Florida Senate - 2010 CS for SB 1256
By the Committee on Health Regulation; and 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; requiring the Department of Health to
7 coordinate and enhance activities regarding the
8 reentry of retired military and other physicians into
9 the physician workforce; revising the list of
10 governmental stakeholders that the Department of
11 Health is required to work with regarding the state
12 strategic plan and in assessing the state’s physician
13 workforce; creating the Physician Workforce Advisory
14 Council; providing membership of the council;
15 providing for appointments to the council; providing
16 terms of membership; providing for removal of a
17 council member; providing for the chair and vice chair
18 of the council; providing that council members are not
19 entitled to receive compensation or reimbursement for
20 per diem or travel expenses; providing the duties of
21 the council; establishing the physician workforce
22 graduate medical education innovation pilot projects
23 under the department; providing the purposes of the
24 pilot projects; providing for the appropriation of
25 state funds for the pilot projects; requiring the
26 pilot projects to meet certain policy needs of the
27 physician workforce in this state; providing criteria
28 for prioritizing proposals for pilot projects;
29 requiring the department to adopt by rule appropriate
30 performance measures; requiring participating pilot
31 projects to submit an annual report to the department;
32 requiring state funds to be used to supplement funds
33 from other sources; requiring the department to adopt
34 rules; amending ss. 458.3192 and 459.0082, F.S.;
35 requiring the department to determine by geographic
36 area and specialty the number of physicians and
37 osteopathic physicians who plan to relocate outside
38 the state, practice medicine in this state, and reduce
39 or modify the scope of their practice; authorizing the
40 department to report additional information in its
41 findings to the Governor and the Legislature; amending
42 s. 409.908, F.S.; conforming a cross-reference;
43 providing an effective date.
45 Be It Enacted by the Legislature of the State of Florida:
47 Section 1. Section 381.0403, Florida Statutes, is repealed.
48 Section 2. Section 381.4018, Florida Statutes, is amended
49 to read:
50 381.4018 Physician workforce assessment and development.—
51 (1) DEFINITIONS.—As used in this section, the term:
52 (a) “Consortium” or “consortia” means a combination of
53 statutory teaching hospitals, statutory rural hospitals, other
54 hospitals, accredited medical schools, clinics operated by the
55 Department of Health, clinics operated by the Department of
56 Veterans’ Affairs, area health education centers, community
57 health centers, federally qualified health centers, prison
58 clinics, local community clinics, or other programs. At least
59 one member of the consortium shall be a sponsoring institution
60 accredited or currently seeking accreditation by the
61 Accreditation Council for Graduate Medical Education or the
62 American Osteopathic Association.
63 (b) “Council” means the Physician Workforce Advisory
65 (c) “Department” means the Department of Health.
66 (d) “Graduate medical education program” means a program
67 accredited by the Accreditation Council for Graduate Medical
68 Education or the American Osteopathic Association.
69 (e) “Primary care specialty” means emergency medicine,
70 family practice, internal medicine, pediatrics, psychiatry,
71 geriatrics, general surgery, obstetrics and gynecology, and
72 combined pediatrics and internal medicine and other specialties
73 as determined by the Physician Workforce Advisory Council or the
74 Department of Health.
(1) LEGISLATIVE INTENT.—The Legislature recognizes that
76 physician workforce planning is an essential component of
77 ensuring that there is an adequate and appropriate supply of
78 well-trained physicians to meet this state’s future health care
79 service needs as the general population and elderly population
80 of the state increase. The Legislature finds that items to
81 consider relative to assessing the physician workforce may
82 include physician practice status; specialty mix; geographic
83 distribution; demographic information, including, but not
84 limited to, age, gender, race, and cultural considerations; and
85 needs of current or projected medically underserved areas in the
86 state. Long-term strategic planning is essential as the period
87 from the time a medical student enters medical school to
88 completion of graduate medical education may range from 7 to 10
89 years or longer. The Legislature recognizes that strategies to
90 provide for a well-trained supply of physicians must include
91 ensuring the availability and capacity of quality graduate
92 medical schools and graduate medical education programs in this
93 state, as well as using new or existing state and federal
94 programs providing incentives for physicians to practice in
95 needed specialties and in underserved areas in a manner that
96 addresses projected needs for physician manpower.
97 (3) (2) PURPOSE.—The department of Health shall serve as a
98 coordinating and strategic planning body to actively assess the
99 state’s current and future physician workforce needs and work
100 with multiple stakeholders to develop strategies and
101 alternatives to address current and projected physician
102 workforce needs.
