Bill Text: FL S1786 | 2021 | Regular Session | Engrossed

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Florida Birth-Related Neurological Injury Compensation Plan

Spectrum: Bipartisan Bill

Status: (Passed) 2021-06-23 - Chapter No. 2021-134 [S1786 Detail]

Download: Florida-2021-S1786-Engrossed.html
       CS for CS for SB 1786                            First Engrossed
       
       
       
       
       
       
       
       
       20211786e1
       
    1                        A bill to be entitled                      
    2         An act relating to the Florida Birth-Related
    3         Neurological Injury Compensation Plan; amending s.
    4         766.303, F.S.; requiring the Florida Birth-Related
    5         Neurological Injury Compensation Association to
    6         administer the Florida Birth-Related Neurological
    7         Injury Compensation Plan in a specified manner;
    8         amending s. 766.305, F.S.; requiring that, if a
    9         physician is involved in more than one filed claim,
   10         the Division of Medical Quality Assurance of the
   11         Department of Health review all such claims together
   12         when making certain determinations; providing
   13         applicability; amending s. 766.31, F.S.; revising
   14         requirements for the award for compensation for claims
   15         under the plan; increasing the maximum amount that may
   16         be awarded to the parents or legal guardians of an
   17         infant found to have sustained a birth-related
   18         neurological injury, as of a specified date; requiring
   19         that the maximum award amount be increased by a
   20         certain percentage annually; requiring the plan to
   21         provide retroactive payments to certain parents or
   22         legal guardians which are sufficient to bring the
   23         total award to a specified amount; authorizing such
   24         payments to be made in a lump sum or periodically;
   25         increasing the amount of the death benefit that must
   26         be awarded; requiring the plan to provide retroactive
   27         payments to certain parents or legal guardians which
   28         are sufficient to bring the total death benefit award
   29         to a specified amount; authorizing such payments to be
   30         made in a lump sum or periodically; requiring parents
   31         and legal guardians to submit a certain letter of
   32         medical necessity to request reimbursement for actual
   33         expenses; requiring the plan to act on a request for
   34         reimbursement of expenses within a specified
   35         timeframe; requiring the plan to notify the parents or
   36         legal guardians and the ombudsman if specific
   37         additional information or documentation is needed;
   38         requiring the plan to consult with the ombudsman
   39         before denying a request; requiring the plan to
   40         provide a detailed written explanation of the reason
   41         for a denial; requiring the plan to request a second
   42         letter of medical necessity if it denies a request on
   43         certain grounds; providing requirements for the second
   44         letter of medical necessity; requiring the plan to
   45         reimburse expenses if a second letter is provided;
   46         providing that the plan is not required to reimburse
   47         expenses if a second letter is not provided; requiring
   48         parents or legal guardians, or their designee, to
   49         submit any additional information or documentation
   50         requested by the plan within a specified timeframe;
   51         requiring the plan to pay or deny a request within a
   52         specified timeframe; providing that failure to pay or
   53         deny a request within a specified timeframe results in
   54         an uncontestable obligation to reimburse the expenses;
   55         amending s. 766.313, F.S.; revising the timeframe
   56         within which birth-related neurological injury
   57         compensation claims must be filed; creating s.
   58         766.3145, F.S.; requiring association employees to
   59         annually sign and submit a conflict-of-interest
   60         statement as a condition of employment; requiring
   61         prospective employees to sign and submit such
   62         statement as a condition of employment; providing that
   63         the executive director, the ombudsman, senior
   64         managers, and the board of directors are subject to
   65         specified provisions; prohibiting board members from
   66         voting on measures under certain circumstances;
   67         providing procedures and requirements for board
   68         members who have a conflict of interest; prohibiting
   69         employees and board members from accepting gifts or
   70         expenditures from certain individuals; providing
   71         penalties; prohibiting certain senior managers and
   72         executive directors from representing persons or
   73         entities before the association for a specified
   74         timeframe; amending s. 766.315, F.S.; revising
   75         membership of the plan’s board of directors;
   76         prohibiting certain appointed directors from voting on
   77         board matters relating to a claim if they were named
   78         in the petition for the claim; requiring the board of
   79         directors to employ an ombudsman for a specified
   80         purpose; providing appointment and removal procedures
   81         for the ombudsman; providing qualifications for and
   82         duties of the ombudsman; requiring the association to
   83         submit an annual report to the Governor, the
   84         Legislature, and the Chief Financial Officer by a
   85         specified date; providing requirements for the report;
   86         requiring that the first report include a certain
   87         actuarial report; providing requirements for the
   88         actuarial report; requiring the Auditor General to
   89         conduct a performance audit of the association and
   90         plan; providing requirements for the audit; requiring
   91         the Auditor General to release the audit by a
   92         specified date; providing applicability; requiring the
   93         Agency for Health Care Administration to conduct a
   94         certain review of its Medicaid third-party liability
   95         functions and rights with respect to the plan;
   96         requiring the agency to submit a report of its
   97         findings to the Legislature and the Chief Financial
   98         Officer by a specified date; providing an effective
   99         date.
