Bill Text: FL S0594 | 2013 | Regular Session | Comm Sub


Bill Title: Health Care Accreditation

Spectrum: Slight Partisan Bill (? 2-1)

Status: (Introduced - Dead) 2013-04-29 - Laid on Table, companion bill(s) passed, see CS/HB 1071 (Ch. 2013-93) [S0594 Detail]

Download: Florida-2013-S0594-Comm_Sub.html
       Florida Senate - 2013                       CS for CS for SB 594
       
       
       
       By the Committees on Rules; and Banking and Insurance; and
       Senator Bean
       
       
       
       595-04843-13                                           2013594c2
    1                        A bill to be entitled                      
    2         An act relating to health care accreditation; amending
    3         ss. 154.11, 394.741, 397.403, 400.925, 400.9935,
    4         402.7306, 408.05, 430.80, 440.13, 627.645, 627.668,
    5         627.669, 627.736, 641.495, and 766.1015, F.S.;
    6         conforming provisions to the revised definition of the
    7         term “accrediting organizations” in s. 395.002, F.S.,
    8         as amended by s. 4, ch. 2012-66, Laws of Florida, for
    9         purposes of hospital licensing and regulation by the
   10         Agency for Health Care Administration; amending s.
   11         395.3038, F.S.; deleting an obsolete provision
   12         relating to a requirement that the agency provide
   13         certain notice relating to stroke centers to
   14         hospitals; conforming provisions to changes made by
   15         the act; providing an effective date.
   16  
   17  Be It Enacted by the Legislature of the State of Florida:
   18  
   19         Section 1. Paragraph (n) of subsection (1) of section
   20  154.11, Florida Statutes, is amended to read:
   21         154.11 Powers of board of trustees.—
   22         (1) The board of trustees of each public health trust shall
   23  be deemed to exercise a public and essential governmental
   24  function of both the state and the county and in furtherance
   25  thereof it shall, subject to limitation by the governing body of
   26  the county in which such board is located, have all of the
   27  powers necessary or convenient to carry out the operation and
   28  governance of designated health care facilities, including, but
   29  without limiting the generality of, the foregoing:
   30         (n) To appoint originally the staff of physicians to
   31  practice in a any designated facility owned or operated by the
   32  board and to approve the bylaws and rules to be adopted by the
   33  medical staff of a any designated facility owned and operated by
   34  the board, such governing regulations shall to be in accordance
   35  with the standards of the Joint Commission on the Accreditation
   36  of Hospitals which provide, among other things, for the method
   37  of appointing additional staff members and for the removal of
   38  staff members.
   39         Section 2. Subsection (2) of section 394.741, Florida
   40  Statutes, is amended to read:
   41         394.741 Accreditation requirements for providers of
   42  behavioral health care services.—
   43         (2) Notwithstanding any provision of law to the contrary,
   44  accreditation shall be accepted by the agency and department in
   45  lieu of the agency’s and department’s facility licensure onsite
   46  review requirements and shall be accepted as a substitute for
   47  the department’s administrative and program monitoring
   48  requirements, except as required by subsections (3) and (4),
   49  for:
   50         (a) An Any organization from which the department purchases
   51  behavioral health care services which that is accredited by an
   52  accrediting organization whose standards incorporate comparable
   53  licensure regulations required by this state the Joint
   54  Commission on Accreditation of Healthcare Organizations or the
   55  Council on Accreditation for Children and Family Services, or
   56  has those services that are being purchased by the department
   57  accredited by CARF—the Rehabilitation Accreditation Commission.
   58         (b) A Any mental health facility licensed by the agency or
   59  a any substance abuse component licensed by the department which
   60  that is accredited by an accrediting organization whose
   61  standards incorporate comparable licensure regulations required
   62  by this state the Joint Commission on Accreditation of
   63  Healthcare Organizations, CARF—the Rehabilitation Accreditation
   64  Commission, or the Council on Accreditation of Children and
   65  Family Services.
   66         (c) A Any network of providers from which the department or
   67  the agency purchases behavioral health care services accredited
   68  by an accrediting organization whose standards incorporate
   69  comparable licensure regulations required by this state the
   70  Joint Commission on Accreditation of Healthcare Organizations,
   71  CARF—the Rehabilitation Accreditation Commission, the Council on
   72  Accreditation of Children and Family Services, or the National
   73  Committee for Quality Assurance. A provider organization that,
   74  which is part of an accredited network, is afforded the same
   75  rights under this part.
