Senate Bill 2456c1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2456
By the Committee on Education and Senator Sullivan
304-2060-00
1 A bill to be entitled
2 An act relating to health care; amending s.
3 381.0403, F.S.; placing an emphasis on primary
4 care physicians rather than family physicians;
5 modifying the provisions relating to the
6 funding of graduate medical education; defining
7 primary care specialties; establishing a
8 program for graduate medical education
9 innovations; creating a process regarding the
10 release of funds; amending s. 408.07, F.S.;
11 modifying the definition of the term "teaching
12 hospital"; amending s. 409.905, F.S.;
13 increasing the Medicaid reimbursement
14 limitation for certain hospital outpatient
15 services; amending s. 409.908, F.S.; providing
16 exceptions to Medicaid reimbursement
17 limitations for certain hospital inpatient
18 care; authorizing the agency to receive certain
19 funds for such exceptional reimbursements;
20 providing an exemption from county contribution
21 requirements; increasing the Medicaid
22 reimbursement limitation for certain hospital
23 outpatient care; authorizing the agency to
24 receive certain funds for such outpatient care;
25 removing authority for additional reimbursement
26 for hospitals participating in the
27 extraordinary disproportionate share program;
28 providing an exemption from county contribution
29 requirements; requiring an annual report
30 addressing specific topics; providing a
31 committee for report purposes; providing a
1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2456
304-2060-00
1 reporting due date; providing an effective
2 date.
3
4 Be It Enacted by the Legislature of the State of Florida:
5
6 Section 1. Section 381.0403, Florida Statutes, is
7 amended to read:
8 381.0403 The Community Hospital Education Act.--
9 (1) SHORT TITLE.--This section shall be known and
10 cited as "The Community Hospital Education Act."
11 (2) LEGISLATIVE INTENT.--
12 (a) It is the intent of the Legislature that health
13 care services for the citizens of this state be upgraded and
14 that a program for continuing these services be maintained
15 through a plan for community medical education. The program
16 is intended to provide additional outpatient and inpatient
17 services, a continuing supply of highly trained physicians,
18 and graduate medical education.
19 (b) The Legislature further acknowledges the critical
20 need for increased numbers of primary care family physicians
21 to provide the necessary current and projected health and
22 medical services. In order to meet both present and
23 anticipated needs, the Legislature supports an expansion in
24 the number of family practice residency positions. The
25 Legislature intends that the funding for graduate education in
26 family practice be maintained and that funding for all primary
27 care specialities be provided at a minimum of $10,000 per
28 resident per year. Should funding for this act remain
29 constant or be reduced, it is intended that all programs
30 funded by this act be maintained or reduced proportionately.
31
2
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2456
304-2060-00
1 (3) PROGRAM FOR COMMUNITY HOSPITAL EDUCATION; STATE
2 AND LOCAL PLANNING.--
3 (a) There is established under the Board of Regents a
4 program for statewide graduate medical education. It is
5 intended that continuing graduate medical education programs
6 for interns and residents be established on a statewide basis.
7 The program shall provide financial support for primary care
8 specialty interns and residents based on policies recommended
9 and approved by the Community Hospital Education Council,
10 herein established, and the Board of Regents. Only those
11 programs with at least three residents or interns in each year
12 of the training program are qualified to apply for financial
13 support. Programs with fewer than three residents or interns
14 per training year are qualified to apply for financial
15 support, but only if the appropriate accrediting entity for
16 the particular specialty has approved the program for fewer
17 positions. When feasible and to the extent allowed through the
18 General Appropriations Act, state funds shall be used to
19 generate federal matching funds under Medicaid or other
20 federal programs, and the resulting combined state and federal
21 funds shall be allocated to participating hospitals for the
22 support of graduate medical education and for administrative
23 costs associated with the production of the annual report as
24 specified in section 5 of this act.
25 (b) For the purposes of this section, primary care
26 specialties include emergency medicine, family practice,
27 internal medicine, pediatrics, psychiatry,
28 obstetrics/gynecology, and combined pediatrics and internal
29 medicine, and other primary care specialties included by the
30 council and the Board of Regents.
31
3
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2456
304-2060-00
1 (c)(b) Medical institutions throughout the state may
2 apply to the Community Hospital Education Council for
3 grants-in-aid for financial support of their approved
4 programs. Recommendations for funding of approved programs
5 shall be forwarded to the Board of Regents.
6 (d)(c) The program shall provide a plan for community
7 clinical teaching and training with the cooperation of the
8 medical profession, hospitals, and clinics. The plan shall
9 also include formal teaching opportunities for intern and
10 resident training. In addition, the plan shall establish an
11 off-campus medical faculty with university faculty review to
12 be located throughout the state in local communities.
