Bill Text: FL S7078 | 2019 | Regular Session | Comm Sub


Bill Title: Health Care

Spectrum: Partisan Bill (? 2-0)

Status: (Introduced) 2019-04-26 - Laid on Table, companion bill(s) passed, see CS/HB 843 (Ch. 2019-138), CS/HB 7 (Ch. 2019-105) [S7078 Detail]

Download: Florida-2019-S7078-Comm_Sub.html
       Florida Senate - 2019                             CS for SB 7078
       
       
        
       By the Committees on Appropriations; and Health Policy
       
       
       
       
       
       576-04629B-19                                         20197078c1
    1                        A bill to be entitled                      
    2         An act relating to health care; providing legislative
    3         intent; creating s. 381.4019, F.S.; establishing the
    4         Dental Student Loan Repayment Program to support
    5         dentists who practice in public health programs
    6         located in certain underserved areas; providing
    7         definitions; requiring the Department of Health to
    8         establish a dental student loan repayment program for
    9         specified purposes; providing for the award of funds;
   10         providing the maximum number of years for which funds
   11         may be awarded; providing eligibility requirements;
   12         requiring the department to adopt rules; specifying
   13         that implementation of the program is subject to
   14         legislative appropriation; creating s. 381.40195,
   15         F.S.; providing a short title; providing definitions;
   16         requiring the Department of Health to establish the
   17         Donated Dental Services Program to provide
   18         comprehensive dental care to certain eligible
   19         individuals; requiring the department to contract with
   20         a nonprofit organization to implement and administer
   21         the program; specifying minimum contractual
   22         responsibilities; requiring the department to adopt
   23         rules; specifying that implementation of the program
   24         is subject to legislative appropriation; amending s.
   25         395.1012, F.S.; requiring a licensed hospital to
   26         provide specified information and data relating to
   27         patient safety and quality measures to a patient under
   28         certain circumstances or to any person upon request;
   29         creating s. 395.1052, F.S.; requiring a hospital to
   30         notify a patient’s primary care provider within a
   31         specified timeframe after the patient’s admission;
   32         requiring a hospital to inform a patient, upon
   33         admission, of the option to request consultation
   34         between the hospital’s treating physician and the
   35         patient’s primary care provider or specialist
   36         provider; requiring a hospital to notify a patient’s
   37         primary care provider of the patient’s discharge and
   38         provide specified information and records to the
   39         primary care provider within a specified timeframe
   40         after discharge; amending s. 395.002, F.S.; revising
   41         the definition of the term “ambulatory surgical
   42         center”; amending s. 395.1055, F.S.; requiring the
   43         Agency for Health Care Administration, in consultation
   44         with the Board of Medicine and the Board of
   45         Osteopathic Medicine, to adopt rules that establish
   46         requirements related to the delivery of surgical care
   47         to children in ambulatory surgical centers, in
   48         accordance with specified standards; specifying that
   49         ambulatory surgical centers may provide certain
   50         procedures only if authorized by agency rule;
   51         authorizing the reimbursement of per diem and travel
   52         expenses to members of the pediatric cardiac technical
   53         advisory panel, established within the Agency for
   54         Health Care Administration; revising panel membership
   55         to include certain alternate at-large members;
   56         providing term limits for voting members; providing
   57         that members of the panel under certain circumstances
   58         are agents of the state for a specified purpose;
   59         requiring the Secretary of Health Care Administration
   60         to consult the panel for advisory recommendations on
   61         certain certificate of need applications; authorizing
   62         the secretary to request announced or unannounced site
   63         visits to any existing pediatric cardiac surgical
   64         center or facility seeking licensure as a pediatric
   65         cardiac surgical center through the certificate of
   66         need process; providing a process for the appointment
   67         of physician experts to a site visit team; requiring
   68         each member of a site visit team to submit a report to
   69         the panel; requiring the panel to discuss such reports
   70         and present an advisory opinion to the secretary;
   71         providing requirements for an on-site inspection;
   72         requiring the Surgeon General of the Department of
   73         Health to provide specified reports to the secretary;
   74         395.301, F.S.; requiring a licensed facility, upon
   75         placing a patient on observation status, to
   76         immediately notify the patient of such status using a
   77         specified form; requiring that such notification be
   78         documented in the patient’s medical records and
   79         discharge papers; creating s. 542.336, F.S.;
   80         specifying that certain restrictive covenants entered
   81         into with certain physicians are not supported by
   82         legitimate business interests; providing legislative
   83         findings; providing that such restrictive covenants
   84         are void and remain void and unenforceable for a
   85         specified period; amending s. 624.27, F.S.; expanding
   86         the scope of direct primary care agreements, which are
   87         renamed “direct health care agreements”; conforming
   88         provisions to changes made by the act; creating s.
