Bill Text: FL S1256 | 2010 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Physician Workforce [SPSC]
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2010-04-30 - Died on Calendar, companion bill(s) passed, see HB 5311 (Ch. 2010-161) [S1256 Detail]
Download: Florida-2010-S1256-Introduced.html
Bill Title: Physician Workforce [SPSC]
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2010-04-30 - Died on Calendar, companion bill(s) passed, see HB 5311 (Ch. 2010-161) [S1256 Detail]
Download: Florida-2010-S1256-Introduced.html
Florida Senate - 2010 SB 1256 By Senator Peaden 2-00484-10 20101256__ 1 A bill to be entitled 2 An act relating to the physician workforce; repealing 3 s. 381.0403, F.S., relating to the Community Hospital 4 Education Act and the Community Hospital Education 5 Council; amending s. 381.4018, F.S.; providing 6 definitions; revising the list of governmental 7 stakeholders that the Department of Health is required 8 to work with regarding the state strategic plan and in 9 assessing the state’s physician workforce; creating 10 the Physician Workforce Advisory Council; providing 11 membership of the council; providing for appointments 12 to the council; providing terms of membership; 13 providing for removal of a council member; providing 14 for the chair and vice chair of the council; providing 15 that council members are not entitled to receive 16 compensation or reimbursement for per diem or travel 17 expenses; providing the duties of the council; 18 establishing the physician workforce graduate medical 19 education innovation pilot projects under the 20 department; providing the purposes of the pilot 21 projects; providing for the appropriation of state 22 funds for the pilot projects; requiring the pilot 23 projects to meet certain policy needs of the physician 24 workforce in this state; providing criteria for 25 prioritizing proposals for pilot projects; requiring 26 the department to adopt by rule appropriate 27 performance measures; requiring participating pilot 28 projects to submit an annual report to the department; 29 requiring state funds to be used to supplement funds 30 from other sources; requiring the department to adopt 31 rules; amending ss. 458.3192 and 459.0082, F.S.; 32 requiring the department to determine by geographic 33 area and specialty the number of physicians and 34 osteopathic physicians who plan to relocate outside 35 the state, practice medicine in this state, and reduce 36 or modify the scope of their practice; authorizing the 37 department to report additional information in its 38 findings to the Governor and the Legislature; amending 39 s. 409.908, F.S.; conforming a cross-reference; 40 providing an effective date. 41 42 Be It Enacted by the Legislature of the State of Florida: 43 44 Section 1. Section 381.0403, Florida Statutes, is repealed. 45 Section 2. Section 381.4018, Florida Statutes, is amended 46 to read: 47 381.4018 Physician workforce assessment and development.— 48 (1) DEFINITIONS.—As used in this section, the term: 49 (a) “Consortium” or “consortia” means a combination of 50 statutory teaching hospitals, statutory rural hospitals, other 51 hospitals, accredited medical schools, clinics operated by the 52 Department of Health, clinics operated by the Department of 53 Veterans’ Affairs, area health education centers, community 54 health centers, federally qualified health centers, prison 55 clinics, local community clinics, or other programs. At least 56 one member of the consortium shall be a sponsoring institution 57 accredited or currently seeking accreditation by the 58 Accreditation Council for Graduate Medical Education or the 59 American Osteopathic Association. 60 (b) “Council” means the Physician Workforce Advisory 61 Council. 62 (c) “Department” means the Department of Health. 63 (d) “Graduate medical education program” means a program 64 accredited by the Accreditation Council for Graduate Medical 65 Education or the American Osteopathic Association. 66 (e) “Primary care specialty” means emergency medicine, 67 family practice, internal medicine, pediatrics, psychiatry, 68 obstetrics and gynecology, and combined internal medicine and 69 other specialties as determined by the Physician Workforce 70 Advisory Council or the Department of Health. 71 (2)(1)LEGISLATIVE INTENT.—The Legislature recognizes that 72 physician workforce planning is an essential component of 73 ensuring that there is an adequate and appropriate supply of 74 well-trained physicians to meet this state’s future health care 75 service needs as the general population and elderly population 76 of the state increase. The Legislature finds that items to 77 consider relative to assessing the physician workforce may 78 include physician practice status; specialty mix; geographic 79 distribution; demographic information, including, but not 80 limited to, age, gender, race, and cultural considerations; and 81 needs of current or projected medically underserved areas in the 82 state. Long-term strategic planning is essential as the period 83 from the time a medical student enters medical school to 84 completion of graduate medical education may range from 7 to 10 85 years or longer. The Legislature recognizes that strategies to 86 provide for a well-trained supply of physicians must include 87 ensuring the availability and capacity of qualitygraduate88 medical schools and graduate medical education programs in this 89 state, as well as using new or existing state and federal 90 programs providing incentives for physicians to practice in 91 needed specialties and in underserved areas in a manner that 92 addresses projected needs for physician manpower. 