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Senate Bill 2490

Senate Bill sb2490

CODING: Words stricken are deletions; words underlined are additions.
    Florida Senate - 2004                                  SB 2490

    By Senator Alexander





    17-1604-04

  1                      A bill to be entitled

  2         An act relating to health care clinics;

  3         amending s. 400.9905, F.S.; redefining the

  4         terms "clinic" and "medical director" for

  5         purposes of the Health Care Clinic Act;

  6         defining the term "mobile clinic"; amending s.

  7         400.991, F.S.; providing that entities that

  8         provide specified portable equipment are

  9         considered mobile clinics; redefining the term

10         "applicant"; amending s. 400.9935, F.S.;

11         requiring applicants who voluntarily apply to

12         the Agency for Health Care Administration for a

13         certification of exemption from licensure to

14         pay a fee; amending s. 400.995, F.S.;

15         clarifying that the agency may deny, revoke, or

16         suspend specified licenses and impose fines;

17         providing that a temporary license expires

18         after a notice of intent to deny an application

19         is issued by the agency; providing that persons

20         or entities made exempt under the act are not

21         in violation due to failure to comply with

22         certain requirements governing clinic

23         licensure; providing an effective date.

24  

25  Be It Enacted by the Legislature of the State of Florida:

26  

27         Section 1.  Subsections (3) and (4) of section

28  400.9905, Florida Statutes, are amended, and subsection (5) is

29  added to that section, to read:

30         400.9905  Definitions.--

31  

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    Florida Senate - 2004                                  SB 2490
    17-1604-04




 1         (3)  "Clinic" means an entity at which health care

 2  services are provided to individuals and which tenders charges

 3  for reimbursement for such services. For purposes of this

 4  part, the term does not include and the licensure requirements

 5  of this part do not apply to:

 6         (a)  Entities licensed or registered by the state and

 7  providing health care services within the scope of services

 8  authorized under s. 383.30, chapter 390, chapter 394, chapter

 9  395, chapter 397, this chapter except part XIII, chapter 463,

10  chapter 465, chapter 466, chapter 478, part I of chapter 483

11  chapter 480, chapter 484, or chapter 651, or end-stage renal

12  disease providers authorized under 42 C.F.R. part 405, subpart

13  U.

14         (b)  Entities that own, directly or indirectly,

15  entities licensed or registered by the state and providing

16  health care services within the scope of services authorized

17  pursuant to s. 383.30, chapter 390, chapter 394, chapter 395,

18  chapter 397, this chapter except part XIII, chapter 463,

19  chapter 465, chapter 466, chapter 478, part I of chapter 483

20  chapter 480, chapter 484, or chapter 651, or end-stage renal

21  disease providers authorized under 42 C.F.R. part 405, subpart

22  U.

23         (c)  Entities that are owned, directly or indirectly,

24  by an entity licensed or registered by the state and providing

25  health care services within the scope of services authorized

26  pursuant to s. 383.30, chapter 390, chapter 394, chapter 395,

27  chapter 397, this chapter except part XIII, chapter 463,

28  chapter 465, chapter 466, chapter 478, part I of chapter 483

29  chapter 480, chapter 484, or chapter 651, or end-stage renal

30  disease providers authorized under 42 C.F.R. part 405, subpart

31  U.

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    Florida Senate - 2004                                  SB 2490
    17-1604-04




 1         (d)  Entities that are under common ownership, directly

 2  or indirectly, with an entity licensed or registered by the

 3  state and providing health care services within the scope of

 4  services authorized pursuant to s. 383.30, chapter 390,

 5  chapter 394, chapter 395, chapter 397, this chapter except

 6  part XIII, chapter 463, chapter 465, chapter 466, chapter 478,

 7  part I of chapter 483 chapter 480, chapter 484, or chapter

 8  651, or end-stage renal disease providers authorized under 42

 9  C.F.R. part 405, subpart U.

10         (e)  An entity that is exempt from federal taxation

11  under 26 U.S.C. s. 501(c)(3) or s. 501 (c)(4), and any

12  community college or university clinic, or any entity owned or

13  operated by federal or state government, including agencies,

14  subdivisions, or municipalities thereof.

15         (f)  A sole proprietorship, group practice,

16  partnership, or corporation that provides health care services

17  by licensed health care practitioners under chapter 457,

18  chapter 458, chapter 459, chapter 460, chapter 461, chapter

19  462, chapter 463, chapter 466, chapter 467, chapter 480

20  chapter 484, chapter 486, chapter 490, chapter 491, or part I,

21  part III, part X, part XIII, or part XIV of chapter 468, or s.

