  members, and 3 alternate at-large members with different program
  345  affiliations, including 1 cardiologist who is board certified in
  346  caring for adults with congenital heart disease and 2 board
  347  certified pediatric cardiologists, neither of whom may be
  348  employed by any of the hospitals specified in subparagraphs 1.
  349  10. or their affiliates, each of whom is appointed by the
  350  Secretary of Health Care Administration, and 10 members, and an
  351  alternate for each member, each of whom is a pediatric
  352  cardiologist or a pediatric cardiovascular surgeon, each
  353  appointed by the chief executive officer of the following
  354  hospitals:
  355         1. Johns Hopkins All Children’s Hospital in St. Petersburg.
  356         2. Arnold Palmer Hospital for Children in Orlando.
  357         3. Joe DiMaggio Children’s Hospital in Hollywood.
  358         4. Nicklaus Children’s Hospital in Miami.
  359         5. St. Joseph’s Children’s Hospital in Tampa.
  360         6. University of Florida Health Shands Hospital in
  361  Gainesville.
  362         7. University of Miami Holtz Children’s Hospital in Miami.
  363         8. Wolfson Children’s Hospital in Jacksonville.
  364         9. Florida Hospital for Children in Orlando.
  365         10. Nemours Children’s Hospital in Orlando.
  366  
  367  Appointments made under subparagraphs 1.-10. are contingent upon
  368  the hospital’s maintenance of pediatric certificates of need and
  369  the hospital’s compliance with this section and rules adopted
  370  thereunder, as determined by the Secretary of Health Care
  371  Administration. A member appointed under subparagraphs 1.-10.
  372  whose hospital fails to maintain such certificates or comply
  373  with standards may serve only as a nonvoting member until the
  374  hospital restores such certificates or complies with such
  375  standards. A voting member may serve a maximum of two 2-year
  376  terms and may be reappointed to the panel after being retired
  377  from the panel for a full 2-year term.
  378         (c) The Secretary of Health Care Administration may appoint
  379  nonvoting members to the panel. Nonvoting members may include:
  380         1. The Secretary of Health Care Administration.
  381         2. The Surgeon General.
  382         3. The Deputy Secretary of Children’s Medical Services.
  383         4. Any current or past Division Director of Children’s
  384  Medical Services.
  385         5. A parent of a child with congenital heart disease.
  386         6. An adult with congenital heart disease.
  387         7. A representative from each of the following
  388  organizations: the Florida Chapter of the American Academy of
  389  Pediatrics, the Florida Chapter of the American College of
  390  Cardiology, the Greater Southeast Affiliate of the American
  391  Heart Association, the Adult Congenital Heart Association, the
  392  March of Dimes, the Florida Association of Children’s Hospitals,
  393  and the Florida Society of Thoracic and Cardiovascular Surgeons.
  394         (d) The panel shall meet biannually, or more frequently
  395  upon the call of the Secretary of Health Care Administration.
  396  Such meetings may be conducted telephonically, or by other
  397  electronic means.
  398         (e) The duties of the panel include recommending to the
  399  agency standards for quality of care, personnel, physical plant,
  400  equipment, emergency transportation, and data reporting for
  401  hospitals that provide pediatric cardiac services.
  402         (f) Beginning on January 1, 2020, and annually thereafter,
  403  the panel shall submit a report to the Governor, the President
  404  of the Senate, the Speaker of the House of Representatives, the
  405  Secretary of Health Care Administration, and the State Surgeon
  406  General. The report must summarize the panel’s activities during
  407  the preceding fiscal year and include data and performance
  408  measures on surgical morbidity and mortality for all pediatric
  409  cardiac programs.
  410         (g) Panel members are agents of the state for purposes of
  411  s. 768.28 throughout the good faith performance of the duties
  412  assigned to them by the Secretary of Health Care Administration.
  413         (11) The Secretary of Health Care Administration shall
  414  consult the pediatric cardiac technical advisory panel for an
  415  advisory recommendation on any certificate of need applications
  416  to establish pediatric cardiac surgical centers.
  417         (12)(10) Based on the recommendations of the pediatric
  418  cardiac technical advisory panel in subsection (9), the agency
  419  shall adopt rules for pediatric cardiac programs which, at a
  420  minimum, include:
  421         (a) Standards for pediatric cardiac catheterization
  422  services and pediatric cardiovascular surgery including quality
  423  of care, personnel, physical plant, equipment, emergency
  424  transportation, data reporting, and appropriate operating hours
  425  and timeframes for mobilization for emergency procedures.
