Bill Text: FL S1726 | 2020 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Agency for Health Care Administration
Spectrum: Slight Partisan Bill (? 2-1)
Status: (Introduced - Dead) 2020-03-10 - Laid on Table, refer to CS/CS/HB 731 [S1726 Detail]
Download: Florida-2020-S1726-Introduced.html
Bill Title: Agency for Health Care Administration
Spectrum: Slight Partisan Bill (? 2-1)
Status: (Introduced - Dead) 2020-03-10 - Laid on Table, refer to CS/CS/HB 731 [S1726 Detail]
Download: Florida-2020-S1726-Introduced.html
Florida Senate - 2020 SB 1726 By Senator Bean 4-00874E-20 20201726__ 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; removing a requirement that a certain 6 report be submitted annually to the agency; 7 authorizing the agency to prescribe by rule the 8 frequency at which such report is submitted; amending 9 s. 395.003, F.S.; removing a requirement that 10 specified information be listed on licenses for 11 certain facilities; repealing s. 395.7015, F.S., 12 relating to an annual assessment on health care 13 entities; amending s. 395.7016, F.S.; conforming a 14 provision to changes made by the act; amending s. 15 400.19, F.S.; revising provisions requiring the agency 16 to conduct licensure inspections of nursing homes; 17 requiring the agency to conduct additional licensure 18 surveys under certain circumstances; requiring the 19 agency to assess a specified fine for such surveys; 20 amending s. 400.462, F.S.; revising definitions; 21 amending s. 400.464, F.S.; revising licensure 22 requirements for home health agencies; amending s. 23 400.471, F.S.; revising provisions related to certain 24 application requirements for home health agencies; 25 amending s. 400.492, F.S.; revising provisions related 26 to services provided by home health agencies during an 27 emergency; amending s. 400.506, F.S.; revising 28 provisions related to licensure requirements for nurse 29 registries; amending s. 400.509, F.S.; revising 30 provisions related to the registration of certain 31 service providers; amending s. 400.605, F.S.; removing 32 a requirement that the agency conduct specified 33 inspections of certain licensees; amending s. 34 400.60501, F.S.; deleting an obsolete date; removing a 35 requirement that the agency develop a specified annual 36 report; amending s. 400.9905, F.S.; revising the 37 definition of the term “clinic”; amending s. 400.991, 38 F.S.; removing the option for health care clinics to 39 file a surety bond under certain circumstances; 40 amending s. 400.9935, F.S.; removing a requirement 41 that certain directors conduct specified reviews; 42 requiring certain clinics to publish and post a 43 schedule of charges; amending s. 408.033, F.S.; 44 conforming a provision to changes made by the act; 45 amending s. 408.061, F.S.; revising provisions 46 requiring health care facilities to submit specified 47 data to the agency; amending s. 408.0611, F.S.; 48 removing the requirement that the agency annually 49 report to the Governor and the Legislature by a 50 specified date on the progress of implementation of 51 electronic prescribing; amending s. 408.062, F.S.; 52 removing requirements that the agency annually report 53 specified information to the Governor and Legislature 54 by a specified date and, instead, requiring the agency 55 to annually publish such information on its website; 56 amending s. 408.063, F.S.; removing a requirement that 57 the agency publish certain annual reports; amending s. 58 408.803, F.S.; conforming a definition to changes made 59 by the act; defining the term “low-risk provider”; 60 amending ss. 408.802, 408.820, 408.831, and 408.832, 61 F.S.; conforming provisions to changes made by the 62 act; amending s. 408.806, F.S.; exempting certain 63 providers from a specified inspection; amending s. 64 408.808, F.S.; authorizing the issuance of a 65 provisional license to certain applicants; amending 66 ss. 408.809 and 409.907, F.S.; revising background 67 screening requirements for certain licensees and 68 providers; amending s. 408.811, F.S.; authorizing the 69 agency to grant certain providers an exemption from a 70 specified inspection under certain circumstances; 71 authorizing the agency to adopt rules to grant waivers 72 of certain inspections and extended inspection periods 73 under certain circumstances; amending s. 408.821, 74 F.S.; revising provisions requiring licensees to have 75 a specified plan; providing requirements for the 76 submission of such plan; amending s. 408.909, F.S.; 77 removing a requirement that the agency and Office of 78 Insurance Regulation evaluate a specified program; 79 amending s. 408.9091, F.S.; requiring the agency and 80 office to each, instead of jointly, submit a specified 81 annual report to the Governor and Legislature; 82 amending s. 409.905, F.S.; deleting the requirement 83 that the agency discontinue its hospital retrospective 84 review program under certain circumstances; amending 85 s. 409.913, F.S.; revising the due date for a certain 86 annual report; deleting the requirement that certain 87 agencies submit their annual reports jointly; amending 88 s. 429.11, F.S.; removing an authorization for the 89 issuance of a provisional license to certain 90 facilities; amending s. 429.19, F.S.; removing 91 requirements that the agency develop and disseminate a 92 specified list and the Department of Children and 93 Families disseminate such list to certain providers; 94 amending ss. 429.35, 429.905, and 429.929, F.S.; 95 revising provisions requiring a biennial inspection 96 cycle for specified facilities and centers, 97 respectively; repealing part I of ch. 483, F.S., 98 relating to the Florida Multiphasic Health Testing 99 Center Law; redesignating parts II and III of ch. 483, 100 F.S., as parts I and II, respectively; amending ss. 101 20.43, 381.0034, 456.001, 456.057, 456.076, and 102 456.47, F.S.; conforming cross-references; providing 103 an effective date. 104 105 Be It Enacted by the Legislature of the State of Florida: 106 107 Section 1. Subsections (2) and (4) of section 383.327, 108 Florida Statutes, are amended to read: 109 383.327 Birth and death records; reports.— 110 (2) Each maternal death, newborn death, and stillbirth 111 shall be reported immediately to the medical examiner and the 112 agency. 113 (4) A report shall be submittedannuallyto the agency. The 114 contents of the report and the frequency with which it is 115 submitted shall be prescribed by rule of the agency. 116 Section 2. Subsection (4) of section 395.003, Florida 117 Statutes, is amended to read: 118 395.003 Licensure; denial, suspension, and revocation.— 119 (4) The agency shall issue a license thatwhichspecifies 120 the service categories and the number of hospital beds in each 121 bed category for which a license is received. Such information 122 shall be listed on the face of the license.All beds which are123not covered by any specialty-bed-need methodology shall be124specified as general beds.A licensed facility shall not operate 125 a number of hospital beds greater than the number indicated by 126 the agency on the face of the license without approval from the 127 agency under conditions established by rule. 128 Section 3. Section 395.7015, Florida Statutes, is repealed. 129 Section 4. Section 395.7016, Florida Statutes, is amended 130 to read: 131 395.7016 Annual appropriation.—The Legislature shall 132 appropriate each fiscal year from either the General Revenue 133 Fund or the Agency for Health Care Administration Tobacco 134 Settlement Trust Fund an amount sufficient to replace the funds 135 lost due toreduction by chapter 2000-256, Laws of Florida, of136the assessment on other health care entities under s. 395.7015,137andthe reduction by chapter 2000-256, Laws of Florida, in the 138 assessment on hospitals under s. 395.701,and to maintain 139 federal approval of the reduced amount of funds deposited into 140 the Public Medical Assistance Trust Fund under s. 395.701,as 141 state match for the state’s Medicaid program. 142 Section 5. Subsection (3) of section 400.19, Florida 143 Statutes, is amended to read: 144 400.19 Right of entry and inspection.— 145 (3) The agency shall conduct periodic,every 15 months146conduct at least oneunannounced licensure inspections 147inspectionto determine compliance by the licensee with 148 statutes, and with rules adoptedpromulgatedunderthe149provisions ofthose statutes, governing minimum standards of 150 construction, quality and adequacy of care, and rights of 151 residents.The survey shall be conducted every 6 months for the152next 2-year periodIf the facility has been cited for a class I 153 deficiency or,has been cited for two or more class II 154 deficienciesarising from separate surveys or investigations155 within a 60-day period, the agency shall conduct an additional 156 licensure surveyor has had three or more substantiated157complaints within a 6-month period, each resulting in at least158one class I or class II deficiency. In addition to any other 159 fees or fines in this part, the agency shall assess a fine for 160 each facility that is subject to the additional licensure survey 1616-month survey cycle. The fine for the additional licensure 162 survey is $3,0002-year periodshall be$6,000, one-half to be163paid at the completion of each survey. The agency may adjust 164 suchthisfine by the change in the Consumer Price Index, based 165 on the 12 months immediately preceding the increase, to cover 166 the cost of the additional surveys. The agency shall verify 167 through subsequent inspection that any deficiency identified 168 during inspection is corrected. However, the agency may verify 169 the correction of a class III or class IV deficiency unrelated 170 to resident rights or resident care without reinspecting the 171 facility if adequate written documentation has been received 172 from the facility, which provides assurance that the deficiency 173 has been corrected. The giving or causing to be given of advance 174 notice of such unannounced inspections by an employee of the 175 agency to any unauthorized person shall constitute cause for 176 suspension of not fewer than 5 working days according tothe177provisions ofchapter 110. 178 Section 6. Subsections (12), (14), (17), (21), and (22) of 179 section 400.462, Florida Statutes, are amended to read: 180 400.462 Definitions.—As used in this part, the term: 181 (12) “Home health agency” means a person or an entityan182organizationthat provides one or more home health servicesand183staffing services. 184 (14) “Home health services” means health and medical 185 services and medical supplies furnishedby an organizationto an 186 individual in the individual’s home or place of residence. The 187 term includesorganizations that provide one or more ofthe 188 following: 189 (a) Nursing care. 190 (b) Physical, occupational, respiratory, or speech therapy. 191 (c) Home health aide services. 192 (d) Dietetics and nutrition practice and nutrition 193 counseling. 194 (e) Medical supplies, restricted to drugs and biologicals 195 prescribed by a physician. 196 (17) “Home infusion therapy provider” means a person or an 197 entityan organizationthat employs, contracts with, or refers a 198 licensed professional who has received advanced training and 199 experience in intravenous infusion therapy and who administers 200 infusion therapy to a patient in the patient’s home or place of 201 residence. 202 (21) “Nurse registry” means any person or entity that 203 procures, offers, promises, or attempts to secure health-care 204 related contracts for registered nurses, licensed practical 205 nurses, certified nursing assistants, home health aides, 206 companions, or homemakers, who are compensated by fees as 207 independent contractors, including, but not limited to, 208 contracts for the provision of services to patients and 209 contracts to provide private duty or staffing services to health 210 care facilities licensed under chapter 395, this chapter, or 211 chapter 429 or other business entities. 212(22)“Organization” means a corporation, government or213governmental subdivision or agency, partnership or association,214or any other legal or commercial entity, any of which involve215more than one health care professional discipline; a health care216professional and a home health aide or certified nursing217assistant; more than one home health aide; more than one218certified nursing assistant; or a home health aide and a219certified nursing assistant. The term does not include an entity220that provides services using only volunteers or only individuals221related by blood or marriage to the patient or client.222 Section 7. Subsections (1), (4), and (5) of section 223 400.464, Florida Statutes, are amended to read: 224 400.464 Home health agencies to be licensed; expiration of 225 license; exemptions; unlawful acts; penalties.— 226 (1) The requirements of part II of chapter 408 apply to the 227 provision of services that require licensure pursuant to this 228 part and part II of chapter 408 and entities licensed or 229 registered by or applying for such licensure or registration 230 from the Agency for Health Care Administration pursuant to this 231 part. A license issued by the agency is required in order to 232 operate a home health agency in this state. A license issued on 233 or after July 1, 2018, must specify the home health services the 234 licenseeorganizationis authorized to perform and indicate 235 whether such specified services are considered skilled care. The 236 provision or advertising of services that require licensure 237 pursuant to this part without such services being specified on 238 the face of the license issued on or after July 1, 2018, 239 constitutes unlicensed activity as prohibited under s. 408.812. 240 (4)(a) A licenseeAn organizationthat offers or advertises 241 to the public any service for which licensure or registration is 242 required under this part must include in the advertisement the 243 license number or registration number issued to the licensee 244organizationby the agency. The agency shall assess a fine of 245 not less than $100 to any licensee or registrant who fails to 246 include the license or registration number when submitting the 247 advertisement for publication, broadcast, or printing. The fine 248 for a second or subsequent offense is $500. The holder of a 249 license issued under this part may not advertise or indicate to 250 the public that it holds a home health agency or nurse registry 251 license other than the one it has been issued. 252 (b) The operation or maintenance of an unlicensed home 253 health agency or the performance of any home health services in 254 violation of this part is declared a nuisance, inimical to the 255 public health, welfare, and safety. The agency or any state 256 attorney may, in addition to other remedies provided in this 257 part, bring an action for an injunction to restrain such 258 violation, or to enjoin the future operation or maintenance of 259 the home health agency or the provision of home health services 260 in violation of this part or part II of chapter 408, until 261 compliance with this part or the rules adopted under this part 262 has been demonstrated to the satisfaction of the agency. 263 (c) A person or entity thatwhoviolates paragraph (a) is 264 subject to an injunctive proceeding under s. 408.816. A 265 violation of paragraph (a) or s. 408.812 is a deceptive and 266 unfair trade practice and constitutes a violation of the Florida 267 Deceptive and Unfair Trade Practices Act under part II of 268 chapter 501. 269 (d) A person or entity thatwhoviolatesthe provisions of270 paragraph (a) commits a misdemeanor of the second degree, 271 punishable as provided in s. 775.082 or s. 775.083. Any person 272 or entity thatwhocommits a second or subsequent violation 273 commits a misdemeanor of the first degree, punishable as 274 provided in s. 775.082 or s. 775.083. Each day of continuing 275 violation constitutes a separate offense. 276 (e) Any person or entity thatwhoowns, operates, or 277 maintains an unlicensed home health agency and who, after 278 receiving notification from the agency, fails to cease operation 279 and apply for a license under this part commits a misdemeanor of 280 the second degree, punishable as provided in s. 775.082 or s. 281 775.083. Each day of continued operation is a separate offense. 282 (f) Any home health agency that fails to cease operation 283 after agency notification may be fined in accordance with s. 284 408.812. 285 (5) The following are exempt fromthelicensure as a home 286 health agency underrequirements ofthis part: 287 (a) A home health agency operated by the Federal 288 Government. 289 (b) Home health services provided by a state agency, either 290 directly or through a contractor with: 291 1. The Department of Elderly Affairs. 292 2. The Department of Health, a community health center, or 293 a rural health network that furnishes home visits for the 294 purpose of providing environmental assessments, case management, 295 health education, personal care services, family planning, or 296 followup treatment, or for the purpose of monitoring and 297 tracking disease. 