Florida Senate - 2010 SB 1256
By Senator Peaden
1 A bill to be entitled
2 An act relating to the physician workforce; repealing
3 s. 381.0403, F.S., relating to the Community Hospital
4 Education Act and the Community Hospital Education
5 Council; amending s. 381.4018, F.S.; providing
6 definitions; revising the list of governmental
7 stakeholders that the Department of Health is required
8 to work with regarding the state strategic plan and in
9 assessing the state’s physician workforce; creating
10 the Physician Workforce Advisory Council; providing
11 membership of the council; providing for appointments
12 to the council; providing terms of membership;
13 providing for removal of a council member; providing
14 for the chair and vice chair of the council; providing
15 that council members are not entitled to receive
16 compensation or reimbursement for per diem or travel
17 expenses; providing the duties of the council;
18 establishing the physician workforce graduate medical
19 education innovation pilot projects under the
20 department; providing the purposes of the pilot
21 projects; providing for the appropriation of state
22 funds for the pilot projects; requiring the pilot
23 projects to meet certain policy needs of the physician
24 workforce in this state; providing criteria for
25 prioritizing proposals for pilot projects; requiring
26 the department to adopt by rule appropriate
27 performance measures; requiring participating pilot
28 projects to submit an annual report to the department;
29 requiring state funds to be used to supplement funds
30 from other sources; requiring the department to adopt
31 rules; amending ss. 458.3192 and 459.0082, F.S.;
32 requiring the department to determine by geographic
33 area and specialty the number of physicians and
34 osteopathic physicians who plan to relocate outside
35 the state, practice medicine in this state, and reduce
36 or modify the scope of their practice; authorizing the
37 department to report additional information in its
38 findings to the Governor and the Legislature; amending
39 s. 409.908, F.S.; conforming a cross-reference;
40 providing an effective date.
42 Be It Enacted by the Legislature of the State of Florida:
44 Section 1. Section 381.0403, Florida Statutes, is repealed.
45 Section 2. Section 381.4018, Florida Statutes, is amended
46 to read:
47 381.4018 Physician workforce assessment and development.—
48 (1) DEFINITIONS.—As used in this section, the term:
49 (a) “Consortium” or “consortia” means a combination of
50 statutory teaching hospitals, statutory rural hospitals, other
51 hospitals, accredited medical schools, clinics operated by the
52 Department of Health, clinics operated by the Department of
53 Veterans’ Affairs, area health education centers, community
54 health centers, federally qualified health centers, prison
55 clinics, local community clinics, or other programs. At least
56 one member of the consortium shall be a sponsoring institution
57 accredited or currently seeking accreditation by the
58 Accreditation Council for Graduate Medical Education or the
59 American Osteopathic Association.
60 (b) “Council” means the Physician Workforce Advisory
62 (c) “Department” means the Department of Health.
63 (d) “Graduate medical education program” means a program
64 accredited by the Accreditation Council for Graduate Medical
65 Education or the American Osteopathic Association.
66 (e) “Primary care specialty” means emergency medicine,
67 family practice, internal medicine, pediatrics, psychiatry,
68 obstetrics and gynecology, and combined internal medicine and
69 other specialties as determined by the Physician Workforce
70 Advisory Council or the Department of Health.
(1) LEGISLATIVE INTENT.—The Legislature recognizes that
72 physician workforce planning is an essential component of
73 ensuring that there is an adequate and appropriate supply of
74 well-trained physicians to meet this state’s future health care
75 service needs as the general population and elderly population
76 of the state increase. The Legislature finds that items to
77 consider relative to assessing the physician workforce may
78 include physician practice status; specialty mix; geographic
79 distribution; demographic information, including, but not
80 limited to, age, gender, race, and cultural considerations; and
81 needs of current or projected medically underserved areas in the
82 state. Long-term strategic planning is essential as the period
83 from the time a medical student enters medical school to
84 completion of graduate medical education may range from 7 to 10
85 years or longer. The Legislature recognizes that strategies to
86 provide for a well-trained supply of physicians must include
87 ensuring the availability and capacity of quality graduate
88 medical schools and graduate medical education programs in this
89 state, as well as using new or existing state and federal
90 programs providing incentives for physicians to practice in
91 needed specialties and in underserved areas in a manner that
92 addresses projected needs for physician manpower.
