Florida Senate - 2018              PROPOSED COMMITTEE SUBSTITUTE
       Bill No. CS for SB 1876
       
       
       
       
       
                               Ì764628FÎ764628                          
       
       576-03268-18                                                    
       Proposed Committee Substitute by the Committee on Appropriations
       (Appropriations Subcommittee on Health and Human Services)
    1                        A bill to be entitled                      
    2         An act relating to trauma services; amending ss.
    3         318.14, 318.18, and 318.21, F.S.; requiring that
    4         moneys received from specified penalties be allocated
    5         to certain trauma centers by a calculation that uses
    6         the Agency of Health Care Administration’s hospital
    7         discharge data; amending s. 395.4001, F.S.; conforming
    8         cross-references; redefining the term “trauma caseload
    9         volume”; amending s. 395.402, F.S.; revising
   10         legislative intent; revising the trauma service areas
   11         and provisions relating to the number and location of
   12         trauma centers; prohibiting the Department of Health
   13         from designating an existing Level II trauma center as
   14         a new pediatric trauma center or from designating an
   15         existing Level II trauma center as a Level I trauma
   16         center in a trauma service area that already has an
   17         existing Level I or pediatric trauma center;
   18         apportioning trauma centers within each trauma service
   19         area; requiring the department to establish the
   20         Florida Trauma System Advisory Council by a specified
   21         date; authorizing the council to submit certain
   22         recommendations to the department; providing for the
   23         membership of the council; requiring the council to
   24         meet no later than a specified date and to meet at
   25         least quarterly; amending s. 395.4025, F.S.;
   26         conforming provisions to changes made by the act;
   27         requiring the department to periodically prepare an
   28         analysis of the state trauma system using the agency’s
   29         hospital discharge data and specified population data;
   30         specifying contents of the report; requiring the
   31         department to make available all data, formulas,
   32         methodologies, and risk adjustment tools used in
   33         analyzing the data in the report; requiring the
   34         department to notify each acute care general hospital
   35         and local and regional trauma agency in a trauma
   36         service area that has an identified need for an
   37         additional trauma center that the department is
   38         accepting letters of intent; prohibiting the
   39         department from accepting a letter of intent and from
   40         approving an application for a trauma center if there
   41         is not statutory capacity for an additional trauma
   42         center; revising the department’s review process for
   43         hospitals seeking designation as a trauma center;
   44         authorizing the department to approve certain
   45         applications for designation as a trauma center if
   46         specified requirements are met; providing that a
   47         hospital applicant that meets such requirements must
   48         be ready to operate in compliance with specified
   49         trauma standards by a specified date; deleting a
   50         provision authorizing the department to grant a
   51         hospital applicant an extension time to meet certain
   52         standards and requirements; requiring the department
   53         to select one or more hospitals for approval to
   54         prepare to operate as a trauma center; providing
   55         selection requirements; prohibiting an applicant from
   56         operating as a trauma center until the department has
   57         completed its review process and approved the
   58         application; requiring a specified review team to make
   59         onsite visits to newly operational trauma centers
   60         within a certain timeframe; requiring the department,
   61         based on recommendations from the review team, to
   62         designate a trauma center that is in compliance with
   63         specified requirements; deleting the date by which the
   64         department must select trauma centers; providing that
   65         only certain hospitals may protest a decision made by
   66         the department; providing that certain trauma centers
   67         that were verified by the department or determined by
   68         the department to be in substantial compliance with
   69         specified standards before specified dates are deemed
   70         to have met application and operational requirements;
   71         requiring the department to designate a certain
   72         provisionally approved Level II trauma center as a
   73         trauma center if certain criteria are met; prohibiting
   74         such designated trauma center from being required to
   75         cease trauma operations unless the department or a
   76         court determines that it has failed to meet certain
   77         standards; providing construction; amending ss.
   78         395.403 and 395.4036, F.S.; conforming provisions to
   79         changes made by the act; amending s. 395.404, F.S.;
   80         requiring trauma centers to participate in the
   81         National Trauma Data Bank; requiring trauma centers
   82         and acute care hospitals to report trauma patient
   83         transfer and outcome data to the department; deleting
   84         provisions relating to the department review of trauma
   85         registry data; amending s. 395.401, F.S.; conforming a
   86         cross-reference; providing for invalidity; providing
   87         an effective date.
   88          
   89  Be It Enacted by the Legislature of the State of Florida:
   90  
   91         Section 1. Paragraph (b) of subsection (5) of section
   92  318.14, Florida Statutes, is amended to read:
   93         318.14 Noncriminal traffic infractions; exception;
   94  procedures.—
   95         (5) Any person electing to appear before the designated
   96  official or who is required so to appear shall be deemed to have
   97  waived his or her right to the civil penalty provisions of s.
