Florida Senate - 2024 SB 1404



By Senator Jones





34-00450A-24 20241404__
1 A bill to be entitled
2 An act relating to the Health Care Freedom Act;
3 providing a short title; repealing ss. 286.31,
4 286.311, and 381.00321, F.S., relating to the
5 prohibited use of state funds for travel to another
6 state for purpose of abortion services, the prohibited
7 use of state funds for sex-reassignment prescriptions
8 or procedures, and the right of medical conscience of
9 health care providers and health care payors,
10 respectively; creating s. 381.027, F.S.; providing a
11 short title; defining terms; requiring a covered
12 entity to adopt a policy relating to providing notice
13 of its refused services by a specified date; providing
14 requirements for such notice; requiring a covered
15 entity to submit a complete list of refused services
16 to the Department of Health by a specified date;
17 requiring a covered entity to notify the department
18 within a specified period after a change is made to
19 such list; requiring a covered entity to submit the
20 list, along with its application, if applying for
21 certain state grants or contracts; providing a civil
22 penalty; requiring the department to adopt rules;
23 requiring the department to publish and maintain on
24 its website a current list of covered entities and
25 their refused services; requiring the department to
26 develop and administer a certain public education and
27 awareness program; providing construction; providing
28 for severability; amending s. 381.96, F.S.; revising
29 the definition of the term “eligible client” and
30 defining the term “pregnancy support services,” rather
31 than “pregnancy and parenting support services”;
32 revising department duties and contract requirements
33 to conform to changes made by the act; repealing ss.
34 4, 6, and 7 of chapter 2023-21, Laws of Florida,
35 relating to termination of pregnancies, powers of the
36 Agency for Health Care Administration, and the use of
37 telehealth to provide services, respectively; amending
38 s. 390.011, F.S.; deleting the definition of the term
39 “fatal fetal abnormality”; amending s. 390.0111, F.S.;
40 revising the timeframe in which a physician may
41 perform a termination of pregnancy; revising
42 exceptions; repealing s. 395.3027, F.S., relating to
43 patient immigration status data collection in
44 hospitals; amending s. 409.905, F.S.; defining the
45 terms “gender identity” and “transgender individual”;
46 requiring the agency to provide Medicaid reimbursement
47 for medically necessary treatment for or related to
48 gender dysphoria or comparable or equivalent
49 diagnoses; prohibiting the agency from discriminating
50 in its reimbursement on the basis of a recipient’s
51 gender identity or that the recipient is a transgender
52 individual; amending s. 456.001, F.S.; deleting the
53 definition of the terms “sex” and “sex-reassignment
54 prescriptions or procedures”; repealing ss. 456.52 and
55 766.318, F.S., relating to sex-reassignment
56 prescriptions and procedures and civil liability for
57 provision of sex-reassignment prescriptions or
58 procedures to minors, respectively; amending ss.
59 61.517, 61.534, 409.908, 409.913, 456.074, and
60 636.0145, F.S.; conforming provisions and cross
61 references to changes made by the act; providing an
62 effective date.
63
64 Be It Enacted by the Legislature of the State of Florida:
65
66 Section 1. This act may be cited as the “Health Care
67 Freedom Act.”
68 Section 2. Section 286.31, Florida Statutes, is repealed.
69 Section 3. Section 286.311, Florida Statutes, is repealed.
70 Section 4. Section 381.00321, Florida Statutes, is
71 repealed.
72 Section 5. Section 381.027, Florida Statutes, is created to
73 read:
74 381.027 Requirements for covered entities; notice of
75 refused services; department duties.—
76 (1) SHORT TITLE.—This section may be cited as the “Health
77 Care Transparency and Accessibility Act.”
78 (2) DEFINITIONS.—As used in this section, the term:
79 (a) “Covered entity” means any health care facility that
80 uses, plans to use, or relies upon a denial of care provision to
81 refuse to provide a health care service, or referral for a
82 health care service, for any reason. The term does not include a
83 health care practitioner.
84 (b) “Denial of care provision” means any federal or state
85 law that purports or is asserted to allow a health care facility
86 to opt out of providing a health care service, or referral for a
87 health care service, including, but not limited to, ss.
88 381.0051(5), 390.0111(8), 483.918, and 765.1105; 42 U.S.C. ss.
89 18023(b)(4) and 18113; 42 U.S.C. s. 300a-7; 42 U.S.C. s. 238n;
90 42 U.S.C. s. 2000bb et seq.; s. 507(d) of the Departments of
91 Labor, Health and Human Services, and Education, and Related
92 Agencies Appropriations Act of 2019, Division B of Pub. L. No.
93 115-245; and 45 C.F.R. part 88.