  100          
  101  Be It Enacted by the Legislature of the State of Florida:
  102  
  103         Section 1. Subsection (4) is added to section 766.303,
  104  Florida Statutes, to read:
  105         766.303 Florida Birth-Related Neurological Injury
  106  Compensation Plan; exclusiveness of remedy.—
  107         (4) The Florida Birth-Related Neurological Injury
  108  Compensation Association shall administer the plan in a manner
  109  that promotes and protects the health and best interests of
  110  children with birth-related neurological injuries who have been
  111  accepted into the plan, and the association shall strive to
  112  ensure that all of their medically necessary needs are being
  113  met.
  114         Section 2. Subsection (5) of section 766.305, Florida
  115  Statutes, is amended to read:
  116         766.305 Filing of claims and responses; medical
  117  disciplinary review.—
  118         (5) Upon receipt of such petition, the Division of Medical
  119  Quality Assurance shall review the information therein and
  120  determine whether it involved conduct by a physician licensed
  121  under chapter 458 or an osteopathic physician licensed under
  122  chapter 459 which that is subject to disciplinary action. If a
  123  physician is involved in more than one filed claim, the division
  124  also must review the circumstances of all such claims together
  125  to determine whether the physician’s conduct establishes a
  126  pattern of practice subject to disciplinary action. Section
  127  456.073 applies in such cases, in which case the provisions of
  128  s. 456.073 shall apply.
  129         Section 3. Present subsection (3) of section 766.31,
  130  Florida Statutes, is redesignated as subsection (4), a new
  131  subsection (3) is added to that section, and subsections (1) and
  132  (2) are amended, to read:
  133         766.31 Administrative law judge awards for birth-related
  134  neurological injuries; notice of award.—
  135         (1) Upon determining that an infant has sustained a birth
  136  related neurological injury and that obstetrical services were
  137  delivered by a participating physician at the birth, the
  138  administrative law judge shall make an award providing
  139  compensation for the following items relative to such injury:
  140         (a) Actual expenses for medically necessary and reasonable
  141  medical and hospital, habilitative and training, family
  142  residential or custodial care, professional residential, and
  143  custodial care and service, for medically necessary drugs,
  144  special equipment, and facilities, and for related travel. At a
  145  minimum, compensation must be provided for the following actual
  146  expenses:
  147         1.Diapers and baby formula for the child from the time of
  148  birth and pureed baby food or other baby food for the child at
  149  the appropriate age or developmental stage.
  150         2.A total annual benefit of up to $10,000 for immediate
  151  family members who reside with the infant for psychotherapeutic
  152  services obtained from providers licensed under chapter 490 or
  153  chapter 491.
  154         3.Transportation-related assistance, including, but not
  155  limited to, the following:
  156         a.Reimbursement for all medically necessary trips,
  157  including travel to the pharmacy each month to purchase the
  158  child’s prescription medications.
  159         b.For the life of the child, providing parents or legal
  160  guardians with a reliable method of transportation for the care
  161  of the child or reimbursing the cost of upgrading an existing
  162  vehicle to accommodate the child’s needs when it becomes
  163  medically necessary for wheelchair transportation. The mode of
  164  transportation must take into account the special accommodations
  165  required for the specific child. The plan may not limit such
  166  transportation assistance based on the child’s age or weight.
