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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 ambulatory surgical centers; 2
creating ch. 396, F.S., to be entitled "Ambulatory 3
Surgical Centers"; creating s. 396.201, F.S.; 4
providing legislative intent; creating s. 396.202, 5
F.S.; providing definitions; creating s. 396.203, 6
F.S.; providing requirements for licensure and the 7
denial, suspension, and revocation of a license; 8
creating s. 396.204, F.S.; providing for application 9
fees; creating s. 396.205, F.S.; providing 10
requirements for specified clinical and diagnostic 11
results as a condition for issuance or renewal of a 12
license; creating s. 396.206, F.S.; requiring the 13
Agency for Health Care Administration to make or cause 14
to be made specified inspections of licensed 15
facilities; requiring a licensee to pay certain fees 16
at the time of inspe ction; creating s. 396.207, F.S.; 17
requiring each licensed facility to maintain and 18
provide upon request records of all inspection reports 19
pertaining to that facility; prohibiting the 20
distribution of specified records; providing a fee for 21
a copy of a report; creating s. 396.208, F.S.; 22
requiring the agency to review facility plans and 23
survey the construction of a licensed facility; 24
requiring the agency to approve or disapprove the 25
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plans and specifications within a specified timeframe; 26
providing an extension u nder certain circumstances; 27
requiring all licensed facilities to submit plans and 28
specifications to the agency for review; authorizing 29
the agency to charge and collect specified fees; 30
creating s. 396.209, F.S.; prohibiting rebates for 31
patients referred to a licensed facility; requiring 32
agency enforcement; providing administrative 33
penalties; creating s. 396.211, F.S.; providing 34
facility requirements for considering and acting upon 35
applications for staff membership and clinical 36
privileges at a licensed facili ty; requiring a 37
licensed facility to establish rules and procedures 38
for consideration of such applications; requiring a 39
licensed facility to make available specified 40
membership or privileges to physicians under certain 41
circumstances; providing construction ; requiring the 42
governing board to set standards and procedures to be 43
applied in considering and acting upon applications; 44
requiring a licensed facility to provide an applicant 45
with reasons for denial within a specified timeframe; 46
providing immunity from m onetary liability to certain 47
persons; providing that investigations, proceedings, 48
and records produced or acquired by a review team are 49
not subject to discovery or introduction into evidence 50
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in certain proceedings under certain circumstances; 51
providing for the award of specified fees and costs; 52
creating s. 396.212, F.S.; requiring licensed 53
facilities to provide for peer review of certain 54
physicians and develop procedures to conduct such 55
reviews; providing requirements for the procedures; 56
providing grounds for peer review and reporting 57
requirements; providing immunity from monetary 58
liability to certain persons; providing construction; 59
providing that communications, information, and 60
records produced or acquired by a review team are not 61
subject to discovery or introduction into evidence in 62
certain proceedings under certain circumstances; 63
providing for the award of specified fees and costs; 64
creating s. 396.213, F.S.; requiring licensed 65
facilities to establish an internal risk management 66
program; providing require ments for such program; 67
requiring licensed facilities to hire a risk manager; 68
providing requirements for such manager; requiring 69
licensed facilities to annually report to the 70
Department of Health specified information; requiring 71
the department and the agen cy to include certain 72
statistical information in their respective annual 73
reports; providing for rulemaking; providing 74
applicability; requiring licensed facilities to 75
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annually report specified information to the agency; 76
authorizing the agency to grant exten sions to the 77
reporting requirement under certain circumstances; 78
requiring the agency to publish certain reports and 79
summaries within certain timeframes on its website; 80
providing certain investigative and reporting 81
requirements for internal risk managers; r equiring the 82
investigation and reporting of an allegation of sexual 83
misconduct or sexual abuse at licensed facilities; 84
prohibiting false allegations; providing penalties; 85
providing licensure inspection review of the internal 86
risk management program; provid ing certain monetary or 87
civil liability for licensed risk managers; requiring 88
the agency to report certain investigative results to 89
the regulatory board; prohibiting intimidation of a 90
risk manager; providing a penalty; creating s. 91
396.214, F.S.; requiring licensed facilities to comply 92
with specified requirements for the transportation of 93
biomedical waste; creating s. 396.215, F.S.; requiring 94
licensed facilities to adopt a patient safety plan, 95
appoint a patient safety officer, and conduct a 96
patient safety culture survey at least biennially; 97
authorizing licensed facilities to develop an internal 98
action plan; creating s. 396.216, F.S.; requiring 99
licensed facilities to adopt protocols for the 100
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treatment of victims of child abuse or neglect; 101
creating s. 396.217, F .S.; providing requirements for 102
notifying parents about adverse incidents; providing 103
construction; creating s. 396.218, F.S.; providing for 104
rulemaking and enforcement; authorizing the agency to 105
impose an immediate moratorium on elective admissions 106
to any licensed facility under certain circumstances; 107
creating s. 396.219, F.S.; providing criminal and 108
administrative penalties; creating s. 396.311, F.S.; 109
providing powers and duties of the agency; creating s. 110
396.312, F.S.; requiring a licensed facility to 111
provide timely and accurate financial information and 112
quality of service measures to certain individuals; 113
providing an exemption; requiring a licensed facility 114
to make available on its website certain information 115
on payments made to that facility for defined b undles 116
of services and procedures and other information for 117
consumers and patients; requiring facility websites to 118
provide specified information and notify and inform 119
patients or prospective patients of certain 120
information; requiring a licensed facility to provide 121
a written or an electronic good faith estimate of 122
charges to a patient or prospective patient within a 123
certain timeframe; requiring a licensed facility to 124
provide information regarding financial assistance 125
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from the facility which may be available to a patient 126
or a prospective patient; providing a penalty for 127
failing to provide an estimate of charges to a 128
patient; requiring that certain records be made 129
available through electronic means that comply with a 130
specified law; reducing the amount of time a fforded to 131
licensed facilities to respond to certain patient 132
requests for information; creating s. 396.313, F.S.; 133
defining the term "extraordinary collection action"; 134
prohibiting certain collection activities by a 135
licensed facility; creating s. 396.314, F. S.; 136
prohibiting the use of a patient's medical records for 137
purposes of solicitation and marketing without 138
specific written release or authorization; providing 139
criminal penalties; creating s. 396.315, F.S.; 140
providing for confidentiality of patient records; 141
providing requirements for appropriate disclosure of 142
patient records; authorizing the department to examine 143
certain records; providing content and use 144
requirements for patient records; requiring a licensed 145
facility to furnish, in a timely manner, a true an d 146
correct copy of all patient records to certain 147
persons; providing exemptions from public records 148
requirements for specified personal information 149
relating to employees of licensed facilities who 150
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provide direct patient care or security services and 151
their spouses and children, and for specified personal 152
information relating to other employees of licensed 153
facilities and their spouses and children upon their 154
request; amending ss. 383.145, 383.50, 385.211, 155
390.011, 394.4787, 395.001, 395.002, 395.003, 156
395.1055, 395.10973, 395.3025, 395.607, 395.701, 157
400.518, 400.93, 400.9935, 401.272, 408.051, 408.07, 158
408.802, 408.820, 409.905, 409.906, 409.975, 456.041, 159
456.053, 456.056, 458.3145, 458.320, 458.351, 160
459.0085, 459.026, 465.0125, 468.505, 627.351, 161
627.357, 627.6056, 627.6405, 627.64194, 627.6616, 162
627.736, 627.912, 765.101, 766.101, 766.110, 766.1115, 163
766.118, 766.202, 766.316, 812.014, 945.6041, and 164
985.6441, F.S.; conforming cross -references and 165
provisions to changes made by the act; providing an 166
effective date. 167
168
Be It Enacted by the Legislature of the State of Florida: 169
170
Section 1. Chapter 396, Florida Statutes, consisting of 171
sections 396.201, 396.202, 396.203, 396.204, 396.205, 396.206, 172
396.207, 369.208, 396.209, 396.211, 396.212, 396.213, 396.214, 173
396.215, 396.216, 396.217, 396.218, 396.219, 396.311, 396.312, 174
396.313, 396.314, and 396.315, is created and entitled 175
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"Ambulatory Surgical Centers." 176
Section 2. Section 396.201, Florida Statutes, is created 177
to read: 178
396.201 Legislative intent. —It is the intent of the 179
Legislature to provide for the protection of public health and 180
safety in the establishment, construction, maintenance, and 181
operation of ambulatory surgical centers by providing for 182
licensure of same and for the development, establishment, and 183
enforcement of minimum standards with respect thereto. 184
Section 3. Section 396.202, Florida Statutes, is created 185
to read: 186
396.202 Definitions. —As used in this chapter, the term: 187
(1) "Accrediting organization" means a national 188
accrediting organization a pproved by the Centers for Medicare 189
and Medicaid Services and whose standards incorporate comparable 190
licensure regulations required by the state. 191
(2) "Agency" means the Agency for Health Care 192
Administration. 193
(3) "Ambulatory surgical center" means a fac ility, the 194
primary purpose of which is to provide elective surgical care, 195
in which the patient is admitted to and discharged from within 196
24 hours, and that is not part of a hospital. However, a 197
facility existing for the primary purpose of performing 198
terminations of pregnancy, an office maintained by a physician 199
for the practice of medicine, or an office maintained for the 200
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practice of dentistry may not be construed to be an ambulatory 201
surgical center, provided that any facility or office that is 202
certified or seeks certification as a Medicare ambulatory 203
surgical center must be licensed as an ambulatory surgical 204
center pursuant to this chapter. 205
(4) "Biomedical waste" means any solid or liquid waste as 206
defined in s. 381.0098(2). 207
(5) "Clinical privileges" mea ns the privileges granted to 208
a physician or other licensed health care practitioner to render 209
patient care services in an ambulatory surgical center, but does 210
not include the privilege of admitting patients. 211
(6) "Department" means the Department of Healt h. 212
(7) "Director" means any member of the official board of 213
directors as reported in the organization's annual corporate 214
report to the Department of State, or, if no such report is 215
made, any member of the operating board of directors. The term 216
does not include members of separate, restricted boards that 217
serve only in an advisory capacity to the operating board. 218
(8) "Licensed facility" means an ambulatory surgical 219
center licensed under this chapter. 220
(9) "Lifesafety" means the control and prevention of fire 221
and other life-threatening conditions on a premises for the 222
purpose of preserving human life. 223
(10) "Managing employee" means the administrator or other 224
similarly titled individual who is responsible for the daily 225
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operation of the licensed facility. 226
(11) "Medical staff" means physicians licensed under 227
chapter 458 or chapter 459 with privileges in a licensed 228
facility, as well as other licensed health care practitioners 229
with clinical privileges as approved by a licensed facility's 230
governing board. 231
(12) "Person" means any individual, partnership, 232
corporation, association, or governmental unit. 233
(13) "Validation inspection" means an inspection of the 234
premises of a licensed facility by the agency to assess whether 235
a review by an accrediting organizatio n has adequately evaluated 236
the licensed facility according to minimum state standards. 237
Section 4. Section 396.203, Florida Statutes, is created 238
to read: 239
396.203 Licensure; denial, suspension, and revocation. — 240
(1)(a) The requirements of part II of c hapter 408 apply to 241
the provision of services that require licensure pursuant to ss. 242
396.201-396.315 and part II of chapter 408 and to entities 243
licensed by or applying for such licensure from the Agency for 244
Health Care Administration pursuant to ss. 396.20 1-396.315. A 245
license issued by the agency is required in order to operate an 246
ambulatory surgical center in this state. 247
(b)1. It is unlawful for a person to use or advertise to 248
the public, in any way or by any medium whatsoever, any facility 249
as an "ambulatory surgical center" unless such facility has 250
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first secured a license under this chapter. 251
2. This chapter does not apply to veterinary hospitals or 252
to commercial business establishments using the word "hospital" 253
as a part of a trade name if no treatment of human beings is 254
performed on the premises of such establishments. 255
(2) In addition to the requirements in part II of chapter 256
408, the agency shall, at the request of a licensee, issue a 257
single license to a licensee for facilities located on separate 258
premises. Such a license shall specifically state the location 259
of the facilities, the services, and the licensed beds available 260
on each separate premises. If a licensee requests a single 261
license, the licensee shall designate which facility or office 262
is responsible for receipt of information, payment of fees, 263
service of process, and all other activities necessary for the 264
agency to carry out this chapter. 265
(3) In addition to the requirements of s. 408.807, after a 266
change of ownership has been approved by the agency, the 267
transferee shall be liable for any liability to the state, 268
regardless of when identified, resulting from changes to 269
allowable costs affecting provider reimbursement for Medicaid 270
participation or Public Medical Assistance Trust Fund 271
Assessments, and related administrative fines. 272
(4) An ambulatory surgical center shall comply with ss. 273
627.64194 and 641.513 as a condition of licensure. 274
(5) In addition to the requirements of part II of chapter 275
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408, whenever the agency finds that there has been a substantial 276
failure to comply with the requirements established under this 277
chapter or in rules, the agency is authorized to deny, modify, 278
suspend, and revoke: 279
(a) A license; 280
(b) That part of a license that is limited to a separate 281
premises, as designa ted on the license; or 282
(c) Licensure approval limited to a facility, building, or 283
portion thereof, or a service, within a given premises. 284
Section 5. Section 396.204, Florida Statutes, is created 285
to read: 286
396.204 Application for license; fees. —In accordance with 287
s. 408.805, an applicant or a licensee shall pay a fee for each 288
license application submitted under this chapter, part II of 289
chapter 408, and applicable rules. The amount of the fee shall 290
be established by rule. The license fee required of a facility 291
licensed under this chapter shall be established by rule, except 292
that the minimum license fee shall be $1,500. 293
Section 6. Section 396.205, Florida Statutes, is created 294
to read: 295
396.205 Minimum standards for clinical laboratory test 296
results and diagnostic X-ray results; prerequisite for issuance 297
or renewal of license. — 298
(1) As a requirement for issuance or renewal of its 299
license, each licensed facility shall require that all clinical 300
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laboratory tests performed by or for the licensed facility be 301
performed by a clinical laboratory appropriately certified by 302
the Centers for Medicare and Medicaid Services under the federal 303
Clinical Laboratory Improvement Amendments and the federal rules 304
adopted thereunder. 305
(2) Each licensed facility, as a requi rement for issuance 306
or renewal of its license, shall establish minimum standards for 307
acceptance of results of diagnostic X rays performed by or for 308
the licensed facility. Such standards shall require licensure or 309
registration of the source of ionizing radi ation under chapter 310
404. 311
(3) The results of clinical laboratory tests and 312
diagnostic X rays performed before admission which meet the 313
minimum standards required by law shall be accepted in lieu of 314
routine examinations required upon admission and in lieu of 315
clinical laboratory tests and diagnostic X rays which may be 316
ordered by a physician for patients of the licensed facility. 317
Section 7. Section 396.206, Florida Statutes, is created 318
to read: 319
396.206 Licensure inspection. — 320
(1) In addition to the re quirement of s. 408.811, the 321
agency shall make or cause to be made such inspections and 322
investigations as it deems necessary, including all of the 323
following: 324
(a) Inspections directed by the Centers for Medicare and 325
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Medicaid Services. 326
(b) Validation inspections. 327
(c) Lifesafety inspections. 328
(d) Licensure complaint investigations, including full 329
licensure investigations with a review of all licensure 330
standards as outlined in the administrative rules. Complaints 331
received by the agency from individual s, organizations, or other 332
sources are subject to review and investigation by the agency. 333
(e) Emergency access complaint investigations. 334
(2) The agency shall accept, in lieu of its own periodic 335
inspections for licensure, the survey or inspection of an 336
accrediting organization, provided that the accreditation of the 337
licensed facility is not provisional and provided that the 338
licensed facility authorizes release of, and the agency receives 339
the report of, the accrediting organization. The agency shall 340
develop, and adopt by rule, criteria for accepting survey 341
reports of accrediting organizations in lieu of conducting a 342
state licensure inspection. 343
(3) In accordance with s. 408.805, an applicant or 344
licensee shall pay a fee for each license application submitt ed 345
under this chapter, part II of chapter 408, and applicable 346
rules. With the exception of state -operated licensed facilities, 347
each facility licensed under this chapter shall pay to the 348
agency, at the time of inspection, the following fees: 349
(a) Inspection for licensure.—A fee shall be paid which is 350
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at least $400 per facility. 351
(b) Inspection for lifesafety only. —A fee shall be paid 352
which is at least $40 per facility. 353
(4) The agency shall coordinate all periodic inspections 354
for licensure made by the age ncy to ensure that the cost to the 355
facility of such inspections and the disruption of services by 356
such inspections is minimized. 357
Section 8. Section 396.207, Florida Statutes, is created 358
to read: 359
396.207 Inspection reports. — 360
(1) Each licensed facili ty shall maintain as public 361
information, available upon request, records of all inspection 362
reports pertaining to that facility. Copies of such reports 363
shall be retained in its records for at least 5 years after the 364
date the reports are filed and issued. 365
(2) Any records, reports, or documents which are 366
confidential and exempt from s. 119.07(1) may not be distributed 367
or made available for purposes of compliance with this section 368
unless or until such confidential status expires. 369
(3) A licensed facility sha ll, upon the request of any 370
person who has completed a written application with intent to be 371
admitted to such facility, any person who is a patient of such 372
facility, or any relative, spouse, guardian, or surrogate of any 373
such person, furnish to the request er a copy of the last 374
inspection report filed with or issued by the agency pertaining 375
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to the licensed facility, as provided in subsection (1), 376
provided that the person requesting such report agrees to pay a 377
reasonable charge to cover copying costs, not to exceed $1 per 378
page. 379
Section 9. Section 396.208, Florida Statutes, is created 380
to read: 381
396.208 Construction inspections; plan submission and 382
approval; fees.— 383
(1)(a) The design, construction, erection, alteration, 384
modification, repair, and demolition of all licensed facilities 385
are governed by the Florida Building Code and the Florida Fire 386
Prevention Code under ss. 553.73 and 633.206. In addition to the 387
requirements of ss. 553.79 and 553.80, the agency shall review 388
facility plans and survey the constru ction of any facility 389
licensed under this chapter. The agency shall make, or cause to 390
be made, such construction inspections and investigations as it 391
deems necessary. The agency may prescribe by rule that any 392
licensee or applicant desiring to make specifie d types of 393
alterations or additions to its facilities or to construct new 394
