Bill Text: FL S1726 | 2020 | Regular Session | Comm Sub
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-Comm_Sub.html
Florida Senate - 2020 CS for CS for SB 1726 By the Committees on Appropriations; and Health Policy; and Senator Bean 576-04557-20 20201726c2 1 A bill to be entitled 2 An act relating to the Agency for Health Care 3 Administration; amending s. 383.327, F.S.; requiring 4 birth centers to report certain deaths and stillbirths 5 to the agency; revising the frequency with which a 6 certain report must be submitted to the agency; 7 authorizing the agency to prescribe by rule the 8 frequency with which such report is submitted; 9 amending s. 395.003, F.S.; removing a requirement that 10 specified information be listed on licenses for 11 certain facilities; amending s. 395.1055, F.S.; 12 requiring the agency to adopt specified rules related 13 to ongoing quality improvement programs for certain 14 cardiac programs; amending s. 395.602, F.S.; revising 15 the definition of the term “rural hospital”; repealing 16 s. 395.7015, F.S., relating to an annual assessment on 17 health care entities; amending s. 395.7016, F.S.; 18 conforming a provision to changes made by the act; 19 amending s. 400.19, F.S.; revising provisions 20 requiring the agency to conduct licensure inspections 21 of nursing homes; requiring the agency to conduct 22 additional licensure surveys under certain 23 circumstances; requiring the agency to assess a 24 specified fine for such surveys; amending s. 400.462, 25 F.S.; revising definitions; amending s. 400.464, F.S.; 26 revising exemptions from licensure requirements for 27 home health agencies; amending s. 400.471, F.S.; 28 revising provisions related to certain application 29 requirements for home health agencies; amending s. 30 400.492, F.S.; revising provisions related to services 31 provided by home health agencies during an emergency; 32 amending s. 400.506, F.S.; revising provisions related 33 to licensure requirements for nurse registries; 34 amending s. 400.509, F.S.; revising provisions related 35 to the registration of certain service providers; 36 amending s. 400.605, F.S.; removing a requirement that 37 the agency conduct specified inspections of certain 38 licensees; amending s. 400.60501, F.S.; deleting an 39 obsolete date; removing a requirement that the agency 40 develop a specified annual report; amending s. 41 400.9905, F.S.; revising the definition of the term 42 “clinic”; amending s. 400.991, F.S.; removing the 43 option for health care clinics to file a surety bond 44 under certain circumstances; amending s. 400.9935, 45 F.S.; revising provisions related to the schedule of 46 charges published and posted by certain clinics; 47 specifying that urgent care centers are subject to 48 such requirements; amending s. 408.033, F.S.; 49 conforming a provision to changes made by the act; 50 amending s. 408.05, F.S.; requiring the agency to 51 publish by a specified date an annual report 52 identifying certain health care services; amending s. 53 408.061, F.S.; revising provisions requiring health 54 care facilities to submit specified data to the 55 agency; amending s. 408.0611, F.S.; removing a 56 requirement that the agency annually report to the 57 Governor and the Legislature by a specified date on 58 the progress of implementation of electronic 59 prescribing and, instead, requiring the agency to 60 annually publish such information on its website; 61 amending s. 408.062, F.S.; removing requirements that 62 the agency annually report specified information to 63 the Governor and Legislature by a specified date and, 64 instead, requiring the agency to annually publish such 65 information on its website; amending s. 408.063, F.S.; 66 removing a requirement that the agency publish certain 67 annual reports; amending s. 408.802, F.S.; conforming 68 provisions to changes made by the act; amending s. 69 408.803, F.S.; conforming a definition to changes made 70 by the act; defining the term “low-risk provider”; 71 amending s. 408.806, F.S.; exempting certain providers 72 from a specified inspection; amending s. 408.808, 73 F.S.; authorizing the issuance of a provisional 74 license to certain applicants; amending s. 408.809, 75 F.S.; revising background screening requirements for 76 certain licensees and providers; amending s. 408.811, 77 F.S.; authorizing the agency to grant certain 78 providers an exemption from a specified inspection 79 under certain circumstances; authorizing the agency to 80 adopt rules to grant waivers of certain inspections 81 and allow for extended inspection periods under 82 certain circumstances; requiring the agency to conduct 83 unannounced licensure inspections of certain providers 84 during a specified time period; providing that the 85 agency may conduct regulatory compliance inspections 86 of providers at any time; amending s. 408.820, F.S.; 87 conforming a provision to changes made by the act; 88 amending s. 408.821, F.S.; revising provisions 89 requiring licensees to have a specified plan; 90 providing requirements for the submission of such 91 plan; amending ss. 408.831 and 408.832, F.S.; 92 conforming provisions to changes made by the act; 93 amending s. 408.909, F.S.; removing a requirement that 94 the agency and the Office of Insurance Regulation 95 evaluate a specified program; amending s. 408.9091, 96 F.S.; deleting a requirement that the agency and 97 office submit a specified joint annual report to the 98 Governor and the Legislature; amending s. 409.905, 99 F.S.; providing construction for a provision that 100 requires the agency to discontinue its hospital 101 retrospective review program under certain 102 circumstances; providing legislative intent; amending 103 s. 409.907, F.S.; requiring that a specified 104 background screening be conducted through the agency 105 on certain persons and entities; repealing s. 19 of 106 chapter 2019-116, Laws of Florida, relating to the 107 abrogation of the scheduled expiration of an amendment 108 to s. 409.908(23), F.S., and the scheduled reversion 109 of the text of that subsection; amending 409.908, 110 F.S.; revising provisions related to the prospective 111 payment methodology for certain Medicaid provider 112 reimbursements; reenacting s. 409.908(23), relating to 113 reimbursement of Medicaid providers for certain 114 services; amending s. 409.913, F.S.; revising the due 115 date for a certain annual report; deleting the 116 requirement that certain agencies submit their annual 117 reports jointly; providing that the agency or its 118 contractor is entitled to recover certain costs and 119 attorney fees related to audits, investigations, or 120 enforcement actions conducted by the agency or its 121 contractor; amending s. 409.920, F.S.; revising 122 provisions related to prohibited referral practices in 123 the Medicaid program; amending ss. 409.967 and 124 409.973, F.S.; revising the length of managed care 125 plan contracts procured by the agency beginning during 126 a specified timeframe; requiring the agency to extend 127 the term of certain existing managed care plan 128 contracts until a specified date; amending s. 429.11, 129 F.S.; removing an authorization for the issuance of a 130 provisional license to certain facilities; amending s. 131 429.19, F.S.; removing requirements that the agency 132 develop and disseminate a specified list and the 133 Department of Children and Families disseminate such 134 list to certain providers; amending ss. 429.35 and 135 429.905, F.S.; revising provisions requiring a 136 biennial inspection cycle for specified facilities; 137 amending s. 429.929, F.S.; revising provisions 138 requiring a biennial inspection cycle for adult day 139 care centers; amending ss. 627.6387, 627.6648, and 140 641.31076, F.S.; revising the definition of the term 141 “shoppable health care service”; revising the duties 142 of certain health insurers and health maintenance 143 organizations; repealing part I of ch. 483, F.S., 144 relating to the Florida Multiphasic Health Testing 145 Center Law; redesignating parts II and III of ch. 483, 146 F.S., as parts I and II, respectively; amending ss. 147 20.43, 381.0034, 456.001, 456.057, 456.076, and 148 456.47, F.S.; conforming cross-references; providing 149 effective dates. 150 151 Be It Enacted by the Legislature of the State of Florida: 152 153 Section 1. Subsections (2) and (4) of section 383.327, 154 Florida Statutes, are amended to read: 155 383.327 Birth and death records; reports.— 156 (2) Each maternal death, newborn death, and stillbirth 157 shall be reported immediately to the medical examiner and the 158 agency. 159 (4) A report shall be submittedannuallyto the agency. The 160 contents of the report and the frequency with which it is 161 submitted shall be prescribed by rule of the agency. 162 Section 2. Subsection (4) of section 395.003, Florida 163 Statutes, is amended to read: 164 395.003 Licensure; denial, suspension, and revocation.— 165 (4) The agency shall issue a license thatwhichspecifies 166 the service categories and the number of hospital beds in each 167 bed category for which a license is received. Such information 168 shall be listed on the face of the license.All beds which are169not covered by any specialty-bed-need methodology shall be170specified as general beds.A licensed facility shall not operate 171 a number of hospital beds greater than the number indicated by 172 the agency on the face of the license without approval from the 173 agency under conditions established by rule. 174 Section 3. Paragraph (g) is added to subsection (18) of 175 section 395.1055, Florida Statutes, to read: 176 395.1055 Rules and enforcement.— 177 (18) In establishing rules for adult cardiovascular 178 services, the agency shall include provisions that allow for: 179 (g) The requirement that hospitals licensed for adult 180 diagnostic cardiac catheterization, Level I or Level II adult 181 cardiovascular services participate in the American College of 182 Cardiology – National Cardiovascular Data Registry or the 183 American Heart Association’s Get with the Guidelines – Coronary 184 Artery Disease program registry and document an ongoing quality 185 improvement plan to ensure these licensed programs meet or 186 exceed national quality and outcome benchmarks reported by the 187 registry in which they participate. Hospitals licensed for Level 188 II adult cardiovascular services must also participate in the 189 clinical outcome reporting systems operated by the Society for 190 Thoracic Surgeons. 191 Section 4. Paragraph (b) of subsection (2) of section 192 395.602, Florida Statutes, is amended to read: 193 395.602 Rural hospitals.— 194 (2) DEFINITIONS.—As used in this part, the term: 195 (b) “Rural hospital” means an acute care hospital licensed 196 under this chapter, having 100 or fewer licensed beds and an 197 emergency room, which is: 198 1. The sole provider within a county with a population 199 density of up to 100 persons per square mile; 200 2. An acute care hospital, in a county with a population 201 density of up to 100 persons per square mile, which is at least 202 30 minutes of travel time, on normally traveled roads under 203 normal traffic conditions, from any other acute care hospital 204 within the same county; 205 3. A hospital supported by a tax district or subdistrict 206 whose boundaries encompass a population of up to 100 persons per 207 square mile; 208 4. A hospital classified as a sole community hospital under 209 42 C.F.R. s. 412.92, regardless of the number of licensed beds; 210 5. A hospital with a service area that has a population of 211 up to 100 persons per square mile. As used in this subparagraph, 212 the term “service area” means the fewest number of zip codes 213 that account for 75 percent of the hospital’s discharges for the 214 most recent 5-year period, based on information available from 215 the hospital inpatient discharge database in the Florida Center 216 for Health Information and Transparency at the agency; or 217 6. A hospital designated as a critical access hospital, as 218 defined in s. 408.07. 219 220 Population densities used in this paragraph must be based upon 221 the most recently completed United States census. A hospital 222 that received funds under s. 409.9116 for a quarter beginning no 223 later than July 1, 2002, is deemed to have been and shall 224 continue to be a rural hospital from that date through June 30, 225 2021, if the hospital continues to have up to 100 licensed beds 226 and an emergency room. An acute care hospital that has not 227 previously been designated as a rural hospital and that meets 228 the criteria of this paragraph shall be granted such designation 229 upon application, including supporting documentation, to the 230 agency. A hospital that was licensed as a rural hospital during 231 the 2010-2011 or 2011-2012 fiscal year shall continue to be a 232 rural hospital from the date of designation through June 30, 233 20252021, if the hospital continues to have up to 100 licensed 234 beds and an emergency room. 235 Section 5. Section 395.7015, Florida Statutes, is repealed. 236 Section 6. Section 395.7016, Florida Statutes, is amended 237 to read: 238 395.7016 Annual appropriation.—The Legislature shall 239 appropriate each fiscal year from either the General Revenue 240 Fund or the Agency for Health Care Administration Tobacco 241 Settlement Trust Fund an amount sufficient to replace the funds 242 lost due toreduction by chapter 2000-256, Laws of Florida, of243the assessment on other health care entities under s. 395.7015,244andthe reduction by chapter 2000-256, Laws of Florida, in the 245 assessment on hospitals under s. 395.701,and to maintain 246 federal approval of the reduced amount of funds deposited into 247 the Public Medical Assistance Trust Fund under s. 395.701,as 248 state match for the state’s Medicaid program. 249 Section 7. Subsection (3) of section 400.19, Florida 250 Statutes, is amended to read: 251 400.19 Right of entry and inspection.— 252 (3) The agency shall conduct periodic,every 15 months253conduct at least oneunannounced licensure inspections 254inspectionto determine compliance by the licensee with 255 statutes, and with rules adoptedpromulgatedunderthe256provisions ofthose statutes, governing minimum standards of 257 construction, quality and adequacy of care, and rights of 258 residents.The survey shall be conducted every 6 months for the259next 2-year periodIf the facility has been cited for a class I 260 deficiency or,has been cited for two or more class II 261 deficiencies arising from separate surveys or investigations 262 within a 60-day period, the agency shall conduct licensure 263 surveys every 6 months until the facility has two consecutive 264 licensure surveys without a citation for a class I or a class II 265 deficiencyor has had three or more substantiated complaints266within a 6-month period, each resulting in at least one class I267or class II deficiency. In addition to any other fees or fines 268 in this part, the agency shall assess a fine offor each269facility that is subject to the6-month survey cycle.The fine270for the2-year period shall be$6,000 for the additional 6-month 271 licensure surveys, one-half to be paid at the completion of each272survey. The agency may adjust suchthisfine by the change in 273 the Consumer Price Index, based on the 12 months immediately 274 preceding the increase, to cover the cost of the additional 275 surveys. The agency shall verify through subsequent inspection 276 that any deficiency identified during inspection is corrected. 277 However, the agency may verify the correction of a class III or 278 class IV deficiency unrelated to resident rights or resident 279 care without reinspecting the facility if adequate written 280 documentation has been received from the facility, which 281 provides assurance that the deficiency has been corrected. The 282 giving or causing to be given of advance notice of such 283 unannounced inspections by an employee of the agency to any 284 unauthorized person shall constitute cause for suspension of not 285 fewer than 5 working days according tothe provisions ofchapter 286 110. 287 Section 8. Subsections (12), (14), (17), (21), and (22) of 288 section 400.462, Florida Statutes, are amended to read: 289 400.462 Definitions.—As used in this part, the term: 290 (12) “Home health agency” means a person whoan291organizationthatprovides one or more home health servicesand292staffing services. 293 (14) “Home health services” means health and medical 294 services and medical supplies furnishedby an organizationto an 295 individual in the individual’s home or place of residence. The 296 term includesorganizations that provide one or more ofthe 297 following: 298 (a) Nursing care. 299 (b) Physical, occupational, respiratory, or speech therapy. 300 (c) Home health aide services. 301 (d) Dietetics and nutrition practice and nutrition 302 counseling. 303 (e) Medical supplies, restricted to drugs and biologicals 304 prescribed by a physician. 305 (17) “Home infusion therapy provider” means a person whoan306organizationthatemploys, contracts with, or refers a licensed 307 professional who has received advanced training and experience 308 in intravenous infusion therapy and who administers infusion 309 therapy to a patient in the patient’s home or place of 310 residence. 311 (21) “Nurse registry” means any person whothatprocures, 312 offers, promises, or attempts to secure health-care-related 313 contracts for registered nurses, licensed practical nurses, 314 certified nursing assistants, home health aides, companions, or 315 homemakers, who are compensated by fees as independent 316 contractors, including, but not limited to, contracts for the 317 provision of services to patients and contracts to provide 318 private duty or staffing services to health care facilities 319 licensed under chapter 395, this chapter, or chapter 429 or 320 other business entities. 321(22)“Organization” means a corporation, government or322governmental subdivision or agency, partnership or association,323or any other legal or commercial entity, any of which involve324more than one health care professional discipline; a health care325professional and a home health aide or certified nursing326assistant; more than one home health aide; more than one327certified nursing assistant; or a home health aide and a328certified nursing assistant. The term does not include an entity329that provides services using only volunteers or only individuals330related by blood or marriage to the patient or client.331 Section 9. Subsection (1), paragraph (a) of subsection (4), 332 and subsection (5) of section 400.464, Florida Statutes, are 333 amended to read: 334 400.464 Home health agencies to be licensed; expiration of 335 license; exemptions; unlawful acts; penalties.— 336 (1) The requirements of part II of chapter 408 apply to the 337 provision of services that require licensure pursuant to this 338 part and part II of chapter 408 and entities licensed or 339 registered by or applying for such licensure or registration 340 from the Agency for Health Care Administration pursuant to this 341 part. A license issued by the agency is required in order to 342 operate a home health agency in this state. A license issued on 343 or after July 1, 2018, must specify the home health services the 344 licenseeorganizationis authorized to perform and indicate 345 whether such specified services are considered skilled care. The 346 provision or advertising of services that require licensure 347 pursuant to this part without such services being specified on 348 the face of the license issued on or after July 1, 2018, 349 constitutes unlicensed activity as prohibited under s. 408.812. 