October 20, 2019
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       CS for CS for CS for SB 2138                     First Engrossed
       
       
       
       
       
       
       
       
       20102138e1
       
    1                        A bill to be entitled                      
    2         An act relating to health care; repealing s.
    3         112.0455(10)(e), F.S., relating to a prohibition
    4         against applying the Drug-Free Workplace Act
    5         retroactively; repealing s. 383.325, F.S., relating to
    6         the requirement of a licensed facility under s.
    7         383.305, F.S., to maintain inspection reports;
    8         repealing s. 395.1046, F.S., relating to the
    9         investigation of complaints regarding hospitals;
   10         repealing s. 395.3037, F.S.; deleting definitions
   11         relating to obsolete provisions governing primary and
   12         comprehensive stroke centers; amending s. 400.0239,
   13         F.S.; deleting an obsolete provision; repealing s.
   14         400.147(10), F.S., relating to a requirement that a
   15         nursing home facility report any notice of a filing of
   16         a claim for a violation of a resident’s rights or a
   17         claim of negligence; repealing s. 400.148, F.S.,
   18         relating to the Medicaid “Up-or-Out” Quality of Care
   19         Contract Management Program; repealing s. 400.195,
   20         F.S., relating to reporting requirements for the
   21         Agency for Health Care Administration; amending s.
   22         400.476, F.S.; providing requirements for an
   23         alternative administrator of a home health agency;
   24         revising the duties of the administrator; revising the
   25         requirements for a director of nursing for a specified
   26         number of home health agencies; prohibiting a home
   27         health agency from using an individual as a home
   28         health aide unless the person has completed training
   29         and an evaluation program; requiring a home health
   30         aide to meet certain standards in order to be
   31         competent in performing certain tasks; requiring a
   32         home health agency and staff to comply with accepted
   33         professional standards; providing certain requirements
   34         for a written contract between certain personnel and
   35         the agency; providing an exception for direct
   36         employees of the home health agency; requiring a home
   37         health agency to provide certain services through its
   38         employees; authorizing a home health agency to provide
   39         additional services with another organization;
   40         providing responsibilities of a home health agency
   41         when it provides home health aide services through
   42         another organization; requiring the home health agency
   43         to coordinate personnel who provide home health
   44         services; requiring personnel to communicate with the
   45         home health agency; amending s. 400.487, F.S.;
   46         requiring a home health agency to provide a copy of
   47         the agreement between the agency and a patient which
   48         specifies the home health services to be provided;
   49         providing the rights that are protected by the home
   50         health agency; requiring the home health agency to
   51         furnish nursing services by or under the supervision
   52         of a registered nurse; requiring the home health
   53         agency to provide therapy services through a qualified
   54         therapist or therapy assistant; requiring physical
   55         therapy services to be provided by or under the
   56         supervision of a licensed physical therapist or
   57         physical therapist assistant; specifying the duties of
   58         a physical therapist assistant; requiring occupational
   59         therapy services to be provided by or under the
   60         supervision of a licensed occupational therapist or
   61         occupational therapy assistant; specifying the duties
   62         of an occupational therapy assistant; providing for
   63         speech therapy services to be provided by a qualified
   64         speech pathologist or audiologist; providing for a
   65         plan of care; providing that only the staff of a home
   66         health agency may administer drugs and treatments as
   67         ordered by certain health professionals; providing
   68         requirements for verbal orders; providing duties of a
   69         registered nurse, licensed practical nurse, home
   70         health aide, and certified nursing assistant who work
   71         for a home health agency; providing for supervisory
   72         visits of services provided by a home health agency;
   73         repealing s. 408.802(11), F.S., relating to the
   74         applicability of the Health Care Licensing Procedures
   75         Act to private review agents; repealing s.
   76         409.912(15)(e), (f), and (g), F.S., relating to a
   77         requirement for the Agency for Health Care
   78         Administration to submit a report to the Legislature
   79         regarding the operations of the CARE program; amending
   80         s. 409.91255, F.S.; transferring administrative
   81         responsibility for the application procedure for
   82         federally qualified health centers from the Department
   83         of Health to the Agency for Health Care
   84         Administration; requiring the Florida Association of
   85         Community Health Centers, Inc., to provide support and
   86         assume administrative costs for the program; amending
   87         s. 400.9905, F.S.; revising the definition of the term
   88         “clinic” applicable to the Health Care Clinic Act;
   89         providing exemptions from licensure requirements for
   90         certain legal entities that provide health care
   91         services; amending s. 413.615, F.S.; removing a
   92         provision that requires the State Board of
   93         Administration to invest and reinvest moneys in the
   94         endowment fund for the Florida Endowment for
   95         Vocational Rehabilitation; requiring that all funds
   96         held for investment and reinvestment by the State
   97         Board of Administration for the endowment be submitted
   98         back to the endowment fund; repealing s. 429.12(2),
   99         F.S., relating to the sale or transfer of ownership of
  100         an assisted living facility; repealing s. 429.23(5),
  101         F.S., relating to each assisted living facility’s
  102         requirement to submit a report to the agency regarding
  103         liability claims filed against it; repealing s.
  104         429.911(2)(a), F.S., relating to grounds for which the
  105         agency may take action against the owner of an adult
  106         day care center or its operator or employee;
  107         reenacting s. 465.0251(1), F.S., to require the Board
  108         of Pharmacy and the Board of Medicine to remove
  109         certain drugs from the negative formulary for generic
  110         and brand-name drugs based on current references
  111         published by the United States Food and Drug
  112         Administration; amending s. 499.01, F.S.; revising the
  113         list of exemptions from the requirement that certain
  114         persons engaged in the manufacture, repackaging, or
  115         assembly of medical devices hold a device manufacturer
  116         permit; repealing s. 381.0403(4) and (9), F.S.,
  117         relating to the program for graduate medical education
  118         innovations and the graduate medical education
  119         committee and report; amending s. 381.4018, F.S.;
  120         providing definitions; requiring the Department of
  121         Health to coordinate and enhance activities regarding
  122         the reentry of retired military and other physicians
  123         into the physician workforce; revising the list of
  124         governmental stakeholders that the Department of
  125         Health is required to work with regarding the state
  126         strategic plan and in assessing the state’s physician
  127         workforce; creating the Physician Workforce Advisory
  128         Council; providing membership of the council;
  129         providing for appointments to the council; providing
  130         terms of membership; providing for removal of a
  131         council member; providing for the chair and vice chair
  132         of the council; providing that council members are not
  133         entitled to receive compensation or reimbursement for
  134         per diem or travel expenses; providing the duties of
  135         the council; establishing the physician workforce
  136         graduate medical education innovation pilot projects
  137         under the department; providing the purposes of the
  138         pilot projects; providing for the appropriation of
  139         state funds for the pilot projects; requiring the
  140         pilot projects to meet certain policy needs of the
  141         physician workforce in this state; providing criteria
  142         for prioritizing proposals for pilot projects;
  143         requiring the department to adopt by rule appropriate
  144         performance measures; requiring participating pilot
  145         projects to submit an annual report to the department;
  146         requiring state funds to be used to supplement funds
  147         from other sources; requiring the department to adopt
  148         rules; amending ss. 458.3192 and 459.0082, F.S.;
  149         requiring the department to determine by geographic
  150         area and specialty the number of physicians and
  151         osteopathic physicians who plan to relocate outside
  152         the state, practice medicine in this state, and reduce
  153         or modify the scope of their practice; authorizing the
  154         department to report additional information in its
  155         findings to the Governor and the Legislature; amending
  156         s. 458.315, F.S.; revising the standards for the Board
  157         of Medicine to issue a temporary certificate to
  158         certain physicians to practice medicine in areas of
  159         critical need; authorizing the State Surgeon General
  160         to designate areas of critical need; creating s.
  161         459.0076, F.S.; authorizing the Board of Osteopathic
  162         Medicine to issue temporary certificates to
  163         osteopathic physicians who meet certain requirements
  164         to practice osteopathic medicine in areas of critical
  165         need; providing restrictions for issuance of a
  166         temporary certificate; authorizing the State Surgeon
  167         General to designate areas of critical need;
  168         authorizing the Board of Osteopathic Medicine to waive
  169         the application fee and licensure fees for obtaining
  170         temporary certificates for certain purposes; requiring
  171         the Department of Health, along with the Agency for
  172         Health Care Administration, to develop a statewide
  173         plan to implement recommendations from the Centers for
  174         Disease Control and Prevention for screening for the
  175         human immunodeficiency virus; providing goals;
  176         requiring the department to seek input from certain
  177         entities; requiring the department to establish a
  178         demonstration project to begin implementation of the
  179         statewide plan; requiring the department to file an
  180         interim report and a final report to the Governor and
  181         the Legislature by specified dates; amending s.
  182         499.003, F.S.; defining the term “medical convenience
  183         kit”; amending s. 499.01212, F.S.; providing that a
  184         pedigree paper is not required for wholesale
  185         distribution of prescription drugs contained within a
  186         medical convenience kit under certain circumstances;
  187         providing appropriations from the General Revenue Fund
  188         and the Medical Care Trust Fund to the Agency for
  189         Health Care Administration; providing for a recurring
  190         reduction in appropriations to the Department of
  191         Health; providing a contingency; requiring persons who
  192         apply for licensure renewal as a dentist or dental
  193         hygienist to furnish certain information to the
  194         Department of Health in a dental workforce survey;
  195         requiring the Board of Dentistry to issue a
  196         nondisciplinary citation and a notice for failure to
  197         complete the survey within a specified time; providing
  198         notification requirements for the citation; requiring
  199         the department to serve as the coordinating body for
  200         the purpose of collecting, disseminating, and updating
  201         dental workforce data; requiring the department to
  202         maintain a database regarding the state’s dental
  203         workforce; requiring the department to develop
  204         strategies to maximize federal and state programs and
  205         to work with an advisory body to address matters
  206         relating to the state’s dental workforce; providing
  207         membership of the advisory body; providing for members
  208         of the advisory body to serve without compensation;
  209         requiring the department to act as a clearinghouse for
  210         collecting and disseminating information regarding the
  211         dental workforce; requiring the department and the
  212         board to adopt rules; providing legislative intent
  213         regarding implementation of the act within existing
  214         resources; amending s. 499.01, F.S.; authorizing
  215         certain business entities to pay for prescription
  216         drugs obtained by practitioners licensed under ch.
  217         466, F.S.; amending s. 624.91, F.S.; revising the
  218         membership of the board of directors of the Florida
  219         Healthy Kids Corporation to include a member nominated
  220         by the Florida Dental Association and appointed by the
  221         Governor; amending s. 381.00315, F.S.; directing the
  222         Department of Health to accept funds from counties,
  223         municipalities, and certain other entities for the
  224         purchase of certain products made available under a
  225         contract with the United States Department of Health
  226         and Human Services for the manufacture and delivery of
  227         such products in response to a public health
  228         emergency; providing an effective date.
  229  
  230  Be It Enacted by the Legislature of the State of Florida:
  231  
  232         Section 1. Paragraph (e) of subsection (10) of section
  233  112.0455, Florida Statutes, is repealed.