   98  318.18. The official, after a hearing, shall make a
   99  determination as to whether an infraction has been committed. If
  100  the commission of an infraction has been proven, the official
  101  may impose a civil penalty not to exceed $500, except that in
  102  cases involving unlawful speed in a school zone or involving
  103  unlawful speed in a construction zone, the civil penalty may not
  104  exceed $1,000; or require attendance at a driver improvement
  105  school, or both. If the person is required to appear before the
  106  designated official pursuant to s. 318.19(1) and is found to
  107  have committed the infraction, the designated official shall
  108  impose a civil penalty of $1,000 in addition to any other
  109  penalties and the person’s driver license shall be suspended for
  110  6 months. If the person is required to appear before the
  111  designated official pursuant to s. 318.19(2) and is found to
  112  have committed the infraction, the designated official shall
  113  impose a civil penalty of $500 in addition to any other
  114  penalties and the person’s driver license shall be suspended for
  115  3 months. If the official determines that no infraction has been
  116  committed, no costs or penalties shall be imposed and any costs
  117  or penalties that have been paid shall be returned. Moneys
  118  received from the mandatory civil penalties imposed pursuant to
  119  this subsection upon persons required to appear before a
  120  designated official pursuant to s. 318.19(1) or (2) shall be
  121  remitted to the Department of Revenue and deposited into the
  122  Department of Health Emergency Medical Services Trust Fund to
  123  provide financial support to certified trauma centers to assure
  124  the availability and accessibility of trauma services throughout
  125  the state. Funds deposited into the Emergency Medical Services
  126  Trust Fund under this section shall be allocated as follows:
  127         (b) Fifty percent shall be allocated among Level I, Level
  128  II, and pediatric trauma centers based on each center’s relative
  129  volume of trauma cases as calculated using the agency’s hospital
  130  discharge data collected pursuant to s. 408.061 reported in the
  131  Department of Health Trauma Registry.
  132         Section 2. Paragraph (h) of subsection (3) of section
  133  318.18, Florida Statutes, is amended to read:
  134         318.18 Amount of penalties.—The penalties required for a
  135  noncriminal disposition pursuant to s. 318.14 or a criminal
  136  offense listed in s. 318.17 are as follows:
  137         (3)
  138         (h) A person cited for a second or subsequent conviction of
  139  speed exceeding the limit by 30 miles per hour and above within
  140  a 12-month period shall pay a fine that is double the amount
  141  listed in paragraph (b). For purposes of this paragraph, the
  142  term “conviction” means a finding of guilt as a result of a jury
  143  verdict, nonjury trial, or entry of a plea of guilty. Moneys
  144  received from the increased fine imposed by this paragraph shall
  145  be remitted to the Department of Revenue and deposited into the
  146  Department of Health Emergency Medical Services Trust Fund to
  147  provide financial support to certified trauma centers to assure
  148  the availability and accessibility of trauma services throughout
  149  the state. Funds deposited into the Emergency Medical Services
  150  Trust Fund under this section shall be allocated as follows:
  151         1. Fifty percent shall be allocated equally among all Level
  152  I, Level II, and pediatric trauma centers in recognition of
  153  readiness costs for maintaining trauma services.
  154         2. Fifty percent shall be allocated among Level I, Level
  155  II, and pediatric trauma centers based on each center’s relative
  156  volume of trauma cases as calculated using the agency’s hospital
  157  discharge data collected pursuant to s. 408.061 reported in the
  158  Department of Health Trauma Registry.
  159         Section 3. Paragraph (b) of subsection (15) of section
  160  318.21, Florida Statutes, is amended to read:
  161         318.21 Disposition of civil penalties by county courts.—All
  162  civil penalties received by a county court pursuant to the
  163  provisions of this chapter shall be distributed and paid monthly
  164  as follows:
  165         (15) Of the additional fine assessed under s. 318.18(3)(e)
  166  for a violation of s. 316.1893, 50 percent of the moneys
  167  received from the fines shall be appropriated to the Agency for
  168  Health Care Administration as general revenue to provide an
  169  enhanced Medicaid payment to nursing homes that serve Medicaid
  170  recipients with brain and spinal cord injuries. The remaining 50
  171  percent of the moneys received from the enhanced fine imposed
  172  under s. 318.18(3)(e) shall be remitted to the Department of
  173  Revenue and deposited into the Department of Health Emergency
  174  Medical Services Trust Fund to provide financial support to
  175  certified trauma centers in the counties where enhanced penalty
  176  zones are established to ensure the availability and
  177  accessibility of trauma services. Funds deposited into the
  178  Emergency Medical Services Trust Fund under this subsection
  179  shall be allocated as follows:
  180         (b) Fifty percent shall be allocated among Level I, Level
  181  II, and pediatric trauma centers based on each center’s relative
  182  volume of trauma cases as calculated using the agency’s hospital
  183  discharge data collected pursuant to s. 408.061 reported in the
  184  Department of Health Trauma Registry.
  185         Section 4. Paragraph (a) of subsection (7) and subsections
  186  (13) and (14) of section 395.4001, Florida Statutes, are amended
  187  to read:
  188         395.4001 Definitions.—As used in this part, the term:
  189         (7) “Level II trauma center” means a trauma center that:
  190         (a) Is verified by the department to be in substantial
  191  compliance with Level II trauma center standards and has been
  192  approved by the department to operate as a Level II trauma
  193  center or is designated pursuant to s. 395.4025(15) s.
  194  395.4025(14).
  195         (13) “Trauma caseload volume” means the number of trauma
  196  patients calculated by the department using the data reported by
  197  each designated trauma center to the hospital discharge data
  198  reported to the agency pursuant to s. 408.061 reported by
  199  individual trauma centers to the Trauma Registry and validated
  200  by the department.
  201         (14) “Trauma center” means a hospital that has been
  202  verified by the department to be in substantial compliance with
  203  the requirements in s. 395.4025 and has been approved by the
  204  department to operate as a Level I trauma center, Level II
  205  trauma center, or pediatric trauma center, or is designated by
  206  the department as a Level II trauma center pursuant to s.
  207  395.4025(15) s. 395.4025(14).
  208         Section 5. Section 395.402, Florida Statutes, is amended to
  209  read:
  210         395.402 Trauma service areas; number and location of trauma
  211  centers.—
  212         (1) The Legislature recognizes the need for a statewide,
  213  cohesive, uniform, and integrated trauma system, as well as the
  214  need to ensure the viability of existing trauma centers when
  215  designating new trauma centers. Consistent with national
  216  standards, future trauma center designations must be based on
  217  need as a factor of demand and capacity. Within the trauma
  218  service areas, Level I and Level II trauma centers shall each be
  219  capable of annually treating a minimum of 1,000 and 500
  220  patients, respectively, with an injury severity score (ISS) of 9
  221  or greater. Level II trauma centers in counties with a
  222  population of more than 500,000 shall have the capacity to care
  223  for 1,000 patients per year.
  224         (2) Trauma service areas as defined in this section are to
  225  be utilized until the Department of Health completes an
  226  assessment of the trauma system and reports its finding to the
  227  Governor, the President of the Senate, the Speaker of the House
  228  of Representatives, and the substantive legislative committees.
  229  The report shall be submitted by February 1, 2005. The
  230  department shall review the existing trauma system and determine
  231  whether it is effective in providing trauma care uniformly
  232  throughout the state. The assessment shall:
  233         (a) Consider aligning trauma service areas within the
  234  trauma region boundaries as established in July 2004.
  235         (b) Review the number and level of trauma centers needed
  236  for each trauma service area to provide a statewide integrated
  237  trauma system.
  238         (c) Establish criteria for determining the number and level
  239  of trauma centers needed to serve the population in a defined
  240  trauma service area or region.
  241         (d) Consider including criteria within trauma center
  242  approval standards based upon the number of trauma victims
  243  served within a service area.
  244         (e) Review the Regional Domestic Security Task Force
  245  structure and determine whether integrating the trauma system
  246  planning with interagency regional emergency and disaster
  247  planning efforts is feasible and identify any duplication of
  248  efforts between the two entities.
  249         (f) Make recommendations regarding a continued revenue
  250  source which shall include a local participation requirement.
  251         (g) Make recommendations regarding a formula for the
  252  distribution of funds identified for trauma centers which shall
  253  address incentives for new centers where needed and the need to
  254  maintain effective trauma care in areas served by existing
  255  centers, with consideration for the volume of trauma patients
  256  served, and the amount of charity care provided.