94 (c) “Department” means the Department of Health.
95 (d) “Health care facility” has the same meaning as in s.
96 381.026(2).
97 (e) “Health care practitioner” has the same meaning as in
98 s. 456.001.
99 (f) “Health care services” has the same meaning as in s.
100 624.27(1).
101 (g) “Referral” has the same meaning as in s. 456.053(3).
102 (h) “Refused service” means a health care service that a
103 covered entity chooses not to provide, or not to provide a
104 referral for, based on one or more denials of care provisions.
105 The term includes health care services that the covered entity
106 selectively provides to some, but not all, patients based on
107 their identity, objections to a health care service, or other
108 nonmedical reasons.
109 (3) REQUIREMENTS FOR COVERED ENTITIES; PENALTY.—
110 (a) By October 1, 2024, each covered entity shall adopt a
111 policy for providing patients with a complete list of its
112 refused services. A covered entity shall:
113 1. Provide written notice to the patient or the patient’s
114 representative which includes the complete list of its refused
115 services before any health care service is initiated.
116 a. In the case of an emergency, the covered entity must
117 promptly provide written notice after the patient is capable of
118 receiving such notice or when the patient’s representative is
119 available.
120 b. The patient or patient’s representative shall
121 acknowledge receipt of the written notice of refused services.
122 2. Retain all acknowledgements of receipt of the written
123 notice of refused services for a period of at least 3 years.
124 3. Provide a complete list of its refused services to any
125 person upon request.
126 (b) By October 1, 2024, a covered entity shall submit to
127 the department a complete list of its refused services. If any
128 change is made to the list, the covered entity must notify the
129 department within 30 days after making the change.
130 (c) If applying for any state grant or contract related to
131 providing a health care service, a covered entity must submit,
132 along with its application, a complete list of its refused
133 services.
134 (d) A covered entity that fails to comply with this
135 subsection is subject to a fine not exceeding $5,000 for each
136 day the covered entity is not in compliance.
137 (4) DEPARTMENT DUTIES.—
138 (a) The department shall adopt rules to implement this
139 section, which must include a process for receiving and
140 investigating complaints regarding covered entities that fail to
141 comply with this section.
142 (b) By January 1, 2025, the department shall publish and
143 maintain on its website a current list of covered entities and
144 the refused services for each covered entity.
145 (c) The department shall develop and administer a public
146 education and awareness program regarding the denial of health
147 care services, including how the denial of health care services
148 can negatively impact health care access and quality, how the
149 denial of health care services may be avoided, and how the
150 denial of health care services affects vulnerable people and
151 communities.
152 (5) CONSTRUCTION.—
153 (a) This section does not authorize denials of health care
154 services or discrimination in the provision of health care
155 services.
156 (b) This section does not limit any cause of action under
157 state or federal law, or limit any remedy in law or equity,
158 against a health care facility or health care practitioner.
159 (c) Compliance with this section does not reduce or limit
160 any potential liability for covered entities associated with the
161 refused services or any violations of state or federal law.
162 (d) Section 761.03 does not provide a claim relating to, or
163 a defense to a claim under, this section, or provide a basis for
164 challenging the application or enforcement of this section or
165 the use of funds associated with the application or enforcement
166 of this section.
167 (6) SEVERABILITY.—If any provision of this section or its
168 application to any person or circumstance is held invalid, the
169 invalidity does not affect other provisions or applications of
170 this section which can be given effect without the invalid
171 provision or application, and to this end the provisions of this
172 section are severable.
173 Section 6. Section 381.96, Florida Statutes, is amended to
174 read:
175 381.96 Pregnancy support and wellness services.—
176 (1) DEFINITIONS.—As used in this section, the term:
177 (a) “Department” means the Department of Health.
178 (b) “Eligible client” means any of the following:
179 1. a pregnant woman or a woman who suspects she is
180 pregnant, and the family of such woman, who voluntarily seeks
181 pregnancy support services and any woman who voluntarily seeks
182 wellness services.
183 2. A woman who has given birth in the previous 12 months
184 and her family.
185 3. A parent or parents or a legal guardian or legal
186 guardians, and the families of such parents and legal guardians,
187 for up to 12 months after the birth of a child or the adoption
188 of a child younger than 3 years of age.
189 (c) “Florida Pregnancy Care Network, Inc.,” or “network”
190 means the not-for-profit statewide alliance of pregnancy support
191 organizations that provide pregnancy support and wellness
192 services through a comprehensive system of care to women and
193 their families.
