Florida Senate - 2020                                    SB 1726
       
       
        
       By Senator Bean
       
       
       
       
       
       4-00874E-20                                           20201726__
    1                        A bill to be entitled                      
    2         An act relating to the Agency for Health Care
    3         Administration; amending s. 383.327, F.S.; requiring
    4         birth centers to report certain deaths and stillbirths
    5         to the agency; removing a requirement that a certain
    6         report be submitted annually to the agency;
    7         authorizing the agency to prescribe by rule the
    8         frequency at which such report is submitted; amending
    9         s. 395.003, F.S.; removing a requirement that
   10         specified information be listed on licenses for
   11         certain facilities; repealing s. 395.7015, F.S.,
   12         relating to an annual assessment on health care
   13         entities; amending s. 395.7016, F.S.; conforming a
   14         provision to changes made by the act; amending s.
   15         400.19, F.S.; revising provisions requiring the agency
   16         to conduct licensure inspections of nursing homes;
   17         requiring the agency to conduct additional licensure
   18         surveys under certain circumstances; requiring the
   19         agency to assess a specified fine for such surveys;
   20         amending s. 400.462, F.S.; revising definitions;
   21         amending s. 400.464, F.S.; revising licensure
   22         requirements for home health agencies; amending s.
   23         400.471, F.S.; revising provisions related to certain
   24         application requirements for home health agencies;
   25         amending s. 400.492, F.S.; revising provisions related
   26         to services provided by home health agencies during an
   27         emergency; amending s. 400.506, F.S.; revising
   28         provisions related to licensure requirements for nurse
   29         registries; amending s. 400.509, F.S.; revising
   30         provisions related to the registration of certain
   31         service providers; amending s. 400.605, F.S.; removing
   32         a requirement that the agency conduct specified
   33         inspections of certain licensees; amending s.
   34         400.60501, F.S.; deleting an obsolete date; removing a
   35         requirement that the agency develop a specified annual
   36         report; amending s. 400.9905, F.S.; revising the
   37         definition of the term “clinic”; amending s. 400.991,
   38         F.S.; removing the option for health care clinics to
   39         file a surety bond under certain circumstances;
   40         amending s. 400.9935, F.S.; removing a requirement
   41         that certain directors conduct specified reviews;
   42         requiring certain clinics to publish and post a
   43         schedule of charges; amending s. 408.033, F.S.;
   44         conforming a provision to changes made by the act;
   45         amending s. 408.061, F.S.; revising provisions
   46         requiring health care facilities to submit specified
   47         data to the agency; amending s. 408.0611, F.S.;
   48         removing the requirement that the agency annually
   49         report to the Governor and the Legislature by a
   50         specified date on the progress of implementation of
   51         electronic prescribing; amending s. 408.062, F.S.;
   52         removing requirements that the agency annually report
   53         specified information to the Governor and Legislature
   54         by a specified date and, instead, requiring the agency
   55         to annually publish such information on its website;
   56         amending s. 408.063, F.S.; removing a requirement that
   57         the agency publish certain annual reports; amending s.
   58         408.803, F.S.; conforming a definition to changes made
   59         by the act; defining the term “low-risk provider”;
   60         amending ss. 408.802, 408.820, 408.831, and 408.832,
   61         F.S.; conforming provisions to changes made by the
   62         act; amending s. 408.806, F.S.; exempting certain
   63         providers from a specified inspection; amending s.
   64         408.808, F.S.; authorizing the issuance of a
   65         provisional license to certain applicants; amending
   66         ss. 408.809 and 409.907, F.S.; revising background
   67         screening requirements for certain licensees and
   68         providers; amending s. 408.811, F.S.; authorizing the
   69         agency to grant certain providers an exemption from a
   70         specified inspection under certain circumstances;
   71         authorizing the agency to adopt rules to grant waivers
   72         of certain inspections and extended inspection periods
   73         under certain circumstances; amending s. 408.821,
   74         F.S.; revising provisions requiring licensees to have
   75         a specified plan; providing requirements for the
   76         submission of such plan; amending s. 408.909, F.S.;
   77         removing a requirement that the agency and Office of
   78         Insurance Regulation evaluate a specified program;
   79         amending s. 408.9091, F.S.; requiring the agency and
   80         office to each, instead of jointly, submit a specified
   81         annual report to the Governor and Legislature;
   82         amending s. 409.905, F.S.; deleting the requirement
   83         that the agency discontinue its hospital retrospective
   84         review program under certain circumstances; amending
   85         s. 409.913, F.S.; revising the due date for a certain
   86         annual report; deleting the requirement that certain
   87         agencies submit their annual reports jointly; amending
   88         s. 429.11, F.S.; removing an authorization for the
   89         issuance of a provisional license to certain
   90         facilities; amending s. 429.19, F.S.; removing
   91         requirements that the agency develop and disseminate a
   92         specified list and the Department of Children and
   93         Families disseminate such list to certain providers;
   94         amending ss. 429.35, 429.905, and 429.929, F.S.;
   95         revising provisions requiring a biennial inspection
   96         cycle for specified facilities and centers,
   97         respectively; repealing part I of ch. 483, F.S.,
   98         relating to the Florida Multiphasic Health Testing
   99         Center Law; redesignating parts II and III of ch. 483,
  100         F.S., as parts I and II, respectively; amending ss.
  101         20.43, 381.0034, 456.001, 456.057, 456.076, and
  102         456.47, F.S.; conforming cross-references; providing
  103         an effective date.
  104          
  105  Be It Enacted by the Legislature of the State of Florida:
  106  
  107         Section 1. Subsections (2) and (4) of section 383.327,
  108  Florida Statutes, are amended to read:
  109         383.327 Birth and death records; reports.—
  110         (2) Each maternal death, newborn death, and stillbirth
  111  shall be reported immediately to the medical examiner and the
  112  agency.
  113         (4) A report shall be submitted annually to the agency. The
  114  contents of the report and the frequency with which it is
  115  submitted shall be prescribed by rule of the agency.
  116         Section 2. Subsection (4) of section 395.003, Florida
  117  Statutes, is amended to read:
  118         395.003 Licensure; denial, suspension, and revocation.—
  119         (4) The agency shall issue a license that which specifies
  120  the service categories and the number of hospital beds in each
  121  bed category for which a license is received. Such information
  122  shall be listed on the face of the license. All beds which are
  123  not covered by any specialty-bed-need methodology shall be
  124  specified as general beds. A licensed facility shall not operate
  125  a number of hospital beds greater than the number indicated by
  126  the agency on the face of the license without approval from the
  127  agency under conditions established by rule.
  128         Section 3. Section 395.7015, Florida Statutes, is repealed.
  129         Section 4. Section 395.7016, Florida Statutes, is amended
  130  to read:
  131         395.7016 Annual appropriation.—The Legislature shall
  132  appropriate each fiscal year from either the General Revenue
  133  Fund or the Agency for Health Care Administration Tobacco
  134  Settlement Trust Fund an amount sufficient to replace the funds
  135  lost due to reduction by chapter 2000-256, Laws of Florida, of
  136  the assessment on other health care entities under s. 395.7015,
  137  and the reduction by chapter 2000-256, Laws of Florida, in the
  138  assessment on hospitals under s. 395.701, and to maintain
  139  federal approval of the reduced amount of funds deposited into
  140  the Public Medical Assistance Trust Fund under s. 395.701, as
  141  state match for the state’s Medicaid program.
  142         Section 5. Subsection (3) of section 400.19, Florida
  143  Statutes, is amended to read:
  144         400.19 Right of entry and inspection.—
  145         (3) The agency shall conduct periodic, every 15 months
  146  conduct at least one unannounced licensure inspections
  147  inspection to determine compliance by the licensee with
  148  statutes, and with rules adopted promulgated under the
  149  provisions of those statutes, governing minimum standards of
  150  construction, quality and adequacy of care, and rights of
  151  residents. The survey shall be conducted every 6 months for the
  152  next 2-year period If the facility has been cited for a class I
  153  deficiency or, has been cited for two or more class II
  154  deficiencies arising from separate surveys or investigations
  155  within a 60-day period, the agency shall conduct an additional
  156  licensure survey or has had three or more substantiated
  157  complaints within a 6-month period, each resulting in at least
  158  one class I or class II deficiency. In addition to any other
  159  fees or fines in this part, the agency shall assess a fine for
  160  each facility that is subject to the additional licensure survey
  161  6-month survey cycle. The fine for the additional licensure
  162  survey is $3,000 2-year period shall be $6,000, one-half to be
  163  paid at the completion of each survey. The agency may adjust
  164  such this fine by the change in the Consumer Price Index, based
  165  on the 12 months immediately preceding the increase, to cover
  166  the cost of the additional surveys. The agency shall verify
  167  through subsequent inspection that any deficiency identified
  168  during inspection is corrected. However, the agency may verify
  169  the correction of a class III or class IV deficiency unrelated
  170  to resident rights or resident care without reinspecting the
  171  facility if adequate written documentation has been received
  172  from the facility, which provides assurance that the deficiency
  173  has been corrected. The giving or causing to be given of advance
  174  notice of such unannounced inspections by an employee of the
  175  agency to any unauthorized person shall constitute cause for
  176  suspension of not fewer than 5 working days according to the
  177  provisions of chapter 110.
  178         Section 6. Subsections (12), (14), (17), (21), and (22) of
  179  section 400.462, Florida Statutes, are amended to read:
  180         400.462 Definitions.—As used in this part, the term:
  181         (12) “Home health agency” means a person or an entity an
  182  organization that provides one or more home health services and
  183  staffing services.
  184         (14) “Home health services” means health and medical
  185  services and medical supplies furnished by an organization to an
  186  individual in the individual’s home or place of residence. The
  187  term includes organizations that provide one or more of the
  188  following:
  189         (a) Nursing care.
  190         (b) Physical, occupational, respiratory, or speech therapy.
  191         (c) Home health aide services.
  192         (d) Dietetics and nutrition practice and nutrition
  193  counseling.
  194         (e) Medical supplies, restricted to drugs and biologicals
  195  prescribed by a physician.
  196         (17) “Home infusion therapy provider” means a person or an
  197  entity an organization that employs, contracts with, or refers a
  198  licensed professional who has received advanced training and
  199  experience in intravenous infusion therapy and who administers
  200  infusion therapy to a patient in the patient’s home or place of
  201  residence.
  202         (21) “Nurse registry” means any person or entity that
  203  procures, offers, promises, or attempts to secure health-care
  204  related contracts for registered nurses, licensed practical
  205  nurses, certified nursing assistants, home health aides,
  206  companions, or homemakers, who are compensated by fees as
  207  independent contractors, including, but not limited to,
  208  contracts for the provision of services to patients and
  209  contracts to provide private duty or staffing services to health
  210  care facilities licensed under chapter 395, this chapter, or
  211  chapter 429 or other business entities.
  212         (22)“Organization” means a corporation, government or
  213  governmental subdivision or agency, partnership or association,
  214  or any other legal or commercial entity, any of which involve
  215  more than one health care professional discipline; a health care
  216  professional and a home health aide or certified nursing
  217  assistant; more than one home health aide; more than one
  218  certified nursing assistant; or a home health aide and a
  219  certified nursing assistant. The term does not include an entity
  220  that provides services using only volunteers or only individuals
  221  related by blood or marriage to the patient or client.
  222         Section 7. Subsections (1), (4), and (5) of section
  223  400.464, Florida Statutes, are amended to read:
  224         400.464 Home health agencies to be licensed; expiration of
  225  license; exemptions; unlawful acts; penalties.—
  226         (1) The requirements of part II of chapter 408 apply to the
  227  provision of services that require licensure pursuant to this
  228  part and part II of chapter 408 and entities licensed or
  229  registered by or applying for such licensure or registration
  230  from the Agency for Health Care Administration pursuant to this
  231  part. A license issued by the agency is required in order to
  232  operate a home health agency in this state. A license issued on
  233  or after July 1, 2018, must specify the home health services the
  234  licensee organization is authorized to perform and indicate
  235  whether such specified services are considered skilled care. The
  236  provision or advertising of services that require licensure
  237  pursuant to this part without such services being specified on
  238  the face of the license issued on or after July 1, 2018,
  239  constitutes unlicensed activity as prohibited under s. 408.812.
  240         (4)(a) A licensee An organization that offers or advertises
  241  to the public any service for which licensure or registration is
  242  required under this part must include in the advertisement the
  243  license number or registration number issued to the licensee
  244  organization by the agency. The agency shall assess a fine of
  245  not less than $100 to any licensee or registrant who fails to
  246  include the license or registration number when submitting the
  247  advertisement for publication, broadcast, or printing. The fine
  248  for a second or subsequent offense is $500. The holder of a
  249  license issued under this part may not advertise or indicate to
  250  the public that it holds a home health agency or nurse registry
  251  license other than the one it has been issued.
  252         (b) The operation or maintenance of an unlicensed home
  253  health agency or the performance of any home health services in
  254  violation of this part is declared a nuisance, inimical to the
  255  public health, welfare, and safety. The agency or any state
  256  attorney may, in addition to other remedies provided in this
  257  part, bring an action for an injunction to restrain such
  258  violation, or to enjoin the future operation or maintenance of
  259  the home health agency or the provision of home health services
  260  in violation of this part or part II of chapter 408, until
  261  compliance with this part or the rules adopted under this part
  262  has been demonstrated to the satisfaction of the agency.
  263         (c) A person or entity that who violates paragraph (a) is
  264  subject to an injunctive proceeding under s. 408.816. A
  265  violation of paragraph (a) or s. 408.812 is a deceptive and
  266  unfair trade practice and constitutes a violation of the Florida
  267  Deceptive and Unfair Trade Practices Act under part II of
  268  chapter 501.
  269         (d) A person or entity that who violates the provisions of
  270  paragraph (a) commits a misdemeanor of the second degree,
  271  punishable as provided in s. 775.082 or s. 775.083. Any person
  272  or entity that who commits a second or subsequent violation
  273  commits a misdemeanor of the first degree, punishable as
  274  provided in s. 775.082 or s. 775.083. Each day of continuing
  275  violation constitutes a separate offense.
  276         (e) Any person or entity that who owns, operates, or
  277  maintains an unlicensed home health agency and who, after
  278  receiving notification from the agency, fails to cease operation
  279  and apply for a license under this part commits a misdemeanor of
  280  the second degree, punishable as provided in s. 775.082 or s.
  281  775.083. Each day of continued operation is a separate offense.
  282         (f) Any home health agency that fails to cease operation
  283  after agency notification may be fined in accordance with s.
  284  408.812.
  285         (5) The following are exempt from the licensure as a home
  286  health agency under requirements of this part:
  287         (a) A home health agency operated by the Federal
  288  Government.
  289         (b) Home health services provided by a state agency, either
  290  directly or through a contractor with:
  291         1. The Department of Elderly Affairs.
  292         2. The Department of Health, a community health center, or
  293  a rural health network that furnishes home visits for the
  294  purpose of providing environmental assessments, case management,
  295  health education, personal care services, family planning, or
  296  followup treatment, or for the purpose of monitoring and
  297  tracking disease.