   76         Section 3. Section 395.3038, Florida Statutes, is amended
   77  to read:
   78         395.3038 State-listed primary stroke centers and
   79  comprehensive stroke centers; notification of hospitals.—
   80         (1) The agency shall make available on its website and to
   81  the department a list of the name and address of each hospital
   82  that meets the criteria for a primary stroke center and the name
   83  and address of each hospital that meets the criteria for a
   84  comprehensive stroke center. The list of primary and
   85  comprehensive stroke centers must shall include only those
   86  hospitals that attest in an affidavit submitted to the agency
   87  that the hospital meets the named criteria, or those hospitals
   88  that attest in an affidavit submitted to the agency that the
   89  hospital is certified as a primary or a comprehensive stroke
   90  center by an accrediting organization the Joint Commission on
   91  Accreditation of Healthcare Organizations.
   92         (2)(a) If a hospital no longer chooses to meet the criteria
   93  for a primary or comprehensive stroke center, the hospital shall
   94  notify the agency and the agency shall immediately remove the
   95  hospital from the list.
   96         (b)1. This subsection does not apply if the hospital is
   97  unable to provide stroke treatment services for a period of time
   98  not to exceed 2 months. The hospital shall immediately notify
   99  all local emergency medical services providers when the
  100  temporary unavailability of stroke treatment services begins and
  101  when the services resume.
  102         2. If stroke treatment services are unavailable for more
  103  than 2 months, the agency shall remove the hospital from the
  104  list of primary or comprehensive stroke centers until the
  105  hospital notifies the agency that stroke treatment services have
  106  been resumed.
  107         (3) The agency shall notify all hospitals in this state by
  108  February 15, 2005, that the agency is compiling a list of
  109  primary stroke centers and comprehensive stroke centers in this
  110  state. The notice shall include an explanation of the criteria
  111  necessary for designation as a primary stroke center and the
  112  criteria necessary for designation as a comprehensive stroke
  113  center. The notice shall also advise hospitals of the process by
  114  which a hospital might be added to the list of primary or
  115  comprehensive stroke centers.
  116         (3)(4) The agency shall adopt by rule criteria for a
  117  primary stroke center which are substantially similar to the
  118  certification standards for primary stroke centers of the Joint
  119  Commission on Accreditation of Healthcare Organizations.
  120         (4)(5) The agency shall adopt by rule criteria for a
  121  comprehensive stroke center. However, if the Joint Commission on
  122  Accreditation of Healthcare Organizations establishes criteria
  123  for a comprehensive stroke center, the agency rules shall be
  124  establish criteria for a comprehensive stroke center which are
  125  substantially similar to those criteria established by the Joint
  126  Commission on Accreditation of Healthcare Organizations.
  127         (5)(6) This act is not a medical practice guideline and may
  128  not be used to restrict the authority of a hospital to provide
  129  services for which it is licensed has received a license under
  130  chapter 395. The Legislature intends that all patients be
  131  treated individually based on each patient’s needs and
  132  circumstances.
  133         Section 4. Subsection (3) of section 397.403, Florida
  134  Statutes, is amended to read:
  135         397.403 License application.—
  136         (3) The department shall accept proof of accreditation by
  137  an accrediting organization whose standards incorporate
  138  comparable licensure regulations required by this state the
  139  Commission on Accreditation of Rehabilitation Facilities(CARF)
  140  or the joint commission, or through another any other nationally
  141  recognized certification process that is acceptable to the
  142  department and meets the minimum licensure requirements under
  143  this chapter, in lieu of requiring the applicant to submit the
  144  information required by paragraphs (1)(a)-(c).
  145         Section 5. Subsection (1) of section 400.925, Florida
  146  Statutes, is amended to read:
  147         400.925 Definitions.—As used in this part, the term:
  148         (1) “Accrediting organizations” means an organization the
  149  Joint Commission on Accreditation of Healthcare Organizations or
  150  other national accreditation agencies whose standards
  151  incorporate licensure regulations for accreditation are
  152  comparable to those required by this state part for licensure.