  234         Section 2. Section 383.325, Florida Statutes, is repealed.
  235         Section 3. Section 395.1046, Florida Statutes, is repealed.
  236         Section 4. Section 395.3037, Florida Statutes, is repealed.
  237         Section 5. Paragraph (g) of subsection (2) of section
  238  400.0239, Florida Statutes, is amended to read:
  239         400.0239 Quality of Long-Term Care Facility Improvement
  240  Trust Fund.—
  241         (2) Expenditures from the trust fund shall be allowable for
  242  direct support of the following:
  243         (g) Other initiatives authorized by the Centers for
  244  Medicare and Medicaid Services for the use of federal civil
  245  monetary penalties, including projects recommended through the
  246  Medicaid “Up-or-Out” Quality of Care Contract Management Program
  247  pursuant to s. 400.148.
  248         Section 6. Subsection (10) of section 400.147, Florida
  249  Statutes, is repealed.
  250         Section 7. Section 400.148, Florida Statutes, is repealed.
  251         Section 8. Section 400.195, Florida Statutes, is repealed.
  252         Section 9. Section 400.476, Florida Statutes, is amended to
  253  read:
  254         400.476 Staffing requirements; notifications; limitations
  255  on staffing services.—
  256         (1) ADMINISTRATOR.—
  257         (a) An administrator may manage only one home health
  258  agency, except that an administrator may manage up to five home
  259  health agencies if all five home health agencies have identical
  260  controlling interests as defined in s. 408.803 and are located
  261  within one agency geographic service area or within an
  262  immediately contiguous county. If the home health agency is
  263  licensed under this chapter and is part of a retirement
  264  community that provides multiple levels of care, an employee of
  265  the retirement community may administer the home health agency
  266  and up to a maximum of four entities licensed under this chapter
  267  or chapter 429 which all have identical controlling interests as
  268  defined in s. 408.803. An administrator shall designate, in
  269  writing, for each licensed entity, a qualified alternate
  270  administrator to serve during the administrator’s absence. An
  271  alternate administrator must meet the requirements in this
  272  paragraph and s. 400.462(1).
  273         (b) An administrator of a home health agency who is a
  274  licensed physician, physician assistant, or registered nurse
  275  licensed to practice in this state may also be the director of
  276  nursing for a home health agency. An administrator may serve as
  277  a director of nursing for up to the number of entities
  278  authorized in subsection (2) only if there are 10 or fewer full
  279  time equivalent employees and contracted personnel in each home
  280  health agency.
  281         (c) The administrator shall organize and direct the
  282  agency’s ongoing functions, maintain an ongoing liaison with the
  283  board members and the staff, employ qualified personnel and
  284  ensure adequate staff education and evaluations, ensure the
  285  accuracy of public informational materials and activities,
  286  implement an effective budgeting and accounting system, and
  287  ensure that the home health agency operates in compliance with
  288  this part and part II of chapter 408 and rules adopted for these
  289  laws.
  290         (d) The administrator shall clearly set forth in writing
  291  the organizational chart, services furnished, administrative
  292  control, and lines of authority for the delegation of
  293  responsibilities for patient care. These responsibilities must
  294  be readily identifiable. Administrative and supervisory
  295  functions may not be delegated to another agency or
  296  organization, and the primary home health agency shall monitor
  297  and control all services that are not furnished directly,
  298  including services provided through contracts.
  299         (2) DIRECTOR OF NURSING.—
  300         (a) A director of nursing may be the director of nursing
  301  for:
  302         1. Up to two licensed home health agencies if the agencies
  303  have identical controlling interests as defined in s. 408.803
  304  and are located within one agency geographic service area or
  305  within an immediately contiguous county; or
  306         2. Up to five licensed home health agencies if:
  307         a. All of the home health agencies have identical
  308  controlling interests as defined in s. 408.803;
  309         b. All of the home health agencies are located within one
  310  agency geographic service area or within an immediately
  311  contiguous county; and
  312         c. Each home health agency has a registered nurse who meets
  313  the qualifications of a director of nursing and who has a
  314  written delegation from the director of nursing to serve as the
  315  director of nursing for that home health agency when the
  316  director of nursing is not present; and.
  317         d. This person, or similarly qualified alternate, is
  318  available at all times by telecommunications during operating
  319  hours and participates in all activities relevant to the
  320  professional services furnished, including, but not limited to,
  321  the oversight of nursing services, home health aides, and
  322  certified nursing assistants, and assignment of personnel.
  323  
  324  If a home health agency licensed under this chapter is part of a
  325  retirement community that provides multiple levels of care, an
  326  employee of the retirement community may serve as the director
  327  of nursing of the home health agency and up to a maximum of four
  328  entities, other than home health agencies, licensed under this
  329  chapter or chapter 429 which all have identical controlling
  330  interests as defined in s. 408.803.
  331         (b) A home health agency that provides skilled nursing care
  332  may not operate for more than 30 calendar days without a
  333  director of nursing. A home health agency that provides skilled
  334  nursing care and the director of nursing of a home health agency
  335  must notify the agency within 10 business days after termination
  336  of the services of the director of nursing for the home health
  337  agency. A home health agency that provides skilled nursing care
  338  must notify the agency of the identity and qualifications of the
  339  new director of nursing within 10 days after the new director is
  340  hired. If a home health agency that provides skilled nursing
  341  care operates for more than 30 calendar days without a director
  342  of nursing, the home health agency commits a class II
  343  deficiency. In addition to the fine for a class II deficiency,
  344  the agency may issue a moratorium in accordance with s. 408.814
  345  or revoke the license. The agency shall fine a home health
  346  agency that fails to notify the agency as required in this
  347  paragraph $1,000 for the first violation and $2,000 for a repeat
  348  violation. The agency may not take administrative action against
  349  a home health agency if the director of nursing fails to notify
  350  the department upon termination of services as the director of
  351  nursing for the home health agency.
  352         (c) A home health agency that is not Medicare or Medicaid
  353  certified and does not provide skilled care or provides only
  354  physical, occupational, or speech therapy is not required to
  355  have a director of nursing and is exempt from paragraph (b).
  356         (3) TRAINING.—A home health agency shall ensure that each
  357  certified nursing assistant employed by or under contract with
  358  the home health agency and each home health aide employed by or
  359  under contract with the home health agency is adequately trained
  360  to perform the tasks of a home health aide in the home setting.
  361         (a) The home health agency may not use as a home health
  362  aide on a full-time, temporary, per diem, or other basis, any
  363  individual to provide services unless the individual has
  364  completed a training and competency evaluation program, or a
  365  competency evaluation program, as permitted in s. 400.497, which
  366  meets the minimum standards established by the agency in state
  367  rules.
  368         (b) A home health aide is not competent in any task for
  369  which he or she is evaluated as “unsatisfactory.” The aide must
  370  perform any such task only under direct supervision by a
  371  licensed nurse until he or she receives training in the task and
  372  satisfactorily passes a subsequent evaluation in performing the
  373  task. A home health aide has not successfully passed a
  374  competency evaluation if the aide does not have a passing score
  375  on the test as specified by agency rule.
  376         (4) STAFFING.—Staffing services may be provided anywhere
  377  within the state.
  378         (5) PERSONNEL.—
  379         (a) The home health agency and its staff must comply with
  380  accepted professional standards and principles that apply to
  381  professionals, including, but not limited to, the state practice
  382  acts and the home health agency’s policies and procedures.
  383         (b) Except for direct employees of the home health agency,
  384  if personnel under hourly or per-visit contracts are used by the
  385  home health agency, there must be a written contract between
  386  those personnel and the agency which specifies the following
  387  requirements:
  388         1. Acceptance for care only of patients by the primary home
  389  health agency.
  390         2. The services to be furnished.
  391         3. The necessity to conform to all applicable agency
  392  policies, including personnel qualifications.
  393         4. The responsibility for participating in developing plans
  394  of care.
  395         5. The manner in which services are controlled,
  396  coordinated, and evaluated by the primary home health agency.
  397         6. The procedures for submitting clinical and progress
  398  notes, scheduling of visits, and periodic patient evaluation.
  399         7. The procedures for payment for services furnished under
  400  the contract.
  401         (c) A home health agency shall directly provide at least
  402  one of the types of services through home health agency
  403  employees, but may provide additional services under
  404  arrangements with another agency or organization. Services
  405  furnished under such arrangements must have a written contract
  406  conforming to the requirements specified in paragraph (b).
  407         (d) If home health aide services are provided by an
  408  individual who is not employed directly by the home health
  409  agency, the services of the home health aide must be provided
  410  under arrangements as stated in paragraphs (b) and (c). If the
  411  home health agency chooses to provide home health aide services
  412  under arrangements with another organization, the
  413  responsibilities of the home health agency include, but are not
  414  limited to:
  415         1. Ensuring the overall quality of the care provided by the
  416  aide;
  417         2. Supervising the aide’s services as described in s.
  418  400.487; and
  419         3. Ensuring that each home health aide providing services
  420  under arrangements with another organization has met the
  421  training requirements or competency evaluation requirements of
  422  s. 400.497.
  423         (e) The home health agency shall coordinate the efforts of
  424  all personnel furnishing services, and the personnel shall
  425  maintain communication with the home health agency to ensure
  426  that personnel efforts support the objectives outlined in the
  427  plan of care. The clinical record or minutes of case conferences
  428  shall ensure that effective interchange, reporting, and
  429  coordination of patient care occurs.
  430         Section 10. Section 400.487, Florida Statutes, is amended
  431  to read:
  432         400.487 Home health service agreements; physician’s,
  433  physician assistant’s, and advanced registered nurse
  434  practitioner’s treatment orders; patient assessment;
  435  establishment and review of plan of care; provision of services;
  436  orders not to resuscitate.—
  437         (1) Services provided by a home health agency must be
  438  covered by an agreement between the home health agency and the
  439  patient or the patient’s legal representative specifying the
  440  home health services to be provided, the rates or charges for
  441  services paid with private funds, and the sources of payment,
  442  which may include Medicare, Medicaid, private insurance,
  443  personal funds, or a combination thereof. The home health agency
  444  shall provide a copy of the agreement to the patient or the
  445  patient’s legal representative. A home health agency providing
  446  skilled care must make an assessment of the patient’s needs
  447  within 48 hours after the start of services.
  448         (2) When required by the provisions of chapter 464; part I,
  449  part III, or part V of chapter 468; or chapter 486, the
  450  attending physician, physician assistant, or advanced registered
  451  nurse practitioner, acting within his or her respective scope of
  452  practice, shall establish treatment orders for a patient who is
  453  to receive skilled care. The treatment orders must be signed by
  454  the physician, physician assistant, or advanced registered nurse
  455  practitioner before a claim for payment for the skilled services
  456  is submitted by the home health agency. If the claim is
  457  submitted to a managed care organization, the treatment orders
  458  must be signed within the time allowed under the provider
  459  agreement. The treatment orders shall be reviewed, as frequently
  460  as the patient’s illness requires, by the physician, physician
  461  assistant, or advanced registered nurse practitioner in
  462  consultation with the home health agency.
  463         (3) A home health agency shall arrange for supervisory
  464  visits by a registered nurse to the home of a patient receiving
  465  home health aide services as specified in subsection (9) in
  466  accordance with the patient’s direction, approval, and agreement
  467  to pay the charge for the visits.
  468         (4) The home health agency shall protect and promote the
  469  rights of each individual under its care, including each of the
  470  following rights:
  471         (a) Notice of rights.—The home health agency shall provide
  472  the patient with a written notice of the patient’s rights in
  473  advance of furnishing care to the patient or during the initial
  474  evaluation visit before the initiation of treatment. The home
  475  health agency must maintain documentation showing that it has
  476  complied with the requirements of this section.
  477         (b) Exercise of rights and respect for property and
  478  person.
