Bill Text: FL H1263 | 2010 | Regular Session | Introduced

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Bill Title: Health Care

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2010-04-30 - Died in Committee on Health Care Regulation Policy (HFPC) [H1263 Detail]

Download: Florida-2010-H1263-Introduced.html

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HB 1263

1	A bill to be entitled
2	An act relating to health care; amending s. 400.990, F.S.;
3	providing additional legislative findings; amending s.
4	400.9905, F.S.; redefining the term "clinic" for purposes
5	of the Health Care Clinic Act to include certain
6	additional providers; defining the terms "fraud" and
7	"infusion therapy"; defining the term "specialty clinic,"
8	to include certain facilities owned by publicly traded
9	corporations excluded by the definition of the term
10	"clinic"; amending s. 400.991, F.S.; requiring specialty
11	clinics to be subject to licensure requirements; requiring
12	additional persons to be subject to background screening;
13	revising certain requirements for applying for licensure
14	as a health care clinic; creating additional requirements
15	for applying for licensure as a specialty clinic; creating
16	s. 400.9914, F.S.; providing additional grounds under
17	which the Agency for Health Care Administration is
18	required to deny or revoke a license due to a finding of
19	guilt for committing a felony; providing grounds for the
20	denial of specialty clinic licensure; amending s.
21	400.9915, F.S.; providing additional grounds for an
22	emergency suspension of a license; creating s. 400.9921,
23	F.S.; providing additional requirements for license
24	renewal and transfer of ownership; amending s. 400.9925,
25	F.S.; authorizing the agency to adopt rules for the
26	administration and licensing of specialty clinics;
27	amending s. 400.993, F.S.; including specialty clinics
28	within provisions regarding the reporting of unlicensed
29	clinics; amending s. 400.9935, F.S.; including specialty
30	clinics within provisions specifying clinic
31	responsibilities; revising the responsibilities of the
32	medical director and the clinical director; requiring all
33	persons providing health care services to individuals in a
34	specialty clinic to comply with the licensure laws and
35	rules under which that person is licensed; providing for a
36	certificate of exemption from licensure as a clinic to
37	expire within a specified period; providing the
38	application procedures for a certificate of exemption;
39	providing a fee; providing for renewal of the certificate
40	of exemption; providing that it is a third-degree felony
41	for an applicant to submit fraudulent or material and
42	misleading information to the agency; providing grounds
43	for the denial, withdrawal, or emergency suspension of a
44	certificate of exemption by the Agency for Health Care
45	Administration; requiring specialty clinics to display
46	signs containing certain information relating to insurance
47	fraud; authorizing compliance inspections by the Division
48	of Insurance Fraud; requiring clinics to allow inspection
49	access; requiring a specialty clinic to file an audited
50	report; providing requirements for the audited report;
51	requiring a specialty clinic to maintain compliance with
52	part X of ch. 400, F.S.; amending s. 400.995, F.S.;
53	authorizing the agency to impose administrative penalties
54	against a specialty clinic; authorizing the agency to
55	request a plan of corrective action from the clinic or
56	specialty clinic; creating s. 400.996, F.S.; creating a
57	process whereby the agency receives, documents, and
58	processes complaints about specialty clinics; requiring
59	the agency to request that complaints regarding billing
60	fraud by a specialty clinic be made by sworn affidavit;
61	requiring the agency to refer to the Office of Fiscal
62	Integrity within the Department of Financial Services any
63	sworn affidavit asserting billing fraud by a specialty
64	clinic; requiring the department to report findings
65	regarding billing fraud by a specialty clinic to the
66	agency; requiring the department to refer an investigation
67	to prosecutorial authorities and provide investigative
68	assistance under certain circumstances; providing that it
69	is a first-degree misdemeanor to submit an affidavit
70	asserting billing fraud by a specialty clinic which is
71	without any factual basis; allowing the department to
72	conduct unannounced reviews, investigations, analyses, and
73	audits to investigate complaints of billing fraud by a
74	specialty clinic; authorizing the department to enter upon
75	the premises of a specialty clinic and immediately secure
76	copies of certain documents; requiring a specialty clinic
77	to allow full and immediate access to the premises and
78	records of the clinic to a department officer or employee
79	under s. 400.996, F.S.; providing that failure to provide
80	such access is a ground for emergency suspension of the
81	license of the specialty clinic; permitting the agency to
82	assess a fee against a specialty clinic equal to the cost
83	of conducting a review, investigation, analysis, or audit
84	performed by the agency or the department; providing that
85	all investigators designated by the Chief Financial
86	Officer to perform duties under part X of ch. 400, F.S.,
87	and certified under s. 943.1395, F.S., are law enforcement
88	officers of the state; amending s. 408.802, F.S.;
89	providing that specialty clinics are subject to part X of
90	ch. 400, F.S.; amending s. 408.820, F.S.; providing that
91	specialty clinics are exempt from s. 408.810(6), (7), and
92	(10), F.S.; amending s. 456.072, F.S.; providing that
93	intentionally placing false information in an application
94	for a certificate of exemption from clinic licensure
95	constitutes grounds for disciplinary action; amending ss.
96	627.732 and 627.736, F.S.; conforming cross-references;
97	designating the Florida Center for Nursing as the "Florida
98	Barbara B. Lumpkin Center for Nursing"; directing the
99	Department of Health to erect suitable markers;
100	authorizing additional positions and providing an
101	appropriation; providing an effective date.
102
103	Be It Enacted by the Legislature of the State of Florida:
104
105	Section 1. Section 400.990, Florida Statutes, is amended
106	to read:
107	400.990 Short title; legislative findings.-
108	(1) This part, consisting of ss. 400.990-400.996 ss.
109	400.990-400.995, may be cited as the "Health Care Clinic Act."
110	(2) The Legislature finds that the regulation of health
111	care clinics must be strengthened to prevent significant cost
112	and harm to consumers.
113	(3) The Legislature further finds the additional
114	regulation of specialty health care clinics is necessary to
115	prevent significant fraudulent practices in the provision of
116	infusion therapy services in this state.