  257         (3) In conducting such assessment and subsequent annual
  258  reviews, the department shall consider:
  259         (a) The recommendations made as part of the regional trauma
  260  system plans submitted by regional trauma agencies.
  261         (b) Stakeholder recommendations.
  262         (c) The geographical composition of an area to ensure rapid
  263  access to trauma care by patients.
  264         (d) Historical patterns of patient referral and transfer in
  265  an area.
  266         (e) Inventories of available trauma care resources,
  267  including professional medical staff.
  268         (f) Population growth characteristics.
  269         (g) Transportation capabilities, including ground and air
  270  transport.
  271         (h) Medically appropriate ground and air travel times.
  272         (i) Recommendations of the Regional Domestic Security Task
  273  Force.
  274         (j) The actual number of trauma victims currently being
  275  served by each trauma center.
  276         (k) Other appropriate criteria.
  277         (4) Annually thereafter, the department shall review the
  278  assignment of the 67 counties to trauma service areas, in
  279  addition to the requirements of paragraphs (2)(b)-(g) and
  280  subsection (3). County assignments are made for the purpose of
  281  developing a system of trauma centers. Revisions made by the
  282  department shall take into consideration the recommendations
  283  made as part of the regional trauma system plans approved by the
  284  department and the recommendations made as part of the state
  285  trauma system plan. In cases where a trauma service area is
  286  located within the boundaries of more than one trauma region,
  287  the trauma service area’s needs, response capability, and system
  288  requirements shall be considered by each trauma region served by
  289  that trauma service area in its regional system plan. Until the
  290  department completes the February 2005 assessment, the
  291  assignment of counties shall remain as established in this
  292  section.
  293         (a) The following trauma service areas are hereby
  294  established:
  295         1. Trauma service area 1 shall consist of Escambia,
  296  Okaloosa, Santa Rosa, and Walton Counties.
  297         2. Trauma service area 2 shall consist of Bay, Gulf,
  298  Holmes, and Washington Counties.
  299         3. Trauma service area 3 shall consist of Calhoun,
  300  Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison,
  301  Taylor, and Wakulla Counties.
  302         4. Trauma service area 4 shall consist of Alachua,
  303  Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy,
  304  Putnam, Suwannee, and Union Counties.
  305         5. Trauma service area 5 shall consist of Baker, Clay,
  306  Duval, Nassau, and St. Johns Counties.
  307         6. Trauma service area 6 shall consist of Citrus, Hernando,
  308  and Marion Counties.
  309         7. Trauma service area 7 shall consist of Flagler and
  310  Volusia Counties.
  311         8. Trauma service area 8 shall consist of Lake, Orange,
  312  Osceola, Seminole, and Sumter Counties.
  313         9. Trauma service area 9 shall consist of Pasco and
  314  Pinellas Counties.
  315         10. Trauma service area 10 shall consist of Hillsborough
  316  County.
  317         11. Trauma service area 11 shall consist of Hardee,
  318  Highlands, and Polk Counties.
  319         12. Trauma service area 12 shall consist of Brevard and
  320  Indian River Counties.
  321         13. Trauma service area 13 shall consist of DeSoto,
  322  Manatee, and Sarasota Counties.
  323         14. Trauma service area 14 shall consist of Martin,
  324  Okeechobee, and St. Lucie Counties.
  325         15. Trauma service area 15 shall consist of Charlotte,
  326  Collier, Glades, Hendry, and Lee Counties.
  327         16. Trauma service area 16 shall consist of Palm Beach
  328  County.
  329         17. Trauma service area 17 shall consist of Broward Collier
  330  County.
  331         18. Trauma service area 18 shall consist of Broward County.
  332         19. Trauma service area 19 shall consist of Miami-Dade and
  333  Monroe Counties.
  334         (b) Each trauma service area must should have at least one
  335  Level I or Level II trauma center. Except as otherwise provided
  336  in s. 395.4025(16), the department may not designate an existing
  337  Level II trauma center as a new pediatric trauma center or
  338  designate an existing Level II trauma center as a Level I trauma
  339  center in a trauma service area that already has an existing
  340  Level I or pediatric trauma center The department shall
  341  allocate, by rule, the number of trauma centers needed for each
  342  trauma service area.
  343         (c) Trauma centers, including Level I, Level II, Level
  344  II/pediatric, and stand-alone pediatric trauma centers, shall be
  345  apportioned as follows:
  346         1. Trauma service area 1 shall have three trauma centers.
  347         2. Trauma service area 2 shall have one trauma center.
  348         3. Trauma service area 3 shall have one trauma center.
  349         4. Trauma service area 4 shall have one trauma center.
  350         5. Trauma service area 5 shall have three trauma centers.
  351         6. Trauma service area 6 shall have one trauma center.
  352         7. Trauma service area 7 shall have one trauma center.
  353         8. Trauma service area 8 shall have three trauma centers.
  354         9. Trauma service area 9 shall have three trauma centers.
  355         10. Trauma service area 10 shall have two trauma centers.
  356         11. Trauma service area 11 shall have one trauma center.
  357         12. Trauma service area 12 shall have one trauma center.
  358         13. Trauma service area 13 shall have two trauma centers.
  359         14. Trauma service area 14 shall have one trauma center.
  360         15. Trauma service area 15 shall have one trauma center.
  361         16. Trauma service area 16 shall have two trauma centers.
  362         17. Trauma service area 17 shall have three trauma centers.
  363         18. Trauma service area 18 shall have five trauma centers.
  364  
  365  Notwithstanding other provisions of this chapter, a trauma
  366  service area may not have more than a total of five Level I,
  367  Level II, Level II/pediatric, and stand-alone pediatric trauma
  368  centers. A trauma service area may not have more than one stand
  369  alone pediatric trauma center There shall be no more than a
  370  total of 44 trauma centers in the state.
  371         (2)(a)By October 1, 2018, the department shall establish
  372  the Florida Trauma System Advisory Council to promote an
  373  inclusive trauma system and enhance cooperation among trauma
  374  system stakeholders. The advisory council may submit
  375  recommendations to the department on how to maximize existing
  376  trauma center, emergency department, and emergency medical
  377  services infrastructure and personnel to achieve the statutory
  378  goal of developing an inclusive trauma system.