  153         Section 6. Paragraph (g) of subsection (1) and paragraph
  154  (a) of subsection (7) of section 400.9935, Florida Statutes, are
  155  amended to read:
  156         400.9935 Clinic responsibilities.—
  157         (1) Each clinic shall appoint a medical director or clinic
  158  director who shall agree in writing to accept legal
  159  responsibility for the following activities on behalf of the
  160  clinic. The medical director or the clinic director shall:
  161         (g) Conduct systematic reviews of clinic billings to ensure
  162  that the billings are not fraudulent or unlawful. Upon discovery
  163  of an unlawful charge, the medical director or clinic director
  164  shall take immediate corrective action. If the clinic performs
  165  only the technical component of magnetic resonance imaging,
  166  static radiographs, computed tomography, or positron emission
  167  tomography, and provides the professional interpretation of such
  168  services, in a fixed facility that is accredited by a national
  169  accrediting organization that is approved by the Centers for
  170  Medicare and Medicaid Services for magnetic resonance imaging
  171  and advanced diagnostic imaging services the Joint Commission on
  172  Accreditation of Healthcare Organizations or the Accreditation
  173  Association for Ambulatory Health Care, and the American College
  174  of Radiology; and if, in the preceding quarter, the percentage
  175  of scans performed by that clinic which was billed to all
  176  personal injury protection insurance carriers was less than 15
  177  percent, the chief financial officer of the clinic may, in a
  178  written acknowledgment provided to the agency, assume the
  179  responsibility for the conduct of the systematic reviews of
  180  clinic billings to ensure that the billings are not fraudulent
  181  or unlawful.
  182         (7)(a) Each clinic engaged in magnetic resonance imaging
  183  services must be accredited by a national accrediting
  184  organization that is approved by the Centers for Medicare and
  185  Medicaid Services for magnetic resonance imaging and advanced
  186  diagnostic imaging services the Joint Commission on
  187  Accreditation of Healthcare Organizations, the American College
  188  of Radiology, or the Accreditation Association for Ambulatory
  189  Health Care, within 1 year after licensure. A clinic that is
  190  accredited by the American College of Radiology or that is
  191  within the original 1-year period after licensure and replaces
  192  its core magnetic resonance imaging equipment shall be given 1
  193  year after the date on which the equipment is replaced to attain
  194  accreditation. However, a clinic may request a single, 6-month
  195  extension if it provides evidence to the agency establishing
  196  that, for good cause shown, such clinic cannot be accredited
  197  within 1 year after licensure, and that such accreditation will
  198  be completed within the 6-month extension. After obtaining
  199  accreditation as required by this subsection, each such clinic
  200  must maintain accreditation as a condition of renewal of its
  201  license. A clinic that files a change of ownership application
  202  must comply with the original accreditation timeframe
  203  requirements of the transferor. The agency shall deny a change
  204  of ownership application if the clinic is not in compliance with
  205  the accreditation requirements. When a clinic adds, replaces, or
  206  modifies magnetic resonance imaging equipment and the
  207  accrediting accreditation agency requires new accreditation, the
  208  clinic must be accredited within 1 year after the date of the
  209  addition, replacement, or modification but may request a single,
  210  6-month extension if the clinic provides evidence of good cause
  211  to the agency.
  212         Section 7. Subsections (1) and (2) of section 402.7306,
  213  Florida Statutes, are amended to read:
  214         402.7306 Administrative monitoring of child welfare
  215  providers, and administrative, licensure, and programmatic
  216  monitoring of mental health and substance abuse service
  217  providers.—The Department of Children and Family Services, the
  218  Department of Health, the Agency for Persons with Disabilities,
  219  the Agency for Health Care Administration, community-based care
  220  lead agencies, managing entities as defined in s. 394.9082, and
  221  agencies who have contracted with monitoring agents shall
  222  identify and implement changes that improve the efficiency of
  223  administrative monitoring of child welfare services, and the
  224  administrative, licensure, and programmatic monitoring of mental
  225  health and substance abuse service providers. For the purpose of
  226  this section, the term “mental health and substance abuse
  227  service provider” means a provider who provides services to this
  228  state’s priority population as defined in s. 394.674. To assist
  229  with that goal, each such agency shall adopt the following
  230  policies:
  231         (1) Limit administrative monitoring to once every 3 years
  232  if the child welfare provider is accredited by an accrediting
  233  organization whose standards incorporate comparable licensure
  234  regulations required by this state the Joint Commission, the
  235  Commission on Accreditation of Rehabilitation Facilities, or the
  236  Council on Accreditation. If the accrediting body does not
  237  require documentation that the state agency requires, that
  238  documentation shall be requested by the state agency and may be
  239  posted by the service provider on the data warehouse for the
  240  agency’s review. Notwithstanding the survey or inspection of an
  241  accrediting organization specified in this subsection, an agency
  242  specified in and subject to this section may continue to monitor
  243  the service provider as necessary with respect to:
  244         (a) Ensuring that services for which the agency is paying
  245  are being provided.