350 (4)(a) A licenseeAn organizationthat offers or advertises 351 to the public any service for which licensure or registration is 352 required under this part must include in the advertisement the 353 license number or registration number issued to the licensee 354organizationby the agency. The agency shall assess a fine of 355 not less than $100 to any licensee or registrant who fails to 356 include the license or registration number when submitting the 357 advertisement for publication, broadcast, or printing. The fine 358 for a second or subsequent offense is $500. The holder of a 359 license issued under this part may not advertise or indicate to 360 the public that it holds a home health agency or nurse registry 361 license other than the one it has been issued. 362 (5) The following are exempt fromthelicensure as a home 363 health agency underrequirements ofthis part: 364 (a) A home health agency operated by the Federal 365 Government. 366 (b) Home health services provided by a state agency, either 367 directly or through a contractor with: 368 1. The Department of Elderly Affairs. 369 2. The Department of Health, a community health center, or 370 a rural health network that furnishes home visits for the 371 purpose of providing environmental assessments, case management, 372 health education, personal care services, family planning, or 373 followup treatment, or for the purpose of monitoring and 374 tracking disease. 375 3. Services provided to persons with developmental 376 disabilities, as defined in s. 393.063. 377 4. Companion and sitter organizations that were registered 378 under s. 400.509(1) on January 1, 1999, and were authorized to 379 provide personal services under a developmental services 380 provider certificate on January 1, 1999, may continue to provide 381 such services to past, present, and future clients of the 382 organization who need such services, notwithstanding the 383 provisions of this act. 384 5. The Department of Children and Families. 385 (c) A health care professional, whether or not 386 incorporated, who is licensed under chapter 457; chapter 458; 387 chapter 459; part I of chapter 464; chapter 467; part I, part 388 III, part V, or part X of chapter 468; chapter 480; chapter 486; 389 chapter 490; or chapter 491; and who is acting alone within the 390 scope of his or her professional license to provide care to 391 patients in their homes. 392 (d) A home health aide or certified nursing assistant who 393 is acting in his or her individual capacity, within the 394 definitions and standards of his or her occupation, and who 395 provides hands-on care to patients in their homes. 396 (e) An individual who acts alone, in his or her individual 397 capacity, and who is not employed by or affiliated with a 398 licensed home health agency or registered with a licensed nurse 399 registry. This exemption does not entitle an individual to 400 perform home health services without the required professional 401 license. 402 (f) The delivery of instructional services in home dialysis 403 and home dialysis supplies and equipment. 404 (g) The delivery of nursing home services for which the 405 nursing home is licensed under part II of this chapter, to serve 406 its residents in its facility. 407 (h) The delivery of assisted living facility services for 408 which the assisted living facility is licensed under part I of 409 chapter 429, to serve its residents in its facility. 410 (i) The delivery of hospice services for which the hospice 411 is licensed under part IV of this chapter, to serve hospice 412 patients admitted to its service. 413 (j) A hospital that provides services for which it is 414 licensed under chapter 395. 415 (k) The delivery of community residential services for 416 which the community residential home is licensed under chapter 417 419, to serve the residents in its facility. 418 (l) A not-for-profit, community-based agency that provides 419 early intervention services to infants and toddlers. 420 (m) Certified rehabilitation agencies and comprehensive 421 outpatient rehabilitation facilities that are certified under 422 Title 18 of the Social Security Act. 423 (n) The delivery of adult family-care home services for 424 which the adult family-care home is licensed under part II of 425 chapter 429, to serve the residents in its facility. 426 (o) A person who provides skilled care by health care 427 professionals licensed solely under part I of chapter 464; part 428 I, part III, or part V of chapter 468; or chapter 486. This 429 exemption does not authorize an individual to perform home 430 health services without the required professional license. 431 (p) A person or entity that provides services using only 432 volunteers or only individuals related by blood or marriage to 433 the patient or client. 434 Section 10. Paragraph (g) of subsection (2) of section 435 400.471, Florida Statutes, is amended to read: 436 400.471 Application for license; fee.— 437 (2) In addition to the requirements of part II of chapter 438 408, the initial applicant, the applicant for a change of 439 ownership, and the applicant for the addition of skilled care 440 services must file with the application satisfactory proof that 441 the home health agency is in compliance with this part and 442 applicable rules, including: 443 (g) In the case of an application for initial licensure, an 444 application for a change of ownership, or an application for the 445 addition of skilled care services, documentation of 446 accreditation, or an application for accreditation, from an 447 accrediting organization that is recognized by the agency as 448 having standards comparable to those required by this part and 449 part II of chapter 408. A home health agency that does not 450 provide skilled care is exempt from this paragraph. 451 Notwithstanding s. 408.806, thean initialapplicant must 452 provide proof of accreditation that is not conditional or 453 provisional and a survey demonstrating compliance with the 454 requirements of this part, part II of chapter 408, and 455 applicable rules from an accrediting organization that is 456 recognized by the agency as having standards comparable to those 457 required by this part and part II of chapter 408 within 120 days 458 after the date of the agency’s receipt of the application for 459 licensure. Such accreditation must be continuously maintained by 460 the home health agency to maintain licensure. The agency shall 461 accept, in lieu of its own periodic licensure survey, the 462 submission of the survey of an accrediting organization that is 463 recognized by the agency if the accreditation of the licensed 464 home health agency is not provisional and if the licensed home 465 health agency authorizes release of, and the agency receives the 466 report of, the accrediting organization. 467 Section 11. Section 400.492, Florida Statutes, is amended 468 to read: 469 400.492 Provision of services during an emergency.—Each 470 home health agency shall prepare and maintain a comprehensive 471 emergency management plan that is consistent with the standards 472 adopted by national or state accreditation organizations and 473 consistent with the local special needs plan. The plan shall be 474 updated annually and shall provide for continuing home health 475 services during an emergency that interrupts patient care or 476 services in the patient’s home. The plan shall include the means 477 by which the home health agency will continue to provide staff 478 to perform the same type and quantity of services to their 479 patients who evacuate to special needs shelters that were being 480 provided to those patients prior to evacuation. The plan shall 481 describe how the home health agency establishes and maintains an 482 effective response to emergencies and disasters, including: 483 notifying staff when emergency response measures are initiated; 484 providing for communication between staff members, county health 485 departments, and local emergency management agencies, including 486 a backup system; identifying resources necessary to continue 487 essential care or services or referrals to other health care 488 providersorganizationssubject to written agreement; and 489 prioritizing and contacting patients who need continued care or 490 services. 491 (1) Each patient record for patients who are listed in the 492 registry established pursuant to s. 252.355 shall include a 493 description of how care or services will be continued in the 494 event of an emergency or disaster. The home health agency shall 495 discuss the emergency provisions with the patient and the 496 patient’s caregivers, including where and how the patient is to 497 evacuate, procedures for notifying the home health agency in the 498 event that the patient evacuates to a location other than the 499 shelter identified in the patient record, and a list of 500 medications and equipment which must either accompany the 501 patient or will be needed by the patient in the event of an 502 evacuation. 503 (2) Each home health agency shall maintain a current 504 prioritized list of patients who need continued services during 505 an emergency. The list shall indicate how services shall be 506 continued in the event of an emergency or disaster for each 507 patient and if the patient is to be transported to a special 508 needs shelter, and shall indicate if the patient is receiving 509 skilled nursing services and the patient’s medication and 510 equipment needs. The list shall be furnished to county health 511 departments and to local emergency management agencies, upon 512 request. 513 (3) Home health agencies shall not be required to continue 514 to provide care to patients in emergency situations that are 515 beyond their control and that make it impossible to provide 516 services, such as when roads are impassable or when patients do 517 not go to the location specified in their patient records. Home 518 health agencies may establish links to local emergency 519 operations centers to determine a mechanism by which to approach 520 specific areas within a disaster area in order for the agency to 521 reach its clients. Home health agencies shall demonstrate a good 522 faith effort to comply with the requirements of this subsection 523 by documenting attempts of staff to follow procedures outlined 524 in the home health agency’s comprehensive emergency management 525 plan, and by the patient’s record, which support a finding that 526 the provision of continuing care has been attempted for those 527 patients who have been identified as needing care by the home 528 health agency and registered under s. 252.355, in the event of 529 an emergency or disaster under subsection (1). 530 (4) Notwithstanding the provisions of s. 400.464(2) or any 531 other provision of law to the contrary, a home health agency may 532 provide services in a special needs shelter located in any 533 county. 534 Section 12. Subsection (4) and paragraph (a) of subsection 535 (5) of section 400.506, Florida Statutes, are amended to read: 536 400.506 Licensure of nurse registries; requirements; 537 penalties.— 538 (4) A licensee whoperson thatprovides, offers, or 539 advertises to the public any service for which licensure is 540 required under this section must include in such advertisement 541 the license number issued to the licenseeitby the Agency for 542 Health Care Administration. The agency shall assess a fine of 543 not less than $100 against any licensee who fails to include the 544 license number when submitting the advertisement for 545 publication, broadcast, or printing. The fine for a second or 546 subsequent offense is $500. 547 (5)(a) In addition to the requirements of s. 408.812, any 548 person or entity thatwhoowns, operates, or maintains an 549 unlicensed nurse registry and who, after receiving notification 550 from the agency, fails to cease operation and apply for a 551 license under this part commits a misdemeanor of the second 552 degree, punishable as provided in s. 775.082 or s. 775.083. Each 553 day of continued operation is a separate offense. 554 Section 13. Subsections (1), (2), (4), and (5) of section 555 400.509, Florida Statutes, are amended to read: 556 400.509 Registration of particular service providers exempt 557 from licensure; certificate of registration; regulation of 558 registrants.— 559 (1) Any person whoorganizationthatprovides companion 560 services or homemaker services and does not provide a home 561 health service to a person is exempt from licensure under this 562 part. However, any person whoorganizationthatprovides 563 companion services or homemaker services must register with the 564 agency. A personAn organizationunder contract with the Agency 565 for Persons with Disabilities whowhichprovides companion 566 services only for persons with a developmental disability, as 567 defined in s. 393.063, is exempt from registration. 568 (2) The requirements of part II of chapter 408 apply to the 569 provision of services that require registration or licensure 570 pursuant to this section and part II of chapter 408 and entities 571 registered by or applying for such registration from the Agency 572 for Health Care Administration pursuant to this section. Each 573 applicant for registration and each registrant must comply with 574 all provisions of part II of chapter 408. Registration or a 575 license issued by the agency is required for a person to provide 576the operation of an organization that providescompanion 577 services or homemaker services. 578 (4) Each registrant must obtain the employment or contract 579 history of persons who are employed by or under contract with 580 the personorganizationand who will have contact at any time 581 with patients or clients in their homes by: 582 (a) Requiring such persons to submit an employment or 583 contractual history to the registrant; and 584 (b) Verifying the employment or contractual history, unless 585 through diligent efforts such verification is not possible. The 586 agency shall prescribe by rule the minimum requirements for 587 establishing that diligent efforts have been made. 588 589 There is no monetary liability on the part of, and no cause of 590 action for damages arises against, a former employer of a 591 prospective employee of or prospective independent contractor 592 with a registrant who reasonably and in good faith communicates 593 his or her honest opinions about the former employee’s or 594 contractor’s job performance. This subsection does not affect 595 the official immunity of an officer or employee of a public 596 corporation. 597 (5) A person whothatoffers or advertises to the public a 598 service for which registration is required must include in its 599 advertisement the registration number issued by the Agency for 600 Health Care Administration. 601 Section 14. Subsection (3) of section 400.605, Florida 602 Statutes, is amended to read: 603 400.605 Administration; forms; fees; rules; inspections; 604 fines.— 605 (3) In accordance with s. 408.811, the agency shall conduct 606annual inspections of all licensees, except that licensure607inspections may be conducted biennially for hospices having a 3608year record of substantial compliance. The agency shall conduct609 such inspections and investigations as are necessary in order to 610 determine the state of compliance withthe provisions ofthis 611 part, part II of chapter 408, and applicable rules. 612 Section 15. Section 400.60501, Florida Statutes, is amended 613 to read: 614 400.60501 Outcome measures; adoption of federal quality 615 measures; public reporting; annual report.— 616 (1)No later than December 31, 2019,The agency shall adopt 617 the national hospice outcome measures and survey data in 42 618 C.F.R. part 418 to determine the quality and effectiveness of 619 hospice care for hospices licensed in the state. 620 (2) The agency shall:621(a)make available to the public the national hospice 622 outcome measures and survey data in a format that is 623 comprehensible by a layperson and that allows a consumer to 624 compare such measures of one or more hospices. 625(b)Develop an annual report that analyzes and evaluates626the information collected under this act and any other data627collection or reporting provisions of law.628 Section 16. Subsection (4) of section 400.9905, Florida 629 Statutes, is amended to read: 630 400.9905 Definitions.— 631 (4) “Clinic” means an entity where health care services are 632 provided to individuals and which tenders charges for 633 reimbursement for such services, including a mobile clinic and a 634 portable equipment provider. As used in this part, the term does 635 not include and the licensure requirements of this part do not 636 apply to: 637 (a) Entities licensed or registered by the state under 638 chapter 395; entities licensed or registered by the state and 639 providing only health care services within the scope of services 640 authorized under their respective licenses under ss. 383.30 641 383.332, chapter 390, chapter 394, chapter 397, this chapter 642 except part X, chapter 429, chapter 463, chapter 465, chapter 643 466, chapter 478, chapter 484, or chapter 651; end-stage renal 644 disease providers authorized under 42 C.F.R. part 405, subpart 645 U; providers certified and providing only health care services 646 within the scope of services authorized under their respective 647 certifications under 42 C.F.R. part 485, subpart B,orsubpart 648 H, or subpart J; providers certified and providing only health 649 care services within the scope of services authorized under 650 their respective certifications under 42 C.F.R. part 486, 651 subpart C; providers certified and providing only health care 652 services within the scope of services authorized under their 653 respective certifications under 42 C.F.R. part 491, subpart A; 654 providers certified by the Centers for Medicare and Medicaid 655 Services under the federal Clinical Laboratory Improvement 656 Amendments and the federal rules adopted thereunder; or any 657 entity that provides neonatal or pediatric hospital-based health 658 care services or other health care services by licensed 659 practitioners solely within a hospital licensed under chapter 660 395. 661 (b) Entities that own, directly or indirectly, entities 662 licensed or registered by the state pursuant to chapter 395; 663 entities that own, directly or indirectly, entities licensed or 664 registered by the state and providing only health care services 665 within the scope of services authorized pursuant to their 666 respective licenses under ss. 383.30-383.332, chapter 390, 667 chapter 394, chapter 397, this chapter except part X, chapter 668 429, chapter 463, chapter 465, chapter 466, chapter 478, chapter 669 484, or chapter 651; end-stage renal disease providers 670 authorized under 42 C.F.R. part 405, subpart U; providers 671 certified and providing only health care services within the 672 scope of services authorized under their respective 673 certifications under 42 C.F.R. part 485, subpart B,orsubpart 674 H, or subpart J; providers certified and providing only health 675 care services within the scope of services authorized under 676 their respective certifications under 42 C.F.R. part 486, 677 subpart C; providers certified and providing only health care 678 services within the scope of services authorized under their 679 respective certifications under 42 C.F.R. part 491, subpart A; 680 providers certified by the Centers for Medicare and Medicaid 681 Services under the federal Clinical Laboratory Improvement 682 Amendments and the federal rules adopted thereunder; or any 683 entity that provides neonatal or pediatric hospital-based health 684 care services by licensed practitioners solely within a hospital 685 licensed under chapter 395. 