  479         1. The patient has the right to exercise his or her rights
  480  as a patient of the home health agency.
  481         2. The patient has the right to have his or her property
  482  treated with respect.
  483         3. The patient has the right to voice grievances regarding
  484  treatment or care that is or fails to be furnished, or regarding
  485  the lack of respect for property by anyone who is furnishing
  486  services on behalf of the home health agency, and not be
  487  subjected to discrimination or reprisal for doing so.
  488         4. The home health agency must investigate complaints made
  489  by a patient or the patient’s family or guardian regarding
  490  treatment or care that is or fails to be furnished, or regarding
  491  the lack of respect for the patient’s property by anyone
  492  furnishing services on behalf of the home health agency. The
  493  home health agency shall document the existence of the complaint
  494  and its resolution.
  495         5. The patient and his or her immediate family or
  496  representative must be informed of the right to report
  497  complaints via the statewide toll-free telephone number to the
  498  agency as required in s. 408.810.
  499         (c) Right to be informed and to participate in planning
  500  care and treatment.
  501         1. The patient has the right to be informed, in advance,
  502  about the care to be furnished and of any changes in the care to
  503  be furnished. The home health agency shall advise the patient in
  504  advance of which disciplines will furnish care and the frequency
  505  of visits proposed to be furnished. The home health agency must
  506  advise the patient in advance of any change in the plan of care
  507  before the change is made.
  508         2. The patient has the right to participate in the planning
  509  of the care. The home health agency must advise the patient in
  510  advance of the right to participate in planning the care or
  511  treatment and in planning changes in the care or treatment. Each
  512  patient has the right to be informed of and to participate in
  513  the planning of his or her care. Each patient must be provided,
  514  upon request, a copy of the plan of care established and
  515  maintained for that patient by the home health agency.
  516         (5) When nursing services are ordered, the home health
  517  agency to which a patient has been admitted for care must
  518  provide the initial admission visit, all service evaluation
  519  visits, and the discharge visit by a direct employee. Services
  520  provided by others under contractual arrangements to a home
  521  health agency must be monitored and managed by the admitting
  522  home health agency. The admitting home health agency is fully
  523  responsible for ensuring that all care provided through its
  524  employees or contract staff is delivered in accordance with this
  525  part and applicable rules.
  526         (6) The skilled care services provided by a home health
  527  agency, directly or under contract, must be supervised and
  528  coordinated in accordance with the plan of care. The home health
  529  agency shall furnish skilled nursing services by or under the
  530  supervision of a registered nurse and in accordance with the
  531  plan of care. Any therapy services offered directly or under
  532  arrangement by the home health agency must be provided by a
  533  qualified therapist or by a qualified therapy assistant under
  534  the supervision of a qualified therapist and in accordance with
  535  the plan of care.
  536         (a) Physical therapy services.—Physical therapy services
  537  shall be furnished only by, or under the supervision of, a
  538  licensed physical therapist or licensed physical therapist
  539  assistant as required under chapter 486 and related rules. A
  540  physical therapist assistant shall perform services planned,
  541  delegated, and supervised by the physical therapist, assist in
  542  preparing clinical notes and progress reports, participate in
  543  educating the patient and his or her family, and participate in
  544  in-service programs. This paragraph does not limit the services
  545  provided by a physician licensed under chapter 458 or chapter
  546  459.
  547         (b) Occupational therapy services.—Occupational therapy
  548  services shall be furnished only by, or under the supervision
  549  of, a licensed occupational therapist or occupational therapy
  550  assistant as provided under part III of chapter 468 and related
  551  rules. An occupational therapy assistant shall perform any
  552  services planned, delegated, and supervised by an occupational
  553  therapist, assist in preparing clinical notes and progress
  554  reports, participate in educating the patient and his or her
  555  family, and participate in in-service programs. This paragraph
  556  does not limit the services provided by a physician licensed
  557  under chapter 458 or chapter 459.
  558         (c) Speech therapy services.—Speech therapy services shall
  559  be furnished only by or under supervision of a qualified speech
  560  pathologist or audiologist as required in part I of chapter 468
  561  and related applicable rules.
  562         (d) Care follows a written plan of care.—The plan of care
  563  shall be reviewed by the physician or health professional who
  564  provided the treatment orders pursuant to subsection (2) and
  565  home health agency personnel as often as the severity of the
  566  patient’s condition requires, but at least once every 60 days or
  567  more when there is a patient-elected transfer, a significant
  568  change in condition, or a discharge and return to the same home
  569  health agency during the 60-day episode. Professional staff of a
  570  home health agency shall promptly alert the physician or other
  571  health professional who provided the treatment orders of any
  572  change that suggests a need to alter the plan of care.
  573         (e) Administration of drugs and treatment.—Only
  574  professional staff of a home health agency may administer drugs
  575  and treatments as ordered by the physician or health
  576  professional pursuant to subsection (2), with the exception of
  577  influenza and pneumococcal polysaccharide vaccines, which may be
  578  administered according to the policy of the home health agency
  579  developed in consultation with a physician and after an
  580  assessment for contraindications. Verbal orders shall be in
  581  writing and signed and dated with the date of receipt by the
  582  registered nurse or qualified therapist who is responsible for
  583  furnishing or supervising the ordered service. A verbal order
  584  may be accepted only by personnel who are authorized to do so by
  585  applicable state laws, rules, and internal policies of the home
  586  health agency.
  587         (7) A registered nurse shall conduct the initial evaluation
  588  visit, regularly reevaluate the patient’s nursing needs,
  589  initiate the plan of care and necessary revisions, furnish those
  590  services requiring substantial and specialized nursing skill,
  591  initiate appropriate preventive and rehabilitative nursing
  592  procedures, prepare clinical and progress notes, coordinate
  593  services, inform the physician and other personnel of changes in
  594  the patient’s condition and needs, counsel the patient and his
  595  or her family in meeting nursing and related needs, participate
  596  in in-service programs, and supervise and teach other nursing
  597  personnel, unless the home health agency providing the home
  598  health aide services is not Medicare-certified or Medicaid
  599  certified, does not provide skilled care, or the patient is not
  600  receiving skilled care.
  601         (8) A licensed practical nurse shall furnish services in
  602  accordance with agency policies, prepare clinical and progress
  603  notes, assist the physician and registered nurse in performing
  604  specialized procedures, prepare equipment and materials for
  605  treatments observing aseptic technique as required, and assist
  606  the patient in learning appropriate self-care techniques.
  607         (9) A home health aide and certified nursing assistant
  608  shall provide services that are in the service provision plan
  609  provided in s. 400.491 and other services that the home health
  610  aide or certified nursing assistant is permitted to perform
  611  under state law. The duties of a home health aide or certified
  612  nursing assistant include the provision of hands-on personal
  613  care, performance of simple procedures as an extension of
  614  therapy or nursing services, assistance in ambulation or
  615  exercises, and assistance in administering medications that are
  616  ordinarily self-administered and are specified in agency rules.
  617  Any services by a home health aide which are offered by a home
  618  health agency must be provided by a qualified home health aide
  619  or certified nursing assistant.
  620         (a) Assignment and duties.—A home health aide or certified
  621  nursing assistant shall be assigned to a specific patient by a
  622  registered nurse, unless the home health agency providing the
  623  home health aide services is not Medicare-certified or Medicaid
  624  certified, does not provide skilled care, or the patient is not
  625  receiving skilled care. Written patient care instructions for
  626  the home health aide and certified nursing assistant must be
  627  prepared by the registered nurse or other appropriate
  628  professional who is responsible for the supervision of the home
  629  health aide and certified nursing assistant as stated in this
  630  section.
  631         (b) Supervision.—If a patient receives skilled nursing
  632  care, the registered nurse shall perform the supervisory visit.
  633  If the patient is not receiving skilled nursing care but is
  634  receiving physical therapy, occupational therapy, or speech
  635  language pathology services, the appropriate therapist may
  636  provide the supervision. A registered nurse or other
  637  professional must make an onsite visit to the patient’s home at
  638  least once every 2 weeks. The visit is not required while the
  639  aide is providing care.
  640         (c) Supervising visits.—If home health aide services are
  641  provided to a patient who is not receiving skilled nursing care,
  642  physical or occupational therapy, or speech-language pathology
  643  services, a registered nurse must make a supervisory visit to
  644  the patient’s home at least once every 60 days, unless the home
  645  health agency providing the home health aide services is not
  646  Medicare or Medicaid certified and does not provide skilled
  647  care, either directly or through contracts. The registered nurse
  648  shall ensure that the aide is properly caring for the patient
  649  and each supervisory visit must occur while the home health aide
  650  is providing patient care. In addition to the requirements in
  651  this subsection, a home health agency shall arrange for
  652  additional supervisory visits by a registered nurse to the home
  653  of a patient receiving home health aide services in accordance
  654  with the patient’s direction, approval, and agreement to pay the
  655  charge for the visits.
  656         (10)(7) Home health agency personnel may withhold or
  657  withdraw cardiopulmonary resuscitation if presented with an
  658  order not to resuscitate executed pursuant to s. 401.45. The
  659  agency shall adopt rules providing for the implementation of
  660  such orders. Home health personnel and agencies shall not be
  661  subject to criminal prosecution or civil liability, nor be
  662  considered to have engaged in negligent or unprofessional
  663  conduct, for withholding or withdrawing cardiopulmonary
  664  resuscitation pursuant to such an order and rules adopted by the
  665  agency.
  666         Section 11. Subsection (11) of section 408.802, Florida
  667  Statutes, is repealed.
  668         Section 12. Paragraphs (e), (f), and (g) of subsection (15)
  669  of section 409.912, Florida Statutes, are repealed.
  670         Section 13. Section 409.91255, Florida Statutes, is amended
  671  to read:
  672         409.91255 Federally qualified health center access
  673  program.—
  674         (1) SHORT TITLE.—This section may be cited as the
  675  “Community Health Center Access Program Act.”
  676         (2) LEGISLATIVE FINDINGS AND INTENT.—
  677         (a) The Legislature finds that, despite significant
  678  investments in health care programs, nearly 6 more than 2
  679  million low-income Floridians, primarily the working poor and
  680  minority populations, continue to lack access to basic health
  681  care services. Further, the Legislature recognizes that
  682  federally qualified health centers have a proven record of
  683  providing cost-effective, comprehensive primary and preventive
  684  health care and are uniquely qualified to address the lack of
  685  adequate health care services for the uninsured.
  686         (b) It is the intent of the Legislature to recognize the
  687  significance of increased federal investments in federally
  688  qualified health centers and to leverage that investment through
  689  the creation of a program to provide for the expansion of the
  690  primary and preventive health care services offered by federally
  691  qualified health centers. Further, such a program will support
  692  the coordination of federal, state, and local resources to
  693  assist such health centers in developing an expanded community
  694  based primary care delivery system.
  695         (3) ASSISTANCE TO FEDERALLY QUALIFIED HEALTH CENTERS.—The
  696  agency shall administer Department of Health shall develop a
  697  program for the expansion of federally qualified health centers
  698  for the purpose of providing comprehensive primary and
  699  preventive health care and urgent care services that may reduce
  700  the morbidity, mortality, and cost of care among the uninsured
  701  population of the state. The program shall provide for
  702  distribution of financial assistance to federally qualified
  703  health centers that apply and demonstrate a need for such
  704  assistance in order to sustain or expand the delivery of primary
  705  and preventive health care services. In selecting centers to
  706  receive this financial assistance, the program:
  707         (a) Shall give preference to communities that have few or
  708  no community-based primary care services or in which the current
  709  services are unable to meet the community’s needs. To assist in
  710  the assessment and identification of areas of critical need, a
  711  federally qualified health-center-based statewide assessment and
  712  strategic plan shall be developed by the Florida Association of
  713  Community Health Centers, Inc., every 5 years, beginning January
  714  1, 2011.