  298         3. Services provided to persons with developmental
  299  disabilities, as defined in s. 393.063.
  300         4. Companion and sitter organizations that were registered
  301  under s. 400.509(1) on January 1, 1999, and were authorized to
  302  provide personal services under a developmental services
  303  provider certificate on January 1, 1999, may continue to provide
  304  such services to past, present, and future clients of the
  305  organization who need such services, notwithstanding the
  306  provisions of this act.
  307         5. The Department of Children and Families.
  308         (c) A health care professional, whether or not
  309  incorporated, who is licensed under chapter 457; chapter 458;
  310  chapter 459; part I of chapter 464; chapter 467; part I, part
  311  III, part V, or part X of chapter 468; chapter 480; chapter 486;
  312  chapter 490; or chapter 491; and who is acting alone within the
  313  scope of his or her professional license to provide care to
  314  patients in their homes.
  315         (d) A home health aide or certified nursing assistant who
  316  is acting in his or her individual capacity, within the
  317  definitions and standards of his or her occupation, and who
  318  provides hands-on care to patients in their homes.
  319         (e) An individual who acts alone, in his or her individual
  320  capacity, and who is not employed by or affiliated with a
  321  licensed home health agency or registered with a licensed nurse
  322  registry. This exemption does not entitle an individual to
  323  perform home health services without the required professional
  324  license.
  325         (f) The delivery of instructional services in home dialysis
  326  and home dialysis supplies and equipment.
  327         (g) The delivery of nursing home services for which the
  328  nursing home is licensed under part II of this chapter, to serve
  329  its residents in its facility.
  330         (h) The delivery of assisted living facility services for
  331  which the assisted living facility is licensed under part I of
  332  chapter 429, to serve its residents in its facility.
  333         (i) The delivery of hospice services for which the hospice
  334  is licensed under part IV of this chapter, to serve hospice
  335  patients admitted to its service.
  336         (j) A hospital that provides services for which it is
  337  licensed under chapter 395.
  338         (k) The delivery of community residential services for
  339  which the community residential home is licensed under chapter
  340  419, to serve the residents in its facility.
  341         (l) A not-for-profit, community-based agency that provides
  342  early intervention services to infants and toddlers.
  343         (m) Certified rehabilitation agencies and comprehensive
  344  outpatient rehabilitation facilities that are certified under
  345  Title 18 of the Social Security Act.
  346         (n) The delivery of adult family-care home services for
  347  which the adult family-care home is licensed under part II of
  348  chapter 429, to serve the residents in its facility.
  349         (o)A person or entity that provides skilled care by health
  350  care professionals licensed solely under part I of chapter 464;
  351  part I, part III, or part V of chapter 468; or chapter 486.
  352         (p)A person or entity that provides services using only
  353  volunteers or only individuals related by blood or marriage to
  354  the patient or client.
  355         Section 8. Paragraph (g) of subsection (2) of section
  356  400.471, Florida Statutes, is amended to read:
  357         400.471 Application for license; fee.—
  358         (2) In addition to the requirements of part II of chapter
  359  408, the initial applicant, the applicant for a change of
  360  ownership, and the applicant for the addition of skilled care
  361  services must file with the application satisfactory proof that
  362  the home health agency is in compliance with this part and
  363  applicable rules, including:
  364         (g) In the case of an application for initial licensure, an
  365  application for a change of ownership, or an application for the
  366  addition of skilled care services, documentation of
  367  accreditation, or an application for accreditation, from an
  368  accrediting organization that is recognized by the agency as
  369  having standards comparable to those required by this part and
  370  part II of chapter 408. A home health agency that does not
  371  provide skilled care is exempt from this paragraph.
  372  Notwithstanding s. 408.806, the an initial applicant must
  373  provide proof of accreditation that is not conditional or
  374  provisional and a survey demonstrating compliance with the
  375  requirements of this part, part II of chapter 408, and
  376  applicable rules from an accrediting organization that is
  377  recognized by the agency as having standards comparable to those
  378  required by this part and part II of chapter 408 within 120 days
  379  after the date of the agency’s receipt of the application for
  380  licensure. Such accreditation must be continuously maintained by
  381  the home health agency to maintain licensure. The agency shall
  382  accept, in lieu of its own periodic licensure survey, the
  383  submission of the survey of an accrediting organization that is
  384  recognized by the agency if the accreditation of the licensed
  385  home health agency is not provisional and if the licensed home
  386  health agency authorizes release of, and the agency receives the
  387  report of, the accrediting organization.
  388         Section 9. Section 400.492, Florida Statutes, is amended to
  389  read:
  390         400.492 Provision of services during an emergency.—Each
  391  home health agency shall prepare and maintain a comprehensive
  392  emergency management plan that is consistent with the standards
  393  adopted by national or state accreditation organizations and
  394  consistent with the local special needs plan. The plan shall be
  395  updated annually and shall provide for continuing home health
  396  services during an emergency that interrupts patient care or
  397  services in the patient’s home. The plan shall include the means
  398  by which the home health agency will continue to provide staff
  399  to perform the same type and quantity of services to their
  400  patients who evacuate to special needs shelters that were being
  401  provided to those patients prior to evacuation. The plan shall
  402  describe how the home health agency establishes and maintains an
  403  effective response to emergencies and disasters, including:
  404  notifying staff when emergency response measures are initiated;
  405  providing for communication between staff members, county health
  406  departments, and local emergency management agencies, including
  407  a backup system; identifying resources necessary to continue
  408  essential care or services or referrals to other health care
  409  providers organizations subject to written agreement; and
  410  prioritizing and contacting patients who need continued care or
  411  services.
  412         (1) Each patient record for patients who are listed in the
  413  registry established pursuant to s. 252.355 shall include a
  414  description of how care or services will be continued in the
  415  event of an emergency or disaster. The home health agency shall
  416  discuss the emergency provisions with the patient and the
  417  patient’s caregivers, including where and how the patient is to
  418  evacuate, procedures for notifying the home health agency in the
  419  event that the patient evacuates to a location other than the
  420  shelter identified in the patient record, and a list of
  421  medications and equipment which must either accompany the
  422  patient or will be needed by the patient in the event of an
  423  evacuation.
  424         (2) Each home health agency shall maintain a current
  425  prioritized list of patients who need continued services during
  426  an emergency. The list shall indicate how services shall be
  427  continued in the event of an emergency or disaster for each
  428  patient and if the patient is to be transported to a special
  429  needs shelter, and shall indicate if the patient is receiving
  430  skilled nursing services and the patient’s medication and
  431  equipment needs. The list shall be furnished to county health
  432  departments and to local emergency management agencies, upon
  433  request.
  434         (3) Home health agencies shall not be required to continue
  435  to provide care to patients in emergency situations that are
  436  beyond their control and that make it impossible to provide
  437  services, such as when roads are impassable or when patients do
  438  not go to the location specified in their patient records. Home
  439  health agencies may establish links to local emergency
  440  operations centers to determine a mechanism by which to approach
  441  specific areas within a disaster area in order for the agency to
  442  reach its clients. Home health agencies shall demonstrate a good
  443  faith effort to comply with the requirements of this subsection
  444  by documenting attempts of staff to follow procedures outlined
  445  in the home health agency’s comprehensive emergency management
  446  plan, and by the patient’s record, which support a finding that
  447  the provision of continuing care has been attempted for those
  448  patients who have been identified as needing care by the home
  449  health agency and registered under s. 252.355, in the event of
  450  an emergency or disaster under subsection (1).
  451         (4) Notwithstanding the provisions of s. 400.464(2) or any
  452  other provision of law to the contrary, a home health agency may
  453  provide services in a special needs shelter located in any
  454  county.
  455         Section 10. Subsection (4) and paragraph (a) of subsection
  456  (5) of section 400.506, Florida Statutes, are amended to read:
  457         400.506 Licensure of nurse registries; requirements;
  458  penalties.—
  459         (4) A licensee who person that provides, offers, or
  460  advertises to the public any service for which licensure is
  461  required under this section must include in such advertisement
  462  the license number issued to the licensee it by the Agency for
  463  Health Care Administration. The agency shall assess a fine of
  464  not less than $100 against any licensee who fails to include the
  465  license number when submitting the advertisement for
  466  publication, broadcast, or printing. The fine for a second or
  467  subsequent offense is $500.
  468         (5)(a) In addition to the requirements of s. 408.812, any
  469  person or entity that who owns, operates, or maintains an
  470  unlicensed nurse registry and who, after receiving notification
  471  from the agency, fails to cease operation and apply for a
  472  license under this part commits a misdemeanor of the second
  473  degree, punishable as provided in s. 775.082 or s. 775.083. Each
  474  day of continued operation is a separate offense.
  475         Section 11. Subsections (1), (2), (4), and (5) of section
  476  400.509, Florida Statutes, are amended to read:
  477         400.509 Registration of particular service providers exempt
  478  from licensure; certificate of registration; regulation of
  479  registrants.—
  480         (1) Any person or entity organization that provides
  481  companion services or homemaker services and does not provide a
  482  home health service to a person is exempt from licensure under
  483  this part. However, any person or entity organization that
  484  provides companion services or homemaker services must register
  485  with the agency. A person or an entity An organization under
  486  contract with the Agency for Persons with Disabilities which
  487  provides companion services only for persons with a
  488  developmental disability, as defined in s. 393.063, is exempt
  489  from registration.
  490         (2) The requirements of part II of chapter 408 apply to the
  491  provision of services that require registration or licensure
  492  pursuant to this section and part II of chapter 408 and entities
  493  registered by or applying for such registration from the Agency
  494  for Health Care Administration pursuant to this section. Each
  495  applicant for registration and each registrant must comply with
  496  all provisions of part II of chapter 408. Registration or a
  497  license issued by the agency is required for a person or an
  498  entity to provide the operation of an organization that provides
  499  companion services or homemaker services.
  500         (4) Each registrant must obtain the employment or contract
  501  history of persons who are employed by or under contract with
  502  the person or entity organization and who will have contact at
  503  any time with patients or clients in their homes by:
  504         (a) Requiring such persons to submit an employment or
  505  contractual history to the registrant; and
  506         (b) Verifying the employment or contractual history, unless
  507  through diligent efforts such verification is not possible. The
  508  agency shall prescribe by rule the minimum requirements for
  509  establishing that diligent efforts have been made.
  510  
  511  There is no monetary liability on the part of, and no cause of
  512  action for damages arises against, a former employer of a
  513  prospective employee of or prospective independent contractor
  514  with a registrant who reasonably and in good faith communicates
  515  his or her honest opinions about the former employee’s or
  516  contractor’s job performance. This subsection does not affect
  517  the official immunity of an officer or employee of a public
  518  corporation.
  519         (5) A person or an entity that offers or advertises to the
  520  public a service for which registration is required must include
  521  in its advertisement the registration number issued by the
  522  Agency for Health Care Administration.
  523         Section 12. Subsection (3) of section 400.605, Florida
  524  Statutes, is amended to read:
  525         400.605 Administration; forms; fees; rules; inspections;
  526  fines.—
  527         (3) In accordance with s. 408.811, the agency shall conduct
  528  annual inspections of all licensees, except that licensure
  529  inspections may be conducted biennially for hospices having a 3
  530  year record of substantial compliance. The agency shall conduct
  531  such inspections and investigations as are necessary in order to
  532  determine the state of compliance with the provisions of this
  533  part, part II of chapter 408, and applicable rules.
  534         Section 13. Section 400.60501, Florida Statutes, is amended
  535  to read:
  536         400.60501 Outcome measures; adoption of federal quality
  537  measures; public reporting; annual report.—
  538         (1) No later than December 31, 2019, The agency shall adopt
  539  the national hospice outcome measures and survey data in 42
  540  C.F.R. part 418 to determine the quality and effectiveness of
  541  hospice care for hospices licensed in the state.
  542         (2) The agency shall:
  543         (a) make available to the public the national hospice
  544  outcome measures and survey data in a format that is
  545  comprehensible by a layperson and that allows a consumer to
  546  compare such measures of one or more hospices.
  547         (b)Develop an annual report that analyzes and evaluates
  548  the information collected under this act and any other data
  549  collection or reporting provisions of law.
  550         Section 14. Subsection (4) of section 400.9905, Florida
  551  Statutes, is amended to read:
  552         400.9905 Definitions.—
  553         (4) “Clinic” means an entity where health care services are
  554  provided to individuals and which tenders charges for
  555  reimbursement for such services, including a mobile clinic and a
  556  portable equipment provider. As used in this part, the term does
  557  not include and the licensure requirements of this part do not
  558  apply to:
  559         (a) Entities licensed or registered by the state under
  560  chapter 395; entities licensed or registered by the state and
  561  providing only health care services within the scope of services
  562  authorized under their respective licenses under ss. 383.30
  563  383.332, chapter 390, chapter 394, chapter 397, this chapter
  564  except part X, chapter 429, chapter 463, chapter 465, chapter
  565  466, chapter 478, chapter 484, or chapter 651; end-stage renal
  566  disease providers authorized under 42 C.F.R. part 405, subpart
  567  U; providers certified and providing only health care services
  568  within the scope of services authorized under their respective
  569  certifications under 42 C.F.R. part 485, subpart B, or subpart
  570  H, or subpart J; providers certified and providing only health
  571  care services within the scope of services authorized under
  572  their respective certifications under 42 C.F.R. part 486,
  573  subpart C; providers certified and providing only health care
  574  services within the scope of services authorized under their
  575  respective certifications under 42 C.F.R. part 491, subpart A;
  576  providers certified by the Centers for Medicare and Medicaid
  577  services under the federal Clinical Laboratory Improvement
  578  Amendments and the federal rules adopted thereunder; or any
  579  entity that provides neonatal or pediatric hospital-based health
  580  care services or other health care services by licensed
  581  practitioners solely within a hospital licensed under chapter
  582  395.
  583         (b) Entities that own, directly or indirectly, entities
  584  licensed or registered by the state pursuant to chapter 395;
  585  entities that own, directly or indirectly, entities licensed or
  586  registered by the state and providing only health care services
  587  within the scope of services authorized pursuant to their
  588  respective licenses under ss. 383.30-383.332, chapter 390,
  589  chapter 394, chapter 397, this chapter except part X, chapter
  590  429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
  591  484, or chapter 651; end-stage renal disease providers
  592  authorized under 42 C.F.R. part 405, subpart U; providers
  593  certified and providing only health care services within the
  594  scope of services authorized under their respective
  595  certifications under 42 C.F.R. part 485, subpart B, or subpart
  596  H, or subpart J; providers certified and providing only health
  597  care services within the scope of services authorized under
  598  their respective certifications under 42 C.F.R. part 486,
  599  subpart C; providers certified and providing only health care
  600  services within the scope of services authorized under their
  601  respective certifications under 42 C.F.R. part 491, subpart A;
  602  providers certified by the Centers for Medicare and Medicaid
  603  services under the federal Clinical Laboratory Improvement
  604  Amendments and the federal rules adopted thereunder; or any
  605  entity that provides neonatal or pediatric hospital-based health
  606  care services by licensed practitioners solely within a hospital
  607  licensed under chapter 395.