103 (4) (3) GENERAL FUNCTIONS.—The department shall maximize the
104 use of existing programs under the jurisdiction of the
105 department and other state agencies and coordinate governmental
106 and nongovernmental stakeholders and resources in order to
107 develop a state strategic plan and assess the implementation of
108 such strategic plan. In developing the state strategic plan, the
109 department shall:
110 (a) Monitor, evaluate, and report on the supply and
111 distribution of physicians licensed under chapter 458 or chapter
112 459. The department shall maintain a database to serve as a
113 statewide source of data concerning the physician workforce.
114 (b) Develop a model and quantify, on an ongoing basis, the
115 adequacy of the state’s current and future physician workforce
116 as reliable data becomes available. Such model must take into
117 account demographics, physician practice status, place of
118 education and training, generational changes, population growth,
119 economic indicators, and issues concerning the “pipeline” into
120 medical education.
121 (c) Develop and recommend strategies to determine whether
122 the number of qualified medical school applicants who might
123 become competent, practicing physicians in this state will be
124 sufficient to meet the capacity of the state’s medical schools.
125 If appropriate, the department shall, working with
126 representatives of appropriate governmental and nongovernmental
127 entities, develop strategies and recommendations and identify
128 best practice programs that introduce health care as a
129 profession and strengthen skills needed for medical school
130 admission for elementary, middle, and high school students, and
131 improve premedical education at the precollege and college level
132 in order to increase this state’s potential pool of medical
134 (d) Develop strategies to ensure that the number of
135 graduates from the state’s public and private allopathic and
136 osteopathic medical schools is are adequate to meet physician
137 workforce needs, based on the analysis of the physician
138 workforce data, so as to provide a high-quality medical
139 education to students in a manner that recognizes the uniqueness
140 of each new and existing medical school in this state.
141 (e) Pursue strategies and policies to create, expand, and
142 maintain graduate medical education positions in the state based
143 on the analysis of the physician workforce data. Such strategies
144 and policies must take into account the effect of federal
145 funding limitations on the expansion and creation of positions
146 in graduate medical education. The department shall develop
147 options to address such federal funding limitations. The
148 department shall consider options to provide direct state
149 funding for graduate medical education positions in a manner
150 that addresses requirements and needs relative to accreditation
151 of graduate medical education programs. The department shall
152 consider funding residency positions as a means of addressing
153 needed physician specialty areas, rural areas having a shortage
154 of physicians, and areas of ongoing critical need, and as a
155 means of addressing the state’s physician workforce needs based
156 on an ongoing analysis of physician workforce data.
157 (f) Develop strategies to maximize federal and state
158 programs that provide for the use of incentives to attract
159 physicians to this state or retain physicians within the state.
160 Such strategies should explore and maximize federal-state
161 partnerships that provide incentives for physicians to practice
162 in federally designated shortage areas. Strategies shall also
163 consider the use of state programs, such as the Florida Health
164 Service Corps established pursuant to s. 381.0302 and the
165 Medical Education Reimbursement and Loan Repayment Program
166 pursuant to s. 1009.65, which provide for education loan
167 repayment or loan forgiveness and provide monetary incentives
168 for physicians to relocate to underserved areas of the state.
169 (g) Coordinate and enhance activities relative to physician
170 workforce needs, undergraduate medical education, and graduate
171 medical education, and reentry of retired military and other
172 physicians into the physician workforce provided by the Division
173 of Medical Quality Assurance, the Community Hospital Education
174 Program and the Graduate Medical Education Committee established
175 pursuant to s. 381.0403 , area health education center networks
176 established pursuant to s. 381.0402, and other offices and
177 programs within the department of Health as designated by the
178 State Surgeon General.
179 (h) Work in conjunction with and act as a coordinating body
180 for governmental and nongovernmental stakeholders to address
181 matters relating to the state’s physician workforce assessment
182 and development for the purpose of ensuring an adequate supply
183 of well-trained physicians to meet the state’s future needs.
184 Such governmental stakeholders shall include, but need not be
185 limited to, the State Surgeon General or his or her designee,
186 the Commissioner of Education or his or her designee, the
187 Secretary of Health Care Administration or his or her designee,
188 and the Chancellor of the State University System or his or her
189 designee from the Board of Governors of the State University
190 System, and, at the discretion of the department, other
191 representatives of state and local agencies that are involved in
192 assessing, educating, or training the state’s current or future
193 physicians. Other stakeholders shall include, but need not be
194 limited to, organizations representing the state’s public and
195 private allopathic and osteopathic medical schools;
196 organizations representing hospitals and other institutions
197 providing health care, particularly those that currently provide
198 or have an interest in providing accredited medical education
199 and graduate medical education to medical students and medical
200 residents; organizations representing allopathic and osteopathic
201 practicing physicians; and, at the discretion of the department,
202 representatives of other organizations or entities involved in
203 assessing, educating, or training the state’s current or future
205 (i) Serve as a liaison with other states and federal
206 agencies and programs in order to enhance resources available to
207 the state’s physician workforce and medical education continuum.
