Bill Text: FL S1726 | 2020 | Regular Session | Comm Sub


Bill Title: Agency for Health Care Administration

Spectrum: Slight Partisan Bill (? 2-1)

Status: (Introduced) 2020-03-10 - Laid on Table, refer to CS/CS/HB 731 [S1726 Detail]

Download: Florida-2020-S1726-Comm_Sub.html
       Florida Senate - 2020                      CS for CS for SB 1726
       
       
        
       By the Committees on Appropriations; and Health Policy; and
       Senator Bean
       
       
       
       
       576-04557-20                                          20201726c2
    1                        A bill to be entitled                      
    2         An act relating to the Agency for Health Care
    3         Administration; amending s. 383.327, F.S.; requiring
    4         birth centers to report certain deaths and stillbirths
    5         to the agency; revising the frequency with which a
    6         certain report must be submitted to the agency;
    7         authorizing the agency to prescribe by rule the
    8         frequency with which such report is submitted;
    9         amending s. 395.003, F.S.; removing a requirement that
   10         specified information be listed on licenses for
   11         certain facilities; amending s. 395.1055, F.S.;
   12         requiring the agency to adopt specified rules related
   13         to ongoing quality improvement programs for certain
   14         cardiac programs; amending s. 395.602, F.S.; revising
   15         the definition of the term “rural hospital”; repealing
   16         s. 395.7015, F.S., relating to an annual assessment on
   17         health care entities; amending s. 395.7016, F.S.;
   18         conforming a provision to changes made by the act;
   19         amending s. 400.19, F.S.; revising provisions
   20         requiring the agency to conduct licensure inspections
   21         of nursing homes; requiring the agency to conduct
   22         additional licensure surveys under certain
   23         circumstances; requiring the agency to assess a
   24         specified fine for such surveys; amending s. 400.462,
   25         F.S.; revising definitions; amending s. 400.464, F.S.;
   26         revising exemptions from licensure requirements for
   27         home health agencies; amending s. 400.471, F.S.;
   28         revising provisions related to certain application
   29         requirements for home health agencies; amending s.
   30         400.492, F.S.; revising provisions related to services
   31         provided by home health agencies during an emergency;
   32         amending s. 400.506, F.S.; revising provisions related
   33         to licensure requirements for nurse registries;
   34         amending s. 400.509, F.S.; revising provisions related
   35         to the registration of certain service providers;
   36         amending s. 400.605, F.S.; removing a requirement that
   37         the agency conduct specified inspections of certain
   38         licensees; amending s. 400.60501, F.S.; deleting an
   39         obsolete date; removing a requirement that the agency
   40         develop a specified annual report; amending s.
   41         400.9905, F.S.; revising the definition of the term
   42         “clinic”; amending s. 400.991, F.S.; removing the
   43         option for health care clinics to file a surety bond
   44         under certain circumstances; amending s. 400.9935,
   45         F.S.; revising provisions related to the schedule of
   46         charges published and posted by certain clinics;
   47         specifying that urgent care centers are subject to
   48         such requirements; amending s. 408.033, F.S.;
   49         conforming a provision to changes made by the act;
   50         amending s. 408.05, F.S.; requiring the agency to
   51         publish by a specified date an annual report
   52         identifying certain health care services; amending s.
   53         408.061, F.S.; revising provisions requiring health
   54         care facilities to submit specified data to the
   55         agency; amending s. 408.0611, F.S.; removing a
   56         requirement that the agency annually report to the
   57         Governor and the Legislature by a specified date on
   58         the progress of implementation of electronic
   59         prescribing and, instead, requiring the agency to
   60         annually publish such information on its website;
   61         amending s. 408.062, F.S.; removing requirements that
   62         the agency annually report specified information to
   63         the Governor and Legislature by a specified date and,
   64         instead, requiring the agency to annually publish such
   65         information on its website; amending s. 408.063, F.S.;
   66         removing a requirement that the agency publish certain
   67         annual reports; amending s. 408.802, F.S.; conforming
   68         provisions to changes made by the act; amending s.
   69         408.803, F.S.; conforming a definition to changes made
   70         by the act; defining the term “low-risk provider”;
   71         amending s. 408.806, F.S.; exempting certain providers
   72         from a specified inspection; amending s. 408.808,
   73         F.S.; authorizing the issuance of a provisional
   74         license to certain applicants; amending s. 408.809,
   75         F.S.; revising background screening requirements for
   76         certain licensees and providers; amending s. 408.811,
   77         F.S.; authorizing the agency to grant certain
   78         providers an exemption from a specified inspection
   79         under certain circumstances; authorizing the agency to
   80         adopt rules to grant waivers of certain inspections
   81         and allow for extended inspection periods under
   82         certain circumstances; requiring the agency to conduct
   83         unannounced licensure inspections of certain providers
   84         during a specified time period; providing that the
   85         agency may conduct regulatory compliance inspections
   86         of providers at any time; amending s. 408.820, F.S.;
   87         conforming a provision to changes made by the act;
   88         amending s. 408.821, F.S.; revising provisions
   89         requiring licensees to have a specified plan;
   90         providing requirements for the submission of such
   91         plan; amending ss. 408.831 and 408.832, F.S.;
   92         conforming provisions to changes made by the act;
   93         amending s. 408.909, F.S.; removing a requirement that
   94         the agency and the Office of Insurance Regulation
   95         evaluate a specified program; amending s. 408.9091,
   96         F.S.; deleting a requirement that the agency and
   97         office submit a specified joint annual report to the
   98         Governor and the Legislature; amending s. 409.905,
   99         F.S.; providing construction for a provision that
  100         requires the agency to discontinue its hospital
  101         retrospective review program under certain
  102         circumstances; providing legislative intent; amending
  103         s. 409.907, F.S.; requiring that a specified
  104         background screening be conducted through the agency
  105         on certain persons and entities; repealing s. 19 of
  106         chapter 2019-116, Laws of Florida, relating to the
  107         abrogation of the scheduled expiration of an amendment
  108         to s. 409.908(23), F.S., and the scheduled reversion
  109         of the text of that subsection; amending 409.908,
  110         F.S.; revising provisions related to the prospective
  111         payment methodology for certain Medicaid provider
  112         reimbursements; reenacting s. 409.908(23), relating to
  113         reimbursement of Medicaid providers for certain
  114         services; amending s. 409.913, F.S.; revising the due
  115         date for a certain annual report; deleting the
  116         requirement that certain agencies submit their annual
  117         reports jointly; providing that the agency or its
  118         contractor is entitled to recover certain costs and
  119         attorney fees related to audits, investigations, or
  120         enforcement actions conducted by the agency or its
  121         contractor; amending s. 409.920, F.S.; revising
  122         provisions related to prohibited referral practices in
  123         the Medicaid program; amending ss. 409.967 and
  124         409.973, F.S.; revising the length of managed care
  125         plan contracts procured by the agency beginning during
  126         a specified timeframe; requiring the agency to extend
  127         the term of certain existing managed care plan
  128         contracts until a specified date; amending s. 429.11,
  129         F.S.; removing an authorization for the issuance of a
  130         provisional license to certain facilities; amending s.
  131         429.19, F.S.; removing requirements that the agency
  132         develop and disseminate a specified list and the
  133         Department of Children and Families disseminate such
  134         list to certain providers; amending ss. 429.35 and
  135         429.905, F.S.; revising provisions requiring a
  136         biennial inspection cycle for specified facilities;
  137         amending s. 429.929, F.S.; revising provisions
  138         requiring a biennial inspection cycle for adult day
  139         care centers; amending ss. 627.6387, 627.6648, and
  140         641.31076, F.S.; revising the definition of the term
  141         “shoppable health care service”; revising the duties
  142         of certain health insurers and health maintenance
  143         organizations; repealing part I of ch. 483, F.S.,
  144         relating to the Florida Multiphasic Health Testing
  145         Center Law; redesignating parts II and III of ch. 483,
  146         F.S., as parts I and II, respectively; amending ss.
  147         20.43, 381.0034, 456.001, 456.057, 456.076, and
  148         456.47, F.S.; conforming cross-references; providing
  149         effective dates.
  150          
  151  Be It Enacted by the Legislature of the State of Florida:
  152  
  153         Section 1. Subsections (2) and (4) of section 383.327,
  154  Florida Statutes, are amended to read:
  155         383.327 Birth and death records; reports.—
  156         (2) Each maternal death, newborn death, and stillbirth
  157  shall be reported immediately to the medical examiner and the
  158  agency.
  159         (4) A report shall be submitted annually to the agency. The
  160  contents of the report and the frequency with which it is
  161  submitted shall be prescribed by rule of the agency.
  162         Section 2. Subsection (4) of section 395.003, Florida
  163  Statutes, is amended to read:
  164         395.003 Licensure; denial, suspension, and revocation.—
  165         (4) The agency shall issue a license that which specifies
  166  the service categories and the number of hospital beds in each
  167  bed category for which a license is received. Such information
  168  shall be listed on the face of the license. All beds which are
  169  not covered by any specialty-bed-need methodology shall be
  170  specified as general beds. A licensed facility shall not operate
  171  a number of hospital beds greater than the number indicated by
  172  the agency on the face of the license without approval from the
  173  agency under conditions established by rule.
  174         Section 3. Paragraph (g) is added to subsection (18) of
  175  section 395.1055, Florida Statutes, to read:
  176         395.1055 Rules and enforcement.—
  177         (18) In establishing rules for adult cardiovascular
  178  services, the agency shall include provisions that allow for:
  179         (g)The requirement that hospitals licensed for adult
  180  diagnostic cardiac catheterization, Level I or Level II adult
  181  cardiovascular services participate in the American College of
  182  Cardiology – National Cardiovascular Data Registry or the
  183  American Heart Association’s Get with the Guidelines – Coronary
  184  Artery Disease program registry and document an ongoing quality
  185  improvement plan to ensure these licensed programs meet or
  186  exceed national quality and outcome benchmarks reported by the
  187  registry in which they participate. Hospitals licensed for Level
  188  II adult cardiovascular services must also participate in the
  189  clinical outcome reporting systems operated by the Society for
  190  Thoracic Surgeons.
  191         Section 4. Paragraph (b) of subsection (2) of section
  192  395.602, Florida Statutes, is amended to read:
  193         395.602 Rural hospitals.—
  194         (2) DEFINITIONS.—As used in this part, the term:
  195         (b) “Rural hospital” means an acute care hospital licensed
  196  under this chapter, having 100 or fewer licensed beds and an
  197  emergency room, which is:
  198         1. The sole provider within a county with a population
  199  density of up to 100 persons per square mile;
  200         2. An acute care hospital, in a county with a population
  201  density of up to 100 persons per square mile, which is at least
  202  30 minutes of travel time, on normally traveled roads under
  203  normal traffic conditions, from any other acute care hospital
  204  within the same county;
  205         3. A hospital supported by a tax district or subdistrict
  206  whose boundaries encompass a population of up to 100 persons per
  207  square mile;
  208         4. A hospital classified as a sole community hospital under
  209  42 C.F.R. s. 412.92, regardless of the number of licensed beds;
  210         5. A hospital with a service area that has a population of
  211  up to 100 persons per square mile. As used in this subparagraph,
  212  the term “service area” means the fewest number of zip codes
  213  that account for 75 percent of the hospital’s discharges for the
  214  most recent 5-year period, based on information available from
  215  the hospital inpatient discharge database in the Florida Center
  216  for Health Information and Transparency at the agency; or
  217         6. A hospital designated as a critical access hospital, as
  218  defined in s. 408.07.
  219  
  220  Population densities used in this paragraph must be based upon
  221  the most recently completed United States census. A hospital
  222  that received funds under s. 409.9116 for a quarter beginning no
  223  later than July 1, 2002, is deemed to have been and shall
  224  continue to be a rural hospital from that date through June 30,
  225  2021, if the hospital continues to have up to 100 licensed beds
  226  and an emergency room. An acute care hospital that has not
  227  previously been designated as a rural hospital and that meets
  228  the criteria of this paragraph shall be granted such designation
  229  upon application, including supporting documentation, to the
  230  agency. A hospital that was licensed as a rural hospital during
  231  the 2010-2011 or 2011-2012 fiscal year shall continue to be a
  232  rural hospital from the date of designation through June 30,
  233  2025 2021, if the hospital continues to have up to 100 licensed
  234  beds and an emergency room.
  235         Section 5. Section 395.7015, Florida Statutes, is repealed.
  236         Section 6. Section 395.7016, Florida Statutes, is amended
  237  to read:
  238         395.7016 Annual appropriation.—The Legislature shall
  239  appropriate each fiscal year from either the General Revenue
  240  Fund or the Agency for Health Care Administration Tobacco
  241  Settlement Trust Fund an amount sufficient to replace the funds
  242  lost due to reduction by chapter 2000-256, Laws of Florida, of
  243  the assessment on other health care entities under s. 395.7015,
  244  and the reduction by chapter 2000-256, Laws of Florida, in the
  245  assessment on hospitals under s. 395.701, and to maintain
  246  federal approval of the reduced amount of funds deposited into
  247  the Public Medical Assistance Trust Fund under s. 395.701, as
  248  state match for the state’s Medicaid program.
  249         Section 7. Subsection (3) of section 400.19, Florida
  250  Statutes, is amended to read:
  251         400.19 Right of entry and inspection.—
  252         (3) The agency shall conduct periodic, every 15 months
  253  conduct at least one unannounced licensure inspections
  254  inspection to determine compliance by the licensee with
  255  statutes, and with rules adopted promulgated under the
  256  provisions of those statutes, governing minimum standards of
  257  construction, quality and adequacy of care, and rights of
  258  residents. The survey shall be conducted every 6 months for the
  259  next 2-year period If the facility has been cited for a class I
  260  deficiency or, has been cited for two or more class II
  261  deficiencies arising from separate surveys or investigations
  262  within a 60-day period, the agency shall conduct licensure
  263  surveys every 6 months until the facility has two consecutive
  264  licensure surveys without a citation for a class I or a class II
  265  deficiency or has had three or more substantiated complaints
  266  within a 6-month period, each resulting in at least one class I
  267  or class II deficiency. In addition to any other fees or fines
  268  in this part, the agency shall assess a fine of for each
  269  facility that is subject to the 6-month survey cycle. The fine
  270  for the 2-year period shall be $6,000 for the additional 6-month
  271  licensure surveys, one-half to be paid at the completion of each
  272  survey. The agency may adjust such this fine by the change in
  273  the Consumer Price Index, based on the 12 months immediately
  274  preceding the increase, to cover the cost of the additional
  275  surveys. The agency shall verify through subsequent inspection
  276  that any deficiency identified during inspection is corrected.
  277  However, the agency may verify the correction of a class III or
  278  class IV deficiency unrelated to resident rights or resident
  279  care without reinspecting the facility if adequate written
  280  documentation has been received from the facility, which
  281  provides assurance that the deficiency has been corrected. The
  282  giving or causing to be given of advance notice of such
  283  unannounced inspections by an employee of the agency to any
  284  unauthorized person shall constitute cause for suspension of not
  285  fewer than 5 working days according to the provisions of chapter
  286  110.
  287         Section 8. Subsections (12), (14), (17), (21), and (22) of
  288  section 400.462, Florida Statutes, are amended to read:
  289         400.462 Definitions.—As used in this part, the term:
  290         (12) “Home health agency” means a person who an
  291  organization that provides one or more home health services and
  292  staffing services.
  293         (14) “Home health services” means health and medical
  294  services and medical supplies furnished by an organization to an
  295  individual in the individual’s home or place of residence. The
  296  term includes organizations that provide one or more of the
  297  following:
  298         (a) Nursing care.
  299         (b) Physical, occupational, respiratory, or speech therapy.
  300         (c) Home health aide services.
  301         (d) Dietetics and nutrition practice and nutrition
  302  counseling.
  303         (e) Medical supplies, restricted to drugs and biologicals
  304  prescribed by a physician.
  305         (17) “Home infusion therapy provider” means a person who an
  306  organization that employs, contracts with, or refers a licensed
  307  professional who has received advanced training and experience
  308  in intravenous infusion therapy and who administers infusion
  309  therapy to a patient in the patient’s home or place of
  310  residence.
  311         (21) “Nurse registry” means any person who that procures,
  312  offers, promises, or attempts to secure health-care-related
  313  contracts for registered nurses, licensed practical nurses,
  314  certified nursing assistants, home health aides, companions, or
  315  homemakers, who are compensated by fees as independent
  316  contractors, including, but not limited to, contracts for the
  317  provision of services to patients and contracts to provide
  318  private duty or staffing services to health care facilities
  319  licensed under chapter 395, this chapter, or chapter 429 or
  320  other business entities.
  321         (22)“Organization” means a corporation, government or
  322  governmental subdivision or agency, partnership or association,
  323  or any other legal or commercial entity, any of which involve
  324  more than one health care professional discipline; a health care
  325  professional and a home health aide or certified nursing
  326  assistant; more than one home health aide; more than one
  327  certified nursing assistant; or a home health aide and a
  328  certified nursing assistant. The term does not include an entity
  329  that provides services using only volunteers or only individuals
  330  related by blood or marriage to the patient or client.
  331         Section 9. Subsection (1), paragraph (a) of subsection (4),
  332  and subsection (5) of section 400.464, Florida Statutes, are
  333  amended to read:
  334         400.464 Home health agencies to be licensed; expiration of
  335  license; exemptions; unlawful acts; penalties.—
  336         (1) The requirements of part II of chapter 408 apply to the
  337  provision of services that require licensure pursuant to this
  338  part and part II of chapter 408 and entities licensed or
  339  registered by or applying for such licensure or registration
  340  from the Agency for Health Care Administration pursuant to this
  341  part. A license issued by the agency is required in order to
  342  operate a home health agency in this state. A license issued on
  343  or after July 1, 2018, must specify the home health services the
  344  licensee organization is authorized to perform and indicate
  345  whether such specified services are considered skilled care. The
  346  provision or advertising of services that require licensure
  347  pursuant to this part without such services being specified on
  348  the face of the license issued on or after July 1, 2018,
  349  constitutes unlicensed activity as prohibited under s. 408.812.
