FL H0731

Nursing home and facility inspections overhauled: Nursing home inspections shift from every 15 months to periodic unannounced visits, with biannual surveys triggered by three or more substantiated complaints (each with Class I or Class II deficiencies) within six months, carrying a $6,000 fine per biannual survey cycle. Low-risk nonresidential providers (nurse registries, home medical equipment providers, health care clinics) are exempt from initial inspection if they have excellent regulatory histories, with the agency conducting unannounced inspections on at least 10% of exempt providers. Relicensure inspections default to biennial, and the agency gains authority to waive or extend inspection intervals based on quality measures and accreditation.

Health care price transparency requirements enacted: Effective January 1, 2021, AHCA must publish an annual report by July 1 identifying health care services with the most significant price variation statewide and regionally. Health care clinics must publish a schedule of charges including prices for uninsured patients, and urgent care centers must conspicuously post their top 50 most frequently provided services on signage of at least 15 square feet or a 3-square-foot electronic board, with fines up to $1,000 per day for noncompliance.

Shared savings incentive programs expanded: Effective January 1, 2021, shoppable health care service definitions for both health insurers and HMOs are broadened to include telehealth services, prescription drugs, and services identified by AHCA as having the most significant price variation. Incentives may be credited as premium reductions, deposited into HSA/FSA/HRA accounts, or paid directly as cash or cash equivalents, at least quarterly.

Medicaid managed care and dental contracts extended: Beginning with the 2023 procurement cycle, managed care plan contracts increase from 5 to 6 years. Existing contracts awarded under the July 2017 invitation to negotiate must be extended through December 31, 2024. Prepaid dental health program contracts are similarly extended to 6 years, with current contracts (October 2017 ITN) running through December 31, 2024.

Medicaid program integrity and provider screening strengthened: The joint fraud and abuse report deadline shifts from January 1 to January 15, with entities reporting separately. The agency may recover costs from enforcement actions in addition to audits and investigations, including attorney fees for uncontested findings or cases where the agency prevailed. Level 2 background screenings must be conducted through the agency on providers, principals with 5%+ ownership, and persons with direct access to recipients, with rescreening required every 5 years.

Hospital quality and cardiac program requirements added: Hospitals with Level I or Level II adult cardiovascular services must participate in the ACC's National Cardiovascular Data Registry or AHA's Get with the Guidelines–Coronary Artery Disease registry and maintain an ongoing quality improvement plan meeting national benchmarks. Level II hospitals must also participate in Society for Thoracic Surgeons clinical outcome reporting.

Home health agency licensure and definitions revised: The definition of "home health agency" changes from "an organization" to "a person," staffing services are removed from the definition, and new licensure exemptions are added for individual health care professionals acting within their scope, home health aides or CNAs acting individually, and persons providing services using only volunteers or family members. Initial licensure applicants must document accreditation within 120 days and continuously maintain it.

Health care clinic licensure exemptions expanded: Three new exemptions are created for entities under common ownership with a mutual insurance holding company entity having $1 billion+ in total annual Florida sales; entities owned by behavioral health providers operating in 5+ states with $90 million+ in annual behavioral health revenues; and Medicaid providers.

Rural hospital designations extended and assessments repealed: The rural hospital designation deadline is extended from June 30, 2021, to June 30, 2025, for hospitals licensed as rural during 2010–2012 fiscal years with 100 or fewer beds and an emergency room. Section 395.7015 (annual assessment on health care entities) is repealed, and Part I of chapter 483 (Multiphasic Health Testing Center Law) is also repealed with conforming cross-reference updates throughout.

Cancer center, birth center, and hospice reporting updated: Tier 3 cancer center participation may not extend beyond June 30, 2024, replacing the prior 6-year limit. Birth centers must report maternal deaths, newborn deaths, and stillbirths to both the medical examiner and the agency, with reporting frequency set by rule rather than annually. Annual hospice inspection and data reporting requirements are removed in favor of inspections under s. 408.811.