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House Bill 0591er

House Bill 0591er

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    ENROLLED

    2000 Legislature                 CS/CS/HB 591, Third Engrossed



  1

  2         An act relating to health care; amending s.

  3         400.408, F.S.; requiring field offices of the

  4         Agency for Health Care Administration to

  5         establish local coordinating workgroups to

  6         identify the operation of unlicensed assisted

  7         living facilities and to develop a plan to

  8         enforce state laws relating to unlicensed

  9         assisted living facilities; requiring a report

10         to the agency of the workgroup's findings and

11         recommendations; requiring health care

12         practitioners to report known operations of

13         unlicensed facilities; prohibiting hospitals

14         and community mental health centers from

15         discharging a patient or client to an

16         unlicensed facility; amending s. 415.1034,

17         F.S.; requiring paramedics and emergency

18         medical technicians to report acts of abuse

19         committed against a disabled adult or elderly

20         person; amending s. 400.471, F.S.; deleting the

21         certificate-of-need requirement for licensure

22         of Medicare-certified home health agencies;

23         amending s. 408.032, F.S.; adding definitions

24         of "exemption" and "mental health services";

25         revising the term "health service"; deleting

26         the definitions of "home health agency,"

27         "institutional health service," "intermediate

28         care facility," "multifacility project," and

29         "respite care"; amending s. 408.033, F.S.;

30         deleting references to the state health plan;

31         amending s. 408.034, F.S.; deleting a reference


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    2000 Legislature                 CS/CS/HB 591, Third Engrossed



  1         to licensing of home health agencies by the

  2         Agency for Health Care Administration; amending

  3         s. 408.035, F.S.; deleting obsolete

  4         certificate-of-need review criteria and

  5         revising other criteria; amending s. 408.036,

  6         F.S.; revising provisions relating to projects

  7         subject to review; deleting references to

  8         Medicare-certified home health agencies;

  9         deleting the review of certain acquisitions;

10         specifying the types of bed increases subject

11         to review; deleting cost overruns from review;

12         deleting review of combinations or division of

13         nursing home certificates of need; providing

14         for expedited review of certain conversions of

15         licensed hospital beds; deleting the

16         requirement for an exemption for initiation or

17         expansion of obstetric services, provision of

18         respite care services, establishment of a

19         Medicare-certified home health agency, or

20         provision of a health service exclusively on an

21         outpatient basis; providing exemptions for

22         combinations or divisions of nursing home

23         certificates of need and additions of certain

24         hospital beds and nursing home beds within

25         specified limitations; requiring a fee for each

26         request for exemption; amending s. 408.037,

27         F.S.; deleting reference to the state health

28         plan; amending ss. 408.038, 408.039, 408.044,

29         and 408.045, F.S.; replacing "department" with

30         "agency"; clarifying the opportunity to

31         challenge an intended award of a certificate of


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    2000 Legislature                 CS/CS/HB 591, Third Engrossed



  1         need; amending s. 408.040, F.S.; deleting an

  2         obsolete reference; revising the format of

  3         conditions related to Medicaid; creating a

  4         certificate-of-need workgroup within the Agency

  5         for Health Care Administration; providing for

  6         expenses; providing membership, duties, and

  7         meetings; providing for termination; amending

  8         s. 651.118, F.S.; excluding a specified number

  9         of beds from a time limit imposed on extension

10         of authorization for continuing care

11         residential community providers to use

12         sheltered beds for nonresidents; requiring a

13         facility to report such use after the

14         expiration of the extension; repealing s.

15         400.464(3), F.S., relating to home health

16         agency licenses provided to certificate-of-need

17         exempt entities; providing applicability;

18         providing an appropriation for continued review

19         of clinical laboratory services for kidney

20         dialysis patients and requiring a report

21         thereon; amending s. 455.564, F.S.; revising

22         general licensing provisions for professions

23         under the jurisdiction of the Department of

24         Health; providing for processing of

25         applications from foreign or nonresident

26         applicants not yet having a social security

27         number; providing for temporary licensure of

28         such applicants; revising provisions relating

29         to ongoing criminal investigations or

30         prosecutions; requiring proof of restoration of

31         civil rights under certain circumstances;


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  1         authorizing requirement for personal appearance

  2         prior to grant or denial of a license;

  3         providing for tolling of application decision

  4         deadlines under certain circumstances; amending

  5         s. 455.565, F.S.; eliminating duplicative

  6         submission of fingerprints and other

  7         information required for criminal history

  8         checks; providing for certain access to

  9         criminal history information through the

10         department's health care practitioner

11         credentialing system; amending s. 455.5651,

12         F.S.; authorizing the department to publish

13         certain information in practitioner profiles;

14         amending s. 455.5653, F.S.; deleting obsolete

15         language relating to scheduling and development

16         of practitioner profiles for additional health

17         care practitioners; providing the department

18         access to information on health care

19         practitioners maintained by the Agency for

20         Health Care Administration for corroboration

21         purposes; amending s. 455.5654, F.S.; providing

22         for adoption by rule of a form for submission

23         of profiling information; amending s. 455.567,

24         F.S.; expanding the prohibition against sexual

25         misconduct to cover violations against

26         guardians and representatives of patients or

27         clients; providing penalties; amending s.

28         455.624, F.S.; revising and providing grounds

29         for disciplinary action relating to having a

30         license to practice a regulated health care

31         profession acted against, sexual misconduct,


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    2000 Legislature                 CS/CS/HB 591, Third Engrossed



  1         inability to practice properly due to alcohol

  2         or substance abuse or a mental or physical

  3         condition, and testing positive for a drug

  4         without a lawful prescription therefor;

  5         providing for restriction of license as a

  6         disciplinary action; providing for issuance of

  7         a citation and assessment of a fine for certain

  8         first-time violations; reenacting ss. 455.577,

  9         455.631, 455.651(2), 455.712(1), 458.347(7)(g),

10         459.022(7)(f), 468.1755(1)(a), 468.719(1)(a)

11         and (2), 468.811, and 484.056(1)(a), F.S.,

12         relating to theft or reproduction of an

13         examination, giving false information,

14         disclosure of confidential information,

15         business establishments providing regulated

16         services without an active status license, and

17         practice violations by physician assistants,

18         nursing home administrators, athletic trainers,

19         orthotists, prosthetists, pedorthists, and

20         hearing aid specialists, to incorporate the

21         amendment to s. 455.624, F.S., in references

22         thereto; repealing s. 455.704, F.S., relating

23         to the Impaired Practitioners Committee;

24         amending s. 455.707, F.S., relating to impaired

25         practitioners, to conform; clarifying

26         provisions relating to complaints against

27         impaired practitioners; amending s. 310.102,

28         F.S.; revising and removing references, to

29         conform; amending s. 455.711, F.S.; revising

30         provisions relating to active and inactive

31         status licensure; eliminating reference to


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    2000 Legislature                 CS/CS/HB 591, Third Engrossed



  1         delinquency as a licensure status; providing

  2         rulemaking authority; amending ss. 455.587 and

  3         455.714, F.S.; revising references, to conform;

  4         creating s. 455.719, F.S.; providing that the

  5         appropriate medical regulatory board, or the

  6         department when there is no board, has

  7         exclusive authority to grant exemptions from

  8         disqualification from employment or contracting

  9         with respect to persons under the licensing

10         jurisdiction of that board or the department,

11         as applicable; amending s. 455.637, F.S.;

12         revising provisions relating to sanctions

13         against the unlicensed practice of a health

14         care profession; providing legislative intent;

15         revising and expanding provisions relating to

16         civil and administrative remedies; providing

17         criminal penalties; incorporating and modifying

18         the substance of current provisions that impose

19         a fee to combat unlicensed activity and provide

20         for disposition of the proceeds thereof;

21         providing statutory construction relating to

22         dietary supplements; reenacting ss. 458.327,

23         459.013, 460.411, 461.012, 462.17, 463.015,

24         464.016, 465.015, 466.026, 467.201, 468.366,

25         483.828, 483.901, 484.053, F.S.; providing

26         penalties; creating s. 458.3135, F.S.;

27         providing for temporary certification for

28         visiting physicians to practice in approved

29         cancer centers; providing certification

30         requirements; providing fees; providing for

31         approval of cancer centers and annual review of


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  1         such approval; providing practice limitations

  2         and conditions; limiting the number of

  3         certificates that may be issued; providing

  4         rulemaking authority; amending s. 458.3145,

  5         F.S.; adding medical schools to list of

  6         programs at which medical faculty

  7         certificateholders may practice; amending s.

  8         458.315, F.S.; waiving application and

  9         licensure fees for physicians obtaining a

10         temporary certificate to practice in areas of

11         critical need when such practice is limited to

12         volunteer, uncompensated care for low-income

13         persons; amending ss. 458.345 and 459.021,

14         F.S.; providing for registration of persons

15         desiring to practice as a resident physician,

16         assistant resident physician, house physician,

17         intern, or fellow in fellowship training in a

18         statutory teaching hospital; providing

19         requirements; providing fees; providing

20         penalties; providing rulemaking authority;

21         amending s. 458.348, F.S.; requiring protocols

22         to contain specified requirements; amending s.

23         458.347, F.S.; providing authority to the

24         Council on Physician Assistants to refuse to

25         certify an applicant for licensure or place

26         restrictions or conditions on license; amending

27         s. 459.022, F.S.; providing authority to the

28         Council on Physician Assistants to refuse to

29         certify an applicant for licensure or place

30         restrictions or conditions on license;

31         providing applicability; repealing s. 455.641,


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  1         F.S., relating to unlicensed activity fees, to

  2         conform; reenacting ss. 455.574(1)(d),

  3         468.1295(1), 484.014(1), and 484.056(1), F.S.,

  4         relating to violation of security provisions

  5         for examinations and violations involving

  6         speech-language pathology, audiology,

  7         opticianry, and the dispensing of hearing aids,

  8         to incorporate the amendment to s. 455.637,

  9         F.S., in references thereto; amending s.

10         921.0022, F.S.; modifying the criminal offense

11         severity ranking chart to add or increase the

12         level of various offenses relating to the

13         practice of a health care profession, the

14         practice of medicine, osteopathic medicine,

15         chiropractic medicine, podiatric medicine,

16         naturopathy, optometry, nursing, pharmacy,

17         dentistry, dental hygiene, midwifery,

18         respiratory therapy, and medical physics,

19         practicing as clinical laboratory personnel,

20         and the dispensing of hearing aids; amending s.

21         457.102, F.S.; revising the definition of

22         "acupuncture"; amending s. 457.105, F.S.;

23         revising licensure qualifications to practice

24         acupuncture; amending s. 457.107, F.S.;

25         modifying the fee for renewal of a license to

26         practice acupuncture; amending s. 483.824,

27         F.S.; revising qualifications of clinical

28         laboratory directors; designating Florida

29         Alzheimer's Disease Day; amending s. 641.51,

30         F.S.; providing for referral to ophthalmologist

31         under certain circumstances; providing that the


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  1         act not be construed to prohibit certain uses

  2         of the Internet; providing that certain funds

  3         appropriated to conduct a review of current

  4         mandated health coverages revert to the fund

  5         from which appropriated and that the review may

  6         not be conducted; abrogating certain exemptions

  7         from s. 408.036(1), F.S., which are enacted in

  8         the 2000 Regular Session; amending s. 627.6699,

  9         F.S.; modifying definitions; requiring small

10         employer carriers to begin to offer and issue

11         all small employer benefit plans on a specified

12         date; deleting the requirement that basic and

13         standard small employer health benefit plans be

14         issued; providing additional requirements for

15         determining premium rates for benefit plans;

16         providing for applicability of the act to plans

17         provided by small employer carriers that are

18         insurers or health maintenance organizations

19         notwithstanding the provisions of certain other

20         specified statutes under specified conditions;

21         amending s. 641.201, F.S.; clarifying

22         applicability of the Florida Insurance Code to

23         health maintenance organizations; amending s.

24         641.234, F.S.; providing conditions under which

25         the Department of Insurance may order a health

26         maintenance organization to cancel a contract;

27         amending s. 641.27, F.S.; providing for payment

28         by a health maintenance organization of fees to

29         outside examiners appointed by the Department

30         of Insurance; creating s. 641.226, F.S.;

31         providing for application of federal solvency


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    ENROLLED

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  1         requirements to provider-sponsored

  2         organizations; creating s. 641.39, F.S.;

  3         prohibiting the solicitation or acceptance of

  4         contracts by insolvent or impaired health

  5         maintenance organizations; providing a criminal

  6         penalty; creating s. 641.2011, F.S.; providing

  7         that part IV of chapter 628, F.S., applies to

  8         health maintenance organizations; making an

  9         appropriation for the purpose of reviewing

10         proposed mandated health coverages; amending s.

11         212.055, F.S.; expanding the authorized use of

12         the indigent care surtax to include trauma

13         centers; renaming the surtax; requiring the

14         plan set out in the ordinance to include

15         additional provisions concerning Level I trauma

16         centers; providing requirements for annual

17         disbursements to hospitals on October 1 to be

18         in recognition of the Level I trauma center

19         status and to be in addition to a base contract

20         amount, plus any negotiated additions to

21         indigent care funding; authorizing funds

22         received to be used to generate federal

23         matching funds under certain conditions and

24         authorizing payment by the clerk of the court;

25         amending part XV of chapter 468, F.S., relating

26         to certified nursing assistants, and

27         transferring that part to chapter 464, F.S.,

28         relating to nursing, to transfer from the

29         Department of Health to the Board of Nursing

30         responsibility and rulemaking authority for

31         regulation of certified nursing assistants;


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    ENROLLED

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  1         changing requirements for nursing assistants;

  2         transferring from the Department of Education

  3         to the board responsibility for approval of

  4         training programs; revising grounds for which

  5         the board may impose certain penalties;

  6         creating s. 464.2085, F.S.; creating and

  7         providing requirements for a Council on

  8         Certified Nursing Assistants; amending ss.

  9         20.43, 39.01, 39.304, 110.131, 232.46,

10         240.4075, 246.081, 310.102, 381.0302, 384.30,

11         384.31, 394.455, 395.0191, 400.021, 400.211,

12         400.402, 400.407, 400.4255, 400.426, 400.462,

13         400.464, 400.506, 400.6105, 401.23, 401.252,

14         408.706, 409.908, 415.1085, 455.597, 455.604,

15         455.667, 455.677, 455.694, 455.707, 458.348,

16         464.001, 464.002, 464.003, 464.006, 464.009,

17         464.016, 464.018, 464.019, 464.022, 464.023,

18         464.027, 466.003, 467.003, 467.0125, 467.203,

19         468.505, 483.041, 483.801, 491.0112, 550.24055,

20         627.351, 627.357, 627.9404, 641.31, 766.101,

21         766.110, 766.1115, 877.111, 945.602, 960.28,

22         984.03, 985.03, F.S.; conforming references;

23         revising application procedures for certified

24         nursing assistants; revising registration

25         requirements for certified nursing assistants;

26         amending ss. 400.215, 400.512, F.S.; revising

27         provisions relating to the granting of

28         exemptions from disqualification for employment

29         in nursing homes or home health agencies;

30         amending s. 400.23, F.S.; authorizing licensed

31         practical nurses in nursing home facilities to


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  1         supervise the activities of other licensed

  2         practical nurses, certified nursing assistants,

  3         and other unlicensed personnel working in such

  4         facilities in accordance with rules adopted by

  5         the Board of Nursing; amending s. 455.557,

  6         F.S.; including advanced registered nurse

  7         practitioners under the credentialing program;

  8         creating s. 455.56503, F.S.; requiring advanced

  9         registered nurse practitioners to submit

10         information and fingerprints for profiling

11         purposes; amending s. 455.5651, F.S.;

12         authorizing the department to publish certain

13         information in practitioner profiles; amending

14         s. 455.5653, F.S.; deleting obsolete provisions

15         relating to scheduling and development of

16         practitioner profiles for additional health

17         care practitioners; providing access to

18         information on advanced registered nurse

19         practitioners maintained by the Agency for

20         Health Care Administration for corroboration

21         purposes; amending s. 455.5654, F.S.; providing

22         for adoption by rule of a form for submission

23         of profiling information; repealing s.

24         400.462(20), F.S., to delete the definition of

25         "screening" under the Home Health Services Act;

26         amending s. 400.471, F.S.; providing for an

27         abuse registry background check through the

28         Agency for Health Care Administration; amending

29         s. 400.484, F.S.; providing for assessment of

30         certain costs of an investigation that results

31         in a successful prosecution; amending s.


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    ENROLLED

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  1         400.487, F.S.; requiring home health service

  2         agreements; revising requirements for

  3         physician's treatment orders; providing for

  4         supervisory visits by a registered nurse under

  5         certain circumstances; deleting provisions

  6         relating to service provision plans; amending

  7         s. 400.497, F.S.; providing for a home health

  8         aide competency test, criteria for the

  9         frequency of onsite licensure surveys, and

10         information to be included in patients'

11         records; amending s. 400.506, F.S.; providing

12         for an abuse registry background check through

13         the Agency for Health Care Administration;

14         authorizing assessment of certain costs of an

15         investigation that results in a successful

16         prosecution; revising a cross reference; making

17         renewal of license contingent on payment or

18         arrangement for payment of any unpaid

19         assessment; amending s. 400.509, F.S.;

20         providing for an abuse registry background

21         check through the Agency for Health Care

22         Administration; authorizing assessment of

23         certain costs of an investigation that results

24         in a successful prosecution; making renewal of

25         registration contingent on payment or

26         arrangement for payment of any unpaid

27         assessment; amending s. 400.512, F.S.; revising

28         provisions relating to the screening of home

29         health agency, nurse registry, and companion

30         and homemaker service personnel; requiring the

31         Agency for Health Care Administration to


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  1         conduct the search for reports of confirmed

  2         abuse; providing an exemption from liability

  3         under certain conditions for providing opinions

  4         on the job performance of former employees and

  5         contract workers; providing conforming changes;

  6         amending s. 455.587, F.S.; providing

  7         requirements for funding regulation of

  8         professions by the Department of Health;

  9         providing an appropriation; amending s.

10         766.106, F.S.; providing that following the

11         initiation of a suit alleging medical

12         malpractice the claimant must provide notice to

13         the Department of Health along with a copy of

14         the service of process; requiring the Agency

15         for Health Care Administration to conduct a

16         study regarding implementation of the federal

17         "Ticket to Work and Work Incentives Act of

18         1999" in the state and report to the

19         Legislature; amending s. 240.241, F.S.;

20         providing for retention of sponsored-research

21         overhead; authorizing the Agency for Health

22         Care Administration to offer specialty prepaid

23         health plans to Medicaid recipients with HIV or

24         AIDS; providing conditions; requiring a report

25         to the Legislature; providing effective dates.

26

27  Be It Enacted by the Legislature of the State of Florida:

28

29         Section 1.  Subsections (1) and (2) of section 400.408,

30  Florida Statutes, are amended to read:

31


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  1         400.408  Unlicensed facilities; referral of person for

  2  residency to unlicensed facility; penalties; verification of

  3  licensure status.--

  4         (1)(a)  It is unlawful to own, operate, or maintain an

  5  assisted living facility without obtaining a license under

  6  this part.

  7         (b)  Except as provided under paragraph (d), any person

  8  who owns, operates, or maintains an unlicensed assisted living

  9  facility commits a felony of the third degree, punishable as

10  provided in s. 775.082, s. 775.083, or s. 775.084. Each day of

11  continued operation is a separate offense.

12         (c)  Any person found guilty of violating paragraph (a)

13  a second or subsequent time commits a felony of the second

14  degree, punishable as provided under s. 775.082, s. 775.083,

15  or s. 775.084. Each day of continued operation is a separate

16  offense.

17         (d)  Any person who owns, operates, or maintains an

18  unlicensed assisted living facility due to a change in this

19  part or a modification in department rule within 6 months

20  after the effective date of such change and who, within 10

21  working days after receiving notification from the agency,

22  fails to cease operation or apply for a license under this

23  part commits a felony of the third degree, punishable as

24  provided in s. 775.082, s. 775.083, or s. 775.084. Each day of

25  continued operation is a separate offense.

26         (e)  Any facility that fails to cease operation after

27  agency notification may be fined for each day of noncompliance

28  pursuant to s. 400.419.

29         (f)  When a licensee has an interest in more than one

30  assisted living facility, and fails to license any one of

31  these facilities, the agency may revoke the license, impose a


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  1  moratorium, or impose a fine pursuant to s. 400.419, on any or

  2  all of the licensed facilities until such time as the

  3  unlicensed facility is licensed or ceases operation.

  4         (g)  If the agency determines that an owner is

  5  operating or maintaining an assisted living facility without

  6  obtaining a license and determines that a condition exists in

  7  the facility that poses a threat to the health, safety, or

  8  welfare of a resident of the facility, the owner is subject to

  9  the same actions and fines imposed against a licensed facility

10  as specified in ss. 400.414 and 400.419.

11         (h)  Any person aware of the operation of an unlicensed

12  assisted living facility must report that facility to the

13  agency. The agency shall provide to the department's elder

14  information and referral providers a list, by county, of

15  licensed assisted living facilities, to assist persons who are

16  considering an assisted living facility placement in locating

17  a licensed facility.

18         (i)  Each field office of the Agency for Health Care

19  Administration shall establish a local coordinating workgroup

20  which includes representatives of local law enforcement

21  agencies, state attorneys, local fire authorities, the

22  Department of Children and Family Services, the district

23  long-term care ombudsman council, and the district human

24  rights advocacy committee to assist in identifying the

25  operation of unlicensed facilities and to develop and

26  implement a plan to ensure effective enforcement of state laws

27  relating to such facilities. The workgroup shall report its

28  findings, actions, and recommendations semi-annually to the

29  Director of Health Facility Regulation of the agency.

30         (2)  It is unlawful to knowingly refer a person for

31  residency to an unlicensed assisted living facility; to an


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  1  assisted living facility the license of which is under denial

  2  or has been suspended or revoked; or to an assisted living

  3  facility that has a moratorium on admissions.  Any person who

  4  violates this subsection commits a noncriminal violation,

  5  punishable by a fine not exceeding $500 as provided in s.

  6  775.083.

  7         (a)  Any health care practitioner, as defined in s.

  8  455.501, which is aware of the operation of an unlicensed

  9  facility shall report that facility to the agency. Failure to

10  report a facility that the practitioner knows or has

11  reasonable cause to suspect is unlicensed shall be reported to

12  the practitioner's licensing board.

13         (b)  Any hospital or community mental health center

14  licensed under chapter 395 or chapter 394 which knowingly

15  discharges a patient or client to an unlicensed facility is

16  subject to sanction by the agency.

17         (c)(a)  Any employee of the agency or department, or

18  the Department of Children and Family Services, who knowingly

19  refers a person for residency to an unlicensed facility; to a

20  facility the license of which is under denial or has been

21  suspended or revoked; or to a facility that has a moratorium

22  on admissions is subject to disciplinary action by the agency

23  or department, or the Department of Children and Family

24  Services.

25         (d)(b)  The employer of any person who is under

26  contract with the agency or department, or the Department of

27  Children and Family Services, and who knowingly refers a

28  person for residency to an unlicensed facility; to a facility

29  the license of which is under denial or has been suspended or

30  revoked; or to a facility that has a moratorium on admissions

31


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  1  shall be fined and required to prepare a corrective action

  2  plan designed to prevent such referrals.

  3         (e)(c)  The agency shall provide the department and the

  4  Department of Children and Family Services with a list of

  5  licensed facilities within each county and shall update the

  6  list at least quarterly.

  7         (f)(d)  At least annually, the agency shall notify, in

  8  appropriate trade publications, physicians licensed under

  9  chapter 458 or chapter 459, hospitals licensed under chapter

10  395, nursing home facilities licensed under part II of this

11  chapter, and employees of the agency or the department, or the

12  Department of Children and Family Services, who are

13  responsible for referring persons for residency, that it is

14  unlawful to knowingly refer a person for residency to an

15  unlicensed assisted living facility and shall notify them of

16  the penalty for violating such prohibition. The department and

17  the Department of Children and Family Services shall, in turn,

18  notify service providers under contract to the respective

19  departments who have responsibility for resident referrals to

20  facilities. Further, the notice must direct each noticed

21  facility and individual to contact the appropriate agency

22  office in order to verify the licensure status of any facility

23  prior to referring any person for residency. Each notice must

24  include the name, telephone number, and mailing address of the

25  appropriate office to contact.

26         Section 2.  Subsection (1) of section 415.1034, Florida

27  Statutes, is amended to read:

28         415.1034  Mandatory reporting of abuse, neglect, or

29  exploitation of disabled adults or elderly persons; mandatory

30  reports of death.--

31         (1)  MANDATORY REPORTING.--


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  1         (a)  Any person, including, but not limited to, any:

  2         1.  Physician, osteopathic physician, medical examiner,

  3  chiropractic physician, nurse, paramedic, emergency medical

  4  technician, or hospital personnel engaged in the admission,

  5  examination, care, or treatment of disabled adults or elderly

  6  persons;

  7         2.  Health professional or mental health professional

  8  other than one listed in subparagraph 1.;

  9         3.  Practitioner who relies solely on spiritual means

10  for healing;

11         4.  Nursing home staff; assisted living facility staff;

12  adult day care center staff; adult family-care home staff;

13  social worker; or other professional adult care, residential,

14  or institutional staff;

15         5.  State, county, or municipal criminal justice

16  employee or law enforcement officer;

17         6.  An employee of the Department of Business and

18  Professional Regulation conducting inspections of public

19  lodging establishments under s. 509.032;

20         7.6.  Human rights advocacy committee or long-term care

21  ombudsman council member; or

22         8.7.  Bank, savings and loan, or credit union officer,

23  trustee, or employee,

24

25  who knows, or has reasonable cause to suspect, that a disabled

26  adult or an elderly person has been or is being abused,

27  neglected, or exploited shall immediately report such

28  knowledge or suspicion to the central abuse registry and

29  tracking system on the single statewide toll-free telephone

30  number.

31


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  1         (b)  To the extent possible, a report made pursuant to

  2  paragraph (a) must contain, but need not be limited to, the

  3  following information:

  4         1.  Name, age, race, sex, physical description, and

  5  location of each disabled adult or an elderly person alleged

  6  to have been abused, neglected, or exploited.

  7         2.  Names, addresses, and telephone numbers of the

  8  disabled adult's or elderly person's family members.

  9         3.  Name, address, and telephone number of each alleged

10  perpetrator.

11         4.  Name, address, and telephone number of the

12  caregiver of the disabled adult or elderly person, if

13  different from the alleged perpetrator.

14         5.  Name, address, and telephone number of the person

15  reporting the alleged abuse, neglect, or exploitation.

16         6.  Description of the physical or psychological

17  injuries sustained.

18         7.  Actions taken by the reporter, if any, such as

19  notification of the criminal justice agency.

20         8.  Any other information available to the reporting

21  person which may establish the cause of abuse, neglect, or

22  exploitation that occurred or is occurring.

23         Section 3.  Subsections (2) and (11) of section

24  400.471, Florida Statutes, are amended to read:

25         400.471  Application for license; fee; provisional

26  license; temporary permit.--

27         (2)  The applicant must file with the application

28  satisfactory proof that the home health agency is in

29  compliance with this part and applicable rules, including:

30

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  1         (a)  A listing of services to be provided, either

  2  directly by the applicant or through contractual arrangements

  3  with existing providers;

  4         (b)  The number and discipline of professional staff to

  5  be employed; and

  6         (c)  Proof of financial ability to operate.

  7

  8  If the applicant has applied for a certificate of need under

  9  ss. 408.0331-408.045 within the preceding 12 months, the

10  applicant may submit the proof required during the

11  certificate-of-need process along with an attestation that

12  there has been no substantial change in the facts and

13  circumstances underlying the original submission.

14         (11)  The agency may not issue a license designated as

15  certified to a home health agency that fails to receive a

16  certificate of need under ss. 408.031-408.045 or that fails to

17  satisfy the requirements of a Medicare certification survey

18  from the agency.

19         Section 4.  Section 408.032, Florida Statutes, is

20  amended to read:

21         408.032  Definitions.--As used in ss. 408.031-408.045,

22  the term:

23         (1)  "Agency" means the Agency for Health Care

24  Administration.

25         (2)  "Capital expenditure" means an expenditure,

26  including an expenditure for a construction project undertaken

27  by a health care facility as its own contractor, which, under

28  generally accepted accounting principles, is not properly

29  chargeable as an expense of operation and maintenance, which

30  is made to change the bed capacity of the facility, or

31  substantially change the services or service area of the


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  1  health care facility, health service provider, or hospice, and

  2  which includes the cost of the studies, surveys, designs,

  3  plans, working drawings, specifications, initial financing

  4  costs, and other activities essential to acquisition,

  5  improvement, expansion, or replacement of the plant and

  6  equipment.

  7         (3)  "Certificate of need" means a written statement

  8  issued by the agency evidencing community need for a new,

  9  converted, expanded, or otherwise significantly modified

10  health care facility, health service, or hospice.

11         (4)  "Commenced construction" means initiation of and

12  continuous activities beyond site preparation associated with

13  erecting or modifying a health care facility, including

14  procurement of a building permit applying the use of

15  agency-approved construction documents, proof of an executed

16  owner/contractor agreement or an irrevocable or binding forced

17  account, and actual undertaking of foundation forming with

18  steel installation and concrete placing.

19         (5)  "District" means a health service planning

20  district composed of the following counties:

21         District 1.--Escambia, Santa Rosa, Okaloosa, and Walton

22  Counties.

23         District 2.--Holmes, Washington, Bay, Jackson,

24  Franklin, Gulf, Gadsden, Liberty, Calhoun, Leon, Wakulla,

25  Jefferson, Madison, and Taylor Counties.

26         District 3.--Hamilton, Suwannee, Lafayette, Dixie,

27  Columbia, Gilchrist, Levy, Union, Bradford, Putnam, Alachua,

28  Marion, Citrus, Hernando, Sumter, and Lake Counties.

29         District 4.--Baker, Nassau, Duval, Clay, St. Johns,

30  Flagler, and Volusia Counties.

31         District 5.--Pasco and Pinellas Counties.


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  1         District 6.--Hillsborough, Manatee, Polk, Hardee, and

  2  Highlands Counties.

  3         District 7.--Seminole, Orange, Osceola, and Brevard

  4  Counties.

  5         District 8.--Sarasota, DeSoto, Charlotte, Lee, Glades,

  6  Hendry, and Collier Counties.

  7         District 9.--Indian River, Okeechobee, St. Lucie,

  8  Martin, and Palm Beach Counties.

  9         District 10.--Broward County.

10         District 11.--Dade and Monroe Counties.

11         (6)  "Exemption" means the process by which a proposal

12  that would otherwise require a certificate of need may proceed

13  without a certificate of need.

14         (7)(6)  "Expedited review" means the process by which

15  certain types of applications are not subject to the review

16  cycle requirements contained in s. 408.039(1), and the letter

17  of intent requirements contained in s. 408.039(2).

18         (8)(7)  "Health care facility" means a hospital,

19  long-term care hospital, skilled nursing facility, hospice,

20  intermediate care facility, or intermediate care facility for

21  the developmentally disabled. A facility relying solely on

22  spiritual means through prayer for healing is not included as

23  a health care facility.

24         (9)(8)  "Health services" means diagnostic, curative,

25  or rehabilitative services and includes alcohol treatment,

26  drug abuse treatment, and mental health services. Obstetric

27  services are not health services for purposes of ss.

28  408.031-408.045.

29         (9)  "Home health agency" means an organization, as

30  defined in s. 400.462(4), that is certified or seeks

31  certification as a Medicare home health service provider.


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  1         (10)  "Hospice" or "hospice program" means a hospice as

  2  defined in part VI of chapter 400.

  3         (11)  "Hospital" means a health care facility licensed

  4  under chapter 395.

  5         (12)  "Institutional health service" means a health

  6  service which is provided by or through a health care facility

  7  and which entails an annual operating cost of $500,000 or

  8  more.  The agency shall, by rule, adjust the annual operating

  9  cost threshold annually using an appropriate inflation index.

10         (13)  "Intermediate care facility" means an institution

11  which provides, on a regular basis, health-related care and

12  services to individuals who do not require the degree of care

13  and treatment which a hospital or skilled nursing facility is

14  designed to provide, but who, because of their mental or

15  physical condition, require health-related care and services

16  above the level of room and board.

17         (12)(14)  "Intermediate care facility for the

18  developmentally disabled" means a residential facility

19  licensed under chapter 393 and certified by the Federal

20  Government pursuant to the Social Security Act as a provider

21  of Medicaid services to persons who are mentally retarded or

22  who have a related condition.

23         (13)(15)  "Long-term care hospital" means a hospital

24  licensed under chapter 395 which meets the requirements of 42

25  C.F.R. s. 412.23(e) and seeks exclusion from the Medicare

26  prospective payment system for inpatient hospital services.

27         (14)  "Mental health services" means inpatient services

28  provided in a hospital licensed under chapter 395 and listed

29  on the hospital license as psychiatric beds for adults;

30  psychiatric beds for children and adolescents; intensive

31  residential treatment beds for children and adolescents;


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  1  substance abuse beds for adults; or substance abuse beds for

  2  children and adolescents.

  3         (16)  "Multifacility project" means an integrated

  4  residential and health care facility consisting of independent

  5  living units, assisted living facility units, and nursing home

  6  beds certificated on or after January 1, 1987, where:

  7         (a)  The aggregate total number of independent living

  8  units and assisted living facility units exceeds the number of

  9  nursing home beds.

10         (b)  The developer of the project has expended the sum

11  of $500,000 or more on the certificated and noncertificated

12  elements of the project combined, exclusive of land costs, by

13  the conclusion of the 18th month of the life of the

14  certificate of need.

15         (c)  The total aggregate cost of construction of the

16  certificated element of the project, when combined with other,

17  noncertificated elements, is $10 million or more.

18         (d)  All elements of the project are contiguous or

19  immediately adjacent to each other and construction of all

20  elements will be continuous.

21         (15)(17)  "Nursing home geographically underserved

22  area" means:

23         (a)  A county in which there is no existing or approved

24  nursing home;

25         (b)  An area with a radius of at least 20 miles in

26  which there is no existing or approved nursing home; or

27         (c)  An area with a radius of at least 20 miles in

28  which all existing nursing homes have maintained at least a 95

29  percent occupancy rate for the most recent 6 months or a 90

30  percent occupancy rate for the most recent 12 months.

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  1         (18)  "Respite care" means short-term care in a

  2  licensed health care facility which is personal or custodial

  3  and is provided for chronic illness, physical infirmity, or

  4  advanced age for the purpose of temporarily relieving family

  5  members of the burden of providing care and attendance.

  6         (16)(19)  "Skilled nursing facility" means an

  7  institution, or a distinct part of an institution, which is

  8  primarily engaged in providing, to inpatients, skilled nursing

  9  care and related services for patients who require medical or

10  nursing care, or rehabilitation services for the

11  rehabilitation of injured, disabled, or sick persons.

12         (17)(20)  "Tertiary health service" means a health

13  service which, due to its high level of intensity, complexity,

14  specialized or limited applicability, and cost, should be

15  limited to, and concentrated in, a limited number of hospitals

16  to ensure the quality, availability, and cost-effectiveness of

17  such service. Examples of such service include, but are not

18  limited to, organ transplantation, specialty burn units,

19  neonatal intensive care units, comprehensive rehabilitation,

20  and medical or surgical services which are experimental or

21  developmental in nature to the extent that the provision of

22  such services is not yet contemplated within the commonly

23  accepted course of diagnosis or treatment for the condition

24  addressed by a given service.  The agency shall establish by

25  rule a list of all tertiary health services.

26         (18)(21)  "Regional area" means any of those regional

27  health planning areas established by the agency to which local

28  and district health planning funds are directed to local

29  health councils through the General Appropriations Act.

30

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  1         Section 5.  Paragraph (b) of subsection (1) and

  2  paragraph (a) of subsection (3) of section 408.033, Florida

  3  Statutes, are amended to read:

  4         408.033  Local and state health planning.--

  5         (1)  LOCAL HEALTH COUNCILS.--

  6         (b)  Each local health council may:

  7         1.  Develop a district or regional area health plan

  8  that permits is consistent with the objectives and strategies

  9  in the state health plan, but that shall permit each local

10  health council to develop strategies and set priorities for

11  implementation based on its unique local health needs.  The

12  district or regional area health plan must contain preferences

13  for the development of health services and facilities, which

14  may be considered by the agency in its review of

15  certificate-of-need applications.  The district health plan

16  shall be submitted to the agency and updated periodically. The

17  district health plans shall use a uniform format and be

18  submitted to the agency according to a schedule developed by

19  the agency in conjunction with the local health councils. The

20  schedule must provide for coordination between the development

21  of the state health plan and the district health plans and for

22  the development of district health plans by major sections

23  over a multiyear period.  The elements of a district plan

24  which are necessary to the review of certificate-of-need

25  applications for proposed projects within the district may be

26  adopted by the agency as a part of its rules.

27         2.  Advise the agency on health care issues and

28  resource allocations.

29         3.  Promote public awareness of community health needs,

30  emphasizing health promotion and cost-effective health service

31  selection.


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  1         4.  Collect data and conduct analyses and studies

  2  related to health care needs of the district, including the

  3  needs of medically indigent persons, and assist the agency and

  4  other state agencies in carrying out data collection

  5  activities that relate to the functions in this subsection.

  6         5.  Monitor the onsite construction progress, if any,

  7  of certificate-of-need approved projects and report council

  8  findings to the agency on forms provided by the agency.

  9         6.  Advise and assist any regional planning councils

10  within each district that have elected to address health

11  issues in their strategic regional policy plans with the

12  development of the health element of the plans to address the

13  health goals and policies in the State Comprehensive Plan.

14         7.  Advise and assist local governments within each

15  district on the development of an optional health plan element

16  of the comprehensive plan provided in chapter 163, to assure

17  compatibility with the health goals and policies in the State

18  Comprehensive Plan and district health plan.  To facilitate

19  the implementation of this section, the local health council

20  shall annually provide the local governments in its service

21  area, upon request, with:

22         a.  A copy and appropriate updates of the district

23  health plan;

24         b.  A report of hospital and nursing home utilization

25  statistics for facilities within the local government

26  jurisdiction; and

27         c.  Applicable agency rules and calculated need

28  methodologies for health facilities and services regulated

29  under s. 408.034 for the district served by the local health

30  council.

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  1         8.  Monitor and evaluate the adequacy, appropriateness,

  2  and effectiveness, within the district, of local, state,

  3  federal, and private funds distributed to meet the needs of

  4  the medically indigent and other underserved population

  5  groups.

  6         9.  In conjunction with the Agency for Health Care

  7  Administration, plan for services at the local level for

  8  persons infected with the human immunodeficiency virus.

  9         10.  Provide technical assistance to encourage and

10  support activities by providers, purchasers, consumers, and

11  local, regional, and state agencies in meeting the health care

12  goals, objectives, and policies adopted by the local health

13  council.

14         11.  Provide the agency with data required by rule for

15  the review of certificate-of-need applications and the

16  projection of need for health services and facilities in the

17  district.

18         (3)  DUTIES AND RESPONSIBILITIES OF THE AGENCY.--

19         (a)  The agency, in conjunction with the local health

20  councils, is responsible for the coordinated planning of all

21  health care services in the state and for the preparation of

22  the state health plan.

23         Section 6.  Subsection (2) of section 408.034, Florida

24  Statutes, is amended to read:

25         408.034  Duties and responsibilities of agency;

26  rules.--

27         (2)  In the exercise of its authority to issue licenses

28  to health care facilities and health service providers, as

29  provided under chapters 393, 395, and parts II, IV, and VI of

30  chapter 400, the agency may not issue a license to any health

31  care facility, health service provider, hospice, or part of a


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  1  health care facility which fails to receive a certificate of

  2  need or an exemption for the licensed facility or service.

  3         Section 7.  Section 408.035, Florida Statutes, is

  4  amended to read:

  5         408.035  Review criteria.--

  6         (1)  The agency shall determine the reviewability of

  7  applications and shall review applications for

  8  certificate-of-need determinations for health care facilities

  9  and health services in context with the following criteria:

10         (1)(a)  The need for the health care facilities and

11  health services being proposed in relation to the applicable

12  district health plan, except in emergency circumstances that

13  pose a threat to the public health.

14         (2)(b)  The availability, quality of care, efficiency,

15  appropriateness, accessibility, and extent of utilization of,

16  and adequacy of like and existing health care facilities and

17  health services in the service district of the applicant.

18         (3)(c)  The ability of the applicant to provide quality

19  of care and the applicant's record of providing quality of

20  care.

21         (d)  The availability and adequacy of other health care

22  facilities and health services in the service district of the

23  applicant, such as outpatient care and ambulatory or home care

24  services, which may serve as alternatives for the health care

25  facilities and health services to be provided by the

26  applicant.

27         (e)  Probable economies and improvements in service

28  which may be derived from operation of joint, cooperative, or

29  shared health care resources.

30         (4)(f)  The need in the service district of the

31  applicant for special health care equipment and services that


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  1  are not reasonably and economically accessible in adjoining

  2  areas.

  3         (5)(g)  The needs of need for research and educational

  4  facilities, including, but not limited to, facilities with

  5  institutional training programs and community training

  6  programs for health care practitioners and for doctors of

  7  osteopathic medicine and medicine at the student, internship,

  8  and residency training levels.

  9         (6)(h)  The availability of resources, including health

10  personnel, management personnel, and funds for capital and

11  operating expenditures, for project accomplishment and

12  operation.; the effects the project will have on clinical

13  needs of health professional training programs in the service

14  district; the extent to which the services will be accessible

15  to schools for health professions in the service district for

16  training purposes if such services are available in a limited

17  number of facilities; the availability of alternative uses of

18  such resources for the provision of other health services; and

19         (7)  The extent to which the proposed services will

20  enhance access to health care for be accessible to all

21  residents of the service district.

22         (8)(i)  The immediate and long-term financial

23  feasibility of the proposal.

24         (j)  The special needs and circumstances of health

25  maintenance organizations.

26         (k)  The needs and circumstances of those entities that

27  provide a substantial portion of their services or resources,

28  or both, to individuals not residing in the service district

29  in which the entities are located or in adjacent service

30  districts.  Such entities may include medical and other health

31  professions, schools, multidisciplinary clinics, and specialty


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  1  services such as open-heart surgery, radiation therapy, and

  2  renal transplantation.

  3         (9)(l)  The extent to which the proposal will foster

  4  competition that promotes quality and cost-effectiveness. The

  5  probable impact of the proposed project on the costs of

  6  providing health services proposed by the applicant, upon

  7  consideration of factors including, but not limited to, the

  8  effects of competition on the supply of health services being

  9  proposed and the improvements or innovations in the financing

10  and delivery of health services which foster competition and

11  service to promote quality assurance and cost-effectiveness.

12         (10)(m)  The costs and methods of the proposed

13  construction, including the costs and methods of energy

14  provision and the availability of alternative, less costly, or

15  more effective methods of construction.

16         (11)(n)  The applicant's past and proposed provision of

17  health care services to Medicaid patients and the medically

18  indigent.