93 (3) (2) PURPOSE.—The Department of Health shall serve as a
94 coordinating and strategic planning body to actively assess the
95 state’s current and future physician workforce needs and work
96 with multiple stakeholders to develop strategies and
97 alternatives to address current and projected physician
98 workforce needs.
99 (4) (3) GENERAL FUNCTIONS.—The department shall maximize the
100 use of existing programs under the jurisdiction of the
101 department and other state agencies and coordinate governmental
102 and nongovernmental stakeholders and resources in order to
103 develop a state strategic plan and assess the implementation of
104 such strategic plan. In developing the state strategic plan, the
105 department shall:
106 (a) Monitor, evaluate, and report on the supply and
107 distribution of physicians licensed under chapter 458 or chapter
108 459. The department shall maintain a database to serve as a
109 statewide source of data concerning the physician workforce.
110 (b) Develop a model and quantify, on an ongoing basis, the
111 adequacy of the state’s current and future physician workforce
112 as reliable data becomes available. Such model must take into
113 account demographics, physician practice status, place of
114 education and training, generational changes, population growth,
115 economic indicators, and issues concerning the “pipeline” into
116 medical education.
117 (c) Develop and recommend strategies to determine whether
118 the number of qualified medical school applicants who might
119 become competent, practicing physicians in this state will be
120 sufficient to meet the capacity of the state’s medical schools.
121 If appropriate, the department shall, working with
122 representatives of appropriate governmental and nongovernmental
123 entities, develop strategies and recommendations and identify
124 best practice programs that introduce health care as a
125 profession and strengthen skills needed for medical school
126 admission for elementary, middle, and high school students, and
127 improve premedical education at the precollege and college level
128 in order to increase this state’s potential pool of medical
130 (d) Develop strategies to ensure that the number of
131 graduates from the state’s public and private allopathic and
132 osteopathic medical schools are adequate to meet physician
133 workforce needs, based on the analysis of the physician
134 workforce data, so as to provide a high-quality medical
135 education to students in a manner that recognizes the uniqueness
136 of each new and existing medical school in this state.
137 (e) Pursue strategies and policies to create, expand, and
138 maintain graduate medical education positions in the state based
139 on the analysis of the physician workforce data. Such strategies
140 and policies must take into account the effect of federal
141 funding limitations on the expansion and creation of positions
142 in graduate medical education. The department shall develop
143 options to address such federal funding limitations. The
144 department shall consider options to provide direct state
145 funding for graduate medical education positions in a manner
146 that addresses requirements and needs relative to accreditation
147 of graduate medical education programs. The department shall
148 consider funding residency positions as a means of addressing
149 needed physician specialty areas, rural areas having a shortage
150 of physicians, and areas of ongoing critical need, and as a
151 means of addressing the state’s physician workforce needs based
152 on an ongoing analysis of physician workforce data.
153 (f) Develop strategies to maximize federal and state
154 programs that provide for the use of incentives to attract
155 physicians to this state or retain physicians within the state.
156 Such strategies should explore and maximize federal-state
157 partnerships that provide incentives for physicians to practice
158 in federally designated shortage areas. Strategies shall also
159 consider the use of state programs, such as the Florida Health
160 Service Corps established pursuant to s. 381.0302 and the
161 Medical Education Reimbursement and Loan Repayment Program
162 pursuant to s. 1009.65, which provide for education loan
163 repayment or loan forgiveness and provide monetary incentives
164 for physicians to relocate to underserved areas of the state.
