Bill Text: FL S1316 | 2012 | Regular Session | Comm Sub

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Health Care

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2012-03-09 - Died on Calendar, companion bill(s) passed, see CS/HB 517 (Ch. [S1316 Detail]

Download: Florida-2012-S1316-Comm_Sub.html
       Florida Senate - 2012                             CS for SB 1316
       
       
       
       By the Committee on Health Regulation; and Senator Gaetz
       
       
       
       
       588-03223-12                                          20121316c1
    1                        A bill to be entitled                      
    2         An act relating to health care; amending s. 395.002,
    3         F.S.; redefining the term “accrediting organizations”
    4         as it applies to the regulation of hospitals and other
    5         licensed facilities; amending s. 400.474, F.S.;
    6         revising the fine that may be imposed against a home
    7         health agency for failing to timely submit certain
    8         information to the Agency for Health Care
    9         Administration; amending s. 400.9905, F.S.; revising
   10         the definition of the term “clinic” as it relates to
   11         the Health Care Clinic Act; amending s. 409.221, F.S.;
   12         revising the background screening requirements for
   13         persons rendering care in the consumer-directed care
   14         program administered by the Agency for Health Care
   15         Administration; amending s. 409.907, F.S.; extending
   16         the records-retention period for certain Medicaid
   17         provider records; revising the provider agreement to
   18         require Medicaid providers to report changes in any
   19         principal of the provider to the agency; defining the
   20         term “administrative fines” for purposes of revoking a
   21         Medicaid provider agreement due to changes of
   22         ownership; authorizing, rather than requiring, an
   23         onsite inspection of a Medicaid provider’s service
   24         location before entering into a provider agreement;
   25         specifying the principals of a hospital or nursing
   26         home provider for the purposes of submitting
   27         fingerprints for background screening; removing
   28         certain providers from being subject to agency
   29         background checks; amending s. 409.913, F.S.; defining
   30         the term “Medicaid provider” or “provider” for
   31         purposes of oversight of the integrity of the Medicaid
   32         program; authorizing the agency to review and analyze
   33         information from sources other than Medicaid-enrolled
   34         providers for purposes of determining fraud, abuse,
   35         overpayment, or neglect; extending the records
   36         retention period for certain Medicaid provider
   37         records; revising the grounds for terminating a
   38         provider from the Medicaid program; requiring the
   39         agency to base its overpayment audit reports on
   40         certain information; deleting a requirement that the
   41         agency pay interest on certain withheld Medicaid
   42         payments; requiring payment arrangements for
   43         overpayments and fines to be made within a certain
   44         time; specifying that the venue for all Medicaid
   45         program integrity cases lies in Leon County;
   46         authorizing the agency and the Medicaid Fraud Control
   47         Unit to review certain records; amending s. 409.920,
   48         F.S.; clarifying the applicability of immunity from
   49         civil liability extended to persons who provide
   50         information about fraud or suspected fraudulent acts
   51         by a Medicaid provider; amending s. 409.967, F.S.;
   52         specifying required components of a Medicaid managed
   53         care plan relating to the provisions of medications;
   54         amending s. 429.23, F.S.; requiring the agency to
   55         submit a report to the Legislature on adverse incident
   56         reports from assisted living facilities; amending s.
   57         429.26, F.S.; authorizing the agency to require a
   58         resident of an assisted living facility to undergo a
   59         physical examination if the agency questions the
   60         appropriateness of the resident’s placement in that
   61         facility; authorizing release of the results of the
   62         examination to a medical review team to be used along
   63         with additional information to determine whether the
   64         resident’s placement in the assisted living facility
   65         is appropriate; providing for resident notification
   66         and relocation if the resident’s continued placement
   67         in the facility is not appropriate; authorizing the
   68         agency to require the evaluation of a mental health
   69         resident by a mental health professional; authorizing
   70         an assisted living facility to discharge a resident
   71         who requires more services or care than the facility
   72         is able to provide; amending s. 456.0635, F.S.;
   73         revising the grounds under which the Department of
   74         Health or corresponding board is required to refuse to
   75         admit a candidate to an examination and refuse to
   76         issue or renew a license, certificate, or registration
   77         of a health care practitioner; providing an exception;
   78         amending s. 456.036, F.S.; providing that all persons
   79         who were denied renewal of licensure, certification,
   80         or registration under s. 456.0635(3), F.S., may regain
   81         licensure, certification, or registration only by
   82         completing the application process for initial
   83         licensure; providing an exception; amending s.
   84         456.074, F.S.; revising the federal offenses for which
   85         the Department of Health must issue an emergency order
   86         suspending the license of certain health care
   87         professionals; amending ss. 458.309 and 459.005, F.S.;
   88         requiring a physician or osteopathic physician who
   89         performs certain medical procedures relating to
   90         liposuction in an office setting to register the
   91         office with the Department of Health unless that
   92         office is licensed as a facility under ch. 395, F.S.,
   93         relating to hospital licensing and regulation;
   94         amending s. 463.002, F.S.; conforming provisions to
   95         changes made by the act; amending s. 463.005, F.S.;
   96         authorizing the Board of Optometry to adopt rules for
   97         the administration and prescription of ocular
   98         pharmaceutical agents; amending s. 463.0055, F.S.;
   99         authorizing certified optometrists to administer and
  100         prescribe pharmaceutical agents under certain
  101         circumstances; requiring that a certified optometrist
  102         complete a course and subsequent examination on
  103         general and ocular pharmacology; providing
  104         requirements for the course; requiring that the
  105         Florida Medical Association and the Florida Optometric
  106         Association jointly develop and administer the course
  107         and examination; revising qualifications of certain
  108         members of the formulary committee; providing for a
  109         formulary of topical ocular pharmaceutical agents
  110         which the committee may modify; specifying the agents
  111         that make up the statutory formulary of oral
  112         pharmaceutical agents; authorizing the deletion of an
  113         oral pharmaceutical agent listed in the statutory
  114         formulary under certain circumstances; prohibiting the
  115         board, the Department of Health, or the State Surgeon
  116         General from deleting an oral pharmaceutical agent
  117         listed in the statutory formulary; amending ss.
  118         463.0057 and 463.006, F.S.; conforming provisions to
  119         changes made by the act; amending s. 463.0135, F.S.;
  120         requiring that a certified optometrist administer and
  121         prescribe oral ocular pharmaceutical agents in a
  122         certain manner; requiring that a licensed practitioner
  123         who diagnoses a patient who has a neovascular form of
  124         glaucoma or progressive glaucoma immediately refer the
  125         patient to a physician who is skilled in the diseases
  126         of the eye; requiring that comanagement of
  127         postoperative care be conducted pursuant to an
  128         established protocol; requiring that the patient be
  129         informed that a physician will be available for
  130         emergency care throughout the postoperative period;
  131         requiring that the patient consent in writing to the
  132         comanagement relationship; amending s. 463.014, F.S.;
  133         revising certain prohibited acts regarding an
  134         optometrist conducting surgery and dispensing,
  135         administering, ordering, supplying, or selling certain
  136         drugs; creating s. 463.0141, F.S.; requiring that
  137         adverse incidents in the practice of optometry be
  138         reported to the Department of Health; providing
  139         requirements for notifying the department of an
  140         adverse incident; providing a definition; requiring
  141         that the department review each incident and determine
  142         whether it involved conduct that is subject to
  143         disciplinary action; requiring that the Board of
  144         Optometry take disciplinary action if necessary;
  145         amending s. 483.035, F.S., relating to licensure and
  146         regulation of clinical laboratories operated by
  147         practitioners for exclusive use; providing
  148         applicability to clinical laboratories operated by
  149         practitioners licensed to practice optometry; amending
  150         s. 483.041, F.S.; revising the definition of the term
  151         “licensed practitioner” to include a practitioner
  152         licensed under ch. 463, F.S.; amending s. 483.181,
  153         F.S.; requiring clinical laboratories to accept human
  154         specimens submitted by practitioners licensed to
  155         practice under ch. 463, F.S.; amending s. 499.003,
  156         F.S.; removing a requirement that a contract provider
  157         or subcontractor maintain prescription drugs of the
  158         agency or entity in its possession separate and apart
  159         from other prescription drugs; amending s. 766.102,
  160         F.S.; providing that the claimant has the burden of
  161         proving by clear and convincing evidence that the
  162         actions of a health care provider represented a breach
  163         of the prevailing professional standard of care in an
  164         action for damages based on death or personal injury
  165         which alleges that the death or injury resulted from
  166         the failure of a health care provider to order,
  167         perform, or administer supplemental diagnostic tests;
  168         amending s. 766.106, F.S.; authorizing a prospective
  169         defendant to obtain informal discovery by conducting
  170         ex parte interviews of treating health care providers;
  171         requiring advance notice to the claimant of an ex
  172         parte interview; creating s. 766.1091, F.S.;
  173         authorizing a health care provider or health care
  174         clinic and a patient to agree to submit a claim of
  175         medical negligence to arbitration; requiring that the
  176         arbitration agreement be governed by ch. 682, F.S.;
  177         authorizing the arbitration agreement to contain a
  178         provision that limits an award of damages; amending s.
  179         893.02, F.S.; revising the definition of the term
  180         “practitioner” to include certified optometrists for
  181         purposes of the Florida Comprehensive Drug Abuse
  182         Prevention and Control Act; amending s. 893.05, F.S.;
  183         prohibiting certified optometrists from administering
  184         and prescribing certain controlled substances;
  185         requiring the Agency for Health Care Administration to
  186         prepare a report for public comment and submission to
  187         the Legislature following the expansion of services to
  188         new populations or of new services; providing
  189         effective dates.
  190  
  191  Be It Enacted by the Legislature of the State of Florida:
  192  
  193         Section 1. Subsection (1) of section 395.002, Florida
  194  Statutes, is amended to read:
  195         395.002 Definitions.—As used in this chapter:
  196         (1) “Accrediting organizations” means national
  197  accreditation organizations that are approved by the Centers for
  198  Medicare and Medicaid Services and whose standards incorporate
  199  comparable licensure regulations required by the state the Joint
  200  Commission on Accreditation of Healthcare Organizations, the
  201  American Osteopathic Association, the Commission on
  202  Accreditation of Rehabilitation Facilities, and the
  203  Accreditation Association for Ambulatory Health Care, Inc.
  204         Section 2. Subsection (6) of section 400.474, Florida
  205  Statutes, is amended, present subsection (7) of that section is
  206  renumbered as subsection (8), and a new subsection (7) is added
  207  to that section, to read:
  208         400.474 Administrative penalties.—
  209         (6) The agency may deny, revoke, or suspend the license of
  210  a home health agency and shall impose a fine of $5,000 against a
  211  home health agency that:
  212         (a) Gives remuneration for staffing services to:
  213         1. Another home health agency with which it has formal or
  214  informal patient-referral transactions or arrangements; or
  215         2. A health services pool with which it has formal or
  216  informal patient-referral transactions or arrangements,
  217  
  218  unless the home health agency has activated its comprehensive
  219  emergency management plan in accordance with s. 400.492. This
  220  paragraph does not apply to a Medicare-certified home health
  221  agency that provides fair market value remuneration for staffing
  222  services to a non-Medicare-certified home health agency that is
  223  part of a continuing care facility licensed under chapter 651
  224  for providing services to its own residents if each resident
  225  receiving home health services pursuant to this arrangement
  226  attests in writing that he or she made a decision without
  227  influence from staff of the facility to select, from a list of
  228  Medicare-certified home health agencies provided by the
  229  facility, that Medicare-certified home health agency to provide
  230  the services.
  231         (b) Provides services to residents in an assisted living
  232  facility for which the home health agency does not receive fair
  233  market value remuneration.
  234         (c) Provides staffing to an assisted living facility for
  235  which the home health agency does not receive fair market value
  236  remuneration.
  237         (d) Fails to provide the agency, upon request, with copies
  238  of all contracts with assisted living facilities which were
  239  executed within 5 years before the request.
  240         (e) Gives remuneration to a case manager, discharge
  241  planner, facility-based staff member, or third-party vendor who
  242  is involved in the discharge planning process of a facility
  243  licensed under chapter 395, chapter 429, or this chapter from
  244  whom the home health agency receives referrals.
