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