Bill Text: FL S2138 | 2010 | Regular Session | Engrossed

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Bill Title: Health Care [SPSC]

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2010-04-30 - Died on Calendar, companion bill(s) passed, see HB 5311 (Ch. 2010-161), CS/CS/SB 1412 (Ch. 2010-102) [S2138 Detail]

Download: Florida-2010-S2138-Engrossed.html

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CS for CS for CS for SB 2138                     First Engrossed 
20102138e1 
1                        A bill to be entitled 
2         An act relating to health care; repealing s. 
3         112.0455(10)(e), F.S., relating to a prohibition 
4         against applying the Drug-Free Workplace Act 
5         retroactively; repealing s. 383.325, F.S., relating to 
6         the requirement of a licensed facility under s. 
7         383.305, F.S., to maintain inspection reports; 
8         repealing s. 395.1046, F.S., relating to the 
9         investigation of complaints regarding hospitals; 
10         repealing s. 395.3037, F.S.; deleting definitions 
11         relating to obsolete provisions governing primary and 
12         comprehensive stroke centers; amending s. 400.0239, 
13         F.S.; deleting an obsolete provision; repealing s. 
14         400.147(10), F.S., relating to a requirement that a 
15         nursing home facility report any notice of a filing of 
16         a claim for a violation of a resident’s rights or a 
17         claim of negligence; repealing s. 400.148, F.S., 
18         relating to the Medicaid “Up-or-Out” Quality of Care 
19         Contract Management Program; repealing s. 400.195, 
20         F.S., relating to reporting requirements for the 
21         Agency for Health Care Administration; amending s. 
22         400.476, F.S.; providing requirements for an 
23         alternative administrator of a home health agency; 
24         revising the duties of the administrator; revising the 
25         requirements for a director of nursing for a specified 
26         number of home health agencies; prohibiting a home 
27         health agency from using an individual as a home 
28         health aide unless the person has completed training 
29         and an evaluation program; requiring a home health 
30         aide to meet certain standards in order to be 
31         competent in performing certain tasks; requiring a 
32         home health agency and staff to comply with accepted 
33         professional standards; providing certain requirements 
34         for a written contract between certain personnel and 
35         the agency; providing an exception for direct 
36         employees of the home health agency; requiring a home 
37         health agency to provide certain services through its 
38         employees; authorizing a home health agency to provide 
39         additional services with another organization; 
40         providing responsibilities of a home health agency 
41         when it provides home health aide services through 
42         another organization; requiring the home health agency 
43         to coordinate personnel who provide home health 
44         services; requiring personnel to communicate with the 
45         home health agency; amending s. 400.487, F.S.; 
46         requiring a home health agency to provide a copy of 
47         the agreement between the agency and a patient which 
48         specifies the home health services to be provided; 
49         providing the rights that are protected by the home 
50         health agency; requiring the home health agency to 
51         furnish nursing services by or under the supervision 
52         of a registered nurse; requiring the home health 
53         agency to provide therapy services through a qualified 
54         therapist or therapy assistant; requiring physical 
55         therapy services to be provided by or under the 
56         supervision of a licensed physical therapist or 
57         physical therapist assistant; specifying the duties of 
58         a physical therapist assistant; requiring occupational 
59         therapy services to be provided by or under the 
60         supervision of a licensed occupational therapist or 
61         occupational therapy assistant; specifying the duties 
62         of an occupational therapy assistant; providing for 
63         speech therapy services to be provided by a qualified 
64         speech pathologist or audiologist; providing for a 
65         plan of care; providing that only the staff of a home 
66         health agency may administer drugs and treatments as 
67         ordered by certain health professionals; providing 
68         requirements for verbal orders; providing duties of a 
69         registered nurse, licensed practical nurse, home 
70         health aide, and certified nursing assistant who work 
71         for a home health agency; providing for supervisory 
72         visits of services provided by a home health agency; 
73         repealing s. 408.802(11), F.S., relating to the 
74         applicability of the Health Care Licensing Procedures 
75         Act to private review agents; repealing s. 
76         409.912(15)(e), (f), and (g), F.S., relating to a 
77         requirement for the Agency for Health Care 
78         Administration to submit a report to the Legislature 
79         regarding the operations of the CARE program; amending 
80         s. 409.91255, F.S.; transferring administrative 
81         responsibility for the application procedure for 
82         federally qualified health centers from the Department 
83         of Health to the Agency for Health Care 
84         Administration; requiring the Florida Association of 
85         Community Health Centers, Inc., to provide support and 
86         assume administrative costs for the program; amending 
87         s. 400.9905, F.S.; revising the definition of the term 
88         “clinic” applicable to the Health Care Clinic Act; 
89         providing exemptions from licensure requirements for 
90         certain legal entities that provide health care 
91         services; amending s. 413.615, F.S.; removing a 
92         provision that requires the State Board of 
93         Administration to invest and reinvest moneys in the 
94         endowment fund for the Florida Endowment for 
95         Vocational Rehabilitation; requiring that all funds 
96         held for investment and reinvestment by the State 
97         Board of Administration for the endowment be submitted 
98         back to the endowment fund; repealing s. 429.12(2), 
99         F.S., relating to the sale or transfer of ownership of 
100         an assisted living facility; repealing s. 429.23(5), 
101         F.S., relating to each assisted living facility’s 
102         requirement to submit a report to the agency regarding 
103         liability claims filed against it; repealing s. 
104         429.911(2)(a), F.S., relating to grounds for which the 
105         agency may take action against the owner of an adult 
106         day care center or its operator or employee; 
107         reenacting s. 465.0251(1), F.S., to require the Board 
108         of Pharmacy and the Board of Medicine to remove 
109         certain drugs from the negative formulary for generic 
110         and brand-name drugs based on current references 
111         published by the United States Food and Drug 
112         Administration; amending s. 499.01, F.S.; revising the 
113         list of exemptions from the requirement that certain 
114         persons engaged in the manufacture, repackaging, or 
115         assembly of medical devices hold a device manufacturer 
116         permit; repealing s. 381.0403(4) and (9), F.S., 
117         relating to the program for graduate medical education 
118         innovations and the graduate medical education 
119         committee and report; amending s. 381.4018, F.S.; 
120         providing definitions; requiring the Department of 
121         Health to coordinate and enhance activities regarding 
122         the reentry of retired military and other physicians 
123         into the physician workforce; revising the list of 
124         governmental stakeholders that the Department of 
125         Health is required to work with regarding the state 
126         strategic plan and in assessing the state’s physician 
127         workforce; creating the Physician Workforce Advisory 
128         Council; providing membership of the council; 
129         providing for appointments to the council; providing 
130         terms of membership; providing for removal of a 
131         council member; providing for the chair and vice chair 
132         of the council; providing that council members are not 
133         entitled to receive compensation or reimbursement for 
134         per diem or travel expenses; providing the duties of 
135         the council; establishing the physician workforce 
136         graduate medical education innovation pilot projects 
137         under the department; providing the purposes of the 
138         pilot projects; providing for the appropriation of 
139         state funds for the pilot projects; requiring the 
140         pilot projects to meet certain policy needs of the 
141         physician workforce in this state; providing criteria 
142         for prioritizing proposals for pilot projects; 
143         requiring the department to adopt by rule appropriate 
144         performance measures; requiring participating pilot 
145         projects to submit an annual report to the department; 
146         requiring state funds to be used to supplement funds 
147         from other sources; requiring the department to adopt 
148         rules; amending ss. 458.3192 and 459.0082, F.S.; 
149         requiring the department to determine by geographic 
150         area and specialty the number of physicians and 
151         osteopathic physicians who plan to relocate outside 
152         the state, practice medicine in this state, and reduce 
153         or modify the scope of their practice; authorizing the 
154         department to report additional information in its 
155         findings to the Governor and the Legislature; amending 
156         s. 458.315, F.S.; revising the standards for the Board 
157         of Medicine to issue a temporary certificate to 
158         certain physicians to practice medicine in areas of 
159         critical need; authorizing the State Surgeon General 
160         to designate areas of critical need; creating s. 
161         459.0076, F.S.; authorizing the Board of Osteopathic 
162         Medicine to issue temporary certificates to 
163         osteopathic physicians who meet certain requirements 
164         to practice osteopathic medicine in areas of critical 
165         need; providing restrictions for issuance of a 
166         temporary certificate; authorizing the State Surgeon 
167         General to designate areas of critical need; 
168         authorizing the Board of Osteopathic Medicine to waive 
169         the application fee and licensure fees for obtaining 
170         temporary certificates for certain purposes; requiring 
171         the Department of Health, along with the Agency for 
172         Health Care Administration, to develop a statewide 
173         plan to implement recommendations from the Centers for 
174         Disease Control and Prevention for screening for the 
175         human immunodeficiency virus; providing goals; 
176         requiring the department to seek input from certain 
177         entities; requiring the department to establish a 
178         demonstration project to begin implementation of the 
179         statewide plan; requiring the department to file an 
180         interim report and a final report to the Governor and 
181         the Legislature by specified dates; amending s. 
182         499.003, F.S.; defining the term “medical convenience 
183         kit”; amending s. 499.01212, F.S.; providing that a 
184         pedigree paper is not required for wholesale 
185         distribution of prescription drugs contained within a 
186         medical convenience kit under certain circumstances; 
187         providing appropriations from the General Revenue Fund 
188         and the Medical Care Trust Fund to the Agency for 
189         Health Care Administration; providing for a recurring 
190         reduction in appropriations to the Department of 
191         Health; providing a contingency; requiring persons who 
192         apply for licensure renewal as a dentist or dental 
193         hygienist to furnish certain information to the 
194         Department of Health in a dental workforce survey; 
195         requiring the Board of Dentistry to issue a 
196         nondisciplinary citation and a notice for failure to 
197         complete the survey within a specified time; providing 
198         notification requirements for the citation; requiring 
199         the department to serve as the coordinating body for 
200         the purpose of collecting, disseminating, and updating 
201         dental workforce data; requiring the department to 
202         maintain a database regarding the state’s dental 
203         workforce; requiring the department to develop 
204         strategies to maximize federal and state programs and 
205         to work with an advisory body to address matters 
206         relating to the state’s dental workforce; providing 
207         membership of the advisory body; providing for members 
208         of the advisory body to serve without compensation; 
209         requiring the department to act as a clearinghouse for 
210         collecting and disseminating information regarding the 
211         dental workforce; requiring the department and the 
212         board to adopt rules; providing legislative intent 
213         regarding implementation of the act within existing 
214         resources; amending s. 499.01, F.S.; authorizing 
215         certain business entities to pay for prescription 
216         drugs obtained by practitioners licensed under ch. 
217         466, F.S.; amending s. 624.91, F.S.; revising the 
218         membership of the board of directors of the Florida 
219         Healthy Kids Corporation to include a member nominated 
220         by the Florida Dental Association and appointed by the 
221         Governor; amending s. 381.00315, F.S.; directing the 
222         Department of Health to accept funds from counties, 
223         municipalities, and certain other entities for the 
224         purchase of certain products made available under a 
225         contract with the United States Department of Health 
226         and Human Services for the manufacture and delivery of 
227         such products in response to a public health 
228         emergency; providing an effective date. 
229 
230  Be It Enacted by the Legislature of the State of Florida: 
231 
232         Section 1. Paragraph (e) of subsection (10) of section 
233  112.0455, Florida Statutes, is repealed. 
