SB 1156 full text · Session Watch

Florida Senate - 2026 SB 1156 By Senator Trumbull 2-00459B-26 20261156__

1 A bill to be entitled

2 An act relating to ambulatory surgical centers;

3 creating ch. 396, F.S., to be entitled “Ambulatory

4 Surgical Centers”; creating s. 396.201, F.S.;

5 providing legislative intent; creating s. 396.202,

6 F.S.; defining terms; creating s. 396.203, F.S.;

7 specifying requirements for issuance, denial,

8 suspension, and revocation of ambulatory surgical

9 center licenses; creating s. 396.204, F.S.; providing

10 for application fees; creating s. 396.205, F.S.;

11 providing for minimum standards for specified clinical

12 and diagnostic results as a condition for issuance or

13 renewal of a license; creating s. 396.206, F.S.;

14 requiring the Agency for Health Care Administration to

15 make or cause to be made specified inspections of

16 licensed facilities; requiring the agency to accept

17 surveys or inspections from certain accrediting

18 organizations in lieu of its own periodic inspections,

19 provided certain conditions are met; requiring the

20 agency to develop and adopt by rule certain criteria;

21 requiring an applicant or a licensee to pay certain

22 fees at the time of inspection; requiring the agency

23 to coordinate periodic inspections to minimize costs

24 and disruption of services; creating s. 396.207, F.S.;

25 requiring each licensed facility to maintain and

26 provide upon request records of all inspection reports

27 pertaining to that facility; providing that such

28 reports be retained for a specified timeframe;

29 prohibiting the distribution of specified records;

30 requiring a licensed facility to provide a copy of its

31 most recent inspection report to certain parties upon

32 request; authorizing licensed facilities to charge for

33 such copies; creating s. 396.208, F.S.; providing that

34 specified provisions govern the design, construction,

35 erection, alteration, modification, repair, and

36 demolition of licensed facilities; requiring the

37 agency to review facility plans and survey the

38 construction of licensed facilities; requiring

39 licensed facilities to submit plans and specifications

40 to the agency for review; requiring the agency to make

41 or cause to be made certain inspections or

42 investigations as it deems necessary; authorizing the

43 agency to adopt certain rules; requiring the agency to

44 approve or disapprove facility plans and

45 specifications within a specified timeframe; providing

46 an extension under certain circumstances; deeming a

47 facility plan or specification approved if the agency

48 fails to act within the specified timeframe; requiring

49 the agency to set forth in writing its reasons for any

50 disapprovals; authorizing the agency to charge and

51 collect specified fees and costs; creating s. 396.209,

52 F.S.; prohibiting any person from paying or receiving

53 a commission, bonus, kickback, or rebate or engaging

54 in any split-fee arrangement for referring a patient

55 to a licensed facility; requiring agency enforcement;

56 providing administrative penalties; creating s.

57 396.211, F.S.; prohibiting a licensed facility from

58 denying, for a specified reason, the applications of

59 certain licensed health care practitioners for staff

60 membership and clinical privileges; requiring a

61 licensed facility to establish rules and procedures

62 for consideration of such applications; providing for

63 the termination of clinical privileges for physician

64 assistants under certain circumstances; authorizing

65 certain advanced practice registered nurses to

66 administer anesthesia subject to certain conditions;

67 requiring the presence of a circulating nurse in the

68 operating room for the duration of surgical

69 procedures; requiring a licensed facility to make

70 available specified membership or privileges to

71 certain physicians under certain circumstances;

72 providing construction; requiring the governing board

73 of a licensed facility to set standards and procedures

74 to be applied in considering and acting upon

75 applications; requiring that such standards and

76 procedures be made available for public inspection;

77 requiring a licensed facility to provide in writing,

78 upon request of an applicant, the reasons for denial

79 of staff membership or clinical privileges within a

80 specified timeframe; requiring that a denial be

81 submitted in writing to the applicant’s respective

82 regulatory board; providing immunity from monetary

83 liability to certain persons and entities; providing

84 that investigations, proceedings, and records produced

85 or acquired by the governing board or its agent are

86 not subject to discovery or introduction into evidence

87 in certain proceedings under certain circumstances;

88 prohibiting persons in attendance at such meetings

89 from testifying in civil actions about the evidence

90 presented or deliberations during such meetings;

91 providing construction; providing for the award of

92 specified fees and costs; requiring applicants who

93 bring an action against certain persons or entities to

94 post a bond or other security in a certain amount, as

95 set by the court; creating s. 396.212, F.S.; providing

96 legislative intent; requiring licensed facilities to

97 provide for peer review of certain physicians and

98 develop procedures to conduct such reviews; specifying

99 requirements for such procedures; requiring that,

100 under certain circumstances, a peer review panel

101 investigate and determine whether grounds for

102 discipline exist with respect to certain staff members

103 or physicians; requiring the governing board to take

104 specified actions if certain determinations are made;

105 providing grounds for such governing board actions;

106 requiring licensed facilities to report disciplinary

107 action to the Department of Health’s Division of

108 Medical Quality Assurance within a specified

109 timeframe; providing requirements for the report;

110 requiring the division to review each report and make

111 certain determinations; providing that such reports

112 are exempt from public records requirements; providing

113 immunity from monetary liability to certain persons

114 and entities; providing construction; providing

115 administrative penalties; providing that certain

116 proceedings and records of peer review panels,

117 committees, and governing boards or agents thereof are

118 exempt from public records requirements and are not

119 subject to discovery or introduction into evidence in

120 certain proceedings; prohibiting persons in attendance

121 at certain meetings from testifying or being required

122 to testify in certain civil or administrative actions;

123 providing construction; providing for the award of

124 specified fees and costs; requiring persons who bring

125 an action against certain persons or entities to post

126 a bond or other security in a certain amount, as set

127 by the court; creating s. 396.213, F.S.; requiring

128 licensed facilities to establish an internal risk

129 management program; specifying requirements for such

130 program; providing that the governing board of the

131 licensed facility is responsible for the program;

132 requiring licensed facilities to hire a risk manager;

133 specifying requirements for such risk manager;

134 encouraging licensed facilities to implement certain

135 innovative approaches; requiring licensed facilities

136 to annually report specified information to the Agency

137 for Health Care Administration and the Department of

138 Health; requiring the agency and the department to

139 include certain statistical information in their

140 respective annual reports; requiring the agency to

141 adopt rules governing the establishment of internal

142 risk management programs; specifying requirements for

143 such programs defining the term “adverse incident” for

144 certain purposes; requiring licensed facilities to

145 report specified information annually to the agency;

146 requiring the agency to review the reported

147 information and make certain determinations; providing

148 that the reported information is exempt from public

149 records requirements and is not discoverable or

150 admissible in civil or administrative actions, with

151 exceptions; requiring licensed facilities to report

152 certain adverse incidents to the agency within a

153 specified timeframe; providing requirements for such

154 reports; authorizing the agency to grant extensions of

155 the reporting requirement under certain circumstances

156 and subject to certain conditions; providing that such

157 reports are exempt from public records requirements

158 and are not discoverable or admissible in civil and

159 administrative actions, with exceptions; authorizing

160 the agency to investigate reported adverse incidents

161 and prescribe measures in response to such incidents;

162 requiring the agency to review adverse incidents and

163 make certain determinations; requiring the agency to

164 publish certain reports and summaries within certain

165 timeframes on its website; prohibiting certain

166 information from being included in such reports and

167 summaries; providing a purpose; specifying certain

168 investigative and reporting requirements for internal

169 risk managers relating to the investigation and

170 reporting of allegations of sexual misconduct or

171 sexual abuse at licensed facilities; specifying

172 requirements for witnesses to such alleged misconduct

173 or abuse; defining the term “sexual abuse”; providing

174 criminal penalties for making a false allegation of

175 sexual misconduct; requiring the agency to require a

176 written plan of correction from the licensed facility

177 for certain violations; requiring the agency to first

178 seek corrective action from a licensed facility for

179 certain nonwillful violations; providing

180 administrative penalties for a facility’s failure to

181 timely correct the violation or for demonstrating a

182 pattern of such violations; requiring licensed

183 facilities to provide the agency with access to all

184 facility records needed for specified purposes;

185 providing that such records obtained by the agency are

186 exempt from public records requirements and are not

187 discoverable or admissible in civil and administrative

188 actions, with exceptions; providing an exemption from

189 public meeting and records requirements for certain

190 meetings of the committees and governing board of a

191 licensed facility; requiring the agency to review the

192 internal risk management program of each licensed

193 facility as part of its licensure review process;

194 providing risk managers with immunity from monetary

195 and civil liability in certain proceedings under

196 certain circumstances; providing immunity from civil

197 liability to risk managers and licensed facilities in

198 certain actions, with an exception; requiring the

199 agency to report certain investigative results to the

200 applicable regulatory board; prohibiting coercion,

201 intimidation, or preclusion of a risk manager;

202 providing for civil penalties; creating s. 396.214,

203 F.S.; requiring licensed facilities to comply with

204 specified requirements for the transportation of

205 biomedical waste; creating s. 396.215, F.S.; requiring

206 licensed facilities to adopt a patient safety plan,

207 appoint a patient safety officer and a patient safety

208 committee for specified purposes, and conduct a

209 patient safety culture survey at least biennially;

210 specifying requirements for such survey; authorizing

211 facilities to contract for administration of the

212 survey; requiring that survey data be submitted to the

213 agency in a certain format; authorizing licensed

214 facilities to develop an internal action plan for a

215 certain purpose and submit the plan to the agency;

216 requiring licensed facilities to develop and implement

217 policies and procedures for the rendering of certain

218 medical care; specifying requirements for the policies

219 and procedures; requiring licensed facilities to train

220 all nonphysician personnel on the policies and

221 procedures at least annually; defining the term

222 “nonphysician personnel”; creating s. 396.216, F.S.;

223 requiring licensed facilities to adopt specified

224 protocols for the treatment of victims of child abuse,

225 abandonment, or neglect; creating s. 396.217, F.S.;

226 providing requirements for notifying a patient or a

227 patient’s proxy about adverse incidents; providing

228 construction; creating s. 396.218, F.S.; requiring the

229 agency to adopt specified rules relating to minimum

230 standards for licensed facilities; providing

231 construction; providing that certain licensed

232 facilities are allowed a specified timeframe in which

233 to comply with any newly adopted agency rules;

234 preempting the adoption of certain rules to the

235 Florida Building Commission and the State Fire

236 Marshal; requiring the agency to provide technical

237 assistance to the commission and the State Fire

238 Marshal in updating the construction standards

239 governing licensed facilities; creating s. 396.219,

240 F.S.; providing for criminal and administrative

241 penalties; requiring the agency to consider specified

242 factors in determining the amounts of administrative

243 fines levied; authorizing the agency to impose an

244 immediate moratorium on elective admissions to any

245 licensed facility under certain circumstances;

246 creating s. 396.221, F.S.; providing powers and duties

247 of the agency; creating s. 396.222, F.S.; requiring a

248 licensed facility to provide timely and accurate

249 financial information and quality of service measures

250 to certain individuals; requiring a licensed facility

251 to make available on its website certain information

252 on payments made to that facility for defined bundles

253 of services and procedures and other information for

254 consumers and patients; providing requirements for

255 such information; requiring that facility websites

256 provide specified information and notify and inform

257 patients or prospective patients of certain

258 information; defining the terms “shoppable health care

259 service” and “standard charge”; requiring a licensed

260 facility to provide a written or electronic good faith

261 estimate of certain charges to a patient or

262 prospective patient within a certain timeframe;

263 specifying requirements for such estimates; requiring

264 a licensed facility to provide to a patient or a

265 prospective patient specified information regarding

266 the facility’s financial assistance policy; providing

267 a civil penalty for failing to timely provide an

268 estimate of charges to a patient or prospective

269 patient and the insurer; requiring licensed facilities

270 to make certain health-related data available on its

271 website; requiring licensed facilities to take action

272 to notify the public of the availability of such

273 information; requiring licensed facilities to provide

274 an itemized statement or bill to a patient or his or

275 her survivor or legal guardian within a specified

276 timeframe upon request and after discharge; specifying

277 requirements for the statement or bill; requiring

278 licensed facilities to make available to a patient or

279 his or her survivor or legal guardian certain records

280 within a specified timeframe and in a specified

281 manner; authorizing licensed facilities to charge fees

282 in a specified amount for copies of such records;

283 requiring licensed facilities to establish certain

284 internal processes relating to itemized statements and

285 bills and grievances; requiring licensed facilities to

286 disclose certain information relating to the patient’s

287 cost-sharing obligation; providing an administrative

288 penalty for failure to disclose such information;

289 creating s. 396.223, F.S.; defining the term

290 “extraordinary collection action”; prohibiting certain

291 collection actions by a licensed facility; creating s.

292 396.224, F.S.; providing criminal penalties and

293 disciplinary action for the fraudulent alteration,

294 defacement, or falsification of medical records;

295 creating s. 396.225, F.S.; requiring a licensed

296 facility to furnish, in a timely manner, a true and

297 correct copy of all patient records to certain

298 persons; specifying authorized charges for copies of

299 such records; providing an exception; providing for

300 confidentiality of patient records; providing

301 exceptions; authorizing the department to examine

302 certain records for certain purposes; providing

303 criminal penalties for the unauthorized release of

304 information from such records by department agents;

305 providing content and use requirements and limitations

306 for confidential patient records released under the

307 exemptions; authorizing licensed facilities to

308 prescribe the content and custody of limited-access

309 records that the facility maintains on its employees;

310 specifying the types of records that may be limited in

311 this manner; providing requirements for the release of

312 such limited-access records; providing an exemption

313 from public records requirements for such records;

314 providing exemptions from public records requirements

315 for specified personal information relating to

316 employees of licensed facilities who provide direct

317 patient care or security services and their spouses

318 and children, and for specified personal information

319 relating to certain other employees of licensed

320 facilities and their spouses and children upon their

321 request; providing exceptions to the exemptions;

322 amending ss. 39.304, 95.11, 222.26, 381.00316,

323 381.0035, 381.026, 381.028, 381.915, 383.145, 385.202,

324 385.211, 390.011, 390.025, 394.4787, 395.001, 395.002,

325 395.003, 395.1055, 395.10973, 395.3025, 395.607,

326 395.701, 400.518, 400.93, 400.9905, 400.9935, 401.272,

327 408.051, 408.07, 408.802, 408.820, 409.905, 409.906,

328 409.975, 456.013, 456.0135, 456.041, 456.053, 456.056,

329 456.0575, 456.072, 456.073, 458.3145, 458.320,

330 458.3265, 458.328, 458.347, 458.351, 459.0085,

331 459.0137, 459.0138, 459.015, 459.022, 459.026,

332 460.413, 460.4167, 461.013, 464.012, 465.0125,

333 465.016, 466.028, 468.505, 486.021, 499.003, 499.0295,

334 553.80, 627.351, 627.357, 627.6056, 627.6387,

335 627.6405, 627.64194, 627.6616, 627.6648, 627.736,

336 627.912, 641.31076, 765.101, 766.101, 766.1016,

337 766.106, 766.110, 766.1115, 766.118, 766.202, 766.316,

338 790.338, 812.014, 893.05, 893.13, 945.6041, 985.6441,

339 1001.42, and 1012.965, F.S.; conforming cross

340 references and provisions to changes made by the act;

341 bifurcating fees applicable to ambulatory surgical

342 centers under ch. 395, F.S., and transferring them to

343 ch. 396, F.S.; authorizing the agency to maintain its

344 current fees for ambulatory surgical centers and adopt

345 certain rules; providing an effective date.

347 Be It Enacted by the Legislature of the State of Florida:

349 Section 1. Chapter 396, Florida Statutes, consisting of ss.

350 396.201-396.225, Florida Statutes, is created and entitled

351 “Ambulatory Surgical Centers.”

352 Section 2. Section 396.201, Florida Statutes, is created to

353 read:

354 396.201 Legislative intent.—It is the intent of the

355 Legislature to provide for the protection of public health and

356 safety in the establishment, construction, maintenance, and

357 operation of ambulatory surgical centers by providing for

358 licensure of the same and for the development, establishment,

359 and enforcement of minimum standards with respect thereto.

360 Section 3. Section 396.202, Florida Statutes, is created to

361 read:

362 396.202 Definitions.—As used in this chapter, the term:

363 (1) “Accrediting organization” means a national accrediting

364 organization approved by the Centers for Medicare and Medicaid

365 Services whose standards incorporate comparable licensure

366 regulations required by this state.

367 (2) “Agency” means the Agency for Health Care

368 Administration.

369 (3) “Ambulatory surgical center” means a facility, the

370 primary purpose of which is to provide elective surgical care,

371 in which the patient is admitted to and discharged from such

372 facility within 24 hours, and which is not part of a hospital.

373 The term does not include a facility existing for the primary

374 purpose of performing terminations of pregnancy, an office

375 maintained by a physician for the practice of medicine, or an

376 office maintained for the practice of dentistry, except that

377 that any such facility or office that is certified or seeks

378 certification as a Medicare ambulatory surgical center must be

379 licensed as an ambulatory surgical center under this chapter.

380 (4) “Biomedical waste” has the same meaning as provided in

381 s. 381.0098(2).

382 (5) “Clinical privileges” means the privileges granted to a

383 physician or other licensed health care practitioner to render

384 patient care services in an ambulatory surgical center, but does

385 not include the privilege of admitting patients.

386 (6) “Department” means the Department of Health.

387 (7) “Director” means any member of the official board of

388 directors as reported in the licensed facility owner’s annual

389 corporate report to the Department of State or, if no such

390 report is made, any member of the operating board of directors.

391 The term does not include members of separate, restricted boards

392 who serve only in an advisory capacity to the operating board.

393 (8) “Emergency medical condition” means:

394 (a) A medical condition manifesting itself by acute

395 symptoms of sufficient severity, which may include severe pain,

396 such that the absence of immediate medical attention could

397 reasonably be expected to result in any of the following:

398 1. Serious jeopardy to patient health, including for a

399 pregnant woman or fetus.

400 2. Serious impairment to bodily functions.

401 3. Serious dysfunction of any bodily organ or part.

402 (b) With respect to a pregnant woman:

403 1. That there is inadequate time to effect safe transfer to

404 a hospital before delivery;

405 2. That a transfer may pose a threat to the health and

406 safety of the patient or fetus; or

407 3. That there is evidence of the onset and persistence of

408 uterine contractions or a rupture of the membranes.

409 (9) “Governmental unit” means the state or any county,

410 municipality, or other political subdivision, or any department,

411 division, board, or other agency of any of the foregoing.

412 (10) “Hospital” has the same meaning as in s. 395.002.

413 (11) “Licensed facility” means an ambulatory surgical

414 center licensed under this chapter.

415 (12) “Lifesafety” means the control and prevention of fire

416 and other life-threatening conditions on a premises for the

417 purpose of preserving human life.

418 (13) “Medical staff” means physicians licensed under

419 chapter 458 or chapter 459 with privileges in a licensed

420 facility, as well as other licensed health care practitioners

421 with clinical privileges as approved by a licensed facility’s

422 governing board.

423 (14) “Person” means any individual, partnership,

424 corporation, association, or governmental unit.

425 (15) “Premises” means those buildings, beds, and equipment

426 located at the address of the licensed facility, and all other

427 buildings, beds, and equipment for the provision of ambulatory

428 surgical care located in such reasonable proximity to the

429 address of the licensed facility as to appear to the public to

430 be under the dominion and control of the licensee.

431 (16) “Validation inspection” means an inspection of the

432 premises of a licensed facility by the agency to assess whether

433 a review by an accrediting organization has adequately evaluated

434 the licensed facility according to minimum state standards.

435 Section 4. Section 396.203, Florida Statutes, is created to

436 read:

437 396.203 Licensure; denial, suspension, and revocation.—

438 (1)(a) The requirements of part II of chapter 408 apply to

439 the provision of services that require licensure pursuant to ss.

440 396.201-396.225 and part II of chapter 408 and to entities

441 licensed by or applying for such licensure from the Agency for

442 Health Care Administration pursuant to ss. 396.201-396.225. A

443 license issued by the agency is required in order to operate an

444 ambulatory surgical center in this state.

445 (b)1. It is unlawful for a person to use or advertise to

446 the public, in any way or by any medium whatsoever, any facility

447 as an “ambulatory surgical center” unless such facility has

448 first secured a license under this chapter.

449 2. This chapter does not apply to commercial business

450 establishments using the word “ambulatory surgical center” as a

451 part of a trade name if no treatment of human beings is

452 performed on the premises of such establishments.

453 (2) In addition to the requirements of s. 408.807, after a

454 change of ownership has been approved by the agency, the

455 transferee is liable for any liability due to the state,

456 regardless of when identified, resulting from changes to

457 allowable costs affecting provider reimbursement for Medicaid

458 participation and related administrative fines.

459 (3) An ambulatory surgical center must comply with ss.

460 627.64194 and 641.513 as a condition of licensure.

461 (4) In addition to the requirements of part II of chapter

462 408, whenever the agency finds that there has been a substantial

463 failure to comply with the requirements established under this

464 chapter or in rules, the agency is authorized to deny, modify,

465 suspend, or revoke a license.

466 Section 5. Section 396.204, Florida Statutes, is created to

467 read:

468 396.204 Application for license; fees.—In accordance with

469 s. 408.805, an applicant or a licensee shall pay a fee for each

470 license application submitted under this chapter, part II of

471 chapter 408, and applicable rules. The amount of the fee is

472 established by rule. The license fee required of a facility

473 licensed under this chapter is established by rule, except that

474 the minimum license fee is $1,500.

475 Section 6. Section 396.205, Florida Statutes, is created to

476 read:

477 396.205 Minimum standards for clinical laboratory test

478 results and diagnostic X-ray results; prerequisite for issuance

479 or renewal of license.—

480 (1) As a requirement for issuance or renewal of its

481 license, each licensed facility shall require that all clinical

482 laboratory tests performed by or for the licensed facility be

483 performed by a clinical laboratory appropriately certified by

484 the Centers for Medicare and Medicaid Services under the federal

485 Clinical Laboratory Improvement Amendments and the federal rules

486 adopted thereunder.

487 (2) Each licensed facility, as a requirement for issuance

488 or renewal of its license, shall establish minimum standards for

489 acceptance of results of diagnostic X rays performed by or for

490 the licensed facility. Such standards must require licensure or

491 registration of the source of ionizing radiation under chapter

492 404.

493 (3) The results of clinical laboratory tests and diagnostic

494 X rays performed before admission which meet the minimum

495 standards required by law must be accepted in lieu of routine

496 examinations required upon admission and in lieu of clinical

497 laboratory tests and diagnostic X rays which may be ordered by a

498 physician for patients of the licensed facility.

499 Section 7. Section 396.206, Florida Statutes, is created to

500 read:

501 396.206 Licensure inspection.—

502 (1) In addition to the requirement of s. 408.811, the

503 agency shall make or cause to be made such inspections and

504 investigations as it deems necessary, including, but not limited

505 to:

506 (a) Inspections directed by the Centers for Medicare and

507 Medicaid Services.

508 (b) Validation inspections.

509 (c) Lifesafety inspections.

510 (d) Licensure complaint investigations, including full

511 licensure investigations with a review of all licensure

512 standards as outlined in the administrative rules. Complaints

513 received by the agency from individuals, organizations, or other

514 sources are subject to review and investigation by the agency.

515 (2) The agency shall accept, in lieu of its own periodic

516 inspections for licensure, the survey or inspection of an

517 accrediting organization, provided that the accreditation of the

518 licensed facility is not provisional and provided that the

519 licensed facility authorizes release of, and the agency receives

520 the report of, the accrediting organization. The agency shall

521 develop and adopt by rule criteria for accepting survey reports

522 of accrediting organizations in lieu of conducting a state

523 licensure inspection.

524 (3) In accordance with s. 408.805, an applicant or a

525 licensee must pay a fee for each license application submitted

526 under this chapter, part II of chapter 408, and applicable

527 rules. Each facility licensed under this chapter must pay to the

528 agency, at the time of inspection, the following fees:

529 (a) Inspection for licensure.—A fee of at least $400 per

530 facility.

531 (b) Inspection for lifesafety only.—A fee of at least $40

532 per facility.

533 (4) The agency shall coordinate all periodic inspections

534 for licensure made by the agency to ensure that the cost to the

535 facility of such inspections and the disruption of services by

536 such inspections are minimized.

537 Section 8. Section 396.207, Florida Statutes, is created to

538 read:

539 396.207 Inspection reports.—

540 (1) Each licensed facility shall maintain as public

541 information, available upon request, records of all inspection

542 reports pertaining to that facility. Copies of such reports must

543 be retained in its records for at least 5 years after the date

544 the reports are filed and issued.

545 (2) Any record, report, or document that is confidential

546 and exempt from s. 119.07(1) may not be distributed or made

547 available for purposes of compliance with this section unless or

548 until such confidential status expires.

549 (3) A licensed facility shall, upon the request of any

550 person who has completed a written application with intent to be

551 admitted to such facility, any person who is a patient of such

552 facility, or any relative, spouse, guardian, or surrogate of any

553 such person, furnish to the requester a copy of the last

554 inspection report filed with or issued by the agency pertaining

555 to the licensed facility, as provided in subsection (1),

556 provided that the person requesting such report agrees to pay a

557 reasonable charge to cover copying costs, not to exceed $1 per

558 page.

559 Section 9. Section 396.208, Florida Statutes, is created to

560 read:

561 396.208 Construction inspections; plan submission and

562 approval; fees.—

563 (1)(a) The design, construction, erection, alteration,

564 modification, repair, and demolition of all licensed health care

565 facilities are governed by the Florida Building Code and the

566 Florida Fire Prevention Code under ss. 553.73 and 633.202.

567 (b) In addition to the requirements of ss. 553.79 and

568 553.80, the agency shall review facility plans and survey the

569 construction of any facility licensed under this chapter. All

570 licensed facilities shall submit plans and specifications to the

571 agency for review under this section. The agency shall make, or

572 cause to be made, such construction inspections and

573 investigations as it deems necessary. The agency may prescribe

574 by rule that any licensee or applicant desiring to make

575 specified types of alterations or additions to its facilities or

576 to construct new facilities shall, before commencing such

577 alteration, addition, or new construction, submit plans and

578 specifications therefor to the agency for preliminary inspection

579 and approval or recommendation with respect to compliance with

580 applicable provisions of the Florida Building Code or agency

581 rules and standards.

582 (c) The agency shall approve or disapprove the plans and

583 specifications within 60 days after receipt of the fee for

584 review of plans as required in subsection (2). The agency may be

585 granted one 15-day extension for the review period if the

586 director of the agency approves the extension. If the agency

587 fails to act within the specified timeframe, it is deemed to

588 have approved the plans and specifications. When the agency

589 disapproves plans and specifications, it must set forth in

590 writing the reasons for its disapproval. Conferences and

591 consultations may be provided as necessary.

