Senate Bill sb2092c2
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Florida Senate - 2001 CS for CS for SB 2092
By the Committees on Appropriations; Health, Aging and
Long-Term Care; and Senator Sanderson
309-1897-01
1 A bill to be entitled
2 An act relating to health care; amending s.
3 154.306, F.S.; providing procedures for
4 computing the maximum amount that specified
5 counties must pay for the treatment of an
6 indigent resident of the county at a hospital
7 located outside the county; providing for the
8 exclusion of active-duty military personnel and
9 certain institutionalized county residents from
10 state population estimates when calculating a
11 county's financial responsibility for such
12 hospital care; requiring the county of
13 residence to accept the hospital's
14 documentation of financial eligibility and
15 county residence; requiring that the
16 documentation meet specified criteria; amending
17 s. 381.0403, F.S.; transferring the community
18 hospital education program from the Board of
19 Regents to the Department of Health;
20 prescribing membership of a committee reporting
21 on graduate medical education; amending s.
22 409.908, F.S.; revising provisions relating to
23 the reimbursement of Medicaid providers to
24 conform to the transfer of the Community
25 Hospital Education Program from the Board of
26 Regents to the Department of Health; providing
27 for the certification of local matching funds;
28 providing requirements for the distribution of
29 federal funds earned as a result of local
30 matching funds; requiring an impact statement;
31 providing rulemaking authority to the
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1 Department of Health; amending s. 409.911,
2 F.S.; redefining the term "charity care" or
3 "uncompensated charity care" for purposes of
4 the disproportionate share program; amending s.
5 409.9117, F.S.; revising eligibility criteria
6 for payments under the primary care
7 disproportionate share program; providing an
8 effective date.
9
10 Be It Enacted by the Legislature of the State of Florida:
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12 Section 1. Present subsections (3) and (4) of section
13 154.306, Florida Statutes, are redesignated as subsections (4)
14 and (5), respectively, and a new subsection (3) is added to
15 that section, to read:
16 154.306 Financial responsibility for certified
17 residents who are qualified indigent patients treated at an
18 out-of-county participating hospital or regional referral
19 hospital.--Ultimate financial responsibility for treatment
20 received at a participating hospital or a regional referral
21 hospital by a qualified indigent patient who is a certified
22 resident of a county in the State of Florida, but is not a
23 resident of the county in which the participating hospital or
24 regional referral hospital is located, is the obligation of
25 the county of which the qualified indigent patient is a
26 resident. Each county shall reimburse participating hospitals
27 or regional referral hospitals as provided for in this part,
28 and shall provide or arrange for indigent eligibility
29 determination procedures and resident certification
30 determination procedures as provided for in rules developed to
31 implement this part. The agency, or any county determining
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1 eligibility of a qualified indigent, shall provide to the
2 county of residence, upon request, a copy of any documents,
3 forms, or other information, as determined by rule, which may
4 be used in making an eligibility determination.
5 (3) For the purpose of computing the maximum amount
6 that a county having a population of 100,000 or less may be
7 required to pay, the agency must reduce the official state
8 population estimates by the number of inmates and patients
9 residing in the county in institutions operated by the Federal
10 Government, the Department of Corrections, the Department of
11 Health, or the Department of Children and Family Services, and
12 by the number of active-duty military personnel residing in
13 the county, all of whom shall not be considered residents of
14 the county. However, a county is entitled to receive the
15 benefit of such a reduction in estimated population figures
16 only if the county accepts as valid and true, and does not
17 require any reverification of, the documentation of financial
18 eligibility and county residency which is provided to it by
19 the participating hospital or regional referral hospital. The
20 participating hospital or regional referral hospital must
21 provide documentation that is complete and in the form
22 required by s. 154.3105.
23 Section 2. Subsections (3), (4), (5), (6), (7), and
24 (9) of section 381.0403, Florida Statutes, are amended, and
25 subsection (10) is added to that section, to read:
26 381.0403 The Community Hospital Education Act.--
27 (3) PROGRAM FOR COMMUNITY HOSPITAL EDUCATION; STATE
28 AND LOCAL PLANNING.--
29 (a) There is established under the Department of
30 Health Board of Regents a program for statewide graduate
31 medical education. It is intended that continuing graduate
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1 medical education programs for interns and residents be
2 established on a statewide basis. The program shall provide
3 financial support for primary care specialty interns and
4 residents based on policies recommended and approved by the
5 Community Hospital Education Council, herein established, and
6 the Department of Health Board of Regents. Only those programs
7 with at least three residents or interns in each year of the
8 training program are qualified to apply for financial support.