  245         (f) Fails to submit to the agency, within 15 days after the
  246  end of each calendar quarter, a written report that includes the
  247  following data based on data as it existed on the last day of
  248  the quarter:
  249         1. The number of insulin-dependent diabetic patients
  250  receiving insulin-injection services from the home health
  251  agency;
  252         2. The number of patients receiving both home health
  253  services from the home health agency and hospice services;
  254         3. The number of patients receiving home health services
  255  from that home health agency; and
  256         4. The names and license numbers of nurses whose primary
  257  job responsibility is to provide home health services to
  258  patients and who received remuneration from the home health
  259  agency in excess of $25,000 during the calendar quarter.
  260         (f)(g) Gives cash, or its equivalent, to a Medicare or
  261  Medicaid beneficiary.
  262         (g)(h) Has more than one medical director contract in
  263  effect at one time or more than one medical director contract
  264  and one contract with a physician-specialist whose services are
  265  mandated for the home health agency in order to qualify to
  266  participate in a federal or state health care program at one
  267  time.
  268         (h)(i) Gives remuneration to a physician without a medical
  269  director contract being in effect. The contract must:
  270         1. Be in writing and signed by both parties;
  271         2. Provide for remuneration that is at fair market value
  272  for an hourly rate, which must be supported by invoices
  273  submitted by the medical director describing the work performed,
  274  the dates on which that work was performed, and the duration of
  275  that work; and
  276         3. Be for a term of at least 1 year.
  277  
  278  The hourly rate specified in the contract may not be increased
  279  during the term of the contract. The home health agency may not
  280  execute a subsequent contract with that physician which has an
  281  increased hourly rate and covers any portion of the term that
  282  was in the original contract.
  283         (i)(j) Gives remuneration to:
  284         1. A physician, and the home health agency is in violation
  285  of paragraph (g) (h) or paragraph (h) (i);
  286         2. A member of the physician’s office staff; or
  287         3. An immediate family member of the physician,
  288  
  289  if the home health agency has received a patient referral in the
  290  preceding 12 months from that physician or physician’s office
  291  staff.
  292         (j)(k) Fails to provide to the agency, upon request, copies
  293  of all contracts with a medical director which were executed
  294  within 5 years before the request.
  295         (k)(l) Demonstrates a pattern of billing the Medicaid
  296  program for services to Medicaid recipients which are medically
  297  unnecessary as determined by a final order. A pattern may be
  298  demonstrated by a showing of at least two such medically
  299  unnecessary services within one Medicaid program integrity audit
  300  period.
  301  
  302  Paragraphs (e) and (i) do not apply to or preclude Nothing in
  303  paragraph (e) or paragraph (j) shall be interpreted as applying
  304  to or precluding any discount, compensation, waiver of payment,
  305  or payment practice permitted by 42 U.S.C. s. 1320a-7(b) or
  306  regulations adopted thereunder, including 42 C.F.R. s. 1001.952
  307  or s. 1395nn or regulations adopted thereunder.
  308         (7) The agency shall impose a fine of $50 per day against a
  309  home health agency that fails to submit to the agency, within 15
  310  days after the end of each calendar quarter, a written report
  311  that includes the following data based on data as it existed on
  312  the last day of the quarter:
  313         (a) The number of patients receiving both home health
  314  services from the home health agency and hospice services;
  315         (b) The number of patients receiving home health services
  316  from the home health agency;
  317         (c) The number of insulin-dependent diabetic patients
  318  receiving insulin-injection services from the home health
  319  agency; and
  320         (d) The names and license numbers of nurses whose primary
  321  job responsibility is to provide home health services to
  322  patients and who received remuneration from the home health
  323  agency in excess of $25,000 during the calendar quarter.
  324         Section 3. Paragraph (l) of subsection (4) of section
  325  400.9905, Florida Statutes, is amended, and paragraph (m) is
  326  added to that subsection, to read:
  327         400.9905 Definitions.—
  328         (4) “Clinic” means an entity at which health care services
  329  are provided to individuals and which tenders charges for
  330  reimbursement for such services, including a mobile clinic and a
  331  portable equipment provider. For purposes of this part, the term
  332  does not include and the licensure requirements of this part do
  333  not apply to:
  334         (l) Orthotic, or prosthetic, pediatric cardiology, or
  335  perinatology clinical facilities or anesthesia clinical
  336  facilities that are not otherwise exempt under paragraph (a) or
  337  paragraph (k) and that are a publicly traded corporation or that
  338  are wholly owned, directly or indirectly, by a publicly traded
  339  corporation. As used in this paragraph, a publicly traded
  340  corporation is a corporation that issues securities traded on an
  341  exchange registered with the United States Securities and
  342  Exchange Commission as a national securities exchange.
  343         (m)Entities that are owned or controlled, directly or
  344  indirectly, by a publicly traded entity that has $100 million or
  345  more, in the aggregate, in total annual revenues derived from
  346  providing health care services by licensed health care
  347  practitioners who are employed or contracted by an entity
  348  described in this paragraph.
  349         Section 4. Paragraph (i) of subsection (4) of section
  350  409.221, Florida Statutes, is amended to read:
  351         409.221 Consumer-directed care program.—
  352         (4) CONSUMER-DIRECTED CARE.—
  353         (i) Background screening requirements.—All persons who
  354  render care under this section must undergo level 2 background
  355  screening pursuant to chapter 435 and s. 408.809. The agency
  356  shall, as allowable, reimburse consumer-employed caregivers for
  357  the cost of conducting such background screening as required by
  358  this section. For purposes of this section, a person who has
  359  undergone screening, who is qualified for employment under this
  360  section and applicable rule, and who has not been unemployed for
  361  more than 90 days following such screening is not required to be
  362  rescreened. Such person must attest under penalty of perjury to
  363  not having been convicted of a disqualifying offense since
  364  completing such screening.
  365         Section 5. Paragraph (c) of subsection (3) of section
  366  409.907, Florida Statutes, is amended, paragraph (k) is added to
  367  that subsection, and subsections (6), (7), and (8) of that
  368  section are amended, to read:
  369         409.907 Medicaid provider agreements.—The agency may make
  370  payments for medical assistance and related services rendered to
  371  Medicaid recipients only to an individual or entity who has a
  372  provider agreement in effect with the agency, who is performing
  373  services or supplying goods in accordance with federal, state,
  374  and local law, and who agrees that no person shall, on the
  375  grounds of handicap, race, color, or national origin, or for any
  376  other reason, be subjected to discrimination under any program
  377  or activity for which the provider receives payment from the
  378  agency.
  379         (3) The provider agreement developed by the agency, in
  380  addition to the requirements specified in subsections (1) and
  381  (2), shall require the provider to:
  382         (c) Retain all medical and Medicaid-related records for 6 a
  383  period of 5 years to satisfy all necessary inquiries by the
  384  agency.
  385         (k) Report a change in any principal of the provider,
  386  including any officer, director, agent, managing employee, or
  387  affiliated person, or any partner or shareholder who has an
  388  ownership interest equal to 5 percent or more in the provider,
  389  to the agency in writing no later than 30 days after the change
  390  occurs.
  391         (6) A Medicaid provider agreement may be revoked, at the
  392  option of the agency, due to as the result of a change of
  393  ownership of any facility, association, partnership, or other
  394  entity named as the provider in the provider agreement.
  395         (a) In the event of a change of ownership, the transferor
  396  remains liable for all outstanding overpayments, administrative
  397  fines, and any other moneys owed to the agency before the
  398  effective date of the change of ownership. In addition to the
  399  continuing liability of the transferor, The transferee is also
  400  liable to the agency for all outstanding overpayments identified
  401  by the agency on or before the effective date of the change of
  402  ownership. For purposes of this subsection, the term
  403  “outstanding overpayment” includes any amount identified in a
  404  preliminary audit report issued to the transferor by the agency
  405  on or before the effective date of the change of ownership. In
  406  the event of a change of ownership for a skilled nursing
  407  facility or intermediate care facility, the Medicaid provider
  408  agreement shall be assigned to the transferee if the transferee
  409  meets all other Medicaid provider qualifications. In the event
  410  of a change of ownership involving a skilled nursing facility
  411  licensed under part II of chapter 400, liability for all
  412  outstanding overpayments, administrative fines, and any moneys
  413  owed to the agency before the effective date of the change of
  414  ownership shall be determined in accordance with s. 400.179.
  415         (b) At least 60 days before the anticipated date of the
  416  change of ownership, the transferor must shall notify the agency
  417  of the intended change of ownership and the transferee must
  418  shall submit to the agency a Medicaid provider enrollment
  419  application. If a change of ownership occurs without compliance
  420  with the notice requirements of this subsection, the transferor
  421  and transferee are shall be jointly and severally liable for all
  422  overpayments, administrative fines, and other moneys due to the
  423  agency, regardless of whether the agency identified the
  424  overpayments, administrative fines, or other moneys before or
  425  after the effective date of the change of ownership. The agency
  426  may not approve a transferee’s Medicaid provider enrollment
  427  application if the transferee or transferor has not paid or
  428  agreed in writing to a payment plan for all outstanding
  429  overpayments, administrative fines, and other moneys due to the
  430  agency. This subsection does not preclude the agency from
  431  seeking any other legal or equitable remedies available to the
  432  agency for the recovery of moneys owed to the Medicaid program.
  433  In the event of a change of ownership involving a skilled
  434  nursing facility licensed under part II of chapter 400,
  435  liability for all outstanding overpayments, administrative
  436  fines, and any moneys owed to the agency before the effective
  437  date of the change of ownership shall be determined in
  438  accordance with s. 400.179 if the Medicaid provider enrollment
  439  application for change of ownership is submitted before the
  440  change of ownership.
  441         (c) As used in this subsection, the term:
  442         1. “Administrative fines” includes any amount identified in
  443  a notice of a monetary penalty or fine which has been issued by
  444  the agency or other regulatory or licensing agency that governs
  445  the provider.
  446         2. “Outstanding overpayment” includes any amount identified
  447  in a preliminary audit report issued to the transferor by the
  448  agency on or before the effective date of a change of ownership.
  449         (7) The agency may require, As a condition of participating
  450  in the Medicaid program and before entering into the provider
  451  agreement, the agency may require that the provider to submit
  452  information, in an initial and any required renewal
  453  applications, concerning the professional, business, and
  454  personal background of the provider and permit an onsite
  455  inspection of the provider’s service location by agency staff or
  456  other personnel designated by the agency to perform this
  457  function. Before entering into a provider agreement, the agency
  458  may shall perform an a random onsite inspection, within 60 days
  459  after receipt of a fully complete new provider’s application, of
  460  the provider’s service location prior to making its first
  461  payment to the provider for Medicaid services to determine the
  462  applicant’s ability to provide the services in compliance with
  463  the Medicaid program and professional regulations that the
  464  applicant is proposing to provide for Medicaid reimbursement.
  465  The agency is not required to perform an onsite inspection of a
  466  provider or program that is licensed by the agency, that
  467  provides services under waiver programs for home and community
  468  based services, or that is licensed as a medical foster home by
  469  the Department of Children and Family Services. As a continuing
  470  condition of participation in the Medicaid program, a provider
  471  must shall immediately notify the agency of any current or
  472  pending bankruptcy filing. Before entering into the provider
  473  agreement, or as a condition of continuing participation in the
  474  Medicaid program, the agency may also require that Medicaid
  475  providers reimbursed on a fee-for-services basis or fee schedule
  476  basis that which is not cost-based, post a surety bond not to
  477  exceed $50,000 or the total amount billed by the provider to the
  478  program during the current or most recent calendar year,
  479  whichever is greater. For new providers, the amount of the
  480  surety bond shall be determined by the agency based on the
  481  provider’s estimate of its first year’s billing. If the
  482  provider’s billing during the first year exceeds the bond
  483  amount, the agency may require the provider to acquire an
  484  additional bond equal to the actual billing level of the
  485  provider. A provider’s bond need shall not exceed $50,000 if a
  486  physician or group of physicians licensed under chapter 458,
  487  chapter 459, or chapter 460 has a 50 percent or greater
  488  ownership interest in the provider or if the provider is an
  489  assisted living facility licensed under chapter 429. The bonds
  490  permitted by this section are in addition to the bonds
  491  referenced in s. 400.179(2)(d). If the provider is a
  492  corporation, partnership, association, or other entity, the
  493  agency may require the provider to submit information concerning
  494  the background of that entity and of any principal of the
  495  entity, including any partner or shareholder having an ownership
  496  interest in the entity equal to 5 percent or greater, and any
  497  treating provider who participates in or intends to participate
  498  in Medicaid through the entity. The information must include:
  499         (a) Proof of holding a valid license or operating
  500  certificate, as applicable, if required by the state or local
  501  jurisdiction in which the provider is located or if required by
  502  the Federal Government.
