HB 0159 2003
1	A bill to be entitled
2	An act relating to graduate medical education; amending s.
3	381.0403, F.S.; revising provisions relating to "The
4	Community Hospital Education Act"; renaming the act;
5	providing legislative intent to improve and maintain
6	health care services through the availability of high
7	quality residency and internship programs; deleting the
8	Community Hospital Education Council, the program for
9	community hospital education, and the program of family
10	practice residencies; establishing the Commission on
11	Graduate Medical Education; providing membership and
12	assignment to the Department of Health for administrative
13	purposes; providing duties of the commission; deleting
14	Department of Health duties relating to the program for
15	community hospital education and its funding; revising
16	provisions relating to annual reporting on graduate
17	medical education; requiring the Department of Health to
18	provide the Agency for Health Care Administration with
19	certain information with respect to accredited residency
20	and internship programs; amending s. 409.908, F.S.;
21	conforming provisions; providing an effective date.
22
23	Be It Enacted by the Legislature of the State of Florida:
24
25	Section 1. Section 381.0403, Florida Statutes, is amended
26	to read:
27	381.0403 TheGraduate MedicalCommunity HospitalEducation
28	Act.--
29	(1)POPULAR NAMESHORT TITLE.--This section shall be known
30	by the popular nameand cited as"TheGraduate MedicalCommunity
31	HospitalEducation Act."
32	(2) LEGISLATIVE INTENT.--
33	(a)It is the intent of the Legislature that health care
34	services for the citizens of this state beimprovedupgradedand
35	that a program for continuing these services bemaintained
36	throughthe availability of high quality Florida residency and
37	internship programs that ensurea plan for community medical
38	education. The program is intended to provide additional
39	outpatient and inpatient services,a continuing supply of highly
40	trained physiciansfor the state, and graduate medical
41	education.
42	(b)The Legislature further acknowledges the critical need
43	for increased numbers of primary care physicians to provide the
44	necessary current and projected health and medical services.In
45	order to meet both present and anticipated needs, the
46	Legislature supports an expansion in the number of family
47	practice residency positions. The Legislature intends that the
48	funding for graduate education in family practice be maintained
49	and that funding for all primary care specialties be provided at
50	a minimum of $10,000 per resident per year. Should funding for
51	this act remain constant or be reduced, it is intended that all
52	programs funded by this act be maintained or reduced
53	proportionately.
54	(3)PRIMARY CARE SPECIALTIESPROGRAM FOR COMMUNITY
55	HOSPITAL EDUCATION; STATE AND LOCAL PLANNING.--
56	(a) There is established under the Department of Health a
57	program for statewide graduate medical education. It is intended
58	that continuing graduate medical education programs for interns
59	and residents be established on a statewide basis. The program
60	shall provide financial support for primary care specialty
61	interns and residents based on policies recommended and approved
62	by the Community Hospital Education Council, herein established,
63	and the Department of Health. Only those programs with at least
64	three residents or interns in each year of the training program
65	are qualified to apply for financial support. Programs with
66	fewer than three residents or interns per training year are
67	qualified to apply for financial support, but only if the
68	appropriate accrediting entity for the particular specialty has
69	approved the program for fewer positions. Programs added after
70	fiscal year 1997-1998 shall have 5 years to attain the requisite
71	number of residents or interns. When feasible and to the extent
72	allowed through the General Appropriations Act, state funds
73	shall be used to generate federal matching funds under Medicaid,
74	or other federal programs, and the resulting combined state and
75	federal funds shall be allocated to participating hospitals for
76	the support of graduate medical education. The department may
77	spend up to $75,000 of the state appropriation for
78	administrative costs associated with the production of the
79	annual report as specified in subsection (9), and for
80	administration of the program.
81	(b)For the purposes of this section, primary care
82	specialties include emergency medicine, family practice,
83	internal medicine, pediatrics, psychiatry,
84	obstetrics/gynecology, and combined pediatrics and internal
85	medicine, and other primary care specialties as may be included
86	by theCommission on Graduate Medical Education established in
87	subsection (5)councilandtheDepartment of Health.