19         (o)  The applicant's past and proposed provision of

20  services that promote a continuum of care in a multilevel

21  health care system, which may include, but are not limited to,

22  acute care, skilled nursing care, home health care, and

23  assisted living facilities.

24         (12)(p)  The applicant's designation as a Gold Seal

25  Program nursing facility pursuant to s. 400.235, when the

26  applicant is requesting additional nursing home beds at that

27  facility.

28         (2)  In cases of capital expenditure proposals for the

29  provision of new health services to inpatients, the agency

30  shall also reference each of the following in its findings of

31  fact:


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  1         (a)  That less costly, more efficient, or more

  2  appropriate alternatives to such inpatient services are not

  3  available and the development of such alternatives has been

  4  studied and found not practicable.

  5         (b)  That existing inpatient facilities providing

  6  inpatient services similar to those proposed are being used in

  7  an appropriate and efficient manner.

  8         (c)  In the case of new construction or replacement

  9  construction, that alternatives to the construction, for

10  example, modernization or sharing arrangements, have been

11  considered and have been implemented to the maximum extent

12  practicable.

13         (d)  That patients will experience serious problems in

14  obtaining inpatient care of the type proposed, in the absence

15  of the proposed new service.

16         (e)  In the case of a proposal for the addition of beds

17  for the provision of skilled nursing or intermediate care

18  services, that the addition will be consistent with the plans

19  of other agencies of the state responsible for the provision

20  and financing of long-term care, including home health

21  services.

22         Section 8.  Section 408.036, Florida Statutes, is

23  amended to read:

24         408.036  Projects subject to review.--

25         (1)  APPLICABILITY.--Unless exempt under subsection

26  (3), all health-care-related projects, as described in

27  paragraphs (a)-(h)(k), are subject to review and must file an

28  application for a certificate of need with the agency. The

29  agency is exclusively responsible for determining whether a

30  health-care-related project is subject to review under ss.

31  408.031-408.045.


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  1         (a)  The addition of beds by new construction or

  2  alteration.

  3         (b)  The new construction or establishment of

  4  additional health care facilities, including a replacement

  5  health care facility when the proposed project site is not

  6  located on the same site as the existing health care facility.

  7         (c)  The conversion from one type of health care

  8  facility to another, including the conversion from one level

  9  of care to another, in a skilled or intermediate nursing

10  facility, if the conversion effects a change in the level of

11  care of 10 beds or 10 percent of total bed capacity of the

12  skilled or intermediate nursing facility within a 2-year

13  period.  If the nursing facility is certified for both skilled

14  and intermediate nursing care, the provisions of this

15  paragraph do not apply.

16         (d)  An Any increase in the total licensed bed capacity

17  of a health care facility.

18         (e)  Subject to the provisions of paragraph (3)(i), The

19  establishment of a Medicare-certified home health agency, the

20  establishment of a hospice or hospice inpatient facility,

21  except as provided in s. 408.043 or the direct provision of

22  such services by a health care facility or health maintenance

23  organization for those other than the subscribers of the

24  health maintenance organization; except that this paragraph

25  does not apply to the establishment of a Medicare-certified

26  home health agency by a facility described in paragraph

27  (3)(h).

28         (f)  An acquisition by or on behalf of a health care

29  facility or health maintenance organization, by any means,

30  which acquisition would have required review if the

31  acquisition had been by purchase.


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  1         (f)(g)  The establishment of inpatient institutional

  2  health services by a health care facility, or a substantial

  3  change in such services.

  4         (h)  The acquisition by any means of an existing health

  5  care facility by any person, unless the person provides the

  6  agency with at least 30 days' written notice of the proposed

  7  acquisition, which notice is to include the services to be

  8  offered and the bed capacity of the facility, and unless the

  9  agency does not determine, within 30 days after receipt of

10  such notice, that the services to be provided and the bed

11  capacity of the facility will be changed.

12         (i)  An increase in the cost of a project for which a

13  certificate of need has been issued when the increase in cost

14  exceeds 20 percent of the originally approved cost of the

15  project, except that a cost overrun review is not necessary

16  when the cost overrun is less than $20,000.

17         (g)(j)  An increase in the number of beds for acute

18  care, nursing home care beds, specialty burn units, neonatal

19  intensive care units, comprehensive rehabilitation, mental

20  health services, or hospital-based distinct part skilled

21  nursing units, or at a long-term care hospital psychiatric or

22  rehabilitation beds.

23         (h)(k)  The establishment of tertiary health services.

24         (2)  PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless

25  exempt pursuant to subsection (3), projects subject to an

26  expedited review shall include, but not be limited to:

27         (a)  Cost overruns, as defined in paragraph (1)(i).

28         (a)(b)  Research, education, and training programs.

29         (b)(c)  Shared services contracts or projects.

30         (c)(d)  A transfer of a certificate of need.

31


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  1         (d)(e)  A 50-percent increase in nursing home beds for

  2  a facility incorporated and operating in this state for at

  3  least 60 years on or before July 1, 1988, which has a licensed

  4  nursing home facility located on a campus providing a variety

  5  of residential settings and supportive services.  The

  6  increased nursing home beds shall be for the exclusive use of

  7  the campus residents.  Any application on behalf of an

  8  applicant meeting this requirement shall be subject to the

  9  base fee of $5,000 provided in s. 408.038.

10         (f)  Combination within one nursing home facility of

11  the beds or services authorized by two or more certificates of

12  need issued in the same planning subdistrict.

13         (g)  Division into two or more nursing home facilities

14  of beds or services authorized by one certificate of need

15  issued in the same planning subdistrict.  Such division shall

16  not be approved if it would adversely affect the original

17  certificate's approved cost.

18         (e)(h)  Replacement of a health care facility when the

19  proposed project site is located in the same district and

20  within a 1-mile radius of the replaced health care facility.

21         (f)  The conversion of mental health services beds

22  licensed under chapter 395 or hospital-based distinct part

23  skilled nursing unit beds to general acute care beds; the

24  conversion of mental health services beds between or among the

25  licensed bed categories defined as beds for mental health

26  services; or the conversion of general acute care beds to beds

27  for mental health services.

28         1.  Conversion under this paragraph shall not establish

29  a new licensed bed category at the hospital but shall apply

30  only to categories of beds licensed at that hospital.

31


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  1         2.  Beds converted under this paragraph must be

  2  licensed and operational for at least 12 months before the

  3  hospital may apply for additional conversion affecting beds of

  4  the same type.

  5

  6  The agency shall develop rules to implement the provisions for

  7  expedited review, including time schedule, application content

  8  which may be reduced from the full requirements of s.

  9  408.037(1), and application processing.

10         (3)  EXEMPTIONS.--Upon request, the following projects

11  are subject to supported by such documentation as the agency

12  requires, the agency shall grant an exemption from the

13  provisions of subsection (1):

14         (a)  For the initiation or expansion of obstetric

15  services.

16         (a)(b)  For replacement of any expenditure to replace

17  or renovate any part of a licensed health care facility on the

18  same site, provided that the number of licensed beds in each

19  licensed bed category will not increase and, in the case of a

20  replacement facility, the project site is the same as the

21  facility being replaced.

22         (c)  For providing respite care services. An individual

23  may be admitted to a respite care program in a hospital

24  without regard to inpatient requirements relating to admitting

25  order and attendance of a member of a medical staff.

26         (b)(d)  For hospice services or home health services

27  provided by a rural hospital, as defined in s. 395.602, or for

28  swing beds in a such rural hospital, as defined in s. 395.602,

29  in a number that does not exceed one-half of its licensed

30  beds.

31


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  1         (c)(e)  For the conversion of licensed acute care

  2  hospital beds to Medicare and Medicaid certified skilled

  3  nursing beds in a rural hospital, as defined in s. 395.602, so

  4  long as the conversion of the beds does not involve the

  5  construction of new facilities. The total number of skilled

  6  nursing beds, including swing beds, may not exceed one-half of

  7  the total number of licensed beds in the rural hospital as of

  8  July 1, 1993. Certified skilled nursing beds designated under

  9  this paragraph, excluding swing beds, shall be included in the

10  community nursing home bed inventory.  A rural hospital which

11  subsequently decertifies any acute care beds exempted under

12  this paragraph shall notify the agency of the decertification,

13  and the agency shall adjust the community nursing home bed

14  inventory accordingly.

15         (d)(f)  For the addition of nursing home beds at a

16  skilled nursing facility that is part of a retirement

17  community that provides a variety of residential settings and

18  supportive services and that has been incorporated and

19  operated in this state for at least 65 years on or before July

20  1, 1994. All nursing home beds must not be available to the

21  public but must be for the exclusive use of the community

22  residents.

23         (e)(g)  For an increase in the bed capacity of a

24  nursing facility licensed for at least 50 beds as of January

25  1, 1994, under part II of chapter 400 which is not part of a

26  continuing care facility if, after the increase, the total

27  licensed bed capacity of that facility is not more than 60

28  beds and if the facility has been continuously licensed since

29  1950 and has received a superior rating on each of its two

30  most recent licensure surveys.

31


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  1         (h)  For the establishment of a Medicare-certified home

  2  health agency by a facility certified under chapter 651; a

  3  retirement community, as defined in s. 400.404(2)(g); or a

  4  residential facility that serves only retired military

  5  personnel, their dependents, and the surviving dependents of

  6  deceased military personnel. Medicare-reimbursed home health

  7  services provided through such agency shall be offered

  8  exclusively to residents of the facility or retirement

  9  community or to residents of facilities or retirement

10  communities owned, operated, or managed by the same corporate

11  entity. Each visit made to deliver Medicare-reimbursable home

12  health services to a home health patient who, at the time of

13  service, is not a resident of the facility or retirement

14  community shall be a deceptive and unfair trade practice and

15  constitutes a violation of ss. 501.201-501.213.

16         (i)  For the establishment of a Medicare-certified home

17  health agency. This paragraph shall take effect 90 days after

18  the adjournment sine die of the next regular session of the

19  Legislature occurring after the legislative session in which

20  the Legislature receives a report from the Director of Health

21  Care Administration certifying that the federal Health Care

22  Financing Administration has implemented a per-episode

23  prospective pay system for Medicare-certified home health

24  agencies.

25         (f)(j)  For an inmate health care facility built by or

26  for the exclusive use of the Department of Corrections as

27  provided in chapter 945. This exemption expires when such

28  facility is converted to other uses.

29         (k)  For an expenditure by or on behalf of a health

30  care facility to provide a health service exclusively on an

31  outpatient basis.


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  1         (g)(l)  For the termination of an inpatient a health

  2  care service.

  3         (h)(m)  For the delicensure of beds. A request for

  4  exemption An application submitted under this paragraph must

  5  identify the number, the category of beds classification, and

  6  the name of the facility in which the beds to be delicensed

  7  are located.

  8         (i)(n)  For the provision of adult inpatient diagnostic

  9  cardiac catheterization services in a hospital.

10         1.  In addition to any other documentation otherwise

11  required by the agency, a request for an exemption submitted

12  under this paragraph must comply with the following criteria:

13         a.  The applicant must certify it will not provide

14  therapeutic cardiac catheterization pursuant to the grant of

15  the exemption.

16         b.  The applicant must certify it will meet and

17  continuously maintain the minimum licensure requirements

18  adopted by the agency governing such programs pursuant to

19  subparagraph 2.

20         c.  The applicant must certify it will provide a

21  minimum of 2 percent of its services to charity and Medicaid

22  patients.

23         2.  The agency shall adopt licensure requirements by

24  rule which govern the operation of adult inpatient diagnostic

25  cardiac catheterization programs established pursuant to the

26  exemption provided in this paragraph. The rules shall ensure

27  that such programs:

28         a.  Perform only adult inpatient diagnostic cardiac

29  catheterization services authorized by the exemption and will

30  not provide therapeutic cardiac catheterization or any other

31  services not authorized by the exemption.


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  1         b.  Maintain sufficient appropriate equipment and

  2  health personnel to ensure quality and safety.

  3         c.  Maintain appropriate times of operation and

  4  protocols to ensure availability and appropriate referrals in

  5  the event of emergencies.

  6         d.  Maintain appropriate program volumes to ensure

  7  quality and safety.

  8         e.  Provide a minimum of 2 percent of its services to

  9  charity and Medicaid patients each year.

10         3.a.  The exemption provided by this paragraph shall

11  not apply unless the agency determines that the program is in

12  compliance with the requirements of subparagraph 1. and that

13  the program will, after beginning operation, continuously

14  comply with the rules adopted pursuant to subparagraph 2.  The

15  agency shall monitor such programs to ensure compliance with

16  the requirements of subparagraph 2.

17         b.(I)  The exemption for a program shall expire

18  immediately when the program fails to comply with the rules

19  adopted pursuant to sub-subparagraphs 2.a., b., and c.

20         (II)  Beginning 18 months after a program first begins

21  treating patients, the exemption for a program shall expire

22  when the program fails to comply with the rules adopted

23  pursuant to sub-subparagraphs 2.d. and e.

24         (III)  If the exemption for a program expires pursuant

25  to sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the

26  agency shall not grant an exemption pursuant to this paragraph

27  for an adult inpatient diagnostic cardiac catheterization

28  program located at the same hospital until 2 years following

29  the date of the determination by the agency that the program

30  failed to comply with the rules adopted pursuant to

31  subparagraph 2.


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  1         4.  The agency shall not grant any exemption under this

  2  paragraph until the adoption of the rules required under this

  3  paragraph, or until March 1, 1998, whichever comes first.

  4  However, if final rules have not been adopted by March 1,

  5  1998, the proposed rules governing the exemptions shall be

  6  used by the agency to grant exemptions under the provisions of

  7  this paragraph until final rules become effective.

  8         (j)(o)  For any expenditure to provide mobile surgical

  9  facilities and related health care services provided under

10  contract with the Department of Corrections or a private

11  correctional facility operating pursuant to chapter 957.

12         (k)(p)  For state veterans' nursing homes operated by

13  or on behalf of the Florida Department of Veterans' Affairs in

14  accordance with part II of chapter 296 for which at least 50

15  percent of the construction cost is federally funded and for

16  which the Federal Government pays a per diem rate not to

17  exceed one-half of the cost of the veterans' care in such

18  state nursing homes. These beds shall not be included in the

19  nursing home bed inventory.

20         (l)  For combination within one nursing home facility

21  of the beds or services authorized by two or more certificates

22  of need issued in the same planning subdistrict.  An exemption

23  granted under this paragraph shall extend the validity period

24  of the certificates of need to be consolidated by the length

25  of the period beginning upon submission of the exemption

26  request and ending with issuance of the exemption.  The

27  longest validity period among the certificates shall be

28  applicable to each of the combined certificates.

29         (m)  For division into two or more nursing home

30  facilities of beds or services authorized by one certificate

31  of need issued in the same planning subdistrict.  An exemption


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  1  granted under this paragraph shall extend the validity period

  2  of the certificate of need to be divided by the length of the

  3  period beginning upon submission of the exemption request and

  4  ending with issuance of the exemption.

  5         (n)  For the addition of hospital beds licensed under

  6  chapter 395 for acute care, mental health services, or a

  7  hospital-based distinct part skilled nursing unit in a number

  8  that may not exceed 10 total beds or 10 percent of the

  9  licensed capacity of the bed category being expanded,

10  whichever is greater. Beds for specialty burn units, neonatal

11  intensive care units, or comprehensive rehabilitation, or at a

12  long-term care hospital, may not be increased under this

13  paragraph.

14         1.  In addition to any other documentation otherwise

15  required by the agency, a request for exemption submitted

16  under this paragraph must:

17         a.  Certify that the prior 12-month average occupancy

18  rate for the category of licensed beds being expanded at the

19  facility meets or exceeds 80 percent or, for a hospital-based

20  distinct part skilled nursing unit, the prior 12-month average

21  occupancy rate meets or exceeds 96 percent.

22         b.  Certify that any beds of the same type authorized

23  for the facility under this paragraph before the date of the

24  current request for an exemption have been licensed and

25  operational for at least 12 months.

26         2.  The timeframes and monitoring process specified in

27  s. 408.040(2)(a)-(c) apply to any exemption issued under this

28  paragraph.

29         3.  The agency shall count beds authorized under this

30  paragraph as approved beds in the published inventory of

31  hospital beds until the beds are licensed.


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  1         (o)  For the addition of acute care beds, as authorized

  2  by rule consistent with s. 395.003(4), in a number that may

  3  not exceed 10 total beds or 10 percent of licensed bed

  4  capacity, whichever is greater, for temporary beds in a

  5  hospital that has experienced high seasonal occupancy within

  6  the prior 12-month period or in a hospital that must respond

  7  to emergency circumstances.

  8         (p)  For the addition of nursing home beds licensed

  9  under chapter 400 in a number not exceeding 10 total beds or

10  10 percent of the number of beds licensed in the facility

11  being expanded, whichever is greater.

12         1.  In addition to any other documentation required by

13  the agency, a request for exemption submitted under this

14  paragraph must:

15         a.  Effective until June 30, 2001, certify that the

16  facility has not had any class I or class II deficiencies

17  within the 30 months preceding the request for addition.

18         b.  Effective on July 1, 2001, certify that the

19  facility has been designated as a Gold Seal nursing home under

20  s. 400.235.

21         c.  Certify that the prior 12-month average occupancy

22  rate for the nursing home beds at the facility meets or

23  exceeds 96 percent.

24         d.  Certify that any beds authorized for the facility

25  under this paragraph before the date of the current request

26  for an exemption have been licensed and operational for at

27  least 12 months.

28         2.  The timeframes and monitoring process specified in

29  s. 408.040(2)(a)-(c) apply to any exemption issued under this

30  paragraph.

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  1         3.  The agency shall count beds authorized under this

  2  paragraph as approved beds in the published inventory of

  3  nursing home beds until the beds are licensed.

  4         (4)  A request for exemption under this subsection (3)

  5  may be made at any time and is not subject to the batching

  6  requirements of this section. The request shall be supported

  7  by such documentation as the agency requires by rule. The

  8  agency shall assess a fee of $250 for each request for

  9  exemption submitted under subsection (3).

10         Section 9.  Paragraph (a) of subsection (1) of section

11  408.037, Florida Statutes, is amended to read:

12         408.037  Application content.--

13         (1)  An application for a certificate of need must

14  contain:

15         (a)  A detailed description of the proposed project and

16  statement of its purpose and need in relation to the local

17  health plan and the state health plan.

18         Section 10.  Section 408.038, Florida Statutes, is

19  amended to read:

20         408.038  Fees.--The agency department shall assess fees

21  on certificate-of-need applications.  Such fees shall be for

22  the purpose of funding the functions of the local health

23  councils and the activities of the agency department and shall

24  be allocated as provided in s. 408.033. The fee shall be

25  determined as follows:

26         (1)  A minimum base fee of $5,000.

27         (2)  In addition to the base fee of $5,000, 0.015 of

28  each dollar of proposed expenditure, except that a fee may not

29  exceed $22,000.

30

31


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  1         Section 11.  Subsections (3) and (4) and paragraphs (a)

  2  and (b) of subsection (6) of section 408.039, Florida

  3  Statutes, are amended to read:

  4         408.039  Review process.--The review process for

  5  certificates of need shall be as follows:

  6         (3)  APPLICATION PROCESSING.--

  7         (a)  An applicant shall file an application with the

  8  agency department, and shall furnish a copy of the application

  9  to the local health council and the agency department. Within

10  15 days after the applicable application filing deadline

11  established by agency department rule, the staff of the agency

12  department shall determine if the application is complete.  If

13  the application is incomplete, the staff shall request

14  specific information from the applicant necessary for the

15  application to be complete; however, the staff may make only

16  one such request. If the requested information is not filed

17  with the agency department within 21 days of the receipt of

18  the staff's request, the application shall be deemed

19  incomplete and deemed withdrawn from consideration.

20         (b)  Upon the request of any applicant or substantially

21  affected person within 14 days after notice that an

22  application has been filed, a public hearing may be held at

23  the agency's department's discretion if the agency department

24  determines that a proposed project involves issues of great

25  local public interest. The public hearing shall allow

26  applicants and other interested parties reasonable time to

27  present their positions and to present rebuttal information. A

28  recorded verbatim record of the hearing shall be maintained.

29  The public hearing shall be held at the local level within 21

30  days after the application is deemed complete.

31         (4)  STAFF RECOMMENDATIONS.--


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  1         (a)  The agency's department's review of and final

  2  agency action on applications shall be in accordance with the

  3  district health plan, and statutory criteria, and the

  4  implementing administrative rules.  In the application review

  5  process, the agency department shall give a preference, as

  6  defined by rule of the agency department, to an applicant

  7  which proposes to develop a nursing home in a nursing home

  8  geographically underserved area.

  9         (b)  Within 60 days after all the applications in a

10  review cycle are determined to be complete, the agency

11  department shall issue its State Agency Action Report and

12  Notice of Intent to grant a certificate of need for the

13  project in its entirety, to grant a certificate of need for

14  identifiable portions of the project, or to deny a certificate

15  of need.  The State Agency Action Report shall set forth in

16  writing its findings of fact and determinations upon which its

17  decision is based.  If a finding of fact or determination by

18  the agency department is counter to the district health plan

19  of the local health council, the agency department shall

20  provide in writing its reason for its findings, item by item,

21  to the local health council.  If the agency department intends

22  to grant a certificate of need, the State Agency Action Report

23  or the Notice of Intent shall also include any conditions

24  which the agency department intends to attach to the

25  certificate of need. The agency department shall designate by

26  rule a senior staff person, other than the person who issues

27  the final order, to issue State Agency Action Reports and

28  Notices of Intent.

29         (c)  The agency department shall publish its proposed

30  decision set forth in the Notice of Intent in the Florida

31


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  1  Administrative Weekly within 14 days after the Notice of

  2  Intent is issued.

  3         (d)  If no administrative hearing is requested pursuant

  4  to subsection (5), the State Agency Action Report and the

  5  Notice of Intent shall become the final order of the agency

  6  department.  The agency department shall provide a copy of the

  7  final order to the appropriate local health council.

  8         (6)  JUDICIAL REVIEW.--

  9         (a)  A party to an administrative hearing for an

10  application for a certificate of need has the right, within

11  not more than 30 days after the date of the final order, to

12  seek judicial review in the District Court of Appeal pursuant

13  to s. 120.68.  The agency department shall be a party in any

14  such proceeding.

15         (b)  In such judicial review, the court shall affirm

16  the final order of the agency department, unless the decision

17  is arbitrary, capricious, or not in compliance with ss.

18  408.031-408.045.

19         Section 12.  Subsections (1) and (2) of section

20  408.040, Florida Statutes, are amended to read:

21         408.040  Conditions and monitoring.--

22         (1)(a)  The agency may issue a certificate of need

23  predicated upon statements of intent expressed by an applicant

24  in the application for a certificate of need. Any conditions

25  imposed on a certificate of need based on such statements of

26  intent shall be stated on the face of the certificate of need.

27         1.  Any certificate of need issued for construction of

28  a new hospital or for the addition of beds to an existing

29  hospital shall include a statement of the number of beds

30  approved by category of service, including rehabilitation or

31  psychiatric service, for which the agency has adopted by rule


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  1  a specialty-bed-need methodology. All beds that are approved,

  2  but are not covered by any specialty-bed-need methodology,

  3  shall be designated as general.

  4         (b)2.  The agency may consider, in addition to the

  5  other criteria specified in s. 408.035, a statement of intent

  6  by the applicant that a specified to designate a percentage of

  7  the annual patient days at beds of the facility will be

  8  utilized for use by patients eligible for care under Title XIX

  9  of the Social Security Act. Any certificate of need issued to

10  a nursing home in reliance upon an applicant's statements that

11  to provide a specified percentage number of annual patient

12  days will be utilized beds for use by residents eligible for

13  care under Title XIX of the Social Security Act must include a

14  statement that such certification is a condition of issuance

15  of the certificate of need. The certificate-of-need program

16  shall notify the Medicaid program office and the Department of

17  Elderly Affairs when it imposes conditions as authorized in

18  this paragraph subparagraph in an area in which a community

19  diversion pilot project is implemented.

20         (c)(b)  A certificateholder may apply to the agency for

21  a modification of conditions imposed under paragraph (a) or

22  paragraph (b). If the holder of a certificate of need

23  demonstrates good cause why the certificate should be

24  modified, the agency shall reissue the certificate of need

25  with such modifications as may be appropriate.  The agency

26  shall by rule define the factors constituting good cause for

27  modification.

28         (d)(c)  If the holder of a certificate of need fails to

29  comply with a condition upon which the issuance of the

30  certificate was predicated, the agency may assess an

31  administrative fine against the certificateholder in an amount


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  1  not to exceed $1,000 per failure per day.  In assessing the

  2  penalty, the agency shall take into account as mitigation the

  3  relative lack of severity of a particular failure.  Proceeds

  4  of such penalties shall be deposited in the Public Medical

  5  Assistance Trust Fund.

  6         (2)(a)  Unless the applicant has commenced

  7  construction, if the project provides for construction, unless

  8  the applicant has incurred an enforceable capital expenditure

  9  commitment for a project, if the project does not provide for

10  construction, or unless subject to paragraph (b), a

11  certificate of need shall terminate 18 months after the date

12  of issuance, except in the case of a multifacility project, as

13  defined in s. 408.032, where the certificate of need shall

14  terminate 2 years after the date of issuance. The agency shall

15  monitor the progress of the holder of the certificate of need

16  in meeting the timetable for project development specified in

17  the application with the assistance of the local health

18  council as specified in s. 408.033(1)(b)5., and may revoke the

19  certificate of need, if the holder of the certificate is not

20  meeting such timetable and is not making a good-faith good

21  faith effort, as defined by rule, to meet it.

22         (b)  A certificate of need issued to an applicant

23  holding a provisional certificate of authority under chapter

24  651 shall terminate 1 year after the applicant receives a

25  valid certificate of authority from the Department of

26  Insurance.

27         (c)  The certificate-of-need validity period for a

28  project shall be extended by the agency, to the extent that

29  the applicant demonstrates to the satisfaction of the agency

30  that good-faith good faith commencement of the project is

31  being delayed by litigation or by governmental action or


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  1  inaction with respect to regulations or permitting precluding

  2  commencement of the project.

  3         (d)  If an application is filed to consolidate two or

  4  more certificates as authorized by s. 408.036(2)(f) or to

  5  divide a certificate of need into two or more facilities as

  6  authorized by s. 408.036(2)(g), the validity period of the

  7  certificate or certificates of need to be consolidated or

  8  divided shall be extended for the period beginning upon

  9  submission of the application and ending when final agency

10  action and any appeal from such action has been concluded.

11  However, no such suspension shall be effected if the

12  application is withdrawn by the applicant.

13         Section 13.  Section 408.044, Florida Statutes, is

14  amended to read:

15         408.044  Injunction.--Notwithstanding the existence or

16  pursuit of any other remedy, the agency department may

17  maintain an action in the name of the state for injunction or

18  other process against any person to restrain or prevent the

19  pursuit of a project subject to review under ss.

20  408.031-408.045, in the absence of a valid certificate of

21  need.

22         Section 14.  Section 408.045, Florida Statutes, is

23  amended to read:

24         408.045  Certificate of need; competitive sealed

25  proposals.--

26         (1)  The application, review, and issuance procedures

27  for a certificate of need for an intermediate care facility

28  for the developmentally disabled may be made by the agency

29  department by competitive sealed proposals.

30         (2)  The agency department shall make a decision

31  regarding the issuance of the certificate of need in


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  1  accordance with the provisions of s. 287.057(15), rules

  2  adopted by the agency department relating to intermediate care

  3  facilities for the developmentally disabled, and the criteria

  4  in s. 408.035, as further defined by rule.

  5         (3)  Notification of the decision shall be issued to

  6  all applicants not later than 28 calendar days after the date

  7  responses to a request for proposal are due.

  8         (4)  The procedures provided for under this section are

  9  exempt from the batching cycle requirements and the public

10  hearing requirement of s. 408.039.

11         (5)  The agency department may use the competitive

12  sealed proposal procedure for determining a certificate of

13  need for other types of health care facilities and services if

14  the agency department identifies an unmet health care need and

15  when funding in whole or in part for such health care

16  facilities or services is authorized by the Legislature.

17         Section 15.  (1)(a)  There is created a

18  certificate-of-need workgroup staffed by the Agency for Health

19  Care Administration.

20         (b)  Workgroup participants shall be responsible for

21  only the expenses that they generate individually through

22  workgroup participation.  The agency shall be responsible for

23  expenses incidental to the production of any required data or

24  reports.

25         (2)  The workgroup shall consist of 30 members, 10

26  appointed by the Governor, 10 appointed by the President of

27  the Senate, and 10 appointed by the Speaker of the House of

28  Representatives. The workgroup chairperson shall be selected

29  by majority vote of a quorum present. Sixteen members shall

30  constitute a quorum. The membership shall include, but not be

31  limited to, representatives from health care provider


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  1  organizations, health care facilities, individual health care

  2  practitioners, local health councils, and consumer

  3  organizations, and persons with health care market expertise

  4  as a private-sector consultant.

  5         (3)  Appointment to the workgroup shall be as follows:

  6         (a)  The Governor shall appoint one representative each

  7  from the hospital industry; nursing home industry; hospice

  8  industry; local health councils; a consumer organization; and

  9  three health care market consultants, one of whom is a

10  recognized expert on hospital markets, one of whom is a

11  recognized expert on nursing home or long-term-care markets,

12  and one of whom is a recognized expert on hospice markets; one

13  representative from the Medicaid program; and one

14  representative from a health care facility that provides a

15  tertiary service.

16         (b)  The President of the Senate shall appoint a

17  representative of a for-profit hospital, a representative of a

18  not-for-profit hospital, a representative of a public

19  hospital, two representatives of the nursing home industry,

20  two representatives of the hospice industry, a representative

21  of a consumer organization, a representative from the

22  Department of Elderly Affairs involved with the implementation

23  of a long-term-care community diversion program, and a health

24  care market consultant with expertise in health care

25  economics.

26         (c)  The Speaker of the House of Representatives shall

27  appoint a representative from the Florida Hospital

28  Association, a representative of the Association of Community

29  Hospitals and Health Systems of Florida, a representative of

30  the Florida League of Health Systems, a representative of the

31  Florida Health Care Association, a representative of the


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  1  Florida Association of Homes for the Aging, three

  2  representatives of Florida Hospices and Palliative Care, one

  3  representative of local health councils, and one

  4  representative of a consumer organization.

  5         (4)  The workgroup shall study issues pertaining to the

  6  certificate-of-need program, including the impact of trends in

  7  health care delivery and financing. The workgroup shall study

  8  issues relating to implementation of the certificate-of-need

  9  program.

10         (5)  The workgroup shall meet at least annually, at the

11  request of the chairperson. The workgroup shall submit an

12  interim report by December 31, 2001, and a final report by

13  December 31, 2002. The workgroup is abolished effective July

14  1, 2003.

15         Section 16.  Subsection (7) of section 651.118, Florida

16  Statutes, is amended to read:

17         651.118  Agency for Health Care Administration;

18  certificates of need; sheltered beds; community beds.--

19         (7)  Notwithstanding the provisions of subsection (2),

20  at the discretion of the continuing care provider, sheltered

21  nursing home beds may be used for persons who are not

22  residents of the facility and who are not parties to a

23  continuing care contract for a period of up to 5 years after

24  the date of issuance of the initial nursing home license.  A

25  provider whose 5-year period has expired or is expiring may

26  request the Agency for Health Care Administration for an

27  extension, not to exceed 30 percent of the total sheltered

28  nursing home beds, if the utilization by residents of the

29  facility in the sheltered beds will not generate sufficient

30  income to cover facility expenses, as evidenced by one of the

31  following:


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  1         (a)  The facility has a net loss for the most recent

  2  fiscal year as determined under generally accepted accounting

  3  principles, excluding the effects of extraordinary or unusual

  4  items, as demonstrated in the most recently audited financial

  5  statement; or

  6         (b)  The facility would have had a pro forma loss for

  7  the most recent fiscal year, excluding the effects of

  8  extraordinary or unusual items, if revenues were reduced by

  9  the amount of revenues from persons in sheltered beds who were

10  not residents, as reported on by a certified public

11  accountant.

12

13  The agency shall be authorized to grant an extension to the

14  provider based on the evidence required in this subsection.

15  The agency may request a facility to use up to 25 percent of

16  the patient days generated by new admissions of nonresidents

17  during the extension period to serve Medicaid recipients for

18  those beds authorized for extended use if there is a

19  demonstrated need in the respective service area and if funds

20  are available. A provider who obtains an extension is

21  prohibited from applying for additional sheltered beds under

22  the provision of subsection (2), unless additional residential

23  units are built or the provider can demonstrate need by

24  facility residents to the Agency for Health Care

25  Administration. The 5-year limit does not apply to up to five

26  sheltered beds designated for inpatient hospice care as part

27  of a contractual arrangement with a hospice licensed under

28  part VI of chapter 400. A facility that uses such beds after

29  the 5-year period shall report such use to the Agency for

30  Health Care Administration. For purposes of this subsection,

31  "resident" means a person who, upon admission to the facility,


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  1  initially resides in a part of the facility not licensed under

  2  part II of chapter 400.

  3         Section 17.  Subsection (3) of section 400.464, Florida

  4  Statutes, is repealed.

  5         Section 18.  Applications for certificates of need

  6  submitted under section 408.031-408.045, Florida Statutes,

  7  before the effective date of this act shall be governed by the

  8  law in effect at the time the application was submitted.

  9         Section 19.  Pursuant to section 187 of chapter 99-397,

10  Laws of Florida, the Agency for Health Care Administration was

11  directed to conduct a detailed study and analysis of clinical

12  laboratory services for kidney dialysis patients in the State

13  of Florida and to report back to the Legislature no later than

14  February 1, 2000. The agency reported that additional time and

15  investigative resources were necessary to adequately respond

16  to the legislative directives. Therefore, the sum of $230,000

17  from the Agency for Health Care Administration Tobacco

18  Settlement Trust Fund is appropriated to the Agency for Health

19  Care Administration to contract with the University of South

20  Florida to conduct a review of laboratory test utilization,

21  any self-referral to clinical laboratories, financial

22  arrangements among kidney dialysis centers, their medical

23  directors, referring physicians, and any business

24  relationships and affiliations with clinical laboratories, and

25  the quality and effectiveness of kidney dialysis treatment in

26  this state. A report on the findings from such review shall be

27  presented to the President of the Senate, the Speaker of the

28  House of Representatives, and the chairs of the appropriate

29  substantive committees of the Legislature no later than

30  February 1, 2001.

31


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  1         Section 20.  Subsections (1) and (3) of section

  2  455.564, Florida Statutes, are amended to read:

  3         455.564  Department; general licensing provisions.--

  4         (1)(a)  Any person desiring to be licensed in a

  5  profession within the jurisdiction of the department shall

  6  apply to the department in writing to take the licensure

  7  examination.  The application shall be made on a form prepared

  8  and furnished by the department. The application form must be

  9  available on the World Wide Web and the department may accept

10  electronically submitted applications beginning July 1, 2001.

11  The application and shall require the social security number

12  of the applicant, except as provided in paragraph (b). The

13  form shall be supplemented as needed to reflect any material

14  change in any circumstance or condition stated in the

15  application which takes place between the initial filing of

16  the application and the final grant or denial of the license

17  and which might affect the decision of the department. If an

18  application is submitted electronically, the department may

19  require supplemental materials, including an original

20  signature of the applicant and verification of credentials, to

21  be submitted in a non-electronic format. An incomplete

22  application shall expire 1 year after initial filing. In order

23  to further the economic development goals of the state, and

24  notwithstanding any law to the contrary, the department may

25  enter into an agreement with the county tax collector for the

26  purpose of appointing the county tax collector as the

27  department's agent to accept applications for licenses and

28  applications for renewals of licenses. The agreement must

29  specify the time within which the tax collector must forward

30  any applications and accompanying application fees to the

31  department.


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  1         (b)  If an applicant has not been issued a social

  2  security number by the Federal Government at the time of

  3  application because the applicant is not a citizen or resident

  4  of this country, the department may process the application

  5  using a unique personal identification number. If such an

  6  applicant is otherwise eligible for licensure, the board, or

  7  the department when there is no board, may issue a temporary

  8  license to the applicant, which shall expire 30 days after

  9  issuance unless a social security number is obtained and

10  submitted in writing to the department. Upon receipt of the

11  applicant's social security number, the department shall issue

12  a new license, which shall expire at the end of the current

13  biennium.

14         (3)(a)  The board, or the department when there is no

15  board, may refuse to issue an initial license to any applicant

16  who is under investigation or prosecution in any jurisdiction

17  for an action that would constitute a violation of this part

18  or the professional practice acts administered by the

19  department and the boards, until such time as the

20  investigation or prosecution is complete, and the time period

21  in which the licensure application must be granted or denied

22  shall be tolled until 15 days after the receipt of the final

23  results of the investigation or prosecution.

24         (b)  If an applicant has been convicted of a felony

25  related to the practice or ability to practice any health care

26  profession, the board, or the department when there is no

27  board, may require the applicant to prove that his or her

28  civil rights have been restored.

29         (c)  In considering applications for licensure, the

30  board, or the department when there is no board, may require a

31  personal appearance of the applicant. If the applicant is


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  1  required to appear, the time period in which a licensure

  2  application must be granted or denied shall be tolled until

  3  such time as the applicant appears. However, if the applicant

  4  fails to appear before the board at either of the next two

  5  regularly scheduled board meetings, or fails to appear before

  6  the department within 30 days if there is no board, the

  7  application for licensure shall be denied.

  8         Section 21.  Paragraph (d) is added to subsection (4)

  9  of section 455.565, Florida Statutes, to read:

10         455.565  Designated health care professionals;

11  information required for licensure.--

12         (4)

13         (d)  Any applicant for initial licensure or renewal of

14  licensure as a health care practitioner who submits to the

15  Department of Health a set of fingerprints or information

16  required for the criminal history check required under this

17  section shall not be required to provide a subsequent set of

18  fingerprints or other duplicate information required for a

19  criminal history check to the Agency for Health Care

20  Administration, the Department of Juvenile Justice, or the

21  Department of Children and Family Services for employment or

22  licensure with such agency or department if the applicant has

23  undergone a criminal history check as a condition of initial

24  licensure or licensure renewal as a health care practitioner

25  with the Department of Health or any of its regulatory boards,

26  notwithstanding any other provision of law to the contrary. In

27  lieu of such duplicate submission, the Agency for Health Care

28  Administration, the Department of Juvenile Justice, and the

29  Department of Children and Family Services shall obtain

30  criminal history information for employment or licensure of

31  health care practitioners by such agency and departments from


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  1  the Department of Health's health care practitioner

  2  credentialing system.

  3         Section 22.  Section 455.5651, Florida Statutes, is

  4  amended to read:

  5         455.5651  Practitioner profile; creation.--

  6         (1)  Beginning July 1, 1999, the Department of Health

  7  shall compile the information submitted pursuant to s. 455.565

  8  into a practitioner profile of the applicant submitting the

  9  information, except that the Department of Health may develop

10  a format to compile uniformly any information submitted under

11  s. 455.565(4)(b).

12         (2)  On the profile published required under subsection

13  (1), the department shall indicate if the information provided

14  under s. 455.565(1)(a)7. is not corroborated by a criminal

15  history check conducted according to this subsection. If the

16  information provided under s. 455.565(1)(a)7. is corroborated

17  by the criminal history check, the fact that the criminal

18  history check was performed need not be indicated on the

19  profile. The department, or the board having regulatory

20  authority over the practitioner acting on behalf of the

21  department, shall investigate any information received by the

22  department or the board when it has reasonable grounds to

23  believe that the practitioner has violated any law that

24  relates to the practitioner's practice.

25         (3)  The Department of Health may include in each

26  practitioner's practitioner profile that criminal information

27  that directly relates to the practitioner's ability to

28  competently practice his or her profession.  The department

29  must include in each practitioner's practitioner profile the

30  following statement:  "The criminal history information, if

31


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  1  any exists, may be incomplete; federal criminal history

  2  information is not available to the public."

  3         (4)  The Department of Health shall include, with

  4  respect to a practitioner licensed under chapter 458 or

  5  chapter 459, a statement of how the practitioner has elected

  6  to comply with the financial responsibility requirements of s.

  7  458.320 or s. 459.0085. The department shall include, with

  8  respect to practitioners subject to s. 455.694, a statement of

  9  how the practitioner has elected to comply with the financial

10  responsibility requirements of that section. The department

11  shall include, with respect to practitioners licensed under

12  chapter 458, chapter 459, or chapter 461, information relating

13  to liability actions which has been reported under s. 455.697

14  or s. 627.912 within the previous 10 years for any paid claim

15  that exceeds $5,000. Such claims information shall be reported

16  in the context of comparing an individual practitioner's

17  claims to the experience of other practitioners physicians

18  within the same specialty, or profession if the practitioner

19  is not a specialist, to the extent such information is

20  available to the Department of Health. If information relating

21  to a liability action is included in a practitioner's

22  practitioner profile, the profile must also include the

23  following statement:  "Settlement of a claim may occur for a

24  variety of reasons that do not necessarily reflect negatively

25  on the professional competence or conduct of the practitioner

26  physician.  A payment in settlement of a medical malpractice

27  action or claim should not be construed as creating a

28  presumption that medical malpractice has occurred."

29         (5)  The Department of Health may not include

30  disciplinary action taken by a licensed hospital or an

31  ambulatory surgical center in the practitioner profile.


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  1         (6)  The Department of Health may include in the

  2  practitioner's practitioner profile any other information that

  3  is a public record of any governmental entity and that relates

  4  to a practitioner's ability to competently practice his or her

  5  profession.  However, the department must consult with the

  6  board having regulatory authority over the practitioner before

  7  such information is included in his or her profile.

  8         (7)  Upon the completion of a practitioner profile

  9  under this section, the Department of Health shall furnish the

10  practitioner who is the subject of the profile a copy of it.

11  The practitioner has a period of 30 days in which to review

12  the profile and to correct any factual inaccuracies in it. The

13  Department of Health shall make the profile available to the

14  public at the end of the 30-day period. The department shall

15  make the profiles available to the public through the World

16  Wide Web and other commonly used means of distribution.

17         (8)  Making a practitioner profile available to the

18  public under this section does not constitute agency action

19  for which a hearing under s. 120.57 may be sought.

20         Section 23.  Section 455.5653, Florida Statutes, is

21  amended to read:

22         455.5653  Practitioner profiles; data

23  storage.--Effective upon this act becoming a law, the

24  Department of Health must develop or contract for a computer

25  system to accommodate the new data collection and storage

26  requirements under this act pending the development and

27  operation of a computer system by the Department of Health for

28  handling the collection, input, revision, and update of data

29  submitted by physicians as a part of their initial licensure

30  or renewal to be compiled into individual practitioner

31  profiles. The Department of Health must incorporate any data


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  1  required by this act into the computer system used in

  2  conjunction with the regulation of health care professions

  3  under its jurisdiction. The department must develop, by the

  4  year 2000, a schedule and procedures for each practitioner

  5  within a health care profession regulated within the Division

  6  of Medical Quality Assurance to submit relevant information to

  7  be compiled into a profile to be made available to the public.