  503         (b) Information concerning any prior violation, fine,
  504  suspension, termination, or other administrative action taken
  505  under the Medicaid laws, rules, or regulations of this state or
  506  of any other state or the Federal Government; any prior
  507  violation of the laws, rules, or regulations relating to the
  508  Medicare program; any prior violation of the rules or
  509  regulations of any other public or private insurer; and any
  510  prior violation of the laws, rules, or regulations of any
  511  regulatory body of this or any other state.
  512         (c) Full and accurate disclosure of any financial or
  513  ownership interest that the provider, or any principal, partner,
  514  or major shareholder thereof, may hold in any other Medicaid
  515  provider or health care related entity or any other entity that
  516  is licensed by the state to provide health or residential care
  517  and treatment to persons.
  518         (d) If a group provider, identification of all members of
  519  the group and attestation that all members of the group are
  520  enrolled in or have applied to enroll in the Medicaid program.
  521         (8)(a) Each provider, or each principal of the provider if
  522  the provider is a corporation, partnership, association, or
  523  other entity, seeking to participate in the Medicaid program
  524  must submit a complete set of his or her fingerprints to the
  525  agency for the purpose of conducting a criminal history record
  526  check. Principals of the provider include any officer, director,
  527  billing agent, managing employee, or affiliated person, or any
  528  partner or shareholder who has an ownership interest equal to 5
  529  percent or more in the provider. However, for a hospital
  530  licensed under chapter 395 or a nursing home licensed under
  531  chapter 400, principals of the provider are those who meet the
  532  definition of a controlling interest under s. 408.803. A
  533  director of a not-for-profit corporation or organization is not
  534  a principal for purposes of a background investigation as
  535  required by this section if the director: serves solely in a
  536  voluntary capacity for the corporation or organization, does not
  537  regularly take part in the day-to-day operational decisions of
  538  the corporation or organization, receives no remuneration from
  539  the not-for-profit corporation or organization for his or her
  540  service on the board of directors, has no financial interest in
  541  the not-for-profit corporation or organization, and has no
  542  family members with a financial interest in the not-for-profit
  543  corporation or organization; and if the director submits an
  544  affidavit, under penalty of perjury, to this effect to the
  545  agency and the not-for-profit corporation or organization
  546  submits an affidavit, under penalty of perjury, to this effect
  547  to the agency as part of the corporation’s or organization’s
  548  Medicaid provider agreement application.
  549         (a) Notwithstanding the above, the agency may require a
  550  background check for any person reasonably suspected by the
  551  agency to have been convicted of a crime. This subsection does
  552  not apply to:
  553         1. A hospital licensed under chapter 395;
  554         2. A nursing home licensed under chapter 400;
  555         3. A hospice licensed under chapter 400;
  556         4. An assisted living facility licensed under chapter 429;
  557         1.5. A unit of local government, except that requirements
  558  of this subsection apply to nongovernmental providers and
  559  entities contracting with the local government to provide
  560  Medicaid services. The actual cost of the state and national
  561  criminal history record checks must be borne by the
  562  nongovernmental provider or entity; or
  563         2.6. Any business that derives more than 50 percent of its
  564  revenue from the sale of goods to the final consumer, and the
  565  business or its controlling parent is required to file a form
  566  10-K or other similar statement with the Securities and Exchange
  567  Commission or has a net worth of $50 million or more.
  568         (b) Background screening shall be conducted in accordance
  569  with chapter 435 and s. 408.809. The cost of the state and
  570  national criminal record check shall be borne by the provider.
  571         (c) Proof of compliance with the requirements of level 2
  572  screening under chapter 435 conducted within 12 months before
  573  the date the Medicaid provider application is submitted to the
  574  agency fulfills the requirements of this subsection.
  575         Section 6. Present paragraphs (e) and (f) of subsection (1)
  576  of section 409.913, Florida Statutes, are redesignated as
  577  paragraphs (f) and (g), respectively, a new paragraph (e) is
  578  added to that subsection, and subsections (2), (9), (13), (15),
  579  (16), (21), (22), (25), (28), (29), (30), and (31) of that
  580  section are amended, to read:
  581         409.913 Oversight of the integrity of the Medicaid
  582  program.—The agency shall operate a program to oversee the
  583  activities of Florida Medicaid recipients, and providers and
  584  their representatives, to ensure that fraudulent and abusive
  585  behavior and neglect of recipients occur to the minimum extent
  586  possible, and to recover overpayments and impose sanctions as
  587  appropriate. Beginning January 1, 2003, and each year
  588  thereafter, the agency and the Medicaid Fraud Control Unit of
  589  the Department of Legal Affairs shall submit a joint report to
  590  the Legislature documenting the effectiveness of the state’s
  591  efforts to control Medicaid fraud and abuse and to recover
  592  Medicaid overpayments during the previous fiscal year. The
  593  report must describe the number of cases opened and investigated
  594  each year; the sources of the cases opened; the disposition of
  595  the cases closed each year; the amount of overpayments alleged
  596  in preliminary and final audit letters; the number and amount of
  597  fines or penalties imposed; any reductions in overpayment
  598  amounts negotiated in settlement agreements or by other means;
  599  the amount of final agency determinations of overpayments; the
  600  amount deducted from federal claiming as a result of
  601  overpayments; the amount of overpayments recovered each year;
  602  the amount of cost of investigation recovered each year; the
  603  average length of time to collect from the time the case was
  604  opened until the overpayment is paid in full; the amount
  605  determined as uncollectible and the portion of the uncollectible
  606  amount subsequently reclaimed from the Federal Government; the
  607  number of providers, by type, that are terminated from
  608  participation in the Medicaid program as a result of fraud and
  609  abuse; and all costs associated with discovering and prosecuting
  610  cases of Medicaid overpayments and making recoveries in such
  611  cases. The report must also document actions taken to prevent
  612  overpayments and the number of providers prevented from
  613  enrolling in or reenrolling in the Medicaid program as a result
  614  of documented Medicaid fraud and abuse and must include policy
  615  recommendations necessary to prevent or recover overpayments and
  616  changes necessary to prevent and detect Medicaid fraud. All
  617  policy recommendations in the report must include a detailed
  618  fiscal analysis, including, but not limited to, implementation
  619  costs, estimated savings to the Medicaid program, and the return
  620  on investment. The agency must submit the policy recommendations
  621  and fiscal analyses in the report to the appropriate estimating
  622  conference, pursuant to s. 216.137, by February 15 of each year.
  623  The agency and the Medicaid Fraud Control Unit of the Department
  624  of Legal Affairs each must include detailed unit-specific
  625  performance standards, benchmarks, and metrics in the report,
  626  including projected cost savings to the state Medicaid program
  627  during the following fiscal year.
  628         (1) For the purposes of this section, the term:
  629         (e) “Medicaid provider” or “provider” has the same meaning
  630  as provided in s. 409.901 and, for purposes of oversight of the
  631  integrity of the Medicaid program, also includes a participant
  632  in a Medicaid managed care provider network.
  633         (2) The agency shall conduct, or cause to be conducted by
  634  contract or otherwise, reviews, investigations, analyses,
  635  audits, or any combination thereof, to determine possible fraud,
  636  abuse, overpayment, or recipient neglect in the Medicaid program
  637  and shall report the findings of any overpayments in audit
  638  reports as appropriate. At least 5 percent of all audits must
  639  shall be conducted on a random basis. As part of its ongoing
  640  fraud detection activities, the agency shall identify and
  641  monitor, by contract or otherwise, patterns of overutilization
  642  of Medicaid services based on state averages. The agency shall
  643  track Medicaid provider prescription and billing patterns and
  644  evaluate them against Medicaid medical necessity criteria and
  645  coverage and limitation guidelines adopted by rule. Medical
  646  necessity determination requires that service be consistent with
  647  symptoms or confirmed diagnosis of illness or injury under
  648  treatment and not in excess of the patient’s needs. The agency
  649  shall conduct reviews of provider exceptions to peer group norms
  650  and shall, using statistical methodologies, provider profiling,
  651  and analysis of billing patterns, detect and investigate
  652  abnormal or unusual increases in billing or payment of claims
  653  for Medicaid services and medically unnecessary provision of
  654  services. The agency may review and analyze information from
  655  sources other than enrolled Medicaid providers in conducting its
  656  activities under this subsection.
  657         (9) A Medicaid provider shall retain medical, professional,
  658  financial, and business records pertaining to services and goods
  659  furnished to a Medicaid recipient and billed to Medicaid for 6 a
  660  period of 5 years after the date of furnishing such services or
  661  goods. The agency may investigate, review, or analyze such
  662  records, which must be made available during normal business
  663  hours. However, 24-hour notice must be provided if patient
  664  treatment would be disrupted. The provider is responsible for
  665  furnishing to the agency, and keeping the agency informed of the
  666  location of, the provider’s Medicaid-related records. The
  667  authority of the agency to obtain Medicaid-related records from
  668  a provider is neither curtailed nor limited during a period of
  669  litigation between the agency and the provider.
  670         (13) The agency shall immediately terminate participation
  671  of a Medicaid provider in the Medicaid program and may seek
  672  civil remedies or impose other administrative sanctions against
  673  a Medicaid provider, if the provider or any principal, officer,
  674  director, agent, managing employee, or affiliated person of the
  675  provider, or any partner or shareholder having an ownership
  676  interest in the provider equal to 5 percent or greater, has been
  677  convicted of a criminal offense under federal law or the law of
  678  any state relating to the practice of the provider’s profession,
  679  or an offense listed under s. 409.907(10), s. 408.809(4), or s.
  680  435.04(2) has been:
  681         (a) Convicted of a criminal offense related to the delivery
  682  of any health care goods or services, including the performance
  683  of management or administrative functions relating to the
  684  delivery of health care goods or services;
  685         (b) Convicted of a criminal offense under federal law or
  686  the law of any state relating to the practice of the provider’s
  687  profession; or
  688         (c) Found by a court of competent jurisdiction to have
  689  neglected or physically abused a patient in connection with the
  690  delivery of health care goods or services. If the agency
  691  determines that the a provider did not participate or acquiesce
  692  in the an offense specified in paragraph (a), paragraph (b), or
  693  paragraph (c), termination will not be imposed. If the agency
  694  effects a termination under this subsection, the agency shall
  695  issue an immediate final order pursuant to s. 120.569(2)(n).
