HB 1263

A bill to be entitled
2An act relating to health care; amending s. 400.990, F.S.;
3providing additional legislative findings; amending s.
4400.9905, F.S.; redefining the term "clinic" for purposes
5of the Health Care Clinic Act to include certain
6additional providers; defining the terms "fraud" and
7"infusion therapy"; defining the term "specialty clinic,"
8to include certain facilities owned by publicly traded
9corporations excluded by the definition of the term
10"clinic"; amending s. 400.991, F.S.; requiring specialty
11clinics to be subject to licensure requirements; requiring
12additional persons to be subject to background screening;
13revising certain requirements for applying for licensure
14as a health care clinic; creating additional requirements
15for applying for licensure as a specialty clinic; creating
16s. 400.9914, F.S.; providing additional grounds under
17which the Agency for Health Care Administration is
18required to deny or revoke a license due to a finding of
19guilt for committing a felony; providing grounds for the
20denial of specialty clinic licensure; amending s.
21400.9915, F.S.; providing additional grounds for an
22emergency suspension of a license; creating s. 400.9921,
23F.S.; providing additional requirements for license
24renewal and transfer of ownership; amending s. 400.9925,
25F.S.; authorizing the agency to adopt rules for the
26administration and licensing of specialty clinics;
27amending s. 400.993, F.S.; including specialty clinics
28within provisions regarding the reporting of unlicensed
29clinics; amending s. 400.9935, F.S.; including specialty
30clinics within provisions specifying clinic
31responsibilities; revising the responsibilities of the
32medical director and the clinical director; requiring all
33persons providing health care services to individuals in a
34specialty clinic to comply with the licensure laws and
35rules under which that person is licensed; providing for a
36certificate of exemption from licensure as a clinic to
37expire within a specified period; providing the
38application procedures for a certificate of exemption;
39providing a fee; providing for renewal of the certificate
40of exemption; providing that it is a third-degree felony
41for an applicant to submit fraudulent or material and
42misleading information to the agency; providing grounds
43for the denial, withdrawal, or emergency suspension of a
44certificate of exemption by the Agency for Health Care
45Administration; requiring specialty clinics to display
46signs containing certain information relating to insurance
47fraud; authorizing compliance inspections by the Division
48of Insurance Fraud; requiring clinics to allow inspection
49access; requiring a specialty clinic to file an audited
50report; providing requirements for the audited report;
51requiring a specialty clinic to maintain compliance with
52part X of ch. 400, F.S.; amending s. 400.995, F.S.;
53authorizing the agency to impose administrative penalties
54against a specialty clinic; authorizing the agency to
55request a plan of corrective action from the clinic or
56specialty clinic; creating s. 400.996, F.S.; creating a
57process whereby the agency receives, documents, and
58processes complaints about specialty clinics; requiring
59the agency to request that complaints regarding billing
60fraud by a specialty clinic be made by sworn affidavit;
61requiring the agency to refer to the Office of Fiscal
62Integrity within the Department of Financial Services any
63sworn affidavit asserting billing fraud by a specialty
64clinic; requiring the department to report findings
65regarding billing fraud by a specialty clinic to the
66agency; requiring the department to refer an investigation
67to prosecutorial authorities and provide investigative
68assistance under certain circumstances; providing that it
69is a first-degree misdemeanor to submit an affidavit
70asserting billing fraud by a specialty clinic which is
71without any factual basis; allowing the department to
72conduct unannounced reviews, investigations, analyses, and
73audits to investigate complaints of billing fraud by a
74specialty clinic; authorizing the department to enter upon
75the premises of a specialty clinic and immediately secure
76copies of certain documents; requiring a specialty clinic
77to allow full and immediate access to the premises and
78records of the clinic to a department officer or employee
79under s. 400.996, F.S.; providing that failure to provide
80such access is a ground for emergency suspension of the
81license of the specialty clinic; permitting the agency to
82assess a fee against a specialty clinic equal to the cost
83of conducting a review, investigation, analysis, or audit
84performed by the agency or the department; providing that
85all investigators designated by the Chief Financial
86Officer to perform duties under part X of ch. 400, F.S.,
87and certified under s. 943.1395, F.S., are law enforcement
88officers of the state; amending s. 408.802, F.S.;
89providing that specialty clinics are subject to part X of
90ch. 400, F.S.; amending s. 408.820, F.S.; providing that
91specialty clinics are exempt from s. 408.810(6), (7), and
92(10), F.S.; amending s. 456.072, F.S.; providing that
93intentionally placing false information in an application
94for a certificate of exemption from clinic licensure
95constitutes grounds for disciplinary action; amending ss.
96627.732 and 627.736, F.S.; conforming cross-references;
97designating the Florida Center for Nursing as the "Florida
98Barbara B. Lumpkin Center for Nursing"; directing the
99Department of Health to erect suitable markers;
100authorizing additional positions and providing an
101appropriation; providing an effective date.
103Be It Enacted by the Legislature of the State of Florida:
105     Section 1.  Section 400.990, Florida Statutes, is amended
106to read:
107     400.990  Short title; legislative findings.-
108     (1)  This part, consisting of ss. 400.990-400.996 ss.
109400.990-400.995, may be cited as the "Health Care Clinic Act."
110     (2)  The Legislature finds that the regulation of health
111care clinics must be strengthened to prevent significant cost
112and harm to consumers.
113     (3)  The Legislature further finds the additional
114regulation of specialty health care clinics is necessary to
115prevent significant fraudulent practices in the provision of
116infusion therapy services in this state.
117     (4)  The purpose of this part is to provide for the
118licensure, establishment, and enforcement of basic standards for
119health care clinics and to provide administrative oversight by
120the Agency for Health Care Administration.