facilities shall, before commencing such alteration, addition, 395
or new construction, submit plans and specifications therefor to 396
the agency for preliminary inspection and approval or 397
recommendation with respect to compliance with applicable 398
provisions of the Florida Building Code or agency rules and 399
standards. The agency shall approve or disapprove the plans and 400
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specifications within 60 days after receipt of the fee for 401
review of plans as required in subsection (2). The agency may be 402
granted one 15-day extension for the review period if the 403
director of the agency approves the extension. If the agency 404
fails to act within the specified time, it shall be deemed to 405
have approved the plans a nd specifications. When the agency 406
disapproves plans and specifications, it shall set forth in 407
writing the reasons for its disapproval. Conferences and 408
consultations may be provided as necessary. 409
(b) All licensed facilities shall submit plans and 410
specifications to the agency for review under this section. 411
(2) The agency is authorized to charge an initial fee of 412
$2,000 for review of plans and construction on all projects, no 413
part of which is refundable. The agency may also collect a fee, 414
not to exceed 1 percent of the estimated construction cost or 415
the actual cost of review, whichever is less, for the portion of 416
the review which encompasses initial review through the initial 417
revised construction document review. The agency is further 418
authorized to collect its actual costs on all subsequent 419
portions of the review and construction inspections. The initial 420
fee payment shall accompany the initial submission of plans and 421
specifications. Any subsequent payment that is due is payable 422
upon receipt of the invoice f rom the agency. 423
Section 10. Section 396.209, Florida Statutes, is created 424
to read: 425
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396.209 Rebates prohibited; penalties. — 426
(1) It is unlawful for any person to pay or receive any 427
commission, bonus, kickback, or rebate or engage in any split -428
fee arrangement, in any form whatsoever, with any physician, 429
surgeon, organization, or person, either directly or indirectly, 430
for patients referred to a licensed facility. 431
(2) The agency shall enforce subsection (1). In the case 432
of an entity not licensed by the agency, administrative 433
penalties may include: 434
(a) A fine not to exceed $1,000. 435
(b) If applicable, a recommendation by the agency to the 436
appropriate licensing board that disciplinary action be taken. 437
Section 11. Section 396.211, Florida Statutes, i s created 438
to read: 439
396.211 Staff membership and clinical privileges. — 440
(1) A licensed facility, in considering and acting upon an 441
application for staff membership or clinical privileges, may not 442
deny the application of a qualified doctor of medicine lic ensed 443
under chapter 458, a doctor of osteopathic medicine licensed 444
under chapter 459, a doctor of dentistry licensed under chapter 445
466, a doctor of podiatric medicine licensed under chapter 461, 446
or a psychologist licensed under chapter 490 for such staff 447
membership or clinical privileges within the scope of his or her 448
respective licensure solely because the applicant is licensed 449
under any of such chapters. 450
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(2)(a) Each licensed facility shall establish rules and 451
procedures for consideration of an applicati on for clinical 452
privileges submitted by an advanced practice registered nurse 453
licensed under part I of chapter 464, in accordance with this 454
section. A licensed facility may not deny such application 455
solely because the applicant is licensed under part I of chapter 456
464 or because the applicant is not a participant in the Florida 457
Birth-Related Neurological Injury Compensation Plan. 458
(b) An advanced practice registered nurse who is certified 459
as a registered nurse anesthetist licensed under part I of 460
chapter 464 shall administer anesthesia under the onsite medical 461
direction of a professional licensed under chapter 458, chapter 462
459, or chapter 466, and in accordance with an established 463
protocol approved by the medical staff. The medical direction 464
shall specifically address the needs of the individual patient. 465
(c) Each licensed facility shall establish rules and 466
procedures for consideration of an application for clinical 467
privileges submitted by a physician assistant licensed pursuant 468
to s. 458.347 or s. 459.022 . Clinical privileges granted to a 469
physician assistant pursuant to this subsection shall 470
automatically terminate upon termination of staff membership of 471
the physician assistant's supervising physician. 472
(3) When a licensed facility requires, as a precondi tion 473
to obtaining staff membership or clinical privileges, the 474
completion of, eligibility in, or graduation from any program or 475
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society established by or relating to the American Medical 476
Association or the Liaison Committee on Graduate Medical 477
Education, the licensed facility shall also make available such 478
membership or privileges to physicians who have attained 479
completion of, eligibility in, or graduation from any equivalent 480
program established by or relating to the American Osteopathic 481
Association. 482
(4) This section does not restrict in any way the 483
authority of the medical staff of a licensed facility to review 484
for approval or disapproval all applications for appointment and 485
reappointment to all categories of staff and to make 486
recommendations on each appl icant to the governing board, 487
including the delineation of privileges to be granted in each 488
case. In making such recommendations and in the delineation of 489
privileges, each applicant shall be considered individually 490
pursuant to criteria for a doctor license d under chapter 458, 491
chapter 459, chapter 461, or chapter 466, or for an advanced 492
practice registered nurse licensed under part I of chapter 464, 493
or for a psychologist licensed under chapter 490, as applicable. 494
The applicant's eligibility for staff members hip or clinical 495
privileges shall be determined by the applicant's background, 496
experience, health, training, and demonstrated competency; the 497
applicant's adherence to applicable professional ethics; the 498
applicant's reputation; and the applicant's ability to work with 499
others and by such other elements as determined by the governing 500
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board, consistent with this chapter. 501
(5) The governing board of each licensed facility shall 502
set standards and procedures to be applied by the licensed 503
facility and its medical s taff in considering and acting upon 504
applications for staff membership or clinical privileges. 505
These standards and procedures shall be available for public 506
inspection. 507
(6) Upon the written request of the applicant, any 508
licensed facility that has denied staff membership or clinical 509
privileges to any applicant specified in subsection (1) or 510
subsection (2) shall, within 30 days after such request, provide 511
the applicant with the reasons for such denial in writing. A 512
denial of staff membership or clinical pri vileges to any 513
applicant shall be submitted, in writing, to the applicant's 514
respective licensing board. 515
(7) There is no monetary liability on the part of, and no 516
cause of action for injunctive relief or damages shall arise 517
against, any licensed facility, its governing board or governing 518
board members, medical staff, or disciplinary board or against 519
its agents, investigators, witnesses, or employees, or against 520
any other person, for any action arising out of or related to 521
carrying out this section, absent intentional fraud. 522
(8) The investigations, proceedings, and records of the 523
board, or its agent with whom there is a specific written 524
contract for the purposes of this section, as described in this 525
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section are not subject to discovery or introduction into 526
evidence in any civil action against a provider of professional 527
health services arising out of matters which are the subject of 528
evaluation and review by such board, and any person who was in 529
attendance at a meeting of such board or its agent is not 530
permitted or required to testify in any such civil action as to 531
any evidence or other matters produced or presented during the 532
proceedings of such board or its agent or as to any findings, 533
recommendations, evaluations, opinions, or other actions of such 534
board or its agent or any members thereof. However, information, 535
documents, or records otherwise available from original sources 536
are not to be construed as immune from discovery or use in any 537
such civil action merely because they were presented during 538
proceedings of such board; nor should any person who testifies 539
before such board or who is a member of such board be prevented 540
from testifying as to matters within his or her knowledge, but 541
such witness cannot be asked about his or her testimony before 542
such a board or opinions formed by him or her as a result of 543
such board hearings. 544
(9)(a) If the defendant prevails in an action brought by 545
an applicant against any person or entity that initiated, 546
participated in, was a witness in, or conducted any review as 547
authorized by this section, the court shall award reasonable 548
attorney fees and costs to the defendant. 549
(b) As a condition of any applicant bringing any action 550
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against any person or entity that initiated, participated in, 551
was a witness in, or conducted any review a s authorized by this 552
section and before any responsive pleading is due, the applicant 553
shall post a bond or other security, as set by the court having 554
jurisdiction of the action, in an amount sufficient to pay the 555
costs and attorney fees. 556
Section 12. Section 396.212, Florida Statutes, is created 557
to read: 558
396.212 Licensed facilities; peer review; disciplinary 559
powers; agency or partnership with physicians. — 560
(1) It is the intent of the Legislature that good faith 561
participants in the process of investiga ting and disciplining 562
physicians pursuant to the state -mandated peer review process 563
shall, in addition to receiving immunity from retaliatory tort 564
suits pursuant to s. 456.073(12), be protected from federal 565
antitrust suits filed under the Sherman AntiTrust Act, 15 566
U.S.C.A. ss. 1 et seq. Such intent is within the public policy 567
of the state to secure the provision of quality medical services 568
to the public. 569
(2) Each licensed facility, as a condition of licensure, 570
shall provide for peer review of physicians w ho deliver health 571
care services at the facility. Each licensed facility shall 572
develop written, binding procedures by which such peer review 573
shall be conducted. Such procedures shall include all of the 574
following: 575
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(a) Mechanism for choosing the membership of the body or 576
bodies that conduct peer review. 577
(b) Adoption of rules of order for the peer review 578
process. 579
(c) Fair review of the case with the physician involved. 580
(d) Mechanism to identify and avoid conflict of interest 581
on the part of the peer revi ew panel members. 582
(e) Recording of agendas and minutes which do not contain 583
confidential material, for review by the Division of Health 584
Quality Assurance of the agency. 585
(f) Review, at least annually, of the peer review 586
procedures by the governing board of the licensed facility. 587
(g) Focus of the peer review process on review of 588
professional practices at the facility to reduce morbidity and 589
mortality and to improve patient care. 590
(3) If reasonable belief exists that conduct by a staff 591
member or physician who delivers health care services at the 592
licensed facility may constitute one or more grounds for 593
discipline as provided in this subsection, a peer review panel 594
shall investigate and determine whether grounds for discipline 595
exist with respect to such st aff member or physician. The 596
governing board of any licensed facility, after considering the 597
recommendations of its peer review panel, shall suspend, deny, 598
revoke, or curtail the privileges, or reprimand, counsel, or 599
require education, of any such staff me mber or physician after a 600
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final determination has been made that one or more of the 601
following grounds exist: 602
(a) Incompetence. 603
(b) Being found to be a habitual user of intoxicants or 604
drugs to the extent that he or she is deemed dangerous to 605
himself, herself, or others. 606
(c) Mental or physical impairment which may adversely 607
affect patient care. 608
(d) Being found liable by a court of competent 609
jurisdiction for medical negligence or malpractice involving 610
negligent conduct. 611
(e) One or more settlements ex ceeding $10,000 for medical 612
negligence or malpractice involving negligent conduct by the 613
staff member. 614
(f) Medical negligence other than as specified in 615
paragraph (d) or paragraph (e). 616
(g) Failure to comply with the policies, procedures, or 617
directives of the risk management program or any quality 618
assurance committees of any licensed facility. 619
(4) Pursuant to ss. 458.337 and 459.016, any disciplinary 620
actions taken under subsection (3) shall be reported in writing 621
to the Division of Health Quality Assur ance of the agency within 622
30 working days after its initial occurrence, regardless of the 623
pendency of appeals to the governing board of the ambulatory 624
surgical center. The notification shall identify the disciplined 625
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practitioner, the action taken, and the reason for such action. 626
All final disciplinary actions taken under subsection (3), if 627
different from those which were reported to the agency within 30 628
days after the initial occurrence, shall be reported within 10 629
working days to the Division of Health Qua lity Assurance of the 630
agency in writing and shall specify the disciplinary action 631
taken and the specific grounds therefor. The division shall 632
review each report and determine whether it potentially involved 633
conduct by the licensee that is subject to discip linary action, 634
in which case s. 456.073 shall apply. The reports are not 635
subject to inspection under s. 119.07(1) even if the division's 636
investigation results in a finding of probable cause. 637
(5) There is no monetary liability on the part of, and no 638
cause of action for damages against, any licensed facility, its 639
governing board or governing board members, peer review panel, 640
medical staff, or disciplinary body, or its agents, 641
investigators, witnesses, or employees; a committee of an 642
ambulatory surgical cent er; or any other person for any action 643
taken without intentional fraud in carrying out this section. 644
(6) For a single incident or series of isolated incidents 645
that are nonwillful violations of the reporting requirements of 646
this section or part II of chap ter 408, the agency shall first 647
seek to obtain corrective action by the licensed facility. If 648
correction is not demonstrated within the timeframe established 649
by the agency or if there is a pattern of nonwillful violations 650
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of this section or part II of chap ter 408, the agency may impose 651
an administrative fine, not to exceed $5,000 for any violation 652
of the reporting requirements of this section or part II of 653
chapter 408. The administrative fine for repeated nonwillful 654
violations may not exceed $10,000 for any violation. The 655
administrative fine for each intentional and willful violation 656
may not exceed $25,000 per violation, per day. The fine for an 657
intentional and willful violation of this section or part II of 658
chapter 408 may not exceed $250,000. In determinin g the amount 659
of fine to be levied, the agency shall be guided by s. 660
395.1065(2)(b). 661
(7) The proceedings and records of peer review panels, 662
committees, and governing boards or agents thereof which relate 663
solely to actions taken in carrying out this sectio n are not 664
subject to inspection under s. 119.07(1); and meetings held 665
pursuant to achieving the objectives of such panels, committees, 666
and governing boards or agents thereof are not open to the 667
public under chapter 286. 668
(8) The investigations, proceeding s, and records of the 669
peer review panel, a disciplinary board, or a governing board, 670
or any agent thereof with whom there is a specific written 671
contract for that purpose, as described in this section may not 672
be subject to discovery or introduction into evi dence in any 673
civil or administrative action against a provider of 674
professional health services arising out of the matters which 675
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are the subject of evaluation and review by such group or its 676
agent, and a person who was in attendance at a meeting of such 677
group or its agent may not be permitted or required to testify 678
in any such civil or administrative action as to any evidence or 679
other matters produced or presented during the proceedings of 680
such group or its agent or as to any findings, recommendations, 681
evaluations, opinions, or other actions of such group or its 682
agent or any members thereof. However, information, documents, 683
or records otherwise available from original sources are not to 684
be construed as immune from discovery or use in any such civil 685
or administrative action merely because they were presented 686
during proceedings of such group, and any person who testifies 687
before such group or who is a member of such group may not be 688
prevented from testifying as to matters within his or her 689
knowledge, but such wit ness may not be asked about his or her 690
testimony before such a group or opinions formed by him or her 691
as a result of such group hearings. 692
(9)(a) If the defendant prevails in an action brought by a 693
staff member or physician who delivers health care servic es at 694
the licensed facility against any person or entity that 695
initiated, participated in, was a witness in, or conducted any 696
review as authorized by this section, the court shall award 697
reasonable attorney fees and costs to the defendant. 698
(b) As a condition of any staff member or physician 699
bringing any action against any person or entity that initiated, 700
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participated in, was a witness in, or conducted any review as 701
authorized by this section and before any responsive pleading is 702
due, the staff member or phy sician shall post a bond or other 703
security, as set by the court having jurisdiction of the action, 704
in an amount sufficient to pay the costs and attorney fees. 705
Section 13. Section 396.213, Florida Statutes, is created 706
to read: 707
396.213 Internal risk ma nagement program.— 708
(1) Every licensed facility shall, as a part of its 709
administrative functions, establish an internal risk management 710
program that includes all of the following components: 711
(a) The investigation and analysis of the frequency and 712
causes of general categories and specific types of adverse 713
incidents to patients. 714
(b) The development of appropriate measures to minimize 715
the risk of adverse incidents to patients, including, but not 716
limited to: 717
1. Risk management and risk prevention educati on and 718
training of all nonphysician personnel as follows: 719
a. Such education and training of all nonphysician 720
personnel as part of their initial orientation; and 721
b. At least 1 hour of such education and training annually 722
for all personnel of the license d facility working in clinical 723
areas and providing patient care, except those persons licensed 724
as health care practitioners who are required to complete 725
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continuing education coursework pursuant to chapter 456 or the 726
respective practice act. 727
2. A prohibition, except when emergency circumstances 728
require otherwise, against a staff member of the licensed 729
facility attending a patient in the recovery room, unless the 730
staff member is authorized to attend the patient in the recovery 731
room and is in the company of at least one other person. 732
However, a licensed facility is exempt from the two -person 733
requirement if it has: 734
a. Live visual observation; 735
b. Electronic observation; or 736
c. Any other reasonable measure taken to ensure patient 737
protection and privacy. 738
3. A prohibition against an unlicensed person from 739
assisting or participating in any surgical procedure unless the 740
licensed facility has authorized the person to do so following a 741
competency assessment, and such assistance or participation is 742
done under the direct and immediate supervision of a licensed 743
physician and is not otherwise an activity that may only be 744
performed by a licensed health care practitioner. 745
4. Development, implementation, and ongoing evaluation of 746
procedures, protocols, and systems to accurately identify 747
patients, planned procedures, and the correct site of the 748
planned procedure so as to minimize the performance of a 749
surgical procedure on the wrong patient, a wrong surgical 750
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procedure, a wrong-site surgical procedure, or a surgical 751
procedure otherwise unrelated to the patient's diagnosis or 752
medical condition. 753
(c) The analysis of patient grievances that relate to 754
patient care and the quality of medical services. 755
(d) A system for informing a patient or an individual 756
identified pursuant to s. 765.401(1) that the patient was the 757
subject of an adverse incident, as defined in subsection (5). 758
Such notice shall be given by an appropriately trained person 759
designated by the licensed facility as soon as practicable to 760
allow the patient an opportu nity to minimize damage or injury. 761