  8  The Department of Health is authorized to contract with and

  9  negotiate any interagency agreement necessary to develop and

10  implement the practitioner profiles. The Department of Health

11  shall have access to any information or record maintained by

12  the Agency for Health Care Administration, including any

13  information or record that is otherwise confidential and

14  exempt from the provisions of chapter 119 and s. 24(a), Art. I

15  of the State Constitution, so that the Department of Health

16  may corroborate any information that practitioners physicians

17  are required to report under s. 455.565.

18         Section 24.  Section 455.5654, Florida Statutes, is

19  amended to read:

20         455.5654  Practitioner profiles; rules;

21  workshops.--Effective upon this act becoming a law, the

22  Department of Health shall adopt rules for the form of a

23  practitioner profile that the agency is required to prepare.

24  The Department of Health, pursuant to chapter 120, must hold

25  public workshops for purposes of rule development to implement

26  this section. An agency to which information is to be

27  submitted under this act may adopt by rule a form for the

28  submission of the information required under s. 455.565.

29         Section 25.  Subsection (1) of section 455.567, Florida

30  Statutes, is amended to read:

31


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  1         455.567  Sexual misconduct; disqualification for

  2  license, certificate, or registration.--

  3         (1)  Sexual misconduct in the practice of a health care

  4  profession means violation of the professional relationship

  5  through which the health care practitioner uses such

  6  relationship to engage or attempt to engage the patient or

  7  client, or an immediate family member, guardian, or

  8  representative of the patient or client in, or to induce or

  9  attempt to induce such person to engage in, verbal or physical

10  sexual activity outside the scope of the professional practice

11  of such health care profession. Sexual misconduct in the

12  practice of a health care profession is prohibited.

13         Section 26.  Paragraphs (f) and (u) of subsection (1),

14  paragraph (c) of subsection (2), and subsection (3) of section

15  455.624, Florida Statutes, are amended, and paragraphs (y) and

16  (z) are added to subsection (1) of said section, to read:

17         455.624  Grounds for discipline; penalties;

18  enforcement.--

19         (1)  The following acts shall constitute grounds for

20  which the disciplinary actions specified in subsection (2) may

21  be taken:

22         (f)  Having a license or the authority to practice any

23  the regulated profession revoked, suspended, or otherwise

24  acted against, including the denial of licensure, by the

25  licensing authority of any jurisdiction, including its

26  agencies or subdivisions, for a violation that would

27  constitute a violation under Florida law. The licensing

28  authority's acceptance of a relinquishment of licensure,

29  stipulation, consent order, or other settlement, offered in

30  response to or in anticipation of the filing of charges

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  1  against the license, shall be construed as action against the

  2  license.

  3         (u)  Engaging or attempting to engage in sexual

  4  misconduct as defined and prohibited in s. 455.567(1) a

  5  patient or client in verbal or physical sexual activity. For

  6  the purposes of this section, a patient or client shall be

  7  presumed to be incapable of giving free, full, and informed

  8  consent to verbal or physical sexual activity.

  9         (y)  Being unable to practice with reasonable skill and

10  safety to patients by reason of illness or use of alcohol,

11  drugs, narcotics, chemicals, or any other type of material or

12  as a result of any mental or physical condition. In enforcing

13  this paragraph, the department shall have, upon a finding of

14  the secretary or the secretary's designee that probable cause

15  exists to believe that the licensee is unable to practice

16  because of the reasons stated in this paragraph, the authority

17  to issue an order to compel a licensee to submit to a mental

18  or physical examination by physicians designated by the

19  department. If the licensee refuses to comply with such order,

20  the department's order directing such examination may be

21  enforced by filing a petition for enforcement in the circuit

22  court where the licensee resides or does business. The

23  department shall be entitled to the summary procedure provided

24  in s. 51.011. A licensee or certificateholder affected under

25  this paragraph shall at reasonable intervals be afforded an

26  opportunity to demonstrate that he or she can resume the

27  competent practice of his or her profession with reasonable

28  skill and safety to patients.

29         (z)  Testing positive for any drug, as defined in s.

30  112.0455, on any confirmed preemployment or employer-ordered

31  drug screening when the practitioner does not have a lawful


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  1  prescription and legitimate medical reason for using such

  2  drug.

  3         (2)  When the board, or the department when there is no

  4  board, finds any person guilty of the grounds set forth in

  5  subsection (1) or of any grounds set forth in the applicable

  6  practice act, including conduct constituting a substantial

  7  violation of subsection (1) or a violation of the applicable

  8  practice act which occurred prior to obtaining a license, it

  9  may enter an order imposing one or more of the following

10  penalties:

11         (c)  Restriction of practice or license.

12

13  In determining what action is appropriate, the board, or

14  department when there is no board, must first consider what

15  sanctions are necessary to protect the public or to compensate

16  the patient. Only after those sanctions have been imposed may

17  the disciplining authority consider and include in the order

18  requirements designed to rehabilitate the practitioner. All

19  costs associated with compliance with orders issued under this

20  subsection are the obligation of the practitioner.

21         (3)(a)  Notwithstanding subsection (2), if the ground

22  for disciplinary action is the first-time failure of the

23  licensee to satisfy continuing education requirements

24  established by the board, or by the department if there is no

25  board, the board or department, as applicable, shall issue a

26  citation in accordance with s. 455.617 and assess a fine, as

27  determined by the board or department by rule. In addition,

28  for each hour of continuing education not completed or

29  completed late, the board or department, as applicable, may

30  require the licensee to take 1 additional hour of continuing

31  education for each hour not completed or completed late.


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  1         (b)  Notwithstanding subsection (2), if the ground for

  2  disciplinary action is the first-time violation of a practice

  3  act for unprofessional conduct, as used in ss. 464.018(1)(h),

  4  467.203(1)(f), 468.365(1)(f), and 478.52(1)(f), and no actual

  5  harm to the patient occurred, the board or department, as

  6  applicable, shall issue a citation in accordance with s.

  7  455.617 and assess a penalty as determined by rule of the

  8  board or department.

  9         Section 27.  For the purpose of incorporating the

10  amendment to section 455.624, Florida Statutes, in references

11  thereto, the sections or subdivisions of Florida Statutes set

12  forth below are reenacted to read:

13         455.577  Penalty for theft or reproduction of an

14  examination.--In addition to, or in lieu of, any other

15  discipline imposed pursuant to s. 455.624, the theft of an

16  examination in whole or in part or the act of reproducing or

17  copying any examination administered by the department,

18  whether such examination is reproduced or copied in part or in

19  whole and by any means, constitutes a felony of the third

20  degree, punishable as provided in s. 775.082, s. 775.083, or

21  s. 775.084.

22         455.631  Penalty for giving false information.--In

23  addition to, or in lieu of, any other discipline imposed

24  pursuant to s. 455.624, the act of knowingly giving false

25  information in the course of applying for or obtaining a

26  license from the department, or any board thereunder, with

27  intent to mislead a public servant in the performance of his

28  or her official duties, or the act of attempting to obtain or

29  obtaining a license from the department, or any board

30  thereunder, to practice a profession by knowingly misleading

31  statements or knowing misrepresentations constitutes a felony


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  1  of the third degree, punishable as provided in s. 775.082, s.

  2  775.083, or s. 775.084.

  3         455.651  Disclosure of confidential information.--

  4         (2)  Any person who willfully violates any provision of

  5  this section is guilty of a misdemeanor of the first degree,

  6  punishable as provided in s. 775.082 or s. 775.083, and may be

  7  subject to discipline pursuant to s. 455.624, and, if

  8  applicable, shall be removed from office, employment, or the

  9  contractual relationship.

10         455.712  Business establishments; requirements for

11  active status licenses.--

12         (1)  A business establishment regulated by the Division

13  of Medical Quality Assurance pursuant to this part may provide

14  regulated services only if the business establishment has an

15  active status license. A business establishment that provides

16  regulated services without an active status license is in

17  violation of this section and s. 455.624, and the board, or

18  the department if there is no board, may impose discipline on

19  the business establishment.

20         458.347  Physician assistants.--

21         (7)  PHYSICIAN ASSISTANT LICENSURE.--

22         (g)  The Board of Medicine may impose any of the

23  penalties specified in ss. 455.624 and 458.331(2) upon a

24  physician assistant if the physician assistant or the

25  supervising physician has been found guilty of or is being

26  investigated for any act that constitutes a violation of this

27  chapter or part II of chapter 455.

28         459.022  Physician assistants.--

29         (7)  PHYSICIAN ASSISTANT LICENSURE.--

30         (f)  The Board of Osteopathic Medicine may impose any

31  of the penalties specified in ss. 455.624 and 459.015(2) upon


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  1  a physician assistant if the physician assistant or the

  2  supervising physician has been found guilty of or is being

  3  investigated for any act that constitutes a violation of this

  4  chapter or part II of chapter 455.

  5         468.1755  Disciplinary proceedings.--

  6         (1)  The following acts shall constitute grounds for

  7  which the disciplinary actions in subsection (2) may be taken:

  8         (a)  Violation of any provision of s. 455.624(1) or s.

  9  468.1745(1).

10         468.719  Disciplinary actions.--

11         (1)  The following acts shall be grounds for

12  disciplinary actions provided for in subsection (2):

13         (a)  A violation of any law relating to the practice of

14  athletic training, including, but not limited to, any

15  violation of this part, s. 455.624, or any rule adopted

16  pursuant thereto.

17         (2)  When the board finds any person guilty of any of

18  the acts set forth in subsection (1), the board may enter an

19  order imposing one or more of the penalties provided in s.

20  455.624.

21         468.811  Disciplinary proceedings.--

22         (1)  The following acts are grounds for disciplinary

23  action against a licensee and the issuance of cease and desist

24  orders or other related action by the department, pursuant to

25  s. 455.624, against any person who engages in or aids in a

26  violation.

27         (a)  Attempting to procure a license by fraudulent

28  misrepresentation.

29         (b)  Having a license to practice orthotics,

30  prosthetics, or pedorthics revoked, suspended, or otherwise

31


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  1  acted against, including the denial of licensure in another

  2  jurisdiction.

  3         (c)  Being convicted or found guilty of or pleading

  4  nolo contendere to, regardless of adjudication, in any

  5  jurisdiction, a crime that directly relates to the practice of

  6  orthotics, prosthetics, or pedorthics, including violations of

  7  federal laws or regulations regarding orthotics, prosthetics,

  8  or pedorthics.

  9         (d)  Filing a report or record that the licensee knows

10  is false, intentionally or negligently failing to file a

11  report or record required by state or federal law, willfully

12  impeding or obstructing such filing, or inducing another

13  person to impede or obstruct such filing. Such reports or

14  records include only reports or records that are signed in a

15  person's capacity as a licensee under this act.

16         (e)  Advertising goods or services in a fraudulent,

17  false, deceptive, or misleading manner.

18         (f)  Violation of this act or part II of chapter 455,

19  or any rules adopted thereunder.

20         (g)  Violation of an order of the board, agency, or

21  department previously entered in a disciplinary hearing or

22  failure to comply with a subpoena issued by the board, agency,

23  or department.

24         (h)  Practicing with a revoked, suspended, or inactive

25  license.

26         (i)  Gross or repeated malpractice or the failure to

27  deliver orthotic, prosthetic, or pedorthic services with that

28  level of care and skill which is recognized by a reasonably

29  prudent licensed practitioner with similar professional

30  training as being acceptable under similar conditions and

31  circumstances.


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  1         (j)  Failing to provide written notice of any

  2  applicable warranty for an orthosis, prosthesis, or pedorthic

  3  device that is provided to a patient.

  4         (2)  The board may enter an order imposing one or more

  5  of the penalties in s. 455.624(2) against any person who

  6  violates any provision of subsection (1).

  7         484.056  Disciplinary proceedings.--

  8         (1)  The following acts relating to the practice of

  9  dispensing hearing aids shall be grounds for both disciplinary

10  action against a hearing aid specialist as set forth in this

11  section and cease and desist or other related action by the

12  department as set forth in s. 455.637 against any person

13  owning or operating a hearing aid establishment who engages

14  in, aids, or abets any such violation:

15         (a)  Violation of any provision of s. 455.624(1), s.

16  484.0512, or s. 484.053.

17         Section 28.  Section 455.704, Florida Statutes, is

18  repealed.

19         Section 29.  Subsections (1), (2), and (3) of section

20  455.707, Florida Statutes, are amended to read:

21         455.707  Treatment programs for impaired

22  practitioners.--

23         (1)  For professions that do not have impaired

24  practitioner programs provided for in their practice acts, the

25  department shall, by rule, designate approved impaired

26  practitioner treatment programs under this section. The

27  department may adopt rules setting forth appropriate criteria

28  for approval of treatment providers based on the policies and

29  guidelines established by the Impaired Practitioners

30  Committee.  The rules may must specify the manner in which the

31  consultant, retained as set forth in subsection (2), works


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  1  with the department in intervention, requirements for

  2  evaluating and treating a professional, and requirements for

  3  the continued care and monitoring of a professional by the

  4  consultant by an approved at a department-approved treatment

  5  provider.  The department shall not compel any impaired

  6  practitioner program in existence on October 1, 1992, to serve

  7  additional professions.

  8         (2)  The department shall retain one or more impaired

  9  practitioner consultants as recommended by the committee.  A

10  consultant shall be a licensee or recovered licensee under the

11  jurisdiction of the Division of Medical Quality Assurance

12  within the department, and at least one consultant must be a

13  practitioner or recovered practitioner licensed under chapter

14  458, chapter 459, or chapter 464.  The consultant shall assist

15  the probable cause panel and department in carrying out the

16  responsibilities of this section.  This shall include working

17  with department investigators to determine whether a

18  practitioner is, in fact, impaired.

19         (3)(a)  Whenever the department receives a written or

20  oral legally sufficient complaint alleging that a licensee

21  under the jurisdiction of the Division of Medical Quality

22  Assurance within the department is impaired as a result of the

23  misuse or abuse of alcohol or drugs, or both, or due to a

24  mental or physical condition which could affect the licensee's

25  ability to practice with skill and safety, and no complaint

26  against the licensee other than impairment exists, the

27  reporting of such information shall not constitute grounds for

28  discipline pursuant to s. 455.624 or the corresponding grounds

29  for discipline within the applicable practice act a complaint

30  within the meaning of s. 455.621 if the probable cause panel

31


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  1  of the appropriate board, or the department when there is no

  2  board, finds:

  3         1.  The licensee has acknowledged the impairment

  4  problem.

  5         2.  The licensee has voluntarily enrolled in an

  6  appropriate, approved treatment program.

  7         3.  The licensee has voluntarily withdrawn from

  8  practice or limited the scope of practice as required by the

  9  consultant determined by the panel, or the department when

10  there is no board, in each case, until such time as the panel,

11  or the department when there is no board, is satisfied the

12  licensee has successfully completed an approved treatment

13  program.

14         4.  The licensee has executed releases for medical

15  records, authorizing the release of all records of

16  evaluations, diagnoses, and treatment of the licensee,

17  including records of treatment for emotional or mental

18  conditions, to the consultant. The consultant shall make no

19  copies or reports of records that do not regard the issue of

20  the licensee's impairment and his or her participation in a

21  treatment program.

22         (b)  If, however, the department has not received a

23  legally sufficient complaint and the licensee agrees to

24  withdraw from practice until such time as the consultant

25  determines the licensee has satisfactorily completed an

26  approved treatment program or evaluation, the probable cause

27  panel, or the department when there is no board, shall not

28  become involved in the licensee's case.

29         (c)  Inquiries related to impairment treatment programs

30  designed to provide information to the licensee and others and

31  which do not indicate that the licensee presents a danger to


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  1  the public shall not constitute a complaint within the meaning

  2  of s. 455.621 and shall be exempt from the provisions of this

  3  subsection.

  4         (d)  Whenever the department receives a legally

  5  sufficient complaint alleging that a licensee is impaired as

  6  described in paragraph (a) and no complaint against the

  7  licensee other than impairment exists, the department shall

  8  forward all information in its possession regarding the

  9  impaired licensee to the consultant. For the purposes of this

10  section, a suspension from hospital staff privileges due to

11  the impairment does not constitute a complaint.

12         (e)  The probable cause panel, or the department when

13  there is no board, shall work directly with the consultant,

14  and all information concerning a practitioner obtained from

15  the consultant by the panel, or the department when there is

16  no board, shall remain confidential and exempt from the

17  provisions of s. 119.07(1), subject to the provisions of

18  subsections (5) and (6).

19         (f)  A finding of probable cause shall not be made as

20  long as the panel, or the department when there is no board,

21  is satisfied, based upon information it receives from the

22  consultant and the department, that the licensee is

23  progressing satisfactorily in an approved impaired

24  practitioner treatment program and no other complaint against

25  the licensee exists.

26         Section 30.  Subsection (1) of section 310.102, Florida

27  Statutes, is amended to read:

28         310.102  Treatment programs for impaired pilots and

29  deputy pilots.--

30         (1)  The department shall, by rule, designate approved

31  treatment programs for impaired pilots and deputy pilots under


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  1  this section. The department may adopt rules setting forth

  2  appropriate criteria for approval of treatment providers based

  3  on the policies and guidelines established by the Impaired

  4  Practitioners Committee under s. 455.704.

  5         Section 31.  Section 455.711, Florida Statutes, is

  6  amended to read:

  7         455.711  Licenses; active and inactive and delinquent

  8  status; delinquency.--

  9         (1)  A licensee may practice a profession only if the

10  licensee has an active status license. A licensee who

11  practices a profession without an active status license is in

12  violation of this section and s. 455.624, and the board, or

13  the department if there is no board, may impose discipline on

14  the licensee.

15         (2)  Each board, or the department if there is no

16  board, shall permit a licensee to choose, at the time of

17  licensure renewal, an active or inactive status. However, a

18  licensee who changes from inactive to active status is not

19  eligible to return to inactive status until the licensee

20  thereafter completes a licensure cycle on active status.

21         (3)  Each board, or the department if there is no

22  board, shall by rule impose a fee for renewal of an active or

23  inactive status license. The renewal fee for an inactive

24  status license may not exceed which is no greater than the fee

25  for an active status license.

26         (4)  Notwithstanding any other provision of law to the

27  contrary, a licensee may change licensure status at any time.

28         (a)  Active status licensees choosing inactive status

29  at the time of license renewal must pay the inactive status

30  renewal fee, and, if applicable, the delinquency fee and the

31  fee to change licensure status. Active status licensees


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  1  choosing inactive status at any other time than at the time of

  2  license renewal must pay the fee to change licensure status.

  3         (b)  An inactive status licensee may change to active

  4  status at any time, if the licensee meets all requirements for

  5  active status, pays any additional licensure fees necessary to

  6  equal those imposed on an active status licensee, pays any

  7  applicable reactivation fees as set by the board, or the

  8  department if there is no board, and meets all continuing

  9  education requirements as specified in this section. Inactive

10  status licensees choosing active status at the time of license

11  renewal must pay the active status renewal fee, any applicable

12  reactivation fees as set by the board, or the department if

13  there is no board, and, if applicable, the delinquency fee and

14  the fee to change licensure status. Inactive status licensees

15  choosing active status at any other time than at the time of

16  license renewal must pay the difference between the inactive

17  status renewal fee and the active status renewal fee, if any

18  exists, any applicable reactivation fees as set by the board,

19  or the department if there is no board, and the fee to change

20  licensure status.

21         (5)  A licensee must apply with a complete application,

22  as defined by rule of the board, or the department if there is

23  no board, to renew an active status or inactive status license

24  before the license expires. If a licensee fails to renew

25  before the license expires, the license becomes delinquent in

26  the license cycle following expiration.

27         (6)  A delinquent status licensee must affirmatively

28  apply with a complete application, as defined by rule of the

29  board, or the department if there is no board, for active or

30  inactive status during the licensure cycle in which a licensee

31  becomes delinquent. Failure by a delinquent status licensee to


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  1  become active or inactive before the expiration of the current

  2  licensure cycle renders the license null without any further

  3  action by the board or the department. Any subsequent

  4  licensure shall be as a result of applying for and meeting all

  5  requirements imposed on an applicant for new licensure.

  6         (7)  Each board, or the department if there is no

  7  board, shall by rule impose an additional delinquency fee, not

  8  to exceed the biennial renewal fee for an active status

  9  license, on a delinquent status licensee when such licensee

10  applies for active or inactive status.

11         (8)  Each board, or the department if there is no

12  board, shall by rule impose an additional fee, not to exceed

13  the biennial renewal fee for an active status license, for

14  processing a licensee's request to change licensure status at

15  any time other than at the beginning of a licensure cycle.

16         (9)  Each board, or the department if there is no

17  board, may by rule impose reasonable conditions, excluding

18  full reexamination but including part of a national

19  examination or a special purpose examination to assess current

20  competency, necessary to ensure that a licensee who has been

21  on inactive status for more than two consecutive biennial

22  licensure cycles and who applies for active status can

23  practice with the care and skill sufficient to protect the

24  health, safety, and welfare of the public. Reactivation

25  requirements may differ depending on the length of time

26  licensees are inactive. The costs to meet reactivation

27  requirements shall be borne by licensees requesting

28  reactivation.

29         (10)  Before reactivation, an inactive status licensee

30  or a delinquent licensee who was inactive prior to becoming

31  delinquent must meet the same continuing education


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  1  requirements, if any, imposed on an active status licensee for

  2  all biennial licensure periods in which the licensee was

  3  inactive or delinquent.

  4         (11)  The status or a change in status of a licensee

  5  does not alter in any way the right of the board, or of the

  6  department if there is no board, to impose discipline or to

  7  enforce discipline previously imposed on a licensee for acts

  8  or omissions committed by the licensee while holding a

  9  license, whether active, inactive, or delinquent.

10         (12)  This section does not apply to a business

11  establishment registered, permitted, or licensed by the

12  department to do business.

13         (13)  The board, or the department when there is no

14  board, may adopt rules pursuant to ss. 120.536(1) and 120.54

15  as necessary to implement this section.

16         Section 32.  Subsection (3) of section 455.587, Florida

17  Statutes, is amended to read:

18         455.587  Fees; receipts; disposition.--

19         (3)  Each board, or the department if there is no

20  board, may, by rule, assess and collect a one-time fee from

21  each active status licensee and each voluntary inactive status

22  licensee in an amount necessary to eliminate a cash deficit

23  or, if there is not a cash deficit, in an amount sufficient to

24  maintain the financial integrity of the professions as

25  required in this section. Not more than one such assessment

26  may be made in any 4-year period without specific legislative

27  authorization.

28         Section 33.  Subsection (1) of section 455.714, Florida

29  Statutes, is amended to read:

30         455.714  Renewal and cancellation notices.--

31


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  1         (1)  At least 90 days before the end of a licensure

  2  cycle, the department shall:

  3         (a)  Forward a licensure renewal notification to an

  4  active or inactive status licensee at the licensee's last

  5  known address of record with the department.

  6         (b)  Forward a notice of pending cancellation of

  7  licensure to a delinquent status licensee at the licensee's

  8  last known address of record with the department.

  9         Section 34.  Section 455.719, Florida Statutes, is

10  created to read:

11         455.719  Health care professionals; exemption from

12  disqualification from employment or contracting.--Any other

13  provision of law to the contrary notwithstanding, only the

14  appropriate regulatory board, or the department when there is

15  no board, may grant an exemption from disqualification from

16  employment or contracting as provided in s. 435.07 to a person

17  under the licensing jurisdiction of that board or the

18  department, as applicable.

19         Section 35.  Section 455.637, Florida Statutes, is

20  amended to read:

21         455.637  Unlicensed practice of a health care

22  profession; intent; cease and desist notice; penalties civil

23  penalty; enforcement; citations; fees; allocation and

24  disposition of moneys collected.--

25         (1)  It is the intent of the Legislature that vigorous

26  enforcement of licensure regulation for all health care

27  professions is a state priority in order to protect Florida

28  residents and visitors from the potentially serious and

29  dangerous consequences of receiving medical and health care

30  services from unlicensed persons whose professional education

31  and training and other relevant qualifications have not been


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  1  approved through the issuance of a license by the appropriate

  2  regulatory board or the department when there is no board. The

  3  unlicensed practice of a health care profession or the

  4  performance or delivery of medical or health care services to

  5  patients in this state without a valid, active license to

  6  practice that profession, regardless of the means of the

  7  performance or delivery of such services, is strictly

  8  prohibited.

  9         (2)  The penalties for unlicensed practice of a health

10  care profession shall include the following:

11         (a)(1)  When the department has probable cause to

12  believe that any person not licensed by the department, or the

13  appropriate regulatory board within the department, has

14  violated any provision of this part or any statute that

15  relates to the practice of a profession regulated by the

16  department, or any rule adopted pursuant thereto, the

17  department may issue and deliver to such person a notice to

18  cease and desist from such violation. In addition, the

19  department may issue and deliver a notice to cease and desist

20  to any person who aids and abets the unlicensed practice of a

21  profession by employing such unlicensed person. The issuance

22  of a notice to cease and desist shall not constitute agency

23  action for which a hearing under ss. 120.569 and 120.57 may be

24  sought. For the purpose of enforcing a cease and desist order,

25  the department may file a proceeding in the name of the state

26  seeking issuance of an injunction or a writ of mandamus

27  against any person who violates any provisions of such order.

28         (b)  In addition to the foregoing remedies under

29  paragraph (a), the department may impose by citation an

30  administrative penalty not to exceed $5,000 per incident

31  pursuant to the provisions of chapter 120 or may issue a


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  1  citation pursuant to the provisions of subsection (3). The

  2  citation shall be issued to the subject and shall contain the

  3  subject's name and any other information the department

  4  determines to be necessary to identify the subject, a brief

  5  factual statement, the sections of the law allegedly violated,

  6  and the penalty imposed. If the subject does not dispute the

  7  matter in the citation with the department within 30 days

  8  after the citation is served, the citation shall become a

  9  final order of the department. The department may adopt rules

10  to implement this section. The penalty shall be a fine of not

11  less than $500 nor more than $5,000 as established by rule of

12  the department. Each day that the unlicensed practice

13  continues after issuance of a notice to cease and desist

14  constitutes a separate violation. The department shall be

15  entitled to recover the costs of investigation and prosecution

16  in addition to the fine levied pursuant to the citation.

17  Service of a citation may be made by personal service or by

18  mail to the subject at the subject's last known address or

19  place of practice. If the department is required to seek

20  enforcement of the cease and desist or agency order for a

21  penalty pursuant to s. 120.569, it shall be entitled to

22  collect its attorney's fees and costs, together with any cost

23  of collection.

24         (c)(2)  In addition to or in lieu of any other

25  administrative remedy provided in subsection (1), the

26  department may seek the imposition of a civil penalty through

27  the circuit court for any violation for which the department

28  may issue a notice to cease and desist under subsection (1).

29  The civil penalty shall be no less than $500 and no more than

30  $5,000 for each offense. The court may also award to the

31  prevailing party court costs and reasonable attorney fees and,


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  1  in the event the department prevails, may also award

  2  reasonable costs of investigation and prosecution.

  3         (d)  In addition to the administrative and civil

  4  remedies under paragraphs (b) and (c) and in addition to the

  5  criminal violations and penalties listed in the individual

  6  health care practice acts:

  7         1.  It is a felony of the third degree, punishable as

  8  provided in s. 775.082, s. 775.083, or s. 775.084, to

  9  practice, attempt to practice, or offer to practice a health

10  care profession without an active, valid Florida license to

11  practice that profession. Practicing without an active, valid

12  license also includes practicing on a suspended, revoked, or

13  void license, but does not include practicing, attempting to

14  practice, or offering to practice with an inactive or

15  delinquent license for a period of up to 12 months which is

16  addressed in subparagraph 3. Applying for employment for a

17  position that requires a license without notifying the

18  employer that the person does not currently possess a valid,

19  active license to practice that profession shall be deemed to

20  be an attempt or offer to practice that health care profession

21  without a license. Holding oneself out, regardless of the

22  means of communication, as able to practice a health care

23  profession or as able to provide services that require a

24  health care license shall be deemed to be an attempt or offer

25  to practice such profession without a license. The minimum

26  penalty for violating this subparagraph shall be a fine of

27  $1,000 and a minimum mandatory period of incarceration of 1

28  year.

29         2.  It is a felony of the second degree, punishable as

30  provided in s. 775.082, s. 775.083, or s. 775.084, to practice

31  a health care profession without an active, valid Florida


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  1  license to practice that profession when such practice results

  2  in serious bodily injury. For purposes of this section,

  3  "serious bodily injury" means death; brain or spinal damage;

  4  disfigurement; fracture or dislocation of bones or joints;

  5  limitation of neurological, physical, or sensory function; or

  6  any condition that required subsequent surgical repair. The

  7  minimum penalty for violating this subparagraph shall be a

  8  fine of $1,000 and a minimum mandatory period of incarceration

  9  of 1 year.

10         3.  It is a misdemeanor of the first degree, punishable

11  as provided in s. 775.082 or s. 775.083, to practice, attempt

12  to practice, or offer to practice a health care profession

13  with an inactive or delinquent license for any period of time

14  up to 12 months. However, practicing, attempting to practice,

15  or offering to practice a health care profession when that

16  person's license has been inactive or delinquent for a period

17  of time of 12 months or more shall be a felony of the third

18  degree, punishable as provided in s. 775.082, s. 775.083, or

19  s. 775.084. The minimum penalty for violating this

20  subparagraph shall be a term of imprisonment of 30 days and a

21  fine of $500.

22         (3)  Because all enforcement costs should be covered by

23  professions regulated by the department, the department shall

24  impose, upon initial licensure and each licensure renewal, a

25  special fee of $5 per licensee to fund efforts to combat

26  unlicensed activity. Such fee shall be in addition to all

27  other fees collected from each licensee. The board with

28  concurrence of the department, or the department when there is

29  no board, may earmark $5 of the current licensure fee for this

30  purpose, if such board, or profession regulated by the

31  department, is not in a deficit and has a reasonable cash


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  1  balance. The department shall make direct charges to the

  2  Medical Quality Assurance Trust Fund by profession. The

  3  department shall seek board advice regarding enforcement

  4  methods and strategies. The department shall directly credit

  5  the Medical Quality Assurance Trust Fund, by profession, with

  6  the revenues received from the department's efforts to enforce

  7  licensure provisions. The department shall include all

  8  financial and statistical data resulting from unlicensed

  9  activity enforcement as a separate category in the quarterly

10  management report provided for in s. 455.587. For an

11  unlicensed activity account, a balance which remains at the

12  end of a renewal cycle may, with concurrence of the applicable

13  board and the department, be transferred to the operating fund

14  account of that profession. The department shall also use

15  these funds to inform and educate consumers generally on the

16  importance of using licensed health care practitioners.

17         (3)(a)  Notwithstanding the provisions of s. 455.621,

18  the department shall adopt rules to permit the issuance of

19  citations for unlicensed practice of a profession. The

20  citation shall be issued to the subject and shall contain the

21  subject's name and any other information the department

22  determines to be necessary to identify the subject, a brief

23  factual statement, the sections of the law allegedly violated,

24  and the penalty imposed. The citation must clearly state that

25  the subject may choose, in lieu of accepting the citation, to

26  follow the procedure under s. 455.621. If the subject disputes

27  the matter in the citation, the procedures set forth in s.

28  455.621 must be followed. However, if the subject does not

29  dispute the matter in the citation with the department within

30  30 days after the citation is served, the citation shall

31  become a final order of the department. The penalty shall be a


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  1  fine of not less than $500 or more than $5,000 or other

  2  conditions as established by rule.

  3         (b)  Each day that the unlicensed practice continues

  4  after issuance of a citation constitutes a separate violation.

  5         (c)  The department shall be entitled to recover the

  6  costs of investigation, in addition to any penalty provided

  7  according to department rule as part of the penalty levied

  8  pursuant to the citation.

  9         (d)  Service of a citation may be made by personal

10  service or certified mail, restricted delivery, to the subject

11  at the subject's last known address.

12         (4)  All fines, fees, and costs collected through the

13  procedures set forth in this section shall be allocated to the

14  professions in the manner provided for in s. 455.641 for the

15  allocation of the fees assessed and collected to combat

16  unlicensed practice of a profession.

17         (4)(5)  The provisions of this section apply only to

18  health care the professional practice acts administered by the

19  department.

20         (5)  Nothing herein shall be construed to limit or

21  restrict the sale, use, or recommendation of the use of a

22  dietary supplement, as defined by the Food, Drug, and Cosmetic

23  Act, Title 21, s. 321, so long as the person selling, using,

24  or recommending the dietary supplement does so in compliance

25  with federal and state law.

26         Section 36.  Section 458.3135, Florida Statutes, is

27  created to read:

28         458.3135  Temporary certificate for visiting physicians

29  to practice in approved cancer centers.--

30         (1)  Any physician who has been accepted for a course

31  of training by a cancer center approved by the board and who


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  1  meets all of the qualifications set forth in this section may

  2  be issued a temporary certificate to practice in a

  3  board-approved cancer center under the International Cancer

  4  Center Visiting Physician Program. A certificate may be issued

  5  to a physician who will be training under the direct

  6  supervision of a physician employed by or under contract with

  7  an approved cancer center for a period of no more than 1 year.

  8  The purpose of the International Cancer Center Visiting

  9  Physician Program is to provide to internationally respected

10  and highly qualified physicians advanced education and

11  training on cancer treatment techniques developed at an

12  approved cancer center. The board may issue this temporary

13  certificate in accordance with the restrictions set forth in

14  this section.

15         (2)  A temporary certificate for practice in an

16  approved cancer center may be issued without examination to an

17  individual who:

18         (a)  Is a graduate of an accredited medical school or

19  its equivalent, or is a graduate of a foreign medical school

20  listed with the World Health Organization;

21         (b)  Holds a valid and unencumbered license to practice

22  medicine in another country;

23         (c)  Has completed the application form adopted by the

24  board and remitted a nonrefundable application fee not to

25  exceed $300;

26         (d)  Has not committed any act in this or any other

27  jurisdiction which would constitute the basis for disciplining

28  a physician under s. 455.624 or s. 458.331;

29         (e)  Meets the financial responsibility requirements of

30  s. 458.320; and

31


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  1         (f)  Has been accepted for a course of training by a

  2  cancer center approved by the board.

  3         (3)  The board shall by rule establish qualifications

  4  for approval of cancer centers under this section, which at a

  5  minimum shall require the cancer center to be licensed under

  6  chapter 395 and have met the standards required to be a

  7  National Cancer Institute-designated cancer center. The board

  8  shall review the cancer centers approved under this section

  9  not less than annually to ascertain that the minimum

10  requirements of this chapter and the rules adopted thereunder

11  are being complied with. If it is determined that such minimum

12  requirements are not being met by an approved cancer center,

13  the board shall rescind its approval of that cancer center and

14  no temporary certificate for that cancer center shall be valid

15  until such time as the board reinstates its approval of that

16  cancer center.

17         (4)  A recipient of a temporary certificate for

18  practice in an approved cancer center may use the certificate

19  to practice for the duration of the course of training at the

20  approved cancer center so long as the duration of the course

21  does not exceed 1 year. If at any time the cancer center is no

22  longer approved by the board, the temporary certificate shall

23  expire and the recipient shall no longer be authorized to

24  practice in this state.

25         (5)  A recipient of a temporary certificate for

26  practice in an approved cancer center is limited to practicing

27  in facilities owned or operated by that approved cancer center

28  and is limited to only practicing under the direct supervision

29  of a physician who holds a valid, active, and unencumbered

30  license to practice medicine in this state issued under this

31  chapter or chapter 459.


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  1         (6)  The board shall not issue a temporary certificate

  2  for practice in an approved cancer center to any physician who

  3  is under investigation in another jurisdiction for an act that

  4  would constitute a violation of this chapter or chapter 455

  5  until such time as the investigation is complete and the

  6  physician is found innocent of all charges.

  7         (7)  A physician applying under this section is exempt

  8  from the requirements of ss. 455.565-455.5656. All other

  9  provisions of chapters 455 and 458 apply.

10         (8)  In any year, the maximum number of temporary

11  certificates that may be issued by the board under this

12  section may not exceed 10 at each approved cancer center.

13         (9)  The board may adopt rules pursuant to ss.

14  120.536(1) and 120.54 as necessary to implement this section.

15         (10)  Nothing in this section may be construed to

16  authorize a physician who is not licensed to practice medicine

17  in this state to qualify for or otherwise engage in the

18  practice of medicine in this state, except as provided in this

19  section.

20         Section 37.  Paragraph (i) of subsection (1), and

21  subsection (4) of section 458.3145, Florida Statutes, are

22  amended to read:

23           458.3145  Medical faculty certificate.--

24         (1)  A medical faculty certificate may be issued

25  without examination to an individual who:

26         (a)  Is a graduate of an accredited medical school or

27  its equivalent, or is a graduate of a foreign medical school

28  listed with the World Health Organization;

29         (b)  Holds a valid, current license to practice

30  medicine in another jurisdiction;

31


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  1         (c)  Has completed the application form and remitted a

  2  nonrefundable application fee not to exceed $500;

  3         (d)  Has completed an approved residency or fellowship

  4  of at least 1 year or has received training which has been

  5  determined by the board to be equivalent to the 1-year

  6  residency requirement;

  7         (e)  Is at least 21 years of age;

  8         (f)  Is of good moral character;

  9         (g)  Has not committed any act in this or any other

10  jurisdiction which would constitute the basis for disciplining

11  a physician under s. 458.331;

12         (h)  For any applicant who has graduated from medical

13  school after October 1, 1992, has completed, before entering

14  medical school, the equivalent of 2 academic years of

15  preprofessional, postsecondary education, as determined by

16  rule of the board, which must include, at a minimum, courses

17  in such fields as anatomy, biology, and chemistry; and

18         (i)  Has been offered and has accepted a full-time

19  faculty appointment to teach in a program of medicine at:

20         1.  The University of Florida,

21         2.  The University of Miami,

22         3.  The University of South Florida, or

23         4.  The Florida State University, or

24         54.  The Mayo Medical School at the Mayo Clinic in

25  Jacksonville, Florida.

26         (2)  The certificate authorizes the holder to practice

27  only in conjunction with his or her faculty position at an

28  accredited medical school and its affiliated clinical

29  facilities or teaching hospitals that are registered with the

30  Board of Medicine as sites at which holders of medical faculty

31  certificates will be practicing.  Such certificate


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  1  automatically expires when the holder's relationship with the

  2  medical school is terminated or after a period of 24 months,

  3  whichever occurs sooner, and is renewable every 2 years by a

  4  holder who applies to the board on a form prescribed by the

  5  board and provides certification by the dean of the medical

  6  school that the holder is a distinguished medical scholar and

  7  an outstanding practicing physician.

  8         (3)  The holder of a medical faculty certificate issued

  9  under this section has all rights and responsibilities

10  prescribed by law for the holder of a license issued under s.

11  458.311, except as specifically provided otherwise by law.

12  Such responsibilities include compliance with continuing

13  medical education requirements as set forth by rule of the

14  board. A hospital or ambulatory surgical center licensed under

15  chapter 395, health maintenance organization certified under

16  chapter 641, insurer as defined in s. 624.03,

17  multiple-employer welfare arrangement as defined in s.

18  624.437, or any other entity in this state, in considering and

19  acting upon an application for staff membership, clinical

20  privileges, or other credentials as a health care provider,

21  may not deny the application of an otherwise qualified

22  physician for such staff membership, clinical privileges, or

23  other credentials solely because the applicant is a holder of

24  a medical faculty certificate under this section.

25         (4)  In any year, the maximum number of extended

26  medical faculty certificateholders as provided in subsection

27  (2) may not exceed 15 persons at each institution named in

28  subparagraphs (1)(i)1.-43. and at the facility named in s.

29  240.512 and may not exceed 5 persons at the institution named

30  in subparagraph (1)(i)54.

31


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  1         5.  Annual review of all such certificate recipients

  2  will be made by the deans of the accredited 4-year medical

  3  schools within this state and reported to the Board of

  4  Medicine.

  5         (5)  Notwithstanding subsection (1), any physician,

  6  when providing medical care or treatment in connection with

  7  the education of students, residents, or faculty at the

  8  request of the dean of an accredited medical school within

  9  this state or at the request of the medical director of a

10  statutory teaching hospital as defined in s. 408.07, may do so

11  upon registration with the board and demonstration of

12  financial responsibility pursuant to s. 458.320(1) or (2)

13  unless such physician is exempt under s. 458.320(5)(a).  The

14  performance of such medical care or treatment must be limited

15  to a single period of time, which may not exceed 180

16  consecutive days, and must be rendered within a facility

17  registered under subsection (2) or within a statutory teaching

18  hospital as defined in s. 408.07.  A registration fee not to

19  exceed $300, as set by the board, is required of each

20  physician registered under this subsection. However, no more

21  than three physicians per year per institution may be

22  registered under this subsection, and an exemption under this

23  subsection may not be granted to a physician more than once in

24  any given 5-year period.

25         Section 38.  Subsection (5) is added to section

26  458.315, Florida Statutes, to read:

27         458.315  Temporary certificate for practice in areas of

28  critical need.--Any physician who is licensed to practice in

29  any other state, whose license is currently valid, and who

30  pays an application fee of $300 may be issued a temporary

31  certificate to practice in communities of Florida where there


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  1  is a critical need for physicians.  A certificate may be

  2  issued to a physician who will be employed by a county health

  3  department, correctional facility, community health center

  4  funded by s. 329, s. 330, or s. 340 of the United States

  5  Public Health Services Act, or other entity that provides

  6  health care to indigents and that is approved by the State

  7  Health Officer.  The Board of Medicine may issue this

  8  temporary certificate with the following restrictions:

  9         (5)  The application fee and all licensure fees,

10  including neurological injury compensation assessments, shall

11  be waived for those persons obtaining a temporary certificate

12  to practice in areas of critical need for the purpose of

13  providing volunteer, uncompensated care for low-income

14  Floridians. The applicant must submit an affidavit from the

15  employing agency or institution stating that the physician

16  will not receive any compensation for any service involving

17  the practice of medicine.

18         Section 39.  Section 458.345, Florida Statutes, is

19  amended to read:

20         458.345  Registration of resident physicians, interns,

21  and fellows; list of hospital employees; prescribing of

22  medicinal drugs; penalty.--

23         (1)  Any person desiring to practice as a resident

24  physician, assistant resident physician, house physician,

25  intern, or fellow in fellowship training which leads to

26  subspecialty board certification in this state, or any person

27  desiring to practice as a resident physician, assistant

28  resident physician, house physician, intern, or fellow in

29  fellowship training in a teaching hospital in this state as

30  defined in s. 408.07(44) or s. 395.805(2), who does not hold a

31  valid, active license issued under this chapter shall apply to


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  1  the department to be registered and shall remit a fee not to

  2  exceed $300 as set by the board.  The department shall

  3  register any applicant the board certifies has met the

  4  following requirements:

  5         (a)  Is at least 21 years of age.

  6         (b)  Has not committed any act or offense within or

  7  without the state which would constitute the basis for refusal

  8  to certify an application for licensure pursuant to s.

  9  458.331.

10         (c)  Is a graduate of a medical school or college as

11  specified in s. 458.311(1)(f).