298 3. Services provided to persons with developmental 299 disabilities, as defined in s. 393.063. 300 4. Companion and sitter organizations that were registered 301 under s. 400.509(1) on January 1, 1999, and were authorized to 302 provide personal services under a developmental services 303 provider certificate on January 1, 1999, may continue to provide 304 such services to past, present, and future clients of the 305 organization who need such services, notwithstanding the 306 provisions of this act. 307 5. The Department of Children and Families. 308 (c) A health care professional, whether or not 309 incorporated, who is licensed under chapter 457; chapter 458; 310 chapter 459; part I of chapter 464; chapter 467; part I, part 311 III, part V, or part X of chapter 468; chapter 480; chapter 486; 312 chapter 490; or chapter 491; and who is acting alone within the 313 scope of his or her professional license to provide care to 314 patients in their homes. 315 (d) A home health aide or certified nursing assistant who 316 is acting in his or her individual capacity, within the 317 definitions and standards of his or her occupation, and who 318 provides hands-on care to patients in their homes. 319 (e) An individual who acts alone, in his or her individual 320 capacity, and who is not employed by or affiliated with a 321 licensed home health agency or registered with a licensed nurse 322 registry. This exemption does not entitle an individual to 323 perform home health services without the required professional 324 license. 325 (f) The delivery of instructional services in home dialysis 326 and home dialysis supplies and equipment. 327 (g) The delivery of nursing home services for which the 328 nursing home is licensed under part II of this chapter, to serve 329 its residents in its facility. 330 (h) The delivery of assisted living facility services for 331 which the assisted living facility is licensed under part I of 332 chapter 429, to serve its residents in its facility. 333 (i) The delivery of hospice services for which the hospice 334 is licensed under part IV of this chapter, to serve hospice 335 patients admitted to its service. 336 (j) A hospital that provides services for which it is 337 licensed under chapter 395. 338 (k) The delivery of community residential services for 339 which the community residential home is licensed under chapter 340 419, to serve the residents in its facility. 341 (l) A not-for-profit, community-based agency that provides 342 early intervention services to infants and toddlers. 343 (m) Certified rehabilitation agencies and comprehensive 344 outpatient rehabilitation facilities that are certified under 345 Title 18 of the Social Security Act. 346 (n) The delivery of adult family-care home services for 347 which the adult family-care home is licensed under part II of 348 chapter 429, to serve the residents in its facility. 349 (o) A person or entity that provides skilled care by health 350 care professionals licensed solely under part I of chapter 464; 351 part I, part III, or part V of chapter 468; or chapter 486. 352 (p) A person or entity that provides services using only 353 volunteers or only individuals related by blood or marriage to 354 the patient or client. 355 Section 8. Paragraph (g) of subsection (2) of section 356 400.471, Florida Statutes, is amended to read: 357 400.471 Application for license; fee.— 358 (2) In addition to the requirements of part II of chapter 359 408, the initial applicant, the applicant for a change of 360 ownership, and the applicant for the addition of skilled care 361 services must file with the application satisfactory proof that 362 the home health agency is in compliance with this part and 363 applicable rules, including: 364 (g) In the case of an application for initial licensure, an 365 application for a change of ownership, or an application for the 366 addition of skilled care services, documentation of 367 accreditation, or an application for accreditation, from an 368 accrediting organization that is recognized by the agency as 369 having standards comparable to those required by this part and 370 part II of chapter 408. A home health agency that does not 371 provide skilled care is exempt from this paragraph. 372 Notwithstanding s. 408.806, thean initialapplicant must 373 provide proof of accreditation that is not conditional or 374 provisional and a survey demonstrating compliance with the 375 requirements of this part, part II of chapter 408, and 376 applicable rules from an accrediting organization that is 377 recognized by the agency as having standards comparable to those 378 required by this part and part II of chapter 408 within 120 days 379 after the date of the agency’s receipt of the application for 380 licensure. Such accreditation must be continuously maintained by 381 the home health agency to maintain licensure. The agency shall 382 accept, in lieu of its own periodic licensure survey, the 383 submission of the survey of an accrediting organization that is 384 recognized by the agency if the accreditation of the licensed 385 home health agency is not provisional and if the licensed home 386 health agency authorizes release of, and the agency receives the 387 report of, the accrediting organization. 388 Section 9. Section 400.492, Florida Statutes, is amended to 389 read: 390 400.492 Provision of services during an emergency.—Each 391 home health agency shall prepare and maintain a comprehensive 392 emergency management plan that is consistent with the standards 393 adopted by national or state accreditation organizations and 394 consistent with the local special needs plan. The plan shall be 395 updated annually and shall provide for continuing home health 396 services during an emergency that interrupts patient care or 397 services in the patient’s home. The plan shall include the means 398 by which the home health agency will continue to provide staff 399 to perform the same type and quantity of services to their 400 patients who evacuate to special needs shelters that were being 401 provided to those patients prior to evacuation. The plan shall 402 describe how the home health agency establishes and maintains an 403 effective response to emergencies and disasters, including: 404 notifying staff when emergency response measures are initiated; 405 providing for communication between staff members, county health 406 departments, and local emergency management agencies, including 407 a backup system; identifying resources necessary to continue 408 essential care or services or referrals to other health care 409 providersorganizationssubject to written agreement; and 410 prioritizing and contacting patients who need continued care or 411 services. 412 (1) Each patient record for patients who are listed in the 413 registry established pursuant to s. 252.355 shall include a 414 description of how care or services will be continued in the 415 event of an emergency or disaster. The home health agency shall 416 discuss the emergency provisions with the patient and the 417 patient’s caregivers, including where and how the patient is to 418 evacuate, procedures for notifying the home health agency in the 419 event that the patient evacuates to a location other than the 420 shelter identified in the patient record, and a list of 421 medications and equipment which must either accompany the 422 patient or will be needed by the patient in the event of an 423 evacuation. 424 (2) Each home health agency shall maintain a current 425 prioritized list of patients who need continued services during 426 an emergency. The list shall indicate how services shall be 427 continued in the event of an emergency or disaster for each 428 patient and if the patient is to be transported to a special 429 needs shelter, and shall indicate if the patient is receiving 430 skilled nursing services and the patient’s medication and 431 equipment needs. The list shall be furnished to county health 432 departments and to local emergency management agencies, upon 433 request. 434 (3) Home health agencies shall not be required to continue 435 to provide care to patients in emergency situations that are 436 beyond their control and that make it impossible to provide 437 services, such as when roads are impassable or when patients do 438 not go to the location specified in their patient records. Home 439 health agencies may establish links to local emergency 440 operations centers to determine a mechanism by which to approach 441 specific areas within a disaster area in order for the agency to 442 reach its clients. Home health agencies shall demonstrate a good 443 faith effort to comply with the requirements of this subsection 444 by documenting attempts of staff to follow procedures outlined 445 in the home health agency’s comprehensive emergency management 446 plan, and by the patient’s record, which support a finding that 447 the provision of continuing care has been attempted for those 448 patients who have been identified as needing care by the home 449 health agency and registered under s. 252.355, in the event of 450 an emergency or disaster under subsection (1). 451 (4) Notwithstanding the provisions of s. 400.464(2) or any 452 other provision of law to the contrary, a home health agency may 453 provide services in a special needs shelter located in any 454 county. 455 Section 10. Subsection (4) and paragraph (a) of subsection 456 (5) of section 400.506, Florida Statutes, are amended to read: 457 400.506 Licensure of nurse registries; requirements; 458 penalties.— 459 (4) A licensee whopersonthatprovides, offers, or 460 advertises to the public any service for which licensure is 461 required under this section must include in such advertisement 462 the license number issued to the licenseeitby the Agency for 463 Health Care Administration. The agency shall assess a fine of 464 not less than $100 against any licensee who fails to include the 465 license number when submitting the advertisement for 466 publication, broadcast, or printing. The fine for a second or 467 subsequent offense is $500. 468 (5)(a) In addition to the requirements of s. 408.812, any 469 person or entity thatwhoowns, operates, or maintains an 470 unlicensed nurse registry and who, after receiving notification 471 from the agency, fails to cease operation and apply for a 472 license under this part commits a misdemeanor of the second 473 degree, punishable as provided in s. 775.082 or s. 775.083. Each 474 day of continued operation is a separate offense. 475 Section 11. Subsections (1), (2), (4), and (5) of section 476 400.509, Florida Statutes, are amended to read: 477 400.509 Registration of particular service providers exempt 478 from licensure; certificate of registration; regulation of 479 registrants.— 480 (1) Any person or entityorganizationthat provides 481 companion services or homemaker services and does not provide a 482 home health service to a person is exempt from licensure under 483 this part. However, any person or entityorganizationthat 484 provides companion services or homemaker services must register 485 with the agency. A person or an entityAn organizationunder 486 contract with the Agency for Persons with Disabilities which 487 provides companion services only for persons with a 488 developmental disability, as defined in s. 393.063, is exempt 489 from registration. 490 (2) The requirements of part II of chapter 408 apply to the 491 provision of services that require registration or licensure 492 pursuant to this section and part II of chapter 408 and entities 493 registered by or applying for such registration from the Agency 494 for Health Care Administration pursuant to this section. Each 495 applicant for registration and each registrant must comply with 496 all provisions of part II of chapter 408. Registration or a 497 license issued by the agency is required for a person or an 498 entity to providethe operation of an organization that provides499 companion services or homemaker services. 500 (4) Each registrant must obtain the employment or contract 501 history of persons who are employed by or under contract with 502 the person or entityorganizationand who will have contact at 503 any time with patients or clients in their homes by: 504 (a) Requiring such persons to submit an employment or 505 contractual history to the registrant; and 506 (b) Verifying the employment or contractual history, unless 507 through diligent efforts such verification is not possible. The 508 agency shall prescribe by rule the minimum requirements for 509 establishing that diligent efforts have been made. 510 511 There is no monetary liability on the part of, and no cause of 512 action for damages arises against, a former employer of a 513 prospective employee of or prospective independent contractor 514 with a registrant who reasonably and in good faith communicates 515 his or her honest opinions about the former employee’s or 516 contractor’s job performance. This subsection does not affect 517 the official immunity of an officer or employee of a public 518 corporation. 519 (5) A person or an entity that offers or advertises to the 520 public a service for which registration is required must include 521 in its advertisement the registration number issued by the 522 Agency for Health Care Administration. 523 Section 12. Subsection (3) of section 400.605, Florida 524 Statutes, is amended to read: 525 400.605 Administration; forms; fees; rules; inspections; 526 fines.— 527 (3) In accordance with s. 408.811, the agency shall conduct 528annual inspections of all licensees, except that licensure529inspections may be conducted biennially for hospices having a 3530year record of substantial compliance. The agency shall conduct531 such inspections and investigations as are necessary in order to 532 determine the state of compliance withthe provisions ofthis 533 part, part II of chapter 408, and applicable rules. 534 Section 13. Section 400.60501, Florida Statutes, is amended 535 to read: 536 400.60501 Outcome measures; adoption of federal quality 537 measures; public reporting; annual report.— 538 (1)No later than December 31, 2019,The agency shall adopt 539 the national hospice outcome measures and survey data in 42 540 C.F.R. part 418 to determine the quality and effectiveness of 541 hospice care for hospices licensed in the state. 542 (2) The agency shall:543(a)make available to the public the national hospice 544 outcome measures and survey data in a format that is 545 comprehensible by a layperson and that allows a consumer to 546 compare such measures of one or more hospices. 547(b)Develop an annual report that analyzes and evaluates548the information collected under this act and any other data549collection or reporting provisions of law.550 Section 14. Subsection (4) of section 400.9905, Florida 551 Statutes, is amended to read: 552 400.9905 Definitions.— 553 (4) “Clinic” means an entity where health care services are 554 provided to individuals and which tenders charges for 555 reimbursement for such services, including a mobile clinic and a 556 portable equipment provider. As used in this part, the term does 557 not include and the licensure requirements of this part do not 558 apply to: 559 (a) Entities licensed or registered by the state under 560 chapter 395; entities licensed or registered by the state and 561 providing only health care services within the scope of services 562 authorized under their respective licenses under ss. 383.30 563 383.332, chapter 390, chapter 394, chapter 397, this chapter 564 except part X, chapter 429, chapter 463, chapter 465, chapter 565 466, chapter 478, chapter 484, or chapter 651; end-stage renal 566 disease providers authorized under 42 C.F.R. part 405, subpart 567 U; providers certified and providing only health care services 568 within the scope of services authorized under their respective 569 certifications under 42 C.F.R. part 485, subpart B,orsubpart 570 H, or subpart J; providers certified and providing only health 571 care services within the scope of services authorized under 572 their respective certifications under 42 C.F.R. part 486, 573 subpart C; providers certified and providing only health care 574 services within the scope of services authorized under their 575 respective certifications under 42 C.F.R. part 491, subpart A; 576 providers certified by the Centers for Medicare and Medicaid 577 services under the federal Clinical Laboratory Improvement 578 Amendments and the federal rules adopted thereunder; or any 579 entity that provides neonatal or pediatric hospital-based health 580 care services or other health care services by licensed 581 practitioners solely within a hospital licensed under chapter 582 395. 