  608         (c) Entities that are owned, directly or indirectly, by an
  609  entity licensed or registered by the state pursuant to chapter
  610  395; entities that are owned, directly or indirectly, by an
  611  entity licensed or registered by the state and providing only
  612  health care services within the scope of services authorized
  613  pursuant to their respective licenses under ss. 383.30-383.332,
  614  chapter 390, chapter 394, chapter 397, this chapter except part
  615  X, chapter 429, chapter 463, chapter 465, chapter 466, chapter
  616  478, chapter 484, or chapter 651; end-stage renal disease
  617  providers authorized under 42 C.F.R. part 405, subpart U;
  618  providers certified and providing only health care services
  619  within the scope of services authorized under their respective
  620  certifications under 42 C.F.R. part 485, subpart B, or subpart
  621  H, or subpart J; providers certified and providing only health
  622  care services within the scope of services authorized under
  623  their respective certifications under 42 C.F.R. part 486,
  624  subpart C; providers certified and providing only health care
  625  services within the scope of services authorized under their
  626  respective certifications under 42 C.F.R. part 491, subpart A;
  627  providers certified by the Centers for Medicare and Medicaid
  628  services under the federal Clinical Laboratory Improvement
  629  Amendments and the federal rules adopted thereunder; or any
  630  entity that provides neonatal or pediatric hospital-based health
  631  care services by licensed practitioners solely within a hospital
  632  under chapter 395.
  633         (d) Entities that are under common ownership, directly or
  634  indirectly, with an entity licensed or registered by the state
  635  pursuant to chapter 395; entities that are under common
  636  ownership, directly or indirectly, with an entity licensed or
  637  registered by the state and providing only health care services
  638  within the scope of services authorized pursuant to their
  639  respective licenses under ss. 383.30-383.332, chapter 390,
  640  chapter 394, chapter 397, this chapter except part X, chapter
  641  429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
  642  484, or chapter 651; end-stage renal disease providers
  643  authorized under 42 C.F.R. part 405, subpart U; providers
  644  certified and providing only health care services within the
  645  scope of services authorized under their respective
  646  certifications under 42 C.F.R. part 485, subpart B, or subpart
  647  H, or subpart J; providers certified and providing only health
  648  care services within the scope of services authorized under
  649  their respective certifications under 42 C.F.R. part 486,
  650  subpart C; providers certified and providing only health care
  651  services within the scope of services authorized under their
  652  respective certifications under 42 C.F.R. part 491, subpart A;
  653  providers certified by the Centers for Medicare and Medicaid
  654  services under the federal Clinical Laboratory Improvement
  655  Amendments and the federal rules adopted thereunder; or any
  656  entity that provides neonatal or pediatric hospital-based health
  657  care services by licensed practitioners solely within a hospital
  658  licensed under chapter 395.
  659         (e) An entity that is exempt from federal taxation under 26
  660  U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
  661  under 26 U.S.C. s. 409 that has a board of trustees at least
  662  two-thirds of which are Florida-licensed health care
  663  practitioners and provides only physical therapy services under
  664  physician orders, any community college or university clinic,
  665  and any entity owned or operated by the federal or state
  666  government, including agencies, subdivisions, or municipalities
  667  thereof.
  668         (f) A sole proprietorship, group practice, partnership, or
  669  corporation that provides health care services by physicians
  670  covered by s. 627.419, that is directly supervised by one or
  671  more of such physicians, and that is wholly owned by one or more
  672  of those physicians or by a physician and the spouse, parent,
  673  child, or sibling of that physician.
  674         (g) A sole proprietorship, group practice, partnership, or
  675  corporation that provides health care services by licensed
  676  health care practitioners under chapter 457, chapter 458,
  677  chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
  678  chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
  679  chapter 490, chapter 491, or part I, part III, part X, part
  680  XIII, or part XIV of chapter 468, or s. 464.012, and that is
  681  wholly owned by one or more licensed health care practitioners,
  682  or the licensed health care practitioners set forth in this
  683  paragraph and the spouse, parent, child, or sibling of a
  684  licensed health care practitioner if one of the owners who is a
  685  licensed health care practitioner is supervising the business
  686  activities and is legally responsible for the entity’s
  687  compliance with all federal and state laws. However, a health
  688  care practitioner may not supervise services beyond the scope of
  689  the practitioner’s license, except that, for the purposes of
  690  this part, a clinic owned by a licensee in s. 456.053(3)(b)
  691  which provides only services authorized pursuant to s.
  692  456.053(3)(b) may be supervised by a licensee specified in s.
  693  456.053(3)(b).
  694         (h) Clinical facilities affiliated with an accredited
  695  medical school at which training is provided for medical
  696  students, residents, or fellows.
  697         (i) Entities that provide only oncology or radiation
  698  therapy services by physicians licensed under chapter 458 or
  699  chapter 459 or entities that provide oncology or radiation
  700  therapy services by physicians licensed under chapter 458 or
  701  chapter 459 which are owned by a corporation whose shares are
  702  publicly traded on a recognized stock exchange.
  703         (j) Clinical facilities affiliated with a college of
  704  chiropractic accredited by the Council on Chiropractic Education
  705  at which training is provided for chiropractic students.
  706         (k) Entities that provide licensed practitioners to staff
  707  emergency departments or to deliver anesthesia services in
  708  facilities licensed under chapter 395 and that derive at least
  709  90 percent of their gross annual revenues from the provision of
  710  such services. Entities claiming an exemption from licensure
  711  under this paragraph must provide documentation demonstrating
  712  compliance.
  713         (l) Orthotic, prosthetic, pediatric cardiology, or
  714  perinatology clinical facilities or anesthesia clinical
  715  facilities that are not otherwise exempt under paragraph (a) or
  716  paragraph (k) and that are a publicly traded corporation or are
  717  wholly owned, directly or indirectly, by a publicly traded
  718  corporation. As used in this paragraph, a publicly traded
  719  corporation is a corporation that issues securities traded on an
  720  exchange registered with the United States Securities and
  721  Exchange Commission as a national securities exchange.
  722         (m) Entities that are owned by a corporation that has $250
  723  million or more in total annual sales of health care services
  724  provided by licensed health care practitioners where one or more
  725  of the persons responsible for the operations of the entity is a
  726  health care practitioner who is licensed in this state and who
  727  is responsible for supervising the business activities of the
  728  entity and is responsible for the entity’s compliance with state
  729  law for purposes of this part.
  730         (n) Entities that employ 50 or more licensed health care
  731  practitioners licensed under chapter 458 or chapter 459 where
  732  the billing for medical services is under a single tax
  733  identification number. The application for exemption under this
  734  subsection shall contain information that includes: the name,
  735  residence, and business address and phone number of the entity
  736  that owns the practice; a complete list of the names and contact
  737  information of all the officers and directors of the
  738  corporation; the name, residence address, business address, and
  739  medical license number of each licensed Florida health care
  740  practitioner employed by the entity; the corporate tax
  741  identification number of the entity seeking an exemption; a
  742  listing of health care services to be provided by the entity at
  743  the health care clinics owned or operated by the entity and a
  744  certified statement prepared by an independent certified public
  745  accountant which states that the entity and the health care
  746  clinics owned or operated by the entity have not received
  747  payment for health care services under personal injury
  748  protection insurance coverage for the preceding year. If the
  749  agency determines that an entity which is exempt under this
  750  subsection has received payments for medical services under
  751  personal injury protection insurance coverage, the agency may
  752  deny or revoke the exemption from licensure under this
  753  subsection.
  754         (o)Entities that are, directly or indirectly, under the
  755  common ownership of or that are subject to common control by a
  756  mutual insurance holding company, as defined in s. 628.703, with
  757  an entity licensed or certified under chapter 624 or chapter 641
  758  which has $1 billion or more in total annual sales in this
  759  state.
  760         (p)Entities that are owned by an entity that is a
  761  behavioral health service provider in at least 5 states other
  762  than Florida and that, together with its affiliates, has $90
  763  million or more in total annual revenues associated with the
  764  provision of behavioral health services and where one or more of
  765  the persons responsible for the operations of the entity is a
  766  health care practitioner who is licensed in this state and who
  767  is responsible for supervising the business activities of the
  768  entity and who is responsible for the entity’s compliance with
  769  state law for purposes of this part.
  770         (q)Medicaid providers.
  771  
  772  Notwithstanding this subsection, an entity shall be deemed a
  773  clinic and must be licensed under this part in order to receive
  774  reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
  775  627.730-627.7405, unless exempted under s. 627.736(5)(h).
  776         Section 15. Paragraph (c) of subsection (3) of section
  777  400.991, Florida Statutes, is amended to read:
  778         400.991 License requirements; background screenings;
  779  prohibitions.—
  780         (3) In addition to the requirements of part II of chapter
  781  408, the applicant must file with the application satisfactory
  782  proof that the clinic is in compliance with this part and
  783  applicable rules, including:
  784         (c) Proof of financial ability to operate as required under
  785  ss. 408.8065(1) and 408.810(8) s. 408.810(8). As an alternative
  786  to submitting proof of financial ability to operate as required
  787  under s. 408.810(8), the applicant may file a surety bond of at
  788  least $500,000 which guarantees that the clinic will act in full
  789  conformity with all legal requirements for operating a clinic,
  790  payable to the agency. The agency may adopt rules to specify
  791  related requirements for such surety bond.
  792         Section 16. Paragraph (i) of subsection (1) of section
  793  400.9935, Florida Statutes, is amended to read:
  794         400.9935 Clinic responsibilities.—
  795         (1) Each clinic shall appoint a medical director or clinic
  796  director who shall agree in writing to accept legal
  797  responsibility for the following activities on behalf of the
  798  clinic. The medical director or the clinic director shall:
  799         (i) Ensure that the clinic publishes a schedule of charges
  800  for the medical services offered to patients. The schedule must
  801  include the prices charged to an uninsured person paying for
  802  such services by cash, check, credit card, or debit card. The
  803  schedule may group services by price levels, listing services in
  804  each price level. The schedule must be posted in a conspicuous
  805  place in the reception area of any clinic that is an the urgent
  806  care center as defined in s. 395.002(29)(b) and must include,
  807  but is not limited to, the 50 services most frequently provided
  808  by the clinic. The schedule may group services by three price
  809  levels, listing services in each price level. The posting may be
  810  a sign that must be at least 15 square feet in size or through
  811  an electronic messaging board that is at least 3 square feet in
  812  size. The failure of a clinic, including a clinic that is an
  813  urgent care center, to publish and post a schedule of charges as
  814  required by this section shall result in a fine of not more than
  815  $1,000, per day, until the schedule is published and posted.
  816         Section 17. Paragraph (a) of subsection (2) of section
  817  408.033, Florida Statutes, is amended to read:
  818         408.033 Local and state health planning.—
  819         (2) FUNDING.—
  820         (a) The Legislature intends that the cost of local health
  821  councils be borne by assessments on selected health care
  822  facilities subject to facility licensure by the Agency for
  823  Health Care Administration, including abortion clinics, assisted
  824  living facilities, ambulatory surgical centers, birth centers,
  825  home health agencies, hospices, hospitals, intermediate care
  826  facilities for the developmentally disabled, nursing homes, and
  827  health care clinics, and multiphasic testing centers and by
  828  assessments on organizations subject to certification by the
  829  agency pursuant to chapter 641, part III, including health
  830  maintenance organizations and prepaid health clinics. Fees
  831  assessed may be collected prospectively at the time of licensure
  832  renewal and prorated for the licensure period.
  833         Section 18. Paragraph (a) of subsection (1) of section
  834  408.061, Florida Statutes, is amended to read:
  835         408.061 Data collection; uniform systems of financial
  836  reporting; information relating to physician charges;
  837  confidential information; immunity.—
  838         (1) The agency shall require the submission by health care
  839  facilities, health care providers, and health insurers of data
  840  necessary to carry out the agency’s duties and to facilitate
  841  transparency in health care pricing data and quality measures.
  842  Specifications for data to be collected under this section shall
  843  be developed by the agency and applicable contract vendors, with
  844  the assistance of technical advisory panels including
  845  representatives of affected entities, consumers, purchasers, and
  846  such other interested parties as may be determined by the
  847  agency.
  848         (a) Data submitted by health care facilities, including the
  849  facilities as defined in chapter 395, shall include, but are not
  850  limited to,: case-mix data, patient admission and discharge
  851  data, hospital emergency department data which shall include the
  852  number of patients treated in the emergency department of a
  853  licensed hospital reported by patient acuity level, data on
  854  hospital-acquired infections as specified by rule, data on
  855  complications as specified by rule, data on readmissions as
  856  specified by rule, including patient- with patient and provider
  857  specific identifiers included, actual charge data by diagnostic
  858  groups or other bundled groupings as specified by rule,
  859  financial data, accounting data, operating expenses, expenses
  860  incurred for rendering services to patients who cannot or do not
  861  pay, interest charges, depreciation expenses based on the
  862  expected useful life of the property and equipment involved, and
  863  demographic data. The agency shall adopt nationally recognized
  864  risk adjustment methodologies or software consistent with the
  865  standards of the Agency for Healthcare Research and Quality and
  866  as selected by the agency for all data submitted as required by
  867  this section. Data may be obtained from documents including such
  868  as, but not limited to,: leases, contracts, debt instruments,
  869  itemized patient statements or bills, medical record abstracts,
  870  and related diagnostic information. Reported Data elements shall
  871  be reported electronically in accordance with the inpatient data
  872  reporting instructions as prescribed by agency rule 59E-7.012,
  873  Florida Administrative Code. Data submitted shall be certified
  874  by the chief executive officer or an appropriate and duly
  875  authorized representative or employee of the licensed facility
  876  that the information submitted is true and accurate.
  877         Section 19. Subsection (4) of section 408.0611, Florida
  878  Statutes, is amended to read:
  879         408.0611 Electronic prescribing clearinghouse.—
  880         (4) Pursuant to s. 408.061, the agency shall monitor the
  881  implementation of electronic prescribing by health care
  882  practitioners, health care facilities, and pharmacies. By
  883  January 31 of each year, The agency shall report annually on its
  884  website on the progress of implementation of electronic
  885  prescribing to the Governor and the Legislature. Information
  886  reported pursuant to this subsection must shall include federal
  887  and private sector electronic prescribing initiatives and, to
  888  the extent that data is readily available from organizations
  889  that operate electronic prescribing networks, the number of
  890  health care practitioners using electronic prescribing and the
  891  number of prescriptions electronically transmitted.