(e) The development and implementation of an incident 762
reporting system based upon the affirmative duty of all health 763
care providers and all agents and employees of the licensed 764
facility to report adverse incidents to th e risk manager, or to 765
his or her designee, within 3 business days after their 766
occurrence. 767
(2) The internal risk management program is the 768
responsibility of the governing board of the licensed facility. 769
Each licensed facility shall hire a risk manager who is 770
responsible for implementation and oversight of the facility's 771
internal risk management program and who demonstrates 772
competence, through education or experience, in all of the 773
following areas: 774
(a) Applicable standards of health care risk management. 775
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(b) Applicable federal, state, and local health and safety 776
laws and rules. 777
(c) General risk management administration. 778
(d) Patient care. 779
(e) Medical care. 780
(f) Personal and social care. 781
(g) Accident prevention. 782
(h) Departmental organization and management. 783
(i) Community interrelationships. 784
(j) Medical terminology. 785
(3) In addition to the programs mandated by this section, 786
other innovative approaches intended to reduce the frequency and 787
severity of medical malpractice and patient injury c laims are 788
encouraged and their implementation and operation facilitated. 789
Such additional approaches may include extending internal risk 790
management programs to health care providers' offices and the 791
assuming of provider liability by a licensed facility for acts 792
or omissions occurring within the licensed facility. Each 793
licensed facility shall annually report to the agency and the 794
Department of Health the name and judgments entered against each 795
health care practitioner for which it assumes liability. The 796
agency and Department of Health, in their respective annual 797
reports, shall include statistics that report the number of 798
licensed facilities that assume such liability and the number of 799
health care practitioners, by profession, for whom they assume 800
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liability. 801
(4) The agency shall adopt rules governing the 802
establishment of internal risk management programs to meet the 803
needs of individual licensed facilities. Each internal risk 804
management program shall include the use of incident reports to 805
be filed with an indiv idual of responsibility who is competent 806
in risk management techniques in the employ of each licensed 807
facility, such as an insurance coordinator, or who is retained 808
by the licensed facility as a consultant. The individual 809
responsible for the risk managemen t program shall have free 810
access to all medical records of the licensed facility. The 811
incident reports are part of the workpapers of the attorney 812
defending the licensed facility in litigation relating to the 813
licensed facility and are subject to discovery, but are not 814
admissible as evidence in court. A person filing an incident 815
report is not subject to civil suit by virtue of such incident 816
report. As a part of each internal risk management program, the 817
incident reports shall be used to develop categories of 818
incidents which identify problem areas. Once identified, 819
procedures shall be adjusted to correct the problem areas. 820
(5) For purposes of reporting to the agency pursuant to 821
this section, the term "adverse incident" means an event over 822
which health care pe rsonnel could exercise control and which is 823
associated in whole or in part with medical intervention, rather 824
than the condition for which such intervention occurred, and 825
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which: 826
(a) Results in one of the following injuries: 827
1. Death; 828
2. Brain or spinal damage; 829
3. Permanent disfigurement; 830
4. Fracture or dislocation of bones or joints; 831
5. A resulting limitation of neurological, physical, or 832
sensory function which continues after discharge from the 833
licensed facility; 834
6. Any condition that required specialized medical 835
attention or surgical intervention resulting from nonemergency 836
medical intervention, other than an emergency medical condition, 837
to which the patient has not given his or her informed consent; 838
or 839
7. Any condition that required the tra nsfer of the 840
patient, within or outside the licensed facility, to a unit 841
providing a more acute level of care due to the adverse 842
incident, rather than the patient's condition before the adverse 843
incident. 844
(b) Was the performance of a surgical procedure on the 845
wrong patient, a wrong surgical procedure, a wrong -site surgical 846
procedure, or a surgical procedure otherwise unrelated to the 847
patient's diagnosis or medical condition; 848
(c) Required the surgical repair of damage resulting to a 849
patient from a planned surgical procedure, where the damage was 850
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not a recognized specific risk, as disclosed to the patient and 851
documented through the informed -consent process; or 852
(d) Was a procedure to remove unplanned foreign objects 853
remaining from a surgical procedure. 854
(6)(a) Each licensed facility subject to this section 855
shall submit an annual report to the agency summarizing the 856
incident reports that have been filed in the facility for that 857
year. The report shall include: 858
1. The total number of adverse incidents. 859
2. A listing, by category, of the types of operations, 860
diagnostic or treatment procedures, or other actions causing the 861
injuries, and the number of incidents occurring within each 862
category. 863
3. A listing, by category, of the types of injuries caused 864
and the number of incidents occurring within each category. 865
4. A code number using the health care professional's 866
licensure number and a separate code number identifying all 867
other individuals directly involved in adverse incidents to 868
patients, the relationship of the individual to the licensed 869
facility, and the number of incidents in which each individual 870
has been directly involved. Each licensed facility shall 871
maintain names of the health care professionals and individuals 872
identified by code numbers for purpose s of this section. 873
5. A description of all malpractice claims filed against 874
the licensed facility, including the total number of pending and 875
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closed claims and the nature of the incident which led to, the 876
persons involved in, and the status and dispositio n of each 877
claim. Each report shall update status and disposition for all 878
prior reports. 879
(b) The information reported to the agency pursuant to 880
paragraph (a) which relates to persons licensed under chapter 881
458, chapter 459, chapter 461, or chapter 466 sha ll be reviewed 882
by the agency. The agency shall determine whether any of the 883
incidents potentially involved conduct by a health care 884
professional who is subject to disciplinary action, in which 885
case s. 456.073 shall apply. 886
(c) The report submitted to the agency must also contain 887
the name of the risk manager of the licensed facility, a copy of 888
its policy and procedures which govern the measures taken by the 889
licensed facility and its risk manager to reduce the risk of 890
injuries and adverse incidents, and the results of such 891
measures. The annual report is confidential and is not available 892
to the public pursuant to s. 119.07(1) or any other law 893
providing access to public records. The annual report is not 894
discoverable or admissible in any civil or administrative 895
action, except in disciplinary proceedings by the agency or the 896
appropriate regulatory board. The annual report is not available 897
to the public as part of the record of investigation for and 898
prosecution in disciplinary proceedings made available to the 899
public by the agency or the appropriate regulatory board. 900
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However, the agency or the appropriate regulatory board shall 901
make available, upon written request by a health care 902
professional against whom probable cause has been found, any 903
such records which form t he basis of the determination of 904
probable cause. 905
(7) Any of the following adverse incidents, whether 906
occurring in the licensed facility or arising from health care 907
services administered before admission in the licensed facility, 908
shall be reported by the licensed facility to the agency within 909
15 calendar days after its occurrence: 910
(a) The death of a patient; 911
(b) Brain or spinal damage to a patient; 912
(c) The performance of a surgical procedure on the wrong 913
patient; 914
(d) The performance of a wrong -site surgical procedure; 915
(e) The performance of a wrong surgical procedure; 916
(f) The performance of a surgical procedure that is 917
medically unnecessary or otherwise unrelated to the patient's 918
diagnosis or medical condition; 919
(g) The surgical repair of damag e resulting to a patient 920
from a planned surgical procedure, where the damage is not a 921
recognized specific risk, as disclosed to the patient and 922
documented through the informed -consent process; or 923
(h) The performance of procedures to remove unplanned 924
foreign objects remaining from a surgical procedure. 925
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926
The agency may grant extensions to this reporting requirement 927
for more than 15 days upon justification submitted in writing by 928
the licensed facility administrator to the agency. The agency 929
may require an additional, final report. These reports may not 930
be available to the public pursuant to s. 119.07(1) or any other 931
law providing access to public records, nor be discoverable or 932
admissible in any civil or administrative action, except in 933
disciplinary proceed ings by the agency or the appropriate 934
regulatory board, nor shall they be available to the public as 935
part of the record of investigation for and prosecution in 936
disciplinary proceedings made available to the public by the 937
agency or the appropriate regulator y board. However, the agency 938
or the appropriate regulatory board shall make available, upon 939
written request by a health care professional against whom 940
probable cause has been found, any such records which form the 941
basis of the determination of probable cau se. The agency may 942
investigate, as it deems appropriate, any such incident and 943
prescribe measures that must or may be taken in response to the 944
incident. The agency shall review each incident and determine 945
whether it potentially involved conduct by the heal th care 946
professional who is subject to disciplinary action, in which 947
case s. 456.073 shall apply. 948
(8) The agency shall publish on the agency's website, at 949
least quarterly, a summary and trend analysis of adverse 950
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incident reports received pursuant to this section, which may 951
not include information that would identify the patient, the 952
reporting facility, or the practitioners involved. The agency 953
shall publish on the agency's website an annual summary and 954
trend analysis of all adverse incident reports and ma lpractice 955
claims information provided by licensed facilities in their 956
annual reports, which may not include information that would 957
identify the patient, the reporting facility, or the 958
practitioners involved. The purpose of the publication of the 959
summary and trend analysis is to promote the rapid dissemination 960
of information relating to adverse incidents and malpractice 961
claims to assist in avoidance of similar incidents and reduce 962
morbidity and mortality. 963
(9) The internal risk manager of each licensed faci lity 964
shall: 965
(a) Investigate every allegation of sexual misconduct 966
which is made against a member of the licensed facility's 967
personnel who has direct patient contact, when the allegation is 968
that the sexual misconduct occurred at the facility or on the 969
grounds of the facility. 970
(b) Report every allegation of sexual misconduct to the 971
administrator of the licensed facility. 972
(c) Notify the family or guardian of the victim, if a 973
minor, that an allegation of sexual misconduct has been made and 974
that an investigation is being conducted. 975
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(d) Report to the Department of Health every allegation of 976
sexual misconduct, as defined in chapter 456 and the respective 977
practice act, by a licensed health care practitioner that 978
involves a patient. 979
(10) Any witness who wit nessed or who possesses actual 980
knowledge of the act that is the basis of an allegation of 981
sexual abuse shall: 982
(a) Notify the local police; and 983
(b) Notify the risk manager and the administrator. 984
For purposes of this subsection, the term "sexual abuse" m eans 985
acts of a sexual nature committed for the sexual gratification 986
of anyone upon, or in the presence of, a vulnerable adult, 987
without the vulnerable adult's informed consent, or a minor. The 988
term includes, but is not limited to, the acts defined in s. 989
794.011(1)(j), fondling, exposure of a vulnerable adult's or 990
minor's sexual organs, or the use of the vulnerable adult or 991
minor to solicit for or engage in prostitution or sexual 992
performance. The term does not include any act intended for a 993
valid medical purpose or any act which may reasonably be 994
construed to be a normal caregiving action. 995
(11) A person who, with malice or with intent to discredit 996
or harm a licensed facility or any person, makes a false 997
allegation of sexual misconduct against a member of a l icensed 998
facility's personnel is guilty of a misdemeanor of the second 999
degree, punishable as provided in s. 775.082 or s. 775.083. 1000
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(12) In addition to any penalty imposed pursuant to this 1001
section or part II of chapter 408, the agency shall require a 1002
written plan of correction from the licensed facility. For a 1003
single incident or series of isolated incidents that are 1004
nonwillful violations of the reporting requirements of this 1005
section or part II of chapter 408, the agency shall first seek 1006
to obtain corrective action by the licensed facility. If the 1007
correction is not demonstrated within the timeframe established 1008
by the agency or if there is a pattern of nonwillful violations 1009
of this section or part II of chapter 408, the agency may impose 1010
an administrative fine , not to exceed $5,000, for any violation 1011
of the reporting requirements of this section or part II of 1012
chapter 408. The administrative fine for repeated nonwillful 1013
violations may not exceed $10,000 for any violation. The 1014
administrative fine for each intenti onal and willful violation 1015
may not exceed $25,000 per violation, per day. The fine for an 1016
intentional and willful violation of this section or part II of 1017
chapter 408 may not exceed $250,000. In determining the amount 1018
of fine to be levied, the agency shall be guided by s. 1019
395.1065(2)(b). 1020
(13) The agency shall have access to all licensed facility 1021
records necessary to carry out this section. The records 1022
obtained by the agency under subsection (6), subsection (7), or 1023
subsection (9) are not available to the pu blic under s. 1024
119.07(1), nor shall they be discoverable or admissible in any 1025
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civil or administrative action, except in disciplinary 1026
proceedings by the agency or the appropriate regulatory board, 1027
nor shall records obtained pursuant to s. 456.071 be availabl e 1028
to the public as part of the record of investigation for and 1029
prosecution in disciplinary proceedings made available to the 1030
public by the agency or the appropriate regulatory board. 1031
However, the agency or the appropriate regulatory board shall 1032
make available, upon written request by a health care 1033
professional against whom probable cause has been found, any 1034
such records which form the basis of the determination of 1035
probable cause, except that, with respect to medical review 1036
committee records, s. 766.101 cont rols. 1037
(14) The meetings of the committees and governing board of 1038
a licensed facility held solely for the purpose of achieving the 1039
objectives of risk management as provided by this section may 1040
not be open to the public under chapter 286. The records of su ch 1041
meetings are confidential and exempt from s. 119.07(1), except 1042
as provided in subsection (13). 1043
(15) The agency shall review, as part of its licensure 1044
inspection process, the internal risk management program at each 1045
licensed facility regulated by this section to determine whether 1046
the program meets standards established in statutes and rules, 1047
whether the program is being conducted in a manner designed to 1048
reduce adverse incidents, and whether the program is 1049
appropriately reporting incidents under this sec tion. 1050
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(16) There is no monetary liability on the part of, and no 1051
cause of action for damages shall arise against, any risk 1052
manager for the implementation and oversight of the internal 1053
risk management program in a facility licensed under this 1054
chapter or chapter 390 as required by this section, for any act 1055
or proceeding undertaken or performed within the scope of the 1056
functions of such internal risk management program if the risk 1057
manager acts without intentional fraud. 1058
(17) A privilege against civil liabil ity is granted to any 1059
risk manager or licensed facility with regard to information 1060
furnished pursuant to this chapter, unless the risk manager or 1061
facility acted in bad faith or with malice in providing such 1062
information. 1063
(18) If the agency, through its re ceipt of any reports 1064
required under this section or through any investigation, has a 1065
reasonable belief that conduct by a staff member or employee of 1066
a licensed facility is grounds for disciplinary action by the 1067
appropriate regulatory board, the agency shal l report this fact 1068
to such regulatory board. 1069
(19) It is unlawful for any person to coerce, intimidate, 1070
or preclude a risk manager from lawfully executing his or her 1071
reporting obligations pursuant to this chapter. Such unlawful 1072
action shall be subject to civil monetary penalties not to 1073
exceed $10,000 per violation. 1074
Section 14. Section 396.214, Florida Statutes, is created 1075
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to read: 1076
396.214 Identification, segregation, and separation of 1077
biomedical waste.—Each licensed facility shall comply with the 1078
requirements in s. 381.0098. Any transporter or potential 1079
transporter of such waste shall be notified of the existence and 1080
locations of such waste. 1081
Section 15. Section 396.215, Florida Statutes, is created 1082
to read: 1083
396.215 Patient safety. — 1084
(1) Each licensed facility must adopt a patient safety 1085
plan. A plan adopted to implement the requirements of 42 C.F.R. 1086
s. 482.21 shall be deemed to comply with this requirement. 1087
(2) Each licensed facility shall appoint a patient safety 1088
officer for the purpose of pr omoting the health and safety of 1089
patients, reviewing and evaluating the quality of patient safety 1090
measures used by the facility, and assisting in the 1091
implementation of the facility patient safety plan. 1092
(3) Each licensed facility must, at least biennially , 1093
conduct a patient safety culture survey using the applicable 1094
Survey on Patient Safety Culture developed by the federal Agency 1095
for Healthcare Research and Quality. Each licensed facility 1096
shall conduct the survey anonymously to encourage completion of 1097
the survey by staff working in or employed by the facility. Each 1098
licensed facility may contract to administer the survey. Each 1099
facility shall biennially submit the survey data to the agency 1100
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in a format specified by rule, which must include the survey 1101
participation rate. Each licensed facility may develop an 1102
internal action plan between conducting surveys to identify 1103
measures to improve the survey and submit the plan to the 1104
agency. 1105
Section 16. Section 396.216, Florida Statutes, is created 1106
to read: 1107
396.216 Child abuse and neglect cases; duties. —Each 1108
licensed facility shall adopt a protocol that, at a minimum, 1109
requires the facility to: 1110
(1) Incorporate a facility policy that every staff member 1111
has an affirmative duty to report, pursuant to chapter 39, any 1112
actual or suspected case of child abuse, abandonment, or 1113
neglect; and 1114
(2) In any case involving suspected child abuse, 1115
abandonment, or neglect, designate, at the request of the 1116
department, a staff physician to act as a liaison between the 1117
licensed facility and the Department of Children and Families, 1118
which is investigating the suspected abuse, abandonment, or 1119
neglect, and the Child Protection Team, as defined in s. 39.01, 1120
when the case is referred to such a team. 1121
Section 17. Section 396.217, Florida Sta tutes, is created 1122
to read: 1123
396.217 Duty to notify patients. —An appropriately trained 1124
person designated by each licensed facility shall inform each 1125
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patient, or an individual identified pursuant to s. 765.401(1), 1126
in person about adverse incidents that resu lt in serious harm to 1127
the patient. Notification of outcomes of care that result in 1128
harm to the patient under this section do not constitute an 1129
acknowledgment or admission of liability and may not be 1130
introduced as evidence. 1131
Section 18. Section 396.218, Florida Statutes, is created 1132
to read: 1133
396.218 Rules and enforcement. — 1134
(1) The agency shall adopt rules pursuant to ss. 1135
120.536(1) and 120.54 to implement this chapter, which shall 1136
include reasonable and fair minimum standards for ensuring that: 1137
(a) Sufficient numbers and qualified types of personnel 1138
