Bill Text: FL H1503 | 2010 | Regular Session | Engrossed

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Bill Title: Health Care [SPSC]

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2010-04-30 - Died in Committee on Health Regulation, companion bill(s) passed, see HB 5311 (Ch. 2010-161), CS/CS/SB 1412 (Ch. 2010-102) [H1503 Detail]

Download: Florida-2010-H1503-Engrossed.html

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CS/CS/HB 1503

1	A bill to be entitled
2	An act relating to health care; amending s. 112.0455,
3	F.S., and repealing paragraph (10)(e), relating to a
4	prohibition against applying the Drug-Free Workplace Act
5	retroactively; conforming a cross-reference; amending s.
6	381.00315, F.S.; directing the Department of Health to
7	accept funds from counties, municipalities, and certain
8	other entities for the purchase of certain products made
9	available under a contract with the United States
10	Department of Health and Human Services for the
11	manufacture and delivery of such products in response to a
12	public health emergency; amending s. 381.932, F.S.;
13	revising certain criteria of the breast cancer early
14	detection and treatment referral program by requiring that
15	the public education and outreach initiative and
16	professional education programs use guidelines currently
17	employed by the United States Centers for Disease Control
18	and Prevention rather than the United States Preventive
19	Services Task Force; amending s. 381.06015, F.S.;
20	requiring the State Surgeon General to make certain
21	resources and materials relating to umbilical cord blood
22	available on the Internet website of the Department of
23	Health; requiring the Department of Health to encourage
24	certain health care professionals to make specified
25	information available to patients; repealing s. 383.325,
26	F.S., relating to the requirement of a licensed facility
27	under s. 383.305, F.S., to maintain inspection reports;
28	amending s. 395.1055, F.S., requiring Agency for Health
29	Care Administration rules related to infection control to
30	include a requirement that hospitals establish a
31	comprehensive plan to reduce health care associated
32	infections; establishing components for the plan;
33	repealing s. 395.1046, F.S., relating to the investigation
34	of complaints regarding hospitals; repealing s. 395.3037,
35	F.S.; deleting definitions relating to obsolete provisions
36	governing primary and comprehensive stroke centers;
37	amending s. 400.0239, F.S.; deleting an obsolete
38	provision; repealing s. 400.147(10), F.S., relating to a
39	requirement that a nursing home facility report any notice
40	of a filing of a claim for a violation of a resident's
41	rights or a claim of negligence; repealing s. 400.148,
42	F.S., relating to the Medicaid "Up-or-Out" Quality of Care
43	Contract Management Program; repealing s. 400.195, F.S.,
44	relating to reporting requirements for the Agency for
45	Health Care Administration; amending s. 400.476, F.S.;
46	providing requirements for an alternate administrator of a
47	home health agency; revising the duties of the
48	administrator; revising the requirements for a director of
49	nursing for a specified number of home health agencies;
50	prohibiting a home health agency from using an individual
51	as a home health aide unless the person has completed
52	training and an evaluation program; requiring a home
53	health aide to meet certain standards in order to be
54	competent in performing certain tasks; requiring a home
55	health agency and staff to comply with accepted
56	professional standards; providing certain requirements for
57	a written contract between certain personnel and the
58	agency; requiring a home health agency to provide certain
59	services through its employees; authorizing a home health
60	agency to provide additional services with another
61	organization; providing responsibilities of a home health
62	agency when it provides home health aide services through
63	another organization; requiring the home health agency to
64	coordinate personnel who provide home health services;
65	requiring personnel to communicate with the home health
66	agency; amending s. 400.487, F.S.; requiring a home health
67	agency to provide a patient or the patient's legal
68	representative a copy of the agreement between the agency
69	and the patient which specifies the home health services
70	to be provided; providing the rights that are protected by
71	the home health agency; requiring the home health agency
72	to furnish nursing services by or under the supervision of
73	a registered nurse; requiring the home health agency to
74	provide therapy services through a qualified therapist or
75	therapy assistant; providing the duties and qualifications
76	of a therapist and therapy assistant; requiring
77	supervision by a physical therapist or occupational
78	therapist of a physical therapist assistant or
79	occupational therapy assistant; providing duties of a
80	physical therapist assistant or occupational therapy
81	assistant; providing for speech therapy services to be
82	provided by a qualified speech-language pathologist or
83	audiologist; providing for a plan of care; providing that
84	only the staff of a home health agency may administer
85	drugs and treatments as ordered by certain health
86	professionals; providing requirements for verbal orders;
87	providing duties of a registered nurse, licensed practical
88	nurse, home health aide, and certified nursing assistant
89	who work for a home health agency; providing for
90	supervisory visits of services provided by a home health
91	agency; amending s. 400.9905, F.S.; revising the
92	definition of the term "clinic" applicable to the Health
93	Care Clinic Act; providing exemptions from licensure
94	requirements for certain legal entities that provide
95	health care services; repealing s. 408.802(11), F.S.,
96	relating to the applicability of the Health Care Licensing
97	Procedures Act to private review agents; repealing s.
98	409.912(15)(e), (f), and (g), F.S., relating to a
99	requirement for the Agency for Health Care Administration
100	to submit a report to the Legislature regarding the
101	operations of the CARE program; repealing s. 409.9122(13),
102	F.S., relating to Medicaid managed prepaid plan minimum
103	enrollment levels for plans operating in Miami-Dade
104	County; amending s. 409.91255, F.S.; transferring
105	administrative responsibility for the application
106	procedure for federally qualified health centers from the
107	Department of Health to the Agency for Health Care
108	Administration; requiring the Florida Association of
109	Community Health Centers, Inc., to provide support and
110	assume administrative costs for the program; amending s.
111	429.075, F.S.; requiring certain assisted living
112	facilities to maintain certain security services;
113	repealing s. 429.12(2), F.S., relating to the sale or
114	transfer of ownership of an assisted living facility;
115	repealing s. 429.23(5), F.S., relating to each assisted
116	living facility's requirement to submit a report to the
117	agency regarding liability claims filed against it;
118	repealing s. 429.911(2)(a), F.S., relating to an
119	intentional or negligent act materially affecting the
120	health or safety of center participants as grounds for
121	which the agency may take action against the owner of an
122	adult day care center or its operator or employee;
123	requiring persons who apply for licensure renewal as a
124	dentist or dental hygienist to furnish certain information
125	to the Department of Health in a dental workforce survey;
126	requiring the Board of Dentistry to issue a
127	nondisciplinary citation and a notice for failure to
128	complete the survey within a specified time; providing
129	notification requirements for the citation; requiring the
130	department to serve as the coordinating body for the
131	purpose of collecting, disseminating, and updating dental
132	workforce data; requiring the department to maintain a
133	database regarding the state's dental workforce; requiring
134	the department to develop strategies to maximize federal
135	and state programs and to work with an advisory body to
136	address matters relating to the state's dental workforce;
137	providing membership of the advisory body; providing for
138	members of the advisory body to serve without
139	compensation; requiring the department to act as a
140	clearinghouse for collecting and disseminating information
141	regarding the dental workforce; requiring the department
142	and the board to adopt rules; providing legislative intent
143	regarding implementation of the act within existing
144	resources; amending s. 499.01, F.S.; exempting certain
145	persons from requirements for medical device manufacturer
146	permits; authorizing certain business entities to pay for
147	prescription drugs obtained by practitioners licensed
148	under ch. 466, F.S.; amending s. 499.003, F.S.; defining
149	the term "medical convenience kit" for purposes of the
150	Florida Drug and Cosmetic Act; conforming cross-
151	references; amending ss. 409.9201, 465.0265, 499.0121,
152	499.01211, 499.03, 499.05, and 794.075, F.S.; conforming
153	cross-references; amending s. 624.91, F.S.; revising the
154	membership of the board of directors of the Florida
155	Healthy Kids Corporation to include a member nominated by
156	the Florida Dental Association and appointed by the
157	Governor; amending s. 381.0403, F.S.; deleting provisions
158	relating to the program for graduate medical education
159	innovations and the graduate medical education committee
160	and report; conforming cross-references; amending s.
161	381.4018, F.S.; providing definitions; requiring the
162	Department of Health to coordinate and enhance activities
163	regarding the reentry of retired military and other
164	physicians into the physician workforce; revising the list
165	of governmental stakeholders that the department is
166	required to work with regarding the state strategic plan
167	and in assessing the state's physician workforce; creating
168	the Physician Workforce Advisory Council; providing
169	membership of the council; providing for appointments to
170	the council; providing terms of membership; providing for
171	removal of a council member; providing for a chair and
172	vice chair of the council; providing that council members
173	are not entitled to receive compensation or reimbursement
174	for per diem or travel expenses; providing the duties of
175	the council; establishing the physician workforce graduate
176	medical education innovation pilot projects under the
177	department; providing the purposes of the pilot projects;
178	providing for the appropriation of state funds for the
179	pilot projects; requiring the pilot projects to meet
180	certain policy needs of the physician workforce in this
181	state; providing criteria for prioritizing proposals for
182	pilot projects; requiring the department to adopt by rule
183	appropriate performance measures; requiring participating
184	pilot projects to submit an annual report to the
185	department; requiring state funds to be used to supplement
186	funds from other sources; requiring the department to
187	adopt rules; amending s. 400.9905, F.S.; revising the
188	definition of the term "clinic"; amending ss. 458.3192 and
189	459.0082, F.S.; requiring the department to determine by
190	geographic area and specialty the number of physicians and
191	osteopathic physicians who plan to relocate outside the
192	state, practice medicine in this state, and reduce or
193	modify the scope of their practice; authorizing the
194	department to report additional information in its
195	findings to the Governor and the Legislature; amending s.
196	458.315, F.S.; revising the standards for the Board of
197	Medicine to issue a temporary certificate to a certain
198	physicians to practice medicine in areas of critical need;
199	authorizing the State Surgeon General to designate areas
200	of critical need; creating s. 459.0076, F.S.; authorizing
201	the Board of Osteopathic Medicine to issue temporary
202	certificates to osteopathic physicians who meet certain
203	requirements to practice osteopathic medicine in areas of
204	critical need; providing restrictions for issuance of a
205	temporary certificate; authorizing the State Surgeon
206	General to designate areas of critical need; authorizing
207	the Board of Osteopathic Medicine to waive the application
208	fee and licensure fees for obtaining temporary
209	certificates for certain purposes; amending s. 499.01212,
210	F.S.; exempting prescription drugs contained in sealed
211	medical convenience kits from the pedigree paper
212	requirements under specified circumstances; reenacting s.
213	465.0251, F.S., to require the Board of Pharmacy and the
214	Board of Medicine to remove certain drugs from the
215	negative formulary for generic and brand-name drugs based
216	on current references published by the United States Food
217	and Drug Administration; amending s. 626.9541, F.S.;
218	authorizing an insurer offering a group or individual
219	health benefit plan to offer a wellness program;
220	authorizing rewards or incentives; providing that such
221	rewards or incentives are not insurance benefits;
222	providing for verification of a member's inability to
223	participate for medical reasons; providing an effective
224	date.
225
226	Be It Enacted by the Legislature of the State of Florida:
227
228	Section 1. Paragraph (e) of subsection (10) of section
229	112.0455, Florida Statutes, is repealed, and paragraph (e) of
230	subsection (14) of that section is amended to read:
231	112.0455 Drug-Free Workplace Act.-
232	(14) DISCIPLINE REMEDIES.-
233	(e) Upon resolving an appeal filed pursuant to paragraph
234	(c), and finding a violation of this section, the commission may
235	order the following relief:
236	1. Rescind the disciplinary action, expunge related
237	records from the personnel file of the employee or job applicant
238	and reinstate the employee.
239	2. Order compliance with paragraph (10)(f)(g).
240	3. Award back pay and benefits.
241	4. Award the prevailing employee or job applicant the
242	necessary costs of the appeal, reasonable attorney's fees, and
243	expert witness fees.
244	Section 2. Subsection (3) is added to section 381.00315,
245	Florida Statutes, to read:
246	381.00315 Public health advisories; public health
247	emergencies.-The State Health Officer is responsible for
248	declaring public health emergencies and issuing public health
249	advisories.
250	(3) To facilitate effective emergency management, when the
251	United States Department of Health and Human Services contracts
252	for the manufacture and delivery of licensable products in
253	response to a public health emergency and the terms of those
254	contracts are made available to the states, the department shall
255	accept funds provided by cities, counties, and other entities
256	designated in the state emergency management plan required under
257	s. 252.35(2)(a) for the purpose of participation in those
258	contracts. The department shall deposit those funds in the
259	Grants and Donations Trust Fund and expend those funds on behalf
260	of the donor city, county, or other entity for the purchase of
261	the licensable products made available under the contract.