165 (g) Coordinate and enhance activities relative to physician
166 workforce needs, undergraduate medical education, and graduate
167 medical education provided by the Division of Medical Quality
168 Assurance, the Community Hospital Education Program and the
169 Graduate Medical Education Committee established pursuant to s.
170 381.0403 , area health education center networks established
171 pursuant to s. 381.0402, and other offices and programs within
172 the Department of Health as designated by the State Surgeon
174 (h) Work in conjunction with and act as a coordinating body
175 for governmental and nongovernmental stakeholders to address
176 matters relating to the state’s physician workforce assessment
177 and development for the purpose of ensuring an adequate supply
178 of well-trained physicians to meet the state’s future needs.
179 Such governmental stakeholders shall include, but need not be
180 limited to, the State Surgeon General or his or her designee,
181 the Commissioner of Education or his or her designee, the
182 Secretary of Health Care Administration or his or her designee,
183 and the Chancellor of the State University System or his or her
184 designee from the Board of Governors of the State University
185 System, and, at the discretion of the department, other
186 representatives of state and local agencies that are involved in
187 assessing, educating, or training the state’s current or future
188 physicians. Other stakeholders shall include, but need not be
189 limited to, organizations representing the state’s public and
190 private allopathic and osteopathic medical schools;
191 organizations representing hospitals and other institutions
192 providing health care, particularly those that have an interest
193 in providing accredited medical education and graduate medical
194 education to medical students and medical residents;
195 organizations representing allopathic and osteopathic practicing
196 physicians; and, at the discretion of the department,
197 representatives of other organizations or entities involved in
198 assessing, educating, or training the state’s current or future
200 (i) Serve as a liaison with other states and federal
201 agencies and programs in order to enhance resources available to
202 the state’s physician workforce and medical education continuum.
203 (j) Act as a clearinghouse for collecting and disseminating
204 information concerning the physician workforce and medical
205 education continuum in this state.
206 (5) PHYSICIAN WORKFORCE ADVISORY COUNCIL.—There is created
207 in the Department of Health the Physician Workforce Advisory
208 Council, an advisory council as defined in s. 20.03. The council
209 shall comply with the requirements of s. 20.052, except as
210 otherwise provided in this section.
211 (a) The council shall consist of 23 members, appointed by
212 the State Surgeon General, which shall include:
213 1. A designee from the department.
214 2. An individual recommended by the Area Health Education
215 Center Network.
216 3. Two individuals recommended by the Council of Florida
217 Medical School Deans, one representing a college of allopathic
218 medicine and one representing a college of osteopathic medicine.
219 4. Two individuals recommended by the Florida Hospital
220 Association, one representing a statutory teaching hospital and
221 one representing a hospital that is licensed under chapter 395,
222 has an accredited graduate medical education program, and is not
223 a statutory teaching hospital.
224 5. Two individuals recommended by the Florida Medical
225 Association, one representing a primary care specialty and one
226 representing a nonprimary care specialty.
227 6. Two individuals recommended by the Florida Osteopathic
228 Medical Association, one representing a primary care specialty
229 and one representing a nonprimary care specialty.
230 7. Two individuals who are program directors of accredited
231 graduate medical education programs, one representing a program
232 that is accredited by the Accreditation Council for Graduate
233 Medical Education and one representing a program that is
234 accredited by the American Osteopathic Association.
235 8. An individual recommended by the Florida Justice
237 9. An individual representing a profession in the field of
238 health services administration.
239 10. The Commissioner of Education or his or her designee.
240 11. The Chancellor of the State University System or his or
241 her designee.
242 12. The Secretary of Health Care Administration or his or
243 her designee.
244 13. The executive director of the Department of Veterans’
245 Affairs or his or her designee.
246 14. The Secretary of Elderly Affairs or his or her
248 15. The President of the Senate or his or her designee.
249 16. The Speaker of the House of Representatives or his or
250 her designee.
251 17. A layperson member as determined by the State Surgeon
253 18. A designee of Florida’s Congressional Delegation.
255 Appointments to the council shall be made by the State Surgeon
256 General, except that representatives from a state agency and
257 legislative representatives shall be appointed by the respective
258 agency head, legislative presiding officer, or congressional
259 delegation. Each entity authorized to make recommendations under
260 this subsection shall make at least two recommendations to the
261 State Surgeon General for each appointment to the council. The
262 State Surgeon General shall name one appointee for each position
263 from the recommendations made by each authorized entity.