and occupational disciplines are on duty and available at all 1139
times to provide necessary and adequate patient care and safety. 1140
(b) Infection control, housekeeping, sanitary conditions, 1141
and medical record procedures that will adequately protect 1142
patient care and safety are established and implemented. 1143
(c) A comprehensive emergency management plan is prepared 1144
and updated annually. The standards must be included in the 1145
rules adopted by the agency after cons ulting with the Division 1146
of Emergency Management. At a minimum, the rules must provide 1147
for plan components that address emergency evacuation 1148
transportation; adequate sheltering arrangements; postdisaster 1149
activities, including emergency power, food, and wat er; 1150
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postdisaster transportation; supplies; staffing; emergency 1151
equipment; individual identification of residents and transfer 1152
of records, and responding to family inquiries. The 1153
comprehensive emergency management plan is subject to review and 1154
approval by the local emergency management agency. During its 1155
review, the local emergency management agency shall ensure that 1156
the following agencies, at a minimum, are given the opportunity 1157
to review the plan: the Department of Elderly Affairs, the 1158
Department of Health , the Agency for Health Care Administration, 1159
and the Division of Emergency Management. Also, appropriate 1160
volunteer organizations must be given the opportunity to review 1161
the plan. The local emergency management agency shall complete 1162
its review within 60 day s and either approve the plan or advise 1163
the licensed facility of necessary revisions. 1164
(d) Licensed facilities are established, organized, and 1165
operated consistent with established standards and rules. 1166
(e) Licensed facility beds conform to minimum space, 1167
equipment, and furnishings standards as specified by the 1168
department. 1169
(f) Each licensed facility has a quality improvement 1170
program designed according to standards established by its 1171
current accrediting organization. This program will enhance 1172
quality of care and emphasize quality patient outcomes, 1173
corrective action for problems, governing board review, and 1174
reporting to the agency of standardized data elements necessary 1175
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to analyze quality of care outcomes. The agency shall use 1176
existing data, when available, and may not duplicate the efforts 1177
of other state agencies in order to obtain such data. 1178
(g) Licensed facilities make available on their Internet 1179
websites, and in a hard copy format upon request, a description 1180
of and a link to the patient charge and performance outcome data 1181
collected from licensed facilities pursuant to s. 408.061. 1182
(2) The agency shall adopt rules that establish minimum 1183
standards for pediatric patient care in ambulatory surgical 1184
centers to ensure the safe and effective delivery of s urgical 1185
care to children in ambulatory surgical centers. Such standards 1186
must include quality of care, nurse staffing, physician 1187
staffing, and equipment standards. Ambulatory surgical centers 1188
may not provide operative procedures to children under 18 years 1189
of age which require a length of stay past midnight until such 1190
standards are established by rule. 1191
(3) Any rule adopted under this chapter by the agency may 1192
not deny a license to a facility required to be licensed under 1193
this part, solely by reason of the s chool or system of practice 1194
employed or permitted to be employed by physicians therein, 1195
provided that such school or system of practice is recognized by 1196
the laws of this state. However, this subsection does not limit 1197
the powers of the agency to provide and require minimum 1198
standards for the maintenance and operation of, and for the 1199
treatment of patients in, those licensed facilities which 1200
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receive federal aid, in order to meet minimum standards related 1201
to such matters in such licensed facilities which may now or 1202
hereafter be required by appropriate federal officers or 1203
agencies in pursuance of federal law or adopted in pursuance of 1204
federal law. 1205
(4) Any licensed facility which is in operation at the 1206
time of adoption of any applicable rules under this chapter 1207
shall be given a reasonable time, under the particular 1208
circumstances, but not to exceed 1 year after the date of such 1209
adoption, within which to comply with such rules. 1210
(5) The agency may not adopt any rule governing the 1211
design, construction, erection, alt eration, modification, 1212
repair, or demolition of any ambulatory surgical center. It is 1213
the intent of the Legislature to preempt that function to the 1214
Florida Building Commission and the State Fire Marshal through 1215
adoption and maintenance of the Florida Build ing Code and the 1216
Florida Fire Prevention Code. However, the agency shall provide 1217
technical assistance to the commission and the State Fire 1218
Marshal in updating the construction standards of the Florida 1219
Building Code and the Florida Fire Prevention Code whic h govern 1220
licensed facilities. 1221
Section 19. Section 396.219, Florida Statutes, is created 1222
to read: 1223
396.219 Criminal and administrative penalties; 1224
moratorium.— 1225
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(1) In addition to s. 408.812, any person establishing, 1226
conducting, managing, or operating any facility without a 1227
license under this chapter commits a misdemeanor and, upon 1228
conviction, shall be fined not more than $500 for the first 1229
offense and not more than $1,000 for each subsequent offense, 1230
and each day of continuing violation after convictio n is 1231
considered a separate offense. 1232
(2)(a) The agency may impose an administrative fine, not 1233
to exceed $1,000 per violation, per day, for the violation of 1234
this part, part II of chapter 408, or applicable rules. Each day 1235
of violation constitutes a separat e violation and is subject to 1236
a separate fine. 1237
(b) In determining the amount of fine to be levied for a 1238
violation, as provided in paragraph (a), the following factors 1239
shall be considered: 1240
1. The severity of the violation, including the 1241
probability that death or serious harm to the health or safety 1242
of any person will result or has resulted, the severity of the 1243
actual or potential harm, and the extent to which this part was 1244
violated. 1245
2. Actions taken by the licensee to correct the violations 1246
or to remedy complaints. 1247
3. Any previous violations of the licensee. 1248
(c) The agency may impose an administrative fine for the 1249
violation of s. 641.3154 or, if sufficient claims due to a 1250
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provider from a health maintenance organization do not exist to 1251
enable the take-back of an overpayment, as provided under s. 1252
641.3155(5), for the violation of s. 641.3155(5). The 1253
administrative fine for a violation cited in this paragraph 1254
shall be in the amounts specified in s. 641.52(5), and paragraph 1255
(a) does not apply. 1256
(3) In accordance with part II of chapter 408, the agency 1257
may impose an immediate moratorium on elective admissions to any 1258
licensed facility, building, or portion thereof, or service, 1259
when the agency determines that any condition in the licensed 1260
facility presents a threat to public health or safety. 1261
(4) The agency shall impose a fine of $500 for each 1262
instance of the licensed facility's failure to provide the 1263
information required by rules adopted pursuant to s. 1264
396.1055(1)(g). 1265
Section 20. Section 396.311, Flor ida Statutes, is created 1266
to read: 1267
396.311 Powers and duties of the agency. —The agency shall: 1268
(1) Adopt rules pursuant to ss. 120.536(1) and 120.54 to 1269
implement this part and part II of chapter 408 conferring duties 1270
upon it. 1271
(2) Develop a model risk m anagement program for licensed 1272
facilities that will satisfy the requirements of s. 395.0197. 1273
(3) Enforce the special -occupancy provisions of the 1274
Florida Building Code which apply to ambulatory surgical centers 1275
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in conducting any inspection authorized by t his chapter and part 1276
II of chapter 408. 1277
Section 21. Section 396.312, Florida Statutes, is created 1278
to read: 1279
396.312 Price transparency; itemized patient statement or 1280
bill; patient admission status notification. — 1281
(1) A facility licensed under this ch apter shall provide 1282
timely and accurate financial information and quality of service 1283
measures to patients and prospective patients of the facility, 1284
or to patients' survivors or legal guardians, as appropriate. 1285
Such information shall be provided in accordan ce with this 1286
section and rules adopted by the agency pursuant to this chapter 1287
and s. 408.05. Licensed facilities operating exclusively as 1288
state facilities are exempt from this subsection. 1289
(a) Each licensed facility shall make available to the 1290
public on its website information on payments made to that 1291
facility for defined bundles of services and procedures. The 1292
payment data must be presented and searchable in accordance 1293
with, and through a hyperlink to, the system established by the 1294
agency and its vendor u sing the descriptive service bundles 1295
developed under s. 408.05(3)(c). At a minimum, the licensed 1296
facility shall provide the estimated average payment received 1297
from all payors, excluding Medicaid and Medicare, for the 1298
descriptive service bundles available a t that facility and the 1299
estimated payment range for such bundles. Using plain language, 1300
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comprehensible to an ordinary layperson, the licensed facility 1301
must disclose that the information on average payments and the 1302
payment ranges is an estimate of costs tha t may be incurred by 1303
the patient or prospective patient and that actual costs will be 1304
based on the services actually provided to the patient. The 1305
licensed facility's website must: 1306
1. Provide information to prospective patients on the 1307
licensed facility's financial assistance policy, including the 1308
application process, payment plans, and discounts, and the 1309
facility's charity care policy and collection procedures. 1310
2. If applicable, notify patients and prospective patients 1311
that services may be provided in th e licensed facility by that 1312
facility as well as by other health care providers who may 1313
separately bill the patient and that such health care providers 1314
may or may not participate with the same health insurers or 1315
health maintenance organizations as the facil ity. 1316
3. Inform patients and prospective patients that they may 1317
request from the licensed facility and other health care 1318
providers a more personalized estimate of charges and other 1319
information, and inform patients that they should contact each 1320
health care practitioner who will provide services in the 1321
facility to determine the health insurers and health maintenance 1322
organizations with which the health care practitioner 1323
participates as a network provider or preferred provider. 1324
4. Provide the names, mailing addresses, and telephone 1325
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numbers of the health care practitioners and medical practice 1326
groups with which it contracts to provide services in the 1327
licensed facility and instructions on how to contact the 1328
practitioners and groups to determine the health insur ers and 1329
health maintenance organizations with which they participate as 1330
network providers or preferred providers. 1331
(b) Each licensed facility shall post on its website a 1332
consumer-friendly list of standard charges for at least 300 1333
shoppable health care ser vices, or an Internet -based price 1334
estimator tool meeting federal standards. If a licensed facility 1335
provides fewer than 300 distinct shoppable health care services, 1336
it shall make available on its website the standard charges for 1337
each service it provides. As used in this paragraph, the term: 1338
1. "Shoppable health care service" means a service that 1339
can be scheduled by a healthcare consumer in advance. The term 1340
includes, but is not limited to, the services described in s. 1341
627.6387(2)(e) and any services define d in regulations or 1342
guidance issued by the United States Department of Health and 1343
Human Services. 1344
2. "Standard charge" has the same meaning as that term is 1345
defined in regulations or guidance issued by the United States 1346
Department of Health and Human Serv ices for purposes of 1347
ambulatory surgical center price transparency. 1348
(c)1. Before providing any nonemergency medical services, 1349
each licensed facility shall provide in writing or by electronic 1350
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means a good faith estimate of reasonably anticipated charges b y 1351
the licensed facility for the treatment of a patient's or 1352
prospective patient's specific condition. The licensed facility 1353
is not required to adjust the estimate for any potential 1354
insurance coverage. The licensed facility must provide the 1355
estimate to the patient's health insurer, as defined in s. 1356
627.446(1), and the patient at least 3 business days before the 1357
date such service is to be provided, but no later than 1 1358
business day after the date such service is scheduled or, in the 1359
case of a service scheduled at least 10 business days in 1360
advance, no later than 3 business days after the date the 1361
service is scheduled. The licensed facility must provide the 1362
estimate to the patient no later than 3 business days after the 1363
date the patient requests an estimate. The estimate may be based 1364
on the descriptive service bundles developed by the agency under 1365
s. 408.05(3)(c) unless the patient or prospective patient 1366
requests a more personalized and specific estimate that accounts 1367
for the specific condition and characteristics of the patient or 1368
prospective patient. The licensed facility shall inform the 1369
patient or prospective patient that he or she may contact his or 1370
her health insurer for additional information concerning cost -1371
sharing responsibilities. 1372
2. In the estimate, th e licensed facility shall provide to 1373
the patient or prospective patient information on the facility's 1374
financial assistance policy, including the application process, 1375
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payment plans, and discounts and the facility's charity care 1376
policy and collection procedu res. 1377
3. The estimate shall clearly identify any licensed 1378
facility fees and, if applicable, include a statement notifying 1379
the patient or prospective patient that a facility fee is 1380
included in the estimate, the purpose of the fee, and that the 1381
patient may pay less for the procedure or service at another 1382
facility or in another health care setting. 1383
4. The licensed facility shall notify the patient or 1384
prospective patient of any revision to the estimate. 1385
5. In the estimate, the licensed facility must notify the 1386
patient or prospective patient that services may be provided in 1387
the facility by the facility as well as by other health care 1388
providers that may separately bill the patient, if applicable. 1389
6. Failure to timely provide the estimate pursuant to this 1390
paragraph shall result in a daily fine of $1,000 until the 1391
estimate is provided to the patient or prospective patient and 1392
the health insurer. The total fine per patient estimate may not 1393
exceed $10,000. 1394
(d) Each licensed facility shall make available on its 1395
website a hyperlink to the health -related data, including 1396
quality measures and statistics that are disseminated by the 1397
agency pursuant to s. 408.05. The licensed facility shall also 1398
take action to notify the public that such information is 1399
electronically available and provide a hyperlink to the agency's 1400
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website. 1401
(e)1. Upon request, and after the patient's discharge or 1402
release from a licensed facility, the facility must provide to 1403
the patient or to the patient's survivor or legal guardian, as 1404
appropriate, an itemized statement or a bill detailing in plain 1405
language, comprehensible to an ordinary layperson, the specific 1406
nature of charges or expenses incurred by the patient. The 1407
initial statement or bill shall be provided within 7 days after 1408
the patient's discharge or release or after a request for such 1409
statement or bill, whichever is later. The initial statement or 1410
bill must contain a statement of specific services received and 1411
expenses incurred by date and provider for such items of 1412
service, enumerating in d etail as prescribed by the agency the 1413
constituent components of the services received within each 1414
department of the licensed facility and including unit price 1415
data on rates charged by the licensed facility. The statement or 1416
bill must also clearly identify any facility fee and explain the 1417
purpose of the fee. The statement or bill must identify each 1418
item as paid, pending payment by a third party, or pending 1419
payment by the patient, and must include the amount due, if 1420
applicable. If an amount is due from the pa tient, a due date 1421
must be included. The initial statement or bill must direct the 1422
patient or the patient's survivor or legal guardian, as 1423
appropriate, to contact the patient's insurer or health 1424
maintenance organization regarding the patient's cost -sharing 1425
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responsibilities. 1426
2. Any subsequent statement or bill provided to a patient 1427
or to the patient's survivor or legal guardian, as appropriate, 1428
relating to the episode of care must include all of the 1429
information required by subparagraph 1., with any revision s 1430
clearly delineated. 1431
3. Each statement or bill provided pursuant to this 1432
subsection: 1433
a. Must include notice of physicians and other health care 1434
providers who bill separately. 1435
b. May not include any generalized category of expenses 1436
such as "other" or "miscellaneous" or similar categories. 1437
(2) Each itemized statement or bill must prominently 1438
display the telephone number of the licensed facility's patient 1439
liaison who is responsible for expediting the resolution of any 1440
billing dispute between the patie nt, or the patient's survivor 1441
or legal guardian, and the billing department. 1442
(3) A licensed facility shall make available to a patient 1443
all records necessary for verification of the accuracy of the 1444
patient's statement or bill within 10 business days after the 1445
request for such records. The records must be made available in 1446
the licensed facility's offices and through electronic means 1447
that comply with the Health Insurance Portability and 1448
Accountability Act of 1996, 42 U.S.C. s. 1320d, as amended. Such 1449
records must be available to the patient before and after 1450
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payment of the statement or bill. The licensed facility may not 1451
charge the patient for making such verification records 1452
available; however, the facility may charge its usual fee for 1453
providing copies of rec ords as specified in s. 396.3025. 1454
(4) Each licensed facility shall establish a method for 1455
reviewing and responding to questions from patients concerning 1456
the patient's itemized statement or bill. Such response shall be 1457
provided within 7 business days afte r the date a question is 1458
received. If the patient is not satisfied with the response, the 1459
facility must provide the patient with the contact information 1460
of the agency to which the issue may be sent for review. 1461
(5) Each licensed facility shall establish a n internal 1462
process for reviewing and responding to grievances from 1463
patients. Such process must allow a patient to dispute charges 1464
that appear on the patient's itemized statement or bill. The 1465
licensed facility shall prominently post on its website and 1466
indicate in bold print on each itemized statement or bill the 1467
instructions for initiating a grievance and the direct contact 1468
information required to initiate the grievance process. The 1469
licensed facility must provide an initial response to a patient 1470
grievance within 7 business days after the patient formally 1471
files a grievance disputing all or a portion of an itemized 1472
statement or bill. 1473
(6) Each licensed facility shall disclose to a patient, a 1474
prospective patient, or a patient's legal guardian whether a 1475
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cost-sharing obligation for a particular covered health care 1476
service or item exceeds the charge that applies to an individual 1477
who pays cash or the cash equivalent for the same health care 1478
service or item in the absence of health insurance coverage. 1479
Failure to provide a disclosure in compliance with this 1480
subsection may result in a fine not to exceed $500 per incident. 1481
Section 22. Section 396.313, Florida Statutes, is created 1482
to read: 1483
396.313 Billing and collection activities. — 1484
(1) As used in this section, th e term "extraordinary 1485
collection action" means any of the following actions taken by a 1486
licensed facility against an individual in relation to obtaining 1487
payment of a bill for care covered under the licensed facility's 1488
financial assistance policy: 1489
(a) Selling the individual's debt to another party. 1490
(b) Reporting adverse information about the individual to 1491
consumer credit reporting agencies or credit bureaus. 1492
(c) Deferring, denying, or requiring a payment before 1493
providing medically necessary care because of the individual's 1494
nonpayment of one or more bills for previously provided care 1495
covered under the licensed facility's financial assistance 1496
policy. 1497
(d) Actions that require a legal or judicial process, 1498