  715         (b) Shall require that primary care services be provided to
  716  the medically indigent using a sliding fee schedule based on
  717  income.
  718         (c) Shall promote allow innovative and creative uses of
  719  federal, state, and local health care resources.
  720         (d) Shall require that the funds provided be used to pay
  721  for operating costs of a projected expansion in patient
  722  caseloads or services or for capital improvement projects.
  723  Capital improvement projects may include renovations to existing
  724  facilities or construction of new facilities, provided that an
  725  expansion in patient caseloads or services to a new patient
  726  population will occur as a result of the capital expenditures.
  727  The agency department shall include in its standard contract
  728  document a requirement that any state funds provided for the
  729  purchase of or improvements to real property are contingent upon
  730  the contractor granting to the state a security interest in the
  731  property at least to the amount of the state funds provided for
  732  at least 5 years from the date of purchase or the completion of
  733  the improvements or as further required by law. The contract
  734  must include a provision that, as a condition of receipt of
  735  state funding for this purpose, the contractor agrees that, if
  736  it disposes of the property before the agency’s department’s
  737  interest is vacated, the contractor will refund the
  738  proportionate share of the state’s initial investment, as
  739  adjusted by depreciation.
  740         (e) Shall May require in-kind support from other sources.
  741         (f) Shall promote May encourage coordination among
  742  federally qualified health centers, other private sector
  743  providers, and publicly supported programs.
  744         (g) Shall promote allow the development of community
  745  emergency room diversion programs in conjunction with local
  746  resources, providing extended hours of operation to urgent care
  747  patients. Diversion programs shall include case management for
  748  emergency room followup care.
  749         (4) EVALUATION OF APPLICATIONS.—A review panel shall be
  750  established, consisting of four persons appointed by the
  751  Secretary of Health Care Administration State Surgeon General
  752  and three persons appointed by the chief executive officer of
  753  the Florida Association of Community Health Centers, Inc., to
  754  review all applications for financial assistance under the
  755  program. Applicants shall specify in the application whether the
  756  program funds will be used for the expansion of patient
  757  caseloads or services or for capital improvement projects to
  758  expand and improve patient facilities. The panel shall use the
  759  following elements in reviewing application proposals and shall
  760  determine the relative weight for scoring and evaluating these
  761  elements:
  762         (a) The target population to be served.
  763         (b) The health benefits to be provided.
  764         (c) The methods that will be used to measure cost
  765  effectiveness.
  766         (d) How patient satisfaction will be measured.
  767         (e) The proposed internal quality assurance process.
  768         (f) Projected health status outcomes.
  769         (g) How data will be collected to measure cost
  770  effectiveness, health status outcomes, and overall achievement
  771  of the goals of the proposal.
  772         (h) All resources, including cash, in-kind, voluntary, or
  773  other resources that will be dedicated to the proposal.
  774         (5) ADMINISTRATION AND TECHNICAL ASSISTANCE.—The agency
  775  shall Department of Health may contract with the Florida
  776  Association of Community Health Centers, Inc., to develop and
  777  coordinate administer the program and provide technical
  778  assistance to the federally qualified health centers selected to
  779  receive financial assistance. The contracted entity shall be
  780  responsible for program support and assume all costs related to
  781  administration of this program.
  782         Section 14. Paragraphs (f) and (g) of subsection (4) of
  783  section 400.9905, Florida Statutes, are amended to read:
  784         400.9905 Definitions.—
  785         (4) “Clinic” means an entity at which health care services
  786  are provided to individuals and which tenders charges for
  787  reimbursement for such services, including a mobile clinic and a
  788  portable equipment provider. For purposes of this part, the term
  789  does not include and the licensure requirements of this part do
  790  not apply to:
  791         (f) A sole proprietorship, group practice, partnership, or
  792  corporation, or other legal entity that provides health care
  793  services by practitioners licensed under chapter 458, chapter
  794  459, chapter 461, chapter 466, or chapter 460 and subject to the
  795  limitations of s. 460.4167 physicians covered by s. 627.419,
  796  that is directly supervised by one or more of such physicians or
  797  physician assistants, and that is wholly owned by one or more of
  798  those physicians or physician assistants or by a physician or
  799  physician assistant or and the spouse, parent, child, or sibling
  800  of that physician or physician assistant. A certificate of
  801  exemption is valid only for the entity, persons, and location
  802  for which it was originally issued.
  803         1. An individual who is not a medical professional or
  804  family member listed in this paragraph may own up to 30 percent
  805  of a health care clinic entity that is exempt under this
  806  paragraph if the individual obtains prior approval from the
  807  agency for ownership of a percentage of a health care clinic.
  808  Such an individual is considered an “applicant” under s.
  809  400.991(5) and must meet all the requirements of that section
  810  and the level 2 background screening requirements of s. 408.809
  811  before being approved by the agency for ownership of a minority
  812  interest in a health care clinic.
  813         2. If an individual who is not a medical professional or
  814  family member listed in this paragraph assumes ownership of an
  815  investment interest in a health care clinic without the prior
  816  approval of the agency, the health care clinic shall lose its
  817  exemption from licensure under this paragraph.
  818         3. Ownership of a health care clinic by an individual other
  819  than the physician or physician assistant, or by the spouse,
  820  parent, child, or sibling of the physician or physician
  821  assistant to whom the exemption was granted, may not exceed 30
  822  percent.
  823         (g) A sole proprietorship, group practice, partnership, or
  824  corporation that provides health care services by licensed
  825  health care practitioners under chapter 457, chapter 458,
  826  chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
  827  chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
  828  chapter 490, chapter 491, or part I, part III, part X, part
  829  XIII, or part XIV of chapter 468, or s. 464.012, which are
  830  wholly owned by one or more licensed health care practitioners,
  831  or the licensed health care practitioners set forth in this
  832  paragraph and the spouse, parent, child, or sibling of a
  833  licensed health care practitioner, so long as one of the owners
  834  who is a licensed health care practitioner is directly
  835  supervising health care services the business activities and is
  836  legally responsible for the entity’s compliance with all federal
  837  and state laws. However, a health care practitioner who is a
  838  supervising owner may not supervise services beyond the scope of
  839  the practitioner’s license, except that, for the purposes of
  840  this part, a clinic owned by a licensee in s. 456.053(3)(b) that
  841  provides only services authorized pursuant to s. 456.053(3)(b)
  842  may be supervised by a licensee specified in s. 456.053(3)(b). A
  843  certificate of exemption is valid only for the entity, persons,
  844  and location for which it was originally issued.
  845         Section 15. Subsection (4) of section 413.615, Florida
  846  Statutes, is amended to read:
  847         413.615 Florida Endowment for Vocational Rehabilitation.—
  848         (4) REVENUE FOR THE ENDOWMENT FUND.—
  849         (a) The endowment fund of the Florida Endowment for
  850  Vocational Rehabilitation is created as a long-term, stable, and
  851  growing source of revenue to be administered, in accordance with
  852  rules promulgated by the division, by the foundation as a
  853  direct-support organization of the division.
  854         (b) The principal of the endowment fund shall derive from
  855  the deposits made pursuant to s. 318.21(2)(e), together with any
  856  legislative appropriations which may be made to the endowment,
  857  and such bequests, gifts, grants, and donations as may be
  858  solicited for such purpose by the foundation from public or
  859  private sources.
  860         (c) All funds currently held for investment and
  861  reinvestment by the State Board of Administration for the
  862  endowment shall be submitted back to the endowment fund within a
  863  reasonable time. Additional revenues received pursuant to s.
  864  318.21(2)(e), shall be transferred to the endowment fund. The
  865  State Board of Administration shall invest and reinvest moneys
  866  of the endowment fund in accordance with the provisions of ss.
  867  215.44-215.53. Moneys in the endowment fund in excess of the
  868  endowment fund principal, or such lesser amount as may be
  869  requested in writing by the foundation, shall be annually
  870  transmitted to the foundation, based upon a fiscal year which
  871  shall run from July 1 through June 30, and shall be deposited in
  872  the foundation’s operating account, for distribution as provided
  873  in subsection (10). The endowment fund principal shall be $1
  874  million for the 2000-2001 fiscal year and shall be increased by
  875  5 percent in each subsequent fiscal year.
  876         (d) The board of directors of the foundation shall
  877  establish the operating account and shall deposit therein the
  878  moneys transmitted pursuant to paragraph (c). Moneys in the
  879  operating account shall be available to carry out the purposes
  880  of subsection (10).
  881         Section 16. Subsection (2) of section 429.12, Florida
  882  Statutes, is repealed.
  883         Section 17. Subsection (5) of section 429.23, Florida
  884  Statutes, is repealed.
  885         Section 18. Paragraph (a) of subsection (2) of section
  886  429.911, Florida Statutes, is repealed.
  887         Section 19. Subsection (1) of section 465.0251, Florida
  888  Statutes, is reenacted to read:
  889         465.0251 Generic drugs; removal from formulary under
  890  specified circumstances.—
  891         (1) The Board of Pharmacy and the Board of Medicine shall
  892  remove any generic named drug product from the formulary
  893  established by s. 465.025(6), if every commercially marketed
  894  equivalent of that drug product is “A” rated as therapeutically
  895  equivalent to a reference listed drug or is a reference listed
  896  drug as referred to in “Approved Drug Products with Therapeutic
  897  Equivalence Evaluations” (Orange Book) published by the United
  898  States Food and Drug Administration.
  899         Section 20. Paragraph (q) of subsection (2) of section
  900  499.01, Florida Statutes, is amended to read:
  901         499.01 Permits.—
  902         (2) The following permits are established:
  903         (q) Device manufacturer permit.—
  904         1. A device manufacturer permit is required for any person
  905  that engages in the manufacture, repackaging, or assembly of
  906  medical devices for human use in this state, except that a
  907  permit is not required if:
  908         a. The person is engaged only in manufacturing,
  909  repackaging, or assembling a medical device pursuant to a
  910  practitioner’s order for a specific patient; or.
  911         b. The person does not manufacture, repackage, or assemble
  912  medical devices or components for such devices, except for
  913  devices or components that are exempt from registration under s.
  914  499.015(8).
  915         2.1. A manufacturer or repackager of medical devices in
  916  this state must comply with all appropriate state and federal
  917  good manufacturing practices and quality system rules.
  918         3.2. The department shall adopt rules related to storage,
  919  handling, and recordkeeping requirements for manufacturers of
  920  medical devices for human use.
  921         Section 21. Subsections (4) and (9) of section 381.0403,
  922  Florida Statutes, are repealed.
  923         Section 22. Section 381.4018, Florida Statutes, is amended
  924  to read:
  925         381.4018 Physician workforce assessment and development.—
  926         (1) DEFINITIONS.—As used in this section, the term:
  927         (a) “Consortium” or “consortia” means a combination of
  928  statutory teaching hospitals, statutory rural hospitals,
  929  specialty children’s hospitals, other hospitals, accredited
  930  medical schools, clinics operated by the Department of Health,
  931  clinics operated by the Department of Veterans’ Affairs, area
  932  health education centers, community health centers, federally
  933  qualified health centers, prison clinics, local community
  934  clinics, or other programs. At least one member of the
  935  consortium shall be a sponsoring institution accredited or
  936  currently seeking accreditation by the Accreditation Council for
  937  Graduate Medical Education or the American Osteopathic
  938  Association.
  939         (b) “Council” means the Physician Workforce Advisory
  940  Council.
  941         (c) “Department” means the Department of Health.