  426         (b) Outcome standards consistent with nationally
  427  established levels of performance in pediatric cardiac programs.
  428         (c) Specific steps to be taken by the agency and licensed
  429  facilities when the facilities do not meet the outcome standards
  430  within a specified time, including time required for detailed
  431  case reviews and the development and implementation of
  432  corrective action plans.
  433         (13)(11) A pediatric cardiac program shall:
  434         (a) Have a pediatric cardiology clinic affiliated with a
  435  hospital licensed under this chapter.
  436         (b) Have a pediatric cardiac catheterization laboratory and
  437  a pediatric cardiovascular surgical program located in the
  438  hospital.
  439         (c) Have a risk adjustment surgical procedure protocol
  440  following the guidelines established by the Society of Thoracic
  441  Surgeons.
  442         (d) Have quality assurance and quality improvement
  443  processes in place to enhance clinical operation and patient
  444  satisfaction with services.
  445         (e) Participate in the clinical outcome reporting systems
  446  operated by the Society of Thoracic Surgeons and the American
  447  College of Cardiology.
  448         (14)(a) The Secretary of Health Care Administration may
  449  request announced or unannounced site visits to any existing
  450  pediatric cardiac surgical center or facility seeking licensure
  451  as a pediatric cardiac surgical center through the certificate
  452  of need process, to ensure compliance with this section and
  453  rules adopted hereunder.
  454         (b) At the request of the Secretary of Health Care
  455  Administration, the pediatric cardiac technical advisory panel
  456  shall recommend in-state physician experts to conduct an on-site
  457  visit. The Secretary may also appoint up to two out-of-state
  458  physician experts.
  459         (c) A site visit team shall conduct an on-site inspection
  460  of the designated hospital’s pediatric medical and surgical
  461  programs, and each member shall submit a written report of his
  462  or her findings to the panel. The panel shall discuss the
  463  written reports and present an advisory opinion to the Secretary
  464  of Health Care Administration which includes recommendations and
  465  any suggested actions for correction.
  466         (d) Each on-site inspection must include all of the
  467  following:
  468         1. An inspection of the program’s physical facilities,
  469  clinics, and laboratories.
  470         2. Interviews with support staff and hospital
  471  administrators.
  472         3.A review of:
  473         a. Randomly selected medical records and reports,
  474  including, but not limited to, advanced cardiac imaging,
  475  computed tomography, magnetic resonance imaging, cardiac
  476  ultrasound, cardiac catheterization, and surgical operative
  477  notes.
  478         b.The program’s clinical outcome data submitted to the
  479  Society of Thoracic Surgeons and the American College of
  480  Cardiology pursuant to s. 408.05(3)(k).
  481         c.Mortality reports from cardiac-related deaths that
  482  occurred in the previous year.
  483         d. Program volume data from the preceding year for
  484  interventional and electrophysiology catheterizations and
  485  surgical procedures.
  486         (15) The Surgeon General shall provide quarterly reports to
  487  the Secretary of Health Care Administration consisting of data
  488  from the Children’s Medical Services critical congenital heart
  489  disease screening program for review by the advisory panel.
  490         (16)(12) The agency may adopt rules to administer the
  491  requirements of part II of chapter 408.
  492         Section 8. Subsection (3) of section 395.301, Florida
  493  Statutes, is amended to read:
  494         395.301 Price transparency; itemized patient statement or
  495  bill; patient admission status notification.—
  496         (3) If a licensed facility places a patient on observation
  497  status rather than inpatient status, the licensed facility must
  498  immediately notify the patient of such status using the form
  499  adopted under 42 C.F.R. s. 489.20 for Medicare patients or a
  500  form adopted by agency rule for non-Medicare patients. Such
  501  notification must observation services shall be documented in
  502  the patient’s medical records and discharge papers. The patient
  503  or the patient’s survivor or legal guardian must shall be
  504  notified of observation services through discharge papers, which
  505  may also include brochures, signage, or other forms of
  506  communication for this purpose.