   89         627.42393, F.S.; prohibiting certain health insurers
   90         from employing step-therapy protocols under certain
   91         circumstances; defining the term “health coverage
   92         plan”; clarifying that a health insurer is not
   93         required to take specific actions regarding
   94         prescription drugs; amending s. 641.31, F.S.;
   95         prohibiting certain health maintenance organizations
   96         from employing step-therapy protocols under certain
   97         circumstances; defining the term “health coverage
   98         plan”; clarifying that a health maintenance
   99         organization is not required to take specific actions
  100         regarding prescription drugs; requiring the Office of
  101         Program Policy Analysis and Government Accountability
  102         to submit by a specified date a report and
  103         recommendations to the Governor and the Legislature
  104         which addresses this state’s prospective entrance into
  105         the Interstate Medical Licensure Compact as a member
  106         state; providing parameters for the report; providing
  107         effective dates.
  108          
  109  Be It Enacted by the Legislature of the State of Florida:
  110  
  111         Section 1. It is the intent of the Legislature to promote
  112  programs and initiatives that help make available preventive and
  113  educational dental services for the residents of the state, as
  114  well as provide quality dental treatment services. The
  115  geographic characteristics among the residents of the state are
  116  distinctive and vary from region to region, with such residents
  117  having unique needs regarding access to dental care. The
  118  Legislature recognizes that maintaining good oral health is
  119  integral to the overall health status of individuals and that
  120  the good health of the residents of this state is an important
  121  contributing factor in economic development. Better health,
  122  including better oral health, increases workplace productivity,
  123  reduces the burden of health care costs, and improves the
  124  cognitive development of children, resulting in a reduction of
  125  missed school days.
  126         Section 2. Section 381.4019, Florida Statutes, is created
  127  to read:
  128         381.4019Dental Student Loan Repayment Program.—The Dental
  129  Student Loan Repayment Program is established to promote access
  130  to dental care by supporting qualified dentists who treat
  131  medically underserved populations in dental health professional
  132  shortage areas or medically underserved areas.
  133         (1)As used in this section, the term:
  134         (a)“Dental health professional shortage area” means a
  135  geographic area designated as such by the Health Resources and
  136  Services Administration of the United States Department of
  137  Health and Human Services.
  138         (b)“Department” means the Department of Health.
  139         (c)“Loan program” means the Dental Student Loan Repayment
  140  Program.
  141         (d)“Medically underserved area” means a geographic area,
  142  an area having a special population, or a facility which is
  143  designated by department rule as a health professional shortage
  144  area as defined by federal regulation and which has a shortage
  145  of dental health professionals who serve Medicaid recipients and
  146  other low-income patients.
  147         (e)“Public health program” means a county health
  148  department, the Children’s Medical Services program, a federally
  149  funded community health center, a federally funded migrant
  150  health center, or other publicly funded or nonprofit health care
  151  program designated by the department.
  152         (2)The department shall establish a dental student loan
  153  repayment program to benefit Florida-licensed dentists who
  154  demonstrate, as required by department rule, active employment
  155  in a public health program that serves Medicaid recipients and
  156  other low-income patients and is located in a dental health
  157  professional shortage area or a medically underserved area.
  158         (3)The department shall award funds from the loan program
  159  to repay the student loans of a dentist who meets the
  160  requirements of subsection (2).
  161         (a)An award may not exceed $50,000 per year per eligible
  162  dentist.
  163         (b)Only loans to pay the costs of tuition, books, dental
  164  equipment and supplies, uniforms, and living expenses may be
  165  covered.
  166         (c)All repayments are contingent upon continued proof of
  167  eligibility and must be made directly to the holder of the loan.
  168  The state bears no responsibility for the collection of any
  169  interest charges or other remaining balances.
  170         (d)A dentist may receive funds under the loan program for
  171  at least 1 year, up to a maximum of 5 years.
  172         (e)The department shall limit the number of new dentists
  173  participating in the loan program to not more than 10 per fiscal
  174  year.
  175         (4)A dentist is no longer eligible to receive funds under
  176  the loan program if the dentist:
  177         (a)Is no longer employed by a public health program that
  178  meets the requirements of subsection (2).
  179         (b)Ceases to participate in the Florida Medicaid program.
  180         (c)Has disciplinary action taken against his or her
  181  license by the Board of Dentistry for a violation of s. 466.028.
  182         (5)The department shall adopt rules to administer the loan
  183  program.
  184         (6) Implementation of the loan program is subject to
  185  legislative appropriation.
  186         Section 3. Section 381.40195, Florida Statutes, is created
  187  to read:
  188         381.40195Donated Dental Services Program.—
  189         (1)This act may be cited as the “Donated Dental Services
  190  Act.”
  191         (2)As used in this section, the term:
  192         (a)“Department” means the Department of Health.
  193         (b)“Program” means the Donated Dental Services Program as
  194  established pursuant to subsection (3).