13 (4) PROGRAM FOR GRADUATE MEDICAL EDUCATION
14 INNOVATIONS.--
15 (a) There is established under the Board of Regents a
16 program for fostering graduate medical education innovations.
17 Funds appropriated annually by the Legislature for this
18 purpose shall be distributed to participating hospitals or
19 consortia of participating hospitals and Florida medical
20 schools on a competitive-grant or formula basis to achieve
21 state health care workforce policy objectives, including, but
22 not limited to:
23 1. Increasing the number of residents in primary care
24 and other high demand specialties or fellowships;
25 2. Enhancing retention of primary care physicians in
26 Florida practice;
27 3. Promoting practice in medically under-served areas
28 of the state;
29 4. Encouraging racial and ethnic diversity within the
30 state's physician workforce; and
31 5. Encouraging increased production of geriatricians.
4
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2456
304-2060-00
1 (b) Participating hospitals or consortia of
2 participating hospitals and Florida medical schools may apply
3 to the Community Hospital Education Council for funding under
4 this innovation program. Innovation program funding shall
5 provide funding based on policies recommended and approved by
6 the Community Hospital Education Council and the Board of
7 Regents.
8 (c) Participating hospitals or consortia of
9 participating hospitals and Florida medical schools awarded an
10 innovation grant shall provide the Community Hospital
11 Education Council and Board of Regents with an annual report
12 on their project.
13 (5)(4) FAMILY PRACTICE RESIDENCIES.--In addition to
14 the programs established in subsection (3), the Community
15 Hospital Education Council and the Board of Regents shall
16 establish an ongoing statewide program of family practice
17 residencies. The administration of this program shall be in
18 the manner described in this section.
19 (6)(5) COUNCIL AND DIRECTOR.--
20 (a) There is established the Community Hospital
21 Education Council, hereinafter referred to as the council,
22 which shall consist of eleven members, as follows:
23 1. Seven members must be program directors of
24 accredited graduate medical education programs or practicing
25 physicians who have faculty appointments in accredited
26 graduate medical education programs. Six of these members
27 must be board certified or board eligible in family practice,
28 internal medicine, pediatrics, emergency medicine,
29 obstetrics-gynecology, and psychiatry, respectively, and
30 licensed pursuant to chapter 458. No more than one of these
31
5
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2456
304-2060-00
1 members may be appointed from any one specialty. One member
2 must be licensed pursuant to chapter 459.
3 2. One member must be a representative of the
4 administration of a hospital with an approved community
5 hospital medical education program;
6 3. One member must be the dean of a medical school in
7 this state; and
8 4. Two members must be consumer representatives.
9
10 All of the members shall be appointed by the Governor for
11 terms of 4 years each.
12 (b) Council membership shall cease when a member's
13 representative status no longer exists. Members of similar
14 representative status shall be appointed to replace retiring
15 or resigning members of the council.
16 (c) The Chancellor of the State University System
17 shall designate an administrator to serve as staff director.
18 The council shall elect a chair from among its membership.
19 Such other personnel as may be necessary to carry out the
20 program shall be employed as authorized by the Board of
21 Regents.
22 (7)(6) BOARD OF REGENTS; STANDARDS.--
23 (a) The Board of Regents, with recommendations from
24 the council, shall establish standards and policies for the
25 use and expenditure of graduate medical education funds
26 appropriated pursuant to subsection (8) (7) for a program of
27 community hospital education. The board shall establish
28 requirements for hospitals to be qualified for participation
29 in the program which shall include, but not be limited to:
30 1. Submission of an educational plan and a training
31 schedule.
6
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2456
304-2060-00
1 2. A determination by the council to ascertain that
2 each portion of the program of the hospital provides a high
3 degree of academic excellence and is accredited by the
4 Accreditation Council for Graduate Medical Education of the
5 American Medical Association or is accredited by the American
6 Osteopathic Association.
7 3. Supervision of the educational program of the
8 hospital by a physician who is not the hospital administrator.
9 (b) The Board of Regents shall periodically review the
10 educational program provided by a participating hospital to
11 assure that the program includes a reasonable amount of both
12 formal and practical training and that the formal sessions are
13 presented as scheduled in the plan submitted by each hospital.
14 (c) In years that funds are transferred to the Agency
15 for Health Care Administration, the Board of Regents shall
16 certify to the Agency for Health Care Administration quarterly
17 the number of primary care specialty residents and interns at
18 each of the participating hospitals for which the Community
19 Hospital Education Council and the board recommend funding.
20 (8)(7) MATCHING FUNDS.--State funds shall be used to
21 match funds from any local governmental or hospital source.