including, but not limited to: 1499
1. Placing a lien on the individual's property; 1500
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2. Foreclosing on the individual's real property; 1501
3. Attaching or seizing the individual's bank account or 1502
any other personal property; 1503
4. Commencing a civil action against the individual; 1504
5. Causing the individual's a rrest; or 1505
6. Garnishing the individual's wages. 1506
(2) A licensed facility may not engage in an extraordinary 1507
collection action against an individual to obtain payment for 1508
services: 1509
(a) Before the licensed facility has made reasonable 1510
efforts to determine whether the individual is eligible for 1511
assistance under its financial assistance policy for the care 1512
provided and, if eligible, before a decision is made by the 1513
facility on the patient's application for such financial 1514
assistance. 1515
(b) Before the licensed facility has provided the 1516
individual with an itemized statement or bill. 1517
(c) During an ongoing grievance process as described in s. 1518
395.301(6) or an ongoing appeal of a claim adjudication. 1519
(d) Before billing any applicable insurer and allowing the 1520
insurer to adjudicate a claim. 1521
(e) For 30 days after notifying the patient in writing, by 1522
certified mail, or by other traceable delivery method, that a 1523
collection action will commence absent additional action by the 1524
patient. 1525
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(f) While the individu al: 1526
1. Negotiates in good faith the final amount of a bill for 1527
services rendered; or 1528
2. Complies with all terms of a payment plan with the 1529
licensed facility. 1530
Section 23. Section 396.314, Florida Statutes, is created 1531
to read: 1532
396.314 Patient recor ds; penalties for alteration. — 1533
(1) Any person who fraudulently alters, defaces, or 1534
falsifies any medical record, or causes or procures any of these 1535
offenses to be committed, commits a misdemeanor of the second 1536
degree, punishable as provided in s. 775.082 or s. 1537
775.083. 1538
(2) A conviction under subsection (1) is also grounds for 1539
restriction, suspension, or termination of license privileges. 1540
Section 24. Section 396.315, Florida Statutes, is created 1541
to read: 1542
396.315 Patient and personnel records; copie s; 1543
examination.— 1544
(1) Any licensed facility shall, upon written request, and 1545
only after discharge of the patient, furnish, in a timely 1546
manner, without delays for legal review, to any person admitted 1547
to the licensed facility for care and treatment or treat ed at 1548
the licensed facility, or to any such person's guardian, 1549
curator, or personal representative, or in the absence of one of 1550
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those persons, to the next of kin of a decedent or the parent of 1551
a minor, or to anyone designated by such person in writing, a 1552
true and correct copy of all patient records, including X rays, 1553
and insurance information concerning such person, which records 1554
are in the possession of the licensed facility, provided that 1555
the person requesting such records agrees to pay a charge. The 1556
exclusive charge for copies of patient records may include sales 1557
tax and actual postage, and, except for nonpaper records that 1558
are subject to a charge not to exceed $2, may not exceed $1 per 1559
page. A fee of up to $1 may be charged for each year of records 1560
requested. These charges shall apply to all records furnished, 1561
whether directly from the licensed facility or from a copy 1562
service providing these services on behalf of the licensed 1563
facility. However, a patient whose records are copied or 1564
searched for the purpos e of continuing to receive medical care 1565
is not required to pay a charge for copying or for the search. 1566
The licensed facility shall further allow any such person to 1567
examine the original records in its possession, or microforms or 1568
other suitable reproduction s of the records, upon such 1569
reasonable terms as shall be imposed to ensure that the records 1570
will not be damaged, destroyed, or altered. 1571
(2) Patient records are confidential and must not be 1572
disclosed without the consent of the patient or his or her legal 1573
representative, but appropriate disclosure may be made without 1574
such consent to: 1575
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(a) Licensed facility personnel, attending physicians, or 1576
other health care practitioners and providers currently involved 1577
in the care or treatment of the patient for use onl y in 1578
connection with the treatment of the patient. 1579
(b) Licensed facility personnel only for administrative 1580
purposes or risk management and quality assurance functions. 1581
(c) The agency, for purposes of health care cost 1582
containment. 1583
(d) In any civil or criminal action, unless otherwise 1584
prohibited by law, upon the issuance of a subpoena from a 1585
court of competent jurisdiction and proper notice by the party 1586
seeking such records to the patient or his or her legal 1587
representative. 1588
(e) The agency upon subpoen a issued pursuant to s. 1589
456.071, but the records obtained must be used solely for the 1590
purpose of the agency and the appropriate professional board in 1591
its investigation, prosecution, and appeal of disciplinary 1592
proceedings. If the agency requests copies of t he records, the 1593
licensed facility shall charge no more than its actual copying 1594
costs, including reasonable staff time. The records must be 1595
sealed and must not be available to the public pursuant to s. 1596
119.07(1) or any other statute providing access to reco rds, nor 1597
may they be available to the public as part of the record of 1598
investigation for and prosecution in disciplinary proceedings 1599
made available to the public by the agency or the appropriate 1600
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regulatory board. However, the agency must make available, upo n 1601
written request by a practitioner against whom probable cause 1602
has been found, any such records that form the basis of the 1603
determination of probable cause. 1604
(f) Organ procurement organizations, tissue banks, and eye 1605
banks required to conduct death records reviews pursuant to s. 1606
396.2050. 1607
(g) The Medicaid Fraud Control Unit in the Department of 1608
Legal Affairs pursuant to s. 409.920. 1609
(h) The Department of Financial Services, or an agent, 1610
employee, or independent contractor of the department who is 1611
auditing for unclaimed property pursuant to chapter 717. 1612
(i) A regional poison control center for purposes of 1613
treating a poison episode under evaluation, case management of 1614
poison cases, or compliance with data collection and reporting 1615
requirements of s. 395.1027 and the professional organization 1616
that certifies poison control centers in accordance with federal 1617
law. 1618
(3) The Department of Health may examine patient records 1619
of a licensed facility, whether held by the licensed facility or 1620
the Agency for Health Care Administration, for the purpose of 1621
epidemiological investigations. The unauthorized release of 1622
information by agents of the department which would identify an 1623
individual patient is a misdemeanor of the first degree, 1624
punishable as provided in s. 77 5.082 or s. 775.083. 1625
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(4) Patient records shall contain information required for 1626
completion of birth, death, and fetal death certificates. 1627
(5)(a) If the content of any record of patient treatment 1628
is provided under this section, the recipient, if other t han the 1629
patient or the patient's representative, may use such 1630
information only for the purpose provided and may not further 1631
disclose any information to any other person or entity, unless 1632
expressly permitted by the written consent of the patient. A 1633
general authorization for the release of medical information is 1634
not sufficient for this purpose. The content of such patient 1635
treatment record is confidential and exempt from s. 119.07(1) 1636
and s. 24(a), Art. I of the State Constitution. 1637
(b) Absent a specific written release or authorization 1638
permitting utilization of patient information for solicitation 1639
or marketing the sale of goods or services, any use of that 1640
information for those purposes is prohibited. 1641
(6) Patient records at ambulatory surgical centers a re 1642
exempt from disclosure under s. 119.07(1), except as provided in 1643
subsections (1)-(5). 1644
(7) A licensed facility may prescribe the content and 1645
custody of limited-access records which the licensed facility 1646
may maintain on its employees. Such records shall be limited to 1647
information regarding evaluations of employee performance, 1648
including records forming the basis for evaluation and 1649
subsequent actions, and shall be open to inspection only by the 1650
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employee and by officials of the licensed facility who are 1651
responsible for the supervision of the employee. The custodian 1652
of limited-access employee records shall release information 1653
from such records to other employers or only upon authorization 1654
in writing from the employee or upon order of a court of 1655
competent jurisdiction. Any licensed facility releasing such 1656
records pursuant to this chapter shall be considered to be 1657
acting in good faith and may not be held liable for information 1658
contained in such records, absent a showing that the facility 1659
maliciously falsified suc h records. Such limited -access employee 1660
records are exempt from s. 119.07(1) for a period of 5 years 1661
after the date such records are designated limited -access 1662
records. 1663
(8) The home addresses, telephone numbers, and photographs 1664
of employees of any license d facility who provide direct patient 1665
care or security services; the home addresses, telephone 1666
numbers, and places of employment of the spouses and children of 1667
such persons; and the names and locations of schools and day 1668
care facilities attended by the chi ldren of such persons are 1669
confidential and exempt from s. 119.07(1) and s. 24(a), Art. I 1670
of the State Constitution. However, any state or federal agency 1671
that is authorized to have access to such information by any 1672
provision of law shall be granted such acc ess in the furtherance 1673
of its statutory duties, notwithstanding this subsection. The 1674
Department of Financial Services, or an agent, employee, or 1675
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independent contractor of the department who is auditing for 1676
unclaimed property pursuant to chapter 717, shall be granted 1677
access to the name, address, and social security number of any 1678
employee owed unclaimed property. 1679
(9) The home addresses, telephone numbers, and photographs 1680
of employees of any licensed facility who have a reasonable 1681
belief, based upon specific circumstances that have been 1682
reported in accordance with the procedure adopted by the 1683
licensed facility, that release of the information may be used 1684
to threaten, intimidate, harass, inflict violence upon, or 1685
defraud the employee or any member of the emplo yee's family; the 1686
home addresses, telephone numbers, and places of employment of 1687
the spouses and children of such persons; and the names and 1688
locations of schools and day care facilities attended by the 1689
children of such persons are confidential and exempt f rom s. 1690
119.07(1) and s. 24(a), Art. I of the State Constitution. 1691
However, any state or federal agency that is authorized to have 1692
access to such information by any provision of law shall be 1693
granted such access in the furtherance of its statutory duties, 1694
notwithstanding this subsection. The licensed facility shall 1695
maintain the confidentiality of the personal information only if 1696
the employee submits a written request for confidentiality to 1697
the licensed facility. 1698
Section 25. Paragraph (d) of subsection (2) of section 1699
383.145, Florida Statutes, is amended to read: 1700
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383.145 Newborn, infant, and toddler hearing screening. — 1701
(2) DEFINITIONS.—As used in this section, the term: 1702
(d) "Hospital" means a facility as defined in s. 395.002 1703
s. 395.002(13) and licensed under chapter 395 and part II of 1704
chapter 408. 1705
Section 26. Paragraph (b) of subsection (4) of section 1706
383.50, Florida Statutes, is amended to read: 1707
383.50 Treatment of surrendered infant. — 1708
(4) 1709
(b) Each hospital of this state subject to s. 395.104 1 1710
shall, and any other hospital may, admit and provide all 1711
necessary emergency services and care, as defined in s. 395.002 1712
s. 395.002(9), to any infant left with the hospital in 1713
accordance with this section. The hospital or any of its medical 1714
staff or licensed health care professionals shall consider these 1715
actions as implied consent for treatment, and a hospital 1716
accepting physical custody of an infant has implied consent to 1717
perform all necessary emergency services and care. The hospital 1718
or any of its medica l staff or licensed health care 1719
professionals are immune from criminal or civil liability for 1720
acting in good faith in accordance with this section. This 1721
subsection does not limit liability for negligence. 1722
Section 27. Subsection (2) of section 385.211, Florida 1723
Statutes, is amended to read: 1724
385.211 Refractory and intractable epilepsy treatment and 1725
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research at recognized medical centers. — 1726
(2) Notwithstanding chapter 893, medical centers 1727
recognized pursuant to s. 381.925, or an academic medical 1728
research institution legally affiliated with a licensed 1729
children's specialty hospital as defined in s. 395.002 s. 1730
395.002(28) that contracts with the Department of Health, may 1731
conduct research on cannabidiol and low -THC cannabis. This 1732
research may include, but is not limited to, the agricultural 1733
development, production, clinical research, and use of liquid 1734
medical derivatives of cannabidiol and low -THC cannabis for the 1735
treatment for refractory or intractable epilepsy. The authority 1736
for recognized medical centers t o conduct this research is 1737
derived from 21 C.F.R. parts 312 and 316. Current state or 1738
privately obtained research funds may be used to support the 1739
activities described in this section. 1740
Section 28. Subsection (8) of section 390.011, Florida 1741
Statutes, is amended to read: 1742
390.011 Definitions. —As used in this chapter, the term: 1743
(8) "Hospital" means a facility as defined in s. 395.002 1744
s. 395.002(12) and licensed under chapter 395 and part II of 1745
chapter 408. 1746
Section 29. Subsection (7) of section 394.4 787, Florida 1747
Statutes, is amended to read: 1748
394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, 1749
and 394.4789.—As used in this section and ss. 394.4786, 1750
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394.4788, and 394.4789: 1751
(7) "Specialty psychiatric hospital" means a hospital 1752
licensed by the agency pursuant to s. 395.002 s. 395.002(28) and 1753
part II of chapter 408 as a specialty psychiatric hospital. 1754
Section 30. Section 395.001, Florida Statutes, is amended 1755
to read: 1756
395.001 Legislative intent. —It is the intent of the 1757
Legislature to provide fo r the protection of public health and 1758
safety in the establishment, construction, maintenance, and 1759
operation of hospitals and ambulatory surgical centers by 1760
providing for licensure of same and for the development, 1761
establishment, and enforcement of minimum s tandards with respect 1762
thereto. 1763
Section 31. Subsections (4) through (33) of section 1764
395.002, Florida Statutes, are renumbered as subsections (3) 1765
through (32), respectively, and present subsections (3), (10), 1766
(17), (23), and (28) of that section are amen ded to read: 1767
395.002 Definitions. —As used in this chapter: 1768
(3) "Ambulatory surgical center" means a facility, the 1769
primary purpose of which is to provide elective surgical care, 1770
in which the patient is admitted to and discharged from such 1771
facility within 24 hours, and which is not part of a hospital. 1772
However, a facility existing for the primary purpose of 1773
performing terminations of pregnancy, an office maintained by a 1774
physician for the practice of medicine, or an office maintained 1775
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for the practice of den tistry may not be construed to be an 1776
ambulatory surgical center, provided that any facility or office 1777
which is certified or seeks certification as a Medicare 1778
ambulatory surgical center shall be licensed as an ambulatory 1779
surgical center pursuant to s. 395.0 03. 1780
(9)(10) "General hospital" means any facility which meets 1781
the provisions of subsection (11) (12) and which regularly makes 1782
its facilities and services available to the general population. 1783
(16)(17) "Licensed facility" means a hospital or 1784
ambulatory surgical center licensed in accordance with this 1785
chapter. 1786
(22)(23) "Premises" means those buildings, beds, and 1787
equipment located at the address of the licensed facility and 1788
all other buildings, beds, and equipment for the provision of 1789
hospital or ambulatory surgical care located in such reasonable 1790
proximity to the address of the licensed facility as to appear 1791
to the public to be under the dominion and control of the 1792
licensee. For any licensee that is a teaching hospital as 1793
defined in s. 408.07, rea sonable proximity includes any 1794
buildings, beds, services, programs, and equipment under the 1795
dominion and control of the licensee that are located at a site 1796
with a main address that is within 1 mile of the main address of 1797
the licensed facility; and all such buildings, beds, and 1798
equipment may, at the request of a licensee or applicant, be 1799
included on the facility license as a single premises. 1800
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(27)(28) "Specialty hospital" means any facility which 1801
meets the provisions of subsection (11) (12), and which 1802
regularly makes available either: 1803
(a) The range of medical services offered by general 1804
hospitals but restricted to a defined age or gender group of the 1805
population; 1806
(b) A restricted range of services appropriate to the 1807
diagnosis, care, and treatment of patie nts with specific 1808
categories of medical or psychiatric illnesses or disorders; or 1809
(c) Intensive residential treatment programs for children 1810
and adolescents as defined in subsection (16). 1811
Section 32. Subsection (1) and paragraph (d) of subsection 1812
(5) of section 395.003, Florida Statutes, are amended to read: 1813
395.003 Licensure; denial, suspension, and revocation. — 1814
(1)(a) The requirements of part II of chapter 408 apply to 1815
the provision of services that require licensure pursuant to ss. 1816
395.001-395.1065 and part II of chapter 408 and to entities 1817
licensed by or applying for such licensure from the Agency for 1818
Health Care Administration pursuant to ss. 395.001 -395.1065. A 1819
license issued by the agency is required in order to operate a 1820
hospital or ambulatory surgical center in this state. 1821
(b)1. It is unlawful for a person to use or advertise to 1822
the public, in any way or by any medium whatsoever, any facility 1823
as a "hospital" or "ambulatory surgical center" unless such 1824
facility has first secured a license u nder this part. 1825
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2. This part does not apply to veterinary hospitals or to 1826
commercial business establishments using the word "hospital" or 1827
"ambulatory surgical center" as a part of a trade name if no 1828
treatment of human beings is performed on the premises of such 1829
establishments. 1830
(5) 1831
(d) A hospital, an ambulatory surgical center, a specialty 1832
hospital, or an urgent care center shall comply with ss. 1833
627.64194 and 641.513 as a condition of licensure. 1834
Section 33. Subsections (4) through (19) of section 1835
395.1055, Florida Statutes, are renumbered as subsections (3) 1836
through (18), respectively, and subsection (2) and present 1837
subsections (3) and (9) of that section are amended, to read: 1838
395.1055 Rules and enforcement. — 1839
(2) Separate standards may be provided for general and 1840
specialty hospitals, ambulatory surgical centers, and statutory 1841
rural hospitals as defined in s. 395.602. 1842
(3) The agency shall adopt rules that establish minimum 1843
standards for pediatric patient care in ambulatory surgical 1844
centers to ensure the safe and effective delivery of surgical 1845
care to children in ambulatory surgical centers. Such standards 1846
must include quality of care, nurse staffing, physician 1847
staffing, and equipment standards. Ambulatory surgical centers 1848
may not provide operative procedures to children under 18 years 1849
of age which require a length of stay past midnight until such 1850
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standards are established by rule. 1851
(8)(9) The agency may not adopt any rule governing the 1852
design, construction, erection, alteration, modification, 1853
repair, or demolition of any public or private hospital or, 1854
intermediate residential treatment facility , or ambulatory 1855
surgical center. It is the intent of the Legislature to preempt 1856
that function to the Florida Building Commission and the State 1857
Fire Marshal through adoption and maintenance of the Florida 1858
Building Code and the Florida Fire Prevention Code. However, the 1859
agency shall provide technical assistance to the commission and 1860
the State Fire Marshal in updating the construction standards of 1861
the Florida Building Code and the Florida Fire Prevention Code 1862
which govern hospitals and, intermediate residential treatment 1863
facilities, and ambulatory surgical centers . 1864
Section 34. Subsection (3) of section 395.10973, Florida 1865
Statutes, is amended to read: 1866
395.10973 Powers and duties of the agency. —It is the 1867