264 (b) Each council member shall be appointed to a 4-year
265 term. An individual may not serve more than two terms. Any
266 council member may be removed from office for malfeasance;
267 misfeasance; neglect of duty; incompetence; permanent inability
268 to perform official duties; or pleading guilty or nolo
269 contendere to, or being found guilty of, a felony. Any council
270 member who meets the criteria for removal, or who is otherwise
271 unwilling or unable to properly fulfill the duties of the
272 office, shall be succeeded by an individual chosen by the State
273 Surgeon General to serve out the remainder of the council
274 member’s term. If the remainder of the replaced council member’s
275 term is less than 18 months, notwithstanding the provisions of
276 this paragraph, the succeeding council member may be reappointed
277 twice by the State Surgeon General.
278 (c) The chair of the council is the State Surgeon General,
279 who shall designate a vice chair to serve in the absence of the
280 State Surgeon General. A vacancy shall be filled for the
281 remainder of the unexpired term in the same manner as the
282 original appointment.
283 (d) Council members are not entitled to receive
284 compensation or reimbursement for per diem or travel expenses.
285 (e) The council shall meet twice a year in person or by
287 (f) The council shall:
288 1. Advise the State Surgeon General and the department on
289 matters concerning current and future physician workforce needs
290 in this state;
291 2. Review survey materials and the compilation of survey
293 3. Provide recommendations to the department for the
294 development of additional items to be incorporated in the survey
295 completed by physicians licensed under chapter 458 or chapter
297 4. Assist the department in preparing the annual report to
298 the Legislature pursuant to ss. 458.3192 and 459.0082;
299 5. Assist the department in preparing an initial strategic
300 plan, conduct ongoing strategic planning in accordance with this
301 section, and provide ongoing advice on implementing the
303 6. Monitor the need for an increased number of primary care
304 physicians to provide the necessary current and projected health
305 and medical services for the state; and
306 7. Monitor the status of graduate medical education in this
307 state, including, but not limited to, as considered appropriate:
308 a. The effectiveness of graduate medical education pilot
309 projects funded pursuant to subsection (6).
310 b. The role of residents and medical faculty in the
311 provision of health care.
312 c. The relationship of graduate medical education to the
313 state’s physician workforce.
314 d. The availability and use of state and federal
315 appropriated funds for graduate medical education.
316 (6) PHYSICIAN WORKFORCE GRADUATE MEDICAL EDUCATION
317 INNOVATION PILOT PROJECTS.—
318 (a) The Legislature finds that:
319 1. In order to ensure a physician workforce that is
320 adequate to meet the needs of this state’s residents and its
321 health care system, policymakers must consider the training of
322 future generations of well-trained health care providers.
323 2. Physicians are likely to practice in the state where
324 they complete their graduate medical education. The instate
325 retention rate following graduate medical education for
326 physicians in this state is more than 61 percent.
327 3. It can directly affect the makeup of the physician
328 workforce by selectively funding graduate medical education
329 programs to provide needed specialists in geographic areas of
330 the state which have a deficient number of such specialists.
331 4. Developing additional positions in graduate medical
332 education programs is essential to the future of this state’s
333 health care system.
334 5. It was necessary in 2007 to pass legislation that
335 provided for an assessment of the status of this state’s current
336 and future physician workforce. The department is collecting and
337 analyzing information on an ongoing basis to assess this state’s
338 physician workforce needs, and such assessment can serve as a
339 basis for determining graduate medical education needs and
340 strategies for the state.
341 (b) There is established under the department a program to
342 foster innovative graduate medical education pilot projects that
343 are designed to promote the expansion of graduate medical
344 education programs or positions to prepare physicians to
345 practice in needed specialties and underserved areas or settings
346 and to provide demographic and cultural representation in a
347 manner that addresses projected needs for this state’s physician
348 workforce. Funds appropriated annually by the Legislature for
349 this purpose shall be distributed to participating hospitals,
350 medical schools, other sponsors of graduate medical education
351 programs, consortia engaged in developing new graduate medical
352 education programs or positions in those programs, or pilot
353 projects providing innovative graduate medical education in
354 community-based clinical settings. Pilot projects shall be
355 selected on a competitive grant basis, subject to available
357 (c) Pilot projects shall be designed to meet one or more of
358 this state’s physician workforce needs, as determined pursuant
359 to this section, including, but not limited to:
360 1. Increasing the number of residencies or fellowships in
361 primary care or other needed specialties.