88	(c) Medical institutions throughout the state may apply to
89	the Community Hospital Education Council for grants-in-aid for
90	financial support of their approved programs. Recommendations
91	for funding of approved programs shall be forwarded to the
92	Department of Health.
93	(d) The program shall provide a plan for community
94	clinical teaching and training with the cooperation of the
95	medical profession, hospitals, and clinics. The plan shall also
96	include formal teaching opportunities for intern and resident
97	training. In addition, the plan shall establish an off-campus
98	medical faculty with university faculty review to be located
99	throughout the state in local communities.
100	(4) PROGRAM FOR GRADUATE MEDICAL EDUCATION INNOVATIONS.--
101	(a) There is established under the Department of Health a
102	program for fostering graduate medical education innovations.
103	Funds appropriated annually by the Legislature for this purpose
104	shall be distributed to participating hospitals or consortia of
105	participating hospitals and Florida medical schools or to a
106	Florida medical school for the direct costs of providing
107	graduate medical education in community-based clinical settings
108	on a competitive grant or formula basis to achieve state health
109	care workforce policy objectives, including, but not limited to:
110	1. Increasing the number of residents in primary care and
111	other high demand specialties or fellowships;
112	2. Enhancing retention of primary care physicians in
113	Florida practice;
114	3. Promoting practice in medically underserved areas of
115	the state;
116	4. Encouraging racial and ethnic diversity within the
117	state's physician workforce; and
118	5. Encouraging increased production of geriatricians.
119	(b) Participating hospitals or consortia of participating
120	hospitals and Florida medical schools or a Florida medical
121	school providing graduate medical education in community-based
122	clinical settings may apply to theCommission on Graduate
123	Medical EducationCommunity Hospital Education Councilfor
124	funding under this innovations program, except when such
125	innovations directly compete with services or programs provided
126	by participating hospitals or consortia of participating
127	hospitals, or by both hospitals and consortia. Innovations
128	program funding shall provide funding based on policies
129	recommended and approved by theCommission on Graduate Medical
130	EducationCommunity Hospital Education Counciland the
131	Department of Health.
132	(c) Participating hospitals or consortia of participating
133	hospitals and Florida medical schools or Florida medical schools
134	awarded an innovations grant shall provide theCommission on
135	Graduate Medical EducationCommunity Hospital Education Council
136	andtheDepartment of Health with an annual report on their
137	project.
138	(5) FAMILY PRACTICE RESIDENCIES.--In addition to the
139	programs established in subsection (3), the Community Hospital
140	Education Council and the Department of Health shall establish
141	an ongoing statewide program of family practice residencies. The
142	administration of this program shall be in the manner described
143	in this section.
144	(5)(6)COMMISSION ON GRADUATE MEDICAL EDUCATIONCOUNCIL
145	AND DIRECTOR.--
146	(a) There is established theCommission on Graduate
147	Medical EducationCommunity Hospital Education Council,
148	hereinafter referred to as thecommissioncouncil, which shall
149	consist of1711members, as follows:
150	1.SixSevenmembers must be program directors of
151	accreditedFloridagraduate medical education programs or
152	practicing physicians who have faculty appointments in
153	accreditedFloridagraduate medical education programs.Six of
154	These members must be board certified or board eligible in
155	family practice, internal medicine, pediatrics, emergency
156	medicine, obstetrics-gynecology, and psychiatry, respectively,
157	and licensed pursuant to chapter 458or chapter 459.The
158	Governor shall appoint the family practice member from nominees
159	submitted by the Florida Council of Family Practice Teaching
160	Hospitals and shall appoint the internal medicine, pediatrics,
161	emergency medicine, obstetrics-gynecology, and psychiatry
162	members from nominees submitted by the Florida Statutory
163	Teaching Hospital Council.No more than one of these members may
164	be appointed from any one specialty. One member must be licensed
165	pursuant to chapter 459.