592 (2) The agency may charge an initial fee of $2,000 for

593 review of plans and construction on all projects, which is

594 nonrefundable. The agency may also collect a fee, not to exceed

595 1 percent of the estimated construction cost or the actual cost

596 of review, whichever is less, for the portion of the review

597 which encompasses initial review through the initial revised

598 construction document review. The agency is further authorized

599 to collect its actual costs on all subsequent portions of the

600 review and construction inspections. The initial fee payment

601 must accompany the initial submission of plans and

602 specifications. Any subsequent payment that is due is payable

603 upon receipt of the invoice from the agency.

604 Section 10. Section 396.209, Florida Statutes, is created

605 to read:

606 396.209 Rebates prohibited; penalties.—

607 (1) It is unlawful for any person to pay or receive any

608 commission, bonus, kickback, or rebate or engage in any split

609 fee arrangement, in any form whatsoever, with any physician,

610 surgeon, organization, or person, either directly or indirectly,

611 for patients referred to a licensed facility.

612 (2) The agency shall enforce subsection (1). In the case of

613 an entity not licensed by the agency, administrative penalties

614 may include:

615 (a) A fine not to exceed $1,000.

616 (b) If applicable, a recommendation by the agency to the

617 appropriate regulatory board that disciplinary action be taken.

618 Section 11. Section 396.211, Florida Statutes, is created

619 to read:

620 396.211 Staff membership and clinical privileges.—

621 (1) A licensed facility, in considering and acting upon an

622 application for staff membership or clinical privileges, may not

623 deny the application of a qualified doctor of medicine licensed

624 under chapter 458, a doctor of osteopathic medicine licensed

625 under chapter 459, a doctor of dentistry licensed under chapter

626 466, or a doctor of podiatric medicine licensed under chapter

627 461 for such staff membership or clinical privileges within the

628 scope of his or her respective licensure solely because the

629 applicant is licensed under any of such chapters.

630 (2)(a) Each licensed facility shall establish rules and

631 procedures for consideration of an application for clinical

632 privileges submitted by a physician assistant licensed pursuant

633 to s. 458.347 or s. 459.022. Clinical privileges granted to a

634 physician assistant pursuant to this subsection automatically

635 terminate upon termination of staff membership of the physician

636 assistant’s supervising physician.

637 (b) An advanced practice registered nurse who is certified

638 as a registered nurse anesthetist licensed under part I of

639 chapter 464 may administer anesthesia under the onsite medical

640 direction of a professional licensed under chapter 458, chapter

641 459, or chapter 466, and in accordance with an established

642 protocol approved by the medical staff. The medical direction

643 must specifically address the needs of the individual patient.

644 (c) A circulating nurse must be present in the operating

645 room for the duration of a surgical procedure.

646 (3) When a licensed facility requires, as a precondition to

647 obtaining staff membership or clinical privileges, the

648 completion of, eligibility in, or graduation from any program or

649 society established by or relating to the American Medical

650 Association or the Liaison Committee on Medical Education, the

651 licensed facility must also make available such membership or

652 privileges to physicians who have attained completion of,

653 eligibility in, or graduation from any equivalent program

654 established by or relating to the American Osteopathic

655 Association.

656 (4) This section does not restrict in any way the authority

657 of the medical staff of a licensed facility to review for

658 approval or disapproval all applications for appointment and

659 reappointment to all categories of staff and to make

660 recommendations on each applicant to the governing board of the

661 facility, including the delineation of privileges to be granted

662 in each case. In making such recommendations and in the

663 delineation of privileges, each applicant must be considered

664 individually pursuant to criteria for a doctor licensed under

665 chapter 458, chapter 459, chapter 461, or chapter 466; or for an

666 advanced practice registered nurse licensed under part I of

667 chapter 464, as applicable. The applicant’s eligibility for

668 staff membership or clinical privileges must be determined by

669 the applicant’s background, experience, health, training, and

670 demonstrated competency; the applicant’s adherence to applicable

671 professional ethics; the applicant’s reputation; and the

672 applicant’s ability to work with others, and by such other

673 elements as determined by the governing board consistent with

674 this chapter.

675 (5) The governing board of each licensed facility shall set

676 standards and procedures to be applied by the licensed facility

677 and its medical staff in considering and acting upon

678 applications for staff membership or clinical privileges. Such

679 standards and procedures must be made available for public

680 inspection.

681 (6) Upon the written request of the applicant, any licensed

682 facility that has denied staff membership or clinical privileges

683 to an applicant specified in subsection (1) or subsection (2)

684 must, within 30 days after such request, provide the applicant

685 with the reasons for such denial in writing. A denial of staff

686 membership or clinical privileges to any applicant must be

687 submitted, in writing, to the applicant’s respective regulatory

688 board.

689 (7) There is no monetary liability on the part of, and no

690 cause of action for injunctive relief or damages may arise

691 against, any licensed facility, its governing board or governing

692 board members, medical staff, or disciplinary board or against

693 its agents, investigators, witnesses, or employees, or against

694 any other person, for any action arising out of or related to

695 carrying out this section, absent intentional fraud.

696 (8) The investigations, proceedings, and records of the

697 board, or its agent with whom there is a specific written

698 contract for the purposes of this section, as described in this

699 section are not subject to discovery or introduction into

700 evidence in any civil action against a provider of professional

701 health services arising out of matters that are the subject of

702 evaluation and review by such board, and any person who was in

703 attendance at a meeting of such board or its agent is not

704 permitted or required to testify in any such civil action as to

705 any evidence or other matters produced or presented during the

706 proceedings of such board or its agent or as to any findings,

707 recommendations, evaluations, opinions, or other actions of such

708 board or its agent or any members thereof. However, information,

709 documents, or records otherwise available from original sources

710 are not to be construed as immune from discovery or use in any

711 such civil action merely because they were presented during

712 proceedings of such board; nor may any person who testifies

713 before such board or who is a member of such board be prevented

714 from testifying as to matters within his or her knowledge, but

715 such witness cannot be asked about his or her testimony before

716 such a board or opinions formed by him or her as a result of

717 such board hearings.

718 (9)(a) If the defendant prevails in an action brought by an

719 applicant against any person or entity that initiated,

720 participated in, was a witness in, or conducted any review as

721 authorized by this section, the court must award reasonable

722 attorney fees and costs to the defendant.

723 (b) As a condition of an applicant bringing any action

724 against any person or entity that initiated, participated in,

725 was a witness in, or conducted any review as authorized by this

726 section and before any responsive pleading is due, the applicant

727 must post a bond or other security, as set by the court having

728 jurisdiction in the action, in an amount sufficient to pay the

729 costs and attorney fees.

730 Section 12. Section 396.212, Florida Statutes, is created

731 to read:

732 396.212 Licensed facilities; peer review; disciplinary

733 powers; agency or partnership with physicians.—

734 (1) It is the intent of the Legislature that good faith

735 participants in the process of investigating and disciplining

736 physicians pursuant to the state-mandated peer review process

737 shall, in addition to receiving immunity from retaliatory tort

738 suits pursuant to s. 456.073(12), be protected from federal

739 antitrust suits filed under the Sherman Antitrust Act, 15 U.S.C.

740 ss. 1 et seq. Such intent is within the public policy of the

741 state to secure the provision of quality medical services to the

742 public.

743 (2) Each licensed facility, as a condition of licensure,

744 shall provide for peer review of physicians who deliver health

745 care services at the facility. Each licensed facility shall

746 develop written, binding procedures by which such peer review

747 must be conducted. Such procedures must include all of the

748 following:

749 (a) A mechanism for choosing the membership of the body or

750 bodies that conduct peer review.

751 (b) Adoption of rules of order for the peer review process.

752 (c) Fair review of the case with the physician involved.

753 (d) A mechanism to identify and avoid conflicts of interest

754 on the part of the peer review panel members.

755 (e) Recording of agendas and minutes that do not contain

756 confidential material, for review by the Division of Health

757 Quality Assurance of the agency.

758 (f) A review, at least annually, of the peer review

759 procedures by the governing board of the licensed facility.

760 (g) Focusing the peer review process on reviewing

761 professional practices at the facility to reduce morbidity and

762 mortality and to improve patient care.

763 (3) If reasonable belief exists that conduct by a staff

764 member or physician who delivers health care services at the

765 licensed facility may constitute one or more grounds for

766 discipline as provided in this subsection, a peer review panel

767 must investigate and determine whether grounds for discipline

768 exist with respect to such staff member or physician. The

769 governing board of a licensed facility, after considering the

770 recommendations of its peer review panel, shall suspend, deny,

771 revoke, or curtail the privileges, or reprimand, counsel, or

772 require education, of any such staff member or physician after a

773 final determination has been made that one or more of the

774 following grounds exist:

775 (a) Incompetence.

776 (b) Being found to be a habitual user of intoxicants or

777 drugs to the extent that the staff member or physician is deemed

778 dangerous to himself, herself, or others.

779 (c) Mental or physical impairment that may adversely affect

780 patient care.

781 (d) Being found liable by a court of competent jurisdiction

782 for medical negligence or malpractice involving negligent

783 conduct.

784 (e) One or more settlements exceeding $10,000 for medical

785 negligence or malpractice involving negligent conduct by the

786 staff member or physician.

787 (f) Medical negligence other than as specified in paragraph

788 (d) or paragraph (e).

789 (g) Failure to comply with the policies, procedures, or

790 directives of the risk management program or any quality

791 assurance committees of any licensed facility.

792 (4) Pursuant to ss. 458.337 and 459.016, any disciplinary

793 action taken under subsection (3) must be reported in writing to

794 the Division of Medical Quality Assurance of the Department of

795 Health within 30 working days after its initial occurrence,

796 regardless of the pendency of appeals to the governing board of

797 the licensed facility. The report must identify the disciplined

798 practitioner, the action taken, and the reason for such action.

799 All final disciplinary actions taken under subsection (3), if

800 different from those reported to the agency within 30 days after

801 its initial occurrence, must be reported within 10 working days

802 to the Division of Medical Quality Assurance in writing and must

803 specify the disciplinary action taken and the specific grounds

804 therefor. The division shall review each report and determine

805 whether it potentially involved conduct by the licensee which is

806 subject to disciplinary action, in which case s. 456.073

807 applies. The reports are not subject to inspection under s.

808 119.07(1) even if the division’s investigation results in a

809 finding of probable cause.

810 (5) There is no monetary liability on the part of, and no

811 cause of action for damages may rise against, any licensed

812 facility, its governing board or governing board members, peer

813 review panel, medical staff, or disciplinary body, or its

814 agents, investigators, witnesses, or employees; a committee of a

815 licensed facility; or any other person for any action taken

816 without intentional fraud in carrying out this section.

817 (6) For a single incident or series of isolated incidents

818 that are nonwillful violations of the reporting requirements of

819 this section or part II of chapter 408, the agency shall first

820 seek to obtain corrective action by the licensed facility. If

821 correction is not demonstrated within the timeframe established

822 by the agency or if there is a pattern of nonwillful violations

823 of this section or part II of chapter 408, the agency may impose

824 an administrative fine, not to exceed $5,000 for any violation

825 of the reporting requirements of this section or part II of

826 chapter 408. The administrative fine for repeated nonwillful

827 violations may not exceed $10,000 for any violation. The

828 administrative fine for each intentional and willful violation

829 may not exceed $25,000 per violation, per day. The fine for an

830 intentional and willful violation of this section or part II of

831 chapter 408 may not exceed $250,000. In determining the amount

832 of fine to be levied, the agency shall be guided by s.

833 396.219(2)(b).

834 (7) The proceedings and records of peer review panels,

835 committees, and governing boards or agents thereof which relate

836 solely to actions taken in carrying out this section are not

837 subject to inspection under s. 119.07(1); and meetings held

838 pursuant to achieving the objectives of such panels, committees,

839 and governing boards or agents thereof are not open to the

840 public under chapter 286.

841 (8) The investigations, proceedings, and records of the

842 peer review panel, a committee of an ambulatory surgical center,

843 a disciplinary board, or a governing board, or agents thereof

844 with whom there is a specific written contract for that purpose,

845 as described in this section, are not subject to discovery or

846 introduction into evidence in any civil or administrative action

847 against a provider of professional health services arising out

848 of the matters that are the subject of evaluation and review by

849 such group or its agent, and a person who was in attendance at a

850 meeting of such group or its agent is not permitted and may not

851 be required to testify in any such civil or administrative

852 action as to any evidence or other matters produced or presented

853 during the proceedings of such group or its agent or as to any

854 findings, recommendations, evaluations, opinions, or other

855 actions of such group or its agent or any members thereof.

856 However, information, documents, or records otherwise available

857 from original sources are not to be construed as immune from

858 discovery or use in any such civil or administrative action

859 merely because such information, documents, or records were

860 presented during proceedings of such group, and any person who

861 testifies before such group or who is a member of such group may

862 not be prevented from testifying as to matters within his or her

863 knowledge, but such witness may not be asked about his or her

864 testimony before such a group or opinions formed by him or her

865 as a result of such group hearings.

866 (9)(a) If the defendant prevails in an action brought by a

867 staff member or physician who delivers health care services at

868 the licensed facility against any person or entity that

869 initiated, participated in, was a witness in, or conducted any

870 review as authorized by this section, the court must award

871 reasonable attorney fees and costs to the defendant.

872 (b) As a condition of any staff member or physician

873 bringing any action against any person or entity that initiated,

874 participated in, was a witness in, or conducted any review as

875 authorized by this section and before any responsive pleading is

876 due, the staff member or physician must post a bond or other

877 security, as set by the court having jurisdiction in the action,

878 in an amount sufficient to pay the costs and attorney fees.

879 Section 13. Section 396.213, Florida Statutes, is created

880 to read:

881 396.213 Internal risk management program.—

882 (1) Every licensed facility shall, as a part of its

883 administrative functions, establish an internal risk management

884 program that includes all of the following components:

885 (a) The investigation and analysis of the frequency and

886 causes of general categories and specific types of adverse

887 incidents to patients.

888 (b) The development of appropriate measures to minimize the

889 risk of adverse incidents to patients, including, but not

890 limited to:

891 1. Risk management and risk prevention education and

892 training of all nonphysician personnel as follows:

893 a. Such education and training of all nonphysician

894 personnel as part of their initial orientation; and

895 b. At least 1 hour of such education and training annually

896 for all personnel of the licensed facility working in clinical

897 areas and providing patient care, except those persons licensed

898 as health care practitioners who are required to complete

899 continuing education coursework pursuant to chapter 456 or the

900 practitioner’s respective practice act.

901 2. A prohibition, except when emergency circumstances

902 require otherwise, against a staff member of the licensed

903 facility attending a patient in the recovery room, unless the

904 staff member is authorized to attend the patient in the recovery

905 room and is in the company of at least one other person.

906 However, a licensed facility is exempt from the two-person

907 requirement if it has:

908 a. Live visual observation;

909 b. Electronic observation; or

910 c. Any other reasonable measure taken to ensure patient

911 protection and privacy.

912 3. A prohibition against an unlicensed person assisting or

913 participating in any surgical procedure unless the licensed

914 facility has authorized the person to do so following a

915 competency assessment, and such assistance or participation is

916 done under the direct and immediate supervision of a licensed

917 physician and is not otherwise an activity that may be performed

918 only by a licensed health care practitioner.

919 4. Development, implementation, and ongoing evaluation of

920 procedures, protocols, and systems to accurately identify

921 patients, planned procedures, and the correct site of planned

922 procedures so as to minimize the performance of a surgical

923 procedure on the wrong patient, a wrong surgical procedure, a

924 wrong-site surgical procedure, or a surgical procedure otherwise

925 unrelated to the patient’s diagnosis or medical condition.

926 (c) The analysis of patient grievances that relate to

927 patient care and the quality of medical services.

928 (d) A system for informing a patient or an individual

929 identified pursuant to s. 765.401(1) that the patient was the

930 subject of an adverse incident, as defined in subsection (5).

931 Such notice must be given by an appropriately trained person

932 designated by the licensed facility as soon as practicable to

933 allow the patient an opportunity to minimize damage or injury.

934 (e) The development and implementation of an incident

935 reporting system based upon the affirmative duty of all health

936 care providers and all agents and employees of the licensed

937 facility to report adverse incidents to the risk manager, or to

938 his or her designee, within 3 business days after the occurrence

939 of such incidents.

940 (2) The internal risk management program is the

941 responsibility of the governing board of the licensed facility.

942 Each licensed facility shall hire a risk manager who is

943 responsible for implementation and oversight of the facility’s

944 internal risk management program and who demonstrates

945 competence, through education or experience, in all of the

946 following areas:

947 (a) Applicable standards of health care risk management.

948 (b) Applicable federal, state, and local health and safety

949 laws and rules.

950 (c) General risk management administration.

951 (d) Patient care.

952 (e) Medical care.

953 (f) Personal and social care.

954 (g) Accident prevention.

955 (h) Departmental organization and management.

956 (i) Community interrelationships.

957 (j) Medical terminology.

958 (3) In addition to the programs mandated by this section,

959 other innovative approaches intended to reduce the frequency and

960 severity of medical malpractice and patient injury claims are

961 encouraged and their implementation and operation facilitated.

962 Such additional approaches may include extending internal risk

963 management programs to health care providers’ offices and the

964 assuming of provider liability by a licensed facility for acts

965 or omissions occurring within the licensed facility. Each

966 licensed facility shall annually report to the agency and the

967 department the name and judgments entered against each health

968 care practitioner for which it assumes liability. The agency and

969 the department shall, in their respective annual reports,

970 include statistics that report the number of licensed facilities

971 that assume such liability and the number of health care

972 practitioners, by profession, for whom they assume liability.

973 (4) The agency shall adopt rules governing the

974 establishment of internal risk management programs to meet the

975 needs of individual licensed facilities. Each internal risk

976 management program shall include the use of incident reports to

977 be filed with a responsible individual who is competent in risk

978 management techniques, such as an insurance coordinator, in the

979 employ of each licensed facility or who is retained by the

980 licensed facility as a consultant. The individual responsible

981 for the risk management program shall have free access to all

982 medical records of the licensed facility. The incident reports

983 are part of the workpapers of the attorney defending the

984 licensed facility in litigation relating to the licensed

985 facility and are subject to discovery, but are not admissible as

986 evidence in court. A person filing an incident report is not

987 subject to civil suit by virtue of such incident report. As a

988 part of each internal risk management program, the incident

989 reports must be used to develop categories of incidents which

990 identify problem areas. Once identified, procedures must be

991 adjusted to correct the problem areas.

992 (5) For purposes of reporting to the agency pursuant to

993 this section, the term “adverse incident” means an event over

994 which health care personnel could exercise control and which is

995 associated in whole or in part with medical intervention, rather

996 than the condition for which such intervention occurred, and

997 which:

998 (a) Results in one of the following outcomes:

999 1. Death;

1000 2. Brain or spinal damage;

1001 3. Permanent disfigurement;

1002 4. Fracture or dislocation of bones or joints;

1003 5. A resulting limitation of neurological, physical, or

1004 sensory function which continues after discharge from the

1005 licensed facility; or

1006 6. Any condition that required specialized medical

1007 attention or surgical intervention resulting from nonemergency

1008 medical intervention, other than an emergency medical condition,

1009 to which the patient has not given his or her informed consent;

1010 (b) Was the performance of a surgical procedure on the

1011 wrong patient, a wrong surgical procedure, a wrong-site surgical

1012 procedure, or a surgical procedure otherwise unrelated to the

1013 patient’s diagnosis or medical condition;

1014 (c) Required the surgical repair of damage resulting to a

1015 patient from a planned surgical procedure, where the damage was

1016 not a recognized specific risk, as disclosed to the patient and

1017 documented through the informed-consent process; or

1018 (d) Was a procedure to remove unplanned foreign objects

1019 remaining from a surgical procedure.

1020 (6)(a) Each licensed facility subject to this section shall

1021 submit an annual report to the agency summarizing the adverse

1022 incident reports that have been filed in the facility for that

1023 year. The report must include:

1024 1. The total number of adverse incidents.

1025 2. A listing, by category, of the types of operations,

1026 diagnostic or treatment procedures, or other actions causing the

1027 injuries, and the number of incidents occurring within each

1028 category.

1029 3. A listing, by category, of the types of injuries caused

1030 and the number of incidents occurring within each category.

1031 4. A code number using the health care professional’s

1032 licensure number and a separate code number identifying all

1033 other individuals directly involved in adverse incidents to

1034 patients, the relationship of the individual to the licensed

1035 facility, and the number of incidents in which each individual

1036 has been directly involved. Each licensed facility shall

1037 maintain names of the health care professionals and individuals

1038 identified by code numbers for purposes of this section.

1039 5. A description of all malpractice claims filed against

1040 the licensed facility, including the total number of pending and

1041 closed claims and the nature of the incident which led to, the

1042 persons involved in, and the status and disposition of each

1043 claim. Each report must update status and disposition for all

1044 prior claims pending.

1045 (b) The information reported to the agency pursuant to

1046 paragraph (a) which relates to persons licensed under chapter

1047 458, chapter 459, chapter 461, or chapter 466 must be reviewed

1048 by the agency. The agency shall determine whether any of the

1049 incidents potentially involved conduct by a health care

1050 professional who is subject to disciplinary action, in which

1051 case s. 456.073 applies.

1052 (c) The report submitted to the agency must also contain

1053 the name of the risk manager of the licensed facility, a copy of

1054 the policies and procedures governing the measures taken by the

1055 licensed facility and its risk manager to reduce the risk of

1056 injuries and adverse incidents, and the results of such

1057 measures. The annual report is confidential and is not available

1058 to the public pursuant to s. 119.07(1) or any other law

1059 providing access to public records. The annual report is not

1060 discoverable or admissible in any civil or administrative

1061 action, except in disciplinary proceedings by the agency or the

1062 appropriate regulatory board. The annual report is not available

1063 to the public as part of the record of investigation for and

1064 prosecution in disciplinary proceedings made available to the

1065 public by the agency or the appropriate regulatory board.

1066 However, the agency or the appropriate regulatory board shall

1067 make available, upon written request by a health care

1068 professional against whom probable cause has been found, any

1069 such records which form the basis of the determination of

1070 probable cause.

1071 (7) Any of the following adverse incidents, whether

1072 occurring in the licensed facility or arising from health care

1073 services administered before the patient’s admission to the

1074 licensed facility, must be reported by the licensed facility to

1075 the agency within 15 calendar days after its occurrence:

1076 (a) The death of a patient;

1077 (b) Brain or spinal damage to a patient;

1078 (c) The performance of a surgical procedure on the wrong

1079 patient;

1080 (d) The performance of a wrong-site surgical procedure;

1081 (e) The performance of a wrong surgical procedure;

1082 (f) The performance of a surgical procedure that is

1083 medically unnecessary or otherwise unrelated to the patient’s

1084 diagnosis or medical condition;

1085 (g) The surgical repair of damage resulting to a patient

1086 from a planned surgical procedure, where the damage is not a

1087 recognized specific risk, as disclosed to the patient and

1088 documented through the informed-consent process; or

1089 (h) The performance of procedures to remove unplanned

1090 foreign objects remaining from a surgical procedure.

1092 The agency may grant extensions to this reporting requirement

1093 for no more than 15 days upon justification submitted in writing

1094 to the agency by the licensed facility administrator. The agency

1095 may require an additional, final report. These reports are not

1096 available to the public pursuant to s. 119.07(1) or any other

1097 law providing access to public records, nor discoverable or

1098 admissible in any civil or administrative action, except in

1099 disciplinary proceedings by the agency or the appropriate

1100 regulatory board, nor available to the public as part of the

1101 record of investigation for and prosecution in disciplinary

1102 proceedings made available to the public by the agency or the

1103 appropriate regulatory board. However, the agency or the

1104 appropriate regulatory board shall make available, upon written

1105 request by a health care professional against whom probable

1106 cause has been found, any such records that form the basis of

1107 the determination of probable cause. The agency may, as it deems

1108 appropriate, investigate any such incident and prescribe

1109 measures that must or may be taken in response to the incident.

1110 The agency shall review each incident and determine whether it

1111 potentially involved conduct by the health care professional,

1112 who would be subject to disciplinary action, in which case s.

1113 456.073 applies.

1114 (8) The agency shall publish on the agency’s website, at

1115 least quarterly, a summary and trend analysis of adverse

1116 incident reports received pursuant to this section, which may

1117 not include information that would identify the patient, the

1118 reporting facility, or the health care practitioners involved.

1119 The agency shall publish on the agency’s website an annual

1120 summary and trend analysis of all adverse incident reports and

1121 malpractice claims information provided by licensed facilities

1122 in their annual reports, which may not include information that

1123 would identify the patient, the reporting facility, or the

1124 practitioners involved. The purpose of the publication of the

1125 summary and trend analysis is to promote the rapid dissemination

1126 of information relating to adverse incidents and malpractice

1127 claims to assist licensed facilities in avoiding similar

1128 incidents and reduce morbidity and mortality.

1129 (9) The internal risk manager of each licensed facility

1130 shall:

1131 (a) Investigate every allegation of sexual misconduct which

1132 is made against a member of the licensed facility’s staff who

1133 has direct patient contact, when the allegation is that the

1134 sexual misconduct occurred at the facility or on the grounds of

1135 the facility.

1136 (b) Report every allegation of sexual misconduct to the

1137 administrator of the licensed facility.

1138 (c) Notify the family or guardian of the victim, if a

1139 minor, that an allegation of sexual misconduct has been made and

1140 that an investigation is being conducted.

1141 (d) Report to the department every allegation of sexual

1142 misconduct by a licensed health care practitioner which involves

1143 a patient.

1144 (10) Any witness who witnessed or who possesses actual

1145 knowledge of the act that is the basis of an allegation of

1146 sexual abuse shall:

1147 (a) Notify the local police; and

1148 (b) Notify the risk manager and the administrator.

1150 For purposes of this subsection, the term “sexual abuse” means

1151 acts of a sexual nature committed for the sexual gratification

1152 of anyone upon or in the presence of a vulnerable adult as

1153 defined in s. 415.102, without the vulnerable adult’s informed

1154 consent, or upon or in the presence of a minor. The term

1155 includes, but is not limited to, the acts defined in s.

1156 794.011(1)(j), fondling, exposure of a vulnerable adult’s or

1157 minor’s sexual organs, or the use of the vulnerable adult or

1158 minor to solicit for or engage in prostitution or sexual

1159 performance. The term does not include any act intended for a

1160 valid medical purpose or any act which may reasonably be

1161 construed to be a normal caregiving action.