function of the agency to: 1868
(3) Enforce the special -occupancy provisions of the 1869
Florida Building Code which apply to hospitals and, intermediate 1870
residential treatment facilities , and ambulatory surgical 1871
centers in conducting any inspection authorized by this chapter 1872
and part II of chapter 408. 1873
Section 35. Subsection (8) of section 395.3025, Florida 1874
Statutes, is amended to read: 1875
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395.3025 Patient and personnel records; copies; 1876
examination.— 1877
(8) Patient records at hospitals and ambulatory surgical 1878
centers are exempt from disclosure under s. 119.07(1), except as 1879
provided by subsections (1) -(5). 1880
Section 36. Subsection (3) of section 395.607, Florida 1881
Statutes, is amended to read: 1882
395.607 Rural emergency h ospitals.— 1883
(3) Notwithstanding s. 395.002 s. 395.002(12), a rural 1884
emergency hospital is not required to offer acute inpatient care 1885
or care beyond 24 hours, or to make available treatment 1886
facilities for surgery, obstetrical care, or similar services in 1887
order to be deemed a hospital as long as it maintains its 1888
designation as a rural emergency hospital, and may be required 1889
to make such services available only if it ceases to be 1890
designated as a rural emergency hospital. 1891
Section 37. Paragraphs (b) and (c) of subsection (1) of 1892
section 395.701, Florida Statutes, are amended to read: 1893
395.701 Annual assessments on net operating revenues for 1894
inpatient and outpatient services to fund public medical 1895
assistance; administrative fines for failure to pay assessments 1896
when due; exemption. — 1897
(1) For the purposes of this section, the term: 1898
(b) "Gross operating revenue" or "gross revenue" means the 1899
sum of daily hospital service charges, ambulatory service 1900
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charges, ancillary service charges, and other operating revenue. 1901
(c) "Hospital" means a health care institution as defined 1902
in s. 395.002 s. 395.002(12), but does not include any hospital 1903
operated by a state agency. 1904
Section 38. Paragraph (b) of subsection (3) of section 1905
400.518, Florida Statutes, is amended to rea d: 1906
400.518 Prohibited referrals to home health agencies. — 1907
(3) 1908
(b) A physician who violates this section is subject to 1909
disciplinary action by the appropriate board under s. 458.331(2) 1910
or s. 459.015(2). A hospital or ambulatory surgical center that 1911
violates this section is subject to s. 395.0185(2). An 1912
ambulatory surgical center that violates this section is subject 1913
to s. 396.209. 1914
Section 39. Paragraph (h) of subsection (5) of section 1915
400.93, Florida Statutes, is amended to read: 1916
400.93 Licensure required; exemptions; unlawful acts; 1917
penalties.— 1918
(5) The following are exempt from home medical equipment 1919
provider licensure, unless they have a separate company, 1920
corporation, or division that is in the business of providing 1921
home medical equipment and se rvices for sale or rent to 1922
consumers at their regular or temporary place of residence 1923
pursuant to the provisions of this part: 1924
(h) Hospitals licensed under chapter 395 and ambulatory 1925
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surgical centers licensed under chapter 396 395. 1926
Section 40. Paragraph (i) of subsection (1) of section 1927
400.9935, Florida Statutes, is amended to read: 1928
400.9935 Clinic responsibilities. — 1929
(1) Each clinic shall appoint a medical director or clinic 1930
director who shall agree in writing to accept legal 1931
responsibility for th e following activities on behalf of the 1932
clinic. The medical director or the clinic director shall: 1933
(i) Ensure that the clinic publishes a schedule of charges 1934
for the medical services offered to patients. The schedule must 1935
include the prices charged to an uninsured person paying for 1936
such services by cash, check, credit card, or debit card. The 1937
schedule may group services by price levels, listing services in 1938
each price level. The schedule must be posted in a conspicuous 1939
place in the reception area of any cl inic that is considered an 1940
urgent care center as defined in s. 395.002 s. 395.002(30)(b) 1941
and must include, but is not limited to, the 50 services most 1942
frequently provided by the clinic. The posting may be a sign 1943
that must be at least 15 square feet in size or through an 1944
electronic messaging board that is at least 3 square feet in 1945
size. The failure of a clinic, including a clinic that is 1946
considered an urgent care center, to publish and post a schedule 1947
of charges as required by this section shall result in a fine of 1948
not more than $1,000, per day, until the schedule is published 1949
and posted. 1950
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Section 41. Paragraph (b) of subsection (2) of section 1951
401.272, Florida Statutes, is amended to read: 1952
401.272 Emergency medical services community health care. — 1953
(2) Notwithstanding any other provision of law to the 1954
contrary: 1955
(b) Paramedics and emergency medical technicians shall 1956
operate under the medical direction of a physician through two -1957
way communication or pursuant to established standing orders or 1958
protocols and within the scope of their training when a patient 1959
is not transported to an emergency department or is transported 1960
to a facility other than a hospital as defined in s. 395.002 s. 1961
395.002(12). 1962
Section 42. Subsections (4) and (5) of section 408.051, 1963
Florida Statutes, are amended to read: 1964
408.051 Florida Electronic Health Records Exchange Act. — 1965
(4) EMERGENCY RELEASE OF IDENTIFIABLE HEALTH RECORD. —A 1966
health care provider may release or access an identifiable 1967
health record of a patient without the patien t's consent for use 1968
in the treatment of the patient for an emergency medical 1969
condition, as defined in s. 395.002 s. 395.002(8), when the 1970
health care provider is unable to obtain the patient's consent 1971
or the consent of the patient representative due to the 1972
patient's condition or the nature of the situation requiring 1973
immediate medical attention. A health care provider who in good 1974
faith releases or accesses an identifiable health record of a 1975
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patient in any form or medium under this subsection is immune 1976
from civil liability for accessing or releasing an identifiable 1977
health record. 1978
(5) HOSPITAL DATA.—A hospital as defined in s. 395.002 s. 1979
395.002(12) which maintains certified electronic health record 1980
technology must make available admit, transfer, and discharge 1981
data to the agency's Florida Health Information Exchange program 1982
for the purpose of supporting public health data registries and 1983
patient care coordination. The agency may adopt rules to 1984
implement this subsection. 1985
Section 43. Subsection (6) of section 408.07, Florida 1986
Statutes, is amended to read: 1987
408.07 Definitions. —As used in this chapter, with the 1988
exception of ss. 408.031 -408.045, the term: 1989
(6) "Ambulatory surgical center" means a facility licensed 1990
as an ambulatory surgical center under chapter 396 395. 1991
Section 44. Subsection (9) of section 408.802, Florida 1992
Statutes, is amended to read: 1993
408.802 Applicability. —This part applies to the provision 1994
of services that require licensure as defined in this part and 1995
to the following entities licensed, r egistered, or certified by 1996
the agency, as described in chapters 112, 383, 390, 394, 395, 1997
400, 429, 440, and 765: 1998
(9) Ambulatory surgical centers, as provided under part I 1999
of chapter 396 395. 2000
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Section 45. Subsection (9) of section 408.820, Florida 2001
Statutes, is amended to read: 2002
408.820 Exemptions. —Except as prescribed in authorizing 2003
statutes, the following exemptions shall apply to specified 2004
requirements of this part: 2005
(9) Ambulatory surgical centers, as provided under part I 2006
of chapter 396 395, are exempt from s. 408.810(7) -(10). 2007
Section 46. Subsection (8) of section 409.905, Florida 2008
Statutes, is amended to read: 2009
409.905 Mandatory Medicaid services. —The agency may make 2010
payments for the following services, which are required of the 2011
state by Title XIX of the Social Security Act, furnished by 2012
Medicaid providers to recipients who are determined to be 2013
eligible on the dates on which the services were provided. Any 2014
service under this section shall be provided only when medically 2015
necessary and in accord ance with state and federal law. 2016
Mandatory services rendered by providers in mobile units to 2017
Medicaid recipients may be restricted by the agency. Nothing in 2018
this section shall be construed to prevent or limit the agency 2019
from adjusting fees, reimbursement r ates, lengths of stay, 2020
number of visits, number of services, or any other adjustments 2021
necessary to comply with the availability of moneys and any 2022
limitations or directions provided for in the General 2023
Appropriations Act or chapter 216. 2024
(8) NURSING FACILIT Y SERVICES.—The agency shall pay for 2025
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24-hour-a-day nursing and rehabilitative services for a 2026
recipient in a nursing facility licensed under part II of 2027
chapter 400 or in a rural hospital, as defined in s. 395.602, or 2028
in a Medicare certified skilled nursing facility operated by a 2029
hospital, as defined in s. 395.002 by s. 395.002(10), that is 2030
licensed under part I of chapter 395, and in accordance with 2031
provisions set forth in s. 409.908(2)(a), which services are 2032
ordered by and provided under the direction of a licensed 2033
physician. However, if a nursing facility has been destroyed or 2034
otherwise made uninhabitable by natural disaster or other 2035
emergency and another nursing facility is not available, the 2036
agency must pay for similar services temporarily in a hospital 2037
licensed under part I of chapter 395 provided federal funding is 2038
approved and available. The agency shall pay only for bed -hold 2039
days if the facility has an occupancy rate of 95 percent or 2040
greater. The agency is authorized to seek any federal waivers to 2041
implement this policy. 2042
Section 47. Subsection (3) of section 409.906, Florida 2043
Statutes, is amended to read: 2044
409.906 Optional Medicaid services. —Subject to specific 2045
appropriations, the agency may make payments for services which 2046
are optional to the state under Title XIX of the Social Security 2047
Act and are furnished by Medicaid providers to recipients who 2048
are determined to be eligible on the dates on which the services 2049
were provided. Any optional service that is provided shall be 2050
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provided only when medically necessary and in accordance with 2051
state and federal law. Optional services rendered by providers 2052
in mobile units to Medicaid recipients may be restricted or 2053
prohibited by the agency. Nothing in this section shall be 2054
construed to prevent or limit the agency from adjusting fees, 2055
reimbursement rates, lengths of stay, number of visits, or 2056
number of services, or making any other adjustments necessary to 2057
comply with the availability of moneys and any limitations or 2058
directions provided for in the General Appropria tions Act or 2059
chapter 216. If necessary to safeguard the state's systems of 2060
providing services to elderly and disabled persons and subject 2061
to the notice and review provisions of s. 216.177, the Governor 2062
may direct the Agency for Health Care Administration t o amend 2063
the Medicaid state plan to delete the optional Medicaid service 2064
known as "Intermediate Care Facilities for the Developmentally 2065
Disabled." Optional services may include: 2066
(3) AMBULATORY SURGICAL CENTER SERVICES. —The agency may 2067
pay for services prov ided to a recipient in an ambulatory 2068
surgical center licensed under part I of chapter 396 395, by or 2069
under the direction of a licensed physician or dentist. 2070
Section 48. Paragraph (b) of subsection (1) of section 2071
409.975, Florida Statutes, is amended to read: 2072
409.975 Managed care plan accountability. —In addition to 2073
the requirements of s. 409.967, plans and providers 2074
participating in the managed medical assistance program shall 2075
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comply with the requirements of this section. 2076
(1) PROVIDER NETWORKS. —Managed care plans must develop and 2077
maintain provider networks that meet the medical needs of their 2078
enrollees in accordance with standards established pursuant to 2079
s. 409.967(2)(c). Except as provided in this section, managed 2080
care plans may limit the providers i n their networks based on 2081
credentials, quality indicators, and price. 2082
(b) Certain providers are statewide resources and 2083
essential providers for all managed care plans in all regions. 2084
All managed care plans must include these essential providers in 2085
their networks. Statewide essential providers include: 2086
1. Faculty plans of Florida medical schools. 2087
2. Regional perinatal intensive care centers as defined in 2088
s. 383.16(2). 2089
3. Hospitals licensed as specialty children's hospitals as 2090
defined in s. 395.002 s. 395.002(28). 2091
4. Accredited and integrated systems serving medically 2092
complex children which comprise separately licensed, but 2093
commonly owned, health care providers delivering at least the 2094
following services: medical group home, in -home and outpatient 2095
nursing care and therapies, pharmacy services, durable medical 2096
equipment, and Prescribed Pediatric Extended Care. 2097
5. Florida cancer hospitals that meet the criteria in 42 2098
U.S.C. s. 1395ww(d)(1)(B)(v). 2099
2100
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Managed care plans that have not contracted with all st atewide 2101
essential providers in all regions as of the first date of 2102
recipient enrollment must continue to negotiate in good faith. 2103
Payments to physicians on the faculty of nonparticipating 2104
Florida medical schools shall be made at the applicable Medicaid 2105
rate. Payments for services rendered by regional perinatal 2106
intensive care centers shall be made at the applicable Medicaid 2107
rate as of the first day of the contract between the agency and 2108
the plan. Except for payments for emergency services, payments 2109
to nonparticipating specialty children's hospitals, and payments 2110
to nonparticipating Florida cancer hospitals that meet the 2111
criteria in 42 U.S.C. s. 1395ww(d)(1)(B)(v), shall equal the 2112
highest rate established by contract between that provider and 2113
any other Medicaid managed care plan. 2114
Section 49. Subsection (5) of section 456.041, Florida 2115
Statutes, is amended to read: 2116
456.041 Practitioner profile; creation. — 2117
(5) The Department of Health shall include the date of a 2118
hospital or ambulatory surgical center disci plinary action taken 2119
by a licensed hospital or an ambulatory surgical center, in 2120
accordance with the requirements of s. 395.0193 and s. 396.212, 2121
in the practitioner profile. The department shall state whether 2122
the action related to professional competence a nd whether it 2123
related to the delivery of services to a patient. 2124
Section 50. Paragraph (n) of subsection (3) of section 2125
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456.053, Florida Statutes, is amended to read: 2126
456.053 Financial arrangements between referring health 2127
care providers and providers of health care services. — 2128
(3) DEFINITIONS.—For the purpose of this section, the 2129
word, phrase, or term: 2130
(n) "Referral" means any referral of a patient by a health 2131
care provider for health care services, including, without 2132
limitation: 2133
1. The forwarding of a patient by a health care provider 2134
to another health care provider or to an entity which provides 2135
or supplies designated health services or any other health care 2136
item or service; or 2137
2. The request or establishment of a plan of care by a 2138
health care provider, which includes the provision of designated 2139
health services or other health care item or service. 2140
3. The following orders, recommendations, or plans of care 2141
shall not constitute a referral by a health care provider: 2142
a. By a radiologist for diagnostic-imaging services. 2143
b. By a physician specializing in the provision of 2144
radiation therapy services for such services. 2145
c. By a medical oncologist for drugs and solutions to be 2146
prepared and administered intravenously to such oncologist's 2147
patient, as well as for the supplies and equipment used in 2148
connection therewith to treat such patient for cancer and the 2149
complications thereof. 2150
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d. By a cardiologist for cardiac catheterization services. 2151
e. By a pathologist for diagnostic clinical laboratory 2152
tests and pathological examination services, if furnished by or 2153
under the supervision of such pathologist pursuant to a 2154
consultation requested by another physician. 2155
f. By a health care provider who is the sole provider or 2156
member of a group practice for des ignated health services or 2157
other health care items or services that are prescribed or 2158
provided solely for such referring health care provider's or 2159
group practice's own patients, and that are provided or 2160
performed by or under the supervision of such referri ng health 2161
care provider or group practice if such supervision complies 2162
with all applicable Medicare payment and coverage rules for 2163
services; provided, however, a physician licensed pursuant to 2164
chapter 458, chapter 459, chapter 460, or chapter 461 or an 2165
advanced practice registered nurse registered under s. 464.0123 2166
may refer a patient to a sole provider or group practice for 2167
diagnostic imaging services, excluding radiation therapy 2168
services, for which the sole provider or group practice billed 2169
both the technical and the professional fee for or on behalf of 2170
the patient, if the referring physician or advanced practice 2171
registered nurse registered under s. 464.0123 has no investment 2172
interest in the practice. The diagnostic imaging service 2173
referred to a group prac tice or sole provider must be a 2174
diagnostic imaging service normally provided within the scope of 2175
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practice to the patients of the group practice or sole provider. 2176
The group practice or sole provider may accept no more than 15 2177
percent of their patients recei ving diagnostic imaging services 2178
from outside referrals, excluding radiation therapy services. 2179
However, the 15 percent limitation of this sub -subparagraph and 2180
the requirements of subparagraph (4)(a)2. do not apply to a 2181
group practice entity that owns an ac countable care organization 2182
or an entity operating under an advanced alternative payment 2183
model according to federal regulations if such entity provides 2184
diagnostic imaging services and has more than 30,000 patients 2185
enrolled per year. 2186
g. By a health care p rovider for services provided by an 2187
ambulatory surgical center licensed under chapter 396 395. 2188
h. By a urologist for lithotripsy services. 2189
i. By a dentist for dental services performed by an 2190
employee of or health care provider who is an independent 2191
contractor with the dentist or group practice of which the 2192
dentist is a member. 2193
j. By a physician for infusion therapy services to a 2194
patient of that physician or a member of that physician's group 2195
practice. 2196
k. By a nephrologist for renal dialysis services and 2197
supplies, except laboratory services. 2198
l. By a health care provider whose principal professional 2199
practice consists of treating patients in their private 2200
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residences for services to be rendered in such private 2201
residences, except for services rendered b y a home health agency 2202
licensed under chapter 400. For purposes of this sub -2203
subparagraph, the term "private residences" includes patients' 2204
private homes, independent living centers, and assisted living 2205
facilities, but does not include skilled nursing facil ities. 2206
m. By a health care provider for sleep -related testing. 2207
Section 51. Subsection (3) of section 456.056, Florida 2208
Statutes, is amended to read: 2209
456.056 Treatment of Medicare beneficiaries; refusal, 2210
emergencies, consulting physicians. — 2211
(3) If treatment is provided to a beneficiary for an 2212
emergency medical condition as defined in s. 395.002 s. 2213
395.002(8)(a), the physician must accept Medicare assignment 2214
provided that the requirement to accept Medicare assignment for 2215
an emergency medical conditio n shall not apply to treatment 2216
rendered after the patient is stabilized, or the treatment is 2217
unrelated to the original emergency medical condition. For the 2218
purpose of this subsection "stabilized" is defined to mean with 2219
respect to an emergency medical cond ition, that no material 2220
deterioration of the condition is likely within reasonable 2221
medical probability. 2222
Section 52. Subsection (3) of section 458.3145, Florida 2223
Statutes, is amended to read: 2224
458.3145 Medical faculty certificate. — 2225
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(3) The holder of a medical faculty certificate issued 2226
under this section has all rights and responsibilities 2227
prescribed by law for the holder of a license issued under s. 2228
458.311, except as specifically provided otherwise by law. Such 2229
responsibilities include compliance wit h continuing medical 2230
education requirements as set forth by rule of the board. A 2231
hospital or ambulatory surgical center licensed under chapter 2232
396 395, health maintenance organization certified under chapter 2233
641, insurer as defined in s. 624.03, multiple -employer welfare 2234
arrangement as defined in s. 624.437, or any other entity in 2235
this state, in considering and acting upon an application for 2236