12         (2)  The board shall not certify to the department for

13  registration any applicant who is under investigation in any

14  state or jurisdiction for an act which would constitute the

15  basis for imposing a disciplinary penalty specified in s.

16  458.331(2)(b) until such time as the investigation is

17  completed, at which time the provisions of s. 458.331 shall

18  apply.

19         (3)  Every hospital or teaching hospital employing or

20  utilizing the services of a resident physician, assistant

21  resident physician, house physician, intern, or fellow in

22  fellowship training registered under this section which leads

23  to subspecialty board certification shall designate a person

24  who shall, on dates designated by the board, in consultation

25  with the department, furnish the department with a list of

26  such the hospital's employees and such other information as

27  the board may direct.  The chief executive officer of each

28  such hospital shall provide the executive director of the

29  board with the name, title, and address of the person

30  responsible for furnishing such reports.

31


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  1         (4)  Registration under this section shall

  2  automatically expire after 2 years without further action by

  3  the board or the department unless an application for renewal

  4  is approved by the board.  No person registered under this

  5  section may be employed or utilized as a house physician or

  6  act as a resident physician, an assistant resident physician,

  7  an intern, or a fellow in fellowship training which leads to a

  8  subspecialty board certification in a hospital or teaching

  9  hospital of this state for more than 2 years without a valid,

10  active license or renewal of registration under this section.

11  Requirements for renewal of registration shall be established

12  by rule of the board.  An application fee not to exceed $300

13  as set by the board shall accompany the application for

14  renewal, except that resident physicians, assistant resident

15  physicians, interns, and fellows in fellowship training

16  registered under this section which leads to subspecialty

17  board certification shall be exempt from payment of any

18  renewal fees.

19         (5)  Notwithstanding any provision of this section or

20  s. 120.52 to the contrary, any person who is registered under

21  this section is subject to the provisions of s. 458.331.

22         (6)  A person registered as a resident physician under

23  this section may in the normal course of his or her employment

24  prescribe medicinal drugs described in schedules set out in

25  chapter 893 when:

26         (a)  The person prescribes such medicinal drugs through

27  use of a Drug Enforcement Administration number issued to the

28  hospital or teaching hospital by which the person is employed

29  or at which the person's services are used;

30         (b)  The person is identified by a discrete suffix to

31  the identification number issued to such the hospital; and


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  1         (c)  The use of the institutional identification number

  2  and individual suffixes conforms to the requirements of the

  3  federal Drug Enforcement Administration.

  4         (7)  Any person willfully violating this section

  5  commits a misdemeanor of the first degree, punishable as

  6  provided in s. 775.082 or s. 775.083.

  7         (8)  The board shall promulgate rules pursuant to ss.

  8  120.536(1) and 120.54 as necessary to implement this section.

  9         Section 40.  Subsection (3) of section 458.348, Florida

10  Statutes, is created to read:

11         458.348  Formal supervisory relationships, standing

12  orders, and established protocols; notice; standards.--

13         (3)  PROTOCOLS REQUIRING DIRECT SUPERVISION.--All

14  protocols relating to electrolysis or electrology using laser

15  or light-based hair removal or reduction by persons other than

16  physicians licensed under this chapter or chapter 459 shall

17  require the person performing such service to be appropriately

18  trained and work only under the direct supervision and

19  responsibility of a physician licensed under this chapter or

20  chapter 459.

21         Section 41.  Section 459.021, Florida Statutes, is

22  amended to read:

23         459.021  Registration of resident physicians, interns,

24  and fellows; list of hospital employees; penalty.--

25         (1)  Any person who holds a degree of Doctor of

26  Osteopathic Medicine from a college of osteopathic medicine

27  recognized and approved by the American Osteopathic

28  Association who desires to practice as a resident physician,

29  assistant resident physician, house physician, intern, or

30  fellow in fellowship training which leads to subspecialty

31  board certification in this state, or any person desiring to


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  1  practice as a resident physician, assistant resident

  2  physician, house physician, intern, or fellow in fellowship

  3  training in a teaching hospital in this state as defined in s.

  4  408.07(44) or s. 395.805(2), who does not hold an active

  5  license issued under this chapter shall apply to the

  6  department to be registered, on an application provided by the

  7  department, within 30 days of commencing such a training

  8  program and shall remit a fee not to exceed $300 as set by the

  9  board.

10         (2)  Any person required to be registered under this

11  section shall renew such registration annually.  Such

12  registration shall be terminated upon the registrant's receipt

13  of an active license issued under this chapter.  No person

14  shall be registered under this section for an aggregate of

15  more than 5 years, unless additional years are approved by the

16  board.

17         (3)  Every hospital or teaching hospital having

18  employed or contracted with or utilized the services of a

19  person who holds a degree of Doctor of Osteopathic Medicine

20  from a college of osteopathic medicine recognized and approved

21  by the American Osteopathic Association as a resident

22  physician, assistant resident physician, house physician,

23  intern, or fellow in fellowship training registered under this

24  section which leads to subspecialty board certification shall

25  designate a person who shall furnish, on dates designated by

26  the board, in consultation with the department, to the

27  department a list of all such persons who have served in such

28  the hospital during the preceding 6-month period. The chief

29  executive officer of each such hospital shall provide the

30  executive director of the board with the name, title, and

31  address of the person responsible for filing such reports.


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  1         (4)  The registration may be revoked or the department

  2  may refuse to issue any registration for any cause which would

  3  be a ground for its revocation or refusal to issue a license

  4  to practice osteopathic medicine, as well as on the following

  5  grounds:

  6         (a)  Omission of the name of an intern, resident

  7  physician, assistant resident physician, house physician, or

  8  fellow in fellowship training from the list of employees

  9  required by subsection (3) to be furnished to the department

10  by the hospital or teaching hospital served by the employee.

11         (b)  Practicing osteopathic medicine outside of a bona

12  fide hospital training program.

13         (5)  It is a misdemeanor of the second degree,

14  punishable as provided in s. 775.082 or s. 775.083 for any

15  hospital or teaching hospital, and also for the

16  superintendent, administrator, and other person or persons

17  having administrative authority in such a hospital:

18         (a)  To employ the services in such the hospital of any

19  person listed in subsection (3), unless such person is

20  registered with the department under the law or the holder of

21  a license to practice osteopathic medicine under this chapter.

22         (b)  To fail to furnish to the department the list and

23  information required by subsection (3).

24         (6)  Any person desiring registration pursuant to this

25  section shall meet all the requirements of s. 459.0055.

26         (7)  The board shall promulgate rules pursuant to ss.

27  120.536(1) and 120.54 as necessary to implement this section.

28         (8)  Notwithstanding any provision of this section or

29  s. 120.52 to the contrary, any person who is registered under

30  this section is subject to the provisions of s. 459.015.

31


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  1         (9)  A person registered as a resident physician under

  2  this section may in the normal course of his or her employment

  3  prescribe medicinal drugs described in schedules set out in

  4  chapter 893 when:

  5         (a)  The person prescribes such medicinal drugs through

  6  use of a Drug Enforcement Administration number issued to the

  7  hospital or teaching hospital by which the person is employed

  8  or at which the person's services are used;

  9         (b)  The person is identified by a discrete suffix to

10  the identification number issued to such the hospital; and

11         (c)  The use of the institutional identification number

12  and individual suffixes conforms to the requirements of the

13  federal Drug Enforcement Administration.

14         Section 42.  Paragraph (d) is added to subsection (9)

15  of section 458.347, Florida Statutes, to read:

16         458.347  Physician assistants.--

17         (9)  COUNCIL ON PHYSICIAN ASSISTANTS.--The Council on

18  Physician Assistants is created within the department.

19         (a)  The council shall consist of five members

20  appointed as follows:

21         1.  The chairperson of the Board of Medicine shall

22  appoint three members who are physicians and members of the

23  Board of Medicine.  One of the physicians must supervise a

24  physician assistant in the physician's practice.

25         2.  The chairperson of the Board of Osteopathic

26  Medicine shall appoint one member who is a physician and a

27  member of the Board of Osteopathic Medicine.

28         3.  The secretary of the department or his or her

29  designee shall appoint a fully licensed physician assistant

30  licensed under this chapter or chapter 459.

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  1         (b)  Two of the members appointed to the council must

  2  be physicians who supervise physician assistants in their

  3  practice. Members shall be appointed to terms of 4 years,

  4  except that of the initial appointments, two members shall be

  5  appointed to terms of 2 years, two members shall be appointed

  6  to terms of 3 years, and one member shall be appointed to a

  7  term of 4 years, as established by rule of the boards.

  8  Council members may not serve more than two consecutive terms.

  9  The council shall annually elect a chairperson from among its

10  members.

11         (c)  The council shall:

12         1.  Recommend to the department the licensure of

13  physician assistants.

14         2.  Develop all rules regulating the use of physician

15  assistants by physicians under this chapter and chapter 459,

16  except for rules relating to the formulary developed under

17  paragraph (4)(f). The council shall also develop rules to

18  ensure that the continuity of supervision is maintained in

19  each practice setting.  The boards shall consider adopting a

20  proposed rule developed by the council at the regularly

21  scheduled meeting immediately following the submission of the

22  proposed rule by the council.  A proposed rule submitted by

23  the council may not be adopted by either board unless both

24  boards have accepted and approved the identical language

25  contained in the proposed rule. The language of all proposed

26  rules submitted by the council must be approved by both boards

27  pursuant to each respective board's guidelines and standards

28  regarding the adoption of proposed rules. If either board

29  rejects the council's proposed rule, that board must specify

30  its objection to the council with particularity and include

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  1  any recommendations it may have for the modification of the

  2  proposed rule.

  3         3.  Make recommendations to the boards regarding all

  4  matters relating to physician assistants.

  5         4.  Address concerns and problems of practicing

  6  physician assistants in order to improve safety in the

  7  clinical practices of licensed physician assistants.

  8         (d)  When the Council finds that an applicant for

  9  licensure has failed to meet, to the Council's satisfaction,

10  each of the requirements for licensure set forth in this

11  section, the Council may enter an order to:

12         1.  Refuse to certify the applicant for licensure;

13         2.  Approve the applicant for licensure with

14  restrictions on the scope of practice or license; or

15         3.  Approve the applicant for conditional licensure.

16  Such conditions may include placement of the licensee on

17  probation for a period of time and subject to such conditions

18  as the Council may specify, including but not limited to,

19  requiring the licensee to undergo treatment, to attend

20  continuing education courses, to work under the direct

21  supervision of a physician licensed in this state, or to take

22  corrective action.

23         Section 43.  Paragraph (d) is added to subsection (9)

24  of section 459.022, Florida Statutes, to read:

25         459.022  Physician assistants.--

26         (9)  COUNCIL ON PHYSICIAN ASSISTANTS.--The Council on

27  Physician Assistants is created within the department.

28         (a)  The council shall consist of five members

29  appointed as follows:

30         1.  The chairperson of the Board of Medicine shall

31  appoint three members who are physicians and members of the


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  1  Board of Medicine.  One of the physicians must supervise a

  2  physician assistant in the physician's practice.

  3         2.  The chairperson of the Board of Osteopathic

  4  Medicine shall appoint one member who is a physician and a

  5  member of the Board of Osteopathic Medicine.

  6         3.  The secretary of the department or her or his

  7  designee shall appoint a fully licensed physician assistant

  8  licensed under chapter 458 or this chapter.

  9         (b)  Two of the members appointed to the council must

10  be physicians who supervise physician assistants in their

11  practice. Members shall be appointed to terms of 4 years,

12  except that of the initial appointments, two members shall be

13  appointed to terms of 2 years, two members shall be appointed

14  to terms of 3 years, and one member shall be appointed to a

15  term of 4 years, as established by rule of the boards.

16  Council members may not serve more than two consecutive terms.

17  The council shall annually elect a chairperson from among its

18  members.

19         (c)  The council shall:

20         1.  Recommend to the department the licensure of

21  physician assistants.

22         2.  Develop all rules regulating the use of physician

23  assistants by physicians under chapter 458 and this chapter,

24  except for rules relating to the formulary developed under s.

25  458.347(4)(f). The council shall also develop rules to ensure

26  that the continuity of supervision is maintained in each

27  practice setting. The boards shall consider adopting a

28  proposed rule developed by the council at the regularly

29  scheduled meeting immediately following the submission of the

30  proposed rule by the council.  A proposed rule submitted by

31  the council may not be adopted by either board unless both


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  1  boards have accepted and approved the identical language

  2  contained in the proposed rule. The language of all proposed

  3  rules submitted by the council must be approved by both boards

  4  pursuant to each respective board's guidelines and standards

  5  regarding the adoption of proposed rules.  If either board

  6  rejects the council's proposed rule, that board must specify

  7  its objection to the council with particularity and include

  8  any recommendations it may have for the modification of the

  9  proposed rule.

10         3.  Make recommendations to the boards regarding all

11  matters relating to physician assistants.

12         4.  Address concerns and problems of practicing

13  physician assistants in order to improve safety in the

14  clinical practices of licensed physician assistants.

15         (d)  When the Council finds that an applicant for

16  licensure has failed to meet, to the Council's satisfaction,

17  each of the requirements for licensure set forth in this

18  section, the Council may enter an order to:

19         1.  Refuse to certify the applicant for licensure;

20         2.  Approve the applicant for licensure with

21  restrictions on the scope of practice or license; or

22         3.  Approve the applicant for conditional licensure.

23  Such conditions may include placement of the licensee on

24  probation for a period of time and subject to such conditions

25  as the Council may specify, including but not limited to,

26  requiring the licensee to undergo treatment, to attend

27  continuing education courses, to work under the direct

28  supervision of a physician licensed in this state, or to take

29  corrective action.

30

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  1         Section 44.  The amendment of s. 455.637, Florida

  2  Statutes, by this act applies to offenses committed on or

  3  after the effective date of such section.

  4         Section 45.  Section 455.641, Florida Statutes, is

  5  repealed.

  6         Section 46.  For the purpose of incorporating the

  7  amendment to section 455.637, Florida Statutes, in references

  8  thereto, the sections or subdivisions of Florida Statutes set

  9  forth below are reenacted to read:

10         455.574  Department of Health; examinations.--

11         (1)

12         (d)  Each board, or the department when there is no

13  board, shall adopt rules regarding the security and monitoring

14  of examinations.  The department shall implement those rules

15  adopted by the respective boards.  In order to maintain the

16  security of examinations, the department may employ the

17  procedures set forth in s. 455.637 to seek fines and

18  injunctive relief against an examinee who violates the

19  provisions of s. 455.577 or the rules adopted pursuant to this

20  paragraph.  The department, or any agent thereof, may, for the

21  purposes of investigation, confiscate any written,

22  photographic, or recording material or device in the

23  possession of the examinee at the examination site which the

24  department deems necessary to enforce such provisions or

25  rules.

26         468.1295  Disciplinary proceedings.--

27         (1)  The following acts constitute grounds for both

28  disciplinary actions as set forth in subsection (2) and cease

29  and desist or other related actions by the department as set

30  forth in s. 455.637:

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  1         (a)  Procuring or attempting to procure a license by

  2  bribery, by fraudulent misrepresentation, or through an error

  3  of the department or the board.

  4         (b)  Having a license revoked, suspended, or otherwise

  5  acted against, including denial of licensure, by the licensing

  6  authority of another state, territory, or country.

  7         (c)  Being convicted or found guilty of, or entering a

  8  plea of nolo contendere to, regardless of adjudication, a

  9  crime in any jurisdiction which directly relates to the

10  practice of speech-language pathology or audiology.

11         (d)  Making or filing a report or record which the

12  licensee knows to be false, intentionally or negligently

13  failing to file a report or records required by state or

14  federal law, willfully impeding or obstructing such filing, or

15  inducing another person to impede or obstruct such filing.

16  Such report or record shall include only those reports or

17  records which are signed in one's capacity as a licensed

18  speech-language pathologist or audiologist.

19         (e)  Advertising goods or services in a manner which is

20  fraudulent, false, deceptive, or misleading in form or

21  content.

22         (f)  Being proven guilty of fraud or deceit or of

23  negligence, incompetency, or misconduct in the practice of

24  speech-language pathology or audiology.

25         (g)  Violating a lawful order of the board or

26  department previously entered in a disciplinary hearing, or

27  failing to comply with a lawfully issued subpoena of the board

28  or department.

29         (h)  Practicing with a revoked, suspended, inactive, or

30  delinquent license.

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  1         (i)  Using, or causing or promoting the use of, any

  2  advertising matter, promotional literature, testimonial,

  3  guarantee, warranty, label, brand, insignia, or other

  4  representation, however disseminated or published, which is

  5  misleading, deceiving, or untruthful.

  6         (j)  Showing or demonstrating or, in the event of sale,

  7  delivery of a product unusable or impractical for the purpose

  8  represented or implied by such action.

  9         (k)  Failing to submit to the board on an annual basis,

10  or such other basis as may be provided by rule, certification

11  of testing and calibration of such equipment as designated by

12  the board and on the form approved by the board.

13         (l)  Aiding, assisting, procuring, employing, or

14  advising any licensee or business entity to practice

15  speech-language pathology or audiology contrary to this part,

16  part II of chapter 455, or any rule adopted pursuant thereto.

17         (m)  Violating any provision of this part or part II of

18  chapter 455 or any rule adopted pursuant thereto.

19         (n)  Misrepresenting the professional services

20  available in the fitting, sale, adjustment, service, or repair

21  of a hearing aid, or using any other term or title which might

22  connote the availability of professional services when such

23  use is not accurate.

24         (o)  Representing, advertising, or implying that a

25  hearing aid or its repair is guaranteed without providing full

26  disclosure of the identity of the guarantor; the nature,

27  extent, and duration of the guarantee; and the existence of

28  conditions or limitations imposed upon the guarantee.

29         (p)  Representing, directly or by implication, that a

30  hearing aid utilizing bone conduction has certain specified

31  features, such as the absence of anything in the ear or


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  1  leading to the ear, or the like, without disclosing clearly

  2  and conspicuously that the instrument operates on the bone

  3  conduction principle and that in many cases of hearing loss

  4  this type of instrument may not be suitable.

  5         (q)  Stating or implying that the use of any hearing

  6  aid will improve or preserve hearing or prevent or retard the

  7  progression of a hearing impairment or that it will have any

  8  similar or opposite effect.

  9         (r)  Making any statement regarding the cure of the

10  cause of a hearing impairment by the use of a hearing aid.

11         (s)  Representing or implying that a hearing aid is or

12  will be "custom-made," "made to order," or

13  "prescription-made," or in any other sense specially

14  fabricated for an individual, when such is not the case.

15         (t)  Canvassing from house to house or by telephone,

16  either in person or by an agent, for the purpose of selling a

17  hearing aid, except that contacting persons who have evidenced

18  an interest in hearing aids, or have been referred as in need

19  of hearing aids, shall not be considered canvassing.

20         (u)  Failing to notify the department in writing of a

21  change in current mailing and place-of-practice address within

22  30 days after such change.

23         (v)  Failing to provide all information as described in

24  ss. 468.1225(5)(b), 468.1245(1), and 468.1246.

25         (w)  Exercising influence on a client in such a manner

26  as to exploit the client for financial gain of the licensee or

27  of a third party.

28         (x)  Practicing or offering to practice beyond the

29  scope permitted by law or accepting and performing

30  professional responsibilities the licensee or

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  1  certificateholder knows, or has reason to know, the licensee

  2  or certificateholder is not competent to perform.

  3         (y)  Aiding, assisting, procuring, or employing any

  4  unlicensed person to practice speech-language pathology or

  5  audiology.

  6         (z)  Delegating or contracting for the performance of

  7  professional responsibilities by a person when the licensee

  8  delegating or contracting for performance of such

  9  responsibilities knows, or has reason to know, such person is

10  not qualified by training, experience, and authorization to

11  perform them.

12         (aa)  Committing any act upon a patient or client which

13  would constitute sexual battery or which would constitute

14  sexual misconduct as defined pursuant to s. 468.1296.

15         (bb)  Being unable to practice the profession for which

16  he or she is licensed or certified under this chapter with

17  reasonable skill or competence as a result of any mental or

18  physical condition or by reason of illness, drunkenness, or

19  use of drugs, narcotics, chemicals, or any other substance. In

20  enforcing this paragraph, upon a finding by the secretary, his

21  or her designee, or the board that probable cause exists to

22  believe that the licensee or certificateholder is unable to

23  practice the profession because of the reasons stated in this

24  paragraph, the department shall have the authority to compel a

25  licensee or certificateholder to submit to a mental or

26  physical examination by a physician, psychologist, clinical

27  social worker, marriage and family therapist, or mental health

28  counselor designated by the department or board.  If the

29  licensee or certificateholder refuses to comply with the

30  department's order directing the examination, such order may

31  be enforced by filing a petition for enforcement in the


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  1  circuit court in the circuit in which the licensee or

  2  certificateholder resides or does business.  The department

  3  shall be entitled to the summary procedure provided in s.

  4  51.011.  A licensee or certificateholder affected under this

  5  paragraph shall at reasonable intervals be afforded an

  6  opportunity to demonstrate that he or she can resume the

  7  competent practice for which he or she is licensed or

  8  certified with reasonable skill and safety to patients.

  9         484.014  Disciplinary actions.--

10         (1)  The following acts relating to the practice of

11  opticianry shall be grounds for both disciplinary action

12  against an optician as set forth in this section and cease and

13  desist or other related action by the department as set forth

14  in s. 455.637 against any person operating an optical

15  establishment who engages in, aids, or abets any such

16  violation:

17         (a)  Procuring or attempting to procure a license by

18  misrepresentation, bribery, or fraud or through an error of

19  the department or the board.

20         (b)  Procuring or attempting to procure a license for

21  any other person by making or causing to be made any false

22  representation.

23         (c)  Making or filing a report or record which the

24  licensee knows to be false, intentionally or negligently

25  failing to file a report or record required by federal or

26  state law, willfully impeding or obstructing such filing, or

27  inducing another person to do so. Such reports or records

28  shall include only those which the person is required to make

29  or file as an optician.

30

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  1         (d)  Failing to make fee or price information readily

  2  available by providing such information upon request or upon

  3  the presentation of a prescription.

  4         (e)  Advertising goods or services in a manner which is

  5  fraudulent, false, deceptive, or misleading in form or

  6  content.

  7         (f)  Fraud or deceit, or negligence, incompetency, or

  8  misconduct, in the authorized practice of opticianry.

  9         (g)  Violation or repeated violation of this part or of

10  part II of chapter 455 or any rules promulgated pursuant

11  thereto.

12         (h)  Practicing with a revoked, suspended, inactive, or

13  delinquent license.

14         (i)  Violation of a lawful order of the board or

15  department previously entered in a disciplinary hearing or

16  failing to comply with a lawfully issued subpoena of the

17  department.

18         (j)  Violation of any provision of s. 484.012.

19         (k)  Conspiring with another licensee or with any

20  person to commit an act, or committing an act, which would

21  coerce, intimidate, or preclude another licensee from lawfully

22  advertising her or his services.

23         (l)  Willfully submitting to any third-party payor a

24  claim for services which were not provided to a patient.

25         (m)  Failing to keep written prescription files.

26         (n)  Willfully failing to report any person who the

27  licensee knows is in violation of this part or of rules of the

28  department or the board.

29         (o)  Exercising influence on a client in such a manner

30  as to exploit the client for financial gain of the licensee or

31  of a third party.


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  1         (p)  Gross or repeated malpractice.

  2         (q)  Permitting any person not licensed as an optician

  3  in this state to fit or dispense any lenses, spectacles,

  4  eyeglasses, or other optical devices which are part of the

  5  practice of opticianry.

  6         (r)  Being convicted or found guilty of, or entering a

  7  plea of nolo contendere to, regardless of adjudication, in a

  8  court of this state or other jurisdiction, a crime which

  9  relates to the ability to practice opticianry or to the

10  practice of opticianry.

11         (s)  Having been disciplined by a regulatory agency in

12  another state for any offense that would constitute a

13  violation of Florida law or rules regulating opticianry.

14         (t)  Being unable to practice opticianry with

15  reasonable skill and safety by reason of illness or use of

16  drugs, narcotics, chemicals, or any other type of material or

17  as a result of any mental or physical condition. An optician

18  affected under this paragraph shall at reasonable intervals be

19  afforded an opportunity to demonstrate that she or he can

20  resume the competent practice of opticianry with reasonable

21  skill and safety to her or his customers.

22         484.056  Disciplinary proceedings.--

23         (1)  The following acts relating to the practice of

24  dispensing hearing aids shall be grounds for both disciplinary

25  action against a hearing aid specialist as set forth in this

26  section and cease and desist or other related action by the

27  department as set forth in s. 455.637 against any person

28  owning or operating a hearing aid establishment who engages

29  in, aids, or abets any such violation:

30         (a)  Violation of any provision of s. 455.624(1), s.

31  484.0512, or s. 484.053.


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  1         (b)  Attempting to procure a license to dispense

  2  hearing aids by bribery, by fraudulent misrepresentations, or

  3  through an error of the department or the board.

  4         (c)  Having a license to dispense hearing aids revoked,

  5  suspended, or otherwise acted against, including the denial of

  6  licensure, by the licensing authority of another state,

  7  territory, or country.

  8         (d)  Being convicted or found guilty of, or entering a

  9  plea of nolo contendere to, regardless of adjudication, a

10  crime in any jurisdiction which directly relates to the

11  practice of dispensing hearing aids or the ability to practice

12  dispensing hearing aids, including violations of any federal

13  laws or regulations regarding hearing aids.

14         (e)  Making or filing a report or record which the

15  licensee knows to be false, intentionally or negligently

16  failing to file a report or record required by state or

17  federal law, willfully impeding or obstructing such filing, or

18  inducing another person to impede or obstruct such filing.

19  Such reports or records shall include only those reports or

20  records which are signed in one's capacity as a licensed

21  hearing aid specialist.

22         (f)  Advertising goods or services in a manner which is

23  fraudulent, false, deceptive, or misleading in form or

24  content.

25         (g)  Proof that the licensee is guilty of fraud or

26  deceit or of negligence, incompetency, or misconduct in the

27  practice of dispensing hearing aids.

28         (h)  Violation or repeated violation of this part or of

29  part II of chapter 455, or any rules promulgated pursuant

30  thereto.

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  1         (i)  Violation of a lawful order of the board or

  2  department previously entered in a disciplinary hearing or

  3  failure to comply with a lawfully issued subpoena of the board

  4  or department.

  5         (j)  Practicing with a revoked, suspended, inactive, or

  6  delinquent license.

  7         (k)  Using, or causing or promoting the use of, any

  8  advertising matter, promotional literature, testimonial,

  9  guarantee, warranty, label, brand, insignia, or other

10  representation, however disseminated or published, which is

11  misleading, deceiving, or untruthful.

12         (l)  Showing or demonstrating, or, in the event of

13  sale, delivery of, a product unusable or impractical for the

14  purpose represented or implied by such action.

15         (m)  Misrepresentation of professional services

16  available in the fitting, sale, adjustment, service, or repair

17  of a hearing aid, or use of the terms "doctor," "clinic,"

18  "clinical," "medical audiologist," "clinical audiologist,"

19  "research audiologist," or "audiologic" or any other term or

20  title which might connote the availability of professional

21  services when such use is not accurate.

22         (n)  Representation, advertisement, or implication that

23  a hearing aid or its repair is guaranteed without providing

24  full disclosure of the identity of the guarantor; the nature,

25  extent, and duration of the guarantee; and the existence of

26  conditions or limitations imposed upon the guarantee.

27         (o)  Representing, directly or by implication, that a

28  hearing aid utilizing bone conduction has certain specified

29  features, such as the absence of anything in the ear or

30  leading to the ear, or the like, without disclosing clearly

31  and conspicuously that the instrument operates on the bone


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  1  conduction principle and that in many cases of hearing loss

  2  this type of instrument may not be suitable.

  3         (p)  Making any predictions or prognostications as to

  4  the future course of a hearing impairment, either in general

  5  terms or with reference to an individual person.

  6         (q)  Stating or implying that the use of any hearing

  7  aid will improve or preserve hearing or prevent or retard the

  8  progression of a hearing impairment or that it will have any

  9  similar or opposite effect.

10         (r)  Making any statement regarding the cure of the

11  cause of a hearing impairment by the use of a hearing aid.

12         (s)  Representing or implying that a hearing aid is or

13  will be "custom-made," "made to order," or "prescription-made"

14  or in any other sense specially fabricated for an individual

15  person when such is not the case.

16         (t)  Canvassing from house to house or by telephone

17  either in person or by an agent for the purpose of selling a

18  hearing aid, except that contacting persons who have evidenced

19  an interest in hearing aids, or have been referred as in need

20  of hearing aids, shall not be considered canvassing.

21         (u)  Failure to submit to the board on an annual basis,

22  or such other basis as may be provided by rule, certification

23  of testing and calibration of audiometric testing equipment on

24  the form approved by the board.

25         (v)  Failing to provide all information as described in

26  s. 484.051(1).

27         (w)  Exercising influence on a client in such a manner

28  as to exploit the client for financial gain of the licensee or

29  of a third party.

30         Section 47.  Paragraphs (a) and (g) of subsection (3)

31  of section 921.0022, Florida Statutes, are amended to read:


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  1         921.0022  Criminal Punishment Code; offense severity

  2  ranking chart.--

  3         (3)  OFFENSE SEVERITY RANKING CHART

  4

  5  Florida           Felony

  6  Statute           Degree             Description

  7

  8                              (a)  LEVEL 1

  9  24.118(3)(a)       3rd      Counterfeit or altered state

10                              lottery ticket.

11  212.054(2)(b)      3rd      Discretionary sales surtax;

12                              limitations, administration, and

13                              collection.

14  212.15(2)(b)       3rd      Failure to remit sales taxes,

15                              amount greater than $300 but less

16                              than $20,000.

17  319.30(5)          3rd      Sell, exchange, give away

18                              certificate of title or

19                              identification number plate.

20  319.35(1)(a)       3rd      Tamper, adjust, change, etc., an

21                              odometer.

22  320.26(1)(a)       3rd      Counterfeit, manufacture, or sell

23                              registration license plates or

24                              validation stickers.

25  322.212(1)         3rd      Possession of forged, stolen,

26                              counterfeit, or unlawfully issued

27                              driver's license; possession of

28                              simulated identification.

29  322.212(4)         3rd      Supply or aid in supplying

30                              unauthorized driver's license or

31                              identification card.


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  1  322.212(5)(a)      3rd      False application for driver's

  2                              license or identification card.

  3  370.13(3)(a)       3rd      Molest any stone crab trap, line,

  4                              or buoy which is property of

  5                              licenseholder.

  6  370.135(1)         3rd      Molest any blue crab trap, line,

  7                              or buoy which is property of

  8                              licenseholder.

  9  372.663(1)         3rd      Poach any alligator or

10                              crocodilia.

11  414.39(2)          3rd      Unauthorized use, possession,

12                              forgery, or alteration of food

13                              stamps, Medicaid ID, value

14                              greater than $200.

15  414.39(3)(a)       3rd      Fraudulent misappropriation of

16                              public assistance funds by

17                              employee/official, value more

18                              than $200.

19  443.071(1)         3rd      False statement or representation

20                              to obtain or increase

21                              unemployment compensation

22                              benefits.

23  458.327(1)(a)      3rd      Unlicensed practice of medicine.

24  466.026(1)(a)      3rd      Unlicensed practice of dentistry

25                              or dental hygiene.

26  509.151(1)         3rd      Defraud an innkeeper, food or

27                              lodging value greater than $300.

28  517.302(1)         3rd      Violation of the Florida

29                              Securities and Investor

30                              Protection Act.

31  562.27(1)          3rd      Possess still or still apparatus.


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  1  713.69             3rd      Tenant removes property upon

  2                              which lien has accrued, value

  3                              more than $50.

  4  812.014(3)(c)      3rd      Petit theft (3rd conviction);

  5                              theft of any property not

  6                              specified in subsection (2).

  7  812.081(2)         3rd      Unlawfully makes or causes to be

  8                              made a reproduction of a trade

  9                              secret.

10  815.04(4)(a)       3rd      Offense against intellectual

11                              property (i.e., computer

12                              programs, data).

13  817.52(2)          3rd      Hiring with intent to defraud,

14                              motor vehicle services.

15  826.01             3rd      Bigamy.

16  828.122(3)         3rd      Fighting or baiting animals.

17  831.04(1)          3rd      Any erasure, alteration, etc., of

18                              any replacement deed, map, plat,

19                              or other document listed in s.

20                              92.28.

21  831.31(1)(a)       3rd      Sell, deliver, or possess

22                              counterfeit controlled

23                              substances, all but s. 893.03(5)

24                              drugs.

25  832.041(1)         3rd      Stopping payment with intent to

26                              defraud $150 or more.

27  832.05

28   (2)(b)&(4)(c)     3rd      Knowing, making, issuing

29                              worthless checks $150 or more or

30                              obtaining property in return for

31                              worthless check $150 or more.


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  1  838.015(3)         3rd      Bribery.

  2  838.016(1)         3rd      Public servant receiving unlawful

  3                              compensation.

  4  838.15(2)          3rd      Commercial bribe receiving.

  5  838.16             3rd      Commercial bribery.

  6  843.18             3rd      Fleeing by boat to elude a law

  7                              enforcement officer.

  8  847.011(1)(a)      3rd      Sell, distribute, etc., obscene,

  9                              lewd, etc., material (2nd

10                              conviction).

11  849.01             3rd      Keeping gambling house.

12  849.09(1)(a)-(d)   3rd      Lottery; set up, promote, etc.,

13                              or assist therein, conduct or

14                              advertise drawing for prizes, or

15                              dispose of property or money by

16                              means of lottery.

17  849.23             3rd      Gambling-related machines;

18                              "common offender" as to property

19                              rights.

20  849.25(2)          3rd      Engaging in bookmaking.

21  860.08             3rd      Interfere with a railroad signal.

22  860.13(1)(a)       3rd      Operate aircraft while under the

23                              influence.

24  893.13(2)(a)2.     3rd      Purchase of cannabis.

25  893.13(6)(a)       3rd      Possession of cannabis (more than

26                              20 grams).

27  893.13(7)(a)10.    3rd      Affix false or forged label to

28                              package of controlled substance.

29  934.03(1)(a)       3rd      Intercepts, or procures any other

30                              person to intercept, any wire or

31                              oral communication.


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  1                              (g)  LEVEL 7

  2  316.193(3)(c)2.    3rd      DUI resulting in serious bodily

  3                              injury.

  4  327.35(3)(c)2.     3rd      Vessel BUI resulting in serious

  5                              bodily injury.

  6  402.319(2)         2nd      Misrepresentation and negligence

  7                              or intentional act resulting in

  8                              great bodily harm, permanent

  9                              disfiguration, permanent

10                              disability, or death.

11  409.920(2)         3rd      Medicaid provider fraud.

12  455.637(2)         3rd      Practicing a health care

13                              profession without a license.

14  455.637(2)         2nd      Practicing a health care

15                              profession without a license

16                              which results in serious bodily

17                              injury.

18  458.327(1)         3rd      Practicing medicine without a

19                              license.

20  459.013(1)         3rd      Practicing osteopathic medicine

21                              without a license.

22  460.411(1)         3rd      Practicing chiropractic medicine

23                              without a license.

24  461.012(1)         3rd      Practicing podiatric medicine

25                              without a license.

26  462.17             3rd      Practicing naturopathy without a

27                              license.

28  463.015(1)         3rd      Practicing optometry without a

29                              license.

30  464.016(1)         3rd      Practicing nursing without a

31                              license.


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  1  465.015(2)         3rd      Practicing pharmacy without a

  2                              license.

  3  466.026(1)         3rd      Practicing dentistry or dental

  4                              hygiene without a license.

  5  467.201            3rd      Practicing midwifery without a

  6                              license.

  7  468.366            3rd      Delivering respiratory care

  8                              services without a license.

  9  483.828(1)         3rd      Practicing as clinical laboratory

10                              personnel without a license.

11  483.901(9)         3rd      Practicing medical physics

12                              without a license.

13  484.053            3rd      Dispensing hearing aids without a

14                              license.

15  494.0018(2)        1st      Conviction of any violation of

16                              ss. 494.001-494.0077 in which the

17                              total money and property

18                              unlawfully obtained exceeded

19                              $50,000 and there were five or

20                              more victims.

21  782.051(3)         2nd      Attempted felony murder of a

22                              person by a person other than the

23                              perpetrator or the perpetrator of

24                              an attempted felony.

25  782.07(1)          2nd      Killing of a human being by the

26                              act, procurement, or culpable

27                              negligence of another

28                              (manslaughter).

29

30

31


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  1  782.071            2nd      Killing of human being or viable

  2                              fetus by the operation of a motor

  3                              vehicle in a reckless manner

  4                              (vehicular homicide).

  5  782.072            2nd      Killing of a human being by the

  6                              operation of a vessel in a

  7                              reckless manner (vessel

  8                              homicide).

  9  784.045(1)(a)1.    2nd      Aggravated battery; intentionally

10                              causing great bodily harm or

11                              disfigurement.

12  784.045(1)(a)2.    2nd      Aggravated battery; using deadly

13                              weapon.

14  784.045(1)(b)      2nd      Aggravated battery; perpetrator

15                              aware victim pregnant.

16  784.048(4)         3rd      Aggravated stalking; violation of

17                              injunction or court order.

18  784.07(2)(d)       1st      Aggravated battery on law

19                              enforcement officer.

20  784.08(2)(a)       1st      Aggravated battery on a person 65

21                              years of age or older.

22  784.081(1)         1st      Aggravated battery on specified

23                              official or employee.

24  784.082(1)         1st      Aggravated battery by detained

25                              person on visitor or other

26                              detainee.

27  784.083(1)         1st      Aggravated battery on code

28                              inspector.

29  790.07(4)          1st      Specified weapons violation

30                              subsequent to previous conviction

31                              of s. 790.07(1) or (2).


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  1  790.16(1)          1st      Discharge of a machine gun under

  2                              specified circumstances.

  3  796.03             2nd      Procuring any person under 16

  4                              years for prostitution.

  5  800.04(5)(c)1.     2nd      Lewd or lascivious molestation;

  6                              victim less than 12 years of age;

  7                              offender less than 18 years.

  8  800.04(5)(c)2.     2nd      Lewd or lascivious molestation;

  9                              victim 12 years of age or older

10                              but less than 16 years; offender

11                              18 years or older.

12  806.01(2)          2nd      Maliciously damage structure by

13                              fire or explosive.

14  810.02(3)(a)       2nd      Burglary of occupied dwelling;

15                              unarmed; no assault or battery.

16  810.02(3)(b)       2nd      Burglary of unoccupied dwelling;

17                              unarmed; no assault or battery.

18  810.02(3)(d)       2nd      Burglary of occupied conveyance;

19                              unarmed; no assault or battery.

20  812.014(2)(a)      1st      Property stolen, valued at

21                              $100,000 or more; property stolen

22                              while causing other property

23                              damage; 1st degree grand theft.

24  812.019(2)         1st      Stolen property; initiates,

25                              organizes, plans, etc., the theft

26                              of property and traffics in

27                              stolen property.

28  812.131(2)(a)      2nd      Robbery by sudden snatching.

29  812.133(2)(b)      1st      Carjacking; no firearm, deadly

30                              weapon, or other weapon.

31


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  1  825.102(3)(b)      2nd      Neglecting an elderly person or

  2                              disabled adult causing great

  3                              bodily harm, disability, or

  4                              disfigurement.

  5  825.1025(2)        2nd      Lewd or lascivious battery upon

  6                              an elderly person or disabled

  7                              adult.

  8  825.103(2)(b)      2nd      Exploiting an elderly person or

  9                              disabled adult and property is

10                              valued at $20,000 or more, but

11                              less than $100,000.

12  827.03(3)(b)       2nd      Neglect of a child causing great

13                              bodily harm, disability, or

14                              disfigurement.

15  827.04(3)          3rd      Impregnation of a child under 16

16                              years of age by person 21 years

17                              of age or older.

18  837.05(2)          3rd      Giving false information about

19                              alleged capital felony to a law

20                              enforcement officer.

21  872.06             2nd      Abuse of a dead human body.

22  893.13(1)(c)1.     1st      Sell, manufacture, or deliver

23                              cocaine (or other drug prohibited

24                              under s. 893.03(1)(a), (1)(b),

25                              (1)(d), (2)(a), or (2)(b)) within

26                              1,000 feet of a child care

27                              facility or school.

28

29

30

31


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  1  893.13(1)(e)       1st      Sell, manufacture, or deliver

  2                              cocaine or other drug prohibited

  3                              under s. 893.03(1)(a), (1)(b),

  4                              (1)(d), (2)(a), or (2)(b), within

  5                              1,000 feet of property used for

  6                              religious services or a specified

  7                              business site.

  8  893.13(4)(a)       1st      Deliver to minor cocaine (or

  9                              other s. 893.03(1)(a), (1)(b),

10                              (1)(d), (2)(a), or (2)(b) drugs).

11  893.135(1)(a)1.    1st      Trafficking in cannabis, more

12                              than 50 lbs., less than 2,000

13                              lbs.

14  893.135

15   (1)(b)1.a.        1st      Trafficking in cocaine, more than

16                              28 grams, less than 200 grams.

17  893.135

18   (1)(c)1.a.        1st      Trafficking in illegal drugs,

19                              more than 4 grams, less than 14

20                              grams.

21  893.135

22   (1)(d)1.          1st      Trafficking in phencyclidine,

23                              more than 28 grams, less than 200

24                              grams.

25  893.135(1)(e)1.    1st      Trafficking in methaqualone, more

26                              than 200 grams, less than 5

27                              kilograms.

28  893.135(1)(f)1.    1st      Trafficking in amphetamine, more

29                              than 14 grams, less than 28

30                              grams.

31


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  1  893.135

  2   (1)(g)1.a.        1st      Trafficking in flunitrazepam, 4

  3                              grams or more, less than 14

  4                              grams.

  5         Section 48.  Subsection (1) of section 458.327, Florida

  6  Statutes, reads:

  7         458.327  Penalty for violations.--

  8         (1)  Each of the following acts constitutes a felony of

  9  the third degree, punishable as provided in s. 775.082, s.

10  775.083, or s. 775.084:

11         (a)  The practice of medicine or an attempt to practice

12  medicine without a license to practice in Florida.

13         (b)  The use or attempted use of a license which is

14  suspended or revoked to practice medicine.

15         (c)  Attempting to obtain or obtaining a license to

16  practice medicine by knowing misrepresentation.

17         (d)  Attempting to obtain or obtaining a position as a

18  medical practitioner or medical resident in a clinic or

19  hospital through knowing misrepresentation of education,

20  training, or experience.

21         Section 49.  Subsection (1) of section 459.013, Florida

22  Statutes, reads:

23         459.013  Penalty for violations.--

24         (1)  Each of the following acts constitutes a felony of

25  the third degree, punishable as provided in s. 775.082, s.

26  775.083, or s. 775.084:

27         (a)  The practice of osteopathic medicine, or an

28  attempt to practice osteopathic medicine, without an active

29  license or certificate issued pursuant to this chapter.