194 (d) “Pregnancy and parenting support services” means
195 services that promote and encourage childbirth, including, but
196 not limited to:
197 1. Direct client services, such as pregnancy testing,
198 counseling, referral, training, and education for pregnant women
199 and their families. A woman and her family continue to be
200 eligible to receive direct client services for up to 12 months
201 after the birth of the child.
202 2. Nonmedical material assistance that improves the
203 pregnancy or parenting situation of families, including, but not
204 limited to, clothing, car seats, cribs, formula, and diapers.
205 3. Counseling or mentoring, education materials, and
206 classes regarding pregnancy, parenting, adoption, life skills,
207 and employment readiness.
208 4. Network awareness activities, including a promotional
209 campaign to educate the public about the pregnancy support
210 services offered by the network and a website that provides
211 information on the location of providers in the user’s area and
212 other available community resources.
213 3.5. Communication activities, including the operation and
214 maintenance of a hotline or call center with a single statewide
215 toll-free number that is available 24 hours a day for an
216 eligible client to obtain the location and contact information
217 for a pregnancy center located in the client’s area.
218 (e) “Wellness services” means services or activities
219 intended to maintain and improve health or prevent illness and
220 injury, including, but not limited to, high blood pressure
221 screening, anemia testing, thyroid screening, cholesterol
222 screening, diabetes screening, and assistance with smoking
223 cessation.
224 (2) DEPARTMENT DUTIES.—The department shall contract with
225 the network for the management and delivery of pregnancy and
226 parenting support services and wellness services to eligible
227 clients.
228 (3) CONTRACT REQUIREMENTS.—The department contract shall
229 specify the contract deliverables, including financial reports
230 and other reports due to the department, timeframes for
231 achieving contractual obligations, and any other requirements
232 the department determines are necessary, such as staffing and
233 location requirements. The contract shall require the network
234 to:
235 (a) Establish, implement, and monitor a comprehensive
236 system of care through subcontractors to meet the pregnancy and
237 parenting support and wellness needs of eligible clients.
238 (b) Establish and manage subcontracts with a sufficient
239 number of providers to ensure the availability of pregnancy and
240 parenting support services and wellness services for eligible
241 clients, and maintain and manage the delivery of such services
242 throughout the contract period.
243 (c) Spend at least 90 85 percent of the contract funds on
244 pregnancy and parenting support services, excluding services
245 specified in subparagraph (1)(d)4., and wellness services.
246 (d) Offer wellness services through vouchers or other
247 appropriate arrangements that allow the purchase of services
248 from qualified health care providers.
249 (e) Require a background screening under s. 943.0542 for
250 all paid staff and volunteers of a subcontractor if such staff
251 or volunteers provide direct client services to an eligible
252 client who is a minor or an elderly person or who has a
253 disability.
254 (f) Annually monitor its subcontractors and specify the
255 sanctions that shall be imposed for noncompliance with the terms
256 of a subcontract.
257 (g) Subcontract only with providers that exclusively
258 promote and support childbirth.
259 (h) Ensure that informational materials provided to an
260 eligible client by a provider are current and accurate and cite
261 the reference source of any medical statement included in such
262 materials.
263 (i) Ensure that the department is provided with all
264 information necessary for the report required under subsection
265 (5).
266 (4) SERVICES.—Services provided pursuant to this section
267 must be provided in a noncoercive manner and may not include any
268 religious content.
269 (5) REPORT.—By July 1, 2024, and each year thereafter, the
270 department shall report to the Governor, the President of the
271 Senate, and the Speaker of the House of Representatives on the
272 amount and types of services provided by the network; the
273 expenditures for such services; and the number of, and
274 demographic information for, women, parents, and families served
275 by the network.
276 Section 7. Sections 4, 6, and 7 of chapter 2023-21, Laws of
277 Florida, are repealed.
278 Section 8. Subsection (6) of section 390.011, Florida
279 Statutes, is amended to read:
280 390.011 Definitions.—As used in this chapter, the term:
281 (6) “Fatal fetal abnormality” means a terminal condition
282 that, in reasonable medical judgment, regardless of the
283 provision of life-saving medical treatment, is incompatible with
284 life outside the womb and will result in death upon birth or
285 imminently thereafter.
286 Section 9. Subsection (1) of section 390.0111, Florida
287 Statutes, is amended to read:
288 390.0111 Termination of pregnancies.—
289 (1) TERMINATION IN THIRD TRIMESTER AFTER GESTATIONAL AGE OF
290 15 WEEKS; WHEN ALLOWED.—A physician may not perform a
291 termination of pregnancy on any human being in the third
292 trimester of pregnancy if the physician determines the
293 gestational age of the fetus is more than 15 weeks unless one of
294 the following conditions is met:
295 (a) Two physicians certify in writing that, in reasonable