262	Section 3. Paragraphs (a) and (b) of subsection (3) of
263	section 381.932, Florida Statutes, are amended to read:
264	381.932 Breast cancer early detection and treatment
265	referral program.-
266	(3) The program shall include, but not be limited to, the:
267	(a) Establishment of a public education and outreach
268	initiative to publicize breast cancer early detection services,
269	the benefits of early detection of breast cancer, and the
270	recommended frequency for receiving screening services,
271	including clinical breast examinations and mammography
272	guidelines currently employed established by the United States
273	Centers for Disease Control and Prevention Preventive Services
274	Task Force.
275	(b) Development of professional education programs that
276	include information regarding the benefits of the early
277	detection of breast cancer and the recommended frequency for
278	receiving a mammogram, as recommended in the most current breast
279	cancer screening guidelines currently employed established by
280	the United States Centers for Disease Control and Prevention
281	Preventive Services Task Force.
282	Section 4. Subsection (2) of section 381.06015, Florida
283	Statutes, is amended, and subsection (8) is added to that
284	section, to read:
285	381.06015 Public Cord Blood Tissue Bank.-
286	(2)(a) The Agency for Health Care Administration and the
287	Department of Health shall encourage health care providers,
288	including, but not limited to, hospitals, birthing facilities,
289	county health departments, physicians, midwives, and nurses, to
290	disseminate information about the Public Cord Blood Tissue Bank.
291	(b) The State Surgeon General shall make publicly
292	available, by posting on the Internet website of the Department
293	of Health, resources and an Internet website link to materials
294	relating to umbilical cord blood that have been developed by the
295	Parent's Guide to Cord Blood Foundation.
296	(8) Beginning October 1, 2010, the Department of Health
297	shall encourage health care professionals who provide health
298	care services that are directly related to a woman's pregnancy
299	to make available to the patient before her third trimester of
300	pregnancy, or, if later, at the first visit of such pregnant
301	woman to the provider, information developed under paragraph
302	(2)(b) relating to the woman's options with respect to umbilical
303	cord blood banking.
304	Section 5. Section 383.325, Florida Statutes, is repealed.
305	Section 6. Paragraph (b) of subsection (1) of section
306	395.1055, Florida Statutes, is amended to read:
307	395.1055 Rules and enforcement.-
308	(1) The agency shall adopt rules pursuant to ss.
309	120.536(1) and 120.54 to implement the provisions of this part,
310	which shall include reasonable and fair minimum standards for
311	ensuring that:
312	(b) Infection control, housekeeping, sanitary conditions,
313	and medical record procedures that will adequately protect
314	patient care and safety are established and implemented.
315	Infection control rules shall include a requirement to establish
316	and implement a comprehensive plan to reduce health care
317	associated infections. The plan must include all of the
318	following components:
319	1. A baseline measurement of health care associated
320	infections in the hospital that uses the National Healthcare
321	Safety Network and Centers for Disease Control and Prevention
322	surveillance definitions and reports the number of infections in
323	each category relative to the volume of possible cases in the
324	hospital.
325	2. A goal for reducing the incidence of infections by a
326	specific amount within a defined period of time. The hospital's
327	goal for reduction of infections must be commensurate with the
328	national goal for reducing each type of health care associated
329	infection.
330	3. An action plan for reducing each type of health care
331	associated infection, including the use of real-time infection
332	surveillance technology or automated infection control or
333	prevention technology.
334	4. Methods for making information available to patients
335	and the public regarding baseline measurements and periodic
336	reports on the hospital's progress in improving measures
337	designed to reduce health care associated infections.
338	Section 7. Section 395.1046, Florida Statutes, is
339	repealed.
340	Section 8. Section 395.3037, Florida Statutes, is
341	repealed.
342	Section 9. Paragraph (g) of subsection (2) of section
343	400.0239, Florida Statutes, is amended to read:
344	400.0239 Quality of Long-Term Care Facility Improvement
345	Trust Fund.-
346	(2) Expenditures from the trust fund shall be allowable
347	for direct support of the following:
348	(g) Other initiatives authorized by the Centers for
349	Medicare and Medicaid Services for the use of federal civil
350	monetary penalties, including projects recommended through the
351	Medicaid "Up-or-Out" Quality of Care Contract Management Program
352	pursuant to s. 400.148.
353	Section 10. Subsection (10) of section 400.147, Florida
354	Statutes, is repealed.
355	Section 11. Section 400.148, Florida Statutes, is
356	repealed.
357	Section 12. Section 400.195, Florida Statutes, is
358	repealed.
359	Section 13. Section 400.476, Florida Statutes, is amended
360	to read:
361	400.476 Staffing requirements; notifications; limitations
362	on staffing services.-
363	(1) ADMINISTRATOR.-
364	(a) An administrator may manage only one home health
365	agency, except that an administrator may manage up to five home
366	health agencies if all five home health agencies have identical
367	controlling interests as defined in s. 408.803 and are located
368	within one agency geographic service area or within an
369	immediately contiguous county. If the home health agency is
370	licensed under this chapter and is part of a retirement
371	community that provides multiple levels of care, an employee of
372	the retirement community may administer the home health agency
373	and up to a maximum of four entities licensed under this chapter
374	or chapter 429 which all have identical controlling interests as
375	defined in s. 408.803. An administrator shall designate, in
376	writing, for each licensed entity, a qualified alternate
377	administrator to serve during the administrator's absence. An
378	alternate administrator must meet the requirements in this
379	paragraph and s. 400.462(1).
380	(b) An administrator of a home health agency who is a
381	licensed physician, physician assistant, or registered nurse
382	licensed to practice in this state may also be the director of
383	nursing for a home health agency. An administrator may serve as
384	a director of nursing for up to the number of entities
385	authorized in subsection (2) only if there are 10 or fewer full-
386	time equivalent employees and contracted personnel in each home
387	health agency.
388	(c) The administrator shall organize and direct the
389	agency's ongoing functions, maintain an ongoing liaison with the
390	board members and the staff, employ qualified personnel and
391	ensure adequate staff education and evaluations, ensure the
392	accuracy of public informational materials and activities,
393	implement an effective budgeting and accounting system, and
394	ensure that the home health agency operates in compliance with
395	this part and part II of chapter 408 and rules adopted for these
396	laws.
397	(d) The administrator shall clearly set forth in writing
398	the organizational chart, services furnished, administrative
399	control authority, and lines of authority for the delegation of
400	responsibilities for patient care. These responsibilities must
401	be readily identifiable. Administrative and supervisory
402	functions may not be delegated to another agency or
403	organization, and the primary home health agency shall monitor
404	and control all services that are not furnished directly,
405	including services provided through contracts.
406	(2) DIRECTOR OF NURSING.-
407	(a) A director of nursing may be the director of nursing
408	for:
409	1. Up to two licensed home health agencies if the agencies
410	have identical controlling interests as defined in s. 408.803
411	and are located within one agency geographic service area or
412	within an immediately contiguous county; or
413	2. Up to five licensed home health agencies if:
414	a. All of the home health agencies have identical
415	controlling interests as defined in s. 408.803;
416	b. All of the home health agencies are located within one
417	agency geographic service area or within an immediately
418	contiguous county; and
419	c. Each home health agency has a registered nurse who
420	meets the qualifications of a director of nursing and who has a
421	written delegation from the director of nursing to serve as the
422	director of nursing for that home health agency when the
423	director of nursing is not present; and.
424	d. This person, or a similarly qualified alternate, is
425	available at all times by telecommunications during operating
426	hours and participates.
427
428	If a home health agency licensed under this chapter is part of a
429	retirement community that provides multiple levels of care, an
430	employee of the retirement community may serve as the director
431	of nursing of the home health agency and up to a maximum of four
432	entities, other than home health agencies, licensed under this
433	chapter or chapter 429 which all have identical controlling
434	interests as defined in s. 408.803.
435	(b) A home health agency that provides skilled nursing
436	care may not operate for more than 30 calendar days without a
437	director of nursing. A home health agency that provides skilled
438	nursing care and the director of nursing of a home health agency
439	must notify the agency within 10 business days after termination
440	of the services of the director of nursing for the home health
441	agency. A home health agency that provides skilled nursing care
442	must notify the agency of the identity and qualifications of the
443	new director of nursing within 10 days after the new director is
444	hired. If a home health agency that provides skilled nursing
445	care operates for more than 30 calendar days without a director
446	of nursing, the home health agency commits a class II
447	deficiency. In addition to the fine for a class II deficiency,
448	the agency may issue a moratorium in accordance with s. 408.814
449	or revoke the license. The agency shall fine a home health
450	agency that fails to notify the agency as required in this
451	paragraph $1,000 for the first violation and $2,000 for a repeat
452	violation. The agency may not take administrative action against
453	a home health agency if the director of nursing fails to notify
454	the department upon termination of services as the director of
455	nursing for the home health agency.
456	(c) A home health agency that is not Medicare or Medicaid
457	certified and does not provide skilled care or provides only
458	physical, occupational, or speech therapy is not required to
459	have a director of nursing and is exempt from paragraph (b).
460	(3) TRAINING.-A home health agency shall ensure that each
461	certified nursing assistant employed by or under contract with
462	the home health agency and each home health aide employed by or
463	under contract with the home health agency is adequately trained
464	to perform the tasks of a home health aide in the home setting.
465	(a) The home health agency may not use as a home health
466	aide on a full-time, temporary, per diem, or other basis any
467	individual to provide services unless the individual has
468	completed a training and competency evaluation program, or a
469	competency evaluation program, as permitted in s. 400.497, which
470	meets the minimum standards established by the agency in state
471	rules.
472	(b) A home health aide is not competent in any task for
473	which he or she is evaluated as "unsatisfactory." The aide must
474	perform any such task only under direct supervision by a
475	licensed nurse until he or she receives training in the task and
476	satisfactorily passes a subsequent evaluation in performing the
477	task. A home health aide has not successfully passed a
478	competency evaluation if the aide does not have a passing score
479	on the test as specified by agency rule.
480	(4) STAFFING.-Staffing services may be provided anywhere
481	within the state.
482	(5) PERSONNEL.-
483	(a) The home health agency and its staff must comply with
484	accepted professional standards and principles that apply to
485	professionals, including, but not limited to, the state practice
486	acts and the home health agency's policies and procedures.
487	(b) Except for direct employees of the home health agency,
488	if personnel under hourly or per-visit contracts are used by the
489	home health agency, there must be a written contract between
490	those personnel and the agency which specifies the following
491	requirements:
492	1. Acceptance for care only of patients by the primary
493	home health agency.
494	2. The services to be furnished.
495	3. The necessity to conform to all applicable agency
496	policies, including personnel qualifications.
497	4. The responsibility for participating in developing
498	plans of care.
499	5. The manner in which services are controlled,
500	coordinated, and evaluated by the primary home health agency.
501	6. The procedures for submitting clinical and progress
502	notes, scheduling visits, and providing periodic patient
503	evaluations.
504	7. The procedures for payment for services furnished under
505	the contract.
506	(c) A home health agency shall directly provide at least
507	one of the types of authorized services through home health
508	agency employees, but may provide additional services under
509	arrangements with another agency or organization. Services
510	furnished under such arrangements must have a written contract
511	conforming to the requirements specified in paragraph (b).
512	(d) If home health aide services are provided by an
513	individual who is not employed directly by the home health
514	agency, the services of the home health aide must be provided
515	under arrangements as stated in paragraphs (b) and (c). If the
516	home health agency chooses to provide home health aide services
517	under arrangements with another organization, the
518	responsibilities of the home health agency include, but are not
519	limited to:
520	1. Ensuring the overall quality of the care provided by
521	the aide.
522	2. Supervising the aide's services as described in s.
523	400.487.
524	3. Ensuring that each home health aide providing services
525	under arrangements with another organization has met the
526	training requirements or competency evaluation requirements of
527	s. 400.497.
528	(e) The home health agency shall coordinate the efforts of
529	all personnel furnishing services, and the personnel shall
530	maintain communication with the home health agency to ensure
531	that personnel efforts support the objectives outlined in the
532	plan of care. The clinical record or minutes of case conferences
533	shall ensure that effective interchange, reporting, and
534	coordination of patient care occurs.
535	Section 14. Section 400.487, Florida Statutes, is amended
536	to read:
537	400.487 Home health service agreements; physician's,
538	physician assistant's, and advanced registered nurse
539	practitioner's treatment orders; patient assessment;
540	establishment and review of plan of care; provision of services;
541	orders not to resuscitate.-
542	(1) Services provided by a home health agency must be
543	covered by an agreement between the home health agency and the
544	patient or the patient's legal representative specifying the
545	home health services to be provided, the rates or charges for
546	services paid with private funds, and the sources of payment,
547	which may include Medicare, Medicaid, private insurance,
548	personal funds, or a combination thereof. The home health agency
549	shall provide a copy of the agreement to the patient or the
550	patient's legal representative. A home health agency providing
551	skilled care must make an assessment of the patient's needs
552	within 48 hours after the start of services.
553	(2) When required by the provisions of chapter 464; part
554	I, part III, or part V of chapter 468; or chapter 486, the
555	attending physician, physician assistant, or advanced registered
556	nurse practitioner, acting within his or her respective scope of
557	practice, shall establish treatment orders for a patient who is
558	to receive skilled care. The treatment orders must be signed by
559	the physician, physician assistant, or advanced registered nurse
560	practitioner before a claim for payment for the skilled services
561	is submitted by the home health agency. If the claim is
562	submitted to a managed care organization, the treatment orders
563	must be signed within the time allowed under the provider
564	agreement. The treatment orders shall be reviewed, as frequently
565	as the patient's illness requires, by the physician, physician
566	assistant, or advanced registered nurse practitioner in
567	consultation with the home health agency.
568	(3) A home health agency shall arrange for supervisory
569	visits by a registered nurse to the home of a patient receiving
570	home health aide services as specified in subsection (9) in
571	accordance with the patient's direction, approval, and agreement
572	to pay the charge for the visits.