93 (3)(2)PURPOSE.—The Department of Health shall serve as a 94 coordinating and strategic planning body to actively assess the 95 state’s current and future physician workforce needs and work 96 with multiple stakeholders to develop strategies and 97 alternatives to address current and projected physician 98 workforce needs. 99 (4)(3)GENERAL FUNCTIONS.—The department shall maximize the 100 use of existing programs under the jurisdiction of the 101 department and other state agencies and coordinate governmental 102 and nongovernmental stakeholders and resources in order to 103 develop a state strategic plan and assess the implementation of 104 such strategic plan. In developing the state strategic plan, the 105 department shall: 106 (a) Monitor, evaluate, and report on the supply and 107 distribution of physicians licensed under chapter 458 or chapter 108 459. The department shall maintain a database to serve as a 109 statewide source of data concerning the physician workforce. 110 (b) Develop a model and quantify, on an ongoing basis, the 111 adequacy of the state’s current and future physician workforce 112 as reliable data becomes available. Such model must take into 113 account demographics, physician practice status, place of 114 education and training, generational changes, population growth, 115 economic indicators, and issues concerning the “pipeline” into 116 medical education. 117 (c) Develop and recommend strategies to determine whether 118 the number of qualified medical school applicants who might 119 become competent, practicing physicians in this state will be 120 sufficient to meet the capacity of the state’s medical schools. 121 If appropriate, the department shall, working with 122 representatives of appropriate governmental and nongovernmental 123 entities, develop strategies and recommendations and identify 124 best practice programs that introduce health care as a 125 profession and strengthen skills needed for medical school 126 admission for elementary, middle, and high school students, and 127 improve premedical education at the precollege and college level 128 in order to increase this state’s potential pool of medical 129 students. 130 (d) Develop strategies to ensure that the number of 131 graduates from the state’s public and private allopathic and 132 osteopathic medical schools are adequate to meet physician 133 workforce needs, based on the analysis of the physician 134 workforce data, so as to provide a high-quality medical 135 education to students in a manner that recognizes the uniqueness 136 of each new and existing medical school in this state. 137 (e) Pursue strategies and policies to create, expand, and 138 maintain graduate medical education positions in the state based 139 on the analysis of the physician workforce data. Such strategies 140 and policies must take into account the effect of federal 141 funding limitations on the expansion and creation of positions 142 in graduate medical education. The department shall develop 143 options to address such federal funding limitations. The 144 department shall consider options to provide direct state 145 funding for graduate medical education positions in a manner 146 that addresses requirements and needs relative to accreditation 147 of graduate medical education programs. The department shall 148 consider funding residency positions as a means of addressing 149 needed physician specialty areas, rural areas having a shortage 150 of physicians, and areas of ongoing critical need, and as a 151 means of addressing the state’s physician workforce needs based 152 on an ongoing analysis of physician workforce data. 153 (f) Develop strategies to maximize federal and state 154 programs that provide for the use of incentives to attract 155 physicians to this state or retain physicians within the state. 156 Such strategies should explore and maximize federal-state 157 partnerships that provide incentives for physicians to practice 158 in federally designated shortage areas. Strategies shall also 159 consider the use of state programs, such as the Florida Health 160 Service Corps established pursuant to s. 381.0302 and the 161 Medical Education Reimbursement and Loan Repayment Program 162 pursuant to s. 1009.65, which provide for education loan 163 repayment or loan forgiveness and provide monetary incentives 164 for physicians to relocate to underserved areas of the state. 