583 (b) Entities that own, directly or indirectly, entities 584 licensed or registered by the state pursuant to chapter 395; 585 entities that own, directly or indirectly, entities licensed or 586 registered by the state and providing only health care services 587 within the scope of services authorized pursuant to their 588 respective licenses under ss. 383.30-383.332, chapter 390, 589 chapter 394, chapter 397, this chapter except part X, chapter 590 429, chapter 463, chapter 465, chapter 466, chapter 478, chapter 591 484, or chapter 651; end-stage renal disease providers 592 authorized under 42 C.F.R. part 405, subpart U; providers 593 certified and providing only health care services within the 594 scope of services authorized under their respective 595 certifications under 42 C.F.R. part 485, subpart B,orsubpart 596 H, or subpart J; providers certified and providing only health 597 care services within the scope of services authorized under 598 their respective certifications under 42 C.F.R. part 486, 599 subpart C; providers certified and providing only health care 600 services within the scope of services authorized under their 601 respective certifications under 42 C.F.R. part 491, subpart A; 602 providers certified by the Centers for Medicare and Medicaid 603 services under the federal Clinical Laboratory Improvement 604 Amendments and the federal rules adopted thereunder; or any 605 entity that provides neonatal or pediatric hospital-based health 606 care services by licensed practitioners solely within a hospital 607 licensed under chapter 395. 608 (c) Entities that are owned, directly or indirectly, by an 609 entity licensed or registered by the state pursuant to chapter 610 395; entities that are owned, directly or indirectly, by an 611 entity licensed or registered by the state and providing only 612 health care services within the scope of services authorized 613 pursuant to their respective licenses under ss. 383.30-383.332, 614 chapter 390, chapter 394, chapter 397, this chapter except part 615 X, chapter 429, chapter 463, chapter 465, chapter 466, chapter 616 478, chapter 484, or chapter 651; end-stage renal disease 617 providers authorized under 42 C.F.R. part 405, subpart U; 618 providers certified and providing only health care services 619 within the scope of services authorized under their respective 620 certifications under 42 C.F.R. part 485, subpart B,orsubpart 621 H, or subpart J; providers certified and providing only health 622 care services within the scope of services authorized under 623 their respective certifications under 42 C.F.R. part 486, 624 subpart C; providers certified and providing only health care 625 services within the scope of services authorized under their 626 respective certifications under 42 C.F.R. part 491, subpart A; 627 providers certified by the Centers for Medicare and Medicaid 628 services under the federal Clinical Laboratory Improvement 629 Amendments and the federal rules adopted thereunder; or any 630 entity that provides neonatal or pediatric hospital-based health 631 care services by licensed practitioners solely within a hospital 632 under chapter 395. 633 (d) Entities that are under common ownership, directly or 634 indirectly, with an entity licensed or registered by the state 635 pursuant to chapter 395; entities that are under common 636 ownership, directly or indirectly, with an entity licensed or 637 registered by the state and providing only health care services 638 within the scope of services authorized pursuant to their 639 respective licenses under ss. 383.30-383.332, chapter 390, 640 chapter 394, chapter 397, this chapter except part X, chapter 641 429, chapter 463, chapter 465, chapter 466, chapter 478, chapter 642 484, or chapter 651; end-stage renal disease providers 643 authorized under 42 C.F.R. part 405, subpart U; providers 644 certified and providing only health care services within the 645 scope of services authorized under their respective 646 certifications under 42 C.F.R. part 485, subpart B,orsubpart 647 H, or subpart J; providers certified and providing only health 648 care services within the scope of services authorized under 649 their respective certifications under 42 C.F.R. part 486, 650 subpart C; providers certified and providing only health care 651 services within the scope of services authorized under their 652 respective certifications under 42 C.F.R. part 491, subpart A; 653 providers certified by the Centers for Medicare and Medicaid 654 services under the federal Clinical Laboratory Improvement 655 Amendments and the federal rules adopted thereunder; or any 656 entity that provides neonatal or pediatric hospital-based health 657 care services by licensed practitioners solely within a hospital 658 licensed under chapter 395. 659 (e) An entity that is exempt from federal taxation under 26 660 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan 661 under 26 U.S.C. s. 409 that has a board of trustees at least 662 two-thirds of which are Florida-licensed health care 663 practitioners and provides only physical therapy services under 664 physician orders, any community college or university clinic, 665 and any entity owned or operated by the federal or state 666 government, including agencies, subdivisions, or municipalities 667 thereof. 668 (f) A sole proprietorship, group practice, partnership, or 669 corporation that provides health care services by physicians 670 covered by s. 627.419, that is directly supervised by one or 671 more of such physicians, and that is wholly owned by one or more 672 of those physicians or by a physician and the spouse, parent, 673 child, or sibling of that physician. 674 (g) A sole proprietorship, group practice, partnership, or 675 corporation that provides health care services by licensed 676 health care practitioners under chapter 457, chapter 458, 677 chapter 459, chapter 460, chapter 461, chapter 462, chapter 463, 678 chapter 466, chapter 467, chapter 480, chapter 484, chapter 486, 679 chapter 490, chapter 491, or part I, part III, part X, part 680 XIII, or part XIV of chapter 468, or s. 464.012, and that is 681 wholly owned by one or more licensed health care practitioners, 682 or the licensed health care practitioners set forth in this 683 paragraph and the spouse, parent, child, or sibling of a 684 licensed health care practitioner if one of the owners who is a 685 licensed health care practitioner is supervising the business 686 activities and is legally responsible for the entity’s 687 compliance with all federal and state laws. However, a health 688 care practitioner may not supervise services beyond the scope of 689 the practitioner’s license, except that, for the purposes of 690 this part, a clinic owned by a licensee in s. 456.053(3)(b) 691 which provides only services authorized pursuant to s. 692 456.053(3)(b) may be supervised by a licensee specified in s. 693 456.053(3)(b). 694 (h) Clinical facilities affiliated with an accredited 695 medical school at which training is provided for medical 696 students, residents, or fellows. 697 (i) Entities that provide only oncology or radiation 698 therapy services by physicians licensed under chapter 458 or 699 chapter 459 or entities that provide oncology or radiation 700 therapy services by physicians licensed under chapter 458 or 701 chapter 459 which are owned by a corporation whose shares are 702 publicly traded on a recognized stock exchange. 703 (j) Clinical facilities affiliated with a college of 704 chiropractic accredited by the Council on Chiropractic Education 705 at which training is provided for chiropractic students. 706 (k) Entities that provide licensed practitioners to staff 707 emergency departments or to deliver anesthesia services in 708 facilities licensed under chapter 395 and that derive at least 709 90 percent of their gross annual revenues from the provision of 710 such services. Entities claiming an exemption from licensure 711 under this paragraph must provide documentation demonstrating 712 compliance. 713 (l) Orthotic, prosthetic, pediatric cardiology, or 714 perinatology clinical facilities or anesthesia clinical 715 facilities that are not otherwise exempt under paragraph (a) or 716 paragraph (k) and that are a publicly traded corporation or are 717 wholly owned, directly or indirectly, by a publicly traded 718 corporation. As used in this paragraph, a publicly traded 719 corporation is a corporation that issues securities traded on an 720 exchange registered with the United States Securities and 721 Exchange Commission as a national securities exchange. 722 (m) Entities that are owned by a corporation that has $250 723 million or more in total annual sales of health care services 724 provided by licensed health care practitioners where one or more 725 of the persons responsible for the operations of the entity is a 726 health care practitioner who is licensed in this state and who 727 is responsible for supervising the business activities of the 728 entity and is responsible for the entity’s compliance with state 729 law for purposes of this part. 730 (n) Entities that employ 50 or more licensed health care 731 practitioners licensed under chapter 458 or chapter 459 where 732 the billing for medical services is under a single tax 733 identification number. The application for exemption under this 734 subsection shall contain information that includes: the name, 735 residence, and business address and phone number of the entity 736 that owns the practice; a complete list of the names and contact 737 information of all the officers and directors of the 738 corporation; the name, residence address, business address, and 739 medical license number of each licensed Florida health care 740 practitioner employed by the entity; the corporate tax 741 identification number of the entity seeking an exemption; a 742 listing of health care services to be provided by the entity at 743 the health care clinics owned or operated by the entity and a 744 certified statement prepared by an independent certified public 745 accountant which states that the entity and the health care 746 clinics owned or operated by the entity have not received 747 payment for health care services under personal injury 748 protection insurance coverage for the preceding year. If the 749 agency determines that an entity which is exempt under this 750 subsection has received payments for medical services under 751 personal injury protection insurance coverage, the agency may 752 deny or revoke the exemption from licensure under this 753 subsection. 754 (o) Entities that are, directly or indirectly, under the 755 common ownership of or that are subject to common control by a 756 mutual insurance holding company, as defined in s. 628.703, with 757 an entity licensed or certified under chapter 624 or chapter 641 758 which has $1 billion or more in total annual sales in this 759 state. 760 (p) Entities that are owned by an entity that is a 761 behavioral health service provider in at least 5 states other 762 than Florida and that, together with its affiliates, has $90 763 million or more in total annual revenues associated with the 764 provision of behavioral health services and where one or more of 765 the persons responsible for the operations of the entity is a 766 health care practitioner who is licensed in this state and who 767 is responsible for supervising the business activities of the 768 entity and who is responsible for the entity’s compliance with 769 state law for purposes of this part. 770 (q) Medicaid providers. 771 772 Notwithstanding this subsection, an entity shall be deemed a 773 clinic and must be licensed under this part in order to receive 774 reimbursement under the Florida Motor Vehicle No-Fault Law, ss. 775 627.730-627.7405, unless exempted under s. 627.736(5)(h). 776 Section 15. Paragraph (c) of subsection (3) of section 777 400.991, Florida Statutes, is amended to read: 778 400.991 License requirements; background screenings; 779 prohibitions.— 780 (3) In addition to the requirements of part II of chapter 781 408, the applicant must file with the application satisfactory 782 proof that the clinic is in compliance with this part and 783 applicable rules, including: 784 (c) Proof of financial ability to operate as required under 785 ss. 408.8065(1) and 408.810(8)s. 408.810(8).As an alternative786to submitting proof of financial ability to operate as required787under s. 408.810(8), the applicant may file a surety bond of at788least $500,000 which guarantees that the clinic will act in full789conformity with all legal requirements for operating a clinic,790payable to the agency. The agency may adopt rules to specify791related requirements for such surety bond. 792 Section 16. Paragraph (i) of subsection (1) of section 793 400.9935, Florida Statutes, is amended to read: 794 400.9935 Clinic responsibilities.— 795 (1) Each clinic shall appoint a medical director or clinic 796 director who shall agree in writing to accept legal 797 responsibility for the following activities on behalf of the 798 clinic. The medical director or the clinic director shall: 799 (i) Ensure that the clinic publishes a schedule of charges 800 for the medical services offered to patients. The schedule must 801 include the prices charged to an uninsured person paying for 802 such services by cash, check, credit card, or debit card. The 803 schedule may group services by price levels, listing services in 804 each price level. The schedule must be posted in a conspicuous 805 place in the reception area of any clinic that is antheurgent 806 care center as defined in s. 395.002(29)(b) and must include, 807 but is not limited to, the 50 services most frequently provided 808 by the clinic.The schedule may group services by three price809levels, listing services in each price level.The posting may be 810 a sign that must be at least 15 square feet in size or through 811 an electronic messaging board that is at least 3 square feet in 812 size. The failure of a clinic, including a clinic that is an 813 urgent care center, to publish and post a schedule of charges as 814 required by this section shall result in a fine of not more than 815 $1,000, per day, until the schedule is published and posted. 816 Section 17. Paragraph (a) of subsection (2) of section 817 408.033, Florida Statutes, is amended to read: 818 408.033 Local and state health planning.— 819 (2) FUNDING.— 820 (a) The Legislature intends that the cost of local health 821 councils be borne by assessments on selected health care 822 facilities subject to facility licensure by the Agency for 823 Health Care Administration, including abortion clinics, assisted 824 living facilities, ambulatory surgical centers, birth centers, 825 home health agencies, hospices, hospitals, intermediate care 826 facilities for the developmentally disabled, nursing homes, and 827 health care clinics,and multiphasic testing centersand by 828 assessments on organizations subject to certification by the 829 agency pursuant to chapter 641, part III, including health 830 maintenance organizations and prepaid health clinics. Fees 831 assessed may be collected prospectively at the time of licensure 832 renewal and prorated for the licensure period. 833 Section 18. Paragraph (a) of subsection (1) of section 834 408.061, Florida Statutes, is amended to read: 835 408.061 Data collection; uniform systems of financial 836 reporting; information relating to physician charges; 837 confidential information; immunity.— 838 (1) The agency shall require the submission by health care 839 facilities, health care providers, and health insurers of data 840 necessary to carry out the agency’s duties and to facilitate 841 transparency in health care pricing data and quality measures. 842 Specifications for data to be collected under this section shall 843 be developed by the agency and applicable contract vendors, with 844 the assistance of technical advisory panels including 845 representatives of affected entities, consumers, purchasers, and 846 such other interested parties as may be determined by the 847 agency. 848 (a) Data submitted by health care facilities, including the 849 facilities as defined in chapter 395, shall include, but are not 850 limited to,:case-mix data, patient admission and discharge 851 data, hospital emergency department data which shall include the 852 number of patients treated in the emergency department of a 853 licensed hospital reported by patient acuity level, data on 854 hospital-acquired infections as specified by rule, data on 855 complications as specified by rule, data on readmissions as 856 specified by rule, including patient-with patientand provider 857 specific identifiersincluded, actual charge data by diagnostic 858 groups or other bundled groupings as specified by rule, 859 financial data, accounting data, operating expenses, expenses 860 incurred for rendering services to patients who cannot or do not 861 pay, interest charges, depreciation expenses based on the 862 expected useful life of the property and equipment involved, and 863 demographic data. The agency shall adopt nationally recognized 864 risk adjustment methodologies or software consistent with the 865 standards of the Agency for Healthcare Research and Quality and 866 as selected by the agency for all data submitted as required by 867 this section. Data may be obtained from documents includingsuch868as, but not limited to,:leases, contracts, debt instruments, 869 itemized patient statements or bills, medical record abstracts, 870 and related diagnostic information.ReportedData elements shall 871 be reported electronically in accordance with the inpatient data 872 reporting instructions as prescribed by agency rule59E-7.012,873Florida Administrative Code. Data submitted shall be certified 874 by the chief executive officer or an appropriate and duly 875 authorized representative or employee of the licensed facility 876 that the information submitted is true and accurate. 