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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to referral of patients by health care 2
providers; amending s. 456.053, F.S.; deleting the 3
definitions of the terms "direct supervision" and 4
"present in the office suite"; revising the definition 5
of the term "referral" to remove direct physician 6
supervision and to require compliance with certain 7
Medicare payments and rules; amending s. 641.316, 8
F.S.; conforming cross -references; providing an 9
effective date. 10
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Be It Enacted by the Legislature of the State of Florida: 12
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Section 1. Paragraphs (f) through (n) and (p) through (r) 14
of subsection (3) of section 456.053, Florida Statutes, are 15
redesignated as paragraphs (e) through (m) and (n) throu gh (p), 16
respectively, and paragraph (e) and present paragraphs (o) and 17
(p) of that subsection are amended, to read: 18
456.053 Financial arrangements between referring health 19
care providers and providers of health care services. — 20
(3) DEFINITIONS.—For the purpose of this section, the 21
word, phrase, or term: 22
(e) "Direct supervision" means supervision by a physician 23
who is present in the office suite and immediately available to 24
provide assistance and direction throughout the time services 25
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are being performed. 26
(o) "Present in the office suite" means that the physician 27
is actually physically present; provided, however, that the 28
health care provider is considered physically present during 29
brief unexpected absences as well as during routine absences of 30
a short duration if the absences occur during time periods in 31
which the health care provider is otherwise scheduled and 32
ordinarily expected to be present and the absences do not 33
conflict with any other requirement in the Medicare program for 34
a particular level of health care provider supervision. 35
(n)(p) "Referral" means any referral of a patient by a 36
health care provider for health care services, including, 37
without limitation: 38
1. The forwarding of a patient by a health care provider 39
to another health care prov ider or to an entity which provides 40
or supplies designated health services or any other health care 41
item or service; or 42
2. The request or establishment of a plan of care by a 43
health care provider, which includes the provision of designated 44
health services or other health care item or service. 45
3. The following orders, recommendations, or plans of care 46
shall not constitute a referral by a health care provider: 47
a. By a radiologist for diagnostic -imaging services. 48
b. By a physician specializing in the p rovision of 49
radiation therapy services for such services. 50
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c. By a medical oncologist for drugs and solutions to be 51
prepared and administered intravenously to such oncologist's 52
patient, as well as for the supplies and equipment used in 53
connection therewith to treat such patient for cancer and the 54
complications thereof. 55
d. By a cardiologist for cardiac catheterization services. 56
e. By a pathologist for diagnostic clinical laboratory 57
tests and pathological examination services, if furnished by or 58
under the supervision of such pathologist pursuant to a 59
consultation requested by another physician. 60
f. By a health care provider who is the sole provider or 61
member of a group practice for designated health services or 62
other health care items or services that are prescribed or 63
provided solely for such referring health care provider's or 64
group practice's own patients, and that are provided or 65
performed by or under the direct supervision of such referring 66
health care provider or group practice if such supervision 67
complies with all applicable Medicare payment and coverage rules 68
for services; provided, however, a physician licensed pursuant 69
to chapter 458, chapter 459, chapter 460, or chapter 461 or an 70
advanced practice registered nurse registered under s. 464 .0123 71
may refer a patient to a sole provider or group practice for 72
diagnostic imaging services, excluding radiation therapy 73
services, for which the sole provider or group practice billed 74
both the technical and the professional fee for or on behalf of 75
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the patient, if the referring physician or advanced practice 76
registered nurse registered under s. 464.0123 has no investment 77
interest in the practice. The diagnostic imaging service 78
referred to a group practice or sole provider must be a 79
diagnostic imaging serv ice normally provided within the scope of 80
practice to the patients of the group practice or sole provider. 81
The group practice or sole provider may accept no more than 15 82
percent of their patients receiving diagnostic imaging services 83
from outside referrals , excluding radiation therapy services. 84
However, the 15 percent limitation of this sub -subparagraph and 85
the requirements of subparagraph (4)(a)2. do not apply to a 86
group practice entity that owns an accountable care organization 87
or an entity operating unde r an advanced alternative payment 88
model according to federal regulations if such entity provides 89
diagnostic imaging services and has more than 30,000 patients 90
enrolled per year. 91
g. By a health care provider for services provided by an 92
ambulatory surgical center licensed under chapter 395. 93
h. By a urologist for lithotripsy services. 94
i. By a dentist for dental services performed by an 95
employee of or health care provider who is an independent 96
contractor with the dentist or group practice of which the 97
dentist is a member. 98
j. By a physician for infusion therapy services to a 99
patient of that physician or a member of that physician's group 100
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practice. 101
k. By a nephrologist for renal dialysis services and 102
supplies, except laboratory services. 103
l. By a health care provider whose principal professional 104
practice consists of treating patients in their private 105
residences for services to be rendered in such private 106
residences, except for services rendered by a home health agency 107
licensed under chapter 400. For purp oses of this sub-108
subparagraph, the term "private residences" includes patients' 109
private homes, independent living centers, and assisted living 110
facilities, but does not include skilled nursing facilities. 111
m. By a health care provider for sleep -related testing. 112
Section 2. Paragraph (b) of subsection (2) and subsection 113
(6) of section 641.316, Florida Statutes, are amended to read: 114
641.316 Fiscal intermediary services. — 115
(2) 116
(b) The term "fiscal intermediary services organization" 117
means a person or en tity that performs fiduciary or fiscal 118
intermediary services to health care professionals who contract 119
with health maintenance organizations other than a hospital 120
licensed under chapter 395, an insurer licensed under chapter 121
624, a third-party administrator licensed under chapter 626, a 122
prepaid limited health service organization licensed under 123
chapter 636, a health maintenance organization licensed under 124
this chapter, or a physician group practice as defined in s. 125
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456.053(3) s. 456.053(3)(h) which provides services under the 126
scope of licenses of the members of the group practice. 127
(6) Any fiscal intermediary services organization, other 128
than a hospital licensed under chapter 395, an insurer licensed 129
under chapter 624, a third -party administrator licensed u nder 130
chapter 626, a prepaid limited health service organization 131
licensed under chapter 636, a health maintenance organization 132
licensed under this chapter, a not -for-profit corporation that 133
provides health care services directly to patients through 134
employed, salaried physicians and that is affiliated with an 135
accredited hospital licensed in this state, or a physician group 136
practice as defined in s. 456.053(3) s. 456.053(3)(h) which 137
provides services under the scope of licenses of the members of 138
the group practice, must register with the office and meet the 139
requirements of this section. In order to register as a fiscal 140
intermediary services organization, the organization must comply 141
with ss. 641.21(1)(c), (d), and (j), 641.22(6), and 641.27. The 142
fiscal intermediary services organization must also comply with 143
the provisions of ss. 641.3155, 641.3156, and 641.51(4). Should 144
the office determine that the fiscal intermediary services 145
organization does not meet the requirements of this section, the 146
registration shall be denied. If the registrant fails to 147
maintain compliance with this section, the office may revoke or 148
suspend the registration. In lieu of revocation or suspension of 149
the registration, the office may levy an administrative penalty 150
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
in accordance with s. 641 .25. 151
Section 3. This act shall take effect July 1, 2023. 152