117	(4) The purpose of this part is to provide for the
118	licensure, establishment, and enforcement of basic standards for
119	health care clinics and to provide administrative oversight by
120	the Agency for Health Care Administration.
121	Section 2. Subsections (5) through (7) of section
122	400.9905, Florida Statutes, are renumbered as subsections (7)
123	through (9), respectively, paragraphs (f), (g), and (l) of
124	subsection (4) are amended, new subsections (5), (6), and (10)
125	are added to that section, to read:
126	400.9905 Definitions.-
127	(4) "Clinic" means an entity at which health care services
128	are provided to individuals and which tenders charges for
129	reimbursement for such services, including a mobile clinic and a
130	portable equipment provider. For purposes of this part, the term
131	does not include and the licensure requirements of this part do
132	not apply to:
133	(f) A sole proprietorship, group practice, partnership, or
134	corporation, or other legal entity that provides health care
135	services by physicians and physician assistants licensed under
136	chapter 458, chapter 459, chapter 460, chapter 461, or chapter
137	466 covered by s. 627.419, that is directly supervised by one or
138	more of such physicians or physician assistants, and that is
139	wholly owned by one or more of those physicians or physician
140	assistants or by a physician or physician assistant and the
141	spouse, parent, child, or sibling of that physician or physician
142	assistant.
143	(g) A sole proprietorship, group practice, partnership, or
144	corporation, or other legal entity that provides health care
145	services by licensed health care practitioners under chapter
146	457, chapter 458, chapter 459, chapter 460, chapter 461, chapter
147	462, chapter 463, chapter 466, chapter 467, chapter 480, chapter
148	484, chapter 486, chapter 490, chapter 491, or part I, part III,
149	part X, part XIII, or part XIV of chapter 468, or s. 464.012,
150	which entities are wholly owned by one or more licensed health
151	care practitioners, or the licensed health care practitioners
152	set forth in this paragraph and the spouse, parent, child, or
153	sibling of a licensed health care practitioner, so long as one
154	of the owners who is a licensed health care practitioner is
155	supervising the health care services business activities and is
156	legally responsible for the entity's compliance with all federal
157	and state laws. However, the a health care services provided may
158	not exceed the scope of the licensed owner's health care
159	practitioner may not supervise services beyond the scope of the
160	practitioner's license, except that, for the purposes of this
161	part, a clinic owned by a licensee in s. 456.053(3)(b) that
162	provides only services authorized pursuant to s. 456.053(3)(b)
163	may be supervised by a licensee specified in s. 456.053(3)(b).
164	(l) Orthotic or prosthetic Clinical facilities that are a
165	publicly traded corporation or that are wholly owned, directly
166	or indirectly, by a publicly traded corporation. As used in this
167	paragraph, a publicly traded corporation is a corporation that
168	issues securities traded on an exchange registered with the
169	United States Securities and Exchange Commission as a national
170	securities exchange.
171	(5) "Fraud" means deception or misrepresentation made by a
172	person or business entity with the intent that the deception
173	will likely result in an unauthorized benefit to that person or
174	business entity or to another person. The term includes any act
175	that constitutes fraud under applicable federal or state law.
176	(6) "Infusion therapy" includes, but is not limited to,
177	the therapeutic infusion of substances into, or injection of
178	substances through, the venous peripheral system and consists of
179	activities that include observing, initiating, monitoring,
180	discontinuing, maintaining, regulating, adjusting, documenting,
181	planning, intervening, and evaluating. The term includes the
182	administration of nutrition, antibiotic therapy, and fluid and
183	electrolyte repletion.
184	(10) "Specialty clinic" means a clinic, as defined in
185	subsection (4), and includes those entities exempt under
186	subsection (4) that are not licensed as a home health agency
187	that provides infusion therapy services to treat conditions
188	caused by or related to HIV or AIDS to outpatients who remain
189	less than 24 hours at the facility or to patients who receive
190	such services where they reside. The term does not include:
191	(a) Entities licensed under part II or part III;
192	(b) Entities licensed under part IV that provide infusion
193	therapy to patients only in the home or residence of the
194	patient; or
195	(c) Entities licensed under chapter 395.
196	Section 3. Section 400.991, Florida Statutes, is amended
197	to read:
198	400.991 License requirements; background screenings;
199	prohibitions.-
200	(1)(a) The requirements of part II of chapter 408 apply to
201	the provision of services that require licensure pursuant to
202	this part and part II of chapter 408 and to entities licensed by
203	or applying for such licensure from the agency pursuant to this
204	part. A license issued by the agency is required in order to
205	operate a clinic or a specialty clinic in this state. Each
206	clinic and specialty clinic location shall be licensed
207	separately regardless of whether the clinic or specialty clinic
208	is operated under the same business name or management as
209	another clinic or specialty clinic.
210	(b) Each mobile clinic and specialty clinic must obtain a
211	separate health care clinic license and must provide to the
212	agency, at least quarterly, its projected street location to
213	enable the agency to locate and inspect such clinic or specialty
214	clinic. A portable equipment provider must obtain a health care
215	clinic license for a single administrative office and is not
216	required to submit quarterly projected street locations.
217	(c) A specialty clinic operating without a specialty
218	clinic license on or before January 1, 2011, shall be given
219	until July 2, 2011, to obtain a specialty clinic license.
220	(2) The initial clinic license application and the initial
221	specialty clinic license application shall be filed with the
222	agency by all clinics, as defined in s. 400.9905, on or before
223	July 1, 2004. A clinic license and a specialty clinic license
224	must be renewed biennially.
225	(3)(a) The application shall contain information that
226	includes, but is need not be limited to, information pertaining
227	to the name, residence and business address, phone number,
228	social security number, and license number of the medical or
229	clinic director of the licensed medical providers employed or
230	under contract with the clinic.