  507         Section 9. Paragraphs (a), (b), (c), and (d) of subsection
  508  (4) of section 400.9905, Florida Statutes, are amended to read:
  509         400.9905 Definitions.—
  510         (4) “Clinic” means an entity where health care services are
  511  provided to individuals and which tenders charges for
  512  reimbursement for such services, including a mobile clinic and a
  513  portable equipment provider. As used in this part, the term does
  514  not include and the licensure requirements of this part do not
  515  apply to:
  516         (a) Entities licensed or registered by the state under
  517  chapter 395; entities licensed or registered by the state and
  518  providing only health care services within the scope of services
  519  authorized under their respective licenses under ss. 383.30
  520  383.332, chapter 390, chapter 394, chapter 397, this chapter
  521  except part X, chapter 429, chapter 463, chapter 465, chapter
  522  466, chapter 478, chapter 484, or chapter 651; end-stage renal
  523  disease providers authorized under 42 C.F.R. part 405, subpart
  524  U; providers certified under 42 C.F.R. part 485, subpart B or
  525  subpart H; providers certified by the Centers for Medicare and
  526  Medicaid services under the federal Clinical Laboratory
  527  Improvement Amendments and the federal rules adopted thereunder;
  528  or any entity that provides neonatal or pediatric hospital-based
  529  health care services or other health care services by licensed
  530  practitioners solely within a hospital licensed under chapter
  531  395.
  532         (b) Entities that own, directly or indirectly, entities
  533  licensed or registered by the state pursuant to chapter 395;
  534  entities that own, directly or indirectly, entities licensed or
  535  registered by the state and providing only health care services
  536  within the scope of services authorized pursuant to their
  537  respective licenses under ss. 383.30-383.332, chapter 390,
  538  chapter 394, chapter 397, this chapter except part X, chapter
  539  429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
  540  484, or chapter 651; end-stage renal disease providers
  541  authorized under 42 C.F.R. part 405, subpart U; providers
  542  certified under 42 C.F.R. part 485, subpart B or subpart H;
  543  providers certified by the Centers for Medicare and Medicaid
  544  services under the federal Clinical Laboratory Improvement
  545  Amendments and the federal rules adopted thereunder; or any
  546  entity that provides neonatal or pediatric hospital-based health
  547  care services by licensed practitioners solely within a hospital
  548  licensed under chapter 395.
  549         (c) Entities that are owned, directly or indirectly, by an
  550  entity licensed or registered by the state pursuant to chapter
  551  395; entities that are owned, directly or indirectly, by an
  552  entity licensed or registered by the state and providing only
  553  health care services within the scope of services authorized
  554  pursuant to their respective licenses under ss. 383.30-383.332,
  555  chapter 390, chapter 394, chapter 397, this chapter except part
  556  X, chapter 429, chapter 463, chapter 465, chapter 466, chapter
  557  478, chapter 484, or chapter 651; end-stage renal disease
  558  providers authorized under 42 C.F.R. part 405, subpart U;
  559  providers certified under 42 C.F.R. part 485, subpart B or
  560  subpart H; providers certified by the Centers for Medicare and
  561  Medicaid services under the federal Clinical Laboratory
  562  Improvement Amendments and the federal rules adopted thereunder;
  563  or any entity that provides neonatal or pediatric hospital-based
  564  health care services by licensed practitioners solely within a
  565  hospital under chapter 395.
  566         (d) Entities that are under common ownership, directly or
  567  indirectly, with an entity licensed or registered by the state
  568  pursuant to chapter 395; entities that are under common
  569  ownership, directly or indirectly, with an entity licensed or
  570  registered by the state and providing only health care services
  571  within the scope of services authorized pursuant to their
  572  respective licenses under ss. 383.30-383.332, chapter 390,
  573  chapter 394, chapter 397, this chapter except part X, chapter
  574  429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
  575  484, or chapter 651; end-stage renal disease providers
  576  authorized under 42 C.F.R. part 405, subpart U; providers
  577  certified under 42 C.F.R. part 485, subpart B or subpart H;
  578  providers certified by the Centers for Medicare and Medicaid
  579  services under the federal Clinical Laboratory Improvement
  580  Amendments and the federal rules adopted thereunder; or any
  581  entity that provides neonatal or pediatric hospital-based health
  582  care services by licensed practitioners solely within a hospital
  583  licensed under chapter 395.
  584  
  585  Notwithstanding this subsection, an entity shall be deemed a
  586  clinic and must be licensed under this part in order to receive
  587  reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
  588  627.730-627.7405, unless exempted under s. 627.736(5)(h).