  892         Section 20. Paragraphs (i) and (j) of subsection (1) of
  893  section 408.062, Florida Statutes, are amended to read:
  894         408.062 Research, analyses, studies, and reports.—
  895         (1) The agency shall conduct research, analyses, and
  896  studies relating to health care costs and access to and quality
  897  of health care services as access and quality are affected by
  898  changes in health care costs. Such research, analyses, and
  899  studies shall include, but not be limited to:
  900         (i) The use of emergency department services by patient
  901  acuity level and the implication of increasing hospital cost by
  902  providing nonurgent care in emergency departments. The agency
  903  shall publish annually on its website information submit an
  904  annual report based on this monitoring and assessment to the
  905  Governor, the Speaker of the House of Representatives, the
  906  President of the Senate, and the substantive legislative
  907  committees, due January 1.
  908         (j) The making available on its Internet website, and in a
  909  hard-copy format upon request, of patient charge, volumes,
  910  length of stay, and performance indicators collected from health
  911  care facilities pursuant to s. 408.061(1)(a) for specific
  912  medical conditions, surgeries, and procedures provided in
  913  inpatient and outpatient facilities as determined by the agency.
  914  In making the determination of specific medical conditions,
  915  surgeries, and procedures to include, the agency shall consider
  916  such factors as volume, severity of the illness, urgency of
  917  admission, individual and societal costs, and whether the
  918  condition is acute or chronic. Performance outcome indicators
  919  shall be risk adjusted or severity adjusted, as applicable,
  920  using nationally recognized risk adjustment methodologies or
  921  software consistent with the standards of the Agency for
  922  Healthcare Research and Quality and as selected by the agency.
  923  The website shall also provide an interactive search that allows
  924  consumers to view and compare the information for specific
  925  facilities, a map that allows consumers to select a county or
  926  region, definitions of all of the data, descriptions of each
  927  procedure, and an explanation about why the data may differ from
  928  facility to facility. Such public data shall be updated
  929  quarterly. The agency shall publish annually on its website
  930  information submit an annual status report on the collection of
  931  data and publication of health care quality measures to the
  932  Governor, the Speaker of the House of Representatives, the
  933  President of the Senate, and the substantive legislative
  934  committees, due January 1.
  935         Section 21. Subsection (5) of section 408.063, Florida
  936  Statutes, is amended to read:
  937         408.063 Dissemination of health care information.—
  938         (5)The agency shall publish annually a comprehensive
  939  report of state health expenditures. The report shall identify:
  940         (a)The contribution of health care dollars made by all
  941  payors.
  942         (b)The dollars expended by type of health care service in
  943  Florida.
  944         Section 22. Section 408.802, Florida Statutes, is amended
  945  to read:
  946         408.802 Applicability.—The provisions of This part applies
  947  apply to the provision of services that require licensure as
  948  defined in this part and to the following entities licensed,
  949  registered, or certified by the agency, as described in chapters
  950  112, 383, 390, 394, 395, 400, 429, 440, 483, and 765:
  951         (1) Laboratories authorized to perform testing under the
  952  Drug-Free Workplace Act, as provided under ss. 112.0455 and
  953  440.102.
  954         (2) Birth centers, as provided under chapter 383.
  955         (3) Abortion clinics, as provided under chapter 390.
  956         (4) Crisis stabilization units, as provided under parts I
  957  and IV of chapter 394.
  958         (5) Short-term residential treatment facilities, as
  959  provided under parts I and IV of chapter 394.
  960         (6) Residential treatment facilities, as provided under
  961  part IV of chapter 394.
  962         (7) Residential treatment centers for children and
  963  adolescents, as provided under part IV of chapter 394.
  964         (8) Hospitals, as provided under part I of chapter 395.
  965         (9) Ambulatory surgical centers, as provided under part I
  966  of chapter 395.
  967         (10) Nursing homes, as provided under part II of chapter
  968  400.
  969         (11) Assisted living facilities, as provided under part I
  970  of chapter 429.
  971         (12) Home health agencies, as provided under part III of
  972  chapter 400.
  973         (13) Nurse registries, as provided under part III of
  974  chapter 400.
  975         (14) Companion services or homemaker services providers, as
  976  provided under part III of chapter 400.
  977         (15) Adult day care centers, as provided under part III of
  978  chapter 429.
  979         (16) Hospices, as provided under part IV of chapter 400.
  980         (17) Adult family-care homes, as provided under part II of
  981  chapter 429.
  982         (18) Homes for special services, as provided under part V
  983  of chapter 400.
  984         (19) Transitional living facilities, as provided under part
  985  XI of chapter 400.
  986         (20) Prescribed pediatric extended care centers, as
  987  provided under part VI of chapter 400.
  988         (21) Home medical equipment providers, as provided under
  989  part VII of chapter 400.
  990         (22) Intermediate care facilities for persons with
  991  developmental disabilities, as provided under part VIII of
  992  chapter 400.
  993         (23) Health care services pools, as provided under part IX
  994  of chapter 400.
  995         (24) Health care clinics, as provided under part X of
  996  chapter 400.
  997         (25)Multiphasic health testing centers, as provided under
  998  part I of chapter 483.
  999         (25)(26) Organ, tissue, and eye procurement organizations,
 1000  as provided under part V of chapter 765.
 1001         Section 23. Present subsections (10) through (14) of
 1002  section 408.803, Florida Statutes, are redesignated as
 1003  subsections (11) through (15), respectively, a new subsection
 1004  (10) is added to that section, and subsection (3) of that
 1005  section is amended, to read:
 1006         408.803 Definitions.—As used in this part, the term:
 1007         (3) “Authorizing statute” means the statute authorizing the
 1008  licensed operation of a provider listed in s. 408.802 and
 1009  includes chapters 112, 383, 390, 394, 395, 400, 429, 440, 483,
 1010  and 765.
 1011         (10)“Low-risk provider” means nurse registries, home
 1012  medical equipment providers, and health care clinics.
 1013         Section 24. Paragraph (b) of subsection (7) of section
 1014  408.806, Florida Statutes, is amended to read:
 1015         408.806 License application process.—
 1016         (7)
 1017         (b) An initial inspection is not required for companion
 1018  services or homemaker services providers, as provided under part
 1019  III of chapter 400, or for health care services pools, as
 1020  provided under part IX of chapter 400, or for low-risk providers
 1021  as provided under s. 408.811.
 1022         Section 25. Subsection (2) of section 408.808, Florida
 1023  Statutes, is amended to read:
 1024         408.808 License categories.—
 1025         (2) PROVISIONAL LICENSE.—An applicant against whom a
 1026  proceeding denying or revoking a license is pending at the time
 1027  of license renewal may be issued a provisional license effective
 1028  until final action not subject to further appeal. A provisional
 1029  license may also be issued to an applicant for initial licensure
 1030  or applying for a change of ownership. A provisional license
 1031  must be limited in duration to a specific period of time, up to
 1032  12 months, as determined by the agency.
 1033         Section 26. Subsections (2) and (5) of section 408.809,
 1034  Florida Statutes, are amended to read:
 1035         408.809 Background screening; prohibited offenses.—
 1036         (2) Every 5 years following his or her licensure,
 1037  employment, or entry into a contract in a capacity that under
 1038  subsection (1) would require level 2 background screening under
 1039  chapter 435, each such person must submit to level 2 background
 1040  rescreening as a condition of retaining such license or
 1041  continuing in such employment or contractual status. For any
 1042  such rescreening, the agency shall request the Department of Law
 1043  Enforcement to forward the person’s fingerprints to the Federal
 1044  Bureau of Investigation for a national criminal history record
 1045  check unless the person’s fingerprints are enrolled in the
 1046  Federal Bureau of Investigation’s national retained print arrest
 1047  notification program. If the fingerprints of such a person are
 1048  not retained by the Department of Law Enforcement under s.
 1049  943.05(2)(g) and (h), the person must submit fingerprints
 1050  electronically to the Department of Law Enforcement for state
 1051  processing, and the Department of Law Enforcement shall forward
 1052  the fingerprints to the Federal Bureau of Investigation for a
 1053  national criminal history record check. The fingerprints shall
 1054  be retained by the Department of Law Enforcement under s.
 1055  943.05(2)(g) and (h) and enrolled in the national retained print
 1056  arrest notification program when the Department of Law
 1057  Enforcement begins participation in the program. The cost of the
 1058  state and national criminal history records checks required by
 1059  level 2 screening may be borne by the licensee or the person
 1060  fingerprinted. Until a specified agency is fully implemented in
 1061  the clearinghouse created under s. 435.12, The agency may accept
 1062  as satisfying the requirements of this section proof of
 1063  compliance with level 2 screening standards submitted within the
 1064  previous 5 years to meet any provider or professional licensure
 1065  requirements of the agency, the Department of Health, the
 1066  Department of Elderly Affairs, the Agency for Persons with
 1067  Disabilities, the Department of Children and Families, or the
 1068  Department of Financial Services for an applicant for a
 1069  certificate of authority or provisional certificate of authority
 1070  to operate a continuing care retirement community under chapter
 1071  651, provided that:
 1072         (a) The screening standards and disqualifying offenses for
 1073  the prior screening are equivalent to those specified in s.
 1074  435.04 and this section;
 1075         (b) The person subject to screening has not had a break in
 1076  service from a position that requires level 2 screening for more
 1077  than 90 days; and
 1078         (c) Such proof is accompanied, under penalty of perjury, by
 1079  an attestation of compliance with chapter 435 and this section
 1080  using forms provided by the agency.
 1081         (5) A person who serves as a controlling interest of, is
 1082  employed by, or contracts with a licensee on July 31, 2010, who
 1083  has been screened and qualified according to standards specified
 1084  in s. 435.03 or s. 435.04 must be rescreened by July 31, 2015,
 1085  in compliance with the following schedule. If, upon rescreening,
 1086  such person has a disqualifying offense that was not a
 1087  disqualifying offense at the time of the last screening, but is
 1088  a current disqualifying offense and was committed before the
 1089  last screening, he or she may apply for an exemption from the
 1090  appropriate licensing agency and, if agreed to by the employer,
 1091  may continue to perform his or her duties until the licensing
 1092  agency renders a decision on the application for exemption if
 1093  the person is eligible to apply for an exemption and the
 1094  exemption request is received by the agency within 30 days after
 1095  receipt of the rescreening results by the person. The
 1096  rescreening schedule shall be:
 1097         (a) Individuals for whom the last screening was conducted
 1098  on or before December 31, 2004, must be rescreened by July 31,
 1099  2013.
 1100         (b) Individuals for whom the last screening conducted was
 1101  between January 1, 2005, and December 31, 2008, must be
 1102  rescreened by July 31, 2014.
 1103         (c) Individuals for whom the last screening conducted was
 1104  between January 1, 2009, through July 31, 2011, must be
 1105  rescreened by July 31, 2015.
 1106         Section 27. Subsection (1) of section 408.811, Florida
 1107  Statutes, is amended to read:
 1108         408.811 Right of inspection; copies; inspection reports;
 1109  plan for correction of deficiencies.—
 1110         (1) An authorized officer or employee of the agency may
 1111  make or cause to be made any inspection or investigation deemed
 1112  necessary by the agency to determine the state of compliance
 1113  with this part, authorizing statutes, and applicable rules. The
 1114  right of inspection extends to any business that the agency has
 1115  reason to believe is being operated as a provider without a
 1116  license, but inspection of any business suspected of being
 1117  operated without the appropriate license may not be made without
 1118  the permission of the owner or person in charge unless a warrant
 1119  is first obtained from a circuit court. Any application for a
 1120  license issued under this part, authorizing statutes, or
 1121  applicable rules constitutes permission for an appropriate
 1122  inspection to verify the information submitted on or in
 1123  connection with the application.
 1124         (a) All inspections shall be unannounced, except as
 1125  specified in s. 408.806.
 1126         (b) Inspections for relicensure shall be conducted
 1127  biennially unless otherwise specified by this section,
 1128  authorizing statutes, or applicable rules.
 1129         (c)The agency may exempt a low-risk provider from
 1130  licensure inspection if the provider or controlling interest has
 1131  an excellent regulatory history with regard to deficiencies,
 1132  sanctions, complaints, and other regulatory actions, as defined
 1133  by rule. The agency shall continue to conduct unannounced
 1134  licensure inspections for at least 10 percent of exempt low-risk
 1135  providers to verify compliance.
 1136         (d)The agency may adopt rules to waive a routine
 1137  inspection, including inspection for relicensure, or allow for
 1138  an extended period between relicensure inspections for specific
 1139  providers based upon:
 1140         1.A favorable regulatory history with regard to
 1141  deficiencies, sanctions, complaints, and other regulatory
 1142  measures.
 1143         2.Outcome measures that demonstrate quality performance.
 1144         3.Successful participation in a recognized quality
 1145  assurance program.
 1146         4.Accreditation status.
 1147         5.Other measures reflective of quality and safety.
 1148         6.The length of time between inspections.
 1149  
 1150  The agency shall continue to conduct unannounced licensure
 1151  inspections for at least 10 percent of providers that qualify
 1152  for a waiver or extended period between relicensure inspections.
 1153         (e)The agency maintains the authority to conduct an
 1154  inspection of any provider at any time to determine regulatory
 1155  compliance.
 1156         Section 28. Subsection (24) of section 408.820, Florida
 1157  Statutes, is amended to read:
 1158         408.820 Exemptions.—Except as prescribed in authorizing
 1159  statutes, the following exemptions shall apply to specified
 1160  requirements of this part:
 1161         (24)Multiphasic health testing centers, as provided under
 1162  part I of chapter 483, are exempt from s. 408.810(5)-(10).
 1163         Section 29. Subsections (1) and (2) of section 408.821,
 1164  Florida Statutes, are amended to read:
 1165         408.821 Emergency management planning; emergency
 1166  operations; inactive license.—
 1167         (1) A licensee required by authorizing statutes and agency
 1168  rule to have a comprehensive an emergency management operations
 1169  plan must designate a safety liaison to serve as the primary
 1170  contact for emergency operations. Such licensee shall submit its
 1171  comprehensive emergency management plan to the local emergency
 1172  management agency, county health department, or Department of
 1173  Health as follows:
 1174         (a)Submit the plan within 30 days after initial licensure
 1175  and change of ownership, and notify the agency within 30 days
 1176  after submission of the plan.
 1177         (b)Submit the plan annually and within 30 days after any
 1178  significant modification, as defined by agency rule, to a
 1179  previously approved plan.
 1180         (c)Respond with necessary plan revisions within 30 days
 1181  after notification that plan revisions are required.
 1182         (d)Notify the agency within 30 days after approval of its
 1183  plan by the local emergency management agency, county health
 1184  department, or Department of Health.
 1185         (2) An entity subject to this part may temporarily exceed
 1186  its licensed capacity to act as a receiving provider in
 1187  accordance with an approved comprehensive emergency management
 1188  operations plan for up to 15 days. While in an overcapacity
 1189  status, each provider must furnish or arrange for appropriate
 1190  care and services to all clients. In addition, the agency may
 1191  approve requests for overcapacity in excess of 15 days, which
 1192  approvals may be based upon satisfactory justification and need
 1193  as provided by the receiving and sending providers.