362 2. Enhancing the retention of primary care physicians or
363 other needed specialties in this state.
364 3. Promoting practice in rural or medically underserved
365 areas of the state.
366 4. Encouraging racial and ethnic diversity within the
367 state’s physician workforce.
368 5. Encouraging practice in community health care or other
369 ambulatory care settings.
370 6. Encouraging practice in clinics operated by the
371 Department of Health, clinics operated by the Department of
372 Veterans’ Affairs, prison clinics, or similar settings of need.
373 7. Encouraging the increased production of geriatricians.
374 (d) Priority shall be given to a proposal for a pilot
375 project that:
376 1. Demonstrates a collaboration of federal, state, and
377 local entities that are public or private.
378 2. Obtains funding from multiple sources.
379 3. Focuses on enhancing graduate medical education in rural
380 or underserved areas.
381 4. Focuses on enhancing graduate medical education in
382 ambulatory or community-based settings other than a hospital
384 5. Includes the use of technology, such as electronic
385 medical records, distance consultation, and telemedicine, to
386 ensure that residents are better prepared to care for patients
387 in this state, regardless of the community in which the
388 residents practice.
389 6. Is designed to meet multiple policy needs as enumerated
390 in subsection (3).
391 7. Uses a consortium to provide for graduate medical
392 education experiences.
393 (e) The department shall adopt by rule appropriate
394 performance measures to use in order to consistently evaluate
395 the effectiveness, safety, and quality of the programs, as well
396 as the impact of each program on meeting this state’s physician
397 workforce needs.
398 (f) Participating pilot projects shall submit to the
399 department an annual report on the project in a manner required
400 by the department.
401 (g) Funding provided to a pilot project may be used only
402 for the direct costs of providing graduate medical education.
403 Accounting of such costs and expenditures shall be documented in
404 the annual report.
405 (h) State funds shall be used to supplement funds from any
406 local government, community, or private source. The state may
407 provide up to 50 percent of the funds, and local governmental
408 grants or community or private sources shall provide the
409 remainder of the funds.
410 (7) RULEMAKING.—The department shall adopt rules as
411 necessary to administer this section.
412 Section 3. Section 458.3192, Florida Statutes, is amended
413 to read:
414 458.3192 Analysis of survey results; report.—
415 (1) Each year, the Department of Health shall analyze the
416 results of the physician survey required by s. 458.3191 and
417 determine by geographic area and specialty the number of
418 physicians who:
419 (a) Perform deliveries of children in this state Florida.
420 (b) Read mammograms and perform breast-imaging-guided
421 procedures in Florida.
422 (c) Perform emergency care on an on-call basis for a
423 hospital emergency department.
424 (d) Plan to reduce or increase emergency on-call hours in a
425 hospital emergency department.
426 (e) Plan to relocate their allopathic or osteopathic
427 practice outside the state.
428 (f) Practice medicine in this state.
429 (g) Reduce or modify the scope of their practice.
430 (2) The Department of Health must report its findings to
431 the Governor, the President of the Senate, and the Speaker of
432 the House of Representatives by November 1 each year. The
433 department may also include in its report findings,
434 recommendations, or other information requested by the council.
435 Section 4. Section 459.0082, Florida Statutes, is amended
436 to read:
437 459.0082 Analysis of survey results; report.—
438 (1) Each year, the Department of Health shall analyze the
439 results of the physician survey required by s. 459.0081 and
440 determine by geographic area and specialty the number of
441 physicians who:
442 (a) Perform deliveries of children in this state Florida.
443 (b) Read mammograms and perform breast-imaging-guided
444 procedures in this state Florida.