234         Section 2. Section 383.325, Florida Statutes, is repealed. 
235         Section 3. Section 395.1046, Florida Statutes, is repealed. 
236         Section 4. Section 395.3037, Florida Statutes, is repealed. 
237         Section 5. Paragraph (g) of subsection (2) of section 
238  400.0239, Florida Statutes, is amended to read: 
239         400.0239 Quality of Long-Term Care Facility Improvement 
240  Trust Fund.— 
241         (2) Expenditures from the trust fund shall be allowable for 
242  direct support of the following: 
243         (g) Other initiatives authorized by the Centers for 
244  Medicare and Medicaid Services for the use of federal civil 
245  monetary penalties, including projects recommended through the 
246  Medicaid “Up-or-Out” Quality of Care Contract Management Program 
247  pursuant to s. 400.148. 
248         Section 6. Subsection (10) of section 400.147, Florida 
249  Statutes, is repealed. 
250         Section 7. Section 400.148, Florida Statutes, is repealed. 
251         Section 8. Section 400.195, Florida Statutes, is repealed. 
252         Section 9. Section 400.476, Florida Statutes, is amended to 
253  read: 
254         400.476 Staffing requirements; notifications; limitations 
255  on staffing services.— 
256         (1) ADMINISTRATOR.— 
257         (a) An administrator may manage only one home health 
258  agency, except that an administrator may manage up to five home 
259  health agencies if all five home health agencies have identical 
260  controlling interests as defined in s. 408.803 and are located 
261  within one agency geographic service area or within an 
262  immediately contiguous county. If the home health agency is 
263  licensed under this chapter and is part of a retirement 
264  community that provides multiple levels of care, an employee of 
265  the retirement community may administer the home health agency 
266  and up to a maximum of four entities licensed under this chapter 
267  or chapter 429 which all have identical controlling interests as 
268  defined in s. 408.803. An administrator shall designate, in 
269  writing, for each licensed entity, a qualified alternate 
270  administrator to serve during the administrator’s absence. An 
271  alternate administrator must meet the requirements in this 
272  paragraph and s. 400.462(1). 
273         (b) An administrator of a home health agency who is a 
274  licensed physician, physician assistant, or registered nurse 
275  licensed to practice in this state may also be the director of 
276  nursing for a home health agency. An administrator may serve as 
277  a director of nursing for up to the number of entities 
278  authorized in subsection (2) only if there are 10 or fewer full 
279  time equivalent employees and contracted personnel in each home 
280  health agency. 
281         (c) The administrator shall organize and direct the 
282  agency’s ongoing functions, maintain an ongoing liaison with the 
283  board members and the staff, employ qualified personnel and 
284  ensure adequate staff education and evaluations, ensure the 
285  accuracy of public informational materials and activities, 
286  implement an effective budgeting and accounting system, and 
287  ensure that the home health agency operates in compliance with 
288  this part and part II of chapter 408 and rules adopted for these 
289  laws. 
290         (d) The administrator shall clearly set forth in writing 
291  the organizational chart, services furnished, administrative 
292  control, and lines of authority for the delegation of 
293  responsibilities for patient care. These responsibilities must 
294  be readily identifiable. Administrative and supervisory 
295  functions may not be delegated to another agency or 
296  organization, and the primary home health agency shall monitor 
297  and control all services that are not furnished directly, 
298  including services provided through contracts. 
299         (2) DIRECTOR OF NURSING.— 
300         (a) A director of nursing may be the director of nursing 
301  for: 
302         1. Up to two licensed home health agencies if the agencies 
303  have identical controlling interests as defined in s. 408.803 
304  and are located within one agency geographic service area or 
305  within an immediately contiguous county; or 
306         2. Up to five licensed home health agencies if: 
307         a. All of the home health agencies have identical 
308  controlling interests as defined in s. 408.803; 
309         b. All of the home health agencies are located within one 
310  agency geographic service area or within an immediately 
311  contiguous county; and 
312         c. Each home health agency has a registered nurse who meets 
313  the qualifications of a director of nursing and who has a 
314  written delegation from the director of nursing to serve as the 
315  director of nursing for that home health agency when the 
316  director of nursing is not present; and. 
317         d. This person, or similarly qualified alternate, is 
318  available at all times by telecommunications during operating 
319  hours and participates in all activities relevant to the 
320  professional services furnished, including, but not limited to, 
321  the oversight of nursing services, home health aides, and 
322  certified nursing assistants, and assignment of personnel. 
323 
324  If a home health agency licensed under this chapter is part of a 
325  retirement community that provides multiple levels of care, an 
326  employee of the retirement community may serve as the director 
327  of nursing of the home health agency and up to a maximum of four 
328  entities, other than home health agencies, licensed under this 
329  chapter or chapter 429 which all have identical controlling 
330  interests as defined in s. 408.803. 
331         (b) A home health agency that provides skilled nursing care 
332  may not operate for more than 30 calendar days without a 
333  director of nursing. A home health agency that provides skilled 
334  nursing care and the director of nursing of a home health agency 
335  must notify the agency within 10 business days after termination 
336  of the services of the director of nursing for the home health 
337  agency. A home health agency that provides skilled nursing care 
338  must notify the agency of the identity and qualifications of the 
339  new director of nursing within 10 days after the new director is 
340  hired. If a home health agency that provides skilled nursing 
341  care operates for more than 30 calendar days without a director 
342  of nursing, the home health agency commits a class II 
343  deficiency. In addition to the fine for a class II deficiency, 
344  the agency may issue a moratorium in accordance with s. 408.814 
345  or revoke the license. The agency shall fine a home health 
346  agency that fails to notify the agency as required in this 
347  paragraph $1,000 for the first violation and $2,000 for a repeat 
348  violation. The agency may not take administrative action against 
349  a home health agency if the director of nursing fails to notify 
350  the department upon termination of services as the director of 
351  nursing for the home health agency. 
352         (c) A home health agency that is not Medicare or Medicaid 
353  certified and does not provide skilled care or provides only 
354  physical, occupational, or speech therapy is not required to 
355  have a director of nursing and is exempt from paragraph (b). 
356         (3) TRAINING.—A home health agency shall ensure that each 
357  certified nursing assistant employed by or under contract with 
358  the home health agency and each home health aide employed by or 
359  under contract with the home health agency is adequately trained 
360  to perform the tasks of a home health aide in the home setting. 
361         (a) The home health agency may not use as a home health 
362  aide on a full-time, temporary, per diem, or other basis, any 
363  individual to provide services unless the individual has 
364  completed a training and competency evaluation program, or a 
365  competency evaluation program, as permitted in s. 400.497, which 
366  meets the minimum standards established by the agency in state 
367  rules. 
368         (b) A home health aide is not competent in any task for 
369  which he or she is evaluated as “unsatisfactory.” The aide must 
370  perform any such task only under direct supervision by a 
371  licensed nurse until he or she receives training in the task and 
372  satisfactorily passes a subsequent evaluation in performing the 
373  task. A home health aide has not successfully passed a 
374  competency evaluation if the aide does not have a passing score 
375  on the test as specified by agency rule. 
376         (4) STAFFING.—Staffing services may be provided anywhere 
377  within the state. 
378         (5) PERSONNEL.— 
379         (a) The home health agency and its staff must comply with 
380  accepted professional standards and principles that apply to 
381  professionals, including, but not limited to, the state practice 
382  acts and the home health agency’s policies and procedures. 
383         (b) Except for direct employees of the home health agency, 
384  if personnel under hourly or per-visit contracts are used by the 
385  home health agency, there must be a written contract between 
386  those personnel and the agency which specifies the following 
387  requirements: 
388         1. Acceptance for care only of patients by the primary home 
389  health agency. 
390         2. The services to be furnished. 
391         3. The necessity to conform to all applicable agency 
392  policies, including personnel qualifications. 
393         4. The responsibility for participating in developing plans 
394  of care. 
395         5. The manner in which services are controlled, 
396  coordinated, and evaluated by the primary home health agency. 
397         6. The procedures for submitting clinical and progress 
398  notes, scheduling of visits, and periodic patient evaluation. 
399         7. The procedures for payment for services furnished under 
400  the contract. 
401         (c) A home health agency shall directly provide at least 
402  one of the types of services through home health agency 
403  employees, but may provide additional services under 
404  arrangements with another agency or organization. Services 
405  furnished under such arrangements must have a written contract 
406  conforming to the requirements specified in paragraph (b). 
407         (d) If home health aide services are provided by an 
408  individual who is not employed directly by the home health 
409  agency, the services of the home health aide must be provided 
410  under arrangements as stated in paragraphs (b) and (c). If the 
411  home health agency chooses to provide home health aide services 
412  under arrangements with another organization, the 
413  responsibilities of the home health agency include, but are not 
414  limited to: 
415         1. Ensuring the overall quality of the care provided by the 
416  aide; 
417         2. Supervising the aide’s services as described in s. 
418  400.487; and 
419         3. Ensuring that each home health aide providing services 
420  under arrangements with another organization has met the 
421  training requirements or competency evaluation requirements of 
422  s. 400.497. 
423         (e) The home health agency shall coordinate the efforts of 
424  all personnel furnishing services, and the personnel shall 
425  maintain communication with the home health agency to ensure 
426  that personnel efforts support the objectives outlined in the 
427  plan of care. The clinical record or minutes of case conferences 
428  shall ensure that effective interchange, reporting, and 
429  coordination of patient care occurs. 
430         Section 10. Section 400.487, Florida Statutes, is amended 
431  to read: 
432         400.487 Home health service agreements; physician’s, 
433  physician assistant’s, and advanced registered nurse 
434  practitioner’s treatment orders; patient assessment; 
435  establishment and review of plan of care; provision of services; 
436  orders not to resuscitate.— 
437         (1) Services provided by a home health agency must be 
438  covered by an agreement between the home health agency and the 
439  patient or the patient’s legal representative specifying the 
440  home health services to be provided, the rates or charges for 
441  services paid with private funds, and the sources of payment, 
442  which may include Medicare, Medicaid, private insurance, 
443  personal funds, or a combination thereof. The home health agency 
444  shall provide a copy of the agreement to the patient or the 
445  patient’s legal representative. A home health agency providing 
446  skilled care must make an assessment of the patient’s needs 
447  within 48 hours after the start of services. 
448         (2) When required by the provisions of chapter 464; part I, 
449  part III, or part V of chapter 468; or chapter 486, the 
450  attending physician, physician assistant, or advanced registered 
451  nurse practitioner, acting within his or her respective scope of 
452  practice, shall establish treatment orders for a patient who is 
453  to receive skilled care. The treatment orders must be signed by 
454  the physician, physician assistant, or advanced registered nurse 
455  practitioner before a claim for payment for the skilled services 
456  is submitted by the home health agency. If the claim is 
457  submitted to a managed care organization, the treatment orders 
458  must be signed within the time allowed under the provider 
459  agreement. The treatment orders shall be reviewed, as frequently 
460  as the patient’s illness requires, by the physician, physician 
461  assistant, or advanced registered nurse practitioner in 
462  consultation with the home health agency. 
463         (3) A home health agency shall arrange for supervisory 
464  visits by a registered nurse to the home of a patient receiving 
465  home health aide services as specified in subsection (9) in 
466  accordance with the patient’s direction, approval, and agreement 
467  to pay the charge for the visits. 
468         (4) The home health agency shall protect and promote the 
469  rights of each individual under its care, including each of the 
470  following rights: 
471         (a) Notice of rights.—The home health agency shall provide 
472  the patient with a written notice of the patient’s rights in 
473  advance of furnishing care to the patient or during the initial 
474  evaluation visit before the initiation of treatment. The home 
475  health agency must maintain documentation showing that it has 
476  complied with the requirements of this section. 