121     Section 2.  Subsections (5) through (7) of section
122400.9905, Florida Statutes, are renumbered as subsections (7)
123through (9), respectively, paragraphs (f), (g), and (l) of
124subsection (4) are amended, new subsections (5), (6), and (10)
125are added to that section, to read:
126     400.9905  Definitions.-
127     (4)  "Clinic" means an entity at which health care services
128are provided to individuals and which tenders charges for
129reimbursement for such services, including a mobile clinic and a
130portable equipment provider. For purposes of this part, the term
131does not include and the licensure requirements of this part do
132not apply to:
133     (f)  A sole proprietorship, group practice, partnership, or
134corporation, or other legal entity that provides health care
135services by physicians and physician assistants licensed under
136chapter 458, chapter 459, chapter 460, chapter 461, or chapter
137466 covered by s. 627.419, that is directly supervised by one or
138more of such physicians or physician assistants, and that is
139wholly owned by one or more of those physicians or physician
140assistants or by a physician or physician assistant and the
141spouse, parent, child, or sibling of that physician or physician
143     (g)  A sole proprietorship, group practice, partnership, or
144corporation, or other legal entity that provides health care
145services by licensed health care practitioners under chapter
146457, chapter 458, chapter 459, chapter 460, chapter 461, chapter
147462, chapter 463, chapter 466, chapter 467, chapter 480, chapter
148484, chapter 486, chapter 490, chapter 491, or part I, part III,
149part X, part XIII, or part XIV of chapter 468, or s. 464.012,
150which entities are wholly owned by one or more licensed health
151care practitioners, or the licensed health care practitioners
152set forth in this paragraph and the spouse, parent, child, or
153sibling of a licensed health care practitioner, so long as one
154of the owners who is a licensed health care practitioner is
155supervising the health care services business activities and is
156legally responsible for the entity's compliance with all federal
157and state laws. However, the a health care services provided may
158not exceed the scope of the licensed owner's health care
159practitioner may not supervise services beyond the scope of the
160practitioner's license, except that, for the purposes of this
161part, a clinic owned by a licensee in s. 456.053(3)(b) that
162provides only services authorized pursuant to s. 456.053(3)(b)
163may be supervised by a licensee specified in s. 456.053(3)(b).
164     (l)  Orthotic or prosthetic Clinical facilities that are a
165publicly traded corporation or that are wholly owned, directly
166or indirectly, by a publicly traded corporation. As used in this
167paragraph, a publicly traded corporation is a corporation that
168issues securities traded on an exchange registered with the
169United States Securities and Exchange Commission as a national
170securities exchange.
171     (5)  "Fraud" means deception or misrepresentation made by a
172person or business entity with the intent that the deception
173will likely result in an unauthorized benefit to that person or
174business entity or to another person. The term includes any act
175that constitutes fraud under applicable federal or state law.
176     (6)  "Infusion therapy" includes, but is not limited to,
177the therapeutic infusion of substances into, or injection of
178substances through, the venous peripheral system and consists of
179activities that include observing, initiating, monitoring,
180discontinuing, maintaining, regulating, adjusting, documenting,
181planning, intervening, and evaluating. The term includes the
182administration of nutrition, antibiotic therapy, and fluid and
183electrolyte repletion.
184     (10)  "Specialty clinic" means a clinic, as defined in
185subsection (4), and includes those entities exempt under
186subsection (4) that are not licensed as a home health agency
187that provides infusion therapy services to treat conditions
188caused by or related to HIV or AIDS to outpatients who remain
189less than 24 hours at the facility or to patients who receive
190such services where they reside. The term does not include:
191     (a)  Entities licensed under part II or part III;
192     (b)  Entities licensed under part IV that provide infusion
193therapy to patients only in the home or residence of the
194patient; or
195     (c)  Entities licensed under chapter 395.
196     Section 3.  Section 400.991, Florida Statutes, is amended
197to read:
198     400.991  License requirements; background screenings;
200     (1)(a)  The requirements of part II of chapter 408 apply to
201the provision of services that require licensure pursuant to
202this part and part II of chapter 408 and to entities licensed by
203or applying for such licensure from the agency pursuant to this
204part. A license issued by the agency is required in order to
205operate a clinic or a specialty clinic in this state. Each
206clinic and specialty clinic location shall be licensed
207separately regardless of whether the clinic or specialty clinic
208is operated under the same business name or management as
209another clinic or specialty clinic.
210     (b)  Each mobile clinic and specialty clinic must obtain a
211separate health care clinic license and must provide to the
212agency, at least quarterly, its projected street location to
213enable the agency to locate and inspect such clinic or specialty
214clinic. A portable equipment provider must obtain a health care
215clinic license for a single administrative office and is not
216required to submit quarterly projected street locations.
217     (c)  A specialty clinic operating without a specialty
218clinic license on or before January 1, 2011, shall be given
219until July 2, 2011, to obtain a specialty clinic license.
220     (2)  The initial clinic license application and the initial
221specialty clinic license application shall be filed with the
222agency by all clinics, as defined in s. 400.9905, on or before
223July 1, 2004. A clinic license and a specialty clinic license
224must be renewed biennially.
225     (3)(a)  The application shall contain information that
226includes, but is need not be limited to, information pertaining
227to the name, residence and business address, phone number,
228social security number, and license number of the medical or
229clinic director of the licensed medical providers employed or
230under contract with the clinic.
231     (b)  Any person or entity that has a pecuniary interest in
232a clinic who may or may not own stock or an equivalent interest
233in the clinic, but who has control over, or the authority to
234approve, directly or indirectly, clinic billing, policy,
235business activities, or personnel decisions, including, but not
236limited to, contracted or employed third-party billing persons
237or entities, managers, management companies, and persons and
238entities that, directly or indirectly, lend, give, or make a
239gift of money of any denomination or anything of value exceeding
240an aggregate of $5,000 for clinic use, with or without an
241expectation of a return of the money or thing of value and
242regardless of profit motive, is subject to background screening
243requirements under this part.