231	(b) Any person or entity that has a pecuniary interest in
232	a clinic who may or may not own stock or an equivalent interest
233	in the clinic, but who has control over, or the authority to
234	approve, directly or indirectly, clinic billing, policy,
235	business activities, or personnel decisions, including, but not
236	limited to, contracted or employed third-party billing persons
237	or entities, managers, management companies, and persons and
238	entities that, directly or indirectly, lend, give, or make a
239	gift of money of any denomination or anything of value exceeding
240	an aggregate of $5,000 for clinic use, with or without an
241	expectation of a return of the money or thing of value and
242	regardless of profit motive, is subject to background screening
243	requirements under this part.
244	(c) The agency may adopt rules to administer this
245	subsection.
246	(4) An application for a specialty clinic must contain, in
247	addition to the information required in subsection (3) and s.
248	408.806:
249	(a) The correct business name of each business entity and
250	full name of each individual holding any ownership interest of 5
251	percent or more, or any pecuniary interest of $5,000 or more, in
252	any legal entity that owns or operates any specialty clinic
253	seeking licensure, whether such ownership or pecuniary interest
254	arose out of a contract, loan, gift, investment, inheritance, or
255	any other source. Individual possession of an ownership or
256	pecuniary interest in any subject specialty clinic includes, but
257	is not limited to, a direct or indirect interest in:
258	1. The business operation, equipment, or legend
259	pharmaceuticals used in the clinic;
260	2. The premises in which the clinic provides its services;
261	or
262	3. Any legal entity that owns any such interest, directly
263	or indirectly, in the business operation of the clinic; the
264	equipment used in providing infusion therapy services at the
265	clinic; the legend pharmaceuticals used at the clinic; or the
266	premises in which the clinic provides its services.
267	(b) In the case of an incorporated business entity that
268	holds any ownership interest of 5 percent or more, or any
269	pecuniary interest of $5,000 or more, in the specialty clinic,
270	copies of the articles of incorporation and bylaws and the names
271	and addresses of all officers and directors of the corporation.
272	(c) On a form furnished by the agency, a sworn, notarized
273	statement by each business entity and individual that holds any
274	ownership interest of 5 percent or more, or any pecuniary
275	interest of $5,000 or more, in the subject specialty clinic
276	which discloses the nature and degree of each such ownership or
277	pecuniary interest and discloses the source of funds which gave
278	rise to each such ownership or pecuniary interest.
279	(d) On a form furnished by the agency, a sworn, notarized
280	statement by each business entity and individual that holds any
281	ownership interest of 5 percent or more, or any pecuniary
282	interest of $5,000 or more, in the subject specialty clinic
283	which discloses whether he or she has been an owner or part
284	owner, individually or through any business entity, of any
285	business entity whose health care license has been revoked or
286	suspended in any jurisdiction.
287	(e) On a form furnished by the agency, an estimate of the
288	costs for establishing the specialty clinic and the source of
289	funds for payment of those costs and for sustaining the
290	operation of the clinic until its operation produces a positive
291	cash flow.
292
293	For purposes of this subsection, the term "ownership" or
294	"pecuniary interest" does not include an individual whose
295	interest in a specialty clinic arises only out of that
296	individual's interest in a lending company, insurance company,
297	or banking institution licensed by this state or any other state
298	of the United States; a company regularly trading on a national
299	stock exchange of the United States; or a governmental entity in
300	the United States.
301	(5)(4) In addition to the requirements of part II of
302	chapter 408, the applicant must file with the application
303	satisfactory proof that the clinic or specialty clinic is in
304	compliance with this part and applicable rules, including:
305	(a) A listing of services to be provided either directly
306	by the applicant or through contractual arrangements with
307	existing providers;
308	(b) The number and discipline of each professional staff
309	member to be employed; and
310	(c) Proof of financial ability to operate as required
311	under s. 408.810(8). As an alternative to submitting proof of
312	financial ability to operate as required under s. 408.810(8),
313	the applicant may file a surety bond of at least $500,000 which
314	guarantees that the clinic or specialty clinic will act in full
315	conformity with all legal requirements for operating a clinic,
316	payable to the agency. The agency may adopt rules to specify
317	related requirements for such surety bond.
318	(6)(5) Each applicant for licensure shall comply with the
319	following requirements:
320	(a) As used in this subsection, the term "applicant" means
321	an individual individuals owning or controlling, directly or
322	indirectly, 5 percent or more of an interest in a clinic or an
323	individual owning or controlling, directly or indirectly, any
324	interest in a specialty clinic; the medical or clinic director,
325	or a similarly titled person who is responsible for the day-to-
326	day operation of the licensed clinic; the financial officer or
327	similarly titled individual who is responsible for the financial
328	operation of the clinic; and licensed health care practitioners
329	at the clinic.
330	(b) Upon receipt of a completed, signed, and dated
331	application, the agency shall require background screening of
332	the applicant, in accordance with the level 2 standards for
333	screening set forth in paragraph (d) chapter 435. Proof of
334	compliance with the level 2 background screening requirements of
335	paragraph (d) chapter 435 which has been submitted within the
336	previous 5 years in compliance with the any other health care
337	clinic licensure requirements of this part state is acceptable
338	in fulfillment of this paragraph. Applicants who own less than
339	10 percent of a health care clinic are not required to submit
340	fingerprints under this section.
341	(c) Each applicant must submit to the agency, with the
342	application, a description and explanation of any exclusions,
343	permanent suspensions, or terminations of an applicant from the
344	Medicare or Medicaid programs. Proof of compliance with the
345	requirements for disclosure of ownership and controlling control
346	interest under the Medicaid or Medicare programs may be accepted
347	in lieu of this submission. The description and explanation may
348	indicate whether such exclusions, suspensions, or terminations
349	were voluntary or not voluntary on the part of the applicant.
350	The agency may deny or revoke licensure based on information
351	received under this paragraph.