1162 (11) A person who, with malice or with intent to discredit

1163 or harm a licensed facility or any person, makes a false

1164 allegation of sexual misconduct against a member of a licensed

1165 facility’s staff commits a misdemeanor of the second degree,

1166 punishable as provided in s. 775.082 or s. 775.083.

1167 (12) In addition to any penalty imposed pursuant to this

1168 section or part II of chapter 408, the agency shall require a

1169 written plan of correction from the licensed facility. For a

1170 single incident or series of isolated incidents that are

1171 nonwillful violations of the reporting requirements of this

1172 section or part II of chapter 408, the agency shall first seek

1173 to obtain corrective action by the licensed facility. If the

1174 correction is not demonstrated within the timeframe established

1175 by the agency or if there is a pattern of nonwillful violations

1176 of this section or part II of chapter 408, the agency may impose

1177 an administrative fine, not to exceed $5,000 for any violation

1178 of the reporting requirements of this section or part II of

1179 chapter 408. The administrative fine for repeated nonwillful

1180 violations may not exceed $10,000 for any violation. The

1181 administrative fine for each intentional and willful violation

1182 may not exceed $25,000 per violation, per day. The fine for an

1183 intentional and willful violation of this section or part II of

1184 chapter 408 may not exceed $250,000. In determining the amount

1185 of fine to be levied, the agency shall be guided by s.

1186 396.219(2)(b).

1187 (13) The agency shall be given access to all licensed

1188 facility records necessary to carry out this section. The

1189 records obtained by the agency under subsection (6), subsection

1190 (7), or subsection (9) are not available to the public under s.

1191 119.07(1), nor discoverable or admissible in any civil or

1192 administrative action, except in disciplinary proceedings by the

1193 agency or the appropriate regulatory board, nor are records

1194 obtained pursuant to s. 456.071 available to the public as part

1195 of the record of investigation for and prosecution in

1196 disciplinary proceedings made available to the public by the

1197 agency or the appropriate regulatory board. However, the agency

1198 or the appropriate regulatory board shall make available, upon

1199 written request by a health care practitioner against whom

1200 probable cause has been found, any such records that form the

1201 basis of the determination of probable cause, except that, with

1202 respect to medical review committee records, s. 766.101

1203 controls.

1204 (14) The meetings of the committees and governing board of

1205 a licensed facility held solely for the purpose of achieving the

1206 objectives of risk management as provided by this section may

1207 not be open to the public under chapter 286. The records of such

1208 meetings are confidential and exempt from s. 119.07(1), except

1209 as provided in subsection (13).

1210 (15) The agency shall review, as part of its licensure

1211 review process, the internal risk management program at each

1212 licensed facility regulated by this section to determine whether

1213 the program meets standards established in statutes and rules,

1214 whether the program is being conducted in a manner designed to

1215 reduce adverse incidents, and whether the program is

1216 appropriately reporting incidents under this section.

1217 (16) There is no monetary liability on the part of, and no

1218 cause of action for damages may arise against, any risk manager

1219 for the implementation and oversight of the internal risk

1220 management program in a facility licensed under this chapter as

1221 required by this section, for any act or proceeding undertaken

1222 or performed within the scope of the functions of such internal

1223 risk management program, if the risk manager acts without

1224 intentional fraud.

1225 (17) A privilege against civil liability is granted to any

1226 risk manager or licensed facility with regard to information

1227 furnished pursuant to this chapter, unless the risk manager or

1228 facility acted in bad faith or with malice in providing such

1229 information.

1230 (18) If the agency, through its receipt of any report

1231 required under this section or through any investigation, has a

1232 reasonable belief that conduct by a staff member or employee of

1233 a licensed facility is grounds for disciplinary action by the

1234 appropriate regulatory board, the agency must report this fact

1235 to such regulatory board.

1236 (19) It is unlawful for any person to coerce, intimidate,

1237 or preclude a risk manager from lawfully executing his or her

1238 reporting obligations pursuant to this chapter. Such unlawful

1239 action is subject to civil monetary penalties not to exceed

1240 $10,000 per violation.

1241 Section 14. Section 396.214, Florida Statutes, is created

1242 to read:

1243 396.214 Identification, segregation, and separation of

1244 biomedical waste.—Each licensed facility shall comply with the

1245 requirements in s. 381.0098 relating to biomedical waste. Any

1246 transporter or potential transporter of such waste must be

1247 notified of the existence and locations of such waste.

1248 Section 15. Section 396.215, Florida Statutes, is created

1249 to read:

1250 396.215 Patient safety.—

1251 (1) Each licensed facility shall adopt a patient safety

1252 plan. A plan adopted to implement the requirements of 42 C.F.R.

1253 s. 416.43 is deemed to comply with this requirement.

1254 (2) Each licensed facility shall appoint a patient safety

1255 officer and a patient safety committee, which must include at

1256 least one person who is neither employed by nor practicing at

1257 the facility, for the purpose of promoting the health and safety

1258 of patients, reviewing and evaluating the quality of patient

1259 safety measures used by the facility, and assisting in the

1260 implementation of the facility patient safety plan.

1261 (3) Each licensed facility shall, at least biennially,

1262 conduct a patient safety culture survey using the applicable

1263 Survey on Patient Safety Culture developed by the federal Agency

1264 for Healthcare Research and Quality. Each licensed facility

1265 shall conduct the survey anonymously to encourage completion of

1266 the survey by staff working in or employed by the facility. Each

1267 licensed facility may contract to administer the survey. Each

1268 licensed facility shall biennially submit the survey data to the

1269 agency in a format specified by rule, which must include the

1270 survey participation rate. Each licensed facility may develop an

1271 internal action plan between conducting surveys to identify

1272 measures to improve the survey and submit the plan to the

1273 agency.

1274 (4) Each licensed facility shall:

1275 (a) Develop and implement policies and procedures for the

1276 rendering of appropriate medical care for persons at risk of

1277 forming venous thromboembolisms which reflect evidence-based

1278 best practices relating to, at a minimum:

1279 1. Assessing patients for risk of venous thromboembolism

1280 using a nationally recognized risk assessment tool.

1281 2. Treatment options for a patient diagnosed with venous

1282 thromboembolism.

1283 (b) Train all nonphysician personnel at least annually on

1284 the policies and procedures developed under this subsection. For

1285 purposes of this subsection, the term “nonphysician personnel”

1286 means all personnel of the licensed facility working in clinical

1287 areas and providing patient care, except those persons licensed

1288 as health care practitioners.

1289 Section 16. Section 396.216, Florida Statutes, is created

1290 to read:

1291 396.216 Cases of child abuse, abandonment, or neglect;

1292 duties.—Each licensed facility shall adopt protocols that, at a

1293 minimum, require the facility to:

1294 (1) Incorporate a facility policy that every staff member

1295 has an affirmative duty to report, pursuant to chapter 39, any

1296 actual or suspected case of child abuse, abandonment, or

1297 neglect; and

1298 (2) In any case involving suspected child abuse,

1299 abandonment, or neglect, designate, at the request of the

1300 Department of Children and Families, a staff physician to act as

1301 a liaison between the licensed facility and the Department of

1302 Children and Families office that is investigating the suspected

1303 abuse, abandonment, or neglect, and the Child Protection Team,

1304 as defined in s. 39.01, when the case is referred to such a

1305 team.

1306 Section 17. Section 396.217, Florida Statutes, is created

1307 to read:

1308 396.217 Duty to notify patients.—An appropriately trained

1309 person designated by each licensed facility shall inform each

1310 patient, or an individual identified pursuant to s. 765.401(1),

1311 in person about adverse incidents that result in serious harm to

1312 the patient. Notifications of outcomes of care that result in

1313 harm to the patient under this section do not constitute an

1314 acknowledgment or admission of liability, and may not be

1315 introduced as evidence.

1316 Section 18. Section 396.218, Florida Statutes, is created

1317 to read:

1318 396.218 Rules and enforcement.—

1319 (1) The agency shall adopt rules pursuant to ss. 120.536(1)

1320 and 120.54 to implement this chapter, which must include

1321 reasonable and fair minimum standards for ensuring that:

1322 (a) Sufficient numbers and qualified types of personnel and

1323 occupational disciplines are on duty and available at all times

1324 to provide necessary and adequate patient care and safety.

1325 (b) Infection control, housekeeping, sanitary conditions,

1326 and medical record procedures that will adequately protect

1327 patient care and safety are established and implemented.

1328 (c) A comprehensive emergency management plan is prepared

1329 and updated annually. Standards for such plans must be included

1330 in the rules adopted by the agency after consulting with the

1331 Division of Emergency Management. At a minimum, the rules must

1332 provide for plan components that address emergency evacuation

1333 transportation; adequate sheltering arrangements; postdisaster

1334 activities, including emergency power, food, and water;

1335 postdisaster transportation; supplies; staffing; emergency

1336 equipment; individual identification of residents and transfer

1337 of records; and responding to family inquiries. The

1338 comprehensive emergency management plan is subject to review and

1339 approval by the local emergency management agency. During its

1340 review, the local emergency management agency shall ensure that

1341 the following agencies, at a minimum, are given the opportunity

1342 to review the plan: the Agency for Health Care Administration,

1343 the Department of Elderly Affairs, the Department of Health, and

1344 the Division of Emergency Management. Also, appropriate

1345 volunteer organizations must be given the opportunity to review

1346 the plan. The local emergency management agency shall complete

1347 its review within 60 days and either approve the plan or advise

1348 the licensed facility of necessary revisions.

1349 (d) Licensed facilities are established, organized, and

1350 operated consistently with established standards and rules.

1351 (e) Licensed facility beds conform to minimum space,

1352 equipment, and furnishings standards as specified by the agency.

1353 (f) Each licensed facility has a quality improvement

1354 program designed to enhance quality of care and to emphasize

1355 quality patient outcomes, corrective action for problems,

1356 governing board review, and reporting to the agency of

1357 standardized data elements necessary to analyze quality of care

1358 outcomes. The agency shall use existing data, when available,

1359 and may not duplicate the efforts of other state agencies in

1360 order to obtain such data.

1361 (g) Licensed facilities make available on their websites,

1362 and in a hard copy format upon request, a description of and a

1363 link to the patient charge and performance outcome data

1364 collected from licensed facilities pursuant to s. 408.061.

1365 (2) The agency shall adopt rules that establish minimum

1366 standards for pediatric patient care in ambulatory surgical

1367 centers to ensure the safe and effective delivery of surgical

1368 care to children. Such standards must include quality of care,

1369 nurse staffing, physician staffing, and equipment standards.

1370 Ambulatory surgical centers may not provide operative procedures

1371 to children under 18 years of age which require a length of stay

1372 past midnight unless such standards are established by rule.

1373 (3) Any rule adopted under this chapter by the agency may

1374 not deny a license to a facility required to be licensed under

1375 this chapter solely by reason of the school or system of

1376 practice employed or permitted to be employed by physicians

1377 therein, provided that such school or system of practice is

1378 recognized by the laws of this state. However, this subsection

1379 does not limit the powers of the agency to provide and require

1380 minimum standards for the maintenance and operation of, and for

1381 the treatment of patients in, those licensed facilities that

1382 receive federal aid, in order to meet minimum standards related

1383 to such matters in such licensed facilities which may now or

1384 hereafter be required by appropriate federal officers or

1385 agencies pursuant to federal law or rules adopted pursuant

1386 thereto.

1387 (4) Any licensed facility that is in operation at the time

1388 of adoption of any applicable rule under this chapter must be

1389 given a reasonable time, under the particular circumstances, but

1390 not to exceed 1 year after the date of such adoption, within

1391 which to comply with such rule.

1392 (5) The agency may not adopt any rule governing the design,

1393 construction, erection, alteration, modification, repair, or

1394 demolition of any ambulatory surgical center. It is the intent

1395 of the Legislature to preempt that function to the Florida

1396 Building Commission and the State Fire Marshal through adoption

1397 and maintenance of the Florida Building Code and the Florida

1398 Fire Prevention Code. However, the agency shall provide

1399 technical assistance to the commission and the State Fire

1400 Marshal in updating the construction standards of the Florida

1401 Building Code and the Florida Fire Prevention Code which govern

1402 ambulatory surgical centers.

1403 Section 19. Section 396.219, Florida Statutes, is created

1404 to read:

1405 396.219 Criminal and administrative penalties; moratorium.—

1406 (1) In addition to the penalties provided in s. 408.812, a

1407 person establishing, conducting, managing, or operating any

1408 facility without a license under this chapter commits a

1409 misdemeanor and, upon conviction, shall be fined not more than

1410 $500 for the first offense and not more than $1,000 for each

1411 subsequent offense, and each day of continuing violation after

1412 conviction is considered a separate offense.

1413 (2)(a) The agency may impose an administrative fine, not to

1414 exceed $1,000 per violation, per day, for the violation of any

1415 provision of this chapter, part II of chapter 408, or applicable

1416 rules. Each day of violation constitutes a separate violation

1417 and is subject to a separate fine.

1418 (b) In determining the amount of fine to be levied for a

1419 violation, as provided in paragraph (a), the following factors

1420 must be considered:

1421 1. The severity of the violation, including the probability

1422 that death or serious harm to the health or safety of any person

1423 will result or has resulted, the severity of the actual or

1424 potential harm, and the extent to which the provisions of this

1425 chapter were violated.

1426 2. Actions taken by the licensee to correct the violations

1427 or to remedy complaints.

1428 3. Any previous violations of the licensee.

1429 (c) The agency may impose an administrative fine for the

1430 violation of s. 641.3154 or, if sufficient claims due a provider

1431 from a health maintenance organization do not exist to enable

1432 the take-back of an overpayment, as provided under s.

1433 641.3155(5), for the violation of s. 641.3155(5). The

1434 administrative fine for a violation cited in this paragraph

1435 shall be in the amounts specified in s. 641.52(5), and paragraph

1436 (a) does not apply.

1437 (3) In accordance with part II of chapter 408, the agency

1438 may impose an immediate moratorium on elective admissions to any

1439 licensed facility, building, or portion thereof, or service,

1440 when the agency determines that any condition in the licensed

1441 facility presents a threat to public health or safety.

1442 (4) The agency shall impose a fine of $500 for each

1443 instance of the licensed facility’s failure to provide the

1444 information required by rules adopted pursuant to s.

1445 396.218(1)(g).

1446 Section 20. Section 396.221, Florida Statutes, is created

1447 to read:

1448 396.221 Powers and duties of the agency.—The agency shall:

1449 (1) Adopt rules pursuant to ss. 120.536(1) and 120.54 to

1450 implement this chapter and part II of chapter 408 conferring

1451 duties upon it.

1452 (2) Enforce the special-occupancy provisions of the Florida

1453 Building Code which apply to ambulatory surgical centers in

1454 conducting any inspection authorized by this chapter and part II

1455 of chapter 408.

1456 Section 21. Section 396.222, Florida Statutes, is created

1457 to read:

1458 396.222 Price transparency; itemized patient statement or

1459 bill; patient admission status notification.—

1460 (1) A facility licensed under this chapter shall provide

1461 timely and accurate financial information and quality of service

1462 measures to patients and prospective patients of the facility,

1463 or to patients’ survivors or legal guardians, as appropriate.

1464 Such information must be provided in accordance with this

1465 section and rules adopted by the agency pursuant to this chapter

1466 and s. 408.05.

1467 (a) Each licensed facility shall make available to the

1468 public on its website information on payments made to that

1469 facility for defined bundles of services and procedures. The

1470 payment data must be presented and searchable in accordance

1471 with, and through a hyperlink to, the system established by the

1472 agency and its vendor using the descriptive service bundles

1473 developed under s. 408.05(3)(c). At a minimum, the licensed

1474 facility shall provide the estimated average payment received

1475 from all payors, excluding Medicaid and Medicare, for the

1476 descriptive service bundles available at that facility and the

1477 estimated payment range for such bundles. Using plain language,

1478 comprehensible to an ordinary layperson, the licensed facility

1479 shall disclose that the information on average payments and the

1480 payment ranges is an estimate of costs that may be incurred by

1481 the patient or prospective patient and that actual costs will be

1482 based on the services actually provided to the patient. The

1483 licensed facility’s website must:

1484 1. Provide information to prospective patients on the

1485 licensed facility’s financial assistance policy, including the

1486 application process, payment plans, and discounts, and the

1487 facility’s charity care policy and collection procedures.

1488 2. If applicable, notify patients and prospective patients

1489 that services may be provided in the licensed facility by that

1490 facility as well as by other health care providers who may

1491 separately bill the patient and that such health care providers

1492 may or may not participate with the same health insurers or

1493 health maintenance organizations as the facility.

1494 3. Inform patients and prospective patients that they may

1495 request from the licensed facility and other health care

1496 providers a more personalized estimate of charges and other

1497 information, and inform patients that they should contact each

1498 health care practitioner who will provide services in the

1499 facility to determine the health insurers and health maintenance

1500 organizations with which the health care practitioner

1501 participates as a network provider or preferred provider.

1502 4. Provide the names, mailing addresses, and telephone

1503 numbers of the health care practitioners and medical practice

1504 groups with which it contracts to provide services in the

1505 licensed facility and instructions on how to contact the

1506 practitioners and groups to determine the health insurers and

1507 health maintenance organizations with which they participate as

1508 network providers or preferred providers.

1509 (b) Each licensed facility shall post on its website a

1510 consumer-friendly list of standard charges for at least 300

1511 shoppable health care services, or an Internet-based price

1512 estimator tool that meets federal standards. If a licensed

1513 facility provides fewer than 300 distinct shoppable health care

1514 services, it must make available on its website the standard

1515 charges for each service it provides. As used in this paragraph,

1516 the term:

1517 1. “Shoppable health care service” means a service that can

1518 be scheduled by a health care consumer in advance. The term

1519 includes, but is not limited to, the services described in s.

1520 627.6387(2)(e) and any services defined in regulations or

1521 guidance issued by the United States Department of Health and

1522 Human Services.

1523 2. “Standard charge” has the same meaning as that term is

1524 defined in regulations or guidance issued by the United States

1525 Department of Health and Human Services for purposes of

1526 ambulatory surgical center price transparency.

1527 (c)1. Before providing any nonemergency medical service,

1528 each licensed facility shall provide in writing or by electronic

1529 means a good faith estimate of reasonably anticipated charges

1530 for the treatment of a patient’s or prospective patient’s

1531 specific condition. The licensed facility is not required to

1532 adjust the estimate for any potential insurance coverage. The

1533 licensed facility must provide the estimate to the patient’s

1534 health insurer, as defined in s. 627.446(1), and the patient at

1535 least 3 business days before the date such service is to be

1536 provided, but no later than 1 business day after the date such

1537 service is scheduled or, in the case of a service scheduled at

1538 least 10 business days in advance, no later than 3 business days

1539 after the date the service is scheduled. The licensed facility

1540 shall provide the estimate to the patient no later than 3

1541 business days after the date the patient requests an estimate.

1542 The estimate may be based on the descriptive service bundles

1543 developed by the agency under s. 408.05(3)(c) unless the patient

1544 or prospective patient requests a more personalized and specific

1545 estimate that accounts for the specific condition and

1546 characteristics of the patient or prospective patient. The

1547 licensed facility shall inform the patient or prospective

1548 patient that he or she may contact his or her health insurer for

1549 additional information concerning cost-sharing responsibilities.

1550 2. In the estimate, the licensed facility shall provide to

1551 the patient or prospective patient information on the facility’s

1552 financial assistance policy, including the application process,

1553 payment plans, and discounts and the facility’s charity care

1554 policy and collection procedures.

1555 3. The estimate must clearly identify any facility fee and,

1556 if applicable, include a statement notifying the patient or

1557 prospective patient that a facility fee is included in the

1558 estimate, the purpose of the fee, and that the patient may pay

1559 less for the procedure or service at another facility or in

1560 another health care setting.

1561 4. The licensed facility shall notify the patient or

1562 prospective patient of any revision to the estimate.

1563 5. In the estimate, the licensed facility shall notify the

1564 patient or prospective patient that services may be provided by

1565 the facility as well as by other health care providers that may

1566 separately bill the patient, if applicable.

1567 6. Failure to timely provide the estimate pursuant to this

1568 paragraph shall result in a daily fine of $1,000 until the

1569 estimate is provided to the patient or prospective patient and

1570 the health insurer. The total fine per patient estimate may not

1571 exceed $10,000.

1572 (d) Each licensed facility shall make available on its

1573 website a hyperlink to the health-related data, including

1574 quality measures and statistics that are disseminated by the

1575 agency pursuant to s. 408.05. The licensed facility shall also

1576 take action to notify the public that such information is

1577 electronically available and provide a hyperlink to the agency’s

1578 website.

1579 (e)1. Upon request, and after the patient’s discharge or

1580 release from a licensed facility, the facility shall provide to

1581 the patient or to the patient’s survivor or legal guardian, as

1582 applicable, an itemized statement or a bill detailing in plain

1583 language, comprehensible to an ordinary layperson, the specific

1584 nature of charges or expenses incurred by the patient. The

1585 initial statement or bill must be provided within 7 days after

1586 the patient’s discharge or release or after a request for such

1587 statement or bill, whichever is later. The initial statement or

1588 bill must contain a statement of specific services received and

1589 expenses incurred by date and provider for such services,

1590 enumerating in detail as prescribed by the agency the

1591 constituent components of the services received within each

1592 department of the licensed facility and including unit price

1593 data on rates charged by the licensed facility. The statement or

1594 bill must also clearly identify any facility fee and explain the

1595 purpose of the fee. The statement or bill must identify each

1596 item as paid, pending payment by a third party, or pending

1597 payment by the patient, and must include the amount due, if

1598 applicable. If an amount is due from the patient, a due date

1599 must be included. The initial statement or bill must direct the

1600 patient or the patient’s survivor or legal guardian, as

1601 applicable, to contact the patient’s insurer or health

1602 maintenance organization regarding the patient’s cost-sharing

1603 responsibilities.

1604 2. Any subsequent statement or bill provided to a patient

1605 or to the patient’s survivor or legal guardian, as applicable,

1606 relating to the episode of care must include all of the

1607 information required by subparagraph 1., with any revision

1608 clearly delineated.

1609 3. Each statement or bill provided pursuant to this

1610 subsection:

1611 a. Must include notice of physicians and other health care

1612 providers who bill separately.

1613 b. May not include any generalized category of expenses

1614 such as “other” or “miscellaneous” or similar categories.

1615 (2) Each itemized statement or bill must prominently

1616 display the telephone number of the licensed facility’s patient

1617 liaison who is responsible for expediting the resolution of any

1618 billing dispute between the patient, or the patient’s survivor

1619 or legal guardian, and the billing department.

1620 (3) A licensed facility shall make available to a patient

1621 or his or her survivor or legal guardian all records necessary

1622 for verification of the accuracy of the patient’s statement or

1623 bill within 10 business days after the request for such records.

1624 The records must be made available in the licensed facility’s

1625 offices and through electronic means that comply with the Health

1626 Insurance Portability and Accountability Act of 1996, 42 U.S.C.

1627 s. 1320d, as amended. Such records must be available before and

1628 after payment of the statement or bill. The licensed facility

1629 may not charge the patient or his or her survivor or legal

1630 guardian for making such verification records available;

1631 however, the facility may charge fees for providing copies of

1632 records as specified in s. 396.225(1).

1633 (4) Each licensed facility shall establish a method for

1634 reviewing and responding to questions from patients or their

1635 survivors or legal guardians concerning the patient’s itemized

1636 statement or bill. Such response must be provided within 7

1637 business days after the date a question is received. If the

1638 patient is not satisfied with the response, the facility must

1639 provide the patient or his or her survivor or legal guardian

1640 with the contact information of the agency to which the issue

1641 may be sent for review.

1642 (5) Each licensed facility shall establish an internal

1643 process for reviewing and responding to grievances from

1644 patients. Such process must allow a patient or his or her

1645 survivor or legal guardian to dispute charges that appear on the

1646 patient’s itemized statement or bill. The licensed facility

1647 shall prominently post on its website and indicate in bold print

1648 on each itemized statement or bill the instructions for

1649 initiating a grievance and the direct contact information

1650 required to initiate the grievance process. The licensed

1651 facility shall provide an initial response to a patient

1652 grievance within 7 business days after the patient or his or her

1653 survivor or legal guardian formally files a grievance disputing

1654 all or a portion of an itemized statement or bill.

1655 (6) Each licensed facility shall disclose to a patient, a

1656 prospective patient, or a patient’s legal guardian whether a

1657 cost-sharing obligation for a particular covered health care

1658 service or item exceeds the charge that applies to an individual

1659 who pays cash or the cash equivalent for the same health care

1660 service or item in the absence of health insurance coverage.

1661 Failure to provide a disclosure in compliance with this

1662 subsection may result in a fine not to exceed $500 per incident.

1663 Section 22. Section 396.223, Florida Statutes, is created

1664 to read:

1665 396.223 Billing and collection activities.—

1666 (1) As used in this section, the term “extraordinary

1667 collection action” means any of the following actions taken by a

1668 licensed facility against an individual in relation to obtaining

1669 payment of a bill for care:

1670 (a) Selling the individual’s debt to another party.

1671 (b) Reporting adverse information about the individual to

1672 consumer credit reporting agencies or credit bureaus.

1673 (c) Actions that require a legal or judicial process,

1674 including, but not limited to:

1675 1. Placing a lien on the individual’s property;

1676 2. Foreclosing on the individual’s real property;

1677 3. Attaching or seizing the individual’s bank account or

1678 any other personal property;

1679 4. Commencing a civil action against the individual;

1680 5. Causing the individual’s arrest; or

1681 6. Garnishing the individual’s wages.

1682 (2) A licensed facility may not engage in an extraordinary

1683 collection action against an individual to obtain payment for

1684 services:

1685 (a) Before the licensed facility has made reasonable

1686 efforts to determine whether the individual is eligible for

1687 assistance under its financial assistance policy for the care

1688 provided and, if eligible, before a decision is made by the

1689 facility on the patient’s application for such financial

1690 assistance.

1691 (b) Before the licensed facility has provided the

1692 individual with an itemized statement or bill.

1693 (c) During an ongoing grievance process as described in s.

1694 395.301(6) or an ongoing appeal of a claim adjudication.

1695 (d) Before billing any applicable insurer and allowing the

1696 insurer to adjudicate a claim.

1697 (e) For 30 days after notifying the patient in writing, by

1698 certified mail or by other traceable delivery method, that a

1699 collection action will commence absent additional action by the

1700 patient. This paragraph does not apply to a sale of debt

1701 governed by a contract executed by the facility which provides

1702 that the debt may not incur interest or fees and that no other

1703 extraordinary collection actions may be taken by the purchaser

1704 of the debt which could otherwise be taken by the licensed

1705 facility, as described in subsection (1), and that the debt will

1706 be returned to the facility if the debt buyer determines the

1707 individual is eligible for assistance under the facility’s

1708 financial assistance policy.