445 (c) Perform emergency care on an on-call basis for a
446 hospital emergency department.
447 (d) Plan to reduce or increase emergency on-call hours in a
448 hospital emergency department.
449 (e) Plan to relocate their allopathic or osteopathic
450 practice outside the state.
451 (f) Practice medicine in this state.
452 (2) The Department of Health must report its findings to
453 the Governor, the President of the Senate, and the Speaker of
454 the House of Representatives by November 1 each year. The
455 department may also include in its report findings,
456 recommendations, or other information requested by the council.
457 Section 5. Paragraph (a) of subsection (1) of section
458 409.908, Florida Statutes, is amended to read:
459 409.908 Reimbursement of Medicaid providers.—Subject to
460 specific appropriations, the agency shall reimburse Medicaid
461 providers, in accordance with state and federal law, according
462 to methodologies set forth in the rules of the agency and in
463 policy manuals and handbooks incorporated by reference therein.
464 These methodologies may include fee schedules, reimbursement
465 methods based on cost reporting, negotiated fees, competitive
466 bidding pursuant to s. 287.057, and other mechanisms the agency
467 considers efficient and effective for purchasing services or
468 goods on behalf of recipients. If a provider is reimbursed based
469 on cost reporting and submits a cost report late and that cost
470 report would have been used to set a lower reimbursement rate
471 for a rate semester, then the provider’s rate for that semester
472 shall be retroactively calculated using the new cost report, and
473 full payment at the recalculated rate shall be effected
474 retroactively. Medicare-granted extensions for filing cost
475 reports, if applicable, shall also apply to Medicaid cost
476 reports. Payment for Medicaid compensable services made on
477 behalf of Medicaid eligible persons is subject to the
478 availability of moneys and any limitations or directions
479 provided for in the General Appropriations Act or chapter 216.
480 Further, nothing in this section shall be construed to prevent
481 or limit the agency from adjusting fees, reimbursement rates,
482 lengths of stay, number of visits, or number of services, or
483 making any other adjustments necessary to comply with the
484 availability of moneys and any limitations or directions
485 provided for in the General Appropriations Act, provided the
486 adjustment is consistent with legislative intent.
487 (1) Reimbursement to hospitals licensed under part I of
488 chapter 395 must be made prospectively or on the basis of
490 (a) Reimbursement for inpatient care is limited as provided
491 for in s. 409.905(5), except for:
492 1. The raising of rate reimbursement caps, excluding rural
494 2. Recognition of the costs of graduate medical education.
495 3. Other methodologies recognized in the General
496 Appropriations Act.
498 During the years funds are transferred from the Department of
499 Health, any reimbursement supported by such funds shall be
500 subject to certification by the Department of Health that the
501 hospital has complied with s. 381.4018 s. 381.0403. The agency
502 may is authorized to receive funds from state entities,
503 including, but not limited to, the Department of Health, local
504 governments, and other local political subdivisions, for the
505 purpose of making special exception payments, including federal
506 matching funds, through the Medicaid inpatient reimbursement
507 methodologies. Funds received from state entities or local
508 governments for this purpose shall be separately accounted for
509 and shall not be commingled with other state or local funds in
510 any manner. The agency may certify all local governmental funds
511 used as state match under Title XIX of the Social Security Act,
512 to the extent that the identified local health care provider
513 that is otherwise entitled to and is contracted to receive such
514 local funds is the benefactor under the state’s Medicaid program
515 as determined under the General Appropriations Act and pursuant
516 to an agreement between the Agency for Health Care
517 Administration and the local governmental entity. The local
518 governmental entity shall use a certification form prescribed by
519 the agency. At a minimum, the certification form shall identify
520 the amount being certified and describe the relationship between
521 the certifying local governmental entity and the local health
522 care provider. The agency shall prepare an annual statement of
523 impact which documents the specific activities undertaken during
524 the previous fiscal year pursuant to this paragraph, to be
525 submitted to the Legislature no later than January 1, annually.
526 Section 6. This act shall take effect July 1, 2010.