  246         (b) Investigating complaints or suspected problems and
  247  monitoring the service provider’s compliance with any resulting
  248  negotiated terms and conditions, including provisions relating
  249  to consent decrees that are unique to a specific service and are
  250  not statements of general applicability.
  251         (c) Ensuring compliance with federal and state laws,
  252  federal regulations, or state rules if such monitoring does not
  253  duplicate the accrediting organization’s review pursuant to
  254  accreditation standards.
  255  
  256  Medicaid certification and precertification reviews are exempt
  257  from this subsection to ensure Medicaid compliance.
  258         (2) Limit administrative, licensure, and programmatic
  259  monitoring to once every 3 years if the mental health or
  260  substance abuse service provider is accredited by an accrediting
  261  organization whose standards incorporate comparable licensure
  262  regulations required by this state the Joint Commission, the
  263  Commission on Accreditation of Rehabilitation Facilities, or the
  264  Council on Accreditation. If the services being monitored are
  265  not the services for which the provider is accredited, the
  266  limitations of this subsection do not apply. If the accrediting
  267  body does not require documentation that the state agency
  268  requires, that documentation, except documentation relating to
  269  licensure applications and fees, must be requested by the state
  270  agency and may be posted by the service provider on the data
  271  warehouse for the agency’s review. Notwithstanding the survey or
  272  inspection of an accrediting organization specified in this
  273  subsection, an agency specified in and subject to this section
  274  may continue to monitor the service provider as necessary with
  275  respect to:
  276         (a) Ensuring that services for which the agency is paying
  277  are being provided.
  278         (b) Investigating complaints, identifying problems that
  279  would affect the safety or viability of the service provider,
  280  and monitoring the service provider’s compliance with any
  281  resulting negotiated terms and conditions, including provisions
  282  relating to consent decrees that are unique to a specific
  283  service and are not statements of general applicability.
  284         (c) Ensuring compliance with federal and state laws,
  285  federal regulations, or state rules if such monitoring does not
  286  duplicate the accrediting organization’s review pursuant to
  287  accreditation standards.
  288  
  289  Federal certification and precertification reviews are exempt
  290  from this subsection to ensure Medicaid compliance.
  291         Section 8. Paragraph (k) of subsection (3) of section
  292  408.05, Florida Statutes, is amended to read:
  293         408.05 Florida Center for Health Information and Policy
  294  Analysis.—
  295         (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.—In order to
  296  produce comparable and uniform health information and statistics
  297  for the development of policy recommendations, the agency shall
  298  perform the following functions:
  299         (k) Develop, in conjunction with the State Consumer Health
  300  Information and Policy Advisory Council, and implement a long
  301  range plan for making available health care quality measures and
  302  financial data that will allow consumers to compare health care
  303  services. The health care quality measures and financial data
  304  the agency must make available includes shall include, but is
  305  not limited to, pharmaceuticals, physicians, health care
  306  facilities, and health plans and managed care entities. The
  307  agency shall update the plan and report on the status of its
  308  implementation annually. The agency shall also make the plan and
  309  status report available to the public on its Internet website.
  310  As part of the plan, the agency shall identify the process and
  311  timeframes for implementation, any barriers to implementation,
  312  and recommendations of changes in the law that may be enacted by
  313  the Legislature to eliminate the barriers. As preliminary
  314  elements of the plan, the agency shall:
  315         1. Make available patient-safety indicators, inpatient
  316  quality indicators, and performance outcome and patient charge
  317  data collected from health care facilities pursuant to s.
