August 20, 2003 ADDENDUM TO THE INTERIM WORK PLAN …

   August 20, 2003




   ADDENDUM

     TO THE


INTERIM WORK PLAN

  2004 SESSION
COMMITTEE ON BANKING AND INSURANCE

INTERIM PROJECT TITLE:
    Implementation of Medical Malpractice Insurance Reforms

DATE DUE:      January 1, 2004

PROJECT NUMBER:        2004-163

BACKGROUND and DESCRIPTION:
     In the 2003 Special Session D, the Legislature enacted medical malpractice reform
legislation that provides for a rate freeze for medical malpractice at the rates approved on
or before July 1, 2003, and requires rates for policies issued on or after the effective date
of the act (September 15, 2003) to reflect the savings of the act. Insurers must either use
the "presumed factor" that reflects the savings of the act as determined by the Office of
Insurance Regulation (OIR), or must file and justify use of a different factor, subject to
prior approval by OIR. The act's appropriations to OIR include amounts expected to be
used to contract with an independent actuarial consultant to assist OIR in determining the
presumed factor.
     The 2003 legislation also revised the requirements for insurers to file data on closed
medical malpractice claims to broaden its applicability to include additional types of
insurers (surplus lines, risk retention groups, and self-insurance funds), as well as health
care providers for whom an insurance entity is not required to file such information. The
act authorizes the Financial Services Commission to adopt rules to require the reporting
of additional data on closed claims, as well as the reporting of data on open claims and
reserving practices. The OIR is required to annually publish a study and analysis of the
closed claims data, the financial reports of medical malpractice insurers, and the rate
filings that have been approved.
     Other insurance reforms of the act include authorizing medical malpractice self-
insurance funds to be licensed; deleting the option for insurers to require arbitration of a
rate filing for medical malpractice insurance; prohibiting insurers from including bad
faith awards in a rate filing; and requiring notice to policyholders of rate filings proposing
a statewide average increase of 25 percent or more.

PROJECT OBJECTIVE(S):
     To monitor the determination by OIR of the presumed factor to be used by insurers
in rate filings to reflect the savings of the act, including any contract by OIR with an
actuarial consultant for this purpose and the findings of such report; to monitor the rate
filings made by insurers to reflect the savings of the bill and whether such filings adopt
the presumed factor by OIR or use a different factor; to determine which medical
malpractice insurers are actively selling new policies; and to report on any lawsuits filed
by insurers challenging the rating provisions of the act. The report will also describe the
insurance reforms in the medical malpractice act, as compared with the insurance laws of
California. The report will also monitor and report on activities of OIR to implement the
closed claim reporting requirements, as revised, including rulemaking by the Financial
Services Commission to require reports on open claims. The report will also monitor
rulemaking to implement the authority for OIR to license medical malpractice self-
insurance trust funds and any applications for licensure that are filed.

METHODOLOGY:
     Staff will interview OIR personnel, monitor all rule-development activities; and
review OIR consultant contracts and reports related to determination of the expected rate
savings of the act; review all medical malpractice rate filings; review any lawsuits
challenging the insurance rate provisions; review the insurance laws of California; review
all rulemaking activities related to claims reporting and licensure of self-insurance funds;
and interview representatives of selected medical malpractice insurers regarding such
issues.
COMPREHENSIVE PLANNING

INTERIM PROJECT TITLE:
    Strategies to Promote and Encourage Urban Infill and Redevelopment

DATE DUE:      December 1, 2003

PROJECT NUMBER:        2004-165

BACKGROUND and DESCRIPTION:
     Florida's "Growth Policy Act," contained in sections 163.2511-163.2526, F.S.,
recognizes the importance of urban infill and redevelopment in supporting fiscally strong
urban cores. State and regional entities, as well as local governments, are encouraged to
provide incentives for urban infill and redevelopment. An urban infill and redevelopment
area, for purposes of the act, is defined in s. 163.2514, F.S.

     Section 163.2517, F.S., provides for the designation of urban infill and
redevelopment areas based on specific criteria. The Legislature appropriated $2.5 million
in fiscal year 2000-01 to implement the Urban Infill and Redevelopment Assistance
Program under s. 163.2523, F.S. As a result of this funding, there are 22 local
governments that received either a planning or implementation grant for the designation
of an urban infill and redevelopment area.

