SENATE AMENDMENT
    Bill No. CS for CS for SB 2738
    Amendment No. ___   Barcode 583304
                            CHAMBER ACTION
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11  Senator Saunders moved the following amendment:
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13         Senate Amendment (with title amendment) 
14         On page 77, line 7, through
15            page 79, line 13, delete those lines
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17  and insert:  
18         Section 56.  Section 154.306, Florida Statutes, is
19  amended to read:
20         154.306  Financial responsibility for certified
21  residents who are qualified indigent patients treated at an
22  out-of-county participating hospital or regional referral
23  hospital.--Ultimate financial responsibility for treatment
24  received at a participating hospital or a regional referral
25  hospital or a state-approved trama center by a qualified
26  indigent patient who is a certified resident of a county in
27  the State of Florida, but is not a resident of the county in
28  which the participating hospital or regional referral hospital
29  or a state-approved trama center is located, is the obligation
30  of the county of which the qualified indigent patient is a
31  resident. Each county shall reimburse participating hospitals
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    11:08 AM   05/01/03                             s2738c2c-37e0a

SENATE AMENDMENT Bill No. CS for CS for SB 2738 Amendment No. ___ Barcode 583304 1 or regional referral hospitals or a state-approved trauma 2 center as provided for in this part, and shall provide or 3 arrange for indigent eligibility determination procedures and 4 resident certification determination procedures as provided 5 for in rules developed to implement this part. The agency, or 6 any county determining eligibility of a qualified indigent, 7 shall provide to the county of residence, upon request, a copy 8 of any documents, forms, or other information, as determined 9 by rule, which may be used in making an eligibility 10 determination. 11 (1) A county's financial obligation for each certified 12 resident who qualifies as an indigent patient under this part, 13 and who has received treatment at an out-of-county hospital, 14 shall not exceed 45 days per county fiscal year at a rate of 15 payment equivalent to 100 percent of the per diem 16 reimbursement rate currently in effect for the out-of-county 17 hospital under the medical assistance program for the needy 18 under Title XIX of the Social Security Act, as amended, except 19 that those counties that are at their 10-mill cap on October 20 1, 1991, shall reimburse hospitals for such services at not 21 less than 80 percent of the hospital Medicaid per diem. 22 However, nothing in this section shall preclude a hospital 23 that has a formal signed agreement with a county to treat such 24 county's indigents from negotiating a higher or lower per diem 25 rate with the county. No county shall be required to pay more 26 than the equivalent of $4 per capita in the county's fiscal 27 year. The agency shall calculate and certify to each county 28 by March 1 of each year, the maximum amount the county may be 29 required to pay by multiplying the most recent official state 30 population estimate for the total population of the county by 31 $4 per capita. Each county shall certify to the agency within 2 11:08 AM 05/01/03 s2738c2c-37e0a
SENATE AMENDMENT Bill No. CS for CS for SB 2738 Amendment No. ___ Barcode 583304 1 60 days after the end of the county's fiscal year, or upon 2 reaching the $4 per capita threshold, should that occur before 3 the end of the fiscal year, the amount of reimbursement it 4 paid to all out-of-county hospitals under this part. The 5 maximum amount a county may be required to pay to 6 out-of-county hospitals for care provided to qualified 7 indigent residents may be reduced by up to one-half, provided 8 that the amount not paid has or is being spent for in-county 9 hospital care provided to qualified indigent residents. 10 (2) No county shall be required to pay for any 11 elective or nonemergency admissions or services at an 12 out-of-county hospital for a qualified indigent who is a 13 certified resident of the county if the county provides 14 funding for such services and the services are available at a 15 local hospital in the county where the indigent resides; or 16 the out-of-county hospital has not obtained prior written 17 authorization and approval for such hospital admission or 18 service, provided that the resident county has established a 19 procedure to authorize and approve such admissions. 