1709 (f) While the individual:

1710 1. Negotiates in good faith the final amount of a bill for

1711 services rendered; or

1712 2. Complies with all terms of a payment plan with the

1713 licensed facility.

1714 Section 23. Section 396.224, Florida Statutes, is created

1715 to read:

1716 396.224 Patient records; penalties for alteration.—

1717 (1) A person who fraudulently alters, defaces, or falsifies

1718 any medical record, or causes or procures any of these offenses

1719 to be committed, commits a misdemeanor of the second degree,

1720 punishable as provided in s. 775.082 or s. 775.083.

1721 (2) A conviction under subsection (1) is also grounds for

1722 restriction, suspension, or termination of a license.

1723 Section 24. Section 396.225, Florida Statutes, is created

1724 to read:

1725 396.225 Patient and personnel records; copies;

1726 examination.—

1727 (1) A licensed facility shall, upon written request, and

1728 only after discharge of the patient, furnish, in a timely

1729 manner, without delays for legal review, to any person admitted

1730 to the licensed facility for care and treatment or treated at

1731 the licensed facility, or to any such person’s guardian,

1732 curator, or personal representative, or in the absence of one of

1733 those persons, to the next of kin of a decedent or the parent of

1734 a minor, or to anyone designated by such person in writing, a

1735 true and correct copy of all patient records, including X rays,

1736 and insurance information concerning such person, which records

1737 are in the possession of the licensed facility, provided that

1738 the person requesting such records agrees to pay a charge. The

1739 exclusive charge for copies of patient records may include sales

1740 tax and actual postage, and, except for nonpaper records that

1741 are subject to a charge not to exceed $2, may not exceed $1 per

1742 page. A fee of up to $1 may be charged for each year of records

1743 requested. These charges apply to all records furnished, whether

1744 directly from the licensed facility or from a copy service

1745 providing these services on behalf of the licensed facility.

1746 However, a patient whose records are copied or searched for the

1747 purpose of continuing to receive medical care is not required to

1748 pay a charge for copying or for the search. The licensed

1749 facility shall further allow any such person to examine the

1750 original records in its possession, or microforms or other

1751 suitable reproductions of the records, upon such reasonable

1752 terms as must be imposed to ensure that the records will not be

1753 damaged, destroyed, or altered.

1754 (2) Patient records are confidential and may not be

1755 disclosed without the consent of the patient or his or her legal

1756 representative, but appropriate disclosure may be made without

1757 such consent to:

1758 (a) Licensed facility personnel, attending physicians, or

1759 other health care practitioners and providers currently involved

1760 in the care or treatment of the patient for use only in

1761 connection with the treatment of the patient.

1762 (b) Licensed facility personnel only for administrative

1763 purposes or risk management and quality assurance functions.

1764 (c) The agency, for purposes of health care cost

1765 containment.

1766 (d) In any civil or criminal action, unless otherwise

1767 prohibited by law, upon the issuance of a subpoena from a court

1768 of competent jurisdiction and proper notice by the party seeking

1769 such records to the patient or his or her legal representative.

1770 (e) The department upon a subpoena issued pursuant to s.

1771 456.071, but the records obtained must be used solely for the

1772 purpose of the department and the appropriate regulatory board

1773 in its investigation, prosecution, and appeal of disciplinary

1774 proceedings. If the department requests copies of the records,

1775 the licensed facility must charge no more than its actual

1776 copying costs, including reasonable staff time. The records must

1777 be sealed and must not be available to the public pursuant to s.

1778 119.07(1) or any other statute providing access to records, nor

1779 may they be available to the public as part of the record of

1780 investigation for and prosecution in disciplinary proceedings

1781 made available to the public by the department or the

1782 appropriate regulatory board. However, the department shall make

1783 available, upon written request by a health care practitioner

1784 against whom probable cause has been found, any such record that

1785 forms the basis of the determination of probable cause.

1786 (f) The Medicaid Fraud Control Unit in the Department of

1787 Legal Affairs pursuant to s. 409.920.

1788 (g) The Department of Financial Services, or an agent,

1789 employee, or independent contractor of the department who is

1790 auditing for unclaimed property pursuant to chapter 717.

1791 (h) If applicable to a licensed facility, a regional poison

1792 control center for purposes of treating a poison episode under

1793 evaluation, case management of poison cases, or compliance with

1794 data collection and reporting requirements of s. 395.1027 and

1795 the professional organization that certifies poison control

1796 centers in accordance with federal law.

1797 (i) The Department of Children and Families, its agent, or

1798 its contracted entity, for the purposes of investigations of or

1799 services for cases of abuse, neglect, or exploitation of

1800 children or vulnerable adults.

1801 (j) Organ procurement organizations, tissue banks, and eye

1802 banks required to conduct death records reviews pursuant to s.

1803 395.2050.

1804 (3) The Department of Health may examine patient records of

1805 a licensed facility, whether held by the licensed facility or

1806 the agency, for the purpose of epidemiological investigations.

1807 The unauthorized release of information by agents of the

1808 department which would identify an individual patient is a

1809 misdemeanor of the first degree, punishable as provided in s.

1810 775.082 or s. 775.083.

1811 (4) Patient records must contain information required for

1812 completion of birth, death, and fetal death certificates.

1813 (5)(a) If the content of any record of patient treatment is

1814 provided under this section, the recipient, if other than the

1815 patient or the patient’s representative, may use such

1816 information only for the purpose provided and may not further

1817 disclose any information to any other person or entity, unless

1818 expressly permitted by the written consent of the patient. A

1819 general authorization for the release of medical information is

1820 not sufficient for this purpose. The content of such patient

1821 treatment record is confidential and exempt from s. 119.07(1)

1822 and s. 24(a), Art. I of the State Constitution.

1823 (b) Absent a specific written release or authorization

1824 permitting utilization of patient information for solicitation

1825 or marketing the sale of goods or services, any use of patient

1826 information for those purposes is prohibited.

1827 (6) A licensed facility may prescribe the content and

1828 custody of limited-access records that the facility may maintain

1829 on its employees. Such records are limited to information

1830 regarding evaluations of employee performance, including records

1831 forming the basis for evaluation and subsequent actions, and

1832 must be open to inspection only by the employee and by officials

1833 of the licensed facility who are responsible for the supervision

1834 of the employee. The custodian of limited-access employee

1835 records shall release information from such records to other

1836 employers or only upon authorization in writing from the

1837 employee or upon order of a court of competent jurisdiction. Any

1838 licensed facility releasing such records pursuant to this

1839 chapter is considered to be acting in good faith and may not be

1840 held liable for information contained in such records, absent a

1841 showing that the facility maliciously falsified such records.

1842 Such limited-access employee records are exempt from s.

1843 119.07(1) for a period of 5 years from the date such records are

1844 designated limited-access records.

1845 (7) The home addresses, telephone numbers, and photographs

1846 of employees of any licensed facility who provide direct patient

1847 care or security services; the home addresses, telephone

1848 numbers, and places of employment of the spouses and children of

1849 such persons; and the names and locations of schools and day

1850 care facilities attended by the children of such persons are

1851 confidential and exempt from s. 119.07(1) and s. 24(a), Art. I

1852 of the State Constitution. However, any state or federal agency

1853 that is authorized to have access to such information by any

1854 provision of law shall be granted such access in the furtherance

1855 of its statutory duties, notwithstanding this subsection. The

1856 Department of Financial Services, or an agent, employee, or

1857 independent contractor of the department who is auditing for

1858 unclaimed property pursuant to chapter 717, shall be granted

1859 access to the name, address, and social security number of any

1860 employee owed unclaimed property.

1861 (8) The home addresses, telephone numbers, and photographs

1862 of employees of any licensed facility who have a reasonable

1863 belief, based upon specific circumstances that have been

1864 reported in accordance with the procedure adopted by the

1865 licensed facility, that release of the information may be used

1866 to threaten, intimidate, harass, inflict violence upon, or

1867 defraud the employee or any member of the employee’s family; the

1868 home addresses, telephone numbers, and places of employment of

1869 the spouses and children of such persons; and the names and

1870 locations of schools and day care facilities attended by the

1871 children of such persons are confidential and exempt from s.

1872 119.07(1) and s. 24(a), Art. I of the State Constitution.

1873 However, any state or federal agency that is authorized to have

1874 access to such information by any provision of law shall be

1875 granted such access in the furtherance of its statutory duties,

1876 notwithstanding this subsection. The licensed facility shall

1877 maintain the confidentiality of the personal information only if

1878 the employee submits a written request for confidentiality to

1879 the licensed facility.

1880 Section 25. Subsection (3) of section 39.304, Florida

1881 Statutes, is amended to read:

1882 39.304 Photographs, medical examinations, X rays, and

1883 medical treatment of abused, abandoned, or neglected child.—

1884 (3) Any facility licensed under chapter 395 or chapter 396

1885 shall provide to the department, its agent, or a Child

1886 Protection Team that contracts with the department any

1887 photograph or report on examinations made or X rays taken

1888 pursuant to this section, or copies thereof, for the purpose of

1889 investigation or assessment of cases of abuse, abandonment,

1890 neglect, or exploitation of children.

1891 Section 26. Subsection (4) of section 95.11, Florida

1892 Statutes, is amended to read:

1893 95.11 Limitations other than for the recovery of real

1894 property.—Actions other than for recovery of real property shall

1895 be commenced as follows:

1896 (4) WITHIN THREE YEARS.—An action to collect medical debt

1897 for services rendered by a facility licensed under chapter 395

1898 or chapter 396 , provided that the period of limitations shall

1899 run from the date on which the facility refers the medical debt

1900 to a third party for collection.

1901 Section 27. Section 222.26, Florida Statutes, is amended to

1902 read:

1903 222.26 Additional exemptions from legal process concerning

1904 medical debt.—If a debt is owed for medical services provided by

1905 a facility licensed under chapter 395 or chapter 396 , the

1906 following property is exempt from attachment, garnishment, or

1907 other legal process in an action on such debt:

1908 (1) A debtor’s interest, not to exceed $10,000 in value, in

1909 a single motor vehicle as defined in s. 320.01(1).

1910 (2) A debtor’s interest in personal property, not to exceed

1911 $10,000 in value, if the debtor does not claim or receive the

1912 benefits of a homestead exemption under s. 4, Art. X of the

1913 State Constitution.

1914 Section 28. Paragraph (d) of subsection (3) of section

1915 381.00316, Florida Statutes, is amended to read:

1916 381.00316 Discrimination by governmental and business

1917 entities based on health care choices; prohibition.—

1918 (3)

1919 (d) A hospital licensed under chapter 395 or an ambulatory

1920 surgical center licensed under chapter 396 ~~licensed facility as~~

1921 ~~defined in s. 395.002~~ may not discriminate in providing health

1922 care to a patient based solely on that patient’s vaccination

1923 status with a COVID-19 vaccine.

1924 Section 29. Subsections (1) and (2) of section 381.0035,

1925 Florida Statutes, are amended to read:

1926 381.0035 Educational course on HIV and AIDS; employees and

1927 clients of certain health care facilities.—

1928 (1) The Department of Health shall require all employees

1929 and clients of facilities licensed under chapter 393, chapter

1930 394, or chapter 397 and employees of facilities licensed under

1931 chapter 395 or chapter 396 , part II, part III, or part IV of

1932 chapter 400, or part I of chapter 429 to complete a one-time

1933 educational course on the modes of transmission, infection

1934 control procedures, clinical management, and prevention of human

1935 immunodeficiency virus and acquired immune deficiency syndrome

1936 with an emphasis on appropriate behavior and attitude change.

1937 Such instruction shall include information on current Florida

1938 law and its impact on testing, confidentiality of test results,

1939 and treatment of patients and any protocols and procedures

1940 applicable to human immunodeficiency counseling and testing,

1941 reporting, the offering of HIV testing to pregnant women, and

1942 partner notification issues pursuant to ss. 381.004 and 384.25.

1943 An employee who has completed the educational course required in

1944 this subsection is not required to repeat the course upon

1945 changing employment to a different facility licensed under

1946 chapter 393, chapter 394, chapter 395, chapter 396, chapter 397,

1947 part II, part III, or part IV of chapter 400, or part I of

1948 chapter 429.

1949 (2) Facilities licensed under chapter 393, chapter 394,

1950 chapter 395, chapter 396, or chapter 397, part II, part III, or

1951 part IV of chapter 400, or part I of chapter 429 shall maintain

1952 a record of employees and dates of attendance at human

1953 immunodeficiency virus and acquired immune deficiency syndrome

1954 educational courses.

1955 Section 30. Paragraph (b) of subsection (2) and subsection

1956 (6) of section 381.026, Florida Statutes, are amended to read:

1957 381.026 Florida Patient’s Bill of Rights and

1958 Responsibilities.—

1959 (2) DEFINITIONS.—As used in this section and s. 381.0261,

1960 the term:

1961 (b) “Health care facility” means a facility licensed under

1962 chapter 395 or chapter 396 .

1963 (6) SUMMARY OF RIGHTS AND RESPONSIBILITIES.—Any health care

1964 provider who treats a patient in an office or any health care

1965 facility licensed under chapter 395 or chapter 396 that provides

1966 emergency services and care or outpatient services and care to a

1967 patient, or admits and treats a patient, shall adopt and make

1968 available to the patient, in writing, a statement of the rights

1969 and responsibilities of patients, including the following:

1971 SUMMARY OF THE FLORIDA PATIENT’S BILL

1972 OF RIGHTS AND RESPONSIBILITIES

1974 Florida law requires that your health care provider or

1975 health care facility recognize your rights while you are

1976 receiving medical care and that you respect the health care

1977 provider’s or health care facility’s right to expect certain

1978 behavior on the part of patients. You may request a copy of the

1979 full text of this law from your health care provider or health

1980 care facility. A summary of your rights and responsibilities

1981 follows:

1982 A patient has the right to be treated with courtesy and

1983 respect, with appreciation of his or her individual dignity, and

1984 with protection of his or her need for privacy.

1985 A patient has the right to a prompt and reasonable response

1986 to questions and requests.

1987 A patient has the right to know who is providing medical

1988 services and who is responsible for his or her care.

1989 A patient has the right to know what patient support

1990 services are available, including whether an interpreter is

1991 available if he or she does not speak English.

1992 A patient has the right to bring any person of his or her

1993 choosing to the patient-accessible areas of the health care

1994 facility or provider’s office to accompany the patient while the

1995 patient is receiving inpatient or outpatient treatment or is

1996 consulting with his or her health care provider, unless doing so

1997 would risk the safety or health of the patient, other patients,

1998 or staff of the facility or office or cannot be reasonably

1999 accommodated by the facility or provider.

2000 A patient has the right to know what rules and regulations

2001 apply to his or her conduct.

2002 A patient has the right to be given by the health care

2003 provider information concerning diagnosis, planned course of

2004 treatment, alternatives, risks, and prognosis.

2005 A patient has the right to refuse any treatment, except as

2006 otherwise provided by law.

2007 A patient has the right to be given, upon request, full

2008 information and necessary counseling on the availability of

2009 known financial resources for his or her care.

2010 A patient who is eligible for Medicare has the right to

2011 know, upon request and in advance of treatment, whether the

2012 health care provider or health care facility accepts the

2013 Medicare assignment rate.

2014 A patient has the right to receive, upon request, prior to

2015 treatment, a reasonable estimate of charges for medical care.

2016 A patient has the right to receive a copy of a reasonably

2017 clear and understandable, itemized bill and, upon request, to

2018 have the charges explained.

2019 A patient has the right to impartial access to medical

2020 treatment or accommodations, regardless of race, national

2021 origin, religion, handicap, or source of payment.

2022 A patient has the right to treatment for any emergency

2023 medical condition that will deteriorate from failure to provide

2024 treatment.

2025 A patient has the right to know if medical treatment is for

2026 purposes of experimental research and to give his or her consent

2027 or refusal to participate in such experimental research.

2028 A patient has the right to express grievances regarding any

2029 violation of his or her rights, as stated in Florida law,

2030 through the grievance procedure of the health care provider or

2031 health care facility which served him or her and to the

2032 appropriate state licensing agency.

2033 A patient is responsible for providing to the health care

2034 provider, to the best of his or her knowledge, accurate and

2035 complete information about present complaints, past illnesses,

2036 hospitalizations, medications, and other matters relating to his

2037 or her health.

2038 A patient is responsible for reporting unexpected changes

2039 in his or her condition to the health care provider.

2040 A patient is responsible for reporting to the health care

2041 provider whether he or she comprehends a contemplated course of

2042 action and what is expected of him or her.

2043 A patient is responsible for following the treatment plan

2044 recommended by the health care provider.

2045 A patient is responsible for keeping appointments and, when

2046 he or she is unable to do so for any reason, for notifying the

2047 health care provider or health care facility.

2048 A patient is responsible for his or her actions if he or

2049 she refuses treatment or does not follow the health care

2050 provider’s instructions.

2051 A patient is responsible for assuring that the financial

2052 obligations of his or her health care are fulfilled as promptly

2053 as possible.

2054 A patient is responsible for following health care facility

2055 rules and regulations affecting patient care and conduct.

2056 Section 31. Paragraph (f) of subsection (3), paragraph (a)

2057 of subsection (6), and paragraph (b) of subsection (7) of

2058 section 381.028, Florida Statutes, are amended to read:

2059 381.028 Adverse medical incidents.—

2060 (3) DEFINITIONS.—As used in s. 25, Art. X of the State

2061 Constitution and this act, the term:

2062 (f) “Health care facility” means a facility licensed under

2063 chapter 395 or chapter 396 .

2064 (6) USE OF RECORDS.—

2065 (a) This section does not repeal or otherwise alter any

2066 existing restrictions on the discoverability or admissibility of

2067 records relating to adverse medical incidents otherwise provided

2068 by law, including, but not limited to, those contained in ss.

2069 395.0191, 395.0193, 395.0197, 396.211, 396.212, 396.213,

2070 766.101, and 766.1016, or repeal or otherwise alter any immunity

2071 provided to, or prohibition against compelling testimony by,

2072 persons providing information or participating in any peer

2073 review panel, medical review committee, hospital committee, or

2074 other hospital board otherwise provided by law, including, but

2075 not limited to, ss. 395.0191, 395.0193, 396.211, 396.212,

2076 766.101, and 766.1016.

2077 (7) PRODUCTION OF RECORDS.—

2078 (b)1. Using the process provided in s. 395.0197 or s.

2079 396.213, as applicable , the health care facility shall be

2080 responsible for identifying records as records of an adverse

2081 medical incident, as defined in s. 25, Art. X of the State

2082 Constitution.

2083 2. Using the process provided in s. 458.351, the health

2084 care provider shall be responsible for identifying records as

2085 records of an adverse medical incident, as defined in s. 25,

2086 Art. X of the State Constitution, occurring in an office

2087 setting.

2088 Section 32. Paragraph (b) of subsection (9) and paragraph

2089 (d) of subsection (12) of section 381.915, Florida Statutes, is

2090 amended to read:

2091 381.915 Casey DeSantis Cancer Research Program.—

2092 (9)

2093 (b) To be eligible for grant funding under this subsection,

2094 a licensed or certified health care provider, facility, or

2095 entity must meet at least one of the following criteria:

2096 1. Operates as a licensed hospital that has a minimum of 30

2097 percent of its current cancer patients residing in rural or

2098 underserved areas.

2099 2. Operates as a licensed health care clinic or facility

2100 that employs or contracts with at least one physician licensed

2101 under chapter 458 or chapter 459 who is board certified in

2102 oncology and that administers chemotherapy treatments for

2103 cancer.

2104 3. Operates as a licensed facility that employs or

2105 contracts with at least one physician licensed under chapter 458

2106 or chapter 459 who is board certified in oncology and that

2107 administers radiation therapy treatments for cancer.

2108 4. Operates as a licensed health care clinic or facility

2109 that provides cancer screening services at no cost or a minimal

2110 cost to patients.

2111 5. Operates as a rural hospital as defined in s.

2112 395.602(2)(b).

2113 6. Operates as a critical access hospital as defined in s.

2114 408.07(14).

2115 7. Operates as a specialty hospital as defined in s.

2116 395.002(27)(a) ~~s. 395.002(28)(a)~~ which provides cancer treatment

2117 for patients from birth to 18 years of age.

2118 8. Operates as a licensed hospital that is accredited by

2119 the American College of Surgeons as a Comprehensive Community

2120 Cancer Program or Integrated Network Cancer Program.

2121 9. Engages in biomedical research intended to develop

2122 therapies, medical pharmaceuticals, treatment protocols, or

2123 medical procedures intended to cure cancer or improve the

2124 quality of life of cancer patients.

2125 10. Educates or trains students, postdoctoral fellows, or

2126 licensed or certified health care practitioners in the

2127 screening, diagnosis, or treatment of cancer.

2128 (12)

2129 (d) Applications for incubator funding may be submitted by

2130 any Florida-based specialty hospital as defined in s.

2131 395.002(27)(a) ~~s. 395.002(28)(a)~~ which provides cancer treatment

2132 for patients from birth to 18 years of age. All qualified

2133 applicants must have equal access and opportunity to compete for

2134 research funding. Incubator grants must be recommended by the

2135 collaborative and awarded by the department on the basis of

2136 scientific merit, as determined by a competitively open and

2137 peer-reviewed process to ensure objectivity, consistency, and

2138 high quality.

2139 Section 33. Paragraph (d) of subsection (2) of section

2140 383.145, Florida Statutes, is amended to read:

2141 383.145 Newborn, infant, and toddler hearing screening.—

2142 (2) DEFINITIONS.—As used in this section, the term:

2143 (d) “Hospital” means a facility as defined in s. 395.002 s.

2144 ~~395.002(13)~~ and licensed under chapter 395 and part II of

2145 chapter 408.

2146 Section 34. Subsection (1) of section 385.202, Florida

2147 Statutes, is amended to read:

2148 385.202 Statewide cancer registry.—

2149 (1) Each facility licensed under chapter 395 or chapter 396

2150 and each freestanding radiation therapy center as defined in s.

2151 408.07 shall report to the Department of Health such

2152 information, specified by the department, by rule, which

2153 indicates diagnosis, stage of disease, medical history,

2154 laboratory data, tissue diagnosis, and radiation, surgical, or

2155 other methods of diagnosis or treatment for each cancer

2156 diagnosed or treated by the facility or center. Failure to

2157 comply with this requirement may be cause for registration or

2158 licensure suspension or revocation.

2159 Section 35. Subsection (2) of section 385.211, Florida

2160 Statutes, is amended to read:

2161 385.211 Refractory and intractable epilepsy treatment and

2162 research at recognized medical centers.—

2163 (2) Notwithstanding chapter 893, medical centers recognized

2164 pursuant to s. 381.925, or an academic medical research

2165 institution legally affiliated with a licensed children’s

2166 specialty hospital as defined in s. 395.002 which ~~s. 395.002(28)~~

2167 ~~that~~ contracts with the Department of Health, may conduct

2168 research on cannabidiol and low-THC cannabis. This research may

2169 include, but is not limited to, the agricultural development,

2170 production, clinical research, and use of liquid medical

2171 derivatives of cannabidiol and low-THC cannabis for the

2172 treatment for refractory or intractable epilepsy. The authority

2173 for recognized medical centers to conduct this research is

2174 derived from 21 C.F.R. parts 312 and 316. Current state or

2175 privately obtained research funds may be used to support the

2176 activities described in this section.

2177 Section 36. Subsection (8) of section 390.011, Florida

2178 Statutes, is amended to read:

2179 390.011 Definitions.—As used in this chapter, the term:

2180 (8) “Hospital” means a facility as defined in s. 395.002 s.

2181 ~~395.002(12)~~ and licensed under chapter 395 and part II of

2182 chapter 408.

2183 Section 37. Paragraphs (a) and (c) of subsection (4) of

2184 section 390.025, Florida Statutes, are amended to read:

2185 390.025 Abortion referral or counseling agencies;

2186 penalties.—

2187 (4) The following are exempt from the requirement to

2188 register pursuant to subsection (3):

2189 (a) Facilities licensed pursuant to this chapter, chapter

2190 395, chapter 396, chapter 400, or chapter 408;

2191 (c) Health care practitioners, as defined in s. 456.001,

2192 who, in the course of their practice outside of a facility

2193 licensed pursuant to this chapter, chapter 395, chapter 396,

2194 chapter 400, or chapter 408, refer five or fewer patients for

2195 abortions each month.

2196 Section 38. Subsection (7) of section 394.4787, Florida

2197 Statutes, is amended to read:

2198 394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and

2199 394.4789.—As used in this section and ss. 394.4786, 394.4788,

2200 and 394.4789:

2201 (7) “Specialty psychiatric hospital” means a hospital

2202 licensed by the agency pursuant to s. 395.002 ~~s. 395.002(28)~~ and

2203 part II of chapter 408 as a specialty psychiatric hospital.

2204 Section 39. Section 395.001, Florida Statutes, is amended

2205 to read:

2206 395.001 Legislative intent.—It is the intent of the

2207 Legislature to provide for the protection of public health and

2208 safety in the establishment, construction, maintenance, and

2209 operation of hospitals ~~and ambulatory surgical centers~~ by

2210 providing for licensure of same and for the development,

2211 establishment, and enforcement of minimum standards with respect

2212 thereto.

2213 Section 40. Subsections (3), (10), (17), (23), and (28) of

2214 section 395.002, Florida Statutes, are amended to read:

2215 395.002 Definitions.—As used in this chapter:

2216 ~~(3) “Ambulatory surgical center” means a facility, the~~

2217 ~~primary purpose of which is to provide elective surgical care,~~

2218 ~~in which the patient is admitted to and discharged from such~~

2219 ~~facility within 24 hours, and which is not part of a hospital.~~

2220 ~~However, a facility existing for the primary purpose of~~

2221 ~~performing terminations of pregnancy, an office maintained by a~~

2222 ~~physician for the practice of medicine, or an office maintained~~

2223 ~~for the practice of dentistry may not be construed to be an~~

2224 ~~ambulatory surgical center, provided that any facility or office~~

2225 ~~which is certified or seeks certification as a Medicare~~

2226 ~~ambulatory surgical center shall be licensed as an ambulatory~~

2227 ~~surgical center pursuant to s. 395.003.~~

2228 (9) ~~(10)~~ “General hospital” means any facility which meets

2229 the provisions of subsection (11) ~~(12)~~ and which regularly makes

2230 its facilities and services available to the general population.

2231 (16) ~~(17)~~ “Licensed facility” means a hospital ~~or ambulatory~~

2232 ~~surgical center~~ licensed in accordance with this chapter.