  379         (b)1. The advisory council shall consist of 11 members
  380  appointed by the Governor, including:
  381         a. The State Trauma Medical Director;
  382         b. A representative from an emergency medical services
  383  organization;
  384         c. A representative of a local or regional trauma agency;
  385         d. A trauma program manager or trauma medical director
  386  actively working in a trauma center who represents an investor
  387  owned hospital with a trauma center;
  388         e. A trauma program manager or trauma medical director
  389  actively working in a trauma center who represents a nonprofit
  390  or public hospital with a trauma center;
  391         f. A trauma surgeon who is board-certified in critical care
  392  and actively practicing medicine in a Level II trauma center who
  393  represents an investor-owned hospital with a trauma center;
  394         g. A trauma surgeon who is board-certified in critical care
  395  and actively practicing medicine who represents a nonprofit or
  396  public hospital with a trauma center;
  397         h. A representative of the American College of Surgeons
  398  Committee on Trauma;
  399         i. A representative of the Safety Net Hospital Alliance of
  400  Florida;
  401         j. A representative of the Florida Hospital Association;
  402  and
  403         k. A trauma surgeon who is board-certified in critical care
  404  and actively practicing medicine in a Level I trauma center.
  405         2. No two members may be employed by the same health care
  406  facility.
  407         3. Each council member shall be appointed to a 3-year term;
  408  however, for the purpose of providing staggered terms, of the
  409  initial appointments, four members shall be appointed to 1-year
  410  terms, four members shall be appointed to 2-year terms, and
  411  three members shall be appointed to 3-year terms.
  412         (c) The advisory council shall convene no later than
  413  January 5, 2019, and shall meet at least quarterly.
  414         Section 6. Section 395.4025, Florida Statutes, is amended
  415  to read:
  416         395.4025 Trauma centers; selection; quality assurance;
  417  records.—
  418         (1) For purposes of developing a system of trauma centers,
  419  the department shall use the 18 19 trauma service areas
  420  established in s. 395.402. Within each service area and based on
  421  the state trauma system plan, the local or regional trauma
  422  services system plan, and recommendations of the local or
  423  regional trauma agency, the department shall establish the
  424  approximate number of trauma centers needed to ensure reasonable
  425  access to high-quality trauma services. The department shall
  426  select those hospitals that are to be recognized as trauma
  427  centers.
  428         (2)(a)The department shall prepare an analysis of the
  429  Florida trauma system every 3 years, beginning in August 2020,
  430  using the agency’s hospital discharge database described in s.
  431  408.061 for the most current year and the most recent 5 years of
  432  population data for Florida available from the United States
  433  Census Bureau. The department’s report must include all of the
  434  following:
  435         1.The population growth for each trauma service area and
  436  for the state of Florida;
  437         2.The number of severely injured patients with an Injury
  438  Severity Score of 15 or greater treated at each trauma center
  439  within each trauma service area, including pediatric trauma
  440  centers;
  441         3.The total number of severely injured patients with an
  442  Injury Severity Score of 15 or greater treated at all acute care
  443  hospitals inclusive of non-trauma centers in the trauma service
  444  area;
  445         4.The percentage of each trauma center’s sufficient volume
  446  of trauma patients, as described in subparagraph (3)(d)2., in
  447  accordance with the Injury Severity Score for the trauma
  448  center’s designation, inclusive of the additional caseload
  449  volume required for those trauma centers with graduate medical
  450  education programs.
  451         (b) The department shall make available all data, formulas,
  452  methodologies, and risk adjustment tools used in preparing the
  453  report.
  454         (3)(a)(2)(a) The department shall annually notify each
  455  acute care general hospital and each local and each regional
  456  trauma agency in the trauma service area with an identified need
  457  for an additional trauma center state that the department is
  458  accepting letters of intent from hospitals that are interested
  459  in becoming trauma centers. The department may accept a letter
  460  of intent only if there is statutory capacity for an additional
  461  trauma center in accordance with subsection (2), paragraph (d),
  462  and s. 395.402. In order to be considered by the department, a
  463  hospital that operates within the geographic area of a local or
  464  regional trauma agency must certify that its intent to operate
  465  as a trauma center is consistent with the trauma services plan
  466  of the local or regional trauma agency, as approved by the
  467  department, if such agency exists. Letters of intent must be
  468  postmarked no later than midnight October 1 of the year in which
  469  the department notifies hospitals that it plans to accept
  470  letters of intent.
  471         (b) By October 15, the department shall send to all
  472  hospitals that submitted a letter of intent an application
  473  package that will provide the hospitals with instructions for
  474  submitting information to the department for selection as a
  475  trauma center. The standards for trauma centers provided for in
  476  s. 395.401(2), as adopted by rule of the department, shall serve
  477  as the basis for these instructions.
  478         (c) In order to be considered by the department,
  479  applications from those hospitals seeking selection as trauma
  480  centers, including those current verified trauma centers that
  481  seek a change or redesignation in approval status as a trauma
  482  center, must be received by the department no later than the
  483  close of business on April 1 of the year following submission of
  484  the letter of intent. The department shall conduct an initial a
  485  provisional review of each application for the purpose of
  486  determining whether that the hospital’s application is complete
  487  and that the hospital is capable of constructing and operating a
  488  trauma center that includes has the critical elements required
  489  for a trauma center. This critical review must will be based on
  490  trauma center standards and must shall include, but need not be
  491  limited to, a review as to of whether the hospital is prepared
  492  to attain and operate with all of the following components
  493  before April 30 of the following year has:
  494         1. Equipment and physical facilities necessary to provide
  495  trauma services.
  496         2. Personnel in sufficient numbers and with proper
  497  qualifications to provide trauma services.
  498         3. An effective quality assurance process.
  499         4. Submitted written confirmation by the local or regional
  500  trauma agency that the hospital applying to become a trauma
  501  center is consistent with the plan of the local or regional
  502  trauma agency, as approved by the department, if such agency
  503  exists.
  504         (d)1.Except as otherwise provided in this act, the
  505  department may not approve an application for a Level I, Level
  506  II, Level II/pediatric, or stand-alone pediatric trauma center
  507  if approval of the application would exceed the limits on the
  508  numbers of Level I, Level II, Level II/pediatric, or stand-alone
  509  pediatric trauma centers set forth in s. 395.402(1). However,
  510  the department shall review and may approve an application for a
  511  trauma center when approval of the application would result in a
  512  number of trauma centers which exceeds the limit on the numbers
  513  of trauma centers in a trauma service area as set forth in s.