  696         (15) The agency shall seek a remedy provided by law,
  697  including, but not limited to, any remedy provided in
  698  subsections (13) and (16) and s. 812.035, if:
  699         (a) The provider’s license has not been renewed, or has
  700  been revoked, suspended, or terminated, for cause, by the
  701  licensing agency of any state;
  702         (b) The provider has failed to make available or has
  703  refused access to Medicaid-related records to an auditor,
  704  investigator, or other authorized employee or agent of the
  705  agency, the Attorney General, a state attorney, or the Federal
  706  Government;
  707         (c) The provider has not furnished or has failed to make
  708  available such Medicaid-related records as the agency has found
  709  necessary to determine whether Medicaid payments are or were due
  710  and the amounts thereof;
  711         (d) The provider has failed to maintain medical records
  712  made at the time of service, or prior to service if prior
  713  authorization is required, demonstrating the necessity and
  714  appropriateness of the goods or services rendered;
  715         (e) The provider is not in compliance with provisions of
  716  Medicaid provider publications that have been adopted by
  717  reference as rules in the Florida Administrative Code; with
  718  provisions of state or federal laws, rules, or regulations; with
  719  provisions of the provider agreement between the agency and the
  720  provider; or with certifications found on claim forms or on
  721  transmittal forms for electronically submitted claims that are
  722  submitted by the provider or authorized representative, as such
  723  provisions apply to the Medicaid program;
  724         (f) The provider or person who ordered, authorized, or
  725  prescribed the care, services, or supplies has furnished, or
  726  ordered, or authorized the furnishing of, goods or services to a
  727  recipient which are inappropriate, unnecessary, excessive, or
  728  harmful to the recipient or are of inferior quality;
  729         (g) The provider has demonstrated a pattern of failure to
  730  provide goods or services that are medically necessary;
  731         (h) The provider or an authorized representative of the
  732  provider, or a person who ordered, authorized, or prescribed the
  733  goods or services, has submitted or caused to be submitted false
  734  or a pattern of erroneous Medicaid claims;
  735         (i) The provider or an authorized representative of the
  736  provider, or a person who has ordered, authorized, or prescribed
  737  the goods or services, has submitted or caused to be submitted a
  738  Medicaid provider enrollment application, a request for prior
  739  authorization for Medicaid services, a drug exception request,
  740  or a Medicaid cost report that contains materially false or
  741  incorrect information;
  742         (j) The provider or an authorized representative of the
  743  provider has collected from or billed a recipient or a
  744  recipient’s responsible party improperly for amounts that should
  745  not have been so collected or billed by reason of the provider’s
  746  billing the Medicaid program for the same service;
  747         (k) The provider or an authorized representative of the
  748  provider has included in a cost report costs that are not
  749  allowable under a Florida Title XIX reimbursement plan, after
  750  the provider or authorized representative had been advised in an
  751  audit exit conference or audit report that the costs were not
  752  allowable;
  753         (l) The provider is charged by information or indictment
  754  with fraudulent billing practices or any offense referenced in
  755  subsection (13). The sanction applied for this reason is limited
  756  to suspension of the provider’s participation in the Medicaid
  757  program for the duration of the indictment unless the provider
  758  is found guilty pursuant to the information or indictment;
  759         (m) The provider or a person who has ordered, authorized,
  760  or prescribed the goods or services is found liable for
  761  negligent practice resulting in death or injury to the
  762  provider’s patient;
  763         (n) The provider fails to demonstrate that it had available
  764  during a specific audit or review period sufficient quantities
  765  of goods, or sufficient time in the case of services, to support
  766  the provider’s billings to the Medicaid program;
  767         (o) The provider has failed to comply with the notice and
  768  reporting requirements of s. 409.907;
  769         (p) The agency has received reliable information of patient
  770  abuse or neglect or of any act prohibited by s. 409.920; or
  771         (q) The provider has failed to comply with an agreed-upon
  772  repayment schedule.
  773  
  774  A provider is subject to sanctions for violations of this
  775  subsection as the result of actions or inactions of the
  776  provider, or actions or inactions of any principal, officer,
  777  director, agent, managing employee, or affiliated person of the
  778  provider, or any partner or shareholder having an ownership
  779  interest in the provider equal to 5 percent or greater, in which
  780  the provider participated or acquiesced.
  781         (16) The agency shall impose any of the following sanctions
  782  or disincentives on a provider or a person for any of the acts
  783  described in subsection (15):
  784         (a) Suspension for a specific period of time of not more
  785  than 1 year. Suspension precludes shall preclude participation
  786  in the Medicaid program, which includes any action that results
  787  in a claim for payment to the Medicaid program as a result of
  788  furnishing, supervising a person who is furnishing, or causing a
  789  person to furnish goods or services.
  790         (b) Termination for a specific period of time of from more
  791  than 1 year to 20 years. Termination precludes shall preclude
  792  participation in the Medicaid program, which includes any action
  793  that results in a claim for payment to the Medicaid program as a
  794  result of furnishing, supervising a person who is furnishing, or
  795  causing a person to furnish goods or services.
  796         (c) Imposition of a fine of up to $5,000 for each
  797  violation. Each day that an ongoing violation continues, such as
  798  refusing to furnish Medicaid-related records or refusing access
  799  to records, is considered, for the purposes of this section, to
  800  be a separate violation. Each instance of improper billing of a
  801  Medicaid recipient; each instance of including an unallowable
  802  cost on a hospital or nursing home Medicaid cost report after
  803  the provider or authorized representative has been advised in an
  804  audit exit conference or previous audit report of the cost
  805  unallowability; each instance of furnishing a Medicaid recipient
  806  goods or professional services that are inappropriate or of
  807  inferior quality as determined by competent peer judgment; each
  808  instance of knowingly submitting a materially false or erroneous
  809  Medicaid provider enrollment application, request for prior
  810  authorization for Medicaid services, drug exception request, or
  811  cost report; each instance of inappropriate prescribing of drugs
  812  for a Medicaid recipient as determined by competent peer
  813  judgment; and each false or erroneous Medicaid claim leading to
  814  an overpayment to a provider is considered, for the purposes of
  815  this section, to be a separate violation.
  816         (d) Immediate suspension, if the agency has received
  817  information of patient abuse or neglect or of any act prohibited
  818  by s. 409.920. Upon suspension, the agency must issue an
  819  immediate final order under s. 120.569(2)(n).
  820         (e) A fine, not to exceed $10,000, for a violation of
  821  paragraph (15)(i).
  822         (f) Imposition of liens against provider assets, including,
  823  but not limited to, financial assets and real property, not to
  824  exceed the amount of fines or recoveries sought, upon entry of
  825  an order determining that such moneys are due or recoverable.
  826         (g) Prepayment reviews of claims for a specified period of
  827  time.
  828         (h) Comprehensive followup reviews of providers every 6
  829  months to ensure that they are billing Medicaid correctly.
  830         (i) Corrective-action plans that would remain in effect for
  831  providers for up to 3 years and that are would be monitored by
  832  the agency every 6 months while in effect.
  833         (j) Other remedies as permitted by law to effect the
  834  recovery of a fine or overpayment.
  835  
  836  If a provider voluntarily relinquishes its Medicaid provider
  837  number after receiving written notice that the agency is
  838  conducting, or has conducted, an audit or investigation and the
  839  sanction of suspension or termination will be imposed for
  840  noncompliance discovered as a result of the audit or
  841  investigation, the agency shall impose the sanction of
  842  termination for cause against the provider. The Secretary of
  843  Health Care Administration may make a determination that
  844  imposition of a sanction or disincentive is not in the best
  845  interest of the Medicaid program, in which case a sanction or
  846  disincentive may shall not be imposed.
  847         (21) When making a determination that an overpayment has
  848  occurred, the agency shall prepare and issue an audit report to
  849  the provider showing the calculation of overpayments. The
  850  agency’s determination shall be based solely upon information
  851  available to it before issuance of the audit report and, in the
  852  case of documentation obtained to substantiate claims for
  853  Medicaid reimbursement, based solely upon contemporaneous
  854  records.
  855         (22) The audit report, supported by agency work papers,
  856  showing an overpayment to a provider constitutes evidence of the
  857  overpayment. A provider may not present or elicit testimony,
  858  either on direct examination or cross-examination in any court
  859  or administrative proceeding, regarding the purchase or
  860  acquisition by any means of drugs, goods, or supplies; sales or
  861  divestment by any means of drugs, goods, or supplies; or
  862  inventory of drugs, goods, or supplies, unless such acquisition,
  863  sales, divestment, or inventory is documented by written
  864  invoices, written inventory records, or other competent written
  865  documentary evidence maintained in the normal course of the
  866  provider’s business. Testimony or evidence that is not based
  867  upon contemporaneous records or that was not furnished to the
  868  agency within 21 days after the issuance of the audit report is
  869  inadmissible in an administrative hearing on a Medicaid
  870  overpayment or an administrative sanction. Notwithstanding the
  871  applicable rules of discovery, all documentation to that will be
  872  offered as evidence at an administrative hearing on a Medicaid
  873  overpayment or an administrative sanction must be exchanged by
  874  all parties at least 14 days before the administrative hearing
  875  or must be excluded from consideration.
  876         (25)(a) The agency shall withhold Medicaid payments, in
  877  whole or in part, to a provider upon receipt of reliable
  878  evidence that the circumstances giving rise to the need for a
  879  withholding of payments involve fraud, willful
  880  misrepresentation, or abuse under the Medicaid program, or a
  881  crime committed while rendering goods or services to Medicaid
  882  recipients. If it is determined that fraud, willful
  883  misrepresentation, abuse, or a crime did not occur, the payments
  884  withheld must be paid to the provider within 14 days after such
  885  determination with interest at the rate of 10 percent a year.
  886  Any money withheld in accordance with this paragraph shall be
  887  placed in a suspended account, readily accessible to the agency,
  888  so that any payment ultimately due the provider shall be made
  889  within 14 days.
  890         (b) The agency shall deny payment, or require repayment, if
  891  the goods or services were furnished, supervised, or caused to
  892  be furnished by a person who has been suspended or terminated
  893  from the Medicaid program or Medicare program by the Federal
  894  Government or any state.
  895         (c) Overpayments owed to the agency bear interest at the
  896  rate of 10 percent per year from the date of determination of
  897  the overpayment by the agency, and payment arrangements
  898  regarding overpayments and fines must be made within 30 days
  899  after the date of the final order and are not subject to further
  900  appeal at the conclusion of legal proceedings. A provider who
  901  does not enter into or adhere to an agreed-upon repayment
  902  schedule may be terminated by the agency for nonpayment or
  903  partial payment.
  904         (d) The agency, upon entry of a final agency order, a
  905  judgment or order of a court of competent jurisdiction, or a
  906  stipulation or settlement, may collect the moneys owed by all
  907  means allowable by law, including, but not limited to, notifying
  908  any fiscal intermediary of Medicare benefits that the state has
  909  a superior right of payment. Upon receipt of such written
  910  notification, the Medicare fiscal intermediary shall remit to
  911  the state the sum claimed.
  912         (e) The agency may institute amnesty programs to allow
  913  Medicaid providers the opportunity to voluntarily repay
  914  overpayments. The agency may adopt rules to administer such
  915  programs.
  916         (28) Venue for all Medicaid program integrity overpayment
  917  cases lies shall lie in Leon County, at the discretion of the
  918  agency.
  919         (29) Notwithstanding other provisions of law, the agency
  920  and the Medicaid Fraud Control Unit of the Department of Legal
  921  Affairs may review a person’s or provider’s Medicaid-related and
  922  non-Medicaid-related records in order to determine the total
  923  output of a provider’s practice to reconcile quantities of goods
  924  or services billed to Medicaid with quantities of goods or
  925  services used in the provider’s total practice.
  926         (30) The agency shall terminate a provider’s participation
  927  in the Medicaid program if the provider fails to reimburse an
  928  overpayment or pay a fine that has been determined by final
  929  order, not subject to further appeal, within 30 35 days after
  930  the date of the final order, unless the provider and the agency
  931  have entered into a repayment agreement.
  932         (31) If a provider requests an administrative hearing
  933  pursuant to chapter 120, such hearing must be conducted within
  934  90 days following assignment of an administrative law judge,
  935  absent exceptionally good cause shown as determined by the
  936  administrative law judge or hearing officer. Upon issuance of a
  937  final order, the outstanding balance of the amount determined to
  938  constitute the overpayment and fines is shall become due. If a
  939  provider fails to make payments in full, fails to enter into a
  940  satisfactory repayment plan, or fails to comply with the terms
  941  of a repayment plan or settlement agreement, the agency shall
  942  withhold medical assistance reimbursement payments for Medicaid
  943  services until the amount due is paid in full.
  944         Section 7. Subsection (8) of section 409.920, Florida
  945  Statutes, is amended to read:
  946         409.920 Medicaid provider fraud.—
  947         (8) A person who provides the state, any state agency, any
  948  of the state’s political subdivisions, or any agency of the
  949  state’s political subdivisions with information about fraud or
  950  suspected fraudulent acts fraud by a Medicaid provider,
  951  including a managed care organization, is immune from civil
  952  liability for libel, slander, or any other relevant tort for
  953  providing any the information about fraud or suspected
  954  fraudulent acts, unless the person acted with knowledge that the
  955  information was false or with reckless disregard for the truth
  956  or falsity of the information. For purposes of this subsection,
  957  the term “fraudulent acts” includes actual or suspected fraud,
  958  abuse, or overpayment, including any fraud-related matters that
  959  a provider or health plan is required to report to the agency or
  960  a law enforcement agency. The immunity from civil liability
  961  extends to reports of fraudulent acts conveyed to the agency in
  962  any manner, including any forum and with any audience as
  963  directed by the agency, and includes all discussions subsequent
  964  to the report and subsequent inquiries from the agency, unless
  965  the person acted with knowledge that the information was false
  966  or with reckless disregard for the truth or falsity of the
  967  information.