  350         (4)(a) A licensee An organization that offers or advertises
  351  to the public any service for which licensure or registration is
  352  required under this part must include in the advertisement the
  353  license number or registration number issued to the licensee
  354  organization by the agency. The agency shall assess a fine of
  355  not less than $100 to any licensee or registrant who fails to
  356  include the license or registration number when submitting the
  357  advertisement for publication, broadcast, or printing. The fine
  358  for a second or subsequent offense is $500. The holder of a
  359  license issued under this part may not advertise or indicate to
  360  the public that it holds a home health agency or nurse registry
  361  license other than the one it has been issued.
  362         (5) The following are exempt from the licensure as a home
  363  health agency under requirements of this part:
  364         (a) A home health agency operated by the Federal
  365  Government.
  366         (b) Home health services provided by a state agency, either
  367  directly or through a contractor with:
  368         1. The Department of Elderly Affairs.
  369         2. The Department of Health, a community health center, or
  370  a rural health network that furnishes home visits for the
  371  purpose of providing environmental assessments, case management,
  372  health education, personal care services, family planning, or
  373  followup treatment, or for the purpose of monitoring and
  374  tracking disease.
  375         3. Services provided to persons with developmental
  376  disabilities, as defined in s. 393.063.
  377         4. Companion and sitter organizations that were registered
  378  under s. 400.509(1) on January 1, 1999, and were authorized to
  379  provide personal services under a developmental services
  380  provider certificate on January 1, 1999, may continue to provide
  381  such services to past, present, and future clients of the
  382  organization who need such services, notwithstanding the
  383  provisions of this act.
  384         5. The Department of Children and Families.
  385         (c) A health care professional, whether or not
  386  incorporated, who is licensed under chapter 457; chapter 458;
  387  chapter 459; part I of chapter 464; chapter 467; part I, part
  388  III, part V, or part X of chapter 468; chapter 480; chapter 486;
  389  chapter 490; or chapter 491; and who is acting alone within the
  390  scope of his or her professional license to provide care to
  391  patients in their homes.
  392         (d) A home health aide or certified nursing assistant who
  393  is acting in his or her individual capacity, within the
  394  definitions and standards of his or her occupation, and who
  395  provides hands-on care to patients in their homes.
  396         (e) An individual who acts alone, in his or her individual
  397  capacity, and who is not employed by or affiliated with a
  398  licensed home health agency or registered with a licensed nurse
  399  registry. This exemption does not entitle an individual to
  400  perform home health services without the required professional
  401  license.
  402         (f) The delivery of instructional services in home dialysis
  403  and home dialysis supplies and equipment.
  404         (g) The delivery of nursing home services for which the
  405  nursing home is licensed under part II of this chapter, to serve
  406  its residents in its facility.
  407         (h) The delivery of assisted living facility services for
  408  which the assisted living facility is licensed under part I of
  409  chapter 429, to serve its residents in its facility.
  410         (i) The delivery of hospice services for which the hospice
  411  is licensed under part IV of this chapter, to serve hospice
  412  patients admitted to its service.
  413         (j) A hospital that provides services for which it is
  414  licensed under chapter 395.
  415         (k) The delivery of community residential services for
  416  which the community residential home is licensed under chapter
  417  419, to serve the residents in its facility.
  418         (l) A not-for-profit, community-based agency that provides
  419  early intervention services to infants and toddlers.
  420         (m) Certified rehabilitation agencies and comprehensive
  421  outpatient rehabilitation facilities that are certified under
  422  Title 18 of the Social Security Act.
  423         (n) The delivery of adult family-care home services for
  424  which the adult family-care home is licensed under part II of
  425  chapter 429, to serve the residents in its facility.
  426         (o)A person who provides skilled care by health care
  427  professionals licensed solely under part I of chapter 464; part
  428  I, part III, or part V of chapter 468; or chapter 486. This
  429  exemption does not authorize an individual to perform home
  430  health services without the required professional license.
  431         (p)A person or entity that provides services using only
  432  volunteers or only individuals related by blood or marriage to
  433  the patient or client.
  434         Section 10. Paragraph (g) of subsection (2) of section
  435  400.471, Florida Statutes, is amended to read:
  436         400.471 Application for license; fee.—
  437         (2) In addition to the requirements of part II of chapter
  438  408, the initial applicant, the applicant for a change of
  439  ownership, and the applicant for the addition of skilled care
  440  services must file with the application satisfactory proof that
  441  the home health agency is in compliance with this part and
  442  applicable rules, including:
  443         (g) In the case of an application for initial licensure, an
  444  application for a change of ownership, or an application for the
  445  addition of skilled care services, documentation of
  446  accreditation, or an application for accreditation, from an
  447  accrediting organization that is recognized by the agency as
  448  having standards comparable to those required by this part and
  449  part II of chapter 408. A home health agency that does not
  450  provide skilled care is exempt from this paragraph.
  451  Notwithstanding s. 408.806, the an initial applicant must
  452  provide proof of accreditation that is not conditional or
  453  provisional and a survey demonstrating compliance with the
  454  requirements of this part, part II of chapter 408, and
  455  applicable rules from an accrediting organization that is
  456  recognized by the agency as having standards comparable to those
  457  required by this part and part II of chapter 408 within 120 days
  458  after the date of the agency’s receipt of the application for
  459  licensure. Such accreditation must be continuously maintained by
  460  the home health agency to maintain licensure. The agency shall
  461  accept, in lieu of its own periodic licensure survey, the
  462  submission of the survey of an accrediting organization that is
  463  recognized by the agency if the accreditation of the licensed
  464  home health agency is not provisional and if the licensed home
  465  health agency authorizes release of, and the agency receives the
  466  report of, the accrediting organization.
  467         Section 11. Section 400.492, Florida Statutes, is amended
  468  to read:
  469         400.492 Provision of services during an emergency.—Each
  470  home health agency shall prepare and maintain a comprehensive
  471  emergency management plan that is consistent with the standards
  472  adopted by national or state accreditation organizations and
  473  consistent with the local special needs plan. The plan shall be
  474  updated annually and shall provide for continuing home health
  475  services during an emergency that interrupts patient care or
  476  services in the patient’s home. The plan shall include the means
  477  by which the home health agency will continue to provide staff
  478  to perform the same type and quantity of services to their
  479  patients who evacuate to special needs shelters that were being
  480  provided to those patients prior to evacuation. The plan shall
  481  describe how the home health agency establishes and maintains an
  482  effective response to emergencies and disasters, including:
  483  notifying staff when emergency response measures are initiated;
  484  providing for communication between staff members, county health
  485  departments, and local emergency management agencies, including
  486  a backup system; identifying resources necessary to continue
  487  essential care or services or referrals to other health care
  488  providers organizations subject to written agreement; and
  489  prioritizing and contacting patients who need continued care or
  490  services.
  491         (1) Each patient record for patients who are listed in the
  492  registry established pursuant to s. 252.355 shall include a
  493  description of how care or services will be continued in the
  494  event of an emergency or disaster. The home health agency shall
  495  discuss the emergency provisions with the patient and the
  496  patient’s caregivers, including where and how the patient is to
  497  evacuate, procedures for notifying the home health agency in the
  498  event that the patient evacuates to a location other than the
  499  shelter identified in the patient record, and a list of
  500  medications and equipment which must either accompany the
  501  patient or will be needed by the patient in the event of an
  502  evacuation.
  503         (2) Each home health agency shall maintain a current
  504  prioritized list of patients who need continued services during
  505  an emergency. The list shall indicate how services shall be
  506  continued in the event of an emergency or disaster for each
  507  patient and if the patient is to be transported to a special
  508  needs shelter, and shall indicate if the patient is receiving
  509  skilled nursing services and the patient’s medication and
  510  equipment needs. The list shall be furnished to county health
  511  departments and to local emergency management agencies, upon
  512  request.
  513         (3) Home health agencies shall not be required to continue
  514  to provide care to patients in emergency situations that are
  515  beyond their control and that make it impossible to provide
  516  services, such as when roads are impassable or when patients do
  517  not go to the location specified in their patient records. Home
  518  health agencies may establish links to local emergency
  519  operations centers to determine a mechanism by which to approach
  520  specific areas within a disaster area in order for the agency to
  521  reach its clients. Home health agencies shall demonstrate a good
  522  faith effort to comply with the requirements of this subsection
  523  by documenting attempts of staff to follow procedures outlined
  524  in the home health agency’s comprehensive emergency management
  525  plan, and by the patient’s record, which support a finding that
  526  the provision of continuing care has been attempted for those
  527  patients who have been identified as needing care by the home
  528  health agency and registered under s. 252.355, in the event of
  529  an emergency or disaster under subsection (1).
  530         (4) Notwithstanding the provisions of s. 400.464(2) or any
  531  other provision of law to the contrary, a home health agency may
  532  provide services in a special needs shelter located in any
  533  county.
  534         Section 12. Subsection (4) and paragraph (a) of subsection
  535  (5) of section 400.506, Florida Statutes, are amended to read:
  536         400.506 Licensure of nurse registries; requirements;
  537  penalties.—
  538         (4) A licensee who person that provides, offers, or
  539  advertises to the public any service for which licensure is
  540  required under this section must include in such advertisement
  541  the license number issued to the licensee it by the Agency for
  542  Health Care Administration. The agency shall assess a fine of
  543  not less than $100 against any licensee who fails to include the
  544  license number when submitting the advertisement for
  545  publication, broadcast, or printing. The fine for a second or
  546  subsequent offense is $500.
  547         (5)(a) In addition to the requirements of s. 408.812, any
  548  person or entity that who owns, operates, or maintains an
  549  unlicensed nurse registry and who, after receiving notification
  550  from the agency, fails to cease operation and apply for a
  551  license under this part commits a misdemeanor of the second
  552  degree, punishable as provided in s. 775.082 or s. 775.083. Each
  553  day of continued operation is a separate offense.
  554         Section 13. Subsections (1), (2), (4), and (5) of section
  555  400.509, Florida Statutes, are amended to read:
  556         400.509 Registration of particular service providers exempt
  557  from licensure; certificate of registration; regulation of
  558  registrants.—
  559         (1) Any person who organization that provides companion
  560  services or homemaker services and does not provide a home
  561  health service to a person is exempt from licensure under this
  562  part. However, any person who organization that provides
  563  companion services or homemaker services must register with the
  564  agency. A person An organization under contract with the Agency
  565  for Persons with Disabilities who which provides companion
  566  services only for persons with a developmental disability, as
  567  defined in s. 393.063, is exempt from registration.
  568         (2) The requirements of part II of chapter 408 apply to the
  569  provision of services that require registration or licensure
  570  pursuant to this section and part II of chapter 408 and entities
  571  registered by or applying for such registration from the Agency
  572  for Health Care Administration pursuant to this section. Each
  573  applicant for registration and each registrant must comply with
  574  all provisions of part II of chapter 408. Registration or a
  575  license issued by the agency is required for a person to provide
  576  the operation of an organization that provides companion
  577  services or homemaker services.
  578         (4) Each registrant must obtain the employment or contract
  579  history of persons who are employed by or under contract with
  580  the person organization and who will have contact at any time
  581  with patients or clients in their homes by:
  582         (a) Requiring such persons to submit an employment or
  583  contractual history to the registrant; and
  584         (b) Verifying the employment or contractual history, unless
  585  through diligent efforts such verification is not possible. The
  586  agency shall prescribe by rule the minimum requirements for
  587  establishing that diligent efforts have been made.
  588  
  589  There is no monetary liability on the part of, and no cause of
  590  action for damages arises against, a former employer of a
  591  prospective employee of or prospective independent contractor
  592  with a registrant who reasonably and in good faith communicates
  593  his or her honest opinions about the former employee’s or
  594  contractor’s job performance. This subsection does not affect
  595  the official immunity of an officer or employee of a public
  596  corporation.
  597         (5) A person who that offers or advertises to the public a
  598  service for which registration is required must include in its
  599  advertisement the registration number issued by the Agency for
  600  Health Care Administration.
  601         Section 14. Subsection (3) of section 400.605, Florida
  602  Statutes, is amended to read:
  603         400.605 Administration; forms; fees; rules; inspections;
  604  fines.—
  605         (3) In accordance with s. 408.811, the agency shall conduct
  606  annual inspections of all licensees, except that licensure
  607  inspections may be conducted biennially for hospices having a 3
  608  year record of substantial compliance. The agency shall conduct
  609  such inspections and investigations as are necessary in order to
  610  determine the state of compliance with the provisions of this
  611  part, part II of chapter 408, and applicable rules.
  612         Section 15. Section 400.60501, Florida Statutes, is amended
  613  to read:
  614         400.60501 Outcome measures; adoption of federal quality
  615  measures; public reporting; annual report.—
  616         (1) No later than December 31, 2019, The agency shall adopt
  617  the national hospice outcome measures and survey data in 42
  618  C.F.R. part 418 to determine the quality and effectiveness of
  619  hospice care for hospices licensed in the state.
  620         (2) The agency shall:
  621         (a) make available to the public the national hospice
  622  outcome measures and survey data in a format that is
  623  comprehensible by a layperson and that allows a consumer to
  624  compare such measures of one or more hospices.
  625         (b)Develop an annual report that analyzes and evaluates
  626  the information collected under this act and any other data
  627  collection or reporting provisions of law.
  628         Section 16. Subsection (4) of section 400.9905, Florida
  629  Statutes, is amended to read:
  630         400.9905 Definitions.—
  631         (4) “Clinic” means an entity where health care services are
  632  provided to individuals and which tenders charges for
  633  reimbursement for such services, including a mobile clinic and a
  634  portable equipment provider. As used in this part, the term does
  635  not include and the licensure requirements of this part do not
  636  apply to:
  637         (a) Entities licensed or registered by the state under
  638  chapter 395; entities licensed or registered by the state and
  639  providing only health care services within the scope of services
  640  authorized under their respective licenses under ss. 383.30
  641  383.332, chapter 390, chapter 394, chapter 397, this chapter
  642  except part X, chapter 429, chapter 463, chapter 465, chapter
  643  466, chapter 478, chapter 484, or chapter 651; end-stage renal
  644  disease providers authorized under 42 C.F.R. part 405, subpart
  645  U; providers certified and providing only health care services
  646  within the scope of services authorized under their respective
  647  certifications under 42 C.F.R. part 485, subpart B, or subpart
  648  H, or subpart J; providers certified and providing only health
  649  care services within the scope of services authorized under
  650  their respective certifications under 42 C.F.R. part 486,
  651  subpart C; providers certified and providing only health care
  652  services within the scope of services authorized under their
  653  respective certifications under 42 C.F.R. part 491, subpart A;
  654  providers certified by the Centers for Medicare and Medicaid
  655  Services under the federal Clinical Laboratory Improvement
  656  Amendments and the federal rules adopted thereunder; or any
  657  entity that provides neonatal or pediatric hospital-based health
  658  care services or other health care services by licensed
  659  practitioners solely within a hospital licensed under chapter
  660  395.
  661         (b) Entities that own, directly or indirectly, entities
  662  licensed or registered by the state pursuant to chapter 395;
  663  entities that own, directly or indirectly, entities licensed or
  664  registered by the state and providing only health care services
  665  within the scope of services authorized pursuant to their
  666  respective licenses under ss. 383.30-383.332, chapter 390,
  667  chapter 394, chapter 397, this chapter except part X, chapter
  668  429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
  669  484, or chapter 651; end-stage renal disease providers
  670  authorized under 42 C.F.R. part 405, subpart U; providers
  671  certified and providing only health care services within the
  672  scope of services authorized under their respective
  673  certifications under 42 C.F.R. part 485, subpart B, or subpart
  674  H, or subpart J; providers certified and providing only health
  675  care services within the scope of services authorized under
  676  their respective certifications under 42 C.F.R. part 486,
  677  subpart C; providers certified and providing only health care
  678  services within the scope of services authorized under their
  679  respective certifications under 42 C.F.R. part 491, subpart A;
  680  providers certified by the Centers for Medicare and Medicaid
  681  Services under the federal Clinical Laboratory Improvement
  682  Amendments and the federal rules adopted thereunder; or any
  683  entity that provides neonatal or pediatric hospital-based health
  684  care services by licensed practitioners solely within a hospital
  685  licensed under chapter 395.
  686         (c) Entities that are owned, directly or indirectly, by an
  687  entity licensed or registered by the state pursuant to chapter
  688  395; entities that are owned, directly or indirectly, by an
  689  entity licensed or registered by the state and providing only
  690  health care services within the scope of services authorized
  691  pursuant to their respective licenses under ss. 383.30-383.332,
  692  chapter 390, chapter 394, chapter 397, this chapter except part
  693  X, chapter 429, chapter 463, chapter 465, chapter 466, chapter
  694  478, chapter 484, or chapter 651; end-stage renal disease
  695  providers authorized under 42 C.F.R. part 405, subpart U;
  696  providers certified and providing only health care services
  697  within the scope of services authorized under their respective
  698  certifications under 42 C.F.R. part 485, subpart B, or subpart
  699  H, or subpart J; providers certified and providing only health
  700  care services within the scope of services authorized under
  701  their respective certifications under 42 C.F.R. part 486,
  702  subpart C; providers certified and providing only health care
  703  services within the scope of services authorized under their
  704  respective certifications under 42 C.F.R. part 491, subpart A;
  705  providers certified by the Centers for Medicare and Medicaid
  706  Services under the federal Clinical Laboratory Improvement
  707  Amendments and the federal rules adopted thereunder; or any
  708  entity that provides neonatal or pediatric hospital-based health
  709  care services by licensed practitioners solely within a hospital
  710  under chapter 395.
