October 22, 2020
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Bill No. 1935
Amendment No. 487279
Senate House

1Representative(s) Holloway offered the following:
3     Amendment (with title amendment)
4     Remove everything after the enacting clause and insert:
5     Section 1.  Paragraph (a) of subsection (1) and subsection
6(4) of section 408.061, Florida Statutes, are amended to read:
7     408.061  Data collection; uniform systems of financial
8reporting; information relating to physician charges;
9confidential information; immunity.--
10     (1)  The agency shall require the submission by health care
11facilities, health care providers, and health insurers of data
12necessary to carry out the agency's duties. Specifications for
13data to be collected under this section shall be developed by
14the agency with the assistance of technical advisory panels
15including representatives of affected entities, consumers,
16purchasers, and such other interested parties as may be
17determined by the agency.
18     (a)  Data submitted by health care facilities, including
19the facilities as defined in chapter 395, shall include, but are
20not limited to: case-mix data, patient admission and discharge
21data, hospital emergency department data which shall include the
22number of patients treated in the emergency department of a
23licensed hospital reported by patient acuity level, data on
24hospital-acquired infections as specified by rule, data on the
25number of patients assigned to each direct care registered nurse
26in each unit of the facility for each shift, data on
27complications as specified by rule, data on readmissions as
28specified by rule, with patient and provider-specific
29identifiers included, actual charge data by diagnostic groups,
30financial data, accounting data, operating expenses, expenses
31incurred for rendering services to patients who cannot or do not
32pay, interest charges, depreciation expenses based on the
33expected useful life of the property and equipment involved, and
34demographic data. The agency shall adopt nationally recognized
35risk adjustment methodologies or software consistent with the
36standards of the Agency for Healthcare Research and Quality and
37as selected by the agency for all data submitted as required by
38this section. Data may be obtained from documents such as, but
39not limited to: leases, contracts, debt instruments, itemized
40patient bills, medical record abstracts, and related diagnostic
41information. Reported data elements shall be reported
42electronically in accordance with rule 59E-7.012, Florida
43Administrative Code. Data submitted shall be certified by the
44chief executive officer or an appropriate and duly authorized
45representative or employee of the licensed facility that the
46information submitted is true and accurate.
48     (4)  Within 120 days after the end of its fiscal year, each
49health care facility, excluding continuing care facilities and
50nursing homes as defined in s. 408.07(14) and (37) (36), shall
51file with the agency, on forms adopted by the agency and based
52on the uniform system of financial reporting, its actual
53financial experience for that fiscal year, including
54expenditures, revenues, and statistical measures. Such data may
55be based on internal financial reports which are certified to be
56complete and accurate by the provider. However, hospitals'
57actual financial experience shall be their audited actual
58experience. Every nursing home shall submit to the agency, in a
59format designated by the agency, a statistical profile of the
60nursing home residents. The agency, in conjunction with the
61Department of Elderly Affairs and the Department of Health,
62shall review these statistical profiles and develop
63recommendations for the types of residents who might more
64appropriately be placed in their homes or other noninstitutional
66     Section 2.  Paragraph (j) of subsection (1) of section
67408.062, Florida Statutes, is amended to read:
68     408.062  Research, analyses, studies, and reports.--
69     (1)  The agency shall conduct research, analyses, and
70studies relating to health care costs and access to and quality
71of health care services as access and quality are affected by
72changes in health care costs. Such research, analyses, and
73studies shall include, but not be limited to:
74     (j)  The making available on its Internet website no later
75than October 1, 2004, and in a hard-copy format upon request, of
76the number of patients assigned per direct care registered nurse
77and patient charge, volumes, length of stay, and performance
78outcome indicators collected from health care facilities
79pursuant to s. 408.061(1)(a) for specific medical conditions,
80surgeries, and procedures provided in inpatient and outpatient
81facilities as determined by the agency. In making the
82determination of specific medical conditions, surgeries, and
83procedures to include, the agency shall consider such factors as
84volume, severity of the illness, urgency of admission,
85individual and societal costs, and whether the condition is
86acute or chronic. Performance outcome indicators shall be risk
87adjusted or severity adjusted, as applicable, using nationally
88recognized risk adjustment methodologies or software consistent
89with the standards of the Agency for Healthcare Research and
90Quality and as selected by the agency. The website shall also
91provide an interactive search that allows consumers to view and
92compare the information for specific facilities, a map that
93allows consumers to select a county or region, definitions of
94all of the data, descriptions of each procedure, and an
95explanation about why the data may differ from facility to
96facility. Such public data shall be updated quarterly. The
97agency shall submit an annual status report on the collection of
98data and publication of performance outcome indicators to the
99Governor, the Speaker of the House of Representatives, the
100President of the Senate, and the substantive legislative
101committees with the first status report due January 1, 2005.
102     Section 3.  Subsection (2) of section 408.063, Florida
103Statutes, is amended to read:
104     408.063  Dissemination of health care information.--
105     (2)  The agency shall publish and disseminate information
106to the public which will enhance informed decisionmaking in the
107selection of health care providers, facilities, and services.  