  968         Section 8. Paragraph (c) of subsection (2) of section
  969  409.967, Florida Statutes, is amended to read:
  970         409.967 Managed care plan accountability.—
  971         (2) The agency shall establish such contract requirements
  972  as are necessary for the operation of the statewide managed care
  973  program. In addition to any other provisions the agency may deem
  974  necessary, the contract must require:
  975         (c) Access.—
  976         1. Providers.—The agency shall establish specific standards
  977  for the number, type, and regional distribution of providers in
  978  managed care plan networks to ensure access to care for both
  979  adults and children. Each plan must maintain a regionwide
  980  network of providers in sufficient numbers to meet the access
  981  standards for specific medical services for all recipients
  982  enrolled in the plan. The exclusive use of mail-order pharmacies
  983  is may not be sufficient to meet network access standards.
  984  Consistent with the standards established by the agency,
  985  provider networks may include providers located outside the
  986  region. A plan may contract with a new hospital facility before
  987  the date the hospital becomes operational if the hospital has
  988  commenced construction, will be licensed and operational by
  989  January 1, 2013, and a final order has issued in any civil or
  990  administrative challenge. Each plan shall establish and maintain
  991  an accurate and complete electronic database of contracted
  992  providers, including information about licensure or
  993  registration, locations and hours of operation, specialty
  994  credentials and other certifications, specific performance
  995  indicators, and such other information as the agency deems
  996  necessary. The database must be available online to both the
  997  agency and the public and have the capability to compare the
  998  availability of providers to network adequacy standards and to
  999  accept and display feedback from each provider’s patients. Each
 1000  plan shall submit quarterly reports to the agency identifying
 1001  the number of enrollees assigned to each primary care provider.
 1002         2. Prescribed drugs.—
 1003         a. If establishing a prescribed drug formulary or preferred
 1004  drug list, a managed care plan must:
 1005         (I)Provide a broad range of therapeutic options for the
 1006  treatment of disease states consistent with the general needs of
 1007  an outpatient population. Whenever feasible, the formulary or
 1008  preferred drug list should include at least two products in a
 1009  therapeutic class;
 1010         (II)Include coverage via prior authorization for each drug
 1011  newly approved by the federal Food and Drug Administration until
 1012  the plan’s Pharmaceutical and Therapeutics Committee reviews
 1013  such drug for inclusion on the formulary. The timing of the
 1014  formulary review must comply with s. 409.91195; and
 1015         (III)Provide a response within 24 hours after receipt of
 1016  all necessary information from the medical provider for a
 1017  request for prior authorization and provide a procedure for
 1018  escalating a delayed prior authorization request to the pharmacy
 1019  management team for resolution or to override other medical
 1020  management tools.
 1021         b. Each managed care plan shall must publish any prescribed
 1022  drug formulary or preferred drug list on the plan’s website in a
 1023  manner that is accessible to and searchable by enrollees and
 1024  providers. The plan must update the list within 24 hours after
 1025  making a change. Each plan must ensure that the prior
 1026  authorization process for prescribed drugs is readily accessible
 1027  to health care providers, including posting appropriate contact
 1028  information on its website and providing timely responses to
 1029  providers.
 1030         c.The managed care plan must continue to permit an
 1031  enrollee who was receiving a prescription drug that was on the
 1032  plan’s formulary and subsequently removed or changed to continue
 1033  to receive that drug if the provider submits a written request
 1034  that demonstrates that the drug is medically necessary, and the
 1035  enrollee meets clinical criteria to receive the drug.
 1036         d.A managed care plan that imposes a step-therapy or a
 1037  fail-first protocol must do so in accordance with the following:
 1038         (I)If prescribed drugs for the treatment of a medical
 1039  condition are restricted for use by the plan through a step
 1040  therapy or fail-first protocol, the plan must provide the
 1041  prescriber with access to a clear and convenient process to
 1042  expeditiously request a prior authorization that includes a
 1043  procedure for escalation to the pharmacy management team if not
 1044  resolved in a timely manner.
 1045         (II)Escalation to the pharmacy management team must be
 1046  expeditiously granted by the plan if the prescriber can submit
 1047  appropriate and complete medical documentation to the plan that
 1048  the preferred treatment required under the step-therapy or fail
 1049  first protocol:
 1050         (A) Has been ineffective in the treatment of the enrollee’s
 1051  disease or medical condition;
 1052         (B) Is reasonably expected to be ineffective based on the
 1053  known relevant physical or mental characteristics and medical
 1054  history of the enrollee and known characteristics of the drug
 1055  regimen; or
 1056         (C) Will cause or will likely cause an adverse reaction or
 1057  other physical harm to the enrollee.
 1058         (III)The pharmacy management team shall work directly with
 1059  the medical provider to bring the prior-authorization request to
 1060  a clinically appropriate, cost-effective, and timely resolution.
 1061         e. For enrollees Medicaid recipients diagnosed with
 1062  hemophilia who have been prescribed anti-hemophilic-factor
 1063  replacement products, the agency shall provide for those
 1064  products and hemophilia overlay services through the agency’s
 1065  hemophilia disease management program.
 1066         3.Prior authorization.—
 1067         a. Each managed care plan must ensure that the prior
 1068  authorization process for prescribed drugs is readily accessible
 1069  to health care providers, including posting appropriate contact
 1070  information on its website and providing timely responses to
 1071  providers.
 1072         b. If a drug, determined to be medically necessary and
 1073  prescribed for an enrollee by a physician using sound clinical
 1074  judgment, is subject to prior authorization and approved, the
 1075  managed care plan must provide for sufficient refills to
 1076  complete the duration of the prescription. If the medication is
 1077  still clinically appropriate for ongoing therapy after the
 1078  initial prior authorization expires, the plan must provide a
 1079  process of expedited review to evaluate ongoing therapy.
 1080         c.If a prescribed drug requires prior authorization, the
 1081  managed care plan shall reimburse the pharmacist for dispensing
 1082  a 72-hour supply of oral maintenance medications to the enrollee
 1083  and process the prior authorization request. Dispensing a 72
 1084  hour supply must be consistent with laws that govern pharmacy
 1085  practice and controlled substances. The managed care plan shall
 1086  process all prior authorization requests in as timely a manner
 1087  as possible.
 1088         d.3. Managed care plans, and their fiscal agents or
 1089  intermediaries, must accept prior authorization requests for
 1090  prescribed drugs any service electronically.
 1091         Section 9. Subsection (11) is added to section 429.23,
 1092  Florida Statutes, to read:
 1093         429.23 Internal risk management and quality assurance
 1094  program; adverse incidents and reporting requirements.—
 1095         (11) The agency shall annually submit a report to the
 1096  Legislature on adverse incident reports by assisted living
 1097  facilities. The report must include the following information
 1098  arranged by county:
 1099         (a) A total number of adverse incidents;
 1100         (b) A listing, by category, of the type of adverse
 1101  incidents occurring within each category and the type of staff
 1102  involved;
 1103         (c) A listing, by category, of the types of injuries, if
 1104  any, and the number of injuries occurring within each category;
 1105         (d) Types of liability claims filed based on an adverse
 1106  incident report or reportable injury; and
 1107         (e) Disciplinary action taken against staff, categorized by
 1108  the type of staff involved.
 1109         Section 10. Present subsections (9), (10), and (11) of
 1110  section 429.26, Florida Statutes, are renumbered as subsections
 1111  (12), (13), and (14), respectively, and new subsections (9),
 1112  (10), and (11) are added to that section, to read:
 1113         429.26 Appropriateness of placements; examinations of
 1114  residents.—
 1115         (9) If, at any time after admission to a facility, agency
 1116  personnel question whether a resident needs care beyond that
 1117  which the facility is licensed to provide, the agency may
 1118  require the resident to be physically examined by a licensed
 1119  physician, licensed physician assistant, or certified nurse
 1120  practitioner. To the extent possible, the examination must be
 1121  performed by the resident’s preferred physician, physician
 1122  assistant, or nurse practitioner and paid for by the resident
 1123  with personal funds, except as provided in s. 429.18(2). This
 1124  subsection does not preclude the agency from imposing sanctions
 1125  for violations of subsection (1).
 1126         (a) Following examination, the examining physician,
 1127  physician assistant, or nurse practitioner shall complete and
 1128  sign a medical form provided by the agency. The completed
 1129  medical form must be submitted to the agency within 30 days
 1130  after the date the facility owner or administrator was notified
 1131  by the agency that a physical examination is required.
 1132         (b) A medical review team designated by the agency shall
 1133  determine whether the resident is appropriately residing in the
 1134  facility based on the completed medical form and, if necessary,
 1135  consultation with the physician, physician assistant, or nurse
 1136  practitioner who performed the examination. Members of the
 1137  medical review team making the determination may not include the
 1138  agency personnel who initially questioned the appropriateness of
 1139  the resident’s placement. The medical review team shall base its
 1140  decision on a comprehensive review of the resident’s physical
 1141  and functional status. A determination that the resident’s
 1142  placement is not appropriate is final and binding upon the
 1143  facility and the resident.
 1144         (c) A resident who is determined by the medical review team
 1145  to be inappropriately residing in a facility shall be given 30
 1146  days’ written notice to relocate by the owner or administrator,
 1147  unless the resident’s continued residence in the facility
 1148  presents an imminent danger to the health, safety, or welfare of
 1149  the resident or a substantial probability exists that death or
 1150  serious physical harm to the resident would result if the
 1151  resident is allowed to remain in the facility.
 1152         (10) If a mental health resident appears to have needs in
 1153  addition to those identified in the community living support
 1154  plan, the agency may require an evaluation by a mental health
 1155  professional, as determined by the Department of Children and
 1156  Family Services.
 1157         (11) A facility may not be required to retain a resident
 1158  who requires more services or care than the facility is able to
 1159  provide in accordance with its policies and criteria for
 1160  admission and continued residency.
 1161         Section 11. Effective July 1, 2012, section 456.0635,
 1162  Florida Statutes, is amended to read:
 1163         456.0635 Health care Medicaid fraud; disqualification for
 1164  license, certificate, or registration.—
 1165         (1) Health care Medicaid fraud in the practice of a health
 1166  care profession is prohibited.
 1167         (2) Each board under within the jurisdiction of the
 1168  department, or the department if there is no board, shall refuse
 1169  to admit a candidate to an any examination and refuse to issue
 1170  or renew a license, certificate, or registration to an any
 1171  applicant if the candidate or applicant or any principal,
 1172  officer, agent, managing employee, or affiliated person of the
 1173  applicant, has been:
 1174         (a) Has been convicted of, or entered a plea of guilty or
 1175  nolo contendere to, regardless of adjudication, a felony under
 1176  chapter 409, chapter 817, or chapter 893, or a similar felony
 1177  offense committed in another state or jurisdiction, unless the
 1178  candidate or applicant has successfully completed a drug court
 1179  program for that felony and provides proof that the plea has
 1180  been withdrawn or the charges have been dismissed. Any such
 1181  conviction or plea shall exclude the applicant or candidate from
 1182  licensure, examination, certification, or registration 21 U.S.C.
 1183  ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the sentence and
 1184  any subsequent period of probation for such conviction or plea
 1185  pleas ended: more than 15 years prior to the date of the
 1186  application;
 1187         1. For felonies of the first or second degree, more than 15
 1188  years before the date of application.
 1189         2. For felonies of the third degree, more than 10 years
 1190  before the date of application, except for felonies of the third
 1191  degree under s. 893.13(6)(a).
 1192         3. For felonies of the third degree under s. 893.13(6)(a),
 1193  more than 5 years before the date of application.
 1194         (b) Has been convicted of, or entered a plea of guilty or
 1195  nolo contendere to, regardless of adjudication, a felony under
 1196  21 U.S.C. ss. 801-970 or 42 U.S.C. ss. 1395-1396, unless the
 1197  sentence and any subsequent period of probation for such
 1198  conviction or plea ended more than 15 years before the date of
 1199  the application.