  514  395.402(1), if the applicant demonstrates and the department
  515  determines that:
  516         1. The existing trauma centers’ actual caseload volume of
  517  severely injured patients with an Injury Severity Score of 15 or
  518  greater exceeds the minimum caseload volume capabilities,
  519  inclusive of the additional caseload volume for graduate medical
  520  education critical care and trauma surgical subspecialty
  521  residents or fellows by more than two times the statutory
  522  minimums listed in sub-subparagraphs 2.a.-d. and three times the
  523  statutory minimum listed in sub-subparagraph 2.e., and the
  524  population growth for the trauma service area exceeds the
  525  statewide population growth by more than 15 percent based on the
  526  United States census data for the 5-year period before the date
  527  the applicant files its letter of intent; and
  528         2. A sufficient volume of potential trauma patients exists
  529  within the trauma service area to ensure that existing trauma
  530  centers’ volumes are at the following levels:
  531         a. For Level I trauma centers in trauma service areas with
  532  a population of greater than 1.5 million, a minimum caseload of
  533  the greater of 1,200 severely injured admitted patients with an
  534  Injury Severity Score of 15 or greater per year or 1,200
  535  severely injured admitted patients with an Injury Severity Score
  536  of 15 or greater plus 40 cases per year for each accredited
  537  critical care and trauma surgical subspecialty medical resident
  538  or fellow.
  539         b. For Level I trauma centers in trauma service areas with
  540  a population of less than 1.5 million, the minimum caseload of
  541  the greater of 1,000 severely injured admitted patients with an
  542  Injury Severity Score of 15 or greater per year or 1,000
  543  severely injured admitted patients with an Injury Severity Score
  544  of 15 or greater plus 40 cases per year for each accredited
  545  critical care and trauma surgical subspecialty medical resident
  546  or fellow.
  547         c. For Level II and Level II/pediatric trauma centers in
  548  trauma service areas with a population of greater than 1.25
  549  million, the minimum caseload of the greater of 1,000 severely
  550  injured admitted patients with an Injury Severity Score of 15 or
  551  greater per year or 1,000 severely injured admitted patients
  552  with an Injury Severity Score of 15 or greater plus 40 cases per
  553  year for each accredited critical care and trauma surgical
  554  subspecialty medical resident or fellow.
  555         d. For Level II and Level II/pediatric trauma centers in
  556  trauma service areas with a population of less than 1.25
  557  million, the minimum caseload of the greater of 500 severely
  558  injured admitted patients with an Injury Severity Score of 15 or
  559  greater per year or 500 severely injured admitted patients with
  560  an Injury Severity Score of 15 or greater per year plus 40 cases
  561  per year for each accredited critical care and trauma surgical
  562  subspecialty medical resident or fellow.
  563         e. For pediatric trauma centers, the minimum caseload of
  564  the greater of 500 severely injured admitted patients with an
  565  Injury Severity Score of 15 or greater per year or 500 severely
  566  injured admitted patients with an Injury Severity Score of 15 or
  567  greater per year plus 40 cases per year for each accredited
  568  critical care and trauma surgical subspecialty medical resident
  569  or fellow.
  570  
  571  The Injury Severity Score calculations and caseload volume must
  572  be calculated using the most recent available hospital discharge
  573  data collected by the agency from all acute care hospitals
  574  pursuant to s. 408.061.
  575         (e) If the department determines that the hospital is
  576  capable of attaining and operating with the components required
  577  in paragraph (c), the applicant must be ready to operate in
  578  compliance with Florida trauma center standards no later than
  579  April 30 of the year following the department’s initial review
  580  and approval of the hospital’s application to proceed with
  581  preparation to operate as a trauma center. A hospital that fails
  582  to comply with this subsection may not be designated as a trauma
  583  center Notwithstanding other provisions in this section, the
  584  department may grant up to an additional 18 months to a hospital
  585  applicant that is unable to meet all requirements as provided in
  586  paragraph (c) at the time of application if the number of
  587  applicants in the service area in which the applicant is located
  588  is equal to or less than the service area allocation, as
  589  provided by rule of the department. An applicant that is granted
  590  additional time pursuant to this paragraph shall submit a plan
  591  for departmental approval which includes timelines and
  592  activities that the applicant proposes to complete in order to
  593  meet application requirements. Any applicant that demonstrates
  594  an ongoing effort to complete the activities within the
  595  timelines outlined in the plan shall be included in the number
  596  of trauma centers at such time that the department has conducted
  597  a provisional review of the application and has determined that
  598  the application is complete and that the hospital has the
  599  critical elements required for a trauma center.
  600         2. Timeframes provided in subsections (1)-(8) shall be
  601  stayed until the department determines that the application is
  602  complete and that the hospital has the critical elements
  603  required for a trauma center.
  604         (4)(3)By May 1, the department shall select one or more
  605  hospitals After April 30, any hospital that submitted an
  606  application found acceptable by the department based on initial
  607  provisional review for approval to prepare shall be eligible to
  608  operate with the components required in paragraph (3)(c). If the
  609  department receives more applications than may be approved under
  610  the statutory capacity in the specified trauma service area, the
  611  department must select the best applicant or applicants from the
  612  available pool based on the department’s determination of the
  613  capability of an applicant to provide the greatest improvement
  614  in access to trauma services and the highest quality patient
  615  care using the most recent technological, medical, and staffing
  616  resources available. The number of applicants selected is
  617  limited to available statutory need in the specified trauma
  618  service area, as designated in paragraph (3)(d) or s. 395.402(1)
  619  as a provisional trauma center.
  620         (5)(4)Following the initial review, Between May 1 and
  621  October 1 of each year, the department shall conduct an in-depth
  622  evaluation of all applications found acceptable in the initial
  623  provisional review. The applications shall be evaluated against
  624  criteria enumerated in the application packages as provided to
  625  the hospitals by the department. An applicant may not operate as
  626  a provisional trauma center until the department completes the
  627  initial and in-depth review and approves the application through
  628  those review stages.
  629         (6)(5)Within Beginning October 1 of each year and ending
  630  no later than June 1 of the following year after the hospital
  631  begins operating as a provisional trauma center, a review team
  632  of out-of-state experts assembled by the department shall make
  633  onsite visits to all provisional trauma centers. The department
  634  shall develop a survey instrument to be used by the expert team
  635  of reviewers. The instrument must shall include objective
  636  criteria and guidelines for reviewers based on existing trauma
  637  center standards such that all trauma centers are assessed
  638  equally. The survey instrument must shall also include a uniform
  639  rating system that will be used by reviewers must use to
  640  indicate the degree of compliance of each trauma center with
  641  specific standards, and to indicate the quality of care provided
  642  by each trauma center as determined through an audit of patient
  643  charts. In addition, hospitals being considered as provisional
  644  trauma centers must shall meet all the requirements of a trauma
  645  center and must shall be located in a trauma service area that
  646  has a need for such a trauma center.