9 Programs with fewer than three residents or interns per
10 training year are qualified to apply for financial support,
11 but only if the appropriate accrediting entity for the
12 particular specialty has approved the program for fewer
13 positions. Programs added after fiscal year 1997-1998 shall
14 have 5 years to attain the requisite number of residents or
15 interns. When feasible and to the extent allowed through the
16 General Appropriations Act, state funds shall be used to
17 generate federal matching funds under Medicaid, or other
18 federal programs, and the resulting combined state and federal
19 funds shall be allocated to participating hospitals for the
20 support of graduate medical education. The department may
21 spend up to $75,000 of the state appropriation, for
22 administrative costs associated with the production of the
23 annual report as specified in subsection (9), and for
24 administration of the program council.
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 as may be
30 included by the council and Department of Health Board of
31 Regents.
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1 (c) 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 Department of Health Board of
6 Regents.
7 (d) The program shall provide a plan for community
8 clinical teaching and training with the cooperation of the
9 medical profession, hospitals, and clinics. The plan shall
10 also include formal teaching opportunities for intern and
11 resident training. In addition, the plan shall establish an
12 off-campus medical faculty with university faculty review to
13 be located throughout the state in local communities.
14 (4) PROGRAM FOR GRADUATE MEDICAL EDUCATION
15 INNOVATIONS.--
16 (a) There is established under the Department of
17 Health Board of Regents a program for fostering graduate
18 medical education innovations. Funds appropriated annually by
19 the Legislature for this purpose shall be distributed to
20 participating hospitals or consortia of participating
21 hospitals and Florida medical schools or to a Florida medical
22 school for the direct costs of providing graduate medical
23 education in community-based clinical settings on a
24 competitive grant or formula basis to achieve state health
25 care workforce policy objectives, including, but not limited
26 to:
27 1. Increasing the number of residents in primary care
28 and other high demand specialties or fellowships;
29 2. Enhancing retention of primary care physicians in
30 Florida practice;
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1 3. Promoting practice in medically underserved areas
2 of the state;
3 4. Encouraging racial and ethnic diversity within the
4 state's physician workforce; and
5 5. Encouraging increased production of geriatricians.
6 (b) Participating hospitals or consortia of
7 participating hospitals and Florida medical schools or a
8 Florida medical school providing graduate medical education in
9 community-based clinical settings may apply to the Community
10 Hospital Education Council for funding under this innovations
11 program, except when such innovations directly compete with
12 services or programs provided by participating hospitals or
13 consortia of participating hospitals, or by both hospitals and
14 consortia. Innovations program funding shall provide funding
15 based on policies recommended and approved by the Community
16 Hospital Education Council and the Department of Health Board
17 of Regents.
18 (c) Participating hospitals or consortia of
19 participating hospitals and Florida medical schools or Florida
20 medical schools awarded an innovations grant shall provide the
21 Community Hospital Education Council and Department of Health
22 Board of Regents with an annual report on their project.
23 (5) FAMILY PRACTICE RESIDENCIES.--In addition to the
24 programs established in subsection (3), the Community Hospital
25 Education Council and the Department of Health Board of
26 Regents shall establish an ongoing statewide program of family
27 practice residencies. The administration of this program
28 shall be in the manner described in this section.
29 (6) COUNCIL AND DIRECTOR.--
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1 (a) There is established the Community Hospital
2 Education Council, hereinafter referred to as the council,
3 which shall consist of 11 members, as follows:
4 1. Seven members must be program directors of
5 accredited graduate medical education programs or practicing
6 physicians who have faculty appointments in accredited
7 graduate medical education programs. Six of these members
8 must be board certified or board eligible in family practice,
9 internal medicine, pediatrics, emergency medicine,
10 obstetrics-gynecology, and psychiatry, respectively, and
11 licensed pursuant to chapter 458. No more than one of these
12 members may be appointed from any one specialty. One member
13 must be licensed pursuant to chapter 459.
14 2. One member must be a representative of the
15 administration of a hospital with an approved community
16 hospital medical education program;
17 3. One member must be the dean of a medical school in
18 this state; and
19 4. Two members must be consumer representatives.