  711         (d) Entities that are under common ownership, directly or
  712  indirectly, with an entity licensed or registered by the state
  713  pursuant to chapter 395; entities that are under common
  714  ownership, directly or indirectly, with an entity licensed or
  715  registered by the state and providing only health care services
  716  within the scope of services authorized pursuant to their
  717  respective licenses under ss. 383.30-383.332, chapter 390,
  718  chapter 394, chapter 397, this chapter except part X, chapter
  719  429, chapter 463, chapter 465, chapter 466, chapter 478, chapter
  720  484, or chapter 651; end-stage renal disease providers
  721  authorized under 42 C.F.R. part 405, subpart U; providers
  722  certified and providing only health care services within the
  723  scope of services authorized under their respective
  724  certifications under 42 C.F.R. part 485, subpart B, or subpart
  725  H, or subpart J; providers certified and providing only health
  726  care services within the scope of services authorized under
  727  their respective certifications under 42 C.F.R. part 486,
  728  subpart C; providers certified and providing only health care
  729  services within the scope of services authorized under their
  730  respective certifications under 42 C.F.R. part 491, subpart A;
  731  providers certified by the Centers for Medicare and Medicaid
  732  Services under the federal Clinical Laboratory Improvement
  733  Amendments and the federal rules adopted thereunder; or any
  734  entity that provides neonatal or pediatric hospital-based health
  735  care services by licensed practitioners solely within a hospital
  736  licensed under chapter 395.
  737         (e) An entity that is exempt from federal taxation under 26
  738  U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
  739  under 26 U.S.C. s. 409 that has a board of trustees at least
  740  two-thirds of which are Florida-licensed health care
  741  practitioners and provides only physical therapy services under
  742  physician orders, any community college or university clinic,
  743  and any entity owned or operated by the federal or state
  744  government, including agencies, subdivisions, or municipalities
  745  thereof.
  746         (f) A sole proprietorship, group practice, partnership, or
  747  corporation that provides health care services by physicians
  748  covered by s. 627.419, that is directly supervised by one or
  749  more of such physicians, and that is wholly owned by one or more
  750  of those physicians or by a physician and the spouse, parent,
  751  child, or sibling of that physician.
  752         (g) A sole proprietorship, group practice, partnership, or
  753  corporation that provides health care services by licensed
  754  health care practitioners under chapter 457, chapter 458,
  755  chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
  756  chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
  757  chapter 490, chapter 491, or part I, part III, part X, part
  758  XIII, or part XIV of chapter 468, or s. 464.012, and that is
  759  wholly owned by one or more licensed health care practitioners,
  760  or the licensed health care practitioners set forth in this
  761  paragraph and the spouse, parent, child, or sibling of a
  762  licensed health care practitioner if one of the owners who is a
  763  licensed health care practitioner is supervising the business
  764  activities and is legally responsible for the entity’s
  765  compliance with all federal and state laws. However, a health
  766  care practitioner may not supervise services beyond the scope of
  767  the practitioner’s license, except that, for the purposes of
  768  this part, a clinic owned by a licensee in s. 456.053(3)(b)
  769  which provides only services authorized pursuant to s.
  770  456.053(3)(b) may be supervised by a licensee specified in s.
  771  456.053(3)(b).
  772         (h) Clinical facilities affiliated with an accredited
  773  medical school at which training is provided for medical
  774  students, residents, or fellows.
  775         (i) Entities that provide only oncology or radiation
  776  therapy services by physicians licensed under chapter 458 or
  777  chapter 459 or entities that provide oncology or radiation
  778  therapy services by physicians licensed under chapter 458 or
  779  chapter 459 which are owned by a corporation whose shares are
  780  publicly traded on a recognized stock exchange.
  781         (j) Clinical facilities affiliated with a college of
  782  chiropractic accredited by the Council on Chiropractic Education
  783  at which training is provided for chiropractic students.
  784         (k) Entities that provide licensed practitioners to staff
  785  emergency departments or to deliver anesthesia services in
  786  facilities licensed under chapter 395 and that derive at least
  787  90 percent of their gross annual revenues from the provision of
  788  such services. Entities claiming an exemption from licensure
  789  under this paragraph must provide documentation demonstrating
  790  compliance.
  791         (l) Orthotic, prosthetic, pediatric cardiology, or
  792  perinatology clinical facilities or anesthesia clinical
  793  facilities that are not otherwise exempt under paragraph (a) or
  794  paragraph (k) and that are a publicly traded corporation or are
  795  wholly owned, directly or indirectly, by a publicly traded
  796  corporation. As used in this paragraph, a publicly traded
  797  corporation is a corporation that issues securities traded on an
  798  exchange registered with the United States Securities and
  799  Exchange Commission as a national securities exchange.
  800         (m) Entities that are owned by a corporation that has $250
  801  million or more in total annual sales of health care services
  802  provided by licensed health care practitioners where one or more
  803  of the persons responsible for the operations of the entity is a
  804  health care practitioner who is licensed in this state and who
  805  is responsible for supervising the business activities of the
  806  entity and is responsible for the entity’s compliance with state
  807  law for purposes of this part.
  808         (n) Entities that employ 50 or more licensed health care
  809  practitioners licensed under chapter 458 or chapter 459 where
  810  the billing for medical services is under a single tax
  811  identification number. The application for exemption under this
  812  subsection shall contain information that includes: the name,
  813  residence, and business address and phone number of the entity
  814  that owns the practice; a complete list of the names and contact
  815  information of all the officers and directors of the
  816  corporation; the name, residence address, business address, and
  817  medical license number of each licensed Florida health care
  818  practitioner employed by the entity; the corporate tax
  819  identification number of the entity seeking an exemption; a
  820  listing of health care services to be provided by the entity at
  821  the health care clinics owned or operated by the entity and a
  822  certified statement prepared by an independent certified public
  823  accountant which states that the entity and the health care
  824  clinics owned or operated by the entity have not received
  825  payment for health care services under personal injury
  826  protection insurance coverage for the preceding year. If the
  827  agency determines that an entity which is exempt under this
  828  subsection has received payments for medical services under
  829  personal injury protection insurance coverage, the agency may
  830  deny or revoke the exemption from licensure under this
  831  subsection.
  832         (o)Entities that are, directly or indirectly, under the
  833  common ownership of or that are subject to common control by a
  834  mutual insurance holding company, as defined in s. 628.703, with
  835  an entity licensed or certified under chapter 627 or chapter 641
  836  which has $1 billion or more in total annual sales in this
  837  state.
  838         (p)Entities that are owned by an entity that is a
  839  behavioral health service provider in at least 5 states other
  840  than Florida and that, together with its affiliates, has $90
  841  million or more in total annual revenues associated with the
  842  provision of behavioral health services and where one or more of
  843  the persons responsible for the operations of the entity is a
  844  health care practitioner who is licensed in this state and who
  845  is responsible for supervising the business activities of the
  846  entity and for the entity’s compliance with state law for
  847  purposes of this part.
  848         (q)Medicaid providers.
  849  
  850  Notwithstanding this subsection, an entity shall be deemed a
  851  clinic and must be licensed under this part in order to receive
  852  reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
  853  627.730-627.7405, unless exempted under s. 627.736(5)(h).
  854         Section 17. Paragraph (c) of subsection (3) of section
  855  400.991, Florida Statutes, is amended to read:
  856         400.991 License requirements; background screenings;
  857  prohibitions.—
  858         (3) In addition to the requirements of part II of chapter
  859  408, the applicant must file with the application satisfactory
  860  proof that the clinic is in compliance with this part and
  861  applicable rules, including:
  862         (c) Proof of financial ability to operate as required under
  863  ss. 408.8065(1) and 408.810(8) s. 408.810(8). As an alternative
  864  to submitting proof of financial ability to operate as required
  865  under s. 408.810(8), the applicant may file a surety bond of at
  866  least $500,000 which guarantees that the clinic will act in full
  867  conformity with all legal requirements for operating a clinic,
  868  payable to the agency. The agency may adopt rules to specify
  869  related requirements for such surety bond.
  870         Section 18. Paragraph (i) of subsection (1) of section
  871  400.9935, Florida Statutes, is amended to read:
  872         400.9935 Clinic responsibilities.—
  873         (1) Each clinic shall appoint a medical director or clinic
  874  director who shall agree in writing to accept legal
  875  responsibility for the following activities on behalf of the
  876  clinic. The medical director or the clinic director shall:
  877         (i) Ensure that the clinic publishes a schedule of charges
  878  for the medical services offered to patients. The schedule must
  879  include the prices charged to an uninsured person paying for
  880  such services by cash, check, credit card, or debit card. The
  881  schedule may group services by price levels, listing services in
  882  each price level. The schedule must be posted in a conspicuous
  883  place in the reception area of any clinic that is an the urgent
  884  care center as defined in s. 395.002(29)(b) and must include,
  885  but is not limited to, the 50 services most frequently provided
  886  by the clinic. The schedule may group services by three price
  887  levels, listing services in each price level. The posting may be
  888  a sign that must be at least 15 square feet in size or through
  889  an electronic messaging board that is at least 3 square feet in
  890  size. The failure of a clinic, including a clinic that is an
  891  urgent care center, to publish and post a schedule of charges as
  892  required by this section shall result in a fine of not more than
  893  $1,000, per day, until the schedule is published and posted.
  894         Section 19. Paragraph (a) of subsection (2) of section
  895  408.033, Florida Statutes, is amended to read:
  896         408.033 Local and state health planning.—
  897         (2) FUNDING.—
  898         (a) The Legislature intends that the cost of local health
  899  councils be borne by assessments on selected health care
  900  facilities subject to facility licensure by the Agency for
  901  Health Care Administration, including abortion clinics, assisted
  902  living facilities, ambulatory surgical centers, birth centers,
  903  home health agencies, hospices, hospitals, intermediate care
  904  facilities for the developmentally disabled, nursing homes, and
  905  health care clinics, and multiphasic testing centers and by
  906  assessments on organizations subject to certification by the
  907  agency pursuant to chapter 641, part III, including health
  908  maintenance organizations and prepaid health clinics. Fees
  909  assessed may be collected prospectively at the time of licensure
  910  renewal and prorated for the licensure period.
  911         Section 20. Effective January 1, 2021, paragraph (l) is
  912  added to subsection (3) of section 408.05, Florida Statutes, to
  913  read:
  914         408.05 Florida Center for Health Information and
  915  Transparency.—
  916         (3) HEALTH INFORMATION TRANSPARENCY.—In order to
  917  disseminate and facilitate the availability of comparable and
  918  uniform health information, the agency shall perform the
  919  following functions:
  920         (l) By July 1 of each year, publish a report identifying
  921  the health care services with the most significant price
  922  variation both statewide and regionally.
  923         Section 21. Paragraph (a) of subsection (1) of section
  924  408.061, Florida Statutes, is amended to read:
  925         408.061 Data collection; uniform systems of financial
  926  reporting; information relating to physician charges;
  927  confidential information; immunity.—
  928         (1) The agency shall require the submission by health care
  929  facilities, health care providers, and health insurers of data
  930  necessary to carry out the agency’s duties and to facilitate
  931  transparency in health care pricing data and quality measures.
  932  Specifications for data to be collected under this section shall
  933  be developed by the agency and applicable contract vendors, with
  934  the assistance of technical advisory panels including
  935  representatives of affected entities, consumers, purchasers, and
  936  such other interested parties as may be determined by the
  937  agency.
  938         (a) Data submitted by health care facilities, including the
  939  facilities as defined in chapter 395, shall include, but are not
  940  limited to,: case-mix data, patient admission and discharge
  941  data, hospital emergency department data which shall include the
  942  number of patients treated in the emergency department of a
  943  licensed hospital reported by patient acuity level, data on
  944  hospital-acquired infections as specified by rule, data on
  945  complications as specified by rule, data on readmissions as
  946  specified by rule, including patient- with patient and provider
  947  specific identifiers included, actual charge data by diagnostic
  948  groups or other bundled groupings as specified by rule,
  949  financial data, accounting data, operating expenses, expenses
  950  incurred for rendering services to patients who cannot or do not
  951  pay, interest charges, depreciation expenses based on the
  952  expected useful life of the property and equipment involved, and
  953  demographic data. The agency shall adopt nationally recognized
  954  risk adjustment methodologies or software consistent with the
  955  standards of the Agency for Healthcare Research and Quality and
  956  as selected by the agency for all data submitted as required by
  957  this section. Data may be obtained from documents including such
  958  as, but not limited to,: leases, contracts, debt instruments,
  959  itemized patient statements or bills, medical record abstracts,
  960  and related diagnostic information. Reported Data elements shall
  961  be reported electronically in accordance with the inpatient data
  962  reporting instructions as prescribed by agency rule 59E-7.012,
  963  Florida Administrative Code. Data submitted shall be certified
  964  by the chief executive officer or an appropriate and duly
  965  authorized representative or employee of the licensed facility
  966  that the information submitted is true and accurate.
  967         Section 22. Subsection (4) of section 408.0611, Florida
  968  Statutes, is amended to read:
  969         408.0611 Electronic prescribing clearinghouse.—
  970         (4) Pursuant to s. 408.061, the agency shall monitor the
  971  implementation of electronic prescribing by health care
  972  practitioners, health care facilities, and pharmacies. By
  973  January 31 of each year, The agency shall report annually on its
  974  website on the progress of implementation of electronic
  975  prescribing to the Governor and the Legislature. Information
  976  reported pursuant to this subsection must shall include federal
  977  and private sector electronic prescribing initiatives and, to
  978  the extent that data is readily available from organizations
  979  that operate electronic prescribing networks, the number of
  980  health care practitioners using electronic prescribing and the
  981  number of prescriptions electronically transmitted.
  982         Section 23. Paragraphs (i) and (j) of subsection (1) of
  983  section 408.062, Florida Statutes, are amended to read:
  984         408.062 Research, analyses, studies, and reports.—
  985         (1) The agency shall conduct research, analyses, and
  986  studies relating to health care costs and access to and quality
  987  of health care services as access and quality are affected by
  988  changes in health care costs. Such research, analyses, and
  989  studies shall include, but not be limited to:
  990         (i) The use of emergency department services by patient
  991  acuity level and the implication of increasing hospital cost by
  992  providing nonurgent care in emergency departments. The agency
  993  shall annually publish on its website information submit an
  994  annual report based on this monitoring and assessment to the
  995  Governor, the Speaker of the House of Representatives, the
  996  President of the Senate, and the substantive legislative
  997  committees, due January 1.
  998         (j) The making available on its Internet website, and in a
  999  hard-copy format upon request, of patient charge, volumes,
 1000  length of stay, and performance indicators collected from health
 1001  care facilities pursuant to s. 408.061(1)(a) for specific
 1002  medical conditions, surgeries, and procedures provided in
 1003  inpatient and outpatient facilities as determined by the agency.
 1004  In making the determination of specific medical conditions,
 1005  surgeries, and procedures to include, the agency shall consider
 1006  such factors as volume, severity of the illness, urgency of
 1007  admission, individual and societal costs, and whether the
 1008  condition is acute or chronic. Performance outcome indicators
 1009  shall be risk adjusted or severity adjusted, as applicable,
 1010  using nationally recognized risk adjustment methodologies or
 1011  software consistent with the standards of the Agency for
 1012  Healthcare Research and Quality and as selected by the agency.
 1013  The website shall also provide an interactive search that allows
 1014  consumers to view and compare the information for specific
 1015  facilities, a map that allows consumers to select a county or
 1016  region, definitions of all of the data, descriptions of each
 1017  procedure, and an explanation about why the data may differ from
 1018  facility to facility. Such public data shall be updated
 1019  quarterly. The agency shall annually publish on its website
 1020  information submit an annual status report on the collection of
 1021  data and publication of health care quality measures to the
 1022  Governor, the Speaker of the House of Representatives, the
 1023  President of the Senate, and the substantive legislative
 1024  committees, due January 1.
 1025         Section 24. Subsection (5) of section 408.063, Florida
 1026  Statutes, is amended to read:
 1027         408.063 Dissemination of health care information.—
 1028         (5)The agency shall publish annually a comprehensive
 1029  report of state health expenditures. The report shall identify:
 1030         (a)The contribution of health care dollars made by all
 1031  payors.
 1032         (b)The dollars expended by type of health care service in
 1033  Florida.
 1034         Section 25. Section 408.802, Florida Statutes, is amended
 1035  to read:
 1036         408.802 Applicability.—The provisions of This part applies
 1037  apply to the provision of services that require licensure as
 1038  defined in this part and to the following entities licensed,
 1039  registered, or certified by the agency, as described in chapters
 1040  112, 383, 390, 394, 395, 400, 429, 440, 483, and 765:
 1041         (1) Laboratories authorized to perform testing under the
 1042  Drug-Free Workplace Act, as provided under ss. 112.0455 and
 1043  440.102.
 1044         (2) Birth centers, as provided under chapter 383.
 1045         (3) Abortion clinics, as provided under chapter 390.
 1046         (4) Crisis stabilization units, as provided under parts I
 1047  and IV of chapter 394.
 1048         (5) Short-term residential treatment facilities, as
 1049  provided under parts I and IV of chapter 394.
 1050         (6) Residential treatment facilities, as provided under
 1051  part IV of chapter 394.