2233 (22) ~~(23)~~ “Premises” means those buildings, beds, and

2234 equipment located at the address of the licensed facility and

2235 all other buildings, beds, and equipment for the provision of

2236 hospital ~~or ambulatory surgical~~ care located in such reasonable

2237 proximity to the address of the licensed facility as to appear

2238 to the public to be under the dominion and control of the

2239 licensee. For any licensee that is a teaching hospital as

2240 defined in s. 408.07, reasonable proximity includes any

2241 buildings, beds, services, programs, and equipment under the

2242 dominion and control of the licensee that are located at a site

2243 with a main address that is within 1 mile of the main address of

2244 the licensed facility; and all such buildings, beds, and

2245 equipment may, at the request of a licensee or applicant, be

2246 included on the facility license as a single premises.

2247 (27) ~~(28)~~ “Specialty hospital” means any facility which

2248 meets the provisions of subsection (11) ~~(12)~~ , and which

2249 regularly makes available either:

2250 (a) The range of medical services offered by general

2251 hospitals but restricted to a defined age or gender group of the

2252 population;

2253 (b) A restricted range of services appropriate to the

2254 diagnosis, care, and treatment of patients with specific

2255 categories of medical or psychiatric illnesses or disorders; or

2256 (c) Intensive residential treatment programs for children

2257 and adolescents as defined in subsection (15) ~~(16)~~ .

2258 Section 41. Subsection (1) and paragraph (d) of subsection

2259 (5) of section 395.003, Florida Statutes, are amended to read:

2260 395.003 Licensure; denial, suspension, and revocation.—

2261 (1)(a) The requirements of part II of chapter 408 apply to

2262 the provision of services that require licensure pursuant to ss.

2263 395.001-395.1065 and part II of chapter 408 and to entities

2264 licensed by or applying for such licensure from the Agency for

2265 Health Care Administration pursuant to ss. 395.001-395.1065. A

2266 license issued by the agency is required in order to operate a

2267 hospital ~~or ambulatory surgical center~~ in this state.

2268 (b)1. It is unlawful for a person to use or advertise to

2269 the public, in any way or by any medium whatsoever, any facility

2270 as a “hospital” ~~or “ambulatory surgical center”~~ unless such

2271 facility has first secured a license under this chapter ~~part~~ .

2272 2. This part does not apply to veterinary hospitals or to

2273 commercial business establishments using the word “hospital” or

2274 ~~“ambulatory surgical center”~~ as a part of a trade name if no

2275 treatment of human beings is performed on the premises of such

2276 establishments.

2277 (5)

2278 (d) A hospital, ~~an ambulatory surgical center,~~ a specialty

2279 hospital, or an urgent care center shall comply with ss.

2280 627.64194 and 641.513 as a condition of licensure.

2281 Section 42. Subsections (2), (3), and (9) of section

2282 395.1055, Florida Statutes, are amended to read:

2283 395.1055 Rules and enforcement.—

2284 (2) Separate standards may be provided for general and

2285 specialty hospitals ~~, ambulatory surgical centers,~~ and statutory

2286 rural hospitals as defined in s. 395.602.

2287 ~~(3) The agency shall adopt rules that establish minimum~~

2288 ~~standards for pediatric patient care in ambulatory surgical~~

2289 ~~centers to ensure the safe and effective delivery of surgical~~

2290 ~~care to children in ambulatory surgical centers. Such standards~~

2291 ~~must include quality of care, nurse staffing, physician~~

2292 ~~staffing, and equipment standards. Ambulatory surgical centers~~

2293 ~~may not provide operative procedures to children under 18 years~~

2294 ~~of age which require a length of stay past midnight until such~~

2295 ~~standards are established by rule.~~

2296 (8) ~~(9)~~ The agency may not adopt any rule governing the

2297 design, construction, erection, alteration, modification,

2298 repair, or demolition of any public or private hospital or ,

2299 intermediate residential treatment facility ~~, or ambulatory~~

2300 ~~surgical center~~ . It is the intent of the Legislature to preempt

2301 that function to the Florida Building Commission and the State

2302 Fire Marshal through adoption and maintenance of the Florida

2303 Building Code and the Florida Fire Prevention Code. However, the

2304 agency shall provide technical assistance to the commission and

2305 the State Fire Marshal in updating the construction standards of

2306 the Florida Building Code and the Florida Fire Prevention Code

2307 which govern hospitals and , intermediate residential treatment

2308 facilities ~~, and ambulatory surgical centers~~ .

2309 Section 43. Subsection (3) of section 395.10973, Florida

2310 Statutes, is amended to read:

2311 395.10973 Powers and duties of the agency.—It is the

2312 function of the agency to:

2313 (3) Enforce the special-occupancy provisions of the Florida

2314 Building Code which apply to hospitals and , intermediate

2315 residential treatment facilities ~~, and ambulatory surgical~~

2316 ~~centers~~ in conducting any inspection authorized by this chapter

2317 and part II of chapter 408.

2318 Section 44. Subsection (8) of section 395.3025, Florida

2319 Statutes, is amended to read:

2320 395.3025 Patient and personnel records; copies;

2321 examination.—

2322 (8) Patient records at hospitals ~~and ambulatory surgical~~

2323 ~~centers~~ are exempt from disclosure under s. 119.07(1), except as

2324 provided by subsections (1)-(5).

2325 Section 45. Subsection (3) of section 395.607, Florida

2326 Statutes, is amended to read:

2327 395.607 Rural emergency hospitals.—

2328 (3) Notwithstanding s. 395.002 ~~s. 395.002(12)~~ , a rural

2329 emergency hospital is not required to offer acute inpatient care

2330 or care beyond 24 hours, or to make available treatment

2331 facilities for surgery, obstetrical care, or similar services in

2332 order to be deemed a hospital as long as it maintains its

2333 designation as a rural emergency hospital, and may be required

2334 to make such services available only if it ceases to be

2335 designated as a rural emergency hospital.

2336 Section 46. Paragraph (c) of subsection (1) of section

2337 395.701, Florida Statutes, is amended to read:

2338 395.701 Annual assessments on net operating revenues for

2339 inpatient and outpatient services to fund public medical

2340 assistance; administrative fines for failure to pay assessments

2341 when due; exemption.—

2342 (1) For the purposes of this section, the term:

2343 (c) “Hospital” means a health care institution as defined

2344 in s. 395.002 ~~s. 395.002(12)~~ , but does not include any hospital

2345 operated by a state agency.

2346 Section 47. Paragraph (b) of subsection (3) of section

2347 400.518, Florida Statutes, is amended to read:

2348 400.518 Prohibited referrals to home health agencies.—

2349 (3)

2350 (b) A physician who violates this section is subject to

2351 disciplinary action by the appropriate board under s. 458.331(2)

2352 or s. 459.015(2). A hospital ~~or ambulatory surgical center~~ that

2353 violates this section is subject to s. 395.0185(2). An

2354 ambulatory surgical center that violates this section is subject

2355 to s. 396.209.

2356 Section 48. Paragraph (h) of subsection (5) of section

2357 400.93, Florida Statutes, is amended to read:

2358 400.93 Licensure required; exemptions; unlawful acts;

2359 penalties.—

2360 (5) The following are exempt from home medical equipment

2361 provider licensure, unless they have a separate company,

2362 corporation, or division that is in the business of providing

2363 home medical equipment and services for sale or rent to

2364 consumers at their regular or temporary place of residence

2365 pursuant to the provisions of this part:

2366 (h) Hospitals licensed under chapter 395 and ambulatory

2367 surgical centers licensed under chapter 396 ~~395~~ .

2368 Section 49. Paragraphs (a) through (d) of subsection (4) of

2369 section 400.9905, Florida Statutes, are amended to read:

2370 400.9905 Definitions.—

2371 (4) “Clinic” means an entity where health care services are

2372 provided to individuals and which tenders charges for

2373 reimbursement for such services, including a mobile clinic and a

2374 portable equipment provider. As used in this part, the term does

2375 not include and the licensure requirements of this part do not

2376 apply to:

2377 (a) Entities licensed or registered by the state under

2378 chapter 395 or chapter 396 ; entities licensed or registered by

2379 the state and providing only health care services within the

2380 scope of services authorized under their respective licenses

2381 under ss. 383.30-383.332, chapter 390, chapter 394, chapter 397,

2382 this chapter except part X, chapter 429, chapter 463, chapter

2383 465, chapter 466, chapter 478, chapter 484, or chapter 651; end

2384 stage renal disease providers authorized under 42 C.F.R. part

2385 494; providers certified and providing only health care services

2386 within the scope of services authorized under their respective

2387 certifications under 42 C.F.R. part 485, subpart B, subpart H,

2388 or subpart J; providers certified and providing only health care

2389 services within the scope of services authorized under their

2390 respective certifications under 42 C.F.R. part 486, subpart C;

2391 providers certified and providing only health care services

2392 within the scope of services authorized under their respective

2393 certifications under 42 C.F.R. part 491, subpart A; providers

2394 certified by the Centers for Medicare and Medicaid services

2395 under the federal Clinical Laboratory Improvement Amendments and

2396 the federal rules adopted thereunder; or any entity that

2397 provides neonatal or pediatric hospital-based health care

2398 services or other health care services by licensed practitioners

2399 solely within a hospital licensed under chapter 395.

2400 (b) Entities that own, directly or indirectly, entities

2401 licensed or registered by the state pursuant to chapter 395 or

2402 chapter 396 ; entities that own, directly or indirectly, entities

2403 licensed or registered by the state and providing only health

2404 care services within the scope of services authorized pursuant

2405 to their respective licenses under ss. 383.30-383.332, chapter

2406 390, chapter 394, chapter 397, this chapter except part X,

2407 chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,

2408 chapter 484, or chapter 651; end-stage renal disease providers

2409 authorized under 42 C.F.R. part 494; providers certified and

2410 providing only health care services within the scope of services

2411 authorized under their respective certifications under 42 C.F.R.

2412 part 485, subpart B, subpart H, or subpart J; providers

2413 certified and providing only health care services within the

2414 scope of services authorized under their respective

2415 certifications under 42 C.F.R. part 486, subpart C; providers

2416 certified and providing only health care services within the

2417 scope of services authorized under their respective

2418 certifications under 42 C.F.R. part 491, subpart A; providers

2419 certified by the Centers for Medicare and Medicaid services

2420 under the federal Clinical Laboratory Improvement Amendments and

2421 the federal rules adopted thereunder; or any entity that

2422 provides neonatal or pediatric hospital-based health care

2423 services by licensed practitioners solely within a hospital

2424 licensed under chapter 395.

2425 (c) Entities that are owned, directly or indirectly, by an

2426 entity licensed or registered by the state pursuant to chapter

2427 395 or chapter 396 ; entities that are owned, directly or

2428 indirectly, by an entity licensed or registered by the state and

2429 providing only health care services within the scope of services

2430 authorized pursuant to their respective licenses under ss.

2431 383.30-383.332, chapter 390, chapter 394, chapter 397, this

2432 chapter except part X, chapter 429, chapter 463, chapter 465,

2433 chapter 466, chapter 478, chapter 484, or chapter 651; end-stage

2434 renal disease providers authorized under 42 C.F.R. part 494;

2435 providers certified and providing only health care services

2436 within the scope of services authorized under their respective

2437 certifications under 42 C.F.R. part 485, subpart B, subpart H,

2438 or subpart J; providers certified and providing only health care

2439 services within the scope of services authorized under their

2440 respective certifications under 42 C.F.R. part 486, subpart C;

2441 providers certified and providing only health care services

2442 within the scope of services authorized under their respective

2443 certifications under 42 C.F.R. part 491, subpart A; providers

2444 certified by the Centers for Medicare and Medicaid services

2445 under the federal Clinical Laboratory Improvement Amendments and

2446 the federal rules adopted thereunder; or any entity that

2447 provides neonatal or pediatric hospital-based health care

2448 services by licensed practitioners solely within a hospital

2449 under chapter 395.

2450 (d) Entities that are under common ownership, directly or

2451 indirectly, with an entity licensed or registered by the state

2452 pursuant to chapter 395 or chapter 396 ; entities that are under

2453 common ownership, directly or indirectly, with an entity

2454 licensed or registered by the state and providing only health

2455 care services within the scope of services authorized pursuant

2456 to their respective licenses under ss. 383.30-383.332, chapter

2457 390, chapter 394, chapter 397, this chapter except part X,

2458 chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,

2459 chapter 484, or chapter 651; end-stage renal disease providers

2460 authorized under 42 C.F.R. part 494; providers certified and

2461 providing only health care services within the scope of services

2462 authorized under their respective certifications under 42 C.F.R.

2463 part 485, subpart B, subpart H, or subpart J; providers

2464 certified and providing only health care services within the

2465 scope of services authorized under their respective

2466 certifications under 42 C.F.R. part 486, subpart C; providers

2467 certified and providing only health care services within the

2468 scope of services authorized under their respective

2469 certifications under 42 C.F.R. part 491, subpart A; providers

2470 certified by the Centers for Medicare and Medicaid services

2471 under the federal Clinical Laboratory Improvement Amendments and

2472 the federal rules adopted thereunder; or any entity that

2473 provides neonatal or pediatric hospital-based health care

2474 services by licensed practitioners solely within a hospital

2475 licensed under chapter 395.

2477 Notwithstanding this subsection, an entity shall be deemed a

2478 clinic and must be licensed under this part in order to receive

2479 reimbursement under the Florida Motor Vehicle No-Fault Law, ss.

2480 627.730-627.7405, unless exempted under s. 627.736(5)(h).

2481 Section 50. Paragraph (i) of subsection (1) of section

2482 400.9935, Florida Statutes, is amended to read:

2483 400.9935 Clinic responsibilities.—

2484 (1) Each clinic shall appoint a medical director or clinic

2485 director who shall agree in writing to accept legal

2486 responsibility for the following activities on behalf of the

2487 clinic. The medical director or the clinic director shall:

2488 (i) Ensure that the clinic publishes a schedule of charges

2489 for the medical services offered to patients. The schedule must

2490 include the prices charged to an uninsured person paying for

2491 such services by cash, check, credit card, or debit card. The

2492 schedule may group services by price levels, listing services in

2493 each price level. The schedule must be posted in a conspicuous

2494 place in the reception area of any clinic that is considered an

2495 urgent care center as defined in s. 395.002 ~~s. 395.002(30)(b)~~

2496 and must include, but is not limited to, the 50 services most

2497 frequently provided by the clinic. The posting may be a sign

2498 that must be at least 15 square feet in size or through an

2499 electronic messaging board that is at least 3 square feet in

2500 size. The failure of a clinic, including a clinic that is

2501 considered an urgent care center, to publish and post a schedule

2502 of charges as required by this section shall result in a fine of

2503 not more than $1,000, per day, until the schedule is published

2504 and posted.

2505 Section 51. Paragraph (b) of subsection (2) of section

2506 401.272, Florida Statutes, is amended to read:

2507 401.272 Emergency medical services community health care.—

2508 (2) Notwithstanding any other provision of law to the

2509 contrary:

2510 (b) Paramedics and emergency medical technicians shall

2511 operate under the medical direction of a physician through two

2512 way communication or pursuant to established standing orders or

2513 protocols and within the scope of their training when a patient

2514 is not transported to an emergency department or is transported

2515 to a facility other than a hospital as defined in s. 395.002 s.

2516 ~~395.002(12)~~ .

2517 Section 52. Subsections (4) and (5) of section 408.051,

2518 Florida Statutes, are amended to read:

2519 408.051 Florida Electronic Health Records Exchange Act.—

2520 (4) EMERGENCY RELEASE OF IDENTIFIABLE HEALTH RECORD.—A

2521 health care provider may release or access an identifiable

2522 health record of a patient without the patient’s consent for use

2523 in the treatment of the patient for an emergency medical

2524 condition, as defined in s. 395.002 ~~s. 395.002(8)~~ , when the

2525 health care provider is unable to obtain the patient’s consent

2526 or the consent of the patient representative due to the

2527 patient’s condition or the nature of the situation requiring

2528 immediate medical attention. A health care provider who in good

2529 faith releases or accesses an identifiable health record of a

2530 patient in any form or medium under this subsection is immune

2531 from civil liability for accessing or releasing an identifiable

2532 health record.

2533 (5) HOSPITAL DATA.—A hospital as defined in s. 395.002 s.

2534 ~~395.002(12)~~ which maintains certified electronic health record

2535 technology must make available admission, transfer, and

2536 discharge data to the agency’s Florida Health Information

2537 Exchange program for the purpose of supporting public health

2538 data registries and patient care coordination. The agency may

2539 adopt rules to implement this subsection.

2540 Section 53. Subsection (6) of section 408.07, Florida

2541 Statutes, is amended to read:

2542 408.07 Definitions.—As used in this chapter, with the

2543 exception of ss. 408.031-408.045, the term:

2544 (6) “Ambulatory surgical center” means a facility licensed

2545 as an ambulatory surgical center under chapter 396 ~~395~~ .

2546 Section 54. Subsection (9) of section 408.802, Florida

2547 Statutes, is amended to read:

2548 408.802 Applicability.—This part applies to the provision

2549 of services that require licensure as defined in this part and

2550 to the following entities licensed, registered, or certified by

2551 the agency, as described in chapters 112, 383, 390, 394, 395,

2552 400, 429, 440, and 765:

2553 (9) Ambulatory surgical centers, as provided under ~~part I~~

2554 of chapter 396 ~~395~~ .

2555 Section 55. Subsection (9) of section 408.820, Florida

2556 Statutes, is amended to read:

2557 408.820 Exemptions.—Except as prescribed in authorizing

2558 statutes, the following exemptions shall apply to specified

2559 requirements of this part:

2560 (9) Ambulatory surgical centers, as provided under ~~part I~~

2561 of chapter 396 ~~395~~ , are exempt from s. 408.810(7)-(10).

2562 Section 56. Subsection (8) of section 409.905, Florida

2563 Statutes, is amended to read:

2564 409.905 Mandatory Medicaid services.—The agency may make

2565 payments for the following services, which are required of the

2566 state by Title XIX of the Social Security Act, furnished by

2567 Medicaid providers to recipients who are determined to be

2568 eligible on the dates on which the services were provided. Any

2569 service under this section shall be provided only when medically

2570 necessary and in accordance with state and federal law.

2571 Mandatory services rendered by providers in mobile units to

2572 Medicaid recipients may be restricted by the agency. Nothing in

2573 this section shall be construed to prevent or limit the agency

2574 from adjusting fees, reimbursement rates, lengths of stay,

2575 number of visits, number of services, or any other adjustments

2576 necessary to comply with the availability of moneys and any

2577 limitations or directions provided for in the General

2578 Appropriations Act or chapter 216.

2579 (8) NURSING FACILITY SERVICES.—The agency shall pay for 24

2580 hour-a-day nursing and rehabilitative services for a recipient

2581 in a nursing facility licensed under part II of chapter 400 or

2582 in a rural hospital, as defined in s. 395.602, or in a Medicare

2583 certified skilled nursing facility operated by a hospital, as

2584 defined in s. 395.002 ~~by s. 395.002(10)~~ , that is licensed under

2585 part I of chapter 395, and in accordance with provisions set

2586 forth in s. 409.908(2)(a), which services are ordered by and

2587 provided under the direction of a licensed physician. However,

2588 if a nursing facility has been destroyed or otherwise made

2589 uninhabitable by natural disaster or other emergency and another

2590 nursing facility is not available, the agency must pay for

2591 similar services temporarily in a hospital licensed under part I

2592 of chapter 395 provided federal funding is approved and

2593 available. The agency shall pay only for bed-hold days if the

2594 facility has an occupancy rate of 95 percent or greater. The

2595 agency is authorized to seek any federal waivers to implement

2596 this policy.

2597 Section 57. Subsection (3) of section 409.906, Florida

2598 Statutes, is amended to read:

2599 409.906 Optional Medicaid services.—Subject to specific

2600 appropriations, the agency may make payments for services which

2601 are optional to the state under Title XIX of the Social Security

2602 Act and are furnished by Medicaid providers to recipients who

2603 are determined to be eligible on the dates on which the services

2604 were provided. Any optional service that is provided shall be

2605 provided only when medically necessary and in accordance with

2606 state and federal law. Optional services rendered by providers

2607 in mobile units to Medicaid recipients may be restricted or

2608 prohibited by the agency. Nothing in this section shall be

2609 construed to prevent or limit the agency from adjusting fees,

2610 reimbursement rates, lengths of stay, number of visits, or

2611 number of services, or making any other adjustments necessary to

2612 comply with the availability of moneys and any limitations or

2613 directions provided for in the General Appropriations Act or

2614 chapter 216. If necessary to safeguard the state’s systems of

2615 providing services to elderly and disabled persons and subject

2616 to the notice and review provisions of s. 216.177, the Governor

2617 may direct the Agency for Health Care Administration to amend

2618 the Medicaid state plan to delete the optional Medicaid service

2619 known as “Intermediate Care Facilities for the Developmentally

2620 Disabled.” Optional services may include:

2621 (3) AMBULATORY SURGICAL CENTER SERVICES.—The agency may pay

2622 for services provided to a recipient in an ambulatory surgical

2623 center licensed under ~~part I of~~ chapter 396 ~~395~~ , by or under the

2624 direction of a licensed physician or dentist.

2625 Section 58. Paragraph (b) of subsection (1) of section

2626 409.975, Florida Statutes, is amended to read:

2627 409.975 Managed care plan accountability.—In addition to

2628 the requirements of s. 409.967, plans and providers

2629 participating in the managed medical assistance program shall

2630 comply with the requirements of this section.

2631 (1) PROVIDER NETWORKS.—Managed care plans must develop and

2632 maintain provider networks that meet the medical needs of their

2633 enrollees in accordance with standards established pursuant to

2634 s. 409.967(2)(c). Except as provided in this section, managed

2635 care plans may limit the providers in their networks based on

2636 credentials, quality indicators, and price.

2637 (b) Certain providers are statewide resources and essential

2638 providers for all managed care plans in all regions. All managed

2639 care plans must include these essential providers in their

2640 networks. Statewide essential providers include:

2641 1. Faculty plans of Florida medical schools.

2642 2. Regional perinatal intensive care centers as defined in

2643 s. 383.16(2).

2644 3. Hospitals licensed as specialty children’s hospitals as

2645 defined in s. 395.002 ~~s. 395.002(28)~~ .

2646 4. Accredited and integrated systems serving medically

2647 complex children which comprise separately licensed, but

2648 commonly owned, health care providers delivering at least the

2649 following services: medical group home, in-home and outpatient

2650 nursing care and therapies, pharmacy services, durable medical

2651 equipment, and Prescribed Pediatric Extended Care.

2652 5. Florida cancer hospitals that meet the criteria in 42

2653 U.S.C. s. 1395ww(d)(1)(B)(v).

2655 Managed care plans that have not contracted with all statewide

2656 essential providers in all regions as of the first date of

2657 recipient enrollment must continue to negotiate in good faith.

2658 Payments to physicians on the faculty of nonparticipating

2659 Florida medical schools shall be made at the applicable Medicaid

2660 rate. Payments for services rendered by regional perinatal

2661 intensive care centers shall be made at the applicable Medicaid

2662 rate as of the first day of the contract between the agency and

2663 the plan. Except for payments for emergency services, payments

2664 to nonparticipating specialty children’s hospitals, and payments

2665 to nonparticipating Florida cancer hospitals that meet the

2666 criteria in 42 U.S.C. s. 1395ww(d)(1)(B)(v), shall equal the

2667 highest rate established by contract between that provider and

2668 any other Medicaid managed care plan.

2669 Section 59. Subsection (7) of section 456.013, Florida

2670 Statutes, is amended to read:

2671 456.013 Department; general licensing provisions.—

2672 (7) The boards, or the department when there is no board,

2673 shall require the completion of a 2-hour course relating to

2674 prevention of medical errors as part of the biennial renewal

2675 process. The 2-hour course counts toward the total number of

2676 continuing education hours required for the profession. The

2677 course must be approved by the board or department, as

2678 appropriate, and must include a study of root-cause analysis,

2679 error reduction and prevention, and patient safety. In addition,

2680 the course approved by the Board of Medicine and the Board of

2681 Osteopathic Medicine must include information relating to the

2682 five most misdiagnosed conditions during the previous biennium,

2683 as determined by the board. If the course is being offered by a

2684 facility licensed under ~~pursuant to~~ chapter 395 or chapter 396

2685 for its employees, the board may approve up to 1 hour of the 2

2686 hour course to be specifically related to error reduction and

2687 prevention methods used in that facility.

2688 Section 60. Subsection (5) of section 456.0135, Florida

2689 Statutes, is amended to read:

2690 456.0135 General background screening provisions.—

2691 (5) In addition to the offenses listed in s. 435.04, all

2692 persons required to undergo background screening under this

2693 section, other than those licensed under s. 465.022, must not

2694 have an arrest awaiting final disposition for, must not have

2695 been found guilty of, regardless of adjudication, or entered a

2696 plea of nolo contendere or guilty to, and must not have been

2697 adjudicated delinquent and the record not have been sealed or

2698 expunged for an offense under s. 784.03 or any similar offense

2699 of another jurisdiction relating to battery, if the victim is a

2700 vulnerable adult as defined in s. 415.102 or a patient or

2701 resident of a facility licensed under chapter 395, chapter 396,

2702 chapter 400, or chapter 429.

2703 Section 61. Subsection (5) of section 456.041, Florida

2704 Statutes, is amended to read:

2705 456.041 Practitioner profile; creation.—

2706 (5) The Department of Health shall include the date of a

2707 hospital or ambulatory surgical center disciplinary action taken

2708 by a licensed hospital or an ambulatory surgical center, in

2709 accordance with the requirements of ss. 395.013 and 396.212 s.

2710 ~~395.0193~~ , in the practitioner profile. The department shall

2711 state whether the action related to professional competence and

2712 whether it related to the delivery of services to a patient.

2713 Section 62. Paragraph (n) of subsection (3) of section

2714 456.053, Florida Statutes, is amended to read:

2715 456.053 Financial arrangements between referring health

2716 care providers and providers of health care services.—

2717 (3) DEFINITIONS.—For the purpose of this section, the word,

2718 phrase, or term:

2719 (n) “Referral” means any referral of a patient by a health

2720 care provider for health care services, including, without

2721 limitation:

2722 1. The forwarding of a patient by a health care provider to

2723 another health care provider or to an entity which provides or

2724 supplies designated health services or any other health care

2725 item or service; or

2726 2. The request or establishment of a plan of care by a

2727 health care provider, which includes the provision of designated

2728 health services or other health care item or service.

2729 3. The following orders, recommendations, or plans of care

2730 do ~~shall~~ not constitute a referral by a health care provider:

2731 a. By a radiologist for diagnostic-imaging services.