208 (j) Act as a clearinghouse for collecting and disseminating
209 information concerning the physician workforce and medical
210 education continuum in this state.
211 (5) PHYSICIAN WORKFORCE ADVISORY COUNCIL.—There is created
212 in the department the Physician Workforce Advisory Council, an
213 advisory council as defined in s. 20.03. The council shall
214 comply with the requirements of s. 20.052, except as otherwise
215 provided in this section.
216 (a) The council shall consist of 18 members. Members
217 appointed by the State Surgeon General shall include:
218 1. A designee from the department who is a physician
219 licensed under chapter 458 or chapter 459 and recommended by the
220 State Surgeon General.
221 2. An individual who is affiliated with the Science
222 Students Together Reaching Instructional Diversity and
223 Excellence program and recommended by the area health education
224 center network.
225 3. Two individuals recommended by the Council of Florida
226 Medical School Deans, one representing a college of allopathic
227 medicine and one representing a college of osteopathic medicine.
228 4. One individual recommended by the Florida Hospital
229 Association, representing a hospital that is licensed under
230 chapter 395, has an accredited graduate medical education
231 program, and is not a statutory teaching hospital.
232 5. One individual representing a statutory teaching
233 hospital as defined in s. 408.07 and recommended by the Safety
234 Net Hospital Alliance.
235 6. One individual representing a family practice teaching
236 hospital as defined in s. 395.805 and recommended by the Council
237 of Family Medicine and Community Teaching Hospitals.
238 7. Two individuals recommended by the Florida Medical
239 Association, one representing a primary care specialty and one
240 representing a nonprimary care specialty.
241 8. Two individuals recommended by the Florida Osteopathic
242 Medical Association, one representing a primary care specialty
243 and one representing a nonprimary care specialty.
244 9. Two individuals who are program directors of accredited
245 graduate medical education programs, one representing a program
246 that is accredited by the Accreditation Council for Graduate
247 Medical Education and one representing a program that is
248 accredited by the American Osteopathic Association.
249 10. An individual recommended by the Florida Rural Health
251 11. An individual recommended by the Florida Alliance for
252 Health Professions Diversity.
253 12. The Chancellor of the State University System or his or
254 her designee.
255 13. A layperson member as determined by the State Surgeon
258 Appointments to the council shall be made by the State Surgeon
259 General. 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 from the membership of the
280 council to serve in the absence of the State Surgeon General. A
281 vacancy shall be filled for the remainder of the unexpired term
282 in the same manner as the 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 at least twice a year in person
286 or by teleconference.
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. Annually review the number, location, cost, and
294 reimbursement of graduate medical education programs and
296 4. Provide recommendations to the department regarding the
297 survey completed by physicians licensed under chapter 458 or
298 chapter 459;
299 5. Assist the department in preparing the annual report to
300 the Legislature pursuant to ss. 458.3192 and 459.0082;
301 6. Assist the department in preparing an initial strategic
302 plan, conduct ongoing strategic planning in accordance with this
303 section, and provide ongoing advice on implementing the
305 7. Monitor and provide recommendations regarding the need
306 for an increased number of primary care or other physician
307 specialties to provide the necessary current and projected
308 health and medical services for the state; and
309 8. Monitor and make recommendations regarding the status of
310 the needs relating to graduate medical education in this state.
311 (6) PHYSICIAN WORKFORCE GRADUATE MEDICAL EDUCATION
312 INNOVATION PILOT PROJECTS.—
313 (a) The Legislature finds that:
314 1. In order to ensure a physician workforce that is
315 adequate to meet the needs of this state’s residents and its
316 health care system, policymakers must consider the education and
317 training of future generations of well-trained health care
319 2. Physicians are likely to practice in the state where
320 they complete their graduate medical education.
321 3. It can directly affect the makeup of the physician
322 workforce by selectively funding graduate medical education
323 programs to provide needed specialists in geographic areas of
324 the state which have a deficient number of such specialists.
325 4. Developing additional positions in graduate medical
326 education programs is essential to the future of this state’s
327 health care system.