573	(4) The home health agency shall protect and promote the
574	rights of each individual under its care, including each of the
575	following rights:
576	(a) Notice of rights.-The home health agency shall provide
577	the patient with a written notice of the patient's rights in
578	advance of furnishing care to the patient or during the initial
579	evaluation visit before the initiation of treatment. The home
580	health agency must maintain documentation showing that it has
581	complied with the requirements of this section.
582	(b) Exercise of rights and respect for property and
583	person.-
584	1. The patient has the right to exercise his or her rights
585	as a patient of the home health agency.
586	2. The patient has the right to have his or her property
587	treated with respect.
588	3. The patient has the right to voice grievances regarding
589	treatment or care that is or fails to be furnished, or regarding
590	the lack of respect for property by anyone who is furnishing
591	services on behalf of the home health agency, and not be
592	subjected to discrimination or reprisal for doing so.
593	4. The home health agency must investigate complaints made
594	by a patient or the patient's family or guardian regarding
595	treatment or care that is or fails to be furnished or regarding
596	the lack of respect for the patient's property by anyone
597	furnishing services on behalf of the home health agency. The
598	home health agency shall document the existence of the complaint
599	and its resolution.
600	5. The patient and his or her immediate family or
601	representative must be informed of the right to report
602	complaints via the statewide toll-free telephone number to the
603	agency as required in s. 408.810.
604	(c) Right to be informed and to participate in planning
605	care and treatment.-
606	1. The patient has the right to be informed, in advance,
607	about the care to be furnished and of any changes in the care to
608	be furnished. The home health agency shall advise the patient in
609	advance of which disciplines will furnish care and the frequency
610	of visits proposed to be furnished. The home health agency must
611	advise the patient in advance of any change in the plan of care
612	before the change is made.
613	2. The patient has the right to participate in the
614	planning of the care. The home health agency must advise the
615	patient in advance of the right to participate in planning the
616	care or treatment and in planning changes in the care or
617	treatment. Each patient has the right to be informed of and to
618	participate in the planning of his or her care. Each patient
619	must be provided, upon request, a copy of the plan of care
620	established and maintained for that patient by the home health
621	agency.
622	(5) When nursing services are ordered, the home health
623	agency to which a patient has been admitted for care must
624	provide the initial admission visit, all service evaluation
625	visits, and the discharge visit by a direct employee. Services
626	provided by others under contractual arrangements to a home
627	health agency must be monitored and managed by the admitting
628	home health agency. The admitting home health agency is fully
629	responsible for ensuring that all care provided through its
630	employees or contract staff is delivered in accordance with this
631	part and applicable rules.
632	(6) The skilled care services provided by a home health
633	agency, directly or under contract, must be supervised and
634	coordinated in accordance with the plan of care. The home health
635	agency shall furnish skilled nursing services by or under the
636	supervision of a registered nurse and in accordance with the
637	plan of care. Any therapy services offered directly or under
638	arrangement by the home health agency must be provided by a
639	qualified therapist or by a qualified therapy assistant under
640	the supervision of a qualified therapist and in accordance with
641	the plan of care.
642	(a) Physical therapy services.-Physical therapy services
643	shall be furnished only by or under the supervision of a
644	licensed physical therapist or licensed physical therapist
645	assistant as required under chapter 486 and related applicable
646	rules. A physical therapist assistant shall perform services
647	planned, delegated, and supervised by the physical therapist,
648	assist in preparing clinical notes and progress reports,
649	participate in educating the patient and his or her family, and
650	participate in in-service programs. This paragraph does not
651	limit the services provided by a physician licensed under
652	chapter 458 or chapter 459.
653	(b) Occupational therapy services.-Occupational therapy
654	services shall be furnished only by or under the supervision of
655	a licensed occupational therapist or occupational therapy
656	assistant as provided under part III of chapter 468 and related
657	applicable rules. An occupational therapy assistant shall
658	perform any services planned, delegated, and supervised by an
659	occupational therapist, assist in preparing clinical notes and
660	progress reports, participate in educating the patient and his
661	or her family, and participate in in-service programs. This
662	paragraph does not limit the services provided by a physician
663	licensed under chapter 458 or chapter 459.
664	(c) Speech therapy services.-Speech therapy services shall
665	be furnished only by or under supervision of a qualified speech-
666	language pathologist or audiologist as required in part I of
667	chapter 468 and applicable rules.
668	(d) Care follows a written plan of care.-The plan of care
669	shall be reviewed by the physician or health professional who
670	provided the treatment orders pursuant to subsection (2) and
671	home health agency personnel as often as the severity of the
672	patient's condition requires, but at least once every 60 days or
673	more when there is a patient-elected transfer, a significant
674	change in condition, or a discharge and return to the same home
675	health agency during the 60-day episode. Professional staff of a
676	home health agency shall promptly alert the physician or other
677	health professional who provided the treatment orders of any
678	change that suggests a need to alter the plan of care.
679	(e) Administration of drugs and treatment.-Only
680	professional staff of a home health agency may administer drugs
681	and treatments as ordered by the physician or health
682	professional pursuant to subsection (2), with the exception of
683	influenza and pneumococcal polysaccharide vaccines, which may be
684	administered according to the policy of the home health agency
685	developed in consultation with a physician and after an
686	assessment for contraindications. Verbal orders shall be in
687	writing and signed and dated with the date of receipt by the
688	registered nurse or qualified therapist who is responsible for
689	furnishing or supervising the ordered service. A verbal order
690	may be accepted only by personnel who are authorized to do so by
691	applicable state laws, rules, and internal policies of the home
692	health agency.
693	(7) A registered nurse shall conduct the initial
694	evaluation visit, regularly reevaluate the patient's nursing
695	needs, initiate the plan of care and necessary revisions,
696	furnish those services requiring substantial and specialized
697	nursing skill, initiate appropriate preventive and
698	rehabilitative nursing procedures, prepare clinical and progress
699	notes, coordinate services, inform the physician and other
700	personnel of changes in the patient's condition and needs,
701	counsel the patient and his or her family in meeting nursing and
702	related needs, participate in in-service programs, and supervise
703	and teach other nursing personnel, unless the home health agency
704	providing the home health aide services is not Medicare-
705	certified or Medicaid-certified and does not provide skilled
706	care or the patient is not receiving skilled care.
707	(8) A licensed practical nurse shall furnish services in
708	accordance with agency policies, prepare clinical and progress
709	notes, assist the physician and registered nurse in performing
710	specialized procedures, prepare equipment and materials for
711	treatments observing aseptic technique as required, and assist
712	the patient in learning appropriate self-care techniques.
713	(9) A home health aide and certified nursing assistant
714	shall provide services that are in the service provision plan
715	provided in s. 400.491 and other services that the home health
716	aide or certified nursing assistant is permitted to perform
717	under state law. The duties of a home health aide or certified
718	nursing assistant include the provision of hands-on personal
719	care, performance of simple procedures as an extension of
720	therapy or nursing services, assistance in ambulation or
721	exercises, and assistance in administering medications that are
722	ordinarily self-administered and are specified in agency rules.
723	Any services by a home health aide which are offered by a home
724	health agency must be provided by a qualified home health aide
725	or certified nursing assistant.
726	(a) Assignment and duties.-A home health aide or certified
727	nursing assistant shall be assigned to a specific patient by a
728	registered nurse, unless the home health agency providing the
729	home health aide services is not Medicare-certified or Medicaid-
730	certified and does not provide skilled care or the patient is
731	not receiving skilled care. Written patient care instructions
732	for the home health aide and certified nursing assistant must be
733	prepared by the registered nurse or other appropriate
734	professional who is responsible for the supervision of the home
735	health aide and certified nursing assistant as stated in this
736	section.
737	(b) Supervision.-If a patient receives skilled nursing
738	care, the registered nurse shall perform the supervisory visit.
739	If the patient is not receiving skilled nursing care but is
740	receiving physical therapy, occupational therapy, or speech-
741	language pathology services, the appropriate therapist may
742	provide the supervision. A registered nurse or other
743	professional must make an onsite visit to the patient's home at
744	least once every 2 weeks. The visit is not required while the
745	aide is providing care.
746	(c) Supervisory visits.-If home health aide services are
747	provided to a patient who is not receiving skilled nursing care,
748	physical or occupational therapy, or speech-language pathology
749	services, a registered nurse must make a supervisory visit to
750	the patient's home at least once every 60 days, unless the home
751	health agency providing the home health aide services is not
752	Medicare-certified or Medicaid-certified and does not provide
753	skilled care, either directly or through contracts. The
754	registered nurse shall ensure that the aide is properly caring
755	for the patient and each supervisory visit must occur while the
756	home health aide is providing patient care. In addition to the
757	requirements in this subsection, a home health agency shall
758	arrange for additional supervisory visits by a registered nurse
759	to the home of a patient receiving home health aide services in
760	accordance with the patient's direction, approval, and agreement
761	to pay the charge for the visits.
762	(10)(7) Home health agency personnel may withhold or
763	withdraw cardiopulmonary resuscitation if presented with an
764	order not to resuscitate executed pursuant to s. 401.45. The
765	agency shall adopt rules providing for the implementation of
766	such orders. Home health personnel and agencies shall not be
767	subject to criminal prosecution or civil liability, nor be
768	considered to have engaged in negligent or unprofessional
769	conduct, for withholding or withdrawing cardiopulmonary
770	resuscitation pursuant to such an order and rules adopted by the
771	agency.
772	Section 15. Paragraphs (f) and (g) of subsection (4) of
773	section 400.9905, Florida Statutes, are amended to read:
774	400.9905 Definitions.-
775	(4) "Clinic" means an entity at which health care services
776	are provided to individuals and which tenders charges for
777	reimbursement for such services, including a mobile clinic and a
778	portable equipment provider. For purposes of this part, the term
779	does not include and the licensure requirements of this part do
780	not apply to:
781	(f) A sole proprietorship, group practice, partnership, or
782	corporation, or other legal entity that provides health care
783	services by practitioners licensed under chapter 458, chapter
784	459, chapter 461, chapter 466, or chapter 460 and subject to the
785	limitations of s. 460.4167 physicians covered by s. 627.419,
786	that is directly supervised by one or more of such physicians or
787	physician assistants, and that is wholly owned by one or more of
788	those physicians or physician assistants or by a physician or
789	physician assistant or and the spouse, parent, child, or sibling
790	of that physician or physician assistant. A certificate of
791	exemption is valid only for the entity, persons, and location
792	for which it was originally issued.
793	1. An individual who is not a medical professional or
794	family member listed in this paragraph may own up to 30 percent
795	of a health care clinic entity that is exempt under this
796	paragraph if the individual obtains prior approval from the
797	agency for ownership of a percentage of a health care clinic.
798	Such an individual is considered an "applicant" under s.
799	400.991(5) and must meet all the requirements of that section
800	and the level 2 background screening requirements of s. 408.809
801	before being approved by the agency for ownership of a minority
802	interest in a health care clinic.
803	2. If an individual who is not a medical professional or
804	family member listed in this paragraph assumes ownership of an
805	investment interest in a health care clinic without the prior
806	approval of the agency, the health care clinic shall lose its
807	exemption from licensure under this paragraph.
808	3. Ownership of a health care clinic by an individual
809	other than the physician or physician assistant, or by the
810	spouse, parent, child, or sibling of the physician or physician
811	assistant to whom the exemption was granted, may not exceed 30
812	percent.
813	(g) A sole proprietorship, group practice, partnership, or
814	corporation that provides health care services by licensed
815	health care practitioners under chapter 457, chapter 458,
816	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
817	chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
818	chapter 490, chapter 491, or part I, part III, part X, part
819	XIII, or part XIV of chapter 468, or s. 464.012, which are
820	wholly owned by one or more licensed health care practitioners,
821	or the licensed health care practitioners set forth in this
822	paragraph and the spouse, parent, child, or sibling of a
823	licensed health care practitioner, so long as one of the owners
824	who is a licensed health care practitioner is supervising the
825	business activities and is legally responsible for the entity's
826	compliance with all federal and state laws. However, a health
827	care practitioner who is a supervising owner may not supervise
828	services beyond the scope of the practitioner's license, except
829	that, for the purposes of this part, a clinic owned by a
830	licensee in s. 456.053(3)(b) that provides only services
831	authorized pursuant to s. 456.053(3)(b) may be supervised by a
832	licensee specified in s. 456.053(3)(b). A certificate of
833	exemption is valid only for the entity, persons, and location
834	for which it was originally issued.
835	Section 16. Subsection (11) of section 408.802, Florida
836	Statutes, is repealed.
837	Section 17. Paragraphs (e), (f), and (g) of subsection
838	(15) of section 409.912, Florida Statutes, are repealed.
839	Section 18. Subsection (13) of section 409.9122, Florida
840	Statutes, is repealed.
841	Section 19. Section 409.91255, Florida Statutes, is
842	amended to read:
843	409.91255 Federally qualified health center access
844	program.-
845	(1) SHORT TITLE.-This section may be cited as the
846	"Community Health Center Access Program Act."
847	(2) LEGISLATIVE FINDINGS AND INTENT.-
848	(a) The Legislature finds that, despite significant
849	investments in health care programs, nearly 6 more than 2
850	million low-income Floridians, primarily the working poor and
851	minority populations, continue to lack access to basic health
852	care services. Further, the Legislature recognizes that
853	federally qualified health centers have a proven record of
854	providing cost-effective, comprehensive primary and preventive
855	health care and are uniquely qualified to address the lack of
856	adequate health care services for the uninsured.