  942         (d) “Graduate medical education program” means a program
  943  accredited by the Accreditation Council for Graduate Medical
  944  Education or the American Osteopathic Association.
  945         (e) “Primary care specialty” means emergency medicine,
  946  family practice, internal medicine, pediatrics, psychiatry,
  947  geriatrics, general surgery, obstetrics and gynecology, and
  948  combined pediatrics and internal medicine and other specialties
  949  as determined by the Physician Workforce Advisory Council or the
  950  Department of Health.
  951         (2)(1) LEGISLATIVE INTENT.—The Legislature recognizes that
  952  physician workforce planning is an essential component of
  953  ensuring that there is an adequate and appropriate supply of
  954  well-trained physicians to meet this state’s future health care
  955  service needs as the general population and elderly population
  956  of the state increase. The Legislature finds that items to
  957  consider relative to assessing the physician workforce may
  958  include physician practice status; specialty mix; geographic
  959  distribution; demographic information, including, but not
  960  limited to, age, gender, race, and cultural considerations; and
  961  needs of current or projected medically underserved areas in the
  962  state. Long-term strategic planning is essential as the period
  963  from the time a medical student enters medical school to
  964  completion of graduate medical education may range from 7 to 10
  965  years or longer. The Legislature recognizes that strategies to
  966  provide for a well-trained supply of physicians must include
  967  ensuring the availability and capacity of quality graduate
  968  medical schools and graduate medical education programs in this
  969  state, as well as using new or existing state and federal
  970  programs providing incentives for physicians to practice in
  971  needed specialties and in underserved areas in a manner that
  972  addresses projected needs for physician manpower.
  973         (3)(2) PURPOSE.—The department of Health shall serve as a
  974  coordinating and strategic planning body to actively assess the
  975  state’s current and future physician workforce needs and work
  976  with multiple stakeholders to develop strategies and
  977  alternatives to address current and projected physician
  978  workforce needs.
  979         (4)(3) GENERAL FUNCTIONS.—The department shall maximize the
  980  use of existing programs under the jurisdiction of the
  981  department and other state agencies and coordinate governmental
  982  and nongovernmental stakeholders and resources in order to
  983  develop a state strategic plan and assess the implementation of
  984  such strategic plan. In developing the state strategic plan, the
  985  department shall:
  986         (a) Monitor, evaluate, and report on the supply and
  987  distribution of physicians licensed under chapter 458 or chapter
  988  459. The department shall maintain a database to serve as a
  989  statewide source of data concerning the physician workforce.
  990         (b) Develop a model and quantify, on an ongoing basis, the
  991  adequacy of the state’s current and future physician workforce
  992  as reliable data becomes available. Such model must take into
  993  account demographics, physician practice status, place of
  994  education and training, generational changes, population growth,
  995  economic indicators, and issues concerning the “pipeline” into
  996  medical education.
  997         (c) Develop and recommend strategies to determine whether
  998  the number of qualified medical school applicants who might
  999  become competent, practicing physicians in this state will be
 1000  sufficient to meet the capacity of the state’s medical schools.
 1001  If appropriate, the department shall, working with
 1002  representatives of appropriate governmental and nongovernmental
 1003  entities, develop strategies and recommendations and identify
 1004  best practice programs that introduce health care as a
 1005  profession and strengthen skills needed for medical school
 1006  admission for elementary, middle, and high school students, and
 1007  improve premedical education at the precollege and college level
 1008  in order to increase this state’s potential pool of medical
 1009  students.
 1010         (d) Develop strategies to ensure that the number of
 1011  graduates from the state’s public and private allopathic and
 1012  osteopathic medical schools is are adequate to meet physician
 1013  workforce needs, based on the analysis of the physician
 1014  workforce data, so as to provide a high-quality medical
 1015  education to students in a manner that recognizes the uniqueness
 1016  of each new and existing medical school in this state.
 1017         (e) Pursue strategies and policies to create, expand, and
 1018  maintain graduate medical education positions in the state based
 1019  on the analysis of the physician workforce data. Such strategies
 1020  and policies must take into account the effect of federal
 1021  funding limitations on the expansion and creation of positions
 1022  in graduate medical education. The department shall develop
 1023  options to address such federal funding limitations. The
 1024  department shall consider options to provide direct state
 1025  funding for graduate medical education positions in a manner
 1026  that addresses requirements and needs relative to accreditation
 1027  of graduate medical education programs. The department shall
 1028  consider funding residency positions as a means of addressing
 1029  needed physician specialty areas, rural areas having a shortage
 1030  of physicians, and areas of ongoing critical need, and as a
 1031  means of addressing the state’s physician workforce needs based
 1032  on an ongoing analysis of physician workforce data.
 1033         (f) Develop strategies to maximize federal and state
 1034  programs that provide for the use of incentives to attract
 1035  physicians to this state or retain physicians within the state.
 1036  Such strategies should explore and maximize federal-state
 1037  partnerships that provide incentives for physicians to practice
 1038  in federally designated shortage areas. Strategies shall also
 1039  consider the use of state programs, such as the Florida Health
 1040  Service Corps established pursuant to s. 381.0302 and the
 1041  Medical Education Reimbursement and Loan Repayment Program
 1042  pursuant to s. 1009.65, which provide for education loan
 1043  repayment or loan forgiveness and provide monetary incentives
 1044  for physicians to relocate to underserved areas of the state.
 1045         (g) Coordinate and enhance activities relative to physician
 1046  workforce needs, undergraduate medical education, and graduate
 1047  medical education, and reentry of retired military and other
 1048  physicians into the physician workforce provided by the Division
 1049  of Medical Quality Assurance, the Community Hospital Education
 1050  Program and the Graduate Medical Education Committee established
 1051  pursuant to s. 381.0403, area health education center networks
 1052  established pursuant to s. 381.0402, and other offices and
 1053  programs within the department of Health as designated by the
 1054  State Surgeon General.
 1055         (h) Work in conjunction with and act as a coordinating body
 1056  for governmental and nongovernmental stakeholders to address
 1057  matters relating to the state’s physician workforce assessment
 1058  and development for the purpose of ensuring an adequate supply
 1059  of well-trained physicians to meet the state’s future needs.
 1060  Such governmental stakeholders shall include, but need not be
 1061  limited to, the State Surgeon General or his or her designee,
 1062  the Commissioner of Education or his or her designee, the
 1063  Secretary of Health Care Administration or his or her designee,
 1064  and the Chancellor of the State University System or his or her
 1065  designee from the Board of Governors of the State University
 1066  System, and, at the discretion of the department, other
 1067  representatives of state and local agencies that are involved in
 1068  assessing, educating, or training the state’s current or future
 1069  physicians. Other stakeholders shall include, but need not be
 1070  limited to, organizations representing the state’s public and
 1071  private allopathic and osteopathic medical schools;
 1072  organizations representing hospitals and other institutions
 1073  providing health care, particularly those that currently provide
 1074  or have an interest in providing accredited medical education
 1075  and graduate medical education to medical students and medical
 1076  residents; organizations representing allopathic and osteopathic
 1077  practicing physicians; and, at the discretion of the department,
 1078  representatives of other organizations or entities involved in
 1079  assessing, educating, or training the state’s current or future
 1080  physicians.
 1081         (i) Serve as a liaison with other states and federal
 1082  agencies and programs in order to enhance resources available to
 1083  the state’s physician workforce and medical education continuum.
 1084         (j) Act as a clearinghouse for collecting and disseminating
 1085  information concerning the physician workforce and medical
 1086  education continuum in this state.
 1087         (5) PHYSICIAN WORKFORCE ADVISORY COUNCIL.—There is created
 1088  in the department the Physician Workforce Advisory Council, an
 1089  advisory council as defined in s. 20.03. The council shall
 1090  comply with the requirements of s. 20.052, except as otherwise
 1091  provided in this section.
 1092         (a)The council shall consist of 19 members. Members
 1093  appointed by the State Surgeon General shall include:
 1094         1.A designee from the department who is a physician
 1095  licensed under chapter 458 or chapter 459 and recommended by the
 1096  State Surgeon General.
 1097         2.An individual who is affiliated with the Science
 1098  Students Together Reaching Instructional Diversity and
 1099  Excellence program and recommended by the area health education
 1100  center network.
 1101         3.Two individuals recommended by the Council of Florida
 1102  Medical School Deans, one representing a college of allopathic
 1103  medicine and one representing a college of osteopathic medicine.
 1104         4.One individual recommended by the Florida Hospital
 1105  Association, representing a hospital that is licensed under
 1106  chapter 395, has an accredited graduate medical education
 1107  program, and is not a statutory teaching hospital.
 1108         5.One individual representing a statutory teaching
 1109  hospital as defined in s. 408.07 and recommended by the Safety
 1110  Net Hospital Alliance.
 1111         6.One individual representing a family practice teaching
 1112  hospital as defined in s. 395.805 and recommended by the Council
 1113  of Family Medicine and Community Teaching Hospitals.
 1114         7.Two individuals recommended by the Florida Medical
 1115  Association, one representing a primary care specialty and one
 1116  representing a nonprimary care specialty.
 1117         8.Two individuals recommended by the Florida Osteopathic
 1118  Medical Association, one representing a primary care specialty
 1119  and one representing a nonprimary care specialty.
 1120         9.Two individuals who are program directors of accredited
 1121  graduate medical education programs, one representing a program
 1122  that is accredited by the Accreditation Council for Graduate
 1123  Medical Education and one representing a program that is
 1124  accredited by the American Osteopathic Association.
 1125         10.An individual recommended by the Florida Association of
 1126  Community Health Centers representing a federally qualified
 1127  health center located in a rural area as defined in s.
 1128  381.0406(2)(a).
 1129         11.An individual recommended by the Florida Academy of
 1130  Family Physicians.
 1131         12. An individual recommended by the Florida Alliance for
 1132  Health Professions Diversity.
 1133         13.The Chancellor of the State University System or his or
 1134  her designee.
 1135         14. A layperson member as determined by the State Surgeon
 1136  General.
 1137  
 1138  Appointments to the council shall be made by the State Surgeon
 1139  General. Each entity authorized to make recommendations under
 1140  this subsection shall make at least two recommendations to the
 1141  State Surgeon General for each appointment to the council. The
 1142  State Surgeon General shall name one appointee for each position
 1143  from the recommendations made by each authorized entity.
 1144         (b) Each council member shall be appointed to a 4-year
 1145  term. An individual may not serve more than two terms. Any
 1146  council member may be removed from office for malfeasance;
 1147  misfeasance; neglect of duty; incompetence; permanent inability
 1148  to perform official duties; or pleading guilty or nolo
 1149  contendere to, or being found guilty of, a felony. Any council
 1150  member who meets the criteria for removal, or who is otherwise
 1151  unwilling or unable to properly fulfill the duties of the
 1152  office, shall be succeeded by an individual chosen by the State
 1153  Surgeon General to serve out the remainder of the council
 1154  member’s term. If the remainder of the replaced council member’s
 1155  term is less than 18 months, notwithstanding the provisions of
 1156  this paragraph, the succeeding council member may be reappointed
 1157  twice by the State Surgeon General.