  318  408.061(1)(a) and (2). The terms “patient-safety indicators” and
  319  “inpatient quality indicators” have the same meaning as that
  320  ascribed shall be as defined by the Centers for Medicare and
  321  Medicaid Services, an accrediting organization whose standards
  322  incorporate comparable regulations required by this state, the
  323  National Quality Forum, the Joint Commission on Accreditation of
  324  Healthcare Organizations, the Agency for Healthcare Research and
  325  Quality, the Centers for Disease Control and Prevention, or a
  326  similar national entity that establishes standards to measure
  327  the performance of health care providers, or by other states.
  328  The agency shall determine which conditions, procedures, health
  329  care quality measures, and patient charge data to disclose based
  330  upon input from the council. When determining which conditions
  331  and procedures are to be disclosed, the council and the agency
  332  shall consider variation in costs, variation in outcomes, and
  333  magnitude of variations and other relevant information. When
  334  determining which health care quality measures to disclose, the
  335  agency:
  336         a. Shall consider such factors as volume of cases; average
  337  patient charges; average length of stay; complication rates;
  338  mortality rates; and infection rates, among others, which shall
  339  be adjusted for case mix and severity, if applicable.
  340         b. May consider such additional measures that are adopted
  341  by the Centers for Medicare and Medicaid Studies, an accrediting
  342  organization whose standards incorporate comparable regulations
  343  required by this state, the National Quality Forum, the Joint
  344  Commission on Accreditation of Healthcare Organizations, the
  345  Agency for Healthcare Research and Quality, the Centers for
  346  Disease Control and Prevention, or a similar national entity
  347  that establishes standards to measure the performance of health
  348  care providers, or by other states.
  349  
  350  When determining which patient charge data to disclose, the
  351  agency shall include such measures as the average of
  352  undiscounted charges on frequently performed procedures and
  353  preventive diagnostic procedures, the range of procedure charges
  354  from highest to lowest, average net revenue per adjusted patient
  355  day, average cost per adjusted patient day, and average cost per
  356  admission, among others.
  357         2. Make available performance measures, benefit design, and
  358  premium cost data from health plans licensed pursuant to chapter
  359  627 or chapter 641. The agency shall determine which health care
  360  quality measures and member and subscriber cost data to
  361  disclose, based upon input from the council. When determining
  362  which data to disclose, the agency shall consider information
  363  that may be required by either individual or group purchasers to
  364  assess the value of the product, which may include membership
  365  satisfaction, quality of care, current enrollment or membership,
  366  coverage areas, accreditation status, premium costs, plan costs,
  367  premium increases, range of benefits, copayments and
  368  deductibles, accuracy and speed of claims payment, credentials
  369  of physicians, number of providers, names of network providers,
  370  and hospitals in the network. Health plans shall make available
  371  to the agency any such data or information that is not currently
  372  reported to the agency or the office.
  373         3. Determine the method and format for public disclosure of
  374  data reported pursuant to this paragraph. The agency shall make
  375  its determination based upon input from the State Consumer
  376  Health Information and Policy Advisory Council. At a minimum,
  377  the data shall be made available on the agency’s Internet
  378  website in a manner that allows consumers to conduct an
  379  interactive search that allows them to view and compare the
  380  information for specific providers. The website must include
  381  such additional information as is determined necessary to ensure
  382  that the website enhances informed decisionmaking among
  383  consumers and health care purchasers, which shall include, at a
  384  minimum, appropriate guidance on how to use the data and an
  385  explanation of why the data may vary from provider to provider.
  386         4. Publish on its website undiscounted charges for no fewer
  387  than 150 of the most commonly performed adult and pediatric
  388  procedures, including outpatient, inpatient, diagnostic, and
  389  preventative procedures.