328 5. It was necessary in 2007 to pass legislation that
329 provided for an assessment of the status of this state’s current
330 and future physician workforce. The department is collecting and
331 analyzing information on an ongoing basis to assess this state’s
332 physician workforce needs, and such assessment may facilitate
333 the determination of graduate medical education needs and
334 strategies for the state.
335 (b) There is established under the department a program to
336 foster innovative graduate medical education pilot projects that
337 are designed to promote the expansion of graduate medical
338 education programs or positions to prepare physicians to
339 practice in needed specialties and underserved areas or settings
340 and to provide demographic and cultural representation in a
341 manner that addresses current and projected needs for this
342 state’s physician workforce. Funds appropriated annually by the
343 Legislature for this purpose shall be distributed to
344 participating hospitals, medical schools, other sponsors of
345 graduate medical education programs, consortia engaged in
346 developing new graduate medical education programs or positions
347 in those programs, or pilot projects providing innovative
348 graduate medical education in community-based clinical settings.
349 Pilot projects shall be selected on a competitive grant basis,
350 subject to available funds.
351 (c) Pilot projects shall be designed to meet one or more of
352 this state’s physician workforce needs, as determined pursuant
353 to this section, including, but not limited to:
354 1. Increasing the number of residencies or fellowships in
355 primary care or other needed specialties.
356 2. Enhancing the retention of primary care physicians or
357 other needed specialties in this state.
358 3. Promoting practice in rural or medically underserved
359 areas of the state.
360 4. Encouraging racial and ethnic diversity within the
361 state’s physician workforce.
362 5. Encouraging practice in community health care or other
363 ambulatory care settings.
364 6. Encouraging practice in clinics operated by the
365 department, including, but not limited to, county health
366 departments, clinics operated by the Department of Veterans’
367 Affairs, prison clinics, or similar settings of need.
368 7. Encouraging the increased production of geriatricians.
369 (d) Priority shall be given to a proposal for a pilot
370 project that:
371 1. Demonstrates a collaboration of federal, state, and
372 local entities that are public or private.
373 2. Obtains funding from multiple sources.
374 3. Focuses on enhancing graduate medical education in rural
375 or underserved areas.
376 4. Focuses on enhancing graduate medical education in
377 ambulatory or community-based settings other than a hospital
379 5. Includes the use of technology, such as electronic
380 medical records, distance consultation, and telemedicine, to
381 ensure that residents are better prepared to care for patients
382 in this state, regardless of the community in which the
383 residents practice.
384 6. Is designed to meet multiple policy needs as enumerated
385 in subsection (3).
386 7. Uses a consortium to provide for graduate medical
387 education experiences.
388 (e) The department shall adopt by rule appropriate
389 performance measures to use in order to consistently evaluate
390 the effectiveness, safety, and quality of the programs, as well
391 as the impact of each program on meeting this state’s physician
392 workforce needs.
393 (f) Participating pilot projects shall submit to the
394 department an annual report on the project in a manner required
395 by the department.
396 (g) Funding provided to a pilot project may be used only
397 for the direct costs of providing graduate medical education.
398 Accounting of such costs and expenditures shall be documented in
399 the annual report.
400 (h) State funds shall be used to supplement funds from any
401 local government, community, or private source. The state may
402 provide up to 50 percent of the funds, and local governmental
403 grants or community or private sources shall provide the
404 remainder of the funds.
405 (7) RULEMAKING.—The department shall adopt rules as
406 necessary to administer this section.
407 Section 3. Section 458.3192, Florida Statutes, is amended
408 to read:
409 458.3192 Analysis of survey results; report.—
410 (1) Each year, the Department of Health shall analyze the
411 results of the physician survey required by s. 458.3191 and
412 determine by geographic area and specialty the number of
413 physicians who:
414 (a) Perform deliveries of children in this state Florida.
415 (b) Read mammograms and perform breast-imaging-guided
416 procedures in this state Florida.
417 (c) Perform emergency care on an on-call basis for a
418 hospital emergency department.
419 (d) Plan to reduce or increase emergency on-call hours in a
420 hospital emergency department.
421 (e) Plan to relocate their allopathic or osteopathic
422 practice outside the state.
423 (f) Practice medicine in this state.
424 (g) Plan to reduce or modify the scope of their practice.
425 (2) The Department of Health must report its findings to
426 the Governor, the President of the Senate, and the Speaker of
427 the House of Representatives by November 1 each year. The
428 department shall also include in its report findings,
429 recommendations, and strategic planning activities as provided
430 in s. 381.4018. The department may also include other
431 information requested by the Physician Workforce Advisory
433 Section 4. Section 459.0082, Florida Statutes, is amended
434 to read:
435 459.0082 Analysis of survey results; report.—
436 (1) Each year, the Department of Health shall analyze the
437 results of the physician survey required by s. 459.0081 and
438 determine by geographic area and specialty the number of
439 physicians who:
440 (a) Perform deliveries of children in this state Florida.