staff membership, clinical privileges, or other credentials as a 2237
health care provider, may not deny the application o f an 2238
otherwise qualified physician for such staff membership, 2239
clinical privileges, or other credentials solely because the 2240
applicant is a holder of a medical faculty certificate under 2241
this section. 2242
Section 53. Subsection (2) of section 458.320, Florida 2243
Statutes, is amended to read: 2244
458.320 Financial responsibility. — 2245
(2) Physicians who perform surgery in an ambulatory 2246
surgical center licensed under chapter 396 395 and, as a 2247
continuing condition of hospital staff privileges, physicians 2248
who have staff privileges must also establish financial 2249
responsibility by one of the following methods: 2250
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(a) Establishing and maintaining an escrow account 2251
consisting of cash or assets eligible for deposit in accordance 2252
with s. 625.52 in the per claim amounts specified in paragraph 2253
(b). The required escrow amount set forth in this paragraph may 2254
not be used for litigation costs or attorney's fees for the 2255
defense of any medical malpractice claim. 2256
(b) Obtaining and maintaining professional liability 2257
coverage in an amount not less than $250,000 per claim, with a 2258
minimum annual aggregate of not less than $750,000 from an 2259
authorized insurer as defined under s. 624.09, from a surplus 2260
lines insurer as defined under s. 626.914(2), from a risk 2261
retention group as defined under s. 627.942, from the Joint 2262
Underwriting Association established under s. 627.351(4), 2263
through a plan of self -insurance as provided in s. 627.357, or 2264
through a plan of self -insurance which meets the conditions 2265
specified for satisfying financial responsibility i n s. 766.110. 2266
The required coverage amount set forth in this paragraph may not 2267
be used for litigation costs or attorney attorney's fees for the 2268
defense of any medical malpractice claim. 2269
(c) Obtaining and maintaining an unexpired irrevocable 2270
letter of credit, established pursuant to chapter 675, in an 2271
amount not less than $250,000 per claim, with a minimum 2272
aggregate availability of credit of not less than $750,000. The 2273
letter of credit must be payable to the physician as beneficiary 2274
upon presentment of a f inal judgment indicating liability and 2275
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awarding damages to be paid by the physician or upon presentment 2276
of a settlement agreement signed by all parties to such 2277
agreement when such final judgment or settlement is a result of 2278
a claim arising out of the rende ring of, or the failure to 2279
render, medical care and services. The letter of credit may not 2280
be used for litigation costs or attorney's fees for the defense 2281
of any medical malpractice claim. The letter of credit must be 2282
nonassignable and nontransferable. The letter of credit must be 2283
issued by any bank or savings association organized and existing 2284
under the laws of this state or any bank or savings association 2285
organized under the laws of the United States which has its 2286
principal place of business in this state or has a branch office 2287
that is authorized under the laws of this state or of the United 2288
States to receive deposits in this state. 2289
2290
This subsection shall be inclusive of the coverage in subsection 2291
(1). 2292
Section 54. Paragraph (f) of subsection (4) of sec tion 2293
458.351, Florida Statutes, is amended to read: 2294
458.351 Reports of adverse incidents in office practice 2295
settings.— 2296
(4) For purposes of notification to the department 2297
pursuant to this section, the term "adverse incident" means an 2298
event over which the physician or licensee could exercise 2299
control and which is associated in whole or in part with a 2300
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medical intervention, ra ther than the condition for which such 2301
intervention occurred, and which results in the following 2302
patient injuries: 2303
(f) Any condition that required the transfer of a patient 2304
to a hospital licensed under chapter 395 from an ambulatory 2305
surgical center licen sed under chapter 396 395 or any facility 2306
or any office maintained by a physician for the practice of 2307
medicine which is not licensed under chapter 395. 2308
Section 55. Subsection (2) of section 459.0085, Florida 2309
Statutes, is amended to read: 2310
459.0085 Financial responsibility. — 2311
(2) Osteopathic physicians who perform surgery in an 2312
ambulatory surgical center licensed under chapter 396 395 and, 2313
as a continuing condition of hospital staff privileges, 2314
osteopathic physicians who have staff privileges must also 2315
establish financial responsibility by one of the following 2316
methods: 2317
(a) Establishing and maintaining an escrow account 2318
consisting of cash or assets eligible for deposit in accordance 2319
with s. 625.52 in the per -claim amounts specified in paragraph 2320
(b). The required escrow amount set forth in this paragraph may 2321
not be used for litigation costs or attorney's fees for the 2322
defense of any medical malpractice claim. 2323
(b) Obtaining and maintaining professional liability 2324
coverage in an amount not less than $250,0 00 per claim, with a 2325
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minimum annual aggregate of not less than $750,000 from an 2326
authorized insurer as defined under s. 624.09, from a surplus 2327
lines insurer as defined under s. 626.914(2), from a risk 2328
retention group as defined under s. 627.942, from the Jo int 2329
Underwriting Association established under s. 627.351(4), 2330
through a plan of self -insurance as provided in s. 627.357, or 2331
through a plan of self -insurance that meets the conditions 2332
specified for satisfying financial responsibility in s. 766.110. 2333
The required coverage amount set forth in this paragraph may not 2334
be used for litigation costs or attorney's fees for the defense 2335
of any medical malpractice claim. 2336
(c) Obtaining and maintaining an unexpired, irrevocable 2337
letter of credit, established pursuant to chapter 675, in an 2338
amount not less than $250,000 per claim, with a minimum 2339
aggregate availability of credit of not less than $750,000. The 2340
letter of credit must be payable to the osteopathic physician as 2341
beneficiary upon presentment of a final judgment ind icating 2342
liability and awarding damages to be paid by the osteopathic 2343
physician or upon presentment of a settlement agreement signed 2344
by all parties to such agreement when such final judgment or 2345
settlement is a result of a claim arising out of the rendering 2346
of, or the failure to render, medical care and services. The 2347
letter of credit may not be used for litigation costs or 2348
attorney's fees for the defense of any medical malpractice 2349
claim. The letter of credit must be nonassignable and 2350
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nontransferable. The lett er of credit must be issued by any bank 2351
or savings association organized and existing under the laws of 2352
this state or any bank or savings association organized under 2353
the laws of the United States which has its principal place of 2354
business in this state or h as a branch office that is authorized 2355
under the laws of this state or of the United States to receive 2356
deposits in this state. 2357
2358
This subsection shall be inclusive of the coverage in subsection 2359
(1). 2360
Section 56. Paragraph (f) of subsection (4) of section 2361
459.026, Florida Statutes, is amended to read: 2362
459.026 Reports of adverse incidents in office practice 2363
settings.— 2364
(4) For purposes of notification to the department 2365
pursuant to this section, the term "adverse incident" means an 2366
event over which the phy sician or licensee could exercise 2367
control and which is associated in whole or in part with a 2368
medical intervention, rather than the condition for which such 2369
intervention occurred, and which results in the following 2370
patient injuries: 2371
(f) Any condition that required the transfer of a patient 2372
to a hospital licensed under chapter 395 from an ambulatory 2373
surgical center licensed under chapter 396 395 or any facility 2374
or any office maintained by a physician for the practice of 2375
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medicine which is not licensed under chapter 395. 2376
Section 57. Paragraph (e) of subsection (1) of section 2377
465.0125, Florida Statutes, is amended to read: 2378
465.0125 Consultant pharmacist license; application, 2379
renewal, fees; responsibilities; rules. — 2380
(1) The department shall issue or rene w a consultant 2381
pharmacist license upon receipt of an initial or renewal 2382
application that conforms to the requirements for consultant 2383
pharmacist initial licensure or renewal as adopted by the board 2384
by rule and a fee set by the board not to exceed $250. To b e 2385
licensed as a consultant pharmacist, a pharmacist must complete 2386
additional training as required by the board. 2387
(e) For purposes of this subsection, the term "health care 2388
facility" means an ambulatory surgical center licensed under 2389
chapter 396, a or hospital licensed under chapter 395, an 2390
alcohol or chemical dependency treatment center licensed under 2391
chapter 397, an inpatient hospice licensed under part IV of 2392
chapter 400, a nursing home licensed under part II of chapter 2393
400, an ambulatory care center as d efined in s. 408.07, or a 2394
nursing home component under chapter 400 within a continuing 2395
care facility licensed under chapter 651. 2396
Section 58. Paragraph (l) of subsection (1) of section 2397
468.505, Florida Statutes, is amended to read: 2398
468.505 Exemptions; exceptions.— 2399
(1) Nothing in this part may be construed as prohibiting 2400
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or restricting the practice, services, or activities of: 2401
(l) A person employed by a nursing facility exempt from 2402
licensing under s. 395.002 s. 395.002(12), or a person exempt 2403
from licensing under s. 464.022. 2404
Section 59. Paragraph (h) of subsection (4) of section 2405
627.351, Florida Statutes, is amended to read: 2406
627.351 Insurance risk apportionment plans. — 2407
(4) MEDICAL MALPRACTICE RISK APPORTIONMENT; ASSOCIATION 2408
CONTRACTS AND PURCHASES.— 2409
(h) As used in this subsection: 2410
1. "Health care provider" means hospitals licensed under 2411
chapter 395; physicians licensed under chapter 458; osteopathic 2412
physicians licensed under chapter 459; podiatric physicians 2413
licensed under chapter 461; de ntists licensed under chapter 466; 2414
chiropractic physicians licensed under chapter 460; naturopaths 2415
licensed under chapter 462; nurses licensed under part I of 2416
chapter 464; midwives licensed under chapter 467; physician 2417
assistants licensed under chapter 458 or chapter 459; physical 2418
therapists and physical therapist assistants licensed under 2419
chapter 486; health maintenance organizations certificated under 2420
part I of chapter 641; ambulatory surgical centers licensed 2421
under chapter 396 395; other medical faciliti es as defined in 2422
subparagraph 2.; blood banks, plasma centers, industrial 2423
clinics, and renal dialysis facilities; or professional 2424
associations, partnerships, corporations, joint ventures, or 2425
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other associations for professional activity by health care 2426
providers. 2427
2. "Other medical facility" means a facility the primary 2428
purpose of which is to provide human medical diagnostic services 2429
or a facility providing nonsurgical human medical treatment, to 2430
which facility the patient is admitted and from which facility 2431
the patient is discharged within the same working day, and which 2432
facility is not part of a hospital. However, a facility existing 2433
for the primary purpose of performing terminations of pregnancy 2434
or an office maintained by a physician or dentist for the 2435
practice of medicine may not be construed to be an "other 2436
medical facility." 2437
3. "Health care facility" means any hospital licensed 2438
under chapter 395, health maintenance organization certificated 2439
under part I of chapter 641, ambulatory surgical center licens ed 2440
under chapter 396 395, or other medical facility as defined in 2441
subparagraph 2. 2442
Section 60. Paragraph (b) of subsection (1) of section 2443
627.357, Florida Statutes, is amended to read: 2444
627.357 Medical malpractice self -insurance.— 2445
(1) DEFINITIONS.—As used in this section, the term: 2446
(b) "Health care provider" means any: 2447
1. Hospital licensed under chapter 395. 2448
2. Physician licensed, or physician assistant licensed, 2449
under chapter 458. 2450
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3. Osteopathic physician or physician assistant licensed 2451
under chapter 459. 2452
4. Podiatric physician licensed under chapter 461. 2453
5. Health maintenance organization certificated under part 2454
I of chapter 641. 2455
6. Ambulatory surgical center licensed under chapter 396 2456
395. 2457
7. Chiropractic physician licensed under cha pter 460. 2458
8. Psychologist licensed under chapter 490. 2459
9. Optometrist licensed under chapter 463. 2460
10. Dentist licensed under chapter 466. 2461
11. Pharmacist licensed under chapter 465. 2462
12. Registered nurse, licensed practical nurse, or 2463
advanced practice registered nurse licensed or registered under 2464
part I of chapter 464. 2465
13. Other medical facility. 2466
14. Professional association, partnership, corporation, 2467
joint venture, or other association established by the 2468
individuals set forth in subparagraphs 2. , 3., 4., 7., 8., 9., 2469
10., 11., and 12. for professional activity. 2470
Section 61. Section 627.6056, Florida Statutes, is amended 2471
to read: 2472
627.6056 Coverage for ambulatory surgical center service. —2473
An No individual health insurance policy providing covera ge on 2474
an expense-incurred basis or individual service or indemnity -2475
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type contract issued by a nonprofit corporation, of any kind or 2476
description, may not shall be issued unless coverage provided 2477
for any service performed in an ambulatory surgical center, as 2478
defined in s. 396.202 s. 395.002, is provided if such service 2479
would have been covered under the terms of the policy or 2480
contract as an eligible inpatient service. 2481
Section 62. Subsection (3) of section 627.6405, Florida 2482
Statutes, is amended to read: 2483
627.6405 Decreasing inappropriate utilization of emergency 2484
care.— 2485
(3) As a disincentive for insureds to inappropriately use 2486
emergency department services for nonemergency care, health 2487
insurers may require higher copayments for urgent care or 2488
primary care provided in an emergency department and higher 2489
copayments for use of out -of-network emergency departments. 2490
Higher copayments may not be charged for the utilization of the 2491
emergency department for emergency care. For the purposes of 2492
this section, the term "e mergency care" has the same meaning as 2493
the term "emergency services and care" as defined in s. 395.002 2494
s. 395.002(9) and includes services provided to rule out an 2495
emergency medical condition. 2496
Section 63. Paragraph (b) of subsection (1) of section 2497
627.64194, Florida Statutes, is amended to read: 2498
627.64194 Coverage requirements for services provided by 2499
nonparticipating providers; payment collection limitations. — 2500
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(1) As used in this section, the term: 2501
(b) "Facility" means a licensed facility as defin ed in s. 2502
395.002 s. 395.002(17) and an urgent care center as defined in 2503
s. 395.002. 2504
Section 64. Section 627.6616, Florida Statutes, is amended 2505
to read: 2506
627.6616 Coverage for ambulatory surgical center service. —2507
A No group health insurance policy provi ding coverage on an 2508
expense-incurred basis, or group service or indemnity -type 2509
contract issued by a nonprofit corporation, or self -insured 2510
group health benefit plan or trust, of any kind or description, 2511
may not shall be issued unless coverage provided for any service 2512
performed in an ambulatory surgical center, as defined in s. 2513
396.202 s. 395.002, is provided if such service would have been 2514
covered under the terms of the policy or contract as an eligible 2515
inpatient service. 2516
Section 65. Paragraph (a) of subsection (1) of section 2517
627.736, Florida Statutes, is amended to read: 2518
627.736 Required personal injury protection benefits; 2519
exclusions; priority; claims. — 2520
(1) REQUIRED BENEFITS. —An insurance policy complying with 2521
the security requirements of s. 627. 733 must provide personal 2522
injury protection to the named insured, relatives residing in 2523
the same household unless excluded under s. 627.747, persons 2524
operating the insured motor vehicle, passengers in the motor 2525
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vehicle, and other persons struck by the motor vehicle and 2526
suffering bodily injury while not an occupant of a self -2527
propelled vehicle, subject to subsection (2) and paragraph 2528
(4)(e), to a limit of $10,000 in medical and disability benefits 2529
and $5,000 in death benefits resulting from bodily injury, 2530
sickness, disease, or death arising out of the ownership, 2531
maintenance, or use of a motor vehicle as follows: 2532
(a) Medical benefits. —Eighty percent of all reasonable 2533
expenses for medically necessary medical, surgical, X -ray, 2534
dental, and rehabilitative services , including prosthetic 2535
devices and medically necessary ambulance, hospital, and nursing 2536
services if the individual receives initial services and care 2537
pursuant to subparagraph 1. within 14 days after the motor 2538
vehicle accident. The medical benefits provide reimbursement 2539
only for: 2540
1. Initial services and care that are lawfully provided, 2541
supervised, ordered, or prescribed by a physician licensed under 2542
chapter 458 or chapter 459, a dentist licensed under chapter 2543
466, a chiropractic physician licensed under ch apter 460, or an 2544
advanced practice registered nurse registered under s. 464.0123 2545
or that are provided in a hospital or in a facility that owns, 2546
or is wholly owned by, a hospital. Initial services and care may 2547
also be provided by a person or entity licensed under part III 2548
of chapter 401 which provides emergency transportation and 2549
treatment. 2550
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2. Upon referral by a provider described in subparagraph 2551
1., followup services and care consistent with the underlying 2552
medical diagnosis rendered pursuant to subparagra ph 1. which may 2553
be provided, supervised, ordered, or prescribed only by a 2554
physician licensed under chapter 458 or chapter 459, a 2555
chiropractic physician licensed under chapter 460, a dentist 2556
licensed under chapter 466, or an advanced practice registered 2557
nurse registered under s. 464.0123, or, to the extent permitted 2558
by applicable law and under the supervision of such physician, 2559
osteopathic physician, chiropractic physician, or dentist, by a 2560
physician assistant licensed under chapter 458 or chapter 459 or 2561
an advanced practice registered nurse licensed under chapter 2562
464. Followup services and care may also be provided by the 2563
following persons or entities: 2564
a. A hospital or ambulatory surgical center licensed under 2565
chapter 396 395. 2566
b. An entity wholly owned b y one or more physicians 2567
licensed under chapter 458 or chapter 459, chiropractic 2568
physicians licensed under chapter 460, advanced practice 2569
registered nurses registered under s. 464.0123, or dentists 2570
licensed under chapter 466 or by such practitioners and th e 2571
spouse, parent, child, or sibling of such practitioners. 2572
c. An entity that owns or is wholly owned, directly or 2573
indirectly, by a hospital or hospitals. 2574
d. A physical therapist licensed under chapter 486, based 2575
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upon a referral by a provider described in this subparagraph. 2576
e. A health care clinic licensed under part X of chapter 2577
400 which is accredited by an accrediting organization whose 2578
standards incorporate comparable regulations required by this 2579
state, or 2580
(I) Has a medical director licensed unde r chapter 458, 2581
chapter 459, or chapter 460; 2582
(II) Has been continuously licensed for more than 3 years 2583
or is a publicly traded corporation that issues securities 2584
traded on an exchange registered with the United States 2585
Securities and Exchange Commission as a national securities 2586
exchange; and 2587
(III) Provides at least four of the following medical 2588
specialties: 2589
(A) General medicine. 2590
(B) Radiography. 2591
(C) Orthopedic medicine. 2592
(D) Physical medicine. 2593
(E) Physical therapy. 2594
(F) Physical rehabilitation. 2595
(G) Prescribing or dispensing outpatient prescription 2596
medication. 2597
(H) Laboratory services. 2598
3. Reimbursement for services and care provided in 2599
subparagraph 1. or subparagraph 2. up to $10,000 if a physician 2600
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licensed under chapter 458 or chapter 459, a dentist licensed 2601
under chapter 466, a physician assistant licensed under chapter 2602
458 or chapter 459, or an advanced practice registered nurse 2603
licensed under chapter 464 has determined that the injured 2604
person had an emergency medical condition. 2605
4. Reimbursement for services and care provided in 2606
subparagraph 1. or subparagraph 2. is limited to $2,500 if a 2607
provider listed in subparagraph 1. or subparagraph 2. determines 2608
that the injured person did not have an emergency medical 2609
condition. 2610
5. Medical benefits do not include massage therapy as 2611
defined in s. 480.033 or acupuncture as defined in s. 457.102, 2612
regardless of the person, entity, or licensee providing massage 2613
therapy or acupuncture, and a licensed massage therapist or 2614
licensed acupuncturist may not b e reimbursed for medical 2615
benefits under this section. 2616
6. The Financial Services Commission shall adopt by rule 2617