  390         Section 9. Paragraph (b) of subsection (3) of section
  391  430.80, Florida Statutes, is amended to read:
  392         430.80 Implementation of a teaching nursing home pilot
  393  project.—
  394         (3) To be designated as a teaching nursing home, a nursing
  395  home licensee must, at a minimum:
  396         (b) Participate in a nationally recognized accrediting
  397  accreditation program and hold a valid accreditation, such as
  398  the accreditation awarded by the Joint Commission on
  399  Accreditation of Healthcare Organizations, or, at the time of
  400  initial designation, possess a Gold Seal Award as conferred by
  401  the state on its licensed nursing home;
  402         Section 10. Paragraph (a) of subsection (2) of section
  403  440.13, Florida Statutes, is amended to read:
  404         440.13 Medical services and supplies; penalty for
  405  violations; limitations.—
  406         (2) MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.—
  407         (a) Subject to the limitations specified elsewhere in this
  408  chapter, the employer shall furnish to the employee such
  409  medically necessary remedial treatment, care, and attendance for
  410  such period as the nature of the injury or the process of
  411  recovery may require, which is in accordance with established
  412  practice parameters and protocols of treatment as provided for
  413  in this chapter, including medicines, medical supplies, durable
  414  medical equipment, orthoses, prostheses, and other medically
  415  necessary apparatus. Remedial treatment, care, and attendance,
  416  including work-hardening programs or pain-management programs
  417  accredited by an accrediting organization whose standards
  418  incorporate comparable regulations required by this state the
  419  Commission on Accreditation of Rehabilitation Facilities or
  420  Joint Commission on the Accreditation of Health Organizations or
  421  pain-management programs affiliated with medical schools, shall
  422  be considered as covered treatment only when such care is given
  423  based on a referral by a physician as defined in this chapter.
  424  Medically necessary treatment, care, and attendance does not
  425  include chiropractic services in excess of 24 treatments or
  426  rendered 12 weeks beyond the date of the initial chiropractic
  427  treatment, whichever comes first, unless the carrier authorizes
  428  additional treatment or the employee is catastrophically
  429  injured.
  430  
  431  Failure of the carrier to timely comply with this subsection
  432  shall be a violation of this chapter and the carrier shall be
  433  subject to penalties as provided for in s. 440.525.
  434         Section 11. Subsection (1) of section 627.645, Florida
  435  Statutes, is amended to read:
  436         627.645 Denial of health insurance claims restricted.—
  437         (1) A No claim for payment under a health insurance policy
  438  or self-insured program of health benefits for treatment, care,
  439  or services in a licensed hospital that which is accredited by
  440  an accrediting organization whose standards incorporate
  441  comparable regulations required by this state may not the Joint
  442  Commission on the Accreditation of Hospitals, the American
  443  Osteopathic Association, or the Commission on the Accreditation
  444  of Rehabilitative Facilities shall be denied because such
  445  hospital lacks major surgical facilities and is primarily of a
  446  rehabilitative nature, if such rehabilitation is specifically
  447  for treatment of physical disability.
  448         Section 12. Paragraph (c) of subsection (2) of section
  449  627.668, Florida Statutes, is amended to read:
  450         627.668 Optional coverage for mental and nervous disorders
  451  required; exception.—
  452         (2) Under group policies or contracts, inpatient hospital
  453  benefits, partial hospitalization benefits, and outpatient
  454  benefits consisting of durational limits, dollar amounts,
  455  deductibles, and coinsurance factors shall not be less favorable
  456  than for physical illness generally, except that:
  457         (c) Partial hospitalization benefits shall be provided
  458  under the direction of a licensed physician. For purposes of
  459  this part, the term “partial hospitalization services” is
  460  defined as those services offered by a program that is
  461  accredited by an accrediting organization whose standards
  462  incorporate comparable regulations required by this state the
  463  Joint Commission on Accreditation of Hospitals (JCAH) or in
  464  compliance with equivalent standards. Alcohol rehabilitation
  465  programs accredited by an accrediting organization whose
  466  standards incorporate comparable regulations required by this
  467  state the Joint Commission on Accreditation of Hospitals or
  468  approved by the state and licensed drug abuse rehabilitation
  469  programs shall also be qualified providers under this section.
  470  In a given any benefit year, if partial hospitalization services
  471  or a combination of inpatient and partial hospitalization are
  472  used utilized, the total benefits paid for all such services may
  473  shall not exceed the cost of 30 days after of inpatient
  474  hospitalization for psychiatric services, including physician
  475  fees, which prevail in the community in which the partial
  476  hospitalization services are rendered. If partial
  477  hospitalization services benefits are provided beyond the limits
  478  set forth in this paragraph, the durational limits, dollar
  479  amounts, and coinsurance factors thereof need not be the same as
  480  those applicable to physical illness generally.