22 The state shall provide up to 50 percent of the funds, and the
23 community hospital medical education program shall provide the
24 remainder. However, except for fixed capital outlay, the
25 provisions of this subsection shall not apply to any program
26 authorized under the provisions of subsection (5) (4) for the
27 first 3 years after such program is in operation.
28 Section 2. Subsection (44) of section 408.07, Florida
29 Statutes, is amended to read:
30 408.07 Definitions.--As used in this chapter, with the
31 exception of ss. 408.031-408.045, the term:
7
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2456
304-2060-00
1 (44) "Teaching hospital" means any Florida hospital
2 officially formally affiliated with an accredited medical
3 school which exhibits activity in the area of graduate medical
4 education as reflected by at least seven different graduate
5 medical education programs accredited by the Accreditation
6 Council for Graduate Medical Education resident physician
7 specialties and the presence of 100 or more
8 full-time-equivalent resident physicians. The Director of the
9 Agency for Health Care Administration shall be responsible for
10 determining which hospitals meet this definition.
11 Section 3. Subsection (6) of section 409.905, Florida
12 Statutes, is amended to read:
13 409.905 Mandatory Medicaid services.--The agency may
14 make payments for the following services, which are required
15 of the state by Title XIX of the Social Security Act,
16 furnished by Medicaid providers to recipients who are
17 determined to be eligible on the dates on which the services
18 were provided. Any service under this section shall be
19 provided only when medically necessary and in accordance with
20 state and federal law. Nothing in this section shall be
21 construed to prevent or limit the agency from adjusting fees,
22 reimbursement rates, lengths of stay, number of visits, number
23 of services, or any other adjustments necessary to comply with
24 the availability of moneys and any limitations or directions
25 provided for in the General Appropriations Act or chapter 216.
26 (6) HOSPITAL OUTPATIENT SERVICES.--The agency shall
27 pay for preventive, diagnostic, therapeutic, or palliative
28 care and other services provided to a recipient in the
29 outpatient portion of a hospital licensed under part I of
30 chapter 395, and provided under the direction of a licensed
31 physician or licensed dentist, except that payment for such
8
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2456
304-2060-00
1 care and services is limited to $1,500 $1,000 per state fiscal
2 year per recipient, unless an exception has been made by the
3 agency, and with the exception of a Medicaid recipient under
4 age 21, in which case the only limitation is medical
5 necessity.
6 Section 4. Subsection (1) of section 409.908, Florida
7 Statutes, is amended to read:
8 409.908 Reimbursement of Medicaid providers.--Subject
9 to specific appropriations, the agency shall reimburse
10 Medicaid providers, in accordance with state and federal law,
11 according to methodologies set forth in the rules of the
12 agency and in policy manuals and handbooks incorporated by
13 reference therein. These methodologies may include fee
14 schedules, reimbursement methods based on cost reporting,
15 negotiated fees, competitive bidding pursuant to s. 287.057,
16 and other mechanisms the agency considers efficient and
17 effective for purchasing services or goods on behalf of
18 recipients. Payment for Medicaid compensable services made on
19 behalf of Medicaid eligible persons is subject to the
20 availability of moneys and any limitations or directions
21 provided for in the General Appropriations Act or chapter 216.
22 Further, nothing in this section shall be construed to prevent
23 or limit the agency from adjusting fees, reimbursement rates,
24 lengths of stay, number of visits, or number of services, or
25 making any other adjustments necessary to comply with the
26 availability of moneys and any limitations or directions
27 provided for in the General Appropriations Act, provided the
28 adjustment is consistent with legislative intent.
29 (1) Reimbursement to hospitals licensed under part I
30 of chapter 395 must be made prospectively or on the basis of
31 negotiation.
9
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2456
304-2060-00
1 (a) Reimbursement for inpatient care is limited as
2 provided for in s. 409.905(5), except for:.
3 1. The raising of rate reimbursement caps, subject to
4 certification from the Board of Regents that the hospital has
5 complied with s. 381.0403 excluding rural hospitals.
6 2. Recognition of the costs of graduate medical
7 education.
8 3. Other methodologies recognized in the General
9 Appropriations Act.
10
11 The agency is authorized to receive funds from state entities,
12 including the Board of Regents, local governments, and other
13 local political subdivisions, for the purpose of making
14 special exception payments, including federal matching funds,
15 through the Medicaid inpatient reimbursement methodologies.