877 Section 19. Subsection (4) of section 408.0611, Florida 878 Statutes, is amended to read: 879 408.0611 Electronic prescribing clearinghouse.— 880 (4) Pursuant to s. 408.061, the agency shall monitor the 881 implementation of electronic prescribing by health care 882 practitioners, health care facilities, and pharmacies.By883January 31 of each year,The agency shall report annually on its 884 website on the progress of implementation of electronic 885 prescribingto the Governor and the Legislature. Information 886 reported pursuant to this subsection mustshallinclude federal 887 and private sector electronic prescribing initiatives and, to 888 the extent that data is readily available from organizations 889 that operate electronic prescribing networks, the number of 890 health care practitioners using electronic prescribing and the 891 number of prescriptions electronically transmitted. 892 Section 20. Paragraphs (i) and (j) of subsection (1) of 893 section 408.062, Florida Statutes, are amended to read: 894 408.062 Research, analyses, studies, and reports.— 895 (1) The agency shall conduct research, analyses, and 896 studies relating to health care costs and access to and quality 897 of health care services as access and quality are affected by 898 changes in health care costs. Such research, analyses, and 899 studies shall include, but not be limited to: 900 (i) The use of emergency department services by patient 901 acuity leveland the implication of increasing hospital cost by902providing nonurgent care in emergency departments. The agency 903 shall publish annually on its website informationsubmit an904annual reportbased on this monitoring and assessmentto the905Governor, the Speaker of the House of Representatives, the906President of the Senate, and the substantive legislative907committees, due January 1. 908 (j) The making available on its Internet website, and in a 909 hard-copy format upon request, of patient charge, volumes, 910 length of stay, and performance indicators collected from health 911 care facilities pursuant to s. 408.061(1)(a) for specific 912 medical conditions, surgeries, and procedures provided in 913 inpatient and outpatient facilities as determined by the agency. 914 In making the determination of specific medical conditions, 915 surgeries, and procedures to include, the agency shall consider 916 such factors as volume, severity of the illness, urgency of 917 admission, individual and societal costs, and whether the 918 condition is acute or chronic. Performance outcome indicators 919 shall be risk adjusted or severity adjusted, as applicable, 920 using nationally recognized risk adjustment methodologies or 921 software consistent with the standards of the Agency for 922 Healthcare Research and Quality and as selected by the agency. 923 The website shall also provide an interactive search that allows 924 consumers to view and compare the information for specific 925 facilities, a map that allows consumers to select a county or 926 region, definitions of all of the data, descriptions of each 927 procedure, and an explanation about why the data may differ from 928 facility to facility. Such public data shall be updated 929 quarterly. The agency shall publish annually on its website 930 informationsubmit an annual status reporton the collection of 931 data and publication of health care quality measuresto the932Governor, the Speaker of the House of Representatives, the933President of the Senate, and the substantive legislative934committees, due January 1. 935 Section 21. Subsection (5) of section 408.063, Florida 936 Statutes, is amended to read: 937 408.063 Dissemination of health care information.— 938(5)The agency shall publish annually a comprehensive939report of state health expenditures. The report shall identify:940(a)The contribution of health care dollars made by all941payors.942(b)The dollars expended by type of health care service in943Florida.944 Section 22. Section 408.802, Florida Statutes, is amended 945 to read: 946 408.802 Applicability.—The provisions ofThis part applies 947applyto the provision of services that require licensure as 948 defined in this part and to the following entities licensed, 949 registered, or certified by the agency, as described in chapters 950 112, 383, 390, 394, 395, 400, 429, 440,483,and 765: 951 (1) Laboratories authorized to perform testing under the 952 Drug-Free Workplace Act, as provided under ss. 112.0455 and 953 440.102. 954 (2) Birth centers, as provided under chapter 383. 955 (3) Abortion clinics, as provided under chapter 390. 956 (4) Crisis stabilization units, as provided under parts I 957 and IV of chapter 394. 958 (5) Short-term residential treatment facilities, as 959 provided under parts I and IV of chapter 394. 960 (6) Residential treatment facilities, as provided under 961 part IV of chapter 394. 962 (7) Residential treatment centers for children and 963 adolescents, as provided under part IV of chapter 394. 964 (8) Hospitals, as provided under part I of chapter 395. 965 (9) Ambulatory surgical centers, as provided under part I 966 of chapter 395. 967 (10) Nursing homes, as provided under part II of chapter 968 400. 969 (11) Assisted living facilities, as provided under part I 970 of chapter 429. 971 (12) Home health agencies, as provided under part III of 972 chapter 400. 973 (13) Nurse registries, as provided under part III of 974 chapter 400. 975 (14) Companion services or homemaker services providers, as 976 provided under part III of chapter 400. 977 (15) Adult day care centers, as provided under part III of 978 chapter 429. 979 (16) Hospices, as provided under part IV of chapter 400. 980 (17) Adult family-care homes, as provided under part II of 981 chapter 429. 982 (18) Homes for special services, as provided under part V 983 of chapter 400. 984 (19) Transitional living facilities, as provided under part 985 XI of chapter 400. 986 (20) Prescribed pediatric extended care centers, as 987 provided under part VI of chapter 400. 988 (21) Home medical equipment providers, as provided under 989 part VII of chapter 400. 990 (22) Intermediate care facilities for persons with 991 developmental disabilities, as provided under part VIII of 992 chapter 400. 993 (23) Health care services pools, as provided under part IX 994 of chapter 400. 995 (24) Health care clinics, as provided under part X of 996 chapter 400. 997(25)Multiphasic health testing centers, as provided under998part I of chapter 483.999 (25)(26)Organ, tissue, and eye procurement organizations, 1000 as provided under part V of chapter 765. 1001 Section 23. Present subsections (10) through (14) of 1002 section 408.803, Florida Statutes, are redesignated as 1003 subsections (11) through (15), respectively, a new subsection 1004 (10) is added to that section, and subsection (3) of that 1005 section is amended, to read: 1006 408.803 Definitions.—As used in this part, the term: 1007 (3) “Authorizing statute” means the statute authorizing the 1008 licensed operation of a provider listed in s. 408.802 and 1009 includes chapters 112, 383, 390, 394, 395, 400, 429, 440,483,1010 and 765. 1011 (10) “Low-risk provider” means nurse registries, home 1012 medical equipment providers, and health care clinics. 1013 Section 24. Paragraph (b) of subsection (7) of section 1014 408.806, Florida Statutes, is amended to read: 1015 408.806 License application process.— 1016 (7) 1017 (b) An initial inspection is not required for companion 1018 services or homemaker services providers,as provided under part 1019 III of chapter 400,orfor health care services pools,as 1020 provided under part IX of chapter 400, or for low-risk providers 1021 as provided under s. 408.811. 1022 Section 25. Subsection (2) of section 408.808, Florida 1023 Statutes, is amended to read: 1024 408.808 License categories.— 1025 (2) PROVISIONAL LICENSE.—An applicant against whom a 1026 proceeding denying or revoking a license is pending at the time 1027 of license renewal may be issued a provisional license effective 1028 until final action not subject to further appeal. A provisional 1029 license may also be issued to an applicant for initial licensure 1030 or applying for a change of ownership. A provisional license 1031 must be limited in duration to a specific period of time, up to 1032 12 months, as determined by the agency. 1033 Section 26. Subsections (2) and (5) of section 408.809, 1034 Florida Statutes, are amended to read: 1035 408.809 Background screening; prohibited offenses.— 1036 (2) Every 5 years following his or her licensure, 1037 employment, or entry into a contract in a capacity that under 1038 subsection (1) would require level 2 background screening under 1039 chapter 435, each such person must submit to level 2 background 1040 rescreening as a condition of retaining such license or 1041 continuing in such employment or contractual status. For any 1042 such rescreening, the agency shall request the Department of Law 1043 Enforcement to forward the person’s fingerprints to the Federal 1044 Bureau of Investigation for a national criminal history record 1045 check unless the person’s fingerprints are enrolled in the 1046 Federal Bureau of Investigation’s national retained print arrest 1047 notification program. If the fingerprints of such a person are 1048 not retained by the Department of Law Enforcement under s. 1049 943.05(2)(g) and (h), the person must submit fingerprints 1050 electronically to the Department of Law Enforcement for state 1051 processing, and the Department of Law Enforcement shall forward 1052 the fingerprints to the Federal Bureau of Investigation for a 1053 national criminal history record check. The fingerprints shall 1054 be retained by the Department of Law Enforcement under s. 1055 943.05(2)(g) and (h) and enrolled in the national retained print 1056 arrest notification program when the Department of Law 1057 Enforcement begins participation in the program. The cost of the 1058 state and national criminal history records checks required by 1059 level 2 screening may be borne by the licensee or the person 1060 fingerprinted.Until a specified agency is fully implemented in1061the clearinghouse created under s. 435.12,The agency may accept 1062 as satisfying the requirements of this section proof of 1063 compliance with level 2 screening standards submitted within the 1064 previous 5 years to meet any provider or professional licensure 1065 requirements ofthe agency, the Department of Health, the1066Department of Elderly Affairs, the Agency for Persons with1067Disabilities, the Department of Children and Families, orthe 1068 Department of Financial Services for an applicant for a 1069 certificate of authority or provisional certificate of authority 1070 to operate a continuing care retirement community under chapter 1071 651, provided that: 1072 (a) The screening standards and disqualifying offenses for 1073 the prior screening are equivalent to those specified in s. 1074 435.04 and this section; 1075 (b) The person subject to screening has not had a break in 1076 service from a position that requires level 2 screening for more 1077 than 90 days; and 1078 (c) Such proof is accompanied, under penalty of perjury, by 1079 an attestation of compliance with chapter 435 and this section 1080 using forms provided by the agency. 1081(5) A person who serves as a controlling interest of, is1082employed by, or contracts with a licensee on July 31, 2010, who1083has been screened and qualified according to standards specified1084in s. 435.03 or s. 435.04 must be rescreened by July 31, 2015,1085in compliance with the following schedule. If, upon rescreening,1086such person has a disqualifying offense that was not a1087disqualifying offense at the time of the last screening, but is1088a current disqualifying offense and was committed before the1089last screening, he or she may apply for an exemption from the1090appropriate licensing agency and, if agreed to by the employer,1091may continue to perform his or her duties until the licensing1092agency renders a decision on the application for exemption if1093the person is eligible to apply for an exemption and the1094exemption request is received by the agency within 30 days after1095receipt of the rescreening results by the person. The1096rescreening schedule shall be:1097(a) Individuals for whom the last screening was conducted1098on or before December 31, 2004, must be rescreened by July 31,10992013.1100(b) Individuals for whom the last screening conducted was1101between January 1, 2005, and December 31, 2008, must be1102rescreened by July 31, 2014.1103(c) Individuals for whom the last screening conducted was1104between January 1, 2009, through July 31, 2011, must be1105rescreened by July 31, 2015.1106 Section 27. Subsection (1) of section 408.811, Florida 1107 Statutes, is amended to read: 1108 408.811 Right of inspection; copies; inspection reports; 1109 plan for correction of deficiencies.— 1110 (1) An authorized officer or employee of the agency may 1111 make or cause to be made any inspection or investigation deemed 1112 necessary by the agency to determine the state of compliance 1113 with this part, authorizing statutes, and applicable rules. The 1114 right of inspection extends to any business that the agency has 1115 reason to believe is being operated as a provider without a 1116 license, but inspection of any business suspected of being 1117 operated without the appropriate license may not be made without 1118 the permission of the owner or person in charge unless a warrant 1119 is first obtained from a circuit court. Any application for a 1120 license issued under this part, authorizing statutes, or 1121 applicable rules constitutes permission for an appropriate 1122 inspection to verify the information submitted on or in 1123 connection with the application. 1124 (a) All inspections shall be unannounced, except as 1125 specified in s. 408.806. 1126 (b) Inspections for relicensure shall be conducted 1127 biennially unless otherwise specified by this section, 1128 authorizing statutes, or applicable rules. 1129 (c) The agency may exempt a low-risk provider from 1130 licensure inspection if the provider or controlling interest has 1131 an excellent regulatory history with regard to deficiencies, 1132 sanctions, complaints, and other regulatory actions, as defined 1133 by rule. The agency shall continue to conduct unannounced 1134 licensure inspections for at least 10 percent of exempt low-risk 1135 providers to verify compliance. 1136 (d) The agency may adopt rules to waive a routine 1137 inspection, including inspection for relicensure, or allow for 1138 an extended period between relicensure inspections for specific 1139 providers based upon: 1140 1. A favorable regulatory history with regard to 1141 deficiencies, sanctions, complaints, and other regulatory 1142 measures. 1143 2. Outcome measures that demonstrate quality performance. 1144 3. Successful participation in a recognized quality 1145 assurance program. 1146 4. Accreditation status. 1147 5. Other measures reflective of quality and safety. 1148 6. The length of time between inspections. 1149 1150 The agency shall continue to conduct unannounced licensure 1151 inspections for at least 10 percent of providers that qualify 1152 for a waiver or extended period between relicensure inspections. 1153 (e) The agency maintains the authority to conduct an 1154 inspection of any provider at any time to determine regulatory 1155 compliance. 1156 Section 28. Subsection (24) of section 408.820, Florida 1157 Statutes, is amended to read: 1158 408.820 Exemptions.—Except as prescribed in authorizing 1159 statutes, the following exemptions shall apply to specified 1160 requirements of this part: 1161(24)Multiphasic health testing centers, as provided under1162part I of chapter 483, are exempt from s. 408.810(5)-(10).1163 Section 29. Subsections (1) and (2) of section 408.821, 1164 Florida Statutes, are amended to read: 1165 408.821 Emergency management planning; emergency 1166 operations; inactive license.