 1194         Section 30. Subsection (3) of section 408.831, Florida
 1195  Statutes, is amended to read:
 1196         408.831 Denial, suspension, or revocation of a license,
 1197  registration, certificate, or application.—
 1198         (3) This section provides standards of enforcement
 1199  applicable to all entities licensed or regulated by the Agency
 1200  for Health Care Administration. This section controls over any
 1201  conflicting provisions of chapters 39, 383, 390, 391, 394, 395,
 1202  400, 408, 429, 468, 483, and 765 or rules adopted pursuant to
 1203  those chapters.
 1204         Section 31. Section 408.832, Florida Statutes, is amended
 1205  to read:
 1206         408.832 Conflicts.—In case of conflict between the
 1207  provisions of this part and the authorizing statutes governing
 1208  the licensure of health care providers by the Agency for Health
 1209  Care Administration found in s. 112.0455 and chapters 383, 390,
 1210  394, 395, 400, 429, 440, 483, and 765, the provisions of this
 1211  part shall prevail.
 1212         Section 32. Subsection (9) of section 408.909, Florida
 1213  Statutes, is amended to read:
 1214         408.909 Health flex plans.—
 1215         (9)PROGRAM EVALUATION.—The agency and the office shall
 1216  evaluate the pilot program and its effect on the entities that
 1217  seek approval as health flex plans, on the number of enrollees,
 1218  and on the scope of the health care coverage offered under a
 1219  health flex plan; shall provide an assessment of the health flex
 1220  plans and their potential applicability in other settings; shall
 1221  use health flex plans to gather more information to evaluate
 1222  low-income consumer driven benefit packages; and shall, by
 1223  January 15, 2016, and annually thereafter, jointly submit a
 1224  report to the Governor, the President of the Senate, and the
 1225  Speaker of the House of Representatives.
 1226         Section 33. Paragraph (d) of subsection (10) of section
 1227  408.9091, Florida Statutes, is amended to read:
 1228         408.9091 Cover Florida Health Care Access Program.—
 1229         (10) PROGRAM EVALUATION.—The agency and the office shall:
 1230         (d)Jointly submit by March 1, annually, a report to the
 1231  Governor, the President of the Senate, and the Speaker of the
 1232  House of Representatives which provides the information
 1233  specified in paragraphs (a)-(c) and recommendations relating to
 1234  the successful implementation and administration of the program.
 1235         Section 34. Paragraph (a) of subsection (5) of section
 1236  409.905, Florida Statutes, is amended to read:
 1237         409.905 Mandatory Medicaid services.—The agency may make
 1238  payments for the following services, which are required of the
 1239  state by Title XIX of the Social Security Act, furnished by
 1240  Medicaid providers to recipients who are determined to be
 1241  eligible on the dates on which the services were provided. Any
 1242  service under this section shall be provided only when medically
 1243  necessary and in accordance with state and federal law.
 1244  Mandatory services rendered by providers in mobile units to
 1245  Medicaid recipients may be restricted by the agency. Nothing in
 1246  this section shall be construed to prevent or limit the agency
 1247  from adjusting fees, reimbursement rates, lengths of stay,
 1248  number of visits, number of services, or any other adjustments
 1249  necessary to comply with the availability of moneys and any
 1250  limitations or directions provided for in the General
 1251  Appropriations Act or chapter 216.
 1252         (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
 1253  all covered services provided for the medical care and treatment
 1254  of a recipient who is admitted as an inpatient by a licensed
 1255  physician or dentist to a hospital licensed under part I of
 1256  chapter 395. However, the agency shall limit the payment for
 1257  inpatient hospital services for a Medicaid recipient 21 years of
 1258  age or older to 45 days or the number of days necessary to
 1259  comply with the General Appropriations Act.
 1260         (a) The agency may implement reimbursement and utilization
 1261  management reforms in order to comply with any limitations or
 1262  directions in the General Appropriations Act, which may include,
 1263  but are not limited to: prior authorization for inpatient
 1264  psychiatric days; prior authorization for nonemergency hospital
 1265  inpatient admissions for individuals 21 years of age and older;
 1266  authorization of emergency and urgent-care admissions within 24
 1267  hours after admission; enhanced utilization and concurrent
 1268  review programs for highly utilized services; reduction or
 1269  elimination of covered days of service; adjusting reimbursement
 1270  ceilings for variable costs; adjusting reimbursement ceilings
 1271  for fixed and property costs; and implementing target rates of
 1272  increase. The agency may limit prior authorization for hospital
 1273  inpatient services to selected diagnosis-related groups, based
 1274  on an analysis of the cost and potential for unnecessary
 1275  hospitalizations represented by certain diagnoses. Admissions
 1276  for normal delivery and newborns are exempt from requirements
 1277  for prior authorization. In implementing the provisions of this
 1278  section related to prior authorization, the agency shall ensure
 1279  that the process for authorization is accessible 24 hours per
 1280  day, 7 days per week and authorization is automatically granted
 1281  when not denied within 4 hours after the request. Authorization
 1282  procedures must include steps for review of denials. Upon
 1283  implementing the prior authorization program for hospital
 1284  inpatient services, the agency shall discontinue its hospital
 1285  retrospective review program.
 1286         Section 35. Subsection (8) of section 409.907, Florida
 1287  Statutes, is amended to read:
 1288         409.907 Medicaid provider agreements.—The agency may make
 1289  payments for medical assistance and related services rendered to
 1290  Medicaid recipients only to an individual or entity who has a
 1291  provider agreement in effect with the agency, who is performing
 1292  services or supplying goods in accordance with federal, state,
 1293  and local law, and who agrees that no person shall, on the
 1294  grounds of handicap, race, color, or national origin, or for any
 1295  other reason, be subjected to discrimination under any program
 1296  or activity for which the provider receives payment from the
 1297  agency.
 1298         (8)(a)A level 2 background screening pursuant to chapter
 1299  435 must be conducted through the agency on each of the
 1300  following:
 1301         1.The Each provider, or each principal of the provider if
 1302  the provider is a corporation, partnership, association, or
 1303  other entity, seeking to participate in the Medicaid program
 1304  must submit a complete set of his or her fingerprints to the
 1305  agency for the purpose of conducting a criminal history record
 1306  check.
 1307         2. Principals of the provider, who include any officer,
 1308  director, billing agent, managing employee, or affiliated
 1309  person, or any partner or shareholder who has an ownership
 1310  interest equal to 5 percent or more in the provider. However,
 1311  for a hospital licensed under chapter 395 or a nursing home
 1312  licensed under chapter 400, principals of the provider are those
 1313  who meet the definition of a controlling interest under s.
 1314  408.803. A director of a not-for-profit corporation or
 1315  organization is not a principal for purposes of a background
 1316  investigation required by this section if the director: serves
 1317  solely in a voluntary capacity for the corporation or
 1318  organization, does not regularly take part in the day-to-day
 1319  operational decisions of the corporation or organization,
 1320  receives no remuneration from the not-for-profit corporation or
 1321  organization for his or her service on the board of directors,
 1322  has no financial interest in the not-for-profit corporation or
 1323  organization, and has no family members with a financial
 1324  interest in the not-for-profit corporation or organization; and
 1325  if the director submits an affidavit, under penalty of perjury,
 1326  to this effect to the agency and the not-for-profit corporation
 1327  or organization submits an affidavit, under penalty of perjury,
 1328  to this effect to the agency as part of the corporation’s or
 1329  organization’s Medicaid provider agreement application.
 1330         3.Any person who participates or seeks to participate in
 1331  the Florida Medicaid program by way of rendering services to
 1332  Medicaid recipients or having direct access to Medicaid
 1333  recipients, recipient living areas, or the financial, medical,
 1334  or service records of a Medicaid recipient or who supervises the
 1335  delivery of goods or services to a Medicaid recipient. This
 1336  subparagraph does not impose additional screening requirements
 1337  on any providers licensed under part II of chapter 408.
 1338         (b) Notwithstanding paragraph (a) the above, the agency may
 1339  require a background check for any person reasonably suspected
 1340  by the agency to have been convicted of a crime.
 1341         (c)(a)Paragraph (a) This subsection does not apply to:
 1342         1. A unit of local government, except that requirements of
 1343  this subsection apply to nongovernmental providers and entities
 1344  contracting with the local government to provide Medicaid
 1345  services. The actual cost of the state and national criminal
 1346  history record checks must be borne by the nongovernmental
 1347  provider or entity; or
 1348         2. Any business that derives more than 50 percent of its
 1349  revenue from the sale of goods to the final consumer, and the
 1350  business or its controlling parent is required to file a form
 1351  10-K or other similar statement with the Securities and Exchange
 1352  Commission or has a net worth of $50 million or more.
 1353         (d)(b) Background screening shall be conducted in
 1354  accordance with chapter 435 and s. 408.809. The cost of the
 1355  state and national criminal record check shall be borne by the
 1356  provider.
 1357         Section 36. Section 409.913, Florida Statutes, is amended
 1358  to read:
 1359         409.913 Oversight of the integrity of the Medicaid
 1360  program.—The agency shall operate a program to oversee the
 1361  activities of Florida Medicaid recipients, and providers and
 1362  their representatives, to ensure that fraudulent and abusive
 1363  behavior and neglect of recipients occur to the minimum extent
 1364  possible, and to recover overpayments and impose sanctions as
 1365  appropriate. Each January 15 January 1, the agency and the
 1366  Medicaid Fraud Control Unit of the Department of Legal Affairs
 1367  shall submit reports a joint report to the Legislature
 1368  documenting the effectiveness of the state’s efforts to control
 1369  Medicaid fraud and abuse and to recover Medicaid overpayments
 1370  during the previous fiscal year. The report must describe the
 1371  number of cases opened and investigated each year; the sources
 1372  of the cases opened; the disposition of the cases closed each
 1373  year; the amount of overpayments alleged in preliminary and
 1374  final audit letters; the number and amount of fines or penalties
 1375  imposed; any reductions in overpayment amounts negotiated in
 1376  settlement agreements or by other means; the amount of final
 1377  agency determinations of overpayments; the amount deducted from
 1378  federal claiming as a result of overpayments; the amount of
 1379  overpayments recovered each year; the amount of cost of
 1380  investigation recovered each year; the average length of time to
 1381  collect from the time the case was opened until the overpayment
 1382  is paid in full; the amount determined as uncollectible and the
 1383  portion of the uncollectible amount subsequently reclaimed from
 1384  the Federal Government; the number of providers, by type, that
 1385  are terminated from participation in the Medicaid program as a
 1386  result of fraud and abuse; and all costs associated with
 1387  discovering and prosecuting cases of Medicaid overpayments and
 1388  making recoveries in such cases. The report must also document
 1389  actions taken to prevent overpayments and the number of
 1390  providers prevented from enrolling in or reenrolling in the
 1391  Medicaid program as a result of documented Medicaid fraud and
 1392  abuse and must include policy recommendations necessary to
 1393  prevent or recover overpayments and changes necessary to prevent
 1394  and detect Medicaid fraud. All policy recommendations in the
 1395  report must include a detailed fiscal analysis, including, but
 1396  not limited to, implementation costs, estimated savings to the
 1397  Medicaid program, and the return on investment. The agency must
 1398  submit the policy recommendations and fiscal analyses in the
 1399  report to the appropriate estimating conference, pursuant to s.
 1400  216.137, by February 15 of each year. The agency and the
 1401  Medicaid Fraud Control Unit of the Department of Legal Affairs
 1402  each must include detailed unit-specific performance standards,
 1403  benchmarks, and metrics in the report, including projected cost
 1404  savings to the state Medicaid program during the following
 1405  fiscal year.
 1406         (1) For the purposes of this section, the term:
 1407         (a) “Abuse” means:
 1408         1. Provider practices that are inconsistent with generally
 1409  accepted business or medical practices and that result in an
 1410  unnecessary cost to the Medicaid program or in reimbursement for
 1411  goods or services that are not medically necessary or that fail
 1412  to meet professionally recognized standards for health care.
 1413         2. Recipient practices that result in unnecessary cost to
 1414  the Medicaid program.
 1415         (b) “Complaint” means an allegation that fraud, abuse, or
 1416  an overpayment has occurred.
 1417         (c) “Fraud” means an intentional deception or
 1418  misrepresentation made by a person with the knowledge that the
 1419  deception results in unauthorized benefit to herself or himself
 1420  or another person. The term includes any act that constitutes
 1421  fraud under applicable federal or state law.
 1422         (d) “Medical necessity” or “medically necessary” means any
 1423  goods or services necessary to palliate the effects of a
 1424  terminal condition, or to prevent, diagnose, correct, cure,
 1425  alleviate, or preclude deterioration of a condition that
 1426  threatens life, causes pain or suffering, or results in illness
 1427  or infirmity, which goods or services are provided in accordance
 1428  with generally accepted standards of medical practice. For
 1429  purposes of determining Medicaid reimbursement, the agency is
 1430  the final arbiter of medical necessity. Determinations of
 1431  medical necessity must be made by a licensed physician employed
 1432  by or under contract with the agency and must be based upon
 1433  information available at the time the goods or services are
 1434  provided.
 1435         (e) “Overpayment” includes any amount that is not
 1436  authorized to be paid by the Medicaid program whether paid as a
 1437  result of inaccurate or improper cost reporting, improper
 1438  claiming, unacceptable practices, fraud, abuse, or mistake.
 1439         (f) “Person” means any natural person, corporation,
 1440  partnership, association, clinic, group, or other entity,
 1441  whether or not such person is enrolled in the Medicaid program
 1442  or is a provider of health care.
 1443         (2) The agency shall conduct, or cause to be conducted by
 1444  contract or otherwise, reviews, investigations, analyses,
 1445  audits, or any combination thereof, to determine possible fraud,
 1446  abuse, overpayment, or recipient neglect in the Medicaid program
 1447  and shall report the findings of any overpayments in audit
 1448  reports as appropriate. At least 5 percent of all audits shall
 1449  be conducted on a random basis. As part of its ongoing fraud
 1450  detection activities, the agency shall identify and monitor, by
 1451  contract or otherwise, patterns of overutilization of Medicaid
 1452  services based on state averages. The agency shall track
 1453  Medicaid provider prescription and billing patterns and evaluate
 1454  them against Medicaid medical necessity criteria and coverage
 1455  and limitation guidelines adopted by rule. Medical necessity
 1456  determination requires that service be consistent with symptoms
 1457  or confirmed diagnosis of illness or injury under treatment and
 1458  not in excess of the patient’s needs. The agency shall conduct
 1459  reviews of provider exceptions to peer group norms and shall,
 1460  using statistical methodologies, provider profiling, and
 1461  analysis of billing patterns, detect and investigate abnormal or
 1462  unusual increases in billing or payment of claims for Medicaid
 1463  services and medically unnecessary provision of services.