 1052         (7) Residential treatment centers for children and
 1053  adolescents, as provided under part IV of chapter 394.
 1054         (8) Hospitals, as provided under part I of chapter 395.
 1055         (9) Ambulatory surgical centers, as provided under part I
 1056  of chapter 395.
 1057         (10) Nursing homes, as provided under part II of chapter
 1058  400.
 1059         (11) Assisted living facilities, as provided under part I
 1060  of chapter 429.
 1061         (12) Home health agencies, as provided under part III of
 1062  chapter 400.
 1063         (13) Nurse registries, as provided under part III of
 1064  chapter 400.
 1065         (14) Companion services or homemaker services providers, as
 1066  provided under part III of chapter 400.
 1067         (15) Adult day care centers, as provided under part III of
 1068  chapter 429.
 1069         (16) Hospices, as provided under part IV of chapter 400.
 1070         (17) Adult family-care homes, as provided under part II of
 1071  chapter 429.
 1072         (18) Homes for special services, as provided under part V
 1073  of chapter 400.
 1074         (19) Transitional living facilities, as provided under part
 1075  XI of chapter 400.
 1076         (20) Prescribed pediatric extended care centers, as
 1077  provided under part VI of chapter 400.
 1078         (21) Home medical equipment providers, as provided under
 1079  part VII of chapter 400.
 1080         (22) Intermediate care facilities for persons with
 1081  developmental disabilities, as provided under part VIII of
 1082  chapter 400.
 1083         (23) Health care services pools, as provided under part IX
 1084  of chapter 400.
 1085         (24) Health care clinics, as provided under part X of
 1086  chapter 400.
 1087         (25)Multiphasic health testing centers, as provided under
 1088  part I of chapter 483.
 1089         (25)(26) Organ, tissue, and eye procurement organizations,
 1090  as provided under part V of chapter 765.
 1091         Section 26. Present subsections (10) through (14) of
 1092  section 408.803, Florida Statutes, are redesignated as
 1093  subsections (11) through (15), respectively, a new subsection
 1094  (10) is added to that section, and subsection (3) of that
 1095  section is amended, to read:
 1096         408.803 Definitions.—As used in this part, the term:
 1097         (3) “Authorizing statute” means the statute authorizing the
 1098  licensed operation of a provider listed in s. 408.802 and
 1099  includes chapters 112, 383, 390, 394, 395, 400, 429, 440, 483,
 1100  and 765.
 1101         (10)“Low-risk provider” means nurse registries, home
 1102  medical equipment providers, and health care clinics.
 1103         Section 27. Paragraph (b) of subsection (7) of section
 1104  408.806, Florida Statutes, is amended to read:
 1105         408.806 License application process.—
 1106         (7)
 1107         (b) An initial inspection is not required for companion
 1108  services or homemaker services providers, as provided under part
 1109  III of chapter 400, or for health care services pools, as
 1110  provided under part IX of chapter 400, or for low-risk providers
 1111  as provided under s. 408.811.
 1112         Section 28. Subsection (2) of section 408.808, Florida
 1113  Statutes, is amended to read:
 1114         408.808 License categories.—
 1115         (2) PROVISIONAL LICENSE.—An applicant against whom a
 1116  proceeding denying or revoking a license is pending at the time
 1117  of license renewal may be issued a provisional license effective
 1118  until final action not subject to further appeal. A provisional
 1119  license may also be issued to an applicant for initial licensure
 1120  or an applicant applying for a change of ownership. A
 1121  provisional license must be limited in duration to a specific
 1122  period of time, up to 12 months, as determined by the agency.
 1123         Section 29. Subsections (2) and (5) of section 408.809,
 1124  Florida Statutes, are amended to read:
 1125         408.809 Background screening; prohibited offenses.—
 1126         (2) Every 5 years following his or her licensure,
 1127  employment, or entry into a contract in a capacity that under
 1128  subsection (1) would require level 2 background screening under
 1129  chapter 435, each such person must submit to level 2 background
 1130  rescreening as a condition of retaining such license or
 1131  continuing in such employment or contractual status. For any
 1132  such rescreening, the agency shall request the Department of Law
 1133  Enforcement to forward the person’s fingerprints to the Federal
 1134  Bureau of Investigation for a national criminal history record
 1135  check unless the person’s fingerprints are enrolled in the
 1136  Federal Bureau of Investigation’s national retained print arrest
 1137  notification program. If the fingerprints of such a person are
 1138  not retained by the Department of Law Enforcement under s.
 1139  943.05(2)(g) and (h), the person must submit fingerprints
 1140  electronically to the Department of Law Enforcement for state
 1141  processing, and the Department of Law Enforcement shall forward
 1142  the fingerprints to the Federal Bureau of Investigation for a
 1143  national criminal history record check. The fingerprints shall
 1144  be retained by the Department of Law Enforcement under s.
 1145  943.05(2)(g) and (h) and enrolled in the national retained print
 1146  arrest notification program when the Department of Law
 1147  Enforcement begins participation in the program. The cost of the
 1148  state and national criminal history records checks required by
 1149  level 2 screening may be borne by the licensee or the person
 1150  fingerprinted. Until a specified agency is fully implemented in
 1151  the clearinghouse created under s. 435.12, The agency may accept
 1152  as satisfying the requirements of this section proof of
 1153  compliance with level 2 screening standards submitted within the
 1154  previous 5 years to meet any provider or professional licensure
 1155  requirements of the agency, the Department of Health, the
 1156  Department of Elderly Affairs, the Agency for Persons with
 1157  Disabilities, the Department of Children and Families, or the
 1158  Department of Financial Services for an applicant for a
 1159  certificate of authority or provisional certificate of authority
 1160  to operate a continuing care retirement community under chapter
 1161  651, provided that:
 1162         (a) The screening standards and disqualifying offenses for
 1163  the prior screening are equivalent to those specified in s.
 1164  435.04 and this section;
 1165         (b) The person subject to screening has not had a break in
 1166  service from a position that requires level 2 screening for more
 1167  than 90 days; and
 1168         (c) Such proof is accompanied, under penalty of perjury, by
 1169  an attestation of compliance with chapter 435 and this section
 1170  using forms provided by the agency.
 1171         (5) A person who serves as a controlling interest of, is
 1172  employed by, or contracts with a licensee on July 31, 2010, who
 1173  has been screened and qualified according to standards specified
 1174  in s. 435.03 or s. 435.04 must be rescreened by July 31, 2015,
 1175  in compliance with the following schedule. If, upon rescreening,
 1176  such person has a disqualifying offense that was not a
 1177  disqualifying offense at the time of the last screening, but is
 1178  a current disqualifying offense and was committed before the
 1179  last screening, he or she may apply for an exemption from the
 1180  appropriate licensing agency and, if agreed to by the employer,
 1181  may continue to perform his or her duties until the licensing
 1182  agency renders a decision on the application for exemption if
 1183  the person is eligible to apply for an exemption and the
 1184  exemption request is received by the agency within 30 days after
 1185  receipt of the rescreening results by the person. The
 1186  rescreening schedule shall be:
 1187         (a) Individuals for whom the last screening was conducted
 1188  on or before December 31, 2004, must be rescreened by July 31,
 1189  2013.
 1190         (b) Individuals for whom the last screening conducted was
 1191  between January 1, 2005, and December 31, 2008, must be
 1192  rescreened by July 31, 2014.
 1193         (c) Individuals for whom the last screening conducted was
 1194  between January 1, 2009, through July 31, 2011, must be
 1195  rescreened by July 31, 2015.
 1196         Section 30. Subsection (1) of section 408.811, Florida
 1197  Statutes, is amended to read:
 1198         408.811 Right of inspection; copies; inspection reports;
 1199  plan for correction of deficiencies.—
 1200         (1) An authorized officer or employee of the agency may
 1201  make or cause to be made any inspection or investigation deemed
 1202  necessary by the agency to determine the state of compliance
 1203  with this part, authorizing statutes, and applicable rules. The
 1204  right of inspection extends to any business that the agency has
 1205  reason to believe is being operated as a provider without a
 1206  license, but inspection of any business suspected of being
 1207  operated without the appropriate license may not be made without
 1208  the permission of the owner or person in charge unless a warrant
 1209  is first obtained from a circuit court. Any application for a
 1210  license issued under this part, authorizing statutes, or
 1211  applicable rules constitutes permission for an appropriate
 1212  inspection to verify the information submitted on or in
 1213  connection with the application.
 1214         (a) All inspections shall be unannounced, except as
 1215  specified in s. 408.806.
 1216         (b) Inspections for relicensure shall be conducted
 1217  biennially unless otherwise specified by this section,
 1218  authorizing statutes, or applicable rules.
 1219         (c)The agency may exempt a low-risk provider from
 1220  licensure inspection if the provider or controlling interest has
 1221  an excellent regulatory history with regard to deficiencies,
 1222  sanctions, complaints, and other regulatory actions, as defined
 1223  by rule. The agency shall continue to conduct unannounced
 1224  licensure inspections for at least 10 percent of exempt low-risk
 1225  providers to verify compliance.
 1226         (d)The agency may adopt rules to waive a routine
 1227  inspection, including inspection for relicensure, or allow for
 1228  an extended period between relicensure inspections for specific
 1229  providers based upon all of the following:
 1230         1.A favorable regulatory history with regard to
 1231  deficiencies, sanctions, complaints, and other regulatory
 1232  measures.
 1233         2.Outcome measures that demonstrate quality performance.
 1234         3.Successful participation in a recognized quality
 1235  assurance program.
 1236         4.Accreditation status.
 1237         5.Other measures reflective of quality and safety.
 1238         6.The length of time between inspections.
 1239  
 1240  The agency shall continue to conduct unannounced licensure
 1241  inspections for at least 10 percent of providers that qualify
 1242  for a waiver or extended period between relicensure inspections.
 1243         (e)The agency maintains the authority to conduct an
 1244  inspection of any provider at any time to determine regulatory
 1245  compliance.
 1246         Section 31. Subsection (24) of section 408.820, Florida
 1247  Statutes, is amended to read:
 1248         408.820 Exemptions.—Except as prescribed in authorizing
 1249  statutes, the following exemptions shall apply to specified
 1250  requirements of this part:
 1251         (24)Multiphasic health testing centers, as provided under
 1252  part I of chapter 483, are exempt from s. 408.810(5)-(10).
 1253         Section 32. Subsections (1) and (2) of section 408.821,
 1254  Florida Statutes, are amended to read:
 1255         408.821 Emergency management planning; emergency
 1256  operations; inactive license.—
 1257         (1) A licensee required by authorizing statutes and agency
 1258  rule to have a comprehensive an emergency management operations
 1259  plan must designate a safety liaison to serve as the primary
 1260  contact for emergency operations. Such licensee shall submit its
 1261  comprehensive emergency management plan to the local emergency
 1262  management agency, the county health department, or the
 1263  Department of Health as follows:
 1264         (a)Submit the plan within 30 days after initial licensure
 1265  and change of ownership, and notify the agency within 30 days
 1266  after submission of the plan.
 1267         (b)Submit the plan annually and within 30 days after any
 1268  significant modification, as defined by agency rule, to a
 1269  previously approved plan.
 1270         (c)Respond with necessary plan revisions within 30 days
 1271  after notification that plan revisions are required.
 1272         (d)Notify the agency within 30 days after approval of its
 1273  plan by the local emergency management agency, county health
 1274  department, or Department of Health.
 1275         (2) An entity subject to this part may temporarily exceed
 1276  its licensed capacity to act as a receiving provider in
 1277  accordance with an approved comprehensive emergency management
 1278  operations plan for up to 15 days. While in an overcapacity
 1279  status, each provider must furnish or arrange for appropriate
 1280  care and services to all clients. In addition, the agency may
 1281  approve requests for overcapacity in excess of 15 days, which
 1282  approvals may be based upon satisfactory justification and need
 1283  as provided by the receiving and sending providers.
 1284         Section 33. Subsection (3) of section 408.831, Florida
 1285  Statutes, is amended to read:
 1286         408.831 Denial, suspension, or revocation of a license,
 1287  registration, certificate, or application.—
 1288         (3) This section provides standards of enforcement
 1289  applicable to all entities licensed or regulated by the Agency
 1290  for Health Care Administration. This section controls over any
 1291  conflicting provisions of chapters 39, 383, 390, 391, 394, 395,
 1292  400, 408, 429, 468, 483, and 765 or rules adopted pursuant to
 1293  those chapters.
 1294         Section 34. Section 408.832, Florida Statutes, is amended
 1295  to read:
 1296         408.832 Conflicts.—In case of conflict between the
 1297  provisions of this part and the authorizing statutes governing
 1298  the licensure of health care providers by the Agency for Health
 1299  Care Administration found in s. 112.0455 and chapters 383, 390,
 1300  394, 395, 400, 429, 440, 483, and 765, the provisions of this
 1301  part shall prevail.
 1302         Section 35. Subsection (9) of section 408.909, Florida
 1303  Statutes, is amended to read:
 1304         408.909 Health flex plans.—
 1305         (9)PROGRAM EVALUATION.—The agency and the office shall
 1306  evaluate the pilot program and its effect on the entities that
 1307  seek approval as health flex plans, on the number of enrollees,
 1308  and on the scope of the health care coverage offered under a
 1309  health flex plan; shall provide an assessment of the health flex
 1310  plans and their potential applicability in other settings; shall
 1311  use health flex plans to gather more information to evaluate
 1312  low-income consumer driven benefit packages; and shall, by
 1313  January 15, 2016, and annually thereafter, jointly submit a
 1314  report to the Governor, the President of the Senate, and the
 1315  Speaker of the House of Representatives.
 1316         Section 36. Paragraph (d) of subsection (10) of section
 1317  408.9091, Florida Statutes, is amended to read:
 1318         408.9091 Cover Florida Health Care Access Program.—
 1319         (10) PROGRAM EVALUATION.—The agency and the office shall:
 1320         (d)Jointly submit by March 1, annually, a report to the
 1321  Governor, the President of the Senate, and the Speaker of the
 1322  House of Representatives which provides the information
 1323  specified in paragraphs (a)-(c) and recommendations relating to
 1324  the successful implementation and administration of the program.
 1325         Section 37. Effective upon becoming a law, paragraph (a) of
 1326  subsection (5) of section 409.905, Florida Statutes, is amended
 1327  to read:
 1328         409.905 Mandatory Medicaid services.—The agency may make
 1329  payments for the following services, which are required of the
 1330  state by Title XIX of the Social Security Act, furnished by
 1331  Medicaid providers to recipients who are determined to be
 1332  eligible on the dates on which the services were provided. Any
 1333  service under this section shall be provided only when medically
 1334  necessary and in accordance with state and federal law.
 1335  Mandatory services rendered by providers in mobile units to
 1336  Medicaid recipients may be restricted by the agency. Nothing in
 1337  this section shall be construed to prevent or limit the agency
 1338  from adjusting fees, reimbursement rates, lengths of stay,
 1339  number of visits, number of services, or any other adjustments
 1340  necessary to comply with the availability of moneys and any
 1341  limitations or directions provided for in the General
 1342  Appropriations Act or chapter 216.
 1343         (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
 1344  all covered services provided for the medical care and treatment
 1345  of a recipient who is admitted as an inpatient by a licensed
 1346  physician or dentist to a hospital licensed under part I of
 1347  chapter 395. However, the agency shall limit the payment for
 1348  inpatient hospital services for a Medicaid recipient 21 years of
 1349  age or older to 45 days or the number of days necessary to
 1350  comply with the General Appropriations Act.
 1351         (a)1. The agency may implement reimbursement and
 1352  utilization management reforms in order to comply with any
 1353  limitations or directions in the General Appropriations Act,
 1354  which may include, but are not limited to: prior authorization
 1355  for inpatient psychiatric days; prior authorization for
 1356  nonemergency hospital inpatient admissions for individuals 21
 1357  years of age and older; authorization of emergency and urgent
 1358  care admissions within 24 hours after admission; enhanced
 1359  utilization and concurrent review programs for highly utilized
 1360  services; reduction or elimination of covered days of service;
 1361  adjusting reimbursement ceilings for variable costs; adjusting
 1362  reimbursement ceilings for fixed and property costs; and
 1363  implementing target rates of increase.
 1364         2. The agency may limit prior authorization for hospital
 1365  inpatient services to selected diagnosis-related groups, based
 1366  on an analysis of the cost and potential for unnecessary
 1367  hospitalizations represented by certain diagnoses. Admissions
 1368  for normal delivery and newborns are exempt from requirements
 1369  for prior authorization.
 1370         3. In implementing the provisions of this section related
 1371  to prior authorization, the agency shall ensure that the process
 1372  for authorization is accessible 24 hours per day, 7 days per
 1373  week and authorization is automatically granted when not denied
 1374  within 4 hours after the request. Authorization procedures must
 1375  include steps for review of denials.
 1376         4. Upon implementing the prior authorization program for
 1377  hospital inpatient services, the agency shall discontinue its
 1378  hospital retrospective review program. However, this
 1379  subparagraph may not be construed to prevent the agency from
 1380  conducting retrospective reviews under s. 409.913, including,
 1381  but not limited to, reviews in which an overpayment is suspected
 1382  due to a mistake or submission of an improper claim or for other
 1383  reasons that do not rise to the level of fraud or abuse.
 1384         Section 38. It is the intent of the Legislature that
 1385  section 409.905(5)(a), Florida Statutes, as amended by this act,
 1386  confirms and clarifies existing law. This section shall take
 1387  effect upon becoming a law.