30         (b)  The practice of osteopathic medicine by a person

31  holding a limited license, osteopathic faculty certificate, or


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  1  other certificate issued under this chapter beyond the scope

  2  of practice authorized for such licensee or certificateholder.

  3         (c)  Attempting to obtain or obtaining a license to

  4  practice osteopathic medicine by knowing misrepresentation.

  5         (d)  Attempting to obtain or obtaining a position as an

  6  osteopathic medical practitioner or osteopathic medical

  7  resident in a clinic or hospital through knowing

  8  misrepresentation of education, training, or experience.

  9         Section 50.  Subsection (1) of section 460.411, Florida

10  Statutes, reads:

11         460.411  Violations and penalties.--

12         (1)  Each of the following acts constitutes a violation

13  of this chapter and is a felony of the third degree,

14  punishable as provided in s. 775.082, s. 775.083, or s.

15  775.084:

16         (a)  Practicing or attempting to practice chiropractic

17  medicine without an active license or with a license

18  fraudulently obtained.

19         (b)  Using or attempting to use a license to practice

20  chiropractic medicine which has been suspended or revoked.

21         Section 51.  Subsection (1) of section 461.012, Florida

22  Statutes, reads:

23         461.012  Violations and penalties.--

24         (1)  Each of the following acts constitutes a violation

25  of this chapter and is a felony of the third degree,

26  punishable as provided in s. 775.082, s. 775.083, or s.

27  775.084:

28         (a)  Practicing or attempting to practice podiatric

29  medicine without an active license or with a license

30  fraudulently obtained.

31


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  1         (b)  Advertising podiatric services without an active

  2  license obtained pursuant to this chapter or with a license

  3  fraudulently obtained.

  4         (c)  Using or attempting to use a license to practice

  5  podiatric medicine which has been suspended or revoked.

  6         Section 52.  Section 462.17, Florida Statutes, reads:

  7         462.17  Penalty for offenses relating to

  8  naturopathy.--Any person who shall:

  9         (1)  Sell, fraudulently obtain, or furnish any

10  naturopathic diploma, license, record, or registration or aid

11  or abet in the same;

12         (2)  Practice naturopathy under the cover of any

13  diploma, license, record, or registration illegally or

14  fraudulently obtained or secured or issued unlawfully or upon

15  fraudulent representations;

16         (3)  Advertise to practice naturopathy under a name

17  other than her or his own or under an assumed name;

18         (4)  Falsely impersonate another practitioner of a like

19  or different name;

20         (5)  Practice or advertise to practice naturopathy or

21  use in connection with her or his name any designation tending

22  to imply or to designate the person as a practitioner of

23  naturopathy without then being lawfully licensed and

24  authorized to practice naturopathy in this state; or

25         (6)  Practice naturopathy during the time her or his

26  license is suspended or revoked

27

28  shall be guilty of a felony of the third degree, punishable as

29  provided in s. 775.082, s. 775.083, or s. 775.084.

30         Section 53.  Subsection (1) of section 463.015, Florida

31  Statutes, reads:


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  1         463.015  Violations and penalties.--

  2         (1)  Each of the following acts constitutes a felony of

  3  the third degree, punishable as provided in s. 775.082, s.

  4  775.083, or s. 775.084:

  5         (a)  Practicing or attempting to practice optometry

  6  without a valid active license issued pursuant to this

  7  chapter.

  8         (b)  Attempting to obtain or obtaining a license to

  9  practice optometry by fraudulent misrepresentation.

10         (c)  Using or attempting to use a license to practice

11  optometry which has been suspended or revoked.

12         Section 54.  Subsection (1) of section 464.016, Florida

13  Statutes, reads:

14         464.016  Violations and penalties.--

15         (1)  Each of the following acts constitutes a felony of

16  the third degree, punishable as provided in s. 775.082, s.

17  775.083, or s. 775.084:

18         (a)  Practicing advanced or specialized, professional

19  or practical nursing, as defined in this chapter, unless

20  holding an active license or certificate to do so.

21         (b)  Using or attempting to use a license or

22  certificate which has been suspended or revoked.

23         (c)  Knowingly employing unlicensed persons in the

24  practice of nursing.

25         (d)  Obtaining or attempting to obtain a license or

26  certificate under this chapter by misleading statements or

27  knowing misrepresentation.

28         Section 55.  Subsection (2) of section 465.015, Florida

29  Statutes, reads:

30         465.015  Violations and penalties.--

31         (2)  It is unlawful for any person:


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  1         (a)  To make a false or fraudulent statement, either

  2  for herself or himself or for another person, in any

  3  application, affidavit, or statement presented to the board or

  4  in any proceeding before the board.

  5         (b)  To fill, compound, or dispense prescriptions or to

  6  dispense medicinal drugs if such person does not hold an

  7  active license as a pharmacist in this state, is not

  8  registered as an intern in this state, or is an intern not

  9  acting under the direct and immediate personal supervision of

10  a licensed pharmacist.

11         (c)  To sell or dispense drugs as defined in s.

12  465.003(8) without first being furnished with a prescription.

13         (d)  To sell samples or complimentary packages of drug

14  products.

15         Section 56.  Subsection (1) of section 466.026, Florida

16  Statutes, reads:

17         466.026  Prohibitions; penalties.--

18         (1)  Each of the following acts constitutes a felony of

19  the third degree, punishable as provided in s. 775.082, s.

20  775.083, or s. 775.084:

21         (a)  Practicing dentistry or dental hygiene unless the

22  person has an appropriate, active license issued by the

23  department pursuant to this chapter.

24         (b)  Using or attempting to use a license issued

25  pursuant to this chapter which license has been suspended or

26  revoked.

27         (c)  Knowingly employing any person to perform duties

28  outside the scope allowed such person under this chapter or

29  the rules of the board.

30         (d)  Giving false or forged evidence to the department

31  or board for the purpose of obtaining a license.


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  1         (e)  Selling or offering to sell a diploma conferring a

  2  degree from a dental college or dental hygiene school or

  3  college, or a license issued pursuant to this chapter, or

  4  procuring such diploma or license with intent that it shall be

  5  used as evidence of that which the document stands for, by a

  6  person other than the one upon whom it was conferred or to

  7  whom it was granted.

  8         Section 57.  Section 467.201, Florida Statutes, reads:

  9         467.201  Violations and penalties.--Each of the

10  following acts constitutes a felony of the third degree,

11  punishable as provided in s. 775.082, s. 775.083, or s.

12  775.084:

13         (1)  Practicing midwifery, unless holding an active

14  license to do so.

15         (2)  Using or attempting to use a license which has

16  been suspended or revoked.

17         (3)  The willful practice of midwifery by a student

18  midwife without a preceptor present, except in an emergency.

19         (4)  Knowingly allowing a student midwife to practice

20  midwifery without a preceptor present, except in an emergency.

21         (5)  Obtaining or attempting to obtain a license under

22  this chapter through bribery or fraudulent misrepresentation.

23         (6)  Using the name or title "midwife" or "licensed

24  midwife" or any other name or title which implies that a

25  person is licensed to practice midwifery, unless such person

26  is duly licensed as provided in this chapter.

27         (7)  Knowingly concealing information relating to the

28  enforcement of this chapter or rules adopted pursuant thereto.

29         Section 58.  Section 468.366, Florida Statutes, reads:

30         468.366  Penalties for violations.--

31


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  1         (1)  It is a violation of law for any person, including

  2  any firm, association, or corporation, to:

  3         (a)  Sell or fraudulently obtain, attempt to obtain, or

  4  furnish to any person a diploma, license, or record, or aid or

  5  abet in the sale, procurement, or attempted procurement

  6  thereof.

  7         (b)  Deliver respiratory care services, as defined by

  8  this part or by rule of the board, under cover of any diploma,

  9  license, or record that was illegally or fraudulently obtained

10  or signed or issued unlawfully or under fraudulent

11  representation.

12         (c)  Deliver respiratory care services, as defined by

13  this part or by rule of the board, unless such person is duly

14  licensed to do so under the provisions of this part or unless

15  such person is exempted pursuant to s. 468.368.

16         (d)  Use, in connection with his or her name, any

17  designation tending to imply that he or she is a respiratory

18  care practitioner or a respiratory therapist, duly licensed

19  under the provisions of this part, unless he or she is so

20  licensed.

21         (e)  Advertise an educational program as meeting the

22  requirements of this part, or conduct an educational program

23  for the preparation of respiratory care practitioners or

24  respiratory therapists, unless such program has been approved

25  by the board.

26         (f)  Knowingly employ unlicensed persons in the

27  delivery of respiratory care services, unless exempted by this

28  part.

29         (g)  Knowingly conceal information relative to any

30  violation of this part.

31


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  1         (2)  Any violation of this section is a felony of the

  2  third degree, punishable as provided in s. 775.082, s.

  3  775.083, or s. 775.084.

  4         Section 59.  Subsection (1) of section 483.828, Florida

  5  Statutes, reads:

  6         483.828  Penalties for violations.--

  7         (1)  Each of the following acts constitutes a felony of

  8  the third degree, punishable as provided in s. 775.082, s.

  9  775.083, or s. 775.084:

10         (a)  Practicing as clinical laboratory personnel

11  without an active license.

12         (b)  Using or attempting to use a license to practice

13  as clinical laboratory personnel which is suspended or

14  revoked.

15         (c)  Attempting to obtain or obtaining a license to

16  practice as clinical laboratory personnel by knowing

17  misrepresentation.

18         Section 60.  Subsection (9) of section 483.901, Florida

19  Statutes, reads:

20         483.901  Medical physicists; definitions; licensure.--

21         (9)  PENALTY FOR VIOLATIONS.--It is a felony of the

22  third degree, punishable as provided in s. 775.082, s.

23  775.083, or s. 775.084, to:

24         (a)  Practice or attempt to practice medical physics or

25  hold oneself out to be a licensed medical physicist without

26  holding an active license.

27         (b)  Practice or attempt to practice medical physics

28  under a name other than one's own.

29         (c)  Use or attempt to use a revoked or suspended

30  license or the license of another.

31         Section 61.  Section 484.053, Florida Statutes, reads:


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  1         484.053  Prohibitions; penalties.--

  2         (1)  A person may not:

  3         (a)  Practice dispensing hearing aids unless the person

  4  is a licensed hearing aid specialist;

  5         (b)  Use the name or title "hearing aid specialist"

  6  when the person has not been licensed under this part;

  7         (c)  Present as her or his own the license of another;

  8         (d)  Give false, incomplete, or forged evidence to the

  9  board or a member thereof for the purposes of obtaining a

10  license;

11         (e)  Use or attempt to use a hearing aid specialist

12  license that is delinquent or has been suspended, revoked, or

13  placed on inactive status;

14         (f)  Knowingly employ unlicensed persons in the

15  practice of dispensing hearing aids; or

16         (g)  Knowingly conceal information relative to

17  violations of this part.

18         (2)  Any person who violates any of the provisions of

19  this section is guilty of a felony of the third degree,

20  punishable as provided in s. 775.082 or s. 775.083.

21         (3)  If a person licensed under this part allows the

22  sale of a hearing aid by an unlicensed person not registered

23  as a trainee or fails to comply with the requirements of s.

24  484.0445(2) relating to supervision of trainees, the board

25  shall, upon determination of that violation, order the full

26  refund of moneys paid by the purchaser upon return of the

27  hearing aid to the seller's place of business.

28         Section 62.  Subsection (1) of section 457.102, Florida

29  Statutes, is amended to read:

30         457.102  Definitions.--As used in this chapter:

31


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  1         (1)  "Acupuncture" means a form of primary health care,

  2  based on traditional Chinese medical concepts and modern

  3  oriental medical techniques, that employs acupuncture

  4  diagnosis and treatment, as well as adjunctive therapies and

  5  diagnostic techniques, for the promotion, maintenance, and

  6  restoration of health and the prevention of disease.

  7  Acupuncture shall include, but not be limited to, the

  8  insertion of acupuncture needles and the application of

  9  moxibustion to specific areas of the human body and the use of

10  electroacupuncture, Qi Gong, oriental massage, herbal therapy,

11  dietary guidelines, and other adjunctive therapies, as defined

12  by board rule.

13         Section 63.  Section 457.105, Florida Statutes, is

14  amended to read:

15         457.105  Licensure qualifications and fees.--

16         (1)  It is unlawful for any person to practice

17  acupuncture in this state unless such person has been licensed

18  by the board, is in a board-approved course of study, or is

19  otherwise exempted by this chapter.

20         (2)  A person may become licensed to practice

21  acupuncture if the person applies to the department and:

22         (a)  Is 21 18 years of age or older, has good moral

23  character, and has the ability to communicate in English,

24  which is demonstrated by having passed the national written

25  examination in English or, if such examination was passed in a

26  foreign language, by also having passed a nationally

27  recognized English proficiency examination;

28         (b)  Has completed 60 college credits from an

29  accredited postsecondary institution as a prerequisite to

30  enrollment in an authorized 3-year course of study in

31  acupuncture and oriental medicine, and has completed a 3-year


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  1  course of study in acupuncture and oriental medicine, and

  2  effective July 31, 2001, a 4-year course of study in

  3  acupuncture and oriental medicine, which meets standards

  4  established by the board by rule, which standards include, but

  5  are not limited to, successful completion of academic courses

  6  in western anatomy, western physiology, western pathology,

  7  western biomedical terminology, first aid, and cardiopulmonary

  8  resuscitation (CPR). However, any person who enrolled in an

  9  authorized course of study in acupuncture before August 1,

10  1997, must have completed only a 2-year course of study which

11  meets standards established by the board by rule, which

12  standards must include, but are not limited to, successful

13  completion of academic courses in western anatomy, western

14  physiology, and western pathology;

15         (c)  Has successfully completed a board-approved

16  national certification process, is actively licensed in a

17  state that has examination requirements that are substantially

18  equivalent to or more stringent than those of this state, or

19  passes an examination administered by the department, which

20  examination tests the applicant's competency and knowledge of

21  the practice of acupuncture and oriental medicine. At the

22  request of any applicant, oriental nomenclature for the points

23  shall be used in the examination. The examination shall

24  include a practical examination of the knowledge and skills

25  required to practice modern and traditional acupuncture and

26  oriental medicine, covering diagnostic and treatment

27  techniques and procedures; and

28         (d)  Pays the required fees set by the board by rule

29  not to exceed the following amounts:

30         1.  Examination fee: $500 plus the actual per applicant

31  cost to the department for purchase of the written and


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  1  practical portions of the examination from a national

  2  organization approved by the board.

  3         2.  Application fee: $300.

  4         3.  Reexamination fee: $500 plus the actual per

  5  applicant cost to the department for purchase of the written

  6  and practical portions of the examination from a national

  7  organization approved by the board.

  8         4.  Initial biennial licensure fee: $400, if licensed

  9  in the first half of the biennium, and $200, if licensed in

10  the second half of the biennium.

11         Section 64.  Subsection (1) of section 457.107, Florida

12  Statutes, is amended to read:

13         457.107  Renewal of licenses; continuing education.--

14         (1)  The department shall renew a license upon receipt

15  of the renewal application and the fee set by the board by

16  rule, not to exceed $500 $700.

17         Section 65.  Section 483.824, Florida Statutes, is

18  amended to read:

19         483.824  Qualifications of clinical laboratory

20  director.--A clinical laboratory director must have 4 years of

21  clinical laboratory experience with 2 years of experience in

22  the specialty to be directed or be nationally board certified

23  in the specialty to be directed, and must meet one of the

24  following requirements:

25         (1)  Be a physician licensed under chapter 458 or

26  chapter 459;

27         (2)  Hold an earned doctoral degree in a chemical,

28  physical, or biological science from a regionally accredited

29  institution and maintain national certification requirements

30  equal to those required by the federal Health Care Financing

31  Administration be nationally certified; or


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  1         (3)  For the subspecialty of oral pathology, be a

  2  physician licensed under chapter 458 or chapter 459 or a

  3  dentist licensed under chapter 466.

  4         Section 66.  February 6th of each year is designated

  5  Florida Alzheimer's Disease Day.

  6         Section 67.  Subsection (11) of section 641.51, Florida

  7  Statutes, is created to read:

  8         641.51  Quality assurance program; second medical

  9  opinion requirement.--

10         (11)  If a contracted primary care physician, licensed

11  under Chapter 458 or Chapter 459, and the organization

12  determine that a subscriber requires examination by a licensed

13  ophthalmologist for medically necessary, contractually covered

14  services, then the organization shall authorize the contracted

15  primary care physician to send the subscriber to a contracted

16  licensed ophthalmologist.

17         Section 68.  This act shall not be construed to

18  prohibit anyone from seeking medical information on the

19  Internet from any site.

20         Section 69.  Effective upon this act becoming a law:

21         (1)  Any funds appropriated in Committee Substitute for

22  House Bill 2339, enacted in the 2000 Regular Session of the

23  Legislature, for the purpose of a review of current mandated

24  health coverages shall revert to the fund from which

25  appropriated, and such review may not be conducted.

26         (2)  Notwithstanding any provision to the contrary

27  contained in Committee Substitute for House Bill 2339, enacted

28  in the 2000 Regular Session of the Legislature, the

29  establishement of a specialty hospital offering a range of

30  medical services restricted to a defined age or gender group

31  of the population or a restricted range of services


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  1  appropriate to the diagnosis, care, and treatment of patients

  2  with specific categories of medical illnesses or disorders,

  3  through the transfer of beds and services from an existing

  4  hospital in the same county, is not exempt from the provisions

  5  of section 408.036(1), Florida Statutes.

  6         Section 70.  Paragraph (n) of subsection (3), paragraph

  7  (c) of subsection (5), and paragraphs (b) and (d) of

  8  subsection (6) of section 627.6699, Florida Statutes, are

  9  amended to read:

10         627.6699  Employee Health Care Access Act.--

11         (3)  DEFINITIONS.--As used in this section, the term:

12         (n)  "Modified community rating" means a method used to

13  develop carrier premiums which spreads financial risk across a

14  large population and allows adjustments for age, gender,

15  family composition, tobacco usage, and geographic area as

16  determined under paragraph (5)(j); claims experience, health

17  status, or duration of coverage as permitted under

18  subparagraph (6)(b)5.; and administrative and acquisition

19  expenses as permitted under subparagraph (6)(b)6.

20         (5)  AVAILABILITY OF COVERAGE.--

21         (c)  Every small employer carrier must, as a condition

22  of transacting business in this state:

23         1.  Beginning July 1, 2000, January 1, 1994, offer and

24  issue all small employer health benefit plans on a

25  guaranteed-issue basis to every eligible small employer, with

26  2 3 to 50 eligible employees, that elects to be covered under

27  such plan, agrees to make the required premium payments, and

28  satisfies the other provisions of the plan. A rider for

29  additional or increased benefits may be medically underwritten

30  and may only be added to the standard health benefit plan.

31


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  1  The increased rate charged for the additional or increased

  2  benefit must be rated in accordance with this section.

  3         2.  Beginning July 1, 2000, and until July 31, 2001,

  4  offer and issue basic and standard small employer health

  5  benefit plans on a guaranteed-issue basis to every eligible

  6  small employer which is eligible for guaranteed renewal, has

  7  less than two eligible employees, is not formed primarily for

  8  the purpose of buying health insurance, elects to be covered

  9  under such plan, agrees to make the required premium payments,

10  and satisfies the other provisions of the plan. A rider for

11  additional or increased benefits may be medically underwritten

12  and may be added only to the standard benefit plan. The

13  increased rate charged for the additional or increased benefit

14  must be rated in accordance with this section. For purposes of

15  this subparagraph, a person, his or her spouse, and his or her

16  dependent children shall constitute a single eligible employee

17  if that person and spouse are employed by the same small

18  employer and either one has a normal work week of less than 25

19  hours.

20         3.2.  Beginning August 1, 2001 April 15, 1994, offer

21  and issue basic and standard small employer health benefit

22  plans on a guaranteed-issue basis, during a 31-day open

23  enrollment period of August 1 through August 31 of each year,

24  to every eligible small employer, with less than one or two

25  eligible employees, which small employer is not formed

26  primarily for the purpose of buying health insurance and which

27  elects to be covered under such plan, agrees to make the

28  required premium payments, and satisfies the other provisions

29  of the plan. Coverage provided under this subparagraph shall

30  begin on October 1 of the same year as the date of enrollment,

31  unless the small employer carrier and the small employer agree


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  1  to a different date. A rider for additional or increased

  2  benefits may be medically underwritten and may only be added

  3  to the standard health benefit plan.  The increased rate

  4  charged for the additional or increased benefit must be rated

  5  in accordance with this section. For purposes of this

  6  subparagraph, a person, his or her spouse, and his or her

  7  dependent children constitute a single eligible employee if

  8  that person and spouse are employed by the same small employer

  9  and either that person or his or her spouse has a normal work

10  week of less than 25 hours.

11         4.3.  Offer to eligible small employers the standard

12  and basic health benefit plans.  This paragraph subparagraph

13  does not limit a carrier's ability to offer other health

14  benefit plans to small employers if the standard and basic

15  health benefit plans are offered and rejected.

16         (6)  RESTRICTIONS RELATING TO PREMIUM RATES.--

17         (b)  For all small employer health benefit plans that

18  are subject to this section and are issued by small employer

19  carriers on or after January 1, 1994, premium rates for health

20  benefit plans subject to this section are subject to the

21  following:

22         1.  Small employer carriers must use a modified

23  community rating methodology in which the premium for each

24  small employer must be determined solely on the basis of the

25  eligible employee's and eligible dependent's gender, age,

26  family composition, tobacco use, or geographic area as

27  determined under paragraph (5)(j) and in which the premium may

28  be adjusted as permitted by subparagraphs 5. and 6.

29         2.  Rating factors related to age, gender, family

30  composition, tobacco use, or geographic location may be

31  developed by each carrier to reflect the carrier's experience.


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  1  The factors used by carriers are subject to department review

  2  and approval.

  3         3.  Small employer carriers may not modify the rate for

  4  a small employer for 12 months from the initial issue date or

  5  renewal date, unless the composition of the group changes or

  6  benefits are changed. However, a small employer carrier may

  7  modify the rate one time prior to 12 months after the initial

  8  issue date for a small employer who enrolls under a previously

  9  issued group policy that has a common anniversary date for all

10  employers covered under the policy if:

11         a.  The carrier discloses to the employer in a clear

12  and conspicuous manner the date of the first renewal and the

13  fact that the premium may increase on or after that date.

14         b.  The insurer demonstrates to the department that

15  efficiencies in administration are achieved and reflected in

16  the rates charged to small employers covered under the policy.

17         4.  A carrier may issue a group health insurance policy

18  to a small employer health alliance or other group association

19  with rates that reflect a premium credit for expense savings

20  attributable to administrative activities being performed by

21  the alliance or group association if such expense savings are

22  specifically documented in the insurer's rate filing and are

23  approved by the department.  Any such credit may not be based

24  on different morbidity assumptions or on any other factor

25  related to the health status or claims experience of any

26  person covered under the policy. Nothing in this subparagraph

27  exempts an alliance or group association from licensure for

28  any activities that require licensure under the Insurance

29  Code. A carrier issuing a group health insurance policy to a

30  small-employer health alliance or other group association

31  shall allow any properly licensed and appointed agent of that


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  1  carrier to market and sell the small-employer health alliance

  2  or other group association policy. Such agent shall be paid

  3  the usual and customary commission paid to any agent selling

  4  the policy. Carriers participating in the alliance program, in

  5  accordance with ss. 408.70-408.706, may apply a different

  6  community rate to business written in that program.

  7         5.  Any adjustments in rates for claims experience,

  8  health status, or duration of coverage may not be charged to

  9  individual employees or dependents. For a small employer's

10  policy, such adjustments may not result in a rate for the

11  small employer which deviates more than 15 percent from the

12  carrier's approved rate. Any such adjustment must be applied

13  uniformly to the rates charged for all employees and

14  dependents of the small employer. A small employer carrier may

15  make an adjustment to a small employer's renewal premium, not

16  to exceed 10 percent annually, due to the claims experience,

17  health status, or duration of coverage of the employees or

18  dependents of the small employer. Semiannually small group

19  carriers shall report information on forms adopted by rule by

20  the department to enable the department to monitor the

21  relationship of aggregate adjusted premiums actually charged

22  policyholders by each carrier to the premiums that would have

23  been charged by application of the carrier's approved modified

24  community rates. If the aggregate resulting from the

25  application of such adjustment exceeds the premium that would

26  have been charged by application of the approved modified

27  community rate by 5 percent for the current reporting period,

28  the carrier shall limit the application of such adjustments

29  only to minus adjustments beginning not more than 60 days

30  after the report is sent to the department. For any subsequent

31  reporting period, if the total aggregate adjusted premium


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  1  actually charged does not exceed the premium that would have

  2  been charged by application of the approved modified community

  3  rate by 5 percent, the carrier may apply both plus and minus

  4  adjustments. A small employer carrier may provide a credit to

  5  a small employer's premium based on administrative and

  6  acquisition expense differences resulting from the size of the

  7  group. Group size administrative and acquisition expense

  8  factors may be developed by each carrier to reflect the

  9  carrier's experience and are subject to department review and

10  approval.

11         6.  A small employer carrier rating methodology may

12  include separate rating categories for one dependent child,

13  for two dependent children, and for three or more dependent

14  children for family coverage of employees having a spouse and

15  dependent children or employees having dependent children

16  only. A small employer carrier may have fewer, but not

17  greater, numbers of categories for dependent children than

18  those specified in this subparagraph.

19         7.  Small employer carriers may not use a composite

20  rating methodology to rate a small employer with fewer than 10

21  employees. For the purposes of this subparagraph, a "composite

22  rating methodology" means a rating methodology that averages

23  the impact of the rating factors for age and gender in the

24  premiums charged to all of the employees of a small employer.

25         (d)  Notwithstanding s. 627.401(2), this section and

26  ss. 627.410 and 627.411 apply to any health benefit plan

27  provided by a small employer carrier that is an insurer, and

28  this section and s. 641.31 apply to any health benefit

29  provided by a small employer carrier that is a health

30  maintenance organization that provides coverage to one or more

31  employees of a small employer regardless of where the policy,


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  1  certificate, or contract is issued or delivered, if the health

  2  benefit plan covers employees or their covered dependents who

  3  are residents of this state.

  4         Section 71.  Section 641.201, Florida Statutes, is

  5  amended to read:

  6         641.201  Applicability of other laws.--Except as

  7  provided in this part, health maintenance organizations shall

  8  be governed by the provisions of this part and part III of

  9  this chapter and shall be exempt from all other provisions of

10  the Florida Insurance Code except those provisions of the

11  Florida Insurance Code that are explicitly made applicable to

12  health maintenance organizations.

13         Section 72.  Section 641.234, Florida Statutes, is

14  amended to read:

15         641.234  Administrative, provider, and management

16  contracts.--

17         (1)  The department may require a health maintenance

18  organization to submit any contract for administrative

19  services, contract with a provider other than an individual

20  physician, contract for management services, and contract with

21  an affiliated entity to the department.

22         (2)  After review of a contract the department may

23  order the health maintenance organization to cancel the

24  contract in accordance with the terms of the contract and

25  applicable law if it determines:

26         (a)  That the fees to be paid by the health maintenance

27  organization under the contract are so unreasonably high as

28  compared with similar contracts entered into by the health

29  maintenance organization or as compared with similar contracts

30  entered into by other health maintenance organizations in

31  similar circumstances that the contract is detrimental to the


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  1  subscribers, stockholders, investors, or creditors of the

  2  health maintenance organization; or.

  3         (b)  That the contract is with an entity that is not

  4  licensed under state statutes, if such license is required, or

  5  is not in good standing with the applicable regulatory agency.

  6         (3)  All contracts for administrative services,

  7  management services, provider services other than individual

  8  physician contracts, and with affiliated entities entered into

  9  or renewed by a health maintenance organization on or after

10  October 1, 1988, shall contain a provision that the contract

11  shall be canceled upon issuance of an order by the department

12  pursuant to this section.

13         Section 73.  Subsection (2) of section 641.27, Florida

14  Statutes, is amended to read:

15         641.27  Examination by the department.--

16         (2)  The department may contract, at reasonable fees

17  for work performed, with qualified, impartial outside sources

18  to perform audits or examinations or portions thereof

19  pertaining to the qualification of an entity for issuance of a

20  certificate of authority or to determine continued compliance

21  with the requirements of this part, in which case the payment

22  must be made, directly to the contracted examiner by the

23  health maintenance organization examined, in accordance with

24  the rates and terms agreed to by the department and the

25  examiner. Any contracted assistance shall be under the direct

26  supervision of the department.  The results of any contracted

27  assistance shall be subject to the review of, and approval,

28  disapproval, or modification by, the department.

29         Section 74.  Section 641.226, Florida Statutes, is

30  created to read:

31


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  1         641.226  Application of federal solvency requirements

  2  to provider-sponsored organizations.--The solvency

  3  requirements of sections 1855 and 1856 of the Balanced Budget

  4  Act of 1997 and rules adopted by the Secretary of the United

  5  States Department of Health and Human Services apply to a

  6  health maintenance organization that is a provider-sponsored

  7  organization rather than the solvency requirements of this

  8  part. However, if the provider-sponsored organization does not

  9  meet the solvency requirements of this part, the organization

10  is limited to the issuance of Medicare+Choice plans to

11  eligible individuals. For the purposes of this section, the

12  terms "Medicare+Choice plans," "provider-sponsored

13  organizations," and "solvency requirements" have the same

14  meaning as defined in the federal act and federal rules and

15  regulations.

16         Section 75.  Section 641.39, Florida Statutes, is

17  created to read:

18         641.39  Soliciting or accepting new or renewal health

19  maintenance contracts by insolvent or impaired health

20  maintenance organization prohibited; penalty.--

21         (1)  Whether or not delinquency proceedings as to a

22  health maintenance organization have been or are to be

23  initiated, a director or officer of a health maintenance

24  organization, except with the written permission of the

25  Department of Insurance, may not authorize or permit the

26  health maintenance organization to solicit or accept new or

27  renewal health maintenance contracts or provider contracts in

28  this state after the director or officer knew, or reasonably

29  should have known, that the health maintenance organization

30  was insolvent or impaired. As used in this section, the term

31


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  1  "impaired" means that the health maintenance organization does

  2  not meet the requirements of s. 641.225.

  3         (2)  Any director or officer who violates this section

  4  is guilty of a felony of the third degree, punishable as

  5  provided in s. 775.082, s. 775.083, or s. 775.084.

  6         Section 76.  Section 641.2011, Florida Statutes, is

  7  created to read:

  8         641.2011  Insurance holding companies.--Part IV of

  9  chapter 628 applies to health maintenance organizations

10  licensed under part I of chapter 641.

11         Section 77.  Notwithstanding any other provision of

12  law, the sum of $200,000 is appropriated from the Insurance

13  Commissioner's Regulatory Trust Fund to the Office of

14  Legislative Services for the purpose of implementing the

15  legislative intent expressed in s. 624.215(1), Florida

16  Statutes, for a systematic review of proposed mandated health

17  coverages. The review must be conducted by certified actuaries

18  and other appropriate professionals and shall consist of an

19  assessment of the impact, including, but not limited to, the

20  costs and benefits, of mandated health coverages using the

21  guidelines provided in s. 624.215(2), Florida Statutes. This

22  assessment shall establish the aggregate cost of proposed

23  mandated health coverages. THe term "mandated health

24  coverages" as used herein does not include health care

25  providers.

26         Section 78.  Subsection (4) of section 212.055, Florida

27  Statutes, is amended to read:

28         212.055  Discretionary sales surtaxes; legislative

29  intent; authorization and use of proceeds.--It is the

30  legislative intent that any authorization for imposition of a

31  discretionary sales surtax shall be published in the Florida


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  1  Statutes as a subsection of this section, irrespective of the

  2  duration of the levy.  Each enactment shall specify the types

  3  of counties authorized to levy; the rate or rates which may be

  4  imposed; the maximum length of time the surtax may be imposed,

  5  if any; the procedure which must be followed to secure voter

  6  approval, if required; the purpose for which the proceeds may

  7  be expended; and such other requirements as the Legislature

  8  may provide.  Taxable transactions and administrative

  9  procedures shall be as provided in s. 212.054.

10         (4)  INDIGENT CARE AND TRAUMA CENTER SURTAX.--

11         (a)  The governing body in each county the government

12  of which is not consolidated with that of one or more

13  municipalities, which has a population of at least 800,000

14  residents and is not authorized to levy a surtax under

15  subsection (5) or subsection (6), may levy, pursuant to an

16  ordinance either approved by an extraordinary vote of the

17  governing body or conditioned to take effect only upon

18  approval by a majority vote of the electors of the county

19  voting in a referendum, a discretionary sales surtax at a rate

20  that may not exceed 0.5 percent.

21         (b)  If the ordinance is conditioned on a referendum, a

22  statement that includes a brief and general description of the

23  purposes to be funded by the surtax and that conforms to the

24  requirements of s. 101.161 shall be placed on the ballot by

25  the governing body of the county.  The following questions

26  shall be placed on the ballot:

27

28                     FOR THE. . . .CENTS TAX

29                   AGAINST THE. . . .CENTS TAX

30

31


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  1         (c)  The ordinance adopted by the governing body

  2  providing for the imposition of the surtax shall set forth a

  3  plan for providing health care services to qualified

  4  residents, as defined in paragraph (d).  Such plan and

  5  subsequent amendments to it shall fund a broad range of health

  6  care services for both indigent persons and the medically

  7  poor, including, but not limited to, primary care and

  8  preventive care as well as hospital care. The plan must also

  9  address the services to be provided by the Level I trauma

10  center. It shall emphasize a continuity of care in the most

11  cost-effective setting, taking into consideration both a high

12  quality of care and geographic access.  Where consistent with

13  these objectives, it shall include, without limitation,

14  services rendered by physicians, clinics, community hospitals,

15  mental health centers, and alternative delivery sites, as well

16  as at least one regional referral hospital where appropriate.

17  It shall provide that agreements negotiated between the county

18  and providers, including hospitals with a Level I trauma

19  center, will include reimbursement methodologies that take

20  into account the cost of services rendered to eligible

21  patients, recognize hospitals that render a disproportionate

22  share of indigent care, provide other incentives to promote

23  the delivery of charity care, promote the advancement of

24  technology in medical services, recognize the level of

25  responsiveness to medical needs in trauma cases, and require

26  cost containment including, but not limited to, case

27  management. It must also provide that any hospitals that are

28  owned and operated by government entities on May 21, 1991,

29  must, as a condition of receiving funds under this subsection,

30  afford public access equal to that provided under s. 286.011

31  as to meetings of the governing board, the subject of which is


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  1  budgeting resources for the rendition of charity care as that

  2  term is defined in the Florida Hospital Uniform Reporting

  3  System (FHURS) manual referenced in s. 408.07.  The plan shall

  4  also include innovative health care programs that provide

  5  cost-effective alternatives to traditional methods of service

  6  delivery and funding.

  7         (d)  For the purpose of this subsection, the term

  8  "qualified resident" means residents of the authorizing county

  9  who are:

10         1.  Qualified as indigent persons as certified by the

11  authorizing county;

12         2.  Certified by the authorizing county as meeting the

13  definition of the medically poor, defined as persons having

14  insufficient income, resources, and assets to provide the

15  needed medical care without using resources required to meet

16  basic needs for shelter, food, clothing, and personal

17  expenses; or not being eligible for any other state or federal

18  program, or having medical needs that are not covered by any

19  such program; or having insufficient third-party insurance

20  coverage.  In all cases, the authorizing county is intended to

21  serve as the payor of last resort; or

22         3.  Participating in innovative, cost-effective

23  programs approved by the authorizing county.

24         (e)  Moneys collected pursuant to this subsection

25  remain the property of the state and shall be distributed by

26  the Department of Revenue on a regular and periodic basis to

27  the clerk of the circuit court as ex officio custodian of the

28  funds of the authorizing county. The clerk of the circuit

29  court shall:

30         1.  Maintain the moneys in an indigent health care

31  trust fund;


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  1         2.  Invest any funds held on deposit in the trust fund

  2  pursuant to general law; and

  3         3.  Disburse the funds, including any interest earned,

  4  to any provider of health care services, as provided in

  5  paragraphs (c) and (d), upon directive from the authorizing

  6  county. However, if a county has a population of at least

  7  800,000 residents and has levied the surtax authorized in this

  8  subsection, notwithstanding any directive from the authorizing

  9  county, on October 1 of each calendar year, the clerk of the

10  court shall issue a check in the amount of $6.5 million to a

11  hospital in its jurisdiction that has a Level I trauma center

12  or shall issue a check in the amount of $3.5 million to a

13  hospital in its jurisdiction that has a Level I trauma center

14  if that county enacts and implements a hospital lien law in

15  accordance with chapter 98-499, Laws of Florida. The issuance

16  of the checks on October 1 of each year is provided in

17  recognition of the Level I trauma center status and shall be

18  in addition to the base contract amount received during fiscal

19  year 1999-2000 and any additional amount negotiated to the

20  base contract. If the hospital receiving funds for its Level I

21  trauma center status requests such funds to be used to

22  generate federal matching funds under Medicaid, the clerk of

23  the court shall instead issue a check to the Agency for Health

24  Care Administration to accomplish that purpose to the extent

25  that it is allowed through the General Appropriations Act.

26         (f)  Notwithstanding any other provision of this

27  section, a county shall not levy local option sales surtaxes

28  authorized in this subsection and subsections (2) and (3) in

29  excess of a combined rate of 1 percent.

30         (g)  This subsection expires October 1, 2005.

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  1         Section 79.  Sections 468.821 through 468.829, Florida

  2  Statutes, are renumbered as sections 464.201 through 464.209,

  3  respectively, designated as part II of chapter 464, Florida

  4  Statutes, and amended to read:

  5         464.201 468.821  Definitions.--As used in this part,

  6  the term:

  7         (1)  "Approved training program" means:

  8         (a)  A course of training conducted by a public sector

  9  or private sector educational center licensed by the

10  Department of Education to implement the basic curriculum for

11  nursing assistants which is approved by the Department of

12  Education. Beginning October 1, 2000, the board shall assume

13  responsibility for approval of training programs under this

14  paragraph.

15         (b)  A training program operated under s. 400.141.

16         (2)  "Board" means the Board of Nursing.

17         (3)(2)  "Certified nursing assistant" means a person

18  who meets the qualifications specified in this part and who is

19  certified by the board department as a certified nursing

20  assistant.

21         (4)(3)  "Department" means the Department of Health.

22         (5)(4)  "Registry" means the listing of certified

23  nursing assistants maintained by the board department.

24         464.202 468.822  Duties and powers of the board

25  department.--The board department shall maintain, or contract

26  with or approve another entity to maintain, a state registry

27  of certified nursing assistants. The registry must consist of

28  the name of each certified nursing assistant in this state;

29  other identifying information defined by board department

30  rule; certification status; the effective date of

31  certification; other information required by state or federal


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  1  law; information regarding any crime or any abuse, neglect, or

  2  exploitation as provided under chapter 435; and any

  3  disciplinary action taken against the certified nursing

  4  assistant. The registry shall be accessible to the public, the

  5  certificateholder, employers, and other state agencies. The

  6  board department shall adopt by rule testing procedures for

  7  use in certifying nursing assistants and shall adopt rules

  8  regulating the practice of certified nursing assistants to

  9  enforce this part. The board department may contract with or

10  approve another entity or organization to provide the

11  examination services, including the development and

12  administration of examinations. The board shall require that

13  the contract provider offer certified nursing assistant

14  applications via the Internet, and may require the contract

15  provider to accept certified nursing assistant applications

16  for processing via the Internet.  The board shall require the

17  contract provider to provide the preliminary results of the

18  certified nursing examination on the date the test is

19  administered. The provider shall pay all reasonable costs and

20  expenses incurred by the board department in evaluating the

21  provider's application and performance during the delivery of

22  services, including examination services and procedures for

23  maintaining the certified nursing assistant registry.

24         464.203 468.823  Certified nursing assistants;

25  certification requirement.--

26         (1)  The board department shall issue a certificate to

27  practice as a certified nursing assistant to any person who

28  demonstrates a minimum competency to read and write and

29  successfully passes the required Level I or Level II screening

30  pursuant to s. 400.215 and meets one of the following

31  requirements:


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  1         (a)  Has successfully completed an approved training

  2  program and achieved a minimum score, established by rule of

  3  the board department, on the nursing assistant competency

  4  examination, which consists of a written portion and

  5  skills-demonstration portion approved by the board department

  6  and administered at a site and by personnel approved by the

  7  department.

  8         (b)  Has achieved a minimum score, established by rule

  9  of the board department, on the nursing assistant competency

10  examination, which consists of a written portion and

11  skills-demonstration portion, approved by the board department

12  and administered at a site and by personnel approved by the

13  department and:

14         1.  Has a high school diploma, or its equivalent; or

15         2.  Is at least 18 years of age.

16         (c)  Is currently certified in another state; is listed

17  on that state's certified nursing assistant registry; and has

18  not been found to have committed abuse, neglect, or

19  exploitation in that state; and has successfully completed a

20  national nursing assistant evaluation in order to receive

21  certification in that state.

22         (d)  Has completed the curriculum developed under the

23  Enterprise Florida Jobs and Education Partnership Grant and

24  achieved a minimum score, established by rule of the board, on

25  the nursing assistant competency examination, which consists

26  of a written portion and skills-demonstration portion,

27  approved by the board and administered at a site and by

28  personnel approved by the department.

29         (2)  If an applicant fails to pass the nursing

30  assistant competency examination in three attempts, the

31


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  1  applicant is not eligible for reexamination unless the

  2  applicant completes an approved training program.

  3         (3)  An oral examination shall be administered as a

  4  substitute for the written portion of the examination upon

  5  request. The oral examination shall be administered at a site

  6  and by personnel approved by the department.

  7         (4)  The board department shall adopt rules to provide

  8  for the initial certification of certified nursing assistants.

  9         (5)  A certified nursing assistant shall maintain a

10  current address with the board department in accordance with

11  s. 455.717.

12         464.204 468.824  Denial, suspension, or revocation of

13  certification; disciplinary actions.--

14         (1)  The following acts constitute grounds for which

15  the board department may impose disciplinary sanctions as

16  specified in subsection (2):

17         (a)  Obtaining or attempting to obtain certification or

18  an exemption, or possessing or attempting to possess

19  certification or a letter of exemption, by bribery,

20  misrepresentation, deceit, or through an error of the board

21  department.

22         (b)  Intentionally violating any provision of this

23  chapter, chapter 455, or the rules adopted by the board

24  department.

25         (2)  When the board department finds any person guilty

26  of any of the grounds set forth in subsection (1), it may

27  enter an order imposing one or more of the following

28  penalties:

29         (a)  Denial, suspension, or revocation of

30  certification.

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  1         (b)  Imposition of an administrative fine not to exceed

  2  $150 for each count or separate offense.

  3         (c)  Imposition of probation or restriction of

  4  certification, including conditions such as corrective actions

  5  as retraining or compliance with an approved treatment program

  6  for impaired practitioners.