 1158         (c) The chair of the council is the State Surgeon General,
 1159  who shall designate a vice chair from the membership of the
 1160  council to serve in the absence of the State Surgeon General. A
 1161  vacancy shall be filled for the remainder of the unexpired term
 1162  in the same manner as the original appointment.
 1163         (d) Council members are not entitled to receive
 1164  compensation or reimbursement for per diem or travel expenses.
 1165         (e) The council shall meet at least twice a year in person
 1166  or by teleconference.
 1167         (f) The council shall:
 1168         1. Advise the State Surgeon General and the department on
 1169  matters concerning current and future physician workforce needs
 1170  in this state;
 1171         2. Review survey materials and the compilation of survey
 1172  information;
 1173         3.Annually review the number, location, cost, and
 1174  reimbursement of graduate medical education programs and
 1175  positions;
 1176         4. Provide recommendations to the department regarding the
 1177  survey completed by physicians licensed under chapter 458 or
 1178  chapter 459;
 1179         5. Assist the department in preparing the annual report to
 1180  the Legislature pursuant to ss. 458.3192 and 459.0082;
 1181         6. Assist the department in preparing an initial strategic
 1182  plan, conduct ongoing strategic planning in accordance with this
 1183  section, and provide ongoing advice on implementing the
 1184  recommendations;
 1185         7. Monitor and provide recommendations regarding the need
 1186  for an increased number of primary care or other physician
 1187  specialties to provide the necessary current and projected
 1188  health and medical services for the state; and
 1189         8. Monitor and make recommendations regarding the status of
 1190  the needs relating to graduate medical education in this state.
 1191         (6) PHYSICIAN WORKFORCE GRADUATE MEDICAL EDUCATION
 1192  INNOVATION PILOT PROJECTS.—
 1193         (a) The Legislature finds that:
 1194         1. In order to ensure a physician workforce that is
 1195  adequate to meet the needs of this state’s residents and its
 1196  health care system, policymakers must consider the education and
 1197  training of future generations of well-trained health care
 1198  providers.
 1199         2. Physicians are likely to practice in the state where
 1200  they complete their graduate medical education.
 1201         3. It can directly affect the makeup of the physician
 1202  workforce by selectively funding graduate medical education
 1203  programs to provide needed specialists in geographic areas of
 1204  the state which have a deficient number of such specialists.
 1205         4. Developing additional positions in graduate medical
 1206  education programs is essential to the future of this state’s
 1207  health care system.
 1208         5. It was necessary in 2007 to pass legislation that
 1209  provided for an assessment of the status of this state’s current
 1210  and future physician workforce. The department is collecting and
 1211  analyzing information on an ongoing basis to assess this state’s
 1212  physician workforce needs, and such assessment may facilitate
 1213  the determination of graduate medical education needs and
 1214  strategies for the state.
 1215         (b) There is established under the department a program to
 1216  foster innovative graduate medical education pilot projects that
 1217  are designed to promote the expansion of graduate medical
 1218  education programs or positions to prepare physicians to
 1219  practice in needed specialties and underserved areas or settings
 1220  and to provide demographic and cultural representation in a
 1221  manner that addresses current and projected needs for this
 1222  state’s physician workforce. Funds appropriated annually by the
 1223  Legislature for this purpose shall be distributed to
 1224  participating hospitals, medical schools, other sponsors of
 1225  graduate medical education programs, consortia engaged in
 1226  developing new graduate medical education programs or positions
 1227  in those programs, or pilot projects providing innovative
 1228  graduate medical education in community-based clinical settings.
 1229  Pilot projects shall be selected on a competitive grant basis,
 1230  subject to available funds.
 1231         (c) Pilot projects shall be designed to meet one or more of
 1232  this state’s physician workforce needs, as determined pursuant
 1233  to this section, including, but not limited to:
 1234         1. Increasing the number of residencies or fellowships in
 1235  primary care or other needed specialties.
 1236         2. Enhancing the retention of primary care physicians or
 1237  other needed specialties in this state.
 1238         3. Promoting practice in rural or medically underserved
 1239  areas of the state.
 1240         4. Encouraging racial and ethnic diversity within the
 1241  state’s physician workforce.
 1242         5. Encouraging practice in community health care or other
 1243  ambulatory care settings.
 1244         6. Encouraging practice in clinics operated by the
 1245  department, including, but not limited to, county health
 1246  departments, clinics operated by the Department of Veterans’
 1247  Affairs, prison clinics, or similar settings of need.
 1248         7. Encouraging the increased production of geriatricians.
 1249         (d) Priority shall be given to a proposal for a pilot
 1250  project that:
 1251         1. Demonstrates a collaboration of federal, state, and
 1252  local entities that are public or private.
 1253         2. Obtains funding from multiple sources.
 1254         3. Focuses on enhancing graduate medical education in rural
 1255  or underserved areas.
 1256         4. Focuses on enhancing graduate medical education in
 1257  ambulatory or community-based settings other than a hospital
 1258  environment.
 1259         5. Includes the use of technology, such as electronic
 1260  medical records, distance consultation, and telemedicine, to
 1261  ensure that residents are better prepared to care for patients
 1262  in this state, regardless of the community in which the
 1263  residents practice.
 1264         6. Is designed to meet multiple policy needs as enumerated
 1265  in subsection (3).
 1266         7. Uses a consortium to provide for graduate medical
 1267  education experiences.
 1268         (e) The department shall adopt by rule appropriate
 1269  performance measures to use in order to consistently evaluate
 1270  the effectiveness, safety, and quality of the programs, as well
 1271  as the impact of each program on meeting this state’s physician
 1272  workforce needs.
 1273         (f) Participating pilot projects shall submit to the
 1274  department an annual report on the project in a manner required
 1275  by the department.
 1276         (g) Funding provided to a pilot project may be used only
 1277  for the direct costs of providing graduate medical education.
 1278  Accounting of such costs and expenditures shall be documented in
 1279  the annual report.
 1280         (h) State funds shall be used to supplement funds from any
 1281  local government, community, or private source. The state may
 1282  provide up to 50 percent of the funds, and local governmental
 1283  grants or community or private sources shall provide the
 1284  remainder of the funds.
 1285         (7) RULEMAKING.—The department shall adopt rules as
 1286  necessary to administer this section.
 1287         Section 23. Section 458.3192, Florida Statutes, is amended
 1288  to read:
 1289         458.3192 Analysis of survey results; report.—
 1290         (1) Each year, the Department of Health shall analyze the
 1291  results of the physician survey required by s. 458.3191 and
 1292  determine by geographic area and specialty the number of
 1293  physicians who:
 1294         (a) Perform deliveries of children in this state Florida.
 1295         (b) Read mammograms and perform breast-imaging-guided
 1296  procedures in this state Florida.
 1297         (c) Perform emergency care on an on-call basis for a
 1298  hospital emergency department.
 1299         (d) Plan to reduce or increase emergency on-call hours in a
 1300  hospital emergency department.
 1301         (e) Plan to relocate their allopathic or osteopathic
 1302  practice outside the state.
 1303         (f) Practice medicine in this state.
 1304         (g) Plan to reduce or modify the scope of their practice.
 1305         (2) The Department of Health must report its findings to
 1306  the Governor, the President of the Senate, and the Speaker of
 1307  the House of Representatives by November 1 each year. The
 1308  department shall also include in its report findings,
 1309  recommendations, and strategic planning activities as provided
 1310  in s. 381.4018. The department may also include other
 1311  information requested by the Physician Workforce Advisory
 1312  Council.
 1313         Section 24. Section 459.0082, Florida Statutes, is amended
 1314  to read:
 1315         459.0082 Analysis of survey results; report.—
 1316         (1) Each year, the Department of Health shall analyze the
 1317  results of the physician survey required by s. 459.0081 and
 1318  determine by geographic area and specialty the number of
 1319  physicians who:
 1320         (a) Perform deliveries of children in this state Florida.
 1321         (b) Read mammograms and perform breast-imaging-guided
 1322  procedures in this state Florida.
 1323         (c) Perform emergency care on an on-call basis for a
 1324  hospital emergency department.
 1325         (d) Plan to reduce or increase emergency on-call hours in a
 1326  hospital emergency department.
 1327         (e) Plan to relocate their allopathic or osteopathic
 1328  practice outside the state.
 1329         (f) Practice medicine in this state.
 1330         (g)Plan to reduce or modify the scope of their practice.
 1331         (2) The Department of Health must report its findings to
 1332  the Governor, the President of the Senate, and the Speaker of
 1333  the House of Representatives by November 1 each year. The
 1334  department shall also include in its report findings,
 1335  recommendations, and strategic planning activities as provided
 1336  in s. 381.4018. The department may also include other
 1337  information requested by the Physician Workforce Advisory
 1338  Council.
 1339         Section 25. Section 458.315, Florida Statutes, is amended
 1340  to read:
 1341         458.315 Temporary certificate for practice in areas of
 1342  critical need.—
 1343         (1) Any physician who:
 1344         (a) Is licensed to practice in any jurisdiction in the
 1345  United States and other state, whose license is currently valid;
 1346  or,
 1347         (b) Has served as a physician in the United States Armed
 1348  Forces for at least 10 years and received an honorable discharge
 1349  from the military;
 1350  
 1351  and who pays an application fee of $300 may be issued a
 1352  temporary certificate for to practice in areas of communities of
 1353  Florida where there is a critical need for physicians.
 1354         (2) A certificate may be issued to a physician who:
 1355         (a) Practices in an area of critical need;
 1356         (b) Will be employed by or practice in a county health
 1357  department, correctional facility, Department of Veterans’
 1358  Affairs clinic, community health center funded by s. 329, s.
 1359  330, or s. 340 of the United States Public Health Services Act,
 1360  or other agency or institution that is approved by the State
 1361  Surgeon General and provides health care to meet the needs of
 1362  underserved populations in this state; or
 1363         (c) Will practice for a limited time to address critical
 1364  physician-specialty, demographic, or geographic needs for this
 1365  state’s physician workforce as determined by the State Surgeon
 1366  General entity that provides health care to indigents and that
 1367  is approved by the State Health Officer.
 1368         (3) The Board of Medicine may issue this temporary
 1369  certificate with the following restrictions:
 1370         (a)(1) The State Surgeon General board shall determine the
 1371  areas of critical need, and the physician so certified may
 1372  practice in any of those areas for a time to be determined by
 1373  the board. Such areas shall include, but are not be limited to,
 1374  health professional shortage areas designated by the United
 1375  States Department of Health and Human Services.
 1376         1.(a) A recipient of a temporary certificate for practice
 1377  in areas of critical need may use the certificate license to
 1378  work for any approved entity employer in any area of critical
 1379  need or as authorized by the State Surgeon General approved by
 1380  the board.
 1381         2.(b) The recipient of a temporary certificate for practice
 1382  in areas of critical need shall, within 30 days after accepting
 1383  employment, notify the board of all approved institutions in
 1384  which the licensee practices and of all approved institutions
 1385  where practice privileges have been denied.