  195         (3)The department shall establish the Donated Dental
  196  Services Program for the purpose of providing comprehensive
  197  dental care through a network of volunteer dentists and other
  198  dental providers to needy, disabled, elderly, and medically
  199  compromised individuals who cannot afford necessary treatment
  200  but are ineligible for public assistance. An eligible individual
  201  may receive treatment in a volunteer dentist’s or participating
  202  dental provider’s private office or at any other suitable
  203  location. An eligible individual is not required to pay any fee
  204  or cost associated with the treatment he or she receives.
  205         (4)The department shall establish the program. The
  206  department shall contract with a nonprofit organization that has
  207  experience in providing similar services or administering
  208  similar programs. The contract must specify the responsibilities
  209  of the nonprofit organization, which may include, but are not
  210  limited to:
  211         (a)Maintaining a network of volunteer dentists and other
  212  dental providers, including, but not limited to, dental
  213  specialists and dental laboratories, to provide comprehensive
  214  dental services to eligible individuals.
  215         (b)Maintaining a system to refer eligible individuals to
  216  the appropriate volunteer dentist or participating dental
  217  provider.
  218         (c)Developing a public awareness and marketing campaign to
  219  promote the program and educate eligible individuals about its
  220  availability and services.
  221         (d)Providing the necessary administrative and technical
  222  support to administer the program.
  223         (e)Submitting an annual report to the department which
  224  must include, at a minimum:
  225         1.Financial data relating to administering the program.
  226         2.Demographic data and other information relating to the
  227  eligible individuals who are referred to and receive treatment
  228  through the program.
  229         3.Demographic data and other information relating to the
  230  volunteer dentists and participating dental providers who
  231  provide dental services through the program.
  232         4.Any other data or information that the department may
  233  require.
  234         (f)Performing any other program-related duties and
  235  responsibilities as required by the department.
  236         (5)The department shall adopt rules to administer the
  237  program.
  238         (6) Implementation of the program is subject to legislative
  239  appropriation.
  240         Section 4. Subsection (3) is added to section 395.1012,
  241  Florida Statutes, to read:
  242         395.1012 Patient safety.—
  243         (3)(a)Each hospital shall provide to any patient upon
  244  admission, upon scheduling of nonemergency care, or before
  245  treatment, written information on a form created by the agency
  246  which contains the following information available for the
  247  hospital for the most recent year and the statewide average for
  248  all hospitals related to the following quality measures:
  249         1.The rate of hospital-acquired infections;
  250         2.The overall rating of the Hospital Consumer Assessment
  251  of Healthcare Providers and Systems survey; and
  252         3.The 15-day readmission rate.
  253         (b)A hospital shall also provide to any person, upon
  254  request, the written information specified in paragraph (a).
  255         (c)The information required by this subsection must be
  256  presented in a manner that is easily understandable and
  257  accessible to the patient and must also include an explanation
  258  of the quality measures and the relationship between patient
  259  safety and the hospital’s data for the quality measures.
  260         Section 5. Section 395.1052, Florida Statutes, is created
  261  to read:
  262         395.1052 Patient access to primary care and specialty
  263  providers; notification.—A hospital shall:
  264         (1) Notify each patient’s primary care provider, if any,
  265  within 24 hours after the patient’s admission to the hospital.
  266         (2) Inform the patient immediately upon admission that he
  267  or she may request to have the hospital’s treating physician
  268  consult with the patient’s primary care provider or specialist
  269  provider, if any, when developing the patient’s plan of care.
  270  Upon the patient’s request, the hospital’s treating physician
  271  shall make reasonable efforts to consult with the patient’s
  272  primary care provider or specialist provider when developing the
  273  patient’s plan of care.
  274         (3) Notify the patient’s primary care provider, if any, of
  275  the patient’s discharge from the hospital within 24 hours after
  276  the discharge.
  277         (4) Provide the discharge summary and any related
  278  information or records to the patient’s primary care provider,
  279  if any, within 14 days after the patient’s discharge from the
  280  hospital.
  281         Section 6. Subsection (3) of section 395.002, Florida
  282  Statutes, is amended to read:
  283         395.002 Definitions.—As used in this chapter:
  284         (3) “Ambulatory surgical center” means a facility the
  285  primary purpose of which is to provide elective surgical care,
  286  in which the patient is admitted to and discharged from such
  287  facility within 24 hours the same working day and is not
  288  permitted to stay overnight, and which is not part of a
  289  hospital. However, a facility existing for the primary purpose
  290  of performing terminations of pregnancy, an office maintained by
  291  a physician for the practice of medicine, or an office
  292  maintained for the practice of dentistry may not be construed to
  293  be an ambulatory surgical center, provided that any facility or
  294  office which is certified or seeks certification as a Medicare
  295  ambulatory surgical center shall be licensed as an ambulatory
  296  surgical center pursuant to s. 395.003.