  7         (3)  The board department may, upon the request of a

  8  certificateholder, exempt the certificateholder from

  9  disqualification of certification or disqualification of

10  employment in accordance with chapter 435 and issue a letter

11  of exemption. After January 1, 2000, The board department must

12  notify an applicant seeking an exemption from disqualification

13  from certification or employment of its decision to approve or

14  deny the request within 30 days after the date the board

15  department receives all required documentation.

16         464.205 468.825  Availability of disciplinary records

17  and proceedings.--Pursuant to s. 455.621, any complaint or

18  record maintained by the department of Health pursuant to the

19  discipline of a certified nursing assistant and any proceeding

20  held by the board department to discipline a certified nursing

21  assistant shall remain open and available to the public.

22         464.206 468.826  Exemption from liability.--If an

23  employer terminates or denies employment to a certified

24  nursing assistant whose certification is inactive as shown on

25  the certified nursing assistant registry or whose name appears

26  on the central abuse registry and tracking system of the

27  Department of Children and Family Services or on a criminal

28  screening report of the Department of Law Enforcement, the

29  employer is not civilly liable for such termination and a

30  cause of action may not be brought against the employer for

31  damages, regardless of whether the employee has filed for an


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  1  exemption from the board department under s. 464.204(3)

  2  468.824(1). There may not be any monetary liability on the

  3  part of, and a cause of action for damages may not arise

  4  against, any licensed facility, its governing board or members

  5  thereof, medical staff, disciplinary board, agents,

  6  investigators, witnesses, employees, or any other person for

  7  any action taken in good faith without intentional fraud in

  8  carrying out this section.

  9         464.207 468.827  Penalties.--It is a misdemeanor of the

10  first degree, punishable as provided under s. 775.082 or s.

11  775.083, for any person, knowingly or intentionally, to fail

12  to disclose, by false statement, misrepresentation,

13  impersonation, or other fraudulent means, in any application

14  for voluntary or paid employment or certification licensure

15  regulated under this part, a material fact used in making a

16  determination as to such person's qualifications to be an

17  employee or certificateholder licensee.

18         464.208 468.828  Background screening information;

19  rulemaking authority.--

20         (1)  The Agency for Health Care Administration shall

21  allow the board department to electronically access its

22  background screening database and records, and the Department

23  of Children and Family Services shall allow the board

24  department to electronically access its central abuse registry

25  and tracking system under chapter 415.

26         (2)  An employer, or an agent thereof, may not use

27  criminal records, juvenile records, or information obtained

28  from the central abuse hotline under chapter 415 relating to

29  vulnerable adults for any purpose other than determining if

30  the person meets the requirements of this part. Such records

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  1  and information obtained by the board department shall remain

  2  confidential and exempt from s. 119.07(1).

  3         (3)  If the requirements of the Omnibus Budget

  4  Reconciliation Act of 1987, as amended, for the certification

  5  of nursing assistants are in conflict with this part, the

  6  federal requirements shall prevail for those facilities

  7  certified to provide care under Title XVIII (Medicare) or

  8  Title XIX (Medicaid) of the Social Security Act.

  9         (4)  The board department shall adopt rules to

10  administer this part.

11         464.209 468.829  Certified nursing assistant

12  registry.--

13         (1)  By October 1, 1999, and by October 1 of every year

14  thereafter, each employer of certified nursing assistants

15  shall submit to the board Department of Health a list of the

16  names and social security numbers of each person employed by

17  the employer as a certified nursing assistant in a

18  nursing-related occupation for a minimum of 8 hours for

19  monetary compensation during the preceding 24 months.

20  Employers may submit such information electronically through

21  the department's Internet site.

22         (2)  The board department shall update the certified

23  nursing assistant registry upon receipt of the lists of

24  certified nursing assistants, and shall complete the first of

25  such updates by December 31, 1999.

26         (3)  Each certified nursing assistant whose name is not

27  reported to the board department under subsection (1) on

28  October 1, 1999, shall be assigned an inactive certification

29  on January 1, 2000. A certified nursing assistant may remove

30  such an inactive certification by submitting documentation to

31  the board department that he or she was employed for a minimum


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  1  of 8 hours for monetary compensation as a certified nursing

  2  assistant in a nursing-related occupation during the preceding

  3  24 months.

  4         (4)  This section is repealed October 2, 2001.

  5         Section 80.  Section 464.2085, Florida Statutes, is

  6  created to read:

  7         464.2085  Council on Certified Nursing Assistants.--The

  8  Council on Certified Nursing Assistants is created within the

  9  department, under the Board of Nursing.

10         (1)  The council shall consist of five members

11  appointed as follows:

12         (a)  The chairperson of the Board of Nursing shall

13  appoint two members who are registered nurses. One of the

14  members must currently supervise a certified nursing assistant

15  in a licensed nursing home.

16         (b)  The chairperson of the Board of Nursing shall

17  appoint one member who is a licensed practical nurse who is

18  currently working in a licensed nursing home.

19         (c)  The secretary of the department or his or her

20  designee shall appoint two certified nursing assistants

21  currently certified under this chapter, at least one of whom

22  is currently working in a licensed nursing home.

23         (2)  The council shall:

24         (a)  Recommend to the department policies and

25  procedures for the certification of nursing assistants.

26         (b)  Develop all rules regulating the education,

27  training, and certification process for nursing assistants

28  certified under this chapter. The Board of Nursing shall

29  consider adopting a proposed rule developed by the council at

30  the regularly scheduled meeting immediately following the

31  submission of the proposed rule by the council.


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  1         (c)  Make recommendations to the board regarding all

  2  matters relating to the certification of nursing assistants.

  3         (d)  Address concerns and problems of certified nursing

  4  assistants in order to improve safety in the practice of

  5  certified nursing assistants.

  6         Section 81.  Paragraph (g) of subsection (3) of section

  7  20.43, Florida Statutes, is amended to read:

  8         20.43  Department of Health.--There is created a

  9  Department of Health.

10         (3)  The following divisions of the Department of

11  Health are established:

12         (g)  Division of Medical Quality Assurance, which is

13  responsible for the following boards and professions

14  established within the division:

15         1.  Nursing assistants, as provided under s. 400.211.

16         1.2.  Health care services pools, as provided under s.

17  402.48.

18         2.3.  The Board of Acupuncture, created under chapter

19  457.

20         3.4.  The Board of Medicine, created under chapter 458.

21         4.5.  The Board of Osteopathic Medicine, created under

22  chapter 459.

23         5.6.  The Board of Chiropractic Medicine, created under

24  chapter 460.

25         6.7.  The Board of Podiatric Medicine, created under

26  chapter 461.

27         7.8.  Naturopathy, as provided under chapter 462.

28         8.9.  The Board of Optometry, created under chapter

29  463.

30         9.10.  The Board of Nursing, created under part I of

31  chapter 464.


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  1         10.  Nursing assistants, as provided under part II of

  2  chapter 464.

  3         11.  The Board of Pharmacy, created under chapter 465.

  4         12.  The Board of Dentistry, created under chapter 466.

  5         13.  Midwifery, as provided under chapter 467.

  6         14.  The Board of Speech-Language Pathology and

  7  Audiology, created under part I of chapter 468.

  8         15.  The Board of Nursing Home Administrators, created

  9  under part II of chapter 468.

10         16.  The Board of Occupational Therapy, created under

11  part III of chapter 468.

12         17.  Respiratory therapy, as provided under part V of

13  chapter 468.

14         18.  Dietetics and nutrition practice, as provided

15  under part X of chapter 468.

16         19.  The Board of Athletic Training, created under part

17  XIII of chapter 468.

18         20.  The Board of Orthotists and Prosthetists, created

19  under part XIV of chapter 468.

20         21.  Electrolysis, as provided under chapter 478.

21         22.  The Board of Massage Therapy, created under

22  chapter 480.

23         23.  The Board of Clinical Laboratory Personnel,

24  created under part III of chapter 483.

25         24.  Medical physicists, as provided under part IV of

26  chapter 483.

27         25.  The Board of Opticianry, created under part I of

28  chapter 484.

29         26.  The Board of Hearing Aid Specialists, created

30  under part II of chapter 484.

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  1         27.  The Board of Physical Therapy Practice, created

  2  under chapter 486.

  3         28.  The Board of Psychology, created under chapter

  4  490.

  5         29.  School psychologists, as provided under chapter

  6  490.

  7         30.  The Board of Clinical Social Work, Marriage and

  8  Family Therapy, and Mental Health Counseling, created under

  9  chapter 491.

10

11  The department may contract with the Agency for Health Care

12  Administration who shall provide consumer complaint,

13  investigative, and prosecutorial services required by the

14  Division of Medical Quality Assurance, councils, or boards, as

15  appropriate.

16         Section 82.  Subsection (38) of section 39.01, Florida

17  Statutes, is amended to read:

18         39.01  Definitions.--When used in this chapter, unless

19  the context otherwise requires:

20         (38)  "Licensed health care professional" means a

21  physician licensed under chapter 458, an osteopathic physician

22  licensed under chapter 459, a nurse licensed under part I of

23  chapter 464, a physician assistant licensed under chapter 458

24  or chapter 459, or a dentist licensed under chapter 466.

25         Section 83.  Paragraph (b) of subsection (1) of section

26  39.304, Florida Statutes, is amended to read:

27         39.304  Photographs, medical examinations, X rays, and

28  medical treatment of abused, abandoned, or neglected child.--

29         (1)

30         (b)  If the areas of trauma visible on a child indicate

31  a need for a medical examination, or if the child verbally


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  1  complains or otherwise exhibits distress as a result of injury

  2  through suspected child abuse, abandonment, or neglect, or is

  3  alleged to have been sexually abused, the person required to

  4  investigate may cause the child to be referred for diagnosis

  5  to a licensed physician or an emergency department in a

  6  hospital without the consent of the child's parents or legal

  7  custodian. Such examination may be performed by any licensed

  8  physician or an advanced registered nurse practitioner

  9  licensed pursuant to part I of chapter 464. Any licensed

10  physician, or advanced registered nurse practitioner licensed

11  pursuant to part I of chapter 464, who has reasonable cause to

12  suspect that an injury was the result of child abuse,

13  abandonment, or neglect may authorize a radiological

14  examination to be performed on the child without the consent

15  of the child's parent or legal custodian.

16         Section 84.  Paragraph (c) of subsection (6) of section

17  110.131, Florida Statutes, is amended to read:

18         110.131  Other-personal-services temporary

19  employment.--

20         (6)

21         (c)  Notwithstanding the provisions of this section,

22  the agency head or his or her designee may extend the

23  other-personal-services employment of a health care

24  practitioner licensed pursuant to chapter 458, chapter 459,

25  chapter 460, chapter 461, chapter 463, part I of chapter 464,

26  chapter 466, chapter 468, chapter 483, chapter 486, or chapter

27  490 beyond 2,080 hours and may employ such practitioner on an

28  hourly or other basis.

29         Section 85.  Subsection (1) of section 232.46, Florida

30  Statutes, is amended to read:

31


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  1         232.46  Administration of medication by school district

  2  personnel.--

  3         (1)  Notwithstanding the provisions of the Nurse

  4  Practice Act, part I of chapter 464, school district personnel

  5  shall be authorized to assist students in the administration

  6  of prescription medication when the following conditions have

  7  been met:

  8         (a)  Each district school board shall include in its

  9  approved school health services plan a procedure to provide

10  training, by a registered nurse, a licensed practical nurse, a

11  physician licensed pursuant to chapter 458 or chapter 459, or

12  a physician assistant licensed pursuant to chapter 458 or

13  chapter 459, to the school personnel designated by the

14  principal to assist students in the administration of

15  prescribed medication.  Such training may be provided in

16  collaboration with other school districts, through contract

17  with an education consortium, or by any other arrangement

18  consistent with the intent of this section.

19         (b)  Each district school board shall adopt policies

20  and procedures governing the administration of prescription

21  medication by school district personnel.  The policies and

22  procedures shall include, but not be limited to, the following

23  provisions:

24         1.  For each prescribed medication, the student's

25  parent or guardian shall provide to the school principal a

26  written statement which shall grant to the principal or the

27  principal's designee permission to assist in the

28  administration of such medication and which shall explain the

29  necessity for such medication to be provided during the school

30  day, including any occasion when the student is away from

31  school property on official school business. The school


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  1  principal or the principal's trained designee shall assist the

  2  student in the administration of such medication.

  3         2.  Each prescribed medication to be administered by

  4  school district personnel shall be received, counted, and

  5  stored in its original container. When the medication is not

  6  in use, it shall be stored in its original container in a

  7  secure fashion under lock and key in a location designated by

  8  the principal.

  9         Section 86.  Subsection (6) of section 240.4075,

10  Florida Statutes, is amended to read:

11         240.4075  Nursing Student Loan Forgiveness Program.--

12         (6)  In addition to licensing fees imposed under part I

13  of chapter 464, there is hereby levied and imposed an

14  additional fee of $5, which fee shall be paid upon licensure

15  or renewal of nursing licensure. Revenues collected from the

16  fee imposed in this subsection shall be deposited in the

17  Nursing Student Loan Forgiveness Trust Fund of the Department

18  of Education and will be used solely for the purpose of

19  carrying out the provisions of this section and s. 240.4076.

20  Up to 50 percent of the revenues appropriated to implement

21  this subsection may be used for the nursing scholarship

22  program established pursuant to s. 240.4076.

23         Section 87.  Paragraph (b) of subsection (1) of section

24  246.081, Florida Statutes, is amended to read:

25         246.081  License, certificate of exemption, or

26  authorization required; exceptions.--

27         (1)  The following colleges are not under the

28  jurisdiction of the board and are not required to obtain a

29  license, a certificate of exemption, permission to operate, or

30  an authorization from the board:

31


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  1         (b)  Any college, school, or course licensed or

  2  approved for establishment and operation under part I of

  3  chapter 464, chapter 466, or chapter 475, or any other chapter

  4  of the Florida Statutes, requiring licensing or approval as

  5  defined in ss. 246.011-246.151.

  6         Section 88.  Subsection (2) of section 310.102, Florida

  7  Statutes, is amended to read:

  8         310.102  Treatment programs for impaired pilots and

  9  deputy pilots.--

10         (2)  The department shall retain one or more impaired

11  practitioner consultants as recommended by the committee. A

12  consultant shall be a licensee under the jurisdiction of the

13  Division of Medical Quality Assurance within the Department of

14  Health, and at least one consultant must be a practitioner

15  licensed under chapter 458, chapter 459, or part I of chapter

16  464. The consultant shall assist the probable cause panel and

17  department in carrying out the responsibilities of this

18  section. This shall include working with department

19  investigators to determine whether a pilot or deputy pilot is,

20  in fact, impaired.

21         Section 89.  Subsection (7) of section 381.0302,

22  Florida Statutes, is amended to read:

23         381.0302  Florida Health Services Corps.--

24         (7)  The financial penalty for noncompliance with

25  participation requirements for persons who have received

26  financial payments under subsection (5) or subsection (6)

27  shall be determined in the same manner as in the National

28  Health Services Corps scholarship program.  In addition,

29  noncompliance with participation requirements shall also

30  result in ineligibility for professional licensure or renewal

31  of licensure under chapter 458, chapter 459, chapter 460, part


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  1  I of chapter 464, chapter 465, or chapter 466.  For a

  2  participant who is unable to participate for reasons of

  3  disability, the penalty is the actual amount of financial

  4  assistance provided to the participant.  Financial penalties

  5  shall be deposited in the Florida Health Services Corps Trust

  6  Fund and shall be used to provide additional scholarship and

  7  financial assistance.

  8         Section 90.  Subsection (1) of section 384.30, Florida

  9  Statutes, is amended to read:

10         384.30  Minors' consent to treatment.--

11         (1)  The department and its authorized representatives,

12  each physician licensed to practice medicine under the

13  provisions of chapter 458 or chapter 459, each health care

14  professional licensed under the provisions of part I of

15  chapter 464 who is acting pursuant to the scope of his or her

16  license, and each public or private hospital, clinic, or other

17  health facility may examine and provide treatment for sexually

18  transmissible diseases to any minor, if the physician, health

19  care professional, or facility is qualified to provide such

20  treatment.  The consent of the parents or guardians of a minor

21  is not a prerequisite for an examination or treatment.

22         Section 91.  Section 384.31, Florida Statutes, is

23  amended to read:

24         384.31  Serological testing of pregnant women; duty of

25  the attendant.--

26         (1)  Every person, including every physician licensed

27  under chapter 458 or chapter 459 or midwife licensed under

28  part I of chapter 464 or chapter 467, attending a pregnant

29  woman for conditions relating to pregnancy during the period

30  of gestation and delivery shall take or cause to be taken a

31  sample of venous blood at a time or times specified by the


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  1  department.  Each sample of blood shall be tested by a

  2  laboratory approved for such purposes under part I of chapter

  3  483 for sexually transmissible diseases as required by rule of

  4  the department.

  5         (2)  At the time the venous blood sample is taken,

  6  testing for human immunodeficiency virus (HIV) infection shall

  7  be offered to each pregnant woman. The prevailing professional

  8  standard of care in this state requires each health care

  9  provider and midwife who attends a pregnant woman to counsel

10  the woman to be tested for human immunodeficiency virus (HIV).

11  Counseling shall include a discussion of the availability of

12  treatment if the pregnant woman tests HIV positive. If a

13  pregnant woman objects to HIV testing, reasonable steps shall

14  be taken to obtain a written statement of such objection,

15  signed by the patient, which shall be placed in the patient's

16  medical record. Every person, including every physician

17  licensed under chapter 458 or chapter 459 or midwife licensed

18  under part I of chapter 464 or chapter 467, who attends a

19  pregnant woman who has been offered and objects to HIV testing

20  shall be immune from liability arising out of or related to

21  the contracting of HIV infection or acquired immune deficiency

22  syndrome (AIDS) by the child from the mother.

23         Section 92.  Subsection (23) of section 394.455,

24  Florida Statutes, is amended to read:

25         394.455  Definitions.--As used in this part, unless the

26  context clearly requires otherwise, the term:

27         (23)  "Psychiatric nurse" means a registered nurse

28  licensed under part I of chapter 464 who has a master's degree

29  or a doctorate in psychiatric nursing and 2 years of

30  post-master's clinical experience under the supervision of a

31  physician.


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  1         Section 93.  Paragraphs (a) and (b) of subsection (2)

  2  and subsection (4) of section 395.0191, Florida Statutes, are

  3  amended to read:

  4         395.0191  Staff membership and clinical privileges.--

  5         (2)(a)  Each licensed facility shall establish rules

  6  and procedures for consideration of an application for

  7  clinical privileges submitted by an advanced registered nurse

  8  practitioner licensed and certified under part I of chapter

  9  464, in accordance with the provisions of this section.  No

10  licensed facility shall deny such application solely because

11  the applicant is licensed under part I of chapter 464 or

12  because the applicant is not a participant in the Florida

13  Birth-Related Neurological Injury Compensation Plan.

14         (b)  An advanced registered nurse practitioner who is

15  certified as a registered nurse anesthetist licensed under

16  part I of chapter 464 shall administer anesthesia under the

17  onsite medical direction of a professional licensed under

18  chapter 458, chapter 459, or chapter 466, and in accordance

19  with an established protocol approved by the medical staff.

20  The medical direction shall specifically address the needs of

21  the individual patient.

22         (4)  Nothing herein shall restrict in any way the

23  authority of the medical staff of a licensed facility to

24  review for approval or disapproval all applications for

25  appointment and reappointment to all categories of staff and

26  to make recommendations on each applicant to the governing

27  board, including the delineation of privileges to be granted

28  in each case.  In making such recommendations and in the

29  delineation of privileges, each applicant shall be considered

30  individually pursuant to criteria for a doctor licensed under

31  chapter 458, chapter 459, chapter 461, or chapter 466, or for


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  1  an advanced registered nurse practitioner licensed and

  2  certified under part I of chapter 464, or for a psychologist

  3  licensed under chapter 490, as applicable.  The applicant's

  4  eligibility for staff membership or clinical privileges shall

  5  be determined by the applicant's background, experience,

  6  health, training, and demonstrated competency; the applicant's

  7  adherence to applicable professional ethics; the applicant's

  8  reputation; and the applicant's ability to work with others

  9  and by such other elements as determined by the governing

10  board, consistent with this part.

11         Section 94.  Subsection (11) of section 400.021,

12  Florida Statutes, is amended to read:

13         400.021  Definitions.--When used in this part, unless

14  the context otherwise requires, the term:

15         (11)  "Nursing home facility" means any facility which

16  provides nursing services as defined in part I of chapter 464

17  and which is licensed according to this part.

18         Section 95.  Section 400.211, Florida Statutes, is

19  amended to read:

20         400.211  Persons employed as nursing assistants;

21  certification requirement.--

22         (1)  To serve as a nursing assistant in any nursing

23  home, a person must be certified as a nursing assistant under

24  part II XV of chapter 464 468, unless the person is except a

25  registered nurse or practical nurse licensed in accordance

26  with part I of chapter 464 or an applicant for such licensure

27  who is permitted to practice nursing in accordance with rules

28  adopted by the Board of Nursing pursuant to part I of chapter

29  464, to serve as a nursing assistant in any nursing home.

30         (2)  The following categories of persons who are not

31  certified as nursing assistants under this part II of chapter


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  1  464 may be employed by a nursing facility for a period of 4

  2  months:

  3         (a)  Persons who are enrolled in, or have completed, a

  4  state-approved nursing assistant program; or

  5         (b)  Persons who have been positively verified by a

  6  state approved test site as actively certified and on the

  7  registry in another state with no findings of abuse, but who

  8  have not completed the written examination required under this

  9  section.;or

10         (c)  Persons who have preliminarily passed the state's

11  certification exam.

12

13  The certification requirement must be met within 4 months

14  after of initial employment as a nursing assistant in a

15  licensed nursing facility.

16         (3)  Nursing homes shall require persons seeking

17  employment as a certified nursing assistant to submit an

18  employment history to the facility. The facility shall verify

19  the employment history unless, through diligent efforts, such

20  verification is not possible.  There shall be no monetary

21  liability on the part of, and no cause of action for damages

22  shall arise against, a former employer who reasonably and in

23  good faith communicates his or her honest opinion about a

24  former employee's job performance.

25         Section 96.  Paragraph (b) of subsection (4) of section

26  400.215, Florida Statutes, is amended to read:

27         400.215  Personnel screening requirement.--

28         (4)

29         (b)  As provided in s. 435.07, the appropriate

30  regulatory board within the Department of Health, or that

31  department itself when there is no board, may grant an


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  1  exemption from disqualification to an employee or prospective

  2  employee who is subject to this section and who has received a

  3  professional license or certification from the Department of

  4  Health or a regulatory board within that department.

  5         Section 97.  Paragraph (c) is added to subsection (3)

  6  of section 400.23, Florida Statutes, to read:

  7         400.23  Rules; evaluation and deficiencies; licensure

  8  status.--

  9         (3)

10         (c)  Licensed practical nurses licensed under chapter

11  464 who are providing nursing services in nursing home

12  facilities under this part may supervise the activities of

13  other licensed practical nurses, certified nursing assistants,

14  and other unlicensed personnel providing services in such

15  facilities in accordance with rules adopted by the Board of

16  Nursing.

17         Section 98.  Subsections (12) and (14) of section

18  400.402, Florida Statutes, are amended to read:

19         400.402  Definitions.--When used in this part, the

20  term:

21         (12)  "Extended congregate care" means acts beyond

22  those authorized in subsection (17) that may be performed

23  pursuant to part I of chapter 464 by persons licensed

24  thereunder while carrying out their professional duties, and

25  other supportive services which may be specified by rule.  The

26  purpose of such services is to enable residents to age in

27  place in a residential environment despite mental or physical

28  limitations that might otherwise disqualify them from

29  residency in a facility licensed under this part.

30         (14)  "Limited nursing services" means acts that may be

31  performed pursuant to part I of chapter 464 by persons


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  1  licensed thereunder while carrying out their professional

  2  duties but limited to those acts which the department

  3  specifies by rule.  Acts which may be specified by rule as

  4  allowable limited nursing services shall be for persons who

  5  meet the admission criteria established by the department for

  6  assisted living facilities and shall not be complex enough to

  7  require 24-hour nursing supervision and may include such

  8  services as the application and care of routine dressings, and

  9  care of casts, braces, and splints.

10         Section 99.  Paragraphs (a) and (b) of subsection (3)

11  of section 400.407, Florida Statutes, are amended to read:

12         400.407  License required; fee, display.--

13         (3)  Any license granted by the agency must state the

14  maximum resident capacity of the facility, the type of care

15  for which the license is granted, the date the license is

16  issued, the expiration date of the license, and any other

17  information deemed necessary by the agency. Licenses shall be

18  issued for one or more of the following categories of care:

19  standard, extended congregate care, limited nursing services,

20  or limited mental health.

21         (a)  A standard license shall be issued to facilities

22  providing one or more of the services identified in s.

23  400.402. Such facilities may also employ or contract with a

24  person licensed under part I of chapter 464 to administer

25  medications and perform other tasks as specified in s.

26  400.4255.

27         (b)  An extended congregate care license shall be

28  issued to facilities providing, directly or through contract,

29  services beyond those authorized in paragraph (a), including

30  acts performed pursuant to part I of chapter 464 by persons

31  licensed thereunder, and supportive services defined by rule


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  1  to persons who otherwise would be disqualified from continued

  2  residence in a facility licensed under this part.

  3         1.  In order for extended congregate care services to

  4  be provided in a facility licensed under this part, the agency

  5  must first determine that all requirements established in law

  6  and rule are met and must specifically designate, on the

  7  facility's license, that such services may be provided and

  8  whether the designation applies to all or part of a facility.

  9  Such designation may be made at the time of initial licensure

10  or biennial relicensure, or upon request in writing by a

11  licensee under this part. Notification of approval or denial

12  of such request shall be made within 90 days after receipt of

13  such request and all necessary documentation. Existing

14  facilities qualifying to provide extended congregate care

15  services must have maintained a standard license and may not

16  have been subject to administrative sanctions during the

17  previous 2 years, or since initial licensure if the facility

18  has been licensed for less than 2 years, for any of the

19  following reasons:

20         a.  A class I or class II violation;

21         b.  Three or more repeat or recurring class III

22  violations of identical or similar resident care standards as

23  specified in rule from which a pattern of noncompliance is

24  found by the agency;

25         c.  Three or more class III violations that were not

26  corrected in accordance with the corrective action plan

27  approved by the agency;

28         d.  Violation of resident care standards resulting in a

29  requirement to employ the services of a consultant pharmacist

30  or consultant dietitian;

31


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  1         e.  Denial, suspension, or revocation of a license for

  2  another facility under this part in which the applicant for an

  3  extended congregate care license has at least 25 percent

  4  ownership interest; or

  5         f.  Imposition of a moratorium on admissions or

  6  initiation of injunctive proceedings.

  7         2.  Facilities that are licensed to provide extended

  8  congregate care services shall maintain a written progress

  9  report on each person who receives such services, which report

10  describes the type, amount, duration, scope, and outcome of

11  services that are rendered and the general status of the

12  resident's health.  A registered nurse, or appropriate

13  designee, representing the agency shall visit such facilities

14  at least two times a year to monitor residents who are

15  receiving extended congregate care services and to determine

16  if the facility is in compliance with this part and with rules

17  that relate to extended congregate care. One of these visits

18  may be in conjunction with the regular biennial survey.  The

19  monitoring visits may be provided through contractual

20  arrangements with appropriate community agencies.  A

21  registered nurse shall serve as part of the team that

22  biennially inspects such facility. The agency may waive one of

23  the required yearly monitoring visits for a facility that has

24  been licensed for at least 24 months to provide extended

25  congregate care services, if, during the biennial inspection,

26  the registered nurse determines that extended congregate care

27  services are being provided appropriately, and if the facility

28  has no class I or class II violations and no uncorrected class

29  III violations. Before such decision is made, the agency shall

30  consult with the long-term care ombudsman council for the area

31  in which the facility is located to determine if any


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  1  complaints have been made and substantiated about the quality

  2  of services or care.  The agency may not waive one of the

  3  required yearly monitoring visits if complaints have been made

  4  and substantiated.

  5         3.  Facilities that are licensed to provide extended

  6  congregate care services shall:

  7         a.  Demonstrate the capability to meet unanticipated

  8  resident service needs.

  9         b.  Offer a physical environment that promotes a

10  homelike setting, provides for resident privacy, promotes

11  resident independence, and allows sufficient congregate space

12  as defined by rule.

13         c.  Have sufficient staff available, taking into

14  account the physical plant and firesafety features of the

15  building, to assist with the evacuation of residents in an

16  emergency, as necessary.

17         d.  Adopt and follow policies and procedures that

18  maximize resident independence, dignity, choice, and

19  decisionmaking to permit residents to age in place to the

20  extent possible, so that moves due to changes in functional

21  status are minimized or avoided.

22         e.  Allow residents or, if applicable, a resident's

23  representative, designee, surrogate, guardian, or attorney in

24  fact to make a variety of personal choices, participate in

25  developing service plans, and share responsibility in

26  decisionmaking.

27         f.  Implement the concept of managed risk.

28         g.  Provide, either directly or through contract, the

29  services of a person licensed pursuant to part I of chapter

30  464.

31


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  1         h.  In addition to the training mandated in s. 400.452,

  2  provide specialized training as defined by rule for facility

  3  staff.

  4         4.  Facilities licensed to provide extended congregate

  5  care services are exempt from the criteria for continued

  6  residency as set forth in rules adopted under s. 400.441.

  7  Facilities so licensed shall adopt their own requirements

  8  within guidelines for continued residency set forth by the

  9  department in rule.  However, such facilities may not serve

10  residents who require 24-hour nursing supervision. Facilities

11  licensed to provide extended congregate care services shall

12  provide each resident with a written copy of facility policies

13  governing admission and retention.

14         5.  The primary purpose of extended congregate care

15  services is to allow residents, as they become more impaired,

16  the option of remaining in a familiar setting from which they

17  would otherwise be disqualified for continued residency.  A

18  facility licensed to provide extended congregate care services

19  may also admit an individual who exceeds the admission

20  criteria for a facility with a standard license, if the

21  individual is determined appropriate for admission to the

22  extended congregate care facility.

23         6.  Before admission of an individual to a facility

24  licensed to provide extended congregate care services, the

25  individual must undergo a medical examination as provided in

26  s. 400.426(4) and the facility must develop a preliminary

27  service plan for the individual.

28         7.  When a facility can no longer provide or arrange

29  for services in accordance with the resident's service plan

30  and needs and the facility's policy, the facility shall make

31


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  1  arrangements for relocating the person in accordance with s.

  2  400.428(1)(k).

  3         8.  Failure to provide extended congregate care

  4  services may result in denial of extended congregate care

  5  license renewal.

  6         9.  No later than January 1 of each year, the

  7  department, in consultation with the agency, shall prepare and

  8  submit to the Governor, the President of the Senate, the

  9  Speaker of the House of Representatives, and the chairs of

10  appropriate legislative committees, a report on the status of,

11  and recommendations related to, extended congregate care

12  services. The status report must include, but need not be

13  limited to, the following information:

14         a.  A description of the facilities licensed to provide

15  such services, including total number of beds licensed under

16  this part.

17         b.  The number and characteristics of residents

18  receiving such services.

19         c.  The types of services rendered that could not be

20  provided through a standard license.

21         d.  An analysis of deficiencies cited during biennial

22  inspections.

23         e.  The number of residents who required extended

24  congregate care services at admission and the source of

25  admission.

26         f.  Recommendations for statutory or regulatory

27  changes.

28         g.  The availability of extended congregate care to

29  state clients residing in facilities licensed under this part

30  and in need of additional services, and recommendations for

31


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  1  appropriations to subsidize extended congregate care services

  2  for such persons.

  3         h.  Such other information as the department considers

  4  appropriate.

  5         Section 100.  Paragraphs (a) and (c) of subsection (1)

  6  and subsection (2) of section 400.4255, Florida Statutes, are

  7  amended to read:

  8         400.4255  Use of personnel; emergency care.--

  9         (1)(a)  Persons under contract to the facility,

10  facility staff, or volunteers, who are licensed according to

11  part I of chapter 464, or those persons exempt under s.

12  464.022(1), and others as defined by rule, may administer

13  medications to residents, take residents' vital signs, manage

14  individual weekly pill organizers for residents who

15  self-administer medication, give prepackaged enemas ordered by

16  a physician, observe residents, document observations on the

17  appropriate resident's record, report observations to the

18  resident's physician, and contract or allow residents or a

19  resident's representative, designee, surrogate, guardian, or

20  attorney in fact to contract with a third party, provided

21  residents meet the criteria for appropriate placement as

22  defined in s. 400.426.  Nursing assistants certified pursuant

23  to part II of chapter 464 s. 400.211 may take residents' vital

24  signs as directed by a licensed nurse or physician.

25         (c)  In an emergency situation, licensed personnel may

26  carry out their professional duties pursuant to part I of

27  chapter 464 until emergency medical personnel assume

28  responsibility for care.

29         (2)  In facilities licensed to provide extended

30  congregate care, persons under contract to the facility,

31  facility staff, or volunteers, who are licensed according to


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  1  part I of chapter 464, or those persons exempt under s.

  2  464.022(1), or those persons certified as nursing assistants

  3  pursuant to part II of chapter 464 s. 400.211, may also

  4  perform all duties within the scope of their license or

  5  certification, as approved by the facility administrator and

  6  pursuant to this part.

  7         Section 101.  Subsection (3) of section 400.426,

  8  Florida Statutes, is amended to read:

  9         400.426  Appropriateness of placements; examinations of

10  residents.--

11         (3)  Persons licensed under part I of chapter 464 who

12  are employed by or under contract with a facility shall, on a

13  routine basis or at least monthly, perform a nursing

14  assessment of the residents for whom they are providing

15  nursing services ordered by a physician, except administration

16  of medication, and shall document such assessment, including

17  any substantial changes in a resident's status which may

18  necessitate relocation to a nursing home, hospital, or

19  specialized health care facility.  Such records shall be

20  maintained in the facility for inspection by the agency and

21  shall be forwarded to the resident's case manager, if

22  applicable.

23         Section 102.  Subsections (3) and (21) of section

24  400.462, Florida Statutes, are amended to read:

25         400.462  Definitions.--As used in this part, the term:

26         (3)  "Certified nursing assistant" means any person who

27  has been issued a certificate under part II of chapter 464 s.

28  400.211. The licensed home health agency or licensed nurse

29  registry shall ensure that the certified nursing assistant

30  employed by or under contract with the home health agency or

31


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  1  licensed nurse registry is adequately trained to perform the

  2  tasks of a home health aide in the home setting.

  3         (21)  "Skilled care" means nursing services or

  4  therapeutic services delivered by a health care professional

  5  who is licensed under part I of chapter 464; part I, part III,

  6  or part V of chapter 468; or chapter 486 and who is employed

  7  by or under contract with a licensed home health agency or is

  8  referred by a licensed nurse registry.

  9         Section 103.  Paragraph (c) of subsection (6) of

10  section 400.464, Florida Statutes, is amended to read:

11         400.464  Home health agencies to be licensed;

12  expiration of license; exemptions; unlawful acts; penalties.--

13         (6)  The following are exempt from the licensure

14  requirements of this part:

15         (c)  A health care professional, whether or not

16  incorporated, who is licensed under chapter 457; chapter 458;

17  chapter 459; part I of chapter 464; chapter 467; part I, part

18  III, part V, or part X of chapter 468; chapter 480; chapter

19  486; chapter 490; or chapter 491; and who is acting alone

20  within the scope of his or her professional license to provide

21  care to patients in their homes.

22         Section 104.  Paragraph (a) of subsection (10),

23  subsection (11), and paragraph (a) of subsection (15) of

24  section 400.506, Florida Statutes, are amended to read:

25         400.506  Licensure of nurse registries; requirements;

26  penalties.--

27         (10)(a)  A nurse registry may refer for contract in

28  private residences registered nurses and licensed practical

29  nurses registered and licensed under part I of chapter 464,

30  certified nursing assistants certified under part II of

31  chapter 464 s. 400.211, home health aides who present


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  1  documented proof of successful completion of the training

  2  required by rule of the agency, and companions or homemakers

  3  for the purposes of providing those services authorized under

  4  s. 400.509(1). Each person referred by a nurse registry must

  5  provide current documentation that he or she is free from

  6  communicable diseases.

  7         (11)  A person who is referred by a nurse registry for

  8  contract in private residences and who is not a nurse licensed

  9  under part I of chapter 464 may perform only those services or

10  care to clients that the person has been certified to perform

11  or trained to perform as required by law or rules of the

12  Agency for Health Care Administration or the Department of

13  Business and Professional Regulation. Providing services

14  beyond the scope authorized under this subsection constitutes

15  the unauthorized practice of medicine or a violation of the

16  Nurse Practice Act and is punishable as provided under chapter

17  458, chapter 459, or part I of chapter 464.

18         (15)  All persons referred for contract in private

19  residences by a nurse registry must comply with the following

20  requirements for a plan of treatment:

21         (a)  When, in accordance with the privileges and

22  restrictions imposed upon a nurse under part I of chapter 464,

23  the delivery of care to a patient is under the direction or

24  supervision of a physician or when a physician is responsible

25  for the medical care of the patient, a medical plan of

26  treatment must be established for each patient receiving care

27  or treatment provided by a licensed nurse in the home.  The

28  original medical plan of treatment must be timely signed by

29  the physician and reviewed by him or her in consultation with

30  the licensed nurse at least every 2 months.  Any additional

31  order or change in orders must be obtained from the physician


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  1  and reduced to writing and timely signed by the physician.

  2  The delivery of care under a medical plan of treatment must be

  3  substantiated by the appropriate nursing notes or

  4  documentation made by the nurse in compliance with nursing

  5  practices established under part I of chapter 464.

  6         Section 105.  Subsection (1) of section 400.512,

  7  Florida Statutes, is amended to read:

  8         400.512  Screening of home health agency personnel;

  9  nurse registry personnel; and companions and homemakers.--The

10  agency shall require employment or contractor screening as

11  provided in chapter 435, using the level 1 standards for

12  screening set forth in that chapter, for home health agency

13  personnel; persons referred for employment by nurse

14  registries; and persons employed by companion or homemaker

15  services registered under s. 400.509.

16         (1)(a)  The Agency for Health Care Administration may,

17  upon request, grant exemptions from disqualification from

18  employment or contracting under this section as provided in s.

19  435.07, except for health care practitioners licensed by the

20  Department of Health or a regulatory board within that

21  department.

22         (b)  The appropriate regulatory board within the

23  Department of Health, or that department itself when there is

24  no board, may, upon request of the licensed health care

25  practitioner, grant exemptions from disqualification from

26  employment or contracting under this section as provided in s.

27  435.07.

28         Section 106.  Subsections (2) and (3) of section

29  400.6105, Florida Statutes, are amended to read:

30         400.6105  Staffing and personnel.--

31


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  1         (2)  Each hospice shall employ a full-time registered

  2  nurse licensed pursuant to part I of chapter 464 who shall

  3  coordinate the implementation of the plan of care for each

  4  patient.

  5         (3)  A hospice shall employ a hospice care team or

  6  teams who shall participate in the establishment and ongoing

  7  review of the patient's plan of care, and be responsible for

  8  and supervise the delivery of hospice care and services to the

  9  patient. The team shall, at a minimum, consist of a physician

10  licensed pursuant to chapter 458 or chapter 459, a nurse

11  licensed pursuant to part I of chapter 464, a social worker,

12  and a pastoral or other counselor. The composition of the team

13  may vary for each patient and, over time, for the same patient

14  to ensure that all the patient's needs and preferences are

15  met.

16         Section 107.  Subsection (20) of section 401.23,

17  Florida Statutes, is amended to read:

18         401.23  Definitions.--As used in this part, the term:

19         (20)  "Registered nurse" means a practitioner who is

20  licensed to practice professional nursing pursuant to part I

21  of chapter 464.

22         Section 108.  Paragraph (c) of subsection (1) of

23  section 401.252, Florida Statutes, is amended to read:

24         401.252  Interfacility transfer.--

25         (1)  A licensed basic or advanced life support

26  ambulance service may conduct interfacility transfers in a

27  permitted ambulance, using a registered nurse in place of an

28  emergency medical technician or paramedic, if:

29         (c)  The registered nurse operates within the scope of

30  part I of chapter 464.

31


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  1         Section 109.  Subsection (11) of section 408.706,

  2  Florida Statutes, is amended to read:

  3         408.706  Community health purchasing alliances;

  4  accountable health partnerships.--

  5         (11)  The ability to recruit and retain alliance

  6  district health care providers in its provider network. For

  7  provider networks initially formed in an alliance district

  8  after July 1, 1993, an accountable health partnership shall

  9  make offers as to provider participation in its provider

10  network to relevant alliance district health care providers

11  for at least 60 percent of the available provider positions. A

12  provider who is made an offer may participate in an

13  accountable health partnership as long as the provider abides

14  by the terms and conditions of the provider network contract,

15  provides services at a rate or price equal to the rate or

16  price negotiated by the accountable health partnership, and

17  meets all of the accountable health partnership's

18  qualifications for participation in its provider networks

19  including, but not limited to, network adequacy criteria. For

20  purposes of this subsection, "alliance district health care

21  provider" means a health care provider who is licensed under

22  chapter 458, chapter 459, chapter 460, chapter 461, part I of

23  chapter 464, or chapter 465 who has practiced in Florida for

24  more than 1 year within the alliance district served by the

25  accountable health partnership.

26         Section 110.  Paragraph (d) of subsection (12) of

27  section 409.908, Florida Statutes, is amended to read:

28         409.908  Reimbursement of Medicaid providers.--Subject

29  to specific appropriations, the agency shall reimburse

30  Medicaid providers, in accordance with state and federal law,

31  according to methodologies set forth in the rules of the


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  1  agency and in policy manuals and handbooks incorporated by

  2  reference therein.  These methodologies may include fee

  3  schedules, reimbursement methods based on cost reporting,

  4  negotiated fees, competitive bidding pursuant to s. 287.057,

  5  and other mechanisms the agency considers efficient and

  6  effective for purchasing services or goods on behalf of

  7  recipients.  Payment for Medicaid compensable services made on

  8  behalf of Medicaid eligible persons is subject to the

  9  availability of moneys and any limitations or directions

10  provided for in the General Appropriations Act or chapter 216.

11  Further, nothing in this section shall be construed to prevent

12  or limit the agency from adjusting fees, reimbursement rates,

13  lengths of stay, number of visits, or number of services, or

14  making any other adjustments necessary to comply with the

15  availability of moneys and any limitations or directions

16  provided for in the General Appropriations Act, provided the

17  adjustment is consistent with legislative intent.

18         (12)

19         (d)  Notwithstanding paragraph (b), reimbursement fees

20  to physicians for providing total obstetrical services to

21  Medicaid recipients, which include prenatal, delivery, and

22  postpartum care, shall be at least $1,500 per delivery for a

23  pregnant woman with low medical risk and at least $2,000 per

24  delivery for a pregnant woman with high medical risk. However,

25  reimbursement to physicians working in Regional Perinatal

26  Intensive Care Centers designated pursuant to chapter 383, for

27  services to certain pregnant Medicaid recipients with a high

28  medical risk, may be made according to obstetrical care and

29  neonatal care groupings and rates established by the agency.