2732 b. By a physician specializing in the provision of

2733 radiation therapy services for such services.

2734 c. By a medical oncologist for drugs and solutions to be

2735 prepared and administered intravenously to such oncologist’s

2736 patient, as well as for the supplies and equipment used in

2737 connection therewith to treat such patient for cancer and the

2738 complications thereof.

2739 d. By a cardiologist for cardiac catheterization services.

2740 e. By a pathologist for diagnostic clinical laboratory

2741 tests and pathological examination services, if furnished by or

2742 under the supervision of such pathologist pursuant to a

2743 consultation requested by another physician.

2744 f. By a health care provider who is the sole provider or

2745 member of a group practice for designated health services or

2746 other health care items or services that are prescribed or

2747 provided solely for such referring health care provider’s or

2748 group practice’s own patients, and that are provided or

2749 performed by or under the supervision of such referring health

2750 care provider or group practice if such supervision complies

2751 with all applicable Medicare payment and coverage rules for

2752 services; provided, however, a physician licensed pursuant to

2753 chapter 458, chapter 459, chapter 460, or chapter 461 or an

2754 advanced practice registered nurse registered under s. 464.0123

2755 may refer a patient to a sole provider or group practice for

2756 diagnostic imaging services, excluding radiation therapy

2757 services, for which the sole provider or group practice billed

2758 both the technical and the professional fee for or on behalf of

2759 the patient, if the referring physician or advanced practice

2760 registered nurse registered under s. 464.0123 has no investment

2761 interest in the practice. The diagnostic imaging service

2762 referred to a group practice or sole provider must be a

2763 diagnostic imaging service normally provided within the scope of

2764 practice to the patients of the group practice or sole provider.

2765 The group practice or sole provider may accept no more than 15

2766 percent of their patients receiving diagnostic imaging services

2767 from outside referrals, excluding radiation therapy services.

2768 However, the 15 percent limitation of this sub-subparagraph and

2769 the requirements of subparagraph (4)(a)2. do not apply to a

2770 group practice entity that owns an accountable care organization

2771 or an entity operating under an advanced alternative payment

2772 model according to federal regulations if such entity provides

2773 diagnostic imaging services and has more than 30,000 patients

2774 enrolled per year.

2775 g. By a health care provider for services provided by an

2776 ambulatory surgical center licensed under chapter 396 ~~395~~ .

2777 h. By a urologist for lithotripsy services.

2778 i. By a dentist for dental services performed by an

2779 employee of or health care provider who is an independent

2780 contractor with the dentist or group practice of which the

2781 dentist is a member.

2782 j. By a physician for infusion therapy services to a

2783 patient of that physician or a member of that physician’s group

2784 practice.

2785 k. By a nephrologist for renal dialysis services and

2786 supplies, except laboratory services.

2787 l. By a health care provider whose principal professional

2788 practice consists of treating patients in their private

2789 residences for services to be rendered in such private

2790 residences, except for services rendered by a home health agency

2791 licensed under chapter 400. For purposes of this sub

2792 subparagraph, the term “private residences” includes patients’

2793 private homes, independent living centers, and assisted living

2794 facilities, but does not include skilled nursing facilities.

2795 m. By a health care provider for sleep-related testing.

2796 Section 63. Subsection (3) of section 456.056, Florida

2797 Statutes, is amended to read:

2798 456.056 Treatment of Medicare beneficiaries; refusal,

2799 emergencies, consulting physicians.—

2800 (3) If treatment is provided to a beneficiary for an

2801 emergency medical condition as defined in s. 395.002 s.

2802 ~~395.002(8)(a)~~ , the physician must accept Medicare assignment

2803 provided that the requirement to accept Medicare assignment for

2804 an emergency medical condition does ~~shall~~ not apply to treatment

2805 rendered after the patient is stabilized , or ~~the~~ treatment that

2806 is unrelated to the original emergency medical condition. For

2807 the purpose of this subsection , the term “stabilized” means is

2808 ~~defined to mean~~ with respect to an emergency medical condition,

2809 that no material deterioration of the condition is likely within

2810 reasonable medical probability.

2811 Section 64. Subsection (2) of section 456.0575, Florida

2812 Statutes, is amended to read:

2813 456.0575 Duty to notify patients.—

2814 (2) Upon request by a patient, before providing

2815 nonemergency medical services in a facility licensed under

2816 chapter 395 or chapter 396 , a health care practitioner shall

2817 provide, in writing or by electronic means, a good faith

2818 estimate of reasonably anticipated charges to treat the

2819 patient’s condition at the facility. The health care

2820 practitioner shall provide the estimate to the patient within 7

2821 business days after receiving the request and is not required to

2822 adjust the estimate for any potential insurance coverage. The

2823 health care practitioner shall inform the patient that the

2824 patient may contact his or her health insurer or health

2825 maintenance organization for additional information concerning

2826 cost-sharing responsibilities. The health care practitioner

2827 shall provide information to uninsured patients and insured

2828 patients for whom the practitioner is not a network provider or

2829 preferred provider which discloses the practitioner’s financial

2830 assistance policy, including the application process, payment

2831 plans, discounts, or other available assistance, and the

2832 practitioner’s charity care policy and collection procedures.

2833 Such estimate does not preclude the actual charges from

2834 exceeding the estimate. Failure to provide the estimate in

2835 accordance with this subsection, without good cause, shall

2836 result in disciplinary action against the health care

2837 practitioner and a daily fine of $500 until the estimate is

2838 provided to the patient. The total fine may not exceed $5,000.

2839 Section 65. Paragraph (t) of subsection (1) of section

2840 456.072, Florida Statutes, is amended to read:

2841 456.072 Grounds for discipline; penalties; enforcement.—

2842 (1) The following acts shall constitute grounds for which

2843 the disciplinary actions specified in subsection (2) may be

2844 taken:

2845 (t) Failing to identify through written notice, which may

2846 include the wearing of a name tag, or orally to a patient the

2847 type of license under which the practitioner is practicing. Any

2848 advertisement for health care services naming the practitioner

2849 must identify the type of license the practitioner holds. This

2850 paragraph does not apply to a practitioner while the

2851 practitioner is providing services in a facility licensed under

2852 chapter 394, chapter 395, chapter 396, chapter 400, or chapter

2853 429. Each board, or the department where there is no board, is

2854 authorized by rule to determine how its practitioners may comply

2855 with this disclosure requirement.

2856 Section 66. Paragraph (b) of subsection (12) of section

2857 456.073, Florida Statutes, is amended to read:

2858 456.073 Disciplinary proceedings.—Disciplinary proceedings

2859 for each board shall be within the jurisdiction of the

2860 department.

2861 (12)

2862 (b) No facility licensed under chapter 395 or chapter 396 ,

2863 health maintenance organization certificated under part I of

2864 chapter 641, physician licensed under chapter 458, or

2865 osteopathic physician licensed under chapter 459 shall

2866 discharge, threaten to discharge, intimidate, or coerce any

2867 employee or staff member by reason of such employee’s or staff

2868 member’s report to the department about a physician licensed

2869 under chapter 458, chapter 459, chapter 460, chapter 461, or

2870 chapter 466 who may be guilty of incompetence, impairment, or

2871 unprofessional conduct so long as such report is given without

2872 intentional fraud or malice.

2873 Section 67. Subsection (3) of section 458.3145, Florida

2874 Statutes, is amended to read:

2875 458.3145 Medical faculty certificate.—

2876 (3) The holder of a medical faculty certificate issued

2877 under this section has all rights and responsibilities

2878 prescribed by law for the holder of a license issued under s.

2879 458.311, except as specifically provided otherwise by law. Such

2880 responsibilities include compliance with continuing medical

2881 education requirements as set forth by rule of the board. A

2882 hospital licensed under chapter 395, an or ambulatory surgical

2883 center licensed under chapter 396 ~~395~~ , a health maintenance

2884 organization certified under chapter 641, an insurer as defined

2885 in s. 624.03, a multiple-employer welfare arrangement as defined

2886 in s. 624.437, or any other entity in this state, in considering

2887 and acting upon an application for staff membership, clinical

2888 privileges, or other credentials as a health care provider, may

2889 not deny the application of an otherwise qualified physician for

2890 such staff membership, clinical privileges, or other credentials

2891 solely because the applicant is a holder of a medical faculty

2892 certificate under this section.

2893 Section 68. Subsection (2) of section 458.320, Florida

2894 Statutes, is amended to read:

2895 458.320 Financial responsibility.—

2896 (2) Physicians who perform surgery in an ambulatory

2897 surgical center licensed under chapter 396 ~~395~~ and, as a

2898 continuing condition of hospital staff privileges, physicians

2899 who have staff privileges must also establish financial

2900 responsibility by one of the following methods:

2901 (a) Establishing and maintaining an escrow account

2902 consisting of cash or assets eligible for deposit in accordance

2903 with s. 625.52 in the per claim amounts specified in paragraph

2904 (b). The required escrow amount set forth in this paragraph may

2905 not be used for litigation costs or attorney ~~attorney’s~~ fees for

2906 the defense of any medical malpractice claim.

2907 (b) Obtaining and maintaining professional liability

2908 coverage in an amount not less than $250,000 per claim, with a

2909 minimum annual aggregate of not less than $750,000 from an

2910 authorized insurer as defined under s. 624.09, from a surplus

2911 lines insurer as defined under s. 626.914(2), from a risk

2912 retention group as defined under s. 627.942, from the Joint

2913 Underwriting Association established under s. 627.351(4),

2914 through a plan of self-insurance as provided in s. 627.357, or

2915 through a plan of self-insurance which meets the conditions

2916 specified for satisfying financial responsibility in s. 766.110.

2917 The required coverage amount set forth in this paragraph may not

2918 be used for litigation costs or attorney ~~attorney’s~~ fees for the

2919 defense of any medical malpractice claim.

2920 (c) Obtaining and maintaining an unexpired irrevocable

2921 letter of credit, established pursuant to chapter 675, in an

2922 amount not less than $250,000 per claim, with a minimum

2923 aggregate availability of credit of not less than $750,000. The

2924 letter of credit must be payable to the physician as beneficiary

2925 upon presentment of a final judgment indicating liability and

2926 awarding damages to be paid by the physician or upon presentment

2927 of a settlement agreement signed by all parties to such

2928 agreement when such final judgment or settlement is a result of

2929 a claim arising out of the rendering of, or the failure to

2930 render, medical care and services. The letter of credit may not

2931 be used for litigation costs or attorney ~~attorney’s~~ fees for the

2932 defense of any medical malpractice claim. The letter of credit

2933 must be nonassignable and nontransferable. The letter of credit

2934 must be issued by any bank or savings association organized and

2935 existing under the laws of this state or any bank or savings

2936 association organized under the laws of the United States which

2937 has its principal place of business in this state or has a

2938 branch office that is authorized under the laws of this state or

2939 of the United States to receive deposits in this state.

2941 This subsection shall be inclusive of the coverage in subsection

2942 (1).

2943 Section 69. Paragraph (a) of subsection (1) of section

2944 458.3265, Florida Statutes, is amended to read:

2945 458.3265 Pain-management clinics.—

2946 (1) REGISTRATION.—

2947 (a)1. As used in this section, the term:

2948 a. “Board eligible” means successful completion of an

2949 anesthesia, physical medicine and rehabilitation, rheumatology,

2950 or neurology residency program approved by the Accreditation

2951 Council for Graduate Medical Education or the American

2952 Osteopathic Association for a period of 6 years from successful

2953 completion of such residency program.

2954 b. “Chronic nonmalignant pain” means pain unrelated to

2955 cancer which persists beyond the usual course of disease or the

2956 injury that is the cause of the pain or more than 90 days after

2957 surgery.

2958 c. “Pain-management clinic” or “clinic” means any publicly

2959 or privately owned facility:

2960 (I) That advertises in any medium for any type of pain

2961 management services; or

2962 (II) Where in any month a majority of patients are

2963 prescribed opioids, benzodiazepines, barbiturates, or

2964 carisoprodol for the treatment of chronic nonmalignant pain.

2965 2. Each pain-management clinic must register with the

2966 department or hold a valid certificate of exemption pursuant to

2967 subsection (2).

2968 3. The following clinics are exempt from the registration

2969 requirement of paragraphs (c)-(m) and must apply to the

2970 department for a certificate of exemption:

2971 a. A clinic licensed as a hospital under ~~facility pursuant~~

2972 to chapter 395 or an ambulatory surgical center under chapter

2973 396 ;

2974 b. A clinic in which the majority of the physicians who

2975 provide services in the clinic primarily provide surgical

2976 services;

2977 c. A clinic owned by a publicly held corporation whose

2978 shares are traded on a national exchange or on the over-the

2979 counter market and whose total assets at the end of the

2980 corporation’s most recent fiscal quarter exceeded $50 million;

2981 d. A clinic affiliated with an accredited medical school at

2982 which training is provided for medical students, residents, or

2983 fellows;

2984 e. A clinic that does not prescribe controlled substances

2985 for the treatment of pain;

2986 f. A clinic owned by a corporate entity exempt from federal

2987 taxation under 26 U.S.C. s. 501(c)(3);

2988 g. A clinic wholly owned and operated by one or more board

2989 eligible or board-certified anesthesiologists, physiatrists,

2990 rheumatologists, or neurologists; or

2991 h. A clinic wholly owned and operated by a physician

2992 multispecialty practice where one or more board-eligible or

2993 board-certified medical specialists, who have also completed

2994 fellowships in pain medicine approved by the Accreditation

2995 Council for Graduate Medical Education or who are also board

2996 certified in pain medicine by the American Board of Pain

2997 Medicine or a board approved by the American Board of Medical

2998 Specialties, the American Board of Physician Specialties, or the

2999 American Osteopathic Association, perform interventional pain

3000 procedures of the type routinely billed using surgical codes.

3001 Section 70. Paragraph (a) of subsection (1) and paragraph

3002 (a) of subsection (2) of section 458.328, Florida Statutes, are

3003 amended to read:

3004 458.328 Office surgeries.—

3005 (1) REGISTRATION.—

3006 (a)1. An office in which a physician performs a liposuction

3007 procedure in which more than 1,000 cubic centimeters of

3008 supernatant fat is temporarily or permanently removed, a Level

3009 II office surgery, or a Level III office surgery must register

3010 with the department. A facility licensed under chapter 390 , or

3011 chapter 395 , or chapter 396 may not be registered under this

3012 section.

3013 2. The department must complete an inspection of any office

3014 seeking registration under this section before the office may be

3015 registered.

3016 (2) STANDARDS OF PRACTICE.—

3017 (a) A physician may not perform any surgery or procedure

3018 identified in paragraph (1)(a) in a setting other than an office

3019 surgery setting registered under this section or a facility

3020 licensed under chapter 390 , or chapter 395 , or chapter 396 , as

3021 applicable. The board shall impose a fine of $5,000 per incident

3022 on a physician who violates this paragraph.

3023 Section 71. Paragraph (g) of subsection (4) of section

3024 458.347, Florida Statutes, is amended to read:

3025 458.347 Physician assistants.—

3026 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—

3027 (g) A supervisory physician may delegate to a licensed

3028 physician assistant the authority to, and the licensed physician

3029 assistant acting under the direction of the supervisory

3030 physician may, order any medication for administration to the

3031 supervisory physician’s patient in a facility licensed under

3032 chapter 395 , chapter 396, or part II of chapter 400,

3033 notwithstanding any provisions in chapter 465 or chapter 893

3034 which may prohibit this delegation.

3035 Section 72. Paragraph (f) of subsection (4) of section

3036 458.351, Florida Statutes, is amended to read:

3037 458.351 Reports of adverse incidents in office practice

3038 settings.—

3039 (4) For purposes of notification to the department pursuant

3040 to this section, the term “adverse incident” means an event over

3041 which the physician or licensee could exercise control and which

3042 is associated in whole or in part with a medical intervention,

3043 rather than the condition for which such intervention occurred,

3044 and which results in the following patient injuries:

3045 (f) Any condition that required the transfer of a patient

3046 to a hospital licensed under chapter 395 from an ambulatory

3047 surgical center licensed under chapter 396 ~~395~~ or any facility

3048 or any office maintained by a physician for the practice of

3049 medicine which is not licensed under chapter 395.

3050 Section 73. Subsection (2) of section 459.0085, Florida

3051 Statutes, is amended to read:

3052 459.0085 Financial responsibility.—

3053 (2) Osteopathic physicians who perform surgery in an

3054 ambulatory surgical center licensed under chapter 396 ~~395~~ and,

3055 as a continuing condition of hospital staff privileges,

3056 osteopathic physicians who have staff privileges must also

3057 establish financial responsibility by one of the following

3058 methods:

3059 (a) Establishing and maintaining an escrow account

3060 consisting of cash or assets eligible for deposit in accordance

3061 with s. 625.52 in the per-claim amounts specified in paragraph

3062 (b). The required escrow amount set forth in this paragraph may

3063 not be used for litigation costs or attorney ~~attorney’s~~ fees for

3064 the defense of any medical malpractice claim.

3065 (b) Obtaining and maintaining professional liability

3066 coverage in an amount not less than $250,000 per claim, with a

3067 minimum annual aggregate of not less than $750,000 from an

3068 authorized insurer as defined under s. 624.09, from a surplus

3069 lines insurer as defined under s. 626.914(2), from a risk

3070 retention group as defined under s. 627.942, from the Joint

3071 Underwriting Association established under s. 627.351(4),

3072 through a plan of self-insurance as provided in s. 627.357, or

3073 through a plan of self-insurance that meets the conditions

3074 specified for satisfying financial responsibility in s. 766.110.

3075 The required coverage amount set forth in this paragraph may not

3076 be used for litigation costs or attorney ~~attorney’s~~ fees for the

3077 defense of any medical malpractice claim.

3078 (c) Obtaining and maintaining an unexpired, irrevocable

3079 letter of credit, established pursuant to chapter 675, in an

3080 amount not less than $250,000 per claim, with a minimum

3081 aggregate availability of credit of not less than $750,000. The

3082 letter of credit must be payable to the osteopathic physician as

3083 beneficiary upon presentment of a final judgment indicating

3084 liability and awarding damages to be paid by the osteopathic

3085 physician or upon presentment of a settlement agreement signed

3086 by all parties to such agreement when such final judgment or

3087 settlement is a result of a claim arising out of the rendering

3088 of, or the failure to render, medical care and services. The

3089 letter of credit may not be used for litigation costs or

3090 attorney ~~attorney’s~~ fees for the defense of any medical

3091 malpractice claim. The letter of credit must be nonassignable

3092 and nontransferable. The letter of credit must be issued by any

3093 bank or savings association organized and existing under the

3094 laws of this state or any bank or savings association organized

3095 under the laws of the United States which has its principal

3096 place of business in this state or has a branch office that is

3097 authorized under the laws of this state or of the United States

3098 to receive deposits in this state.

3100 This subsection shall be inclusive of the coverage in subsection

3101 (1).

3102 Section 74. Paragraph (a) of subsection (1) of section

3103 459.0137, Florida Statutes, is amended to read:

3104 459.0137 Pain-management clinics.—

3105 (1) REGISTRATION.—

3106 (a)1. As used in this section, the term:

3107 a. “Board eligible” means successful completion of an

3108 anesthesia, physical medicine and rehabilitation, rheumatology,

3109 or neurology residency program approved by the Accreditation

3110 Council for Graduate Medical Education or the American

3111 Osteopathic Association for a period of 6 years from successful

3112 completion of such residency program.

3113 b. “Chronic nonmalignant pain” means pain unrelated to

3114 cancer which persists beyond the usual course of disease or the

3115 injury that is the cause of the pain or more than 90 days after

3116 surgery.

3117 c. “Pain-management clinic” or “clinic” means any publicly

3118 or privately owned facility:

3119 (I) That advertises in any medium for any type of pain

3120 management services; or

3121 (II) Where in any month a majority of patients are

3122 prescribed opioids, benzodiazepines, barbiturates, or

3123 carisoprodol for the treatment of chronic nonmalignant pain.

3124 2. Each pain-management clinic must register with the

3125 department or hold a valid certificate of exemption pursuant to

3126 subsection (2).

3127 3. The following clinics are exempt from the registration

3128 requirement of paragraphs (c)-(m) and must apply to the

3129 department for a certificate of exemption:

3130 a. A clinic licensed as a hospital under ~~facility pursuant~~

3131 to chapter 395 or an ambulatory surgical center under chapter

3132 396 ;

3133 b. A clinic in which the majority of the physicians who

3134 provide services in the clinic primarily provide surgical

3135 services;

3136 c. A clinic owned by a publicly held corporation whose

3137 shares are traded on a national exchange or on the over-the

3138 counter market and whose total assets at the end of the

3139 corporation’s most recent fiscal quarter exceeded $50 million;

3140 d. A clinic affiliated with an accredited medical school at

3141 which training is provided for medical students, residents, or

3142 fellows;

3143 e. A clinic that does not prescribe controlled substances

3144 for the treatment of pain;

3145 f. A clinic owned by a corporate entity exempt from federal

3146 taxation under 26 U.S.C. s. 501(c)(3);

3147 g. A clinic wholly owned and operated by one or more board

3148 eligible or board-certified anesthesiologists, physiatrists,

3149 rheumatologists, or neurologists; or

3150 h. A clinic wholly owned and operated by a physician

3151 multispecialty practice where one or more board-eligible or

3152 board-certified medical specialists, who have also completed

3153 fellowships in pain medicine approved by the Accreditation

3154 Council for Graduate Medical Education or the American

3155 Osteopathic Association or who are also board-certified in pain

3156 medicine by the American Board of Pain Medicine or a board

3157 approved by the American Board of Medical Specialties, the

3158 American Board of Physician Specialties, or the American

3159 Osteopathic Association, perform interventional pain procedures

3160 of the type routinely billed using surgical codes.

3161 Section 75. Paragraph (a) of subsection (1) and paragraph

3162 (a) of subsection (2) of section 459.0138, Florida Statutes, are

3163 amended to read:

3164 459.0138 Office surgeries.—

3165 (1) REGISTRATION.—

3166 (a)1. An office in which a physician performs a liposuction

3167 procedure in which more than 1,000 cubic centimeters of

3168 supernatant fat is temporarily or permanently removed, a Level

3169 II office surgery, or a Level III office surgery must register

3170 with the department. A facility licensed under chapter 390 , or

3171 chapter 395 , or chapter 396 may not be registered under this

3172 section.

3173 2. The department must complete an inspection of any office

3174 seeking registration under this section before the office may be

3175 registered.

3176 (2) STANDARDS OF PRACTICE.—

3177 (a) A physician may not perform any surgery or procedure

3178 identified in paragraph (1)(a) in a setting other than an office

3179 surgery setting registered under this section or a facility

3180 licensed under chapter 390 , or chapter 395, or chapter 396, as

3181 applicable. The board shall impose a fine of $5,000 per incident

3182 on a physician who violates this paragraph.

3183 Section 76. Paragraph (ll) of subsection (1) and

3184 subsections (7) and (9) of section 459.015, Florida Statutes,

3185 are amended to read:

3186 459.015 Grounds for disciplinary action; action by the

3187 board and department.—

3188 (1) The following acts constitute grounds for denial of a

3189 license or disciplinary action, as specified in s. 456.072(2):

3190 (ll) Failing to report to the department any licensee under

3191 chapter 458 or under this chapter who the osteopathic physician

3192 or physician assistant knows has violated the grounds for

3193 disciplinary action set out in the law under which that person

3194 is licensed and who provides health care services in a facility

3195 licensed under chapter 395 or chapter 396 , or a health

3196 maintenance organization certificated under part I of chapter

3197 641, in which the osteopathic physician or physician assistant

3198 also provides services.

3199 (7) Upon the department’s receipt from the Agency for

3200 Health Care Administration pursuant to s. 395.0197 or s. 396.213

3201 of the name of an osteopathic physician whose conduct may

3202 constitute grounds for disciplinary action by the department,

3203 the department shall investigate the occurrences upon which the

3204 report was based and determine if action by the department

3205 against the osteopathic physician is warranted.

3206 (9) When an investigation of an osteopathic physician is

3207 undertaken, the department shall promptly furnish to the

3208 osteopathic physician or his or her attorney a copy of the

3209 complaint or document which resulted in the initiation of the

3210 investigation. For purposes of this subsection, such documents

3211 include, but are not limited to: the pertinent portions of an

3212 annual report submitted to the department pursuant to s.

3213 395.0197(6) or s. 396.213(6) ; a report of an adverse incident

3214 which is provided to the department pursuant to s. 395.0197 or

3215 s. 396.213 ; a report of peer review disciplinary action

3216 submitted to the department pursuant to s. 395.0193(4) , s.

3217 396.212(4), or s. 459.016, provided that the investigations,

3218 proceedings, and records relating to such peer review

3219 disciplinary action shall continue to retain their privileged

3220 status even as to the licensee who is the subject of the

3221 investigation, as provided by ss. 395.0193(8) , 396.212(8), and

3222 459.016(3); a report of a closed claim submitted pursuant to s.

3223 627.912; a presuit notice submitted pursuant to s. 766.106(2);

3224 and a petition brought under the Florida Birth-Related

3225 Neurological Injury Compensation Plan, pursuant to s.

3226 766.305(2). The osteopathic physician may submit a written

3227 response to the information contained in the complaint or

3228 document which resulted in the initiation of the investigation

3229 within 45 days after service to the osteopathic physician of the

3230 complaint or document. The osteopathic physician’s written

3231 response shall be considered by the probable cause panel.

3232 Section 77. Paragraph (f) of subsection (4) of section

3233 459.022, Florida Statutes, is amended to read:

3234 459.022 Physician assistants.—

3235 (4) PERFORMANCE OF PHYSICIAN ASSISTANTS.—

3236 (f) A supervisory physician may delegate to a licensed

3237 physician assistant the authority to, and the licensed physician

3238 assistant acting under the direction of the supervisory

3239 physician may, order any medication for administration to the

3240 supervisory physician’s patient in a facility licensed under

3241 chapter 395 , chapter 396, or part II of chapter 400,

3242 notwithstanding any provisions in chapter 465 or chapter 893

3243 which may prohibit this delegation.

3244 Section 78. Paragraph (f) of subsection (4) of section

3245 459.026, Florida Statutes, is amended to read:

3246 459.026 Reports of adverse incidents in office practice

3247 settings.—

3248 (4) For purposes of notification to the department pursuant

3249 to this section, the term “adverse incident” means an event over

3250 which the physician or licensee could exercise control and which

3251 is associated in whole or in part with a medical intervention,

3252 rather than the condition for which such intervention occurred,

3253 and which results in the following patient injuries:

3254 (f) Any condition that required the transfer of a patient

3255 to a hospital licensed under chapter 395 from an ambulatory

3256 surgical center licensed under chapter 396 ~~395~~ or any facility

3257 or any office maintained by a physician for the practice of

3258 medicine which is not licensed under chapter 395.