16 Funds received from state entities or local governments for
17 this purpose shall be separately accounted for and shall not
18 be commingled with other state or local funds in any manner.
19 Notwithstanding this section or s. 409.915, counties are
20 exempt from contributing toward the cost of the
21 special-exception reimbursement for hospitals serving a
22 disproportionate share of low-income persons and providing
23 graduate medical education.
24 (b) Reimbursement for hospital outpatient care is
25 limited to $1,500 $1,000 per state fiscal year per recipient,
26 except for:
27 1. Such care provided to a Medicaid recipient under
28 age 21, in which case the only limitation is medical
29 necessity.;
30 2. Renal dialysis services.; and
31 3. Other exceptions made by the agency.
10
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2456
304-2060-00
1
2 The agency is authorized to receive funds from state entities,
3 including the Board of Regents, local governments, and other
4 local political subdivisions, for the purpose of making
5 payments, including federal matching funds, through the
6 Medicaid outpatient reimbursement methodologies. Funds
7 received from state entities and local governments for this
8 purpose shall be separately accounted for and shall not be
9 commingled with other state or local funds in any manner.
10 (c)(b) Hospitals that provide services to a
11 disproportionate share of low-income Medicaid recipients, or
12 that participate in the regional perinatal intensive care
13 center program under chapter 383, or that participate in the
14 statutory teaching hospital disproportionate share program, or
15 that participate in the extraordinary disproportionate share
16 program, may receive additional reimbursement. The total
17 amount of payment for disproportionate share hospitals shall
18 be fixed by the General Appropriations Act. The computation of
19 these payments must be made in compliance with all federal
20 regulations and the methodologies described in ss. 409.911,
21 409.9112, and 409.9113.
22 (d)(c) The agency is authorized to limit inflationary
23 increases for outpatient hospital services as directed by the
24 General Appropriations Act.
25 Section 5. The Board of Regents, the Executive Office
26 of the Governor, the Department of Health, and the Agency for
27 Health Care Administration shall collaborate to establish a
28 committee that shall produce an annual report on graduate
29 medical education. To the maximum extent feasible, the
30 committee shall have the same membership as the Graduate
31 Medical Education Study Committee, established by the proviso
11
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2456
304-2060-00
1 accompanying Specific Appropriation 191 of the fiscal year
2 1999-2000 General Appropriations Act. The report shall be
3 provided to the Governor, the President of the Senate, and the
4 Speaker of the House of Representatives by January 15 of each
5 year. Committee members shall serve without compensation. From
6 the funds provided in section 381.0403(3), Florida Statutes,
7 the committee is authorized to expend a maximum of $75,000 per
8 year to provide for administrative costs and contractual
9 services. The report must address the following topics:
10 (1) The role of residents and medical faculty in the
11 provision of health care.
12 (2) The relationship of graduate medical education to
13 the state's physician workforce.
14 (3) The costs of training medical residents for
15 hospitals, medical schools, teaching hospitals, including all
16 hospital-medical affiliations, practice plans at all of the
17 medical schools, and municipalities.
18 (4) The availability and adequacy of all sources of
19 revenue to support graduate medical education. The report must
20 also recommend alternative sources of funding for graduate
21 medical education.
22 (5) The use of state and federal appropriated funds
23 for graduate medical education by hospitals receiving such
24 funds.
25 Section 6. This act shall take effect July 1, 2000.
26
27
28
29
30
31
12
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2456
304-2060-00
1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 SB 2456
3
4 The Committee Substitute for SB 2456:
5 Transfers funding for the Community Hospital Education Act to
the Agency for Health Care Administration, in an attempt to
6 generate federal matching funds under Medicaid.
7 Creates a Program for Graduate Medical Education Innovations
to achieve workforce policy objectives, such as more
8 physicians in under-served areas, more geriatricians, and more
ethnic diversity among physicians.
9
Defines the term "teaching hospital" and specifies priorities
10 for the Community Hospital Education Program.
11 Creates in statute a committee established in last year's
General Appropriations Act for graduate medical education in
12 Florida.
13 Increases from $1,000 to $1,500 the annual Medicaid hospital
inpatient and outpatient services cap for adults.
14
Revises Medicaid limitations for hospital inpatient services
15 to provide exceptions for raising reimbursement caps,
recognition of the costs associated with graduate medical
16 education, and other methodologies provided in the General
Appropriations Act; authorizes AHCA to receive funds from
17 certain entities for the reimbursements; and exempts counties
from them.
18
Deletes obsolete provisions.
19
20
21
22
23
24
25
26
27
28
29
30
31
13