— 1167 (1) A licensee required by authorizing statutes and agency 1168 rule to have a comprehensiveanemergency managementoperations1169 plan must designate a safety liaison to serve as the primary 1170 contact for emergency operations. Such licensee shall submit its 1171 comprehensive emergency management plan to the local emergency 1172 management agency, county health department, or Department of 1173 Health as follows: 1174 (a) Submit the plan within 30 days after initial licensure 1175 and change of ownership, and notify the agency within 30 days 1176 after submission of the plan. 1177 (b) Submit the plan annually and within 30 days after any 1178 significant modification, as defined by agency rule, to a 1179 previously approved plan. 1180 (c) Respond with necessary plan revisions within 30 days 1181 after notification that plan revisions are required. 1182 (d) Notify the agency within 30 days after approval of its 1183 plan by the local emergency management agency, county health 1184 department, or Department of Health. 1185 (2) An entity subject to this part may temporarily exceed 1186 its licensed capacity to act as a receiving provider in 1187 accordance with an approved comprehensive emergency management 1188operationsplan for up to 15 days. While in an overcapacity 1189 status, each provider must furnish or arrange for appropriate 1190 care and services to all clients. In addition, the agency may 1191 approve requests for overcapacity in excess of 15 days, which 1192 approvals may be based upon satisfactory justification and need 1193 as provided by the receiving and sending providers. 1194 Section 30. Subsection (3) of section 408.831, Florida 1195 Statutes, is amended to read: 1196 408.831 Denial, suspension, or revocation of a license, 1197 registration, certificate, or application.— 1198 (3) This section provides standards of enforcement 1199 applicable to all entities licensed or regulated by the Agency 1200 for Health Care Administration. This section controls over any 1201 conflicting provisions of chapters 39, 383, 390, 391, 394, 395, 1202 400, 408, 429, 468,483,and 765 or rules adopted pursuant to 1203 those chapters. 1204 Section 31. Section 408.832, Florida Statutes, is amended 1205 to read: 1206 408.832 Conflicts.—In case of conflict between the 1207 provisions of this part and the authorizing statutes governing 1208 the licensure of health care providers by the Agency for Health 1209 Care Administration found in s. 112.0455 and chapters 383, 390, 1210 394, 395, 400, 429, 440,483,and 765, the provisions of this 1211 part shall prevail. 1212 Section 32. Subsection (9) of section 408.909, Florida 1213 Statutes, is amended to read: 1214 408.909 Health flex plans.— 1215(9)PROGRAM EVALUATION.—The agency and the office shall1216evaluate the pilot program and its effect on the entities that1217seek approval as health flex plans, on the number of enrollees,1218and on the scope of the health care coverage offered under a1219health flex plan; shall provide an assessment of the health flex1220plans and their potential applicability in other settings; shall1221use health flex plans to gather more information to evaluate1222low-income consumer driven benefit packages; and shall, by1223January 15, 2016, and annually thereafter, jointly submit a1224report to the Governor, the President of the Senate, and the1225Speaker of the House of Representatives.1226 Section 33. Paragraph (d) of subsection (10) of section 1227 408.9091, Florida Statutes, is amended to read: 1228 408.9091 Cover Florida Health Care Access Program.— 1229 (10) PROGRAM EVALUATION.—The agency and the office shall: 1230(d)Jointly submit by March 1, annually, a report to the1231Governor, the President of the Senate, and the Speaker of the1232House of Representatives which provides the information1233specified in paragraphs (a)-(c) and recommendations relating to1234the successful implementation and administration of the program.1235 Section 34. Paragraph (a) of subsection (5) of section 1236 409.905, Florida Statutes, is amended to read: 1237 409.905 Mandatory Medicaid services.—The agency may make 1238 payments for the following services, which are required of the 1239 state by Title XIX of the Social Security Act, furnished by 1240 Medicaid providers to recipients who are determined to be 1241 eligible on the dates on which the services were provided. Any 1242 service under this section shall be provided only when medically 1243 necessary and in accordance with state and federal law. 1244 Mandatory services rendered by providers in mobile units to 1245 Medicaid recipients may be restricted by the agency. Nothing in 1246 this section shall be construed to prevent or limit the agency 1247 from adjusting fees, reimbursement rates, lengths of stay, 1248 number of visits, number of services, or any other adjustments 1249 necessary to comply with the availability of moneys and any 1250 limitations or directions provided for in the General 1251 Appropriations Act or chapter 216. 1252 (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for 1253 all covered services provided for the medical care and treatment 1254 of a recipient who is admitted as an inpatient by a licensed 1255 physician or dentist to a hospital licensed under part I of 1256 chapter 395. However, the agency shall limit the payment for 1257 inpatient hospital services for a Medicaid recipient 21 years of 1258 age or older to 45 days or the number of days necessary to 1259 comply with the General Appropriations Act. 1260 (a) The agency may implement reimbursement and utilization 1261 management reforms in order to comply with any limitations or 1262 directions in the General Appropriations Act, which may include, 1263 but are not limited to: prior authorization for inpatient 1264 psychiatric days; prior authorization for nonemergency hospital 1265 inpatient admissions for individuals 21 years of age and older; 1266 authorization of emergency and urgent-care admissions within 24 1267 hours after admission; enhanced utilization and concurrent 1268 review programs for highly utilized services; reduction or 1269 elimination of covered days of service; adjusting reimbursement 1270 ceilings for variable costs; adjusting reimbursement ceilings 1271 for fixed and property costs; and implementing target rates of 1272 increase. The agency may limit prior authorization for hospital 1273 inpatient services to selected diagnosis-related groups, based 1274 on an analysis of the cost and potential for unnecessary 1275 hospitalizations represented by certain diagnoses. Admissions 1276 for normal delivery and newborns are exempt from requirements 1277 for prior authorization. In implementing the provisions of this 1278 section related to prior authorization, the agency shall ensure 1279 that the process for authorization is accessible 24 hours per 1280 day, 7 days per week and authorization is automatically granted 1281 when not denied within 4 hours after the request. Authorization 1282 procedures must include steps for review of denials.Upon1283implementing the prior authorization program for hospital1284inpatient services, the agency shall discontinue its hospital1285retrospective review program.1286 Section 35. Subsection (8) of section 409.907, Florida 1287 Statutes, is amended to read: 1288 409.907 Medicaid provider agreements.—The agency may make 1289 payments for medical assistance and related services rendered to 1290 Medicaid recipients only to an individual or entity who has a 1291 provider agreement in effect with the agency, who is performing 1292 services or supplying goods in accordance with federal, state, 1293 and local law, and who agrees that no person shall, on the 1294 grounds of handicap, race, color, or national origin, or for any 1295 other reason, be subjected to discrimination under any program 1296 or activity for which the provider receives payment from the 1297 agency. 1298 (8)(a) A level 2 background screening pursuant to chapter 1299 435 must be conducted through the agency on each of the 1300 following: 1301 1. TheEachprovider, or each principal of the provider if 1302 the provider is a corporation, partnership, association, or 1303 other entity, seeking to participate in the Medicaid program1304must submit a complete set of his or her fingerprints to the1305agency for the purpose of conducting a criminal history record1306check. 1307 2. Principals of the provider, who include any officer, 1308 director, billing agent, managing employee, or affiliated 1309 person, or any partner or shareholder who has an ownership 1310 interest equal to 5 percent or more in the provider. However, 1311 for a hospital licensed under chapter 395 or a nursing home 1312 licensed under chapter 400, principals of the provider are those 1313 who meet the definition of a controlling interest under s. 1314 408.803. A director of a not-for-profit corporation or 1315 organization is not a principal for purposes of a background 1316 investigation required by this section if the director: serves 1317 solely in a voluntary capacity for the corporation or 1318 organization, does not regularly take part in the day-to-day 1319 operational decisions of the corporation or organization, 1320 receives no remuneration from the not-for-profit corporation or 1321 organization for his or her service on the board of directors, 1322 has no financial interest in the not-for-profit corporation or 1323 organization, and has no family members with a financial 1324 interest in the not-for-profit corporation or organization; and 1325 if the director submits an affidavit, under penalty of perjury, 1326 to this effect to the agency and the not-for-profit corporation 1327 or organization submits an affidavit, under penalty of perjury, 1328 to this effect to the agency as part of the corporation’s or 1329 organization’s Medicaid provider agreement application. 1330 3. Any person who participates or seeks to participate in 1331 the Florida Medicaid program by way of rendering services to 1332 Medicaid recipients or having direct access to Medicaid 1333 recipients, recipient living areas, or the financial, medical, 1334 or service records of a Medicaid recipient or who supervises the 1335 delivery of goods or services to a Medicaid recipient. This 1336 subparagraph does not impose additional screening requirements 1337 on any providers licensed under part II of chapter 408. 1338 (b) Notwithstanding paragraph (a)the above, the agency may 1339 require a background check for any person reasonably suspected 1340 by the agency to have been convicted of a crime. 1341 (c)(a)Paragraph (a)This subsectiondoes not apply to: 1342 1. A unit of local government, except that requirements of 1343 this subsection apply to nongovernmental providers and entities 1344 contracting with the local government to provide Medicaid 1345 services. The actual cost of the state and national criminal 1346 history record checks must be borne by the nongovernmental 1347 provider or entity; or 1348 2. Any business that derives more than 50 percent of its 1349 revenue from the sale of goods to the final consumer, and the 1350 business or its controlling parent is required to file a form 1351 10-K or other similar statement with the Securities and Exchange 1352 Commission or has a net worth of $50 million or more. 1353 (d)(b)Background screening shall be conducted in 1354 accordance with chapter 435 and s. 408.809. The cost of the 1355 state and national criminal record check shall be borne by the 1356 provider. 1357 Section 36. Section 409.913, Florida Statutes, is amended 1358 to read: 1359 409.913 Oversight of the integrity of the Medicaid 1360 program.—The agency shall operate a program to oversee the 1361 activities of Florida Medicaid recipients, and providers and 1362 their representatives, to ensure that fraudulent and abusive 1363 behavior and neglect of recipients occur to the minimum extent 1364 possible, and to recover overpayments and impose sanctions as 1365 appropriate. Each January 15January 1, the agency and the 1366 Medicaid Fraud Control Unit of the Department of Legal Affairs 1367 shall submit reportsa joint reportto the Legislature 1368 documenting the effectiveness of the state’s efforts to control 1369 Medicaid fraud and abuse and to recover Medicaid overpayments 1370 during the previous fiscal year. The report must describe the 1371 number of cases opened and investigated each year; the sources 1372 of the cases opened; the disposition of the cases closed each 1373 year; the amount of overpayments alleged in preliminary and 1374 final audit letters; the number and amount of fines or penalties 1375 imposed; any reductions in overpayment amounts negotiated in 1376 settlement agreements or by other means; the amount of final 1377 agency determinations of overpayments; the amount deducted from 1378 federal claiming as a result of overpayments; the amount of 1379 overpayments recovered each year; the amount of cost of 1380 investigation recovered each year; the average length of time to 1381 collect from the time the case was opened until the overpayment 1382 is paid in full; the amount determined as uncollectible and the 1383 portion of the uncollectible amount subsequently reclaimed from 1384 the Federal Government; the number of providers, by type, that 1385 are terminated from participation in the Medicaid program as a 1386 result of fraud and abuse; and all costs associated with 1387 discovering and prosecuting cases of Medicaid overpayments and 1388 making recoveries in such cases. The report must also document 1389 actions taken to prevent overpayments and the number of 1390 providers prevented from enrolling in or reenrolling in the 1391 Medicaid program as a result of documented Medicaid fraud and 1392 abuse and must include policy recommendations necessary to 1393 prevent or recover overpayments and changes necessary to prevent 1394 and detect Medicaid fraud. All policy recommendations in the 1395 report must include a detailed fiscal analysis, including, but 1396 not limited to, implementation costs, estimated savings to the 1397 Medicaid program, and the return on investment. The agency must 1398 submit the policy recommendations and fiscal analyses in the 1399 report to the appropriate estimating conference, pursuant to s. 1400 216.137, by February 15 of each year. The agency and the 1401 Medicaid Fraud Control Unit of the Department of Legal Affairs 1402 each must include detailed unit-specific performance standards, 1403 benchmarks, and metrics in the report, including projected cost 1404 savings to the state Medicaid program during the following 1405 fiscal year. 1406 (1) For the purposes of this section, the term: 1407 (a) “Abuse” means: 1408 1. Provider practices that are inconsistent with generally 1409 accepted business or medical practices and that result in an 1410 unnecessary cost to the Medicaid program or in reimbursement for 1411 goods or services that are not medically necessary or that fail 1412 to meet professionally recognized standards for health care. 1413 2. Recipient practices that result in unnecessary cost to 1414 the Medicaid program. 1415 (b) “Complaint” means an allegation that fraud, abuse, or 1416 an overpayment has occurred. 1417 (c) “Fraud” means an intentional deception or 1418 misrepresentation made by a person with the knowledge that the 1419 deception results in unauthorized benefit to herself or himself 1420 or another person. The term includes any act that constitutes 1421 fraud under applicable federal or state law. 1422 (d) “Medical necessity” or “medically necessary” means any 1423 goods or services necessary to palliate the effects of a 1424 terminal condition, or to prevent, diagnose, correct, cure, 1425 alleviate, or preclude deterioration of a condition that 1426 threatens life, causes pain or suffering, or results in illness 1427 or infirmity, which goods or services are provided in accordance 1428 with generally accepted standards of medical practice. For 1429 purposes of determining Medicaid reimbursement, the agency is 1430 the final arbiter of medical necessity. Determinations of 1431 medical necessity must be made by a licensed physician employed 1432 by or under contract with the agency and must be based upon 1433 information available at the time the goods or services are 1434 provided. 1435 (e) “Overpayment” includes any amount that is not 1436 authorized to be paid by the Medicaid program whether paid as a 1437 result of inaccurate or improper cost reporting, improper 1438 claiming, unacceptable practices, fraud, abuse, or mistake. 