  167  The plan must replace any vans purchased by the plan every 7
  168  years or 150,000 miles, whichever comes first.
  169         4.Housing assistance of up to $100,000 for the lifetime of
  170  the child, including home construction and modification costs.
  171         (b) However, the following expenses are not subject to
  172  compensation such expenses shall not include:
  173         1. Expenses for items or services that the infant has
  174  received, or is entitled to receive, under the laws of any state
  175  or the Federal Government, except to the extent such exclusion
  176  may be prohibited by federal law.
  177         2. Expenses for items or services that the infant has
  178  received, or is contractually entitled to receive, from any
  179  prepaid health plan, health maintenance organization, or other
  180  private insuring entity.
  181         3. Expenses for which the infant has received
  182  reimbursement, or for which the infant is entitled to receive
  183  reimbursement, under the laws of any state or the Federal
  184  Government, except to the extent such exclusion may be
  185  prohibited by federal law.
  186         4. Expenses for which the infant has received
  187  reimbursement, or for which the infant is contractually entitled
  188  to receive reimbursement, pursuant to the provisions of any
  189  health or sickness insurance policy or other private insurance
  190  program.
  191         (c) Expenses included under this paragraph (a) may not
  192  exceed usual and customary shall be limited to reasonable
  193  charges prevailing in the same community for similar treatment
  194  of injured persons when such treatment is paid for by the
  195  injured person.
  196         (d)1.a.(b)1. Periodic payments of an award to the parents
  197  or legal guardians of the infant found to have sustained a
  198  birth-related neurological injury, which award may shall not
  199  exceed $100,000. However, at the discretion of the
  200  administrative law judge, such award may be made in a lump sum.
  201  Beginning on January 1, 2021, the award may not exceed $250,000,
  202  and each January 1 thereafter the maximum award authorized under
  203  this paragraph shall increase by 3 percent.
  204         b.Parents or legal guardians who received an award
  205  pursuant to this section before January 1, 2021, and whose child
  206  currently receives benefits under the plan must receive a
  207  retroactive payment in an amount sufficient to bring the total
  208  award paid to the parents or legal guardians pursuant to sub
  209  subparagraph a. to $250,000. This additional payment may be made
  210  in a lump sum or in periodic payments as designated by the
  211  parents or legal guardians.
  212         2. Death benefit for the infant in an amount of $50,000.
  213  Parents or legal guardians who received an award pursuant to
  214  this section, and whose child died since the inception of the
  215  program, must receive a retroactive payment in an amount
  216  sufficient to bring the total award paid to the parents or legal
  217  guardians pursuant to this subparagraph to $50,000. This
  218  additional payment may be made in a lump sum or in periodic
  219  payments as designated by the parents or legal guardians
  220  $10,000.
  221         (e)(c) Reasonable expenses incurred in connection with the
  222  filing of a claim under ss. 766.301-766.316, including
  223  reasonable attorney attorney’s fees, which are shall be subject
  224  to the approval and award of the administrative law judge. In
  225  determining an award for attorney attorney’s fees, the
  226  administrative law judge shall consider the following factors:
  227         1. The time and labor required, the novelty and difficulty
  228  of the questions involved, and the skill requisite to perform
  229  the legal services properly.
  230         2. The fee customarily charged in the locality for similar
  231  legal services.
  232         3. The time limitations imposed by the claimant or the
  233  circumstances.
  234         4. The nature and length of the professional relationship
  235  with the claimant.
  236         5. The experience, reputation, and ability of the lawyer or
  237  lawyers performing services.
  238         6. The contingency or certainty of a fee.
  239  
  240  Should there be a final determination of compensability, and the
  241  claimants accept an award under this section, the claimants are
  242  shall not be liable for any expenses, including attorney
  243  attorney’s fees, incurred in connection with the filing of a
  244  claim under ss. 766.301-766.316 other than those expenses
  245  awarded under this section.
  246         (2) The award shall require the immediate payment of
  247  expenses previously incurred and shall require that future
  248  expenses be paid as incurred.