22  464.012, which are wholly owned by one or more a licensed

23  health care practitioners set forth in this paragraph

24  practitioner, or the licensed health care practitioner and the

25  spouse, parent, or child of a licensed health care

26  practitioner, so long as one of the owners who is a licensed

27  health care practitioner is supervising the services performed

28  therein and is legally responsible for the entity's compliance

29  with all federal and state laws. However, a health care

30  practitioner may not supervise services beyond the scope of

31  the practitioner's license.

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    Florida Senate - 2004                                  SB 2490
    17-1604-04




 1         (g)  Clinical facilities affiliated with an accredited

 2  medical school at which training is provided for medical

 3  students, residents, or fellows.

 4         (4)  "Medical director" means a physician who is

 5  employed or under contract with a clinic and who maintains a

 6  full and unencumbered physician license in accordance with

 7  chapter 458, chapter 459, chapter 460, or chapter 461.

 8  However, if the clinic does not provide services pursuant to

 9  the respective physician practices listed in this subsection,

10  it is limited to providing health care services pursuant to

11  chapter 457, chapter 484, chapter 486, chapter 490, or chapter

12  491 or part I, part III, part X, part XIII, or part XIV of

13  chapter 468, the clinic may appoint a health care practitioner

14  licensed under another health care practice that chapter to

15  serve as a clinic director who is responsible for the clinic's

16  activities. A health care practitioner may not serve as the

17  clinic director if the services provided at the clinic are

18  beyond the scope of that practitioner's license.

19         (5)  "Mobile clinic" means a movable or detached

20  self-contained health care unit within or from which direct

21  health care services are provided to individuals and which

22  otherwise meets the definition of a clinic in subsection (3).

23  Each mobile clinic must obtain a separate health care clinic

24  license.

25         Section 2.  Subsections (1) and (7) of section 400.991,

26  Florida Statutes, are amended to read:

27         400.991  License requirements; background screenings;

28  prohibitions.--

29         (1)  Each clinic, as defined in s. 400.9905, must be

30  licensed and shall at all times maintain a valid license with

31  the agency. Each clinic location shall be licensed separately

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    Florida Senate - 2004                                  SB 2490
    17-1604-04




 1  regardless of whether the clinic is operated under the same

 2  business name or management as another clinic. Mobile clinics

 3  must provide to the agency, at least quarterly, their

 4  projected street locations to enable the agency to locate and

 5  inspect such clinics. Entities that contract with or employ

 6  persons to provide portable equipment to multiple locations

 7  performing treatment or diagnostic testing of individuals and

 8  that bill third-party payers for those services are considered

 9  mobile clinics having a single administrative office and are

10  not required to submit quarterly projected street locations.

11         (7)  Each applicant for licensure shall comply with the

12  following requirements:

13         (a)  As used in this subsection, the term "applicant"

14  means individuals owning or controlling, directly or

15  indirectly, 5 percent or more of an interest in a clinic; the

16  medical or clinic director, or a similarly titled person who

17  is responsible for the day-to-day operation of the licensed

18  clinic; the financial officer or similarly titled individual

19  who is responsible for the financial operation of the clinic;

20  and licensed health care practitioners medical providers at

21  the clinic.

22         (b)  Upon receipt of a completed, signed, and dated

23  application, the agency shall require background screening of

24  the applicant, in accordance with the level 2 standards for

25  screening set forth in chapter 435. Proof of compliance with

26  the level 2 background screening requirements of chapter 435

27  which has been submitted within the previous 5 years in

28  compliance with any other health care licensure requirements

29  of this state is acceptable in fulfillment of this paragraph.

30         (c)  Each applicant must submit to the agency, with the

31  application, a description and explanation of any exclusions,

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    Florida Senate - 2004                                  SB 2490
    17-1604-04




 1  permanent suspensions, or terminations of an applicant from

 2  the Medicare or Medicaid programs. Proof of compliance with

 3  the requirements for disclosure of ownership and control

 4  interest under the Medicaid or Medicare programs may be

 5  accepted in lieu of this submission. The description and

 6  explanation may indicate whether such exclusions, suspensions,

 7  or terminations were voluntary or not voluntary on the part of

 8  the applicant.

 9         (d)  A license may not be granted to a clinic if the

10  applicant has been found guilty of, regardless of

11  adjudication, or has entered a plea of nolo contendere or

12  guilty to, any offense prohibited under the level 2 standards

13  for screening set forth in chapter 435, or a violation of

14  insurance fraud under s. 817.234, within the past 5 years. If

15  the applicant has been convicted of an offense prohibited

16  under the level 2 standards or insurance fraud in any

17  jurisdiction, the applicant must show that his or her civil

18  rights have been restored prior to submitting an application.