857	(b) It is the intent of the Legislature to recognize the
858	significance of increased federal investments in federally
859	qualified health centers and to leverage that investment through
860	the creation of a program to provide for the expansion of the
861	primary and preventive health care services offered by federally
862	qualified health centers. Further, such a program will support
863	the coordination of federal, state, and local resources to
864	assist such health centers in developing an expanded community-
865	based primary care delivery system.
866	(3) ASSISTANCE TO FEDERALLY QUALIFIED HEALTH CENTERS.-The
867	agency shall administer Department of Health shall develop a
868	program for the expansion of federally qualified health centers
869	for the purpose of providing comprehensive primary and
870	preventive health care and urgent care services that may reduce
871	the morbidity, mortality, and cost of care among the uninsured
872	population of the state. The program shall provide for
873	distribution of financial assistance to federally qualified
874	health centers that apply and demonstrate a need for such
875	assistance in order to sustain or expand the delivery of primary
876	and preventive health care services. In selecting centers to
877	receive this financial assistance, the program:
878	(a) Shall give preference to communities that have few or
879	no community-based primary care services or in which the current
880	services are unable to meet the community's needs. To assist in
881	the assessment and identification of areas of critical need, a
882	federally qualified health-center-based statewide assessment and
883	strategic plan shall be developed by the Florida Association of
884	Community Health Centers, Inc., every 5 years, beginning January
885	1, 2011.
886	(b) Shall require that primary care services be provided
887	to the medically indigent using a sliding fee schedule based on
888	income.
889	(c) Shall promote allow innovative and creative uses of
890	federal, state, and local health care resources.
891	(d) Shall require that the funds provided be used to pay
892	for operating costs of a projected expansion in patient
893	caseloads or services or for capital improvement projects.
894	Capital improvement projects may include renovations to existing
895	facilities or construction of new facilities, provided that an
896	expansion in patient caseloads or services to a new patient
897	population will occur as a result of the capital expenditures.
898	The agency department shall include in its standard contract
899	document a requirement that any state funds provided for the
900	purchase of or improvements to real property are contingent upon
901	the contractor granting to the state a security interest in the
902	property at least to the amount of the state funds provided for
903	at least 5 years from the date of purchase or the completion of
904	the improvements or as further required by law. The contract
905	must include a provision that, as a condition of receipt of
906	state funding for this purpose, the contractor agrees that, if
907	it disposes of the property before the agency's department's
908	interest is vacated, the contractor will refund the
909	proportionate share of the state's initial investment, as
910	adjusted by depreciation.
911	(e) Shall May require in-kind support from other sources.
912	(f) Shall promote May encourage coordination among
913	federally qualified health centers, other private sector
914	providers, and publicly supported programs.
915	(g) Shall promote allow the development of community
916	emergency room diversion programs in conjunction with local
917	resources, providing extended hours of operation to urgent care
918	patients. Diversion programs shall include case management for
919	emergency room followup care.
920	(4) EVALUATION OF APPLICATIONS.-A review panel shall be
921	established, consisting of four persons appointed by the
922	Secretary of Health Care Administration State Surgeon General
923	and three persons appointed by the chief executive officer of
924	the Florida Association of Community Health Centers, Inc., to
925	review all applications for financial assistance under the
926	program. Applicants shall specify in the application whether the
927	program funds will be used for the expansion of patient
928	caseloads or services or for capital improvement projects to
929	expand and improve patient facilities. The panel shall use the
930	following elements in reviewing application proposals and shall
931	determine the relative weight for scoring and evaluating these
932	elements:
933	(a) The target population to be served.
934	(b) The health benefits to be provided.
935	(c) The methods that will be used to measure cost-
936	effectiveness.
937	(d) How patient satisfaction will be measured.
938	(e) The proposed internal quality assurance process.
939	(f) Projected health status outcomes.
940	(g) How data will be collected to measure cost-
941	effectiveness, health status outcomes, and overall achievement
942	of the goals of the proposal.
943	(h) All resources, including cash, in-kind, voluntary, or
944	other resources that will be dedicated to the proposal.
945	(5) ADMINISTRATION AND TECHNICAL ASSISTANCE.-The agency
946	shall Department of Health may contract with the Florida
947	Association of Community Health Centers, Inc., to develop and
948	coordinate administer the program and provide technical
949	assistance to the federally qualified health centers selected to
950	receive financial assistance. The contracted entity shall be
951	responsible for program support and assume all costs related to
952	administration of this program.
953	Section 20. Subsection (2) of section 429.075, Florida
954	Statutes, is amended to read:
955	429.075 Limited mental health license.-An assisted living
956	facility that serves three or more mental health residents must
957	obtain a limited mental health license.
958	(2) Facilities licensed to provide services to mental
959	health residents shall provide appropriate supervision and
960	staffing to provide for the health, safety, and welfare of such
961	residents. Assisted living facilities within an area zoned for
962	residential use in a municipality having a population of more
963	than 400,000, which house persons identified as being part of a
964	priority population that includes adult and adolescent residents
965	who have severe and persistent mental illness, as described in
966	s. 394.674, must maintain 24-hour security services provided by
967	uniformed security personnel licensed under part III of chapter
968	493.
969	Section 21. Subsection (2) of section 429.12, Florida
970	Statutes, is repealed.
971	Section 22. Subsection (5) of section 429.23, Florida
972	Statutes, is repealed.
973	Section 23. Paragraph (a) of subsection (2) of section
974	429.911, Florida Statutes, is repealed.
975	Section 24. Dental workforce survey.-
976	(1) Beginning in 2012, each person who applies for
977	licensure renewal as a dentist or dental hygienist under chapter
978	466, Florida Statutes, must, in conjunction with the renewal of
979	such license under procedures and forms adopted by the Board of
980	Dentistry and in addition to any other information that may be
981	required from the applicant, furnish the following information
982	to the Department of Health, working in conjunction with the
983	board, in a dental workforce survey:
984	(a) Licensee information, including, but not limited to:
985	1. The name of the dental school or dental hygiene program
986	that the dentist or dental hygienist graduated from and the year
987	of graduation.
988	2. The year that the dentist or dental hygienist began
989	practicing or working in this state.
990	3. The geographic location of the dentist's or dental
991	hygienist's practice or address within the state.
992	4. For a dentist in private practice:
993	a. The number of full-time dental hygienists employed by
994	the dentist during the reporting period.
995	b. The number of full-time dental assistants employed by
996	the dentist during the reporting period.
997	c. The average number of patients treated per week by the
998	dentist during the reporting period.
999	d. The settings where the dental care was delivered.
1000	5. Anticipated plans of the dentist to change the status
1001	of his or her license or practice.
1002	6. The dentist's areas of specialty or certification.
1003	7. The year that the dentist completed a specialty program
1004	recognized by the American Dental Association.
1005	8. For a hygienist:
1006	a. The average number of patients treated per week by the
1007	hygienist during the reporting period.
1008	b. The settings where the dental care was delivered.
1009	9. The dentist's memberships in professional
1010	organizations.
1011	10. The number of pro bono hours provided by the dentist
1012	or dental hygienist during the last biennium.
1013	(b) Information concerning the availability and trends
1014	relating to critically needed services, including, but not
1015	limited to, the following types of care provided by the dentist
1016	or dental hygienist:
1017	1. Dental care to children having special needs.
1018	2. Geriatric dental care.
1019	3. Dental services in emergency departments.
1020	4. Medicaid services.
1021	5. Other critically needed specialty areas, as determined
1022	by the advisory body.
1023	(2) In addition to the completed survey, the dentist or
1024	dental hygienist must submit a statement that the information
1025	provided is true and accurate to the best of his or her
1026	knowledge and belief.
1027	(3) Beginning in 2012, renewal of a license by a dentist
1028	or dental hygienist licensed under chapter 466, Florida
1029	Statutes, is not contingent upon the completion and submission
1030	of the dental workforce survey; however, for any subsequent
1031	license renewal, the board may not renew the license of any
1032	dentist or dental hygienist until the survey required under this
1033	section is completed and submitted by the licensee.
1034	(4)(a) Beginning in 2012, the Board of Dentistry shall
1035	issue a nondisciplinary citation to any dentist or dental
1036	hygienist licensed under chapter 466, Florida Statutes, who
1037	fails to complete the survey within 90 days after the renewal of
1038	his or her license to practice as a dentist or dental hygienist.
1039	(b) The citation must notify a dentist or dental hygienist
1040	who fails to complete the survey required by this section that
1041	his or her license will not be renewed for any subsequent
1042	license renewal unless the dentist or dental hygienist completes
1043	the survey.
1044	(c) In conjunction with issuing the license renewal notice
1045	required by s. 456.038, Florida Statutes, the board shall notify
1046	each dentist or dental hygienist licensed under chapter 466,
1047	Florida Statutes, who fails to complete the survey that the
1048	survey must be completed before the subsequent license renewal.
1049	Section 25. (1) The Department of Health shall serve as
1050	the coordinating body for the purpose of collecting and
1051	regularly updating and disseminating dental workforce data. The
1052	department shall work with multiple stakeholders, including the
1053	Florida Dental Association and the Florida Dental Hygiene
1054	Association, to assess and share with all communities of
1055	interest all data collected in a timely fashion.
1056	(2) The Department of Health shall maintain a current
1057	database to serve as a statewide source of data concerning the
1058	dental workforce. The department, in conjunction with the Board
1059	of Dentistry, shall also:
1060	(a) Develop strategies to maximize federal and state
1061	programs that provide incentives for dentists to practice in
1062	shortage areas that are federally designated. Strategies shall
1063	include programs such as the Florida Health Services Corps
1064	established under s. 381.0302, Florida Statutes.
1065	(b) Work in conjunction with an advisory body to address
1066	matters relating to the state's dental workforce. The advisory
1067	body shall provide input on developing questions for the dentist
1068	workforce survey. The advisory body shall include, but need not
1069	be limited to, the State Surgeon General or his or her designee,
1070	the dean of each dental school accredited in the United States
1071	and based in this state or his or her designee, a representative
1072	from the Florida Dental Association, a representative from the
1073	Florida Dental Hygiene Association, a representative from the
1074	Board of Dentistry, and a dentist from each of the dental
1075	specialties recognized by the American Dental Association's
1076	Commission on Dental Accreditation. Members of the advisory body
1077	shall serve without compensation.
1078	(c) Act as a clearinghouse for collecting and
1079	disseminating information concerning the dental workforce.
1080	(3) The Department of Health and the Board of Dentistry
1081	shall adopt rules necessary to administer this section.
1082	Section 26. It is the intent of the Legislature that the
1083	Department of Health and the Board of Dentistry implement the
1084	provisions of sections 16 through 20 of this act within existing
1085	resources.
1086	Section 27. Paragraphs (q) and (t) of subsection (2) of
1087	section 499.01, Florida Statutes, are amended to read:
1088	499.01 Permits.-
1089	(2) The following permits are established:
1090	(q) Device manufacturer permit.-
1091	1. A device manufacturer permit is required for any person
1092	that engages in the manufacture, repackaging, or assembly of
1093	medical devices for human use in this state, except that a
1094	permit is not required if:
1095	a. The person manufactures, repackages, or assembles only
1096	those medical devices or components for such devices which are
1097	exempt from registration pursuant to s. 499.015(8); or
1098	b. The person is engaged only in manufacturing,
1099	repackaging, or assembling a medical device pursuant to a
1100	practitioner's order for a specific patient.
1101	2.1. A manufacturer or repackager of medical devices in
1102	this state must comply with all appropriate state and federal
1103	good manufacturing practices and quality system rules.
1104	3.2. The department shall adopt rules related to storage,
1105	handling, and recordkeeping requirements for manufacturers of
1106	medical devices for human use.
1107	(t) Health care clinic establishment permit.-Effective
1108	January 1, 2009, a health care clinic establishment permit is
1109	required for the purchase of a prescription drug by a place of
1110	business at one general physical location that provides health
1111	care or veterinary services, which is owned and operated by a
1112	business entity that has been issued a federal employer tax
1113	identification number. For the purpose of this paragraph, the
1114	term "qualifying practitioner" means a licensed health care
1115	practitioner defined in s. 456.001, or a veterinarian licensed
1116	under chapter 474, who is authorized under the appropriate
1117	practice act to prescribe and administer a prescription drug.
1118	1. An establishment must provide, as part of the
1119	application required under s. 499.012, designation of a
1120	qualifying practitioner who will be responsible for complying
1121	with all legal and regulatory requirements related to the
1122	purchase, recordkeeping, storage, and handling of the
1123	prescription drugs. In addition, the designated qualifying
1124	practitioner shall be the practitioner whose name, establishment
1125	address, and license number is used on all distribution
1126	documents for prescription drugs purchased or returned by the
1127	health care clinic establishment. Upon initial appointment of a
1128	qualifying practitioner, the qualifying practitioner and the
1129	health care clinic establishment shall notify the department on
1130	a form furnished by the department within 10 days after such
1131	employment. In addition, the qualifying practitioner and health
1132	care clinic establishment shall notify the department within 10
1133	days after any subsequent change.
1134	2. The health care clinic establishment must employ a
1135	qualifying practitioner at each establishment.