3259 Section 79. Paragraph (ee) of subsection (1) of section

3260 460.413, Florida Statutes, is amended to read:

3261 460.413 Grounds for disciplinary action; action by board or

3262 department.—

3263 (1) The following acts constitute grounds for denial of a

3264 license or disciplinary action, as specified in s. 456.072(2):

3265 (ee) Failing to report to the department any licensee under

3266 chapter 458 or under chapter 459 who the chiropractic physician

3267 or chiropractic physician’s assistant knows has violated the

3268 grounds for disciplinary action set out in the law under which

3269 that person is licensed and who provides health care services in

3270 a facility licensed under chapter 395 or chapter 396 , or a

3271 health maintenance organization certificated under part I of

3272 chapter 641, in which the chiropractic physician or chiropractic

3273 physician’s assistant also provides services.

3274 Section 80. Paragraph (c) of subsection (1) of section

3275 460.4167, Florida Statutes, is amended to read:

3276 460.4167 Proprietorship by persons other than licensed

3277 chiropractic physicians.—

3278 (1) A person may not employ a chiropractic physician

3279 licensed under this chapter or engage a chiropractic physician

3280 licensed under this chapter as an independent contractor to

3281 provide services that chiropractic physicians are authorized to

3282 offer under this chapter, unless the person is any of the

3283 following:

3284 (c) An entity that is wholly owned, directly or indirectly,

3285 by an entity licensed or registered by the state under chapter

3286 395 or chapter 396 .

3287 Section 81. Paragraph (aa) of subsection (1) and paragraph

3288 (b) of subsection (5) of section 461.013, Florida Statutes, are

3289 amended to read:

3290 461.013 Grounds for disciplinary action; action by the

3291 board; investigations by department.—

3292 (1) The following acts constitute grounds for denial of a

3293 license or disciplinary action, as specified in s. 456.072(2):

3294 (aa) Failing to report to the department any licensee under

3295 chapter 458 or chapter 459 who the podiatric physician knows has

3296 violated the grounds for disciplinary action set out in the law

3297 under which that person is licensed and who provides health care

3298 services in a facility licensed under chapter 395 or chapter

3299 396 , or a health maintenance organization certificated under

3300 part I of chapter 641, in which the podiatric physician also

3301 provides services.

3302 (5)

3303 (b) Upon the department’s receipt from the Agency for

3304 Health Care Administration pursuant to s. 395.0197 or s. 396.213

3305 of the name of the podiatric physician whose conduct may

3306 constitute grounds for disciplinary action by the department,

3307 the department shall investigate the occurrences upon which the

3308 report was based and determine if action by the department

3309 against the podiatric physician is warranted.

3310 Section 82. Paragraph (e) of subsection (3) of section

3311 464.012, Florida Statutes, is amended to read:

3312 464.012 Licensure of advanced practice registered nurses;

3313 fees; controlled substance prescribing.—

3314 (3) An advanced practice registered nurse shall perform

3315 those functions authorized in this section within the framework

3316 of an established protocol that must be maintained on site at

3317 the location or locations at which an advanced practice

3318 registered nurse practices, unless the advanced practice

3319 registered nurse is registered and practicing under s. 464.0123.

3320 In the case of multiple supervising physicians in the same

3321 group, an advanced practice registered nurse must enter into a

3322 supervisory protocol with at least one physician within the

3323 physician group practice. A practitioner currently licensed

3324 under chapter 458, chapter 459, or chapter 466 shall maintain

3325 supervision for directing the specific course of medical

3326 treatment. Within the established framework, an advanced

3327 practice registered nurse may:

3328 (e) Order any medication for administration to a patient in

3329 a facility licensed under chapter 395 , chapter 396, or part II

3330 of chapter 400, notwithstanding any provisions in chapter 465 or

3331 chapter 893.

3332 Section 83. Paragraph (e) of subsection (1) of section

3333 465.0125, Florida Statutes, is amended to read:

3334 465.0125 Consultant pharmacist license; application,

3335 renewal, fees; responsibilities; rules.—

3336 (1) The department shall issue or renew a consultant

3337 pharmacist license upon receipt of an initial or renewal

3338 application that conforms to the requirements for consultant

3339 pharmacist initial licensure or renewal as adopted by the board

3340 by rule and a fee set by the board not to exceed $250. To be

3341 licensed as a consultant pharmacist, a pharmacist must complete

3342 additional training as required by the board.

3343 (e) For purposes of this subsection, the term “health care

3344 facility” means a ~~an ambulatory surgical center or~~ hospital

3345 licensed under chapter 395, an ambulatory surgical center

3346 licensed under chapter 396, an alcohol or chemical dependency

3347 treatment center licensed under chapter 397, an inpatient

3348 hospice licensed under part IV of chapter 400, a nursing home

3349 licensed under part II of chapter 400, an ambulatory care center

3350 as defined in s. 408.07, or a nursing home component under

3351 chapter 400 within a continuing care facility licensed under

3352 chapter 651.

3353 Section 84. Paragraph (o) of subsection (1) of section

3354 465.016, Florida Statutes, is amended to read:

3355 465.016 Disciplinary actions.—

3356 (1) The following acts constitute grounds for denial of a

3357 license or disciplinary action, as specified in s. 456.072(2):

3358 (o) Failing to report to the department any licensee under

3359 chapter 458 or under chapter 459 who the pharmacist knows has

3360 violated the grounds for disciplinary action set out in the law

3361 under which that person is licensed and who provides health care

3362 services in a facility licensed under chapter 395 or chapter

3363 396 , or a health maintenance organization certificated under

3364 part I of chapter 641, in which the pharmacist also provides

3365 services. However, a person who the licensee knows is unable to

3366 practice medicine or osteopathic medicine with reasonable skill

3367 and safety to patients by reason of illness or use of alcohol,

3368 drugs, narcotics, chemicals, or any other type of material, or

3369 as a result of a mental or physical condition, may be reported

3370 to a consultant operating an impaired practitioner program as

3371 described in s. 456.076 rather than to the department.

3372 Section 85. Paragraph (hh) of subsection (1) of section

3373 466.028, Florida Statutes, is amended to read:

3374 466.028 Grounds for disciplinary action; action by the

3375 board.—

3376 (1) The following acts constitute grounds for denial of a

3377 license or disciplinary action, as specified in s. 456.072(2):

3378 (hh) Failing to report to the department any licensee under

3379 chapter 458 or chapter 459 who the dentist knows has violated

3380 the grounds for disciplinary action set out in the law under

3381 which that person is licensed and who provides health care

3382 services in a facility licensed under chapter 395 or chapter

3383 396 , or a health maintenance organization certificated under

3384 part I of chapter 641, in which the dentist also provides

3385 services.

3386 Section 86. Paragraph (l) of subsection (1) of section

3387 468.505, Florida Statutes, is amended to read:

3388 468.505 Exemptions; exceptions.—

3389 (1) Nothing in this part may be construed as prohibiting or

3390 restricting the practice, services, or activities of:

3391 (l) A person employed by a nursing facility exempt from

3392 licensing under s. 395.002 ~~s. 395.002(12)~~ , or a person exempt

3393 from licensing under s. 464.022.

3394 Section 87. Paragraph (d) of subsection (11) of section

3395 486.021, Florida Statutes, is amended to read:

3396 486.021 Definitions.—As used in this chapter, unless the

3397 context otherwise requires, the term:

3398 (11) “Practice of physical therapy” means the performance

3399 of physical therapy assessments and the treatment of any

3400 disability, injury, disease, or other health condition of human

3401 beings, or the prevention of such disability, injury, disease,

3402 or other health condition, and the rehabilitation of such

3403 disability, injury, disease, or other health condition by

3404 alleviating impairments, functional movement limitations, and

3405 disabilities by designing, implementing, and modifying treatment

3406 interventions through therapeutic exercise; functional movement

3407 training in self-management and in-home, community, or work

3408 integration or reintegration; manual therapy; massage; airway

3409 clearance techniques; maintaining and restoring the

3410 integumentary system and wound care; physical agent or modality;

3411 mechanical or electrotherapeutic modality; patient-related

3412 instruction; the use of apparatus and equipment in the

3413 application of such treatment, prevention, or rehabilitation;

3414 the performance of tests of neuromuscular functions as an aid to

3415 the diagnosis or treatment of any human condition; or the

3416 performance of electromyography as an aid to the diagnosis of

3417 any human condition only upon compliance with the criteria set

3418 forth by the Board of Medicine.

3419 (d) This subsection does not authorize a physical therapist

3420 to implement a plan of treatment for a patient currently being

3421 treated in a facility licensed under ~~pursuant to~~ chapter 395 or

3422 chapter 396 .

3423 Section 88. Subsection (22) of section 499.003, Florida

3424 Statutes, is amended to read:

3425 499.003 Definitions of terms used in this part.—As used in

3426 this part, the term:

3427 (22) “Health care facility” means a health care facility

3428 licensed under chapter 395 or chapter 396 .

3429 Section 89. Subsection (5) of section 499.0295, Florida

3430 Statutes, is amended to read:

3431 499.0295 Experimental treatments for terminal conditions.—

3432 (5) A hospital or health care facility licensed under

3433 chapter 395 or chapter 396, as applicable, is not required to

3434 provide new or additional services unless those services are

3435 approved by the hospital or health care facility.

3436 Section 90. Paragraph (c) of subsection (1) of section

3437 553.80, Florida Statutes, is amended to read:

3438 553.80 Enforcement.—

3439 (1) Except as provided in paragraphs (a)-(g), each local

3440 government and each legally constituted enforcement district

3441 with statutory authority shall regulate building construction

3442 and, where authorized in the state agency’s enabling

3443 legislation, each state agency shall enforce the Florida

3444 Building Code required by this part on all public or private

3445 buildings, structures, and facilities, unless such

3446 responsibility has been delegated to another unit of government

3447 under s. 553.79(11).

3448 (c) In addition to the requirements of s. 553.79 and this

3449 section, facilities subject to ~~the provisions of~~ chapter 395 ,

3450 chapter 396, and parts II and VIII of chapter 400 shall have

3451 facility plans reviewed and construction surveyed by the state

3452 agency authorized to do so under the requirements of chapter 395

3453 and parts II and VIII of chapter 400 and the certification

3454 requirements of the Federal Government. Facilities subject to

3455 the provisions of part IV of chapter 400 may have facility plans

3456 reviewed and shall have construction surveyed by the state

3457 agency authorized to do so under the requirements of part IV of

3458 chapter 400 and the certification requirements of the Federal

3459 Government.

3461 The governing bodies of local governments may provide a schedule

3462 of fees, as authorized by s. 125.56(2) or s. 166.222 and this

3463 section, for the enforcement of the provisions of this part.

3464 Such fees shall be used solely for carrying out the local

3465 government’s responsibilities in enforcing the Florida Building

3466 Code. The authority of state enforcing agencies to set fees for

3467 enforcement shall be derived from authority existing on July 1,

3468 1998. However, nothing contained in this subsection shall

3469 operate to limit such agencies from adjusting their fee schedule

3470 in conformance with existing authority.

3471 Section 91. Paragraph (h) of subsection (4) of section

3472 627.351, Florida Statutes, is amended to read:

3473 627.351 Insurance risk apportionment plans.—

3474 (4) MEDICAL MALPRACTICE RISK APPORTIONMENT; ASSOCIATION

3475 CONTRACTS AND PURCHASES.—

3476 (h) As used in this subsection , the term :

3477 1. “Health care provider” means hospitals licensed under

3478 chapter 395; physicians licensed under chapter 458; osteopathic

3479 physicians licensed under chapter 459; podiatric physicians

3480 licensed under chapter 461; dentists licensed under chapter 466;

3481 chiropractic physicians licensed under chapter 460; naturopaths

3482 licensed under chapter 462; nurses licensed under part I of

3483 chapter 464; midwives licensed under chapter 467; physician

3484 assistants licensed under chapter 458 or chapter 459; physical

3485 therapists and physical therapist assistants licensed under

3486 chapter 486; health maintenance organizations certificated under

3487 part I of chapter 641; ambulatory surgical centers licensed

3488 under chapter 396 ~~395~~ ; other medical facilities as defined in

3489 subparagraph 2.; blood banks, plasma centers, industrial

3490 clinics, and renal dialysis facilities; or professional

3491 associations, partnerships, corporations, joint ventures, or

3492 other associations for professional activity by health care

3493 providers.

3494 2. “Other medical facility” means a facility the primary

3495 purpose of which is to provide human medical diagnostic services

3496 or a facility providing nonsurgical human medical treatment, to

3497 which facility the patient is admitted and from which facility

3498 the patient is discharged within the same working day, and which

3499 facility is not part of a hospital. However, a facility existing

3500 for the primary purpose of performing terminations of pregnancy

3501 or an office maintained by a physician or dentist for the

3502 practice of medicine may not be construed to be an “other

3503 medical facility.”

3504 3. “Health care facility” means any hospital licensed under

3505 chapter 395, health maintenance organization certificated under

3506 part I of chapter 641, ambulatory surgical center licensed under

3507 chapter 396 ~~395~~ , or other medical facility as defined in

3508 subparagraph 2.

3509 Section 92. Paragraph (b) of subsection (1) of section

3510 627.357, Florida Statutes, is amended to read:

3511 627.357 Medical malpractice self-insurance.—

3512 (1) DEFINITIONS.—As used in this section, the term:

3513 (b) “Health care provider” means any:

3514 1. Hospital licensed under chapter 395.

3515 2. Physician licensed, or physician assistant licensed,

3516 under chapter 458.

3517 3. Osteopathic physician or physician assistant licensed

3518 under chapter 459.

3519 4. Podiatric physician licensed under chapter 461.

3520 5. Health maintenance organization certificated under part

3521 I of chapter 641.

3522 6. Ambulatory surgical center licensed under chapter 396

3523 ~~395~~ .

3524 7. Chiropractic physician licensed under chapter 460.

3525 8. Psychologist licensed under chapter 490.

3526 9. Optometrist licensed under chapter 463.

3527 10. Dentist licensed under chapter 466.

3528 11. Pharmacist licensed under chapter 465.

3529 12. Registered nurse, licensed practical nurse, or advanced

3530 practice registered nurse licensed or registered under part I of

3531 chapter 464.

3532 13. Other medical facility.

3533 14. Professional association, partnership, corporation,

3534 joint venture, or other association established by the

3535 individuals set forth in subparagraphs 2., 3., 4., 7., 8., 9.,

3536 10., 11., and 12. for professional activity.

3537 Section 93. Section 627.6056, Florida Statutes, is amended

3538 to read:

3539 627.6056 Coverage for ambulatory surgical center service.

3540 An No individual health insurance policy providing coverage on

3541 an expense-incurred basis or individual service or indemnity

3542 type contract issued by a nonprofit corporation, of any kind or

3543 description, may not ~~shall~~ be issued unless coverage provided

3544 for any service performed in an ambulatory surgical center, as

3545 defined in s. 396.202 ~~s. 395.002~~ , is provided if such service

3546 would have been covered under the terms of the policy or

3547 contract as an eligible inpatient service.

3548 Section 94. Paragraph (a) of subsection (2) of section

3549 627.6387, Florida Statutes, is amended to read:

3550 627.6387 Shared savings incentive program.—

3551 (2) As used in this section, the term:

3552 (a) “Health care provider” means a hospital or facility

3553 licensed under chapter 395 or chapter 396 ; an entity licensed

3554 under chapter 400; a health care practitioner as defined in s.

3555 456.001; a blood bank, plasma center, industrial clinic, or

3556 renal dialysis facility; or a professional association,

3557 partnership, corporation, joint venture, or other association

3558 for professional activity by health care providers. The term

3559 includes entities and professionals outside of this state with

3560 an active, unencumbered license for an equivalent facility or

3561 practitioner type issued by another state, the District of

3562 Columbia, or a possession or territory of the United States.

3563 Section 95. Subsection (3) of section 627.6405, Florida

3564 Statutes, is amended to read:

3565 627.6405 Decreasing inappropriate utilization of emergency

3566 care.—

3567 (3) As a disincentive for insureds to inappropriately use

3568 emergency department services for nonemergency care, health

3569 insurers may require higher copayments for urgent care or

3570 primary care provided in an emergency department and higher

3571 copayments for use of out-of-network emergency departments.

3572 Higher copayments may not be charged for the utilization of the

3573 emergency department for emergency care. For the purposes of

3574 this section, the term “emergency care” has the same meaning as

3575 the term “emergency services and care” as defined in s. 395.002

3576 ~~s. 395.002(9)~~ and includes services provided to rule out an

3577 emergency medical condition.

3578 Section 96. Paragraph (b) of subsection (1) of section

3579 627.64194, Florida Statutes, is amended to read:

3580 627.64194 Coverage requirements for services provided by

3581 nonparticipating providers; payment collection limitations.—

3582 (1) As used in this section, the term:

3583 (b) “Facility” means a licensed facility as defined in s.

3584 395.002 ~~s. 395.002(17)~~ and an urgent care center as defined in

3585 s. 395.002.

3586 Section 97. Section 627.6616, Florida Statutes, is amended

3587 to read:

3588 627.6616 Coverage for ambulatory surgical center service.— A

3589 No group health insurance policy providing coverage on an

3590 expense-incurred basis, or group service or indemnity-type

3591 contract issued by a nonprofit corporation, or self-insured

3592 group health benefit plan or trust, of any kind or description,

3593 may not ~~shall~~ be issued unless coverage provided for any service

3594 performed in an ambulatory surgical center, as defined in s.

3595 396.202 ~~s. 395.002~~ , is provided if such service would have been

3596 covered under the terms of the policy or contract as an eligible

3597 inpatient service.

3598 Section 98. Paragraph (a) of subsection (2) of section

3599 627.6648, Florida Statutes, is amended to read:

3600 627.6648 Shared savings incentive program.—

3601 (2) As used in this section, the term:

3602 (a) “Health care provider” means a hospital or facility

3603 licensed under chapter 395 or chapter 396 ; an entity licensed

3604 under chapter 400; a health care practitioner as defined in s.

3605 456.001; a blood bank, plasma center, industrial clinic, or

3606 renal dialysis facility; or a professional association,

3607 partnership, corporation, joint venture, or other association

3608 for professional activity by health care providers. The term

3609 includes entities and professionals outside this state with an

3610 active, unencumbered license for an equivalent facility or

3611 practitioner type issued by another state, the District of

3612 Columbia, or a possession or territory of the United States.

3613 Section 99. Paragraph (a) of subsection (1) of section

3614 627.736, Florida Statutes, is amended to read:

3615 627.736 Required personal injury protection benefits;

3616 exclusions; priority; claims.—

3617 (1) REQUIRED BENEFITS.—An insurance policy complying with

3618 the security requirements of s. 627.733 must provide personal

3619 injury protection to the named insured, relatives residing in

3620 the same household unless excluded under s. 627.747, persons

3621 operating the insured motor vehicle, passengers in the motor

3622 vehicle, and other persons struck by the motor vehicle and

3623 suffering bodily injury while not an occupant of a self

3624 propelled vehicle, subject to subsection (2) and paragraph

3625 (4)(e), to a limit of $10,000 in medical and disability benefits

3626 and $5,000 in death benefits resulting from bodily injury,

3627 sickness, disease, or death arising out of the ownership,

3628 maintenance, or use of a motor vehicle as follows:

3629 (a) Medical benefits.—Eighty percent of all reasonable

3630 expenses for medically necessary medical, surgical, X-ray,

3631 dental, and rehabilitative services, including prosthetic

3632 devices and medically necessary ambulance, hospital, and nursing

3633 services if the individual receives initial services and care

3634 pursuant to subparagraph 1. within 14 days after the motor

3635 vehicle accident. The medical benefits provide reimbursement

3636 only for:

3637 1. Initial services and care that are lawfully provided,

3638 supervised, ordered, or prescribed by a physician licensed under

3639 chapter 458 or chapter 459, a dentist licensed under chapter

3640 466, a chiropractic physician licensed under chapter 460, or an

3641 advanced practice registered nurse registered under s. 464.0123

3642 or that are provided in a hospital or in a facility that owns,

3643 or is wholly owned by, a hospital. Initial services and care may

3644 also be provided by a person or entity licensed under part III

3645 of chapter 401 which provides emergency transportation and

3646 treatment.

3647 2. Upon referral by a provider described in subparagraph

3648 1., follow-up ~~followup~~ services and care consistent with the

3649 underlying medical diagnosis rendered pursuant to subparagraph

3650 1. which may be provided, supervised, ordered, or prescribed

3651 only by a physician licensed under chapter 458 or chapter 459, a

3652 chiropractic physician licensed under chapter 460, a dentist

3653 licensed under chapter 466, or an advanced practice registered

3654 nurse registered under s. 464.0123, or, to the extent permitted

3655 by applicable law and under the supervision of such physician,

3656 osteopathic physician, chiropractic physician, or dentist, by a

3657 physician assistant licensed under chapter 458 or chapter 459 or

3658 an advanced practice registered nurse licensed under chapter

3659 464. Follow-up ~~Followup~~ services and care may also be provided

3660 by the following persons or entities:

3661 a. A hospital licensed under chapter 395 or an ambulatory

3662 surgical center licensed under chapter 396 ~~395~~ .

3663 b. An entity wholly owned by one or more physicians

3664 licensed under chapter 458 or chapter 459, chiropractic

3665 physicians licensed under chapter 460, advanced practice

3666 registered nurses registered under s. 464.0123, or dentists

3667 licensed under chapter 466 or by such practitioners and the

3668 spouse, parent, child, or sibling of such practitioners.

3669 c. An entity that owns or is wholly owned, directly or

3670 indirectly, by a hospital or hospitals.

3671 d. A physical therapist licensed under chapter 486, based

3672 upon a referral by a provider described in this subparagraph.

3673 e. A health care clinic licensed under part X of chapter

3674 400 which is accredited by an accrediting organization whose

3675 standards incorporate comparable regulations required by this

3676 state, or

3677 (I) Has a medical director licensed under chapter 458,

3678 chapter 459, or chapter 460;

3679 (II) Has been continuously licensed for more than 3 years

3680 or is a publicly traded corporation that issues securities

3681 traded on an exchange registered with the United States

3682 Securities and Exchange Commission as a national securities

3683 exchange; and

3684 (III) Provides at least four of the following medical

3685 specialties:

3686 (A) General medicine.

3687 (B) Radiography.

3688 (C) Orthopedic medicine.

3689 (D) Physical medicine.

3690 (E) Physical therapy.

3691 (F) Physical rehabilitation.

3692 (G) Prescribing or dispensing outpatient prescription

3693 medication.

3694 (H) Laboratory services.

3695 3. Reimbursement for services and care provided in

3696 subparagraph 1. or subparagraph 2. up to $10,000 if a physician

3697 licensed under chapter 458 or chapter 459, a dentist licensed

3698 under chapter 466, a physician assistant licensed under chapter

3699 458 or chapter 459, or an advanced practice registered nurse

3700 licensed under chapter 464 has determined that the injured

3701 person had an emergency medical condition.

3702 4. Reimbursement for services and care provided in

3703 subparagraph 1. or subparagraph 2. is limited to $2,500 if a

3704 provider listed in subparagraph 1. or subparagraph 2. determines

3705 that the injured person did not have an emergency medical

3706 condition.

3707 5. Medical benefits do not include massage therapy as

3708 defined in s. 480.033 or acupuncture as defined in s. 457.102,

3709 regardless of the person, entity, or licensee providing massage

3710 therapy or acupuncture, and a licensed massage therapist or

3711 licensed acupuncturist may not be reimbursed for medical

3712 benefits under this section.

3713 6. The Financial Services Commission shall adopt by rule

3714 the form that must be used by an insurer and a health care

3715 provider specified in sub-subparagraph 2.b., sub-subparagraph

3716 2.c., or sub-subparagraph 2.e. to document that the health care

3717 provider meets the criteria of this paragraph. Such rule must

3718 include a requirement for a sworn statement or affidavit.

3720 Only insurers writing motor vehicle liability insurance in this

3721 state may provide the required benefits of this section, and

3722 such insurer may not require the purchase of any other motor

3723 vehicle coverage other than the purchase of property damage

3724 liability coverage as required by s. 627.7275 as a condition for

3725 providing such benefits. Insurers may not require that property

3726 damage liability insurance in an amount greater than $10,000 be

3727 purchased in conjunction with personal injury protection. Such

3728 insurers shall make benefits and required property damage

3729 liability insurance coverage available through normal marketing

3730 channels. An insurer writing motor vehicle liability insurance

3731 in this state who fails to comply with such availability

3732 requirement as a general business practice violates part IX of

3733 chapter 626, and such violation constitutes an unfair method of

3734 competition or an unfair or deceptive act or practice involving

3735 the business of insurance. An insurer committing such violation

3736 is subject to the penalties provided under that part, as well as

3737 those provided elsewhere in the insurance code.

3738 Section 100. Paragraph (a) of subsection (1) of section

3739 627.912, Florida Statutes, is amended to read:

3740 627.912 Professional liability claims and actions; reports

3741 by insurers and health care providers; annual report by office.—

3742 (1)(a) Each self-insurer authorized under s. 627.357 and

3743 each commercial self-insurance fund authorized under s. 624.462,

3744 authorized insurer, surplus lines insurer, risk retention group,

3745 and joint underwriting association providing professional

3746 liability insurance to a practitioner of medicine licensed under

3747 chapter 458, to a practitioner of osteopathic medicine licensed

3748 under chapter 459, to a podiatric physician licensed under

3749 chapter 461, to a dentist licensed under chapter 466, to a

3750 hospital licensed under chapter 395, to a crisis stabilization

3751 unit licensed under part IV of chapter 394, to a health

3752 maintenance organization certificated under part I of chapter

3753 641, to clinics included in chapter 390, or to an ambulatory

3754 surgical center as defined in s. 396.202 ~~s. 395.002~~ , and each

3755 insurer providing professional liability insurance to a member

3756 of The Florida Bar shall report to the office as set forth in

3757 paragraph (c) any written claim or action for damages for

3758 personal injuries claimed to have been caused by error,

3759 omission, or negligence in the performance of such insured’s

3760 professional services or based on a claimed performance of

3761 professional services without consent.

3762 Section 101. Paragraph (a) of subsection (2) of section

3763 641.31076, Florida Statutes, is amended to read:

3764 641.31076 Shared savings incentive program.—

3765 (2) As used in this section, the term:

3766 (a) “Health care provider” means a hospital or facility

3767 licensed under chapter 395 or chapter 396 ; an entity licensed

3768 under chapter 400; a health care practitioner as defined in s.