686 (c) Entities that are owned, directly or indirectly, by an 687 entity licensed or registered by the state pursuant to chapter 688 395; entities that are owned, directly or indirectly, by an 689 entity licensed or registered by the state and providing only 690 health care services within the scope of services authorized 691 pursuant to their respective licenses under ss. 383.30-383.332, 692 chapter 390, chapter 394, chapter 397, this chapter except part 693 X, chapter 429, chapter 463, chapter 465, chapter 466, chapter 694 478, chapter 484, or chapter 651; end-stage renal disease 695 providers authorized under 42 C.F.R. part 405, subpart U; 696 providers certified and providing only health care services 697 within the scope of services authorized under their respective 698 certifications under 42 C.F.R. part 485, subpart B,orsubpart 699 H, or subpart J; providers certified and providing only health 700 care services within the scope of services authorized under 701 their respective certifications under 42 C.F.R. part 486, 702 subpart C; providers certified and providing only health care 703 services within the scope of services authorized under their 704 respective certifications under 42 C.F.R. part 491, subpart A; 705 providers certified by the Centers for Medicare and Medicaid 706 Services under the federal Clinical Laboratory Improvement 707 Amendments and the federal rules adopted thereunder; or any 708 entity that provides neonatal or pediatric hospital-based health 709 care services by licensed practitioners solely within a hospital 710 under chapter 395. 711 (d) Entities that are under common ownership, directly or 712 indirectly, with an entity licensed or registered by the state 713 pursuant to chapter 395; entities that are under common 714 ownership, directly or indirectly, with an entity licensed or 715 registered by the state and providing only health care services 716 within the scope of services authorized pursuant to their 717 respective licenses under ss. 383.30-383.332, chapter 390, 718 chapter 394, chapter 397, this chapter except part X, chapter 719 429, chapter 463, chapter 465, chapter 466, chapter 478, chapter 720 484, or chapter 651; end-stage renal disease providers 721 authorized under 42 C.F.R. part 405, subpart U; providers 722 certified and providing only health care services within the 723 scope of services authorized under their respective 724 certifications under 42 C.F.R. part 485, subpart B,orsubpart 725 H, or subpart J; providers certified and providing only health 726 care services within the scope of services authorized under 727 their respective certifications under 42 C.F.R. part 486, 728 subpart C; providers certified and providing only health care 729 services within the scope of services authorized under their 730 respective certifications under 42 C.F.R. part 491, subpart A; 731 providers certified by the Centers for Medicare and Medicaid 732 Services under the federal Clinical Laboratory Improvement 733 Amendments and the federal rules adopted thereunder; or any 734 entity that provides neonatal or pediatric hospital-based health 735 care services by licensed practitioners solely within a hospital 736 licensed under chapter 395. 737 (e) An entity that is exempt from federal taxation under 26 738 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan 739 under 26 U.S.C. s. 409 that has a board of trustees at least 740 two-thirds of which are Florida-licensed health care 741 practitioners and provides only physical therapy services under 742 physician orders, any community college or university clinic, 743 and any entity owned or operated by the federal or state 744 government, including agencies, subdivisions, or municipalities 745 thereof. 746 (f) A sole proprietorship, group practice, partnership, or 747 corporation that provides health care services by physicians 748 covered by s. 627.419, that is directly supervised by one or 749 more of such physicians, and that is wholly owned by one or more 750 of those physicians or by a physician and the spouse, parent, 751 child, or sibling of that physician. 752 (g) A sole proprietorship, group practice, partnership, or 753 corporation that provides health care services by licensed 754 health care practitioners under chapter 457, chapter 458, 755 chapter 459, chapter 460, chapter 461, chapter 462, chapter 463, 756 chapter 466, chapter 467, chapter 480, chapter 484, chapter 486, 757 chapter 490, chapter 491, or part I, part III, part X, part 758 XIII, or part XIV of chapter 468, or s. 464.012, and that is 759 wholly owned by one or more licensed health care practitioners, 760 or the licensed health care practitioners set forth in this 761 paragraph and the spouse, parent, child, or sibling of a 762 licensed health care practitioner if one of the owners who is a 763 licensed health care practitioner is supervising the business 764 activities and is legally responsible for the entity’s 765 compliance with all federal and state laws. However, a health 766 care practitioner may not supervise services beyond the scope of 767 the practitioner’s license, except that, for the purposes of 768 this part, a clinic owned by a licensee in s. 456.053(3)(b) 769 which provides only services authorized pursuant to s. 770 456.053(3)(b) may be supervised by a licensee specified in s. 771 456.053(3)(b). 772 (h) Clinical facilities affiliated with an accredited 773 medical school at which training is provided for medical 774 students, residents, or fellows. 775 (i) Entities that provide only oncology or radiation 776 therapy services by physicians licensed under chapter 458 or 777 chapter 459 or entities that provide oncology or radiation 778 therapy services by physicians licensed under chapter 458 or 779 chapter 459 which are owned by a corporation whose shares are 780 publicly traded on a recognized stock exchange. 781 (j) Clinical facilities affiliated with a college of 782 chiropractic accredited by the Council on Chiropractic Education 783 at which training is provided for chiropractic students. 784 (k) Entities that provide licensed practitioners to staff 785 emergency departments or to deliver anesthesia services in 786 facilities licensed under chapter 395 and that derive at least 787 90 percent of their gross annual revenues from the provision of 788 such services. Entities claiming an exemption from licensure 789 under this paragraph must provide documentation demonstrating 790 compliance. 791 (l) Orthotic, prosthetic, pediatric cardiology, or 792 perinatology clinical facilities or anesthesia clinical 793 facilities that are not otherwise exempt under paragraph (a) or 794 paragraph (k) and that are a publicly traded corporation or are 795 wholly owned, directly or indirectly, by a publicly traded 796 corporation. As used in this paragraph, a publicly traded 797 corporation is a corporation that issues securities traded on an 798 exchange registered with the United States Securities and 799 Exchange Commission as a national securities exchange. 800 (m) Entities that are owned by a corporation that has $250 801 million or more in total annual sales of health care services 802 provided by licensed health care practitioners where one or more 803 of the persons responsible for the operations of the entity is a 804 health care practitioner who is licensed in this state and who 805 is responsible for supervising the business activities of the 806 entity and is responsible for the entity’s compliance with state 807 law for purposes of this part. 808 (n) Entities that employ 50 or more licensed health care 809 practitioners licensed under chapter 458 or chapter 459 where 810 the billing for medical services is under a single tax 811 identification number. The application for exemption under this 812 subsection shall contain information that includes: the name, 813 residence, and business address and phone number of the entity 814 that owns the practice; a complete list of the names and contact 815 information of all the officers and directors of the 816 corporation; the name, residence address, business address, and 817 medical license number of each licensed Florida health care 818 practitioner employed by the entity; the corporate tax 819 identification number of the entity seeking an exemption; a 820 listing of health care services to be provided by the entity at 821 the health care clinics owned or operated by the entity and a 822 certified statement prepared by an independent certified public 823 accountant which states that the entity and the health care 824 clinics owned or operated by the entity have not received 825 payment for health care services under personal injury 826 protection insurance coverage for the preceding year. If the 827 agency determines that an entity which is exempt under this 828 subsection has received payments for medical services under 829 personal injury protection insurance coverage, the agency may 830 deny or revoke the exemption from licensure under this 831 subsection. 832 (o) Entities that are, directly or indirectly, under the 833 common ownership of or that are subject to common control by a 834 mutual insurance holding company, as defined in s. 628.703, with 835 an entity licensed or certified under chapter 627 or chapter 641 836 which has $1 billion or more in total annual sales in this 837 state. 838 (p) Entities that are owned by an entity that is a 839 behavioral health service provider in at least 5 states other 840 than Florida and that, together with its affiliates, has $90 841 million or more in total annual revenues associated with the 842 provision of behavioral health services and where one or more of 843 the persons responsible for the operations of the entity is a 844 health care practitioner who is licensed in this state and who 845 is responsible for supervising the business activities of the 846 entity and for the entity’s compliance with state law for 847 purposes of this part. 848 (q) Medicaid providers. 849 850 Notwithstanding this subsection, an entity shall be deemed a 851 clinic and must be licensed under this part in order to receive 852 reimbursement under the Florida Motor Vehicle No-Fault Law, ss. 853 627.730-627.7405, unless exempted under s. 627.736(5)(h). 854 Section 17. Paragraph (c) of subsection (3) of section 855 400.991, Florida Statutes, is amended to read: 856 400.991 License requirements; background screenings; 857 prohibitions.— 858 (3) In addition to the requirements of part II of chapter 859 408, the applicant must file with the application satisfactory 860 proof that the clinic is in compliance with this part and 861 applicable rules, including: 862 (c) Proof of financial ability to operate as required under 863 ss. 408.8065(1) and 408.810(8)s. 408.810(8). As an alternative864to submitting proof of financial ability to operate as required865under s. 408.810(8), the applicant may file a surety bond of at866least $500,000 which guarantees that the clinic will act in full867conformity with all legal requirements for operating a clinic,868payable to the agency. The agency may adopt rules to specify869related requirements for such surety bond. 870 Section 18. Paragraph (i) of subsection (1) of section 871 400.9935, Florida Statutes, is amended to read: 872 400.9935 Clinic responsibilities.— 873 (1) Each clinic shall appoint a medical director or clinic 874 director who shall agree in writing to accept legal 875 responsibility for the following activities on behalf of the 876 clinic. The medical director or the clinic director shall: 877 (i) Ensure that the clinic publishes a schedule of charges 878 for the medical services offered to patients. The schedule must 879 include the prices charged to an uninsured person paying for 880 such services by cash, check, credit card, or debit card. The 881 schedule may group services by price levels, listing services in 882 each price level. The schedule must be posted in a conspicuous 883 place in the reception area of any clinic that is antheurgent 884 care center as defined in s. 395.002(29)(b) and must include, 885 but is not limited to, the 50 services most frequently provided 886 by the clinic.The schedule may group services by three price887levels, listing services in each price level.The posting may be 888 a sign that must be at least 15 square feet in size or through 889 an electronic messaging board that is at least 3 square feet in 890 size. The failure of a clinic, including a clinic that is an 891 urgent care center, to publish and post a schedule of charges as 892 required by this section shall result in a fine of not more than 893 $1,000, per day, until the schedule is published and posted. 894 Section 19. Paragraph (a) of subsection (2) of section 895 408.033, Florida Statutes, is amended to read: 896 408.033 Local and state health planning.— 897 (2) FUNDING.— 898 (a) The Legislature intends that the cost of local health 899 councils be borne by assessments on selected health care 900 facilities subject to facility licensure by the Agency for 901 Health Care Administration, including abortion clinics, assisted 902 living facilities, ambulatory surgical centers, birth centers, 903 home health agencies, hospices, hospitals, intermediate care 904 facilities for the developmentally disabled, nursing homes, and 905 health care clinics,and multiphasic testing centersand by 906 assessments on organizations subject to certification by the 907 agency pursuant to chapter 641, part III, including health 908 maintenance organizations and prepaid health clinics. Fees 909 assessed may be collected prospectively at the time of licensure 910 renewal and prorated for the licensure period. 911 Section 20. Effective January 1, 2021, paragraph (l) is 912 added to subsection (3) of section 408.05, Florida Statutes, to 913 read: 914 408.05 Florida Center for Health Information and 915 Transparency.— 916 (3) HEALTH INFORMATION TRANSPARENCY.—In order to 917 disseminate and facilitate the availability of comparable and 918 uniform health information, the agency shall perform the 919 following functions: 920 (l) By July 1 of each year, publish a report identifying 921 the health care services with the most significant price 922 variation both statewide and regionally. 923 Section 21. Paragraph (a) of subsection (1) of section 924 408.061, Florida Statutes, is amended to read: 925 408.061 Data collection; uniform systems of financial 926 reporting; information relating to physician charges; 927 confidential information; immunity.— 928 (1) The agency shall require the submission by health care 929 facilities, health care providers, and health insurers of data 930 necessary to carry out the agency’s duties and to facilitate 931 transparency in health care pricing data and quality measures. 932 Specifications for data to be collected under this section shall 933 be developed by the agency and applicable contract vendors, with 934 the assistance of technical advisory panels including 935 representatives of affected entities, consumers, purchasers, and 936 such other interested parties as may be determined by the 937 agency. 938 (a) Data submitted by health care facilities, including the 939 facilities as defined in chapter 395, shall include, but are not 940 limited to,:case-mix data, patient admission and discharge 941 data, hospital emergency department data which shall include the 942 number of patients treated in the emergency department of a 943 licensed hospital reported by patient acuity level, data on 944 hospital-acquired infections as specified by rule, data on 945 complications as specified by rule, data on readmissions as 946 specified by rule, including patient-with patientand provider 947 specific identifiersincluded, actual charge data by diagnostic 948 groups or other bundled groupings as specified by rule, 949 financial data, accounting data, operating expenses, expenses 950 incurred for rendering services to patients who cannot or do not 951 pay, interest charges, depreciation expenses based on the 952 expected useful life of the property and equipment involved, and 953 demographic data. The agency shall adopt nationally recognized 954 risk adjustment methodologies or software consistent with the 955 standards of the Agency for Healthcare Research and Quality and 956 as selected by the agency for all data submitted as required by 957 this section. Data may be obtained from documents includingsuch958as, but not limited to,:leases, contracts, debt instruments, 959 itemized patient statements or bills, medical record abstracts, 960 and related diagnostic information.ReportedData elements shall 961 be reported electronically in accordance with the inpatient data 962 reporting instructions as prescribed by agency rule59E-7.012,963Florida Administrative Code. Data submitted shall be certified 964 by the chief executive officer or an appropriate and duly 965 authorized representative or employee of the licensed facility 966 that the information submitted is true and accurate. 967 Section 22. Subsection (4) of section 408.0611, Florida 968 Statutes, is amended to read: 969 408.0611 Electronic prescribing clearinghouse.— 970 (4) Pursuant to s. 408.061, the agency shall monitor the 971 implementation of electronic prescribing by health care 972 practitioners, health care facilities, and pharmacies.By973January 31 of each year,The agency shall report annually on its 974 website on the progress of implementation of electronic 975 prescribingto the Governor and the Legislature. Information 976 reported pursuant to this subsection mustshallinclude federal 977 and private sector electronic prescribing initiatives and, to 978 the extent that data is readily available from organizations 979 that operate electronic prescribing networks, the number of 980 health care practitioners using electronic prescribing and the 981 number of prescriptions electronically transmitted. 982 Section 23. Paragraphs (i) and (j) of subsection (1) of 983 section 408.062, Florida Statutes, are amended to read: 984 408.062 Research, analyses, studies, and reports.— 985 (1) The agency shall conduct research, analyses, and 986 studies relating to health care costs and access to and quality 987 of health care services as access and quality are affected by 988 changes in health care costs. Such research, analyses, and 989 studies shall include, but not be limited to: 990 (i) The use of emergency department services by patient 991 acuity leveland the implication of increasing hospital cost by992providing nonurgent care in emergency departments. The agency 993 shall annually publish on its website informationsubmit an994annual reportbased on this monitoring and assessmentto the995Governor, the Speaker of the House of Representatives, the996President of the Senate, and the substantive legislative997committees, due January 1. 998 (j) The making available on its Internet website, and in a 999 hard-copy format upon request, of patient charge, volumes, 1000 length of stay, and performance indicators collected from health 1001 care facilities pursuant to s. 408.061(1)(a) for specific 1002 medical conditions, surgeries, and procedures provided in 1003 inpatient and outpatient facilities as determined by the agency. 1004 In making the determination of specific medical conditions, 1005 surgeries, and procedures to include, the agency shall consider 1006 such factors as volume, severity of the illness, urgency of 1007 admission, individual and societal costs, and whether the 1008 condition is acute or chronic. Performance outcome indicators 1009 shall be risk adjusted or severity adjusted, as applicable, 1010 using nationally recognized risk adjustment methodologies or 1011 software consistent with the standards of the Agency for 1012 Healthcare Research and Quality and as selected by the agency. 1013 The website shall also provide an interactive search that allows 1014 consumers to view and compare the information for specific 1015 facilities, a map that allows consumers to select a county or 1016 region, definitions of all of the data, descriptions of each 1017 procedure, and an explanation about why the data may differ from 1018 facility to facility. Such public data shall be updated 1019 quarterly. The agency shall annually publish on its website 1020 informationsubmit an annual status reporton the collection of 1021 data and publication of health care quality measuresto the1022Governor, the Speaker of the House of Representatives, the1023President of the Senate, and the substantive legislative1024committees, due January 1. 