352	(d) A license may not be granted to a clinic if the
353	applicant, or a person or entity identified in paragraph (3)(b),
354	has been found guilty of, regardless of adjudication, or has
355	entered a plea of nolo contendere or guilty to, any offense
356	prohibited under the level 2 standards for screening set forth
357	in chapter 435; any felony under chapter 400, chapter 408,
358	chapter 409, chapter 440, chapter 624, chapter 626, chapter 627,
359	chapter 812, chapter 817, chapter 831, chapter 837, chapter 838,
360	chapter 895, or chapter 896; or any substantially comparable
361	offense or crime of another state or of the United States, if a
362	felony in that jurisdiction, within the past 10 years. Each
363	person required to provide background screening shall disclose
364	to the agency any arrest for a crime for which a court
365	disposition other than dismissal has been made within the past
366	10 years. Failure to provide such information is a material
367	omission in the application process, or a violation of insurance
368	fraud under s. 817.234, within the past 5 years. If the
369	applicant has been convicted of an offense prohibited under the
370	level 2 standards or insurance fraud in any jurisdiction, the
371	applicant must show that his or her civil rights have been
372	restored prior to submitting an application.
373	(e) Each applicant that performs the technical component
374	of magnetic resonance imaging, static radiographs, computed
375	tomography, or positron emission tomography, and also provides
376	the professional components of such services through an employee
377	or independent contractor, must provide to the agency on a form
378	provided by the agency, the name and address of the clinic, the
379	serial or operating number of each magnetic resonance imaging,
380	static radiograph, computed tomography, and positron emission
381	tomography machine, the name of the manufacturer of the machine,
382	and such other information as required by the agency to identify
383	the machine. The information must be provided to the agency upon
384	renewal of the clinic's licensure and within 30 days after a
385	clinic begins using a machine for which it has not provided the
386	information to the agency.
387	Section 4. Section 400.9914, Florida Statutes, is created
388	to read:
389	400.9914 Revocation or denial of a specialty clinic
390	license.-In addition to the standards provided in s. 408.831,
391	the agency:
392	(1) Shall deny or revoke a specialty clinic license if an
393	applicant has been found guilty of, regardless of adjudication,
394	or entered a plea of nolo contendere or guilty to, any felony
395	involving dishonesty or making a false statement in any
396	jurisdiction within the preceding 10 years.
397	(2) Shall deny a specialty clinic license application when
398	any business entity or individual possessing an ownership or
399	pecuniary interest in the specialty clinic also possessed an
400	ownership or pecuniary interest, individually or through any
401	business entity, in any health care facility whose license was
402	revoked in any jurisdiction during the pendency of that
403	interest.
404	(3) May not issue a specialty clinic license to any
405	applicant to whom the agency has sent notice that there is a
406	pending question as to whether one or more of the individuals
407	having an ownership of 5 percent or more or a pecuniary interest
408	of $5,000 or more in the clinic has a disqualifying criminal
409	record. The agency notice shall request the applicant to submit
410	any additional information necessary to resolve the pending
411	criminal background question within 21 days after receipt of the
412	notice. The agency shall deny a specialty clinic license
413	application if the applicant fails to resolve a criminal
414	background screening issue pertaining to an individual who is
415	required to meet the criminal background screening requirements
416	of this part and the agency raised such background screening
417	issue by providing notice pursuant to this part.
418	Section 5. Section 400.9915, Florida Statutes, is amended
419	to read:
420	400.9915 Emergency suspension; costs.-
421	(1) Failure by a clinic or specialty clinic licensed under
422	this part to allow full and complete access to the premises and
423	to billing records or information to any representative of the
424	agency who makes a request to inspect the clinic or specialty
425	clinic to determine compliance with this part or failure by a
426	clinic or specialty clinic to employ a qualified medical
427	director or clinic director constitutes a ground for emergency
428	suspension of the license by the agency pursuant to s. 408.814.
429	(2) In addition to any administrative fines imposed
430	pursuant to this part or part II of chapter 408, the agency may
431	assess a fee equal to the cost of conducting a complaint
432	investigation.
433	Section 6. Section 400.9921, Florida Statutes, is created
434	to read:
435	400.9921 License renewal; transfer of ownership.-In
436	addition to the requirements set forth in ss. 408.806 and
437	408.807:
438	(1) An application for license renewal must contain
439	information as required by the agency.
440	(2) The clinic or specialty clinic must file with the
441	renewal application satisfactory proof that it is in compliance
442	with this part and applicable rules. If there is evidence of
443	financial instability, the clinic or specialty clinic must
444	submit satisfactory proof of its financial ability to comply
445	with the requirements of this part.
446	(3) An application for change of ownership of a clinic or
447	specialty clinic is required only when 45 percent or more of the
448	ownership, voting shares, or controlling interest of a clinic or
449	specialty clinic is transferred or assigned, including the final
450	transfer or assignment of multiple transfers or assignments over
451	a 2-year period which cumulatively total 45 percent or greater.
452	(4) The license may not be sold, leased, assigned, or
453	otherwise transferred, voluntarily or involuntarily, and is
454	valid only for the clinic or specialty clinic owners and
455	location for which the license was originally issued.
456	Section 7. Section 400.9925, Florida Statutes, is amended
457	to read:
458	400.9925 Rulemaking authority; license fees.-
459	(1) The agency shall adopt rules necessary to administer
460	the clinic and specialty clinic administration, regulation, and
461	licensure program, including rules pursuant to this part and
462	part II of chapter 408, establishing the specific licensure
463	requirements, procedures, forms, and fees. It shall adopt rules
464	establishing a procedure for the biennial renewal of licenses.
465	The agency may issue initial licenses for less than the full 2-
466	year period by charging a prorated licensure fee and specifying
467	a different renewal date than would otherwise be required for
468	biennial licensure. The rules shall specify the expiration dates
469	of licenses, the process of tracking compliance with financial
470	responsibility requirements, and any other conditions of renewal
471	required by law or rule.
472	(2) The agency shall adopt rules specifying limitations on
473	the number of licensed clinics and specialty clinics and
474	licensees for which a medical director or a clinic director may
475	assume responsibility for purposes of this part. In determining
476	the quality of supervision a medical director or a clinic
477	director can provide, the agency shall consider the number of
478	clinic or specialty clinic employees, the clinic location or the
479	specialty clinic location, and the health care services provided
480	by the clinic or specialty clinic.
481	(3) In accordance with s. 408.805, an applicant or a
482	licensee shall pay a fee for each license application submitted
483	under this part, part II of chapter 408, and applicable rules.