441 (b) Read mammograms and perform breast-imaging-guided
442 procedures in this state Florida.
443 (c) Perform emergency care on an on-call basis for a
444 hospital emergency department.
445 (d) Plan to reduce or increase emergency on-call hours in a
446 hospital emergency department.
447 (e) Plan to relocate their allopathic or osteopathic
448 practice outside the state.
449 (f) Practice medicine in this state.
450 (g) Plan to reduce or modify the scope of their practice.
451 (2) The Department of Health must report its findings to
452 the Governor, the President of the Senate, and the Speaker of
453 the House of Representatives by November 1 each year. The
454 department shall also include in its report findings,
455 recommendations, and strategic planning activities as provided
456 in s. 381.4018. The department may also include other
457 information requested by the Physician Workforce Advisory
459 Section 5. Paragraph (a) of subsection (1) of section
460 409.908, Florida Statutes, is amended to read:
461 409.908 Reimbursement of Medicaid providers.—Subject to
462 specific appropriations, the agency shall reimburse Medicaid
463 providers, in accordance with state and federal law, according
464 to methodologies set forth in the rules of the agency and in
465 policy manuals and handbooks incorporated by reference therein.
466 These methodologies may include fee schedules, reimbursement
467 methods based on cost reporting, negotiated fees, competitive
468 bidding pursuant to s. 287.057, and other mechanisms the agency
469 considers efficient and effective for purchasing services or
470 goods on behalf of recipients. If a provider is reimbursed based
471 on cost reporting and submits a cost report late and that cost
472 report would have been used to set a lower reimbursement rate
473 for a rate semester, then the provider’s rate for that semester
474 shall be retroactively calculated using the new cost report, and
475 full payment at the recalculated rate shall be effected
476 retroactively. Medicare-granted extensions for filing cost
477 reports, if applicable, shall also apply to Medicaid cost
478 reports. Payment for Medicaid compensable services made on
479 behalf of Medicaid eligible persons is subject to the
480 availability of moneys and any limitations or directions
481 provided for in the General Appropriations Act or chapter 216.
482 Further, nothing in this section shall be construed to prevent
483 or limit the agency from adjusting fees, reimbursement rates,
484 lengths of stay, number of visits, or number of services, or
485 making any other adjustments necessary to comply with the
486 availability of moneys and any limitations or directions
487 provided for in the General Appropriations Act, provided the
488 adjustment is consistent with legislative intent.
489 (1) Reimbursement to hospitals licensed under part I of
490 chapter 395 must be made prospectively or on the basis of
492 (a) Reimbursement for inpatient care is limited as provided
493 for in s. 409.905(5), except for:
494 1. The raising of rate reimbursement caps, excluding rural
496 2. Recognition of the costs of graduate medical education.
497 3. Other methodologies recognized in the General
498 Appropriations Act.
500 During the years funds are transferred from the Department of
501 Health, any reimbursement supported by such funds shall be
502 subject to certification by the Department of Health that the
503 hospital has complied with s. 381.0403. The agency may is
504 authorized to receive funds from state entities, including, but
505 not limited to, the Department of Health, local governments, and
506 other local political subdivisions, for the purpose of making
507 special exception payments, including federal matching funds,
508 through the Medicaid inpatient reimbursement methodologies.
509 Funds received from state entities or local governments for this
510 purpose shall be separately accounted for and shall not be
511 commingled with other state or local funds in any manner. The
512 agency may certify all local governmental funds used as state
513 match under Title XIX of the Social Security Act, to the extent
514 that the identified local health care provider that is otherwise
515 entitled to and is contracted to receive such local funds is the
516 benefactor under the state’s Medicaid program as determined
517 under the General Appropriations Act and pursuant to an
518 agreement between the Agency for Health Care Administration and
519 the local governmental entity. The local governmental entity
520 shall use a certification form prescribed by the agency. At a
521 minimum, the certification form shall identify the amount being
522 certified and describe the relationship between the certifying
523 local governmental entity and the local health care provider.
524 The agency shall prepare an annual statement of impact which
525 documents the specific activities undertaken during the previous
526 fiscal year pursuant to this paragraph, to be submitted to the
527 Legislature no later than January 1, annually.
528 Section 6. This act shall take effect July 1, 2010.