  647         (7)(6) Based on recommendations from the review team, the
  648  department shall designate a trauma center that is in compliance
  649  with trauma center standards, as established by department rule,
  650  and with this section shall select trauma centers by July 1. An
  651  applicant for designation as a trauma center may request an
  652  extension of its provisional status if it submits a corrective
  653  action plan to the department. The corrective action plan must
  654  demonstrate the ability of the applicant to correct deficiencies
  655  noted during the applicant’s onsite review conducted by the
  656  department between the previous October 1 and June 1. The
  657  department may extend the provisional status of an applicant for
  658  designation as a trauma center through December 31 if the
  659  applicant provides a corrective action plan acceptable to the
  660  department. The department or a team of out-of-state experts
  661  assembled by the department shall conduct an onsite visit on or
  662  before November 1 to confirm that the deficiencies have been
  663  corrected. The provisional trauma center is responsible for all
  664  costs associated with the onsite visit in a manner prescribed by
  665  rule of the department. By January 1, the department must
  666  approve or deny the application of any provisional applicant
  667  granted an extension. Each trauma center shall be granted a 7
  668  year approval period during which time it must continue to
  669  maintain trauma center standards and acceptable patient outcomes
  670  as determined by department rule. An approval, unless sooner
  671  suspended or revoked, automatically expires 7 years after the
  672  date of issuance and is renewable upon application for renewal
  673  as prescribed by rule of the department.
  674         (8)(7)Only an applicant, or hospital with an existing
  675  trauma center in the same trauma service area or in a trauma
  676  service area contiguous to the trauma service area where the
  677  applicant has applied to operate a trauma center, may protest a
  678  decision made by the department with regard to whether the
  679  application should be approved, or whether need has been
  680  established through the criteria in paragraph (3)(d) Any
  681  hospital that wishes to protest a decision made by the
  682  department based on the department’s preliminary or in-depth
  683  review of applications or on the recommendations of the site
  684  visit review team pursuant to this section shall proceed as
  685  provided in chapter 120. Hearings held under this subsection
  686  shall be conducted in the same manner as provided in ss. 120.569
  687  and 120.57. Cases filed under chapter 120 may combine all
  688  disputes between parties.
  689         (9)(8) Notwithstanding any provision of chapter 381, a
  690  hospital licensed under ss. 395.001-395.3025 that operates a
  691  trauma center may not terminate or substantially reduce the
  692  availability of trauma service without providing at least 180
  693  days’ notice of its intent to terminate such service. Such
  694  notice shall be given to the department, to all affected local
  695  or regional trauma agencies, and to all trauma centers,
  696  hospitals, and emergency medical service providers in the trauma
  697  service area. The department shall adopt by rule the procedures
  698  and process for notification, duration, and explanation of the
  699  termination of trauma services.
  700         (10)(9) Except as otherwise provided in this subsection,
  701  the department or its agent may collect trauma care and registry
  702  data, as prescribed by rule of the department, from trauma
  703  centers, hospitals, emergency medical service providers, local
  704  or regional trauma agencies, or medical examiners for the
  705  purposes of evaluating trauma system effectiveness, ensuring
  706  compliance with the standards, and monitoring patient outcomes.
  707  A trauma center, hospital, emergency medical service provider,
  708  medical examiner, or local trauma agency or regional trauma
  709  agency, or a panel or committee assembled by such an agency
  710  under s. 395.50(1) may, but is not required to, disclose to the
  711  department patient care quality assurance proceedings, records,
  712  or reports. However, the department may require a local trauma
  713  agency or a regional trauma agency, or a panel or committee
  714  assembled by such an agency to disclose to the department
  715  patient care quality assurance proceedings, records, or reports
  716  that the department needs solely to conduct quality assurance
  717  activities under s. 395.4015, or to ensure compliance with the
  718  quality assurance component of the trauma agency’s plan approved
  719  under s. 395.401. The patient care quality assurance
  720  proceedings, records, or reports that the department may require
  721  for these purposes include, but are not limited to, the
  722  structure, processes, and procedures of the agency’s quality
  723  assurance activities, and any recommendation for improving or
  724  modifying the overall trauma system, if the identity of a trauma
  725  center, hospital, emergency medical service provider, medical
  726  examiner, or an individual who provides trauma services is not
  727  disclosed.
  728         (11)(10) Out-of-state experts assembled by the department
  729  to conduct onsite visits are agents of the department for the
  730  purposes of s. 395.3025. An out-of-state expert who acts as an
  731  agent of the department under this subsection is not liable for
  732  any civil damages as a result of actions taken by him or her,
  733  unless he or she is found to be operating outside the scope of
  734  the authority and responsibility assigned by the department.
  735         (12)(11) Onsite visits by the department or its agent may
  736  be conducted at any reasonable time and may include but not be
  737  limited to a review of records in the possession of trauma
  738  centers, hospitals, emergency medical service providers, local
  739  or regional trauma agencies, or medical examiners regarding the
  740  care, transport, treatment, or examination of trauma patients.
  741         (13)(12) Patient care, transport, or treatment records or
  742  reports, or patient care quality assurance proceedings, records,
  743  or reports obtained or made pursuant to this section, s.
  744  395.3025(4)(f), s. 395.401, s. 395.4015, s. 395.402, s. 395.403,
  745  s. 395.404, s. 395.4045, s. 395.405, s. 395.50, or s. 395.51
  746  must be held confidential by the department or its agent and are
  747  exempt from the provisions of s. 119.07(1). Patient care quality
  748  assurance proceedings, records, or reports obtained or made
  749  pursuant to these sections are not subject to discovery or
  750  introduction into evidence in any civil or administrative
  751  action.
  752         (14)(13) The department may adopt, by rule, the procedures
  753  and process by which it will select trauma centers. Such
  754  procedures and process must be used in annually selecting trauma
  755  centers and must be consistent with subsections (1)-(9) (1)-(8)
  756  except in those situations in which it is in the best interest
  757  of, and mutually agreed to by, all applicants within a service
  758  area and the department to reduce the timeframes.
  759         (15)(14) Notwithstanding the procedures established
  760  pursuant to subsections (1) through (14) (13), hospitals located
  761  in areas with limited access to trauma center services shall be
  762  designated by the department as Level II trauma centers based on
  763  documentation of a valid certificate of trauma center
  764  verification from the American College of Surgeons. Areas with
  765  limited access to trauma center services are defined by the
  766  following criteria:
  767         (a) The hospital is located in a trauma service area with a
  768  population greater than 600,000 persons but a population density
  769  of less than 225 persons per square mile;
  770         (b) The hospital is located in a county with no verified
  771  trauma center; and
  772         (c) The hospital is located at least 15 miles or 20 minutes
  773  travel time by ground transport from the nearest verified trauma
  774  center.