1136	3. In addition to the remedies and penalties provided in
1137	this part, a violation of this chapter by the health care clinic
1138	establishment or qualifying practitioner constitutes grounds for
1139	discipline of the qualifying practitioner by the appropriate
1140	regulatory board.
1141	4. The purchase of prescription drugs by the health care
1142	clinic establishment is prohibited during any period of time
1143	when the establishment does not comply with this paragraph.
1144	5. A health care clinic establishment permit is not a
1145	pharmacy permit or otherwise subject to chapter 465. A health
1146	care clinic establishment that meets the criteria of a modified
1147	Class II institutional pharmacy under s. 465.019 is not eligible
1148	to be permitted under this paragraph.
1149	6. This paragraph does not apply to the purchase of a
1150	prescription drug by a licensed practitioner under his or her
1151	license. A professional corporation or limited liability company
1152	composed of dentists and operating as authorized in s. 466.0285
1153	may pay for prescription drugs obtained by a practitioner
1154	licensed under chapter 466, and the licensed practitioner is
1155	deemed the purchaser and owner of the prescription drugs.
1156	Section 28. Subsections (32) through (54) of section
1157	499.003, Florida Statutes, are renumbered as subsections (33)
1158	through (55), respectively, present subsection (42) is amended,
1159	and a new subsection (32) is added to that section, to read:
1160	499.003 Definitions of terms used in this part.-As used in
1161	this part, the term:
1162	(32) "Medical convenience kit" means a package or unit
1163	that contains combination products as described in 21 C.F.R. s.
1164	3.2(e)(2).
1165	(43)(42) "Prescription drug" means a prescription,
1166	medicinal, or legend drug, including, but not limited to,
1167	finished dosage forms or active ingredients subject to, defined
1168	by, or described by s. 503(b) of the Federal Food, Drug, and
1169	Cosmetic Act or s. 465.003(8), s. 499.007(13), or subsection
1170	(11), subsection (46) (45), or subsection (53) (52).
1171	Section 29. Paragraph (a) of subsection (1) of section
1172	409.9201, Florida Statutes, is amended to read:
1173	409.9201 Medicaid fraud.-
1174	(1) As used in this section, the term:
1175	(a) "Prescription drug" means any drug, including, but not
1176	limited to, finished dosage forms or active ingredients that are
1177	subject to, defined by, or described by s. 503(b) of the Federal
1178	Food, Drug, and Cosmetic Act or by s. 465.003(8), s.
1179	499.003(45)(45) or (53) (52), or s. 499.007(13).
1180
1181	The value of individual items of the legend drugs or goods or
1182	services involved in distinct transactions committed during a
1183	single scheme or course of conduct, whether involving a single
1184	person or several persons, may be aggregated when determining
1185	the punishment for the offense.
1186	Section 30. Subsection (3) of section 465.0265, Florida
1187	Statutes, is amended to read:
1188	465.0265 Centralized prescription filling.-
1189	(3) The filling, delivery, and return of a prescription by
1190	one pharmacy for another pursuant to this section shall not be
1191	construed as the filling of a transferred prescription as set
1192	forth in s. 465.026 or as a wholesale distribution as set forth
1193	in s. 499.003(54)(53).
1194	Section 31. Paragraph (d) of subsection (4) of section
1195	499.0121, Florida Statutes, is amended to read:
1196	499.0121 Storage and handling of prescription drugs;
1197	recordkeeping.-The department shall adopt rules to implement
1198	this section as necessary to protect the public health, safety,
1199	and welfare. Such rules shall include, but not be limited to,
1200	requirements for the storage and handling of prescription drugs
1201	and for the establishment and maintenance of prescription drug
1202	distribution records.
1203	(4) EXAMINATION OF MATERIALS AND RECORDS.-
1204	(d) Upon receipt, a wholesale distributor must review
1205	records required under this section for the acquisition of
1206	prescription drugs for accuracy and completeness, considering
1207	the total facts and circumstances surrounding the transactions
1208	and the wholesale distributors involved. This includes
1209	authenticating each transaction listed on a pedigree paper, as
1210	defined in s. 499.003(37)(36).
1211	Section 32. Paragraphs (a) and (b) of subsection (2) of
1212	section 499.01211, Florida Statutes, are amended to read:
1213	499.01211 Drug Wholesale Distributor Advisory Council.-
1214	(2) The State Surgeon General, or his or her designee, and
1215	the Secretary of Health Care Administration, or her or his
1216	designee, shall be members of the council. The State Surgeon
1217	General shall appoint nine additional members to the council who
1218	shall be appointed to a term of 4 years each, as follows:
1219	(a) Three different persons each of whom is employed by a
1220	different prescription drug wholesale distributor licensed under
1221	this part which operates nationally and is a primary wholesale
1222	distributor, as defined in s. 499.003(47)(46).
1223	(b) One person employed by a prescription drug wholesale
1224	distributor licensed under this part which is a secondary
1225	wholesale distributor, as defined in s. 499.003(52)(51).
1226	Section 33. Subsection (1) of section 499.03, Florida
1227	Statutes, is amended to read:
1228	499.03 Possession of certain drugs without prescriptions
1229	unlawful; exemptions and exceptions.-
1230	(1) A person may not possess, or possess with intent to
1231	sell, dispense, or deliver, any habit-forming, toxic, harmful,
1232	or new drug subject to s. 499.003(33)(32), or prescription drug
1233	as defined in s. 499.003(43)(42), unless the possession of the
1234	drug has been obtained by a valid prescription of a practitioner
1235	licensed by law to prescribe the drug. However, this section
1236	does not apply to the delivery of such drugs to persons included
1237	in any of the classes named in this subsection, or to the agents
1238	or employees of such persons, for use in the usual course of
1239	their businesses or practices or in the performance of their
1240	official duties, as the case may be; nor does this section apply
1241	to the possession of such drugs by those persons or their agents
1242	or employees for such use:
1243	(a) A licensed pharmacist or any person under the licensed
1244	pharmacist's supervision while acting within the scope of the
1245	licensed pharmacist's practice;
1246	(b) A licensed practitioner authorized by law to prescribe
1247	prescription drugs or any person under the licensed
1248	practitioner's supervision while acting within the scope of the
1249	licensed practitioner's practice;
1250	(c) A qualified person who uses prescription drugs for
1251	lawful research, teaching, or testing, and not for resale;
1252	(d) A licensed hospital or other institution that procures
1253	such drugs for lawful administration or dispensing by
1254	practitioners;
1255	(e) An officer or employee of a federal, state, or local
1256	government; or
1257	(f) A person that holds a valid permit issued by the
1258	department pursuant to this part which authorizes that person to
1259	possess prescription drugs.
1260	Section 34. Paragraphs (i) and (m) of subsection (1) of
1261	section 499.05, Florida Statutes, are amended to read:
1262	499.05 Rules.-
1263	(1) The department shall adopt rules to implement and
1264	enforce this part with respect to:
1265	(i) Additional conditions that qualify as an emergency
1266	medical reason under s. 499.003(54)(53)(b)2.
1267	(m) The recordkeeping, storage, and handling with respect
1268	to each of the distributions of prescription drugs specified in
1269	s. 499.003(54)(53)(a)-(d).
1270	Section 35. Subsection (1) of section 794.075, Florida
1271	Statutes, is amended to read:
1272	794.075 Sexual predators; erectile dysfunction drugs.-
1273	(1) A person may not possess a prescription drug, as
1274	defined in s. 499.003(43)(42), for the purpose of treating
1275	erectile dysfunction if the person is designated as a sexual
1276	predator under s. 775.21.
1277	Section 36. Paragraph (a) of subsection (6) of section
1278	624.91, Florida Statutes, is amended to read:
1279	624.91 The Florida Healthy Kids Corporation Act.-
1280	(6) BOARD OF DIRECTORS.-
1281	(a) The Florida Healthy Kids Corporation shall operate
1282	subject to the supervision and approval of a board of directors
1283	chaired by the Chief Financial Officer or her or his designee,
1284	and composed of 12 11 other members selected for 3-year terms of
1285	office as follows:
1286	1. The Secretary of Health Care Administration, or his or
1287	her designee.
1288	2. One member appointed by the Commissioner of Education
1289	from the Office of School Health Programs of the Florida
1290	Department of Education.
1291	3. One member appointed by the Chief Financial Officer
1292	from among three members nominated by the Florida Pediatric
1293	Society.
1294	4. One member, appointed by the Governor, who represents
1295	the Children's Medical Services Program.
1296	5. One member appointed by the Chief Financial Officer
1297	from among three members nominated by the Florida Hospital
1298	Association.
1299	6. One member, appointed by the Governor, who is an expert
1300	on child health policy.
1301	7. One member, appointed by the Chief Financial Officer,
1302	from among three members nominated by the Florida Academy of
1303	Family Physicians.
1304	8. One member, appointed by the Governor, who represents
1305	the state Medicaid program.
1306	9. One member, appointed by the Chief Financial Officer,
1307	from among three members nominated by the Florida Association of
1308	Counties.
1309	10. The State Health Officer or her or his designee.
1310	11. The Secretary of Children and Family Services, or his
1311	or her designee.
1312	12. One member, appointed by the Governor, from among
1313	three members nominated by the Florida Dental Association.
1314	Section 37. Section 381.0403, Florida Statutes, is amended
1315	to read:
1316	381.0403 The Community Hospital Education Act.-
1317	(1) SHORT TITLE.-This section shall be known and cited as
1318	"The Community Hospital Education Act."
1319	(2) LEGISLATIVE INTENT.-
1320	(a) It is the intent of the Legislature that health care
1321	services for the citizens of this state be upgraded and that a
1322	program for continuing these services be maintained through a
1323	plan for community medical education. The program is intended to
1324	provide additional outpatient and inpatient services, a
1325	continuing supply of highly trained physicians, and graduate
1326	medical education.
1327	(b) The Legislature further acknowledges the critical need
1328	for increased numbers of primary care physicians to provide the
1329	necessary current and projected health and medical services. In
1330	order to meet both present and anticipated needs, the
1331	Legislature supports an expansion in the number of family
1332	practice residency positions. The Legislature intends that the
1333	funding for graduate education in family practice be maintained
1334	and that funding for all primary care specialties be provided at
1335	a minimum of $10,000 per resident per year. Should funding for
1336	this act remain constant or be reduced, it is intended that all
1337	programs funded by this act be maintained or reduced
1338	proportionately.
1339	(3) PROGRAM FOR COMMUNITY HOSPITAL EDUCATION; STATE AND
1340	LOCAL PLANNING.-
1341	(a) There is established under the Department of Health a
1342	program for statewide graduate medical education. It is intended
1343	that continuing graduate medical education programs for interns
1344	and residents be established on a statewide basis. The program
1345	shall provide financial support for primary care specialty
1346	interns and residents based on policies recommended and approved
1347	by the Community Hospital Education Council, herein established,
1348	and the Department of Health. Only those programs with at least
1349	three residents or interns in each year of the training program
1350	are qualified to apply for financial support. Programs with
1351	fewer than three residents or interns per training year are
1352	qualified to apply for financial support, but only if the
1353	appropriate accrediting entity for the particular specialty has
1354	approved the program for fewer positions. Programs added after
1355	fiscal year 1997-1998 shall have 5 years to attain the requisite
1356	number of residents or interns. When feasible and to the extent
1357	allowed through the General Appropriations Act, state funds
1358	shall be used to generate federal matching funds under Medicaid,
1359	or other federal programs, and the resulting combined state and
1360	federal funds shall be allocated to participating hospitals for
1361	the support of graduate medical education. The department may
1362	spend up to $75,000 of the state appropriation for
1363	administrative costs associated with the production of the
1364	annual report as specified in subsection (9), and for
1365	administration of the program.
1366	(b) For the purposes of this section, primary care
1367	specialties include emergency medicine, family practice,
1368	internal medicine, pediatrics, psychiatry,
1369	obstetrics/gynecology, and combined pediatrics and internal
1370	medicine, and other primary care specialties as may be included
1371	by the council and Department of Health.
1372	(c) Medical institutions throughout the state may apply to
1373	the Community Hospital Education Council for grants-in-aid for
1374	financial support of their approved programs. Recommendations
1375	for funding of approved programs shall be forwarded to the
1376	Department of Health.
1377	(d) The program shall provide a plan for community
1378	clinical teaching and training with the cooperation of the
1379	medical profession, hospitals, and clinics. The plan shall also
1380	include formal teaching opportunities for intern and resident
1381	training. In addition, the plan shall establish an off-campus
1382	medical faculty with university faculty review to be located
1383	throughout the state in local communities.
1384	(4) PROGRAM FOR GRADUATE MEDICAL EDUCATION INNOVATIONS.-
1385	(a) There is established under the Department of Health a
1386	program for fostering graduate medical education innovations.
1387	Funds appropriated annually by the Legislature for this purpose
1388	shall be distributed to participating hospitals or consortia of
1389	participating hospitals and Florida medical schools or to a
1390	Florida medical school for the direct costs of providing
1391	graduate medical education in community-based clinical settings
1392	on a competitive grant or formula basis to achieve state health
1393	care workforce policy objectives, including, but not limited to:
1394	1. Increasing the number of residents in primary care and
1395	other high demand specialties or fellowships;
1396	2. Enhancing retention of primary care physicians in
1397	Florida practice;
1398	3. Promoting practice in medically underserved areas of
1399	the state;
1400	4. Encouraging racial and ethnic diversity within the
1401	state's physician workforce; and
1402	5. Encouraging increased production of geriatricians.