the form that must be used by an insurer and a health care 2618
provider specified in sub -subparagraph 2.b., sub -subparagraph 2619
2.c., or sub-subparagraph 2.e. to document that the health care 2620
provider meets the criteria of this paragraph. Such rule must 2621
include a requirement for a sworn statement or affidavit. 2622
2623
Only insurers writing motor vehicle liability insurance in this 2624
state may provide the require d benefits of this section, and 2625
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such insurer may not require the purchase of any other motor 2626
vehicle coverage other than the purchase of property damage 2627
liability coverage as required by s. 627.7275 as a condition for 2628
providing such benefits. Insurers may not require that property 2629
damage liability insurance in an amount greater than $10,000 be 2630
purchased in conjunction with personal injury protection. Such 2631
insurers shall make benefits and required property damage 2632
liability insurance coverage available throug h normal marketing 2633
channels. An insurer writing motor vehicle liability insurance 2634
in this state who fails to comply with such availability 2635
requirement as a general business practice violates part IX of 2636
chapter 626, and such violation constitutes an unfair method of 2637
competition or an unfair or deceptive act or practice involving 2638
the business of insurance. An insurer committing such violation 2639
is subject to the penalties provided under that part, as well as 2640
those provided elsewhere in the insurance code. 2641
Section 66. Paragraph (a) of subsection (1) of section 2642
627.912, Florida Statutes, is amended to read: 2643
627.912 Professional liability claims and actions; reports 2644
by insurers and health care providers; annual report by office. — 2645
(1)(a) Each self-insurer authorized under s. 627.357 and 2646
each commercial self -insurance fund authorized under s. 624.462, 2647
authorized insurer, surplus lines insurer, risk retention group, 2648
and joint underwriting association providing professional 2649
liability insurance to a practitioner of medicine licensed under 2650
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chapter 458, to a practitioner of osteopathic medicine licensed 2651
under chapter 459, to a podiatric physician licensed under 2652
chapter 461, to a dentist licensed under chapter 466, to a 2653
hospital licensed under chapter 395, to a crisis stabilization 2654
unit licensed under part IV of chapter 394, to a health 2655
maintenance organization certificated under part I of chapter 2656
641, to clinics included in chapter 390, or to an ambulatory 2657
surgical center as defined in s. 396.202 s. 395.002, and each 2658
insurer providing professional liability insurance to a member 2659
of The Florida Bar shall report to the office as set forth in 2660
paragraph (c) any written claim or action for damages for 2661
personal injuries claimed to have been caused by error, 2662
omission, or negligence in the performance of such insured's 2663
professional services or based on a claimed performance of 2664
professional services without consent. 2665
Section 67. Subsection (2) of section 765.101, Florida 2666
Statutes, is amended to read: 2667
765.101 Definitions. —As used in this chapter: 2668
(2) "Attending physician" means the physician who has 2669
primary responsibility for the treatment and care of the patient 2670
while the patient receives such treatment or care in a hospital 2671
as defined in s. 395.002 s. 395.002(12). 2672
Section 68. Paragraph (a) of subsection (1) of section 2673
766.101, Florida Statutes, is amended to read: 2674
766.101 Medical review committee, immunity from 2675
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liability.— 2676
(1) As used in this section: 2677
(a) The term "medical review committee" or "committee" 2678
means: 2679
1.a. A committee of a hospital or ambulatory surgical 2680
center licensed under chapter 396 395 or a health maintenance 2681
organization certificated under part I of chapter 641; 2682
b. A committee of a physician -hospital organization, a 2683
provider-sponsored organization, or an integrated delivery 2684
system; 2685
c. A committee of a state or local professional society of 2686
health care providers; 2687
d. A committee of a medical staff of a licensed hospital 2688
or nursing home, provided the medical staff operates pursuant to 2689
written bylaws that have been approved by the governing board of 2690
the hospital or nursing home; 2691
e. A committee of the Department of Corrections or the 2692
Correctional Medical Authority as created under s. 945.602, or 2693
employees, agents, or consultants of either the department or 2694
the authority or both; 2695
f. A committee of a professional service corporation 2696
formed under chapter 621 or a corporation organized under part I 2697
of chapter 607 or chapter 617, which is formed and operated for 2698
the practice of medicine as defined in s. 458.305(3), and which 2699
has at least 25 health care providers who routinely provide 2700
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health care services directly to patients; 2701
g. A committee of the Department of Children and Families 2702
which includes employees, agen ts, or consultants to the 2703
department as deemed necessary to provide peer review, 2704
utilization review, and mortality review of treatment services 2705
provided pursuant to chapters 394, 397, and 916; 2706
h. A committee of a mental health treatment facility 2707
licensed under chapter 394 or a community mental health center 2708
as defined in s. 394.907, provided the quality assurance program 2709
operates pursuant to the guidelines that have been approved by 2710
the governing board of the agency; 2711
i. A committee of a substance abuse treatment and 2712
education prevention program licensed under chapter 397 provided 2713
the quality assurance program operates pursuant to the 2714
guidelines that have been approved by the governing board of the 2715
agency; 2716
j. A peer review or utilization review committe e organized 2717
under chapter 440; 2718
k. A committee of the Department of Health, a county 2719
health department, healthy start coalition, or certified rural 2720
health network, when reviewing quality of care, or employees of 2721
these entities when reviewing mortality rec ords; or 2722
l. A continuous quality improvement committee of a 2723
pharmacy licensed pursuant to chapter 465, 2724
2725
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which committee is formed to evaluate and improve the quality of 2726
health care rendered by providers of health service, to 2727
determine that health service s rendered were professionally 2728
indicated or were performed in compliance with the applicable 2729
standard of care, or that the cost of health care rendered was 2730
considered reasonable by the providers of professional health 2731
services in the area; or 2732
2. A committee of an insurer, self -insurer, or joint 2733
underwriting association of medical malpractice insurance, or 2734
other persons conducting review under s. 766.106. 2735
Section 69. Subsection (3) of section 766.110, Florida 2736
Statutes, is amended to read: 2737
766.110 Liability of health care facilities. — 2738
(3) In order to ensure comprehensive risk management for 2739
diagnosis of disease, a health care facility, including a 2740
hospital or ambulatory surgical center, as defined in chapter 2741
396 395, may use scientific diagnostic dis ease methodologies 2742
that use information regarding specific diseases in health care 2743
facilities and that are adopted by the facility's medical review 2744
committee. 2745
Section 70. Paragraph (d) of subsection (3) of section 2746
766.1115, Florida Statutes, is amended to read: 2747
766.1115 Health care providers; creation of agency 2748
relationship with governmental contractors. — 2749
(3) DEFINITIONS.—As used in this section, the term: 2750
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(d) "Health care provider" or "provider" means: 2751
1. A birth center licensed under chapter 383. 2752
2. An ambulatory surgical center licensed under chapter 2753
396 395. 2754
3. A hospital licensed under chapter 395. 2755
4. A physician or physician assistant licensed under 2756
chapter 458. 2757
5. An osteopathic physician or osteopathic physician 2758
assistant licensed under chapter 459. 2759
6. A chiropractic physician licensed under chapter 460. 2760
7. A podiatric physician licensed under chapter 461. 2761
8. A registered nurse, nurse midwife, licensed practical 2762
nurse, or advanced practice registered nurse licensed or 2763
registered under part I of chapter 464 or any facility which 2764
employs nurses licensed or registered under part I of chapter 2765
464 to supply all or part of the care delivered under this 2766
section. 2767
9. A midwife licensed under chapter 467. 2768
10. A health maintenance o rganization certificated under 2769
part I of chapter 641. 2770
11. A health care professional association and its 2771
employees or a corporate medical group and its employees. 2772
12. Any other medical facility the primary purpose of 2773
which is to deliver human medical d iagnostic services or which 2774
delivers nonsurgical human medical treatment, and which includes 2775
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an office maintained by a provider. 2776
13. A dentist or dental hygienist licensed under chapter 2777
466. 2778
14. A free clinic that delivers only medical diagnostic 2779
services or nonsurgical medical treatment free of charge to all 2780
low-income recipients. 2781
15. Any other health care professional, practitioner, 2782
provider, or facility under contract with a governmental 2783
contractor, including a student enrolled in an accredited 2784
program that prepares the student for licensure as any one of 2785
the professionals listed in subparagraphs 4. -9. 2786
2787
The term includes any nonprofit corporation qualified as exempt 2788
from federal income taxation under s. 501(a) of the Internal 2789
Revenue Code, and descr ibed in s. 501(c) of the Internal Revenue 2790
Code, which delivers health care services provided by licensed 2791
professionals listed in this paragraph, any federally funded 2792
community health center, and any volunteer corporation or 2793
volunteer health care provider t hat delivers health care 2794
services. 2795
Section 71. Subsection (4) and paragraph (b) of subsection 2796
(6) of section 766.118, Florida Statutes, are amended to read: 2797
766.118 Determination of noneconomic damages. — 2798
(4) LIMITATION ON NONECONOMIC DAMAGES FOR NE GLIGENCE OF 2799
PRACTITIONERS PROVIDING EMERGENCY SERVICES AND CARE. —2800
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Notwithstanding subsections (2) and (3), with respect to a cause 2801
of action for personal injury or wrongful death arising from 2802
medical negligence of practitioners providing emergency services 2803
and care, as defined in s. 395.002 s. 395.002(9), or providing 2804
services as provided in s. 401.265, or providing services 2805
pursuant to obligations imposed by 42 U.S.C. s. 1395dd to 2806
persons with whom the practitioner does not have a then -existing 2807
health care patient-practitioner relationship for that medical 2808
condition: 2809
(a) Regardless of the number of such practitioner 2810
defendants, noneconomic damages shall not exceed $150,000 per 2811
claimant. 2812
(b) Notwithstanding paragraph (a), the total noneconomic 2813
damages recoverable by all claimants from all such practitioners 2814
shall not exceed $300,000. 2815
2816
The limitation provided by this subsection applies only to 2817
noneconomic damages awarded as a result of any act or omission 2818
of providing medical care or treatment, including di agnosis that 2819
occurs prior to the time the patient is stabilized and is 2820
capable of receiving medical treatment as a nonemergency 2821
patient, unless surgery is required as a result of the emergency 2822
within a reasonable time after the patient is stabilized, in 2823
which case the limitation provided by this subsection applies to 2824
any act or omission of providing medical care or treatment which 2825
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occurs prior to the stabilization of the patient following the 2826
surgery. 2827
(6) LIMITATION ON NONECONOMIC DAMAGES FOR NEGLIGENCE O F A 2828
PRACTITIONER PROVIDING SERVICES AND CARE TO A MEDICAID 2829
RECIPIENT.—Notwithstanding subsections (2), (3), and (5), with 2830
respect to a cause of action for personal injury or wrongful 2831
death arising from medical negligence of a practitioner 2832
committed in the course of providing medical services and 2833
medical care to a Medicaid recipient, regardless of the number 2834
of such practitioner defendants providing the services and care, 2835
noneconomic damages may not exceed $300,000 per claimant, unless 2836
the claimant pleads an d proves, by clear and convincing 2837
evidence, that the practitioner acted in a wrongful manner. A 2838
practitioner providing medical services and medical care to a 2839
Medicaid recipient is not liable for more than $200,000 in 2840
noneconomic damages, regardless of the number of claimants, 2841
unless the claimant pleads and proves, by clear and convincing 2842
evidence, that the practitioner acted in a wrongful manner. The 2843
fact that a claimant proves that a practitioner acted in a 2844
wrongful manner does not preclude the application of the 2845
limitation on noneconomic damages prescribed elsewhere in this 2846
section. For purposes of this subsection: 2847
(b) The term "practitioner," in addition to the meaning 2848
prescribed in subsection (1), includes a any hospital or 2849
ambulatory surgical center as defined and licensed under chapter 2850
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395 or an ambulatory surgical center as defined and licensed 2851
under chapter 396. 2852
Section 72. Subsection (4) of section 766.202, Florida 2853
Statutes, is amended to read: 2854
766.202 Definitions; ss. 766.201 -766.212.—As used in ss. 2855
766.201-766.212, the term: 2856
(4) "Health care provider" means a any hospital or 2857
ambulatory surgical center as defined and licensed under chapter 2858
395; an ambulatory surgical center as defined and licensed under 2859
chapter 396; a birth center licens ed under chapter 383; any 2860
person licensed under chapter 458, chapter 459, chapter 460, 2861
chapter 461, chapter 462, chapter 463, part I of chapter 464, 2862
chapter 466, chapter 467, part XIV of chapter 468, or chapter 2863
486; a health maintenance organization certif icated under part I 2864
of chapter 641; a blood bank; a plasma center; an industrial 2865
clinic; a renal dialysis facility; or a professional association 2866
partnership, corporation, joint venture, or other association 2867
for professional activity by health care provide rs. 2868
Section 73. Section 766.316, Florida Statutes, is amended 2869
to read: 2870
766.316 Notice to obstetrical patients of participation in 2871
the plan.—Each hospital with a participating physician on its 2872
staff and each participating physician, other than residen ts, 2873
assistant residents, and interns deemed to be participating 2874
physicians under s. 766.314(4)(c), under the Florida Birth -2875
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Related Neurological Injury Compensation Plan shall provide 2876
notice to the obstetrical patients as to the limited no -fault 2877
alternative for birth-related neurological injuries. Such notice 2878
shall be provided on forms furnished by the association and 2879
shall include a clear and concise explanation of a patient's 2880
rights and limitations under the plan. The hospital or the 2881
participating physicia n may elect to have the patient sign a 2882
form acknowledging receipt of the notice form. Signature of the 2883
patient acknowledging receipt of the notice form raises a 2884
rebuttable presumption that the notice requirements of this 2885
section have been met. Notice need not be given to a patient 2886
when the patient has an emergency medical condition as defined 2887
in s. 395.002 s. 395.002(8)(b) or when notice is not 2888
practicable. 2889
Section 74. Paragraph (b) of subsection (2) of section 2890
812.014, Florida Statutes, is amended to r ead: 2891
812.014 Theft.— 2892
(2) 2893
(b)1. If the property stolen is valued at $20,000 or more, 2894
but less than $100,000; 2895
2. If the property stolen is cargo valued at less than 2896
$50,000 that has entered the stream of interstate or intrastate 2897
commerce from the ship per's loading platform to the consignee's 2898
receiving dock; 2899
3. If the property stolen is emergency medical equipment, 2900
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valued at $300 or more, that is taken from a facility licensed 2901
under chapter 395 or from an aircraft or vehicle permitted under 2902
chapter 401; or 2903
4. If the property stolen is law enforcement equipment, 2904
valued at $300 or more, that is taken from an authorized 2905
emergency vehicle, as defined in s. 316.003, 2906
2907
the offender commits grand theft in the second degree, 2908
punishable as a felony of the seco nd degree, as provided in s. 2909
775.082, s. 775.083, or s. 775.084. Emergency medical equipment 2910
means mechanical or electronic apparatus used to provide 2911
emergency services and care as defined in s. 395.002 s. 2912
395.002(9) or to treat medical emergencies. Law en forcement 2913
equipment means any property, device, or apparatus used by any 2914
law enforcement officer as defined in s. 943.10 in the officer's 2915
official business. However, if the property is stolen during a 2916
riot or an aggravated riot prohibited under s. 870.01 a nd the 2917
perpetration of the theft is facilitated by conditions arising 2918
from the riot; or within a county that is subject to a state of 2919
emergency declared by the Governor under chapter 252, the theft 2920
is committed after the declaration of emergency is made, a nd the 2921
perpetration of the theft is facilitated by conditions arising 2922
from the emergency, the theft is a felony of the first degree, 2923
punishable as provided in s. 775.082, s. 775.083, or s. 775.084. 2924
As used in this paragraph, the term "conditions arising fr om the 2925
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riot" means civil unrest, power outages, curfews, or a reduction 2926
in the presence of or response time for first responders or 2927
homeland security personnel and the term "conditions arising 2928
from the emergency" means civil unrest, power outages, curfews, 2929
voluntary or mandatory evacuations, or a reduction in the 2930
presence of or response time for first responders or homeland 2931
security personnel. A person arrested for committing a theft 2932
during a riot or an aggravated riot or within a county that is 2933
subject to a state of emergency may not be released until the 2934
person appears before a committing magistrate at a first 2935
appearance hearing. For purposes of sentencing under chapter 2936
921, a felony offense that is reclassified under this paragraph 2937
is ranked one level abo ve the ranking under s. 921.0022 or s. 2938
921.0023 of the offense committed. 2939
Section 75. Paragraph (b) of subsection (1) of section 2940
945.6041, Florida Statutes, is amended to read: 2941
945.6041 Inmate medical services. — 2942
(1) As used in this section, the ter m: 2943
(b) "Health care provider" means: 2944
1. A hospital licensed under chapter 395. 2945
2. A physician or physician assistant licensed under 2946
chapter 458. 2947
3. An osteopathic physician or physician assistant 2948
licensed under chapter 459. 2949
4. A podiatric physici an licensed under chapter 461. 2950
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5. A health maintenance organization certificated under 2951
part I of chapter 641. 2952
6. An ambulatory surgical center licensed under chapter 2953
396 395. 2954
7. A professional association, partnership, corporation, 2955
joint venture, or other association established by the 2956
individuals set forth in subparagraphs 2., 3., and 4. for 2957
professional activity. 2958
8. An other medical facility. 2959
a. As used in this subparagraph, the term "other medical 2960
facility" means: 2961
(I) A facility the primary p urpose of which is to provide 2962
human medical diagnostic services, or a facility providing 2963
nonsurgical human medical treatment which discharges patients on 2964
the same working day that the patients are admitted; and 2965
(II) A facility that is not part of a hospi tal. 2966
b. The term does not include a facility existing for the 2967
primary purpose of performing terminations of pregnancy, or an 2968
office maintained by a physician or dentist for the practice of 2969
medicine. 2970
Section 76. Paragraph (a) of subsection (1) of section 2971
985.6441, Florida Statutes, is amended to read: 2972
985.6441 Health care services. — 2973
(1) As used in this section, the term: 2974
(a) "Health care provider" means: 2975
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1. A hospital licensed under chapter 395. 2976
2. A physician or physician assistant licen sed under 2977
chapter 458. 2978
3. An osteopathic physician or physician assistant 2979
licensed under chapter 459. 2980
4. A podiatric physician licensed under chapter 461. 2981
5. A health maintenance organization certificated under 2982
part I of chapter 641. 2983
6. An ambulatory surgical center licensed under chapter 2984
396 395. 2985
7. A professional association, partnership, corporation, 2986
joint venture, or other association established by the 2987
individuals set forth in subparagraphs 2. -4. for professional 2988
activity. 2989
8. An other medical facility. 2990
a. As used in this subparagraph, the term "other medical 2991
facility" means: 2992
(I) A facility the primary purpose of which is to provide 2993
human medical diagnostic services, or a facility providing 2994
nonsurgical human medical treatment which discha rges patients on 2995
the same working day that the patients are admitted; and 2996
(II) A facility that is not part of a hospital. 2997
b. The term does not include a facility existing for the 2998
primary purpose of performing terminations of pregnancy, or an 2999
office maintained by a physician or dentist for the practice of 3000
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medicine. 3001
Section 77. This act shall take effect July 1, 2025. 3002