  589         Section 10. Section 542.336, Florida Statutes, is created
  590  to read:
  591         542.336 Invalid restrictive covenants.—A restrictive
  592  covenant entered into with a physician who is licensed under
  593  chapter 458 or chapter 459 and who practices a medical specialty
  594  in a county wherein one entity employs or contracts with, either
  595  directly or through related or affiliated entities, all
  596  physicians who practice such specialty in that county is not
  597  supported by a legitimate business interest. The Legislature
  598  finds that such covenants restrict patient access to physicians,
  599  increase costs, and are void and unenforceable under current
  600  law. Such restrictive covenants shall remain void and
  601  unenforceable for 3 years after the date on which a second
  602  entity that employs or contracts with, either directly or
  603  through related or affiliated entities, one or more physicians
  604  who practice such specialty begins offering such specialty
  605  services in that county.
  606         Section 11. Section 624.27, Florida Statutes, is amended to
  607  read:
  608         624.27 Direct health primary care agreements; exemption
  609  from code.—
  610         (1) As used in this section, the term:
  611         (a) “Direct health primary care agreement” means a contract
  612  between a health primary care provider and a patient, a
  613  patient’s legal representative, or a patient’s employer, which
  614  meets the requirements of subsection (4) and does not indemnify
  615  for services provided by a third party.
  616         (b) “Health Primary care provider” means a health care
  617  provider licensed under chapter 458, chapter 459, chapter 460,
  618  or chapter 464, or chapter 466, or a health primary care group
  619  practice, who provides health primary care services to patients.
  620         (c) “Health Primary care services” means the screening,
  621  assessment, diagnosis, and treatment of a patient conducted
  622  within the competency and training of the health primary care
  623  provider for the purpose of promoting health or detecting and
  624  managing disease or injury.
  625         (2) A direct health primary care agreement does not
  626  constitute insurance and is not subject to the Florida Insurance
  627  Code. The act of entering into a direct health primary care
  628  agreement does not constitute the business of insurance and is
  629  not subject to the Florida Insurance Code.
  630         (3) A health primary care provider or an agent of a health
  631  primary care provider is not required to obtain a certificate of
  632  authority or license under the Florida Insurance Code to market,
  633  sell, or offer to sell a direct health primary care agreement.
  634         (4) For purposes of this section, a direct health primary
  635  care agreement must:
  636         (a) Be in writing.
  637         (b) Be signed by the health primary care provider or an
  638  agent of the health primary care provider and the patient, the
  639  patient’s legal representative, or the patient’s employer.
  640         (c) Allow a party to terminate the agreement by giving the
  641  other party at least 30 days’ advance written notice. The
  642  agreement may provide for immediate termination due to a
  643  violation of the physician-patient relationship or a breach of
  644  the terms of the agreement.
  645         (d) Describe the scope of health primary care services that
  646  are covered by the monthly fee.
  647         (e) Specify the monthly fee and any fees for health primary
  648  care services not covered by the monthly fee.
  649         (f) Specify the duration of the agreement and any automatic
  650  renewal provisions.
  651         (g) Offer a refund to the patient, the patient’s legal
  652  representative, or the patient’s employer of monthly fees paid
  653  in advance if the health primary care provider ceases to offer
  654  health primary care services for any reason.
  655         (h) Contain, in contrasting color and in at least 12-point
  656  type, the following statement on the signature page: “This
  657  agreement is not health insurance and the health primary care
  658  provider will not file any claims against the patient’s health
  659  insurance policy or plan for reimbursement of any health primary
  660  care services covered by the agreement. This agreement does not
  661  qualify as minimum essential coverage to satisfy the individual
  662  shared responsibility provision of the Patient Protection and
  663  Affordable Care Act, 26 U.S.C. s. 5000A. This agreement is not
  664  workers’ compensation insurance and does not replace an
  665  employer’s obligations under chapter 440.”
  666         Section 12. Effective January 1, 2020, section 627.42393,
  667  Florida Statutes, is created to read:
  668         627.42393 Step-therapy protocol.—
  669         (1) A health insurer issuing a major medical individual or
  670  group policy may not require a step-therapy protocol under the
  671  policy for a covered prescription drug requested by an insured
  672  if:
  673         (a) The insured has previously been approved to receive the
  674  prescription drug through the completion of a step-therapy
  675  protocol required by a separate health coverage plan; and
  676         (b) The insured provides documentation originating from the
  677  health coverage plan that approved the prescription drug as
  678  described in paragraph (a) indicating that the health coverage
  679  plan paid for the drug on the insured’s behalf during the 90
  680  days immediately before the request.