484	The amount of the fee shall be established by rule and may not
485	exceed $2,000.
486	Section 8. Subsection (3) of section 400.993, Florida
487	Statutes, is amended to read:
488	400.993 Unlicensed clinics; reporting.-
489	(3) In addition to the requirements of part II of chapter
490	408, any health care provider who is aware of the operation of
491	an unlicensed clinic or specialty clinic shall report that
492	facility to the agency. Failure to report a clinic or specialty
493	clinic that the provider knows or has reasonable cause to
494	suspect is unlicensed shall be reported to the provider's
495	licensing board.
496	Section 9. Subsections (1), (6), and (9) of section
497	400.9935, Florida Statutes, are amended, and subsections (10)
498	and (11) are added to that section, to read:
499	400.9935 Clinic and specialty clinic responsibilities.-
500	(1) Each clinic and specialty clinic shall appoint a
501	medical director or clinic director who shall agree in writing
502	to accept legal responsibility for the following activities on
503	behalf of the clinic or specialty clinic. The medical director
504	or the clinic director shall:
505	(a) Have signs identifying the medical director or clinic
506	director posted in a conspicuous location within the clinic
507	readily visible to all patients.
508	(b) Ensure that all practitioners providing health care
509	services or supplies to patients maintain a current active and
510	unencumbered Florida license.
511	(c) Review any patient referral contracts or agreements
512	executed by the clinic.
513	(d) Ensure that all health care practitioners at the
514	clinic have active appropriate certification or licensure for
515	the level of care being provided.
516	(e) Serve as the clinic records owner as defined in s.
517	456.057.
518	(f) Ensure compliance with the recordkeeping, office
519	surgery, and adverse incident reporting requirements of chapter
520	456, the respective practice acts, and rules adopted under this
521	part and part II of chapter 408.
522	(g) Conduct systematic reviews of clinic billings to
523	ensure that the billings are not fraudulent or unlawful. Upon
524	discovery of an unlawful charge, the medical director or clinic
525	director shall take immediate corrective action. If the clinic
526	performs only the technical component of magnetic resonance
527	imaging, static radiographs, computed tomography, or positron
528	emission tomography, and provides the professional
529	interpretation of such services, in a fixed facility that is
530	accredited by the Joint Commission on Accreditation of
531	Healthcare Organizations or the Accreditation Association for
532	Ambulatory Health Care, and the American College of Radiology;
533	and if, in the preceding quarter, the percentage of scans
534	performed by that clinic which was billed to all personal injury
535	protection insurance carriers was less than 15 percent, the
536	chief financial officer of the clinic may, in a written
537	acknowledgment provided to the agency, assume the responsibility
538	for the conduct of the systematic reviews of clinic billings to
539	ensure that the billings are not fraudulent or unlawful.
540	(h) Not refer a patient to the clinic if the clinic
541	performs magnetic resonance imaging, static radiographs,
542	computed tomography, or positron emission tomography. The term
543	"refer a patient" means the referral of one or more patients of
544	the medical or clinical director or a member of the medical or
545	clinical director's group practice to the clinic for magnetic
546	resonance imaging, static radiographs, computed tomography, or
547	positron emission tomography. A medical director who is found to
548	violate this paragraph commits a felony of the third degree,
549	punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
550	(i) Serve as medical or clinic director for no more than a
551	maximum of five health care clinics that have a cumulative total
552	of no more than 200 employees and persons under contract with
553	the health care clinic at a given time. A medical or clinic
554	director may not supervise a health care clinic more than 200
555	miles away from any other health care clinic supervised by the
556	same medical or clinic director. The agency may allow a waiver
557	of the limitations of this paragraph upon a showing of good
558	cause and a determination by the agency that the medical or
559	clinic director is able to adequately perform the duties
560	required under this subsection.
561	(6) Any person or entity providing health care services
562	which is not a clinic or specialty clinic, as defined under s.
563	400.9905, may voluntarily apply for a certificate of exemption
564	from licensure under its exempt status. Other than certificates
565	of exemptions granted pursuant to the exemption under s.
566	400.9905(4)(f), certificates of exemption shall expire after 2
567	years and may be renewed with the agency on a form that sets
568	forth its name or names and addresses, a statement of the
569	reasons why it cannot be defined as a clinic, and other
570	information deemed necessary by the agency. An exemption is not
571	transferable. The agency may charge an applicant for a
572	certificate of exemption in an amount equal to $100 or the
573	actual cost of processing the certificate, whichever is less.
574	(a) The agency shall provide a form that requires the name
575	or names and addresses, a statement of the reasons why the
576	applicant is exempt from licensure as a health care clinic or
577	specialty clinic, and other information deemed necessary by the
578	agency. The signature on an application for a certificate of
579	exemption must be notarized and signed by persons having
580	knowledge of the truth of its contents. An exemption is not
581	transferable and is valid only for the reasons, location,
582	persons, and entity set forth on the application form. A person
583	or entity that claims an exemption under this part or that holds
584	a current certificate of exemption must be exempt from the
585	licensing provisions of this part at all times or such claim or
586	certificate is invalid from the date that such person or entity
587	is not exempt.
588	(b) The agency shall charge an applicant for a certificate
589	of exemption a fee of $100 to cover the cost of processing the
590	certificate or the actual cost of processing the certificate,
591	whichever is less.
592	(c) An application for the renewal of a certificate of
593	exemption must be submitted to the agency before the expiration
594	of the certificate of exemption. The agency may investigate any
595	applicant, person, or entity claiming an exemption for purposes
596	of determining compliance when a certificate of exemption is
597	sought. Authorized personnel of the agency shall have access to
598	the premises of any certificateholder, applicant, or specialty
599	clinic, other than a person or entity who is exempt pursuant to
600	s. 400.9905(4)(f), for the sole purpose of determining
601	compliance with an exemption under this part. The agency shall
602	have access to all billings and records. The agency may deny or
603	withdraw a certificate of exemption if a person or entity does
604	not qualify under this part.