1025 Section 24. Subsection (5) of section 408.063, Florida 1026 Statutes, is amended to read: 1027 408.063 Dissemination of health care information.— 1028(5)The agency shall publish annually a comprehensive1029report of state health expenditures. The report shall identify:1030(a)The contribution of health care dollars made by all1031payors.1032(b)The dollars expended by type of health care service in1033Florida.1034 Section 25. Section 408.802, Florida Statutes, is amended 1035 to read: 1036 408.802 Applicability.—The provisions ofThis part applies 1037applyto the provision of services that require licensure as 1038 defined in this part and to the following entities licensed, 1039 registered, or certified by the agency, as described in chapters 1040 112, 383, 390, 394, 395, 400, 429, 440,483,and 765: 1041 (1) Laboratories authorized to perform testing under the 1042 Drug-Free Workplace Act, as provided under ss. 112.0455 and 1043 440.102. 1044 (2) Birth centers, as provided under chapter 383. 1045 (3) Abortion clinics, as provided under chapter 390. 1046 (4) Crisis stabilization units, as provided under parts I 1047 and IV of chapter 394. 1048 (5) Short-term residential treatment facilities, as 1049 provided under parts I and IV of chapter 394. 1050 (6) Residential treatment facilities, as provided under 1051 part IV of chapter 394. 1052 (7) Residential treatment centers for children and 1053 adolescents, as provided under part IV of chapter 394. 1054 (8) Hospitals, as provided under part I of chapter 395. 1055 (9) Ambulatory surgical centers, as provided under part I 1056 of chapter 395. 1057 (10) Nursing homes, as provided under part II of chapter 1058 400. 1059 (11) Assisted living facilities, as provided under part I 1060 of chapter 429. 1061 (12) Home health agencies, as provided under part III of 1062 chapter 400. 1063 (13) Nurse registries, as provided under part III of 1064 chapter 400. 1065 (14) Companion services or homemaker services providers, as 1066 provided under part III of chapter 400. 1067 (15) Adult day care centers, as provided under part III of 1068 chapter 429. 1069 (16) Hospices, as provided under part IV of chapter 400. 1070 (17) Adult family-care homes, as provided under part II of 1071 chapter 429. 1072 (18) Homes for special services, as provided under part V 1073 of chapter 400. 1074 (19) Transitional living facilities, as provided under part 1075 XI of chapter 400. 1076 (20) Prescribed pediatric extended care centers, as 1077 provided under part VI of chapter 400. 1078 (21) Home medical equipment providers, as provided under 1079 part VII of chapter 400. 1080 (22) Intermediate care facilities for persons with 1081 developmental disabilities, as provided under part VIII of 1082 chapter 400. 1083 (23) Health care services pools, as provided under part IX 1084 of chapter 400. 1085 (24) Health care clinics, as provided under part X of 1086 chapter 400. 1087(25)Multiphasic health testing centers, as provided under1088part I of chapter 483.1089 (25)(26)Organ, tissue, and eye procurement organizations, 1090 as provided under part V of chapter 765. 1091 Section 26. Present subsections (10) through (14) of 1092 section 408.803, Florida Statutes, are redesignated as 1093 subsections (11) through (15), respectively, a new subsection 1094 (10) is added to that section, and subsection (3) of that 1095 section is amended, to read: 1096 408.803 Definitions.—As used in this part, the term: 1097 (3) “Authorizing statute” means the statute authorizing the 1098 licensed operation of a provider listed in s. 408.802 and 1099 includes chapters 112, 383, 390, 394, 395, 400, 429, 440,483,1100 and 765. 1101 (10) “Low-risk provider” means nurse registries, home 1102 medical equipment providers, and health care clinics. 1103 Section 27. Paragraph (b) of subsection (7) of section 1104 408.806, Florida Statutes, is amended to read: 1105 408.806 License application process.— 1106 (7) 1107 (b) An initial inspection is not required for companion 1108 services or homemaker services providers,as provided under part 1109 III of chapter 400,orfor health care services pools,as 1110 provided under part IX of chapter 400, or for low-risk providers 1111 as provided under s. 408.811. 1112 Section 28. Subsection (2) of section 408.808, Florida 1113 Statutes, is amended to read: 1114 408.808 License categories.— 1115 (2) PROVISIONAL LICENSE.—An applicant against whom a 1116 proceeding denying or revoking a license is pending at the time 1117 of license renewal may be issued a provisional license effective 1118 until final action not subject to further appeal. A provisional 1119 license may also be issued to an applicant for initial licensure 1120 or an applicant applying for a change of ownership. A 1121 provisional license must be limited in duration to a specific 1122 period of time, up to 12 months, as determined by the agency. 1123 Section 29. Subsections (2) and (5) of section 408.809, 1124 Florida Statutes, are amended to read: 1125 408.809 Background screening; prohibited offenses.— 1126 (2) Every 5 years following his or her licensure, 1127 employment, or entry into a contract in a capacity that under 1128 subsection (1) would require level 2 background screening under 1129 chapter 435, each such person must submit to level 2 background 1130 rescreening as a condition of retaining such license or 1131 continuing in such employment or contractual status. For any 1132 such rescreening, the agency shall request the Department of Law 1133 Enforcement to forward the person’s fingerprints to the Federal 1134 Bureau of Investigation for a national criminal history record 1135 check unless the person’s fingerprints are enrolled in the 1136 Federal Bureau of Investigation’s national retained print arrest 1137 notification program. If the fingerprints of such a person are 1138 not retained by the Department of Law Enforcement under s. 1139 943.05(2)(g) and (h), the person must submit fingerprints 1140 electronically to the Department of Law Enforcement for state 1141 processing, and the Department of Law Enforcement shall forward 1142 the fingerprints to the Federal Bureau of Investigation for a 1143 national criminal history record check. The fingerprints shall 1144 be retained by the Department of Law Enforcement under s. 1145 943.05(2)(g) and (h) and enrolled in the national retained print 1146 arrest notification program when the Department of Law 1147 Enforcement begins participation in the program. The cost of the 1148 state and national criminal history records checks required by 1149 level 2 screening may be borne by the licensee or the person 1150 fingerprinted.Until a specified agency is fully implemented in1151the clearinghouse created under s. 435.12,The agency may accept 1152 as satisfying the requirements of this section proof of 1153 compliance with level 2 screening standards submitted within the 1154 previous 5 years to meet any provider or professional licensure 1155 requirements ofthe agency, the Department of Health, the1156Department of Elderly Affairs, the Agency for Persons with1157Disabilities, the Department of Children and Families, orthe 1158 Department of Financial Services for an applicant for a 1159 certificate of authority or provisional certificate of authority 1160 to operate a continuing care retirement community under chapter 1161 651, provided that: 1162 (a) The screening standards and disqualifying offenses for 1163 the prior screening are equivalent to those specified in s. 1164 435.04 and this section; 1165 (b) The person subject to screening has not had a break in 1166 service from a position that requires level 2 screening for more 1167 than 90 days; and 1168 (c) Such proof is accompanied, under penalty of perjury, by 1169 an attestation of compliance with chapter 435 and this section 1170 using forms provided by the agency. 1171(5) A person who serves as a controlling interest of, is1172employed by, or contracts with a licensee on July 31, 2010, who1173has been screened and qualified according to standards specified1174in s. 435.03 or s. 435.04 must be rescreened by July 31, 2015,1175in compliance with the following schedule. If, upon rescreening,1176such person has a disqualifying offense that was not a1177disqualifying offense at the time of the last screening, but is1178a current disqualifying offense and was committed before the1179last screening, he or she may apply for an exemption from the1180appropriate licensing agency and, if agreed to by the employer,1181may continue to perform his or her duties until the licensing1182agency renders a decision on the application for exemption if1183the person is eligible to apply for an exemption and the1184exemption request is received by the agency within 30 days after1185receipt of the rescreening results by the person. The1186rescreening schedule shall be:1187(a) Individuals for whom the last screening was conducted1188on or before December 31, 2004, must be rescreened by July 31,11892013.1190(b) Individuals for whom the last screening conducted was1191between January 1, 2005, and December 31, 2008, must be1192rescreened by July 31, 2014.1193(c) Individuals for whom the last screening conducted was1194between January 1, 2009, through July 31, 2011, must be1195rescreened by July 31, 2015.1196 Section 30. Subsection (1) of section 408.811, Florida 1197 Statutes, is amended to read: 1198 408.811 Right of inspection; copies; inspection reports; 1199 plan for correction of deficiencies.— 1200 (1) An authorized officer or employee of the agency may 1201 make or cause to be made any inspection or investigation deemed 1202 necessary by the agency to determine the state of compliance 1203 with this part, authorizing statutes, and applicable rules. The 1204 right of inspection extends to any business that the agency has 1205 reason to believe is being operated as a provider without a 1206 license, but inspection of any business suspected of being 1207 operated without the appropriate license may not be made without 1208 the permission of the owner or person in charge unless a warrant 1209 is first obtained from a circuit court. Any application for a 1210 license issued under this part, authorizing statutes, or 1211 applicable rules constitutes permission for an appropriate 1212 inspection to verify the information submitted on or in 1213 connection with the application. 1214 (a) All inspections shall be unannounced, except as 1215 specified in s. 408.806. 1216 (b) Inspections for relicensure shall be conducted 1217 biennially unless otherwise specified by this section, 1218 authorizing statutes, or applicable rules. 1219 (c) The agency may exempt a low-risk provider from 1220 licensure inspection if the provider or controlling interest has 1221 an excellent regulatory history with regard to deficiencies, 1222 sanctions, complaints, and other regulatory actions, as defined 1223 by rule. The agency shall continue to conduct unannounced 1224 licensure inspections for at least 10 percent of exempt low-risk 1225 providers to verify compliance. 1226 (d) The agency may adopt rules to waive a routine 1227 inspection, including inspection for relicensure, or allow for 1228 an extended period between relicensure inspections for specific 1229 providers based upon all of the following: 1230 1. A favorable regulatory history with regard to 1231 deficiencies, sanctions, complaints, and other regulatory 1232 measures. 1233 2. Outcome measures that demonstrate quality performance. 1234 3. Successful participation in a recognized quality 1235 assurance program. 1236 4. Accreditation status. 1237 5. Other measures reflective of quality and safety. 1238 6. The length of time between inspections. 1239 1240 The agency shall continue to conduct unannounced licensure 1241 inspections for at least 10 percent of providers that qualify 1242 for a waiver or extended period between relicensure inspections. 1243 (e) The agency maintains the authority to conduct an 1244 inspection of any provider at any time to determine regulatory 1245 compliance. 1246 Section 31. Subsection (24) of section 408.820, Florida 1247 Statutes, is amended to read: 1248 408.820 Exemptions.—Except as prescribed in authorizing 1249 statutes, the following exemptions shall apply to specified 1250 requirements of this part: 1251(24)Multiphasic health testing centers, as provided under1252part I of chapter 483, are exempt from s. 408.810(5)-(10).1253 Section 32. Subsections (1) and (2) of section 408.821, 1254 Florida Statutes, are amended to read: 1255 408.821 Emergency management planning; emergency 1256 operations; inactive license.— 1257 (1) A licensee required by authorizing statutes and agency 1258 rule to have a comprehensiveanemergency managementoperations1259 plan must designate a safety liaison to serve as the primary 1260 contact for emergency operations. Such licensee shall submit its 1261 comprehensive emergency management plan to the local emergency 1262 management agency, the county health department, or the 1263 Department of Health as follows: 1264 (a) Submit the plan within 30 days after initial licensure 1265 and change of ownership, and notify the agency within 30 days 1266 after submission of the plan. 1267 (b) Submit the plan annually and within 30 days after any 1268 significant modification, as defined by agency rule, to a 1269 previously approved plan. 1270 (c) Respond with necessary plan revisions within 30 days 1271 after notification that plan revisions are required. 1272 (d) Notify the agency within 30 days after approval of its 1273 plan by the local emergency management agency, county health 1274 department, or Department of Health. 1275 (2) An entity subject to this part may temporarily exceed 1276 its licensed capacity to act as a receiving provider in 1277 accordance with an approved comprehensive emergency management 1278operationsplan for up to 15 days. While in an overcapacity 1279 status, each provider must furnish or arrange for appropriate 1280 care and services to all clients. In addition, the agency may 1281 approve requests for overcapacity in excess of 15 days, which 1282 approvals may be based upon satisfactory justification and need 1283 as provided by the receiving and sending providers. 1284 Section 33. Subsection (3) of section 408.831, Florida 1285 Statutes, is amended to read: 1286 408.831 Denial, suspension, or revocation of a license, 1287 registration, certificate, or application.— 1288 (3) This section provides standards of enforcement 1289 applicable to all entities licensed or regulated by the Agency 1290 for Health Care Administration. This section controls over any 1291 conflicting provisions of chapters 39, 383, 390, 391, 394, 395, 1292 400, 408, 429, 468,483,and 765 or rules adopted pursuant to 1293 those chapters. 1294 Section 34. Section 408.832, Florida Statutes, is amended 1295 to read: 1296 408.832 Conflicts.—In case of conflict between the 1297 provisions of this part and the authorizing statutes governing 1298 the licensure of health care providers by the Agency for Health 1299 Care Administration found in s. 112.0455 and chapters 383, 390, 1300 394, 395, 400, 429, 440,483,and 765, the provisions of this 1301 part shall prevail. 1302 Section 35. Subsection (9) of section 408.909, Florida 1303 Statutes, is amended to read: 1304 408.909 Health flex plans.— 1305(9)PROGRAM EVALUATION.—The agency and the office shall1306evaluate the pilot program and its effect on the entities that1307seek approval as health flex plans, on the number of enrollees,1308and on the scope of the health care coverage offered under a1309health flex plan; shall provide an assessment of the health flex1310plans and their potential applicability in other settings; shall1311use health flex plans to gather more information to evaluate1312low-income consumer driven benefit packages; and shall, by1313January 15, 2016, and annually thereafter, jointly submit a1314report to the Governor, the President of the Senate, and the1315Speaker of the House of Representatives.1316 Section 36. Paragraph (d) of subsection (10) of section 1317 408.9091, Florida Statutes, is amended to read: 1318 408.9091 Cover Florida Health Care Access Program.— 1319 (10) PROGRAM EVALUATION.—The agency and the office shall: 1320(d)Jointly submit by March 1, annually, a report to the1321Governor, the President of the Senate, and the Speaker of the1322House of Representatives which provides the information1323specified in paragraphs (a)-(c) and recommendations relating to1324the successful implementation and administration of the program.1325 Section 37. Effective upon becoming a law, paragraph (a) of 1326 subsection (5) of section 409.905, Florida Statutes, is amended 1327 to read: 1328 409.905 Mandatory Medicaid services.—The agency may make 1329 payments for the following services, which are required of the 1330 state by Title XIX of the Social Security Act, furnished by 1331 Medicaid providers to recipients who are determined to be 1332 eligible on the dates on which the services were provided. Any 1333 service under this section shall be provided only when medically 1334 necessary and in accordance with state and federal law. 1335 Mandatory services rendered by providers in mobile units to 1336 Medicaid recipients may be restricted by the agency. Nothing in 1337 this section shall be construed to prevent or limit the agency 1338 from adjusting fees, reimbursement rates, lengths of stay, 1339 number of visits, number of services, or any other adjustments 1340 necessary to comply with the availability of moneys and any 1341 limitations or directions provided for in the General 1342 Appropriations Act or chapter 216. 1343 (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for 1344 all covered services provided for the medical care and treatment 1345 of a recipient who is admitted as an inpatient by a licensed 1346 physician or dentist to a hospital licensed under part I of 1347 chapter 395. However, the agency shall limit the payment for 1348 inpatient hospital services for a Medicaid recipient 21 years of 1349 age or older to 45 days or the number of days necessary to 1350 comply with the General Appropriations Act. 1351 (a)1. The agency may implement reimbursement and 1352 utilization management reforms in order to comply with any 1353 limitations or directions in the General Appropriations Act, 1354 which may include, but are not limited to: prior authorization 1355 for inpatient psychiatric days; prior authorization for 1356 nonemergency hospital inpatient admissions for individuals 21 1357 years of age and older; authorization of emergency and urgent 1358 care admissions within 24 hours after admission; enhanced 1359 utilization and concurrent review programs for highly utilized 1360 services; reduction or elimination of covered days of service; 1361 adjusting reimbursement ceilings for variable costs; adjusting 1362 reimbursement ceilings for fixed and property costs; and 1363 implementing target rates of increase. 1364 2. The agency may limit prior authorization for hospital 1365 inpatient services to selected diagnosis-related groups, based 1366 on an analysis of the cost and potential for unnecessary 1367 hospitalizations represented by certain diagnoses. Admissions 1368 for normal delivery and newborns are exempt from requirements 1369 for prior authorization. 1370 3. In implementing the provisions of this section related 1371 to prior authorization, the agency shall ensure that the process 1372 for authorization is accessible 24 hours per day, 7 days per 1373 week and authorization is automatically granted when not denied 1374 within 4 hours after the request. Authorization procedures must 1375 include steps for review of denials. 