 1386         (b)(2) The board may administer an abbreviated oral
 1387  examination to determine the physician’s competency, but a no
 1388  written regular examination is not required necessary. Within 60
 1389  days after receipt of an application for a temporary
 1390  certificate, the board shall review the application and issue
 1391  the temporary certificate, or notify the applicant of denial, or
 1392  notify the applicant that the board recommends additional
 1393  assessment, training, education, or other requirements as a
 1394  condition of certification. If the applicant has not actively
 1395  practiced during the prior 3 years and the board determines that
 1396  the applicant may lack clinical competency, possess diminished
 1397  or inadequate skills, lack necessary medical knowledge, or
 1398  exhibit patterns of deficits in clinical decisionmaking, the
 1399  board may:
 1400         1.Deny the application;
 1401         2.Issue a temporary certificate having reasonable
 1402  restrictions that may include, but are not limited to, a
 1403  requirement for the applicant to practice under the supervision
 1404  of a physician approved by the board; or
 1405         3.Issue a temporary certificate upon receipt of
 1406  documentation confirming that the applicant has met any
 1407  reasonable conditions of the board which may include, but are
 1408  not limited to, completing continuing education or undergoing an
 1409  assessment of skills and training.
 1410         (c)(3) Any certificate issued under this section is shall
 1411  be valid only so long as the State Surgeon General determines
 1412  that the reason area for which it was is issued remains a an
 1413  area of critical need to the state. The Board of Medicine shall
 1414  review each temporary certificateholder not the service within
 1415  said area not less than annually to ascertain that the minimum
 1416  requirements of the Medical Practice Act and its adopted the
 1417  rules and regulations promulgated thereunder are being complied
 1418  with. If it is determined that such minimum requirements are not
 1419  being met, the board shall forthwith revoke such certificate or
 1420  shall impose restrictions or conditions, or both, as a condition
 1421  of continued practice under the certificate.
 1422         (d)(4) The board may shall not issue a temporary
 1423  certificate for practice in an area of critical need to any
 1424  physician who is under investigation in any jurisdiction in the
 1425  United States another state for an act that which would
 1426  constitute a violation of this chapter until such time as the
 1427  investigation is complete, at which time the provisions of s.
 1428  458.331 shall apply.
 1429         (4)(5) The application fee and all licensure fees,
 1430  including neurological injury compensation assessments, shall be
 1431  waived for those persons obtaining a temporary certificate to
 1432  practice in areas of critical need for the purpose of providing
 1433  volunteer, uncompensated care for low-income residents
 1434  Floridians. The applicant must submit an affidavit from the
 1435  employing agency or institution stating that the physician will
 1436  not receive any compensation for any service involving the
 1437  practice of medicine.
 1438         Section 26. Section 459.0076, Florida Statutes, is created
 1439  to read:
 1440         459.0076Temporary certificate for practice in areas of
 1441  critical need.—
 1442         (1) Any physician who:
 1443         (a) Is licensed to practice in any jurisdiction in the
 1444  United States and whose license is currently valid; or
 1445         (b) Has served as a physician in the United States Armed
 1446  Forces for at least 10 years and received an honorable discharge
 1447  from the military;
 1448  
 1449  and who pays an application fee of $300 may be issued a
 1450  temporary certificate for practice in areas of critical need.
 1451         (2) A certificate may be issued to a physician who:
 1452         (a) Will practice in an area of critical need;
 1453         (b) Will be employed by or practice in a county health
 1454  department, correctional facility, Department of Veterans’
 1455  Affairs clinic, community health center funded by s. 329, s.
 1456  330, or s. 340 of the United States Public Health Services Act,
 1457  or other agency or institution that is approved by the State
 1458  Surgeon General and provides health care to meet the needs of
 1459  underserved populations in this state; or
 1460         (c) Will practice for a limited time to address critical
 1461  physician-specialty, demographic, or geographic needs for this
 1462  state’s physician workforce as determined by the State Surgeon
 1463  General.
 1464         (3) The Board of Osteopathic Medicine may issue this
 1465  temporary certificate with the following restrictions:
 1466         (a) The State Surgeon General shall determine the areas of
 1467  critical need. Such areas include, but are not limited to,
 1468  health professional shortage areas designated by the United
 1469  States Department of Health and Human Services.
 1470         1. A recipient of a temporary certificate for practice in
 1471  areas of critical need may use the certificate to work for any
 1472  approved entity in any area of critical need or as authorized by
 1473  the State Surgeon General.
 1474         2. The recipient of a temporary certificate for practice in
 1475  areas of critical need shall, within 30 days after accepting
 1476  employment, notify the board of all approved institutions in
 1477  which the licensee practices and of all approved institutions
 1478  where practice privileges have been denied.
 1479         (b) The board may administer an abbreviated oral
 1480  examination to determine the physician’s competency, but a
 1481  written regular examination is not required. Within 60 days
 1482  after receipt of an application for a temporary certificate, the
 1483  board shall review the application and issue the temporary
 1484  certificate, notify the applicant of denial, or notify the
 1485  applicant that the board recommends additional assessment,
 1486  training, education, or other requirements as a condition of
 1487  certification. If the applicant has not actively practiced
 1488  during the prior 3 years and the board determines that the
 1489  applicant may lack clinical competency, possess diminished or
 1490  inadequate skills, lack necessary medical knowledge, or exhibit
 1491  patterns of deficits in clinical decisionmaking, the board may:
 1492         1.Deny the application;
 1493         2.Issue a temporary certificate having reasonable
 1494  restrictions that may include, but are not limited to, a
 1495  requirement for the applicant to practice under the supervision
 1496  of a physician approved by the board; or
 1497         3.Issue a temporary certificate upon receipt of
 1498  documentation confirming that the applicant has met any
 1499  reasonable conditions of the board which may include, but are
 1500  not limited to, completing continuing education or undergoing an
 1501  assessment of skills and training.
 1502         (c) Any certificate issued under this section is valid only
 1503  so long as the State Surgeon General determines that the reason
 1504  for which it was issued remains a critical need to the state.
 1505  The Board of Osteopathic Medicine shall review each temporary
 1506  certificateholder not less than annually to ascertain that the
 1507  minimum requirements of the Osteopathic Medical Practice Act and
 1508  its adopted rules are being complied with. If it is determined
 1509  that such minimum requirements are not being met, the board
 1510  shall revoke such certificate or shall impose restrictions or
 1511  conditions, or both, as a condition of continued practice under
 1512  the certificate.
 1513         (d) The board may not issue a temporary certificate for
 1514  practice in an area of critical need to any physician who is
 1515  under investigation in any jurisdiction in the United States for
 1516  an act that would constitute a violation of this chapter until
 1517  such time as the investigation is complete, at which time the
 1518  provisions of s. 459.015 apply.
 1519         (4) The application fee and all licensure fees, including
 1520  neurological injury compensation assessments, shall be waived
 1521  for those persons obtaining a temporary certificate to practice
 1522  in areas of critical need for the purpose of providing
 1523  volunteer, uncompensated care for low-income residents. The
 1524  applicant must submit an affidavit from the employing agency or
 1525  institution stating that the physician will not receive any
 1526  compensation for any service involving the practice of medicine.
 1527         Section 27. (1) The Department of Health shall develop, in
 1528  collaboration with the Agency for Health Care Administration, a
 1529  statewide plan aimed at implementing the recommendations from
 1530  the Centers for Disease Control and Prevention for screening for
 1531  the human immunodeficiency virus (HIV) in adults and adolescents
 1532  in public and private health care settings. The goals of the
 1533  plan shall include, but not be limited to, increasing awareness
 1534  of HIV infection rates and causes, increasing voluntary HIV
 1535  screening rates in health care settings, identifying previously
 1536  unrecognized HIV infection, linking HIV-positive clients to
 1537  clinical and prevention services to reduce future infections,
 1538  reducing the transmission of HIV to fetuses, and establishing
 1539  early treatment for those persons infected with HIV. To the
 1540  extent possible, the plan shall integrate with existing HIV
 1541  screening and testing programs that are funded by the Centers
 1542  for Disease Control and Prevention or other organizations. As
 1543  used in this section, the term “department” means the Department
 1544  of Health.
 1545         (2) In developing the plan, the department shall seek the
 1546  input of and collaborate with, at a minimum, representatives of
 1547  the following entities: hospital emergency departments; urgent
 1548  care clinics; inpatient settings, including labor and delivery;
 1549  substance abuse treatment clinics; public health clinics;
 1550  community clinics; federally qualified health clinics; rural
 1551  health clinics; correctional health care facilities; pediatric
 1552  and adolescent care clinics; prenatal care clinics; local health
 1553  departments; and other public and private primary care settings.
 1554         (3) The department shall establish a demonstration project
 1555  as current funds allow in an area of the state with a high
 1556  incidence of HIV infection to begin implementation of the
 1557  statewide plan. The demonstration project shall seek to
 1558  collaborate with the public and private health care settings in
 1559  subsection (2) and be consistent with the department’s current
 1560  “Test Miami” initiative.
 1561         (4) The department shall file an interim report on the
 1562  status of the development of the statewide plan, which includes
 1563  any funding needs for the expansion of the demonstration project
 1564  to other areas of the state, with the Governor, President of the
 1565  Senate, and the Speaker of the House of Representatives by
 1566  December 31, 2010. The Department shall file a final report on
 1567  the statewide plan and implementation and status of the
 1568  demonstration project with the Governor, President of the
 1569  Senate, and the Speaker of the House of Representatives by
 1570  December 31, 2011.
 1571         Section 28. Present subsections (32) through (54) of
 1572  section 499.003, Florida Statutes, are renumbered as subsections
 1573  (33) through (55), respectively, and a new subsection (32) is
 1574  added to that section, to read:
 1575         499.003 Definitions of terms used in this part.—As used in
 1576  this part, the term:
 1577         (32) “Medical convenience kit” means packages or units that
 1578  contain combination products as defined in 21 C.F.R. s.
 1579  3.2(e)(2).
 1580         Section 29. Paragraph (i) is added to subsection (3) of
 1581  section 499.01212, Florida Statutes, to read:
 1582         499.01212 Pedigree paper.—
 1583         (3) EXCEPTIONS.—A pedigree paper is not required for:
 1584         (i) The wholesale distribution of prescription drugs
 1585  contained within a medical convenience kit if:
 1586         1. The medical convenience kit is assembled in an
 1587  establishment that is registered as a medical device
 1588  manufacturer with the United States Food and Drug
 1589  Administration;
 1590         2. The medical convenience kit manufacturer purchased the
 1591  prescription drug directly from the manufacturer or from a
 1592  wholesaler that purchased the prescription drug directly from
 1593  the manufacturer;
 1594         3. The medical convenience kit manufacturer complies with
 1595  federal law for the distribution of the prescription drugs
 1596  within the kit; and
 1597         4. The drugs contained in the medical convenience kit are:
 1598         a. Intravenous solutions intended for the replenishment of
 1599  fluids and electrolytes;
 1600         b. Products intended to maintain the equilibrium of water
 1601  and minerals in the body;
 1602         c. Products intended for irrigation or reconstitution;
 1603         d. Anesthetics; or
 1604         e. Anticoagulants.
 1605         Section 30. (1)In addition to the appropriations contained
 1606  in the General Appropriations Act for the 2010-2011 fiscal year,
 1607  one full-time equivalent position and salary rate of 52,554 are
 1608  authorized for and the sums of $75,000 from the General Revenue
 1609  Fund and $75,000 from the Medical Care Trust Fund are
 1610  appropriated to the Agency for Health Care Administration.
 1611         (2) Notwithstanding the appropriations authorized in the
 1612  General Appropriations Act for the 2010-2011 fiscal year for the
 1613  Department of Health, one full-time equivalent position is
 1614  abolished, salary rate is reduced by 52,554, and appropriations
 1615  from the General Revenue Fund are reduced on a recurring basis
 1616  by $75,000.