  681         (2) As used in this section, the term “health coverage
  682  plan” means any of the following which is currently or was
  683  previously providing major medical or similar comprehensive
  684  coverage or benefits to the insured:
  685         (a) A health insurer or health maintenance organization.
  686         (b)A plan established or maintained by an individual
  687  employer as provided by the Employee Retirement Income Security
  688  Act of 1974, Pub. L. No. 93-406.
  689         (c) A multiple-employer welfare arrangement as defined in
  690  s. 624.437.
  691         (d) A governmental entity providing a plan of self
  692  insurance.
  693         (3) This section does not require a health insurer to add a
  694  drug to its prescription drug formulary or to cover a
  695  prescription drug that the insurer does not otherwise cover.
  696         Section 13. Effective January 1, 2020, subsection (45) is
  697  added to section 641.31, Florida Statutes, to read:
  698         641.31 Health maintenance contracts.—
  699         (45)(a) A health maintenance organization issuing major
  700  medical coverage through an individual or group contract may not
  701  require a step-therapy protocol under the contract for a covered
  702  prescription drug requested by a subscriber if:
  703         1. The subscriber has previously been approved to receive
  704  the prescription drug through the completion of a step-therapy
  705  protocol required by a separate health coverage plan; and
  706         2. The subscriber provides documentation originating from
  707  the health coverage plan that approved the prescription drug as
  708  described in subparagraph 1. indicating that the health coverage
  709  plan paid for the drug on the subscriber’s behalf during the 90
  710  days immediately before the request.
  711         (b) As used in this subsection, the term “health coverage
  712  plan” means any of the following which previously provided or is
  713  currently providing major medical or similar comprehensive
  714  coverage or benefits to the subscriber:
  715         1. A health insurer or health maintenance organization;
  716         2.A plan established or maintained by an individual
  717  employer as provided by the Employee Retirement Income Security
  718  Act of 1974, Pub. L. No. 93-406;
  719         3. A multiple-employer welfare arrangement as defined in s.
  720  624.437; or
  721         4. A governmental entity providing a plan of self
  722  insurance.
  723         (c) This subsection does not require a health maintenance
  724  organization to add a drug to its prescription drug formulary or
  725  to cover a prescription drug that the health maintenance
  726  organization does not otherwise cover.
  727         Section 14. The Office of Program Policy Analysis and
  728  Government Accountability shall research and analyze the
  729  Interstate Medical Licensure Compact and the relevant
  730  requirements and provisions of general law and the State
  731  Constitution and shall develop a report and recommendations
  732  addressing this state’s prospective entrance into the compact as
  733  a member state while remaining consistent with those
  734  requirements and provisions. In conducting such research and
  735  analysis, the office may consult with the executive director,
  736  other executive staff, or the executive committee of the
  737  Interstate Medical Licensure Compact Commission. The office
  738  shall submit the report and recommendations to the Governor, the
  739  President of the Senate, and the Speaker of the House of
  740  Representatives by not later than October 1, 2019.
  741         Section 15. Except as otherwise expressly provided in this
  742  act, and except for this section and s. 542.336, Florida
  743  Statutes, as created by this act, which shall take effect upon
  744  this act becoming a law, this act shall take effect July 1,
  745  2019.
  746  
  747  ================= T I T L E  A M E N D M E N T ================
  748  And the title is amended as follows:
  749         Delete everything before the enacting clause
  750  and insert:
  751                        A bill to be entitled                      
  752         An act relating to health care; providing legislative
  753         intent; creating s. 381.4019, F.S.; establishing the
  754         Dental Student Loan Repayment Program to support
  755         dentists who practice in public health programs
  756         located in certain underserved areas; providing
  757         definitions; requiring the Department of Health to
  758         establish a dental student loan repayment program for
  759         specified purposes; providing for the award of funds;
  760         providing the maximum number of years for which funds
  761         may be awarded; providing eligibility requirements;
  762         requiring the department to adopt rules; specifying
  763         that implementation of the program is subject to
  764         legislative appropriation; creating s. 381.40195,
  765         F.S.; providing a short title; providing definitions;
  766         requiring the Department of Health to establish the
  767         Donated Dental Services Program to provide
  768         comprehensive dental care to certain eligible
  769         individuals; requiring the department to contract with
  770         a nonprofit organization to implement and administer
  771         the program; specifying minimum contractual
  772         responsibilities; requiring the department to adopt
  773         rules; specifying that implementation of the program
  774         is subject to legislative appropriation; amending s.