  249         (3)(a)To request reimbursement from the plan for actual
  250  expenses, the parents or legal guardians of a child under the
  251  plan must submit a letter of medical necessity to the plan from
  252  the child’s physician, who must be licensed under chapter 458 or
  253  chapter 459 or, if the child resides in another state, must be
  254  licensed under the laws of that state, or from another licensed
  255  treating health care practitioner as defined in s. 456.001
  256  requesting reimbursement of the medically necessary services,
  257  drugs, equipment, or treatment. Within 20 days after the receipt
  258  of a request for reimbursement of expenses, the plan must
  259  reimburse the expenses or notify the parents or legal guardians
  260  and the ombudsman appointed pursuant to s. 766.315(4)(i)1. that
  261  specific additional information or documentation is needed to
  262  evaluate the request or that the request for payment of the
  263  expenses is being denied. Before denying the request, the plan
  264  must consult with the ombudsman concerning the request and any
  265  relevant information concerning the child’s unique needs. The
  266  plan must provide the ombudsman with a detailed written
  267  explanation for the proposed denial. If the plan denies the
  268  request because it determines that the services or treatment
  269  were not medically necessary, the plan must request the parents
  270  or legal guardians to provide a letter of medical necessity from
  271  a second licensed physician or health care provider who is not
  272  affiliated with or does not have an investment interest, as
  273  described in s. 456.053, with the first physician or health care
  274  provider who provided the medical necessity letter. If such
  275  letter is provided, the plan must reimburse the parents or legal
  276  guardians for the actual expenses, including the expenses
  277  associated with obtaining the second medical necessity letter
  278  from a physician or other health care practitioner. If the
  279  parents or legal guardians are unable to provide a second
  280  letter, the plan is not required to reimburse the expenses.
  281         (b)Parents or legal guardians, or their designee, must
  282  submit any additional information or documentation requested by
  283  the plan within 35 days after receipt of the notification by the
  284  plan that additional information or documentation is needed.
  285  Additional information is considered submitted on the date it is
  286  mailed or electronically submitted to the plan.
  287         (c)A request for reimbursement of expenses must be paid or
  288  denied within 90 days after receipt of the request. A denial of
  289  reimbursement by the plan must be accompanied by a detailed
  290  written explanation of why the request was denied. Failure to
  291  pay or deny the request for reimbursement within 120 days after
  292  receipt of the request creates an uncontestable obligation to
  293  reimburse the expenses.
  294         Section 4. Section 766.313, Florida Statutes, is amended to
  295  read:
  296         766.313 Limitation on claim.—Any claim for compensation
  297  under ss. 766.301-766.316 which that is filed more than 8 5
  298  years after the birth of an infant alleged to have a birth
  299  related neurological injury is shall be barred.
  300         Section 5. Section 766.3145, Florida Statutes, is created
  301  to read:
  302         766.3145 Code of ethics.—
  303         (1)On or before July 1 of each year, employees of the
  304  association must sign and submit a statement attesting that they
  305  do not have a conflict of interest as defined in part III of
  306  chapter 112. As a condition of employment, all prospective
  307  employees must sign and submit to the association a conflict-of
  308  interest statement.
  309         (2)The executive director, the ombudsman, senior managers,
  310  and members of the board of directors are subject to the code of
  311  ethics under part III of chapter 112. For purposes of applying
  312  part III of chapter 112 to activities of the executive director,
  313  senior managers, and members of the board of directors, those
  314  persons are considered public officers or employees and the
  315  association is considered their agency. A board member may not
  316  vote on any measure that would inure to his or her special
  317  private gain or loss and, notwithstanding s. 112.3143(2), may
  318  not vote on any measure that he or she knows would inure to the
  319  special private gain or loss of any principal by whom he or she
  320  is retained or to the parent organization or subsidiary of a
  321  corporate principal by which he or she is retained, other than
  322  an agency as defined in s. 112.312; or that he or she knows
  323  would inure to the special private gain or loss of a relative or
  324  business associate of the public officer. Before the vote is
  325  taken, such member shall publicly state to the board the nature
  326  of his or her interest in the matter from which he or she is
  327  abstaining from voting and, within 15 days after the vote
  328  occurs, disclose the nature of his or her interest as a public
  329  record in a memorandum filed with the person responsible for
  330  recording the minutes of the meeting, who shall incorporate the
  331  memorandum in the minutes.