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21 All of the members shall be appointed by the Governor for
22 terms of 4 years each.
23 (b) Council membership shall cease when a member's
24 representative status no longer exists. Members of similar
25 representative status shall be appointed to replace retiring
26 or resigning members of the council.
27 (c) The Secretary of the Department of Health
28 Chancellor of the State University System shall designate an
29 administrator to serve as staff director. The council shall
30 elect a chair from among its membership. Such other personnel
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1 as may be necessary to carry out the program shall be employed
2 as authorized by the Department of Health Board of Regents.
3 (7) DEPARTMENT OF HEALTH BOARD OF REGENTS;
4 STANDARDS.--
5 (a) The Department of Health Board of Regents, with
6 recommendations from the council, shall establish standards
7 and policies for the use and expenditure of graduate medical
8 education funds appropriated pursuant to subsection (8) for a
9 program of community hospital education. The Department of
10 Health board shall establish requirements for hospitals to be
11 qualified for participation in the program which shall
12 include, but not be limited to:
13 1. Submission of an educational plan and a training
14 schedule.
15 2. A determination by the council to ascertain that
16 each portion of the program of the hospital provides a high
17 degree of academic excellence and is accredited by the
18 Accreditation Council for Graduate Medical Education of the
19 American Medical Association or is accredited by the American
20 Osteopathic Association.
21 3. Supervision of the educational program of the
22 hospital by a physician who is not the hospital administrator.
23 (b) The Department of Health Board of Regents shall
24 periodically review the educational program provided by a
25 participating hospital to assure that the program includes a
26 reasonable amount of both formal and practical training and
27 that the formal sessions are presented as scheduled in the
28 plan submitted by each hospital.
29 (c) In years that funds are transferred to the Agency
30 for Health Care Administration, the Department of Health Board
31 of Regents shall certify to the Agency for Health Care
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1 Administration on a quarterly basis the number of primary care
2 specialty residents and interns at each of the participating
3 hospitals for which the Community Hospital Education Council
4 and the board recommends funding.
5 (9) ANNUAL REPORT ON GRADUATE MEDICAL EDUCATION;
6 COMMITTEE.--The Board of Regents, the Executive Office of the
7 Governor, the Department of Health, and the Agency for Health
8 Care Administration shall collaborate to establish a committee
9 that shall produce an annual report on graduate medical
10 education. The committee shall be comprised of 11 members:
11 five members shall be deans of the medical schools or their
12 designees; the Governor shall appoint two members, one of whom
13 must be a representative of the Florida Medical Association
14 who has supervised or currently supervises residents or
15 interns and one of whom must be a representative of the
16 Florida Hospital Association; the Secretary of Health Care
17 Administration shall appoint two members, one of whom must be
18 a representative of a statutory teaching hospital and one of
19 whom must be a physician who has supervised or is currently
20 supervising residents or interns; and the Secretary of Health
21 shall appoint two members, one of whom must be a
22 representative of a statutory family practice teaching
23 hospital and one of whom must be a physician who has
24 supervised or is currently supervising residents or interns.
25 With the exception of the deans, members shall serve 4-year
26 terms. In order to stagger the terms, the Governor's
27 appointees shall serve initial terms of 4 years, the Secretary
28 of Health's appointees shall serve initial terms of 3 years,
29 and the Secretary of Health Care Administration's appointees
30 shall serve initial terms of 2 years. A member's term shall be
31 deemed terminated when the member's representative status no
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1 longer exists. Once the committee is appointed, it shall elect
2 a chair to serve for a 1-year term. To the maximum extent
3 feasible, the committee shall have the same membership as the
4 Graduate Medical Education Study Committee, established by
5 proviso accompanying Specific Appropriation 191 of the
6 1999-2000 General Appropriations Act. The report shall be
7 provided to the Governor, the President of Senate, and the
8 Speaker of the House of Representatives by January 15
9 annually. Committee members shall serve without compensation.
10 From the funds provided pursuant to subsection (3), the
11 committee is authorized to expend a maximum of $75,000 per
12 year to provide for administrative costs and contractual
13 services. The report shall address the following:
14 (a) The role of residents and medical faculty in the
15 provision of health care.
16 (b) The relationship of graduate medical education to
17 the state's physician workforce.