1439 (f) “Person” means any natural person, corporation, 1440 partnership, association, clinic, group, or other entity, 1441 whether or not such person is enrolled in the Medicaid program 1442 or is a provider of health care. 1443 (2) The agency shall conduct, or cause to be conducted by 1444 contract or otherwise, reviews, investigations, analyses, 1445 audits, or any combination thereof, to determine possible fraud, 1446 abuse, overpayment, or recipient neglect in the Medicaid program 1447 and shall report the findings of any overpayments in audit 1448 reports as appropriate. At least 5 percent of all audits shall 1449 be conducted on a random basis. As part of its ongoing fraud 1450 detection activities, the agency shall identify and monitor, by 1451 contract or otherwise, patterns of overutilization of Medicaid 1452 services based on state averages. The agency shall track 1453 Medicaid provider prescription and billing patterns and evaluate 1454 them against Medicaid medical necessity criteria and coverage 1455 and limitation guidelines adopted by rule. Medical necessity 1456 determination requires that service be consistent with symptoms 1457 or confirmed diagnosis of illness or injury under treatment and 1458 not in excess of the patient’s needs. The agency shall conduct 1459 reviews of provider exceptions to peer group norms and shall, 1460 using statistical methodologies, provider profiling, and 1461 analysis of billing patterns, detect and investigate abnormal or 1462 unusual increases in billing or payment of claims for Medicaid 1463 services and medically unnecessary provision of services. 1464 (3) The agency may conduct, or may contract for, prepayment 1465 review of provider claims to ensure cost-effective purchasing; 1466 to ensure that billing by a provider to the agency is in 1467 accordance with applicable provisions of all Medicaid rules, 1468 regulations, handbooks, and policies and in accordance with 1469 federal, state, and local law; and to ensure that appropriate 1470 care is rendered to Medicaid recipients. Such prepayment reviews 1471 may be conducted as determined appropriate by the agency, 1472 without any suspicion or allegation of fraud, abuse, or neglect, 1473 and may last for up to 1 year. Unless the agency has reliable 1474 evidence of fraud, misrepresentation, abuse, or neglect, claims 1475 shall be adjudicated for denial or payment within 90 days after 1476 receipt of complete documentation by the agency for review. If 1477 there is reliable evidence of fraud, misrepresentation, abuse, 1478 or neglect, claims shall be adjudicated for denial of payment 1479 within 180 days after receipt of complete documentation by the 1480 agency for review. 1481 (4) Any suspected criminal violation identified by the 1482 agency must be referred to the Medicaid Fraud Control Unit of 1483 the Office of the Attorney General for investigation. The agency 1484 and the Attorney General shall enter into a memorandum of 1485 understanding, which must include, but need not be limited to, a 1486 protocol for regularly sharing information and coordinating 1487 casework. The protocol must establish a procedure for the 1488 referral by the agency of cases involving suspected Medicaid 1489 fraud to the Medicaid Fraud Control Unit for investigation, and 1490 the return to the agency of those cases where investigation 1491 determines that administrative action by the agency is 1492 appropriate. Offices of the Medicaid program integrity program 1493 and the Medicaid Fraud Control Unit of the Department of Legal 1494 Affairs, shall, to the extent possible, be collocated. The 1495 agency and the Department of Legal Affairs shall periodically 1496 conduct joint training and other joint activities designed to 1497 increase communication and coordination in recovering 1498 overpayments. 1499 (5) A Medicaid provider is subject to having goods and 1500 services that are paid for by the Medicaid program reviewed by 1501 an appropriate peer-review organization designated by the 1502 agency. The written findings of the applicable peer-review 1503 organization are admissible in any court or administrative 1504 proceeding as evidence of medical necessity or the lack thereof. 1505 (6) Any notice required to be given to a provider under 1506 this section is presumed to be sufficient notice if sent to the 1507 address last shown on the provider enrollment file. It is the 1508 responsibility of the provider to furnish and keep the agency 1509 informed of the provider’s current address. United States Postal 1510 Service proof of mailing or certified or registered mailing of 1511 such notice to the provider at the address shown on the provider 1512 enrollment file constitutes sufficient proof of notice. Any 1513 notice required to be given to the agency by this section must 1514 be sent to the agency at an address designated by rule. 1515 (7) When presenting a claim for payment under the Medicaid 1516 program, a provider has an affirmative duty to supervise the 1517 provision of, and be responsible for, goods and services claimed 1518 to have been provided, to supervise and be responsible for 1519 preparation and submission of the claim, and to present a claim 1520 that is true and accurate and that is for goods and services 1521 that: 1522 (a) Have actually been furnished to the recipient by the 1523 provider prior to submitting the claim. 1524 (b) Are Medicaid-covered goods or services that are 1525 medically necessary. 1526 (c) Are of a quality comparable to those furnished to the 1527 general public by the provider’s peers. 1528 (d) Have not been billed in whole or in part to a recipient 1529 or a recipient’s responsible party, except for such copayments, 1530 coinsurance, or deductibles as are authorized by the agency. 1531 (e) Are provided in accord with applicable provisions of 1532 all Medicaid rules, regulations, handbooks, and policies and in 1533 accordance with federal, state, and local law. 1534 (f) Are documented by records made at the time the goods or 1535 services were provided, demonstrating the medical necessity for 1536 the goods or services rendered. Medicaid goods or services are 1537 excessive or not medically necessary unless both the medical 1538 basis and the specific need for them are fully and properly 1539 documented in the recipient’s medical record. 1540 1541 The agency shall deny payment or require repayment for goods or 1542 services that are not presented as required in this subsection. 1543 (8) The agency shall not reimburse any person or entity for 1544 any prescription for medications, medical supplies, or medical 1545 services if the prescription was written by a physician or other 1546 prescribing practitioner who is not enrolled in the Medicaid 1547 program. This section does not apply: 1548 (a) In instances involving bona fide emergency medical 1549 conditions as determined by the agency; 1550 (b) To a provider of medical services to a patient in a 1551 hospital emergency department, hospital inpatient or outpatient 1552 setting, or nursing home; 1553 (c) To bona fide pro bono services by preapproved non 1554 Medicaid providers as determined by the agency; 1555 (d) To prescribing physicians who are board-certified 1556 specialists treating Medicaid recipients referred for treatment 1557 by a treating physician who is enrolled in the Medicaid program; 1558 (e) To prescriptions written for dually eligible Medicare 1559 beneficiaries by an authorized Medicare provider who is not 1560 enrolled in the Medicaid program; 1561 (f) To other physicians who are not enrolled in the 1562 Medicaid program but who provide a medically necessary service 1563 or prescription not otherwise reasonably available from a 1564 Medicaid-enrolled physician; or 1565 (9) A Medicaid provider shall retain medical, professional, 1566 financial, and business records pertaining to services and goods 1567 furnished to a Medicaid recipient and billed to Medicaid for a 1568 period of 5 years after the date of furnishing such services or 1569 goods. The agency may investigate, review, or analyze such 1570 records, which must be made available during normal business 1571 hours. However, 24-hour notice must be provided if patient 1572 treatment would be disrupted. The provider must keep the agency 1573 informed of the location of the provider’s Medicaid-related 1574 records. The authority of the agency to obtain Medicaid-related 1575 records from a provider is neither curtailed nor limited during 1576 a period of litigation between the agency and the provider. 1577 (10) Payments for the services of billing agents or persons 1578 participating in the preparation of a Medicaid claim shall not 1579 be based on amounts for which they bill nor based on the amount 1580 a provider receives from the Medicaid program. 1581 (11) The agency shall deny payment or require repayment for 1582 inappropriate, medically unnecessary, or excessive goods or 1583 services from the person furnishing them, the person under whose 1584 supervision they were furnished, or the person causing them to 1585 be furnished. 1586 (12) The complaint and all information obtained pursuant to 1587 an investigation of a Medicaid provider, or the authorized 1588 representative or agent of a provider, relating to an allegation 1589 of fraud, abuse, or neglect are confidential and exempt from the 1590 provisions of s. 119.07(1): 1591 (a) Until the agency takes final agency action with respect 1592 to the provider and requires repayment of any overpayment, or 1593 imposes an administrative sanction; 1594 (b) Until the Attorney General refers the case for criminal 1595 prosecution; 1596 (c) Until 10 days after the complaint is determined without 1597 merit; or 1598 (d) At all times if the complaint or information is 1599 otherwise protected by law. 1600 (13) The agency shall terminate participation of a Medicaid 1601 provider in the Medicaid program and may seek civil remedies or 1602 impose other administrative sanctions against a Medicaid 1603 provider, if the provider or any principal, officer, director, 1604 agent, managing employee, or affiliated person of the provider, 1605 or any partner or shareholder having an ownership interest in 1606 the provider equal to 5 percent or greater, has been convicted 1607 of a criminal offense under federal law or the law of any state 1608 relating to the practice of the provider’s profession, or a 1609 criminal offense listed under s. 408.809(4), s. 409.907(10), or 1610 s. 435.04(2). If the agency determines that the provider did not 1611 participate or acquiesce in the offense, termination will not be 1612 imposed. If the agency effects a termination under this 1613 subsection, the agency shall take final agency action. 1614 (14) If the provider has been suspended or terminated from 1615 participation in the Medicaid program or the Medicare program by 1616 the Federal Government or any state, the agency must immediately 1617 suspend or terminate, as appropriate, the provider’s 1618 participation in this state’s Medicaid program for a period no 1619 less than that imposed by the Federal Government or any other 1620 state, and may not enroll such provider in this state’s Medicaid 1621 program while such foreign suspension or termination remains in 1622 effect. The agency shall also immediately suspend or terminate, 1623 as appropriate, a provider’s participation in this state’s 1624 Medicaid program if the provider participated or acquiesced in 1625 any action for which any principal, officer, director, agent, 1626 managing employee, or affiliated person of the provider, or any 1627 partner or shareholder having an ownership interest in the 1628 provider equal to 5 percent or greater, was suspended or 1629 terminated from participating in the Medicaid program or the 1630 Medicare program by the Federal Government or any state. This 1631 sanction is in addition to all other remedies provided by law. 1632 (15) The agency shall seek a remedy provided by law, 1633 including, but not limited to, any remedy provided in 1634 subsections (13) and (16) and s. 812.035, if: 1635 (a) The provider’s license has not been renewed, or has 1636 been revoked, suspended, or terminated, for cause, by the 1637 licensing agency of any state; 1638 (b) The provider has failed to make available or has 1639 refused access to Medicaid-related records to an auditor, 1640 investigator, or other authorized employee or agent of the 1641 agency, the Attorney General, a state attorney, or the Federal 1642 Government; 1643 (c) The provider has not furnished or has failed to make 1644 available such Medicaid-related records as the agency has found 1645 necessary to determine whether Medicaid payments are or were due 1646 and the amounts thereof; 1647 (d) The provider has failed to maintain medical records 1648 made at the time of service, or prior to service if prior 1649 authorization is required, demonstrating the necessity and 1650 appropriateness of the goods or services rendered; 1651 (e) The provider is not in compliance with provisions of 1652 Medicaid provider publications that have been adopted by 1653 reference as rules in the Florida Administrative Code; with 1654 provisions of state or federal laws, rules, or regulations; with 1655 provisions of the provider agreement between the agency and the 1656 provider; or with certifications found on claim forms or on 1657 transmittal forms for electronically submitted claims that are 1658 submitted by the provider or authorized representative, as such 1659 provisions apply to the Medicaid program; 1660 (f) The provider or person who ordered, authorized, or 1661 prescribed the care, services, or supplies has furnished, or 1662 ordered or authorized the furnishing of, goods or services to a 1663 recipient which are inappropriate, unnecessary, excessive, or 1664 harmful to the recipient or are of inferior quality; 1665 (g) The provider has demonstrated a pattern of failure to 1666 provide goods or services that are medically necessary; 1667 (h) The provider or an authorized representative of the 1668 provider, or a person who ordered, authorized, or prescribed the 1669 goods or services, has submitted or caused to be submitted false 1670 or a pattern of erroneous Medicaid claims; 1671 (i) The provider or an authorized representative of the 1672 provider, or a person who has ordered, authorized, or prescribed 1673 the goods or services, has submitted or caused to be submitted a 1674 Medicaid provider enrollment application, a request for prior 1675 authorization for Medicaid services, a drug exception request, 1676 or a Medicaid cost report that contains materially false or 1677 incorrect information; 1678 (j) The provider or an authorized representative of the 1679 provider has collected from or billed a recipient or a 1680 recipient’s responsible party improperly for amounts that should 1681 not have been so collected or billed by reason of the provider’s 1682 billing the Medicaid program for the same service; 1683 (k) The provider or an authorized representative of the 1684 provider has included in a cost report costs that are not 1685 allowable under a Florida Title XIX reimbursement plan after the 1686 provider or authorized representative had been advised in an 1687 audit exit conference or audit report that the costs were not 1688 allowable; 1689 (l) The provider is charged by information or indictment 1690 with fraudulent billing practices or an offense referenced in 1691 subsection (13). The sanction applied for this reason is limited 1692 to suspension of the provider’s participation in the Medicaid 1693 program for the duration of the indictment unless the provider 1694 is found guilty pursuant to the information or indictment; 1695 (m) The provider or a person who ordered, authorized, or 1696 prescribed the goods or services is found liable for negligent 1697 practice resulting in death or injury to the provider’s patient; 1698 (n) The provider fails to demonstrate that it had available 1699 during a specific audit or review period sufficient quantities 1700 of goods, or sufficient time in the case of services, to support 1701 the provider’s billings to the Medicaid program; 1702 (o) The provider has failed to comply with the notice and 1703 reporting requirements of s. 409.907; 1704 (p) The agency has received reliable information of patient 1705 abuse or neglect or of any act prohibited by s. 409.920; or 1706 (q) The provider has failed to comply with an agreed-upon 1707 repayment schedule. 1708 1709 A provider is subject to sanctions for violations of this 1710 subsection as the result of actions or inactions of the 1711 provider, or actions or inactions of any principal, officer, 1712 director, agent, managing employee, or affiliated person of the 1713 provider, or any partner or shareholder having an ownership 1714 interest in the provider equal to 5 percent or greater, in which 1715 the provider participated or acquiesced. 1716 (16) The agency shall impose any of the following sanctions 1717 or disincentives on a provider or a person for any of the acts 1718 described in subsection (15): 1719 (a) Suspension for a specific period of time of not more 1720 than 1 year. Suspension precludes participation in the Medicaid 1721 program, which includes any action that results in a claim for 1722 payment to the Medicaid program for furnishing, supervising a 1723 person who is furnishing, or causing a person to furnish goods 1724 or services. 1725 (b) Termination for a specific period of time ranging from 1726 more than 1 year to 20 years. Termination precludes 1727 participation in the Medicaid program, which includes any action 1728 that results in a claim for payment to the Medicaid program for 1729 furnishing, supervising a person who is furnishing, or causing a 1730 person to furnish goods or services. 