108Such publications may identify average charges for specified
109services, average number of patients assigned to each direct
110care nurse in each unit of the hospital, lengths of stay
111associated with established diagnostic groups, readmission
112rates, mortality rates, recommended guidelines for selection and
113use of health care providers, health care facilities, and health
114care services, and such other information as the agency deems
116     Section 4.  Present subsections (18) through (44) of
117section 408.07, Florida Statutes, are renumbered as subsections
118(19) through (45), respectively, and a new subsection (18) is
119added to said section to read:
120     408.07  Definitions.--As used in this chapter, with the
121exception of ss. 408.031-408.045, the term:
122     (18)  "Direct care registered nurse" or "direct care nurse"
123means a registered nurse who has direct responsibility for
124overseeing or carrying out medical regimens or nursing care for
125one or more patients. A nurse administrator, nurse supervisor,
126nurse educator, charge nurse, or other registered nurse who does
127not have a specific patient assignment may not be included in
128the calculation of the number of patients assigned to each
129direct care registered nurse on a unit.
130     Section 5.  Subsection (24) of section 395.002, Florida
131Statutes, is amended to read:
132     395.002  Definitions.--As used in this chapter:
133     (24)  "Premises" means those buildings, beds, and equipment
134located at the address of the licensed facility and all other
135buildings, beds, and equipment for the provision of hospital,
136ambulatory surgical, or mobile surgical care located in such
137reasonable proximity to the address of the licensed facility as
138to appear to the public to be under the dominion and control of
139the licensee. For any licensee that is a teaching hospital as
140defined in s. 408.07(45)(44), reasonable proximity includes any
141buildings, beds, services, programs, and equipment under the
142dominion and control of the licensee that are located at a site
143with a main address that is within 1 mile of the main address of
144the licensed facility; and all such buildings, beds, and
145equipment may, at the request of a licensee or applicant, be
146included on the facility license as a single premises.
147     Section 6.  Paragraph (e) of subsection (2) of section
148395.003, Florida Statutes, is amended to read:
149     395.003  Licensure; issuance, renewal, denial,
150modification, suspension, and revocation.--
151     (2)
152     (e)  The agency shall, at the request of a licensee that is
153a teaching hospital as defined in s. 408.07(45)(44), issue a
154single license to a licensee for facilities that have been
155previously licensed as separate premises, provided such
156separately licensed facilities, taken together, constitute the
157same premises as defined in s. 395.002(24). Such license for the
158single premises shall include all of the beds, services, and
159programs that were previously included on the licenses for the
160separate premises. The granting of a single license under this
161paragraph shall not in any manner reduce the number of beds,
162services, or programs operated by the licensee.
163     Section 7.  Subsection (1) of section 458.345, Florida
164Statutes, is amended to read:
165     458.345  Registration of resident physicians, interns, and
166fellows; list of hospital employees; prescribing of medicinal
167drugs; penalty.--
168     (1)  Any person desiring to practice as a resident
169physician, assistant resident physician, house physician,
170intern, or fellow in fellowship training which leads to
171subspecialty board certification in this state, or any person
172desiring to practice as a resident physician, assistant resident
173physician, house physician, intern, or fellow in fellowship
174training in a teaching hospital in this state as defined in s.
175408.07(45)(44) or s. 395.805(2), who does not hold a valid,
176active license issued under this chapter shall apply to the
177department to be registered and shall remit a fee not to exceed
178$300 as set by the board. The department shall register any
179applicant the board certifies has met the following
181     (a)  Is at least 21 years of age.
182     (b)  Has not committed any act or offense within or without
183the state which would constitute the basis for refusal to
184certify an application for licensure pursuant to s. 458.331.
185     (c)  Is a graduate of a medical school or college as
186specified in s. 458.311(1)(f).
187     Section 8.  Subsection (1) of section 459.021, Florida
188Statutes, is amended to read:
189     459.021  Registration of resident physicians, interns, and
190fellows; list of hospital employees; penalty.--
191     (1)  Any person who holds a degree of Doctor of Osteopathic
192Medicine from a college of osteopathic medicine recognized and
193approved by the American Osteopathic Association who desires to
194practice as a resident physician, assistant resident physician,
195house physician, intern, or fellow in fellowship training which
196leads to subspecialty board certification in this state, or any
197person desiring to practice as a resident physician, assistant
198resident physician, house physician, intern, or fellow in
199fellowship training in a teaching hospital in this state as
200defined in s. 408.07(45)(44) or s. 395.805(2), who does not hold
201an active license issued under this chapter shall apply to the
202department to be registered, on an application provided by the
203department, within 30 days of commencing such a training program
204and shall remit a fee not to exceed $300 as set by the board.
205     Section 9.  This act shall take effect July 1, 2005.
207================= T I T L E  A M E N D M E N T =================
208     Remove the entire title and insert:
A bill to be entitled
210An act relating to health care administration; amending
211ss. 408.061, 408.062, and 408.063, F.S.; requiring that
212data relating to the number of patients per direct care
213nurse be reported to the Agency for Health Care
214Administration and made available to the public; amending
215s. 408.07, F.S.; defining the synonymous terms "direct
216care registered nurse" and "direct care nurse" as used in
217ch. 408, F.S., except ss. 408.031-408.045, F.S.; amending
218ss. 395.002, 395.003, 458.345, and 459.021, F.S.;
219correcting cross references; providing an effective date.

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