18 (c) The costs of training medical residents for
19 hospitals, medical schools, teaching hospitals, including all
20 hospital-medical affiliations, practice plans at all of the
21 medical schools, and municipalities.
22 (d) The availability and adequacy of all sources of
23 revenue to support graduate medical education and recommend
24 alternative sources of funding for graduate medical education.
25 (e) The use of state and federal appropriated funds
26 for graduate medical education by hospitals receiving such
27 funds.
28 (10) RULEMAKING.--The department has authority to
29 adopt rules pursuant to ss. 120.536(1) and 120.54 to implement
30 the provisions of this section.
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1 Section 3. All statutory powers, duties, and functions
2 and the records, personnel, property, and unexpended balances
3 of appropriations, allocations, or other funds of the
4 Community Hospital Education Program are transferred from the
5 Board of Regents to the Department of Health by a type two
6 transfer as defined in section 20.06, Florida Statutes.
7 Section 4. Paragraph (a) of subsection (1) of section
8 409.908, Florida Statutes, is amended to read:
9 409.908 Reimbursement of Medicaid providers.--Subject
10 to specific appropriations, the agency shall reimburse
11 Medicaid providers, in accordance with state and federal law,
12 according to methodologies set forth in the rules of the
13 agency and in policy manuals and handbooks incorporated by
14 reference therein. These methodologies may include fee
15 schedules, reimbursement methods based on cost reporting,
16 negotiated fees, competitive bidding pursuant to s. 287.057,
17 and other mechanisms the agency considers efficient and
18 effective for purchasing services or goods on behalf of
19 recipients. Payment for Medicaid compensable services made on
20 behalf of Medicaid eligible persons is subject to the
21 availability of moneys and any limitations or directions
22 provided for in the General Appropriations Act or chapter 216.
23 Further, nothing in this section shall be construed to prevent
24 or limit the agency from adjusting fees, reimbursement rates,
25 lengths of stay, number of visits, or number of services, or
26 making any other adjustments necessary to comply with the
27 availability of moneys and any limitations or directions
28 provided for in the General Appropriations Act, provided the
29 adjustment is consistent with legislative intent.
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1 (1) Reimbursement to hospitals licensed under part I
2 of chapter 395 must be made prospectively or on the basis of
3 negotiation.
4 (a) Reimbursement for inpatient care is limited as
5 provided for in s. 409.905(5), except for:
6 1. The raising of rate reimbursement caps, excluding
7 rural hospitals.
8 2. Recognition of the costs of graduate medical
9 education.
10 3. Other methodologies recognized in the General
11 Appropriations Act.
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13 During the years funds are transferred from the Department of
14 Health Board of Regents, any reimbursement supported by such
15 funds shall be subject to certification by the Department of
16 Health Board of Regents that the hospital has complied with s.
17 381.0403. The agency is authorized to receive funds from state
18 entities, including, but not limited to, the Department of
19 Health, the Board of Regents, local governments, and other
20 local political subdivisions, for the purpose of making
21 special exception payments, including federal matching funds,
22 through the Medicaid inpatient reimbursement methodologies.
23 Funds received from state entities or local governments for
24 this purpose shall be separately accounted for and shall not
25 be commingled with other state or local funds in any manner.
26 The agency may certify all local governmental funds used as
27 state match under Title XIX of the Social Security Act, to the
28 extent that the identified local health care provider that is
29 otherwise entitled to and is contracted to receive such local
30 funds is the benefactor under the state's Medicaid program as
31 determined under the General Appropriations Act and pursuant
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1 to an agreement between the Agency for Health Care
2 Administration and the local governmental entity. The local
3 governmental entity shall use a certification form prescribed
4 by the agency. At a minimum, the certification form shall
5 identify the amount being certified and describe the
6 relationship between the certifying local governmental entity
7 and the local health care provider. The agency shall prepare
8 an annual statement of impact which documents the specific
9 activities undertaken during the previous fiscal year pursuant
10 to this paragraph, to be submitted to the Legislature no later
11 than January 1, annually. Notwithstanding this section and s.
12 409.915, counties are exempt from contributing toward the cost
13 of the special exception reimbursement for hospitals serving a
14 disproportionate share of low-income persons and providing
15 graduate medical education.