1731 (c) Imposition of a fine of up to $5,000 for each 1732 violation. Each day that an ongoing violation continues, such as 1733 refusing to furnish Medicaid-related records or refusing access 1734 to records, is considered a separate violation. Each instance of 1735 improper billing of a Medicaid recipient; each instance of 1736 including an unallowable cost on a hospital or nursing home 1737 Medicaid cost report after the provider or authorized 1738 representative has been advised in an audit exit conference or 1739 previous audit report of the cost unallowability; each instance 1740 of furnishing a Medicaid recipient goods or professional 1741 services that are inappropriate or of inferior quality as 1742 determined by competent peer judgment; each instance of 1743 knowingly submitting a materially false or erroneous Medicaid 1744 provider enrollment application, request for prior authorization 1745 for Medicaid services, drug exception request, or cost report; 1746 each instance of inappropriate prescribing of drugs for a 1747 Medicaid recipient as determined by competent peer judgment; and 1748 each false or erroneous Medicaid claim leading to an overpayment 1749 to a provider is considered a separate violation. 1750 (d) Immediate suspension, if the agency has received 1751 information of patient abuse or neglect or of any act prohibited 1752 by s. 409.920. Upon suspension, the agency must issue an 1753 immediate final order under s. 120.569(2)(n). 1754 (e) A fine, not to exceed $10,000, for a violation of 1755 paragraph (15)(i). 1756 (f) Imposition of liens against provider assets, including, 1757 but not limited to, financial assets and real property, not to 1758 exceed the amount of fines or recoveries sought, upon entry of 1759 an order determining that such moneys are due or recoverable. 1760 (g) Prepayment reviews of claims for a specified period of 1761 time. 1762 (h) Comprehensive followup reviews of providers every 6 1763 months to ensure that they are billing Medicaid correctly. 1764 (i) Corrective-action plans that remain in effect for up to 1765 3 years and that are monitored by the agency every 6 months 1766 while in effect. 1767 (j) Other remedies as permitted by law to effect the 1768 recovery of a fine or overpayment. 1769 1770 If a provider voluntarily relinquishes its Medicaid provider 1771 number or an associated license, or allows the associated 1772 licensure to expire after receiving written notice that the 1773 agency is conducting, or has conducted, an audit, survey, 1774 inspection, or investigation and that a sanction of suspension 1775 or termination will or would be imposed for noncompliance 1776 discovered as a result of the audit, survey, inspection, or 1777 investigation, the agency shall impose the sanction of 1778 termination for cause against the provider. The agency’s 1779 termination with cause is subject to hearing rights as may be 1780 provided under chapter 120. The Secretary of Health Care 1781 Administration may make a determination that imposition of a 1782 sanction or disincentive is not in the best interest of the 1783 Medicaid program, in which case a sanction or disincentive may 1784 not be imposed. 1785 (17) In determining the appropriate administrative sanction 1786 to be applied, or the duration of any suspension or termination, 1787 the agency shall consider: 1788 (a) The seriousness and extent of the violation or 1789 violations. 1790 (b) Any prior history of violations by the provider 1791 relating to the delivery of health care programs which resulted 1792 in either a criminal conviction or in administrative sanction or 1793 penalty. 1794 (c) Evidence of continued violation within the provider’s 1795 management control of Medicaid statutes, rules, regulations, or 1796 policies after written notification to the provider of improper 1797 practice or instance of violation. 1798 (d) The effect, if any, on the quality of medical care 1799 provided to Medicaid recipients as a result of the acts of the 1800 provider. 1801 (e) Any action by a licensing agency respecting the 1802 provider in any state in which the provider operates or has 1803 operated. 1804 (f) The apparent impact on access by recipients to Medicaid 1805 services if the provider is suspended or terminated, in the best 1806 judgment of the agency. 1807 1808 The agency shall document the basis for all sanctioning actions 1809 and recommendations. 1810 (18) The agency may take action to sanction, suspend, or 1811 terminate a particular provider working for a group provider, 1812 and may suspend or terminate Medicaid participation at a 1813 specific location, rather than or in addition to taking action 1814 against an entire group. 1815 (19) The agency shall establish a process for conducting 1816 followup reviews of a sampling of providers who have a history 1817 of overpayment under the Medicaid program. This process must 1818 consider the magnitude of previous fraud or abuse and the 1819 potential effect of continued fraud or abuse on Medicaid costs. 1820 (20) In making a determination of overpayment to a 1821 provider, the agency must use accepted and valid auditing, 1822 accounting, analytical, statistical, or peer-review methods, or 1823 combinations thereof. Appropriate statistical methods may 1824 include, but are not limited to, sampling and extension to the 1825 population, parametric and nonparametric statistics, tests of 1826 hypotheses, and other generally accepted statistical methods. 1827 Appropriate analytical methods may include, but are not limited 1828 to, reviews to determine variances between the quantities of 1829 products that a provider had on hand and available to be 1830 purveyed to Medicaid recipients during the review period and the 1831 quantities of the same products paid for by the Medicaid program 1832 for the same period, taking into appropriate consideration sales 1833 of the same products to non-Medicaid customers during the same 1834 period. In meeting its burden of proof in any administrative or 1835 court proceeding, the agency may introduce the results of such 1836 statistical methods as evidence of overpayment. 1837 (21) When making a determination that an overpayment has 1838 occurred, the agency shall prepare and issue an audit report to 1839 the provider showing the calculation of overpayments. The 1840 agency’s determination must be based solely upon information 1841 available to it before issuance of the audit report and, in the 1842 case of documentation obtained to substantiate claims for 1843 Medicaid reimbursement, based solely upon contemporaneous 1844 records. The agency may consider addenda or modifications to a 1845 note that was made contemporaneously with the patient care 1846 episode if the addenda or modifications are germane to the note. 1847 (22) The audit report, supported by agency work papers, 1848 showing an overpayment to a provider constitutes evidence of the 1849 overpayment. A provider may not present or elicit testimony on 1850 direct examination or cross-examination in any court or 1851 administrative proceeding, regarding the purchase or acquisition 1852 by any means of drugs, goods, or supplies; sales or divestment 1853 by any means of drugs, goods, or supplies; or inventory of 1854 drugs, goods, or supplies, unless such acquisition, sales, 1855 divestment, or inventory is documented by written invoices, 1856 written inventory records, or other competent written 1857 documentary evidence maintained in the normal course of the 1858 provider’s business. A provider may not present records to 1859 contest an overpayment or sanction unless such records are 1860 contemporaneous and, if requested during the audit process, were 1861 furnished to the agency or its agent upon request. This 1862 limitation does not apply to Medicaid cost report audits. This 1863 limitation does not preclude consideration by the agency of 1864 addenda or modifications to a note if the addenda or 1865 modifications are made before notification of the audit, the 1866 addenda or modifications are germane to the note, and the note 1867 was made contemporaneously with a patient care episode. 1868 Notwithstanding the applicable rules of discovery, all 1869 documentation to be offered as evidence at an administrative 1870 hearing on a Medicaid overpayment or an administrative sanction 1871 must be exchanged by all parties at least 14 days before the 1872 administrative hearing or be excluded from consideration. 1873 (23)(a) In an audit,orinvestigation, or enforcement 1874 action taken forofa violation committed by a provider which is 1875 conducted pursuant to this section, the agency is entitled to 1876 recover all investigative and,legal costs incurred as a result 1877 of such audit, investigation, or enforcement action. The costs 1878 associated with an investigation, audit, or enforcement action 1879 may include, but are not limited to, salaries and benefits of 1880 personnel, costs related to the time spent by an attorney and 1881 other personnel working on the case, and any other expenses 1882 incurred by the agency or contractor which are associated with 1883 the case, including any, andexpert witness costs and attorney 1884 fees incurred on behalf of the agency or contractor if the 1885 agency’s findings were not contested by the provider or, if 1886 contested, the agency ultimately prevailed. 1887 (b) The agency has the burden of documenting the costs, 1888 which include salaries and employee benefits and out-of-pocket 1889 expenses. The amount of costs that may be recovered must be 1890 reasonable in relation to the seriousness of the violation and 1891 must be set taking into consideration the financial resources, 1892 earning ability, and needs of the provider, who has the burden 1893 of demonstrating such factors. 1894 (c) The provider may pay the costs over a period to be 1895 determined by the agency if the agency determines that an 1896 extreme hardship would result to the provider from immediate 1897 full payment. Any default in payment of costs may be collected 1898 by any means authorized by law. 1899 (24) If the agency imposes an administrative sanction 1900 pursuant to subsection (13), subsection (14), or subsection 1901 (15), except paragraphs (15)(e) and (o), upon any provider or 1902 any principal, officer, director, agent, managing employee, or 1903 affiliated person of the provider who is regulated by another 1904 state entity, the agency shall notify that other entity of the 1905 imposition of the sanction within 5 business days. Such 1906 notification must include the provider’s or person’s name and 1907 license number and the specific reasons for sanction. 1908 (25)(a) The agency shall withhold Medicaid payments, in 1909 whole or in part, to a provider upon receipt of reliable 1910 evidence that the circumstances giving rise to the need for a 1911 withholding of payments involve fraud, willful 1912 misrepresentation, or abuse under the Medicaid program, or a 1913 crime committed while rendering goods or services to Medicaid 1914 recipients. If it is determined that fraud, willful 1915 misrepresentation, abuse, or a crime did not occur, the payments 1916 withheld must be paid to the provider within 14 days after such 1917 determination. Amounts not paid within 14 days accrue interest 1918 at the rate of 10 percent per year, beginning after the 14th 1919 day. 1920 (b) The agency shall deny payment, or require repayment, if 1921 the goods or services were furnished, supervised, or caused to 1922 be furnished by a person who has been suspended or terminated 1923 from the Medicaid program or Medicare program by the Federal 1924 Government or any state. 1925 (c) Overpayments owed to the agency bear interest at the 1926 rate of 10 percent per year from the date of final determination 1927 of the overpayment by the agency, and payment arrangements must 1928 be made within 30 days after the date of the final order, which 1929 is not subject to further appeal. 1930 (d) The agency, upon entry of a final agency order, a 1931 judgment or order of a court of competent jurisdiction, or a 1932 stipulation or settlement, may collect the moneys owed by all 1933 means allowable by law, including, but not limited to, notifying 1934 any fiscal intermediary of Medicare benefits that the state has 1935 a superior right of payment. Upon receipt of such written 1936 notification, the Medicare fiscal intermediary shall remit to 1937 the state the sum claimed. 1938 (e) The agency may institute amnesty programs to allow 1939 Medicaid providers the opportunity to voluntarily repay 1940 overpayments. The agency may adopt rules to administer such 1941 programs. 1942 (26) The agency may impose administrative sanctions against 1943 a Medicaid recipient, or the agency may seek any other remedy 1944 provided by law, including, but not limited to, the remedies 1945 provided in s. 812.035, if the agency finds that a recipient has 1946 engaged in solicitation in violation of s. 409.920 or that the 1947 recipient has otherwise abused the Medicaid program. 1948 (27) When the Agency for Health Care Administration has 1949 made a probable cause determination and alleged that an 1950 overpayment to a Medicaid provider has occurred, the agency, 1951 after notice to the provider, shall: 1952 (a) Withhold, and continue to withhold during the pendency 1953 of an administrative hearing pursuant to chapter 120, any 1954 medical assistance reimbursement payments until such time as the 1955 overpayment is recovered, unless within 30 days after receiving 1956 notice thereof the provider: 1957 1. Makes repayment in full; or 1958 2. Establishes a repayment plan that is satisfactory to the 1959 Agency for Health Care Administration. 1960 (b) Withhold, and continue to withhold during the pendency 1961 of an administrative hearing pursuant to chapter 120, medical 1962 assistance reimbursement payments if the terms of a repayment 1963 plan are not adhered to by the provider. 1964 (28) Venue for all Medicaid program integrity cases lies in 1965 Leon County, at the discretion of the agency. 1966 (29) Notwithstanding other provisions of law, the agency 1967 and the Medicaid Fraud Control Unit of the Department of Legal 1968 Affairs may review a provider’s Medicaid-related and non 1969 Medicaid-related records in order to determine the total output 1970 of a provider’s practice to reconcile quantities of goods or 1971 services billed to Medicaid with quantities of goods or services 1972 used in the provider’s total practice. 1973 (30) The agency shall terminate a provider’s participation 1974 in the Medicaid program if the provider fails to reimburse an 1975 overpayment or pay an agency-imposed fine that has been 1976 determined by final order, not subject to further appeal, within 1977 30 days after the date of the final order, unless the provider 1978 and the agency have entered into a repayment agreement. 1979 (31) If a provider requests an administrative hearing 1980 pursuant to chapter 120, such hearing must be conducted within 1981 90 days following assignment of an administrative law judge, 1982 absent exceptionally good cause shown as determined by the 1983 administrative law judge or hearing officer. Upon issuance of a 1984 final order, the outstanding balance of the amount determined to 1985 constitute the overpayment and fines is due. If a provider fails 1986 to make payments in full, fails to enter into a satisfactory 1987 repayment plan, or fails to comply with the terms of a repayment 1988 plan or settlement agreement, the agency shall withhold 1989 reimbursement payments for Medicaid services until the amount 1990 due is paid in full. 1991 (32) Duly authorized agents and employees of the agency 1992 shall have the power to inspect, during normal business hours, 1993 the records of any pharmacy, wholesale establishment, or 1994 manufacturer, or any other place in which drugs and medical 1995 supplies are manufactured, packed, packaged, made, stored, sold, 1996 or kept for sale, for the purpose of verifying the amount of 1997 drugs and medical supplies ordered, delivered, or purchased by a 1998 provider. The agency shall provide at least 2 business days’ 1999 prior notice of any such inspection. The notice must identify 2000 the provider whose records will be inspected, and the inspection 2001 shall include only records specifically related to that 2002 provider. 2003 (33) In accordance with federal law, Medicaid recipients 2004 convicted of a crime pursuant to 42 U.S.C. s. 1320a-7b may be 2005 limited, restricted, or suspended from Medicaid eligibility for 2006 a period not to exceed 1 year, as determined by the agency head 2007 or designee. 2008 (34) To deter fraud and abuse in the Medicaid program, the 2009 agency may limit the number of Schedule II and Schedule III 2010 refill prescription claims submitted from a pharmacy provider. 