  481         Section 13. Subsection (3) of section 627.669, Florida
  482  Statutes, is amended to read:
  483         627.669 Optional coverage required for substance abuse
  484  impaired persons; exception.—
  485         (3) The benefits provided under this section are shall be
  486  applicable only if treatment is provided by, or under the
  487  supervision of, or is prescribed by, a licensed physician or
  488  licensed psychologist and if services are provided in a program
  489  that is accredited by an accrediting organization whose
  490  standards incorporate comparable regulations required by this
  491  state the Joint Commission on Accreditation of Hospitals or that
  492  is approved by this the state.
  493         Section 14. Paragraph (a) of subsection (1) of section
  494  627.736, Florida Statutes, is amended to read:
  495         627.736 Required personal injury protection benefits;
  496  exclusions; priority; claims.—
  497         (1) REQUIRED BENEFITS.—An insurance policy complying with
  498  the security requirements of s. 627.733 must provide personal
  499  injury protection to the named insured, relatives residing in
  500  the same household, persons operating the insured motor vehicle,
  501  passengers in the motor vehicle, and other persons struck by the
  502  motor vehicle and suffering bodily injury while not an occupant
  503  of a self-propelled vehicle, subject to subsection (2) and
  504  paragraph (4)(e), to a limit of $10,000 in medical and
  505  disability benefits and $5,000 in death benefits resulting from
  506  bodily injury, sickness, disease, or death arising out of the
  507  ownership, maintenance, or use of a motor vehicle as follows:
  508         (a) Medical benefits.—Eighty percent of all reasonable
  509  expenses for medically necessary medical, surgical, X-ray,
  510  dental, and rehabilitative services, including prosthetic
  511  devices and medically necessary ambulance, hospital, and nursing
  512  services if the individual receives initial services and care
  513  pursuant to subparagraph 1. within 14 days after the motor
  514  vehicle accident. The medical benefits provide reimbursement
  515  only for:
  516         1. Initial services and care that are lawfully provided,
  517  supervised, ordered, or prescribed by a physician licensed under
  518  chapter 458 or chapter 459, a dentist licensed under chapter
  519  466, or a chiropractic physician licensed under chapter 460 or
  520  that are provided in a hospital or in a facility that owns, or
  521  is wholly owned by, a hospital. Initial services and care may
  522  also be provided by a person or entity licensed under part III
  523  of chapter 401 which provides emergency transportation and
  524  treatment.
  525         2. Upon referral by a provider described in subparagraph
  526  1., followup services and care consistent with the underlying
  527  medical diagnosis rendered pursuant to subparagraph 1. which may
  528  be provided, supervised, ordered, or prescribed only by a
  529  physician licensed under chapter 458 or chapter 459, a
  530  chiropractic physician licensed under chapter 460, a dentist
  531  licensed under chapter 466, or, to the extent permitted by
  532  applicable law and under the supervision of such physician,
  533  osteopathic physician, chiropractic physician, or dentist, by a
  534  physician assistant licensed under chapter 458 or chapter 459 or
  535  an advanced registered nurse practitioner licensed under chapter
  536  464. Followup services and care may also be provided by any of
  537  the following persons or entities:
  538         a. A hospital or ambulatory surgical center licensed under
  539  chapter 395.
  540         b. An entity wholly owned by one or more physicians
  541  licensed under chapter 458 or chapter 459, chiropractic
  542  physicians licensed under chapter 460, or dentists licensed
  543  under chapter 466 or by such practitioners and the spouse,
  544  parent, child, or sibling of such practitioners.
  545         c. An entity that owns or is wholly owned, directly or
  546  indirectly, by a hospital or hospitals.
  547         d. A physical therapist licensed under chapter 486, based
  548  upon a referral by a provider described in this subparagraph.
  549         e. A health care clinic licensed under part X of chapter
  550  400 which is accredited by an accrediting organization whose
  551  standards incorporate comparable regulations required by this
  552  state the Joint Commission on Accreditation of Healthcare
  553  Organizations, the American Osteopathic Association, the
  554  Commission on Accreditation of Rehabilitation Facilities, or the
  555  Accreditation Association for Ambulatory Health Care, Inc., or
  556         (I) Has a medical director licensed under chapter 458,
  557  chapter 459, or chapter 460;
  558         (II) Has been continuously licensed for more than 3 years
  559  or is a publicly traded corporation that issues securities
  560  traded on an exchange registered with the United States
  561  Securities and Exchange Commission as a national securities
  562  exchange; and
  563         (III) Provides at least four of the following medical
  564  specialties:
  565         (A) General medicine.