19         (e)  The agency may deny or revoke licensure if the

20  applicant has falsely represented any material fact or omitted

21  any material fact from the application required by this part.

22         Section 3.  Subsections (9) and (11) of section

23  400.9935, Florida Statutes, are amended to read:

24         400.9935  Clinic responsibilities.--

25         (9)  Any person or entity providing health care

26  services which is not a clinic, as defined under s. 400.9905,

27  may voluntarily apply for a certificate of exemption from

28  licensure under its exempt status with the agency on a form

29  that sets forth its name or names and addresses, a statement

30  of the reasons why it cannot be defined as a clinic, and other

31  information deemed necessary by the agency. The applicant

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    Florida Senate - 2004                                  SB 2490
    17-1604-04




 1  shall pay a nonrefundable fee of $200 for a certificate of

 2  exemption. An exemption is not transferable.

 3         (11)(a)  Each clinic engaged in magnetic resonance

 4  imaging services must be accredited by the Joint Commission on

 5  Accreditation of Healthcare Organizations, the American

 6  College of Radiology, or the Accreditation Association for

 7  Ambulatory Health Care, within 1 year after licensure.

 8  However, a clinic may request a single, 6-month extension if

 9  it provides evidence to the agency establishing that, for good

10  cause shown, such clinic can not be accredited within 1 year

11  after licensure, and that such accreditation will be completed

12  within the 6-month extension. After obtaining accreditation as

13  required by this subsection, each such clinic must maintain

14  accreditation as a condition of renewal of its license.

15         (b)  The agency may deny disallow the application or

16  revoke the license of any entity formed for the purpose of

17  avoiding compliance with the accreditation provisions of this

18  subsection and whose principals were previously principals of

19  an entity that was unable to meet the accreditation

20  requirements within the specified timeframes. The agency may

21  adopt rules as to the accreditation of magnetic resonance

22  imaging clinics.

23         Section 4.  Subsections (1) and (3) of section 400.995,

24  Florida Statutes, are amended, and subsection (10) is added to

25  that section, to read:

26         400.995  Agency administrative penalties.--

27         (1)  The agency may deny the application for a license

28  renewal, revoke or suspend the license, and impose

29  administrative fines penalties against clinics of up to $5,000

30  per violation for violations of the requirements of this part

31  or rules of the agency. In determining if a penalty is to be

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    Florida Senate - 2004                                  SB 2490
    17-1604-04




 1  imposed and in fixing the amount of the fine, the agency shall

 2  consider the following factors:

 3         (a)  The gravity of the violation, including the

 4  probability that death or serious physical or emotional harm

 5  to a patient will result or has resulted, the severity of the

 6  action or potential harm, and the extent to which the

 7  provisions of the applicable laws or rules were violated.

 8         (b)  Actions taken by the owner, medical director, or

 9  clinic director to correct violations.

10         (c)  Any previous violations.

11         (d)  The financial benefit to the clinic of committing

12  or continuing the violation.

13         (3)  Any action taken to correct a violation shall be

14  documented in writing by the owner, medical director, or

15  clinic director of the clinic and verified through followup

16  visits by agency personnel. The agency may impose a fine and,

17  in the case of an owner-operated clinic, revoke or deny a

18  clinic's license when a clinic medical director or clinic

19  director knowingly fraudulently misrepresents actions taken to

20  correct a violation.

21         (10)  If the agency issues a notice of intent to deny a

22  license application after a temporary license has been issued

23  pursuant to s. 400.991(3), the temporary license shall expire

24  on the date of the notice and may not be extended during any

25  proceeding for administrative or judicial review pursuant to

26  chapter 120.

27         Section 5.  Any person or entity made exempt from the

28  definition of "clinic" under section 400.9905, Florida

29  Statutes, by the amendment made to that section by this act

30  shall not be in violation of the provisions of part XIII of

31  chapter 400, Florida Statutes, due to failure to apply for a

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    Florida Senate - 2004                                  SB 2490
    17-1604-04




 1  clinic license by March 1, 2003, or otherwise failing to

 2  comply with the provisions of that part.

 3         Section 6.  This act shall take effect July 1, 2004.

 4  

 5            *****************************************

 6                          SENATE SUMMARY

 7    Revises various provisions of the Health Care Clinic Act.
      Clarifies the definition of the term "clinic" and defines
 8    the term "mobile clinic" for purposes of the act.
      Provides a nonrefundable fee of $200 for a certificate of
 9    exemption from licensure. Provides for a temporary
      license to expire after the Agency for Health Care
10    Administration issues a notice of intent to deny
      licensure. (See bill for details.)
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