20 (3) For the purpose of computing the maximum amount 21 that a county having a population of 100,000 or less may be 22 required to pay, the agency must reduce the official state 23 population estimates by the number of inmates and patients 24 residing in the county in institutions operated by the Federal 25 Government, the Department of Corrections, the Department of 26 Health, or the Department of Children and Family Services, and 27 by the number of active-duty military personnel residing in 28 the county, all of whom shall not be considered residents of 29 the county. However, a county is entitled to receive the 30 benefit of such a reduction in estimated population figures 31 only if the county accepts as valid and true, and does not 3 11:08 AM 05/01/03 s2738c2c-37e0a
SENATE AMENDMENT Bill No. CS for CS for SB 2738 Amendment No. ___ Barcode 583304 1 require any reverification of, the documentation of financial 2 eligibility and county residency which is provided to it by 3 the participating hospital or regional referral hospital. The 4 participating hospital or regional referral hospital must 5 provide documentation that is complete and in the form 6 required by s. 154.3105. 7 (4) The county where the indigent resides shall, in 8 all instances, be liable for the cost of treatment provided to 9 a qualified indigent patient at an out-of-county hospital for 10 any emergency medical condition which will deteriorate from 11 failure to provide such treatment if such condition is 12 determined and documented by the attending physician to be of 13 an emergency nature; provided that the patient has been 14 certified to be a resident of such county pursuant to s. 15 154.309. 16 (5) No county shall be liable for payment for 17 treatment of a qualified indigent who is a certified resident 18 and has received services at an out-of-county participating 19 hospital or regional referral hospital, until such time as 20 that hospital has documented to the agency and the agency has 21 determined that it has met its charity care obligation based 22 on the most recent audited actual experience. 23 Section 57. Section 154.317, Florida Statutes, is 24 created to read: 25 154.317 County financial responsibility for trauma 26 care.-- 27 (1) Notwithstanding the provisions of ss. 28 154.301-154.316, state-approved trauma centers shall be 29 responsible for determining eligibility and residency of 30 patients with primary or secondary diagnoses of DRG 483-487. 31 (a) Financial eligibility shall be determined in 4 11:08 AM 05/01/03 s2738c2c-37e0a
SENATE AMENDMENT Bill No. CS for CS for SB 2738 Amendment No. ___ Barcode 583304 1 accordance with s. 154.308, and the methodology defined in 2 rules adopted by the Agency for Health Care Administration. 3 (b) Residence in the county at the time of the 4 hospitalization shall be verified with at least one of the 5 following forms of documentation: 6 1. Current active driver's license; 7 2. Mortgage, lease, or rental receipt or letter from 8 the landlord; 9 3. Water, electric, or other public utility bill in 10 the name of the patient or family member to a residential 11 address within the county; 12 4. A state, county, or federal document mailed to the 13 patient to a residential address within the county; 14 5. Voter registration; or 15 6. Proof of children enrolled in public schools within 16 the county. 17 (2) The Agency for Health Care Administration shall 18 make final eligibility determinations for any cases that are 19 disputed by the counties. 20 21 (Redesignate subsequent sections.) 22 23 24 ================ T I T L E A M E N D M E N T =============== 25 And the title is amended as follows: 26 On page 6, lines 7-12, delete those lines 27 28 and insert: 29 at certain facilities; amending s. 154.306, 30 F.S.; revising requirements for county 31 responsibility for certain indigent patients to 5 11:08 AM 05/01/03 s2738c2c-37e0a
SENATE AMENDMENT Bill No. CS for CS for SB 2738 Amendment No. ___ Barcode 583304 1 include patients treated at state-approved 2 trauma centers; creating s. 154.317, F.S.; 3 requiring state-approved trauma centers to be 4 responsible for determining eligibility and 5 residency of certain patients for purposes of 6 establishing reimbursement by counties; 7 authorizing the Agency for Health Care 8 Administration to adopt rules for financial 9 eligibility for certain trauma care; requiring 10 the Agency for Health Care Administration to 11 make final eligibility determinations for 12 disputed cases involving reimbursement for 13 trauma care of indigent patients by counties; 14 repealing s. 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 6 11:08 AM 05/01/03 s2738c2c-37e0a