 1464         (3) The agency may conduct, or may contract for, prepayment
 1465  review of provider claims to ensure cost-effective purchasing;
 1466  to ensure that billing by a provider to the agency is in
 1467  accordance with applicable provisions of all Medicaid rules,
 1468  regulations, handbooks, and policies and in accordance with
 1469  federal, state, and local law; and to ensure that appropriate
 1470  care is rendered to Medicaid recipients. Such prepayment reviews
 1471  may be conducted as determined appropriate by the agency,
 1472  without any suspicion or allegation of fraud, abuse, or neglect,
 1473  and may last for up to 1 year. Unless the agency has reliable
 1474  evidence of fraud, misrepresentation, abuse, or neglect, claims
 1475  shall be adjudicated for denial or payment within 90 days after
 1476  receipt of complete documentation by the agency for review. If
 1477  there is reliable evidence of fraud, misrepresentation, abuse,
 1478  or neglect, claims shall be adjudicated for denial of payment
 1479  within 180 days after receipt of complete documentation by the
 1480  agency for review.
 1481         (4) Any suspected criminal violation identified by the
 1482  agency must be referred to the Medicaid Fraud Control Unit of
 1483  the Office of the Attorney General for investigation. The agency
 1484  and the Attorney General shall enter into a memorandum of
 1485  understanding, which must include, but need not be limited to, a
 1486  protocol for regularly sharing information and coordinating
 1487  casework. The protocol must establish a procedure for the
 1488  referral by the agency of cases involving suspected Medicaid
 1489  fraud to the Medicaid Fraud Control Unit for investigation, and
 1490  the return to the agency of those cases where investigation
 1491  determines that administrative action by the agency is
 1492  appropriate. Offices of the Medicaid program integrity program
 1493  and the Medicaid Fraud Control Unit of the Department of Legal
 1494  Affairs, shall, to the extent possible, be collocated. The
 1495  agency and the Department of Legal Affairs shall periodically
 1496  conduct joint training and other joint activities designed to
 1497  increase communication and coordination in recovering
 1498  overpayments.
 1499         (5) A Medicaid provider is subject to having goods and
 1500  services that are paid for by the Medicaid program reviewed by
 1501  an appropriate peer-review organization designated by the
 1502  agency. The written findings of the applicable peer-review
 1503  organization are admissible in any court or administrative
 1504  proceeding as evidence of medical necessity or the lack thereof.
 1505         (6) Any notice required to be given to a provider under
 1506  this section is presumed to be sufficient notice if sent to the
 1507  address last shown on the provider enrollment file. It is the
 1508  responsibility of the provider to furnish and keep the agency
 1509  informed of the provider’s current address. United States Postal
 1510  Service proof of mailing or certified or registered mailing of
 1511  such notice to the provider at the address shown on the provider
 1512  enrollment file constitutes sufficient proof of notice. Any
 1513  notice required to be given to the agency by this section must
 1514  be sent to the agency at an address designated by rule.
 1515         (7) When presenting a claim for payment under the Medicaid
 1516  program, a provider has an affirmative duty to supervise the
 1517  provision of, and be responsible for, goods and services claimed
 1518  to have been provided, to supervise and be responsible for
 1519  preparation and submission of the claim, and to present a claim
 1520  that is true and accurate and that is for goods and services
 1521  that:
 1522         (a) Have actually been furnished to the recipient by the
 1523  provider prior to submitting the claim.
 1524         (b) Are Medicaid-covered goods or services that are
 1525  medically necessary.
 1526         (c) Are of a quality comparable to those furnished to the
 1527  general public by the provider’s peers.
 1528         (d) Have not been billed in whole or in part to a recipient
 1529  or a recipient’s responsible party, except for such copayments,
 1530  coinsurance, or deductibles as are authorized by the agency.
 1531         (e) Are provided in accord with applicable provisions of
 1532  all Medicaid rules, regulations, handbooks, and policies and in
 1533  accordance with federal, state, and local law.
 1534         (f) Are documented by records made at the time the goods or
 1535  services were provided, demonstrating the medical necessity for
 1536  the goods or services rendered. Medicaid goods or services are
 1537  excessive or not medically necessary unless both the medical
 1538  basis and the specific need for them are fully and properly
 1539  documented in the recipient’s medical record.
 1540  
 1541  The agency shall deny payment or require repayment for goods or
 1542  services that are not presented as required in this subsection.
 1543         (8) The agency shall not reimburse any person or entity for
 1544  any prescription for medications, medical supplies, or medical
 1545  services if the prescription was written by a physician or other
 1546  prescribing practitioner who is not enrolled in the Medicaid
 1547  program. This section does not apply:
 1548         (a) In instances involving bona fide emergency medical
 1549  conditions as determined by the agency;
 1550         (b) To a provider of medical services to a patient in a
 1551  hospital emergency department, hospital inpatient or outpatient
 1552  setting, or nursing home;
 1553         (c) To bona fide pro bono services by preapproved non
 1554  Medicaid providers as determined by the agency;
 1555         (d) To prescribing physicians who are board-certified
 1556  specialists treating Medicaid recipients referred for treatment
 1557  by a treating physician who is enrolled in the Medicaid program;
 1558         (e) To prescriptions written for dually eligible Medicare
 1559  beneficiaries by an authorized Medicare provider who is not
 1560  enrolled in the Medicaid program;
 1561         (f) To other physicians who are not enrolled in the
 1562  Medicaid program but who provide a medically necessary service
 1563  or prescription not otherwise reasonably available from a
 1564  Medicaid-enrolled physician; or
 1565         (9) A Medicaid provider shall retain medical, professional,
 1566  financial, and business records pertaining to services and goods
 1567  furnished to a Medicaid recipient and billed to Medicaid for a
 1568  period of 5 years after the date of furnishing such services or
 1569  goods. The agency may investigate, review, or analyze such
 1570  records, which must be made available during normal business
 1571  hours. However, 24-hour notice must be provided if patient
 1572  treatment would be disrupted. The provider must keep the agency
 1573  informed of the location of the provider’s Medicaid-related
 1574  records. The authority of the agency to obtain Medicaid-related
 1575  records from a provider is neither curtailed nor limited during
 1576  a period of litigation between the agency and the provider.
 1577         (10) Payments for the services of billing agents or persons
 1578  participating in the preparation of a Medicaid claim shall not
 1579  be based on amounts for which they bill nor based on the amount
 1580  a provider receives from the Medicaid program.
 1581         (11) The agency shall deny payment or require repayment for
 1582  inappropriate, medically unnecessary, or excessive goods or
 1583  services from the person furnishing them, the person under whose
 1584  supervision they were furnished, or the person causing them to
 1585  be furnished.
 1586         (12) The complaint and all information obtained pursuant to
 1587  an investigation of a Medicaid provider, or the authorized
 1588  representative or agent of a provider, relating to an allegation
 1589  of fraud, abuse, or neglect are confidential and exempt from the
 1590  provisions of s. 119.07(1):
 1591         (a) Until the agency takes final agency action with respect
 1592  to the provider and requires repayment of any overpayment, or
 1593  imposes an administrative sanction;
 1594         (b) Until the Attorney General refers the case for criminal
 1595  prosecution;
 1596         (c) Until 10 days after the complaint is determined without
 1597  merit; or
 1598         (d) At all times if the complaint or information is
 1599  otherwise protected by law.
 1600         (13) The agency shall terminate participation of a Medicaid
 1601  provider in the Medicaid program and may seek civil remedies or
 1602  impose other administrative sanctions against a Medicaid
 1603  provider, if the provider or any principal, officer, director,
 1604  agent, managing employee, or affiliated person of the provider,
 1605  or any partner or shareholder having an ownership interest in
 1606  the provider equal to 5 percent or greater, has been convicted
 1607  of a criminal offense under federal law or the law of any state
 1608  relating to the practice of the provider’s profession, or a
 1609  criminal offense listed under s. 408.809(4), s. 409.907(10), or
 1610  s. 435.04(2). If the agency determines that the provider did not
 1611  participate or acquiesce in the offense, termination will not be
 1612  imposed. If the agency effects a termination under this
 1613  subsection, the agency shall take final agency action.
 1614         (14) If the provider has been suspended or terminated from
 1615  participation in the Medicaid program or the Medicare program by
 1616  the Federal Government or any state, the agency must immediately
 1617  suspend or terminate, as appropriate, the provider’s
 1618  participation in this state’s Medicaid program for a period no
 1619  less than that imposed by the Federal Government or any other
 1620  state, and may not enroll such provider in this state’s Medicaid
 1621  program while such foreign suspension or termination remains in
 1622  effect. The agency shall also immediately suspend or terminate,
 1623  as appropriate, a provider’s participation in this state’s
 1624  Medicaid program if the provider participated or acquiesced in
 1625  any action for which any principal, officer, director, agent,
 1626  managing employee, or affiliated person of the provider, or any
 1627  partner or shareholder having an ownership interest in the
 1628  provider equal to 5 percent or greater, was suspended or
 1629  terminated from participating in the Medicaid program or the
 1630  Medicare program by the Federal Government or any state. This
 1631  sanction is in addition to all other remedies provided by law.
 1632         (15) The agency shall seek a remedy provided by law,
 1633  including, but not limited to, any remedy provided in
 1634  subsections (13) and (16) and s. 812.035, if:
 1635         (a) The provider’s license has not been renewed, or has
 1636  been revoked, suspended, or terminated, for cause, by the
 1637  licensing agency of any state;
 1638         (b) The provider has failed to make available or has
 1639  refused access to Medicaid-related records to an auditor,
 1640  investigator, or other authorized employee or agent of the
 1641  agency, the Attorney General, a state attorney, or the Federal
 1642  Government;
 1643         (c) The provider has not furnished or has failed to make
 1644  available such Medicaid-related records as the agency has found
 1645  necessary to determine whether Medicaid payments are or were due
 1646  and the amounts thereof;
 1647         (d) The provider has failed to maintain medical records
 1648  made at the time of service, or prior to service if prior
 1649  authorization is required, demonstrating the necessity and
 1650  appropriateness of the goods or services rendered;
 1651         (e) The provider is not in compliance with provisions of
 1652  Medicaid provider publications that have been adopted by
 1653  reference as rules in the Florida Administrative Code; with
 1654  provisions of state or federal laws, rules, or regulations; with
 1655  provisions of the provider agreement between the agency and the
 1656  provider; or with certifications found on claim forms or on
 1657  transmittal forms for electronically submitted claims that are
 1658  submitted by the provider or authorized representative, as such
 1659  provisions apply to the Medicaid program;
 1660         (f) The provider or person who ordered, authorized, or
 1661  prescribed the care, services, or supplies has furnished, or
 1662  ordered or authorized the furnishing of, goods or services to a
 1663  recipient which are inappropriate, unnecessary, excessive, or
 1664  harmful to the recipient or are of inferior quality;
 1665         (g) The provider has demonstrated a pattern of failure to
 1666  provide goods or services that are medically necessary;
 1667         (h) The provider or an authorized representative of the
 1668  provider, or a person who ordered, authorized, or prescribed the
 1669  goods or services, has submitted or caused to be submitted false
 1670  or a pattern of erroneous Medicaid claims;
 1671         (i) The provider or an authorized representative of the
 1672  provider, or a person who has ordered, authorized, or prescribed
 1673  the goods or services, has submitted or caused to be submitted a
 1674  Medicaid provider enrollment application, a request for prior
 1675  authorization for Medicaid services, a drug exception request,
 1676  or a Medicaid cost report that contains materially false or
 1677  incorrect information;
 1678         (j) The provider or an authorized representative of the
 1679  provider has collected from or billed a recipient or a
 1680  recipient’s responsible party improperly for amounts that should
 1681  not have been so collected or billed by reason of the provider’s
 1682  billing the Medicaid program for the same service;
 1683         (k) The provider or an authorized representative of the
 1684  provider has included in a cost report costs that are not
 1685  allowable under a Florida Title XIX reimbursement plan after the
 1686  provider or authorized representative had been advised in an
 1687  audit exit conference or audit report that the costs were not
 1688  allowable;
 1689         (l) The provider is charged by information or indictment
 1690  with fraudulent billing practices or an offense referenced in
 1691  subsection (13). The sanction applied for this reason is limited
 1692  to suspension of the provider’s participation in the Medicaid
 1693  program for the duration of the indictment unless the provider
 1694  is found guilty pursuant to the information or indictment;
 1695         (m) The provider or a person who ordered, authorized, or
 1696  prescribed the goods or services is found liable for negligent
 1697  practice resulting in death or injury to the provider’s patient;
 1698         (n) The provider fails to demonstrate that it had available
 1699  during a specific audit or review period sufficient quantities
 1700  of goods, or sufficient time in the case of services, to support
 1701  the provider’s billings to the Medicaid program;
 1702         (o) The provider has failed to comply with the notice and
 1703  reporting requirements of s. 409.907;
 1704         (p) The agency has received reliable information of patient
 1705  abuse or neglect or of any act prohibited by s. 409.920; or
 1706         (q) The provider has failed to comply with an agreed-upon
 1707  repayment schedule.
 1708  
 1709  A provider is subject to sanctions for violations of this
 1710  subsection as the result of actions or inactions of the
 1711  provider, or actions or inactions of any principal, officer,
 1712  director, agent, managing employee, or affiliated person of the
 1713  provider, or any partner or shareholder having an ownership
 1714  interest in the provider equal to 5 percent or greater, in which
 1715  the provider participated or acquiesced.
 1716         (16) The agency shall impose any of the following sanctions
 1717  or disincentives on a provider or a person for any of the acts
 1718  described in subsection (15):
 1719         (a) Suspension for a specific period of time of not more
 1720  than 1 year. Suspension precludes participation in the Medicaid
 1721  program, which includes any action that results in a claim for
 1722  payment to the Medicaid program for furnishing, supervising a
 1723  person who is furnishing, or causing a person to furnish goods
 1724  or services.
 1725         (b) Termination for a specific period of time ranging from
 1726  more than 1 year to 20 years. Termination precludes
 1727  participation in the Medicaid program, which includes any action
 1728  that results in a claim for payment to the Medicaid program for
 1729  furnishing, supervising a person who is furnishing, or causing a
 1730  person to furnish goods or services.
 1731         (c) Imposition of a fine of up to $5,000 for each
 1732  violation. Each day that an ongoing violation continues, such as
 1733  refusing to furnish Medicaid-related records or refusing access
 1734  to records, is considered a separate violation. Each instance of
 1735  improper billing of a Medicaid recipient; each instance of
 1736  including an unallowable cost on a hospital or nursing home
 1737  Medicaid cost report after the provider or authorized
 1738  representative has been advised in an audit exit conference or
 1739  previous audit report of the cost unallowability; each instance
 1740  of furnishing a Medicaid recipient goods or professional
 1741  services that are inappropriate or of inferior quality as
 1742  determined by competent peer judgment; each instance of
 1743  knowingly submitting a materially false or erroneous Medicaid
 1744  provider enrollment application, request for prior authorization
 1745  for Medicaid services, drug exception request, or cost report;
 1746  each instance of inappropriate prescribing of drugs for a
 1747  Medicaid recipient as determined by competent peer judgment; and
 1748  each false or erroneous Medicaid claim leading to an overpayment
 1749  to a provider is considered a separate violation.