244     (c)  The agency may adopt rules to administer this
246     (4)  An application for a specialty clinic must contain, in
247addition to the information required in subsection (3) and s.
249     (a)  The correct business name of each business entity and
250full name of each individual holding any ownership interest of 5
251percent or more, or any pecuniary interest of $5,000 or more, in
252any legal entity that owns or operates any specialty clinic
253seeking licensure, whether such ownership or pecuniary interest
254arose out of a contract, loan, gift, investment, inheritance, or
255any other source. Individual possession of an ownership or
256pecuniary interest in any subject specialty clinic includes, but
257is not limited to, a direct or indirect interest in:
258     1.  The business operation, equipment, or legend
259pharmaceuticals used in the clinic;
260     2.  The premises in which the clinic provides its services;
262     3.  Any legal entity that owns any such interest, directly
263or indirectly, in the business operation of the clinic; the
264equipment used in providing infusion therapy services at the
265clinic; the legend pharmaceuticals used at the clinic; or the
266premises in which the clinic provides its services.
267     (b)  In the case of an incorporated business entity that
268holds any ownership interest of 5 percent or more, or any
269pecuniary interest of $5,000 or more, in the specialty clinic,
270copies of the articles of incorporation and bylaws and the names
271and addresses of all officers and directors of the corporation.
272     (c)  On a form furnished by the agency, a sworn, notarized
273statement by each business entity and individual that holds any
274ownership interest of 5 percent or more, or any pecuniary
275interest of $5,000 or more, in the subject specialty clinic
276which discloses the nature and degree of each such ownership or
277pecuniary interest and discloses the source of funds which gave
278rise to each such ownership or pecuniary interest.
279     (d)  On a form furnished by the agency, a sworn, notarized
280statement by each business entity and individual that holds any
281ownership interest of 5 percent or more, or any pecuniary
282interest of $5,000 or more, in the subject specialty clinic
283which discloses whether he or she has been an owner or part
284owner, individually or through any business entity, of any
285business entity whose health care license has been revoked or
286suspended in any jurisdiction.
287     (e)  On a form furnished by the agency, an estimate of the
288costs for establishing the specialty clinic and the source of
289funds for payment of those costs and for sustaining the
290operation of the clinic until its operation produces a positive
291cash flow.
293For purposes of this subsection, the term "ownership" or
294"pecuniary interest" does not include an individual whose
295interest in a specialty clinic arises only out of that
296individual's interest in a lending company, insurance company,
297or banking institution licensed by this state or any other state
298of the United States; a company regularly trading on a national
299stock exchange of the United States; or a governmental entity in
300the United States.
301     (5)(4)  In addition to the requirements of part II of
302chapter 408, the applicant must file with the application
303satisfactory proof that the clinic or specialty clinic is in
304compliance with this part and applicable rules, including:
305     (a)  A listing of services to be provided either directly
306by the applicant or through contractual arrangements with
307existing providers;
308     (b)  The number and discipline of each professional staff
309member to be employed; and
310     (c)  Proof of financial ability to operate as required
311under s. 408.810(8). As an alternative to submitting proof of
312financial ability to operate as required under s. 408.810(8),
313the applicant may file a surety bond of at least $500,000 which
314guarantees that the clinic or specialty clinic will act in full
315conformity with all legal requirements for operating a clinic,
316payable to the agency. The agency may adopt rules to specify
317related requirements for such surety bond.
318     (6)(5)  Each applicant for licensure shall comply with the
319following requirements:
320     (a)  As used in this subsection, the term "applicant" means
321an individual individuals owning or controlling, directly or
322indirectly, 5 percent or more of an interest in a clinic or an
323individual owning or controlling, directly or indirectly, any
324interest in a specialty clinic; the medical or clinic director,
325or a similarly titled person who is responsible for the day-to-
326day operation of the licensed clinic; the financial officer or
327similarly titled individual who is responsible for the financial
328operation of the clinic; and licensed health care practitioners
329at the clinic.
330     (b)  Upon receipt of a completed, signed, and dated
331application, the agency shall require background screening of
332the applicant, in accordance with the level 2 standards for
333screening set forth in paragraph (d) chapter 435. Proof of
334compliance with the level 2 background screening requirements of
335paragraph (d) chapter 435 which has been submitted within the
336previous 5 years in compliance with the any other health care
337clinic licensure requirements of this part state is acceptable
338in fulfillment of this paragraph. Applicants who own less than
33910 percent of a health care clinic are not required to submit
340fingerprints under this section.
341     (c)  Each applicant must submit to the agency, with the
342application, a description and explanation of any exclusions,
343permanent suspensions, or terminations of an applicant from the
344Medicare or Medicaid programs. Proof of compliance with the
345requirements for disclosure of ownership and controlling control
346interest under the Medicaid or Medicare programs may be accepted
347in lieu of this submission. The description and explanation may
348indicate whether such exclusions, suspensions, or terminations
349were voluntary or not voluntary on the part of the applicant.
350The agency may deny or revoke licensure based on information
351received under this paragraph.
352     (d)  A license may not be granted to a clinic if the
353applicant, or a person or entity identified in paragraph (3)(b),
354has been found guilty of, regardless of adjudication, or has
355entered a plea of nolo contendere or guilty to, any offense
356prohibited under the level 2 standards for screening set forth
357in chapter 435; any felony under chapter 400, chapter 408,
358chapter 409, chapter 440, chapter 624, chapter 626, chapter 627,
359chapter 812, chapter 817, chapter 831, chapter 837, chapter 838,
360chapter 895, or chapter 896; or any substantially comparable
361offense or crime of another state or of the United States, if a
362felony in that jurisdiction, within the past 10 years. Each
363person required to provide background screening shall disclose
364to the agency any arrest for a crime for which a court
365disposition other than dismissal has been made within the past
36610 years. Failure to provide such information is a material
367omission in the application process, or a violation of insurance
368fraud under s. 817.234, within the past 5 years. If the
369applicant has been convicted of an offense prohibited under the
370level 2 standards or insurance fraud in any jurisdiction, the
371applicant must show that his or her civil rights have been
372restored prior to submitting an application.