 1388         Section 39. Subsection (8) of section 409.907, Florida
 1389  Statutes, is amended to read:
 1390         409.907 Medicaid provider agreements.—The agency may make
 1391  payments for medical assistance and related services rendered to
 1392  Medicaid recipients only to an individual or entity who has a
 1393  provider agreement in effect with the agency, who is performing
 1394  services or supplying goods in accordance with federal, state,
 1395  and local law, and who agrees that no person shall, on the
 1396  grounds of handicap, race, color, or national origin, or for any
 1397  other reason, be subjected to discrimination under any program
 1398  or activity for which the provider receives payment from the
 1399  agency.
 1400         (8)(a)A level 2 background screening pursuant to chapter
 1401  435 must be conducted through the agency on each of the
 1402  following:
 1403         1.The Each provider, or each principal of the provider if
 1404  the provider is a corporation, partnership, association, or
 1405  other entity, seeking to participate in the Medicaid program
 1406  must submit a complete set of his or her fingerprints to the
 1407  agency for the purpose of conducting a criminal history record
 1408  check.
 1409         2. Principals of the provider, who include any officer,
 1410  director, billing agent, managing employee, or affiliated
 1411  person, or any partner or shareholder who has an ownership
 1412  interest equal to 5 percent or more in the provider. However,
 1413  for a hospital licensed under chapter 395 or a nursing home
 1414  licensed under chapter 400, principals of the provider are those
 1415  who meet the definition of a controlling interest under s.
 1416  408.803. A director of a not-for-profit corporation or
 1417  organization is not a principal for purposes of a background
 1418  investigation required by this section if the director: serves
 1419  solely in a voluntary capacity for the corporation or
 1420  organization, does not regularly take part in the day-to-day
 1421  operational decisions of the corporation or organization,
 1422  receives no remuneration from the not-for-profit corporation or
 1423  organization for his or her service on the board of directors,
 1424  has no financial interest in the not-for-profit corporation or
 1425  organization, and has no family members with a financial
 1426  interest in the not-for-profit corporation or organization; and
 1427  if the director submits an affidavit, under penalty of perjury,
 1428  to this effect to the agency and the not-for-profit corporation
 1429  or organization submits an affidavit, under penalty of perjury,
 1430  to this effect to the agency as part of the corporation’s or
 1431  organization’s Medicaid provider agreement application.
 1432         3.Any person who participates or seeks to participate in
 1433  the Florida Medicaid program by way of rendering services to
 1434  Medicaid recipients or having direct access to Medicaid
 1435  recipients, recipient living areas, or the financial, medical,
 1436  or service records of a Medicaid recipient or who supervises the
 1437  delivery of goods or services to a Medicaid recipient. This
 1438  subparagraph does not impose additional screening requirements
 1439  on any providers licensed under part II of chapter 408 or
 1440  transportation service providers contracted with a
 1441  transportation broker subject to this paragraph while
 1442  administering the Medicaid transportation benefit.
 1443         (b) Notwithstanding paragraph (a) the above, the agency may
 1444  require a background check for any person reasonably suspected
 1445  by the agency to have been convicted of a crime.
 1446         (c)(a)Paragraph (a) This subsection does not apply to:
 1447         1. A unit of local government, except that requirements of
 1448  this subsection apply to nongovernmental providers and entities
 1449  contracting with the local government to provide Medicaid
 1450  services. The actual cost of the state and national criminal
 1451  history record checks must be borne by the nongovernmental
 1452  provider or entity; or
 1453         2. Any business that derives more than 50 percent of its
 1454  revenue from the sale of goods to the final consumer, and the
 1455  business or its controlling parent is required to file a form
 1456  10-K or other similar statement with the Securities and Exchange
 1457  Commission or has a net worth of $50 million or more.
 1458         (d)(b) Background screening shall be conducted in
 1459  accordance with chapter 435 and s. 408.809. The cost of the
 1460  state and national criminal record check shall be borne by the
 1461  provider.
 1462         Section 40. Effective June 30, 2020, section 19 of chapter
 1463  2019-116, Laws of Florida, is repealed.
 1464         Section 41. Paragraph (a) of subsection (1) of section
 1465  409.908, Florida Statutes, is amended, and subsection (23) of
 1466  that section is reenacted, to read:
 1467         409.908 Reimbursement of Medicaid providers.—Subject to
 1468  specific appropriations, the agency shall reimburse Medicaid
 1469  providers, in accordance with state and federal law, according
 1470  to methodologies set forth in the rules of the agency and in
 1471  policy manuals and handbooks incorporated by reference therein.
 1472  These methodologies may include fee schedules, reimbursement
 1473  methods based on cost reporting, negotiated fees, competitive
 1474  bidding pursuant to s. 287.057, and other mechanisms the agency
 1475  considers efficient and effective for purchasing services or
 1476  goods on behalf of recipients. If a provider is reimbursed based
 1477  on cost reporting and submits a cost report late and that cost
 1478  report would have been used to set a lower reimbursement rate
 1479  for a rate semester, then the provider’s rate for that semester
 1480  shall be retroactively calculated using the new cost report, and
 1481  full payment at the recalculated rate shall be effected
 1482  retroactively. Medicare-granted extensions for filing cost
 1483  reports, if applicable, shall also apply to Medicaid cost
 1484  reports. Payment for Medicaid compensable services made on
 1485  behalf of Medicaid eligible persons is subject to the
 1486  availability of moneys and any limitations or directions
 1487  provided for in the General Appropriations Act or chapter 216.
 1488  Further, nothing in this section shall be construed to prevent
 1489  or limit the agency from adjusting fees, reimbursement rates,
 1490  lengths of stay, number of visits, or number of services, or
 1491  making any other adjustments necessary to comply with the
 1492  availability of moneys and any limitations or directions
 1493  provided for in the General Appropriations Act, provided the
 1494  adjustment is consistent with legislative intent.
 1495         (1) Reimbursement to hospitals licensed under part I of
 1496  chapter 395 must be made prospectively or on the basis of
 1497  negotiation.
 1498         (a) Reimbursement for inpatient care is limited as provided
 1499  in s. 409.905(5), except as otherwise provided in this
 1500  subsection.
 1501         1. If authorized by the General Appropriations Act, the
 1502  agency may modify reimbursement for specific types of services
 1503  or diagnoses, recipient ages, and hospital provider types.
 1504         2. The agency may establish an alternative methodology to
 1505  the DRG-based prospective payment system to set reimbursement
 1506  rates for:
 1507         a. State-owned psychiatric hospitals.
 1508         b. Newborn hearing screening services.
 1509         c. Transplant services for which the agency has established
 1510  a global fee.
 1511         d. Recipients who have tuberculosis that is resistant to
 1512  therapy who are in need of long-term, hospital-based treatment
 1513  pursuant to s. 392.62.
 1514         e.Class III psychiatric hospitals.
 1515         3. The agency shall modify reimbursement according to other
 1516  methodologies recognized in the General Appropriations Act.
 1517  
 1518  The agency may receive funds from state entities, including, but
 1519  not limited to, the Department of Health, local governments, and
 1520  other local political subdivisions, for the purpose of making
 1521  special exception payments, including federal matching funds,
 1522  through the Medicaid inpatient reimbursement methodologies.
 1523  Funds received for this purpose shall be separately accounted
 1524  for and may not be commingled with other state or local funds in
 1525  any manner. The agency may certify all local governmental funds
 1526  used as state match under Title XIX of the Social Security Act,
 1527  to the extent and in the manner authorized under the General
 1528  Appropriations Act and pursuant to an agreement between the
 1529  agency and the local governmental entity. In order for the
 1530  agency to certify such local governmental funds, a local
 1531  governmental entity must submit a final, executed letter of
 1532  agreement to the agency, which must be received by October 1 of
 1533  each fiscal year and provide the total amount of local
 1534  governmental funds authorized by the entity for that fiscal year
 1535  under this paragraph, paragraph (b), or the General
 1536  Appropriations Act. The local governmental entity shall use a
 1537  certification form prescribed by the agency. At a minimum, the
 1538  certification form must identify the amount being certified and
 1539  describe the relationship between the certifying local
 1540  governmental entity and the local health care provider. The
 1541  agency shall prepare an annual statement of impact which
 1542  documents the specific activities undertaken during the previous
 1543  fiscal year pursuant to this paragraph, to be submitted to the
 1544  Legislature annually by January 1.
 1545         (23)(a) The agency shall establish rates at a level that
 1546  ensures no increase in statewide expenditures resulting from a
 1547  change in unit costs for county health departments effective
 1548  July 1, 2011. Reimbursement rates shall be as provided in the
 1549  General Appropriations Act.
 1550         (b)1. Base rate reimbursement for inpatient services under
 1551  a diagnosis-related group payment methodology shall be provided
 1552  in the General Appropriations Act.
 1553         2. Base rate reimbursement for outpatient services under an
 1554  enhanced ambulatory payment group methodology shall be provided
 1555  in the General Appropriations Act.
 1556         3. Prospective payment system reimbursement for nursing
 1557  home services shall be as provided in subsection (2) and in the
 1558  General Appropriations Act.
 1559         Section 42. Section 409.913, Florida Statutes, is amended
 1560  to read:
 1561         409.913 Oversight of the integrity of the Medicaid
 1562  program.—The agency shall operate a program to oversee the
 1563  activities of Florida Medicaid recipients, and providers and
 1564  their representatives, to ensure that fraudulent and abusive
 1565  behavior and neglect of recipients occur to the minimum extent
 1566  possible, and to recover overpayments and impose sanctions as
 1567  appropriate. Each January 15 January 1, the agency and the
 1568  Medicaid Fraud Control Unit of the Department of Legal Affairs
 1569  shall submit reports a joint report to the Legislature
 1570  documenting the effectiveness of the state’s efforts to control
 1571  Medicaid fraud and abuse and to recover Medicaid overpayments
 1572  during the previous fiscal year. The report must describe the
 1573  number of cases opened and investigated each year; the sources
 1574  of the cases opened; the disposition of the cases closed each
 1575  year; the amount of overpayments alleged in preliminary and
 1576  final audit letters; the number and amount of fines or penalties
 1577  imposed; any reductions in overpayment amounts negotiated in
 1578  settlement agreements or by other means; the amount of final
 1579  agency determinations of overpayments; the amount deducted from
 1580  federal claiming as a result of overpayments; the amount of
 1581  overpayments recovered each year; the amount of cost of
 1582  investigation recovered each year; the average length of time to
 1583  collect from the time the case was opened until the overpayment
 1584  is paid in full; the amount determined as uncollectible and the
 1585  portion of the uncollectible amount subsequently reclaimed from
 1586  the Federal Government; the number of providers, by type, that
 1587  are terminated from participation in the Medicaid program as a
 1588  result of fraud and abuse; and all costs associated with
 1589  discovering and prosecuting cases of Medicaid overpayments and
 1590  making recoveries in such cases. The report must also document
 1591  actions taken to prevent overpayments and the number of
 1592  providers prevented from enrolling in or reenrolling in the
 1593  Medicaid program as a result of documented Medicaid fraud and
 1594  abuse and must include policy recommendations necessary to
 1595  prevent or recover overpayments and changes necessary to prevent
 1596  and detect Medicaid fraud. All policy recommendations in the
 1597  report must include a detailed fiscal analysis, including, but
 1598  not limited to, implementation costs, estimated savings to the
 1599  Medicaid program, and the return on investment. The agency must
 1600  submit the policy recommendations and fiscal analyses in the
 1601  report to the appropriate estimating conference, pursuant to s.
 1602  216.137, by February 15 of each year. The agency and the
 1603  Medicaid Fraud Control Unit of the Department of Legal Affairs
 1604  each must include detailed unit-specific performance standards,
 1605  benchmarks, and metrics in the report, including projected cost
 1606  savings to the state Medicaid program during the following
 1607  fiscal year.
 1608         (1) For the purposes of this section, the term:
 1609         (a) “Abuse” means:
 1610         1. Provider practices that are inconsistent with generally
 1611  accepted business or medical practices and that result in an
 1612  unnecessary cost to the Medicaid program or in reimbursement for
 1613  goods or services that are not medically necessary or that fail
 1614  to meet professionally recognized standards for health care.
 1615         2. Recipient practices that result in unnecessary cost to
 1616  the Medicaid program.
 1617         (b) “Complaint” means an allegation that fraud, abuse, or
 1618  an overpayment has occurred.
 1619         (c) “Fraud” means an intentional deception or
 1620  misrepresentation made by a person with the knowledge that the
 1621  deception results in unauthorized benefit to herself or himself
 1622  or another person. The term includes any act that constitutes
 1623  fraud under applicable federal or state law.
 1624         (d) “Medical necessity” or “medically necessary” means any
 1625  goods or services necessary to palliate the effects of a
 1626  terminal condition, or to prevent, diagnose, correct, cure,
 1627  alleviate, or preclude deterioration of a condition that
 1628  threatens life, causes pain or suffering, or results in illness
 1629  or infirmity, which goods or services are provided in accordance
 1630  with generally accepted standards of medical practice. For
 1631  purposes of determining Medicaid reimbursement, the agency is
 1632  the final arbiter of medical necessity. Determinations of
 1633  medical necessity must be made by a licensed physician employed
 1634  by or under contract with the agency and must be based upon
 1635  information available at the time the goods or services are
 1636  provided.
 1637         (e) “Overpayment” includes any amount that is not
 1638  authorized to be paid by the Medicaid program whether paid as a
 1639  result of inaccurate or improper cost reporting, improper
 1640  claiming, unacceptable practices, fraud, abuse, or mistake.
 1641         (f) “Person” means any natural person, corporation,
 1642  partnership, association, clinic, group, or other entity,
 1643  whether or not such person is enrolled in the Medicaid program
 1644  or is a provider of health care.
 1645         (2) The agency shall conduct, or cause to be conducted by
 1646  contract or otherwise, reviews, investigations, analyses,
 1647  audits, or any combination thereof, to determine possible fraud,
 1648  abuse, overpayment, or recipient neglect in the Medicaid program
 1649  and shall report the findings of any overpayments in audit
 1650  reports as appropriate. At least 5 percent of all audits shall
 1651  be conducted on a random basis. As part of its ongoing fraud
 1652  detection activities, the agency shall identify and monitor, by
 1653  contract or otherwise, patterns of overutilization of Medicaid
 1654  services based on state averages. The agency shall track
 1655  Medicaid provider prescription and billing patterns and evaluate
 1656  them against Medicaid medical necessity criteria and coverage
 1657  and limitation guidelines adopted by rule. Medical necessity
 1658  determination requires that service be consistent with symptoms
 1659  or confirmed diagnosis of illness or injury under treatment and
 1660  not in excess of the patient’s needs. The agency shall conduct
 1661  reviews of provider exceptions to peer group norms and shall,
 1662  using statistical methodologies, provider profiling, and
 1663  analysis of billing patterns, detect and investigate abnormal or
 1664  unusual increases in billing or payment of claims for Medicaid
 1665  services and medically unnecessary provision of services.
 1666         (3) The agency may conduct, or may contract for, prepayment
 1667  review of provider claims to ensure cost-effective purchasing;
 1668  to ensure that billing by a provider to the agency is in
 1669  accordance with applicable provisions of all Medicaid rules,
 1670  regulations, handbooks, and policies and in accordance with
 1671  federal, state, and local law; and to ensure that appropriate
 1672  care is rendered to Medicaid recipients. Such prepayment reviews
 1673  may be conducted as determined appropriate by the agency,
 1674  without any suspicion or allegation of fraud, abuse, or neglect,
 1675  and may last for up to 1 year. Unless the agency has reliable
 1676  evidence of fraud, misrepresentation, abuse, or neglect, claims
 1677  shall be adjudicated for denial or payment within 90 days after
 1678  receipt of complete documentation by the agency for review. If
 1679  there is reliable evidence of fraud, misrepresentation, abuse,
 1680  or neglect, claims shall be adjudicated for denial of payment
 1681  within 180 days after receipt of complete documentation by the
 1682  agency for review.
 1683         (4) Any suspected criminal violation identified by the
 1684  agency must be referred to the Medicaid Fraud Control Unit of
 1685  the Office of the Attorney General for investigation. The agency
 1686  and the Attorney General shall enter into a memorandum of
 1687  understanding, which must include, but need not be limited to, a
 1688  protocol for regularly sharing information and coordinating
 1689  casework. The protocol must establish a procedure for the
 1690  referral by the agency of cases involving suspected Medicaid
 1691  fraud to the Medicaid Fraud Control Unit for investigation, and
 1692  the return to the agency of those cases where investigation
 1693  determines that administrative action by the agency is
 1694  appropriate. Offices of the Medicaid program integrity program
 1695  and the Medicaid Fraud Control Unit of the Department of Legal
 1696  Affairs, shall, to the extent possible, be collocated. The
 1697  agency and the Department of Legal Affairs shall periodically
 1698  conduct joint training and other joint activities designed to
 1699  increase communication and coordination in recovering
 1700  overpayments.
 1701         (5) A Medicaid provider is subject to having goods and
 1702  services that are paid for by the Medicaid program reviewed by
 1703  an appropriate peer-review organization designated by the
 1704  agency. The written findings of the applicable peer-review
 1705  organization are admissible in any court or administrative
 1706  proceeding as evidence of medical necessity or the lack thereof.
 1707         (6) Any notice required to be given to a provider under
 1708  this section is presumed to be sufficient notice if sent to the
 1709  address last shown on the provider enrollment file. It is the
 1710  responsibility of the provider to furnish and keep the agency
 1711  informed of the provider’s current address. United States Postal
 1712  Service proof of mailing or certified or registered mailing of
 1713  such notice to the provider at the address shown on the provider
 1714  enrollment file constitutes sufficient proof of notice. Any
 1715  notice required to be given to the agency by this section must
 1716  be sent to the agency at an address designated by rule.
