In the dying minutes of the 1999 session , the Florida legislature amended the Florida Patient Self-referral Act (the "Act") by adding two new definitions that are intended to clarify application of the Act, and by amending the in-office ancillary exception under the Act.
First, "direct supervision" is now defined to mean "supervision by a physician who is present in the office suite and immediately available to provide assistance and direction throughout the time services are being performed." Brief unexpected absences are permitted, as are routine absences of a "short duration." The amount of supervision must be consistent with the Medicare program's requirements for physician supervision. Second, "diagnostic imaging services," is now defined to include MRI, nuclear medicine, angiography, arteriography, computer tomography, PET scanning, digital vascular imaging, bronchography, lymphangiography, splenography, ultrasound, EEG, EKG, nerve conduction studies, and evoked potentials." This is a very important definition because previously this designated health service was undefined. This new definition for diagnostic imaging services is significant because it is probably more inclusive that what most people believed it to be prior to the amendment.
During the 1999 legislative session, the Florida legislature also amended the in-office ancillary exception. Effective July 1, 1999, physicians may refer patients to a sole provider or group practice for diagnostic imaging services, other than radiation therapy services, if the sole provider or group practice bills both a technical and professional fee on behalf of the patient and if the referring physician has no investment interest in the practice. The diagnostic imaging service must be one that is normally provided within the scope of practice to the patients of the group practice or sole provider. Group practices or sole providers may accept no more than 15% of their patients receiving diagnostic imaging services from outside referral sources, excluding radiation therapy.
If a sole provider or group practice accepts outside referrals it must meet several conditions:
- The services must be provided exclusively by a group practice physician or by a full-time or part-time employee of the group practice or of the sole provider's practice.
- All equity in the group practice or the sole provider's practice must be held by physicians comprising the practice, each of which must provide at least 75% of his professional services to the group.
- The group practice or sole provider may not be party to any contract with a practice management company that rewards the physician for increasing outside referrals for diagnostic imaging services from any group or sole provider of the same practice management company.
- No portion of any payment may be shared with the referring physician.
- If the group practice or sole provider is a Medicaid provider, it must furnish diagnostic imaging services to its patients directly and may not refer a patient to a hospital for outpatient diagnostic imaging services unless there is medical necessity for such a referral.
- All group practices and sole providers who accept outside referrals for diagnostic imaging must report annually to the Agency for Health Care Administration providing the number of outside referrals accepted and the total number of patients receiving diagnostic imaging.
- Accepting outside referrals in excess of the permitted number would subject the provider to penalties under the Act.
- Each managing physician member of a group practice and each sole provider who accepts outside referrals for diagnostic imaging must submit an annual attestation under oath to AHCA, that confirms that the practice is in compliance with percentage limitations for accepting outside referrals.
As of this writing, the Governor has not yet acted on this bill, but it is expected that it will become law.