1403	(b) Participating hospitals or consortia of participating
1404	hospitals and Florida medical schools or a Florida medical
1405	school providing graduate medical education in community-based
1406	clinical settings may apply to the Community Hospital Education
1407	Council for funding under this innovations program, except when
1408	such innovations directly compete with services or programs
1409	provided by participating hospitals or consortia of
1410	participating hospitals, or by both hospitals and consortia.
1411	Innovations program funding shall provide funding based on
1412	policies recommended and approved by the Community Hospital
1413	Education Council and the Department of Health.
1414	(c) Participating hospitals or consortia of participating
1415	hospitals and Florida medical schools or Florida medical schools
1416	awarded an innovations grant shall provide the Community
1417	Hospital Education Council and Department of Health with an
1418	annual report on their project.
1419	(4)(5) FAMILY PRACTICE RESIDENCIES.-In addition to the
1420	programs established in subsection (3), the Community Hospital
1421	Education Council and the Department of Health shall establish
1422	an ongoing statewide program of family practice residencies. The
1423	administration of this program shall be in the manner described
1424	in this section.
1425	(5)(6) COUNCIL AND DIRECTOR.-
1426	(a) There is established the Community Hospital Education
1427	Council, hereinafter referred to as the council, which shall
1428	consist of 11 members, as follows:
1429	1. Seven members must be program directors of accredited
1430	graduate medical education programs or practicing physicians who
1431	have faculty appointments in accredited graduate medical
1432	education programs. Six of these members must be board certified
1433	or board eligible in family practice, internal medicine,
1434	pediatrics, emergency medicine, obstetrics-gynecology, and
1435	psychiatry, respectively, and licensed pursuant to chapter 458.
1436	No more than one of these members may be appointed from any one
1437	specialty. One member must be licensed pursuant to chapter 459.
1438	2. One member must be a representative of the
1439	administration of a hospital with an approved community hospital
1440	medical education program;
1441	3. One member must be the dean of a medical school in this
1442	state; and
1443	4. Two members must be consumer representatives.
1444
1445	All of the members shall be appointed by the Governor for terms
1446	of 4 years each.
1447	(b) Council membership shall cease when a member's
1448	representative status no longer exists. Members of similar
1449	representative status shall be appointed to replace retiring or
1450	resigning members of the council.
1451	(c) The State Surgeon General shall designate an
1452	administrator to serve as staff director. The council shall
1453	elect a chair from among its membership. Such other personnel as
1454	may be necessary to carry out the program shall be employed as
1455	authorized by the Department of Health.
1456	(6)(7) DEPARTMENT OF HEALTH; STANDARDS.-
1457	(a) The Department of Health, with recommendations from
1458	the council, shall establish standards and policies for the use
1459	and expenditure of graduate medical education funds appropriated
1460	pursuant to subsection (7) (8) for a program of community
1461	hospital education. The Department of Health shall establish
1462	requirements for hospitals to be qualified for participation in
1463	the program which shall include, but not be limited to:
1464	1. Submission of an educational plan and a training
1465	schedule.
1466	2. A determination by the council to ascertain that each
1467	portion of the program of the hospital provides a high degree of
1468	academic excellence and is accredited by the Accreditation
1469	Council for Graduate Medical Education of the American Medical
1470	Association or is accredited by the American Osteopathic
1471	Association.
1472	3. Supervision of the educational program of the hospital
1473	by a physician who is not the hospital administrator.
1474	(b) The Department of Health shall periodically review the
1475	educational program provided by a participating hospital to
1476	assure that the program includes a reasonable amount of both
1477	formal and practical training and that the formal sessions are
1478	presented as scheduled in the plan submitted by each hospital.
1479	(c) In years that funds are transferred to the Agency for
1480	Health Care Administration, the Department of Health shall
1481	certify to the Agency for Health Care Administration on a
1482	quarterly basis the number of primary care specialty residents
1483	and interns at each of the participating hospitals for which the
1484	Community Hospital Education Council and the department
1485	recommends funding.
1486	(7)(8) MATCHING FUNDS.-State funds shall be used to match
1487	funds from any local governmental or hospital source. The state
1488	shall provide up to 50 percent of the funds, and the community
1489	hospital medical education program shall provide the remainder.
1490	However, except for fixed capital outlay, the provisions of this
1491	subsection shall not apply to any program authorized under the
1492	provisions of subsection (5) for the first 3 years after such
1493	program is in operation.
1494	(9) ANNUAL REPORT ON GRADUATE MEDICAL EDUCATION;
1495	COMMITTEE.-The Executive Office of the Governor, the Department
1496	of Health, and the Agency for Health Care Administration shall
1497	collaborate to establish a committee that shall produce an
1498	annual report on graduate medical education. The committee shall
1499	be comprised of 11 members: five members shall be deans of the
1500	medical schools or their designees; the Governor shall appoint
1501	two members, one of whom must be a representative of the Florida
1502	Medical Association who has supervised or currently supervises
1503	residents or interns and one of whom must be a representative of
1504	the Florida Hospital Association; the Secretary of Health Care
1505	Administration shall appoint two members, one of whom must be a
1506	representative of a statutory teaching hospital and one of whom
1507	must be a physician who has supervised or is currently
1508	supervising residents or interns; and the State Surgeon General
1509	shall appoint two members, one of whom must be a representative
1510	of a statutory family practice teaching hospital and one of whom
1511	must be a physician who has supervised or is currently
1512	supervising residents or interns. With the exception of the
1513	deans, members shall serve 4-year terms. In order to stagger the
1514	terms, the Governor's appointees shall serve initial terms of 4
1515	years, the State Surgeon General's appointees shall serve
1516	initial terms of 3 years, and the Secretary of Health Care
1517	Administration's appointees shall serve initial terms of 2
1518	years. A member's term shall be deemed terminated when the
1519	member's representative status no longer exists. Once the
1520	committee is appointed, it shall elect a chair to serve for a 1-
1521	year term. The report shall be provided to the Governor, the
1522	President of the Senate, and the Speaker of the House of
1523	Representatives by January 15 annually. Committee members shall
1524	serve without compensation. The report shall address the
1525	following:
1526	(a) The role of residents and medical faculty in the
1527	provision of health care.
1528	(b) The relationship of graduate medical education to the
1529	state's physician workforce.
1530	(c) The costs of training medical residents for hospitals,
1531	medical schools, teaching hospitals, including all hospital-
1532	medical affiliations, practice plans at all of the medical
1533	schools, and municipalities.
1534	(d) The availability and adequacy of all sources of
1535	revenue to support graduate medical education and recommend
1536	alternative sources of funding for graduate medical education.
1537	(e) The use of state and federal appropriated funds for
1538	graduate medical education by hospitals receiving such funds.
1539	(9)(10) RULEMAKING.-The department has authority to adopt
1540	rules pursuant to ss. 120.536(1) and 120.54 to implement the
1541	provisions of this section.
1542	Section 38. Section 381.4018, Florida Statutes, is amended
1543	to read:
1544	381.4018 Physician workforce assessment and development.-
1545	(1) DEFINITIONS.-As used in this section, the term:
1546	(a) "Consortium" or "consortia" means a combination of
1547	statutory teaching hospitals, specialty children's hospitals,
1548	statutory rural hospitals, other hospitals, accredited medical
1549	schools, clinics operated by the department, clinics operated by
1550	the Department of Veterans' Affairs, area health education
1551	centers, community health centers, federally qualified health
1552	centers, prison clinics, local community clinics, or other
1553	programs. At least one member of the consortium shall be a
1554	sponsoring institution accredited or currently seeking
1555	accreditation by the Accreditation Council for Graduate Medical
1556	Education or the American Osteopathic Association.
1557	(b) "Council" means the Physician Workforce Advisory
1558	Council.
1559	(c) "Department" means the Department of Health.
1560	(d) "Graduate medical education program" means a program
1561	accredited by the Accreditation Council for Graduate Medical
1562	Education or the American Osteopathic Association.
1563	(e) "Primary care specialty" means emergency medicine,
1564	family practice, internal medicine, pediatrics, psychiatry,
1565	geriatrics, general surgery, obstetrics and gynecology, and
1566	combined pediatrics and internal medicine and other specialties
1567	as determined by the Physician Workforce Advisory Council or the
1568	Department of Health.
1569	(2)(1) LEGISLATIVE INTENT.-The Legislature recognizes that
1570	physician workforce planning is an essential component of
1571	ensuring that there is an adequate and appropriate supply of
1572	well-trained physicians to meet this state's future health care
1573	service needs as the general population and elderly population
1574	of the state increase. The Legislature finds that items to
1575	consider relative to assessing the physician workforce may
1576	include physician practice status; specialty mix; geographic
1577	distribution; demographic information, including, but not
1578	limited to, age, gender, race, and cultural considerations; and
1579	needs of current or projected medically underserved areas in the
1580	state. Long-term strategic planning is essential as the period
1581	from the time a medical student enters medical school to
1582	completion of graduate medical education may range from 7 to 10
1583	years or longer. The Legislature recognizes that strategies to
1584	provide for a well-trained supply of physicians must include
1585	ensuring the availability and capacity of quality graduate
1586	medical schools and graduate medical education programs in this
1587	state, as well as using new or existing state and federal
1588	programs providing incentives for physicians to practice in
1589	needed specialties and in underserved areas in a manner that
1590	addresses projected needs for physician manpower.
1591	(3)(2) PURPOSE.-The department of Health shall serve as a
1592	coordinating and strategic planning body to actively assess the
1593	state's current and future physician workforce needs and work
1594	with multiple stakeholders to develop strategies and
1595	alternatives to address current and projected physician
1596	workforce needs.
1597	(4)(3) GENERAL FUNCTIONS.-The department shall maximize
1598	the use of existing programs under the jurisdiction of the
1599	department and other state agencies and coordinate governmental
1600	and nongovernmental stakeholders and resources in order to
1601	develop a state strategic plan and assess the implementation of
1602	such strategic plan. In developing the state strategic plan, the
1603	department shall:
1604	(a) Monitor, evaluate, and report on the supply and
1605	distribution of physicians licensed under chapter 458 or chapter
1606	459. The department shall maintain a database to serve as a
1607	statewide source of data concerning the physician workforce.
1608	(b) Develop a model and quantify, on an ongoing basis, the
1609	adequacy of the state's current and future physician workforce
1610	as reliable data becomes available. Such model must take into
1611	account demographics, physician practice status, place of
1612	education and training, generational changes, population growth,
1613	economic indicators, and issues concerning the "pipeline" into
1614	medical education.
1615	(c) Develop and recommend strategies to determine whether
1616	the number of qualified medical school applicants who might
1617	become competent, practicing physicians in this state will be
1618	sufficient to meet the capacity of the state's medical schools.
1619	If appropriate, the department shall, working with
1620	representatives of appropriate governmental and nongovernmental
1621	entities, develop strategies and recommendations and identify
1622	best practice programs that introduce health care as a
1623	profession and strengthen skills needed for medical school
1624	admission for elementary, middle, and high school students, and
1625	improve premedical education at the precollege and college level
1626	in order to increase this state's potential pool of medical
1627	students.
1628	(d) Develop strategies to ensure that the number of
1629	graduates from the state's public and private allopathic and
1630	osteopathic medical schools is are adequate to meet physician
1631	workforce needs, based on the analysis of the physician
1632	workforce data, so as to provide a high-quality medical
1633	education to students in a manner that recognizes the uniqueness
1634	of each new and existing medical school in this state.
1635	(e) Pursue strategies and policies to create, expand, and
1636	maintain graduate medical education positions in the state based
1637	on the analysis of the physician workforce data. Such strategies
1638	and policies must take into account the effect of federal
1639	funding limitations on the expansion and creation of positions
1640	in graduate medical education. The department shall develop
1641	options to address such federal funding limitations. The
1642	department shall consider options to provide direct state
1643	funding for graduate medical education positions in a manner
1644	that addresses requirements and needs relative to accreditation
1645	of graduate medical education programs. The department shall
1646	consider funding residency positions as a means of addressing
1647	needed physician specialty areas, rural areas having a shortage
1648	of physicians, and areas of ongoing critical need, and as a
1649	means of addressing the state's physician workforce needs based
1650	on an ongoing analysis of physician workforce data.
1651	(f) Develop strategies to maximize federal and state
1652	programs that provide for the use of incentives to attract
1653	physicians to this state or retain physicians within the state.
1654	Such strategies should explore and maximize federal-state
1655	partnerships that provide incentives for physicians to practice
1656	in federally designated shortage areas. Strategies shall also
1657	consider the use of state programs, such as the Florida Health
1658	Service Corps established pursuant to s. 381.0302 and the
1659	Medical Education Reimbursement and Loan Repayment Program
1660	pursuant to s. 1009.65, which provide for education loan
1661	repayment or loan forgiveness and provide monetary incentives
1662	for physicians to relocate to underserved areas of the state.
1663	(g) Coordinate and enhance activities relative to
1664	physician workforce needs, undergraduate medical education, and
1665	graduate medical education, and reentry of retired military and
1666	other physicians into the physician workforce provided by the
1667	Division of Medical Quality Assurance, the Community Hospital
1668	Education Program and the Graduate Medical Education Committee
1669	established pursuant to s. 381.0403, area health education
1670	center networks established pursuant to s. 381.0402, and other
1671	offices and programs within the department of Health as
1672	designated by the State Surgeon General.
