SENATE AMENDMENT
    Bill No. CS for SB 2750
    Amendment No. ___   Barcode 300582
                            CHAMBER ACTION
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11  Senator Diaz de la Portilla moved the following substitute for
12  amendment to amendment (041478):
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14         Senate Amendment (with title amendment) 
15         On page 71, line 19, through page 73, line 24 delete
16  those lines
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18  and insert:  
19         Section 117.  Section 154.306, Florida Statutes, is
20  amended to read:
21         154.306  Financial responsibility for certified
22  residents who are qualified indigent patients treated at an
23  out-of-county participating hospital or regional referral
24  hospital.--Ultimate financial responsibility for treatment
25  received at a participating hospital or a regional referral
26  hospital or a state-approved trama center by a qualified
27  indigent patient who is a certified resident of a county in
28  the State of Florida, but is not a resident of the county in
29  which the participating hospital or regional referral hospital
30  or a state-approved trama center is located, is the obligation
31  of the county of which the qualified indigent patient is a
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    4:50 PM   04/29/03                              s2750c1c-36j01

SENATE AMENDMENT Bill No. CS for SB 2750 Amendment No. ___ Barcode 300582 1 resident. Each county shall reimburse participating hospitals 2 or regional referral hospitals or a state-approved trauma 3 center as provided for in this part, and shall provide or 4 arrange for indigent eligibility determination procedures and 5 resident certification determination procedures as provided 6 for in rules developed to implement this part. The agency, or 7 any county determining eligibility of a qualified indigent, 8 shall provide to the county of residence, upon request, a copy 9 of any documents, forms, or other information, as determined 10 by rule, which may be used in making an eligibility 11 determination. 12 (1) A county's financial obligation for each certified 13 resident who qualifies as an indigent patient under this part, 14 and who has received treatment at an out-of-county hospital, 15 shall not exceed 45 days per county fiscal year at a rate of 16 payment equivalent to 100 percent of the per diem 17 reimbursement rate currently in effect for the out-of-county 18 hospital under the medical assistance program for the needy 19 under Title XIX of the Social Security Act, as amended, except 20 that those counties that are at their 10-mill cap on October 21 1, 1991, shall reimburse hospitals for such services at not 22 less than 80 percent of the hospital Medicaid per diem. 23 However, nothing in this section shall preclude a hospital 24 that has a formal signed agreement with a county to treat such 25 county's indigents from negotiating a higher or lower per diem 26 rate with the county. No county shall be required to pay more 27 than the equivalent of $4 per capita in the county's fiscal 28 year. The agency shall calculate and certify to each county 29 by March 1 of each year, the maximum amount the county may be 30 required to pay by multiplying the most recent official state 31 population estimate for the total population of the county by 2 4:50 PM 04/29/03 s2750c1c-36j01
SENATE AMENDMENT Bill No. CS for SB 2750 Amendment No. ___ Barcode 300582 1 $4 per capita. Each county shall certify to the agency within 2 60 days after the end of the county's fiscal year, or upon 3 reaching the $4 per capita threshold, should that occur before 4 the end of the fiscal year, the amount of reimbursement it 5 paid to all out-of-county hospitals under this part. The 6 maximum amount a county may be required to pay to 7 out-of-county hospitals for care provided to qualified 8 indigent residents may be reduced by up to one-half, provided 9 that the amount not paid has or is being spent for in-county 10 hospital care provided to qualified indigent residents. 11 (2) No county shall be required to pay for any 12 elective or nonemergency admissions or services at an 13 out-of-county hospital for a qualified indigent who is a 14 certified resident of the county if the county provides 15 funding for such services and the services are available at a 16 local hospital in the county where the indigent resides; or 17 the out-of-county hospital has not obtained prior written 18 authorization and approval for such hospital admission or 19 service, provided that the resident county has established a 20 procedure to authorize and approve such admissions. 21 (3) For the purpose of computing the maximum amount 22 that a county having a population of 100,000 or less may be 23 required to pay, the agency must reduce the official state 24 population estimates by the number of inmates and patients 25 residing in the county in institutions operated by the Federal 26 Government, the Department of Corrections, the Department of 27 Health, or the Department of Children and Family Services, and 28 by the number of active-duty military personnel residing in 29 the county, all of whom shall not be considered residents of 30 the county. However, a county is entitled to receive the 31 benefit of such a reduction in estimated population figures 3 4:50 PM 04/29/03 s2750c1c-36j01