477         (b) Exercise of rights and respect for property and 
478  person.— 
479         1. The patient has the right to exercise his or her rights 
480  as a patient of the home health agency. 
481         2. The patient has the right to have his or her property 
482  treated with respect. 
483         3. The patient has the right to voice grievances regarding 
484  treatment or care that is or fails to be furnished, or regarding 
485  the lack of respect for property by anyone who is furnishing 
486  services on behalf of the home health agency, and not be 
487  subjected to discrimination or reprisal for doing so. 
488         4. The home health agency must investigate complaints made 
489  by a patient or the patient’s family or guardian regarding 
490  treatment or care that is or fails to be furnished, or regarding 
491  the lack of respect for the patient’s property by anyone 
492  furnishing services on behalf of the home health agency. The 
493  home health agency shall document the existence of the complaint 
494  and its resolution. 
495         5. The patient and his or her immediate family or 
496  representative must be informed of the right to report 
497  complaints via the statewide toll-free telephone number to the 
498  agency as required in s. 408.810. 
499         (c) Right to be informed and to participate in planning 
500  care and treatment.— 
501         1. The patient has the right to be informed, in advance, 
502  about the care to be furnished and of any changes in the care to 
503  be furnished. The home health agency shall advise the patient in 
504  advance of which disciplines will furnish care and the frequency 
505  of visits proposed to be furnished. The home health agency must 
506  advise the patient in advance of any change in the plan of care 
507  before the change is made. 
508         2. The patient has the right to participate in the planning 
509  of the care. The home health agency must advise the patient in 
510  advance of the right to participate in planning the care or 
511  treatment and in planning changes in the care or treatment. Each 
512  patient has the right to be informed of and to participate in 
513  the planning of his or her care. Each patient must be provided, 
514  upon request, a copy of the plan of care established and 
515  maintained for that patient by the home health agency. 
516         (5) When nursing services are ordered, the home health 
517  agency to which a patient has been admitted for care must 
518  provide the initial admission visit, all service evaluation 
519  visits, and the discharge visit by a direct employee. Services 
520  provided by others under contractual arrangements to a home 
521  health agency must be monitored and managed by the admitting 
522  home health agency. The admitting home health agency is fully 
523  responsible for ensuring that all care provided through its 
524  employees or contract staff is delivered in accordance with this 
525  part and applicable rules. 
526         (6) The skilled care services provided by a home health 
527  agency, directly or under contract, must be supervised and 
528  coordinated in accordance with the plan of care. The home health 
529  agency shall furnish skilled nursing services by or under the 
530  supervision of a registered nurse and in accordance with the 
531  plan of care. Any therapy services offered directly or under 
532  arrangement by the home health agency must be provided by a 
533  qualified therapist or by a qualified therapy assistant under 
534  the supervision of a qualified therapist and in accordance with 
535  the plan of care. 
536         (a) Physical therapy services.—Physical therapy services 
537  shall be furnished only by, or under the supervision of, a 
538  licensed physical therapist or licensed physical therapist 
539  assistant as required under chapter 486 and related rules. A 
540  physical therapist assistant shall perform services planned, 
541  delegated, and supervised by the physical therapist, assist in 
542  preparing clinical notes and progress reports, participate in 
543  educating the patient and his or her family, and participate in 
544  in-service programs. This paragraph does not limit the services 
545  provided by a physician licensed under chapter 458 or chapter 
546  459. 
547         (b) Occupational therapy services.—Occupational therapy 
548  services shall be furnished only by, or under the supervision 
549  of, a licensed occupational therapist or occupational therapy 
550  assistant as provided under part III of chapter 468 and related 
551  rules. An occupational therapy assistant shall perform any 
552  services planned, delegated, and supervised by an occupational 
553  therapist, assist in preparing clinical notes and progress 
554  reports, participate in educating the patient and his or her 
555  family, and participate in in-service programs. This paragraph 
556  does not limit the services provided by a physician licensed 
557  under chapter 458 or chapter 459. 
558         (c) Speech therapy services.—Speech therapy services shall 
559  be furnished only by or under supervision of a qualified speech 
560  pathologist or audiologist as required in part I of chapter 468 
561  and related applicable rules. 
562         (d) Care follows a written plan of care.—The plan of care 
563  shall be reviewed by the physician or health professional who 
564  provided the treatment orders pursuant to subsection (2) and 
565  home health agency personnel as often as the severity of the 
566  patient’s condition requires, but at least once every 60 days or 
567  more when there is a patient-elected transfer, a significant 
568  change in condition, or a discharge and return to the same home 
569  health agency during the 60-day episode. Professional staff of a 
570  home health agency shall promptly alert the physician or other 
571  health professional who provided the treatment orders of any 
572  change that suggests a need to alter the plan of care. 
573         (e) Administration of drugs and treatment.—Only 
574  professional staff of a home health agency may administer drugs 
575  and treatments as ordered by the physician or health 
576  professional pursuant to subsection (2), with the exception of 
577  influenza and pneumococcal polysaccharide vaccines, which may be 
578  administered according to the policy of the home health agency 
579  developed in consultation with a physician and after an 
580  assessment for contraindications. Verbal orders shall be in 
581  writing and signed and dated with the date of receipt by the 
582  registered nurse or qualified therapist who is responsible for 
583  furnishing or supervising the ordered service. A verbal order 
584  may be accepted only by personnel who are authorized to do so by 
585  applicable state laws, rules, and internal policies of the home 
586  health agency. 
587         (7) A registered nurse shall conduct the initial evaluation 
588  visit, regularly reevaluate the patient’s nursing needs, 
589  initiate the plan of care and necessary revisions, furnish those 
590  services requiring substantial and specialized nursing skill, 
591  initiate appropriate preventive and rehabilitative nursing 
592  procedures, prepare clinical and progress notes, coordinate 
593  services, inform the physician and other personnel of changes in 
594  the patient’s condition and needs, counsel the patient and his 
595  or her family in meeting nursing and related needs, participate 
596  in in-service programs, and supervise and teach other nursing 
597  personnel, unless the home health agency providing the home 
598  health aide services is not Medicare-certified or Medicaid 
599  certified, does not provide skilled care, or the patient is not 
600  receiving skilled care. 
601         (8) A licensed practical nurse shall furnish services in 
602  accordance with agency policies, prepare clinical and progress 
603  notes, assist the physician and registered nurse in performing 
604  specialized procedures, prepare equipment and materials for 
605  treatments observing aseptic technique as required, and assist 
606  the patient in learning appropriate self-care techniques. 
607         (9) A home health aide and certified nursing assistant 
608  shall provide services that are in the service provision plan 
609  provided in s. 400.491 and other services that the home health 
610  aide or certified nursing assistant is permitted to perform 
611  under state law. The duties of a home health aide or certified 
612  nursing assistant include the provision of hands-on personal 
613  care, performance of simple procedures as an extension of 
614  therapy or nursing services, assistance in ambulation or 
615  exercises, and assistance in administering medications that are 
616  ordinarily self-administered and are specified in agency rules. 
617  Any services by a home health aide which are offered by a home 
618  health agency must be provided by a qualified home health aide 
619  or certified nursing assistant. 
620         (a) Assignment and duties.—A home health aide or certified 
621  nursing assistant shall be assigned to a specific patient by a 
622  registered nurse, unless the home health agency providing the 
623  home health aide services is not Medicare-certified or Medicaid 
624  certified, does not provide skilled care, or the patient is not 
625  receiving skilled care. Written patient care instructions for 
626  the home health aide and certified nursing assistant must be 
627  prepared by the registered nurse or other appropriate 
628  professional who is responsible for the supervision of the home 
629  health aide and certified nursing assistant as stated in this 
630  section. 
631         (b) Supervision.—If a patient receives skilled nursing 
632  care, the registered nurse shall perform the supervisory visit. 
633  If the patient is not receiving skilled nursing care but is 
634  receiving physical therapy, occupational therapy, or speech 
635  language pathology services, the appropriate therapist may 
636  provide the supervision. A registered nurse or other 
637  professional must make an onsite visit to the patient’s home at 
638  least once every 2 weeks. The visit is not required while the 
639  aide is providing care. 
640         (c) Supervising visits.—If home health aide services are 
641  provided to a patient who is not receiving skilled nursing care, 
642  physical or occupational therapy, or speech-language pathology 
643  services, a registered nurse must make a supervisory visit to 
644  the patient’s home at least once every 60 days, unless the home 
645  health agency providing the home health aide services is not 
646  Medicare or Medicaid certified and does not provide skilled 
647  care, either directly or through contracts. The registered nurse 
648  shall ensure that the aide is properly caring for the patient 
649  and each supervisory visit must occur while the home health aide 
650  is providing patient care. In addition to the requirements in 
651  this subsection, a home health agency shall arrange for 
652  additional supervisory visits by a registered nurse to the home 
653  of a patient receiving home health aide services in accordance 
654  with the patient’s direction, approval, and agreement to pay the 
655  charge for the visits. 
656         (10)(7) Home health agency personnel may withhold or 
657  withdraw cardiopulmonary resuscitation if presented with an 
658  order not to resuscitate executed pursuant to s. 401.45. The 
659  agency shall adopt rules providing for the implementation of 
660  such orders. Home health personnel and agencies shall not be 
661  subject to criminal prosecution or civil liability, nor be 
662  considered to have engaged in negligent or unprofessional 
663  conduct, for withholding or withdrawing cardiopulmonary 
664  resuscitation pursuant to such an order and rules adopted by the 
665  agency. 
666         Section 11. Subsection (11) of section 408.802, Florida 
667  Statutes, is repealed. 
668         Section 12. Paragraphs (e), (f), and (g) of subsection (15) 
669  of section 409.912, Florida Statutes, are repealed. 
670         Section 13. Section 409.91255, Florida Statutes, is amended 
671  to read: 
672         409.91255 Federally qualified health center access 
673  program.— 
674         (1) SHORT TITLE.—This section may be cited as the 
675  “Community Health Center Access Program Act.” 
676         (2) LEGISLATIVE FINDINGS AND INTENT.— 
677         (a) The Legislature finds that, despite significant 
678  investments in health care programs, nearly 6 more than 2 
679  million low-income Floridians, primarily the working poor and 
680  minority populations, continue to lack access to basic health 
681  care services. Further, the Legislature recognizes that 
682  federally qualified health centers have a proven record of 
683  providing cost-effective, comprehensive primary and preventive 
684  health care and are uniquely qualified to address the lack of 
685  adequate health care services for the uninsured. 
686         (b) It is the intent of the Legislature to recognize the 
687  significance of increased federal investments in federally 
688  qualified health centers and to leverage that investment through 
689  the creation of a program to provide for the expansion of the 
690  primary and preventive health care services offered by federally 
691  qualified health centers. Further, such a program will support 
692  the coordination of federal, state, and local resources to 
693  assist such health centers in developing an expanded community 
694  based primary care delivery system. 