  297         Section 7. Section 395.1055, Florida Statutes, is amended
  298  to read:
  299         395.1055 Rules and enforcement.—
  300         (1) The agency shall adopt rules pursuant to ss. 120.536(1)
  301  and 120.54 to implement the provisions of this part, which shall
  302  include reasonable and fair minimum standards for ensuring that:
  303         (a) Sufficient numbers and qualified types of personnel and
  304  occupational disciplines are on duty and available at all times
  305  to provide necessary and adequate patient care and safety.
  306         (b) Infection control, housekeeping, sanitary conditions,
  307  and medical record procedures that will adequately protect
  308  patient care and safety are established and implemented.
  309         (c) A comprehensive emergency management plan is prepared
  310  and updated annually. Such standards must be included in the
  311  rules adopted by the agency after consulting with the Division
  312  of Emergency Management. At a minimum, the rules must provide
  313  for plan components that address emergency evacuation
  314  transportation; adequate sheltering arrangements; postdisaster
  315  activities, including emergency power, food, and water;
  316  postdisaster transportation; supplies; staffing; emergency
  317  equipment; individual identification of residents and transfer
  318  of records, and responding to family inquiries. The
  319  comprehensive emergency management plan is subject to review and
  320  approval by the local emergency management agency. During its
  321  review, the local emergency management agency shall ensure that
  322  the following agencies, at a minimum, are given the opportunity
  323  to review the plan: the Department of Elderly Affairs, the
  324  Department of Health, the Agency for Health Care Administration,
  325  and the Division of Emergency Management. Also, appropriate
  326  volunteer organizations must be given the opportunity to review
  327  the plan. The local emergency management agency shall complete
  328  its review within 60 days and either approve the plan or advise
  329  the facility of necessary revisions.
  330         (d) Licensed facilities are established, organized, and
  331  operated consistent with established standards and rules.
  332         (e) Licensed facility beds conform to minimum space,
  333  equipment, and furnishings standards as specified by the
  334  department.
  335         (f) All hospitals submit such data as necessary to conduct
  336  certificate-of-need reviews required under part I of chapter
  337  408. Such data shall include, but shall not be limited to,
  338  patient origin data, hospital utilization data, type of service
  339  reporting, and facility staffing data. The agency may not
  340  collect data that identifies or could disclose the identity of
  341  individual patients. The agency shall utilize existing uniform
  342  statewide data sources when available and shall minimize
  343  reporting costs to hospitals.
  344         (g) Each hospital has a quality improvement program
  345  designed according to standards established by their current
  346  accrediting organization. This program will enhance quality of
  347  care and emphasize quality patient outcomes, corrective action
  348  for problems, governing board review, and reporting to the
  349  agency of standardized data elements necessary to analyze
  350  quality of care outcomes. The agency shall use existing data,
  351  when available, and shall not duplicate the efforts of other
  352  state agencies in order to obtain such data.
  353         (h) Licensed facilities make available on their Internet
  354  websites, no later than October 1, 2004, and in a hard copy
  355  format upon request, a description of and a link to the patient
  356  charge and performance outcome data collected from licensed
  357  facilities pursuant to s. 408.061.
  358         (i) All hospitals providing organ transplantation, neonatal
  359  intensive care services, inpatient psychiatric services,
  360  inpatient substance abuse services, or comprehensive medical
  361  rehabilitation meet the minimum licensure requirements adopted
  362  by the agency. Such licensure requirements must include quality
  363  of care, nurse staffing, physician staffing, physical plant,
  364  equipment, emergency transportation, and data reporting
  365  standards.
  366         (2) Separate standards may be provided for general and
  367  specialty hospitals, ambulatory surgical centers, and statutory
  368  rural hospitals as defined in s. 395.602.
  369         (3)(a)The agency, in consultation with the Board of
  370  Medicine and the Board of Osteopathic Medicine, shall adopt
  371  rules that establish requirements to ensure the safe and
  372  effective delivery of surgical care to children kept past
  373  midnight in ambulatory surgical centers. The rules must be
  374  consistent with the American College of Surgeons’ 2015 standards
  375  document entitled “Optimal Resources for Children’s Surgical
  376  Care” and must establish minimum standards for pediatric patient
  377  care in ambulatory surgical centers.
  378         (b) Ambulatory surgical centers may provide operative
  379  procedures that require a length of stay past midnight on the
  380  day of surgery for children younger than 18 years of age only if
  381  the agency authorizes the performance of such procedures by
  382  rule.
  383         (4)(3) The agency shall adopt rules with respect to the
  384  care and treatment of patients residing in distinct part nursing
  385  units of hospitals which are certified for participation in
  386  Title XVIII (Medicare) and Title XIX (Medicaid) of the Social
  387  Security Act skilled nursing facility program. Such rules shall
  388  take into account the types of patients treated in hospital
  389  skilled nursing units, including typical patient acuity levels
  390  and the average length of stay in such units, and shall be
  391  limited to the appropriate portions of the Omnibus Budget
  392  Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,
  393  1987), Title IV (Medicare, Medicaid, and Other Health-Related
  394  Programs), Subtitle C (Nursing Home Reform), as amended. The
  395  agency shall require level 2 background screening as specified
  396  in s. 408.809(1)(e) pursuant to s. 408.809 and chapter 435 for
  397  personnel of distinct part nursing units.