  332         (3) Notwithstanding s. 112.3148, s. 112.3149, or any other
  333  law, an employee or board member may not knowingly accept,
  334  directly or indirectly, any gift or expenditure from a person or
  335  entity, or an employee or representative of such person or
  336  entity, which has a contractual relationship with the
  337  association or which is under consideration for a contract.
  338         (4)An employee or board member who fails to comply with
  339  subsection (2) or subsection (3) is subject to penalties
  340  provided under ss. 112.317 and 112.3173.
  341         (5) Any senior manager or executive director of the
  342  association who is employed on or after January 1, 2022,
  343  regardless of the date of hire, who subsequently retires or
  344  terminates employment is prohibited from representing another
  345  person or entity before the association for 2 years after
  346  retirement or termination of employment from the association.
  347         Section 6. Paragraphs (a) and (c) of subsection (1),
  348  paragraph (a) of subsection (2), and paragraph (i) of subsection
  349  (4) of section 766.315, Florida Statutes, are amended, and
  350  subsection (6) is added to that section, to read:
  351         766.315 Florida Birth-Related Neurological Injury
  352  Compensation Association; board of directors.—
  353         (1)(a) The Florida Birth-Related Neurological Injury
  354  Compensation Plan shall be governed by a board of seven five
  355  directors which shall be known as the Florida Birth-Related
  356  Neurological Injury Compensation Association. The association is
  357  not a state agency, board, or commission. Notwithstanding the
  358  provision of s. 15.03, the association is authorized to use the
  359  state seal.
  360         (c) The Chief Financial Officer shall appoint the directors
  361  shall be appointed by the Chief Financial Officer as follows:
  362         1. One citizen representative.
  363         2. One representative of participating physicians.
  364         3. One representative of hospitals.
  365         4. One representative of casualty insurers.
  366         5. One representative of physicians other than
  367  participating physicians.
  368         6.One parent or legal guardian representative of an
  369  injured infant under the plan.
  370         7.One representative of an advocacy organization for
  371  children with disabilities.
  372         (2)(a) The Chief Financial Officer may select the
  373  representative of the participating physicians from a list of at
  374  least three names recommended by the American Congress of
  375  Obstetricians and Gynecologists, District XII; the
  376  representative of hospitals from a list of at least three names
  377  recommended by the Florida Hospital Association; the
  378  representative of casualty insurers from a list of at least
  379  three names, one of which is recommended by the American
  380  Insurance Association, one of which is recommended by the
  381  Florida Insurance Council, and one of which is recommended by
  382  the Property Casualty Insurers Association of America; and the
  383  representative of physicians, other than participating
  384  physicians, from a list of three names recommended by the
  385  Florida Medical Association and a list of three names
  386  recommended by the Florida Osteopathic Medical Association.
  387  However, the Chief Financial Officer is not required to make an
  388  appointment from among the nominees of the respective
  389  associations. A participating physician who is named in a
  390  pending petition for a claim may not be appointed to the board.
  391  An appointed director who is a participating physician may not
  392  vote on any board matter relating to a claim accepted for an
  393  award for compensation if the physician was named in the
  394  petition for the claim.
  395         (4) The board of directors shall have the power to:
  396         (i) Employ or retain such persons as are necessary to
  397  perform the administrative and financial transactions and
  398  responsibilities of the plan and to perform other necessary and
  399  proper functions not prohibited by law.
  400         1.The board of directors shall employ an ombudsman who
  401  will serve at the pleasure of, and must report directly to, the
  402  board and who will act as an advocate for the parents and legal
  403  guardians of children under the plan. The board must appoint or
  404  remove the ombudsman by a majority vote with at least four
  405  affirmative votes, with the board member who is the parent or
  406  legal guardian representative of an injured child under the plan
  407  and the board member who is a representative of an advocacy
  408  organization for children with disabilities on the prevailing
  409  side.
  410         2. At a minimum, the person appointed as the ombudsman must
  411  have at least 5 years of experience and employment in the field
  412  of children with disabilities, which includes advocacy for
  413  children with disabilities.