  775         395.1012, F.S.; requiring a licensed hospital to
  776         provide specified information and data relating to
  777         patient safety and quality measures to a patient under
  778         certain circumstances or to any person upon request;
  779         creating s. 395.1052, F.S.; requiring a hospital to
  780         notify a patient’s primary care provider within a
  781         specified timeframe after the patient’s admission;
  782         requiring a hospital to inform a patient, upon
  783         admission, of the option to request consultation
  784         between the hospital’s treating physician and the
  785         patient’s primary care provider or specialist
  786         provider; requiring a hospital to notify a patient’s
  787         primary care provider of the patient’s discharge
  788         within a specified timeframe after discharge;
  789         requiring a hospital to provide specified information
  790         and records to the primary care provider within a
  791         specified timeframe after completion of the patient’s
  792         discharge summary; amending s. 395.002, F.S.; revising
  793         the definition of the term “ambulatory surgical
  794         center”; amending s. 395.1055, F.S.; requiring the
  795         Agency for Health Care Administration to adopt rules
  796         that establish standards related to the delivery of
  797         surgical care to children in ambulatory surgical
  798         center; specifying that ambulatory surgical centers
  799         may provide certain procedures only if authorized by
  800         agency rule; authorizing the reimbursement of per diem
  801         and travel expenses to members of the pediatric
  802         cardiac technical advisory panel, established within
  803         the Agency for Health Care Administration; revising
  804         panel membership to include certain alternate at-large
  805         members; providing term limits for voting members;
  806         providing that members of the panel under certain
  807         circumstances are agents of the state for a specified
  808         purpose; requiring the Secretary of Health Care
  809         Administration to consult the panel for advisory
  810         recommendations on certain certificate of need
  811         applications; authorizing the secretary to request
  812         announced or unannounced site visits to any existing
  813         pediatric cardiac surgical center or facility seeking
  814         licensure as a pediatric cardiac surgical center
  815         through the certificate of need process; providing a
  816         process for the appointment of physician experts to a
  817         site visit team; requiring each member of a site visit
  818         team to submit a report to the panel; requiring the
  819         panel to discuss such reports and present an advisory
  820         opinion to the secretary; providing requirements for
  821         an on-site inspection; requiring the Surgeon General
  822         of the Department of Health to provide specified
  823         reports to the secretary; amending. s. 395.301, F.S.;
  824         requiring a licensed facility, upon placing a patient
  825         on observation status, to immediately notify the
  826         patient of such status using a specified form;
  827         requiring that such notification be documented in the
  828         patient’s medical records and discharge papers;
  829         amending s. 400.9905, F.S.; revising the definition of
  830         the term “clinic” to exclude certain entities;
  831         creating s. 542.336, F.S.; specifying that certain
  832         restrictive covenants entered into with certain
  833         physicians are not supported by legitimate business
  834         interests; providing legislative findings; providing
  835         that such restrictive covenants are void and remain
  836         void and unenforceable for a specified period;
  837         amending s. 624.27, F.S.; expanding the scope of
  838         direct primary care agreements, which are renamed
  839         “direct health care agreements”; conforming provisions
  840         to changes made by the act; creating s. 627.42393,
  841         F.S.; prohibiting certain health insurers from
  842         employing step-therapy protocols under certain
  843         circumstances; defining the term “health coverage
  844         plan”; clarifying that a health insurer is not
  845         required to take specific actions regarding
  846         prescription drugs; amending s. 641.31, F.S.;
  847         prohibiting certain health maintenance organizations
  848         from employing step-therapy protocols under certain
  849         circumstances; defining the term “health coverage
  850         plan”; clarifying that a health maintenance
  851         organization is not required to take specific actions
  852         regarding prescription drugs; requiring the Office of
  853         Program Policy Analysis and Government Accountability
  854         to submit by a specified date a report and
  855         recommendations to the Governor and the Legislature
  856         which addresses this state’s prospective entrance into
  857         the Interstate Medical Licensure Compact as a member
  858         state; providing parameters for the report; providing
  859         effective dates.