  398         (5)(4) The agency shall adopt rules with respect to the
  399  care and treatment of clients in intensive residential treatment
  400  programs for children and adolescents and with respect to the
  401  safe and healthful development, operation, and maintenance of
  402  such programs.
  403         (6)(5) The agency shall enforce the provisions of part I of
  404  chapter 394, and rules adopted thereunder, with respect to the
  405  rights, standards of care, and examination and placement
  406  procedures applicable to patients voluntarily or involuntarily
  407  admitted to hospitals providing psychiatric observation,
  408  evaluation, diagnosis, or treatment.
  409         (7)(6) No rule shall be adopted under this part by the
  410  agency which would have the effect of denying a license to a
  411  facility required to be licensed under this part, solely by
  412  reason of the school or system of practice employed or permitted
  413  to be employed by physicians therein, provided that such school
  414  or system of practice is recognized by the laws of this state.
  415  However, nothing in this subsection shall be construed to limit
  416  the powers of the agency to provide and require minimum
  417  standards for the maintenance and operation of, and for the
  418  treatment of patients in, those licensed facilities which
  419  receive federal aid, in order to meet minimum standards related
  420  to such matters in such licensed facilities which may now or
  421  hereafter be required by appropriate federal officers or
  422  agencies in pursuance of federal law or promulgated in pursuance
  423  of federal law.
  424         (8)(7) Any licensed facility which is in operation at the
  425  time of promulgation of any applicable rules under this part
  426  shall be given a reasonable time, under the particular
  427  circumstances, but not to exceed 1 year from the date of such
  428  promulgation, within which to comply with such rules.
  429         (9)(8) The agency may not adopt any rule governing the
  430  design, construction, erection, alteration, modification,
  431  repair, or demolition of any public or private hospital,
  432  intermediate residential treatment facility, or ambulatory
  433  surgical center. It is the intent of the Legislature to preempt
  434  that function to the Florida Building Commission and the State
  435  Fire Marshal through adoption and maintenance of the Florida
  436  Building Code and the Florida Fire Prevention Code. However, the
  437  agency shall provide technical assistance to the commission and
  438  the State Fire Marshal in updating the construction standards of
  439  the Florida Building Code and the Florida Fire Prevention Code
  440  which govern hospitals, intermediate residential treatment
  441  facilities, and ambulatory surgical centers.
  442         (10)(9) The agency shall establish a pediatric cardiac
  443  technical advisory panel, pursuant to s. 20.052, to develop
  444  procedures and standards for measuring outcomes of pediatric
  445  cardiac catheterization programs and pediatric cardiovascular
  446  surgery programs.
  447         (a) Members of the panel must have technical expertise in
  448  pediatric cardiac medicine, shall serve without compensation,
  449  and may not be reimbursed for per diem and travel expenses.
  450         (b) Voting members of the panel shall include: 3 at-large
  451  members, and 3 alternate at-large members with different program
  452  affiliations, including 1 cardiologist who is board certified in
  453  caring for adults with congenital heart disease and 2 board
  454  certified pediatric cardiologists, neither of whom may be
  455  employed by any of the hospitals specified in subparagraphs 1.
  456  10. or their affiliates, each of whom is appointed by the
  457  Secretary of Health Care Administration, and 10 members, and an
  458  alternate for each member, each of whom is a pediatric
  459  cardiologist or a pediatric cardiovascular surgeon, each
  460  appointed by the chief executive officer of the following
  461  hospitals:
  462         1. Johns Hopkins All Children’s Hospital in St. Petersburg.
  463         2. Arnold Palmer Hospital for Children in Orlando.
  464         3. Joe DiMaggio Children’s Hospital in Hollywood.
  465         4. Nicklaus Children’s Hospital in Miami.
  466         5. St. Joseph’s Children’s Hospital in Tampa.
  467         6. University of Florida Health Shands Hospital in
  468  Gainesville.
  469         7. University of Miami Holtz Children’s Hospital in Miami.
  470         8. Wolfson Children’s Hospital in Jacksonville.
  471         9. Florida Hospital for Children in Orlando.
  472         10. Nemours Children’s Hospital in Orlando.