SENATE AMENDMENT Bill No. CS for SB 2750 Amendment No. ___ Barcode 300582 1 only if the county accepts as valid and true, and does not 2 require any reverification of, the documentation of financial 3 eligibility and county residency which is provided to it by 4 the participating hospital or regional referral hospital. The 5 participating hospital or regional referral hospital must 6 provide documentation that is complete and in the form 7 required by s. 154.3105. 8 (4) The county where the indigent resides shall, in 9 all instances, be liable for the cost of treatment provided to 10 a qualified indigent patient at an out-of-county hospital for 11 any emergency medical condition which will deteriorate from 12 failure to provide such treatment if such condition is 13 determined and documented by the attending physician to be of 14 an emergency nature; provided that the patient has been 15 certified to be a resident of such county pursuant to s. 16 154.309. 17 (5) No county shall be liable for payment for 18 treatment of a qualified indigent who is a certified resident 19 and has received services at an out-of-county participating 20 hospital or regional referral hospital, until such time as 21 that hospital has documented to the agency and the agency has 22 determined that it has met its charity care obligation based 23 on the most recent audited actual experience. 24 Section 118. Section 154.317, Florida Statutes, is 25 created to read: 26 154.317 County financial responsibility for trauma 27 care.-- 28 (1) Notwithstanding the provisions of ss. 29 154.301-154.316, state-approved trauma centers shall be 30 responsible for determining eligibility and residency of 31 patients with primary or secondary diagnoses of DRG 483-487. 4 4:50 PM 04/29/03 s2750c1c-36j01
SENATE AMENDMENT Bill No. CS for SB 2750 Amendment No. ___ Barcode 300582 1 (a) Financial eligibility shall be determined in 2 accordance with s. 154.308, and the methodology defined in 3 rules adopted by the Agency for Health Care Administration. 4 (b) Residence in the county at the time of the 5 hospitalization shall be verified with at least one of the 6 following forms of documentation: 7 1. Current active driver's license; 8 2. Mortgage, lease, or rental receipt or letter from 9 the landlord; 10 3. Water, electric, or other public utility bill in 11 the name of the patient or family member to a residential 12 address within the county; 13 4. A state, county, or federal document mailed to the 14 patient to a residential address within the county; 15 5. Voter registration; or 16 6. Proof of children enrolled in public schools within 17 the county. 18 (2) The Agency for Health Care Administration shall 19 make final eligibility determinations for any cases that are 20 disputed by the counties. 21 (3) A county is responsible for payment if the county 22 is currently contributing to the financial support of a 23 regional trauma system through direct funding of trauma care, 24 through tax district support for hospitals in the county 25 designated as trauma centers, or under the terms of an 26 intergovernmental agreement with other counties in a trauma 27 region or a written agreement with the nearest trauma center. 28 29 (Redesignate subsequent sections.) 30 31 5 4:50 PM 04/29/03 s2750c1c-36j01
SENATE AMENDMENT Bill No. CS for SB 2750 Amendment No. ___ Barcode 300582 1 ================ T I T L E A M E N D M E N T =============== 2 And the title is amended as follows: 3 On page 79, lines 12-17, delete those lines 4 5 and insert: 6 at certain facilities; amending s. 154.306, 7 F.S.; revising requirements for county 8 responsibility for certain indigent patients to 9 include patients treated at state-approved 10 trauma centers; creating s. 154.317, F.S.; 11 requiring state-approved trauma centers to be 12 responsible for determining eligibility and 13 residency of certain patients for purposes of 14 establishing reimbursement by counties; 15 authorizing the Agency for Health Care 16 Administration to adopt rules for financial 17 eligibility for certain trauma care; requiring 18 the Agency for Health Care Administration to 19 make final eligibility determinations for 20 disputed cases involving reimbursement for 21 trauma care of indigent patients by counties; 22 repealing s. 23 24 25 26 27 28 29 30 31 6 4:50 PM 04/29/03 s2750c1c-36j01