 1200         (c)(b)Has been terminated for cause from the Florida
 1201  Medicaid program pursuant to s. 409.913, unless the candidate or
 1202  applicant has been in good standing with the Florida Medicaid
 1203  program for the most recent 5 years.;
 1204         (d)(c)Has been terminated for cause, pursuant to the
 1205  appeals procedures established by the state or Federal
 1206  Government, from any other state Medicaid program or the federal
 1207  Medicare program, unless the candidate or applicant has been in
 1208  good standing with that a state Medicaid program or the federal
 1209  Medicare program for the most recent 5 years and the termination
 1210  occurred at least 20 years before prior to the date of the
 1211  application.
 1212         (e) Is currently listed on the United States Department of
 1213  Health and Human Services Office of Inspector General’s List of
 1214  Excluded Individuals and Entities.
 1215  
 1216  This subsection does not apply to candidates or applicants for
 1217  initial licensure or certification who were enrolled in an
 1218  educational or training program on or before July 1, 2009, which
 1219  was recognized by a board or, if there is no board, recognized
 1220  by the department, and who applied for licensure after July 1,
 1221  2012.
 1222         (3) The department shall refuse to renew a license,
 1223  certificate, or registration of any applicant if the applicant
 1224  or any principal, officer, agent, managing employee, or
 1225  affiliated person of the applicant:
 1226         (a) Has been convicted of, or entered a plea of guilty or
 1227  nolo contendere to, regardless of adjudication, a felony under
 1228  chapter 409, chapter 817, or chapter 893, or a similar felony
 1229  offense committed in another state or jurisdiction, unless the
 1230  applicant is currently enrolled in a drug court program that
 1231  allows the withdrawal of the plea for that felony upon
 1232  successful completion of that program. Any such conviction or
 1233  plea excludes the applicant or candidate from licensure,
 1234  examination, certification, or registration unless the sentence
 1235  and any subsequent period of probation for such conviction or
 1236  plea ended:
 1237         1. For felonies of the first or second degree, more than 15
 1238  years before the date of application.
 1239         2. For felonies of the third degree, more than 10 years
 1240  before the date of application, except for felonies of the third
 1241  degree under s. 893.13(6)(a).
 1242         3. For felonies of the third degree under s. 893.13(6)(a),
 1243  more than 5 years before the date of application.
 1244         (b) Has been convicted of, or entered a plea of guilty or
 1245  nolo contendere to, regardless of adjudication, a felony under
 1246  21 U.S.C. ss. 801-970 or 42 U.S.C. ss. 1395-1396 since July 1,
 1247  2009, unless the sentence and any subsequent period of probation
 1248  for such conviction or plea ended more than 15 years before the
 1249  date of the application.
 1250         (c) Has been terminated for cause from the Florida Medicaid
 1251  program pursuant to s. 409.913, unless the applicant has been in
 1252  good standing with the Florida Medicaid program for the most
 1253  recent 5 years.
 1254         (d) Has been terminated for cause, pursuant to the appeals
 1255  procedures established by the state, from any other state
 1256  Medicaid program, unless the applicant has been in good standing
 1257  with that state Medicaid program for the most recent 5 years and
 1258  the termination occurred at least 20 years before the date of
 1259  the application.
 1260         (e) Is currently listed on the United States Department of
 1261  Health and Human Services Office of Inspector General’s List of
 1262  Excluded Individuals and Entities.
 1263         (4)(3) Licensed health care practitioners shall report
 1264  allegations of health care Medicaid fraud to the department,
 1265  regardless of the practice setting in which the alleged health
 1266  care Medicaid fraud occurred.
 1267         (5)(4) The acceptance by a licensing authority of a
 1268  licensee’s candidate’s relinquishment of a license which is
 1269  offered in response to or anticipation of the filing of
 1270  administrative charges alleging health care Medicaid fraud or
 1271  similar charges constitutes the permanent revocation of the
 1272  license.
 1273         Section 12. Effective July 1, 2012, present subsections
 1274  (14) and (15) of section 456.036, Florida Statutes, are
 1275  renumbered as subsections (15) and (16), respectively, and a new
 1276  subsection (14) is added to that section, to read:
 1277         456.036 Licenses; active and inactive status; delinquency.—
 1278         (14) A person who has been denied license renewal,
 1279  certification, or registration under s. 456.0635(3) may regain
 1280  licensure, certification, or registration only by meeting the
 1281  qualifications and completing the application process for
 1282  initial licensure as defined by the board, or the department if
 1283  there is no board. However, a person who was denied renewal of
 1284  licensure, certification, or registration under s. 24 of chapter
 1285  2009-223, Laws of Florida, between July 1, 2009, and June 30,
 1286  2012, is not required to retake and pass examinations applicable
 1287  for initial licensure, certification, or registration.
 1288         Section 13. Subsection (1) of section 456.074, Florida
 1289  Statutes, is amended to read:
 1290         456.074 Certain health care practitioners; immediate
 1291  suspension of license.—
 1292         (1) The department shall issue an emergency order
 1293  suspending the license of any person licensed under chapter 458,
 1294  chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
 1295  chapter 464, chapter 465, chapter 466, or chapter 484 who pleads
 1296  guilty to, is convicted or found guilty of, or who enters a plea
 1297  of nolo contendere to, regardless of adjudication, to:
 1298         (a) A felony under chapter 409, chapter 817, or chapter 893
 1299  or under 21 U.S.C. ss. 801-970 or under 42 U.S.C. ss. 1395-1396;
 1300  or
 1301         (b) A misdemeanor or felony under 18 U.S.C. s. 669, ss.
 1302  285-287, s. 371, s. 1001, s. 1035, s. 1341, s. 1343, s. 1347, s.
 1303  1349, or s. 1518 or 42 U.S.C. ss. 1320a-7b, relating to the
 1304  Medicaid program.
 1305         Section 14. Subsection (3) of section 458.309, Florida
 1306  Statutes, is amended to read:
 1307         458.309 Rulemaking authority.—
 1308         (3) A physician All physicians who performs liposuction
 1309  procedures in which more than 1,000 cubic centimeters of
 1310  supernatant fat is removed, perform level 2 procedures lasting
 1311  more than 5 minutes, and all level 3 surgical procedures in an
 1312  office setting must register the office with the department
 1313  unless that office is licensed as a facility under pursuant to
 1314  chapter 395. The department shall inspect the physician’s office
 1315  annually unless the office is accredited by a nationally
 1316  recognized accrediting agency or an accrediting organization
 1317  subsequently approved by the Board of Medicine. The actual costs
 1318  for registration and inspection or accreditation shall be paid
 1319  by the person seeking to register and operate the office setting
 1320  in which office surgery is performed.
 1321         Section 15. Subsection (2) of section 459.005, Florida
 1322  Statutes, is amended to read:
 1323         459.005 Rulemaking authority.—
 1324         (2) A physician All physicians who performs liposuction
 1325  procedures in which more than 1,000 cubic centimeters of
 1326  supernatant fat is removed, perform level 2 procedures lasting
 1327  more than 5 minutes, and all level 3 surgical procedures in an
 1328  office setting must register the office with the department
 1329  unless that office is licensed as a facility under pursuant to
 1330  chapter 395. The department shall inspect the physician’s office
 1331  annually unless the office is accredited by a nationally
 1332  recognized accrediting agency or an accrediting organization
 1333  subsequently approved by the Board of Osteopathic Medicine. The
 1334  actual costs for registration and inspection or accreditation
 1335  shall be paid by the person seeking to register and operate the
 1336  office setting in which office surgery is performed.
 1337         Section 16. Subsections (3), (4), and (5) of section
 1338  463.002, Florida Statutes, are amended to read:
 1339         463.002 Definitions.—As used in this chapter, the term:
 1340         (3)(a) “Licensed practitioner” means a person who is a
 1341  primary health care provider licensed to engage in the practice
 1342  of optometry under the authority of this chapter.
 1343         (b) A licensed practitioner who is not a certified
 1344  optometrist shall be required to display at her or his place of
 1345  practice a sign which states, “I am a Licensed Practitioner, not
 1346  a Certified Optometrist, and I am not able to prescribe topical
 1347  ocular pharmaceutical agents.”
 1348         (c) All practitioners initially licensed after July 1,
 1349  1993, must be certified optometrists.
 1350         (4) “Certified optometrist” means a licensed practitioner
 1351  authorized by the board to administer and prescribe topical
 1352  ocular pharmaceutical agents.
 1353         (5) “Optometry” means the diagnosis of conditions of the
 1354  human eye and its appendages; the employment of any objective or
 1355  subjective means or methods, including the administration of
 1356  topical ocular pharmaceutical agents, for the purpose of
 1357  determining the refractive powers of the human eyes, or any
 1358  visual, muscular, neurological, or anatomic anomalies of the
 1359  human eyes and their appendages; and the prescribing and
 1360  employment of lenses, prisms, frames, mountings, contact lenses,
 1361  orthoptic exercises, light frequencies, and any other means or
 1362  methods, including topical ocular pharmaceutical agents, for the
 1363  correction, remedy, or relief of any insufficiencies or abnormal
 1364  conditions of the human eyes and their appendages.
 1365         Section 17. Paragraph (g) of subsection (1) of section
 1366  463.005, Florida Statutes, is amended to read:
 1367         463.005 Authority of the board.—
 1368         (1) The Board of Optometry has authority to adopt rules
 1369  pursuant to ss. 120.536(1) and 120.54 to implement the
 1370  provisions of this chapter conferring duties upon it. Such rules
 1371  shall include, but not be limited to, rules relating to:
 1372         (g) Administration and prescription of topical ocular
 1373  pharmaceutical agents.
 1374         Section 18. Section 463.0055, Florida Statutes, is amended
 1375  to read:
 1376         463.0055 Administration and prescription of topical ocular
 1377  pharmaceutical agents; committee.—
 1378         (1)(a) Certified optometrists may administer and prescribe
 1379  topical ocular pharmaceutical agents as provided in this section
 1380  for the diagnosis and treatment of ocular conditions of the
 1381  human eye and its appendages without the use of surgery or other
 1382  invasive techniques. However, a licensed practitioner who is not
 1383  certified may use topically applied anesthetics solely for the
 1384  purpose of glaucoma examinations, but is otherwise prohibited
 1385  from administering or prescribing topical ocular pharmaceutical
 1386  agents.
 1387         (b) Before a certified optometrist may administer or
 1388  prescribe oral ocular pharmaceutical agents, the certified
 1389  optometrist must complete a course and subsequent examination on
 1390  general and ocular pharmacology which have a particular emphasis
 1391  on the ingestion of oral pharmaceutical agents and the side
 1392  effects of those agents. For certified optometrists licensed
 1393  before January 1, 1990, the course shall consist of 50 contact
 1394  hours and 25 of those hours shall be Internet-based. For
 1395  certified optometrists licensed on or after January 1, 1990, the
 1396  course shall consist of 20 contact hours and 10 of those hours
 1397  shall be Internet-based. The first course and examination shall
 1398  be presented by January 1, 2013, and shall thereafter be
 1399  administered at least annually. The Florida Medical Association
 1400  and the Florida Optometric Association shall jointly develop and
 1401  administer a course and examination for such purpose and jointly
 1402  determine the site or sites for the course and examination.
 1403         (2)(a) There is hereby created a committee composed of two
 1404  certified optometrists licensed pursuant to this chapter,
 1405  appointed by the Board of Optometry, two board-certified
 1406  ophthalmologists licensed pursuant to chapter 458 or chapter
 1407  459, appointed by the Board of Medicine, and one additional
 1408  person with a doctorate degree in pharmacology who is not
 1409  licensed pursuant to chapter 458, chapter 459, or this chapter,
 1410  appointed by the State Surgeon General. The committee shall
 1411  review requests for additions to, deletions from, or
 1412  modifications of a formulary of topical ocular pharmaceutical
 1413  agents for administration and prescription by certified
 1414  optometrists and shall provide to the board advisory opinions
 1415  and recommendations on such requests. The formulary of topical
 1416  ocular pharmaceutical agents shall consist of those topical
 1417  ocular pharmaceutical agents that are appropriate to treat and
 1418  diagnose ocular diseases and disorders and that which the
 1419  certified optometrist is qualified to use in the practice of
 1420  optometry. The board shall establish, add to, delete from, or
 1421  modify the formulary by rule. Notwithstanding any provision of
 1422  chapter 120 to the contrary, the formulary rule shall become
 1423  effective 60 days from the date it is filed with the Secretary
 1424  of State.