1376 4. Upon implementing the prior authorization program for 1377 hospital inpatient services, the agency shall discontinue its 1378 hospital retrospective review program. However, this 1379 subparagraph may not be construed to prevent the agency from 1380 conducting retrospective reviews under s. 409.913, including, 1381 but not limited to, reviews in which an overpayment is suspected 1382 due to a mistake or submission of an improper claim or for other 1383 reasons that do not rise to the level of fraud or abuse. 1384 Section 38. It is the intent of the Legislature that 1385 section 409.905(5)(a), Florida Statutes, as amended by this act, 1386 confirms and clarifies existing law. This section shall take 1387 effect upon becoming a law. 1388 Section 39. Subsection (8) of section 409.907, Florida 1389 Statutes, is amended to read: 1390 409.907 Medicaid provider agreements.—The agency may make 1391 payments for medical assistance and related services rendered to 1392 Medicaid recipients only to an individual or entity who has a 1393 provider agreement in effect with the agency, who is performing 1394 services or supplying goods in accordance with federal, state, 1395 and local law, and who agrees that no person shall, on the 1396 grounds of handicap, race, color, or national origin, or for any 1397 other reason, be subjected to discrimination under any program 1398 or activity for which the provider receives payment from the 1399 agency. 1400 (8)(a) A level 2 background screening pursuant to chapter 1401 435 must be conducted through the agency on each of the 1402 following: 1403 1. TheEachprovider, or each principal of the provider if 1404 the provider is a corporation, partnership, association, or 1405 other entity, seeking to participate in the Medicaid program1406must submit a complete set of his or her fingerprints to the1407agency for the purpose of conducting a criminal history record1408check. 1409 2. Principals of the provider, who include any officer, 1410 director, billing agent, managing employee, or affiliated 1411 person, or any partner or shareholder who has an ownership 1412 interest equal to 5 percent or more in the provider. However, 1413 for a hospital licensed under chapter 395 or a nursing home 1414 licensed under chapter 400, principals of the provider are those 1415 who meet the definition of a controlling interest under s. 1416 408.803. A director of a not-for-profit corporation or 1417 organization is not a principal for purposes of a background 1418 investigation required by this section if the director: serves 1419 solely in a voluntary capacity for the corporation or 1420 organization, does not regularly take part in the day-to-day 1421 operational decisions of the corporation or organization, 1422 receives no remuneration from the not-for-profit corporation or 1423 organization for his or her service on the board of directors, 1424 has no financial interest in the not-for-profit corporation or 1425 organization, and has no family members with a financial 1426 interest in the not-for-profit corporation or organization; and 1427 if the director submits an affidavit, under penalty of perjury, 1428 to this effect to the agency and the not-for-profit corporation 1429 or organization submits an affidavit, under penalty of perjury, 1430 to this effect to the agency as part of the corporation’s or 1431 organization’s Medicaid provider agreement application. 1432 3. Any person who participates or seeks to participate in 1433 the Florida Medicaid program by way of rendering services to 1434 Medicaid recipients or having direct access to Medicaid 1435 recipients, recipient living areas, or the financial, medical, 1436 or service records of a Medicaid recipient or who supervises the 1437 delivery of goods or services to a Medicaid recipient. This 1438 subparagraph does not impose additional screening requirements 1439 on any providers licensed under part II of chapter 408 or 1440 transportation service providers contracted with a 1441 transportation broker subject to this paragraph while 1442 administering the Medicaid transportation benefit. 1443 (b) Notwithstanding paragraph (a)the above, the agency may 1444 require a background check for any person reasonably suspected 1445 by the agency to have been convicted of a crime. 1446 (c)(a)Paragraph (a)This subsectiondoes not apply to: 1447 1. A unit of local government, except that requirements of 1448 this subsection apply to nongovernmental providers and entities 1449 contracting with the local government to provide Medicaid 1450 services. The actual cost of the state and national criminal 1451 history record checks must be borne by the nongovernmental 1452 provider or entity; or 1453 2. Any business that derives more than 50 percent of its 1454 revenue from the sale of goods to the final consumer, and the 1455 business or its controlling parent is required to file a form 1456 10-K or other similar statement with the Securities and Exchange 1457 Commission or has a net worth of $50 million or more. 1458 (d)(b)Background screening shall be conducted in 1459 accordance with chapter 435 and s. 408.809. The cost of the 1460 state and national criminal record check shall be borne by the 1461 provider. 1462 Section 40. Effective June 30, 2020, section 19 of chapter 1463 2019-116, Laws of Florida, is repealed. 1464 Section 41. Paragraph (a) of subsection (1) of section 1465 409.908, Florida Statutes, is amended, and subsection (23) of 1466 that section is reenacted, to read: 1467 409.908 Reimbursement of Medicaid providers.—Subject to 1468 specific appropriations, the agency shall reimburse Medicaid 1469 providers, in accordance with state and federal law, according 1470 to methodologies set forth in the rules of the agency and in 1471 policy manuals and handbooks incorporated by reference therein. 1472 These methodologies may include fee schedules, reimbursement 1473 methods based on cost reporting, negotiated fees, competitive 1474 bidding pursuant to s. 287.057, and other mechanisms the agency 1475 considers efficient and effective for purchasing services or 1476 goods on behalf of recipients. If a provider is reimbursed based 1477 on cost reporting and submits a cost report late and that cost 1478 report would have been used to set a lower reimbursement rate 1479 for a rate semester, then the provider’s rate for that semester 1480 shall be retroactively calculated using the new cost report, and 1481 full payment at the recalculated rate shall be effected 1482 retroactively. Medicare-granted extensions for filing cost 1483 reports, if applicable, shall also apply to Medicaid cost 1484 reports. Payment for Medicaid compensable services made on 1485 behalf of Medicaid eligible persons is subject to the 1486 availability of moneys and any limitations or directions 1487 provided for in the General Appropriations Act or chapter 216. 1488 Further, nothing in this section shall be construed to prevent 1489 or limit the agency from adjusting fees, reimbursement rates, 1490 lengths of stay, number of visits, or number of services, or 1491 making any other adjustments necessary to comply with the 1492 availability of moneys and any limitations or directions 1493 provided for in the General Appropriations Act, provided the 1494 adjustment is consistent with legislative intent. 1495 (1) Reimbursement to hospitals licensed under part I of 1496 chapter 395 must be made prospectively or on the basis of 1497 negotiation. 1498 (a) Reimbursement for inpatient care is limited as provided 1499 in s. 409.905(5), except as otherwise provided in this 1500 subsection. 1501 1. If authorized by the General Appropriations Act, the 1502 agency may modify reimbursement for specific types of services 1503 or diagnoses, recipient ages, and hospital provider types. 1504 2. The agency may establish an alternative methodology to 1505 the DRG-based prospective payment system to set reimbursement 1506 rates for: 1507 a. State-owned psychiatric hospitals. 1508 b. Newborn hearing screening services. 1509 c. Transplant services for which the agency has established 1510 a global fee. 1511 d. Recipients who have tuberculosis that is resistant to 1512 therapy who are in need of long-term, hospital-based treatment 1513 pursuant to s. 392.62. 1514e.Class III psychiatric hospitals.1515 3. The agency shall modify reimbursement according to other 1516 methodologies recognized in the General Appropriations Act. 1517 1518 The agency may receive funds from state entities, including, but 1519 not limited to, the Department of Health, local governments, and 1520 other local political subdivisions, for the purpose of making 1521 special exception payments, including federal matching funds, 1522 through the Medicaid inpatient reimbursement methodologies. 1523 Funds received for this purpose shall be separately accounted 1524 for and may not be commingled with other state or local funds in 1525 any manner. The agency may certify all local governmental funds 1526 used as state match under Title XIX of the Social Security Act, 1527 to the extent and in the manner authorized under the General 1528 Appropriations Act and pursuant to an agreement between the 1529 agency and the local governmental entity. In order for the 1530 agency to certify such local governmental funds, a local 1531 governmental entity must submit a final, executed letter of 1532 agreement to the agency, which must be received by October 1 of 1533 each fiscal year and provide the total amount of local 1534 governmental funds authorized by the entity for that fiscal year 1535 under this paragraph, paragraph (b), or the General 1536 Appropriations Act. The local governmental entity shall use a 1537 certification form prescribed by the agency. At a minimum, the 1538 certification form must identify the amount being certified and 1539 describe the relationship between the certifying local 1540 governmental entity and the local health care provider. The 1541 agency shall prepare an annual statement of impact which 1542 documents the specific activities undertaken during the previous 1543 fiscal year pursuant to this paragraph, to be submitted to the 1544 Legislature annually by January 1. 1545 (23)(a) The agency shall establish rates at a level that 1546 ensures no increase in statewide expenditures resulting from a 1547 change in unit costs for county health departments effective 1548 July 1, 2011. Reimbursement rates shall be as provided in the 1549 General Appropriations Act. 1550 (b)1. Base rate reimbursement for inpatient services under 1551 a diagnosis-related group payment methodology shall be provided 1552 in the General Appropriations Act. 1553 2. Base rate reimbursement for outpatient services under an 1554 enhanced ambulatory payment group methodology shall be provided 1555 in the General Appropriations Act. 1556 3. Prospective payment system reimbursement for nursing 1557 home services shall be as provided in subsection (2) and in the 1558 General Appropriations Act. 1559 Section 42. Section 409.913, Florida Statutes, is amended 1560 to read: 1561 409.913 Oversight of the integrity of the Medicaid 1562 program.—The agency shall operate a program to oversee the 1563 activities of Florida Medicaid recipients, and providers and 1564 their representatives, to ensure that fraudulent and abusive 1565 behavior and neglect of recipients occur to the minimum extent 1566 possible, and to recover overpayments and impose sanctions as 1567 appropriate. Each January 15January 1, the agency and the 1568 Medicaid Fraud Control Unit of the Department of Legal Affairs 1569 shall submit reportsa joint reportto the Legislature 1570 documenting the effectiveness of the state’s efforts to control 1571 Medicaid fraud and abuse and to recover Medicaid overpayments 1572 during the previous fiscal year. The report must describe the 1573 number of cases opened and investigated each year; the sources 1574 of the cases opened; the disposition of the cases closed each 1575 year; the amount of overpayments alleged in preliminary and 1576 final audit letters; the number and amount of fines or penalties 1577 imposed; any reductions in overpayment amounts negotiated in 1578 settlement agreements or by other means; the amount of final 1579 agency determinations of overpayments; the amount deducted from 1580 federal claiming as a result of overpayments; the amount of 1581 overpayments recovered each year; the amount of cost of 1582 investigation recovered each year; the average length of time to 1583 collect from the time the case was opened until the overpayment 1584 is paid in full; the amount determined as uncollectible and the 1585 portion of the uncollectible amount subsequently reclaimed from 1586 the Federal Government; the number of providers, by type, that 1587 are terminated from participation in the Medicaid program as a 1588 result of fraud and abuse; and all costs associated with 1589 discovering and prosecuting cases of Medicaid overpayments and 1590 making recoveries in such cases. The report must also document 1591 actions taken to prevent overpayments and the number of 1592 providers prevented from enrolling in or reenrolling in the 1593 Medicaid program as a result of documented Medicaid fraud and 1594 abuse and must include policy recommendations necessary to 1595 prevent or recover overpayments and changes necessary to prevent 1596 and detect Medicaid fraud. All policy recommendations in the 1597 report must include a detailed fiscal analysis, including, but 1598 not limited to, implementation costs, estimated savings to the 1599 Medicaid program, and the return on investment. The agency must 1600 submit the policy recommendations and fiscal analyses in the 1601 report to the appropriate estimating conference, pursuant to s. 1602 216.137, by February 15 of each year. The agency and the 1603 Medicaid Fraud Control Unit of the Department of Legal Affairs 1604 each must include detailed unit-specific performance standards, 1605 benchmarks, and metrics in the report, including projected cost 1606 savings to the state Medicaid program during the following 1607 fiscal year. 1608 (1) For the purposes of this section, the term: 1609 (a) “Abuse” means: 1610 1. Provider practices that are inconsistent with generally 1611 accepted business or medical practices and that result in an 1612 unnecessary cost to the Medicaid program or in reimbursement for 1613 goods or services that are not medically necessary or that fail 1614 to meet professionally recognized standards for health care. 1615 2. Recipient practices that result in unnecessary cost to 1616 the Medicaid program. 1617 (b) “Complaint” means an allegation that fraud, abuse, or 1618 an overpayment has occurred. 1619 (c) “Fraud” means an intentional deception or 1620 misrepresentation made by a person with the knowledge that the 1621 deception results in unauthorized benefit to herself or himself 1622 or another person. The term includes any act that constitutes 1623 fraud under applicable federal or state law. 1624 (d) “Medical necessity” or “medically necessary” means any 1625 goods or services necessary to palliate the effects of a 1626 terminal condition, or to prevent, diagnose, correct, cure, 1627 alleviate, or preclude deterioration of a condition that 1628 threatens life, causes pain or suffering, or results in illness 1629 or infirmity, which goods or services are provided in accordance 1630 with generally accepted standards of medical practice. For 1631 purposes of determining Medicaid reimbursement, the agency is 1632 the final arbiter of medical necessity. Determinations of 1633 medical necessity must be made by a licensed physician employed 1634 by or under contract with the agency and must be based upon 1635 information available at the time the goods or services are 1636 provided. 1637 (e) “Overpayment” includes any amount that is not 1638 authorized to be paid by the Medicaid program whether paid as a 1639 result of inaccurate or improper cost reporting, improper 1640 claiming, unacceptable practices, fraud, abuse, or mistake. 1641 (f) “Person” means any natural person, corporation, 1642 partnership, association, clinic, group, or other entity, 1643 whether or not such person is enrolled in the Medicaid program 1644 or is a provider of health care. 1645 (2) The agency shall conduct, or cause to be conducted by 1646 contract or otherwise, reviews, investigations, analyses, 1647 audits, or any combination thereof, to determine possible fraud, 1648 abuse, overpayment, or recipient neglect in the Medicaid program 1649 and shall report the findings of any overpayments in audit 1650 reports as appropriate. At least 5 percent of all audits shall 1651 be conducted on a random basis. As part of its ongoing fraud 1652 detection activities, the agency shall identify and monitor, by 1653 contract or otherwise, patterns of overutilization of Medicaid 1654 services based on state averages. The agency shall track 1655 Medicaid provider prescription and billing patterns and evaluate 1656 them against Medicaid medical necessity criteria and coverage 1657 and limitation guidelines adopted by rule. Medical necessity 1658 determination requires that service be consistent with symptoms 1659 or confirmed diagnosis of illness or injury under treatment and 1660 not in excess of the patient’s needs. The agency shall conduct 1661 reviews of provider exceptions to peer group norms and shall, 1662 using statistical methodologies, provider profiling, and 1663 analysis of billing patterns, detect and investigate abnormal or 1664 unusual increases in billing or payment of claims for Medicaid 1665 services and medically unnecessary provision of services. 1666 (3) The agency may conduct, or may contract for, prepayment 1667 review of provider claims to ensure cost-effective purchasing; 1668 to ensure that billing by a provider to the agency is in 1669 accordance with applicable provisions of all Medicaid rules, 1670 regulations, handbooks, and policies and in accordance with 1671 federal, state, and local law; and to ensure that appropriate 1672 care is rendered to Medicaid recipients. Such prepayment reviews 1673 may be conducted as determined appropriate by the agency, 1674 without any suspicion or allegation of fraud, abuse, or neglect, 1675 and may last for up to 1 year. Unless the agency has reliable 1676 evidence of fraud, misrepresentation, abuse, or neglect, claims 1677 shall be adjudicated for denial or payment within 90 days after 1678 receipt of complete documentation by the agency for review. If 1679 there is reliable evidence of fraud, misrepresentation, abuse, 1680 or neglect, claims shall be adjudicated for denial of payment 1681 within 180 days after receipt of complete documentation by the 1682 agency for review. 1683 (4) Any suspected criminal violation identified by the 1684 agency must be referred to the Medicaid Fraud Control Unit of 1685 the Office of the Attorney General for investigation. The agency 1686 and the Attorney General shall enter into a memorandum of 1687 understanding, which must include, but need not be limited to, a 1688 protocol for regularly sharing information and coordinating 1689 casework. The protocol must establish a procedure for the 1690 referral by the agency of cases involving suspected Medicaid 1691 fraud to the Medicaid Fraud Control Unit for investigation, and 1692 the return to the agency of those cases where investigation 1693 determines that administrative action by the agency is 1694 appropriate. Offices of the Medicaid program integrity program 1695 and the Medicaid Fraud Control Unit of the Department of Legal 1696 Affairs, shall, to the extent possible, be collocated. The 1697 agency and the Department of Legal Affairs shall periodically 1698 conduct joint training and other joint activities designed to 1699 increase communication and coordination in recovering 1700 overpayments. 