373     (e)  Each applicant that performs the technical component
374of magnetic resonance imaging, static radiographs, computed
375tomography, or positron emission tomography, and also provides
376the professional components of such services through an employee
377or independent contractor, must provide to the agency on a form
378provided by the agency, the name and address of the clinic, the
379serial or operating number of each magnetic resonance imaging,
380static radiograph, computed tomography, and positron emission
381tomography machine, the name of the manufacturer of the machine,
382and such other information as required by the agency to identify
383the machine. The information must be provided to the agency upon
384renewal of the clinic's licensure and within 30 days after a
385clinic begins using a machine for which it has not provided the
386information to the agency.
387     Section 4.  Section 400.9914, Florida Statutes, is created
388to read:
389     400.9914  Revocation or denial of a specialty clinic
390license.-In addition to the standards provided in s. 408.831,
391the agency:
392     (1)  Shall deny or revoke a specialty clinic license if an
393applicant has been found guilty of, regardless of adjudication,
394or entered a plea of nolo contendere or guilty to, any felony
395involving dishonesty or making a false statement in any
396jurisdiction within the preceding 10 years.
397     (2)  Shall deny a specialty clinic license application when
398any business entity or individual possessing an ownership or
399pecuniary interest in the specialty clinic also possessed an
400ownership or pecuniary interest, individually or through any
401business entity, in any health care facility whose license was
402revoked in any jurisdiction during the pendency of that
404     (3)  May not issue a specialty clinic license to any
405applicant to whom the agency has sent notice that there is a
406pending question as to whether one or more of the individuals
407having an ownership of 5 percent or more or a pecuniary interest
408of $5,000 or more in the clinic has a disqualifying criminal
409record. The agency notice shall request the applicant to submit
410any additional information necessary to resolve the pending
411criminal background question within 21 days after receipt of the
412notice. The agency shall deny a specialty clinic license
413application if the applicant fails to resolve a criminal
414background screening issue pertaining to an individual who is
415required to meet the criminal background screening requirements
416of this part and the agency raised such background screening
417issue by providing notice pursuant to this part.
418     Section 5.  Section 400.9915, Florida Statutes, is amended
419to read:
420     400.9915  Emergency suspension; costs.-
421     (1)  Failure by a clinic or specialty clinic licensed under
422this part to allow full and complete access to the premises and
423to billing records or information to any representative of the
424agency who makes a request to inspect the clinic or specialty
425clinic to determine compliance with this part or failure by a
426clinic or specialty clinic to employ a qualified medical
427director or clinic director constitutes a ground for emergency
428suspension of the license by the agency pursuant to s. 408.814.
429     (2)  In addition to any administrative fines imposed
430pursuant to this part or part II of chapter 408, the agency may
431assess a fee equal to the cost of conducting a complaint
433     Section 6.  Section 400.9921, Florida Statutes, is created
434to read:
435     400.9921  License renewal; transfer of ownership.-In
436addition to the requirements set forth in ss. 408.806 and
438     (1)  An application for license renewal must contain
439information as required by the agency.
440     (2)  The clinic or specialty clinic must file with the
441renewal application satisfactory proof that it is in compliance
442with this part and applicable rules. If there is evidence of
443financial instability, the clinic or specialty clinic must
444submit satisfactory proof of its financial ability to comply
445with the requirements of this part.
446     (3)  An application for change of ownership of a clinic or
447specialty clinic is required only when 45 percent or more of the
448ownership, voting shares, or controlling interest of a clinic or
449specialty clinic is transferred or assigned, including the final
450transfer or assignment of multiple transfers or assignments over
451a 2-year period which cumulatively total 45 percent or greater.
452     (4)  The license may not be sold, leased, assigned, or
453otherwise transferred, voluntarily or involuntarily, and is
454valid only for the clinic or specialty clinic owners and
455location for which the license was originally issued.
456     Section 7.  Section 400.9925, Florida Statutes, is amended
457to read:
458     400.9925  Rulemaking authority; license fees.-
459     (1)  The agency shall adopt rules necessary to administer
460the clinic and specialty clinic administration, regulation, and
461licensure program, including rules pursuant to this part and
462part II of chapter 408, establishing the specific licensure
463requirements, procedures, forms, and fees. It shall adopt rules
464establishing a procedure for the biennial renewal of licenses.
465The agency may issue initial licenses for less than the full 2-
466year period by charging a prorated licensure fee and specifying
467a different renewal date than would otherwise be required for
468biennial licensure. The rules shall specify the expiration dates
469of licenses, the process of tracking compliance with financial
470responsibility requirements, and any other conditions of renewal
471required by law or rule.
472     (2)  The agency shall adopt rules specifying limitations on
473the number of licensed clinics and specialty clinics and
474licensees for which a medical director or a clinic director may
475assume responsibility for purposes of this part. In determining
476the quality of supervision a medical director or a clinic
477director can provide, the agency shall consider the number of
478clinic or specialty clinic employees, the clinic location or the
479specialty clinic location, and the health care services provided
480by the clinic or specialty clinic.
481     (3)  In accordance with s. 408.805, an applicant or a
482licensee shall pay a fee for each license application submitted
483under this part, part II of chapter 408, and applicable rules.
484The amount of the fee shall be established by rule and may not
485exceed $2,000.