 1425         (b) The topical formulary may be added to, deleted from, or
 1426  modified according to the procedure described in paragraph (a).
 1427  Any person who requests an addition, deletion, or modification
 1428  of an authorized topical ocular pharmaceutical agent shall have
 1429  the burden of proof to show cause why such addition, deletion,
 1430  or modification should be made.
 1431         (c) The State Surgeon General shall have standing to
 1432  challenge any rule or proposed rule of the board pursuant to s.
 1433  120.56. In addition to challenges for any invalid exercise of
 1434  delegated legislative authority, the administrative law judge,
 1435  upon such a challenge by the State Surgeon General, may declare
 1436  all or part of a rule or proposed rule invalid if it:
 1437         1. Does not protect the public from any significant and
 1438  discernible harm or damages;
 1439         2. Unreasonably restricts competition or the availability
 1440  of professional services in the state or in a significant part
 1441  of the state; or
 1442         3. Unnecessarily increases the cost of professional
 1443  services without a corresponding or equivalent public benefit.
 1444  
 1445  However, there shall not be created a presumption of the
 1446  existence of any of the conditions cited in this subsection in
 1447  the event that the rule or proposed rule is challenged.
 1448         (d) Upon adoption of the topical formulary required by this
 1449  section, and upon each addition, deletion, or modification to
 1450  the topical formulary, the board shall mail a copy of the
 1451  amended topical formulary to each certified optometrist and to
 1452  each pharmacy licensed by the state.
 1453         (3) In addition to the formulary of topical ocular
 1454  pharmaceutical agents in subsection (2), there is created a
 1455  statutory formulary of oral pharmaceutical agents, which include
 1456  the following agents:
 1457         (a) The following analgesics, or their generic or
 1458  therapeutic equivalents, which may not be administered or
 1459  prescribed for more than 72 hours without consultation with a
 1460  physician licensed under chapter 458 or chapter 459 who is
 1461  skilled in diseases of the eye:
 1462         1. Tramadol hydrochloride.
 1463         2. Acetaminophen 300 mg with No. 3 codeine phosphate 30 mg.
 1464         (b) The following antibiotics, or their generic or
 1465  therapeutic equivalents:
 1466         1. Amoxicillin.
 1467         2. Azithromycin.
 1468         3. Ciprofloxacin.
 1469         4. Dicloxacillin.
 1470         5. Doxycycline.
 1471         6. Keflex.
 1472         7. Minocycline.
 1473         (c) The following antivirals, or their generic or
 1474  therapeutic equivalents:
 1475         1. Acyclovir.
 1476         2. Famciclovir.
 1477         3. Valacyclovir.
 1478         (d) The following oral anti-glaucoma agents, or their
 1479  generic or therapeutic equivalents, which may not be
 1480  administered or prescribed for more than 72 hours without
 1481  consultation with a physician licensed under chapter 458 or
 1482  chapter 459 who is skilled in diseases of the eye:
 1483         1. Acetazolamide.
 1484         2. Methazolamide.
 1485  
 1486  Any oral pharmaceutical agent listed in the statutory formulary
 1487  set forth in this subsection which is subsequently determined by
 1488  the United States Food and Drug Administration to be unsafe for
 1489  administration or prescription shall be considered to have been
 1490  deleted from the formulary of oral pharmaceutical agents. The
 1491  oral pharmaceutical agents on the statutory formulary set forth
 1492  in this subsection may not otherwise be deleted by the board,
 1493  the department, or the State Surgeon General.
 1494         (4)(3) A certified optometrist shall be issued a prescriber
 1495  number by the board. Any prescription written by a certified
 1496  optometrist for a topical ocular pharmaceutical agent pursuant
 1497  to this section shall have the prescriber number printed
 1498  thereon.
 1499         Section 19. Subsection (3) of section 463.0057, Florida
 1500  Statutes, is amended to read:
 1501         463.0057 Optometric faculty certificate.—
 1502         (3) The holder of a faculty certificate may engage in the
 1503  practice of optometry as permitted by this section, but may not
 1504  administer or prescribe topical ocular pharmaceutical agents
 1505  unless the certificateholder has satisfied the requirements of
 1506  ss. 463.0055(1)(b) and s. 463.006(1)(b)4. and 5.
 1507         Section 20. Subsections (2) and (3) of section 463.006,
 1508  Florida Statutes, are amended to read:
 1509         463.006 Licensure and certification by examination.—
 1510         (2) The examination shall consist of the appropriate
 1511  subjects, including applicable state laws and rules and general
 1512  and ocular pharmacology with emphasis on the use topical
 1513  application and side effects of ocular pharmaceutical agents.
 1514  The board may by rule substitute a national examination as part
 1515  or all of the examination and may by rule offer a practical
 1516  examination in addition to the written examination.
 1517         (3) Each applicant who successfully passes the examination
 1518  and otherwise meets the requirements of this chapter is entitled
 1519  to be licensed as a practitioner and to be certified to
 1520  administer and prescribe topical ocular pharmaceutical agents in
 1521  the diagnosis and treatment of ocular conditions.
 1522         Section 21. Subsections (1) and (2) of section 463.0135,
 1523  Florida Statutes, are amended, and subsection (10) is added to
 1524  that section, to read:
 1525         463.0135 Standards of practice.—
 1526         (1) A licensed practitioner shall provide that degree of
 1527  care which conforms to that level of care provided by medical
 1528  practitioners in the same or similar communities. A certified
 1529  optometrist shall administer and prescribe oral ocular
 1530  pharmaceutical agents in a manner consistent with applicable
 1531  preferred practice patterns of the American Academy of
 1532  Ophthalmology. A licensed practitioner shall advise or assist
 1533  her or his patient in obtaining further care when the service of
 1534  another health care practitioner is required.
 1535         (2) A licensed practitioner diagnosing angle closure,
 1536  neovascular, infantile, or congenital forms of glaucoma shall
 1537  promptly and without unreasonable delay refer the patient to a
 1538  physician skilled in diseases of the eye and licensed under
 1539  chapter 458 or chapter 459. In addition, a licensed practitioner
 1540  shall timely refer any patient who experiences progressive
 1541  glaucoma due to failed pharmaceutical intervention to a
 1542  physician who is skilled in diseases of the eye and licensed
 1543  under chapter 458 or chapter 459.
 1544         (10) Comanagement of postoperative care shall be conducted
 1545  pursuant to an established protocol that governs the
 1546  relationship between the operating surgeon and the optometrist.
 1547  The patient shall be informed that either physician will be
 1548  available for emergency care throughout the postoperative
 1549  period, and the patient shall consent in writing to the
 1550  comanagement relationship.
 1551         Section 22. Subsections (3) and (4) of section 463.014,
 1552  Florida Statutes, are amended to read:
 1553         463.014 Certain acts prohibited.—
 1554         (3) Prescribing, ordering, dispensing, administering,
 1555  supplying, selling, or giving any systemic drugs for the purpose
 1556  of treating a systemic disease by a licensed practitioner is
 1557  prohibited. However, a certified optometrist is permitted to use
 1558  commonly accepted means or methods to immediately address
 1559  incidents of anaphylaxis.
 1560         (4) Surgery of any kind, including the use of lasers, is
 1561  expressly prohibited. For purposes of this subsection, the term
 1562  “surgery” means a procedure using an instrument, including
 1563  lasers, scalpels, or needles, in which human tissue is cut,
 1564  burned, or vaporized by incision, injection, ultrasound, laser,
 1565  or radiation. The term includes procedures using instruments
 1566  that require closing by suturing, clamping, or another such
 1567  device. Certified optometrists may remove superficial foreign
 1568  bodies. For the purposes of this subsection, the term
 1569  “superficial foreign bodies” means any foreign matter that is
 1570  embedded in the conjunctiva or cornea but which has not
 1571  penetrated the globe.
 1572         Section 23. Section 463.0141, Florida Statutes, is created
 1573  to read:
 1574         463.0141Reports of adverse incidents in the practice of
 1575  optometry.—
 1576         (1) Any adverse incident that occurs on or after January 1,
 1577  2013, in the practice of optometry must be reported to the
 1578  department in the accordance with this section.
 1579         (2) The required notification to the department must be
 1580  submitted in writing by certified mail and postmarked within 15
 1581  days after the occurrence of the adverse incident.
 1582         (3) For purposes of notification to the department, the
 1583  term “adverse incident,” as used in this section, means an event
 1584  that is associated in whole or in part with the prescribing of
 1585  an oral ocular pharmaceutical agent and that results in one of
 1586  the following:
 1587         (a) Any condition that requires the transfer of a patient
 1588  to a hospital licensed under chapter 395;
 1589         (b) Any condition that requires the patient to obtain care
 1590  from a physician licensed under chapter 458 or chapter 459,
 1591  other than a referral or a consultation required under this
 1592  chapter;
 1593         (c) Permanent physical injury to the patient;
 1594         (d) Partial or complete permanent loss of sight by the
 1595  patient; or
 1596         (e) Death of the patient.
 1597         (4) The department shall review each incident and determine
 1598  whether it potentially involved conduct by the licensed
 1599  practitioner which may be subject to disciplinary action, in
 1600  which case s. 456.073 applies. Disciplinary action, if any,
 1601  shall be taken by the board.
 1602         Section 24. Subsection (1) of section 483.035, Florida
 1603  Statutes, is amended to read:
 1604         483.035 Clinical laboratories operated by practitioners for
 1605  exclusive use; licensure and regulation.—
 1606         (1) A clinical laboratory operated by one or more
 1607  practitioners licensed under chapter 458, chapter 459, chapter
 1608  460, chapter 461, chapter 462, chapter 463, or chapter 466,
 1609  exclusively in connection with the diagnosis and treatment of
 1610  their own patients, must be licensed under this part and must
 1611  comply with the provisions of this part, except that the agency
 1612  shall adopt rules for staffing, for personnel, including
 1613  education and training of personnel, for proficiency testing,
 1614  and for construction standards relating to the licensure and
 1615  operation of the laboratory based upon and not exceeding the
 1616  same standards contained in the federal Clinical Laboratory
 1617  Improvement Amendments of 1988 and the federal regulations
 1618  adopted thereunder.
 1619         Section 25. Subsection (7) of section 483.041, Florida
 1620  Statutes, is amended to read:
 1621         483.041 Definitions.—As used in this part, the term:
 1622         (7) “Licensed practitioner” means a physician licensed
 1623  under chapter 458, chapter 459, chapter 460, or chapter 461, or
 1624  chapter 463; a dentist licensed under chapter 466; a person
 1625  licensed under chapter 462; or an advanced registered nurse
 1626  practitioner licensed under part I of chapter 464; or a duly
 1627  licensed practitioner from another state licensed under similar
 1628  statutes who orders examinations on materials or specimens for
 1629  nonresidents of the State of Florida, but who reside in the same
 1630  state as the requesting licensed practitioner.
 1631         Section 26. Subsection (5) of section 483.181, Florida
 1632  Statutes, is amended to read:
 1633         483.181 Acceptance, collection, identification, and
 1634  examination of specimens.—
 1635         (5) A clinical laboratory licensed under this part must
 1636  accept a human specimen submitted for examination by a
 1637  practitioner licensed under chapter 458, chapter 459, chapter
 1638  460, chapter 461, chapter 462, chapter 463, s. 464.012, or
 1639  chapter 466, if the specimen and test are the type performed by
 1640  the clinical laboratory. A clinical laboratory may only refuse a
 1641  specimen based upon a history of nonpayment for services by the
 1642  practitioner. A clinical laboratory shall not charge different
 1643  prices for tests based upon the chapter under which a
 1644  practitioner submitting a specimen for testing is licensed.