1701 (5) A Medicaid provider is subject to having goods and 1702 services that are paid for by the Medicaid program reviewed by 1703 an appropriate peer-review organization designated by the 1704 agency. The written findings of the applicable peer-review 1705 organization are admissible in any court or administrative 1706 proceeding as evidence of medical necessity or the lack thereof. 1707 (6) Any notice required to be given to a provider under 1708 this section is presumed to be sufficient notice if sent to the 1709 address last shown on the provider enrollment file. It is the 1710 responsibility of the provider to furnish and keep the agency 1711 informed of the provider’s current address. United States Postal 1712 Service proof of mailing or certified or registered mailing of 1713 such notice to the provider at the address shown on the provider 1714 enrollment file constitutes sufficient proof of notice. Any 1715 notice required to be given to the agency by this section must 1716 be sent to the agency at an address designated by rule. 1717 (7) When presenting a claim for payment under the Medicaid 1718 program, a provider has an affirmative duty to supervise the 1719 provision of, and be responsible for, goods and services claimed 1720 to have been provided, to supervise and be responsible for 1721 preparation and submission of the claim, and to present a claim 1722 that is true and accurate and that is for goods and services 1723 that: 1724 (a) Have actually been furnished to the recipient by the 1725 provider prior to submitting the claim. 1726 (b) Are Medicaid-covered goods or services that are 1727 medically necessary. 1728 (c) Are of a quality comparable to those furnished to the 1729 general public by the provider’s peers. 1730 (d) Have not been billed in whole or in part to a recipient 1731 or a recipient’s responsible party, except for such copayments, 1732 coinsurance, or deductibles as are authorized by the agency. 1733 (e) Are provided in accord with applicable provisions of 1734 all Medicaid rules, regulations, handbooks, and policies and in 1735 accordance with federal, state, and local law. 1736 (f) Are documented by records made at the time the goods or 1737 services were provided, demonstrating the medical necessity for 1738 the goods or services rendered. Medicaid goods or services are 1739 excessive or not medically necessary unless both the medical 1740 basis and the specific need for them are fully and properly 1741 documented in the recipient’s medical record. 1742 1743 The agency shall deny payment or require repayment for goods or 1744 services that are not presented as required in this subsection. 1745 (8) The agency shall not reimburse any person or entity for 1746 any prescription for medications, medical supplies, or medical 1747 services if the prescription was written by a physician or other 1748 prescribing practitioner who is not enrolled in the Medicaid 1749 program. This section does not apply: 1750 (a) In instances involving bona fide emergency medical 1751 conditions as determined by the agency; 1752 (b) To a provider of medical services to a patient in a 1753 hospital emergency department, hospital inpatient or outpatient 1754 setting, or nursing home; 1755 (c) To bona fide pro bono services by preapproved non 1756 Medicaid providers as determined by the agency; 1757 (d) To prescribing physicians who are board-certified 1758 specialists treating Medicaid recipients referred for treatment 1759 by a treating physician who is enrolled in the Medicaid program; 1760 (e) To prescriptions written for dually eligible Medicare 1761 beneficiaries by an authorized Medicare provider who is not 1762 enrolled in the Medicaid program; or 1763 (f) To other physicians who are not enrolled in the 1764 Medicaid program but who provide a medically necessary service 1765 or prescription not otherwise reasonably available from a 1766 Medicaid-enrolled physician.; or1767 (9) A Medicaid provider shall retain medical, professional, 1768 financial, and business records pertaining to services and goods 1769 furnished to a Medicaid recipient and billed to Medicaid for a 1770 period of 5 years after the date of furnishing such services or 1771 goods. The agency may investigate, review, or analyze such 1772 records, which must be made available during normal business 1773 hours. However, 24-hour notice must be provided if patient 1774 treatment would be disrupted. The provider must keep the agency 1775 informed of the location of the provider’s Medicaid-related 1776 records. The authority of the agency to obtain Medicaid-related 1777 records from a provider is neither curtailed nor limited during 1778 a period of litigation between the agency and the provider. 1779 (10) Payments for the services of billing agents or persons 1780 participating in the preparation of a Medicaid claim shall not 1781 be based on amounts for which they bill nor based on the amount 1782 a provider receives from the Medicaid program. 1783 (11) The agency shall deny payment or require repayment for 1784 inappropriate, medically unnecessary, or excessive goods or 1785 services from the person furnishing them, the person under whose 1786 supervision they were furnished, or the person causing them to 1787 be furnished. 1788 (12) The complaint and all information obtained pursuant to 1789 an investigation of a Medicaid provider, or the authorized 1790 representative or agent of a provider, relating to an allegation 1791 of fraud, abuse, or neglect are confidential and exempt from the 1792 provisions of s. 119.07(1): 1793 (a) Until the agency takes final agency action with respect 1794 to the provider and requires repayment of any overpayment, or 1795 imposes an administrative sanction; 1796 (b) Until the Attorney General refers the case for criminal 1797 prosecution; 1798 (c) Until 10 days after the complaint is determined without 1799 merit; or 1800 (d) At all times if the complaint or information is 1801 otherwise protected by law. 1802 (13) The agency shall terminate participation of a Medicaid 1803 provider in the Medicaid program and may seek civil remedies or 1804 impose other administrative sanctions against a Medicaid 1805 provider, if the provider or any principal, officer, director, 1806 agent, managing employee, or affiliated person of the provider, 1807 or any partner or shareholder having an ownership interest in 1808 the provider equal to 5 percent or greater, has been convicted 1809 of a criminal offense under federal law or the law of any state 1810 relating to the practice of the provider’s profession, or a 1811 criminal offense listed under s. 408.809(4), s. 409.907(10), or 1812 s. 435.04(2). If the agency determines that the provider did not 1813 participate or acquiesce in the offense, termination will not be 1814 imposed. If the agency effects a termination under this 1815 subsection, the agency shall take final agency action. 1816 (14) If the provider has been suspended or terminated from 1817 participation in the Medicaid program or the Medicare program by 1818 the Federal Government or any state, the agency must immediately 1819 suspend or terminate, as appropriate, the provider’s 1820 participation in this state’s Medicaid program for a period no 1821 less than that imposed by the Federal Government or any other 1822 state, and may not enroll such provider in this state’s Medicaid 1823 program while such foreign suspension or termination remains in 1824 effect. The agency shall also immediately suspend or terminate, 1825 as appropriate, a provider’s participation in this state’s 1826 Medicaid program if the provider participated or acquiesced in 1827 any action for which any principal, officer, director, agent, 1828 managing employee, or affiliated person of the provider, or any 1829 partner or shareholder having an ownership interest in the 1830 provider equal to 5 percent or greater, was suspended or 1831 terminated from participating in the Medicaid program or the 1832 Medicare program by the Federal Government or any state. This 1833 sanction is in addition to all other remedies provided by law. 1834 (15) The agency shall seek a remedy provided by law, 1835 including, but not limited to, any remedy provided in 1836 subsections (13) and (16) and s. 812.035, if: 1837 (a) The provider’s license has not been renewed, or has 1838 been revoked, suspended, or terminated, for cause, by the 1839 licensing agency of any state; 1840 (b) The provider has failed to make available or has 1841 refused access to Medicaid-related records to an auditor, 1842 investigator, or other authorized employee or agent of the 1843 agency, the Attorney General, a state attorney, or the Federal 1844 Government; 1845 (c) The provider has not furnished or has failed to make 1846 available such Medicaid-related records as the agency has found 1847 necessary to determine whether Medicaid payments are or were due 1848 and the amounts thereof; 1849 (d) The provider has failed to maintain medical records 1850 made at the time of service, or prior to service if prior 1851 authorization is required, demonstrating the necessity and 1852 appropriateness of the goods or services rendered; 1853 (e) The provider is not in compliance with provisions of 1854 Medicaid provider publications that have been adopted by 1855 reference as rules in the Florida Administrative Code; with 1856 provisions of state or federal laws, rules, or regulations; with 1857 provisions of the provider agreement between the agency and the 1858 provider; or with certifications found on claim forms or on 1859 transmittal forms for electronically submitted claims that are 1860 submitted by the provider or authorized representative, as such 1861 provisions apply to the Medicaid program; 1862 (f) The provider or person who ordered, authorized, or 1863 prescribed the care, services, or supplies has furnished, or 1864 ordered or authorized the furnishing of, goods or services to a 1865 recipient which are inappropriate, unnecessary, excessive, or 1866 harmful to the recipient or are of inferior quality; 1867 (g) The provider has demonstrated a pattern of failure to 1868 provide goods or services that are medically necessary; 1869 (h) The provider or an authorized representative of the 1870 provider, or a person who ordered, authorized, or prescribed the 1871 goods or services, has submitted or caused to be submitted false 1872 or a pattern of erroneous Medicaid claims; 1873 (i) The provider or an authorized representative of the 1874 provider, or a person who has ordered, authorized, or prescribed 1875 the goods or services, has submitted or caused to be submitted a 1876 Medicaid provider enrollment application, a request for prior 1877 authorization for Medicaid services, a drug exception request, 1878 or a Medicaid cost report that contains materially false or 1879 incorrect information; 1880 (j) The provider or an authorized representative of the 1881 provider has collected from or billed a recipient or a 1882 recipient’s responsible party improperly for amounts that should 1883 not have been so collected or billed by reason of the provider’s 1884 billing the Medicaid program for the same service; 1885 (k) The provider or an authorized representative of the 1886 provider has included in a cost report costs that are not 1887 allowable under a Florida Title XIX reimbursement plan after the 1888 provider or authorized representative had been advised in an 1889 audit exit conference or audit report that the costs were not 1890 allowable; 1891 (l) The provider is charged by information or indictment 1892 with fraudulent billing practices or an offense referenced in 1893 subsection (13). The sanction applied for this reason is limited 1894 to suspension of the provider’s participation in the Medicaid 1895 program for the duration of the indictment unless the provider 1896 is found guilty pursuant to the information or indictment; 1897 (m) The provider or a person who ordered, authorized, or 1898 prescribed the goods or services is found liable for negligent 1899 practice resulting in death or injury to the provider’s patient; 1900 (n) The provider fails to demonstrate that it had available 1901 during a specific audit or review period sufficient quantities 1902 of goods, or sufficient time in the case of services, to support 1903 the provider’s billings to the Medicaid program; 1904 (o) The provider has failed to comply with the notice and 1905 reporting requirements of s. 409.907; 1906 (p) The agency has received reliable information of patient 1907 abuse or neglect or of any act prohibited by s. 409.920; or 1908 (q) The provider has failed to comply with an agreed-upon 1909 repayment schedule. 1910 1911 A provider is subject to sanctions for violations of this 1912 subsection as the result of actions or inactions of the 1913 provider, or actions or inactions of any principal, officer, 1914 director, agent, managing employee, or affiliated person of the 1915 provider, or any partner or shareholder having an ownership 1916 interest in the provider equal to 5 percent or greater, in which 1917 the provider participated or acquiesced. 1918 (16) The agency shall impose any of the following sanctions 1919 or disincentives on a provider or a person for any of the acts 1920 described in subsection (15): 1921 (a) Suspension for a specific period of time of not more 1922 than 1 year. Suspension precludes participation in the Medicaid 1923 program, which includes any action that results in a claim for 1924 payment to the Medicaid program for furnishing, supervising a 1925 person who is furnishing, or causing a person to furnish goods 1926 or services. 1927 (b) Termination for a specific period of time ranging from 1928 more than 1 year to 20 years. Termination precludes 1929 participation in the Medicaid program, which includes any action 1930 that results in a claim for payment to the Medicaid program for 1931 furnishing, supervising a person who is furnishing, or causing a 1932 person to furnish goods or services. 1933 (c) Imposition of a fine of up to $5,000 for each 1934 violation. Each day that an ongoing violation continues, such as 1935 refusing to furnish Medicaid-related records or refusing access 1936 to records, is considered a separate violation. Each instance of 1937 improper billing of a Medicaid recipient; each instance of 1938 including an unallowable cost on a hospital or nursing home 1939 Medicaid cost report after the provider or authorized 1940 representative has been advised in an audit exit conference or 1941 previous audit report of the cost unallowability; each instance 1942 of furnishing a Medicaid recipient goods or professional 1943 services that are inappropriate or of inferior quality as 1944 determined by competent peer judgment; each instance of 1945 knowingly submitting a materially false or erroneous Medicaid 1946 provider enrollment application, request for prior authorization 1947 for Medicaid services, drug exception request, or cost report; 1948 each instance of inappropriate prescribing of drugs for a 1949 Medicaid recipient as determined by competent peer judgment; and 1950 each false or erroneous Medicaid claim leading to an overpayment 1951 to a provider is considered a separate violation. 1952 (d) Immediate suspension, if the agency has received 1953 information of patient abuse or neglect or of any act prohibited 1954 by s. 409.920. Upon suspension, the agency must issue an 1955 immediate final order under s. 120.569(2)(n). 1956 (e) A fine, not to exceed $10,000, for a violation of 1957 paragraph (15)(i). 1958 (f) Imposition of liens against provider assets, including, 1959 but not limited to, financial assets and real property, not to 1960 exceed the amount of fines or recoveries sought, upon entry of 1961 an order determining that such moneys are due or recoverable. 1962 (g) Prepayment reviews of claims for a specified period of 1963 time. 1964 (h) Comprehensive followup reviews of providers every 6 1965 months to ensure that they are billing Medicaid correctly. 1966 (i) Corrective-action plans that remain in effect for up to 1967 3 years and that are monitored by the agency every 6 months 1968 while in effect. 1969 (j) Other remedies as permitted by law to effect the 1970 recovery of a fine or overpayment. 1971 1972 If a provider voluntarily relinquishes its Medicaid provider 1973 number or an associated license, or allows the associated 1974 licensure to expire after receiving written notice that the 1975 agency is conducting, or has conducted, an audit, survey, 1976 inspection, or investigation and that a sanction of suspension 1977 or termination will or would be imposed for noncompliance 1978 discovered as a result of the audit, survey, inspection, or 1979 investigation, the agency shall impose the sanction of 1980 termination for cause against the provider. The agency’s 1981 termination with cause is subject to hearing rights as may be 1982 provided under chapter 120. The Secretary of Health Care 1983 Administration may make a determination that imposition of a 1984 sanction or disincentive is not in the best interest of the 1985 Medicaid program, in which case a sanction or disincentive may 1986 not be imposed. 1987 (17) In determining the appropriate administrative sanction 1988 to be applied, or the duration of any suspension or termination, 1989 the agency shall consider: 1990 (a) The seriousness and extent of the violation or 1991 violations. 1992 (b) Any prior history of violations by the provider 1993 relating to the delivery of health care programs which resulted 1994 in either a criminal conviction or in administrative sanction or 1995 penalty. 1996 (c) Evidence of continued violation within the provider’s 1997 management control of Medicaid statutes, rules, regulations, or 1998 policies after written notification to the provider of improper 1999 practice or instance of violation. 2000 (d) The effect, if any, on the quality of medical care 2001 provided to Medicaid recipients as a result of the acts of the 2002 provider. 2003 (e) Any action by a licensing agency respecting the 2004 provider in any state in which the provider operates or has 2005 operated. 2006 (f) The apparent impact on access by recipients to Medicaid 2007 services if the provider is suspended or terminated, in the best 2008 judgment of the agency. 2009 2010 The agency shall document the basis for all sanctioning actions 2011 and recommendations. 2012 (18) The agency may take action to sanction, suspend, or 2013 terminate a particular provider working for a group provider, 2014 and may suspend or terminate Medicaid participation at a 2015 specific location, rather than or in addition to taking action 2016 against an entire group. 2017 (19) The agency shall establish a process for conducting 2018 followup reviews of a sampling of providers who have a history 2019 of overpayment under the Medicaid program. This process must 2020 consider the magnitude of previous fraud or abuse and the 2021 potential effect of continued fraud or abuse on Medicaid costs. 2022 (20) In making a determination of overpayment to a 2023 provider, the agency must use accepted and valid auditing, 2024 accounting, analytical, statistical, or peer-review methods, or 2025 combinations thereof. Appropriate statistical methods may 2026 include, but are not limited to, sampling and extension to the 2027 population, parametric and nonparametric statistics, tests of 2028 hypotheses, and other generally accepted statistical methods. 2029 Appropriate analytical methods may include, but are not limited 2030 to, reviews to determine variances between the quantities of 2031 products that a provider had on hand and available to be 2032 purveyed to Medicaid recipients during the review period and the 2033 quantities of the same products paid for by the Medicaid program 2034 for the same period, taking into appropriate consideration sales 2035 of the same products to non-Medicaid customers during the same 2036 period. In meeting its burden of proof in any administrative or 2037 court proceeding, the agency may introduce the results of such 2038 statistical methods as evidence of overpayment. 