  566         (B) Radiography.
  567         (C) Orthopedic medicine.
  568         (D) Physical medicine.
  569         (E) Physical therapy.
  570         (F) Physical rehabilitation.
  571         (G) Prescribing or dispensing outpatient prescription
  572  medication.
  573         (H) Laboratory services.
  574         3. Reimbursement for services and care provided in
  575  subparagraph 1. or subparagraph 2. up to $10,000 if a physician
  576  licensed under chapter 458 or chapter 459, a dentist licensed
  577  under chapter 466, a physician assistant licensed under chapter
  578  458 or chapter 459, or an advanced registered nurse practitioner
  579  licensed under chapter 464 has determined that the injured
  580  person had an emergency medical condition.
  581         4. Reimbursement for services and care provided in
  582  subparagraph 1. or subparagraph 2. is limited to $2,500 if a any
  583  provider listed in subparagraph 1. or subparagraph 2. determines
  584  that the injured person did not have an emergency medical
  585  condition.
  586         5. Medical benefits do not include massage as defined in s.
  587  480.033 or acupuncture as defined in s. 457.102, regardless of
  588  the person, entity, or licensee providing massage or
  589  acupuncture, and a licensed massage therapist or licensed
  590  acupuncturist may not be reimbursed for medical benefits under
  591  this section.
  592         6. The Financial Services Commission shall adopt by rule
  593  the form that must be used by an insurer and a health care
  594  provider specified in sub-subparagraph 2.b., sub-subparagraph
  595  2.c., or sub-subparagraph 2.e. to document that the health care
  596  provider meets the criteria of this paragraph. Such, which rule
  597  must include a requirement for a sworn statement or affidavit.
  598  
  599  Only insurers writing motor vehicle liability insurance in this
  600  state may provide the required benefits of this section, and
  601  such insurer may not require the purchase of any other motor
  602  vehicle coverage other than the purchase of property damage
  603  liability coverage as required by s. 627.7275 as a condition for
  604  providing such benefits. Insurers may not require that property
  605  damage liability insurance in an amount greater than $10,000 be
  606  purchased in conjunction with personal injury protection. Such
  607  insurers shall make benefits and required property damage
  608  liability insurance coverage available through normal marketing
  609  channels. An insurer writing motor vehicle liability insurance
  610  in this state who fails to comply with such availability
  611  requirement as a general business practice violates part IX of
  612  chapter 626, and such violation constitutes an unfair method of
  613  competition or an unfair or deceptive act or practice involving
  614  the business of insurance. An insurer committing such violation
  615  is subject to the penalties provided under that part, as well as
  616  those provided elsewhere in the insurance code.
  617         Section 15. Subsection (12) of section 641.495, Florida
  618  Statutes, is amended to read:
  619         641.495 Requirements for issuance and maintenance of
  620  certificate.—
  621         (12) The provisions of part I of chapter 395 do not apply
  622  to a health maintenance organization that, on or before January
  623  1, 1991, provides not more than 10 outpatient holding beds for
  624  short-term and hospice-type patients in an ambulatory care
  625  facility for its members, provided that such health maintenance
  626  organization maintains current accreditation by an accrediting
  627  organization whose standards incorporate comparable regulations
  628  required by this state the Joint Commission on Accreditation of
  629  Health Care Organizations, the Accreditation Association for
  630  Ambulatory Health Care, or the National Committee for Quality
  631  Assurance.
  632         Section 16. Subsection (2) of section 766.1015, Florida
  633  Statutes, is amended to read:
  634         766.1015 Civil immunity for members of or consultants to
  635  certain boards, committees, or other entities.—
  636         (2) Such committee, board, group, commission, or other
  637  entity must be established in accordance with state law, or in
  638  accordance with requirements of an applicable accrediting
  639  organization whose standards incorporate comparable regulations
  640  required by this state the Joint Commission on Accreditation of
  641  Healthcare Organizations, established and duly constituted by
  642  one or more public or licensed private hospitals or behavioral
  643  health agencies, or established by a governmental agency. To be
  644  protected by this section, the act, decision, omission, or
  645  utterance may not be made or done in bad faith or with malicious
  646  intent.
  647         Section 17. This act shall take effect July 1, 2013.

feedback