2011 The agency shall limit the allowable amount of reimbursement of 2012 prescription refill claims for Schedule II and Schedule III 2013 pharmaceuticals if the agency or the Medicaid Fraud Control Unit 2014 determines that the specific prescription refill was not 2015 requested by the Medicaid recipient or authorized representative 2016 for whom the refill claim is submitted or was not prescribed by 2017 the recipient’s medical provider or physician. Any such refill 2018 request must be consistent with the original prescription. 2019 (35) The Office of Program Policy Analysis and Government 2020 Accountability shall provide a report to the President of the 2021 Senate and the Speaker of the House of Representatives on a 2022 biennial basis, beginning January 31, 2006, on the agency’s 2023 efforts to prevent, detect, and deter, as well as recover funds 2024 lost to, fraud and abuse in the Medicaid program. 2025 (36) The agency may provide to a sample of Medicaid 2026 recipients or their representatives through the distribution of 2027 explanations of benefits information about services reimbursed 2028 by the Medicaid program for goods and services to such 2029 recipients, including information on how to report inappropriate 2030 or incorrect billing to the agency or other law enforcement 2031 entities for review or investigation, information on how to 2032 report criminal Medicaid fraud to the Medicaid Fraud Control 2033 Unit’s toll-free hotline number, and information about the 2034 rewards available under s. 409.9203. The explanation of benefits 2035 may not be mailed for Medicaid independent laboratory services 2036 as described in s. 409.905(7) or for Medicaid certified match 2037 services as described in ss. 409.9071 and 1011.70. 2038 (37) The agency shall post on its website a current list of 2039 each Medicaid provider, including any principal, officer, 2040 director, agent, managing employee, or affiliated person of the 2041 provider, or any partner or shareholder having an ownership 2042 interest in the provider equal to 5 percent or greater, who has 2043 been terminated for cause from the Medicaid program or 2044 sanctioned under this section. The list must be searchable by a 2045 variety of search parameters and provide for the creation of 2046 formatted lists that may be printed or imported into other 2047 applications, including spreadsheets. The agency shall update 2048 the list at least monthly. 2049 (38) In order to improve the detection of health care 2050 fraud, use technology to prevent and detect fraud, and maximize 2051 the electronic exchange of health care fraud information, the 2052 agency shall: 2053 (a) Compile, maintain, and publish on its website a 2054 detailed list of all state and federal databases that contain 2055 health care fraud information and update the list at least 2056 biannually; 2057 (b) Develop a strategic plan to connect all databases that 2058 contain health care fraud information to facilitate the 2059 electronic exchange of health information between the agency, 2060 the Department of Health, the Department of Law Enforcement, and 2061 the Attorney General’s Office. The plan must include recommended 2062 standard data formats, fraud identification strategies, and 2063 specifications for the technical interface between state and 2064 federal health care fraud databases; 2065 (c) Monitor innovations in health information technology, 2066 specifically as it pertains to Medicaid fraud prevention and 2067 detection; and 2068 (d) Periodically publish policy briefs that highlight 2069 available new technology to prevent or detect health care fraud 2070 and projects implemented by other states, the private sector, or 2071 the Federal Government which use technology to prevent or detect 2072 health care fraud. 2073 Section 37. Subsection (6) of section 429.11, Florida 2074 Statutes, is amended to read: 2075 429.11 Initial application for license; provisional 2076 license.— 2077(6)In addition to the license categories available in s.2078408.808, a provisional license may be issued to an applicant2079making initial application for licensure or making application2080for a change of ownership. A provisional license shall be2081limited in duration to a specific period of time not to exceed 62082months, as determined by the agency.2083 Section 38. Subsection (9) of section 429.19, Florida 2084 Statutes, is amended to read: 2085 429.19 Violations; imposition of administrative fines; 2086 grounds.— 2087(9)The agency shall develop and disseminate an annual list2088of all facilities sanctioned or fined for violations of state2089standards, the number and class of violations involved, the2090penalties imposed, and the current status of cases. The list2091shall be disseminated, at no charge, to the Department of2092Elderly Affairs, the Department of Health, the Department of2093Children and Families, the Agency for Persons with Disabilities,2094the area agencies on aging, the Florida Statewide Advocacy2095Council, the State Long-Term Care Ombudsman Program, and state2096and local ombudsman councils. The Department of Children and2097Families shall disseminate the list to service providers under2098contract to the department who are responsible for referring2099persons to a facility for residency. The agency may charge a fee2100commensurate with the cost of printing and postage to other2101interested parties requesting a copy of this list. This2102information may be provided electronically or through the2103agency’s Internet site.2104 Section 39. Subsection (2) of section 429.35, Florida 2105 Statutes, is amended to read: 2106 429.35 Maintenance of records; reports.— 2107 (2) Within 60 days after the date of anthe biennial2108 inspection conductedvisit requiredunder s. 408.811 or within 2109 30 days after the date of ananyinterim visit, the agency shall 2110 forward the results of the inspection to the local ombudsman 2111 council in the district where the facility is located; to at 2112 least one public library or, in the absence of a public library, 2113 the county seat in the county in which the inspected assisted 2114 living facility is located; and, when appropriate, to the 2115 district Adult Services and Mental Health Program Offices. 2116 Section 40. Subsection (2) of section 429.905, Florida 2117 Statutes, is amended to read: 2118 429.905 Exemptions; monitoring of adult day care center 2119 programs colocated with assisted living facilities or licensed 2120 nursing home facilities.— 2121 (2) A licensed assisted living facility, a licensed 2122 hospital, or a licensed nursing home facility may provide 2123 services during the day which include, but are not limited to, 2124 social, health, therapeutic, recreational, nutritional, and 2125 respite services, to adults who are not residents. Such a 2126 facility need not be licensed as an adult day care center; 2127 however, the agency must monitor the facility during the regular 2128 inspectionand at least bienniallyto ensure adequate space and 2129 sufficient staff. If an assisted living facility, a hospital, or 2130 a nursing home holds itself out to the public as an adult day 2131 care center, it must be licensed as such and meet all standards 2132 prescribed by statute and rule. For the purpose of this 2133 subsection, the term “day” means any portion of a 24-hour day. 2134 Section 41. Section 429.929, Florida Statutes, is amended 2135 to read: 2136 429.929 Rules establishing standards.— 2137(1)The agency shall adopt rules to implement this part. 2138 The rules must include reasonable and fair standards. Any 2139 conflict between these standards and those that may be set forth 2140 in local, county, or municipal ordinances shall be resolved in 2141 favor of those having statewide effect. Such standards must 2142 relate to: 2143 (1)(a)The maintenance of adult day care centers with 2144 respect to plumbing, heating, lighting, ventilation, and other 2145 building conditions, including adequate meeting space, to ensure 2146 the health, safety, and comfort of participants and protection 2147 from fire hazard. Such standards may not conflict with chapter 2148 553 and must be based upon the size of the structure and the 2149 number of participants. 2150 (2)(b)The number and qualifications of all personnel 2151 employed by adult day care centers who have responsibilities for 2152 the care of participants. 2153 (3)(c)All sanitary conditions within adult day care 2154 centers and their surroundings, including water supply, sewage 2155 disposal, food handling, and general hygiene, and maintenance of 2156 sanitary conditions, to ensure the health and comfort of 2157 participants. 2158 (4)(d)Basic services provided by adult day care centers. 2159 (5)(e)Supportive and optional services provided by adult 2160 day care centers. 2161 (6)(f)Data and information relative to participants and 2162 programs of adult day care centers, including, but not limited 2163 to, the physical and mental capabilities and needs of the 2164 participants, the availability, frequency, and intensity of 2165 basic services and of supportive and optional services provided, 2166 the frequency of participation, the distances traveled by 2167 participants, the hours of operation, the number of referrals to 2168 other centers or elsewhere, and the incidence of illness. 2169 (7)(g)Components of a comprehensive emergency management 2170 plan, developed in consultation with the Department of Health 2171 and the Division of Emergency Management. 2172(2)Pursuant to this part, s. 408.811, and applicable2173rules, the agency may conduct an abbreviated biennial inspection2174of key quality-of-care standards, in lieu of a full inspection,2175of a center that has a record of good performance. However, the2176agency must conduct a full inspection of a center that has had2177one or more confirmed complaints within the licensure period2178immediately preceding the inspection or which has a serious2179problem identified during the abbreviated inspection. The agency2180shall develop the key quality-of-care standards, taking into2181consideration the comments and recommendations of provider2182groups. These standards shall be included in rules adopted by2183the agency.2184 Section 42. Part I of chapter 483, Florida Statutes, is 2185 repealed, and part II and part III of that chapter are 2186 redesignated as part I and part II, respectively. 2187 Section 43. Paragraph (g) of subsection (3) of section 2188 20.43, Florida Statutes, is amended to read: 2189 20.43 Department of Health.—There is created a Department 2190 of Health. 2191 (3) The following divisions of the Department of Health are 2192 established: 2193 (g) Division of Medical Quality Assurance, which is 2194 responsible for the following boards and professions established 2195 within the division: 2196 1. The Board of Acupuncture, created under chapter 457. 2197 2. The Board of Medicine, created under chapter 458. 2198 3. The Board of Osteopathic Medicine, created under chapter 2199 459. 2200 4. The Board of Chiropractic Medicine, created under 2201 chapter 460. 2202 5. The Board of Podiatric Medicine, created under chapter 2203 461. 2204 6. Naturopathy, as provided under chapter 462. 2205 7. The Board of Optometry, created under chapter 463. 2206 8. The Board of Nursing, created under part I of chapter 2207 464. 2208 9. Nursing assistants, as provided under part II of chapter 2209 464. 2210 10. The Board of Pharmacy, created under chapter 465. 2211 11. The Board of Dentistry, created under chapter 466. 2212 12. Midwifery, as provided under chapter 467. 2213 13. The Board of Speech-Language Pathology and Audiology, 2214 created under part I of chapter 468. 2215 14. The Board of Nursing Home Administrators, created under 2216 part II of chapter 468. 2217 15. The Board of Occupational Therapy, created under part 2218 III of chapter 468. 2219 16. Respiratory therapy, as provided under part V of 2220 chapter 468. 2221 17. Dietetics and nutrition practice, as provided under 2222 part X of chapter 468. 2223 18. The Board of Athletic Training, created under part XIII 2224 of chapter 468. 2225 19. The Board of Orthotists and Prosthetists, created under 2226 part XIV of chapter 468. 2227 20. Electrolysis, as provided under chapter 478. 2228 21. The Board of Massage Therapy, created under chapter 2229 480. 2230 22. The Board of Clinical Laboratory Personnel, created 2231 under part Ipart IIof chapter 483. 2232 23. Medical physicists, as provided under part IIpart III2233 of chapter 483. 2234 24. The Board of Opticianry, created under part I of 2235 chapter 484. 2236 25. The Board of Hearing Aid Specialists, created under 2237 part II of chapter 484. 2238 26. The Board of Physical Therapy Practice, created under 2239 chapter 486. 2240 27. The Board of Psychology, created under chapter 490. 2241 28. School psychologists, as provided under chapter 490. 2242 29. The Board of Clinical Social Work, Marriage and Family 2243 Therapy, and Mental Health Counseling, created under chapter 2244 491. 2245 30. Emergency medical technicians and paramedics, as 2246 provided under part III of chapter 401. 2247 Section 44. Subsection (3) of section 381.0034, Florida 2248 Statutes, is amended to read: 2249 381.0034 Requirement for instruction on HIV and AIDS.— 2250 (3) The department shall require, as a condition of 2251 granting a license under chapter 467 or part Ipart IIof 2252 chapter 483, that an applicant making initial application for 2253 licensure complete an educational course acceptable to the 2254 department on human immunodeficiency virus and acquired immune 2255 deficiency syndrome. Upon submission of an affidavit showing 2256 good cause, an applicant who has not taken a course at the time 2257 of licensure shall be allowed 6 months to complete this 2258 requirement. 2259 Section 45. Subsection (4) of section 456.001, Florida 2260 Statutes, is amended to read: 2261 456.001 Definitions.—As used in this chapter, the term: 2262 (4) “Health care practitioner” means any person licensed 2263 under chapter 457; chapter 458; chapter 459; chapter 460; 2264 chapter 461; chapter 462; chapter 463; chapter 464; chapter 465; 2265 chapter 466; chapter 467; part I, part II, part III, part V, 2266 part X, part XIII, or part XIV of chapter 468; chapter 478; 2267 chapter 480; part I or part IIpart II or part IIIof chapter 2268 483; chapter 484; chapter 486; chapter 490; or chapter 491. 2269 Section 46. Paragraphs (h) and (i) of subsection (2) of 2270 section 456.057, Florida Statutes, are amended to read: 2271 456.057 Ownership and control of patient records; report or 2272 copies of records to be furnished; disclosure of information.— 2273 (2) As used in this section, the terms “records owner,” 2274 “health care practitioner,” and “health care practitioner’s 2275 employer” do not include any of the following persons or 2276 entities; furthermore, the following persons or entities are not 2277 authorized to acquire or own medical records, but are authorized 2278 under the confidentiality and disclosure requirements of this 2279 section to maintain those documents required by the part or 2280 chapter under which they are licensed or regulated: 2281 (h) Clinical laboratory personnel licensed under part I 2282part IIof chapter 483. 2283 (i) Medical physicists licensed under part IIpart IIIof 2284 chapter 483. 2285 Section 47. Paragraph (j) of subsection (1) of section 2286 456.076, Florida Statutes, is amended to read: 2287 456.076 Impaired practitioner programs.— 2288 (1) As used in this section, the term: 2289 (j) “Practitioner” means a person licensed, registered, 2290 certified, or regulated by the department under part III of 2291 chapter 401; chapter 457; chapter 458; chapter 459; chapter 460; 2292 chapter 461; chapter 462; chapter 463; chapter 464; chapter 465; 2293 chapter 466; chapter 467; part I, part II, part III, part V, 2294 part X, part XIII, or part XIV of chapter 468; chapter 478; 2295 chapter 480; part I or part IIpart II or part IIIof chapter 2296 483; chapter 484; chapter 486; chapter 490; or chapter 491; or 2297 an applicant for a license, registration, or certification under 2298 the same laws. 2299 Section 48. Paragraph (b) of subsection (1) of section 2300 456.47, Florida Statutes, is amended to read: 2301 456.47 Use of telehealth to provide services.— 2302 (1) DEFINITIONS.—As used in this section, the term: 2303 (b) “Telehealth provider” means any individual who provides 2304 health care and related services using telehealth and who is 2305 licensed or certified under s. 393.17; part III of chapter 401; 2306 chapter 457; chapter 458; chapter 459; chapter 460; chapter 461; 2307 chapter 463; chapter 464; chapter 465; chapter 466; chapter 467; 2308 part I, part III, part IV, part V, part X, part XIII, or part 2309 XIV of chapter 468; chapter 478; chapter 480; part I or part II 2310part II or part IIIof chapter 483; chapter 484; chapter 486; 2311 chapter 490; or chapter 491; who is licensed under a multistate 2312 health care licensure compact of which Florida is a member 2313 state; or who is registered under and complies with subsection 2314 (4). 2315 Section 49. This act shall take effect July 1, 2020.