3769 456.001; a blood bank, plasma center, industrial clinic, or

3770 renal dialysis facility; or a professional association,

3771 partnership, corporation, joint venture, or other association

3772 for professional activity by health care providers. The term

3773 includes entities and professionals outside this state with an

3774 active, unencumbered license for an equivalent facility or

3775 practitioner type issued by another state, the District of

3776 Columbia, or a possession or territory of the United States.

3777 Section 102. Subsection (2) of section 765.101, Florida

3778 Statutes, is amended to read:

3779 765.101 Definitions.—As used in this chapter , the term :

3780 (2) “Attending physician” means the physician who has

3781 primary responsibility for the treatment and care of the patient

3782 while the patient receives such treatment or care in a hospital

3783 as defined in s. 395.002 ~~s. 395.002(12)~~ .

3784 Section 103. Paragraph (a) of subsection (1) of section

3785 766.101, Florida Statutes, is amended to read:

3786 766.101 Medical review committee, immunity from liability.—

3787 (1) As used in this section:

3788 (a) The term “medical review committee” or “committee”

3789 means:

3790 1.a. A committee of a hospital licensed under chapter 395

3791 or an ambulatory surgical center licensed under chapter 396 ~~395~~

3792 or a health maintenance organization certificated under part I

3793 of chapter 641;

3794 b. A committee of a physician-hospital organization, a

3795 provider-sponsored organization, or an integrated delivery

3796 system;

3797 c. A committee of a state or local professional society of

3798 health care providers;

3799 d. A committee of a medical staff of a licensed hospital or

3800 nursing home, provided the medical staff operates pursuant to

3801 written bylaws that have been approved by the governing board of

3802 the hospital or nursing home;

3803 e. A committee of the Department of Corrections or the

3804 Correctional Medical Authority as created under s. 945.602, or

3805 employees, agents, or consultants of either the department or

3806 the authority or both;

3807 f. A committee of a professional service corporation formed

3808 under chapter 621 or a corporation organized under part I of

3809 chapter 607 or chapter 617, which is formed and operated for the

3810 practice of medicine as defined in s. 458.305(3), and which has

3811 at least 25 health care providers who routinely provide health

3812 care services directly to patients;

3813 g. A committee of the Department of Children and Families

3814 which includes employees, agents, or consultants to the

3815 department as deemed necessary to provide peer review,

3816 utilization review, and mortality review of treatment services

3817 provided pursuant to chapters 394, 397, and 916;

3818 h. A committee of a mental health treatment facility

3819 licensed under chapter 394 or a community mental health center

3820 as defined in s. 394.907, provided the quality assurance program

3821 operates pursuant to the guidelines that have been approved by

3822 the governing board of the agency;

3823 i. A committee of a substance abuse treatment and education

3824 prevention program licensed under chapter 397 provided the

3825 quality assurance program operates pursuant to the guidelines

3826 that have been approved by the governing board of the agency;

3827 j. A peer review or utilization review committee organized

3828 under chapter 440;

3829 k. A committee of the Department of Health, a county health

3830 department, healthy start coalition, or certified rural health

3831 network, when reviewing quality of care, or employees of these

3832 entities when reviewing mortality records; or

3833 l. A continuous quality improvement committee of a pharmacy

3834 licensed pursuant to chapter 465,

3836 which committee is formed to evaluate and improve the quality of

3837 health care rendered by providers of health service, to

3838 determine that health services rendered were professionally

3839 indicated or were performed in compliance with the applicable

3840 standard of care, or that the cost of health care rendered was

3841 considered reasonable by the providers of professional health

3842 services in the area; or

3843 2. A committee of an insurer, self-insurer, or joint

3844 underwriting association of medical malpractice insurance, or

3845 other persons conducting review under s. 766.106.

3846 Section 104. Paragraph (a) of subsection (1) and subsection

3847 (4) of section 766.1016, Florida Statutes, are amended to read:

3848 766.1016 Patient safety data privilege.—

3849 (1) As used in this section, the term:

3850 (a) “Patient safety data” means reports made to patient

3851 safety organizations, including all health care data,

3852 interviews, memoranda, analyses, root cause analyses, products

3853 of quality assurance or quality improvement processes,

3854 corrective action plans, or information collected or created by

3855 a health care facility licensed under chapter 395 or chapter

3856 396 , or a health care practitioner as defined in s. 456.001(4),

3857 as a result of an occurrence related to the provision of health

3858 care services which exacerbates an existing medical condition or

3859 could result in injury, illness, or death.

3860 (4) The exchange of patient safety data among health care

3861 facilities licensed under chapter 395 or chapter 396 , or health

3862 care practitioners as defined in s. 456.001(4), or patient

3863 safety organizations which does not identify any patient shall

3864 not constitute a waiver of any privilege established in this

3865 section.

3866 Section 105. Paragraph (d) of subsection (2) of section

3867 766.106, Florida Statutes, is amended to read:

3868 766.106 Notice before filing action for medical negligence;

3869 presuit screening period; offers for admission of liability and

3870 for arbitration; informal discovery; review.—

3871 (2) PRESUIT NOTICE.—

3872 (d) Following the initiation of a suit alleging medical

3873 negligence with a court of competent jurisdiction, and service

3874 of the complaint upon a prospective defendant, the claimant

3875 shall provide a copy of the complaint to the Department of

3876 Health and, if the complaint involves a facility licensed under

3877 chapter 395, the Agency for Health Care Administration. The

3878 requirement of providing the complaint to the Department of

3879 Health or the Agency for Health Care Administration does not

3880 impair the claimant’s legal rights or ability to seek relief for

3881 his or her claim. The Department of Health or the Agency for

3882 Health Care Administration shall review each incident that is

3883 the subject of the complaint and determine whether it involved

3884 conduct by a licensee which is potentially subject to

3885 disciplinary action, in which case, for a licensed health care

3886 practitioner, s. 456.073 applies ~~and~~ , for a licensed facility,

3887 part I of chapter 395 applies , and for a licensed ambulatory

3888 surgical center, chapter 396 applies .

3889 Section 106. Subsection (3) of section 766.110, Florida

3890 Statutes, is amended to read:

3891 766.110 Liability of health care facilities.—

3892 (3) In order to ensure comprehensive risk management for

3893 diagnosis of disease, a health care facility, including a

3894 hospital as defined in s. 395.002 or an ambulatory surgical

3895 center , as defined in s. 396.202 ~~chapter 395~~ , may use scientific

3896 diagnostic disease methodologies that use information regarding

3897 specific diseases in health care facilities and that are adopted

3898 by the facility’s medical review committee.

3899 Section 107. Paragraph (d) of subsection (3) of section

3900 766.1115, Florida Statutes, is amended to read:

3901 766.1115 Health care providers; creation of agency

3902 relationship with governmental contractors.—

3903 (3) DEFINITIONS.—As used in this section, the term:

3904 (d) “Health care provider” or “provider” means:

3905 1. A birth center licensed under chapter 383.

3906 2. An ambulatory surgical center licensed under chapter 396

3907 ~~395~~ .

3908 3. A hospital licensed under chapter 395.

3909 4. A physician or physician assistant licensed under

3910 chapter 458.

3911 5. An osteopathic physician or osteopathic physician

3912 assistant licensed under chapter 459.

3913 6. A chiropractic physician licensed under chapter 460.

3914 7. A podiatric physician licensed under chapter 461.

3915 8. A registered nurse, nurse midwife, licensed practical

3916 nurse, or advanced practice registered nurse licensed or

3917 registered under part I of chapter 464 or any facility which

3918 employs nurses licensed or registered under part I of chapter

3919 464 to supply all or part of the care delivered under this

3920 section.

3921 9. A midwife licensed under chapter 467.

3922 10. A health maintenance organization certificated under

3923 part I of chapter 641.

3924 11. A health care professional association and its

3925 employees or a corporate medical group and its employees.

3926 12. Any other medical facility the primary purpose of which

3927 is to deliver human medical diagnostic services or which

3928 delivers nonsurgical human medical treatment, and which includes

3929 an office maintained by a provider.

3930 13. A dentist or dental hygienist licensed under chapter

3931 466.

3932 14. A free clinic that delivers only medical diagnostic

3933 services or nonsurgical medical treatment free of charge to all

3934 low-income recipients.

3935 15. Any other health care professional, practitioner,

3936 provider, or facility under contract with a governmental

3937 contractor, including a student enrolled in an accredited

3938 program that prepares the student for licensure as any one of

3939 the professionals listed in subparagraphs 4.-9.

3941 The term includes any nonprofit corporation qualified as exempt

3942 from federal income taxation under s. 501(a) of the Internal

3943 Revenue Code, and described in s. 501(c) of the Internal Revenue

3944 Code, which delivers health care services provided by licensed

3945 professionals listed in this paragraph, any federally funded

3946 community health center, and any volunteer corporation or

3947 volunteer health care provider that delivers health care

3948 services.

3949 Section 108. Subsection (4) and paragraph (b) of subsection

3950 (6) of section 766.118, Florida Statutes, are amended to read:

3951 766.118 Determination of noneconomic damages.—

3952 (4) LIMITATION ON NONECONOMIC DAMAGES FOR NEGLIGENCE OF

3953 PRACTITIONERS PROVIDING EMERGENCY SERVICES AND CARE.

3954 Notwithstanding subsections (2) and (3), with respect to a cause

3955 of action for personal injury or wrongful death arising from

3956 medical negligence of practitioners providing emergency services

3957 and care, as defined in s. 395.002 ~~s. 395.002(9)~~ , or providing

3958 services as provided in s. 401.265, or providing services

3959 pursuant to obligations imposed by 42 U.S.C. s. 1395dd to

3960 persons with whom the practitioner does not have a then-existing

3961 health care patient-practitioner relationship for that medical

3962 condition:

3963 (a) Regardless of the number of such practitioner

3964 defendants, noneconomic damages may ~~shall~~ not exceed $150,000

3965 per claimant.

3966 (b) Notwithstanding paragraph (a), the total noneconomic

3967 damages recoverable by all claimants from all such practitioners

3968 may ~~shall~~ not exceed $300,000.

3970 The limitation provided by this subsection applies only to

3971 noneconomic damages awarded as a result of any act or omission

3972 of providing medical care or treatment, including diagnosis that

3973 occurs prior to the time the patient is stabilized and is

3974 capable of receiving medical treatment as a nonemergency

3975 patient, unless surgery is required as a result of the emergency

3976 within a reasonable time after the patient is stabilized, in

3977 which case the limitation provided by this subsection applies to

3978 any act or omission of providing medical care or treatment which

3979 occurs prior to the stabilization of the patient following the

3980 surgery.

3981 (6) LIMITATION ON NONECONOMIC DAMAGES FOR NEGLIGENCE OF A

3982 PRACTITIONER PROVIDING SERVICES AND CARE TO A MEDICAID

3983 RECIPIENT.—Notwithstanding subsections (2), (3), and (5), with

3984 respect to a cause of action for personal injury or wrongful

3985 death arising from medical negligence of a practitioner

3986 committed in the course of providing medical services and

3987 medical care to a Medicaid recipient, regardless of the number

3988 of such practitioner defendants providing the services and care,

3989 noneconomic damages may not exceed $300,000 per claimant, unless

3990 the claimant pleads and proves, by clear and convincing

3991 evidence, that the practitioner acted in a wrongful manner. A

3992 practitioner providing medical services and medical care to a

3993 Medicaid recipient is not liable for more than $200,000 in

3994 noneconomic damages, regardless of the number of claimants,

3995 unless the claimant pleads and proves, by clear and convincing

3996 evidence, that the practitioner acted in a wrongful manner. The

3997 fact that a claimant proves that a practitioner acted in a

3998 wrongful manner does not preclude the application of the

3999 limitation on noneconomic damages prescribed elsewhere in this

4000 section. For purposes of this subsection:

4001 (b) The term “practitioner,” in addition to the meaning

4002 prescribed in subsection (1), includes a ~~any~~ hospital or

4003 ~~ambulatory surgical center~~ as defined and licensed under chapter

4004 395 or an ambulatory surgical center as defined and licensed

4005 under chapter 396 .

4006 Section 109. Subsection (4) of section 766.202, Florida

4007 Statutes, is amended to read:

4008 766.202 Definitions; ss. 766.201-766.212.—As used in ss.

4009 766.201-766.212, the term:

4010 (4) “Health care provider” means a ~~any~~ hospital or

4011 ~~ambulatory surgical center~~ as defined and licensed under chapter

4012 395; an ambulatory surgical center as defined and licensed under

4013 chapter 396; a birth center licensed under chapter 383; any

4014 person licensed under chapter 458, chapter 459, chapter 460,

4015 chapter 461, chapter 462, chapter 463, part I of chapter 464,

4016 chapter 466, chapter 467, part XIV of chapter 468, or chapter

4017 486; a health maintenance organization certificated under part I

4018 of chapter 641; a blood bank; a plasma center; an industrial

4019 clinic; a renal dialysis facility; or a professional association

4020 partnership, corporation, joint venture, or other association

4021 for professional activity by health care providers.

4022 Section 110. Section 766.316, Florida Statutes, is amended

4023 to read:

4024 766.316 Notice to obstetrical patients of participation in

4025 the plan.—Each hospital with a participating physician on its

4026 staff and each participating physician, other than residents,

4027 assistant residents, and interns deemed to be participating

4028 physicians under s. 766.314(4)(c), under the Florida Birth

4029 Related Neurological Injury Compensation Plan shall provide

4030 notice to the obstetrical patients as to the limited no-fault

4031 alternative for birth-related neurological injuries. Such notice

4032 shall be provided on forms furnished by the association and

4033 shall include a clear and concise explanation of a patient’s

4034 rights and limitations under the plan. The hospital or the

4035 participating physician may elect to have the patient sign a

4036 form acknowledging receipt of the notice form. Signature of the

4037 patient acknowledging receipt of the notice form raises a

4038 rebuttable presumption that the notice requirements of this

4039 section have been met. Notice need not be given to a patient

4040 when the patient has an emergency medical condition as defined

4041 in s. 395.002 ~~s. 395.002(8)(b)~~ or when notice is not

4042 practicable.

4043 Section 111. Subsections (1), (2), (5), (6), and (8) of

4044 section 790.338, Florida Statutes, are amended to read:

4045 790.338 Medical privacy concerning firearms; prohibitions;

4046 penalties; exceptions.—

4047 (1) A health care practitioner licensed under chapter 456

4048 or a health care facility licensed under chapter 395 or chapter

4049 396 may not intentionally enter any disclosed information

4050 concerning firearm ownership into the patient’s medical record

4051 if the practitioner knows that such information is not relevant

4052 to the patient’s medical care or safety, or the safety of

4053 others.

4054 (2) A health care practitioner licensed under chapter 456

4055 or a health care facility licensed under chapter 395 or chapter

4056 396 shall respect a patient’s right to privacy and should

4057 refrain from making a written inquiry or asking questions

4058 concerning the ownership of a firearm or ammunition by the

4059 patient or by a family member of the patient, or the presence of

4060 a firearm in a private home or other domicile of the patient or

4061 a family member of the patient. Notwithstanding this provision,

4062 a health care practitioner or health care facility that in good

4063 faith believes that this information is relevant to the

4064 patient’s medical care or safety, or the safety of others, may

4065 make such a verbal or written inquiry.

4066 (5) A health care practitioner licensed under chapter 456

4067 or a health care facility licensed under chapter 395 or chapter

4068 396 may not discriminate against a patient based solely upon the

4069 patient’s exercise of the constitutional right to own and

4070 possess firearms or ammunition.

4071 (6) A health care practitioner licensed under chapter 456

4072 or a health care facility licensed under chapter 395 or chapter

4073 396 shall respect a patient’s legal right to own or possess a

4074 firearm and should refrain from unnecessarily harassing a

4075 patient about firearm ownership during an examination.

4076 (8) Violations of the provisions of subsections (1)-(4)

4077 constitute grounds for disciplinary action under ss. 456.072(2) ,

4078 ~~and~~ 395.1055 , and 396.218, as applicable .

4079 Section 112. Paragraph (b) of subsection (2) of section

4080 812.014, Florida Statutes, is amended to read:

4081 812.014 Theft.—

4082 (2)

4083 (b)1. If the property stolen is valued at $20,000 or more,

4084 but less than $100,000;

4085 2. If the property stolen is cargo valued at less than

4086 $50,000 that has entered the stream of interstate or intrastate

4087 commerce from the shipper’s loading platform to the consignee’s

4088 receiving dock;

4089 3. If the property stolen is emergency medical equipment,

4090 valued at $300 or more, that is taken from a facility licensed

4091 under chapter 395 or from an aircraft or vehicle permitted under

4092 chapter 401; or

4093 4. If the property stolen is law enforcement equipment,

4094 valued at $300 or more, that is taken from an authorized

4095 emergency vehicle, as defined in s. 316.003,

4097 the offender commits grand theft in the second degree,

4098 punishable as a felony of the second degree, as provided in s.

4099 775.082, s. 775.083, or s. 775.084. Emergency medical equipment

4100 means mechanical or electronic apparatus used to provide

4101 emergency services and care as defined in s. 395.002 s.

4102 ~~395.002(9)~~ or to treat medical emergencies. Law enforcement

4103 equipment means any property, device, or apparatus used by any

4104 law enforcement officer as defined in s. 943.10 in the officer’s

4105 official business. However, if the property is stolen during a

4106 riot or an aggravated riot prohibited under s. 870.01 and the

4107 perpetration of the theft is facilitated by conditions arising

4108 from the riot; or within a county that is subject to a state of

4109 emergency declared by the Governor under chapter 252, the theft

4110 is committed after the declaration of emergency is made, and the

4111 perpetration of the theft is facilitated by conditions arising

4112 from the emergency, the theft is a felony of the first degree,

4113 punishable as provided in s. 775.082, s. 775.083, or s. 775.084.

4114 As used in this paragraph, the term “conditions arising from the

4115 riot” means civil unrest, power outages, curfews, or a reduction

4116 in the presence of or response time for first responders or

4117 homeland security personnel and the term “conditions arising

4118 from the emergency” means civil unrest, power outages, curfews,

4119 voluntary or mandatory evacuations, or a reduction in the

4120 presence of or response time for first responders or homeland

4121 security personnel. A person arrested for committing a theft

4122 during a riot or an aggravated riot or within a county that is

4123 subject to a state of emergency may not be released until the

4124 person appears before a committing magistrate at a first

4125 appearance hearing. For purposes of sentencing under chapter

4126 921, a felony offense that is reclassified under this paragraph

4127 is ranked one level above the ranking under s. 921.0022 or s.

4128 921.0023 of the offense committed.

4129 Section 113. Paragraph (b) of subsection (1) of section

4130 893.05, Florida Statutes, is amended to read:

4131 893.05 Practitioners and persons administering controlled

4132 substances in their absence.—

4133 (1)

4134 (b) Pursuant to s. 458.347(4)(g), s. 459.022(4)(f), or s.

4135 464.012(3), as applicable, a practitioner who supervises a

4136 licensed physician assistant or advanced practice registered

4137 nurse may authorize the licensed physician assistant or advanced

4138 practice registered nurse to order controlled substances for

4139 administration to a patient in a facility licensed under chapter

4140 395 , chapter 396, or part II of chapter 400.

4141 Section 114. Paragraph (h) of subsection (1) of section

4142 893.13, Florida Statutes, is amended to read:

4143 893.13 Prohibited acts; penalties.—

4144 (1)

4145 (h) Except as authorized by this chapter, a person may not

4146 sell, manufacture, or deliver, or possess with intent to sell,

4147 manufacture, or deliver, a controlled substance in, on, or

4148 within 1,000 feet of the real property comprising a mental

4149 health facility, as that term is used in chapter 394; a health

4150 care facility licensed under chapter 395 or chapter 396 which

4151 provides substance abuse treatment; a licensed service provider

4152 as defined in s. 397.311; a facility providing services that

4153 include clinical treatment, intervention, or prevention as

4154 described in s. 397.311(27); a recovery residence as defined in

4155 s. 397.311; an assisted living facility as defined in chapter

4156 429; or a pain management clinic as defined in s.

4157 458.3265(1)(a)1.c. or s. 459.0137(1)(a)1.c. A person who

4158 violates this paragraph with respect to:

4159 1. A controlled substance named or described in s.

4160 893.03(1)(a), (1)(b), (1)(d), (2)(a), (2)(b), or (2)(c)5.

4161 commits a felony of the first degree, punishable as provided in

4162 s. 775.082, s. 775.083, or s. 775.084.

4163 2. A controlled substance named or described in s.

4164 893.03(1)(c), (2)(c)1., (2)(c)2., (2)(c)3., (2)(c)6., (2)(c)7.,

4165 (2)(c)8., (2)(c)9., (2)(c)10., (3), or (4) commits a felony of

4166 the second degree, punishable as provided in s. 775.082, s.

4167 775.083, or s. 775.084.

4168 3. Any other controlled substance, except as lawfully sold,

4169 manufactured, or delivered, must be sentenced to pay a $500 fine

4170 and to serve 100 hours of public service in addition to any

4171 other penalty prescribed by law.

4172 Section 115. Paragraph (b) of subsection (1) of section

4173 945.6041, Florida Statutes, is amended to read:

4174 945.6041 Inmate medical services.—

4175 (1) As used in this section, the term:

4176 (b) “Health care provider” means:

4177 1. A hospital licensed under chapter 395.

4178 2. A physician or physician assistant licensed under

4179 chapter 458.

4180 3. An osteopathic physician or physician assistant licensed

4181 under chapter 459.

4182 4. A podiatric physician licensed under chapter 461.

4183 5. A health maintenance organization certificated under

4184 part I of chapter 641.

4185 6. An ambulatory surgical center licensed under chapter 396

4186 ~~395~~ .

4187 7. A professional association, partnership, corporation,

4188 joint venture, or other association established by the

4189 individuals set forth in subparagraphs 2., 3., and 4. for

4190 professional activity.

4191 8. An other medical facility.

4192 a. As used in this subparagraph, the term “other medical

4193 facility” means:

4194 (I) A facility the primary purpose of which is to provide

4195 human medical diagnostic services, or a facility providing

4196 nonsurgical human medical treatment which discharges patients on

4197 the same working day that the patients are admitted; and

4198 (II) A facility that is not part of a hospital.

4199 b. The term does not include a facility existing for the

4200 primary purpose of performing terminations of pregnancy, or an

4201 office maintained by a physician or dentist for the practice of

4202 medicine.

4203 Section 116. Paragraph (a) of subsection (1) of section

4204 985.6441, Florida Statutes, is amended to read:

4205 985.6441 Health care services.—

4206 (1) As used in this section, the term:

4207 (a) “Health care provider” means:

4208 1. A hospital licensed under chapter 395.

4209 2. A physician or physician assistant licensed under

4210 chapter 458.

4211 3. An osteopathic physician or physician assistant licensed

4212 under chapter 459.

4213 4. A podiatric physician licensed under chapter 461.

4214 5. A health maintenance organization certificated under

4215 part I of chapter 641.

4216 6. An ambulatory surgical center licensed under chapter 396

4217 ~~395~~ .

4218 7. A professional association, partnership, corporation,

4219 joint venture, or other association established by the

4220 individuals set forth in subparagraphs 2.-4. for professional

4221 activity.

4222 8. An other medical facility.

4223 a. As used in this subparagraph, the term “other medical

4224 facility” means:

4225 (I) A facility the primary purpose of which is to provide

4226 human medical diagnostic services, or a facility providing

4227 nonsurgical human medical treatment which discharges patients on

4228 the same working day that the patients are admitted; and

4229 (II) A facility that is not part of a hospital.

4230 b. The term does not include a facility existing for the

4231 primary purpose of performing terminations of pregnancy, or an

4232 office maintained by a physician or dentist for the practice of

4233 medicine.

4234 Section 117. Paragraph (b) of subsection (28) of section

4235 1001.42, Florida Statutes, is amended to read:

4236 1001.42 Powers and duties of district school board.—The

4237 district school board, acting as a board, shall exercise all

4238 powers and perform all duties listed below:

4239 (28) UNACCOMPANIED HOMELESS YOUTH.—Provide to each student

4240 who is an unaccompanied homeless youth certified under s.

4241 743.067 a card that includes information on the rights and

4242 benefits for such youth, as well as the contact information for

4243 the school district’s liaison for homeless children and youths.

4244 The card must be similar in size to the student identification

4245 card issued to students in the district and include all of the

4246 following information:

4247 (b) On the back of the card, the following statement:

4249 Section 743.067, Florida Statutes, provides that this

4250 certified youth may consent to medical care; dental

4251 care; behavioral health care services, including

4252 psychological counseling and treatment, psychiatric

4253 treatment, and substance abuse prevention and

4254 treatment services; and surgical diagnosis and

4255 treatment, including preventative care and care by a

4256 facility licensed under chapter 394, chapter 395,

4257 chapter 396, or chapter 397 and any forensic medical

4258 examination for the purpose of investigating any

4259 felony offense under chapter 784, chapter 787, chapter

4260 794, chapter 800, or chapter 827, for himself or

4261 herself or his or her child, if the certified youth is

4262 unmarried, is the parent of the child, and has actual

4263 custody of the child.

4264 Section 118. Subsection (1) of section 1012.965, Florida

4265 Statutes, is amended to read:

4266 1012.965 Payment of costs of civil action against

4267 employees.—

4268 (1) An employee or agent under the right of control of a

4269 university board of trustees who, pursuant to the university

4270 board’s policies or rules, renders medical care or treatment at

4271 any hospital or health care facility with which the university

4272 board maintains an affiliation agreement whereby the hospital or

4273 health care facility provides to the university board a clinical

4274 setting for health care education, research, and services, is

4275 ~~shall~~ not be deemed to be an agent of any person other than the

4276 university board in any civil action resulting from any act or

4277 omission of the employee or agent while rendering said medical

4278 care or treatment. For this subsection to apply, the patient

4279 shall be provided separate written conspicuous notice by the

4280 university board of trustees or by the hospital or health care

4281 facility, and shall acknowledge receipt of this notice, in

4282 writing, unless impractical by reason of an emergency, either

4283 personally or through another person authorized to give consent

4284 for him or her, that he or she will receive care provided by

4285 university board’s employees and liability, if any, that may

4286 arise from that care is limited as provided by law. Compliance

4287 by a hospital or health care facility with the requirements of

4288 chapter 395 , chapter 396, or s. 766.110(1) may ~~shall~~ not be used

4289 as evidence in any civil action to establish an employment or

4290 agency relationship between the hospital or health care facility

4291 and an employee or agent of the university board of trustees

4292 providing services within the hospital or health care facility.

4293 Section 119. This act shall take effect July 1, 2026.