16 (b) Reimbursement for hospital outpatient care is
17 limited to $1,500 per state fiscal year per recipient, except
18 for:
19 1. Such care provided to a Medicaid recipient under
20 age 21, in which case the only limitation is medical
21 necessity.
22 2. Renal dialysis services.
23 3. Other exceptions made by the agency.
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25 The agency is authorized to receive funds from state entities,
26 including, but not limited to, the Board of Regents, local
27 governments, and other local political subdivisions, for the
28 purpose of making payments, including federal matching funds,
29 through the Medicaid outpatient reimbursement methodologies.
30 Funds received from state entities and local governments for
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1 this purpose shall be separately accounted for and shall not
2 be commingled with other state or local funds in any manner.
3 (c) Hospitals that provide services to a
4 disproportionate share of low-income Medicaid recipients, or
5 that participate in the regional perinatal intensive care
6 center program under chapter 383, or that participate in the
7 statutory teaching hospital disproportionate share program may
8 receive additional reimbursement. The total amount of payment
9 for disproportionate share hospitals shall be fixed by the
10 General Appropriations Act. The computation of these payments
11 must be made in compliance with all federal regulations and
12 the methodologies described in ss. 409.911, 409.9112, and
13 409.9113.
14 (d) The agency is authorized to limit inflationary
15 increases for outpatient hospital services as directed by the
16 General Appropriations Act.
17 Section 5. Paragraph (d) of subsection (1) of section
18 409.911, Florida Statutes, is amended to read:
19 409.911 Disproportionate share program.--Subject to
20 specific allocations established within the General
21 Appropriations Act and any limitations established pursuant to
22 chapter 216, the agency shall distribute, pursuant to this
23 section, moneys to hospitals providing a disproportionate
24 share of Medicaid or charity care services by making quarterly
25 Medicaid payments as required. Notwithstanding the provisions
26 of s. 409.915, counties are exempt from contributing toward
27 the cost of this special reimbursement for hospitals serving a
28 disproportionate share of low-income patients.
29 (1) Definitions.--As used in this section and s.
30 409.9112:
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1 (d) "Charity care" or "uncompensated charity care"
2 means that portion of hospital charges reported to the Agency
3 for Health Care Administration for which there is no
4 compensation, other than restricted or unrestricted revenues
5 provided to a hospital by local governments or tax districts
6 regardless of the method of payment, for care provided to a
7 patient whose family income for the 12 months preceding the
8 determination is less than or equal to 200 150 percent of the
9 federal poverty level, unless the amount of hospital charges
10 due from the patient exceeds 25 percent of the annual family
11 income. However, in no case shall the hospital charges for a
12 patient whose family income exceeds four times the federal
13 poverty level for a family of four be considered charity.
14 Section 6. Paragraph (c) of subsection (2) of section
15 409.9117, Florida Statutes, is amended to read:
16 409.9117 Primary care disproportionate share
17 program.--
18 (2) In the establishment and funding of this program,
19 the agency shall use the following criteria in addition to
20 those specified in s. 409.911, payments may not be made to a
21 hospital unless the hospital agrees to:
22 (c) Coordinate and provide primary care services free
23 of charge, except copayments, to all persons with incomes up
24 to 100 percent of the federal poverty level who are not
25 otherwise covered by Medicaid or another program administered
26 by a governmental entity, and to provide such services based
27 on a sliding fee scale to all persons with incomes up to 200
28 percent of the federal poverty level who are not otherwise
29 covered by Medicaid or another program administered by a
30 governmental entity, except that eligibility may be limited to
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1 persons who reside within a more limited area, as agreed to by
2 the agency and the hospital.
3 Section 7. This act shall take effect July 1, 2001.
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5 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
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8 Specifies procedures for computing the maximum amount that
specified counties must pay for the treatment of indigent
9 residents of the county at a hospital located outside the
county. Provides for the exclusion of active-duty military
10 personnel and certain institutionalized county residents from
the state population estimates when calculating a county's
11 financial responsibility for the hospital care. Requires the
county of residence to accept the hospital's documentation of
12 financial eligibility and county residence and requires that
the documentation meet specified criteria.
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Provides that the Agency for Health Care Administration may
14 certify local governmental funds as match to the Medicaid
Program (Title XIX) and specifies certain policies and
15 procedures and documentation requirements. Requires annual
reports to the legislature documenting the specific activities
16 undertaken pursuant to this provision.
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