1673	(h) Work in conjunction with and act as a coordinating
1674	body for governmental and nongovernmental stakeholders to
1675	address matters relating to the state's physician workforce
1676	assessment and development for the purpose of ensuring an
1677	adequate supply of well-trained physicians to meet the state's
1678	future needs. Such governmental stakeholders shall include, but
1679	need not be limited to, the State Surgeon General or his or her
1680	designee, the Commissioner of Education or his or her designee,
1681	the Secretary of Health Care Administration or his or her
1682	designee, and the Chancellor of the State University System or
1683	his or her designee from the Board of Governors of the State
1684	University System, and, at the discretion of the department,
1685	other representatives of state and local agencies that are
1686	involved in assessing, educating, or training the state's
1687	current or future physicians. Other stakeholders shall include,
1688	but need not be limited to, organizations representing the
1689	state's public and private allopathic and osteopathic medical
1690	schools; organizations representing hospitals and other
1691	institutions providing health care, particularly those that
1692	currently provide or have an interest in providing accredited
1693	medical education and graduate medical education to medical
1694	students and medical residents; organizations representing
1695	allopathic and osteopathic practicing physicians; and, at the
1696	discretion of the department, representatives of other
1697	organizations or entities involved in assessing, educating, or
1698	training the state's current or future physicians.
1699	(i) Serve as a liaison with other states and federal
1700	agencies and programs in order to enhance resources available to
1701	the state's physician workforce and medical education continuum.
1702	(j) Act as a clearinghouse for collecting and
1703	disseminating information concerning the physician workforce and
1704	medical education continuum in this state.
1705	(5) PHYSICIAN WORKFORCE ADVISORY COUNCIL.-There is created
1706	in the department the Physician Workforce Advisory Council, an
1707	advisory council as defined in s. 20.03. The council shall
1708	comply with the requirements of s. 20.052, except as otherwise
1709	provided in this section.
1710	(a) The council shall consist of 19 members. Members
1711	appointed by the State Surgeon General shall include:
1712	1. A designee from the department who is a physician
1713	licensed under chapter 458 or chapter 459 and recommended by the
1714	State Surgeon General.
1715	2. An individual who is affiliated with the Science
1716	Students Together Reaching Instructional Diversity and
1717	Excellence program and recommended by the area health education
1718	center network.
1719	3. Two individuals who are recommended by the Council of
1720	Florida Medical School Deans, one who represents a college of
1721	allopathic medicine and one who represents a college of
1722	osteopathic medicine.
1723	4. One individual who is recommended by the Florida
1724	Hospital Association and represents a hospital that is licensed
1725	under chapter 395, has an accredited graduate medical education
1726	program, and is not a statutory teaching hospital.
1727	5. One individual who represents a statutory teaching
1728	hospital as defined in s. 408.07 and is recommended by the
1729	Safety Net Hospital Alliance.
1730	6. One individual who represents a family practice
1731	teaching hospital as defined in s. 395.805 and is recommended by
1732	the Council of Family Medicine and Community Teaching Hospitals.
1733	7. Two individuals who are recommended by the Florida
1734	Medical Association, one who represents a primary care specialty
1735	and one who represents a nonprimary care specialty.
1736	8. Two individuals who are recommended by the Florida
1737	Osteopathic Medical Association, one who represents a primary
1738	care specialty and one who represents a nonprimary care
1739	specialty.
1740	9. Two individuals who are program directors of accredited
1741	graduate medical education programs, one who represents a
1742	program that is accredited by the Accreditation Council for
1743	Graduate Medical Education and one who represents a program that
1744	is accredited by the American Osteopathic Association.
1745	10. An individual who is recommended by the Florida
1746	Association of Community Health Centers and represents a
1747	federally qualified health center located in a rural area as
1748	defined in s. 381.0406(2)(a).
1749	11. An individual who is recommended by the Florida
1750	Academy of Family Physicians.
1751	12. An individual who is recommended by the Florida
1752	Alliance for Health Professions Diversity.
1753	13. The Chancellor of the State University System or his
1754	or her designee.
1755	14. A layperson member as determined by the State Surgeon
1756	General.
1757
1758	Each entity authorized to make recommendations under this
1759	subsection shall make at least two recommendations to the State
1760	Surgeon General for each appointment to the council. The State
1761	Surgeon General shall name one appointee for each position from
1762	the recommendations made by each authorized entity.
1763	(b) Each council member shall be appointed to a 4-year
1764	term. An individual may not serve more than two terms. Any
1765	council member may be removed from office for malfeasance,
1766	misfeasance, neglect of duty, incompetence, permanent inability
1767	to perform official duties, or pleading guilty or nolo
1768	contendere to, or being found guilty of, a felony. Any council
1769	member who meets the criteria for removal, or who is otherwise
1770	unwilling or unable to properly fulfill the duties of the
1771	office, shall be succeeded by an individual chosen by the State
1772	Surgeon General to serve out the remainder of the council
1773	member's term. If the remainder of the replaced council member's
1774	term is less than 18 months, notwithstanding the provisions of
1775	this paragraph, the succeeding council member may be reappointed
1776	twice by the State Surgeon General.
1777	(c) The chair of the council is the State Surgeon General,
1778	who shall designate a vice chair from the membership of the
1779	council to serve in the absence of the State Surgeon General. A
1780	vacancy shall be filled for the remainder of the unexpired term
1781	in the same manner as the original appointment.
1782	(d) Council members are not entitled to receive
1783	compensation or reimbursement for per diem or travel expenses.
1784	(e) The council shall meet at least twice a year in person
1785	or by teleconference.
1786	(f) The council shall:
1787	1. Advise the State Surgeon General and the department on
1788	matters concerning current and future physician workforce needs
1789	in this state;
1790	2. Review survey materials and the compilation of survey
1791	information;
1792	3. Annually review the number, location, cost, and
1793	reimbursement of graduate medical education programs and
1794	positions;
1795	4. Provide recommendations to the department regarding the
1796	survey completed by physicians licensed under chapter 458 or
1797	chapter 459;
1798	5. Assist the department in preparing the annual report to
1799	the Legislature pursuant to ss. 458.3192 and 459.0082;
1800	6. Assist the department in preparing an initial strategic
1801	plan, conduct ongoing strategic planning in accordance with this
1802	section, and provide ongoing advice on implementing the
1803	recommendations;
1804	7. Monitor and provide recommendations regarding the need
1805	for an increased number of primary care or other physician
1806	specialties to provide the necessary current and projected
1807	health and medical services for the state; and
1808	8. Monitor and make recommendations regarding the status
1809	of the needs relating to graduate medical education in this
1810	state.
1811	(6) PHYSICIAN WORKFORCE GRADUATE MEDICAL EDUCATION
1812	INNOVATION PILOT PROJECTS.-
1813	(a) The Legislature finds that:
1814	1. In order to ensure a physician workforce that is
1815	adequate to meet the needs of this state's residents and its
1816	health care system, policymakers must consider the education and
1817	training of future generations of well-trained health care
1818	providers.
1819	2. Physicians are likely to practice in the state where
1820	they complete their graduate medical education.
1821	3. It can directly affect the makeup of the physician
1822	workforce by selectively funding graduate medical education
1823	programs to provide needed specialists in geographic areas of
1824	the state that have a deficient number of such specialists.
1825	4. Developing additional positions in graduate medical
1826	education programs is essential to the future of this state's
1827	health care system.
1828	5. It was necessary in 2007 to pass legislation that
1829	provided for an assessment of the status of this state's current
1830	and future physician workforce. The department is collecting and
1831	analyzing information on an ongoing basis to assess this state's
1832	physician workforce needs, and such assessment may facilitate
1833	the determination of graduate medical education needs and
1834	strategies for the state.
1835	(b) There is established under the department a program to
1836	foster innovative graduate medical education pilot projects that
1837	are designed to promote the expansion of graduate medical
1838	education programs or positions to prepare physicians to
1839	practice in needed specialties and underserved areas or settings
1840	and to provide demographic and cultural representation in a
1841	manner that addresses current and projected needs for this
1842	state's physician workforce. Funds appropriated annually by the
1843	Legislature for this purpose shall be distributed to
1844	participating hospitals, medical schools, other sponsors of
1845	graduate medical education programs, consortia engaged in
1846	developing new graduate medical education programs or positions
1847	in those programs, or pilot projects providing innovative
1848	graduate medical education in community-based clinical settings.
1849	Pilot projects shall be selected on a competitive grant basis,
1850	subject to available funds.
1851	(c) Pilot projects shall be designed to meet one or more
1852	of this state's physician workforce needs, as determined
1853	pursuant to this section, including, but not limited to:
1854	1. Increasing the number of residencies or fellowships in
1855	primary care or other needed specialties.
1856	2. Enhancing the retention of primary care physicians or
1857	other needed specialties in this state.
1858	3. Promoting practice in rural or medically underserved
1859	areas of the state.
1860	4. Encouraging racial and ethnic diversity within the
1861	state's physician workforce.
1862	5. Encouraging practice in community health care or other
1863	ambulatory care settings.
1864	6. Encouraging practice in clinics operated by the
1865	department, including, but not limited to, county health
1866	departments, clinics operated by the Department of Veterans'
1867	Affairs, prison clinics, or similar settings of need.
1868	7. Encouraging the increased production of geriatricians.
1869	(d) Priority shall be given to a proposal for a pilot
1870	project that:
1871	1. Demonstrates a collaboration of federal, state, and
1872	local entities that are public or private.
1873	2. Obtains funding from multiple sources.
1874	3. Focuses on enhancing graduate medical education in
1875	rural or underserved areas.
1876	4. Focuses on enhancing graduate medical education in
1877	ambulatory or community-based settings other than a hospital
1878	environment.
1879	5. Includes the use of technology, such as electronic
1880	medical records, distance consultation, and telemedicine, to
1881	ensure that residents are better prepared to care for patients
1882	in this state, regardless of the community in which the
1883	residents practice.
1884	6. Is designed to meet multiple policy needs as enumerated
1885	in subsection (4).
1886	7. Uses a consortium to provide for graduate medical
1887	education experiences.
1888	(e) The department shall adopt by rule appropriate
1889	performance measures to use in order to consistently evaluate
1890	the effectiveness, safety, and quality of the programs, as well
1891	as the impact of each program on meeting this state's physician
1892	workforce needs.
1893	(f) Participating pilot projects shall submit to the
1894	department an annual report on the project in a manner required
1895	by the department.
1896	(g) Funding provided to a pilot project may be used only
1897	for the direct costs of providing graduate medical education.
1898	Accounting of such costs and expenditures shall be documented in
1899	the annual report.
1900	(h) State funds shall be used to supplement funds from any
1901	local government, community, or private source. The state may
1902	provide up to 50 percent of the funds, and local governmental
1903	grants or community or private sources shall provide the
1904	remainder of the funds.
1905	(7) RULEMAKING.-The department shall adopt rules as
1906	necessary to administer this section.
1907	Section 39. Paragraph (l) of subsection (4) of section
1908	400.9905, Florida Statutes, is amended to read:
1909	400.9905 Definitions.-
1910	(4) "Clinic" means an entity at which health care services
1911	are provided to individuals and which tenders charges for
1912	reimbursement for such services, including a mobile clinic and a
1913	portable equipment provider. For purposes of this part, the term
1914	does not include and the licensure requirements of this part do
1915	not apply to:
1916	(l) Orthotic, or prosthetic, pediatric cardiology, or
1917	perinatology clinical facilities that are a publicly traded
1918	corporation or that are wholly owned, directly or indirectly, by
1919	a publicly traded corporation. As used in this paragraph, a
1920	publicly traded corporation is a corporation that issues
1921	securities traded on an exchange registered with the United
1922	States Securities and Exchange Commission as a national
1923	securities exchange.
1924	Section 40. Section 458.3192, Florida Statutes, is amended
1925	to read:
1926	458.3192 Analysis of survey results; report.-
1927	(1) Each year, the Department of Health shall analyze the
1928	results of the physician survey required by s. 458.3191 and
1929	determine by geographic area and specialty the number of
1930	physicians who:
1931	(a) Perform deliveries of children in this state Florida.
1932	(b) Read mammograms and perform breast-imaging-guided
1933	procedures in this state Florida.
1934	(c) Perform emergency care on an on-call basis for a
1935	hospital emergency department.
1936	(d) Plan to reduce or increase emergency on-call hours in
1937	a hospital emergency department.
1938	(e) Plan to relocate their allopathic or osteopathic
1939	practice outside the state.
1940	(f) Practice medicine in this state.
1941	(g) Plan to reduce or modify the scope of their practice.
1942	(2) The Department of Health must report its findings to
1943	the Governor, the President of the Senate, and the Speaker of
1944	the House of Representatives by November 1 each year. The
1945	department shall also include in its report findings,
1946	recommendations, and strategic planning activities as provided
1947	in s. 381.4018. The department may also include other
1948	information requested by the Physician Workforce Advisory
1949	Council.
1950	Section 41. Section 459.0082, Florida Statutes, is amended
1951	to read:
1952	459.0082 Analysis of survey results; report.-
1953	(1) Each year, the Department of Health shall analyze the
1954	results of the physician survey required by s. 459.0081 and
1955	determine by geographic area and specialty the number of
1956	physicians who:
1957	(a) Perform deliveries of children in this state Florida.