  473  
  474  Appointments made under subparagraphs 1.-10. are contingent upon
  475  the hospital’s maintenance of pediatric certificates of need and
  476  the hospital’s compliance with this section and rules adopted
  477  thereunder, as determined by the Secretary of Health Care
  478  Administration. A member appointed under subparagraphs 1.-10.
  479  whose hospital fails to maintain such certificates or comply
  480  with standards may serve only as a nonvoting member until the
  481  hospital restores such certificates or complies with such
  482  standards. A voting member may serve a maximum of two 2-year
  483  terms and may be reappointed to the panel after being retired
  484  from the panel for a full 2-year term.
  485         (c) The Secretary of Health Care Administration may appoint
  486  nonvoting members to the panel. Nonvoting members may include:
  487         1. The Secretary of Health Care Administration.
  488         2. The Surgeon General.
  489         3. The Deputy Secretary of Children’s Medical Services.
  490         4. Any current or past Division Director of Children’s
  491  Medical Services.
  492         5. A parent of a child with congenital heart disease.
  493         6. An adult with congenital heart disease.
  494         7. A representative from each of the following
  495  organizations: the Florida Chapter of the American Academy of
  496  Pediatrics, the Florida Chapter of the American College of
  497  Cardiology, the Greater Southeast Affiliate of the American
  498  Heart Association, the Adult Congenital Heart Association, the
  499  March of Dimes, the Florida Association of Children’s Hospitals,
  500  and the Florida Society of Thoracic and Cardiovascular Surgeons.
  501         (d) The panel shall meet biannually, or more frequently
  502  upon the call of the Secretary of Health Care Administration.
  503  Such meetings may be conducted telephonically, or by other
  504  electronic means.
  505         (e) The duties of the panel include recommending to the
  506  agency standards for quality of care, personnel, physical plant,
  507  equipment, emergency transportation, and data reporting for
  508  hospitals that provide pediatric cardiac services.
  509         (f) Beginning on January 1, 2020, and annually thereafter,
  510  the panel shall submit a report to the Governor, the President
  511  of the Senate, the Speaker of the House of Representatives, the
  512  Secretary of Health Care Administration, and the State Surgeon
  513  General. The report must summarize the panel’s activities during
  514  the preceding fiscal year and include data and performance
  515  measures on surgical morbidity and mortality for all pediatric
  516  cardiac programs.
  517         (g) Panel members are agents of the state for purposes of
  518  s. 768.28 throughout the good faith performance of the duties
  519  assigned to them by the Secretary of Health Care Administration.
  520         (11) The Secretary of Health Care Administration shall
  521  consult the pediatric cardiac technical advisory panel for an
  522  advisory recommendation on all certificate of need applications
  523  to establish pediatric cardiac surgical centers.
  524         (12)(10) Based on the recommendations of the pediatric
  525  cardiac technical advisory panel in subsection (9), the agency
  526  shall adopt rules for pediatric cardiac programs which, at a
  527  minimum, include:
  528         (a) Standards for pediatric cardiac catheterization
  529  services and pediatric cardiovascular surgery including quality
  530  of care, personnel, physical plant, equipment, emergency
  531  transportation, data reporting, and appropriate operating hours
  532  and timeframes for mobilization for emergency procedures.
  533         (b) Outcome standards consistent with nationally
  534  established levels of performance in pediatric cardiac programs.
  535         (c) Specific steps to be taken by the agency and licensed
  536  facilities when the facilities do not meet the outcome standards
  537  within a specified time, including time required for detailed
  538  case reviews and the development and implementation of
  539  corrective action plans.
  540         (13)(11) A pediatric cardiac program shall:
  541         (a) Have a pediatric cardiology clinic affiliated with a
  542  hospital licensed under this chapter.
  543         (b) Have a pediatric cardiac catheterization laboratory and
  544  a pediatric cardiovascular surgical program located in the
  545  hospital.
  546         (c) Have a risk adjustment surgical procedure protocol
  547  following the guidelines established by the Society of Thoracic
  548  Surgeons.
  549         (d) Have quality assurance and quality improvement
  550  processes in place to enhance clinical operation and patient
  551  satisfaction with services.
  552         (e) Participate in the clinical outcome reporting systems
  553  operated by the Society of Thoracic Surgeons and the American
  554  College of Cardiology.
  555         (14)(a) The Secretary of Health Care Administration may
  556  request announced or unannounced site visits to any existing
  557  pediatric cardiac surgical center or facility seeking licensure
  558  as a pediatric cardiac surgical center through the certificate
  559  of need process, to ensure compliance with this section and
  560  rules adopted hereunder.
  561         (b) At the request of the Secretary of Health Care
  562  Administration, the pediatric cardiac technical advisory panel
  563  shall recommend in-state physician experts to conduct an on-site
  564  visit. The Secretary may also appoint up to two out-of-state
  565  physician experts.
  566         (c) A site visit team shall conduct an on-site inspection
  567  of the designated hospital’s pediatric medical and surgical
  568  programs, and each member shall submit a written report of his
  569  or her findings to the panel. The panel shall discuss the
  570  written reports and present an advisory opinion to the Secretary
  571  of Health Care Administration which includes recommendations and
  572  any suggested actions for correction.