166	2. One member must bean allopathic physician licensed
167	pursuant to chapter 458 and appointed by the Governor from
168	nominees submitted by the Florida Medical Association.a
169	representative of the administration of a hospital with an
170	approved community hospital medical education program;
171	3.Five membersOne membermust bedeansthe deanofthea
172	medicalschools, or their designees.school in this state; and
173	4.One member must be an osteopathic physician licensed
174	pursuant to chapter 459 and appointed by the Governor from
175	nominees submitted by the Florida Osteopathic Medical
176	Association.Two members must be consumer representatives.
177	5. One member must be appointed by the Governor from
178	nominees submitted by the Florida Council of Family Practice
179	Teaching Hospitals.
180	6. One member must be appointed by the Governor from
181	nominees submitted by the Florida Statutory Teaching Hospital
182	Council.
183	7. One member must be appointed by the Governor from
184	nominees submitted by the Secretary of Health Care
185	Administration.
186	8. One member must appointed by the Governor from nominees
187	submitted by the Secretary of Health.
188	(b)All of the membersother than medical school deans, or
189	their designees,shall be appointed by the Governor for terms of
190	4 years each.
191	(c)(b)CommissionCouncilmembership shall cease when a
192	member's representative status no longer exists. Members of
193	similar representative status shall be appointed to replace
194	retiring or resigning members of thecommissioncouncil.
195	(d)(c)The commission shall be assigned to the Department
196	of Health for administrative purposes.The Secretary ofthe
197	Department ofHealth shall designate an administrator to serve
198	as staff director.For administrative purposes, each yearthe
199	commissioncouncilshall elect a chairand a vice chairfrom
200	among its membership. Such other personnel as may be necessary
201	to carry out the program shall be employed as authorized by the
202	Department of Health.
203	(e) Commission members shall serve without compensation
204	but may be reimbursed for travel and per diem expenses.
205	(7) DEPARTMENT OF HEALTH; STANDARDS.--
206	(a) The Department of Health, with recommendations from
207	the council, shall establish standards and policies for the use
208	and expenditure of graduate medical education funds appropriated
209	pursuant to subsection (8) for a program of community hospital
210	education. The Department of Health shall establish requirements
211	for hospitals to be qualified for participation in the program
212	which shall include, but not be limited to:
213	1. Submission of an educational plan and a training
214	schedule.
215	2. A determination by the council to ascertain that each
216	portion of the program of the hospital provides a high degree of
217	academic excellence and is accredited by the Accreditation
218	Council for Graduate Medical Education of the American Medical
219	Association or is accredited by the American Osteopathic
220	Association.
221	3. Supervision of the educational program of the hospital
222	by a physician who is not the hospital administrator.
223	(b) The Department of Health shall periodically review the
224	educational program provided by a participating hospital to
225	assure that the program includes a reasonable amount of both
226	formal and practical training and that the formal sessions are
227	presented as scheduled in the plan submitted by each hospital.
228	(c) In years that funds are transferred to the Agency for
229	Health Care Administration, the Department of Health shall
230	certify to the Agency for Health Care Administration on a
231	quarterly basis the number of primary care specialty residents
232	and interns at each of the participating hospitals for which the
233	Community Hospital Education Council and the department
234	recommends funding.
235	(8) MATCHING FUNDS.--State funds shall be used to match
236	funds from any local governmental or hospital source. The state
237	shall provide up to 50 percent of the funds, and the community
238	hospital medical education program shall provide the remainder.
239	However, except for fixed capital outlay, the provisions of this
240	subsection shall not apply to any program authorized under the
241	provisions of subsection (5) for the first 3 years after such
242	program is in operation.