165 (g) Coordinate and enhance activities relative to physician 166 workforce needs, undergraduate medical education, and graduate 167 medical education provided by the Division of Medical Quality 168 Assurance,the Community Hospital Education Program and the169Graduate Medical Education Committee established pursuant to s.170381.0403,area health education center networks established 171 pursuant to s. 381.0402, and other offices and programs within 172 the Department of Health as designated by the State Surgeon 173 General. 174 (h) Work in conjunction with and act as a coordinating body 175 for governmental and nongovernmental stakeholders to address 176 matters relating to the state’s physician workforce assessment 177 and development for the purpose of ensuring an adequate supply 178 of well-trained physicians to meet the state’s future needs. 179 Such governmental stakeholders shall include, but need not be 180 limited to, the State Surgeon General or his or her designee, 181 the Commissioner of Education or his or her designee, the 182 Secretary of Health Care Administration or his or her designee, 183 and the Chancellor of the State University System or his or her 184 designeefrom the Board of Governors of the State University185System, and, at the discretion of the department, other 186 representatives of state and local agencies that are involved in 187 assessing, educating, or training the state’s current or future 188 physicians. Other stakeholders shall include, but need not be 189 limited to, organizations representing the state’s public and 190 private allopathic and osteopathic medical schools; 191 organizations representing hospitals and other institutions 192 providing health care, particularly those that have an interest 193 in providing accredited medical education and graduate medical 194 education to medical students and medical residents; 195 organizations representing allopathic and osteopathic practicing 196 physicians; and, at the discretion of the department, 197 representatives of other organizations or entities involved in 198 assessing, educating, or training the state’s current or future 199 physicians. 200 (i) Serve as a liaison with other states and federal 201 agencies and programs in order to enhance resources available to 202 the state’s physician workforce and medical education continuum. 203 (j) Act as a clearinghouse for collecting and disseminating 204 information concerning the physician workforce and medical 205 education continuum in this state. 206 (5) PHYSICIAN WORKFORCE ADVISORY COUNCIL.—There is created 207 in the Department of Health the Physician Workforce Advisory 208 Council, an advisory council as defined in s. 20.03. The council 209 shall comply with the requirements of s. 20.052, except as 210 otherwise provided in this section. 211 (a) The council shall consist of 23 members, appointed by 212 the State Surgeon General, which shall include: 213 1. A designee from the department. 214 2. An individual recommended by the Area Health Education 215 Center Network. 216 3. Two individuals recommended by the Council of Florida 217 Medical School Deans, one representing a college of allopathic 218 medicine and one representing a college of osteopathic medicine. 219 4. Two individuals recommended by the Florida Hospital 220 Association, one representing a statutory teaching hospital and 221 one representing a hospital that is licensed under chapter 395, 222 has an accredited graduate medical education program, and is not 223 a statutory teaching hospital. 224 5. Two individuals recommended by the Florida Medical 225 Association, one representing a primary care specialty and one 226 representing a nonprimary care specialty. 227 6. Two individuals recommended by the Florida Osteopathic 228 Medical Association, one representing a primary care specialty 229 and one representing a nonprimary care specialty. 230 7. Two individuals who are program directors of accredited 231 graduate medical education programs, one representing a program 232 that is accredited by the Accreditation Council for Graduate 233 Medical Education and one representing a program that is 234 accredited by the American Osteopathic Association. 235 8. An individual recommended by the Florida Justice 236 Association. 237 9. An individual representing a profession in the field of 238 health services administration. 239 10. The Commissioner of Education or his or her designee. 240 11. The Chancellor of the State University System or his or 241 her designee. 242 12. The Secretary of Health Care Administration or his or 243 her designee. 244 13. The executive director of the Department of Veterans’ 245 Affairs or his or her designee. 246 14. The Secretary of Elderly Affairs or his or her 247 designee. 248 15. The President of the Senate or his or her designee. 249 16. The Speaker of the House of Representatives or his or 250 her designee. 251 17. A layperson member as determined by the State Surgeon 252 General. 253 18. A designee of Florida’s Congressional Delegation. 