695         (3) ASSISTANCE TO FEDERALLY QUALIFIED HEALTH CENTERS.—The 
696  agency shall administer Department of Health shall develop a 
697  program for the expansion of federally qualified health centers 
698  for the purpose of providing comprehensive primary and 
699  preventive health care and urgent care services that may reduce 
700  the morbidity, mortality, and cost of care among the uninsured 
701  population of the state. The program shall provide for 
702  distribution of financial assistance to federally qualified 
703  health centers that apply and demonstrate a need for such 
704  assistance in order to sustain or expand the delivery of primary 
705  and preventive health care services. In selecting centers to 
706  receive this financial assistance, the program: 
707         (a) Shall give preference to communities that have few or 
708  no community-based primary care services or in which the current 
709  services are unable to meet the community’s needs. To assist in 
710  the assessment and identification of areas of critical need, a 
711  federally qualified health-center-based statewide assessment and 
712  strategic plan shall be developed by the Florida Association of 
713  Community Health Centers, Inc., every 5 years, beginning January 
714  1, 2011. 
715         (b) Shall require that primary care services be provided to 
716  the medically indigent using a sliding fee schedule based on 
717  income. 
718         (c) Shall promote allow innovative and creative uses of 
719  federal, state, and local health care resources. 
720         (d) Shall require that the funds provided be used to pay 
721  for operating costs of a projected expansion in patient 
722  caseloads or services or for capital improvement projects. 
723  Capital improvement projects may include renovations to existing 
724  facilities or construction of new facilities, provided that an 
725  expansion in patient caseloads or services to a new patient 
726  population will occur as a result of the capital expenditures. 
727  The agency department shall include in its standard contract 
728  document a requirement that any state funds provided for the 
729  purchase of or improvements to real property are contingent upon 
730  the contractor granting to the state a security interest in the 
731  property at least to the amount of the state funds provided for 
732  at least 5 years from the date of purchase or the completion of 
733  the improvements or as further required by law. The contract 
734  must include a provision that, as a condition of receipt of 
735  state funding for this purpose, the contractor agrees that, if 
736  it disposes of the property before the agency’s department’s 
737  interest is vacated, the contractor will refund the 
738  proportionate share of the state’s initial investment, as 
739  adjusted by depreciation. 
740         (e) Shall May require in-kind support from other sources. 
741         (f) Shall promote May encourage coordination among 
742  federally qualified health centers, other private sector 
743  providers, and publicly supported programs. 
744         (g) Shall promote allow the development of community 
745  emergency room diversion programs in conjunction with local 
746  resources, providing extended hours of operation to urgent care 
747  patients. Diversion programs shall include case management for 
748  emergency room followup care. 
749         (4) EVALUATION OF APPLICATIONS.—A review panel shall be 
750  established, consisting of four persons appointed by the 
751  Secretary of Health Care Administration State Surgeon General 
752  and three persons appointed by the chief executive officer of 
753  the Florida Association of Community Health Centers, Inc., to 
754  review all applications for financial assistance under the 
755  program. Applicants shall specify in the application whether the 
756  program funds will be used for the expansion of patient 
757  caseloads or services or for capital improvement projects to 
758  expand and improve patient facilities. The panel shall use the 
759  following elements in reviewing application proposals and shall 
760  determine the relative weight for scoring and evaluating these 
761  elements: 
762         (a) The target population to be served. 
763         (b) The health benefits to be provided. 
764         (c) The methods that will be used to measure cost 
765  effectiveness. 
766         (d) How patient satisfaction will be measured. 
767         (e) The proposed internal quality assurance process. 
768         (f) Projected health status outcomes. 
769         (g) How data will be collected to measure cost 
770  effectiveness, health status outcomes, and overall achievement 
771  of the goals of the proposal. 
772         (h) All resources, including cash, in-kind, voluntary, or 
773  other resources that will be dedicated to the proposal. 
774         (5) ADMINISTRATION AND TECHNICAL ASSISTANCE.—The agency 
775  shall Department of Health may contract with the Florida 
776  Association of Community Health Centers, Inc., to develop and 
777  coordinate administer the program and provide technical 
778  assistance to the federally qualified health centers selected to 
779  receive financial assistance. The contracted entity shall be 
780  responsible for program support and assume all costs related to 
781  administration of this program. 
782         Section 14. Paragraphs (f) and (g) of subsection (4) of 
783  section 400.9905, Florida Statutes, are amended to read: 
784         400.9905 Definitions.— 
785         (4) “Clinic” means an entity at which health care services 
786  are provided to individuals and which tenders charges for 
787  reimbursement for such services, including a mobile clinic and a 
788  portable equipment provider. For purposes of this part, the term 
789  does not include and the licensure requirements of this part do 
790  not apply to: 
791         (f) A sole proprietorship, group practice, partnership, or 
792  corporation, or other legal entity that provides health care 
793  services by practitioners licensed under chapter 458, chapter 
794  459, chapter 461, chapter 466, or chapter 460 and subject to the 
795  limitations of s. 460.4167 physicians covered by s. 627.419, 
796  that is directly supervised by one or more of such physicians or 
797  physician assistants, and that is wholly owned by one or more of 
798  those physicians or physician assistants or by a physician or 
799  physician assistant or and the spouse, parent, child, or sibling 
800  of that physician or physician assistant. A certificate of 
801  exemption is valid only for the entity, persons, and location 
802  for which it was originally issued. 
803         1. An individual who is not a medical professional or 
804  family member listed in this paragraph may own up to 30 percent 
805  of a health care clinic entity that is exempt under this 
806  paragraph if the individual obtains prior approval from the 
807  agency for ownership of a percentage of a health care clinic. 
808  Such an individual is considered an “applicant” under s. 
809  400.991(5) and must meet all the requirements of that section 
810  and the level 2 background screening requirements of s. 408.809 
811  before being approved by the agency for ownership of a minority 
812  interest in a health care clinic. 
813         2. If an individual who is not a medical professional or 
814  family member listed in this paragraph assumes ownership of an 
815  investment interest in a health care clinic without the prior 
816  approval of the agency, the health care clinic shall lose its 
817  exemption from licensure under this paragraph. 
818         3. Ownership of a health care clinic by an individual other 
819  than the physician or physician assistant, or by the spouse, 
820  parent, child, or sibling of the physician or physician 
821  assistant to whom the exemption was granted, may not exceed 30 
822  percent. 
823         (g) A sole proprietorship, group practice, partnership, or 
824  corporation that provides health care services by licensed 
825  health care practitioners under chapter 457, chapter 458, 
826  chapter 459, chapter 460, chapter 461, chapter 462, chapter 463, 
827  chapter 466, chapter 467, chapter 480, chapter 484, chapter 486, 
828  chapter 490, chapter 491, or part I, part III, part X, part 
829  XIII, or part XIV of chapter 468, or s. 464.012, which are 
830  wholly owned by one or more licensed health care practitioners, 
831  or the licensed health care practitioners set forth in this 
832  paragraph and the spouse, parent, child, or sibling of a 
833  licensed health care practitioner, so long as one of the owners 
834  who is a licensed health care practitioner is directly 
835  supervising health care services the business activities and is 
836  legally responsible for the entity’s compliance with all federal 
837  and state laws. However, a health care practitioner who is a 
838  supervising owner may not supervise services beyond the scope of 
839  the practitioner’s license, except that, for the purposes of 
840  this part, a clinic owned by a licensee in s. 456.053(3)(b) that 
841  provides only services authorized pursuant to s. 456.053(3)(b) 
842  may be supervised by a licensee specified in s. 456.053(3)(b). A 
843  certificate of exemption is valid only for the entity, persons, 
844  and location for which it was originally issued. 
845         Section 15. Subsection (4) of section 413.615, Florida 
846  Statutes, is amended to read: 
847         413.615 Florida Endowment for Vocational Rehabilitation.— 
848         (4) REVENUE FOR THE ENDOWMENT FUND.— 
849         (a) The endowment fund of the Florida Endowment for 
850  Vocational Rehabilitation is created as a long-term, stable, and 
851  growing source of revenue to be administered, in accordance with 
852  rules promulgated by the division, by the foundation as a 
853  direct-support organization of the division. 
854         (b) The principal of the endowment fund shall derive from 
855  the deposits made pursuant to s. 318.21(2)(e), together with any 
856  legislative appropriations which may be made to the endowment, 
857  and such bequests, gifts, grants, and donations as may be 
858  solicited for such purpose by the foundation from public or 
859  private sources. 
860         (c) All funds currently held for investment and 
861  reinvestment by the State Board of Administration for the 
862  endowment shall be submitted back to the endowment fund within a 
863  reasonable time. Additional revenues received pursuant to s. 
864  318.21(2)(e), shall be transferred to the endowment fund. The 
865  State Board of Administration shall invest and reinvest moneys 
866  of the endowment fund in accordance with the provisions of ss. 
867  215.44-215.53. Moneys in the endowment fund in excess of the 
868  endowment fund principal, or such lesser amount as may be 
869  requested in writing by the foundation, shall be annually 
870  transmitted to the foundation, based upon a fiscal year which 
871  shall run from July 1 through June 30, and shall be deposited in 
872  the foundation’s operating account, for distribution as provided 
873  in subsection (10). The endowment fund principal shall be $1 
874  million for the 2000-2001 fiscal year and shall be increased by 
875  5 percent in each subsequent fiscal year. 
876         (d) The board of directors of the foundation shall 
877  establish the operating account and shall deposit therein the 
878  moneys transmitted pursuant to paragraph (c). Moneys in the 
879  operating account shall be available to carry out the purposes 
880  of subsection (10). 
881         Section 16. Subsection (2) of section 429.12, Florida 
882  Statutes, is repealed. 
883         Section 17. Subsection (5) of section 429.23, Florida 
884  Statutes, is repealed. 
885         Section 18. Paragraph (a) of subsection (2) of section 
886  429.911, Florida Statutes, is repealed. 
887         Section 19. Subsection (1) of section 465.0251, Florida 
888  Statutes, is reenacted to read: 
889         465.0251 Generic drugs; removal from formulary under 
890  specified circumstances.— 
891         (1) The Board of Pharmacy and the Board of Medicine shall 
892  remove any generic named drug product from the formulary 
893  established by s. 465.025(6), if every commercially marketed 
894  equivalent of that drug product is “A” rated as therapeutically 
895  equivalent to a reference listed drug or is a reference listed 
896  drug as referred to in “Approved Drug Products with Therapeutic 
897  Equivalence Evaluations” (Orange Book) published by the United 
898  States Food and Drug Administration. 
899         Section 20. Paragraph (q) of subsection (2) of section 
900  499.01, Florida Statutes, is amended to read: 
901         499.01 Permits.— 
902         (2) The following permits are established: 
903         (q) Device manufacturer permit.— 
904         1. A device manufacturer permit is required for any person 
905  that engages in the manufacture, repackaging, or assembly of 
906  medical devices for human use in this state, except that a 
907  permit is not required if: 
908         a. The person is engaged only in manufacturing, 
909  repackaging, or assembling a medical device pursuant to a 
910  practitioner’s order for a specific patient; or. 
911         b. The person does not manufacture, repackage, or assemble 
912  medical devices or components for such devices, except for 
913  devices or components that are exempt from registration under s. 
914  499.015(8). 
915         2.1. A manufacturer or repackager of medical devices in 
916  this state must comply with all appropriate state and federal 
917  good manufacturing practices and quality system rules. 
918         3.2. The department shall adopt rules related to storage, 
919  handling, and recordkeeping requirements for manufacturers of 
920  medical devices for human use. 