 1645         Section 27. Paragraph (a) of subsection (54) of section
 1646  499.003, Florida Statutes, is amended to read:
 1647         499.003 Definitions of terms used in this part.—As used in
 1648  this part, the term:
 1649         (54) “Wholesale distribution” means distribution of
 1650  prescription drugs to persons other than a consumer or patient,
 1651  but does not include:
 1652         (a) Any of the following activities, which is not a
 1653  violation of s. 499.005(21) if such activity is conducted in
 1654  accordance with s. 499.01(2)(g):
 1655         1. The purchase or other acquisition by a hospital or other
 1656  health care entity that is a member of a group purchasing
 1657  organization of a prescription drug for its own use from the
 1658  group purchasing organization or from other hospitals or health
 1659  care entities that are members of that organization.
 1660         2. The sale, purchase, or trade of a prescription drug or
 1661  an offer to sell, purchase, or trade a prescription drug by a
 1662  charitable organization described in s. 501(c)(3) of the
 1663  Internal Revenue Code of 1986, as amended and revised, to a
 1664  nonprofit affiliate of the organization to the extent otherwise
 1665  permitted by law.
 1666         3. The sale, purchase, or trade of a prescription drug or
 1667  an offer to sell, purchase, or trade a prescription drug among
 1668  hospitals or other health care entities that are under common
 1669  control. For purposes of this subparagraph, “common control”
 1670  means the power to direct or cause the direction of the
 1671  management and policies of a person or an organization, whether
 1672  by ownership of stock, by voting rights, by contract, or
 1673  otherwise.
 1674         4. The sale, purchase, trade, or other transfer of a
 1675  prescription drug from or for any federal, state, or local
 1676  government agency or any entity eligible to purchase
 1677  prescription drugs at public health services prices pursuant to
 1678  Pub. L. No. 102-585, s. 602 to a contract provider or its
 1679  subcontractor for eligible patients of the agency or entity
 1680  under the following conditions:
 1681         a. The agency or entity must obtain written authorization
 1682  for the sale, purchase, trade, or other transfer of a
 1683  prescription drug under this subparagraph from the State Surgeon
 1684  General or his or her designee.
 1685         b. The contract provider or subcontractor must be
 1686  authorized by law to administer or dispense prescription drugs.
 1687         c. In the case of a subcontractor, the agency or entity
 1688  must be a party to and execute the subcontract.
 1689         d. A contract provider or subcontractor must maintain
 1690  separate and apart from other prescription drug inventory any
 1691  prescription drugs of the agency or entity in its possession.
 1692         d.e. The contract provider and subcontractor must maintain
 1693  and produce immediately for inspection all records of movement
 1694  or transfer of all the prescription drugs belonging to the
 1695  agency or entity, including, but not limited to, the records of
 1696  receipt and disposition of prescription drugs. Each contractor
 1697  and subcontractor dispensing or administering these drugs must
 1698  maintain and produce records documenting the dispensing or
 1699  administration. Records that are required to be maintained
 1700  include, but are not limited to, a perpetual inventory itemizing
 1701  drugs received and drugs dispensed by prescription number or
 1702  administered by patient identifier, which must be submitted to
 1703  the agency or entity quarterly.
 1704         e.f. The contract provider or subcontractor may administer
 1705  or dispense the prescription drugs only to the eligible patients
 1706  of the agency or entity or must return the prescription drugs
 1707  for or to the agency or entity. The contract provider or
 1708  subcontractor must require proof from each person seeking to
 1709  fill a prescription or obtain treatment that the person is an
 1710  eligible patient of the agency or entity and must, at a minimum,
 1711  maintain a copy of this proof as part of the records of the
 1712  contractor or subcontractor required under sub-subparagraph e.
 1713         f.g. In addition to the departmental inspection authority
 1714  set forth in s. 499.051, the establishment of the contract
 1715  provider and subcontractor and all records pertaining to
 1716  prescription drugs subject to this subparagraph shall be subject
 1717  to inspection by the agency or entity. All records relating to
 1718  prescription drugs of a manufacturer under this subparagraph
 1719  shall be subject to audit by the manufacturer of those drugs,
 1720  without identifying individual patient information.
 1721         Section 28. Subsection (4) of section 766.102, Florida
 1722  Statutes, is amended to read:
 1723         766.102 Medical negligence; standards of recovery; expert
 1724  witness.—
 1725         (4)(a) The Legislature is cognizant of the changing trends
 1726  and techniques for the delivery of health care in this state and
 1727  the discretion that is inherent in the diagnosis, care, and
 1728  treatment of patients by different health care providers. The
 1729  failure of a health care provider to order, perform, or
 1730  administer supplemental diagnostic tests is shall not be
 1731  actionable if the health care provider acted in good faith and
 1732  with due regard for the prevailing professional standard of
 1733  care.
 1734         (b) The claimant has the burden of proving by clear and
 1735  convincing evidence that the alleged actions of the health care
 1736  provider represent a breach of the prevailing professional
 1737  standard of care in an action for damages based on death or
 1738  personal injury which alleges that the death or injury resulted
 1739  from the failure of a health care provider to order, perform, or
 1740  administer supplemental diagnostic tests.
 1741         Section 29. Paragraph (b) of subsection (6) of section
 1742  766.106, Florida Statutes, is amended to read:
 1743         766.106 Notice before filing action for medical negligence;
 1744  presuit screening period; offers for admission of liability and
 1745  for arbitration; informal discovery; review.—
 1746         (6) INFORMAL DISCOVERY.—
 1747         (b) Informal discovery may be used by a party to obtain
 1748  unsworn statements, the production of documents or things, and
 1749  physical and mental examinations, and ex parte interviews, as
 1750  follows:
 1751         1. Unsworn statements.—Any party may require other parties
 1752  to appear for the taking of an unsworn statement. Such
 1753  statements may be used only for the purpose of presuit screening
 1754  and are not discoverable or admissible in any civil action for
 1755  any purpose by any party. A party desiring to take the unsworn
 1756  statement of any party must give reasonable notice in writing to
 1757  all parties. The notice must state the time and place for taking
 1758  the statement and the name and address of the party to be
 1759  examined. Unless otherwise impractical, the examination of any
 1760  party must be done at the same time by all other parties. Any
 1761  party may be represented by counsel at the taking of an unsworn
 1762  statement. An unsworn statement may be recorded electronically,
 1763  stenographically, or on videotape. The taking of unsworn
 1764  statements is subject to the provisions of the Florida Rules of
 1765  Civil Procedure and may be terminated for abuses.
 1766         2. Documents or things.—Any party may request discovery of
 1767  documents or things. The documents or things must be produced,
 1768  at the expense of the requesting party, within 20 days after the
 1769  date of receipt of the request. A party is required to produce
 1770  discoverable documents or things within that party’s possession
 1771  or control. Medical records shall be produced as provided in s.
 1772  766.204.
 1773         3. Physical and mental examinations.—A prospective
 1774  defendant may require an injured claimant to appear for
 1775  examination by an appropriate health care provider. The
 1776  prospective defendant shall give reasonable notice in writing to
 1777  all parties as to the time and place for examination. Unless
 1778  otherwise impractical, a claimant is required to submit to only
 1779  one examination on behalf of all potential defendants. The
 1780  practicality of a single examination must be determined by the
 1781  nature of the claimant’s condition, as it relates to the
 1782  liability of each prospective defendant. Such examination report
 1783  is available to the parties and their attorneys upon payment of
 1784  the reasonable cost of reproduction and may be used only for the
 1785  purpose of presuit screening. Otherwise, such examination report
 1786  is confidential and exempt from the provisions of s. 119.07(1)
 1787  and s. 24(a), Art. I of the State Constitution.
 1788         4. Written questions.—Any party may request answers to
 1789  written questions, the number of which may not exceed 30,
 1790  including subparts. A response must be made within 20 days after
 1791  receipt of the questions.
 1792         5. Unsworn statements of treating health care providers.—A
 1793  prospective defendant or his or her legal representative may
 1794  also take unsworn statements of the claimant’s treating health
 1795  care providers. The statements must be limited to those areas
 1796  that are potentially relevant to the claim of personal injury or
 1797  wrongful death. Subject to the procedural requirements of
 1798  subparagraph 1., a prospective defendant may take unsworn
 1799  statements from a claimant’s treating physicians. Reasonable
 1800  notice and opportunity to be heard must be given to the claimant
 1801  or the claimant’s legal representative before taking unsworn
 1802  statements. The claimant or claimant’s legal representative has
 1803  the right to attend the taking of such unsworn statements.
 1804         6. Ex parte interviews of treating health care providers.—A
 1805  prospective defendant or his or her legal representative may
 1806  interview the claimant’s treating health care providers without
 1807  the presence of the claimant or the claimant’s legal
 1808  representative. If a prospective defendant or his or her legal
 1809  representative intends to interview a claimant’s health care
 1810  providers, the prospective defendant must provide the claimant
 1811  with notice of such interview at least 10 days before the date
 1812  of the interview.
 1813         Section 30. Section 766.1091, Florida Statutes, is created
 1814  to read:
 1815         766.1091 Voluntary binding arbitration; damages.—
 1816         (1)A health care provider licensed under chapter 458,
 1817  chapter 459, chapter 463, or chapter 466; any entity owned in
 1818  whole or in part by a health care provider licensed under
 1819  chapter 458, chapter 459, chapter 463, or chapter 466; or any
 1820  health care clinic licensed under part X of chapter 400, and a
 1821  patient or prospective patient, may agree in writing to submit
 1822  to arbitration any claim for medical negligence which may
 1823  currently exist or may accrue in the future and would otherwise
 1824  be brought pursuant to this chapter. Any arbitration agreement
 1825  entered into pursuant to this section shall be governed by
 1826  chapter 682.
 1827         (2)Any arbitration agreement entered into pursuant to
 1828  subsection (1) may contain a provision that limits the available
 1829  damages in an arbitration award.
 1830         Section 31. Subsection (21) of section 893.02, Florida
 1831  Statutes, is amended to read:
 1832         893.02 Definitions.—The following words and phrases as used
 1833  in this chapter shall have the following meanings, unless the
 1834  context otherwise requires:
 1835         (21) “Practitioner” means a physician licensed pursuant to
 1836  chapter 458, a dentist licensed pursuant to chapter 466, a
 1837  veterinarian licensed pursuant to chapter 474, an osteopathic
 1838  physician licensed pursuant to chapter 459, a naturopath
 1839  licensed pursuant to chapter 462, a certified optometrist
 1840  licensed under chapter 463, or a podiatric physician licensed
 1841  pursuant to chapter 461, provided such practitioner holds a
 1842  valid federal controlled substance registry number.
 1843         Section 32. Subsection (1) of section 893.05, Florida
 1844  Statutes, is amended to read:
 1845         893.05 Practitioners and persons administering controlled
 1846  substances in their absence.—
 1847         (1) A practitioner, in good faith and in the course of his
 1848  or her professional practice only, may prescribe, administer,
 1849  dispense, mix, or otherwise prepare a controlled substance, or
 1850  the practitioner may cause the same to be administered by a
 1851  licensed nurse or an intern practitioner under his or her
 1852  direction and supervision only. A veterinarian may so prescribe,
 1853  administer, dispense, mix, or prepare a controlled substance for
 1854  use on animals only, and may cause it to be administered by an
 1855  assistant or orderly under the veterinarian’s direction and
 1856  supervision only. A certified optometrist licensed under chapter
 1857  463 may not administer or prescribe pharmaceutical agents in
 1858  Schedule I or Schedule II of the Florida Comprehensive Drug
 1859  Abuse Prevention and Control Act.
 1860         Section 33. The Agency for Health Care Administration shall
 1861  prepare a report within 18 months after the implementation of an
 1862  expansion of managed care to new populations or the provision of
 1863  new items and services. The agency shall post a draft of the
 1864  report on its website and provide an opportunity for public
 1865  comment. The final report shall be submitted to the Legislature,
 1866  along with a description of the process for public input. The
 1867  report must include an assessment of:
 1868         (1) The impact of managed care on patient access to care,
 1869  including an evaluation of any new barriers to the use of
 1870  services and prescription drugs, created by the use of medical
 1871  management or cost-containment tools.
 1872         (2) The impact of the increased managed care expansion on
 1873  the utilization of services, quality of care, and patient
 1874  outcomes.
 1875         (3) The use of prior authorization and other utilization
 1876  management tools, including an assessment of whether these tools
 1877  pose an undue administrative burden for health care providers or
 1878  create barriers to needed care.
 1879         Section 34. Except as otherwise expressly provided in this
 1880  act, this act shall take effect upon becoming a law.

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