  414         3.The ombudsman shall do all of the following:
  415         a.Provide information and assistance, outreach, and
  416  education to parents and legal guardians of children under the
  417  plan regarding plan benefits; assist parents and legal guardians
  418  in the resolution of benefit and payment disputes; and inform
  419  parents and legal guardians regarding community, state, and
  420  federal government resources.
  421         b.Investigate complaints of parents or legal guardians of
  422  children under the plan regarding the operation of the plan.
  423         c.Provide an annual report to the board regarding the
  424  ombudsman’s activities, the disposition of complaints, and any
  425  recommendations to improve the operations of the plan,
  426  resolution of disputes, and the delivery of benefits to
  427  participants.
  428         (6)On or before November 1, 2021, and by each November 1
  429  thereafter, the association shall submit an annual report to the
  430  Governor, the President of the Senate, the Speaker of the House
  431  of Representatives, and the Chief Financial Officer. The report
  432  must include:
  433         (a)The number of petitions filed for compensation with the
  434  division, the number of claimants awarded compensation, the
  435  number of claimants denied compensation, and the reasons for the
  436  denial of compensation.
  437         (b)The number and dollar amount of paid and denied
  438  compensation for expenses by category and the reasons for any
  439  denied compensation for expenses by category.
  440         (c)The average turnaround time for paying or denying
  441  compensation for expenses.
  442         (d)Legislative recommendations to improve the program.
  443         (e)A summary of any pending or resolved litigation during
  444  the year which affects the plan.
  445         (f)The amount of compensation paid to each association
  446  employee or member or the board of directors.
  447         (g)For the initial report due on or before November 1,
  448  2021, an actuarial report conducted by an independent actuary
  449  which provides an analysis of the estimated costs of
  450  implementing the following changes to the plan:
  451         1.Reducing the minimum birth weight eligibility for a
  452  participant in the plan from 2,500 grams to 2,000 grams.
  453         2.Revising the eligibility for participation in the plan
  454  by providing that an infant must be permanently and
  455  substantially mentally or physically impaired, rather than
  456  permanently and substantially mentally and physically impaired.
  457         3.Increasing the annual special benefit or quality of life
  458  benefit from $500 to $2,500 per calendar year.
  459         Section 7. The Auditor General shall conduct a performance
  460  audit of the association and plan to evaluate management’s
  461  performance in administering the laws, policies, and procedures
  462  governing the operations of the association and plan in an
  463  efficient and effective manner.
  464         (1)The audit must include evaluations of all of the
  465  following:
  466         (a)The protocols used for the payment of expenses,
  467  including standards for determining medical necessity and
  468  reasonableness of requests for medical care, services, or other
  469  benefits provided under the plan and the timeliness of the
  470  payment of expenses.
  471         (b)The effectiveness of the association’s outreach to
  472  inform parents and legal guardians of participants of available
  473  benefits and any changes in benefits and processes to resolve
  474  disputes regarding the payment of expenses internally.
  475         (c)The efficacy of the current processes for the
  476  procurement of goods and services.
  477         (d)The internal controls of the plan and association.
  478         (2)The Auditor General shall release the audit by January
  479  15, 2022.
  480         Section 8. The amendments made to s. 766.31(1)(d)1.a. and
  481  2., Florida Statutes, by this act apply to all claims filed
  482  under s. 766.305, Florida Statutes, for which an award was made
  483  through entry of final order under s. 766.31(1), Florida
  484  Statutes, on or after January 1, 2021.
  485         Section 9. The Agency for Health Care Administration shall
  486  review its Medicaid third-party liability functions and rights
  487  under s. 409.910, Florida Statutes, relative to the Florida
  488  Birth-Related Neurological Injury Compensation Plan established
  489  under s. 766.303, Florida Statutes, and must include in its
  490  review the extent and value of the liabilities owed by the plan
  491  as a third-party benefit provider. On or before November 1,
  492  2021, the agency must submit to the President of the Senate, the
  493  Speaker of the House of Representatives, and the Chief Financial
  494  Officer a report of its findings regarding the extent and value
  495  of the liabilities owed by the plan.
  496         Section 10. This act shall take effect upon becoming a law.

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