254 255 Appointments to the council shall be made by the State Surgeon 256 General, except that representatives from a state agency and 257 legislative representatives shall be appointed by the respective 258 agency head, legislative presiding officer, or congressional 259 delegation. Each entity authorized to make recommendations under 260 this subsection shall make at least two recommendations to the 261 State Surgeon General for each appointment to the council. The 262 State Surgeon General shall name one appointee for each position 263 from the recommendations made by each authorized entity. 264 (b) Each council member shall be appointed to a 4-year 265 term. An individual may not serve more than two terms. Any 266 council member may be removed from office for malfeasance; 267 misfeasance; neglect of duty; incompetence; permanent inability 268 to perform official duties; or pleading guilty or nolo 269 contendere to, or being found guilty of, a felony. Any council 270 member who meets the criteria for removal, or who is otherwise 271 unwilling or unable to properly fulfill the duties of the 272 office, shall be succeeded by an individual chosen by the State 273 Surgeon General to serve out the remainder of the council 274 member’s term. If the remainder of the replaced council member’s 275 term is less than 18 months, notwithstanding the provisions of 276 this paragraph, the succeeding council member may be reappointed 277 twice by the State Surgeon General. 278 (c) The chair of the council is the State Surgeon General, 279 who shall designate a vice chair to serve in the absence of the 280 State Surgeon General. A vacancy shall be filled for the 281 remainder of the unexpired term in the same manner as the 282 original appointment. 283 (d) Council members are not entitled to receive 284 compensation or reimbursement for per diem or travel expenses. 285 (e) The council shall meet twice a year in person or by 286 teleconference. 287 (f) The council shall: 288 1. Advise the State Surgeon General and the department on 289 matters concerning current and future physician workforce needs 290 in this state; 291 2. Review survey materials and the compilation of survey 292 information; 293 3. Provide recommendations to the department for the 294 development of additional items to be incorporated in the survey 295 completed by physicians licensed under chapter 458 or chapter 296 459; 297 4. Assist the department in preparing the annual report to 298 the Legislature pursuant to ss. 458.3192 and 459.0082; 299 5. Assist the department in preparing an initial strategic 300 plan, conduct ongoing strategic planning in accordance with this 301 section, and provide ongoing advice on implementing the 302 recommendations; 303 6. Monitor the need for an increased number of primary care 304 physicians to provide the necessary current and projected health 305 and medical services for the state; and 306 7. Monitor the status of graduate medical education in this 307 state, including, but not limited to, as considered appropriate: 308 a. The effectiveness of graduate medical education pilot 309 projects funded pursuant to subsection (6). 310 b. The role of residents and medical faculty in the 311 provision of health care. 312 c. The relationship of graduate medical education to the 313 state’s physician workforce. 314 d. The availability and use of state and federal 315 appropriated funds for graduate medical education. 316 (6) PHYSICIAN WORKFORCE GRADUATE MEDICAL EDUCATION 317 INNOVATION PILOT PROJECTS.— 318 (a) The Legislature finds that: 319 1. In order to ensure a physician workforce that is 320 adequate to meet the needs of this state’s residents and its 321 health care system, policymakers must consider the training of 322 future generations of well-trained health care providers. 323 2. Physicians are likely to practice in the state where 324 they complete their graduate medical education. The instate 325 retention rate following graduate medical education for 326 physicians in this state is more than 61 percent. 327 3. It can directly affect the makeup of the physician 328 workforce by selectively funding graduate medical education 329 programs to provide needed specialists in geographic areas of 330 the state which have a deficient number of such specialists. 331 4. Developing additional positions in graduate medical 332 education programs is essential to the future of this state’s 333 health care system. 334 5. It was necessary in 2007 to pass legislation that 335 provided for an assessment of the status of this state’s current 336 and future physician workforce. The department is collecting and 337 analyzing information on an ongoing basis to assess this state’s 338 physician workforce needs, and such assessment can serve as a 339 basis for determining graduate medical education needs and 340 strategies for the state. 