243	(9) ANNUAL REPORT ON GRADUATE MEDICAL EDUCATION;
244	COMMITTEE.--The Executive Office of the Governor, the Department
245	of Health, and the Agency for Health Care Administration shall
246	collaborate to establish a committee that shall produce an
247	annual report on graduate medical education. The committee shall
248	be comprised of 11 members: five members shall be deans of the
249	medical schools or their designees; the Governor shall appoint
250	two members, one of whom must be a representative of the Florida
251	Medical Association who has supervised or currently supervises
252	residents or interns and one of whom must be a representative of
253	the Florida Hospital Association; the Secretary of Health Care
254	Administration shall appoint two members, one of whom must be a
255	representative of a statutory teaching hospital and one of whom
256	must be a physician who has supervised or is currently
257	supervising residents or interns; and the Secretary of Health
258	shall appoint two members, one of whom must be a representative
259	of a statutory family practice teaching hospital and one of whom
260	must be a physician who has supervised or is currently
261	supervising residents or interns. With the exception of the
262	deans, members shall serve 4-year terms. In order to stagger the
263	terms, the Governor's appointees shall serve initial terms of 4
264	years, the Secretary of Health's appointees shall serve initial
265	terms of 3 years, and the Secretary of Health Care
266	Administration's appointees shall serve initial terms of 2
267	years. A member's term shall be deemed terminated when the
268	member's representative status no longer exists. Once the
269	committee is appointed, it shall elect a chair to serve for a 1-
270	year term. The report shall be provided to the Governor, the
271	President of the Senate, and the Speaker of the House of
272	Representatives by January 15 annually. Committee members shall
273	serve without compensation. The report shall address the
274	following:
275	(f) The commission shall be responsible for advising the
276	Governor, the President of the Senate, the Speaker of the House
277	of Representatives, the Secretary of Health, the Commissioner of
278	Education, and the Secretary of Health Care Administration on
279	the following:
280	1.(a)The role of residents and medical faculty in the
281	provision of health care.
282	2.(b)The availability and adequacy of the state's
283	graduate medical education programs to meet state physician
284	workforce needs.The relationship of graduate medical education
285	to the state's physician workforce.
286	3.(c)The costs of training medical residents for
287	hospitals, medical schools, teaching hospitals, including all
288	hospital-medical affiliations, practice plans at all of the
289	medical schools, and municipalities.
290	4.(d)The availability and adequacy of all sources of
291	revenue to support graduate medical education and recommend
292	alternative sources of funding for graduate medical education.
293	5.(e)The use of state and federal appropriated funds for
294	graduate medical education by hospitals receiving such funds.
295	(g) The commission shall produce an annual report of its
296	findings and recommendations that shall be submitted by January
297	15 to the Governor, the President of the Senate, the Speaker of
298	the House of Representatives, the Secretary of Health, the
299	Commissioner of Education, and the Secretary of Health Care
300	Administration.
301	(6) DEPARTMENT OF HEALTH; REPORTING.--
302	(a) Annually, prior to June 30, each hospital and medical
303	school supporting a graduate medical education program shall
304	report to the Department of Health the following:
305	1. Name of each accredited residency and internship
306	program.
307	2. Number of residents and interns in each program.
308	3. Medicare Cost Report for the most recent year-end
309	period.
310	4. Data on the cost of graduate medical education, as
311	prescribed by the commission.
312	5. Other information required to be reported by the
313	commission in the performance of its functions.
314	(b) In any year that funding for graduate medical
315	education is provided through special Medicaid payments or
316	through the Medicaid disproportionate share program, the
317	Department of Health shall provide the Agency for Health Care
318	Administration with the number of accredited residency and
319	internship programs and the number of residents and interns at
320	each of the participating hospitals so that the agency may
321	calculate distribution amounts.
322	(c) In any year that Medicaid rate reimbursement caps are
323	lifted for hospitals that received funding from Specific
324	Appropriation 195A of the 1999-2000 General Appropriations Act,
325	the Department of Health shall provide the Agency for Health
326	Care Administration with the number of accredited primary care
327	residency and internship programs and the number of primary care
328	residents and interns at each of the hospitals. In the event
329	that the primary care residency and internship programs have not
330	been maintained at the level of participation and funding
331	provided by the hospital in fiscal year 1999-2000, the
332	hospital's Medicaid reimbursement rate shall not be adjusted in
333	accordance with the General Appropriations Act. The Agency for
334	Health Care Administration shall provide data substantiating
335	hospital compliance with this provision upon the request of the
336	commission.