486     Section 8.  Subsection (3) of section 400.993, Florida
487Statutes, is amended to read:
488     400.993  Unlicensed clinics; reporting.-
489     (3)  In addition to the requirements of part II of chapter
490408, any health care provider who is aware of the operation of
491an unlicensed clinic or specialty clinic shall report that
492facility to the agency. Failure to report a clinic or specialty
493clinic that the provider knows or has reasonable cause to
494suspect is unlicensed shall be reported to the provider's
495licensing board.
496     Section 9.  Subsections (1), (6), and (9) of section
497400.9935, Florida Statutes, are amended, and subsections (10)
498and (11) are added to that section, to read:
499     400.9935  Clinic and specialty clinic responsibilities.-
500     (1)  Each clinic and specialty clinic shall appoint a
501medical director or clinic director who shall agree in writing
502to accept legal responsibility for the following activities on
503behalf of the clinic or specialty clinic. The medical director
504or the clinic director shall:
505     (a)  Have signs identifying the medical director or clinic
506director posted in a conspicuous location within the clinic
507readily visible to all patients.
508     (b)  Ensure that all practitioners providing health care
509services or supplies to patients maintain a current active and
510unencumbered Florida license.
511     (c)  Review any patient referral contracts or agreements
512executed by the clinic.
513     (d)  Ensure that all health care practitioners at the
514clinic have active appropriate certification or licensure for
515the level of care being provided.
516     (e)  Serve as the clinic records owner as defined in s.
518     (f)  Ensure compliance with the recordkeeping, office
519surgery, and adverse incident reporting requirements of chapter
520456, the respective practice acts, and rules adopted under this
521part and part II of chapter 408.
522     (g)  Conduct systematic reviews of clinic billings to
523ensure that the billings are not fraudulent or unlawful. Upon
524discovery of an unlawful charge, the medical director or clinic
525director shall take immediate corrective action. If the clinic
526performs only the technical component of magnetic resonance
527imaging, static radiographs, computed tomography, or positron
528emission tomography, and provides the professional
529interpretation of such services, in a fixed facility that is
530accredited by the Joint Commission on Accreditation of
531Healthcare Organizations or the Accreditation Association for
532Ambulatory Health Care, and the American College of Radiology;
533and if, in the preceding quarter, the percentage of scans
534performed by that clinic which was billed to all personal injury
535protection insurance carriers was less than 15 percent, the
536chief financial officer of the clinic may, in a written
537acknowledgment provided to the agency, assume the responsibility
538for the conduct of the systematic reviews of clinic billings to
539ensure that the billings are not fraudulent or unlawful.
540     (h)  Not refer a patient to the clinic if the clinic
541performs magnetic resonance imaging, static radiographs,
542computed tomography, or positron emission tomography. The term
543"refer a patient" means the referral of one or more patients of
544the medical or clinical director or a member of the medical or
545clinical director's group practice to the clinic for magnetic
546resonance imaging, static radiographs, computed tomography, or
547positron emission tomography. A medical director who is found to
548violate this paragraph commits a felony of the third degree,
549punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
550     (i)  Serve as medical or clinic director for no more than a
551maximum of five health care clinics that have a cumulative total
552of no more than 200 employees and persons under contract with
553the health care clinic at a given time. A medical or clinic
554director may not supervise a health care clinic more than 200
555miles away from any other health care clinic supervised by the
556same medical or clinic director. The agency may allow a waiver
557of the limitations of this paragraph upon a showing of good
558cause and a determination by the agency that the medical or
559clinic director is able to adequately perform the duties
560required under this subsection.
561     (6)  Any person or entity providing health care services
562which is not a clinic or specialty clinic, as defined under s.
563400.9905, may voluntarily apply for a certificate of exemption
564from licensure under its exempt status. Other than certificates
565of exemptions granted pursuant to the exemption under s.
566400.9905(4)(f), certificates of exemption shall expire after 2
567years and may be renewed with the agency on a form that sets
568forth its name or names and addresses, a statement of the
569reasons why it cannot be defined as a clinic, and other
570information deemed necessary by the agency. An exemption is not
571transferable. The agency may charge an applicant for a
572certificate of exemption in an amount equal to $100 or the
573actual cost of processing the certificate, whichever is less.
574     (a)  The agency shall provide a form that requires the name
575or names and addresses, a statement of the reasons why the
576applicant is exempt from licensure as a health care clinic or
577specialty clinic, and other information deemed necessary by the
578agency. The signature on an application for a certificate of
579exemption must be notarized and signed by persons having
580knowledge of the truth of its contents. An exemption is not
581transferable and is valid only for the reasons, location,
582persons, and entity set forth on the application form. A person
583or entity that claims an exemption under this part or that holds
584a current certificate of exemption must be exempt from the
585licensing provisions of this part at all times or such claim or
586certificate is invalid from the date that such person or entity
587is not exempt.
588     (b)  The agency shall charge an applicant for a certificate
589of exemption a fee of $100 to cover the cost of processing the
590certificate or the actual cost of processing the certificate,
591whichever is less.
592     (c)  An application for the renewal of a certificate of
593exemption must be submitted to the agency before the expiration
594of the certificate of exemption. The agency may investigate any
595applicant, person, or entity claiming an exemption for purposes
596of determining compliance when a certificate of exemption is
597sought. Authorized personnel of the agency shall have access to
598the premises of any certificateholder, applicant, or specialty
599clinic, other than a person or entity who is exempt pursuant to
600s. 400.9905(4)(f), for the sole purpose of determining
601compliance with an exemption under this part. The agency shall
602have access to all billings and records. The agency may deny or
603withdraw a certificate of exemption if a person or entity does
604not qualify under this part.
605     (d)  A certificate of exemption is considered withdrawn
606when the agency determines that an exempt status cannot be
607confirmed. The provisions applicable to the unlicensed operation
608of a health care clinic or specialty clinic apply to any health
609care provider that self-determines or claims an exemption or
610that is issued a certificate of exemption if, in fact, such
611clinic does not meet the exemption claimed.