 1750         (d) Immediate suspension, if the agency has received
 1751  information of patient abuse or neglect or of any act prohibited
 1752  by s. 409.920. Upon suspension, the agency must issue an
 1753  immediate final order under s. 120.569(2)(n).
 1754         (e) A fine, not to exceed $10,000, for a violation of
 1755  paragraph (15)(i).
 1756         (f) Imposition of liens against provider assets, including,
 1757  but not limited to, financial assets and real property, not to
 1758  exceed the amount of fines or recoveries sought, upon entry of
 1759  an order determining that such moneys are due or recoverable.
 1760         (g) Prepayment reviews of claims for a specified period of
 1761  time.
 1762         (h) Comprehensive followup reviews of providers every 6
 1763  months to ensure that they are billing Medicaid correctly.
 1764         (i) Corrective-action plans that remain in effect for up to
 1765  3 years and that are monitored by the agency every 6 months
 1766  while in effect.
 1767         (j) Other remedies as permitted by law to effect the
 1768  recovery of a fine or overpayment.
 1769  
 1770  If a provider voluntarily relinquishes its Medicaid provider
 1771  number or an associated license, or allows the associated
 1772  licensure to expire after receiving written notice that the
 1773  agency is conducting, or has conducted, an audit, survey,
 1774  inspection, or investigation and that a sanction of suspension
 1775  or termination will or would be imposed for noncompliance
 1776  discovered as a result of the audit, survey, inspection, or
 1777  investigation, the agency shall impose the sanction of
 1778  termination for cause against the provider. The agency’s
 1779  termination with cause is subject to hearing rights as may be
 1780  provided under chapter 120. The Secretary of Health Care
 1781  Administration may make a determination that imposition of a
 1782  sanction or disincentive is not in the best interest of the
 1783  Medicaid program, in which case a sanction or disincentive may
 1784  not be imposed.
 1785         (17) In determining the appropriate administrative sanction
 1786  to be applied, or the duration of any suspension or termination,
 1787  the agency shall consider:
 1788         (a) The seriousness and extent of the violation or
 1789  violations.
 1790         (b) Any prior history of violations by the provider
 1791  relating to the delivery of health care programs which resulted
 1792  in either a criminal conviction or in administrative sanction or
 1793  penalty.
 1794         (c) Evidence of continued violation within the provider’s
 1795  management control of Medicaid statutes, rules, regulations, or
 1796  policies after written notification to the provider of improper
 1797  practice or instance of violation.
 1798         (d) The effect, if any, on the quality of medical care
 1799  provided to Medicaid recipients as a result of the acts of the
 1800  provider.
 1801         (e) Any action by a licensing agency respecting the
 1802  provider in any state in which the provider operates or has
 1803  operated.
 1804         (f) The apparent impact on access by recipients to Medicaid
 1805  services if the provider is suspended or terminated, in the best
 1806  judgment of the agency.
 1807  
 1808  The agency shall document the basis for all sanctioning actions
 1809  and recommendations.
 1810         (18) The agency may take action to sanction, suspend, or
 1811  terminate a particular provider working for a group provider,
 1812  and may suspend or terminate Medicaid participation at a
 1813  specific location, rather than or in addition to taking action
 1814  against an entire group.
 1815         (19) The agency shall establish a process for conducting
 1816  followup reviews of a sampling of providers who have a history
 1817  of overpayment under the Medicaid program. This process must
 1818  consider the magnitude of previous fraud or abuse and the
 1819  potential effect of continued fraud or abuse on Medicaid costs.
 1820         (20) In making a determination of overpayment to a
 1821  provider, the agency must use accepted and valid auditing,
 1822  accounting, analytical, statistical, or peer-review methods, or
 1823  combinations thereof. Appropriate statistical methods may
 1824  include, but are not limited to, sampling and extension to the
 1825  population, parametric and nonparametric statistics, tests of
 1826  hypotheses, and other generally accepted statistical methods.
 1827  Appropriate analytical methods may include, but are not limited
 1828  to, reviews to determine variances between the quantities of
 1829  products that a provider had on hand and available to be
 1830  purveyed to Medicaid recipients during the review period and the
 1831  quantities of the same products paid for by the Medicaid program
 1832  for the same period, taking into appropriate consideration sales
 1833  of the same products to non-Medicaid customers during the same
 1834  period. In meeting its burden of proof in any administrative or
 1835  court proceeding, the agency may introduce the results of such
 1836  statistical methods as evidence of overpayment.
 1837         (21) When making a determination that an overpayment has
 1838  occurred, the agency shall prepare and issue an audit report to
 1839  the provider showing the calculation of overpayments. The
 1840  agency’s determination must be based solely upon information
 1841  available to it before issuance of the audit report and, in the
 1842  case of documentation obtained to substantiate claims for
 1843  Medicaid reimbursement, based solely upon contemporaneous
 1844  records. The agency may consider addenda or modifications to a
 1845  note that was made contemporaneously with the patient care
 1846  episode if the addenda or modifications are germane to the note.
 1847         (22) The audit report, supported by agency work papers,
 1848  showing an overpayment to a provider constitutes evidence of the
 1849  overpayment. A provider may not present or elicit testimony on
 1850  direct examination or cross-examination in any court or
 1851  administrative proceeding, regarding the purchase or acquisition
 1852  by any means of drugs, goods, or supplies; sales or divestment
 1853  by any means of drugs, goods, or supplies; or inventory of
 1854  drugs, goods, or supplies, unless such acquisition, sales,
 1855  divestment, or inventory is documented by written invoices,
 1856  written inventory records, or other competent written
 1857  documentary evidence maintained in the normal course of the
 1858  provider’s business. A provider may not present records to
 1859  contest an overpayment or sanction unless such records are
 1860  contemporaneous and, if requested during the audit process, were
 1861  furnished to the agency or its agent upon request. This
 1862  limitation does not apply to Medicaid cost report audits. This
 1863  limitation does not preclude consideration by the agency of
 1864  addenda or modifications to a note if the addenda or
 1865  modifications are made before notification of the audit, the
 1866  addenda or modifications are germane to the note, and the note
 1867  was made contemporaneously with a patient care episode.
 1868  Notwithstanding the applicable rules of discovery, all
 1869  documentation to be offered as evidence at an administrative
 1870  hearing on a Medicaid overpayment or an administrative sanction
 1871  must be exchanged by all parties at least 14 days before the
 1872  administrative hearing or be excluded from consideration.
 1873         (23)(a) In an audit, or investigation, or enforcement
 1874  action taken for of a violation committed by a provider which is
 1875  conducted pursuant to this section, the agency is entitled to
 1876  recover all investigative and, legal costs incurred as a result
 1877  of such audit, investigation, or enforcement action. The costs
 1878  associated with an investigation, audit, or enforcement action
 1879  may include, but are not limited to, salaries and benefits of
 1880  personnel, costs related to the time spent by an attorney and
 1881  other personnel working on the case, and any other expenses
 1882  incurred by the agency or contractor which are associated with
 1883  the case, including any, and expert witness costs and attorney
 1884  fees incurred on behalf of the agency or contractor if the
 1885  agency’s findings were not contested by the provider or, if
 1886  contested, the agency ultimately prevailed.
 1887         (b) The agency has the burden of documenting the costs,
 1888  which include salaries and employee benefits and out-of-pocket
 1889  expenses. The amount of costs that may be recovered must be
 1890  reasonable in relation to the seriousness of the violation and
 1891  must be set taking into consideration the financial resources,
 1892  earning ability, and needs of the provider, who has the burden
 1893  of demonstrating such factors.
 1894         (c) The provider may pay the costs over a period to be
 1895  determined by the agency if the agency determines that an
 1896  extreme hardship would result to the provider from immediate
 1897  full payment. Any default in payment of costs may be collected
 1898  by any means authorized by law.
 1899         (24) If the agency imposes an administrative sanction
 1900  pursuant to subsection (13), subsection (14), or subsection
 1901  (15), except paragraphs (15)(e) and (o), upon any provider or
 1902  any principal, officer, director, agent, managing employee, or
 1903  affiliated person of the provider who is regulated by another
 1904  state entity, the agency shall notify that other entity of the
 1905  imposition of the sanction within 5 business days. Such
 1906  notification must include the provider’s or person’s name and
 1907  license number and the specific reasons for sanction.
 1908         (25)(a) The agency shall withhold Medicaid payments, in
 1909  whole or in part, to a provider upon receipt of reliable
 1910  evidence that the circumstances giving rise to the need for a
 1911  withholding of payments involve fraud, willful
 1912  misrepresentation, or abuse under the Medicaid program, or a
 1913  crime committed while rendering goods or services to Medicaid
 1914  recipients. If it is determined that fraud, willful
 1915  misrepresentation, abuse, or a crime did not occur, the payments
 1916  withheld must be paid to the provider within 14 days after such
 1917  determination. Amounts not paid within 14 days accrue interest
 1918  at the rate of 10 percent per year, beginning after the 14th
 1919  day.
 1920         (b) The agency shall deny payment, or require repayment, if
 1921  the goods or services were furnished, supervised, or caused to
 1922  be furnished by a person who has been suspended or terminated
 1923  from the Medicaid program or Medicare program by the Federal
 1924  Government or any state.
 1925         (c) Overpayments owed to the agency bear interest at the
 1926  rate of 10 percent per year from the date of final determination
 1927  of the overpayment by the agency, and payment arrangements must
 1928  be made within 30 days after the date of the final order, which
 1929  is not subject to further appeal.
 1930         (d) The agency, upon entry of a final agency order, a
 1931  judgment or order of a court of competent jurisdiction, or a
 1932  stipulation or settlement, may collect the moneys owed by all
 1933  means allowable by law, including, but not limited to, notifying
 1934  any fiscal intermediary of Medicare benefits that the state has
 1935  a superior right of payment. Upon receipt of such written
 1936  notification, the Medicare fiscal intermediary shall remit to
 1937  the state the sum claimed.
 1938         (e) The agency may institute amnesty programs to allow
 1939  Medicaid providers the opportunity to voluntarily repay
 1940  overpayments. The agency may adopt rules to administer such
 1941  programs.
 1942         (26) The agency may impose administrative sanctions against
 1943  a Medicaid recipient, or the agency may seek any other remedy
 1944  provided by law, including, but not limited to, the remedies
 1945  provided in s. 812.035, if the agency finds that a recipient has
 1946  engaged in solicitation in violation of s. 409.920 or that the
 1947  recipient has otherwise abused the Medicaid program.
 1948         (27) When the Agency for Health Care Administration has
 1949  made a probable cause determination and alleged that an
 1950  overpayment to a Medicaid provider has occurred, the agency,
 1951  after notice to the provider, shall:
 1952         (a) Withhold, and continue to withhold during the pendency
 1953  of an administrative hearing pursuant to chapter 120, any
 1954  medical assistance reimbursement payments until such time as the
 1955  overpayment is recovered, unless within 30 days after receiving
 1956  notice thereof the provider:
 1957         1. Makes repayment in full; or
 1958         2. Establishes a repayment plan that is satisfactory to the
 1959  Agency for Health Care Administration.
 1960         (b) Withhold, and continue to withhold during the pendency
 1961  of an administrative hearing pursuant to chapter 120, medical
 1962  assistance reimbursement payments if the terms of a repayment
 1963  plan are not adhered to by the provider.
 1964         (28) Venue for all Medicaid program integrity cases lies in
 1965  Leon County, at the discretion of the agency.
 1966         (29) Notwithstanding other provisions of law, the agency
 1967  and the Medicaid Fraud Control Unit of the Department of Legal
 1968  Affairs may review a provider’s Medicaid-related and non
 1969  Medicaid-related records in order to determine the total output
 1970  of a provider’s practice to reconcile quantities of goods or
 1971  services billed to Medicaid with quantities of goods or services
 1972  used in the provider’s total practice.
 1973         (30) The agency shall terminate a provider’s participation
 1974  in the Medicaid program if the provider fails to reimburse an
 1975  overpayment or pay an agency-imposed fine that has been
 1976  determined by final order, not subject to further appeal, within
 1977  30 days after the date of the final order, unless the provider
 1978  and the agency have entered into a repayment agreement.
 1979         (31) If a provider requests an administrative hearing
 1980  pursuant to chapter 120, such hearing must be conducted within
 1981  90 days following assignment of an administrative law judge,
 1982  absent exceptionally good cause shown as determined by the
 1983  administrative law judge or hearing officer. Upon issuance of a
 1984  final order, the outstanding balance of the amount determined to
 1985  constitute the overpayment and fines is due. If a provider fails
 1986  to make payments in full, fails to enter into a satisfactory
 1987  repayment plan, or fails to comply with the terms of a repayment
 1988  plan or settlement agreement, the agency shall withhold
 1989  reimbursement payments for Medicaid services until the amount
 1990  due is paid in full.
 1991         (32) Duly authorized agents and employees of the agency
 1992  shall have the power to inspect, during normal business hours,
 1993  the records of any pharmacy, wholesale establishment, or
 1994  manufacturer, or any other place in which drugs and medical
 1995  supplies are manufactured, packed, packaged, made, stored, sold,
 1996  or kept for sale, for the purpose of verifying the amount of
 1997  drugs and medical supplies ordered, delivered, or purchased by a
 1998  provider. The agency shall provide at least 2 business days’
 1999  prior notice of any such inspection. The notice must identify
 2000  the provider whose records will be inspected, and the inspection
 2001  shall include only records specifically related to that
 2002  provider.
 2003         (33) In accordance with federal law, Medicaid recipients
 2004  convicted of a crime pursuant to 42 U.S.C. s. 1320a-7b may be
 2005  limited, restricted, or suspended from Medicaid eligibility for
 2006  a period not to exceed 1 year, as determined by the agency head
 2007  or designee.
 2008         (34) To deter fraud and abuse in the Medicaid program, the
 2009  agency may limit the number of Schedule II and Schedule III
 2010  refill prescription claims submitted from a pharmacy provider.
 2011  The agency shall limit the allowable amount of reimbursement of
 2012  prescription refill claims for Schedule II and Schedule III
 2013  pharmaceuticals if the agency or the Medicaid Fraud Control Unit
 2014  determines that the specific prescription refill was not
 2015  requested by the Medicaid recipient or authorized representative
 2016  for whom the refill claim is submitted or was not prescribed by
 2017  the recipient’s medical provider or physician. Any such refill
 2018  request must be consistent with the original prescription.
 2019         (35) The Office of Program Policy Analysis and Government
 2020  Accountability shall provide a report to the President of the
 2021  Senate and the Speaker of the House of Representatives on a
 2022  biennial basis, beginning January 31, 2006, on the agency’s
 2023  efforts to prevent, detect, and deter, as well as recover funds
 2024  lost to, fraud and abuse in the Medicaid program.