     Section 163.2526, F.S., requires the Office of Program Policy Analysis and
Government Accountability to review and evaluate, prior to the 2004 Regular Session,
the effectiveness of a designated urban infill and redevelopment area in revitalizing and
strengthening the urban core. Also, the Legislative Committee on Intergovernmental
Relations has an interim project this year relating to urban infill and redevelopment and
will identify existing programs and available funding mechanisms, including if there are
federal funds available to assist with redevelopment efforts.

     As part of the requirements for an urban infill and redevelopme nt plan under s.
163.2517, F.S., local governments are directed to adopt a package of financial and
regulatory incentives. Pursuant to s. 163.2517(3)(j), F.S., such incentives may include a
waiver of license and permit fees, exemption from local option sales surtaxes, a waiver of
delinquent local taxes to return a property to productive use, expedited permitting, lower
transportation impact fees, prioritization of infrastructure spending within the urban infill
and redevelopment area, and absorption of deve lopers' concurrency costs.

     The incentives for a local government that has adopted a comprehensive plan
amendment to incorporate a designated urban infill and redevelopment area includes
extending the use of tax increment financing, the authority to issue revenue bonds backed
by tax increment financing, and the authority to levy special assessments under s.
163.514, F.S.

     Additional incentives to promote urban infill and redevelopment include allowing
projects located inside a designated urban and infill redevelopment area to be excepted
from transportation concurrency requirements under certain circumstances and provid ing
that projects in a designated area may qualify as a small scale development amendment
that is not subject to the twice per year limitatio n on local government comprehensive
plan amendments.

    Notwithstanding the available incentives, many local governments have properties
within their urban core that are not being used for infill and redevelopment. This lack of
urban infill and redevelopment has resulted in vacant and abandoned buildings, higher
unemployment, and a reduced tax base for some areas.

PROJECT OBJECTIVE(S):
     The objective of this proposed interim project is to identify appropriate additional
strategies to promote and encourage urban infill and redevelopment.

METHODOLOGY:
     Committee staff will work with local governments, financial institutions, residential
and commercial developers, the Department of Community Affairs, and others
knowledgeable about urban issues to determine what additional strategies are necessary
to better promote urban infill and redevelopment.
HEALTH, AGING, AND LONG-TERM CARE

INTERIM PROJECT TITLE:
    Review of Data on Physician Availability and Patient Access to Physician Services

DATE DUE:      January 1, 2004

PROJECT NUMBER:        2004-164

BACKGROUND and DESCRIPTION:
     Chapter 456, F.S., contains the general regulatory provisions for health care
professions and occupations under the Division of Medical Quality Assurance in the
Department of Health (DOH). Chapter 458, F.S., provides for the regulation of the
practice of medicine by the Board of Medicine. Chapter 459, F.S., provides for the
regulation of the practice of osteopathic medicine by the Board of Osteopathic Medicine.
     In addition, to the general regulatory provisions within ch. 456, F.S., the practice acts
provide licensing requirements that medical and osteopathic physicians must meet in
order to become licensed to practice in Florida. Candidates for licensure and licensure
renewal to practice medicine, osteopathic medicine, podiatric medicine, and chiropractic
medicine must provide specified information that DOH must compile into practitioner
profiles pursuant to ss. 456.039 and 456.041, F.S. Medical and osteopathic physicians
must maintain professional liability insurance or other specified financial responsibility to
cover potential claims for medical malpractice as a condition of licensure, with specified
exemptions. Section 456.038, F.S., requires DOH to give a licensure renewal notification
to licensed health care practitioners at least 90 days before the end of the licensure cycle
at the practitioner's last known address of record with the department. The Board of
Medicine and the Board of Osteopathic Medicine, have adopted by rule, initial licensure
applications.

PROJECT OBJECTIVE(S):
     This interim project will review the procedures for medical and osteopathic
physician licensure and licensure renewal to ascertain what data is gathered by DOH and
whether the procedures should be revised to include additional data elements and
demographic information regarding the delivery of health care by physicians, such as
specialty practice, type of practice setting, location of practice, whether the physician is
actively practicing medicine or osteopathic medicine in the state, the means by which a
physician is complying with financial responsibility requirements, and other relevant data
elements, including a procedure to update and verify such data.