612     (e)  Any person or entity that submits an application for a
613certificate of exemption which contains fraudulent or material
614and misleading information commits a felony of the third degree,
615punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
616     (f)  A response to a request in writing for additional
617information or clarification must be filed with the agency no
618later than 21 days after receipt of the request or the
619application shall be denied.
620     (g)  The agency shall grant or deny an application for a
621certificate of exemption in accordance with s. 120.60(1).
622     (h)  A person or entity that qualifies as a health care
623clinic or specialty clinic and has been denied a certificate of
624exemption must file an initial application and pay the fee. A
625certificate of exemption is valid only when issued and current.
626     (i)  The agency shall issue an emergency order of
627suspension of a certificate of exemption when the agency finds
628that the applicant has provided false or misleading material
629information or omitted any material fact from the application
630for a certificate of exemption which is permitted or required by
631this part, or has submitted false or misleading information to
632the agency when self-determining an exempt status and materially
633misleading the agency as to such status.
634     (9)  In addition to the requirements of part II of chapter
635408, the clinic or specialty clinic shall display a sign in a
636conspicuous location within the clinic or specialty clinic
637readily visible to all patients indicating that, pursuant to s.
638626.9892, the Department of Financial Services may pay rewards
639of up to $25,000 to persons providing information leading to the
640arrest and conviction of persons committing crimes investigated
641by the Division of Insurance Fraud arising from violations of s.
642440.105, s. 624.15, s. 626.9541, s. 626.989, or s. 817.234. An
643authorized employee of the Division of Insurance Fraud may make
644unannounced inspections of a clinic or specialty clinic licensed
645under this part as necessary to determine whether the clinic or
646specialty clinic is in compliance with this subsection. A
647licensed clinic or specialty clinic shall allow full and
648complete access to the premises to such authorized employee of
649the division who makes an inspection to determine compliance
650with this subsection.
651     (10)  In addition to the requirements set forth in s.
652408.8065, every licensed specialty clinic shall annually file
653with the agency, including concurrently with the filing of any
654change of ownership application, upon forms to be furnished by
655the agency, an audited report showing the following information:
656     (a)  A report of the number of patients served by the
657specialty clinic during the previous 12-month period. The report
658may exclude any partial month for the month when the report was
660     (b)  Total specialty clinic operating expenses;
661     (c)  Gross patient charges by payor category, including
662Medicare, Medicaid, county indigent programs, any other
663governmental programs, private insurance, self-paying patients,
664nonpaying patients, and other payees;
665     (d)  The cost of operation of the specialty clinic during
666the previous 12-month period, excluding any partial month during
667which time the report was prepared;
668     (e)  Unless the specialty clinic can demonstrate that the
669clinic already has furnished the required information regarding
670a particular subject individual, the full name of any individual
671who became an owner or became possessed of any pecuniary
672interest in the subject clinic since the last report to the
673agency, along with the disclosure of the information required by
674s. 400.991 as to such individual; and
675     (f)  A current statement of the source of funds for payment
676of the costs of establishing the specialty clinic and for
677sustaining the operation of the specialty clinic until its
678operation produces a positive cash flow.
679     (11)  Each licensee of a specialty clinic has a continuing
680obligation to comply with this part and to report to the agency
681any change of circumstance related to the clinic's continuing
682compliance with this part. Such change of circumstance includes,
683but is not limited to, any change in the ownership of the
684specialty clinic, the addition of any individual or business
685entity possessing a pecuniary interest in the specialty clinic,
686the employment of any individual as a member of the specialty
687clinic's staff who would be required to undergo a criminal
688background screening if such individual had been an employee at
689the time of the initial licensure, and any change in the medical
690or clinic director. The specialty clinic shall furnish the
691information about any change of circumstances required under
692this part and s. 400.991 within 30 days after the occurrence of
693such change of circumstance.
694     Section 10.  Section 400.995, Florida Statutes, is amended
695to read:
696     400.995  Agency administrative penalties.-
697     (1)  In addition to the requirements of part II of chapter
698408, the agency may deny the application for a license renewal,
699revoke and suspend the license, and impose administrative fines
700of up to $5,000 per violation for violations of the requirements
701of this part or rules of the agency. In determining if a penalty
702is to be imposed and in fixing the amount of the fine, the
703agency shall consider the following factors:
704     (a)  The gravity of the violation, including the
705probability that death or serious physical or emotional harm to
706a patient will result or has resulted, the severity of the
707action or potential harm, and the extent to which the provisions
708of the applicable laws or rules were violated.
709     (b)  Actions taken by the owner, medical director, or
710clinic director to correct violations.
711     (c)  Any previous violations.
712     (d)  The financial benefit to the clinic or specialty
713clinic of committing or continuing the violation.
714     (2)  Each day of continuing violation after the date fixed
715for termination of the violation, as ordered by the agency,
716constitutes an additional, separate, and distinct violation.
717     (3)  Any action taken to correct a violation shall be
718documented in writing by the owner, medical director, or clinic
719director of the clinic or specialty clinic and verified through
720followup visits by agency personnel. The agency may impose a
721fine and, in the case of an owner-operated clinic or specialty
722clinic, revoke or deny a clinic's license when a clinic medical
723director or clinic director knowingly misrepresents actions
724taken to correct a violation.
725     (4)  Any licensed clinic whose owner, medical director, or
726clinic director concurrently operates an unlicensed clinic shall
727be subject to an administrative fine of $5,000 per day.
728     (5)  Any clinic or specialty clinic whose owner fails to
729apply for a change-of-ownership license and operates the clinic
730or specialty clinic under the new ownership is subject to a fine
731of $5,000.