605	(d) A certificate of exemption is considered withdrawn
606	when the agency determines that an exempt status cannot be
607	confirmed. The provisions applicable to the unlicensed operation
608	of a health care clinic or specialty clinic apply to any health
609	care provider that self-determines or claims an exemption or
610	that is issued a certificate of exemption if, in fact, such
611	clinic does not meet the exemption claimed.
612	(e) Any person or entity that submits an application for a
613	certificate of exemption which contains fraudulent or material
614	and misleading information commits a felony of the third degree,
615	punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
616	(f) A response to a request in writing for additional
617	information or clarification must be filed with the agency no
618	later than 21 days after receipt of the request or the
619	application shall be denied.
620	(g) The agency shall grant or deny an application for a
621	certificate of exemption in accordance with s. 120.60(1).
622	(h) A person or entity that qualifies as a health care
623	clinic or specialty clinic and has been denied a certificate of
624	exemption must file an initial application and pay the fee. A
625	certificate of exemption is valid only when issued and current.
626	(i) The agency shall issue an emergency order of
627	suspension of a certificate of exemption when the agency finds
628	that the applicant has provided false or misleading material
629	information or omitted any material fact from the application
630	for a certificate of exemption which is permitted or required by
631	this part, or has submitted false or misleading information to
632	the agency when self-determining an exempt status and materially
633	misleading the agency as to such status.
634	(9) In addition to the requirements of part II of chapter
635	408, the clinic or specialty clinic shall display a sign in a
636	conspicuous location within the clinic or specialty clinic
637	readily visible to all patients indicating that, pursuant to s.
638	626.9892, the Department of Financial Services may pay rewards
639	of up to $25,000 to persons providing information leading to the
640	arrest and conviction of persons committing crimes investigated
641	by the Division of Insurance Fraud arising from violations of s.
642	440.105, s. 624.15, s. 626.9541, s. 626.989, or s. 817.234. An
643	authorized employee of the Division of Insurance Fraud may make
644	unannounced inspections of a clinic or specialty clinic licensed
645	under this part as necessary to determine whether the clinic or
646	specialty clinic is in compliance with this subsection. A
647	licensed clinic or specialty clinic shall allow full and
648	complete access to the premises to such authorized employee of
649	the division who makes an inspection to determine compliance
650	with this subsection.
651	(10) In addition to the requirements set forth in s.
652	408.8065, every licensed specialty clinic shall annually file
653	with the agency, including concurrently with the filing of any
654	change of ownership application, upon forms to be furnished by
655	the agency, an audited report showing the following information:
656	(a) A report of the number of patients served by the
657	specialty clinic during the previous 12-month period. The report
658	may exclude any partial month for the month when the report was
659	prepared;
660	(b) Total specialty clinic operating expenses;
661	(c) Gross patient charges by payor category, including
662	Medicare, Medicaid, county indigent programs, any other
663	governmental programs, private insurance, self-paying patients,
664	nonpaying patients, and other payees;
665	(d) The cost of operation of the specialty clinic during
666	the previous 12-month period, excluding any partial month during
667	which time the report was prepared;
668	(e) Unless the specialty clinic can demonstrate that the
669	clinic already has furnished the required information regarding
670	a particular subject individual, the full name of any individual
671	who became an owner or became possessed of any pecuniary
672	interest in the subject clinic since the last report to the
673	agency, along with the disclosure of the information required by
674	s. 400.991 as to such individual; and
675	(f) A current statement of the source of funds for payment
676	of the costs of establishing the specialty clinic and for
677	sustaining the operation of the specialty clinic until its
678	operation produces a positive cash flow.
679	(11) Each licensee of a specialty clinic has a continuing
680	obligation to comply with this part and to report to the agency
681	any change of circumstance related to the clinic's continuing
682	compliance with this part. Such change of circumstance includes,
683	but is not limited to, any change in the ownership of the
684	specialty clinic, the addition of any individual or business
685	entity possessing a pecuniary interest in the specialty clinic,
686	the employment of any individual as a member of the specialty
687	clinic's staff who would be required to undergo a criminal
688	background screening if such individual had been an employee at
689	the time of the initial licensure, and any change in the medical
690	or clinic director. The specialty clinic shall furnish the
691	information about any change of circumstances required under
692	this part and s. 400.991 within 30 days after the occurrence of
693	such change of circumstance.
694	Section 10. Section 400.995, Florida Statutes, is amended
695	to read:
696	400.995 Agency administrative penalties.-
697	(1) In addition to the requirements of part II of chapter
698	408, the agency may deny the application for a license renewal,
699	revoke and suspend the license, and impose administrative fines
700	of up to $5,000 per violation for violations of the requirements
701	of this part or rules of the agency. In determining if a penalty
702	is to be imposed and in fixing the amount of the fine, the
703	agency shall consider the following factors:
704	(a) The gravity of the violation, including the
705	probability that death or serious physical or emotional harm to
706	a patient will result or has resulted, the severity of the
707	action or potential harm, and the extent to which the provisions
708	of the applicable laws or rules were violated.
709	(b) Actions taken by the owner, medical director, or
710	clinic director to correct violations.
711	(c) Any previous violations.
712	(d) The financial benefit to the clinic or specialty
713	clinic of committing or continuing the violation.
714	(2) Each day of continuing violation after the date fixed
715	for termination of the violation, as ordered by the agency,
716	constitutes an additional, separate, and distinct violation.
717	(3) Any action taken to correct a violation shall be
718	documented in writing by the owner, medical director, or clinic
719	director of the clinic or specialty clinic and verified through
720	followup visits by agency personnel. The agency may impose a
721	fine and, in the case of an owner-operated clinic or specialty
722	clinic, revoke or deny a clinic's license when a clinic medical
723	director or clinic director knowingly misrepresents actions
724	taken to correct a violation.
725	(4) Any licensed clinic whose owner, medical director, or
726	clinic director concurrently operates an unlicensed clinic shall
727	be subject to an administrative fine of $5,000 per day.
728	(5) Any clinic or specialty clinic whose owner fails to
729	apply for a change-of-ownership license and operates the clinic
730	or specialty clinic under the new ownership is subject to a fine
731	of $5,000.