921         Section 21. Subsections (4) and (9) of section 381.0403, 
922  Florida Statutes, are repealed. 
923         Section 22. Section 381.4018, Florida Statutes, is amended 
924  to read: 
925         381.4018 Physician workforce assessment and development.— 
926         (1) DEFINITIONS.—As used in this section, the term: 
927         (a) “Consortium” or “consortia” means a combination of 
928  statutory teaching hospitals, statutory rural hospitals, 
929  specialty children’s hospitals, other hospitals, accredited 
930  medical schools, clinics operated by the Department of Health, 
931  clinics operated by the Department of Veterans’ Affairs, area 
932  health education centers, community health centers, federally 
933  qualified health centers, prison clinics, local community 
934  clinics, or other programs. At least one member of the 
935  consortium shall be a sponsoring institution accredited or 
936  currently seeking accreditation by the Accreditation Council for 
937  Graduate Medical Education or the American Osteopathic 
938  Association. 
939         (b) “Council” means the Physician Workforce Advisory 
940  Council. 
941         (c) “Department” means the Department of Health. 
942         (d) “Graduate medical education program” means a program 
943  accredited by the Accreditation Council for Graduate Medical 
944  Education or the American Osteopathic Association. 
945         (e) “Primary care specialty” means emergency medicine, 
946  family practice, internal medicine, pediatrics, psychiatry, 
947  geriatrics, general surgery, obstetrics and gynecology, and 
948  combined pediatrics and internal medicine and other specialties 
949  as determined by the Physician Workforce Advisory Council or the 
950  Department of Health. 
951         (2)(1) LEGISLATIVE INTENT.—The Legislature recognizes that 
952  physician workforce planning is an essential component of 
953  ensuring that there is an adequate and appropriate supply of 
954  well-trained physicians to meet this state’s future health care 
955  service needs as the general population and elderly population 
956  of the state increase. The Legislature finds that items to 
957  consider relative to assessing the physician workforce may 
958  include physician practice status; specialty mix; geographic 
959  distribution; demographic information, including, but not 
960  limited to, age, gender, race, and cultural considerations; and 
961  needs of current or projected medically underserved areas in the 
962  state. Long-term strategic planning is essential as the period 
963  from the time a medical student enters medical school to 
964  completion of graduate medical education may range from 7 to 10 
965  years or longer. The Legislature recognizes that strategies to 
966  provide for a well-trained supply of physicians must include 
967  ensuring the availability and capacity of quality graduate 
968  medical schools and graduate medical education programs in this 
969  state, as well as using new or existing state and federal 
970  programs providing incentives for physicians to practice in 
971  needed specialties and in underserved areas in a manner that 
972  addresses projected needs for physician manpower. 
973         (3)(2) PURPOSE.—The department of Health shall serve as a 
974  coordinating and strategic planning body to actively assess the 
975  state’s current and future physician workforce needs and work 
976  with multiple stakeholders to develop strategies and 
977  alternatives to address current and projected physician 
978  workforce needs. 
979         (4)(3) GENERAL FUNCTIONS.—The department shall maximize the 
980  use of existing programs under the jurisdiction of the 
981  department and other state agencies and coordinate governmental 
982  and nongovernmental stakeholders and resources in order to 
983  develop a state strategic plan and assess the implementation of 
984  such strategic plan. In developing the state strategic plan, the 
985  department shall: 
986         (a) Monitor, evaluate, and report on the supply and 
987  distribution of physicians licensed under chapter 458 or chapter 
988  459. The department shall maintain a database to serve as a 
989  statewide source of data concerning the physician workforce. 
990         (b) Develop a model and quantify, on an ongoing basis, the 
991  adequacy of the state’s current and future physician workforce 
992  as reliable data becomes available. Such model must take into 
993  account demographics, physician practice status, place of 
994  education and training, generational changes, population growth, 
995  economic indicators, and issues concerning the “pipeline” into 
996  medical education. 
997         (c) Develop and recommend strategies to determine whether 
998  the number of qualified medical school applicants who might 
999  become competent, practicing physicians in this state will be 
1000  sufficient to meet the capacity of the state’s medical schools. 
1001  If appropriate, the department shall, working with 
1002  representatives of appropriate governmental and nongovernmental 
1003  entities, develop strategies and recommendations and identify 
1004  best practice programs that introduce health care as a 
1005  profession and strengthen skills needed for medical school 
1006  admission for elementary, middle, and high school students, and 
1007  improve premedical education at the precollege and college level 
1008  in order to increase this state’s potential pool of medical 
1009  students. 
1010         (d) Develop strategies to ensure that the number of 
1011  graduates from the state’s public and private allopathic and 
1012  osteopathic medical schools is are adequate to meet physician 
1013  workforce needs, based on the analysis of the physician 
1014  workforce data, so as to provide a high-quality medical 
1015  education to students in a manner that recognizes the uniqueness 
1016  of each new and existing medical school in this state. 
1017         (e) Pursue strategies and policies to create, expand, and 
1018  maintain graduate medical education positions in the state based 
1019  on the analysis of the physician workforce data. Such strategies 
1020  and policies must take into account the effect of federal 
1021  funding limitations on the expansion and creation of positions 
1022  in graduate medical education. The department shall develop 
1023  options to address such federal funding limitations. The 
1024  department shall consider options to provide direct state 
1025  funding for graduate medical education positions in a manner 
1026  that addresses requirements and needs relative to accreditation 
1027  of graduate medical education programs. The department shall 
1028  consider funding residency positions as a means of addressing 
1029  needed physician specialty areas, rural areas having a shortage 
1030  of physicians, and areas of ongoing critical need, and as a 
1031  means of addressing the state’s physician workforce needs based 
1032  on an ongoing analysis of physician workforce data. 
1033         (f) Develop strategies to maximize federal and state 
1034  programs that provide for the use of incentives to attract 
1035  physicians to this state or retain physicians within the state. 
1036  Such strategies should explore and maximize federal-state 
1037  partnerships that provide incentives for physicians to practice 
1038  in federally designated shortage areas. Strategies shall also 
1039  consider the use of state programs, such as the Florida Health 
1040  Service Corps established pursuant to s. 381.0302 and the 
1041  Medical Education Reimbursement and Loan Repayment Program 
1042  pursuant to s. 1009.65, which provide for education loan 
1043  repayment or loan forgiveness and provide monetary incentives 
1044  for physicians to relocate to underserved areas of the state. 
1045         (g) Coordinate and enhance activities relative to physician 
1046  workforce needs, undergraduate medical education, and graduate 
1047  medical education, and reentry of retired military and other 
1048  physicians into the physician workforce provided by the Division 
1049  of Medical Quality Assurance, the Community Hospital Education 
1050  Program and the Graduate Medical Education Committee established 
1051  pursuant to s. 381.0403, area health education center networks 
1052  established pursuant to s. 381.0402, and other offices and 
1053  programs within the department of Health as designated by the 
1054  State Surgeon General. 
1055         (h) Work in conjunction with and act as a coordinating body 
1056  for governmental and nongovernmental stakeholders to address 
1057  matters relating to the state’s physician workforce assessment 
1058  and development for the purpose of ensuring an adequate supply 
1059  of well-trained physicians to meet the state’s future needs. 
1060  Such governmental stakeholders shall include, but need not be 
1061  limited to, the State Surgeon General or his or her designee, 
1062  the Commissioner of Education or his or her designee, the 
1063  Secretary of Health Care Administration or his or her designee, 
1064  and the Chancellor of the State University System or his or her 
1065  designee from the Board of Governors of the State University 
1066  System, and, at the discretion of the department, other 
1067  representatives of state and local agencies that are involved in 
1068  assessing, educating, or training the state’s current or future 
1069  physicians. Other stakeholders shall include, but need not be 
1070  limited to, organizations representing the state’s public and 
1071  private allopathic and osteopathic medical schools; 
1072  organizations representing hospitals and other institutions 
1073  providing health care, particularly those that currently provide 
1074  or have an interest in providing accredited medical education 
1075  and graduate medical education to medical students and medical 
1076  residents; organizations representing allopathic and osteopathic 
1077  practicing physicians; and, at the discretion of the department, 
1078  representatives of other organizations or entities involved in 
1079  assessing, educating, or training the state’s current or future 
1080  physicians. 
1081         (i) Serve as a liaison with other states and federal 
1082  agencies and programs in order to enhance resources available to 
1083  the state’s physician workforce and medical education continuum. 
1084         (j) Act as a clearinghouse for collecting and disseminating 
1085  information concerning the physician workforce and medical 
1086  education continuum in this state. 
1087         (5) PHYSICIAN WORKFORCE ADVISORY COUNCIL.—There is created 
1088  in the department the Physician Workforce Advisory Council, an 
1089  advisory council as defined in s. 20.03. The council shall 
1090  comply with the requirements of s. 20.052, except as otherwise 
1091  provided in this section. 
1092         (a) The council shall consist of 19 members. Members 
1093  appointed by the State Surgeon General shall include: 
1094         1. A designee from the department who is a physician 
1095  licensed under chapter 458 or chapter 459 and recommended by the 
1096  State Surgeon General. 
1097         2. An individual who is affiliated with the Science 
1098  Students Together Reaching Instructional Diversity and 
1099  Excellence program and recommended by the area health education 
1100  center network. 
1101         3. Two individuals recommended by the Council of Florida 
1102  Medical School Deans, one representing a college of allopathic 
1103  medicine and one representing a college of osteopathic medicine. 
1104         4. One individual recommended by the Florida Hospital 
1105  Association, representing a hospital that is licensed under 
1106  chapter 395, has an accredited graduate medical education 
1107  program, and is not a statutory teaching hospital. 
1108         5. One individual representing a statutory teaching 
1109  hospital as defined in s. 408.07 and recommended by the Safety 
1110  Net Hospital Alliance. 
1111         6. One individual representing a family practice teaching 
1112  hospital as defined in s. 395.805 and recommended by the Council 
1113  of Family Medicine and Community Teaching Hospitals. 
1114         7. Two individuals recommended by the Florida Medical 
1115  Association, one representing a primary care specialty and one 
1116  representing a nonprimary care specialty. 
1117         8. Two individuals recommended by the Florida Osteopathic 
1118  Medical Association, one representing a primary care specialty 
1119  and one representing a nonprimary care specialty. 
1120         9. Two individuals who are program directors of accredited 
1121  graduate medical education programs, one representing a program 
1122  that is accredited by the Accreditation Council for Graduate 
1123  Medical Education and one representing a program that is 
1124  accredited by the American Osteopathic Association. 
1125         10. An individual recommended by the Florida Association of 
1126  Community Health Centers representing a federally qualified 
1127  health center located in a rural area as defined in s. 
1128  381.0406(2)(a). 
1129         11. An individual recommended by the Florida Academy of 
1130  Family Physicians. 
1131         12. An individual recommended by the Florida Alliance for 
1132  Health Professions Diversity. 
1133         13. The Chancellor of the State University System or his or 
1134  her designee. 
1135         14. A layperson member as determined by the State Surgeon 
1136  General. 
1137 
1138  Appointments to the council shall be made by the State Surgeon 
1139  General. Each entity authorized to make recommendations under 
1140  this subsection shall make at least two recommendations to the 
1141  State Surgeon General for each appointment to the council. The 
1142  State Surgeon General shall name one appointee for each position 
1143  from the recommendations made by each authorized entity. 
1144         (b) Each council member shall be appointed to a 4-year 
1145  term. An individual may not serve more than two terms. Any 
1146  council member may be removed from office for malfeasance; 
1147  misfeasance; neglect of duty; incompetence; permanent inability 
1148  to perform official duties; or pleading guilty or nolo 
1149  contendere to, or being found guilty of, a felony. Any council 
1150  member who meets the criteria for removal, or who is otherwise 
1151  unwilling or unable to properly fulfill the duties of the 
1152  office, shall be succeeded by an individual chosen by the State 
1153  Surgeon General to serve out the remainder of the council 
1154  member’s term. If the remainder of the replaced council member’s 
1155  term is less than 18 months, notwithstanding the provisions of 
1156  this paragraph, the succeeding council member may be reappointed 
1157  twice by the State Surgeon General. 