30  Nurse midwives licensed under part I of chapter 464 or

31  midwives licensed under chapter 467 shall be reimbursed at no


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  1  less than 80 percent of the low medical risk fee. The agency

  2  shall by rule determine, for the purpose of this paragraph,

  3  what constitutes a high or low medical risk pregnant woman and

  4  shall not pay more based solely on the fact that a caesarean

  5  section was performed, rather than a vaginal delivery. The

  6  agency shall by rule determine a prorated payment for

  7  obstetrical services in cases where only part of the total

  8  prenatal, delivery, or postpartum care was performed. The

  9  Department of Health shall adopt rules for appropriate

10  insurance coverage for midwives licensed under chapter 467.

11  Prior to the issuance and renewal of an active license, or

12  reactivation of an inactive license for midwives licensed

13  under chapter 467, such licensees shall submit proof of

14  coverage with each application.

15         Section 111.  Subsection (1) of section 415.1085,

16  Florida Statutes, is amended to read:

17         415.1085  Photographs, medical examinations, and X rays

18  of abused or neglected aged persons or disabled adults.--

19         (1)  Any person authorized by law to investigate cases

20  of alleged abuse or neglect of an aged person or disabled

21  adult may take or cause to be taken photographs of the areas

22  of trauma visible on the aged person or disabled adult who is

23  the subject of a report, and photographs of the surrounding

24  environment, with the consent of the subject or guardian or

25  guardians.  If the areas of trauma visible on the aged person

26  or disabled adult indicate a need for medical examination, or

27  if the aged person or disabled adult verbally complains or

28  otherwise exhibits distress as a result of injury through

29  suspected adult abuse, neglect, or exploitation, or is alleged

30  to have been sexually abused, the department may, with the

31  consent of the subject or guardian or guardians, cause the


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  1  aged person or disabled adult to be referred to a licensed

  2  physician or any emergency department in a hospital or health

  3  care facility for medical examinations and X rays, if deemed

  4  necessary by the examining physician.  Such examinations may

  5  be performed by an advanced registered nurse practitioner

  6  licensed pursuant to part I of chapter 464.  Medical

  7  examinations performed and X rays taken pursuant to this

  8  section shall be paid for by third-party reimbursement, if

  9  available, or by the subject or his or her guardian, if they

10  are determined to be financially able to pay; or, if neither

11  is available, the department shall pay the costs within

12  available emergency services funds.

13         Section 112.  Paragraph (a) of subsection (1) of

14  section 455.597 Florida Statutes, is amended to read:

15         455.597  Requirement for instruction on domestic

16  violence.--

17         (1)(a)  The appropriate board shall require each person

18  licensed or certified under chapter 458, chapter 459, part I

19  of chapter 464, chapter 466, chapter 467, chapter 490, or

20  chapter 491 to complete a 1-hour continuing education course,

21  approved by the board, on domestic violence, as defined in s.

22  741.28, as part of biennial relicensure or recertification.

23  The course shall consist of information on the number of

24  patients in that professional's practice who are likely to be

25  victims of domestic violence and the number who are likely to

26  be perpetrators of domestic violence, screening procedures for

27  determining whether a patient has any history of being either

28  a victim or a perpetrator of domestic violence, and

29  instruction on how to provide such patients with information

30  on, or how to refer such patients to, resources in the local

31  community, such as domestic violence centers and other


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  1  advocacy groups, that provide legal aid, shelter, victim

  2  counseling, batterer counseling, or child protection services.

  3         Section 113.  Subsection (1) of section 455.604,

  4  Florida Statutes, is amended to read:

  5         455.604  Requirement for instruction for certain

  6  licensees on human immunodeficiency virus and acquired immune

  7  deficiency syndrome.--

  8         (1)  The appropriate board shall require each person

  9  licensed or certified under chapter 457; chapter 458; chapter

10  459; chapter 460; chapter 461; chapter 463; part I of chapter

11  464; chapter 465; chapter 466; part II, part III, part V, or

12  part X of chapter 468; or chapter 486 to complete a continuing

13  educational course, approved by the board, on human

14  immunodeficiency virus and acquired immune deficiency syndrome

15  as part of biennial relicensure or recertification. The course

16  shall consist of education on the modes of transmission,

17  infection control procedures, clinical management, and

18  prevention of human immunodeficiency virus and acquired immune

19  deficiency syndrome. Such course shall include information on

20  current Florida law on acquired immune deficiency syndrome and

21  its impact on testing, confidentiality of test results,

22  treatment of patients, and any protocols and procedures

23  applicable to human immunodeficiency virus counseling and

24  testing, reporting, the offering of HIV testing to pregnant

25  women, and partner notification issues pursuant to ss. 381.004

26  and 384.25.

27         Section 114.  Paragraph (a) of subsection (2) of

28  section 455.667, Florida Statutes, is amended to read:

29         455.667  Ownership and control of patient records;

30  report or copies of records to be furnished.--

31


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  1         (2)  As used in this section, the terms "records

  2  owner," "health care practitioner," and "health care

  3  practitioner's employer" do not include any of the following

  4  persons or entities; furthermore, the following persons or

  5  entities are not authorized to acquire or own medical records,

  6  but are authorized under the confidentiality and disclosure

  7  requirements of this section to maintain those documents

  8  required by the part or chapter under which they are licensed

  9  or regulated:

10         (a)  Certified nursing assistants regulated under part

11  II of chapter 464 s. 400.211.

12         Section 115.  Section 455.677, Florida Statutes, is

13  amended to read:

14         455.677  Disposition of records of deceased

15  practitioners or practitioners relocating or terminating

16  practice.--Each board created under the provisions of chapter

17  457, chapter 458, chapter 459, chapter 460, chapter 461,

18  chapter 463, part I of chapter 464, chapter 465, chapter 466,

19  part I of chapter 484, chapter 486, chapter 490, or chapter

20  491, and the department under the provisions of chapter 462,

21  shall provide by rule for the disposition, under that chapter,

22  of the medical records or records of a psychological nature of

23  practitioners which are in existence at the time the

24  practitioner dies, terminates practice, or relocates and is no

25  longer available to patients and which records pertain to the

26  practitioner's patients.  The rules shall provide that the

27  records be retained for at least 2 years after the

28  practitioner's death, termination of practice, or relocation.

29  In the case of the death of the practitioner, the rules shall

30  provide for the disposition of such records by the estate of

31  the practitioner.


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  1         Section 116.  Paragraph (b) of subsection (2) of

  2  section 455.694, Florida Statutes, is amended to read:

  3         455.694  Financial responsibility requirements for

  4  certain health care practitioners.--

  5         (2)  The board or department may grant exemptions upon

  6  application by practitioners meeting any of the following

  7  criteria:

  8         (b)  Any person whose license or certification has

  9  become inactive under chapter 457, chapter 460, chapter 461,

10  part I of chapter 464, chapter 466, or chapter 467 and who is

11  not practicing in this state.  Any person applying for

12  reactivation of a license must show either that such licensee

13  maintained tail insurance coverage which provided liability

14  coverage for incidents that occurred on or after October 1,

15  1993, or the initial date of licensure in this state,

16  whichever is later, and incidents that occurred before the

17  date on which the license became inactive; or such licensee

18  must submit an affidavit stating that such licensee has no

19  unsatisfied medical malpractice judgments or settlements at

20  the time of application for reactivation.

21         Section 117.  Subsection (2) of section 455.707,

22  Florida Statutes, is amended to read:

23         455.707  Treatment programs for impaired

24  practitioners.--

25         (2)  The department shall retain one or more impaired

26  practitioner consultants as recommended by the committee.  A

27  consultant shall be a licensee or recovered licensee under the

28  jurisdiction of the Division of Medical Quality Assurance

29  within the department, and at least one consultant must be a

30  practitioner or recovered practitioner licensed under chapter

31  458, chapter 459, or part I of chapter 464.  The consultant


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  1  shall assist the probable cause panel and department in

  2  carrying out the responsibilities of this section.  This shall

  3  include working with department investigators to determine

  4  whether a practitioner is, in fact, impaired.

  5         Section 118.  Subsection (2) of section 458.348,

  6  Florida Statutes, is amended to read:

  7         458.348  Formal supervisory relationships, standing

  8  orders, and established protocols; notice; standards.--

  9         (2)  ESTABLISHMENT OF STANDARDS BY JOINT

10  COMMITTEE.--The joint committee created by s. 464.003(3)(c)

11  shall determine minimum standards for the content of

12  established protocols pursuant to which an advanced registered

13  nurse practitioner may perform medical acts identified and

14  approved by the joint committee pursuant to s. 464.003(3)(c)

15  or acts set forth in s. 464.012(3) and (4) and shall determine

16  minimum standards for supervision of such acts by the

17  physician, unless the joint committee determines that any act

18  set forth in s. 464.012(3) or (4) is not a medical act.  Such

19  standards shall be based on risk to the patient and acceptable

20  standards of medical care and shall take into account the

21  special problems of medically underserved areas. The standards

22  developed by the joint committee shall be adopted as rules by

23  the Board of Nursing and the Board of Medicine for purposes of

24  carrying out their responsibilities pursuant to part I of

25  chapter 464 and this chapter, respectively, but neither board

26  shall have disciplinary powers over the licensees of the other

27  board.

28         Section 119.  Section 464.001, Florida Statutes, is

29  amended to read:

30         464.001  Short title.--This part may be cited chapter

31  shall be known as the "Nurse Practice Act."


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  1         Section 120.  Section 464.002, Florida Statutes, is

  2  amended to read:

  3         464.002  Purpose.--The sole legislative purpose in

  4  enacting this part chapter is to ensure that every nurse

  5  practicing in this state meets minimum requirements for safe

  6  practice.  It is the legislative intent that nurses who fall

  7  below minimum competency or who otherwise present a danger to

  8  the public shall be prohibited from practicing in this state.

  9         Section 121.  Section 464.003, Florida Statutes, is

10  amended to read:

11         464.003  Definitions.--As used in this part chapter:

12         (1)  "Department" means the Department of Health.

13         (2)  "Board" means the Board of Nursing as created in

14  this chapter.

15         (3)(a)  "Practice of professional nursing" means the

16  performance of those acts requiring substantial specialized

17  knowledge, judgment, and nursing skill based upon applied

18  principles of psychological, biological, physical, and social

19  sciences which shall include, but not be limited to:

20         1.  The observation, assessment, nursing diagnosis,

21  planning, intervention, and evaluation of care; health

22  teaching and counseling of the ill, injured, or infirm; and

23  the promotion of wellness, maintenance of health, and

24  prevention of illness of others.

25         2.  The administration of medications and treatments as

26  prescribed or authorized by a duly licensed practitioner

27  authorized by the laws of this state to prescribe such

28  medications and treatments.

29         3.  The supervision and teaching of other personnel in

30  the theory and performance of any of the above acts.

31


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  1         (b)  "Practice of practical nursing" means the

  2  performance of selected acts, including the administration of

  3  treatments and medications, in the care of the ill, injured,

  4  or infirm and the promotion of wellness, maintenance of

  5  health, and prevention of illness of others under the

  6  direction of a registered nurse, a licensed physician, a

  7  licensed osteopathic physician, a licensed podiatric

  8  physician, or a licensed dentist.

  9

10  The professional nurse and the practical nurse shall be

11  responsible and accountable for making decisions that are

12  based upon the individual's educational preparation and

13  experience in nursing.

14         (c)  "Advanced or specialized nursing practice" means,

15  in addition to the practice of professional nursing, the

16  performance of advanced-level nursing acts approved by the

17  board which, by virtue of postbasic specialized education,

18  training, and experience, are proper to be performed by an

19  advanced registered nurse practitioner.  Within the context of

20  advanced or specialized nursing practice, the advanced

21  registered nurse practitioner may perform acts of nursing

22  diagnosis and nursing treatment of alterations of the health

23  status.  The advanced registered nurse practitioner may also

24  perform acts of medical diagnosis and treatment, prescription,

25  and operation which are identified and approved by a joint

26  committee composed of three members appointed by the Board of

27  Nursing, two of whom shall be advanced registered nurse

28  practitioners; three members appointed by the Board of

29  Medicine, two of whom shall have had work experience with

30  advanced registered nurse practitioners; and the secretary of

31  the department or the secretary's designee. Each committee


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  1  member appointed by a board shall be appointed to a term of 4

  2  years unless a shorter term is required to establish or

  3  maintain staggered terms. The Board of Nursing shall adopt

  4  rules authorizing the performance of any such acts approved by

  5  the joint committee. Unless otherwise specified by the joint

  6  committee, such acts shall be performed under the general

  7  supervision of a practitioner licensed under chapter 458,

  8  chapter 459, or chapter 466 within the framework of standing

  9  protocols which identify the medical acts to be performed and

10  the conditions for their performance.  The department may, by

11  rule, require that a copy of the protocol be filed with the

12  department along with the notice required by s. 458.348.

13         (d)  "Nursing diagnosis" means the observation and

14  evaluation of physical or mental conditions, behaviors, signs

15  and symptoms of illness, and reactions to treatment and the

16  determination as to whether such conditions, signs, symptoms,

17  and reactions represent a deviation from normal.

18         (e)  "Nursing treatment" means the establishment and

19  implementation of a nursing regimen for the care and comfort

20  of individuals, the prevention of illness, and the education,

21  restoration, and maintenance of health.

22         (4)  "Registered nurse" means any person licensed in

23  this state to practice professional nursing.

24         (5)  "Licensed practical nurse" means any person

25  licensed in this state to practice practical nursing.

26         (6)  "Advanced registered nurse practitioner" means any

27  person licensed in this state to practice professional nursing

28  and certified in advanced or specialized nursing practice.

29         (7)  "Approved program" means a nursing program

30  conducted in a school, college, or university which is

31


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  1  approved by the board pursuant to s. 464.019 for the education

  2  of nurses.

  3         Section 122.  Section 464.006, Florida Statutes, is

  4  amended to read:

  5         464.006  Authority to make rules.--The board of Nursing

  6  has authority to adopt rules pursuant to ss. 120.536(1) and

  7  120.54 to implement the provisions of this part chapter

  8  conferring duties upon it.

  9         Section 123.  Subsection (3) of section 464.009,

10  Florida Statutes, is amended to read:

11         464.009  Licensure by endorsement.--

12         (3)  The department shall not issue a license by

13  endorsement to any applicant who is under investigation in

14  another state for an act which would constitute a violation of

15  this part chapter until such time as the investigation is

16  complete, at which time the provisions of s. 464.018 shall

17  apply.

18         Section 124.  Paragraphs (a) and (d) of subsection (1)

19  and paragraph (b) of subsection (2) of section 464.016,

20  Florida Statutes, are amended to read:

21         464.016  Violations and penalties.--

22         (1)  Each of the following acts constitutes a felony of

23  the third degree, punishable as provided in s. 775.082, s.

24  775.083, or s. 775.084:

25         (a)  Practicing advanced or specialized, professional

26  or practical nursing, as defined in this part chapter, unless

27  holding an active license or certificate to do so.

28         (d)  Obtaining or attempting to obtain a license or

29  certificate under this part chapter by misleading statements

30  or knowing misrepresentation.

31


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  1         (2)  Each of the following acts constitutes a

  2  misdemeanor of the first degree, punishable as provided in s.

  3  775.082 or s. 775.083:

  4         (b)  Knowingly concealing information relating to

  5  violations of this part chapter.

  6         Section 125.  Paragraphs (i), (k), and (l) of

  7  subsection (1) and subsection (4) of section 464.018, Florida

  8  Statutes, are amended to read:

  9         464.018  Disciplinary actions.--

10         (1)  The following acts shall be grounds for

11  disciplinary action set forth in this section:

12         (i)  Engaging or attempting to engage in the

13  possession, sale, or distribution of controlled substances as

14  set forth in chapter 893, for any other than legitimate

15  purposes authorized by this part chapter.

16         (k)  Failing to report to the department any person who

17  the licensee knows is in violation of this part chapter or of

18  the rules of the department or the board; however, if the

19  licensee verifies that such person is actively participating

20  in a board-approved program for the treatment of a physical or

21  mental condition, the licensee is required to report such

22  person only to an impaired professionals consultant.

23         (l)  Knowingly violating any provision of this part

24  chapter, a rule of the board or the department, or a lawful

25  order of the board or department previously entered in a

26  disciplinary proceeding or failing to comply with a lawfully

27  issued subpoena of the department.

28         (4)  The board shall not reinstate the license of a

29  nurse who has been found guilty by the board on three separate

30  occasions of violations of this part chapter relating to the

31  use of drugs or narcotics, which offenses involved the


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  1  diversion of drugs or narcotics from patients to personal use

  2  or sale.

  3         Section 126.  Subsections (1), (2), and (3) of section

  4  464.019, Florida Statutes, are amended to read:

  5         464.019  Approval of nursing programs.--

  6         (1)  An institution desiring to conduct an approved

  7  program for the education of professional or practical nurses

  8  shall apply to the department and submit such evidence as may

  9  be required to show that it complies with the provisions of

10  this part chapter and with the rules of the board. The

11  application shall include a program review fee, as set by the

12  board, not to exceed $1,000.

13         (2)  The board shall adopt rules regarding educational

14  objectives, faculty qualifications, curriculum guidelines,

15  administrative procedures, and clinical training as are

16  necessary to ensure that approved programs graduate nurses

17  capable of competent practice under this part act.

18         (3)  The department shall survey each institution

19  applying for approval and submit its findings to the board.

20  If the board is satisfied that the program meets the

21  requirements of this part chapter and rules pursuant thereto,

22  it shall certify the program for approval and the department

23  shall approve the program.

24         Section 127.  Section 464.022, Florida Statutes, is

25  amended to read:

26         464.022  Exceptions.--No provision of this part chapter

27  shall be construed to prohibit:

28         (1)  The care of the sick by friends or members of the

29  family without compensation, the incidental care of the sick

30  by domestic servants, or the incidental care of

31  noninstitutionalized persons by a surrogate family.


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  1         (2)  Assistance by anyone in the case of an emergency.

  2         (3)  The practice of nursing by students enrolled in

  3  approved schools of nursing.

  4         (4)  The practice of nursing by graduates of approved

  5  programs or the equivalent, pending the result of the first

  6  licensing examination for which they are eligible following

  7  graduation, provided they practice under direct supervision of

  8  a registered professional nurse.  The board shall by rule

  9  define what constitutes direct supervision.

10         (5)  The rendering of services by nursing assistants

11  acting under the direct supervision of a registered

12  professional nurse.

13         (6)  Any nurse practicing in accordance with the

14  practices and principles of the body known as the Church of

15  Christ Scientist; nor shall any rule of the board apply to any

16  sanitarium, nursing home, or rest home operated in accordance

17  with the practices and principles of the body known as the

18  Church of Christ Scientist.

19         (7)  The practice of any legally qualified nurse or

20  licensed attendant of another state who is employed by the

21  United States Government, or any bureau, division, or agency

22  thereof, while in the discharge of official duties.

23         (8)  Any nurse currently licensed in another state from

24  performing nursing services in this state for a period of 60

25  days after furnishing to the employer satisfactory evidence of

26  current licensure in another state and having submitted proper

27  application and fees to the board for licensure prior to

28  employment.  The board may extend this time for administrative

29  purposes when necessary.

30         (9)  The rendering of nursing services on a

31  fee-for-service basis, or the reimbursement for nursing


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  1  services directly to a nurse rendering such services by any

  2  government program, commercial insurance company, hospital or

  3  medical services plan, or any other third-party payor.

  4         (10)  The establishment of an independent practice by

  5  one or more nurses for the purpose of rendering to patients

  6  nursing services within the scope of the nursing license.

  7         (11)  The furnishing of hemodialysis treatments in a

  8  patient's home, using an assistant chosen by the patient,

  9  provided that the assistant is properly trained, as defined by

10  the board by rule, and has immediate telephonic access to a

11  registered nurse who is licensed pursuant to this part chapter

12  and who has dialysis training and experience.

13         (12)  The practice of nursing by any legally qualified

14  nurse of another state whose employment requires the nurse to

15  accompany and care for a patient temporarily residing in this

16  state for not more than 30 consecutive days, provided the

17  patient is not in an inpatient setting, the board is notified

18  prior to arrival of the patient and nurse, the nurse has the

19  standing physician orders and current medical status of the

20  patient available, and prearrangements with the appropriate

21  licensed health care providers in this state have been made in

22  case the patient needs placement in an inpatient setting.

23         (13)  The practice of nursing by individuals enrolled

24  in board-approved remedial courses.

25         Section 128.  Section 464.023, Florida Statutes, is

26  amended to read:

27         464.023  Saving clauses.--

28         (1)  No judicial or administrative proceeding pending

29  on July 1, 1979, shall be abated as a result of the repeal and

30  reenactment of this part chapter.

31


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  1         (2)  Each licensee or holder of a certificate who was

  2  duly licensed or certified on June 30, 1979, shall be entitled

  3  to hold such license or certificate.  Henceforth, such license

  4  or certificate shall be renewed in accordance with the

  5  provisions of this part act.

  6         Section 129.  Subsection (3) of section 464.027,

  7  Florida Statutes, is amended to read:

  8         464.027  Registered nurse first assistant.--

  9         (3)  QUALIFICATIONS.--A registered nurse first

10  assistant is any person who:

11         (a)  Is licensed as a registered nurse under this part

12  chapter;

13         (b)  Is certified in perioperative nursing; and

14         (c)  Holds a certificate from, and has successfully

15  completed, a recognized program.

16         Section 130.  Subsection (6) of section 466.003,

17  Florida Statutes, is amended to read:

18         466.003  Definitions.--As used in this chapter:

19         (6)  "Dental assistant" means a person, other than a

20  dental hygienist, who, under the supervision and authorization

21  of a dentist, provides dental care services directly to a

22  patient. This term shall not include a certified registered

23  nurse anesthetist licensed under part I of chapter 464.

24         Section 131.  Subsection (2) of section 467.003,

25  Florida Statutes, is amended to read:

26         467.003  Definitions.--As used in this chapter, unless

27  the context otherwise requires:

28         (2)  "Certified nurse midwife" means a person who is

29  licensed as an advanced registered nurse practitioner under

30  part I of chapter 464 and who is certified to practice

31  midwifery by the American College of Nurse Midwives.


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  1         Section 132.  Paragraph (a) of subsection (2) of

  2  section 467.0125, Florida Statutes, is amended to read:

  3         467.0125  Licensure by endorsement.--

  4         (2)  The department may issue a temporary certificate

  5  to practice in areas of critical need to any midwife who is

  6  qualifying for licensure by endorsement under subsection (1),

  7  with the following restrictions:

  8         (a)  The Department of Health shall determine the areas

  9  of critical need, and the midwife so certified shall practice

10  only in those specific areas, under the auspices of a

11  physician licensed pursuant to chapter 458 or chapter 459, a

12  certified nurse midwife licensed pursuant to part I of chapter

13  464, or a midwife licensed under this chapter, who has a

14  minimum of 3 years' professional experience. Such areas shall

15  include, but not be limited to, health professional shortage

16  areas designated by the United States Department of Health and

17  Human Services.

18         Section 133.  Paragraph (e) of subsection (2) of

19  section 467.203, Florida Statutes, is amended to read:

20         467.203  Disciplinary actions; penalties.--

21         (2)  When the department finds any person guilty of any

22  of the grounds set forth in subsection (1), it may enter an

23  order imposing one or more of the following penalties:

24         (e)  Placement of the midwife on probation for such

25  period of time and subject to such conditions as the

26  department may specify, including requiring the midwife to

27  submit to treatment; undertake further relevant education or

28  training; take an examination; or work under the supervision

29  of another licensed midwife, a physician, or a nurse midwife

30  licensed under part I of chapter 464.

31


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  1         Section 134.  Paragraph (a) of subsection (1) of

  2  section 468.505, Florida Statutes, is amended to read:

  3         468.505  Exemptions; exceptions.--

  4         (1)  Nothing in this part may be construed as

  5  prohibiting or restricting the practice, services, or

  6  activities of:

  7         (a)  A person licensed in this state under chapter 457,

  8  chapter 458, chapter 459, chapter 460, chapter 461, chapter

  9  462, chapter 463, part I of chapter 464, chapter 465, chapter

10  466, chapter 480, chapter 490, or chapter 491, when engaging

11  in the profession or occupation for which he or she is

12  licensed, or of any person employed by and under the

13  supervision of the licensee when rendering services within the

14  scope of the profession or occupation of the licensee.

15         Section 135.  Subsection (7) of section 483.041,

16  Florida Statutes, is amended to read:

17         483.041  Definitions.--As used in this part, the term:

18         (7)  "Licensed practitioner" means a physician licensed

19  under chapter 458, chapter 459, chapter 460, or chapter 461; a

20  dentist licensed under chapter 466; a person licensed under

21  chapter 462; or an advanced registered nurse practitioner

22  licensed under part I of chapter 464; or a duly licensed

23  practitioner from another state licensed under similar

24  statutes who orders examinations on materials or specimens for

25  nonresidents of the State of Florida, but who reside in the

26  same state as the requesting licensed practitioner.

27         Section 136.  Subsection (5) of section 483.801,

28  Florida Statutes, is amended to read:

29         483.801  Exemptions.--This part applies to all clinical

30  laboratories and clinical laboratory personnel within this

31  state, except:


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  1         (5)  Advanced registered nurse practitioners licensed

  2  under part I of chapter 464 who perform provider-performed

  3  microscopy procedures (PPMP) in an exclusive-use laboratory

  4  setting.

  5         Section 137.  Paragraph (a) of subsection (4) of

  6  section 491.0112, Florida Statutes, is amended to read:

  7         491.0112  Sexual misconduct by a psychotherapist;

  8  penalties.--

  9         (4)  For the purposes of this section:

10         (a)  The term "psychotherapist" means any person

11  licensed pursuant to chapter 458, chapter 459, part I of

12  chapter 464, chapter 490, or chapter 491, or any other person

13  who provides or purports to provide treatment, diagnosis,

14  assessment, evaluation, or counseling of mental or emotional

15  illness, symptom, or condition.

16         Section 138.  Subsection (5) of section 550.24055,

17  Florida Statutes, is amended to read:

18         550.24055  Use of controlled substances or alcohol

19  prohibited; testing of certain occupational licensees;

20  penalty; evidence of test or action taken and admissibility

21  for criminal prosecution limited.--

22         (5)  This section does not apply to the possession and

23  use of controlled or chemical substances that are prescribed

24  as part of the care and treatment of a disease or injury by a

25  practitioner licensed under chapter 458, chapter 459, part I

26  of chapter 464, or chapter 466.

27         Section 139.  Paragraph (h) of subsection (4) of

28  section 627.351, Florida Statutes, is amended to read:

29         627.351  Insurance risk apportionment plans.--

30         (4)  MEDICAL MALPRACTICE RISK APPORTIONMENT.--

31         (h)  As used in this subsection:


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  1         1.  "Health care provider" means hospitals licensed

  2  under chapter 395; physicians licensed under chapter 458;

  3  osteopathic physicians licensed under chapter 459; podiatric

  4  physicians licensed under chapter 461; dentists licensed under

  5  chapter 466; chiropractic physicians licensed under chapter

  6  460; naturopaths licensed under chapter 462; nurses licensed

  7  under part I of chapter 464; midwives licensed under chapter

  8  467; clinical laboratories registered under chapter 483;

  9  physician assistants licensed under chapter 458 or chapter

10  459; physical therapists and physical therapist assistants

11  licensed under chapter 486; health maintenance organizations

12  certificated under part I of chapter 641; ambulatory surgical

13  centers licensed under chapter 395; other medical facilities

14  as defined in subparagraph 2.; blood banks, plasma centers,

15  industrial clinics, and renal dialysis facilities; or

16  professional associations, partnerships, corporations, joint

17  ventures, or other associations for professional activity by

18  health care providers.

19         2.  "Other medical facility" means a facility the

20  primary purpose of which is to provide human medical

21  diagnostic services or a facility providing nonsurgical human

22  medical treatment, to which facility the patient is admitted

23  and from which facility the patient is discharged within the

24  same working day, and which facility is not part of a

25  hospital.  However, a facility existing for the primary

26  purpose of performing terminations of pregnancy or an office

27  maintained by a physician or dentist for the practice of

28  medicine shall not be construed to be an "other medical

29  facility."

30         3.  "Health care facility" means any hospital licensed

31  under chapter 395, health maintenance organization


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  1  certificated under part I of chapter 641, ambulatory surgical

  2  center licensed under chapter 395, or other medical facility

  3  as defined in subparagraph 2.

  4         Section 140.  Paragraph (b) of subsection (1) of

  5  section 627.357, Florida Statutes, is amended to read:

  6         627.357  Medical malpractice self-insurance.--

  7         (1)  DEFINITIONS.--As used in this section, the term:

  8         (b)  "Health care provider" means any:

  9         1.  Hospital licensed under chapter 395.

10         2.  Physician licensed, or physician assistant

11  licensed, under chapter 458.

12         3.  Osteopathic physician or physician assistant

13  licensed under chapter 459.

14         4.  Podiatric physician licensed under chapter 461.

15         5.  Health maintenance organization certificated under

16  part I of chapter 641.

17         6.  Ambulatory surgical center licensed under chapter

18  395.

19         7.  Chiropractic physician licensed under chapter 460.

20         8.  Psychologist licensed under chapter 490.

21         9.  Optometrist licensed under chapter 463.

22         10.  Dentist licensed under chapter 466.

23         11.  Pharmacist licensed under chapter 465.

24         12.  Registered nurse, licensed practical nurse, or

25  advanced registered nurse practitioner licensed or registered

26  under part I of chapter 464.

27         13.  Other medical facility.

28         14.  Professional association, partnership,

29  corporation, joint venture, or other association established

30  by the individuals set forth in subparagraphs 2., 3., 4., 7.,

31  8., 9., 10., 11., and 12. for professional activity.


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  1         Section 141.  Subsection (6) of section 627.9404,

  2  Florida Statutes, is amended to read:

  3         627.9404  Definitions.--For the purposes of this part:

  4         (6)  "Licensed health care practitioner" means any

  5  physician, nurse licensed under part I of chapter 464, or

  6  psychotherapist licensed under chapter 490 or chapter 491, or

  7  any individual who meets any requirements prescribed by rule

  8  by the department.

  9         Section 142.  Subsection (21) of section 641.31,

10  Florida Statutes, is amended to read:

11         641.31  Health maintenance contracts.--

12         (21)  Notwithstanding any other provision of law,

13  health maintenance policies or contracts which provide

14  anesthesia coverage, benefits, or services shall offer to the

15  subscriber, if requested and available, the services of a

16  certified registered nurse anesthetist licensed pursuant to

17  part I of chapter 464.

18         Section 143.  Subsection (8) of section 766.101,

19  Florida Statutes, is amended to read:

20         766.101  Medical review committee, immunity from

21  liability.--

22         (8)  No cause of action of any nature by a person

23  licensed pursuant to chapter 458, chapter 459, chapter 461,

24  chapter 463, part I of chapter 464, chapter 465, or chapter

25  466 shall arise against another person licensed pursuant to

26  chapter 458, chapter 459, chapter 461, chapter 463, part I of

27  chapter 464, chapter 465, or chapter 466 for furnishing

28  information to a duly appointed medical review committee, to

29  an internal risk management program established under s.

30  395.0197, to the Department of Business and Professional

31  Regulation, or to the appropriate regulatory board if the


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  1  information furnished concerns patient care at a facility

  2  licensed pursuant to part I of chapter 395 where both persons

  3  provide health care services, if the information is not

  4  intentionally fraudulent, and if the information is within the

  5  scope of the functions of the committee, department, or board.

  6  However, if such information is otherwise available from

  7  original sources, it is not immune from discovery or use in a

  8  civil action merely because it was presented during a

  9  proceeding of the committee, department, or board.

10         Section 144.  Subsection (2) of section 766.110,

11  Florida Statutes, is amended to read:

12         766.110  Liability of health care facilities.--

13         (2)  Every hospital licensed under chapter 395 may

14  carry liability insurance or adequately insure itself in an

15  amount of not less than $1.5 million per claim, $5 million

16  annual aggregate to cover all medical injuries to patients

17  resulting from negligent acts or omissions on the part of

18  those members of its medical staff who are covered thereby in

19  furtherance of the requirements of ss. 458.320 and 459.0085.

20  Self-insurance coverage extended hereunder to a member of a

21  hospital's medical staff meets the financial responsibility

22  requirements of ss. 458.320 and 459.0085 if the physician's

23  coverage limits are not less than the minimum limits

24  established in ss. 458.320 and 459.0085 and the hospital is a

25  verified trauma center as of July 1, 1990, that has extended

26  self-insurance coverage continuously to members of its medical

27  staff for activities both inside and outside of the hospital

28  since January 1, 1987.  Any insurer authorized to write

29  casualty insurance may make available, but shall not be

30  required to write, such coverage.  The hospital may assess on

31  an equitable and pro rata basis the following professional


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  1  health care providers for a portion of the total hospital

  2  insurance cost for this coverage:  physicians licensed under

  3  chapter 458, osteopathic physicians licensed under chapter

  4  459, podiatric physicians licensed under chapter 461, dentists

  5  licensed under chapter 466, and nurses licensed under part I

  6  of chapter 464. The hospital may provide for a deductible

  7  amount to be applied against any individual health care

  8  provider found liable in a law suit in tort or for breach of

  9  contract.  The legislative intent in providing for the

10  deductible to be applied to individual health care providers

11  found negligent or in breach of contract is to instill in each

12  individual health care provider the incentive to avoid the

13  risk of injury to the fullest extent and ensure that the

14  citizens of this state receive the highest quality health care

15  obtainable.

16         Section 145.  Paragraph (d) of subsection (3) of

17  section 766.1115, Florida Statutes, is amended to read:

18         766.1115  Health care providers; creation of agency

19  relationship with governmental contractors.--

20         (3)  DEFINITIONS.--As used in this section, the term:

21         (d)  "Health care provider" or "provider" means:

22         1.  A birth center licensed under chapter 383.

23         2.  An ambulatory surgical center licensed under

24  chapter 395.

25         3.  A hospital licensed under chapter 395.

26         4.  A physician or physician assistant licensed under

27  chapter 458.

28         5.  An osteopathic physician or osteopathic physician

29  assistant licensed under chapter 459.

30         6.  A chiropractic physician licensed under chapter

31  460.


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  1         7.  A podiatric physician licensed under chapter 461.

  2         8.  A registered nurse, nurse midwife, licensed

  3  practical nurse, or advanced registered nurse practitioner

  4  licensed or registered under part I of chapter 464 or any

  5  facility which employs nurses licensed or registered under

  6  part I of chapter 464 to supply all or part of the care

  7  delivered under this section.

  8         9.  A midwife licensed under chapter 467.

  9         10.  A health maintenance organization certificated

10  under part I of chapter 641.

11         11.  A health care professional association and its

12  employees or a corporate medical group and its employees.

13         12.  Any other medical facility the primary purpose of

14  which is to deliver human medical diagnostic services or which

15  delivers nonsurgical human medical treatment, and which

16  includes an office maintained by a provider.

17         13.  A dentist or dental hygienist licensed under

18  chapter 466.

19         14.  Any other health care professional, practitioner,

20  provider, or facility under contract with a governmental

21  contractor.

22

23  The term includes any nonprofit corporation qualified as

24  exempt from federal income taxation under s. 501(c) of the

25  Internal Revenue Code which delivers health care services

26  provided by licensed professionals listed in this paragraph,

27  any federally funded community health center, and any

28  volunteer corporation or volunteer health care provider that

29  delivers health care services.

30         Section 146.  Subsection (1) of section 877.111,

31  Florida Statutes, is amended to read:


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  1         877.111  Inhalation, ingestion, possession, sale,

  2  purchase, or transfer of harmful chemical substances;

  3  penalties.--

  4         (1)  It is unlawful for any person to inhale or ingest,

  5  or to possess with intent to breathe, inhale, or drink, any

  6  compound, liquid, or chemical containing toluol, hexane,

  7  trichloroethylene, acetone, toluene, ethyl acetate, methyl

  8  ethyl ketone, trichloroethane, isopropanol, methyl isobutyl

  9  ketone, ethylene glycol monomethyl ether acetate,

10  cyclohexanone, nitrous oxide, diethyl ether, alkyl nitrites

11  (butyl nitrite), or any similar substance for the purpose of

12  inducing a condition of intoxication or which distorts or

13  disturbs the auditory, visual, or mental processes.  This

14  section does not apply to the possession and use of these

15  substances as part of the care or treatment of a disease or

16  injury by a practitioner licensed under chapter 458, chapter

17  459, part I of chapter 464, or chapter 466 or to beverages

18  controlled by the provisions of chapter 561, chapter 562,

19  chapter 563, chapter 564, or chapter 565.

20         Section 147.  Subsection (6) of section 945.602,

21  Florida Statutes, is amended to read:

22         945.602  State of Florida Correctional Medical

23  Authority; creation; members.--

24         (6)  At least one member of the authority must be a

25  nurse licensed under part I of chapter 464 and have at least 5

26  years' experience in the practice of nursing.

27         Section 148.  Subsection (2) of section 960.28, Florida

28  Statutes, is amended to read:

29         960.28  Payment for victims' initial forensic physical

30  examinations.--

31


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  1         (2)  The Crime Victims' Services Office of the

  2  department shall pay for medical expenses connected with an

  3  initial forensic physical examination of a victim who reports

  4  a violation of chapter 794 or chapter 800 to a law enforcement

  5  officer.  Such payment shall be made regardless of whether or

  6  not the victim is covered by health or disability insurance.

  7  The payment shall be made only out of moneys allocated to the

  8  Crime Victims' Services Office for the purposes of this

  9  section, and the payment may not exceed $250 with respect to

10  any violation. Payment may not be made for an initial forensic

11  physical examination unless the law enforcement officer

12  certifies in writing that the initial forensic physical

13  examination is needed to aid in the investigation of an

14  alleged sexual offense and that the claimant is the alleged

15  victim of the offense. The department shall develop and

16  maintain separate protocols for the initial forensic physical

17  examination of adults and children. Payment under this section

18  is limited to medical expenses connected with the initial

19  forensic physical examination, and payment may be made to a

20  medical provider using an examiner qualified under part I of

21  chapter 464, excluding s. 464.003(5); chapter 458; or chapter

22  459. Payment made to the medical provider by the department

23  shall be considered by the provider as payment in full for the

24  initial forensic physical examination associated with the

25  collection of evidence. The victim may not be required to pay,

26  directly or indirectly, the cost of an initial forensic

27  physical examination performed in accordance with this

28  section.

29         Section 149.  Subsection (36) of section 984.03,

30  Florida Statutes, is amended to read:

31


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  1         984.03  Definitions.--When used in this chapter, the

  2  term:

  3         (36)  "Licensed health care professional" means a

  4  physician licensed under chapter 458, an osteopathic physician

  5  licensed under chapter 459, a nurse licensed under part I of

  6  chapter 464, a physician assistant licensed under chapter 458

  7  or chapter 459, or a dentist licensed under chapter 466.

  8         Section 150.  Subsection (37) of section 985.03,

  9  Florida Statutes, is amended to read:

10         985.03  Definitions.--When used in this chapter, the

11  term:

12         (37)  "Licensed health care professional" means a

13  physician licensed under chapter 458, an osteopathic physician

14  licensed under chapter 459, a nurse licensed under part I of

15  chapter 464, a physician assistant licensed under chapter 458

16  or chapter 459, or a dentist licensed under chapter 466.

17         Section 151.  Section 455.557, Florida Statutes, is

18  amended to read:

19         455.557  Standardized credentialing for health care

20  practitioners.--

21         (1)  INTENT.--The Legislature recognizes that an

22  efficient and effective health care practitioner credentialing

23  program helps to ensure access to quality health care and also

24  recognizes that health care practitioner credentialing

25  activities have increased significantly as a result of health

26  care reform and recent changes in health care delivery and

27  reimbursement systems. Moreover, the resulting duplication of

28  health care practitioner credentialing activities is

29  unnecessarily costly and cumbersome for both the practitioner

30  and the entity granting practice privileges. Therefore, it is

31  the intent of this section that a credentials collection


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  1  program be established which provides that, once a health care

  2  practitioner's core credentials data are collected, they need

  3  not be collected again, except for corrections, updates, and

  4  modifications thereto. Participation under this section shall

  5  initially include those individuals licensed under chapter

  6  458, chapter 459, chapter 460, or chapter 461, or s. 464.012.

  7  However, the department shall, with the approval of the

  8  applicable board, include other professions under the

  9  jurisdiction of the Division of Medical Quality Assurance in

10  this program, provided they meet the requirements of s.

11  455.565 or s. 455.56503.

12         (2)  DEFINITIONS.--As used in this section, the term:

13         (a)  "Advisory council" or "council" means the

14  Credentials Advisory Council.

15         (a)(b)  "Certified" or "accredited," as applicable,

16  means approved by a quality assessment program, from the

17  National Committee for Quality Assurance, the Joint Commission

18  on Accreditation of Healthcare Organizations, the American

19  Accreditation HealthCare Commission/URAC, or any such other

20  nationally recognized and accepted organization authorized by

21  the department, used to assess and certify any credentials

22  verification program, entity, or organization that verifies

23  the credentials of any health care practitioner.

24         (b)(c)  "Core credentials data" means the following

25  data: current name, any former name, and any alias, any

26  professional education, professional training, licensure,

27  current Drug Enforcement Administration certification, social

28  security number, specialty board certification, Educational

29  Commission for Foreign Medical Graduates certification,

30  hospital or other institutional affiliations, evidence of

31  professional liability coverage or evidence of financial


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  1  responsibility as required by s. 458.320, or s. 459.0085, or

  2  s. 455.694, history of claims, suits, judgments, or

  3  settlements, final disciplinary action reported pursuant to s.

  4  455.565(1)(a)8. or s. 455.56503(1)(a)8., and Medicare or

  5  Medicaid sanctions.

  6         (c)(d)  "Credential" or "credentialing" means the

  7  process of assessing and verifying the qualifications of a

  8  licensed health care practitioner or applicant for licensure

  9  as a health care practitioner.

10         (d)(e)  "Credentials verification organization" means

11  any organization certified or accredited as a credentials

12  verification organization.

13         (e)(f)  "Department" means the Department of Health,

14  Division of Medical Quality Assurance.

15         (f)(g)  "Designated credentials verification

16  organization" means the credentials verification organization

17  which is selected by the health care practitioner, if the

18  health care practitioner chooses to make such a designation.

19         (g)(h)  "Drug Enforcement Administration certification"

20  means certification issued by the Drug Enforcement

21  Administration for purposes of administration or prescription

22  of controlled substances. Submission of such certification

23  under this section must include evidence that the

24  certification is current and must also include all current

25  addresses to which the certificate is issued.

26         (h)(i)  "Health care entity" means:

27         1.  Any health care facility or other health care

28  organization licensed or certified to provide approved medical

29  and allied health services in this state;

30         2.  Any entity licensed by the Department of Insurance

31  as a prepaid health care plan or health maintenance


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  1  organization or as an insurer to provide coverage for health

  2  care services through a network of providers; or

  3         3.  Any accredited medical school in this state.