  775         (16)(a) Notwithstanding the statutory capacity limits
  776  established in s. 395.402(1), the provisions of subsection (8),
  777  or any other provision of this act, an adult Level I trauma
  778  center, an adult Level II trauma center, or a pediatric trauma
  779  center that was verified by the department before December 15,
  780  2017, is deemed to have met the trauma center application and
  781  operational requirements of this section and must be verified
  782  and designated as a trauma center.
  783         (b) Notwithstanding the statutory capacity limits
  784  established in s. 395.402(1), the provisions of subsection (8),
  785  or any other provision of this act, a trauma center that was not
  786  verified by the department before December 15, 2017, but that
  787  was provisionally approved by the department to be in
  788  substantial compliance with Level II trauma standards before
  789  January 1, 2017, and is operating as a Level II trauma center,
  790  is deemed to have met the application and operational
  791  requirements of this section for a trauma center and must be
  792  verified and designated as a Level II trauma center.
  793         (c)Notwithstanding the statutory capacity limits
  794  established in s. 395.402(1), the provisions of subsection (8),
  795  or any other provision of this act, a trauma center that was not
  796  verified by the department before December 15, 2017, as a Level
  797  I trauma center but that was provisionally approved by the
  798  department to be in substantial compliance with Level I trauma
  799  standards before January 1, 2017, and is operating as a Level I
  800  trauma center is deemed to have met the application and
  801  operational requirements of this section for a trauma center and
  802  must be verified and designated as a Level I trauma center.
  803         (d)Notwithstanding the statutory capacity limits
  804  established in s. 395.402(1), the provisions of subsection (8),
  805  or any other provision of this act, a trauma center that was not
  806  verified by the department before December 15, 2017, as a
  807  pediatric trauma center but was provisionally approved by the
  808  department to be in substantial compliance with the pediatric
  809  trauma standards established by rule before January 1, 2018, and
  810  is operating as a pediatric trauma center is deemed to have met
  811  the application and operational requirements of this section for
  812  a pediatric trauma center and, upon successful completion of the
  813  in-depth and site review process, shall be verified and
  814  designated as a pediatric trauma center. Notwithstanding the
  815  provisions of subsection (8), no existing trauma center in the
  816  same trauma service area or in a trauma service area contiguous
  817  to the trauma service area where the applicant is located may
  818  protest the in-depth review, site survey, or verification
  819  decision of the department regarding an applicant that meets the
  820  requirements of this paragraph.
  821         (e)Notwithstanding the statutory capacity limits
  822  established in s. 395.402(1) or any other provision of this act,
  823  any hospital operating as a Level II trauma center after January
  824  1, 2017, must be designated and verified by the department as a
  825  Level II trauma center if all of the following apply:
  826         1. The hospital was provisionally approved after January 1,
  827  2017, to operate as a Level II trauma center, and was in
  828  operation on or before January 1, 2018;
  829         2. The department’s decision to approve the hospital to
  830  operate a provisional Level II trauma center was in litigation
  831  on or before January 1, 2018;
  832         3. The hospital receives a recommended order from the
  833  Division of Administrative Hearings, a final order from the
  834  department, or an order from a court of competent jurisdiction
  835  that it was entitled to be designated and verified as a Level II
  836  trauma center; and
  837         4. The department determines that the hospital is in
  838  substantial compliance with the Level II trauma center
  839  standards, including the in-depth and site reviews.
  840  
  841  Any provisional trauma center operating under this paragraph may
  842  not be required to cease trauma operations unless a court of
  843  competent jurisdiction or the department determines that it has
  844  failed to meet the trauma center standards, as established by
  845  department rule.
  846         (f)Nothing in this subsection shall limit the department’s
  847  authority to review and approve trauma center applications.
  848         Section 7. Section 395.403, Florida Statutes, is amended to
  849  read:
  850         395.403 Reimbursement of trauma centers.—
  851         (1) All verified trauma centers shall be considered
  852  eligible to receive state funding when state funds are
  853  specifically appropriated for state-sponsored trauma centers in
  854  the General Appropriations Act. Effective July 1, 2010, the
  855  department shall make payments from the Emergency Medical
  856  Services Trust Fund under s. 20.435 to the trauma centers.
  857  Payments shall be in equal amounts for the trauma centers
  858  approved by the department as of July 1 of the fiscal year in
  859  which funding is appropriated. In the event a trauma center does
  860  not maintain its status as a trauma center for any state fiscal
  861  year in which such funding is appropriated, the trauma center
  862  shall repay the state for the portion of the year during which
  863  it was not a trauma center.
  864         (2) Trauma centers eligible to receive distributions from
  865  the Emergency Medical Services Trust Fund under s. 20.435 in
  866  accordance with subsection (1) may request that such funds be
  867  used as intergovernmental transfer funds in the Medicaid
  868  program.
  869         (3) In order to receive state funding, a hospital must
  870  shall be a verified trauma center and shall:
  871         (a) Agree to conform to all departmental requirements as
  872  provided by rule to assure high-quality trauma services.
  873         (b) Agree to report trauma data to the National Trauma Data
  874  Bank provide information concerning the provision of trauma
  875  services to the department, in a form and manner prescribed by
  876  rule of the department.
  877         (c) Agree to accept all trauma patients, regardless of
  878  ability to pay, on a functional space-available basis.
  879         (4) A trauma center that fails to comply with any of the
  880  conditions listed in subsection (3) or the applicable rules of
  881  the department may shall not receive payments under this section
  882  for the period in which it was not in compliance.
  883         Section 8. Section 395.4036, Florida Statutes, is amended
  884  to read:
  885         395.4036 Trauma payments.—
  886         (1) Recognizing the Legislature’s stated intent to provide
  887  financial support to the current verified trauma centers and to
  888  provide incentives for the establishment of additional trauma
  889  centers as part of a system of state-sponsored trauma centers,
  890  the department shall utilize funds collected under s. 318.18 and
  891  deposited into the Emergency Medical Services Trust Fund of the
  892  department to ensure the availability and accessibility of
  893  trauma services throughout the state as provided in this
  894  subsection.
  895         (a) Funds collected under s. 318.18(15) shall be
  896  distributed as follows:
  897         1. Twenty percent of the total funds collected during the
  898  state fiscal year shall be distributed to verified trauma
  899  centers that have a local funding contribution as of December
  900  31. Distribution of funds under this subparagraph shall be based
  901  on trauma caseload volume for the most recent calendar year
  902  available.
  903         2. Forty percent of the total funds collected shall be
  904  distributed to verified trauma centers based on trauma caseload
  905  volume for the most recent calendar year available. The
  906  determination of caseload volume for distribution of funds under
  907  this subparagraph shall be based on the agency hospital
  908  discharge data reported by each trauma center pursuant to s.