341 (b) There is established under the department a program to 342 foster innovative graduate medical education pilot projects that 343 are designed to promote the expansion of graduate medical 344 education programs or positions to prepare physicians to 345 practice in needed specialties and underserved areas or settings 346 and to provide demographic and cultural representation in a 347 manner that addresses projected needs for this state’s physician 348 workforce. Funds appropriated annually by the Legislature for 349 this purpose shall be distributed to participating hospitals, 350 medical schools, other sponsors of graduate medical education 351 programs, consortia engaged in developing new graduate medical 352 education programs or positions in those programs, or pilot 353 projects providing innovative graduate medical education in 354 community-based clinical settings. Pilot projects shall be 355 selected on a competitive grant basis, subject to available 356 funds. 357 (c) Pilot projects shall be designed to meet one or more of 358 this state’s physician workforce needs, as determined pursuant 359 to this section, including, but not limited to: 360 1. Increasing the number of residencies or fellowships in 361 primary care or other needed specialties. 362 2. Enhancing the retention of primary care physicians or 363 other needed specialties in this state. 364 3. Promoting practice in rural or medically underserved 365 areas of the state. 366 4. Encouraging racial and ethnic diversity within the 367 state’s physician workforce. 368 5. Encouraging practice in community health care or other 369 ambulatory care settings. 370 6. Encouraging practice in clinics operated by the 371 Department of Health, clinics operated by the Department of 372 Veterans’ Affairs, prison clinics, or similar settings of need. 373 7. Encouraging the increased production of geriatricians. 374 (d) Priority shall be given to a proposal for a pilot 375 project that: 376 1. Demonstrates a collaboration of federal, state, and 377 local entities that are public or private. 378 2. Obtains funding from multiple sources. 379 3. Focuses on enhancing graduate medical education in rural 380 or underserved areas. 381 4. Focuses on enhancing graduate medical education in 382 ambulatory or community-based settings other than a hospital 383 environment. 384 5. Includes the use of technology, such as electronic 385 medical records, distance consultation, and telemedicine, to 386 ensure that residents are better prepared to care for patients 387 in this state, regardless of the community in which the 388 residents practice. 389 6. Is designed to meet multiple policy needs as enumerated 390 in subsection (3). 391 7. Uses a consortium to provide for graduate medical 392 education experiences. 393 (e) The department shall adopt by rule appropriate 394 performance measures to use in order to consistently evaluate 395 the effectiveness, safety, and quality of the programs, as well 396 as the impact of each program on meeting this state’s physician 397 workforce needs. 398 (f) Participating pilot projects shall submit to the 399 department an annual report on the project in a manner required 400 by the department. 401 (g) Funding provided to a pilot project may be used only 402 for the direct costs of providing graduate medical education. 403 Accounting of such costs and expenditures shall be documented in 404 the annual report. 405 (h) State funds shall be used to supplement funds from any 406 local government, community, or private source. The state may 407 provide up to 50 percent of the funds, and local governmental 408 grants or community or private sources shall provide the 409 remainder of the funds. 410 (7) RULEMAKING.—The department shall adopt rules as 411 necessary to administer this section. 412 Section 3. Section 458.3192, Florida Statutes, is amended 413 to read: 414 458.3192 Analysis of survey results; report.— 415 (1) Each year, the Department of Health shall analyze the 416 results of the physician survey required by s. 458.3191 and 417 determine by geographic area and specialty the number of 418 physicians who: 419 (a) Perform deliveries of children in this stateFlorida. 420 (b) Read mammograms and perform breast-imaging-guided 421 procedures in Florida. 422 (c) Perform emergency care on an on-call basis for a 423 hospital emergency department. 424 (d) Plan to reduce or increase emergency on-call hours in a 425 hospital emergency department. 426 (e) Plan to relocatetheir allopathic or osteopathic427practiceoutside the state. 428 (f) Practice medicine in this state. 429 (g) Reduce or modify the scope of their practice. 430 (2) The Department of Health must report its findings to 431 the Governor, the President of the Senate, and the Speaker of 432 the House of Representatives by November 1 each year. The 433 department may also include in its report findings, 434 recommendations, or other information requested by the council. 435 Section 4. Section 459.0082, Florida Statutes, is amended 436 to read: 437 459.0082 Analysis of survey results; report.— 438 (1) Each year, the Department of Health shall analyze the 439 results of the physician survey required by s. 459.0081 and 440 determine by geographic area and specialty the number of 441 physicians who: 442 (a) Perform deliveries of children in this stateFlorida. 