 1717         (7) When presenting a claim for payment under the Medicaid
 1718  program, a provider has an affirmative duty to supervise the
 1719  provision of, and be responsible for, goods and services claimed
 1720  to have been provided, to supervise and be responsible for
 1721  preparation and submission of the claim, and to present a claim
 1722  that is true and accurate and that is for goods and services
 1723  that:
 1724         (a) Have actually been furnished to the recipient by the
 1725  provider prior to submitting the claim.
 1726         (b) Are Medicaid-covered goods or services that are
 1727  medically necessary.
 1728         (c) Are of a quality comparable to those furnished to the
 1729  general public by the provider’s peers.
 1730         (d) Have not been billed in whole or in part to a recipient
 1731  or a recipient’s responsible party, except for such copayments,
 1732  coinsurance, or deductibles as are authorized by the agency.
 1733         (e) Are provided in accord with applicable provisions of
 1734  all Medicaid rules, regulations, handbooks, and policies and in
 1735  accordance with federal, state, and local law.
 1736         (f) Are documented by records made at the time the goods or
 1737  services were provided, demonstrating the medical necessity for
 1738  the goods or services rendered. Medicaid goods or services are
 1739  excessive or not medically necessary unless both the medical
 1740  basis and the specific need for them are fully and properly
 1741  documented in the recipient’s medical record.
 1742  
 1743  The agency shall deny payment or require repayment for goods or
 1744  services that are not presented as required in this subsection.
 1745         (8) The agency shall not reimburse any person or entity for
 1746  any prescription for medications, medical supplies, or medical
 1747  services if the prescription was written by a physician or other
 1748  prescribing practitioner who is not enrolled in the Medicaid
 1749  program. This section does not apply:
 1750         (a) In instances involving bona fide emergency medical
 1751  conditions as determined by the agency;
 1752         (b) To a provider of medical services to a patient in a
 1753  hospital emergency department, hospital inpatient or outpatient
 1754  setting, or nursing home;
 1755         (c) To bona fide pro bono services by preapproved non
 1756  Medicaid providers as determined by the agency;
 1757         (d) To prescribing physicians who are board-certified
 1758  specialists treating Medicaid recipients referred for treatment
 1759  by a treating physician who is enrolled in the Medicaid program;
 1760         (e) To prescriptions written for dually eligible Medicare
 1761  beneficiaries by an authorized Medicare provider who is not
 1762  enrolled in the Medicaid program; or
 1763         (f) To other physicians who are not enrolled in the
 1764  Medicaid program but who provide a medically necessary service
 1765  or prescription not otherwise reasonably available from a
 1766  Medicaid-enrolled physician.; or
 1767         (9) A Medicaid provider shall retain medical, professional,
 1768  financial, and business records pertaining to services and goods
 1769  furnished to a Medicaid recipient and billed to Medicaid for a
 1770  period of 5 years after the date of furnishing such services or
 1771  goods. The agency may investigate, review, or analyze such
 1772  records, which must be made available during normal business
 1773  hours. However, 24-hour notice must be provided if patient
 1774  treatment would be disrupted. The provider must keep the agency
 1775  informed of the location of the provider’s Medicaid-related
 1776  records. The authority of the agency to obtain Medicaid-related
 1777  records from a provider is neither curtailed nor limited during
 1778  a period of litigation between the agency and the provider.
 1779         (10) Payments for the services of billing agents or persons
 1780  participating in the preparation of a Medicaid claim shall not
 1781  be based on amounts for which they bill nor based on the amount
 1782  a provider receives from the Medicaid program.
 1783         (11) The agency shall deny payment or require repayment for
 1784  inappropriate, medically unnecessary, or excessive goods or
 1785  services from the person furnishing them, the person under whose
 1786  supervision they were furnished, or the person causing them to
 1787  be furnished.
 1788         (12) The complaint and all information obtained pursuant to
 1789  an investigation of a Medicaid provider, or the authorized
 1790  representative or agent of a provider, relating to an allegation
 1791  of fraud, abuse, or neglect are confidential and exempt from the
 1792  provisions of s. 119.07(1):
 1793         (a) Until the agency takes final agency action with respect
 1794  to the provider and requires repayment of any overpayment, or
 1795  imposes an administrative sanction;
 1796         (b) Until the Attorney General refers the case for criminal
 1797  prosecution;
 1798         (c) Until 10 days after the complaint is determined without
 1799  merit; or
 1800         (d) At all times if the complaint or information is
 1801  otherwise protected by law.
 1802         (13) The agency shall terminate participation of a Medicaid
 1803  provider in the Medicaid program and may seek civil remedies or
 1804  impose other administrative sanctions against a Medicaid
 1805  provider, if the provider or any principal, officer, director,
 1806  agent, managing employee, or affiliated person of the provider,
 1807  or any partner or shareholder having an ownership interest in
 1808  the provider equal to 5 percent or greater, has been convicted
 1809  of a criminal offense under federal law or the law of any state
 1810  relating to the practice of the provider’s profession, or a
 1811  criminal offense listed under s. 408.809(4), s. 409.907(10), or
 1812  s. 435.04(2). If the agency determines that the provider did not
 1813  participate or acquiesce in the offense, termination will not be
 1814  imposed. If the agency effects a termination under this
 1815  subsection, the agency shall take final agency action.
 1816         (14) If the provider has been suspended or terminated from
 1817  participation in the Medicaid program or the Medicare program by
 1818  the Federal Government or any state, the agency must immediately
 1819  suspend or terminate, as appropriate, the provider’s
 1820  participation in this state’s Medicaid program for a period no
 1821  less than that imposed by the Federal Government or any other
 1822  state, and may not enroll such provider in this state’s Medicaid
 1823  program while such foreign suspension or termination remains in
 1824  effect. The agency shall also immediately suspend or terminate,
 1825  as appropriate, a provider’s participation in this state’s
 1826  Medicaid program if the provider participated or acquiesced in
 1827  any action for which any principal, officer, director, agent,
 1828  managing employee, or affiliated person of the provider, or any
 1829  partner or shareholder having an ownership interest in the
 1830  provider equal to 5 percent or greater, was suspended or
 1831  terminated from participating in the Medicaid program or the
 1832  Medicare program by the Federal Government or any state. This
 1833  sanction is in addition to all other remedies provided by law.
 1834         (15) The agency shall seek a remedy provided by law,
 1835  including, but not limited to, any remedy provided in
 1836  subsections (13) and (16) and s. 812.035, if:
 1837         (a) The provider’s license has not been renewed, or has
 1838  been revoked, suspended, or terminated, for cause, by the
 1839  licensing agency of any state;
 1840         (b) The provider has failed to make available or has
 1841  refused access to Medicaid-related records to an auditor,
 1842  investigator, or other authorized employee or agent of the
 1843  agency, the Attorney General, a state attorney, or the Federal
 1844  Government;
 1845         (c) The provider has not furnished or has failed to make
 1846  available such Medicaid-related records as the agency has found
 1847  necessary to determine whether Medicaid payments are or were due
 1848  and the amounts thereof;
 1849         (d) The provider has failed to maintain medical records
 1850  made at the time of service, or prior to service if prior
 1851  authorization is required, demonstrating the necessity and
 1852  appropriateness of the goods or services rendered;
 1853         (e) The provider is not in compliance with provisions of
 1854  Medicaid provider publications that have been adopted by
 1855  reference as rules in the Florida Administrative Code; with
 1856  provisions of state or federal laws, rules, or regulations; with
 1857  provisions of the provider agreement between the agency and the
 1858  provider; or with certifications found on claim forms or on
 1859  transmittal forms for electronically submitted claims that are
 1860  submitted by the provider or authorized representative, as such
 1861  provisions apply to the Medicaid program;
 1862         (f) The provider or person who ordered, authorized, or
 1863  prescribed the care, services, or supplies has furnished, or
 1864  ordered or authorized the furnishing of, goods or services to a
 1865  recipient which are inappropriate, unnecessary, excessive, or
 1866  harmful to the recipient or are of inferior quality;
 1867         (g) The provider has demonstrated a pattern of failure to
 1868  provide goods or services that are medically necessary;
 1869         (h) The provider or an authorized representative of the
 1870  provider, or a person who ordered, authorized, or prescribed the
 1871  goods or services, has submitted or caused to be submitted false
 1872  or a pattern of erroneous Medicaid claims;
 1873         (i) The provider or an authorized representative of the
 1874  provider, or a person who has ordered, authorized, or prescribed
 1875  the goods or services, has submitted or caused to be submitted a
 1876  Medicaid provider enrollment application, a request for prior
 1877  authorization for Medicaid services, a drug exception request,
 1878  or a Medicaid cost report that contains materially false or
 1879  incorrect information;
 1880         (j) The provider or an authorized representative of the
 1881  provider has collected from or billed a recipient or a
 1882  recipient’s responsible party improperly for amounts that should
 1883  not have been so collected or billed by reason of the provider’s
 1884  billing the Medicaid program for the same service;
 1885         (k) The provider or an authorized representative of the
 1886  provider has included in a cost report costs that are not
 1887  allowable under a Florida Title XIX reimbursement plan after the
 1888  provider or authorized representative had been advised in an
 1889  audit exit conference or audit report that the costs were not
 1890  allowable;
 1891         (l) The provider is charged by information or indictment
 1892  with fraudulent billing practices or an offense referenced in
 1893  subsection (13). The sanction applied for this reason is limited
 1894  to suspension of the provider’s participation in the Medicaid
 1895  program for the duration of the indictment unless the provider
 1896  is found guilty pursuant to the information or indictment;
 1897         (m) The provider or a person who ordered, authorized, or
 1898  prescribed the goods or services is found liable for negligent
 1899  practice resulting in death or injury to the provider’s patient;
 1900         (n) The provider fails to demonstrate that it had available
 1901  during a specific audit or review period sufficient quantities
 1902  of goods, or sufficient time in the case of services, to support
 1903  the provider’s billings to the Medicaid program;
 1904         (o) The provider has failed to comply with the notice and
 1905  reporting requirements of s. 409.907;
 1906         (p) The agency has received reliable information of patient
 1907  abuse or neglect or of any act prohibited by s. 409.920; or
 1908         (q) The provider has failed to comply with an agreed-upon
 1909  repayment schedule.
 1910  
 1911  A provider is subject to sanctions for violations of this
 1912  subsection as the result of actions or inactions of the
 1913  provider, or actions or inactions of any principal, officer,
 1914  director, agent, managing employee, or affiliated person of the
 1915  provider, or any partner or shareholder having an ownership
 1916  interest in the provider equal to 5 percent or greater, in which
 1917  the provider participated or acquiesced.
 1918         (16) The agency shall impose any of the following sanctions
 1919  or disincentives on a provider or a person for any of the acts
 1920  described in subsection (15):
 1921         (a) Suspension for a specific period of time of not more
 1922  than 1 year. Suspension precludes participation in the Medicaid
 1923  program, which includes any action that results in a claim for
 1924  payment to the Medicaid program for furnishing, supervising a
 1925  person who is furnishing, or causing a person to furnish goods
 1926  or services.
 1927         (b) Termination for a specific period of time ranging from
 1928  more than 1 year to 20 years. Termination precludes
 1929  participation in the Medicaid program, which includes any action
 1930  that results in a claim for payment to the Medicaid program for
 1931  furnishing, supervising a person who is furnishing, or causing a
 1932  person to furnish goods or services.
 1933         (c) Imposition of a fine of up to $5,000 for each
 1934  violation. Each day that an ongoing violation continues, such as
 1935  refusing to furnish Medicaid-related records or refusing access
 1936  to records, is considered a separate violation. Each instance of
 1937  improper billing of a Medicaid recipient; each instance of
 1938  including an unallowable cost on a hospital or nursing home
 1939  Medicaid cost report after the provider or authorized
 1940  representative has been advised in an audit exit conference or
 1941  previous audit report of the cost unallowability; each instance
 1942  of furnishing a Medicaid recipient goods or professional
 1943  services that are inappropriate or of inferior quality as
 1944  determined by competent peer judgment; each instance of
 1945  knowingly submitting a materially false or erroneous Medicaid
 1946  provider enrollment application, request for prior authorization
 1947  for Medicaid services, drug exception request, or cost report;
 1948  each instance of inappropriate prescribing of drugs for a
 1949  Medicaid recipient as determined by competent peer judgment; and
 1950  each false or erroneous Medicaid claim leading to an overpayment
 1951  to a provider is considered a separate violation.
 1952         (d) Immediate suspension, if the agency has received
 1953  information of patient abuse or neglect or of any act prohibited
 1954  by s. 409.920. Upon suspension, the agency must issue an
 1955  immediate final order under s. 120.569(2)(n).
 1956         (e) A fine, not to exceed $10,000, for a violation of
 1957  paragraph (15)(i).
 1958         (f) Imposition of liens against provider assets, including,
 1959  but not limited to, financial assets and real property, not to
 1960  exceed the amount of fines or recoveries sought, upon entry of
 1961  an order determining that such moneys are due or recoverable.
 1962         (g) Prepayment reviews of claims for a specified period of
 1963  time.
 1964         (h) Comprehensive followup reviews of providers every 6
 1965  months to ensure that they are billing Medicaid correctly.
 1966         (i) Corrective-action plans that remain in effect for up to
 1967  3 years and that are monitored by the agency every 6 months
 1968  while in effect.
 1969         (j) Other remedies as permitted by law to effect the
 1970  recovery of a fine or overpayment.
 1971  
 1972  If a provider voluntarily relinquishes its Medicaid provider
 1973  number or an associated license, or allows the associated
 1974  licensure to expire after receiving written notice that the
 1975  agency is conducting, or has conducted, an audit, survey,
 1976  inspection, or investigation and that a sanction of suspension
 1977  or termination will or would be imposed for noncompliance
 1978  discovered as a result of the audit, survey, inspection, or
 1979  investigation, the agency shall impose the sanction of
 1980  termination for cause against the provider. The agency’s
 1981  termination with cause is subject to hearing rights as may be
 1982  provided under chapter 120. The Secretary of Health Care
 1983  Administration may make a determination that imposition of a
 1984  sanction or disincentive is not in the best interest of the
 1985  Medicaid program, in which case a sanction or disincentive may
 1986  not be imposed.
 1987         (17) In determining the appropriate administrative sanction
 1988  to be applied, or the duration of any suspension or termination,
 1989  the agency shall consider:
 1990         (a) The seriousness and extent of the violation or
 1991  violations.
 1992         (b) Any prior history of violations by the provider
 1993  relating to the delivery of health care programs which resulted
 1994  in either a criminal conviction or in administrative sanction or
 1995  penalty.
 1996         (c) Evidence of continued violation within the provider’s
 1997  management control of Medicaid statutes, rules, regulations, or
 1998  policies after written notification to the provider of improper
 1999  practice or instance of violation.
 2000         (d) The effect, if any, on the quality of medical care
 2001  provided to Medicaid recipients as a result of the acts of the
 2002  provider.
 2003         (e) Any action by a licensing agency respecting the
 2004  provider in any state in which the provider operates or has
 2005  operated.
 2006         (f) The apparent impact on access by recipients to Medicaid
 2007  services if the provider is suspended or terminated, in the best
 2008  judgment of the agency.
 2009  
 2010  The agency shall document the basis for all sanctioning actions
 2011  and recommendations.
 2012         (18) The agency may take action to sanction, suspend, or
 2013  terminate a particular provider working for a group provider,
 2014  and may suspend or terminate Medicaid participation at a
 2015  specific location, rather than or in addition to taking action
 2016  against an entire group.
 2017         (19) The agency shall establish a process for conducting
 2018  followup reviews of a sampling of providers who have a history
 2019  of overpayment under the Medicaid program. This process must
 2020  consider the magnitude of previous fraud or abuse and the
 2021  potential effect of continued fraud or abuse on Medicaid costs.
 2022         (20) In making a determination of overpayment to a
 2023  provider, the agency must use accepted and valid auditing,
 2024  accounting, analytical, statistical, or peer-review methods, or
 2025  combinations thereof. Appropriate statistical methods may
 2026  include, but are not limited to, sampling and extension to the
 2027  population, parametric and nonparametric statistics, tests of
 2028  hypotheses, and other generally accepted statistical methods.
 2029  Appropriate analytical methods may include, but are not limited
 2030  to, reviews to determine variances between the quantities of
 2031  products that a provider had on hand and available to be
 2032  purveyed to Medicaid recipients during the review period and the
 2033  quantities of the same products paid for by the Medicaid program
 2034  for the same period, taking into appropriate consideration sales
 2035  of the same products to non-Medicaid customers during the same
 2036  period. In meeting its burden of proof in any administrative or
 2037  court proceeding, the agency may introduce the results of such
 2038  statistical methods as evidence of overpayment.
 2039         (21) When making a determination that an overpayment has
 2040  occurred, the agency shall prepare and issue an audit report to
 2041  the provider showing the calculation of overpayments. The
 2042  agency’s determination must be based solely upon information
 2043  available to it before issuance of the audit report and, in the
 2044  case of documentation obtained to substantiate claims for
 2045  Medicaid reimbursement, based solely upon contemporaneous
 2046  records. The agency may consider addenda or modifications to a
 2047  note that was made contemporaneously with the patient care
 2048  episode if the addenda or modifications are germane to the note.