732     (6)  As an alternative to or in conjunction with an
733administrative action against a clinic or specialty clinic for
734violations of this part and adopted rules During an inspection,
735the agency shall make a reasonable attempt to discuss during the
736inspection each violation with the owner, medical director, or
737clinic director of the clinic or specialty clinic, prior to
738written notification. The agency, instead of fixing a period
739within which the clinic or specialty clinic shall enter into
740compliance with standards, may request a plan of corrective
741action from the clinic or specialty clinic which demonstrates a
742good faith effort to remedy each violation by a specific date,
743subject to the approval of the agency.
744     Section 11.  Section 400.996, Florida Statutes, is created
745to read:
746     400.996  Specialty clinics; complaints; audits; referrals.-
747     (1)  The agency shall receive, document, and process
748complaints about specialty clinics. Upon receipt of any
749complaint that asserts the existence of facts evidencing
750possible billing fraud by a specialty clinic or by any employee
751of a specialty clinic, the agency shall request the complainant
752to make such assertions by sworn affidavit.
753     (2)  Upon receipt of any sworn affidavit that asserts the
754existence of facts evidencing possible billing fraud by a
755specialty clinic or any of its employees, the agency shall refer
756the complaint to the Office of Fiscal Integrity within the
757Department of Financial Services.
758     (3)  The Department of Financial Services shall report
759findings to the agency for any appropriate licensure action.
760Such report shall include a statement of facts as determined by
761the Department of Financial Services to exist, specifically with
762regard to the possible violations of licensure requirements. If,
763during an investigation, the Department of Financial Services
764has reason to believe that any criminal law of this state has or
765may have been violated, the department shall refer such
766investigation to appropriate prosecutorial agencies and shall
767provide investigative assistance to those agencies, as required.
768     (4)  The investigating authority and the agency shall
769cooperate with each other and prepare a record and share
770information from which the agency may determine if any action
771for sanctions under this part are warranted.
772     (5)  A person commits a misdemeanor of the first degree,
773punishable as provided in s. 775.082 or s. 775.083 if:
774     (a)  He or she submits a sworn complaint that initiates a
775complaint investigation pursuant to this section; and
776     (b)  The sworn complaint is determined to be totally
777without any factual basis to support the assertions made in the
778complaint that facts existed evidencing possible fraudulent
779practices by a specialty clinic or any of its employees.
780     (6)  The Office of Fiscal Integrity within the Department
781of Financial Services shall conduct unannounced reviews,
782investigations, analyses, and audits to investigate complaints
783and, as necessary, to determine whether a specialty clinic's
784billings are fraudulent or unlawful. The Department of Financial
785Services may enter upon the premises of the clinic during
786regular business hours and demand and immediately secure copies
787of billing and other records of the clinic which will enable the
788Department of Financial Services to investigate complaints or
789determine whether a specialty clinic's billings are fraudulent
790or unlawful.
791     (7)  A licensed specialty clinic shall allow full,
792complete, and immediate access to the premises and to billing
793records or information to any such officer or employee who
794conducts a review, investigation, analysis, or audit to
795determine compliance with this part and with applicable rules.
796Failure to allow full, complete, and immediate access to the
797premises and to billing records or information to any
798representative of the agency or Department of Financial Services
799who attempts to conduct a review, investigation, analysis, or
800audit to determine compliance with this part constitutes a
801ground for emergency suspension of the license by the agency
802pursuant to s. 120.60(6).
803     (8)  In addition to any administrative fines imposed, the
804agency may assess a fee equal to the cost of conducting any
805review, investigation, analysis, or audit performed by the
806agency or the Department of Financial Services.
807     (9)  All investigators designated by the Chief Financial
808Officer to perform duties under this part and who are certified
809under s. 943.1395 are law enforcement officers of the state.
810Such investigators may conduct criminal investigations, bear
811arms, make arrests, and apply for, serve, and execute search
812warrants, arrest warrants, capias, and other processes
813throughout the state pertaining to fraud investigations under
814this section.
815     Section 12.  Subsection (27) of section 408.802, Florida
816Statutes, is amended to read:
817     408.802  Applicability.-The provisions of this part apply
818to the provision of services that require licensure as defined
819in this part and to the following entities licensed, registered,
820or certified by the agency, as described in chapters 112, 383,
821390, 394, 395, 400, 429, 440, 483, and 765:
822     (27)  Health care clinics and specialty clinics, as
823provided under part X of chapter 400.
824     Section 13.  Subsection (25) of section 408.820, Florida
825Statutes, is amended to read:
826     408.820  Exemptions.-Except as prescribed in authorizing
827statutes, the following exemptions shall apply to specified
828requirements of this part:
829     (25)  Health care clinics and specialty clinics, as
830provided under part X of chapter 400, are exempt from s.
831408.810(6), (7), and (10).
832     Section 14.  Paragraph (mm) is added to subsection (1) of
833section 456.072, Florida Statutes, to read:
834     456.072  Grounds for discipline; penalties; enforcement.-
835     (1)  The following acts shall constitute grounds for which
836the disciplinary actions specified in subsection (2) may be
838     (mm)  Intentionally providing false information on an
839application for a certificate of exemption from clinic licensure
840under part XIII of chapter 400.