 1617         (3) The appropriations made in subsection (1) are
 1618  contingent upon the adjustments to appropriations made in
 1619  subsection (2) becoming law.
 1620         Section 31. Dental workforce survey.—
 1621         (1) Beginning in 2012, each person who applies for
 1622  licensure renewal as a dentist or dental hygienist under chapter
 1623  466, Florida Statutes, must, in conjunction with the renewal of
 1624  such license under procedures and forms adopted by the Board of
 1625  Dentistry and in addition to any other information that may be
 1626  required from the applicant, furnish the following information
 1627  to the Department of Health, working in conjunction with the
 1628  board, in a dental workforce survey:
 1629         (a) Licensee information, including, but not limited to:
 1630         1. The name of the dental school or dental hygiene program
 1631  that the dentist or dental hygienist graduated from and the year
 1632  of graduation.
 1633         2. The year that the dentist or dental hygienist began
 1634  practicing or working in this state.
 1635         3. The geographic location of the dentist’s or dental
 1636  hygienist’s practice or address within the state.
 1637         4. For a dentist in private practice:
 1638         a. The number of full-time dental hygienists employed by
 1639  the dentist during the reporting period.
 1640         b. The number of full-time dental assistants employed by
 1641  the dentist during the reporting period.
 1642         c. The average number of patients treated per week by the
 1643  dentist during the reporting period.
 1644         d. The settings where the dental care was delivered.
 1645         5. Anticipated plans of the dentist to change the status of
 1646  his or her license or practice.
 1647         6. The dentist’s areas of specialty or certification.
 1648         7. The year that the dentist completed a specialty program
 1649  recognized by the American Dental Association.
 1650         8. For a hygienist:
 1651         a. The average number of patients treated per week by the
 1652  hygienist during the reporting period.
 1653         b. The settings where the dental care was delivered.
 1654         9. The dentist’s memberships in professional organizations.
 1655         10. The number of pro bono hours provided by the dentist or
 1656  dental hygienist during the last biennium.
 1657         (b) Information concerning the availability and trends
 1658  relating to critically needed services, including, but not
 1659  limited to, the following types of care provided by the dentist
 1660  or dental hygienist:
 1661         1. Dental care to children having special needs.
 1662         2. Geriatric dental care.
 1663         3. Dental services in emergency departments.
 1664         4. Medicaid services.
 1665         5. Other critically needed specialty areas, as determined
 1666  by the advisory body.
 1667         (2) In addition to the completed survey, the dentist or
 1668  dental hygienist must submit a statement that the information
 1669  provided is true and accurate to the best of his or her
 1670  knowledge and belief.
 1671         (3) Beginning in 2012, renewal of a license by a dentist or
 1672  dental hygienist licensed under chapter 466, Florida Statutes,
 1673  is not contingent upon the completion and submission of the
 1674  dental workforce survey; however, for any subsequent license
 1675  renewal, the board may not renew the license of any dentist or
 1676  dental hygienist until the survey required under this section is
 1677  completed and submitted by the licensee.
 1678         (4)(a) Beginning in 2012, the Board of Dentistry shall
 1679  issue a nondisciplinary citation to any dentist or dental
 1680  hygienist licensed under chapter 466, Florida Statutes, who
 1681  fails to complete the survey within 90 days after the renewal of
 1682  his or her license to practice as a dentist or dental hygienist.
 1683         (b) The citation must notify a dentist or dental hygienist
 1684  who fails to complete the survey required by this section that
 1685  his or her license will not be renewed for any subsequent
 1686  license renewal unless the dentist or dental hygienist completes
 1687  the survey.
 1688         (c) In conjunction with issuing the license renewal notice
 1689  required by s. 456.038, Florida Statutes, the board shall notify
 1690  each dentist or dental hygienist licensed under chapter 466,
 1691  Florida Statutes, who fails to complete the survey that the
 1692  survey must be completed before the subsequent license renewal.
 1693         Section 32. (1) The Department of Health shall serve as the
 1694  coordinating body for the purpose of collecting and regularly
 1695  updating and disseminating dental workforce data. The department
 1696  shall work with multiple stakeholders, including the Florida
 1697  Dental Association and the Florida Dental Hygiene Association,
 1698  to assess and share with all communities of interest all data
 1699  collected in a timely fashion.
 1700         (2) The Department of Health shall maintain a current
 1701  database to serve as a statewide source of data concerning the
 1702  dental workforce. The department, in conjunction with the board,
 1703  shall also:
 1704         (a) Develop strategies to maximize federal and state
 1705  programs that provide incentives for dentists to practice in
 1706  shortage areas that are federally designated. Strategies shall
 1707  include programs such as the Florida Health Services Corps
 1708  established under s. 381.0302, Florida Statutes.
 1709         (b) Work in conjunction with an advisory body to address
 1710  matters relating to the state’s dental workforce. The advisory
 1711  body shall provide input on developing questions for the dentist
 1712  workforce survey. An advisory body shall include, but need not
 1713  be limited to, the State Surgeon General or his or her designee,
 1714  the dean of each dental school accredited in the United States
 1715  and based in this state or his or her designee, a representative
 1716  from the Florida Dental Association, a representative from the
 1717  Florida Dental Hygiene Association, a representative from the
 1718  Florida Board of Dentistry, and a dentist from each of the
 1719  dental specialties recognized by the American Dental
 1720  Association’s Commission on Dental Accreditation. Members of the
 1721  advisory body shall serve without compensation.
 1722         (c) Act as a clearinghouse for collecting and disseminating
 1723  information concerning the dental workforce.
 1724         (3) The Department of Health and the Board of Dentistry
 1725  shall adopt rules necessary to administer this section.
 1726         Section 33. It is the intent of the Legislature that the
 1727  Department of Health and the Board of Dentistry implement the
 1728  provisions of this act within existing resources.
 1729         Section 34. Paragraph (t) of subsection (2) of section
 1730  499.01, Florida Statutes, is amended to read:
 1731         499.01 Permits.—
 1732         (2) The following permits are established:
 1733         (t) Health care clinic establishment permit.—Effective
 1734  January 1, 2009, a health care clinic establishment permit is
 1735  required for the purchase of a prescription drug by a place of
 1736  business at one general physical location that provides health
 1737  care or veterinary services, which is owned and operated by a
 1738  business entity that has been issued a federal employer tax
 1739  identification number. For the purpose of this paragraph, the
 1740  term “qualifying practitioner” means a licensed health care
 1741  practitioner defined in s. 456.001, or a veterinarian licensed
 1742  under chapter 474, who is authorized under the appropriate
 1743  practice act to prescribe and administer a prescription drug.
 1744         1. An establishment must provide, as part of the
 1745  application required under s. 499.012, designation of a
 1746  qualifying practitioner who will be responsible for complying
 1747  with all legal and regulatory requirements related to the
 1748  purchase, recordkeeping, storage, and handling of the
 1749  prescription drugs. In addition, the designated qualifying
 1750  practitioner shall be the practitioner whose name, establishment
 1751  address, and license number is used on all distribution
 1752  documents for prescription drugs purchased or returned by the
 1753  health care clinic establishment. Upon initial appointment of a
 1754  qualifying practitioner, the qualifying practitioner and the
 1755  health care clinic establishment shall notify the department on
 1756  a form furnished by the department within 10 days after such
 1757  employment. In addition, the qualifying practitioner and health
 1758  care clinic establishment shall notify the department within 10
 1759  days after any subsequent change.
 1760         2. The health care clinic establishment must employ a
 1761  qualifying practitioner at each establishment.
 1762         3. In addition to the remedies and penalties provided in
 1763  this part, a violation of this chapter by the health care clinic
 1764  establishment or qualifying practitioner constitutes grounds for
 1765  discipline of the qualifying practitioner by the appropriate
 1766  regulatory board.
 1767         4. The purchase of prescription drugs by the health care
 1768  clinic establishment is prohibited during any period of time
 1769  when the establishment does not comply with this paragraph.
 1770         5. A health care clinic establishment permit is not a
 1771  pharmacy permit or otherwise subject to chapter 465. A health
 1772  care clinic establishment that meets the criteria of a modified
 1773  Class II institutional pharmacy under s. 465.019 is not eligible
 1774  to be permitted under this paragraph.
 1775         6. This paragraph does not apply to the purchase of a
 1776  prescription drug by a licensed practitioner under his or her
 1777  license. A professional corporation or limited liability company
 1778  composed of dentists and operating as authorized in s. 466.0285
 1779  may pay for prescription drugs obtained by a practitioner
 1780  licensed under chapter 466, and the licensed practitioner is
 1781  deemed the purchaser and owner of the prescription drugs.
 1782         Section 35. Paragraph (a) of subsection (6) of section
 1783  624.91, Florida Statutes, is amended to read:
 1784         624.91 The Florida Healthy Kids Corporation Act.—
 1785         (6) BOARD OF DIRECTORS.—
 1786         (a) The Florida Healthy Kids Corporation shall operate
 1787  subject to the supervision and approval of a board of directors
 1788  chaired by the Chief Financial Officer or her or his designee,
 1789  and composed of 12 11 other members selected for 3-year terms of
 1790  office as follows:
 1791         1. The Secretary of Health Care Administration, or his or
 1792  her designee.
 1793         2. One member appointed by the Commissioner of Education
 1794  from the Office of School Health Programs of the Florida
 1795  Department of Education.
 1796         3. One member appointed by the Chief Financial Officer from
 1797  among three members nominated by the Florida Pediatric Society.
 1798         4. One member, appointed by the Governor, who represents
 1799  the Children’s Medical Services Program.
 1800         5. One member appointed by the Chief Financial Officer from
 1801  among three members nominated by the Florida Hospital
 1802  Association.
 1803         6. One member, appointed by the Governor, who is an expert
 1804  on child health policy.
 1805         7. One member, appointed by the Chief Financial Officer,
 1806  from among three members nominated by the Florida Academy of
 1807  Family Physicians.
 1808         8. One member, appointed by the Governor, who represents
 1809  the state Medicaid program.
 1810         9. One member, appointed by the Chief Financial Officer,
 1811  from among three members nominated by the Florida Association of
 1812  Counties.
 1813         10. The State Health Officer or her or his designee.
 1814         11. The Secretary of Children and Family Services, or his
 1815  or her designee.
 1816         12. One member, appointed by the Governor, from among three
 1817  members nominated by the Florida Dental Association.
 1818         Section 36. Subsection (3) is added to section 381.00315,
 1819  Florida Statutes, to read:
 1820         381.00315 Public health advisories; public health
 1821  emergencies.—The State Health Officer is responsible for
 1822  declaring public health emergencies and issuing public health
 1823  advisories.
 1824         (3)  To facilitate effective emergency management, when the
 1825  United States Department of Health and Human Services contracts
 1826  for the manufacture and delivery of licensable products in
 1827  response to a public health emergency and the terms of those
 1828  contracts are made available to the states, the department shall
 1829  accept funds provided by cities, counties, and other entities
 1830  designated in the state emergency management plan required under
 1831  s. 252.35(2)(a) for the purpose of participation in those
 1832  contracts. The department shall deposit those funds in the
 1833  Grants and Donations Trust Fund and expend those funds on behalf
 1834  of the donor city, county, or other entity for the purchase of
 1835  the licensable products made available under the contract.
 1836         Section 37. This act shall take effect July 1, 2010.

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