1158         (c) The chair of the council is the State Surgeon General, 
1159  who shall designate a vice chair from the membership of the 
1160  council to serve in the absence of the State Surgeon General. A 
1161  vacancy shall be filled for the remainder of the unexpired term 
1162  in the same manner as the original appointment. 
1163         (d) Council members are not entitled to receive 
1164  compensation or reimbursement for per diem or travel expenses. 
1165         (e) The council shall meet at least twice a year in person 
1166  or by teleconference. 
1167         (f) The council shall: 
1168         1. Advise the State Surgeon General and the department on 
1169  matters concerning current and future physician workforce needs 
1170  in this state; 
1171         2. Review survey materials and the compilation of survey 
1172  information; 
1173         3. Annually review the number, location, cost, and 
1174  reimbursement of graduate medical education programs and 
1175  positions; 
1176         4. Provide recommendations to the department regarding the 
1177  survey completed by physicians licensed under chapter 458 or 
1178  chapter 459; 
1179         5. Assist the department in preparing the annual report to 
1180  the Legislature pursuant to ss. 458.3192 and 459.0082; 
1181         6. Assist the department in preparing an initial strategic 
1182  plan, conduct ongoing strategic planning in accordance with this 
1183  section, and provide ongoing advice on implementing the 
1184  recommendations; 
1185         7. Monitor and provide recommendations regarding the need 
1186  for an increased number of primary care or other physician 
1187  specialties to provide the necessary current and projected 
1188  health and medical services for the state; and 
1189         8. Monitor and make recommendations regarding the status of 
1190  the needs relating to graduate medical education in this state. 
1191         (6) PHYSICIAN WORKFORCE GRADUATE MEDICAL EDUCATION 
1192  INNOVATION PILOT PROJECTS.— 
1193         (a) The Legislature finds that: 
1194         1. In order to ensure a physician workforce that is 
1195  adequate to meet the needs of this state’s residents and its 
1196  health care system, policymakers must consider the education and 
1197  training of future generations of well-trained health care 
1198  providers. 
1199         2. Physicians are likely to practice in the state where 
1200  they complete their graduate medical education. 
1201         3. It can directly affect the makeup of the physician 
1202  workforce by selectively funding graduate medical education 
1203  programs to provide needed specialists in geographic areas of 
1204  the state which have a deficient number of such specialists. 
1205         4. Developing additional positions in graduate medical 
1206  education programs is essential to the future of this state’s 
1207  health care system. 
1208         5. It was necessary in 2007 to pass legislation that 
1209  provided for an assessment of the status of this state’s current 
1210  and future physician workforce. The department is collecting and 
1211  analyzing information on an ongoing basis to assess this state’s 
1212  physician workforce needs, and such assessment may facilitate 
1213  the determination of graduate medical education needs and 
1214  strategies for the state. 
1215         (b) There is established under the department a program to 
1216  foster innovative graduate medical education pilot projects that 
1217  are designed to promote the expansion of graduate medical 
1218  education programs or positions to prepare physicians to 
1219  practice in needed specialties and underserved areas or settings 
1220  and to provide demographic and cultural representation in a 
1221  manner that addresses current and projected needs for this 
1222  state’s physician workforce. Funds appropriated annually by the 
1223  Legislature for this purpose shall be distributed to 
1224  participating hospitals, medical schools, other sponsors of 
1225  graduate medical education programs, consortia engaged in 
1226  developing new graduate medical education programs or positions 
1227  in those programs, or pilot projects providing innovative 
1228  graduate medical education in community-based clinical settings. 
1229  Pilot projects shall be selected on a competitive grant basis, 
1230  subject to available funds. 
1231         (c) Pilot projects shall be designed to meet one or more of 
1232  this state’s physician workforce needs, as determined pursuant 
1233  to this section, including, but not limited to: 
1234         1. Increasing the number of residencies or fellowships in 
1235  primary care or other needed specialties. 
1236         2. Enhancing the retention of primary care physicians or 
1237  other needed specialties in this state. 
1238         3. Promoting practice in rural or medically underserved 
1239  areas of the state. 
1240         4. Encouraging racial and ethnic diversity within the 
1241  state’s physician workforce. 
1242         5. Encouraging practice in community health care or other 
1243  ambulatory care settings. 
1244         6. Encouraging practice in clinics operated by the 
1245  department, including, but not limited to, county health 
1246  departments, clinics operated by the Department of Veterans’ 
1247  Affairs, prison clinics, or similar settings of need. 
1248         7. Encouraging the increased production of geriatricians. 
1249         (d) Priority shall be given to a proposal for a pilot 
1250  project that: 
1251         1. Demonstrates a collaboration of federal, state, and 
1252  local entities that are public or private. 
1253         2. Obtains funding from multiple sources. 
1254         3. Focuses on enhancing graduate medical education in rural 
1255  or underserved areas. 
1256         4. Focuses on enhancing graduate medical education in 
1257  ambulatory or community-based settings other than a hospital 
1258  environment. 
1259         5. Includes the use of technology, such as electronic 
1260  medical records, distance consultation, and telemedicine, to 
1261  ensure that residents are better prepared to care for patients 
1262  in this state, regardless of the community in which the 
1263  residents practice. 
1264         6. Is designed to meet multiple policy needs as enumerated 
1265  in subsection (3). 
1266         7. Uses a consortium to provide for graduate medical 
1267  education experiences. 
1268         (e) The department shall adopt by rule appropriate 
1269  performance measures to use in order to consistently evaluate 
1270  the effectiveness, safety, and quality of the programs, as well 
1271  as the impact of each program on meeting this state’s physician 
1272  workforce needs. 
1273         (f) Participating pilot projects shall submit to the 
1274  department an annual report on the project in a manner required 
1275  by the department. 
1276         (g) Funding provided to a pilot project may be used only 
1277  for the direct costs of providing graduate medical education. 
1278  Accounting of such costs and expenditures shall be documented in 
1279  the annual report. 
1280         (h) State funds shall be used to supplement funds from any 
1281  local government, community, or private source. The state may 
1282  provide up to 50 percent of the funds, and local governmental 
1283  grants or community or private sources shall provide the 
1284  remainder of the funds. 
1285         (7) RULEMAKING.—The department shall adopt rules as 
1286  necessary to administer this section. 
1287         Section 23. Section 458.3192, Florida Statutes, is amended 
1288  to read: 
1289         458.3192 Analysis of survey results; report.— 
1290         (1) Each year, the Department of Health shall analyze the 
1291  results of the physician survey required by s. 458.3191 and 
1292  determine by geographic area and specialty the number of 
1293  physicians who: 
1294         (a) Perform deliveries of children in this state Florida. 
1295         (b) Read mammograms and perform breast-imaging-guided 
1296  procedures in this state Florida. 
1297         (c) Perform emergency care on an on-call basis for a 
1298  hospital emergency department. 
1299         (d) Plan to reduce or increase emergency on-call hours in a 
1300  hospital emergency department. 
1301         (e) Plan to relocate their allopathic or osteopathic 
1302  practice outside the state. 
1303         (f) Practice medicine in this state. 
1304         (g) Plan to reduce or modify the scope of their practice. 
1305         (2) The Department of Health must report its findings to 
1306  the Governor, the President of the Senate, and the Speaker of 
1307  the House of Representatives by November 1 each year. The 
1308  department shall also include in its report findings, 
1309  recommendations, and strategic planning activities as provided 
1310  in s. 381.4018. The department may also include other 
1311  information requested by the Physician Workforce Advisory 
1312  Council. 
1313         Section 24. Section 459.0082, Florida Statutes, is amended 
1314  to read: 
1315         459.0082 Analysis of survey results; report.— 
1316         (1) Each year, the Department of Health shall analyze the 
1317  results of the physician survey required by s. 459.0081 and 
1318  determine by geographic area and specialty the number of 
1319  physicians who: 
1320         (a) Perform deliveries of children in this state Florida. 
1321         (b) Read mammograms and perform breast-imaging-guided 
1322  procedures in this state Florida. 
1323         (c) Perform emergency care on an on-call basis for a 
1324  hospital emergency department. 
1325         (d) Plan to reduce or increase emergency on-call hours in a 
1326  hospital emergency department. 
1327         (e) Plan to relocate their allopathic or osteopathic 
1328  practice outside the state. 
1329         (f) Practice medicine in this state. 
1330         (g) Plan to reduce or modify the scope of their practice. 
1331         (2) The Department of Health must report its findings to 
1332  the Governor, the President of the Senate, and the Speaker of 
1333  the House of Representatives by November 1 each year. The 
1334  department shall also include in its report findings, 
1335  recommendations, and strategic planning activities as provided 
1336  in s. 381.4018. The department may also include other 
1337  information requested by the Physician Workforce Advisory 
1338  Council. 
1339         Section 25. Section 458.315, Florida Statutes, is amended 
1340  to read: 
1341         458.315 Temporary certificate for practice in areas of 
1342  critical need.— 
1343         (1) Any physician who: 
1344         (a) Is licensed to practice in any jurisdiction in the 
1345  United States and other state, whose license is currently valid; 
1346  or, 
1347         (b) Has served as a physician in the United States Armed 
1348  Forces for at least 10 years and received an honorable discharge 
1349  from the military; 
1350 
1351  and who pays an application fee of $300 may be issued a 
1352  temporary certificate for to practice in areas of communities of 
1353  Florida where there is a critical need for physicians. 
1354         (2) A certificate may be issued to a physician who: 
1355         (a) Practices in an area of critical need; 
1356         (b) Will be employed by or practice in a county health 
1357  department, correctional facility, Department of Veterans’ 
1358  Affairs clinic, community health center funded by s. 329, s. 
1359  330, or s. 340 of the United States Public Health Services Act, 
1360  or other agency or institution that is approved by the State 
1361  Surgeon General and provides health care to meet the needs of 
1362  underserved populations in this state; or 
1363         (c) Will practice for a limited time to address critical 
1364  physician-specialty, demographic, or geographic needs for this 
1365  state’s physician workforce as determined by the State Surgeon 
1366  General entity that provides health care to indigents and that 
1367  is approved by the State Health Officer. 
1368         (3) The Board of Medicine may issue this temporary 
1369  certificate with the following restrictions: 
1370         (a)(1) The State Surgeon General board shall determine the 
1371  areas of critical need, and the physician so certified may 
1372  practice in any of those areas for a time to be determined by 
1373  the board. Such areas shall include, but are not be limited to, 
1374  health professional shortage areas designated by the United 
1375  States Department of Health and Human Services. 
1376         1.(a) A recipient of a temporary certificate for practice 
1377  in areas of critical need may use the certificate license to 
1378  work for any approved entity employer in any area of critical 
1379  need or as authorized by the State Surgeon General approved by 
1380  the board. 
1381         2.(b) The recipient of a temporary certificate for practice 
1382  in areas of critical need shall, within 30 days after accepting 
1383  employment, notify the board of all approved institutions in 
1384  which the licensee practices and of all approved institutions 
1385  where practice privileges have been denied. 