  4         (i)(j)  "Health care practitioner" means any person

  5  licensed, or, for credentialing purposes only, any person

  6  applying for licensure, under chapter 458, chapter 459,

  7  chapter 460, or chapter 461, or s. 464.012 or any person

  8  licensed or applying for licensure under a chapter

  9  subsequently made subject to this section by the department

10  with the approval of the applicable board, except a person

11  registered or applying for registration pursuant to s. 458.345

12  or s. 459.021.

13         (j)(k)  "Hospital or other institutional affiliations"

14  means each hospital or other institution for which the health

15  care practitioner or applicant has provided medical services.

16  Submission of such information under this section must

17  include, for each hospital or other institution, the name and

18  address of the hospital or institution, the staff status of

19  the health care practitioner or applicant at that hospital or

20  institution, and the dates of affiliation with that hospital

21  or institution.

22         (k)(l)  "National accrediting organization" means an

23  organization that awards accreditation or certification to

24  hospitals, managed care organizations, credentials

25  verification organizations, or other health care

26  organizations, including, but not limited to, the Joint

27  Commission on Accreditation of Healthcare Organizations, the

28  American Accreditation HealthCare Commission/URAC, and the

29  National Committee for Quality Assurance.

30

31


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  1         (l)(m)  "Professional training" means any internship,

  2  residency, or fellowship relating to the profession for which

  3  the health care practitioner is licensed or seeking licensure.

  4         (m)(n)  "Specialty board certification" means

  5  certification in a specialty issued by a specialty board

  6  recognized by the board in this state that regulates the

  7  profession for which the health care practitioner is licensed

  8  or seeking licensure.

  9         (3)  STANDARDIZED CREDENTIALS VERIFICATION PROGRAM.--

10         (a)  Every health care practitioner shall:

11         1.  Report all core credentials data to the department

12  which is not already on file with the department, either by

13  designating a credentials verification organization to submit

14  the data or by submitting the data directly.

15         2.  Notify the department within 45 days of any

16  corrections, updates, or modifications to the core credentials

17  data either through his or her designated credentials

18  verification organization or by submitting the data directly.

19  Corrections, updates, and modifications to the core

20  credentials data provided the department under this section

21  shall comply with the updating requirements of s. 455.565(3)

22  or s. 455.56503(3) related to profiling.

23         (b)  The department shall:

24         1.  Maintain a complete, current file of core

25  credentials data on each health care practitioner, which shall

26  include all updates provided in accordance with subparagraph

27  (a)2.

28         2.  Release the core credentials data that is otherwise

29  confidential or exempt from the provisions of chapter 119 and

30  s. 24(a), Art. I of the State Constitution and any

31


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  1  corrections, updates, and modifications thereto, if authorized

  2  by the health care practitioner.

  3         3.  Charge a fee to access the core credentials data,

  4  which may not exceed the actual cost, including prorated setup

  5  and operating costs, pursuant to the requirements of chapter

  6  119. The actual cost shall be set in consultation with the

  7  advisory council.

  8         4.  Develop, in consultation with the advisory council,

  9  standardized forms to be used by the health care practitioner

10  or designated credentials verification organization for the

11  initial reporting of core credentials data, for the health

12  care practitioner to authorize the release of core credentials

13  data, and for the subsequent reporting of corrections,

14  updates, and modifications thereto.

15         5.  Establish a Credentials Advisory Council,

16  consisting of 13 members, to assist the department as provided

17  in this section. The secretary, or his or her designee, shall

18  serve as one member and chair of the council and shall appoint

19  the remaining 12 members. Except for any initial lesser term

20  required to achieve staggering, such appointments shall be for

21  4-year staggered terms, with one 4-year reappointment, as

22  applicable. Three members shall represent hospitals, and two

23  members shall represent health maintenance organizations. One

24  member shall represent health insurance entities. One member

25  shall represent the credentials verification industry. Two

26  members shall represent physicians licensed under chapter 458.

27  One member shall represent osteopathic physicians licensed

28  under chapter 459. One member shall represent chiropractic

29  physicians licensed under chapter 460. One member shall

30  represent podiatric physicians licensed under chapter 461.

31


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  1         (c)  A registered credentials verification organization

  2  may be designated by a health care practitioner to assist the

  3  health care practitioner to comply with the requirements of

  4  subparagraph (a)2. A designated credentials verification

  5  organization shall:

  6         1.  Timely comply with the requirements of subparagraph

  7  (a)2., pursuant to rules adopted by the department.

  8         2.  Not provide the health care practitioner's core

  9  data, including all corrections, updates, and modifications,

10  without the authorization of the practitioner.

11         (d)  This section shall not be construed to restrict in

12  any way the authority of the health care entity to credential

13  and to approve or deny an application for hospital staff

14  membership, clinical privileges, or managed care network

15  participation.

16         (4)  DUPLICATION OF DATA PROHIBITED.--

17         (a)  A health care entity or credentials verification

18  organization is prohibited from collecting or attempting to

19  collect duplicate core credentials data from any health care

20  practitioner if the information is available from the

21  department. This section shall not be construed to restrict

22  the right of any health care entity or credentials

23  verification organization to collect additional information

24  from the health care practitioner which is not included in the

25  core credentials data file. This section shall not be

26  construed to prohibit a health care entity or credentials

27  verification organization from obtaining all necessary

28  attestation and release form signatures and dates.

29         (b)  Effective July 1, 2002, a state agency in this

30  state which credentials health care practitioners may not

31  collect or attempt to collect duplicate core credentials data


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  1  from any individual health care practitioner if the

  2  information is already available from the department. This

  3  section shall not be construed to restrict the right of any

  4  such state agency to request additional information not

  5  included in the core credential data file, but which is deemed

  6  necessary for the agency's specific credentialing purposes.

  7         (5)  STANDARDS AND REGISTRATION.--Any credentials

  8  verification organization that does business in this state

  9  must be fully accredited or certified as a credentials

10  verification organization by a national accrediting

11  organization as specified in paragraph (2)(a)(b) and must

12  register with the department. The department may charge a

13  reasonable registration fee, set in consultation with the

14  advisory council, not to exceed an amount sufficient to cover

15  its actual expenses in providing and enforcing such

16  registration. The department shall establish by rule for

17  biennial renewal of such registration. Failure by a registered

18  credentials verification organization to maintain full

19  accreditation or certification, to provide data as authorized

20  by the health care practitioner, to report to the department

21  changes, updates, and modifications to a health care

22  practitioner's records within the time period specified in

23  subparagraph (3)(a)2., or to comply with the prohibition

24  against collection of duplicate core credentials data from a

25  practitioner may result in denial of an application for

26  renewal of registration or in revocation or suspension of a

27  registration.

28         (6)  LIABILITY.--No civil, criminal, or administrative

29  action may be instituted, and there shall be no liability,

30  against any registered credentials verification organization

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  1  or health care entity on account of its reliance on any data

  2  obtained directly from the department.

  3         (7)  LIABILITY INSURANCE REQUIREMENTS.--Each

  4  credentials verification organization doing business in this

  5  state shall maintain liability insurance appropriate to meet

  6  the certification or accreditation requirements established in

  7  this section.

  8         (8)  RULES.--The department, in consultation with the

  9  advisory council, shall adopt rules necessary to develop and

10  implement the standardized core credentials data collection

11  program established by this section.

12         (9)  COUNCIL ABOLISHED; DEPARTMENT AUTHORITY.--The

13  council shall be abolished October 1, 1999. After the council

14  is abolished, all duties of the department required under this

15  section to be in consultation with the council may be carried

16  out by the department on its own.

17         Section 152.  Section 455.56503, Florida Statutes, is

18  created to read:

19         455.56503  Advanced registered nurse practitioners;

20  information required for certification.--

21         (1)(a)  Each person who applies for initial

22  certification under s. 464.012 must, at the time of

23  application, and each person certified under s. 464.012 who

24  applies for certification renewal must, in conjunction with

25  the renewal of such certification and under procedures adopted

26  by the Department of Health, and in addition to any other

27  information that may be required from the applicant, furnish

28  the following information to the Department of Health:

29         1.  The name of each school or training program that

30  the applicant has attended, with the months and years of

31  attendance and the month and year of graduation, and a


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  1  description of all graduate professional education completed

  2  by the applicant, excluding any coursework taken to satisfy

  3  continuing education requirements.

  4         2.  The name of each location at which the applicant

  5  practices.

  6         3.  The address at which the applicant will primarily

  7  conduct his or her practice.

  8         4.  Any certification or designation that the applicant

  9  has received from a specialty or certification board that is

10  recognized or approved by the regulatory board or department

11  to which the applicant is applying.

12         5.  The year that the applicant received initial

13  certification and began practicing the profession in any

14  jurisdiction and the year that the applicant received initial

15  certification in this state.

16         6.  Any appointment which the applicant currently holds

17  to the faculty of a school related to the profession and an

18  indication as to whether the applicant has had the

19  responsibility for graduate education within the most recent

20  10 years.

21         7.  A description of any criminal offense of which the

22  applicant has been found guilty, regardless of whether

23  adjudication of guilt was withheld, or to which the applicant

24  has pled guilty or nolo contendere. A criminal offense

25  committed in another jurisdiction which would have been a

26  felony or misdemeanor if committed in this state must be

27  reported. If the applicant indicates that a criminal offense

28  is under appeal and submits a copy of the notice for appeal of

29  that criminal offense, the department must state that the

30  criminal offense is under appeal if the criminal offense is

31  reported in the applicant's profile. If the applicant


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  1  indicates to the department that a criminal offense is under

  2  appeal, the applicant must, within 15 days after the

  3  disposition of the appeal, submit to the department a copy of

  4  the final written order of disposition.

  5         8.  A description of any final disciplinary action

  6  taken within the previous 10 years against the applicant by a

  7  licensing or regulatory body in any jurisdiction, by a

  8  specialty board that is recognized by the board or department,

  9  or by a licensed hospital, health maintenance organization,

10  prepaid health clinic, ambulatory surgical center, or nursing

11  home. Disciplinary action includes resignation from or

12  nonrenewal of staff membership or the restriction of

13  privileges at a licensed hospital, health maintenance

14  organization, prepaid health clinic, ambulatory surgical

15  center, or nursing home taken in lieu of or in settlement of a

16  pending disciplinary case related to competence or character.

17  If the applicant indicates that the disciplinary action is

18  under appeal and submits a copy of the document initiating an

19  appeal of the disciplinary action, the department must state

20  that the disciplinary action is under appeal if the

21  disciplinary action is reported in the applicant's profile.

22         (b)  In addition to the information required under

23  paragraph (a), each applicant for initial certification or

24  certification renewal must provide the information required of

25  licensees pursuant to s. 455.697.

26         (2)  The Department of Health shall send a notice to

27  each person certified under s. 464.012 at the

28  certificateholder's last known address of record regarding the

29  requirements for information to be submitted by advanced

30  registered nurse practitioners pursuant to this section in

31  conjunction with the renewal of such certificate.


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  1         (3)  Each person certified under s. 464.012 who has

  2  submitted information pursuant to subsection (1) must update

  3  that information in writing by notifying the Department of

  4  Health within 45 days after the occurrence of an event or the

  5  attainment of a status that is required to be reported by

  6  subsection (1). Failure to comply with the requirements of

  7  this subsection to update and submit information constitutes a

  8  ground for disciplinary action under chapter 464 and s.

  9  455.624(1)(k). For failure to comply with the requirements of

10  this subsection to update and submit information, the

11  department or board, as appropriate, may:

12         (a)  Refuse to issue a certificate to any person

13  applying for initial certification who fails to submit and

14  update the required information.

15         (b)  Issue a citation to any certificateholder who

16  fails to submit and update the required information and may

17  fine the certificateholder up to $50 for each day that the

18  certificateholder is not in compliance with this subsection.

19  The citation must clearly state that the certificateholder may

20  choose, in lieu of accepting the citation, to follow the

21  procedure under s. 455.621. If the certificateholder disputes

22  the matter in the citation, the procedures set forth in s.

23  455.621 must be followed. However, if the certificateholder

24  does not dispute the matter in the citation with the

25  department within 30 days after the citation is served, the

26  citation becomes a final order and constitutes discipline.

27  Service of a citation may be made by personal service or

28  certified mail, restricted delivery, to the subject at the

29  certificateholder's last known address.

30         (4)(a)  An applicant for initial certification under s.

31  464.012 must submit a set of fingerprints to the Department of


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  1  Health on a form and under procedures specified by the

  2  department, along with payment in an amount equal to the costs

  3  incurred by the Department of Health for a national criminal

  4  history check of the applicant.

  5         (b)  An applicant for renewed certification who has not

  6  previously submitted a set of fingerprints to the Department

  7  of Health for purposes of certification must submit a set of

  8  fingerprints to the department as a condition of the initial

  9  renewal of his or her certificate after the effective date of

10  this section. The applicant must submit the fingerprints on a

11  form and under procedures specified by the department, along

12  with payment in an amount equal to the costs incurred by the

13  Department of Health for a national criminal history check.

14  For subsequent renewals, the applicant for renewed

15  certification must only submit information necessary to

16  conduct a statewide criminal history check, along with payment

17  in an amount equal to the costs incurred by the Department of

18  Health for a statewide criminal history check.

19         (c)1.  The Department of Health shall submit the

20  fingerprints provided by an applicant for initial

21  certification to the Florida Department of Law Enforcement for

22  a statewide criminal history check, and the Florida Department

23  of Law Enforcement shall forward the fingerprints to the

24  Federal Bureau of Investigation for a national criminal

25  history check of the applicant.

26         2.  The department shall submit the fingerprints

27  provided by an applicant for the initial renewal of

28  certification to the Florida Department of Law Enforcement for

29  a statewide criminal history check, and the Florida Department

30  of Law Enforcement shall forward the fingerprints to the

31  Federal Bureau of Investigation for a national criminal


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  1  history check for the initial renewal of the applicant's

  2  certificate after the effective date of this section.

  3         3.  For any subsequent renewal of the applicant's

  4  certificate, the department shall submit the required

  5  information for a statewide criminal history check of the

  6  applicant to the Florida Department of Law Enforcement.

  7         (d)  Any applicant for initial certification or renewal

  8  of certification as an advanced registered nurse practitioner

  9  who submits to the Department of Health a set of fingerprints

10  and information required for the criminal history check

11  required under this section shall not be required to provide a

12  subsequent set of fingerprints or other duplicate information

13  required for a criminal history check to the Agency for Health

14  Care Administration, the Department of Juvenile Justice, or

15  the Department of Children and Family Services for employment

16  or licensure with such agency or department, if the applicant

17  has undergone a criminal history check as a condition of

18  initial certification or renewal of certification as an

19  advanced registered nurse practitioner with the Department of

20  Health, notwithstanding any other provision of law to the

21  contrary. In lieu of such duplicate submission, the Agency for

22  Health Care Administration, the Department of Juvenile

23  Justice, and the Department of Children and Family Services

24  shall obtain criminal history information for employment or

25  licensure of persons certified under s. 464.012 by such agency

26  or department from the Department of Health's health care

27  practitioner credentialing system.

28         (5)  Each person who is required to submit information

29  pursuant to this section may submit additional information to

30  the Department of Health. Such information may include, but is

31  not limited to:


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  1         (a)  Information regarding publications in

  2  peer-reviewed professional literature within the previous 10

  3  years.

  4         (b)  Information regarding professional or community

  5  service activities or awards.

  6         (c)  Languages, other than English, used by the

  7  applicant to communicate with patients or clients and

  8  identification of any translating service that may be

  9  available at the place where the applicant primarily conducts

10  his or her practice.

11         (d)  An indication of whether the person participates

12  in the Medicaid program.

13         Section 153.  Section 455.5651, Florida Statutes, is

14  amended to read:

15         455.5651  Practitioner profile; creation.--

16         (1)  Beginning July 1, 1999, the Department of Health

17  shall compile the information submitted pursuant to s. 455.565

18  into a practitioner profile of the applicant submitting the

19  information, except that the Department of Health may develop

20  a format to compile uniformly any information submitted under

21  s. 455.565(4)(b). Beginning July 1, 2001, the Department of

22  Health may compile the information submitted pursuant to s.

23  455.56503 into a practitioner profile of the applicant

24  submitting the information.

25         (2)  On the profile published required under subsection

26  (1), the department shall indicate if the information provided

27  under s. 455.565(1)(a)7. or s. 455.56503(1)(a)7. is not

28  corroborated by a criminal history check conducted according

29  to this subsection. If the information provided under s.

30  455.565(1)(a)7. or s. 455.56503(1)(a)7. is corroborated by the

31  criminal history check, the fact that the criminal history


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  1  check was performed need not be indicated on the profile. The

  2  department, or the board having regulatory authority over the

  3  practitioner acting on behalf of the department, shall

  4  investigate any information received by the department or the

  5  board when it has reasonable grounds to believe that the

  6  practitioner has violated any law that relates to the

  7  practitioner's practice.

  8         (3)  The Department of Health may include in each

  9  practitioner's practitioner profile that criminal information

10  that directly relates to the practitioner's ability to

11  competently practice his or her profession.  The department

12  must include in each practitioner's practitioner profile the

13  following statement:  "The criminal history information, if

14  any exists, may be incomplete; federal criminal history

15  information is not available to the public."

16         (4)  The Department of Health shall include, with

17  respect to a practitioner licensed under chapter 458 or

18  chapter 459, a statement of how the practitioner has elected

19  to comply with the financial responsibility requirements of s.

20  458.320 or s. 459.0085. The department shall include, with

21  respect to practitioners subject to s. 455.694, a statement of

22  how the practitioner has elected to comply with the financial

23  responsibility requirements of that section. The department

24  shall include, with respect to practitioners licensed under

25  chapter 458, chapter 459, or chapter 461, information relating

26  to liability actions which has been reported under s. 455.697

27  or s. 627.912 within the previous 10 years for any paid claim

28  that exceeds $5,000. Such claims information shall be reported

29  in the context of comparing an individual practitioner's

30  claims to the experience of other practitioners physicians

31  within the same specialty, or profession if the practitioner


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  1  is not a specialist, to the extent such information is

  2  available to the Department of Health. If information relating

  3  to a liability action is included in a practitioner's

  4  practitioner profile, the profile must also include the

  5  following statement:  "Settlement of a claim may occur for a

  6  variety of reasons that do not necessarily reflect negatively

  7  on the professional competence or conduct of the practitioner

  8  physician.  A payment in settlement of a medical malpractice

  9  action or claim should not be construed as creating a

10  presumption that medical malpractice has occurred."

11         (5)  The Department of Health may not include

12  disciplinary action taken by a licensed hospital or an

13  ambulatory surgical center in the practitioner profile.

14         (6)  The Department of Health may include in the

15  practitioner's practitioner profile any other information that

16  is a public record of any governmental entity and that relates

17  to a practitioner's ability to competently practice his or her

18  profession.  However, the department must consult with the

19  board having regulatory authority over the practitioner before

20  such information is included in his or her profile.

21         (7)  Upon the completion of a practitioner profile

22  under this section, the Department of Health shall furnish the

23  practitioner who is the subject of the profile a copy of it.

24  The practitioner has a period of 30 days in which to review

25  the profile and to correct any factual inaccuracies in it. The

26  Department of Health shall make the profile available to the

27  public at the end of the 30-day period. The department shall

28  make the profiles available to the public through the World

29  Wide Web and other commonly used means of distribution.

30

31


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  1         (8)  Making a practitioner profile available to the

  2  public under this section does not constitute agency action

  3  for which a hearing under s. 120.57 may be sought.

  4         Section 154.  Section 455.5653, Florida Statutes, is

  5  amended to read:

  6         455.5653  Practitioner profiles; data

  7  storage.--Effective upon this act becoming a law, the

  8  Department of Health must develop or contract for a computer

  9  system to accommodate the new data collection and storage

10  requirements under this act pending the development and

11  operation of a computer system by the Department of Health for

12  handling the collection, input, revision, and update of data

13  submitted by physicians as a part of their initial licensure

14  or renewal to be compiled into individual practitioner

15  profiles. The Department of Health must incorporate any data

16  required by this act into the computer system used in

17  conjunction with the regulation of health care professions

18  under its jurisdiction. The department must develop, by the

19  year 2000, a schedule and procedures for each practitioner

20  within a health care profession regulated within the Division

21  of Medical Quality Assurance to submit relevant information to

22  be compiled into a profile to be made available to the public.

23  The Department of Health is authorized to contract with and

24  negotiate any interagency agreement necessary to develop and

25  implement the practitioner profiles. The Department of Health

26  shall have access to any information or record maintained by

27  the Agency for Health Care Administration, including any

28  information or record that is otherwise confidential and

29  exempt from the provisions of chapter 119 and s. 24(a), Art. I

30  of the State Constitution, so that the Department of Health

31


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  1  may corroborate any information that practitioners physicians

  2  are required to report under s. 455.565 or s. 455.56503.

  3         Section 155.  Section 455.5654, Florida Statutes, is

  4  amended to read:

  5         455.5654  Practitioner profiles; rules;

  6  workshops.--Effective upon this act becoming a law, the

  7  Department of Health shall adopt rules for the form of a

  8  practitioner profile that the agency is required to prepare.

  9  The Department of Health, pursuant to chapter 120, must hold

10  public workshops for purposes of rule development to implement

11  this section. An agency to which information is to be

12  submitted under this act may adopt by rule a form for the

13  submission of the information required under s. 455.565 or s.

14  455.56503.

15         Section 156.  Subsection (20) of section 400.462,

16  Florida Statutes, is repealed.

17         Section 157.  Paragraph (d) of subsection (4) of

18  section 400.471, Florida Statutes, is amended to read:

19         400.471  Application for license; fee; provisional

20  license; temporary permit.--

21         (4)  Each applicant for licensure must comply with the

22  following requirements:

23         (d)  A provisional license may be granted to an

24  applicant when each individual required by this section to

25  undergo background screening has met the standards for the

26  abuse registry background check through the agency and the

27  Department of Law Enforcement background check, but the agency

28  has not yet received background screening results from the

29  Federal Bureau of Investigation. A standard license may be

30  granted to the licensee upon the agency's receipt of a report

31  of the results of the Federal Bureau of Investigation


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  1  background screening for each individual required by this

  2  section to undergo background screening which confirms that

  3  all standards have been met, or upon the granting of a

  4  disqualification exemption by the agency as set forth in

  5  chapter 435. Any other person who is required to undergo level

  6  2 background screening may serve in his or her capacity

  7  pending the agency's receipt of the report from the Federal

  8  Bureau of Investigation. However, the person may not continue

  9  to serve if the report indicates any violation of background

10  screening standards and a disqualification exemption has not

11  been requested of and granted by the agency as set forth in

12  chapter 435.

13         Section 158.  Subsection (3) is added to section

14  400.484, Florida Statutes, to read:

15         400.484  Right of inspection; deficiencies; fines.--

16         (3)  In addition to any other penalties imposed

17  pursuant to this section or part, the agency may assess costs

18  related to an investigation that results in a successful

19  prosecution, excluding costs associated with an attorney's

20  time.

21         Section 159.  Section 400.487, Florida Statutes, is

22  amended to read:

23         400.487  Home health service agreements; physician's

24  treatment orders; patient assessment; establishment and review

25  of plan of care; provision of services; orders not to

26  resuscitate.--

27         (1)  Services provided by a home health agency must be

28  covered by an agreement between the home health agency and the

29  patient or the patient's legal representative specifying the

30  home health services to be provided, the rates or charges for

31  services paid with private funds, and the method of payment. A


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  1  The home health agency providing skilled care must make an

  2  assessment of the patient's needs within 48 hours after the

  3  start of services.

  4         (2)  When required by the provisions of chapter 464,

  5  part I, part III, or part V of chapter 468, or chapter 486,

  6  the attending physician for a patient who is to receive

  7  skilled care must establish treatment orders. The treatment

  8  orders must be signed by the physician within 30 24 days after

  9  the start of care and must be reviewed, as at least every 62

10  days or more frequently as if the patient's illness requires,

11  by the physician in consultation with home health agency

12  personnel that provide services to the patient.

13         (3)  A home health agency shall arrange for supervisory

14  visits by a registered nurse to the home of a patient

15  receiving home health aide services in accordance with the

16  patient's direction and approval. If a client is accepted for

17  home health aide services or homemaker or companion services

18  and such services do not require a physician's order, the home

19  health agency shall establish a service provision plan and

20  maintain a record of the services provided.

21         (4)  Each patient or client has the right to be

22  informed of and to participate in the planning of his or her

23  care. Each patient must be provided, upon request, a copy of

24  the plan of care or service provision plan established and

25  maintained for that patient or client by the home health

26  agency.

27         (5)  When nursing services are ordered, the home health

28  agency to which a patient has been admitted for care must

29  provide the initial admission visit, all service evaluation

30  visits, and the discharge visit by qualified personnel who are

31  on the payroll of, and to whom an IRS payroll form W-2 will be


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  1  issued by, the home health agency. Services provided by others

  2  under contractual arrangements to a home health agency must be

  3  monitored and managed by the admitting home health agency. The

  4  admitting home health agency is fully responsible for ensuring

  5  that all care provided through its employees or contract staff

  6  is delivered in accordance with this part and applicable

  7  rules.

  8         (6)  The skilled care services provided by a home

  9  health agency, directly or under contract, must be supervised

10  and coordinated in accordance with the plan of care.

11         (7)  Home health agency personnel may withhold or

12  withdraw cardiopulmonary resuscitation if presented with an

13  order not to resuscitate executed pursuant to s. 401.45. The

14  agency shall adopt rules providing for the implementation of

15  such orders. Home health personnel and agencies shall not be

16  subject to criminal prosecution or civil liability, nor be

17  considered to have engaged in negligent or unprofessional

18  conduct, for withholding or withdrawing cardiopulmonary

19  resuscitation pursuant to such an order and rules adopted by

20  the agency.

21         Section 160.  Section 400.497, Florida Statutes, is

22  amended to read:

23         400.497  Rules establishing minimum standards.--The

24  agency shall adopt, publish, and enforce rules to implement

25  this part, including, as applicable, ss. 400.506 and 400.509,

26  which must provide reasonable and fair minimum standards

27  relating to:

28         (1)  The home health aide competency test and home

29  health aide training. The qualifications, minimum training

30  requirements, and supervision requirements of all home health

31  agency personnel. The agency shall create the home health aide


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  1  competency test and establish the curriculum and instructor

  2  qualifications for home health aide training. Licensed home

  3  health agencies may provide this training and shall furnish

  4  documentation of such training to other licensed home health

  5  agencies upon request. Successful passage of the competency

  6  test by home health aides may be substituted for the training

  7  required under this section and any rule adopted pursuant

  8  thereto.

  9         (2)  Shared staffing. The agency shall allow shared

10  staffing if the home health agency is part of a retirement

11  community that provides multiple levels of care, is located on

12  one campus, is licensed under this chapter, and otherwise

13  meets the requirements of law and rule.

14         (2)  Requirements for prospective employees.  A home

15  health agency must require prospective employees and

16  contractors to submit an employment or contractual history,

17  and it must verify the employment or contractual history

18  unless through diligent efforts such verification is not

19  possible.  The agency shall prescribe by rule the minimum

20  requirements for establishing that diligent efforts have been

21  made. There is no monetary liability on the part of, and no

22  cause of action for damages arising against, a former employer

23  of a prospective employee of or prospective independent

24  contractor with a licensed home health agency who reasonably

25  and in good faith communicates his or her honest opinions

26  about the former employee's job performance. This subsection

27  does not affect the official immunity of an officer or

28  employee of a public corporation.

29         (3)  The criteria for the frequency of onsite licensure

30  surveys.

31         (4)(3)  Licensure application and renewal.


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  1         (5)(4)  The administration of the home health agency,

  2  including requirements for onsite and electronic accessibility

  3  of supervisory personnel of home health agencies.

  4         (5)  Procedures for administering drugs and

  5  biologicals.

  6         (6)  Information to be included in Procedures for

  7  maintaining patients' records.

  8         (7)  Ensuring that home health services are provided in

  9  accordance with the treatment orders established for each

10  patient for whom physician orders are required.

11         (7)(8)  Geographic service areas.

12         (9)  Standards for contractual arrangements for the

13  provision of home health services by providers not employed by

14  the home health agency to whom the patient has been admitted.

15         Section 161.  Paragraph (d) of subsection (2) and

16  subsection (13) of section 400.506, Florida Statutes, are

17  amended, subsection (17) is renumbered as subsection (18), and

18  a new subsection (17) is added to said section, to read:

19         400.506  Licensure of nurse registries; requirements;

20  penalties.--

21         (2)  Each applicant for licensure must comply with the

22  following requirements:

23         (d)  A provisional license may be granted to an

24  applicant when each individual required by this section to

25  undergo background screening has met the standards for the

26  abuse registry background check through the agency and the

27  Department of Law Enforcement background check, but the agency

28  has not yet received background screening results from the

29  Federal Bureau of Investigation. A standard license may be

30  granted to the applicant upon the agency's receipt of a report

31  of the results of the Federal Bureau of Investigation


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  1  background screening for each individual required by this

  2  section to undergo background screening which confirms that

  3  all standards have been met, or upon the granting of a

  4  disqualification exemption by the agency as set forth in

  5  chapter 435. Any other person who is required to undergo level

  6  2 background screening may serve in his or her capacity

  7  pending the agency's receipt of the report from the Federal

  8  Bureau of Investigation. However, the person may not continue

  9  to serve if the report indicates any violation of background

10  screening standards and a disqualification exemption has not

11  been requested of and granted by the agency as set forth in

12  chapter 435.

13         (13)  Each nurse registry must comply with the

14  procedures set forth in s. 400.512 400.497(3) for maintaining

15  records of the employment history of all persons referred for

16  contract and is subject to the standards and conditions set

17  forth in that section s. 400.512. However, an initial

18  screening may not be required for persons who have been

19  continuously registered with the nurse registry since

20  September 30, 1990.

21         (17)  In addition to any other penalties imposed

22  pursuant to this section or part, the agency may assess costs

23  related to an investigation that results in a successful

24  prosecution, excluding costs associated with an attorney's

25  time. If the agency imposes such an assessment and the

26  assessment is not paid, and if challenged is not the subject

27  of a pending appeal, prior to the renewal of the license, the

28  license shall not be issued until the assessment is paid or

29  arrangements for payment of the assessment are made.

30         Section 162.  Paragraph (d) of subsection (4) of

31  section 400.509, Florida Statutes, is amended, subsection (14)


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  1  is renumbered as subsection (15), and a new subsection (14) is

  2  added to said section, to read:

  3         400.509  Registration of particular service providers

  4  exempt from licensure; certificate of registration; regulation

  5  of registrants.--

  6         (4)  Each applicant for registration must comply with

  7  the following requirements:

  8         (d)  A provisional registration may be granted to an

  9  applicant when each individual required by this section to

10  undergo background screening has met the standards for the

11  abuse-registry background check through the agency and the

12  Department of Law Enforcement background check, but the agency

13  has not yet received background screening results from the

14  Federal Bureau of Investigation.  A standard registration may

15  be granted to the applicant upon the agency's receipt of a

16  report of the results of the Federal Bureau of Investigation

17  background screening for each individual required by this

18  section to undergo background screening which confirms that

19  all standards have been met, or upon the granting of a

20  disqualification exemption by the agency as set forth in

21  chapter 435.  Any other person who is required to undergo

22  level 2 background screening may serve in his or her capacity

23  pending the agency's receipt of the report from the Federal

24  Bureau of Investigation.  However, the person may not continue

25  to serve if the report indicates any violation of background

26  screening standards and if a disqualification exemption has

27  not been requested of and granted by the agency as set forth

28  in chapter 435.

29         (14)  In addition to any other penalties imposed

30  pursuant to this section or part, the agency may assess costs

31  related to an investigation that results in a successful


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  1  prosecution, excluding costs associated with an attorney's

  2  time. If the agency imposes such an assessment and the

  3  assessment is not paid, and if challenged is not the subject

  4  of a pending appeal, prior to the renewal of the registration,

  5  the registration shall not be issued until the assessment is

  6  paid or arrangements for payment of the assessment are made.

  7         Section 163.  Section 400.512, Florida Statutes, is

  8  amended to read:

  9         400.512  Screening of home health agency personnel;

10  nurse registry personnel; and companions and homemakers.--The

11  agency shall require employment or contractor screening as

12  provided in chapter 435, using the level 1 standards for

13  screening set forth in that chapter, for home health agency

14  personnel; persons referred for employment by nurse

15  registries; and persons employed by companion or homemaker

16  services registered under s. 400.509.

17         (1)  The agency may grant exemptions from

18  disqualification from employment or contracting under this

19  section as provided in s. 435.07.

20         (2)  The administrator of each home health agency, the

21  managing employee of each nurse registry, and the managing

22  employee of each companion or homemaker service registered

23  under s. 400.509 must sign an affidavit annually, under

24  penalty of perjury, stating that all personnel hired,

25  contracted with, or registered on or after October 1, 1994,

26  who enter the home of a patient or client in their service

27  capacity have been screened and that its remaining personnel

28  have worked for the home health agency or registrant

29  continuously since before October 1, 1994.

30         (3)  As a prerequisite to operating as a home health

31  agency, nurse registry, or companion or homemaker service


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  1  under s. 400.509, the administrator or managing employee,

  2  respectively, must submit to the agency his or her name and

  3  any other information necessary to conduct a complete

  4  screening according to this section.  The agency shall submit

  5  the information to the Department of Law Enforcement and shall

  6  conduct a search for any report of confirmed abuse the

  7  department's abuse hotline for state processing.  The agency

  8  shall review the record of the administrator or manager with

  9  respect to the offenses specified in this section and shall

10  notify the owner of its findings.  If disposition information

11  is missing on a criminal record, the administrator or manager,

12  upon request of the agency, must obtain and supply within 30

13  days the missing disposition information to the agency.

14  Failure to supply missing information within 30 days or to

15  show reasonable efforts to obtain such information will result

16  in automatic disqualification.

17         (4)  Proof of compliance with the screening

18  requirements of chapter 435 shall be accepted in lieu of the

19  requirements of this section if the person has been

20  continuously employed or registered without a breach in

21  service that exceeds 180 days, the proof of compliance is not

22  more than 2 years old, and the person has been screened

23  through the agency for any reports of confirmed abuse central

24  abuse registry and tracking system of the department and for

25  any criminal record from by the Department of Law Enforcement.

26  A home health agency, nurse registry, or companion or

27  homemaker service registered under s. 400.509 shall directly

28  provide proof of compliance to another home health agency,

29  nurse registry, or companion or homemaker service registered

30  under s. 400.509. The recipient home health agency, nurse

31  registry, or companion or homemaker service registered under


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  1  s. 400.509 may not accept any proof of compliance directly

  2  from the person who requires screening. Proof of compliance

  3  with the screening requirements of this section shall be

  4  provided upon request to the person screened by the home

  5  health agencies; nurse registries; or companion or homemaker

  6  services registered under s. 400.509.

  7         (5)(a)  There is no monetary liability on the part of,

  8  and no cause of action for damages arises against, a licensed

  9  home health agency, licensed nurse registry, or companion or

10  homemaker service registered under s. 400.509, that, upon

11  notice of a confirmed report of adult abuse, neglect, or

12  exploitation through the agency, terminates the employee or

13  contractor against whom the report was issued, whether or not

14  the employee or contractor has filed for an exemption with the

15  agency in accordance with chapter 435 and whether or not the

16  time for filing has expired.

17         (b)  If a home health agency is asked about a person

18  who was employed by or contracted with that agency, there is

19  no monetary liability on the part of, and no cause of action

20  for damages arising against, a former employer of the person

21  for that agency, who reasonably and in good faith communicates

22  his or her honest opinions about the former caregiver's job

23  performance. This paragraph does not affect the official

24  immunity of an officer or employee of a public corporation.

25         (6)  The costs of processing the statewide

26  correspondence criminal records checks and the search of the

27  department's central abuse hotline must be borne by the home

28  health agency; the nurse registry; or the companion or

29  homemaker service registered under s. 400.509, or by the

30  person being screened, at the discretion of the home health

31  agency, nurse registry, or s. 400.509 registrant.


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  1         (7)(a)  It is a misdemeanor of the first degree,

  2  punishable under s. 775.082 or s. 775.083, for any person

  3  willfully, knowingly, or intentionally to:

  4         1.  Fail, by false statement, misrepresentation,

  5  impersonation, or other fraudulent means, to disclose in any

  6  application for voluntary or paid employment a material fact

  7  used in making a determination as to such person's

  8  qualifications to be an employee under this section;

  9         2.  Operate or attempt to operate an entity licensed or

10  registered under this part with persons who do not meet the

11  minimum standards for good moral character as contained in

12  this section; or

13         3.  Use information from the criminal records or the

14  agency's reports of confirmed abuse central abuse hotline

15  obtained under this section for any purpose other than

16  screening that person for employment as specified in this

17  section or release such information to any other person for

18  any purpose other than screening for employment under this

19  section.

20         (b)  It is a felony of the third degree, punishable

21  under s. 775.082, s. 775.083, or s. 775.084, for any person

22  willfully, knowingly, or intentionally to use information from

23  the juvenile records of a person obtained under this section

24  for any purpose other than screening for employment under this

25  section.

26         Section 164.  Subsection (5) of section 455.587,

27  Florida Statutes, is amended to read:

28         455.587  Fees; receipts; disposition.--

29         (5)  All moneys collected by the department from fees

30  or fines or from costs awarded to the agency by a court shall

31  be paid into a trust fund used by the department to implement


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  1  this part. The Legislature shall appropriate funds from this

  2  trust fund sufficient to carry out this part and the

  3  provisions of law with respect to professions regulated by the

  4  Division of Medical Quality Assurance within the department

  5  and the boards.  The department may contract with public and

  6  private entities to receive and deposit revenue pursuant to

  7  this section.  The department shall maintain separate accounts

  8  in the trust fund used by the department to implement this

  9  part for every profession within the department.  To the

10  maximum extent possible, the department shall directly charge

11  all expenses to the account of each regulated profession.  For

12  the purpose of this subsection, direct charge expenses

13  include, but are not limited to, costs for investigations,

14  examinations, and legal services.  For expenses that cannot be

15  charged directly, the department shall provide for the

16  proportionate allocation among the accounts of expenses

17  incurred by the department in the performance of its duties

18  with respect to each regulated profession. The regulation by

19  the department of professions, as defined in this part, shall

20  be financed solely from revenue collected by it from fees and

21  other charges and deposited in the Medical Quality Assurance

22  Trust Fund, and all such revenue is hereby appropriated to the

23  department. However, it is legislative intent that each

24  profession shall operate within its anticipated fees. The

25  department may not expend funds from the account of a

26  profession to pay for the expenses incurred on behalf of

27  another profession, except that the Board of Nursing must pay

28  for any costs incurred in the regulation of certified nursing

29  assistants. The department shall maintain adequate records to

30  support its allocation of agency expenses.  The department

31  shall provide any board with reasonable access to these


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  1  records upon request.  The department shall provide each board

  2  an annual report of revenue and direct and allocated expenses

  3  related to the operation of that profession. The board shall

  4  use these reports and the department's adopted long-range plan

  5  to determine the amount of license fees.  A condensed version

  6  of this information, with the department's recommendations,

  7  shall be included in the annual report to the Legislature

  8  prepared under s. 455.644.

  9         Section 165.  There is appropriated from the Medical

10  Quality Assurance Trust Fund to the Department of Health the

11  sum of $280,000 to implement the provisions of this act.

12         Section 166.  Subsection (2) of section 766.106,

13  Florida Statutes, is amended to read:

14         766.106  Notice before filing action for medical

15  malpractice; presuit screening period; offers for admission of

16  liability and for arbitration; informal discovery; review.--

17         (2)  After completion of presuit investigation pursuant

18  to s. 766.203 and prior to filing a claim for medical

19  malpractice, a claimant shall notify each prospective

20  defendant and, if any prospective defendant is a health care

21  provider licensed under chapter 458, chapter 459, chapter 460,

22  chapter 461, or chapter 466, the Department of Health by

23  certified mail, return receipt requested, of intent to

24  initiate litigation for medical malpractice. Following the

25  initiation of a suit alleging medical malpractice with a court

26  of competent jurisdiction, and service of the complaint upon a

27  defendant, the claimant shall provide a copy of the complaint

28  to the Department of Health. Notice to the Department of

29  Health must include the full name and address of the claimant;

30  the full names and any known addresses of any health care

31  providers licensed under chapter 458, chapter 459, chapter


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  1  460, chapter 461, or chapter 466 who are prospective

  2  defendants identified at the time; the date and a summary of

  3  the occurrence giving rise to the claim; and a description of

  4  the injury to the claimant. The requirement of providing the

  5  complaint for notice to the Department of Health does not

  6  impair the claimant's legal rights or ability to seek relief

  7  for his or her claim, and the notice provided to the

  8  department is not discoverable or admissible in any civil or

  9  administrative action. The Department of Health shall review

10  each incident and determine whether it involved conduct by a

11  licensee which is potentially subject to disciplinary action,

12  in which case the provisions of s. 455.621 apply.

13         Section 167.  The Agency for Health Care Administration

14  is directed to conduct a cost and feasibility study regarding

15  the implementation of the federal "Ticket to Work and Work

16  Incentives Act of 1999" in Florida and to report its findings

17  to the Speaker of the House of Representatives and the

18  President of the Senate no later than December 1, 2000.

19         Section 168.  Subsection (11) of section 240.241,

20  Florida Statutes, is amended to read:

21         240.241  Divisions of sponsored research at state

22  universities.--

23         (11)  The sponsored research programs of the Institute

24  of Food and Agricultural Sciences, the University of Florida

25  Health Science Center, and the engineering and industrial

26  experiment station shall continue to be centered at the

27  University of Florida as heretofore provided by law. Indirect

28  cost reimbursements of all grants deposited in the Division of

29  Sponsored Research shall be distributed directly to the above

30  units in direct proportion to the amounts earned by each unit.

31


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  1         Section 169.  The Agency for Health Care Administration

  2  is authorized to contract with specialty prepaid health plans

  3  and pay them on a prepaid capitated basis to provide Medicaid

  4  benefits to Medicaid-eligible recipients who have human

  5  immunodeficiency syndrome (HIV) or acquired immunodeficiency

  6  syndrome (AIDS). The agency shall apply for and is authorized

  7  to implement federal waivers or other necessary federal

  8  authorization to implement the prepaid health plans authorized

  9  by this section. The agency shall procure the specialty

10  prepaid health plans through a competitive procurement. In

11  awarding a contract to a managed care plan, the agency shall

12  take into account price, quality, accessibility, linkages to

13  community-based organizations, and the comprehensiveness of

14  the benefit package offered by the plan. The agency may bid

15  the HIV/AIDS specialty plans on a county, regional, or

16  statewide basis. Qualified plans must be licensed under

17  chapter 641, Florida Statutes. The agency shall monitor and

18  evaluate the implementation of this waiver program if it is

19  approved by the Federal Government and shall report on its

20  status to the President of the Senate and the Speaker of the

21  House of Representatives by February 1, 2001.

22         Section 170.  Except as otherwise provided in this act,

23  this act shall take effect July 1, 2000.

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25

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