1958	(b) Read mammograms and perform breast-imaging-guided
1959	procedures in this state Florida.
1960	(c) Perform emergency care on an on-call basis for a
1961	hospital emergency department.
1962	(d) Plan to reduce or increase emergency on-call hours in
1963	a hospital emergency department.
1964	(e) Plan to relocate their allopathic or osteopathic
1965	practice outside the state.
1966	(f) Practice medicine in this state.
1967	(g) Plan to reduce or modify the scope of their practice.
1968	(2) The Department of Health must report its findings to
1969	the Governor, the President of the Senate, and the Speaker of
1970	the House of Representatives by November 1 each year. The
1971	department shall also include in its report findings,
1972	recommendations, and strategic planning activities as provided
1973	in s. 381.4018. The department may also include other
1974	information requested by the Physician Workforce Advisory
1975	Council.
1976	Section 42. Section 458.315, Florida Statutes, is amended
1977	to read:
1978	458.315 Temporary certificate for practice in areas of
1979	critical need.-
1980	(1) Any physician who:
1981	(a) Is licensed to practice in any jurisdiction in the
1982	United States and other state, whose license is currently valid;
1983	or,
1984	(b) Has served as a physician in the United States Armed
1985	Forces for at least 10 years and received an honorable discharge
1986	from the military;
1987
1988	and who pays an application fee of $300 may be issued a
1989	temporary certificate for to practice in areas of communities of
1990	Florida where there is a critical need for physicians.
1991	(2) A certificate may be issued to a physician who:
1992	(a) Practices in an area of critical need;
1993	(b) Will be employed by or practice in a county health
1994	department, correctional facility, Department of Veterans'
1995	Affairs clinic, community health center funded by s. 329, s.
1996	330, or s. 340 of the United States Public Health Services Act,
1997	or other agency or institution that is approved by the State
1998	Surgeon General and provides health care to meet the needs of
1999	underserved populations in this state; or
2000	(c) Will practice for a limited time to address critical
2001	physician-specialty, demographic, or geographic needs for this
2002	state's physician workforce as determined by the State Surgeon
2003	General entity that provides health care to indigents and that
2004	is approved by the State Health Officer.
2005	(3) The Board of Medicine may issue this temporary
2006	certificate with the following restrictions:
2007	(a)(1) The State Surgeon General board shall determine the
2008	areas of critical need, and the physician so certified may
2009	practice in any of those areas for a time to be determined by
2010	the board. Such areas shall include, but are not be limited to,
2011	health professional shortage areas designated by the United
2012	States Department of Health and Human Services.
2013	1.(a) A recipient of a temporary certificate for practice
2014	in areas of critical need may use the certificate license to
2015	work for any approved entity employer in any area of critical
2016	need or as authorized by the State Surgeon General approved by
2017	the board.
2018	2.(b) The recipient of a temporary certificate for
2019	practice in areas of critical need shall, within 30 days after
2020	accepting employment, notify the board of all approved
2021	institutions in which the licensee practices and of all approved
2022	institutions where practice privileges have been denied.
2023	(b)(2) The board may administer an abbreviated oral
2024	examination to determine the physician's competency, but a no
2025	written regular examination is not required necessary. Within 60
2026	days after receipt of an application for a temporary
2027	certificate, the board shall review the application and issue
2028	the temporary certificate, or notify the applicant of denial, or
2029	notify the applicant that the board recommends additional
2030	assessment, training, education, or other requirements as a
2031	condition of certification. If the applicant has not actively
2032	practiced during the prior 3 years and the board determines that
2033	the applicant may lack clinical competency, possess diminished
2034	or inadequate skills, lack necessary medical knowledge, or
2035	exhibit patterns of deficits in clinical decisionmaking, the
2036	board may:
2037	1. Deny the application;
2038	2. Issue a temporary certificate with reasonable
2039	restrictions that may include, but are not limited to, a
2040	requirement for the applicant to practice under the supervision
2041	of a physician approved by the board; or
2042	3. Issue a temporary certificate upon receipt of
2043	documentation confirming that the applicant has met any
2044	reasonable conditions of the board which may include, but are
2045	not limited to, completing continuing education or undergoing an
2046	assessment of skills and training.
2047	(c)(3) Any certificate issued under this section is shall
2048	be valid only so long as the State Surgeon General determines
2049	that the reason area for which it was is issued remains a an
2050	area of critical need to the state. The Board of Medicine shall
2051	review each temporary certificateholder the service within said
2052	area not less than annually to ascertain that the minimum
2053	requirements of the Medical Practice Act and its adopted the
2054	rules and regulations promulgated thereunder are being complied
2055	with. If it is determined that such minimum requirements are not
2056	being met, the board shall forthwith revoke such certificate or
2057	shall impose restrictions or conditions, or both, as a condition
2058	of continued practice under the certificate.
2059	(d)(4) The board may shall not issue a temporary
2060	certificate for practice in an area of critical need to any
2061	physician who is under investigation in any jurisdiction in the
2062	United States another state for an act that which would
2063	constitute a violation of this chapter until such time as the
2064	investigation is complete, at which time the provisions of s.
2065	458.331 shall apply.
2066	(4)(5) The application fee and all licensure fees,
2067	including neurological injury compensation assessments, shall be
2068	waived for those persons obtaining a temporary certificate to
2069	practice in areas of critical need for the purpose of providing
2070	volunteer, uncompensated care for low-income residents
2071	Floridians. The applicant must submit an affidavit from the
2072	employing agency or institution stating that the physician will
2073	not receive any compensation for any service involving the
2074	practice of medicine.
2075	Section 43. Section 459.0076, Florida Statutes, is created
2076	to read:
2077	459.0076 Temporary certificate for practice in areas of
2078	critical need.-
2079	(1) Any physician who:
2080	(a) Is licensed to practice in any jurisdiction in the
2081	United States and whose license is currently valid; or
2082	(b) Has served as a physician in the United States Armed
2083	Forces for at least 10 years and received an honorable discharge
2084	from the military;
2085
2086	and who pays an application fee of $300 may be issued a
2087	temporary certificate for practice in areas of critical need.
2088	(2) A certificate may be issued to a physician who:
2089	(a) Will practice in an area of critical need;
2090	(b) Will be employed by or practice in a county health
2091	department, correctional facility, Department of Veterans'
2092	Affairs clinic, community health center funded by s. 329, s.
2093	330, or s. 340 of the United States Public Health Services Act,
2094	or other agency or institution that is approved by the State
2095	Surgeon General and provides health care to meet the needs of
2096	underserved populations in this state; or
2097	(c) Will practice for a limited time to address critical
2098	physician-specialty, demographic, or geographic needs for this
2099	state's physician workforce as determined by the State Surgeon
2100	General.
2101	(3) The Board of Osteopathic Medicine may issue this
2102	temporary certificate with the following restrictions:
2103	(a) The State Surgeon General shall determine the areas of
2104	critical need. Such areas include, but are not limited to,
2105	health professional shortage areas designated by the United
2106	States Department of Health and Human Services.
2107	1. A recipient of a temporary certificate for practice in
2108	areas of critical need may use the certificate to work for any
2109	approved entity in any area of critical need or as authorized by
2110	the State Surgeon General.
2111	2. The recipient of a temporary certificate for practice
2112	in areas of critical need shall, within 30 days after accepting
2113	employment, notify the board of all approved institutions in
2114	which the licensee practices and of all approved institutions
2115	where practice privileges have been denied.
2116	(b) The board may administer an abbreviated oral
2117	examination to determine the physician's competency, but a
2118	written regular examination is not required. Within 60 days
2119	after receipt of an application for a temporary certificate, the
2120	board shall review the application and issue the temporary
2121	certificate, notify the applicant of denial, or notify the
2122	applicant that the board recommends additional assessment,
2123	training, education, or other requirements as a condition of
2124	certification. If the applicant has not actively practiced
2125	during the prior 3 years and the board determines that the
2126	applicant may lack clinical competency, possess diminished or
2127	inadequate skills, lack necessary medical knowledge, or exhibit
2128	patterns of deficits in clinical decisionmaking, the board may:
2129	1. Deny the application;
2130	2. Issue a temporary certificate having reasonable
2131	restrictions that may include, but are not limited to, a
2132	requirement for the applicant to practice under the supervision
2133	of a physician approved by the board; or
2134	3. Issue a temporary certificate upon receipt of
2135	documentation confirming that the applicant has met any
2136	reasonable conditions of the board, which may include, but are
2137	not limited to, completing continuing education or undergoing an
2138	assessment of skills and training.
2139	(c) Any certificate issued under this section is valid
2140	only so long as the State Surgeon General determines that the
2141	reason for which it was issued remains a critical need to the
2142	state. The Board of Osteopathic Medicine shall review each
2143	temporary certificateholder not less than annually to ascertain
2144	that the minimum requirements of the Osteopathic Medical
2145	Practice Act and its adopted rules are being complied with. If
2146	it is determined that such minimum requirements are not being
2147	met, the board shall revoke such certificate or shall impose
2148	restrictions or conditions, or both, as a condition of continued
2149	practice under the certificate.
2150	(d) The board may not issue a temporary certificate for
2151	practice in an area of critical need to any physician who is
2152	under investigation in any jurisdiction in the United States for
2153	an act that would constitute a violation of this chapter until
2154	such time as the investigation is complete, at which time the
2155	provisions of s. 459.015 apply.
2156	(4) The application fee and all licensure fees, including
2157	neurological injury compensation assessments, shall be waived
2158	for those persons obtaining a temporary certificate to practice
2159	in areas of critical need for the purpose of providing
2160	volunteer, uncompensated care for low-income residents. The
2161	applicant must submit an affidavit from the employing agency or
2162	institution stating that the physician will not receive any
2163	compensation for any service involving the practice of medicine.
2164	Section 44. Paragraph (i) is added to subsection (3) of
2165	section 499.01212, Florida Statutes, to read:
2166	499.01212 Pedigree paper.-
2167	(3) EXCEPTIONS.-A pedigree paper is not required for:
2168	(i) The wholesale distribution of prescription drugs
2169	within a medical convenience kit if:
2170	1. The medical convenience kit is assembled in an
2171	establishment that is registered with the United States Food and
2172	Drug Administration as a medical device manufacturer;
2173	2. The medical convenience kit manufacturer is an
2174	authorized distributor of record, as defined by 21 C.F.R. s.
2175	203.3, for the manufacturer of the specific drugs contained
2176	within the kit; and
2177	3. The drugs contained in the medical convenience kit are:
2178	a. Intravenous solutions intended for the replenishment of
2179	fluids and electrolytes;
2180	b. Products intended to maintain the equilibrium of water
2181	and minerals in the body;
2182	c. Products intended for irrigation or reconstitution;
2183	d. Anesthetics; or
2184	e. Anticoagulants.
2185
2186	This paragraph does not apply to a medical convenience kit
2187	containing any controlled substance that appears in any schedule
2188	contained in or subject to chapter 893 or the Federal
2189	Comprehensive Drug Abuse Prevention and Control Act of 1970.
2190	Section 45. Subsection (1) of section 465.0251, Florida
2191	Statutes, is reenacted to read:
2192	465.0251 Generic drugs; removal from formulary under
2193	specified circumstances.-
2194	(1) The Board of Pharmacy and the Board of Medicine shall
2195	remove any generic named drug product from the formulary
2196	established by s. 465.025(6), if every commercially marketed
2197	equivalent of that drug product is "A" rated as therapeutically
2198	equivalent to a reference listed drug or is a reference listed
2199	drug as referred to in "Approved Drug Products with Therapeutic
2200	Equivalence Evaluations" (Orange Book) published by the United
2201	States Food and Drug Administration.
2202	Section 46. Subsection (3) is added to section 626.9541,
2203	Florida Statutes, to read:
2204	626.9541 Unfair methods of competition and unfair or
2205	deceptive acts or practices defined; alternative rates of
2206	payment; wellness programs.-
2207	(3) WELLNESS PROGRAMS.-An insurer issuing a group or
2208	individual health benefit plan may offer a voluntary wellness or
2209	health-improvement program that allows for rewards or
2210	incentives, including, but not limited to, merchandise, gift
2211	cards, debit cards, premium discounts or rebates, contributions
2212	towards a member's health savings account, modifications to
2213	copayment, deductible, or coinsurance amounts, or any
2214	combination of these incentives, to encourage or reward
2215	participation in the program. The health plan member may be
2216	required to provide verification, such as a statement from his
2217	or her physician, that a medical condition makes it unreasonably
2218	difficult or medically inadvisable for the individual to
2219	participate in the wellness program. Any reward or incentive
2220	established under this subsection is not an insurance benefit
2221	and does not violate this section. This subsection does not
2222	prohibit an insurer from offering incentives or rewards to
2223	members for adherence to wellness or health improvement programs
2224	if otherwise allowed by state or federal law. Notwithstanding
2225	any provision of this subsection, no insurer, nor its agent, may
2226	use any incentive authorized by this subsection for the purpose
2227	of redirecting patients from one health care insurance plan to
2228	another.
2229	Section 47. This act shall take effect July 1, 2010.

CODING: Words stricken are deletions; words underlined are additions.