1386         (b)(2) The board may administer an abbreviated oral 
1387  examination to determine the physician’s competency, but a no 
1388  written regular examination is not required necessary. Within 60 
1389  days after receipt of an application for a temporary 
1390  certificate, the board shall review the application and issue 
1391  the temporary certificate, or notify the applicant of denial, or 
1392  notify the applicant that the board recommends additional 
1393  assessment, training, education, or other requirements as a 
1394  condition of certification. If the applicant has not actively 
1395  practiced during the prior 3 years and the board determines that 
1396  the applicant may lack clinical competency, possess diminished 
1397  or inadequate skills, lack necessary medical knowledge, or 
1398  exhibit patterns of deficits in clinical decisionmaking, the 
1399  board may: 
1400         1. Deny the application; 
1401         2. Issue a temporary certificate having reasonable 
1402  restrictions that may include, but are not limited to, a 
1403  requirement for the applicant to practice under the supervision 
1404  of a physician approved by the board; or 
1405         3. Issue a temporary certificate upon receipt of 
1406  documentation confirming that the applicant has met any 
1407  reasonable conditions of the board which may include, but are 
1408  not limited to, completing continuing education or undergoing an 
1409  assessment of skills and training. 
1410         (c)(3) Any certificate issued under this section is shall 
1411  be valid only so long as the State Surgeon General determines 
1412  that the reason area for which it was is issued remains a an 
1413  area of critical need to the state. The Board of Medicine shall 
1414  review each temporary certificateholder not the service within 
1415  said area not less than annually to ascertain that the minimum 
1416  requirements of the Medical Practice Act and its adopted the 
1417  rules and regulations promulgated thereunder are being complied 
1418  with. If it is determined that such minimum requirements are not 
1419  being met, the board shall forthwith revoke such certificate or 
1420  shall impose restrictions or conditions, or both, as a condition 
1421  of continued practice under the certificate. 
1422         (d)(4) The board may shall not issue a temporary 
1423  certificate for practice in an area of critical need to any 
1424  physician who is under investigation in any jurisdiction in the 
1425  United States another state for an act that which would 
1426  constitute a violation of this chapter until such time as the 
1427  investigation is complete, at which time the provisions of s. 
1428  458.331 shall apply. 
1429         (4)(5) The application fee and all licensure fees, 
1430  including neurological injury compensation assessments, shall be 
1431  waived for those persons obtaining a temporary certificate to 
1432  practice in areas of critical need for the purpose of providing 
1433  volunteer, uncompensated care for low-income residents 
1434  Floridians. The applicant must submit an affidavit from the 
1435  employing agency or institution stating that the physician will 
1436  not receive any compensation for any service involving the 
1437  practice of medicine. 
1438         Section 26. Section 459.0076, Florida Statutes, is created 
1439  to read: 
1440         459.0076 Temporary certificate for practice in areas of 
1441  critical need.— 
1442         (1) Any physician who: 
1443         (a) Is licensed to practice in any jurisdiction in the 
1444  United States and whose license is currently valid; or 
1445         (b) Has served as a physician in the United States Armed 
1446  Forces for at least 10 years and received an honorable discharge 
1447  from the military; 
1448 
1449  and who pays an application fee of $300 may be issued a 
1450  temporary certificate for practice in areas of critical need. 
1451         (2) A certificate may be issued to a physician who: 
1452         (a) Will practice in an area of critical need; 
1453         (b) Will be employed by or practice in a county health 
1454  department, correctional facility, Department of Veterans’ 
1455  Affairs clinic, community health center funded by s. 329, s. 
1456  330, or s. 340 of the United States Public Health Services Act, 
1457  or other agency or institution that is approved by the State 
1458  Surgeon General and provides health care to meet the needs of 
1459  underserved populations in this state; or 
1460         (c) Will practice for a limited time to address critical 
1461  physician-specialty, demographic, or geographic needs for this 
1462  state’s physician workforce as determined by the State Surgeon 
1463  General. 
1464         (3) The Board of Osteopathic Medicine may issue this 
1465  temporary certificate with the following restrictions: 
1466         (a)� The State Surgeon General shall determine the areas of 
1467  critical need. Such areas include, but are not limited to, 
1468  health professional shortage areas designated by the United 
1469  States Department of Health and Human Services. 
1470         1.� A recipient of a temporary certificate for practice in 
1471  areas of critical need may use the certificate to work for any 
1472  approved entity in any area of critical need or as authorized by 
1473  the State Surgeon General. 
1474         2.� The recipient of a temporary certificate for practice in 
1475  areas of critical need shall, within 30 days after accepting 
1476  employment, notify the board of all approved institutions in 
1477  which the licensee practices and of all approved institutions 
1478  where practice privileges have been denied. 
1479         (b)� The board may administer an abbreviated oral 
1480  examination to determine the physician’s competency, but a 
1481  written regular examination is not required. Within 60 days 
1482  after receipt of an application for a temporary certificate, the 
1483  board shall review the application and issue the temporary 
1484  certificate, notify the applicant of denial, or notify the 
1485  applicant that the board recommends additional assessment, 
1486  training, education, or other requirements as a condition of 
1487  certification. If the applicant has not actively practiced 
1488  during the prior 3 years and the board determines that the 
1489  applicant may lack clinical competency, possess diminished or 
1490  inadequate skills, lack necessary medical knowledge, or exhibit 
1491  patterns of deficits in clinical decisionmaking, the board may: 
1492         1. Deny the application; 
1493         2. Issue a temporary certificate having reasonable 
1494  restrictions that may include, but are not limited to, a 
1495  requirement for the applicant to practice under the supervision 
1496  of a physician approved by the board; or 
1497         3. Issue a temporary certificate upon receipt of 
1498  documentation confirming that the applicant has met any 
1499  reasonable conditions of the board which may include, but are 
1500  not limited to, completing continuing education or undergoing an 
1501  assessment of skills and training. 
1502         (c)� Any certificate issued under this section is valid only 
1503  so long as the State Surgeon General determines that the reason 
1504  for which it was issued remains a critical need to the state. 
1505  The Board of Osteopathic Medicine shall review each temporary 
1506  certificateholder not less than annually to ascertain that the 
1507  minimum requirements of the Osteopathic Medical Practice Act and 
1508  its adopted rules are being complied with. If it is determined 
1509  that such minimum requirements are not being met, the board 
1510  shall revoke such certificate or shall impose restrictions or 
1511  conditions, or both, as a condition of continued practice under 
1512  the certificate. 
1513         (d)� The board may not issue a temporary certificate for 
1514  practice in an area of critical need to any physician who is 
1515  under investigation in any jurisdiction in the United States for 
1516  an act that would constitute a violation of this chapter until 
1517  such time as the investigation is complete, at which time the 
1518  provisions of s. 459.015 apply. 
1519         (4)� The application fee and all licensure fees, including 
1520  neurological injury compensation assessments, shall be waived 
1521  for those persons obtaining a temporary certificate to practice 
1522  in areas of critical need for the purpose of providing 
1523  volunteer, uncompensated care for low-income residents. The 
1524  applicant must submit an affidavit from the employing agency or 
1525  institution stating that the physician will not receive any 
1526  compensation for any service involving the practice of medicine. 
1527         Section 27. (1) The Department of Health shall develop, in 
1528  collaboration with the Agency for Health Care Administration, a 
1529  statewide plan aimed at implementing the recommendations from 
1530  the Centers for Disease Control and Prevention for screening for 
1531  the human immunodeficiency virus (HIV) in adults and adolescents 
1532  in public and private health care settings. The goals of the 
1533  plan shall include, but not be limited to, increasing awareness 
1534  of HIV infection rates and causes, increasing voluntary HIV 
1535  screening rates in health care settings, identifying previously 
1536  unrecognized HIV infection, linking HIV-positive clients to 
1537  clinical and prevention services to reduce future infections, 
1538  reducing the transmission of HIV to fetuses, and establishing 
1539  early treatment for those persons infected with HIV. To the 
1540  extent possible, the plan shall integrate with existing HIV 
1541  screening and testing programs that are funded by the Centers 
1542  for Disease Control and Prevention or other organizations. As 
1543  used in this section, the term “department” means the Department 
1544  of Health. 
1545         (2) In developing the plan, the department shall seek the 
1546  input of and collaborate with, at a minimum, representatives of 
1547  the following entities: hospital emergency departments; urgent 
1548  care clinics; inpatient settings, including labor and delivery; 
1549  substance abuse treatment clinics; public health clinics; 
1550  community clinics; federally qualified health clinics; rural 
1551  health clinics; correctional health care facilities; pediatric 
1552  and adolescent care clinics; prenatal care clinics; local health 
1553  departments; and other public and private primary care settings. 
1554         (3) The department shall establish a demonstration project 
1555  as current funds allow in an area of the state with a high 
1556  incidence of HIV infection to begin implementation of the 
1557  statewide plan. The demonstration project shall seek to 
1558  collaborate with the public and private health care settings in 
1559  subsection (2) and be consistent with the department’s current 
1560  “Test Miami” initiative. 
1561         (4) The department shall file an interim report on the 
1562  status of the development of the statewide plan, which includes 
1563  any funding needs for the expansion of the demonstration project 
1564  to other areas of the state, with the Governor, President of the 
1565  Senate, and the Speaker of the House of Representatives by 
1566  December 31, 2010. The Department shall file a final report on 
1567  the statewide plan and implementation and status of the 
1568  demonstration project with the Governor, President of the 
1569  Senate, and the Speaker of the House of Representatives by 
1570  December 31, 2011. 
1571         Section 28. Present subsections (32) through (54) of 
1572  section 499.003, Florida Statutes, are renumbered as subsections 
1573  (33) through (55), respectively, and a new subsection (32) is 
1574  added to that section, to read: 
1575         499.003 Definitions of terms used in this part.—As used in 
1576  this part, the term: 
1577         (32) “Medical convenience kit” means packages or units that 
1578  contain combination products as defined in 21 C.F.R. s. 
1579  3.2(e)(2). 
1580         Section 29. Paragraph (i) is added to subsection (3) of 
1581  section 499.01212, Florida Statutes, to read: 
1582         499.01212 Pedigree paper.— 
1583         (3) EXCEPTIONS.—A pedigree paper is not required for: 
1584         (i) The wholesale distribution of prescription drugs 
1585  contained within a medical convenience kit if: 
1586         1. The medical convenience kit is assembled in an 
1587  establishment that is registered as a medical device 
1588  manufacturer with the United States Food and Drug 
1589  Administration; 
1590         2. The medical convenience kit manufacturer purchased the 
1591  prescription drug directly from the manufacturer or from a 
1592  wholesaler that purchased the prescription drug directly from 
1593  the manufacturer; 
1594         3. The medical convenience kit manufacturer complies with 
1595  federal law for the distribution of the prescription drugs 
1596  within the kit; and 
1597         4. The drugs contained in the medical convenience kit are: 
1598         a. Intravenous solutions intended for the replenishment of 
1599  fluids and electrolytes; 
1600         b. Products intended to maintain the equilibrium of water 
1601  and minerals in the body; 
1602         c. Products intended for irrigation or reconstitution; 
1603         d. Anesthetics; or 
1604         e. Anticoagulants. 
1605         Section 30. (1) In addition to the appropriations contained 
1606  in the General Appropriations Act for the 2010-2011 fiscal year, 
1607  one full-time equivalent position and salary rate of 52,554 are 
1608  authorized for and the sums of $75,000 from the General Revenue 
1609  Fund and $75,000 from the Medical Care Trust Fund are 
1610  appropriated to the Agency for Health Care Administration. 
1611         (2)� Notwithstanding the appropriations authorized in the 
1612  General Appropriations Act for the 2010-2011 fiscal year for the 
1613  Department of Health, one full-time equivalent position is 
1614  abolished, salary rate is reduced by 52,554, and appropriations 
1615  from the General Revenue Fund are reduced on a recurring basis 
1616  by $75,000. 