2039 (21) When making a determination that an overpayment has 2040 occurred, the agency shall prepare and issue an audit report to 2041 the provider showing the calculation of overpayments. The 2042 agency’s determination must be based solely upon information 2043 available to it before issuance of the audit report and, in the 2044 case of documentation obtained to substantiate claims for 2045 Medicaid reimbursement, based solely upon contemporaneous 2046 records. The agency may consider addenda or modifications to a 2047 note that was made contemporaneously with the patient care 2048 episode if the addenda or modifications are germane to the note. 2049 (22) The audit report, supported by agency work papers, 2050 showing an overpayment to a provider constitutes evidence of the 2051 overpayment. A provider may not present or elicit testimony on 2052 direct examination or cross-examination in any court or 2053 administrative proceeding, regarding the purchase or acquisition 2054 by any means of drugs, goods, or supplies; sales or divestment 2055 by any means of drugs, goods, or supplies; or inventory of 2056 drugs, goods, or supplies, unless such acquisition, sales, 2057 divestment, or inventory is documented by written invoices, 2058 written inventory records, or other competent written 2059 documentary evidence maintained in the normal course of the 2060 provider’s business. A provider may not present records to 2061 contest an overpayment or sanction unless such records are 2062 contemporaneous and, if requested during the audit process, were 2063 furnished to the agency or its agent upon request. This 2064 limitation does not apply to Medicaid cost report audits. This 2065 limitation does not preclude consideration by the agency of 2066 addenda or modifications to a note if the addenda or 2067 modifications are made before notification of the audit, the 2068 addenda or modifications are germane to the note, and the note 2069 was made contemporaneously with a patient care episode. 2070 Notwithstanding the applicable rules of discovery, all 2071 documentation to be offered as evidence at an administrative 2072 hearing on a Medicaid overpayment or an administrative sanction 2073 must be exchanged by all parties at least 14 days before the 2074 administrative hearing or be excluded from consideration. 2075 (23)(a) In an audit,orinvestigation, or enforcement 2076 action taken forofa violation committed by a provider which is 2077 conducted pursuant to this section, the agency is entitled to 2078 recover all investigative and,legal costs incurred as a result 2079 of such audit, investigation, or enforcement action. The costs 2080 associated with an investigation, audit, or enforcement action 2081 may include, but are not limited to, salaries and benefits of 2082 personnel, costs related to the time spent by an attorney and 2083 other personnel working on the case, and any other expenses 2084 incurred by the agency or contractor which are associated with 2085 the case, including any, andexpert witness costs and attorney 2086 fees incurred on behalf of the agency or contractor if the 2087 agency’s findings were not contested by the provider or, if 2088 contested, the agency ultimately prevailed. 2089 (b) The agency has the burden of documenting the costs, 2090 which include salaries and employee benefits and out-of-pocket 2091 expenses. The amount of costs that may be recovered must be 2092 reasonable in relation to the seriousness of the violation and 2093 must be set taking into consideration the financial resources, 2094 earning ability, and needs of the provider, who has the burden 2095 of demonstrating such factors. 2096 (c) The provider may pay the costs over a period to be 2097 determined by the agency if the agency determines that an 2098 extreme hardship would result to the provider from immediate 2099 full payment. Any default in payment of costs may be collected 2100 by any means authorized by law. 2101 (24) If the agency imposes an administrative sanction 2102 pursuant to subsection (13), subsection (14), or subsection 2103 (15), except paragraphs (15)(e) and (o), upon any provider or 2104 any principal, officer, director, agent, managing employee, or 2105 affiliated person of the provider who is regulated by another 2106 state entity, the agency shall notify that other entity of the 2107 imposition of the sanction within 5 business days. Such 2108 notification must include the provider’s or person’s name and 2109 license number and the specific reasons for sanction. 2110 (25)(a) The agency shall withhold Medicaid payments, in 2111 whole or in part, to a provider upon receipt of reliable 2112 evidence that the circumstances giving rise to the need for a 2113 withholding of payments involve fraud, willful 2114 misrepresentation, or abuse under the Medicaid program, or a 2115 crime committed while rendering goods or services to Medicaid 2116 recipients. If it is determined that fraud, willful 2117 misrepresentation, abuse, or a crime did not occur, the payments 2118 withheld must be paid to the provider within 14 days after such 2119 determination. Amounts not paid within 14 days accrue interest 2120 at the rate of 10 percent per year, beginning after the 14th 2121 day. 2122 (b) The agency shall deny payment, or require repayment, if 2123 the goods or services were furnished, supervised, or caused to 2124 be furnished by a person who has been suspended or terminated 2125 from the Medicaid program or Medicare program by the Federal 2126 Government or any state. 2127 (c) Overpayments owed to the agency bear interest at the 2128 rate of 10 percent per year from the date of final determination 2129 of the overpayment by the agency, and payment arrangements must 2130 be made within 30 days after the date of the final order, which 2131 is not subject to further appeal. 2132 (d) The agency, upon entry of a final agency order, a 2133 judgment or order of a court of competent jurisdiction, or a 2134 stipulation or settlement, may collect the moneys owed by all 2135 means allowable by law, including, but not limited to, notifying 2136 any fiscal intermediary of Medicare benefits that the state has 2137 a superior right of payment. Upon receipt of such written 2138 notification, the Medicare fiscal intermediary shall remit to 2139 the state the sum claimed. 2140 (e) The agency may institute amnesty programs to allow 2141 Medicaid providers the opportunity to voluntarily repay 2142 overpayments. The agency may adopt rules to administer such 2143 programs. 2144 (26) The agency may impose administrative sanctions against 2145 a Medicaid recipient, or the agency may seek any other remedy 2146 provided by law, including, but not limited to, the remedies 2147 provided in s. 812.035, if the agency finds that a recipient has 2148 engaged in solicitation in violation of s. 409.920 or that the 2149 recipient has otherwise abused the Medicaid program. 2150 (27) When the Agency for Health Care Administration has 2151 made a probable cause determination and alleged that an 2152 overpayment to a Medicaid provider has occurred, the agency, 2153 after notice to the provider, shall: 2154 (a) Withhold, and continue to withhold during the pendency 2155 of an administrative hearing pursuant to chapter 120, any 2156 medical assistance reimbursement payments until such time as the 2157 overpayment is recovered, unless within 30 days after receiving 2158 notice thereof the provider: 2159 1. Makes repayment in full; or 2160 2. Establishes a repayment plan that is satisfactory to the 2161 Agency for Health Care Administration. 2162 (b) Withhold, and continue to withhold during the pendency 2163 of an administrative hearing pursuant to chapter 120, medical 2164 assistance reimbursement payments if the terms of a repayment 2165 plan are not adhered to by the provider. 2166 (28) Venue for all Medicaid program integrity cases lies in 2167 Leon County, at the discretion of the agency. 2168 (29) Notwithstanding other provisions of law, the agency 2169 and the Medicaid Fraud Control Unit of the Department of Legal 2170 Affairs may review a provider’s Medicaid-related and non 2171 Medicaid-related records in order to determine the total output 2172 of a provider’s practice to reconcile quantities of goods or 2173 services billed to Medicaid with quantities of goods or services 2174 used in the provider’s total practice. 2175 (30) The agency shall terminate a provider’s participation 2176 in the Medicaid program if the provider fails to reimburse an 2177 overpayment or pay an agency-imposed fine that has been 2178 determined by final order, not subject to further appeal, within 2179 30 days after the date of the final order, unless the provider 2180 and the agency have entered into a repayment agreement. 2181 (31) If a provider requests an administrative hearing 2182 pursuant to chapter 120, such hearing must be conducted within 2183 90 days following assignment of an administrative law judge, 2184 absent exceptionally good cause shown as determined by the 2185 administrative law judge or hearing officer. Upon issuance of a 2186 final order, the outstanding balance of the amount determined to 2187 constitute the overpayment and fines is due. If a provider fails 2188 to make payments in full, fails to enter into a satisfactory 2189 repayment plan, or fails to comply with the terms of a repayment 2190 plan or settlement agreement, the agency shall withhold 2191 reimbursement payments for Medicaid services until the amount 2192 due is paid in full. 2193 (32) Duly authorized agents and employees of the agency 2194 shall have the power to inspect, during normal business hours, 2195 the records of any pharmacy, wholesale establishment, or 2196 manufacturer, or any other place in which drugs and medical 2197 supplies are manufactured, packed, packaged, made, stored, sold, 2198 or kept for sale, for the purpose of verifying the amount of 2199 drugs and medical supplies ordered, delivered, or purchased by a 2200 provider. The agency shall provide at least 2 business days’ 2201 prior notice of any such inspection. The notice must identify 2202 the provider whose records will be inspected, and the inspection 2203 shall include only records specifically related to that 2204 provider. 2205 (33) In accordance with federal law, Medicaid recipients 2206 convicted of a crime pursuant to 42 U.S.C. s. 1320a-7b may be 2207 limited, restricted, or suspended from Medicaid eligibility for 2208 a period not to exceed 1 year, as determined by the agency head 2209 or designee. 2210 (34) To deter fraud and abuse in the Medicaid program, the 2211 agency may limit the number of Schedule II and Schedule III 2212 refill prescription claims submitted from a pharmacy provider. 2213 The agency shall limit the allowable amount of reimbursement of 2214 prescription refill claims for Schedule II and Schedule III 2215 pharmaceuticals if the agency or the Medicaid Fraud Control Unit 2216 determines that the specific prescription refill was not 2217 requested by the Medicaid recipient or authorized representative 2218 for whom the refill claim is submitted or was not prescribed by 2219 the recipient’s medical provider or physician. Any such refill 2220 request must be consistent with the original prescription. 2221 (35) The Office of Program Policy Analysis and Government 2222 Accountability shall provide a report to the President of the 2223 Senate and the Speaker of the House of Representatives on a 2224 biennial basis, beginning January 31, 2006, on the agency’s 2225 efforts to prevent, detect, and deter, as well as recover funds 2226 lost to, fraud and abuse in the Medicaid program. 2227 (36) The agency may provide to a sample of Medicaid 2228 recipients or their representatives through the distribution of 2229 explanations of benefits information about services reimbursed 2230 by the Medicaid program for goods and services to such 2231 recipients, including information on how to report inappropriate 2232 or incorrect billing to the agency or other law enforcement 2233 entities for review or investigation, information on how to 2234 report criminal Medicaid fraud to the Medicaid Fraud Control 2235 Unit’s toll-free hotline number, and information about the 2236 rewards available under s. 409.9203. The explanation of benefits 2237 may not be mailed for Medicaid independent laboratory services 2238 as described in s. 409.905(7) or for Medicaid certified match 2239 services as described in ss. 409.9071 and 1011.70. 2240 (37) The agency shall post on its website a current list of 2241 each Medicaid provider, including any principal, officer, 2242 director, agent, managing employee, or affiliated person of the 2243 provider, or any partner or shareholder having an ownership 2244 interest in the provider equal to 5 percent or greater, who has 2245 been terminated for cause from the Medicaid program or 2246 sanctioned under this section. The list must be searchable by a 2247 variety of search parameters and provide for the creation of 2248 formatted lists that may be printed or imported into other 2249 applications, including spreadsheets. The agency shall update 2250 the list at least monthly. 2251 (38) In order to improve the detection of health care 2252 fraud, use technology to prevent and detect fraud, and maximize 2253 the electronic exchange of health care fraud information, the 2254 agency shall: 2255 (a) Compile, maintain, and publish on its website a 2256 detailed list of all state and federal databases that contain 2257 health care fraud information and update the list at least 2258 biannually; 2259 (b) Develop a strategic plan to connect all databases that 2260 contain health care fraud information to facilitate the 2261 electronic exchange of health information between the agency, 2262 the Department of Health, the Department of Law Enforcement, and 2263 the Attorney General’s Office. The plan must include recommended 2264 standard data formats, fraud identification strategies, and 2265 specifications for the technical interface between state and 2266 federal health care fraud databases; 2267 (c) Monitor innovations in health information technology, 2268 specifically as it pertains to Medicaid fraud prevention and 2269 detection; and 2270 (d) Periodically publish policy briefs that highlight 2271 available new technology to prevent or detect health care fraud 2272 and projects implemented by other states, the private sector, or 2273 the Federal Government which use technology to prevent or detect 2274 health care fraud. 2275 Section 43. Paragraph (a) of subsection (2) of section 2276 409.920, Florida Statutes, is amended to read: 2277 409.920 Medicaid provider fraud.— 2278 (2)(a) A person may not: 2279 1. Knowingly make, cause to be made, or aid and abet in the 2280 making of any false statement or false representation of a 2281 material fact, by commission or omission, in any claim submitted 2282 to the agency or its fiscal agent or a managed care plan for 2283 payment. 2284 2. Knowingly make, cause to be made, or aid and abet in the 2285 making of a claim for items or services that are not authorized 2286 to be reimbursed by the Medicaid program. 2287 3. Knowingly charge, solicit, accept, or receive anything 2288 of value, other than an authorized copayment from a Medicaid 2289 recipient, from any source in addition to the amount legally 2290 payable for an item or service provided to a Medicaid recipient 2291 under the Medicaid program or knowingly fail to credit the 2292 agency or its fiscal agent for any payment received from a 2293 third-party source. 2294 4. Knowingly make or in any way cause to be made any false 2295 statement or false representation of a material fact, by 2296 commission or omission, in any document containing items of 2297 income and expense that is or may be used by the agency to 2298 determine a general or specific rate of payment for an item or 2299 service provided by a provider. 2300 5. Knowingly solicit, offer, pay, or receive any 2301 remuneration, including any kickback, bribe, or rebate, directly 2302 or indirectly, overtly or covertly, in cash or in kind, in 2303 return for referring an individual to a person for the 2304 furnishing or arranging for the furnishing of any item or 2305 service for which payment may be made, in whole or in part, 2306 under the Medicaid program, or in return for obtaining, 2307 purchasing, leasing, ordering, or arranging for or recommending, 2308 obtaining, purchasing, leasing, or ordering any goods, facility, 2309 item, or service, for which payment may be made, in whole or in 2310 part, under the Medicaid program. This subparagraph does not 2311 apply to any discount, payment, waiver of payment, or payment 2312 practice not prohibited by 42 U.S.C. s. 1320a-7b(b) or 2313 regulations adopted thereunder. 2314 6. Knowingly submit false or misleading information or 2315 statements to the Medicaid program for the purpose of being 2316 accepted as a Medicaid provider. 2317 7. Knowingly use or endeavor to use a Medicaid provider’s 2318 identification number or a Medicaid recipient’s identification 2319 number to make, cause to be made, or aid and abet in the making 2320 of a claim for items or services that are not authorized to be 2321 reimbursed by the Medicaid program. 2322 Section 44. Subsection (1) of section 409.967, Florida 2323 Statutes, is amended to read: 2324 409.967 Managed care plan accountability.— 2325 (1) Beginning with the contract procurement process 2326 initiated during the 2023 calendar year, the agency shall 2327 establish a 6-year5-yearcontract with each managed care plan 2328 selected through the procurement process described in s. 2329 409.966. A plan contract may not be renewed; however, the agency 2330 may extend the term of a plan contract to cover any delays 2331 during the transition to a new plan. The agency shall extend 2332 until December 31, 2024, the term of existing plan contracts 2333 awarded pursuant to the invitation to negotiate published in 2334 July 2017. 2335 Section 45. Paragraph (b) of subsection (5) of section 2336 409.973, Florida Statutes, is amended to read: 2337 409.973 Benefits.— 2338 (5) PROVISION OF DENTAL SERVICES.— 2339 (b) In the event the Legislature takes no action before 2340 July 1, 2017, with respect to the report findings required under 2341 subparagraph (a)2., the agency shall implement a statewide 2342 Medicaid prepaid dental health program for children and adults 2343 with a choice of at least two licensed dental managed care 2344 providers who must have substantial experience in providing 2345 dental care to Medicaid enrollees and children eligible for 2346 medical assistance under Title XXI of the Social Security Act 2347 and who meet all agency standards and requirements. To qualify 2348 as a provider under the prepaid dental health program, the 2349 entity must be licensed as a prepaid limited health service 2350 organization under part I of chapter 636 or as a health 2351 maintenance organization under part I of chapter 641. The 2352 contracts for program providers shall be awarded through a 2353 competitive procurement process. Beginning with the contract 2354 procurement process initiated during the 2023 calendar year, the 2355 contracts must be for 65years and may not be renewed; however, 2356 the agency may extend the term of a plan contract to cover 2357 delays during a transition to a new plan provider. The agency 2358 shall include in the contracts a medical loss ratio provision 2359 consistent with s. 409.967(4). The agency is authorized to seek 2360 any necessary state plan amendment or federal waiver to commence 2361 enrollment in the Medicaid prepaid dental health program no 2362 later than March 1, 2019. The agency shall extend until December 2363 31, 2024, the term of existing plan contracts awarded pursuant 2364 to the invitation to negotiate published in October 2017. 