732	(6) As an alternative to or in conjunction with an
733	administrative action against a clinic or specialty clinic for
734	violations of this part and adopted rules During an inspection,
735	the agency shall make a reasonable attempt to discuss during the
736	inspection each violation with the owner, medical director, or
737	clinic director of the clinic or specialty clinic, prior to
738	written notification. The agency, instead of fixing a period
739	within which the clinic or specialty clinic shall enter into
740	compliance with standards, may request a plan of corrective
741	action from the clinic or specialty clinic which demonstrates a
742	good faith effort to remedy each violation by a specific date,
743	subject to the approval of the agency.
744	Section 11. Section 400.996, Florida Statutes, is created
745	to read:
746	400.996 Specialty clinics; complaints; audits; referrals.-
747	(1) The agency shall receive, document, and process
748	complaints about specialty clinics. Upon receipt of any
749	complaint that asserts the existence of facts evidencing
750	possible billing fraud by a specialty clinic or by any employee
751	of a specialty clinic, the agency shall request the complainant
752	to make such assertions by sworn affidavit.
753	(2) Upon receipt of any sworn affidavit that asserts the
754	existence of facts evidencing possible billing fraud by a
755	specialty clinic or any of its employees, the agency shall refer
756	the complaint to the Office of Fiscal Integrity within the
757	Department of Financial Services.
758	(3) The Department of Financial Services shall report
759	findings to the agency for any appropriate licensure action.
760	Such report shall include a statement of facts as determined by
761	the Department of Financial Services to exist, specifically with
762	regard to the possible violations of licensure requirements. If,
763	during an investigation, the Department of Financial Services
764	has reason to believe that any criminal law of this state has or
765	may have been violated, the department shall refer such
766	investigation to appropriate prosecutorial agencies and shall
767	provide investigative assistance to those agencies, as required.
768	(4) The investigating authority and the agency shall
769	cooperate with each other and prepare a record and share
770	information from which the agency may determine if any action
771	for sanctions under this part are warranted.
772	(5) A person commits a misdemeanor of the first degree,
773	punishable as provided in s. 775.082 or s. 775.083 if:
774	(a) He or she submits a sworn complaint that initiates a
775	complaint investigation pursuant to this section; and
776	(b) The sworn complaint is determined to be totally
777	without any factual basis to support the assertions made in the
778	complaint that facts existed evidencing possible fraudulent
779	practices by a specialty clinic or any of its employees.
780	(6) The Office of Fiscal Integrity within the Department
781	of Financial Services shall conduct unannounced reviews,
782	investigations, analyses, and audits to investigate complaints
783	and, as necessary, to determine whether a specialty clinic's
784	billings are fraudulent or unlawful. The Department of Financial
785	Services may enter upon the premises of the clinic during
786	regular business hours and demand and immediately secure copies
787	of billing and other records of the clinic which will enable the
788	Department of Financial Services to investigate complaints or
789	determine whether a specialty clinic's billings are fraudulent
790	or unlawful.
791	(7) A licensed specialty clinic shall allow full,
792	complete, and immediate access to the premises and to billing
793	records or information to any such officer or employee who
794	conducts a review, investigation, analysis, or audit to
795	determine compliance with this part and with applicable rules.
796	Failure to allow full, complete, and immediate access to the
797	premises and to billing records or information to any
798	representative of the agency or Department of Financial Services
799	who attempts to conduct a review, investigation, analysis, or
800	audit to determine compliance with this part constitutes a
801	ground for emergency suspension of the license by the agency
802	pursuant to s. 120.60(6).
803	(8) In addition to any administrative fines imposed, the
804	agency may assess a fee equal to the cost of conducting any
805	review, investigation, analysis, or audit performed by the
806	agency or the Department of Financial Services.
807	(9) All investigators designated by the Chief Financial
808	Officer to perform duties under this part and who are certified
809	under s. 943.1395 are law enforcement officers of the state.
810	Such investigators may conduct criminal investigations, bear
811	arms, make arrests, and apply for, serve, and execute search
812	warrants, arrest warrants, capias, and other processes
813	throughout the state pertaining to fraud investigations under
814	this section.
815	Section 12. Subsection (27) of section 408.802, Florida
816	Statutes, is amended to read:
817	408.802 Applicability.-The provisions of this part apply
818	to the provision of services that require licensure as defined
819	in this part and to the following entities licensed, registered,
820	or certified by the agency, as described in chapters 112, 383,
821	390, 394, 395, 400, 429, 440, 483, and 765:
822	(27) Health care clinics and specialty clinics, as
823	provided under part X of chapter 400.
824	Section 13. Subsection (25) of section 408.820, Florida
825	Statutes, is amended to read:
826	408.820 Exemptions.-Except as prescribed in authorizing
827	statutes, the following exemptions shall apply to specified
828	requirements of this part:
829	(25) Health care clinics and specialty clinics, as
830	provided under part X of chapter 400, are exempt from s.
831	408.810(6), (7), and (10).
832	Section 14. Paragraph (mm) is added to subsection (1) of
833	section 456.072, Florida Statutes, to read:
834	456.072 Grounds for discipline; penalties; enforcement.-
835	(1) The following acts shall constitute grounds for which
836	the disciplinary actions specified in subsection (2) may be
837	taken:
838	(mm) Intentionally providing false information on an
839	application for a certificate of exemption from clinic licensure
840	under part XIII of chapter 400.