 2049         (22) The audit report, supported by agency work papers,
 2050  showing an overpayment to a provider constitutes evidence of the
 2051  overpayment. A provider may not present or elicit testimony on
 2052  direct examination or cross-examination in any court or
 2053  administrative proceeding, regarding the purchase or acquisition
 2054  by any means of drugs, goods, or supplies; sales or divestment
 2055  by any means of drugs, goods, or supplies; or inventory of
 2056  drugs, goods, or supplies, unless such acquisition, sales,
 2057  divestment, or inventory is documented by written invoices,
 2058  written inventory records, or other competent written
 2059  documentary evidence maintained in the normal course of the
 2060  provider’s business. A provider may not present records to
 2061  contest an overpayment or sanction unless such records are
 2062  contemporaneous and, if requested during the audit process, were
 2063  furnished to the agency or its agent upon request. This
 2064  limitation does not apply to Medicaid cost report audits. This
 2065  limitation does not preclude consideration by the agency of
 2066  addenda or modifications to a note if the addenda or
 2067  modifications are made before notification of the audit, the
 2068  addenda or modifications are germane to the note, and the note
 2069  was made contemporaneously with a patient care episode.
 2070  Notwithstanding the applicable rules of discovery, all
 2071  documentation to be offered as evidence at an administrative
 2072  hearing on a Medicaid overpayment or an administrative sanction
 2073  must be exchanged by all parties at least 14 days before the
 2074  administrative hearing or be excluded from consideration.
 2075         (23)(a) In an audit, or investigation, or enforcement
 2076  action taken for of a violation committed by a provider which is
 2077  conducted pursuant to this section, the agency is entitled to
 2078  recover all investigative and, legal costs incurred as a result
 2079  of such audit, investigation, or enforcement action. The costs
 2080  associated with an investigation, audit, or enforcement action
 2081  may include, but are not limited to, salaries and benefits of
 2082  personnel, costs related to the time spent by an attorney and
 2083  other personnel working on the case, and any other expenses
 2084  incurred by the agency or contractor which are associated with
 2085  the case, including any, and expert witness costs and attorney
 2086  fees incurred on behalf of the agency or contractor if the
 2087  agency’s findings were not contested by the provider or, if
 2088  contested, the agency ultimately prevailed.
 2089         (b) The agency has the burden of documenting the costs,
 2090  which include salaries and employee benefits and out-of-pocket
 2091  expenses. The amount of costs that may be recovered must be
 2092  reasonable in relation to the seriousness of the violation and
 2093  must be set taking into consideration the financial resources,
 2094  earning ability, and needs of the provider, who has the burden
 2095  of demonstrating such factors.
 2096         (c) The provider may pay the costs over a period to be
 2097  determined by the agency if the agency determines that an
 2098  extreme hardship would result to the provider from immediate
 2099  full payment. Any default in payment of costs may be collected
 2100  by any means authorized by law.
 2101         (24) If the agency imposes an administrative sanction
 2102  pursuant to subsection (13), subsection (14), or subsection
 2103  (15), except paragraphs (15)(e) and (o), upon any provider or
 2104  any principal, officer, director, agent, managing employee, or
 2105  affiliated person of the provider who is regulated by another
 2106  state entity, the agency shall notify that other entity of the
 2107  imposition of the sanction within 5 business days. Such
 2108  notification must include the provider’s or person’s name and
 2109  license number and the specific reasons for sanction.
 2110         (25)(a) The agency shall withhold Medicaid payments, in
 2111  whole or in part, to a provider upon receipt of reliable
 2112  evidence that the circumstances giving rise to the need for a
 2113  withholding of payments involve fraud, willful
 2114  misrepresentation, or abuse under the Medicaid program, or a
 2115  crime committed while rendering goods or services to Medicaid
 2116  recipients. If it is determined that fraud, willful
 2117  misrepresentation, abuse, or a crime did not occur, the payments
 2118  withheld must be paid to the provider within 14 days after such
 2119  determination. Amounts not paid within 14 days accrue interest
 2120  at the rate of 10 percent per year, beginning after the 14th
 2121  day.
 2122         (b) The agency shall deny payment, or require repayment, if
 2123  the goods or services were furnished, supervised, or caused to
 2124  be furnished by a person who has been suspended or terminated
 2125  from the Medicaid program or Medicare program by the Federal
 2126  Government or any state.
 2127         (c) Overpayments owed to the agency bear interest at the
 2128  rate of 10 percent per year from the date of final determination
 2129  of the overpayment by the agency, and payment arrangements must
 2130  be made within 30 days after the date of the final order, which
 2131  is not subject to further appeal.
 2132         (d) The agency, upon entry of a final agency order, a
 2133  judgment or order of a court of competent jurisdiction, or a
 2134  stipulation or settlement, may collect the moneys owed by all
 2135  means allowable by law, including, but not limited to, notifying
 2136  any fiscal intermediary of Medicare benefits that the state has
 2137  a superior right of payment. Upon receipt of such written
 2138  notification, the Medicare fiscal intermediary shall remit to
 2139  the state the sum claimed.
 2140         (e) The agency may institute amnesty programs to allow
 2141  Medicaid providers the opportunity to voluntarily repay
 2142  overpayments. The agency may adopt rules to administer such
 2143  programs.
 2144         (26) The agency may impose administrative sanctions against
 2145  a Medicaid recipient, or the agency may seek any other remedy
 2146  provided by law, including, but not limited to, the remedies
 2147  provided in s. 812.035, if the agency finds that a recipient has
 2148  engaged in solicitation in violation of s. 409.920 or that the
 2149  recipient has otherwise abused the Medicaid program.
 2150         (27) When the Agency for Health Care Administration has
 2151  made a probable cause determination and alleged that an
 2152  overpayment to a Medicaid provider has occurred, the agency,
 2153  after notice to the provider, shall:
 2154         (a) Withhold, and continue to withhold during the pendency
 2155  of an administrative hearing pursuant to chapter 120, any
 2156  medical assistance reimbursement payments until such time as the
 2157  overpayment is recovered, unless within 30 days after receiving
 2158  notice thereof the provider:
 2159         1. Makes repayment in full; or
 2160         2. Establishes a repayment plan that is satisfactory to the
 2161  Agency for Health Care Administration.
 2162         (b) Withhold, and continue to withhold during the pendency
 2163  of an administrative hearing pursuant to chapter 120, medical
 2164  assistance reimbursement payments if the terms of a repayment
 2165  plan are not adhered to by the provider.
 2166         (28) Venue for all Medicaid program integrity cases lies in
 2167  Leon County, at the discretion of the agency.
 2168         (29) Notwithstanding other provisions of law, the agency
 2169  and the Medicaid Fraud Control Unit of the Department of Legal
 2170  Affairs may review a provider’s Medicaid-related and non
 2171  Medicaid-related records in order to determine the total output
 2172  of a provider’s practice to reconcile quantities of goods or
 2173  services billed to Medicaid with quantities of goods or services
 2174  used in the provider’s total practice.
 2175         (30) The agency shall terminate a provider’s participation
 2176  in the Medicaid program if the provider fails to reimburse an
 2177  overpayment or pay an agency-imposed fine that has been
 2178  determined by final order, not subject to further appeal, within
 2179  30 days after the date of the final order, unless the provider
 2180  and the agency have entered into a repayment agreement.
 2181         (31) If a provider requests an administrative hearing
 2182  pursuant to chapter 120, such hearing must be conducted within
 2183  90 days following assignment of an administrative law judge,
 2184  absent exceptionally good cause shown as determined by the
 2185  administrative law judge or hearing officer. Upon issuance of a
 2186  final order, the outstanding balance of the amount determined to
 2187  constitute the overpayment and fines is due. If a provider fails
 2188  to make payments in full, fails to enter into a satisfactory
 2189  repayment plan, or fails to comply with the terms of a repayment
 2190  plan or settlement agreement, the agency shall withhold
 2191  reimbursement payments for Medicaid services until the amount
 2192  due is paid in full.
 2193         (32) Duly authorized agents and employees of the agency
 2194  shall have the power to inspect, during normal business hours,
 2195  the records of any pharmacy, wholesale establishment, or
 2196  manufacturer, or any other place in which drugs and medical
 2197  supplies are manufactured, packed, packaged, made, stored, sold,
 2198  or kept for sale, for the purpose of verifying the amount of
 2199  drugs and medical supplies ordered, delivered, or purchased by a
 2200  provider. The agency shall provide at least 2 business days’
 2201  prior notice of any such inspection. The notice must identify
 2202  the provider whose records will be inspected, and the inspection
 2203  shall include only records specifically related to that
 2204  provider.
 2205         (33) In accordance with federal law, Medicaid recipients
 2206  convicted of a crime pursuant to 42 U.S.C. s. 1320a-7b may be
 2207  limited, restricted, or suspended from Medicaid eligibility for
 2208  a period not to exceed 1 year, as determined by the agency head
 2209  or designee.
 2210         (34) To deter fraud and abuse in the Medicaid program, the
 2211  agency may limit the number of Schedule II and Schedule III
 2212  refill prescription claims submitted from a pharmacy provider.
 2213  The agency shall limit the allowable amount of reimbursement of
 2214  prescription refill claims for Schedule II and Schedule III
 2215  pharmaceuticals if the agency or the Medicaid Fraud Control Unit
 2216  determines that the specific prescription refill was not
 2217  requested by the Medicaid recipient or authorized representative
 2218  for whom the refill claim is submitted or was not prescribed by
 2219  the recipient’s medical provider or physician. Any such refill
 2220  request must be consistent with the original prescription.
 2221         (35) The Office of Program Policy Analysis and Government
 2222  Accountability shall provide a report to the President of the
 2223  Senate and the Speaker of the House of Representatives on a
 2224  biennial basis, beginning January 31, 2006, on the agency’s
 2225  efforts to prevent, detect, and deter, as well as recover funds
 2226  lost to, fraud and abuse in the Medicaid program.
 2227         (36) The agency may provide to a sample of Medicaid
 2228  recipients or their representatives through the distribution of
 2229  explanations of benefits information about services reimbursed
 2230  by the Medicaid program for goods and services to such
 2231  recipients, including information on how to report inappropriate
 2232  or incorrect billing to the agency or other law enforcement
 2233  entities for review or investigation, information on how to
 2234  report criminal Medicaid fraud to the Medicaid Fraud Control
 2235  Unit’s toll-free hotline number, and information about the
 2236  rewards available under s. 409.9203. The explanation of benefits
 2237  may not be mailed for Medicaid independent laboratory services
 2238  as described in s. 409.905(7) or for Medicaid certified match
 2239  services as described in ss. 409.9071 and 1011.70.
 2240         (37) The agency shall post on its website a current list of
 2241  each Medicaid provider, including any principal, officer,
 2242  director, agent, managing employee, or affiliated person of the
 2243  provider, or any partner or shareholder having an ownership
 2244  interest in the provider equal to 5 percent or greater, who has
 2245  been terminated for cause from the Medicaid program or
 2246  sanctioned under this section. The list must be searchable by a
 2247  variety of search parameters and provide for the creation of
 2248  formatted lists that may be printed or imported into other
 2249  applications, including spreadsheets. The agency shall update
 2250  the list at least monthly.
 2251         (38) In order to improve the detection of health care
 2252  fraud, use technology to prevent and detect fraud, and maximize
 2253  the electronic exchange of health care fraud information, the
 2254  agency shall:
 2255         (a) Compile, maintain, and publish on its website a
 2256  detailed list of all state and federal databases that contain
 2257  health care fraud information and update the list at least
 2258  biannually;
 2259         (b) Develop a strategic plan to connect all databases that
 2260  contain health care fraud information to facilitate the
 2261  electronic exchange of health information between the agency,
 2262  the Department of Health, the Department of Law Enforcement, and
 2263  the Attorney General’s Office. The plan must include recommended
 2264  standard data formats, fraud identification strategies, and
 2265  specifications for the technical interface between state and
 2266  federal health care fraud databases;
 2267         (c) Monitor innovations in health information technology,
 2268  specifically as it pertains to Medicaid fraud prevention and
 2269  detection; and
 2270         (d) Periodically publish policy briefs that highlight
 2271  available new technology to prevent or detect health care fraud
 2272  and projects implemented by other states, the private sector, or
 2273  the Federal Government which use technology to prevent or detect
 2274  health care fraud.
 2275         Section 43. Paragraph (a) of subsection (2) of section
 2276  409.920, Florida Statutes, is amended to read:
 2277         409.920 Medicaid provider fraud.—
 2278         (2)(a) A person may not:
 2279         1. Knowingly make, cause to be made, or aid and abet in the
 2280  making of any false statement or false representation of a
 2281  material fact, by commission or omission, in any claim submitted
 2282  to the agency or its fiscal agent or a managed care plan for
 2283  payment.
 2284         2. Knowingly make, cause to be made, or aid and abet in the
 2285  making of a claim for items or services that are not authorized
 2286  to be reimbursed by the Medicaid program.
 2287         3. Knowingly charge, solicit, accept, or receive anything
 2288  of value, other than an authorized copayment from a Medicaid
 2289  recipient, from any source in addition to the amount legally
 2290  payable for an item or service provided to a Medicaid recipient
 2291  under the Medicaid program or knowingly fail to credit the
 2292  agency or its fiscal agent for any payment received from a
 2293  third-party source.
 2294         4. Knowingly make or in any way cause to be made any false
 2295  statement or false representation of a material fact, by
 2296  commission or omission, in any document containing items of
 2297  income and expense that is or may be used by the agency to
 2298  determine a general or specific rate of payment for an item or
 2299  service provided by a provider.
 2300         5. Knowingly solicit, offer, pay, or receive any
 2301  remuneration, including any kickback, bribe, or rebate, directly
 2302  or indirectly, overtly or covertly, in cash or in kind, in
 2303  return for referring an individual to a person for the
 2304  furnishing or arranging for the furnishing of any item or
 2305  service for which payment may be made, in whole or in part,
 2306  under the Medicaid program, or in return for obtaining,
 2307  purchasing, leasing, ordering, or arranging for or recommending,
 2308  obtaining, purchasing, leasing, or ordering any goods, facility,
 2309  item, or service, for which payment may be made, in whole or in
 2310  part, under the Medicaid program. This subparagraph does not
 2311  apply to any discount, payment, waiver of payment, or payment
 2312  practice not prohibited by 42 U.S.C. s. 1320a-7b(b) or
 2313  regulations adopted thereunder.
 2314         6. Knowingly submit false or misleading information or
 2315  statements to the Medicaid program for the purpose of being
 2316  accepted as a Medicaid provider.
 2317         7. Knowingly use or endeavor to use a Medicaid provider’s
 2318  identification number or a Medicaid recipient’s identification
 2319  number to make, cause to be made, or aid and abet in the making
 2320  of a claim for items or services that are not authorized to be
 2321  reimbursed by the Medicaid program.
 2322         Section 44. Subsection (1) of section 409.967, Florida
 2323  Statutes, is amended to read:
 2324         409.967 Managed care plan accountability.—
 2325         (1) Beginning with the contract procurement process
 2326  initiated during the 2023 calendar year, the agency shall
 2327  establish a 6-year 5-year contract with each managed care plan
 2328  selected through the procurement process described in s.
 2329  409.966. A plan contract may not be renewed; however, the agency
 2330  may extend the term of a plan contract to cover any delays
 2331  during the transition to a new plan. The agency shall extend
 2332  until December 31, 2024, the term of existing plan contracts
 2333  awarded pursuant to the invitation to negotiate published in
 2334  July 2017.
 2335         Section 45. Paragraph (b) of subsection (5) of section
 2336  409.973, Florida Statutes, is amended to read:
 2337         409.973 Benefits.—
 2338         (5) PROVISION OF DENTAL SERVICES.—
 2339         (b) In the event the Legislature takes no action before
 2340  July 1, 2017, with respect to the report findings required under
 2341  subparagraph (a)2., the agency shall implement a statewide
 2342  Medicaid prepaid dental health program for children and adults
 2343  with a choice of at least two licensed dental managed care
 2344  providers who must have substantial experience in providing
 2345  dental care to Medicaid enrollees and children eligible for
 2346  medical assistance under Title XXI of the Social Security Act
 2347  and who meet all agency standards and requirements. To qualify
 2348  as a provider under the prepaid dental health program, the
 2349  entity must be licensed as a prepaid limited health service
 2350  organization under part I of chapter 636 or as a health
 2351  maintenance organization under part I of chapter 641. The
 2352  contracts for program providers shall be awarded through a
 2353  competitive procurement process. Beginning with the contract
 2354  procurement process initiated during the 2023 calendar year, the
 2355  contracts must be for 6 5 years and may not be renewed; however,
 2356  the agency may extend the term of a plan contract to cover
 2357  delays during a transition to a new plan provider. The agency
 2358  shall include in the contracts a medical loss ratio provision
 2359  consistent with s. 409.967(4). The agency is authorized to seek
 2360  any necessary state plan amendment or federal waiver to commence
 2361  enrollment in the Medicaid prepaid dental health program no
 2362  later than March 1, 2019. The agency shall extend until December
 2363  31, 2024, the term of existing plan contracts awarded pursuant
 2364  to the invitation to negotiate published in October 2017.
 2365         Section 46. Subsection (6) of section 429.11, Florida
 2366  Statutes, is amended to read:
 2367         429.11 Initial application for license; provisional
 2368  license.—
 2369         (6)In addition to the license categories available in s.
 2370  408.808, a provisional license may be issued to an applicant
 2371  making initial application for licensure or making application
 2372  for a change of ownership. A provisional license shall be
 2373  limited in duration to a specific period of time not to exceed 6
 2374  months, as determined by the agency.