METHODOLOGY:
     Staff will review the requirements of physician licensure laws and administrative
rules adopted by the applicable boards and DOH. Staff will seek input from DOH,
boards, and other interested stakeholders to determine if the laws should be revised to
include additional data elements.
HEALTH, AGING, AND LONG-TERM CARE

INTERIM MONITOR PROJECT TITLE:
    Implementation of Requirements in CS/SB 2-D Relating to Patient Safety, Health
    Care Practitioner and Facility Regulation, and Data Collection

DATE DUE:      N/A

PROJECT NUMBER:        2004-381

BACKGROUND and DESCRIPTION:
     In Committee Substitute for Senate Bill 2-D (ch.2003-416, L.O.F.), which addressed
medical incidents, the 2003 Legislature required the Department of Health (DOH) and
the Agency for Health Care Administration (AHCA) to implement procedures and
conduct studies relating to patient safety, health care practitioner and facility regulation,
and data collection. AHCA is responsible for implementing new regulations regarding
patient safety in health care facilities, while DOH is responsible for implementing
licensure requirements and regulations regarding health care practitioners. New agency
duties are assigned to AHCA, DOH and the Division of Administrative Hearings. AHCA
is responsible for two studies - one regarding inpatient quality indicators and one
regarding the establishment of a statewide Patient Safety Authority. DOH is responsible
for studying the current health care practitioner disciplinary process.

PROJECT OBJECTIVE(S):
     To monitor: implementation of legislatively-mandated requirements relating to
patient safety, health care practitioner and facility regulation, and data collection; and
identify any legal challenges filed to the new provisions contained in the bill.

METHODOLOGY:
    Staff will consult with representatives of AHCA, DOH, professional regulatory
boards, and university patient safety centers as the required quality measures are
implemented and the studies conducted. Staff will attend rule development workshops
and other meetings conducted by AHCA and DOH relating to implementation of the bill.
JUDICIARY

INTERIM MONITOR PROJECT TITLE:
    Study by the Department of Health to see Whether Medical Review Panels Should
    be Created for use in Presuit Process for Medical Malpractice Claims

DATE DUE:      N/A

PROJECT NUMBER:        2004-382

BACKGROUND and DESCRIPTION:
     Section 71, ch. 2003-416, L.O.F., directs the Department of Health to study and
report to the Legislature as to whether medical review panels should be included as part
of the presuit process in medical malpractice litigation. The act directs the department to
report on certain issues surrounding the use of medical review panels within the state as
well as in other states. The act also directs the department to report on the effectiveness
of medical review panels when such panels were used in this state, and the effectiveness
of medical review panels in other states. If the department does recommend that medical
review panels should be included in the presuit process for medical malpractice claims,
then it must provide draft legislation to implement the recommendation. The department
is to submit its report to the President of the Senate and the Speaker of the House no later
that December 31, 2003.

      Medical review panels review a medical malpractice case during the presuit process
and make judgments on the merits of the case based on established standards of care.
When such panels are used in other states, the panel's report is admissible evidence at
trial or for other purposes.

PROJECT OBJECTIVE(S):
    Monitor the department's activities in conducting this study.

METHODOLOGY:
     Committee staff will monitor the activities of the workgroup established to conduct
this study.
JUDICIARY

INTERIM MONITOR PROJECT TITLE:
    Implementation of Revisions to Presuit Procedures for Medical Malpractice
    Claims and Implementation of Changes to Certain Activities in Medical
    Malpractice Cases Before the Courts

DATE DUE:      N/A

PROJECT NUMBER:        2004-383

BACKGROUND and DESCRIPTION:
     CS/SB/1st ENG. 2D (ch. 2003-416, L.O.F.) revised presuit procedures in ch. 766,
F.S., relating to medical malpractice claims. These revisions address the retention and use
of expert witnesses, the availability for discovery of expert witness opinions in the presuit
period, and the availability of claimant's physician for the taking of an unsworn
statement. This act also addressed certain activities in the period after the filing of an
action in court. These revisions include the requirement that the plaintiff file a copy of the
complaint with the Agency for Health Care Administration, that certain language be
included in any settlement agreement involving a claim of medical malpractice, and that a
verdict assessing damages in a medical malpractice case include a specific itemization of
the damage award for future losses.

PROJECT OBJECTIVE(S):
     To monitor the implementation of those provisions of ch. 2003-416, L.O.F., relating
to presuit procedures for medical malpractice claims and certain activities in medical
malpractice cases.

METHODOLOGY:
     Committee staff will contact the Florida Bar, Trial Lawyers Section, and the Florida
Academy of Trial Lawyers to query those organizations regarding the application of the
changes in ch. 766, F.S., relating to presuit procedures, to claims filed after the effective
date of this bill. Committee staff will also query these organizations concerning the
implementation of changes to the suit activities. Finally, committee staff will also
identify other parties, if necessary, to query regarding the implementation of these
change.