  909  408.061 and meeting the criteria for classification as a trauma
  910  patient department’s Trauma Registry data.
  911         3. Forty percent of the total funds collected shall be
  912  distributed to verified trauma centers based on severity of
  913  trauma patients for the most recent calendar year available. The
  914  determination of severity for distribution of funds under this
  915  subparagraph shall be based on the department’s International
  916  Classification Injury Severity Scores or another statistically
  917  valid and scientifically accepted method of stratifying a trauma
  918  patient’s severity of injury, risk of mortality, and resource
  919  consumption as adopted by the department by rule, weighted based
  920  on the costs associated with and incurred by the trauma center
  921  in treating trauma patients. The weighting of scores shall be
  922  established by the department by rule.
  923         (b) Funds collected under s. 318.18(5)(c) and (20) shall be
  924  distributed as follows:
  925         1. Thirty percent of the total funds collected shall be
  926  distributed to Level II trauma centers operated by a public
  927  hospital governed by an elected board of directors as of
  928  December 31, 2008.
  929         2. Thirty-five percent of the total funds collected shall
  930  be distributed to verified trauma centers based on trauma
  931  caseload volume for the most recent calendar year available. The
  932  determination of caseload volume for distribution of funds under
  933  this subparagraph shall be based on the hospital discharge data
  934  reported by each trauma center pursuant to s. 408.061 and
  935  meeting the criteria for classification as a trauma patient
  936  department’s Trauma Registry data.
  937         3. Thirty-five percent of the total funds collected shall
  938  be distributed to verified trauma centers based on severity of
  939  trauma patients for the most recent calendar year available. The
  940  determination of severity for distribution of funds under this
  941  subparagraph shall be based on the department’s International
  942  Classification Injury Severity Scores or another statistically
  943  valid and scientifically accepted method of stratifying a trauma
  944  patient’s severity of injury, risk of mortality, and resource
  945  consumption as adopted by the department by rule, weighted based
  946  on the costs associated with and incurred by the trauma center
  947  in treating trauma patients. The weighting of scores shall be
  948  established by the department by rule.
  949         (2) Funds deposited in the department’s Emergency Medical
  950  Services Trust Fund for verified trauma centers may be used to
  951  maximize the receipt of federal funds that may be available for
  952  such trauma centers. Notwithstanding this section and s. 318.14,
  953  distributions to trauma centers may be adjusted in a manner to
  954  ensure that total payments to trauma centers represent the same
  955  proportional allocation as set forth in this section and s.
  956  318.14. For purposes of this section and s. 318.14, total funds
  957  distributed to trauma centers may include revenue from the
  958  Emergency Medical Services Trust Fund and federal funds for
  959  which revenue from the Administrative Trust Fund is used to meet
  960  state or local matching requirements. Funds collected under ss.
  961  318.14 and 318.18 and deposited in the Emergency Medical
  962  Services Trust Fund of the department shall be distributed to
  963  trauma centers on a quarterly basis using the most recent
  964  calendar year data available. Such data shall not be used for
  965  more than four quarterly distributions unless there are
  966  extenuating circumstances as determined by the department, in
  967  which case the most recent calendar year data available shall
  968  continue to be used and appropriate adjustments shall be made as
  969  soon as the more recent data becomes available.
  970         (3)(a) Any trauma center not subject to audit pursuant to
  971  s. 215.97 shall annually attest, under penalties of perjury,
  972  that such proceeds were used in compliance with law. The annual
  973  attestation shall be made in a form and format determined by the
  974  department. The annual attestation shall be submitted to the
  975  department for review within 9 months after the end of the
  976  organization’s fiscal year.
  977         (b) Any trauma center subject to audit pursuant to s.
  978  215.97 shall submit an audit report in accordance with rules
  979  adopted by the Auditor General.
  980         (4) The department, working with the Agency for Health Care
  981  Administration, shall maximize resources for trauma services
  982  wherever possible.
  983         Section 9. Section 395.404, Florida Statutes, is amended to
  984  read:
  985         395.404 Reporting Review of trauma registry data; report to
  986  National Trauma Data Bank central registry; confidentiality and
  987  limited release.—
  988         (1)(a) Each trauma center shall participate in the National
  989  Trauma Data Bank, and the department shall solely use the
  990  National Trauma Data Bank for quality and assessment purposes.
  991         (2) Each trauma center and acute care hospital shall report
  992  to the department all transfers of trauma patients and the
  993  outcomes of such patients furnish, and, upon request of the
  994  department, all acute care hospitals shall furnish for
  995  department review trauma registry data as prescribed by rule of
  996  the department for the purpose of monitoring patient outcome and
  997  ensuring compliance with the standards of approval.
  998         (b) Trauma registry data obtained pursuant to this
  999  subsection are confidential and exempt from the provisions of s.
 1000  119.07(1) and s. 24(a), Art. I of the State Constitution.
 1001  However, the department may provide such trauma registry data to
 1002  the person, trauma center, hospital, emergency medical service
 1003  provider, local or regional trauma agency, medical examiner, or
 1004  other entity from which the data were obtained. The department
 1005  may also use or provide trauma registry data for purposes of
 1006  research in accordance with the provisions of chapter 405.
 1007         (3)(2) Each trauma center, pediatric trauma center, and
 1008  acute care hospital shall report to the department’s brain and
 1009  spinal cord injury central registry, consistent with the
 1010  procedures and timeframes of s. 381.74, any person who has a
 1011  moderate-to-severe brain or spinal cord injury, and shall
 1012  include in the report the name, age, residence, and type of
 1013  disability of the individual and any additional information that
 1014  the department finds necessary.
 1015         Section 10. Paragraph (k) of subsection (1) of section
 1016  395.401, Florida Statutes, is amended to read:
 1017         395.401 Trauma services system plans; approval of trauma
 1018  centers and pediatric trauma centers; procedures; renewal.—
 1019         (1)
 1020         (k) It is unlawful for any hospital or other facility to
 1021  hold itself out as a trauma center unless it has been so
 1022  verified or designated pursuant to s. 395.4025(15) s.
 1023  395.4025(14).
 1024         Section 11. If the provisions of this act relating to s.
 1025  395.4025(16), Florida Statutes, are held to be invalid or
 1026  inoperative for any reason, the remaining provisions of this act
 1027  shall be deemed to be void and of no effect, it being the
 1028  legislative intent that this act as a whole would not have been
 1029  adopted had any provision of the act not been included.
 1030         Section 12. This act shall take effect July 1, 2018.