1617         (3)� The appropriations made in subsection (1) are 
1618  contingent upon the adjustments to appropriations made in 
1619  subsection (2) becoming law. 
1620         Section 31. Dental workforce survey.— 
1621         (1) Beginning in 2012, each person who applies for 
1622  licensure renewal as a dentist or dental hygienist under chapter 
1623  466, Florida Statutes, must, in conjunction with the renewal of 
1624  such license under procedures and forms adopted by the Board of 
1625  Dentistry and in addition to any other information that may be 
1626  required from the applicant, furnish the following information 
1627  to the Department of Health, working in conjunction with the 
1628  board, in a dental workforce survey: 
1629         (a) Licensee information, including, but not limited to: 
1630         1. The name of the dental school or dental hygiene program 
1631  that the dentist or dental hygienist graduated from and the year 
1632  of graduation. 
1633         2. The year that the dentist or dental hygienist began 
1634  practicing or working in this state. 
1635         3. The geographic location of the dentist’s or dental 
1636  hygienist’s practice or address within the state. 
1637         4. For a dentist in private practice: 
1638         a. The number of full-time dental hygienists employed by 
1639  the dentist during the reporting period. 
1640         b. The number of full-time dental assistants employed by 
1641  the dentist during the reporting period. 
1642         c. The average number of patients treated per week by the 
1643  dentist during the reporting period. 
1644         d. The settings where the dental care was delivered. 
1645         5. Anticipated plans of the dentist to change the status of 
1646  his or her license or practice. 
1647         6. The dentist’s areas of specialty or certification. 
1648         7. The year that the dentist completed a specialty program 
1649  recognized by the American Dental Association. 
1650         8. For a hygienist: 
1651         a. The average number of patients treated per week by the 
1652  hygienist during the reporting period. 
1653         b. The settings where the dental care was delivered. 
1654         9. The dentist’s memberships in professional organizations. 
1655         10. The number of pro bono hours provided by the dentist or 
1656  dental hygienist during the last biennium. 
1657         (b) Information concerning the availability and trends 
1658  relating to critically needed services, including, but not 
1659  limited to, the following types of care provided by the dentist 
1660  or dental hygienist: 
1661         1. Dental care to children having special needs. 
1662         2. Geriatric dental care. 
1663         3. Dental services in emergency departments. 
1664         4. Medicaid services. 
1665         5. Other critically needed specialty areas, as determined 
1666  by the advisory body. 
1667         (2) In addition to the completed survey, the dentist or 
1668  dental hygienist must submit a statement that the information 
1669  provided is true and accurate to the best of his or her 
1670  knowledge and belief. 
1671         (3) Beginning in 2012, renewal of a license by a dentist or 
1672  dental hygienist licensed under chapter 466, Florida Statutes, 
1673  is not contingent upon the completion and submission of the 
1674  dental workforce survey; however, for any subsequent license 
1675  renewal, the board may not renew the license of any dentist or 
1676  dental hygienist until the survey required under this section is 
1677  completed and submitted by the licensee. 
1678         (4)(a) Beginning in 2012, the Board of Dentistry shall 
1679  issue a nondisciplinary citation to any dentist or dental 
1680  hygienist licensed under chapter 466, Florida Statutes, who 
1681  fails to complete the survey within 90 days after the renewal of 
1682  his or her license to practice as a dentist or dental hygienist. 
1683         (b) The citation must notify a dentist or dental hygienist 
1684  who fails to complete the survey required by this section that 
1685  his or her license will not be renewed for any subsequent 
1686  license renewal unless the dentist or dental hygienist completes 
1687  the survey. 
1688         (c) In conjunction with issuing the license renewal notice 
1689  required by s. 456.038, Florida Statutes, the board shall notify 
1690  each dentist or dental hygienist licensed under chapter 466, 
1691  Florida Statutes, who fails to complete the survey that the 
1692  survey must be completed before the subsequent license renewal. 
1693         Section 32. (1) The Department of Health shall serve as the 
1694  coordinating body for the purpose of collecting and regularly 
1695  updating and disseminating dental workforce data. The department 
1696  shall work with multiple stakeholders, including the Florida 
1697  Dental Association and the Florida Dental Hygiene Association, 
1698  to assess and share with all communities of interest all data 
1699  collected in a timely fashion. 
1700         (2) The Department of Health shall maintain a current 
1701  database to serve as a statewide source of data concerning the 
1702  dental workforce. The department, in conjunction with the board, 
1703  shall also: 
1704         (a) Develop strategies to maximize federal and state 
1705  programs that provide incentives for dentists to practice in 
1706  shortage areas that are federally designated. Strategies shall 
1707  include programs such as the Florida Health Services Corps 
1708  established under s. 381.0302, Florida Statutes. 
1709         (b) Work in conjunction with an advisory body to address 
1710  matters relating to the state’s dental workforce. The advisory 
1711  body shall provide input on developing questions for the dentist 
1712  workforce survey. An advisory body shall include, but need not 
1713  be limited to, the State Surgeon General or his or her designee, 
1714  the dean of each dental school accredited in the United States 
1715  and based in this state or his or her designee, a representative 
1716  from the Florida Dental Association, a representative from the 
1717  Florida Dental Hygiene Association, a representative from the 
1718  Florida Board of Dentistry, and a dentist from each of the 
1719  dental specialties recognized by the American Dental 
1720  Association’s Commission on Dental Accreditation. Members of the 
1721  advisory body shall serve without compensation. 
1722         (c) Act as a clearinghouse for collecting and disseminating 
1723  information concerning the dental workforce. 
1724         (3) The Department of Health and the Board of Dentistry 
1725  shall adopt rules necessary to administer this section. 
1726         Section 33. It is the intent of the Legislature that the 
1727  Department of Health and the Board of Dentistry implement the 
1728  provisions of this act within existing resources. 
1729         Section 34. Paragraph (t) of subsection (2) of section 
1730  499.01, Florida Statutes, is amended to read: 
1731         499.01 Permits.— 
1732         (2) The following permits are established: 
1733         (t) Health care clinic establishment permit.—Effective 
1734  January 1, 2009, a health care clinic establishment permit is 
1735  required for the purchase of a prescription drug by a place of 
1736  business at one general physical location that provides health 
1737  care or veterinary services, which is owned and operated by a 
1738  business entity that has been issued a federal employer tax 
1739  identification number. For the purpose of this paragraph, the 
1740  term “qualifying practitioner” means a licensed health care 
1741  practitioner defined in s. 456.001, or a veterinarian licensed 
1742  under chapter 474, who is authorized under the appropriate 
1743  practice act to prescribe and administer a prescription drug. 
1744         1. An establishment must provide, as part of the 
1745  application required under s. 499.012, designation of a 
1746  qualifying practitioner who will be responsible for complying 
1747  with all legal and regulatory requirements related to the 
1748  purchase, recordkeeping, storage, and handling of the 
1749  prescription drugs. In addition, the designated qualifying 
1750  practitioner shall be the practitioner whose name, establishment 
1751  address, and license number is used on all distribution 
1752  documents for prescription drugs purchased or returned by the 
1753  health care clinic establishment. Upon initial appointment of a 
1754  qualifying practitioner, the qualifying practitioner and the 
1755  health care clinic establishment shall notify the department on 
1756  a form furnished by the department within 10 days after such 
1757  employment. In addition, the qualifying practitioner and health 
1758  care clinic establishment shall notify the department within 10 
1759  days after any subsequent change. 
1760         2. The health care clinic establishment must employ a 
1761  qualifying practitioner at each establishment. 
1762         3. In addition to the remedies and penalties provided in 
1763  this part, a violation of this chapter by the health care clinic 
1764  establishment or qualifying practitioner constitutes grounds for 
1765  discipline of the qualifying practitioner by the appropriate 
1766  regulatory board. 
1767         4. The purchase of prescription drugs by the health care 
1768  clinic establishment is prohibited during any period of time 
1769  when the establishment does not comply with this paragraph. 
1770         5. A health care clinic establishment permit is not a 
1771  pharmacy permit or otherwise subject to chapter 465. A health 
1772  care clinic establishment that meets the criteria of a modified 
1773  Class II institutional pharmacy under s. 465.019 is not eligible 
1774  to be permitted under this paragraph. 
1775         6. This paragraph does not apply to the purchase of a 
1776  prescription drug by a licensed practitioner under his or her 
1777  license. A professional corporation or limited liability company 
1778  composed of dentists and operating as authorized in s. 466.0285 
1779  may pay for prescription drugs obtained by a practitioner 
1780  licensed under chapter 466, and the licensed practitioner is 
1781  deemed the purchaser and owner of the prescription drugs. 
1782         Section 35. Paragraph (a) of subsection (6) of section 
1783  624.91, Florida Statutes, is amended to read: 
1784         624.91 The Florida Healthy Kids Corporation Act.— 
1785         (6) BOARD OF DIRECTORS.— 
1786         (a) The Florida Healthy Kids Corporation shall operate 
1787  subject to the supervision and approval of a board of directors 
1788  chaired by the Chief Financial Officer or her or his designee, 
1789  and composed of 12 11 other members selected for 3-year terms of 
1790  office as follows: 
1791         1. The Secretary of Health Care Administration, or his or 
1792  her designee. 
1793         2. One member appointed by the Commissioner of Education 
1794  from the Office of School Health Programs of the Florida 
1795  Department of Education. 
1796         3. One member appointed by the Chief Financial Officer from 
1797  among three members nominated by the Florida Pediatric Society. 
1798         4. One member, appointed by the Governor, who represents 
1799  the Children’s Medical Services Program. 
1800         5. One member appointed by the Chief Financial Officer from 
1801  among three members nominated by the Florida Hospital 
1802  Association. 
1803         6. One member, appointed by the Governor, who is an expert 
1804  on child health policy. 
1805         7. One member, appointed by the Chief Financial Officer, 
1806  from among three members nominated by the Florida Academy of 
1807  Family Physicians. 
1808         8. One member, appointed by the Governor, who represents 
1809  the state Medicaid program. 
1810         9. One member, appointed by the Chief Financial Officer, 
1811  from among three members nominated by the Florida Association of 
1812  Counties. 
1813         10. The State Health Officer or her or his designee. 
1814         11. The Secretary of Children and Family Services, or his 
1815  or her designee. 
1816         12. One member, appointed by the Governor, from among three 
1817  members nominated by the Florida Dental Association. 
1818         Section 36. Subsection (3) is added to section 381.00315, 
1819  Florida Statutes, to read: 
1820         381.00315 Public health advisories; public health 
1821  emergencies.—The State Health Officer is responsible for 
1822  declaring public health emergencies and issuing public health 
1823  advisories. 
1824         (3)  To facilitate effective emergency management, when the 
1825  United States Department of Health and Human Services contracts 
1826  for the manufacture and delivery of licensable products in 
1827  response to a public health emergency and the terms of those 
1828  contracts are made available to the states, the department shall 
1829  accept funds provided by cities, counties, and other entities 
1830  designated in the state emergency management plan required under 
1831  s. 252.35(2)(a) for the purpose of participation in those 
1832  contracts. The department shall deposit those funds in the 
1833  Grants and Donations Trust Fund and expend those funds on behalf 
1834  of the donor city, county, or other entity for the purchase of 
1835  the licensable products made available under the contract. 
1836         Section 37. This act shall take effect July 1, 2010.