  573         (d) Each on-site inspection must include all of the
  574  following:
  575         1. An inspection of the program’s physical facilities,
  576  clinics, and laboratories.
  577         2. Interviews with support staff and hospital
  578  administrators.
  579         3.A review of:
  580         a. Randomly selected medical records and reports,
  581  including, but not limited to, advanced cardiac imaging,
  582  computed tomography, magnetic resonance imaging, cardiac
  583  ultrasound, cardiac catheterization, and surgical operative
  584  notes.
  585         b.The program’s clinical outcome data submitted to the
  586  Society of Thoracic Surgeons and the American College of
  587  Cardiology pursuant to s. 408.05(3)(k).
  588         c.Mortality reports from cardiac-related deaths that
  589  occurred in the previous year.
  590         d. Program volume data from the preceding year for
  591  interventional and electrophysiology catheterizations and
  592  surgical procedures.
  593         (15) The Surgeon General shall provide quarterly reports to
  594  the Secretary of Health Care Administration consisting of data
  595  from the Children’s Medical Services critical congenital heart
  596  disease screening program for review by the advisory panel.
  597         (16)(12) The agency may adopt rules to administer the
  598  requirements of part II of chapter 408.
  599         Section 8. Subsection (3) of section 395.301, Florida
  600  Statutes, is amended to read:
  601         395.301 Price transparency; itemized patient statement or
  602  bill; patient admission status notification.—
  603         (3) If a licensed facility places a patient on observation
  604  status rather than inpatient status, the licensed facility must
  605  immediately notify the patient of such status using the form
  606  adopted under 42 C.F.R. s. 489.20 for Medicare patients or a
  607  form adopted by agency rule for non-Medicare patients. Such
  608  notification must observation services shall be documented in
  609  the patient’s medical records and discharge papers. The patient
  610  or the patient’s survivor or legal guardian must shall be
  611  notified of observation services through discharge papers, which
  612  may also include brochures, signage, or other forms of
  613  communication for this purpose.
  614         Section 9. Section 542.336, Florida Statutes, is created to
  615  read:
  616         542.336 Invalid restrictive covenants.—A restrictive
  617  covenant entered into with a physician who is licensed under
  618  chapter 458 or chapter 459 and who practices a medical specialty
  619  in a county wherein one entity employs or contracts with, either
  620  directly or through related or affiliated entities, all
  621  physicians who practice such specialty in that county is not
  622  supported by a legitimate business interest. The Legislature
  623  finds that such covenants restrict patient access to physicians,
  624  increase costs, and are void and unenforceable under current
  625  law. Such restrictive covenants shall remain void and
  626  unenforceable for 3 years after the date on which a second
  627  entity that employs or contracts with, either directly or
  628  through related or affiliated entities, one or more physicians
  629  who practice such specialty begins offering such specialty
  630  services in that county.
  631         Section 10. Section 624.27, Florida Statutes, is amended to
  632  read:
  633         624.27 Direct health primary care agreements; exemption
  634  from code.—
  635         (1) As used in this section, the term:
  636         (a) “Direct health primary care agreement” means a contract
  637  between a health primary care provider and a patient, a
  638  patient’s legal representative, or a patient’s employer, which
  639  meets the requirements of subsection (4) and does not indemnify
  640  for services provided by a third party.
  641         (b) “Health Primary care provider” means a health care
  642  provider licensed under chapter 458, chapter 459, chapter 460,
  643  or chapter 464, or chapter 466, or a health primary care group
  644  practice, who provides health primary care services to patients.
  645         (c) “Health Primary care services” means the screening,
  646  assessment, diagnosis, and treatment of a patient conducted
  647  within the competency and training of the health primary care
  648  provider for the purpose of promoting health or detecting and
  649  managing disease or injury.
  650         (2) A direct health primary care agreement does not
  651  constitute insurance and is not subject to the Florida Insurance
  652  Code. The act of entering into a direct health primary care
  653  agreement does not constitute the business of insurance and is
  654  not subject to the Florida Insurance Code.
  655         (3) A health primary care provider or an agent of a health
  656  primary care provider is not required to obtain a certificate of
  657  authority or license under the Florida Insurance Code to market,
  658  sell, or offer to sell a direct health primary care agreement.
  659         (4) For purposes of this section, a direct health primary
  660  care agreement must:
  661         (a) Be in writing.
  662         (b) Be signed by the health primary care provider or an
  663  agent of the health primary care provider and the patient, the
  664  patient’s legal representative, or the patient’s employer.
  665         (c) Allow a party to terminate the agreement by giving the
  666  other party at least 30 days’ advance written notice. The
  667  agreement may provide for immediate termination due to a
  668  violation of the physician-patient relationship or a breach of
  669  the terms of the agreement.
  670         (d) Describe the scope of health primary care services that
  671  are covered by the monthly fee.