337	(7)(10)RULEMAKING.--The department has authority to adopt
338	rules pursuant to ss. 120.536(1) and 120.54 to implement the
339	provisions of this section.
340	Section 2. Paragraph (a) of subsection (1) of section
341	409.908, Florida Statutes, is amended to read:
342	409.908 Reimbursement of Medicaid providers.--Subject to
343	specific appropriations, the agency shall reimburse Medicaid
344	providers, in accordance with state and federal law, according
345	to methodologies set forth in the rules of the agency and in
346	policy manuals and handbooks incorporated by reference therein.
347	These methodologies may include fee schedules, reimbursement
348	methods based on cost reporting, negotiated fees, competitive
349	bidding pursuant to s. 287.057, and other mechanisms the agency
350	considers efficient and effective for purchasing services or
351	goods on behalf of recipients. If a provider is reimbursed based
352	on cost reporting and submits a cost report late and that cost
353	report would have been used to set a lower reimbursement rate
354	for a rate semester, then the provider's rate for that semester
355	shall be retroactively calculated using the new cost report, and
356	full payment at the recalculated rate shall be affected
357	retroactively. Medicare-granted extensions for filing cost
358	reports, if applicable, shall also apply to Medicaid cost
359	reports. Payment for Medicaid compensable services made on
360	behalf of Medicaid eligible persons is subject to the
361	availability of moneys and any limitations or directions
362	provided for in the General Appropriations Act or chapter 216.
363	Further, nothing in this section shall be construed to prevent
364	or limit the agency from adjusting fees, reimbursement rates,
365	lengths of stay, number of visits, or number of services, or
366	making any other adjustments necessary to comply with the
367	availability of moneys and any limitations or directions
368	provided for in the General Appropriations Act, provided the
369	adjustment is consistent with legislative intent.
370	(1) Reimbursement to hospitals licensed under part I of
371	chapter 395 must be made prospectively or on the basis of
372	negotiation.
373	(a) Reimbursement for inpatient care is limited as
374	provided for in s. 409.905(5), except for:
375	1. The raising of rate reimbursement caps, excluding rural
376	hospitals.
377	2. Recognition of the costs of graduate medical education.
378	3. Other methodologies recognized in the General
379	Appropriations Act.
380	4. Hospital inpatient rates shall be reduced by 6 percent
381	effective July 1, 2001, and restored effective April 1, 2002.
382
383	During the years funds are transferred from the Department of
384	Health, any reimbursement supported by such funds shall be
385	subject to certification by the Department of Health that the
386	hospital has complied with s. 381.0403.The agency is authorized
387	to receive funds from state entities, including, but not limited
388	to, the Department of Health, local governments, and other local
389	political subdivisions, for the purpose of making special
390	exception payments, including federal matching funds, through
391	the Medicaid inpatient reimbursement methodologies. Funds
392	received from state entities or local governments for this
393	purpose shall be separately accounted for and shall not be
394	commingled with other state or local funds in any manner. The
395	agency may certify all local governmental funds used as state
396	match under Title XIX of the Social Security Act, to the extent
397	that the identified local health care provider that is otherwise
398	entitled to and is contracted to receive such local funds is the
399	benefactor under the state's Medicaid program as determined
400	under the General Appropriations Act and pursuant to an
401	agreement between the Agency for Health Care Administration and
402	the local governmental entity. The local governmental entity
403	shall use a certification form prescribed by the agency. At a
404	minimum, the certification form shall identify the amount being
405	certified and describe the relationship between the certifying
406	local governmental entity and the local health care provider.
407	The agency shall prepare an annual statement of impact which
408	documents the specific activities undertaken during the previous
409	fiscal year pursuant to this paragraph, to be submitted to the
410	Legislature no later than January 1, annually.
411	Section 3. This act shall take effect upon becoming a law.
412