443 (b) Read mammograms and perform breast-imaging-guided 444 procedures in this stateFlorida. 445 (c) Perform emergency care on an on-call basis for a 446 hospital emergency department. 447 (d) Plan to reduce or increase emergency on-call hours in a 448 hospital emergency department. 449 (e) Plan to relocatetheir allopathic or osteopathic450practiceoutside the state. 451 (f) Practice medicine in this state. 452 (2) The Department of Health must report its findings to 453 the Governor, the President of the Senate, and the Speaker of 454 the House of Representatives by November 1 each year. The 455 department may also include in its report findings, 456 recommendations, or other information requested by the council. 457 Section 5. Paragraph (a) of subsection (1) of section 458 409.908, Florida Statutes, is amended to read: 459 409.908 Reimbursement of Medicaid providers.—Subject to 460 specific appropriations, the agency shall reimburse Medicaid 461 providers, in accordance with state and federal law, according 462 to methodologies set forth in the rules of the agency and in 463 policy manuals and handbooks incorporated by reference therein. 464 These methodologies may include fee schedules, reimbursement 465 methods based on cost reporting, negotiated fees, competitive 466 bidding pursuant to s. 287.057, and other mechanisms the agency 467 considers efficient and effective for purchasing services or 468 goods on behalf of recipients. If a provider is reimbursed based 469 on cost reporting and submits a cost report late and that cost 470 report would have been used to set a lower reimbursement rate 471 for a rate semester, then the provider’s rate for that semester 472 shall be retroactively calculated using the new cost report, and 473 full payment at the recalculated rate shall be effected 474 retroactively. Medicare-granted extensions for filing cost 475 reports, if applicable, shall also apply to Medicaid cost 476 reports. Payment for Medicaid compensable services made on 477 behalf of Medicaid eligible persons is subject to the 478 availability of moneys and any limitations or directions 479 provided for in the General Appropriations Act or chapter 216. 480 Further, nothing in this section shall be construed to prevent 481 or limit the agency from adjusting fees, reimbursement rates, 482 lengths of stay, number of visits, or number of services, or 483 making any other adjustments necessary to comply with the 484 availability of moneys and any limitations or directions 485 provided for in the General Appropriations Act, provided the 486 adjustment is consistent with legislative intent. 487 (1) Reimbursement to hospitals licensed under part I of 488 chapter 395 must be made prospectively or on the basis of 489 negotiation. 490 (a) Reimbursement for inpatient care is limited as provided 491 for in s. 409.905(5), except for: 492 1. The raising of rate reimbursement caps, excluding rural 493 hospitals. 494 2. Recognition of the costs of graduate medical education. 495 3. Other methodologies recognized in the General 496 Appropriations Act. 497 498 During the years funds are transferred from the Department of 499 Health, any reimbursement supported by such funds shall be 500 subject to certification by the Department of Health that the 501 hospital has complied with s. 381.4018s.381.0403. The agency 502 mayis authorized toreceive funds from state entities, 503 including, but not limited to, the Department of Health, local 504 governments, and other local political subdivisions, for the 505 purpose of making special exception payments, including federal 506 matching funds, through the Medicaid inpatient reimbursement 507 methodologies. Funds received from state entities or local 508 governments for this purpose shall be separately accounted for 509 and shall not be commingled with other state or local funds in 510 any manner. The agency may certify all local governmental funds 511 used as state match under Title XIX of the Social Security Act, 512 to the extent that the identified local health care provider 513 that is otherwise entitled to and is contracted to receive such 514 local funds is the benefactor under the state’s Medicaid program 515 as determined under the General Appropriations Act and pursuant 516 to an agreement between the Agency for Health Care 517 Administration and the local governmental entity. The local 518 governmental entity shall use a certification form prescribed by 519 the agency. At a minimum, the certification form shall identify 520 the amount being certified and describe the relationship between 521 the certifying local governmental entity and the local health 522 care provider. The agency shall prepare an annual statement of 523 impact which documents the specific activities undertaken during 524 the previous fiscal year pursuant to this paragraph, to be 525 submitted to the Legislature no later than January 1, annually. 526 Section 6. This act shall take effect July 1, 2010.