  672         (e) Specify the monthly fee and any fees for health primary
  673  care services not covered by the monthly fee.
  674         (f) Specify the duration of the agreement and any automatic
  675  renewal provisions.
  676         (g) Offer a refund to the patient, the patient’s legal
  677  representative, or the patient’s employer of monthly fees paid
  678  in advance if the health primary care provider ceases to offer
  679  health primary care services for any reason.
  680         (h) Contain, in contrasting color and in at least 12-point
  681  type, the following statement on the signature page: “This
  682  agreement is not health insurance and the health primary care
  683  provider will not file any claims against the patient’s health
  684  insurance policy or plan for reimbursement of any health primary
  685  care services covered by the agreement. This agreement does not
  686  qualify as minimum essential coverage to satisfy the individual
  687  shared responsibility provision of the Patient Protection and
  688  Affordable Care Act, 26 U.S.C. s. 5000A. This agreement is not
  689  workers’ compensation insurance and does not replace an
  690  employer’s obligations under chapter 440.”
  691         Section 11. Effective January 1, 2020, section 627.42393,
  692  Florida Statutes, is created to read:
  693         627.42393 Step-therapy protocol.—
  694         (1) A health insurer issuing a major medical individual or
  695  group policy may not require a step-therapy protocol under the
  696  policy for a covered prescription drug requested by an insured
  697  if:
  698         (a) The insured has previously been approved to receive the
  699  prescription drug through the completion of a step-therapy
  700  protocol required by a separate health coverage plan; and
  701         (b) The insured provides documentation originating from the
  702  health coverage plan that approved the prescription drug as
  703  described in paragraph (a) indicating that the health coverage
  704  plan paid for the drug on the insured’s behalf during the 90
  705  days immediately before the request.
  706         (2) As used in this section, the term “health coverage
  707  plan” means any of the following which is currently or was
  708  previously providing major medical or similar comprehensive
  709  coverage or benefits to the insured:
  710         (a) A health insurer or health maintenance organization.
  711         (b)A plan established or maintained by an individual
  712  employer as provided by the Employee Retirement Income Security
  713  Act of 1974, Pub. L. No. 93-406.
  714         (c) A multiple-employer welfare arrangement as defined in
  715  s. 624.437.
  716         (d) A governmental entity providing a plan of self
  717  insurance.
  718         (3) This section does not require a health insurer to add a
  719  drug to its prescription drug formulary or to cover a
  720  prescription drug that the insurer does not otherwise cover.
  721         Section 12. Effective January 1, 2020, subsection (45) is
  722  added to section 641.31, Florida Statutes, to read:
  723         641.31 Health maintenance contracts.—
  724         (45)(a) A health maintenance organization issuing major
  725  medical coverage through an individual or group contract may not
  726  require a step-therapy protocol under the contract for a covered
  727  prescription drug requested by a subscriber if:
  728         1. The subscriber has previously been approved to receive
  729  the prescription drug through the completion of a step-therapy
  730  protocol required by a separate health coverage plan; and
  731         2. The subscriber provides documentation originating from
  732  the health coverage plan that approved the prescription drug as
  733  described in subparagraph 1. indicating that the health coverage
  734  plan paid for the drug on the subscriber’s behalf during the 90
  735  days immediately before the request.
  736         (b) As used in this subsection, the term “health coverage
  737  plan” means any of the following which previously provided or is
  738  currently providing major medical or similar comprehensive
  739  coverage or benefits to the subscriber:
  740         1. A health insurer or health maintenance organization;
  741         2.A plan established or maintained by an individual
  742  employer as provided by the Employee Retirement Income Security
  743  Act of 1974, Pub. L. No. 93-406;
  744         3. A multiple-employer welfare arrangement as defined in s.
  745  624.437; or
  746         4. A governmental entity providing a plan of self
  747  insurance.
  748         (c) This subsection does not require a health maintenance
  749  organization to add a drug to its prescription drug formulary or
  750  to cover a prescription drug that the health maintenance
  751  organization does not otherwise cover.
  752         Section 13. The Office of Program Policy Analysis and
  753  Government Accountability shall research and analyze the
  754  Interstate Medical Licensure Compact and the relevant
  755  requirements and provisions of general law and the State
  756  Constitution and shall develop a report and recommendations
  757  addressing this state’s prospective entrance into the compact as
  758  a member state while remaining consistent with those
  759  requirements and provisions. In conducting such research and
  760  analysis, the office may consult with the executive director,
  761  other executive staff, or the executive committee of the
  762  Interstate Medical Licensure Compact Commission. The office
  763  shall submit the report and recommendations to the Governor, the
  764  President of the Senate, and the Speaker of the House of
  765  Representatives by not later than October 1, 2019.
  766         Section 14. Except as otherwise expressly provided in this
  767  act, this act shall take effect July 1, 2019.

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