 2025         (36) The agency may provide to a sample of Medicaid
 2026  recipients or their representatives through the distribution of
 2027  explanations of benefits information about services reimbursed
 2028  by the Medicaid program for goods and services to such
 2029  recipients, including information on how to report inappropriate
 2030  or incorrect billing to the agency or other law enforcement
 2031  entities for review or investigation, information on how to
 2032  report criminal Medicaid fraud to the Medicaid Fraud Control
 2033  Unit’s toll-free hotline number, and information about the
 2034  rewards available under s. 409.9203. The explanation of benefits
 2035  may not be mailed for Medicaid independent laboratory services
 2036  as described in s. 409.905(7) or for Medicaid certified match
 2037  services as described in ss. 409.9071 and 1011.70.
 2038         (37) The agency shall post on its website a current list of
 2039  each Medicaid provider, including any principal, officer,
 2040  director, agent, managing employee, or affiliated person of the
 2041  provider, or any partner or shareholder having an ownership
 2042  interest in the provider equal to 5 percent or greater, who has
 2043  been terminated for cause from the Medicaid program or
 2044  sanctioned under this section. The list must be searchable by a
 2045  variety of search parameters and provide for the creation of
 2046  formatted lists that may be printed or imported into other
 2047  applications, including spreadsheets. The agency shall update
 2048  the list at least monthly.
 2049         (38) In order to improve the detection of health care
 2050  fraud, use technology to prevent and detect fraud, and maximize
 2051  the electronic exchange of health care fraud information, the
 2052  agency shall:
 2053         (a) Compile, maintain, and publish on its website a
 2054  detailed list of all state and federal databases that contain
 2055  health care fraud information and update the list at least
 2056  biannually;
 2057         (b) Develop a strategic plan to connect all databases that
 2058  contain health care fraud information to facilitate the
 2059  electronic exchange of health information between the agency,
 2060  the Department of Health, the Department of Law Enforcement, and
 2061  the Attorney General’s Office. The plan must include recommended
 2062  standard data formats, fraud identification strategies, and
 2063  specifications for the technical interface between state and
 2064  federal health care fraud databases;
 2065         (c) Monitor innovations in health information technology,
 2066  specifically as it pertains to Medicaid fraud prevention and
 2067  detection; and
 2068         (d) Periodically publish policy briefs that highlight
 2069  available new technology to prevent or detect health care fraud
 2070  and projects implemented by other states, the private sector, or
 2071  the Federal Government which use technology to prevent or detect
 2072  health care fraud.
 2073         Section 37. Subsection (6) of section 429.11, Florida
 2074  Statutes, is amended to read:
 2075         429.11 Initial application for license; provisional
 2076  license.—
 2077         (6)In addition to the license categories available in s.
 2078  408.808, a provisional license may be issued to an applicant
 2079  making initial application for licensure or making application
 2080  for a change of ownership. A provisional license shall be
 2081  limited in duration to a specific period of time not to exceed 6
 2082  months, as determined by the agency.
 2083         Section 38. Subsection (9) of section 429.19, Florida
 2084  Statutes, is amended to read:
 2085         429.19 Violations; imposition of administrative fines;
 2086  grounds.—
 2087         (9)The agency shall develop and disseminate an annual list
 2088  of all facilities sanctioned or fined for violations of state
 2089  standards, the number and class of violations involved, the
 2090  penalties imposed, and the current status of cases. The list
 2091  shall be disseminated, at no charge, to the Department of
 2092  Elderly Affairs, the Department of Health, the Department of
 2093  Children and Families, the Agency for Persons with Disabilities,
 2094  the area agencies on aging, the Florida Statewide Advocacy
 2095  Council, the State Long-Term Care Ombudsman Program, and state
 2096  and local ombudsman councils. The Department of Children and
 2097  Families shall disseminate the list to service providers under
 2098  contract to the department who are responsible for referring
 2099  persons to a facility for residency. The agency may charge a fee
 2100  commensurate with the cost of printing and postage to other
 2101  interested parties requesting a copy of this list. This
 2102  information may be provided electronically or through the
 2103  agency’s Internet site.
 2104         Section 39. Subsection (2) of section 429.35, Florida
 2105  Statutes, is amended to read:
 2106         429.35 Maintenance of records; reports.—
 2107         (2) Within 60 days after the date of an the biennial
 2108  inspection conducted visit required under s. 408.811 or within
 2109  30 days after the date of an any interim visit, the agency shall
 2110  forward the results of the inspection to the local ombudsman
 2111  council in the district where the facility is located; to at
 2112  least one public library or, in the absence of a public library,
 2113  the county seat in the county in which the inspected assisted
 2114  living facility is located; and, when appropriate, to the
 2115  district Adult Services and Mental Health Program Offices.
 2116         Section 40. Subsection (2) of section 429.905, Florida
 2117  Statutes, is amended to read:
 2118         429.905 Exemptions; monitoring of adult day care center
 2119  programs colocated with assisted living facilities or licensed
 2120  nursing home facilities.—
 2121         (2) A licensed assisted living facility, a licensed
 2122  hospital, or a licensed nursing home facility may provide
 2123  services during the day which include, but are not limited to,
 2124  social, health, therapeutic, recreational, nutritional, and
 2125  respite services, to adults who are not residents. Such a
 2126  facility need not be licensed as an adult day care center;
 2127  however, the agency must monitor the facility during the regular
 2128  inspection and at least biennially to ensure adequate space and
 2129  sufficient staff. If an assisted living facility, a hospital, or
 2130  a nursing home holds itself out to the public as an adult day
 2131  care center, it must be licensed as such and meet all standards
 2132  prescribed by statute and rule. For the purpose of this
 2133  subsection, the term “day” means any portion of a 24-hour day.
 2134         Section 41. Section 429.929, Florida Statutes, is amended
 2135  to read:
 2136         429.929 Rules establishing standards.—
 2137         (1) The agency shall adopt rules to implement this part.
 2138  The rules must include reasonable and fair standards. Any
 2139  conflict between these standards and those that may be set forth
 2140  in local, county, or municipal ordinances shall be resolved in
 2141  favor of those having statewide effect. Such standards must
 2142  relate to:
 2143         (1)(a) The maintenance of adult day care centers with
 2144  respect to plumbing, heating, lighting, ventilation, and other
 2145  building conditions, including adequate meeting space, to ensure
 2146  the health, safety, and comfort of participants and protection
 2147  from fire hazard. Such standards may not conflict with chapter
 2148  553 and must be based upon the size of the structure and the
 2149  number of participants.
 2150         (2)(b) The number and qualifications of all personnel
 2151  employed by adult day care centers who have responsibilities for
 2152  the care of participants.
 2153         (3)(c) All sanitary conditions within adult day care
 2154  centers and their surroundings, including water supply, sewage
 2155  disposal, food handling, and general hygiene, and maintenance of
 2156  sanitary conditions, to ensure the health and comfort of
 2157  participants.
 2158         (4)(d) Basic services provided by adult day care centers.
 2159         (5)(e) Supportive and optional services provided by adult
 2160  day care centers.
 2161         (6)(f) Data and information relative to participants and
 2162  programs of adult day care centers, including, but not limited
 2163  to, the physical and mental capabilities and needs of the
 2164  participants, the availability, frequency, and intensity of
 2165  basic services and of supportive and optional services provided,
 2166  the frequency of participation, the distances traveled by
 2167  participants, the hours of operation, the number of referrals to
 2168  other centers or elsewhere, and the incidence of illness.
 2169         (7)(g) Components of a comprehensive emergency management
 2170  plan, developed in consultation with the Department of Health
 2171  and the Division of Emergency Management.
 2172         (2)Pursuant to this part, s. 408.811, and applicable
 2173  rules, the agency may conduct an abbreviated biennial inspection
 2174  of key quality-of-care standards, in lieu of a full inspection,
 2175  of a center that has a record of good performance. However, the
 2176  agency must conduct a full inspection of a center that has had
 2177  one or more confirmed complaints within the licensure period
 2178  immediately preceding the inspection or which has a serious
 2179  problem identified during the abbreviated inspection. The agency
 2180  shall develop the key quality-of-care standards, taking into
 2181  consideration the comments and recommendations of provider
 2182  groups. These standards shall be included in rules adopted by
 2183  the agency.
 2184         Section 42. Part I of chapter 483, Florida Statutes, is
 2185  repealed, and part II and part III of that chapter are
 2186  redesignated as part I and part II, respectively.
 2187         Section 43. Paragraph (g) of subsection (3) of section
 2188  20.43, Florida Statutes, is amended to read:
 2189         20.43 Department of Health.—There is created a Department
 2190  of Health.
 2191         (3) The following divisions of the Department of Health are
 2192  established:
 2193         (g) Division of Medical Quality Assurance, which is
 2194  responsible for the following boards and professions established
 2195  within the division:
 2196         1. The Board of Acupuncture, created under chapter 457.
 2197         2. The Board of Medicine, created under chapter 458.
 2198         3. The Board of Osteopathic Medicine, created under chapter
 2199  459.
 2200         4. The Board of Chiropractic Medicine, created under
 2201  chapter 460.
 2202         5. The Board of Podiatric Medicine, created under chapter
 2203  461.
 2204         6. Naturopathy, as provided under chapter 462.
 2205         7. The Board of Optometry, created under chapter 463.
 2206         8. The Board of Nursing, created under part I of chapter
 2207  464.
 2208         9. Nursing assistants, as provided under part II of chapter
 2209  464.
 2210         10. The Board of Pharmacy, created under chapter 465.
 2211         11. The Board of Dentistry, created under chapter 466.
 2212         12. Midwifery, as provided under chapter 467.
 2213         13. The Board of Speech-Language Pathology and Audiology,
 2214  created under part I of chapter 468.
 2215         14. The Board of Nursing Home Administrators, created under
 2216  part II of chapter 468.
 2217         15. The Board of Occupational Therapy, created under part
 2218  III of chapter 468.
 2219         16. Respiratory therapy, as provided under part V of
 2220  chapter 468.
 2221         17. Dietetics and nutrition practice, as provided under
 2222  part X of chapter 468.
 2223         18. The Board of Athletic Training, created under part XIII
 2224  of chapter 468.
 2225         19. The Board of Orthotists and Prosthetists, created under
 2226  part XIV of chapter 468.
 2227         20. Electrolysis, as provided under chapter 478.
 2228         21. The Board of Massage Therapy, created under chapter
 2229  480.
 2230         22. The Board of Clinical Laboratory Personnel, created
 2231  under part I part II of chapter 483.
 2232         23. Medical physicists, as provided under part II part III
 2233  of chapter 483.
 2234         24. The Board of Opticianry, created under part I of
 2235  chapter 484.
 2236         25. The Board of Hearing Aid Specialists, created under
 2237  part II of chapter 484.
 2238         26. The Board of Physical Therapy Practice, created under
 2239  chapter 486.
 2240         27. The Board of Psychology, created under chapter 490.
 2241         28. School psychologists, as provided under chapter 490.
 2242         29. The Board of Clinical Social Work, Marriage and Family
 2243  Therapy, and Mental Health Counseling, created under chapter
 2244  491.
 2245         30. Emergency medical technicians and paramedics, as
 2246  provided under part III of chapter 401.
 2247         Section 44. Subsection (3) of section 381.0034, Florida
 2248  Statutes, is amended to read:
 2249         381.0034 Requirement for instruction on HIV and AIDS.—
 2250         (3) The department shall require, as a condition of
 2251  granting a license under chapter 467 or part I part II of
 2252  chapter 483, that an applicant making initial application for
 2253  licensure complete an educational course acceptable to the
 2254  department on human immunodeficiency virus and acquired immune
 2255  deficiency syndrome. Upon submission of an affidavit showing
 2256  good cause, an applicant who has not taken a course at the time
 2257  of licensure shall be allowed 6 months to complete this
 2258  requirement.
 2259         Section 45. Subsection (4) of section 456.001, Florida
 2260  Statutes, is amended to read:
 2261         456.001 Definitions.—As used in this chapter, the term:
 2262         (4) “Health care practitioner” means any person licensed
 2263  under chapter 457; chapter 458; chapter 459; chapter 460;
 2264  chapter 461; chapter 462; chapter 463; chapter 464; chapter 465;
 2265  chapter 466; chapter 467; part I, part II, part III, part V,
 2266  part X, part XIII, or part XIV of chapter 468; chapter 478;
 2267  chapter 480; part I or part II part II or part III of chapter
 2268  483; chapter 484; chapter 486; chapter 490; or chapter 491.
 2269         Section 46. Paragraphs (h) and (i) of subsection (2) of
 2270  section 456.057, Florida Statutes, are amended to read:
 2271         456.057 Ownership and control of patient records; report or
 2272  copies of records to be furnished; disclosure of information.—
 2273         (2) As used in this section, the terms “records owner,”
 2274  “health care practitioner,” and “health care practitioner’s
 2275  employer” do not include any of the following persons or
 2276  entities; furthermore, the following persons or entities are not
 2277  authorized to acquire or own medical records, but are authorized
 2278  under the confidentiality and disclosure requirements of this
 2279  section to maintain those documents required by the part or
 2280  chapter under which they are licensed or regulated:
 2281         (h) Clinical laboratory personnel licensed under part I
 2282  part II of chapter 483.
 2283         (i) Medical physicists licensed under part II part III of
 2284  chapter 483.
 2285         Section 47. Paragraph (j) of subsection (1) of section
 2286  456.076, Florida Statutes, is amended to read:
 2287         456.076 Impaired practitioner programs.—
 2288         (1) As used in this section, the term:
 2289         (j) “Practitioner” means a person licensed, registered,
 2290  certified, or regulated by the department under part III of
 2291  chapter 401; chapter 457; chapter 458; chapter 459; chapter 460;
 2292  chapter 461; chapter 462; chapter 463; chapter 464; chapter 465;
 2293  chapter 466; chapter 467; part I, part II, part III, part V,
 2294  part X, part XIII, or part XIV of chapter 468; chapter 478;
 2295  chapter 480; part I or part II part II or part III of chapter
 2296  483; chapter 484; chapter 486; chapter 490; or chapter 491; or
 2297  an applicant for a license, registration, or certification under
 2298  the same laws.
 2299         Section 48. Paragraph (b) of subsection (1) of section
 2300  456.47, Florida Statutes, is amended to read:
 2301         456.47 Use of telehealth to provide services.—
 2302         (1) DEFINITIONS.—As used in this section, the term:
 2303         (b) “Telehealth provider” means any individual who provides
 2304  health care and related services using telehealth and who is
 2305  licensed or certified under s. 393.17; part III of chapter 401;
 2306  chapter 457; chapter 458; chapter 459; chapter 460; chapter 461;
 2307  chapter 463; chapter 464; chapter 465; chapter 466; chapter 467;
 2308  part I, part III, part IV, part V, part X, part XIII, or part
 2309  XIV of chapter 468; chapter 478; chapter 480; part I or part II
 2310  part II or part III of chapter 483; chapter 484; chapter 486;
 2311  chapter 490; or chapter 491; who is licensed under a multistate
 2312  health care licensure compact of which Florida is a member
 2313  state; or who is registered under and complies with subsection
 2314  (4).
 2315         Section 49. This act shall take effect July 1, 2020.