Florida Senate - 2023 SB 768 By Senator Martin 33-00843-23 2023768__ 1 A bill to be entitled 2 An act relating to referral of patients by health care 3 providers; amending s. 456.053, F.S.; deleting the 4 definitions of the terms direct supervision and 5 present in the office suite; revising the definition 6 of the term referral to remove reference to direct 7 physician supervision and to require compliance with 8 certain Medicare payment and coverage rules; amending 9 s. 641.316, F.S.; conforming cross-references; 10 providing an effective date. 11 12 Be It Enacted by the Legislature of the State of Florida: 13 14 Section 1.Paragraphs (e) and (o) and present paragraph (p) 15 of subsection (3) of section 456.053, Florida Statutes, are 16 amended to read: 17 456.053Financial arrangements between referring health 18 care providers and providers of health care services. 19 (3)DEFINITIONS.For the purpose of this section, the word, 20 phrase, or term: 21 (e)Direct supervision means supervision by a physician 22 who is present in the office suite and immediately available to 23 provide assistance and direction throughout the time services 24 are being performed. 25 (o)Present in the office suite means that the physician 26 is actually physically present; provided, however, that the 27 health care provider is considered physically present during 28 brief unexpected absences as well as during routine absences of 29 a short duration if the absences occur during time periods in 30 which the health care provider is otherwise scheduled and 31 ordinarily expected to be present and the absences do not 32 conflict with any other requirement in the Medicare program for 33 a particular level of health care provider supervision. 34 (n)(p)Referral means any referral of a patient by a 35 health care provider for health care services, including, 36 without limitation: 37 1.The forwarding of a patient by a health care provider to 38 another health care provider or to an entity which provides or 39 supplies designated health services or any other health care 40 item or service; or 41 2.The request or establishment of a plan of care by a 42 health care provider, which includes the provision of designated 43 health services or other health care item or service. 44 3.The following orders, recommendations, or plans of care 45 shall not constitute a referral by a health care provider: 46 a.By a radiologist for diagnostic-imaging services. 47 b.By a physician specializing in the provision of 48 radiation therapy services for such services. 49 c.By a medical oncologist for drugs and solutions to be 50 prepared and administered intravenously to such oncologists 51 patient, as well as for the supplies and equipment used in 52 connection therewith to treat such patient for cancer and the 53 complications thereof. 54 d.By a cardiologist for cardiac catheterization services. 55 e.By a pathologist for diagnostic clinical laboratory 56 tests and pathological examination services, if furnished by or 57 under the supervision of such pathologist pursuant to a 58 consultation requested by another physician. 59 f.By a health care provider who is the sole provider or 60 member of a group practice for designated health services or 61 other health care items or services that are prescribed or 62 provided solely for such referring health care providers or 63 group practices own patients, and that are provided or 64 performed by or under the direct supervision of such referring 65 health care provider or group practice if such supervision 66 complies with all applicable Medicare payment and coverage rules 67 for services; provided, however, a physician licensed pursuant 68 to chapter 458, chapter 459, chapter 460, or chapter 461 or an 69 advanced practice registered nurse registered under s. 464.0123 70 may refer a patient to a sole provider or group practice for 71 diagnostic imaging services, excluding radiation therapy 72 services, for which the sole provider or group practice billed 73 both the technical and the professional fee for or on behalf of 74 the patient, if the referring physician or advanced practice 75 registered nurse registered under s. 464.0123 has no investment 76 interest in the practice. The diagnostic imaging service 77 referred to a group practice or sole provider must be a 78 diagnostic imaging service normally provided within the scope of 79 practice to the patients of the group practice or sole provider. 80 The group practice or sole provider may accept no more than 15 81 percent of their patients receiving diagnostic imaging services 82 from outside referrals, excluding radiation therapy services. 83 However, the 15 percent limitation of this sub-subparagraph and 84 the requirements of subparagraph (4)(a)2. do not apply to a 85 group practice entity that owns an accountable care organization 86 or an entity operating under an advanced alternative payment 87 model according to federal regulations if such entity provides 88 diagnostic imaging services and has more than 30,000 patients 89 enrolled per year. 90 g.By a health care provider for services provided by an 91 ambulatory surgical center licensed under chapter 395. 92 h.By a urologist for lithotripsy services. 93 i.By a dentist for dental services performed by an 94 employee of or health care provider who is an independent 95 contractor with the dentist or group practice of which the 96 dentist is a member. 97 j.By a physician for infusion therapy services to a 98 patient of that physician or a member of that physicians group 99 practice. 100 k.By a nephrologist for renal dialysis services and 101 supplies, except laboratory services. 102 l.By a health care provider whose principal professional 103 practice consists of treating patients in their private 104 residences for services to be rendered in such private 105 residences, except for services rendered by a home health agency 106 licensed under chapter 400. For purposes of this sub 107 subparagraph, the term private residences includes patients 108 private homes, independent living centers, and assisted living 109 facilities, but does not include skilled nursing facilities. 110 m.By a health care provider for sleep-related testing. 111 Section 2.Paragraph (b) of subsection (2) and subsection 112 (6) of section 641.316, Florida Statutes, are amended to read: 113 641.316Fiscal intermediary services. 114 (2) 115 (b)The term fiscal intermediary services organization 116 means a person or entity that performs fiduciary or fiscal 117 intermediary services to health care professionals who contract 118 with health maintenance organizations other than a hospital 119 licensed under chapter 395, an insurer licensed under chapter 120 624, a third-party administrator licensed under chapter 626, a 121 prepaid limited health service organization licensed under 122 chapter 636, a health maintenance organization licensed under 123 this chapter, or a physician group practice as defined in s. 124 456.053(3) s. 456.053(3)(h) which provides services under the 125 scope of licenses of the members of the group practice. 126 (6)Any fiscal intermediary services organization, other 127 than a hospital licensed under chapter 395, an insurer licensed 128 under chapter 624, a third-party administrator licensed under 129 chapter 626, a prepaid limited health service organization 130 licensed under chapter 636, a health maintenance organization 131 licensed under this chapter, a not-for-profit corporation that 132 provides health care services directly to patients through 133 employed, salaried physicians and that is affiliated with an 134 accredited hospital licensed in this state, or a physician group 135 practice as defined in s. 456.053(3) s. 456.053(3)(h) which 136 provides services under the scope of licenses of the members of 137 the group practice, must register with the office and meet the 138 requirements of this section. In order to register as a fiscal 139 intermediary services organization, the organization must comply 140 with ss. 641.21(1)(c), (d), and (j), 641.22(6), and 641.27. The 141 fiscal intermediary services organization must also comply with 142 the provisions of ss. 641.3155, 641.3156, and 641.51(4). Should 143 the office determine that the fiscal intermediary services 144 organization does not meet the requirements of this section, the 145 registration shall be denied. If the registrant fails to 146 maintain compliance with this section, the office may revoke or 147 suspend the registration. In lieu of revocation or suspension of 148 the registration, the office may levy an administrative penalty 149 in accordance with s. 641.25. 150 Section 3.This act shall take effect July 1, 2023.