841	Section 15. Paragraph (a) of subsection (1) of section
842	627.732, Florida Statutes, is amended to read:
843	627.732 Definitions.-As used in ss. 627.730-627.7405, the
844	term:
845	(1) "Broker" means any person not possessing a license
846	under chapter 395, chapter 400, chapter 429, chapter 458,
847	chapter 459, chapter 460, chapter 461, or chapter 641 who
848	charges or receives compensation for any use of medical
849	equipment and is not the 100-percent owner or the 100-percent
850	lessee of such equipment. For purposes of this section, such
851	owner or lessee may be an individual, a corporation, a
852	partnership, or any other entity and any of its 100-percent-
853	owned affiliates and subsidiaries. For purposes of this
854	subsection, the term "lessee" means a long-term lessee under a
855	capital or operating lease, but does not include a part-time
856	lessee. The term "broker" does not include a hospital or
857	physician management company whose medical equipment is
858	ancillary to the practices managed, a debt collection agency, or
859	an entity that has contracted with the insurer to obtain a
860	discounted rate for such services; nor does the term include a
861	management company that has contracted to provide general
862	management services for a licensed physician or health care
863	facility and whose compensation is not materially affected by
864	the usage or frequency of usage of medical equipment or an
865	entity that is 100-percent owned by one or more hospitals or
866	physicians. The term "broker" does not include a person or
867	entity that certifies, upon request of an insurer, that:
868	(a) It is a clinic licensed under ss. 400.990-400.996
869	400.990-400.995;
870	Section 16. Paragraph (a) of subsection (1) of section
871	627.736, Florida Statutes, is amended to read:
872	627.736 Required personal injury protection benefits;
873	exclusions; priority; claims.-
874	(1) REQUIRED BENEFITS.-Every insurance policy complying
875	with the security requirements of s. 627.733 shall provide
876	personal injury protection to the named insured, relatives
877	residing in the same household, persons operating the insured
878	motor vehicle, passengers in such motor vehicle, and other
879	persons struck by such motor vehicle and suffering bodily injury
880	while not an occupant of a self-propelled vehicle, subject to
881	the provisions of subsection (2) and paragraph (4)(e), to a
882	limit of $10,000 for loss sustained by any such person as a
883	result of bodily injury, sickness, disease, or death arising out
884	of the ownership, maintenance, or use of a motor vehicle as
885	follows:
886	(a) Medical benefits.-Eighty percent of all reasonable
887	expenses for medically necessary medical, surgical, X-ray,
888	dental, and rehabilitative services, including prosthetic
889	devices, and medically necessary ambulance, hospital, and
890	nursing services. However, the medical benefits shall provide
891	reimbursement only for such services and care that are lawfully
892	provided, supervised, ordered, or prescribed by a physician
893	licensed under chapter 458 or chapter 459, a dentist licensed
894	under chapter 466, or a chiropractic physician licensed under
895	chapter 460 or that are provided by any of the following persons
896	or entities:
897	1. A hospital or ambulatory surgical center licensed under
898	chapter 395.
899	2. A person or entity licensed under ss. 401.2101-401.45
900	that provides emergency transportation and treatment.
901	3. An entity wholly owned by one or more physicians
902	licensed under chapter 458 or chapter 459, chiropractic
903	physicians licensed under chapter 460, or dentists licensed
904	under chapter 466 or by such practitioner or practitioners and
905	the spouse, parent, child, or sibling of that practitioner or
906	those practitioners.
907	4. An entity wholly owned, directly or indirectly, by a
908	hospital or hospitals.
909	5. A health care clinic licensed under ss. 400.990-400.996
910	400.990-400.995 that is:
911	a. Accredited by the Joint Commission on Accreditation of
912	Healthcare Organizations, the American Osteopathic Association,
913	the Commission on Accreditation of Rehabilitation Facilities, or
914	the Accreditation Association for Ambulatory Health Care, Inc.;
915	or
916	b. A health care clinic that:
917	(I) Has a medical director licensed under chapter 458,
918	chapter 459, or chapter 460;
919	(II) Has been continuously licensed for more than 3 years
920	or is a publicly traded corporation that issues securities
921	traded on an exchange registered with the United States
922	Securities and Exchange Commission as a national securities
923	exchange; and
924	(III) Provides at least four of the following medical
925	specialties:
926	(A) General medicine.
927	(B) Radiography.
928	(C) Orthopedic medicine.
929	(D) Physical medicine.
930	(E) Physical therapy.
931	(F) Physical rehabilitation.
932	(G) Prescribing or dispensing outpatient prescription
933	medication.
934	(H) Laboratory services.
935
936	The Financial Services Commission shall adopt by rule the form
937	that must be used by an insurer and a health care provider
938	specified in subparagraph 3., subparagraph 4., or subparagraph
939	5. to document that the health care provider meets the criteria
940	of this paragraph, which rule must include a requirement for a
941	sworn statement or affidavit.
942
943	Only insurers writing motor vehicle liability insurance in this
944	state may provide the required benefits of this section, and no
945	such insurer shall require the purchase of any other motor
946	vehicle coverage other than the purchase of property damage
947	liability coverage as required by s. 627.7275 as a condition for
948	providing such required benefits. Insurers may not require that
949	property damage liability insurance in an amount greater than
950	$10,000 be purchased in conjunction with personal injury
951	protection. Such insurers shall make benefits and required
952	property damage liability insurance coverage available through
953	normal marketing channels. Any insurer writing motor vehicle
954	liability insurance in this state who fails to comply with such
955	availability requirement as a general business practice shall be
956	deemed to have violated part IX of chapter 626, and such
957	violation shall constitute an unfair method of competition or an
958	unfair or deceptive act or practice involving the business of
959	insurance; and any such insurer committing such violation shall
960	be subject to the penalties afforded in such part, as well as
961	those which may be afforded elsewhere in the insurance code.
962	Section 17. Florida Barbara B. Lumpkin Center for Nursing
963	designated; Department of Health to erect suitable markers.-
964	(1) The Florida Center for Nursing, created by s.
965	464.0195, Florida Statutes, and located in Orlando is designated
966	as the "Florida Barbara B. Lumpkin Center for Nursing."
967	(2) The Department of Health is directed to erect suitable
968	markers designating the Florida Barbara B. Lumpkin Center for
969	Nursing as described in subsection (1).
970	Section 18. For the 2010-2011 fiscal year, the sums of
971	$212,528 in recurring funds and $25,347 in nonrecurring funds
972	are appropriated from the Health Care Trust Fund to the Agency
973	for Health Care Administration, and four full-time equivalent
974	positions and associated salary rate of 134,455 are authorized
975	for the purpose of administering the provisions of this act.
976	Section 19. This act shall take effect July 1, 2010.

CODING: Words stricken are deletions; words underlined are additions.