 2375         Section 47. Subsection (9) of section 429.19, Florida
 2376  Statutes, is amended to read:
 2377         429.19 Violations; imposition of administrative fines;
 2378  grounds.—
 2379         (9)The agency shall develop and disseminate an annual list
 2380  of all facilities sanctioned or fined for violations of state
 2381  standards, the number and class of violations involved, the
 2382  penalties imposed, and the current status of cases. The list
 2383  shall be disseminated, at no charge, to the Department of
 2384  Elderly Affairs, the Department of Health, the Department of
 2385  Children and Families, the Agency for Persons with Disabilities,
 2386  the area agencies on aging, the Florida Statewide Advocacy
 2387  Council, the State Long-Term Care Ombudsman Program, and state
 2388  and local ombudsman councils. The Department of Children and
 2389  Families shall disseminate the list to service providers under
 2390  contract to the department who are responsible for referring
 2391  persons to a facility for residency. The agency may charge a fee
 2392  commensurate with the cost of printing and postage to other
 2393  interested parties requesting a copy of this list. This
 2394  information may be provided electronically or through the
 2395  agency’s Internet site.
 2396         Section 48. Subsection (2) of section 429.35, Florida
 2397  Statutes, is amended to read:
 2398         429.35 Maintenance of records; reports.—
 2399         (2) Within 60 days after the date of an the biennial
 2400  inspection conducted visit required under s. 408.811 or within
 2401  30 days after the date of an any interim visit, the agency shall
 2402  forward the results of the inspection to the local ombudsman
 2403  council in the district where the facility is located; to at
 2404  least one public library or, in the absence of a public library,
 2405  the county seat in the county in which the inspected assisted
 2406  living facility is located; and, when appropriate, to the
 2407  district Adult Services and Mental Health Program Offices.
 2408         Section 49. Subsection (2) of section 429.905, Florida
 2409  Statutes, is amended to read:
 2410         429.905 Exemptions; monitoring of adult day care center
 2411  programs colocated with assisted living facilities or licensed
 2412  nursing home facilities.—
 2413         (2) A licensed assisted living facility, a licensed
 2414  hospital, or a licensed nursing home facility may provide
 2415  services during the day which include, but are not limited to,
 2416  social, health, therapeutic, recreational, nutritional, and
 2417  respite services, to adults who are not residents. Such a
 2418  facility need not be licensed as an adult day care center;
 2419  however, the agency must monitor the facility during the regular
 2420  inspection and at least biennially to ensure adequate space and
 2421  sufficient staff. If an assisted living facility, a hospital, or
 2422  a nursing home holds itself out to the public as an adult day
 2423  care center, it must be licensed as such and meet all standards
 2424  prescribed by statute and rule. For the purpose of this
 2425  subsection, the term “day” means any portion of a 24-hour day.
 2426         Section 50. Section 429.929, Florida Statutes, is amended
 2427  to read:
 2428         429.929 Rules establishing standards.—
 2429         (1) The agency shall adopt rules to implement this part.
 2430  The rules must include reasonable and fair standards. Any
 2431  conflict between these standards and those that may be set forth
 2432  in local, county, or municipal ordinances shall be resolved in
 2433  favor of those having statewide effect. Such standards must
 2434  relate to:
 2435         (1)(a) The maintenance of adult day care centers with
 2436  respect to plumbing, heating, lighting, ventilation, and other
 2437  building conditions, including adequate meeting space, to ensure
 2438  the health, safety, and comfort of participants and protection
 2439  from fire hazard. Such standards may not conflict with chapter
 2440  553 and must be based upon the size of the structure and the
 2441  number of participants.
 2442         (2)(b) The number and qualifications of all personnel
 2443  employed by adult day care centers who have responsibilities for
 2444  the care of participants.
 2445         (3)(c) All sanitary conditions within adult day care
 2446  centers and their surroundings, including water supply, sewage
 2447  disposal, food handling, and general hygiene, and maintenance of
 2448  sanitary conditions, to ensure the health and comfort of
 2449  participants.
 2450         (4)(d) Basic services provided by adult day care centers.
 2451         (5)(e) Supportive and optional services provided by adult
 2452  day care centers.
 2453         (6)(f) Data and information relative to participants and
 2454  programs of adult day care centers, including, but not limited
 2455  to, the physical and mental capabilities and needs of the
 2456  participants, the availability, frequency, and intensity of
 2457  basic services and of supportive and optional services provided,
 2458  the frequency of participation, the distances traveled by
 2459  participants, the hours of operation, the number of referrals to
 2460  other centers or elsewhere, and the incidence of illness.
 2461         (7)(g) Components of a comprehensive emergency management
 2462  plan, developed in consultation with the Department of Health
 2463  and the Division of Emergency Management.
 2464         (2)Pursuant to this part, s. 408.811, and applicable
 2465  rules, the agency may conduct an abbreviated biennial inspection
 2466  of key quality-of-care standards, in lieu of a full inspection,
 2467  of a center that has a record of good performance. However, the
 2468  agency must conduct a full inspection of a center that has had
 2469  one or more confirmed complaints within the licensure period
 2470  immediately preceding the inspection or which has a serious
 2471  problem identified during the abbreviated inspection. The agency
 2472  shall develop the key quality-of-care standards, taking into
 2473  consideration the comments and recommendations of provider
 2474  groups. These standards shall be included in rules adopted by
 2475  the agency.
 2476         Section 51. Effective January 1, 2021, paragraph (e) of
 2477  subsection (2) and paragraph (e) of subsection (3) of section
 2478  627.6387, Florida Statutes, are amended to read:
 2479         627.6387 Shared savings incentive program.—
 2480         (2) As used in this section, the term:
 2481         (e) “Shoppable health care service” means a lower-cost,
 2482  high-quality nonemergency health care service for which a shared
 2483  savings incentive is available for insureds under a health
 2484  insurer’s shared savings incentive program. Shoppable health
 2485  care services may be provided within or outside this state and
 2486  include, but are not limited to:
 2487         1. Clinical laboratory services.
 2488         2. Infusion therapy.
 2489         3. Inpatient and outpatient surgical procedures.
 2490         4. Obstetrical and gynecological services.
 2491         5. Inpatient and outpatient nonsurgical diagnostic tests
 2492  and procedures.
 2493         6. Physical and occupational therapy services.
 2494         7. Radiology and imaging services.
 2495         8. Prescription drugs.
 2496         9. Services provided through telehealth.
 2497         10. Any additional services published by the Agency for
 2498  Health Care Administration which have the most significant price
 2499  variation pursuant to s. 408.05(3)(l).
 2500         (3) A health insurer may offer a shared savings incentive
 2501  program to provide incentives to an insured when the insured
 2502  obtains a shoppable health care service from the health
 2503  insurer’s shared savings list. An insured may not be required to
 2504  participate in a shared savings incentive program. A health
 2505  insurer that offers a shared savings incentive program must:
 2506         (e) At least quarterly, credit or deposit the shared
 2507  savings incentive amount to the insured’s account as a return or
 2508  reduction in premium, or credit the shared savings incentive
 2509  amount to the insured’s flexible spending account, health
 2510  savings account, or health reimbursement account, or reward the
 2511  insured directly with cash or a cash equivalent such that the
 2512  amount does not constitute income to the insured.
 2513         Section 52. Effective January 1, 2021, paragraph (e) of
 2514  subsection (2) and paragraph (e) of subsection (3) of section
 2515  627.6648, Florida Statutes, are amended to read:
 2516         627.6648 Shared savings incentive program.—
 2517         (2) As used in this section, the term:
 2518         (e) “Shoppable health care service” means a lower-cost,
 2519  high-quality nonemergency health care service for which a shared
 2520  savings incentive is available for insureds under a health
 2521  insurer’s shared savings incentive program. Shoppable health
 2522  care services may be provided within or outside this state and
 2523  include, but are not limited to:
 2524         1. Clinical laboratory services.
 2525         2. Infusion therapy.
 2526         3. Inpatient and outpatient surgical procedures.
 2527         4. Obstetrical and gynecological services.
 2528         5. Inpatient and outpatient nonsurgical diagnostic tests
 2529  and procedures.
 2530         6. Physical and occupational therapy services.
 2531         7. Radiology and imaging services.
 2532         8. Prescription drugs.
 2533         9. Services provided through telehealth.
 2534         10. Any additional services published by the Agency for
 2535  Health Care Administration which have the most significant price
 2536  variation pursuant to s. 408.05(3)(l).
 2537         (3) A health insurer may offer a shared savings incentive
 2538  program to provide incentives to an insured when the insured
 2539  obtains a shoppable health care service from the health
 2540  insurer’s shared savings list. An insured may not be required to
 2541  participate in a shared savings incentive program. A health
 2542  insurer that offers a shared savings incentive program must:
 2543         (e) At least quarterly, credit or deposit the shared
 2544  savings incentive amount to the insured’s account as a return or
 2545  reduction in premium, or credit the shared savings incentive
 2546  amount to the insured’s flexible spending account, health
 2547  savings account, or health reimbursement account, or reward the
 2548  insured directly with cash or a cash equivalent such that the
 2549  amount does not constitute income to the insured.
 2550         Section 53. Effective January 1, 2021, paragraph (e) of
 2551  subsection (2) and paragraph (e) of subsection (3) of section
 2552  641.31076, Florida Statutes, are amended to read:
 2553         641.31076 Shared savings incentive program.—
 2554         (2) As used in this section, the term:
 2555         (e) “Shoppable health care service” means a lower-cost,
 2556  high-quality nonemergency health care service for which a shared
 2557  savings incentive is available for subscribers under a health
 2558  maintenance organization’s shared savings incentive program.
 2559  Shoppable health care services may be provided within or outside
 2560  this state and include, but are not limited to:
 2561         1. Clinical laboratory services.
 2562         2. Infusion therapy.
 2563         3. Inpatient and outpatient surgical procedures.
 2564         4. Obstetrical and gynecological services.
 2565         5. Inpatient and outpatient nonsurgical diagnostic tests
 2566  and procedures.
 2567         6. Physical and occupational therapy services.
 2568         7. Radiology and imaging services.
 2569         8. Prescription drugs.
 2570         9. Services provided through telehealth.
 2571         10. Any additional services published by the Agency for
 2572  Health Care Administration which have the most significant price
 2573  variation pursuant to s. 408.05(3)(l).
 2574         (3) A health maintenance organization may offer a shared
 2575  savings incentive program to provide incentives to a subscriber
 2576  when the subscriber obtains a shoppable health care service from
 2577  the health maintenance organization’s shared savings list. A
 2578  subscriber may not be required to participate in a shared
 2579  savings incentive program. A health maintenance organization
 2580  that offers a shared savings incentive program must:
 2581         (e) At least quarterly, credit or deposit the shared
 2582  savings incentive amount to the subscriber’s account as a return
 2583  or reduction in premium, or credit the shared savings incentive
 2584  amount to the subscriber’s flexible spending account, health
 2585  savings account, or health reimbursement account, or reward the
 2586  subscriber directly with cash or a cash equivalent such that the
 2587  amount does not constitute income to the subscriber.
 2588         Section 54. Part I of chapter 483, Florida Statutes, is
 2589  repealed, and part II and part III of that chapter are
 2590  redesignated as part I and part II, respectively.
 2591         Section 55. Paragraph (g) of subsection (3) of section
 2592  20.43, Florida Statutes, is amended to read:
 2593         20.43 Department of Health.—There is created a Department
 2594  of Health.
 2595         (3) The following divisions of the Department of Health are
 2596  established:
 2597         (g) Division of Medical Quality Assurance, which is
 2598  responsible for the following boards and professions established
 2599  within the division:
 2600         1. The Board of Acupuncture, created under chapter 457.
 2601         2. The Board of Medicine, created under chapter 458.
 2602         3. The Board of Osteopathic Medicine, created under chapter
 2603  459.
 2604         4. The Board of Chiropractic Medicine, created under
 2605  chapter 460.
 2606         5. The Board of Podiatric Medicine, created under chapter
 2607  461.
 2608         6. Naturopathy, as provided under chapter 462.
 2609         7. The Board of Optometry, created under chapter 463.
 2610         8. The Board of Nursing, created under part I of chapter
 2611  464.
 2612         9. Nursing assistants, as provided under part II of chapter
 2613  464.
 2614         10. The Board of Pharmacy, created under chapter 465.
 2615         11. The Board of Dentistry, created under chapter 466.
 2616         12. Midwifery, as provided under chapter 467.
 2617         13. The Board of Speech-Language Pathology and Audiology,
 2618  created under part I of chapter 468.
 2619         14. The Board of Nursing Home Administrators, created under
 2620  part II of chapter 468.
 2621         15. The Board of Occupational Therapy, created under part
 2622  III of chapter 468.
 2623         16. Respiratory therapy, as provided under part V of
 2624  chapter 468.
 2625         17. Dietetics and nutrition practice, as provided under
 2626  part X of chapter 468.
 2627         18. The Board of Athletic Training, created under part XIII
 2628  of chapter 468.
 2629         19. The Board of Orthotists and Prosthetists, created under
 2630  part XIV of chapter 468.
 2631         20. Electrolysis, as provided under chapter 478.
 2632         21. The Board of Massage Therapy, created under chapter
 2633  480.
 2634         22. The Board of Clinical Laboratory Personnel, created
 2635  under part I part II of chapter 483.
 2636         23. Medical physicists, as provided under part II part III
 2637  of chapter 483.
 2638         24. The Board of Opticianry, created under part I of
 2639  chapter 484.
 2640         25. The Board of Hearing Aid Specialists, created under
 2641  part II of chapter 484.
 2642         26. The Board of Physical Therapy Practice, created under
 2643  chapter 486.
 2644         27. The Board of Psychology, created under chapter 490.
 2645         28. School psychologists, as provided under chapter 490.
 2646         29. The Board of Clinical Social Work, Marriage and Family
 2647  Therapy, and Mental Health Counseling, created under chapter
 2648  491.
 2649         30. Emergency medical technicians and paramedics, as
 2650  provided under part III of chapter 401.
 2651         Section 56. Subsection (3) of section 381.0034, Florida
 2652  Statutes, is amended to read:
 2653         381.0034 Requirement for instruction on HIV and AIDS.—
 2654         (3) The department shall require, as a condition of
 2655  granting a license under chapter 467 or part I part II of
 2656  chapter 483, that an applicant making initial application for
 2657  licensure complete an educational course acceptable to the
 2658  department on human immunodeficiency virus and acquired immune
 2659  deficiency syndrome. Upon submission of an affidavit showing
 2660  good cause, an applicant who has not taken a course at the time
 2661  of licensure shall be allowed 6 months to complete this
 2662  requirement.
 2663         Section 57. Subsection (4) of section 456.001, Florida
 2664  Statutes, is amended to read:
 2665         456.001 Definitions.—As used in this chapter, the term:
 2666         (4) “Health care practitioner” means any person licensed
 2667  under chapter 457; chapter 458; chapter 459; chapter 460;
 2668  chapter 461; chapter 462; chapter 463; chapter 464; chapter 465;
 2669  chapter 466; chapter 467; part I, part II, part III, part V,
 2670  part X, part XIII, or part XIV of chapter 468; chapter 478;
 2671  chapter 480; part I or part II part II or part III of chapter
 2672  483; chapter 484; chapter 486; chapter 490; or chapter 491.
 2673         Section 58. Paragraphs (h) and (i) of subsection (2) of
 2674  section 456.057, Florida Statutes, are amended to read:
 2675         456.057 Ownership and control of patient records; report or
 2676  copies of records to be furnished; disclosure of information.—
 2677         (2) As used in this section, the terms “records owner,”
 2678  “health care practitioner,” and “health care practitioner’s
 2679  employer” do not include any of the following persons or
 2680  entities; furthermore, the following persons or entities are not
 2681  authorized to acquire or own medical records, but are authorized
 2682  under the confidentiality and disclosure requirements of this
 2683  section to maintain those documents required by the part or
 2684  chapter under which they are licensed or regulated:
 2685         (h) Clinical laboratory personnel licensed under part I
 2686  part II of chapter 483.
 2687         (i) Medical physicists licensed under part II part III of
 2688  chapter 483.
 2689         Section 59. Paragraph (j) of subsection (1) of section
 2690  456.076, Florida Statutes, is amended to read:
 2691         456.076 Impaired practitioner programs.—
 2692         (1) As used in this section, the term:
 2693         (j) “Practitioner” means a person licensed, registered,
 2694  certified, or regulated by the department under part III of
 2695  chapter 401; chapter 457; chapter 458; chapter 459; chapter 460;
 2696  chapter 461; chapter 462; chapter 463; chapter 464; chapter 465;
 2697  chapter 466; chapter 467; part I, part II, part III, part V,
 2698  part X, part XIII, or part XIV of chapter 468; chapter 478;
 2699  chapter 480; part I or part II part II or part III of chapter
 2700  483; chapter 484; chapter 486; chapter 490; or chapter 491; or
 2701  an applicant for a license, registration, or certification under
 2702  the same laws.
 2703         Section 60. Paragraph (b) of subsection (1) of section
 2704  456.47, Florida Statutes, is amended to read:
 2705         456.47 Use of telehealth to provide services.—
 2706         (1) DEFINITIONS.—As used in this section, the term:
 2707         (b) “Telehealth provider” means any individual who provides
 2708  health care and related services using telehealth and who is
 2709  licensed or certified under s. 393.17; part III of chapter 401;
 2710  chapter 457; chapter 458; chapter 459; chapter 460; chapter 461;
 2711  chapter 463; chapter 464; chapter 465; chapter 466; chapter 467;
 2712  part I, part III, part IV, part V, part X, part XIII, or part
 2713  XIV of chapter 468; chapter 478; chapter 480; part I or part II
 2714  part II or part III of chapter 483; chapter 484; chapter 486;
 2715  chapter 490; or chapter 491; who is licensed under a multistate
 2716  health care licensure compact of which Florida is a member
 2717  state; or who is registered under and complies with subsection
 2718  (4).
 2719         Section 61. Except as otherwise expressly provided in this
 2720  act and except for this section, which shall become effective
 2721  upon this act becoming a law, this act shall take effect July 1,
 2722  2020.

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