841     Section 15.  Paragraph (a) of subsection (1) of section
842627.732, Florida Statutes, is amended to read:
843     627.732  Definitions.-As used in ss. 627.730-627.7405, the
845     (1)  "Broker" means any person not possessing a license
846under chapter 395, chapter 400, chapter 429, chapter 458,
847chapter 459, chapter 460, chapter 461, or chapter 641 who
848charges or receives compensation for any use of medical
849equipment and is not the 100-percent owner or the 100-percent
850lessee of such equipment. For purposes of this section, such
851owner or lessee may be an individual, a corporation, a
852partnership, or any other entity and any of its 100-percent-
853owned affiliates and subsidiaries. For purposes of this
854subsection, the term "lessee" means a long-term lessee under a
855capital or operating lease, but does not include a part-time
856lessee. The term "broker" does not include a hospital or
857physician management company whose medical equipment is
858ancillary to the practices managed, a debt collection agency, or
859an entity that has contracted with the insurer to obtain a
860discounted rate for such services; nor does the term include a
861management company that has contracted to provide general
862management services for a licensed physician or health care
863facility and whose compensation is not materially affected by
864the usage or frequency of usage of medical equipment or an
865entity that is 100-percent owned by one or more hospitals or
866physicians. The term "broker" does not include a person or
867entity that certifies, upon request of an insurer, that:
868     (a)  It is a clinic licensed under ss. 400.990-400.996
870     Section 16.  Paragraph (a) of subsection (1) of section
871627.736, Florida Statutes, is amended to read:
872     627.736  Required personal injury protection benefits;
873exclusions; priority; claims.-
874     (1)  REQUIRED BENEFITS.-Every insurance policy complying
875with the security requirements of s. 627.733 shall provide
876personal injury protection to the named insured, relatives
877residing in the same household, persons operating the insured
878motor vehicle, passengers in such motor vehicle, and other
879persons struck by such motor vehicle and suffering bodily injury
880while not an occupant of a self-propelled vehicle, subject to
881the provisions of subsection (2) and paragraph (4)(e), to a
882limit of $10,000 for loss sustained by any such person as a
883result of bodily injury, sickness, disease, or death arising out
884of the ownership, maintenance, or use of a motor vehicle as
886     (a)  Medical benefits.-Eighty percent of all reasonable
887expenses for medically necessary medical, surgical, X-ray,
888dental, and rehabilitative services, including prosthetic
889devices, and medically necessary ambulance, hospital, and
890nursing services. However, the medical benefits shall provide
891reimbursement only for such services and care that are lawfully
892provided, supervised, ordered, or prescribed by a physician
893licensed under chapter 458 or chapter 459, a dentist licensed
894under chapter 466, or a chiropractic physician licensed under
895chapter 460 or that are provided by any of the following persons
896or entities:
897     1.  A hospital or ambulatory surgical center licensed under
898chapter 395.
899     2.  A person or entity licensed under ss. 401.2101-401.45
900that provides emergency transportation and treatment.
901     3.  An entity wholly owned by one or more physicians
902licensed under chapter 458 or chapter 459, chiropractic
903physicians licensed under chapter 460, or dentists licensed
904under chapter 466 or by such practitioner or practitioners and
905the spouse, parent, child, or sibling of that practitioner or
906those practitioners.
907     4.  An entity wholly owned, directly or indirectly, by a
908hospital or hospitals.
909     5.  A health care clinic licensed under ss. 400.990-400.996
910400.990-400.995 that is:
911     a.  Accredited by the Joint Commission on Accreditation of
912Healthcare Organizations, the American Osteopathic Association,
913the Commission on Accreditation of Rehabilitation Facilities, or
914the Accreditation Association for Ambulatory Health Care, Inc.;
916     b.  A health care clinic that:
917     (I)  Has a medical director licensed under chapter 458,
918chapter 459, or chapter 460;
919     (II)  Has been continuously licensed for more than 3 years
920or is a publicly traded corporation that issues securities
921traded on an exchange registered with the United States
922Securities and Exchange Commission as a national securities
923exchange; and
924     (III)  Provides at least four of the following medical
926     (A)  General medicine.
927     (B)  Radiography.
928     (C)  Orthopedic medicine.
929     (D)  Physical medicine.
930     (E)  Physical therapy.
931     (F)  Physical rehabilitation.
932     (G)  Prescribing or dispensing outpatient prescription
934     (H)  Laboratory services.
936The Financial Services Commission shall adopt by rule the form
937that must be used by an insurer and a health care provider
938specified in subparagraph 3., subparagraph 4., or subparagraph
9395. to document that the health care provider meets the criteria
940of this paragraph, which rule must include a requirement for a
941sworn statement or affidavit.
943Only insurers writing motor vehicle liability insurance in this
944state may provide the required benefits of this section, and no
945such insurer shall require the purchase of any other motor
946vehicle coverage other than the purchase of property damage
947liability coverage as required by s. 627.7275 as a condition for
948providing such required benefits. Insurers may not require that
949property damage liability insurance in an amount greater than
950$10,000 be purchased in conjunction with personal injury
951protection. Such insurers shall make benefits and required
952property damage liability insurance coverage available through
953normal marketing channels. Any insurer writing motor vehicle
954liability insurance in this state who fails to comply with such
955availability requirement as a general business practice shall be
956deemed to have violated part IX of chapter 626, and such
957violation shall constitute an unfair method of competition or an
958unfair or deceptive act or practice involving the business of
959insurance; and any such insurer committing such violation shall
960be subject to the penalties afforded in such part, as well as
961those which may be afforded elsewhere in the insurance code.
962     Section 17.  Florida Barbara B. Lumpkin Center for Nursing
963designated; Department of Health to erect suitable markers.-
964     (1)  The Florida Center for Nursing, created by s.
965464.0195, Florida Statutes, and located in Orlando is designated
966as the "Florida Barbara B. Lumpkin Center for Nursing."
967     (2)  The Department of Health is directed to erect suitable
968markers designating the Florida Barbara B. Lumpkin Center for
969Nursing as described in subsection (1).
970     Section 18.  For the 2010-2011 fiscal year, the sums of
971$212,528 in recurring funds and $25,347 in nonrecurring funds
972are appropriated from the Health Care Trust Fund to the Agency
973for Health Care Administration, and four full-time equivalent
974positions and associated salary rate of 134,455 are authorized
975for the purpose of administering the provisions of this act.
976     Section 19.  This act shall take effect July 1, 2010.

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

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