2365 Section 46. Subsection (6) of section 429.11, Florida 2366 Statutes, is amended to read: 2367 429.11 Initial application for license; provisional 2368 license.— 2369(6)In addition to the license categories available in s.2370408.808, a provisional license may be issued to an applicant2371making initial application for licensure or making application2372for a change of ownership. A provisional license shall be2373limited in duration to a specific period of time not to exceed 62374months, as determined by the agency.2375 Section 47. Subsection (9) of section 429.19, Florida 2376 Statutes, is amended to read: 2377 429.19 Violations; imposition of administrative fines; 2378 grounds.— 2379(9)The agency shall develop and disseminate an annual list2380of all facilities sanctioned or fined for violations of state2381standards, the number and class of violations involved, the2382penalties imposed, and the current status of cases. The list2383shall be disseminated, at no charge, to the Department of2384Elderly Affairs, the Department of Health, the Department of2385Children and Families, the Agency for Persons with Disabilities,2386the area agencies on aging, the Florida Statewide Advocacy2387Council, the State Long-Term Care Ombudsman Program, and state2388and local ombudsman councils. The Department of Children and2389Families shall disseminate the list to service providers under2390contract to the department who are responsible for referring2391persons to a facility for residency. The agency may charge a fee2392commensurate with the cost of printing and postage to other2393interested parties requesting a copy of this list. This2394information may be provided electronically or through the2395agency’s Internet site.2396 Section 48. Subsection (2) of section 429.35, Florida 2397 Statutes, is amended to read: 2398 429.35 Maintenance of records; reports.— 2399 (2) Within 60 days after the date of anthe biennial2400 inspection conductedvisit requiredunder s. 408.811 or within 2401 30 days after the date of ananyinterim visit, the agency shall 2402 forward the results of the inspection to the local ombudsman 2403 council in the district where the facility is located; to at 2404 least one public library or, in the absence of a public library, 2405 the county seat in the county in which the inspected assisted 2406 living facility is located; and, when appropriate, to the 2407 district Adult Services and Mental Health Program Offices. 2408 Section 49. Subsection (2) of section 429.905, Florida 2409 Statutes, is amended to read: 2410 429.905 Exemptions; monitoring of adult day care center 2411 programs colocated with assisted living facilities or licensed 2412 nursing home facilities.— 2413 (2) A licensed assisted living facility, a licensed 2414 hospital, or a licensed nursing home facility may provide 2415 services during the day which include, but are not limited to, 2416 social, health, therapeutic, recreational, nutritional, and 2417 respite services, to adults who are not residents. Such a 2418 facility need not be licensed as an adult day care center; 2419 however, the agency must monitor the facility during the regular 2420 inspectionand at least bienniallyto ensure adequate space and 2421 sufficient staff. If an assisted living facility, a hospital, or 2422 a nursing home holds itself out to the public as an adult day 2423 care center, it must be licensed as such and meet all standards 2424 prescribed by statute and rule. For the purpose of this 2425 subsection, the term “day” means any portion of a 24-hour day. 2426 Section 50. Section 429.929, Florida Statutes, is amended 2427 to read: 2428 429.929 Rules establishing standards.— 2429(1)The agency shall adopt rules to implement this part. 2430 The rules must include reasonable and fair standards. Any 2431 conflict between these standards and those that may be set forth 2432 in local, county, or municipal ordinances shall be resolved in 2433 favor of those having statewide effect. Such standards must 2434 relate to: 2435 (1)(a)The maintenance of adult day care centers with 2436 respect to plumbing, heating, lighting, ventilation, and other 2437 building conditions, including adequate meeting space, to ensure 2438 the health, safety, and comfort of participants and protection 2439 from fire hazard. Such standards may not conflict with chapter 2440 553 and must be based upon the size of the structure and the 2441 number of participants. 2442 (2)(b)The number and qualifications of all personnel 2443 employed by adult day care centers who have responsibilities for 2444 the care of participants. 2445 (3)(c)All sanitary conditions within adult day care 2446 centers and their surroundings, including water supply, sewage 2447 disposal, food handling, and general hygiene, and maintenance of 2448 sanitary conditions, to ensure the health and comfort of 2449 participants. 2450 (4)(d)Basic services provided by adult day care centers. 2451 (5)(e)Supportive and optional services provided by adult 2452 day care centers. 2453 (6)(f)Data and information relative to participants and 2454 programs of adult day care centers, including, but not limited 2455 to, the physical and mental capabilities and needs of the 2456 participants, the availability, frequency, and intensity of 2457 basic services and of supportive and optional services provided, 2458 the frequency of participation, the distances traveled by 2459 participants, the hours of operation, the number of referrals to 2460 other centers or elsewhere, and the incidence of illness. 2461 (7)(g)Components of a comprehensive emergency management 2462 plan, developed in consultation with the Department of Health 2463 and the Division of Emergency Management. 2464(2)Pursuant to this part, s. 408.811, and applicable2465rules, the agency may conduct an abbreviated biennial inspection2466of key quality-of-care standards, in lieu of a full inspection,2467of a center that has a record of good performance. However, the2468agency must conduct a full inspection of a center that has had2469one or more confirmed complaints within the licensure period2470immediately preceding the inspection or which has a serious2471problem identified during the abbreviated inspection. The agency2472shall develop the key quality-of-care standards, taking into2473consideration the comments and recommendations of provider2474groups. These standards shall be included in rules adopted by2475the agency.2476 Section 51. Effective January 1, 2021, paragraph (e) of 2477 subsection (2) and paragraph (e) of subsection (3) of section 2478 627.6387, Florida Statutes, are amended to read: 2479 627.6387 Shared savings incentive program.— 2480 (2) As used in this section, the term: 2481 (e) “Shoppable health care service” means a lower-cost, 2482 high-quality nonemergency health care service for which a shared 2483 savings incentive is available for insureds under a health 2484 insurer’s shared savings incentive program. Shoppable health 2485 care services may be provided within or outside this state and 2486 include, but are not limited to: 2487 1. Clinical laboratory services. 2488 2. Infusion therapy. 2489 3. Inpatient and outpatient surgical procedures. 2490 4. Obstetrical and gynecological services. 2491 5. Inpatient and outpatient nonsurgical diagnostic tests 2492 and procedures. 2493 6. Physical and occupational therapy services. 2494 7. Radiology and imaging services. 2495 8. Prescription drugs. 2496 9. Services provided through telehealth. 2497 10. Any additional services published by the Agency for 2498 Health Care Administration which have the most significant price 2499 variation pursuant to s. 408.05(3)(l). 2500 (3) A health insurer may offer a shared savings incentive 2501 program to provide incentives to an insured when the insured 2502 obtains a shoppable health care service from the health 2503 insurer’s shared savings list. An insured may not be required to 2504 participate in a shared savings incentive program. A health 2505 insurer that offers a shared savings incentive program must: 2506 (e) At least quarterly, credit or deposit the shared 2507 savings incentive amount to the insured’s account as a return or 2508 reduction in premium,orcredit the shared savings incentive 2509 amount to the insured’s flexible spending account, health 2510 savings account, or health reimbursement account, or reward the 2511 insured directly with cash or a cash equivalentsuch that the2512amount does not constitute income to the insured. 2513 Section 52. Effective January 1, 2021, paragraph (e) of 2514 subsection (2) and paragraph (e) of subsection (3) of section 2515 627.6648, Florida Statutes, are amended to read: 2516 627.6648 Shared savings incentive program.— 2517 (2) As used in this section, the term: 2518 (e) “Shoppable health care service” means a lower-cost, 2519 high-quality nonemergency health care service for which a shared 2520 savings incentive is available for insureds under a health 2521 insurer’s shared savings incentive program. Shoppable health 2522 care services may be provided within or outside this state and 2523 include, but are not limited to: 2524 1. Clinical laboratory services. 2525 2. Infusion therapy. 2526 3. Inpatient and outpatient surgical procedures. 2527 4. Obstetrical and gynecological services. 2528 5. Inpatient and outpatient nonsurgical diagnostic tests 2529 and procedures. 2530 6. Physical and occupational therapy services. 2531 7. Radiology and imaging services. 2532 8. Prescription drugs. 2533 9. Services provided through telehealth. 2534 10. Any additional services published by the Agency for 2535 Health Care Administration which have the most significant price 2536 variation pursuant to s. 408.05(3)(l). 2537 (3) A health insurer may offer a shared savings incentive 2538 program to provide incentives to an insured when the insured 2539 obtains a shoppable health care service from the health 2540 insurer’s shared savings list. An insured may not be required to 2541 participate in a shared savings incentive program. A health 2542 insurer that offers a shared savings incentive program must: 2543 (e) At least quarterly, credit or deposit the shared 2544 savings incentive amount to the insured’s account as a return or 2545 reduction in premium,orcredit the shared savings incentive 2546 amount to the insured’s flexible spending account, health 2547 savings account, or health reimbursement account, or reward the 2548 insured directly with cash or a cash equivalentsuch that the2549amount does not constitute income to the insured. 2550 Section 53. Effective January 1, 2021, paragraph (e) of 2551 subsection (2) and paragraph (e) of subsection (3) of section 2552 641.31076, Florida Statutes, are amended to read: 2553 641.31076 Shared savings incentive program.— 2554 (2) As used in this section, the term: 2555 (e) “Shoppable health care service” means a lower-cost, 2556 high-quality nonemergency health care service for which a shared 2557 savings incentive is available for subscribers under a health 2558 maintenance organization’s shared savings incentive program. 2559 Shoppable health care services may be provided within or outside 2560 this state and include, but are not limited to: 2561 1. Clinical laboratory services. 2562 2. Infusion therapy. 2563 3. Inpatient and outpatient surgical procedures. 2564 4. Obstetrical and gynecological services. 2565 5. Inpatient and outpatient nonsurgical diagnostic tests 2566 and procedures. 2567 6. Physical and occupational therapy services. 2568 7. Radiology and imaging services. 2569 8. Prescription drugs. 2570 9. Services provided through telehealth. 2571 10. Any additional services published by the Agency for 2572 Health Care Administration which have the most significant price 2573 variation pursuant to s. 408.05(3)(l). 2574 (3) A health maintenance organization may offer a shared 2575 savings incentive program to provide incentives to a subscriber 2576 when the subscriber obtains a shoppable health care service from 2577 the health maintenance organization’s shared savings list. A 2578 subscriber may not be required to participate in a shared 2579 savings incentive program. A health maintenance organization 2580 that offers a shared savings incentive program must: 2581 (e) At least quarterly, credit or deposit the shared 2582 savings incentive amount to the subscriber’s account as a return 2583 or reduction in premium,orcredit the shared savings incentive 2584 amount to the subscriber’s flexible spending account, health 2585 savings account, or health reimbursement account, or reward the 2586 subscriber directly with cash or a cash equivalentsuch that the2587amount does not constitute income to the subscriber. 2588 Section 54. Part I of chapter 483, Florida Statutes, is 2589 repealed, and part II and part III of that chapter are 2590 redesignated as part I and part II, respectively. 2591 Section 55. Paragraph (g) of subsection (3) of section 2592 20.43, Florida Statutes, is amended to read: 2593 20.43 Department of Health.—There is created a Department 2594 of Health. 2595 (3) The following divisions of the Department of Health are 2596 established: 2597 (g) Division of Medical Quality Assurance, which is 2598 responsible for the following boards and professions established 2599 within the division: 2600 1. The Board of Acupuncture, created under chapter 457. 2601 2. The Board of Medicine, created under chapter 458. 2602 3. The Board of Osteopathic Medicine, created under chapter 2603 459. 2604 4. The Board of Chiropractic Medicine, created under 2605 chapter 460. 2606 5. The Board of Podiatric Medicine, created under chapter 2607 461. 2608 6. Naturopathy, as provided under chapter 462. 2609 7. The Board of Optometry, created under chapter 463. 2610 8. The Board of Nursing, created under part I of chapter 2611 464. 2612 9. Nursing assistants, as provided under part II of chapter 2613 464. 2614 10. The Board of Pharmacy, created under chapter 465. 2615 11. The Board of Dentistry, created under chapter 466. 2616 12. Midwifery, as provided under chapter 467. 2617 13. The Board of Speech-Language Pathology and Audiology, 2618 created under part I of chapter 468. 2619 14. The Board of Nursing Home Administrators, created under 2620 part II of chapter 468. 2621 15. The Board of Occupational Therapy, created under part 2622 III of chapter 468. 2623 16. Respiratory therapy, as provided under part V of 2624 chapter 468. 2625 17. Dietetics and nutrition practice, as provided under 2626 part X of chapter 468. 2627 18. The Board of Athletic Training, created under part XIII 2628 of chapter 468. 2629 19. The Board of Orthotists and Prosthetists, created under 2630 part XIV of chapter 468. 2631 20. Electrolysis, as provided under chapter 478. 2632 21. The Board of Massage Therapy, created under chapter 2633 480. 2634 22. The Board of Clinical Laboratory Personnel, created 2635 under part Ipart IIof chapter 483. 2636 23. Medical physicists, as provided under part IIpart III2637 of chapter 483. 2638 24. The Board of Opticianry, created under part I of 2639 chapter 484. 2640 25. The Board of Hearing Aid Specialists, created under 2641 part II of chapter 484. 2642 26. The Board of Physical Therapy Practice, created under 2643 chapter 486. 2644 27. The Board of Psychology, created under chapter 490. 2645 28. School psychologists, as provided under chapter 490. 2646 29. The Board of Clinical Social Work, Marriage and Family 2647 Therapy, and Mental Health Counseling, created under chapter 2648 491. 2649 30. Emergency medical technicians and paramedics, as 2650 provided under part III of chapter 401. 2651 Section 56. Subsection (3) of section 381.0034, Florida 2652 Statutes, is amended to read: 2653 381.0034 Requirement for instruction on HIV and AIDS.— 2654 (3) The department shall require, as a condition of 2655 granting a license under chapter 467 or part Ipart IIof 2656 chapter 483, that an applicant making initial application for 2657 licensure complete an educational course acceptable to the 2658 department on human immunodeficiency virus and acquired immune 2659 deficiency syndrome. Upon submission of an affidavit showing 2660 good cause, an applicant who has not taken a course at the time 2661 of licensure shall be allowed 6 months to complete this 2662 requirement. 2663 Section 57. Subsection (4) of section 456.001, Florida 2664 Statutes, is amended to read: 2665 456.001 Definitions.—As used in this chapter, the term: 2666 (4) “Health care practitioner” means any person licensed 2667 under chapter 457; chapter 458; chapter 459; chapter 460; 2668 chapter 461; chapter 462; chapter 463; chapter 464; chapter 465; 2669 chapter 466; chapter 467; part I, part II, part III, part V, 2670 part X, part XIII, or part XIV of chapter 468; chapter 478; 2671 chapter 480; part I or part IIpart II or part IIIof chapter 2672 483; chapter 484; chapter 486; chapter 490; or chapter 491. 2673 Section 58. Paragraphs (h) and (i) of subsection (2) of 2674 section 456.057, Florida Statutes, are amended to read: 2675 456.057 Ownership and control of patient records; report or 2676 copies of records to be furnished; disclosure of information.— 2677 (2) As used in this section, the terms “records owner,” 2678 “health care practitioner,” and “health care practitioner’s 2679 employer” do not include any of the following persons or 2680 entities; furthermore, the following persons or entities are not 2681 authorized to acquire or own medical records, but are authorized 2682 under the confidentiality and disclosure requirements of this 2683 section to maintain those documents required by the part or 2684 chapter under which they are licensed or regulated: 2685 (h) Clinical laboratory personnel licensed under part I 2686part IIof chapter 483. 2687 (i) Medical physicists licensed under part IIpart IIIof 2688 chapter 483. 2689 Section 59. Paragraph (j) of subsection (1) of section 2690 456.076, Florida Statutes, is amended to read: 2691 456.076 Impaired practitioner programs.— 2692 (1) As used in this section, the term: 2693 (j) “Practitioner” means a person licensed, registered, 2694 certified, or regulated by the department under part III of 2695 chapter 401; chapter 457; chapter 458; chapter 459; chapter 460; 2696 chapter 461; chapter 462; chapter 463; chapter 464; chapter 465; 2697 chapter 466; chapter 467; part I, part II, part III, part V, 2698 part X, part XIII, or part XIV of chapter 468; chapter 478; 2699 chapter 480; part I or part IIpart II or part IIIof chapter 2700 483; chapter 484; chapter 486; chapter 490; or chapter 491; or 2701 an applicant for a license, registration, or certification under 2702 the same laws. 2703 Section 60. Paragraph (b) of subsection (1) of section 2704 456.47, Florida Statutes, is amended to read: 2705 456.47 Use of telehealth to provide services.— 2706 (1) DEFINITIONS.—As used in this section, the term: 2707 (b) “Telehealth provider” means any individual who provides 2708 health care and related services using telehealth and who is 2709 licensed or certified under s. 393.17; part III of chapter 401; 2710 chapter 457; chapter 458; chapter 459; chapter 460; chapter 461; 2711 chapter 463; chapter 464; chapter 465; chapter 466; chapter 467; 2712 part I, part III, part IV, part V, part X, part XIII, or part 2713 XIV of chapter 468; chapter 478; chapter 480; part I or part II 2714part II or part IIIof chapter 483; chapter 484; chapter 486; 2715 chapter 490; or chapter 491; who is licensed under a multistate 2716 health care licensure compact of which Florida is a member 2717 state; or who is registered under and complies with subsection 2718 (4). 2719 Section 61. Except as otherwise expressly provided in this 2720 act and except for this section, which shall become effective 2721 upon this act becoming a law, this act shall take effect July 1, 2722 2020.