HB 0441 2003
1	CHAMBER ACTION
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6	The Committee on Appropriations recommends the following:
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8	Committee Substitute
9	Remove the entire bill and insert:
10	A bill to be entitled
11	An act relating to hospitals; amending ss. 395.602 and
12	408.07, F.S.; revising the definition of the term "rural
13	hospital"; declaring and continuing such designation for
14	certain hospitals for a specified period; authorizing the
15	granting of such designation for certain other hospitals
16	upon application with supporting documentation; creating
17	s. 395.6025, F.S.; providing exemption for a statutory
18	rural hospital or a not-for-profit operator of rural
19	hospitals from certificate-of-need review for the
20	construction of a new or replacement facility; providing
21	conditions for eligibility for the exemption; amending s.
22	766.314, F.S.; excluding infants born in certain family
23	practice teaching hospitals from assessments used to fund
24	the Florida Birth-Related Neurological Injury Compensation
25	Plan; providing an effective date.
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27	Be It Enacted by the Legislature of the State of Florida:
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29	Section 1. Paragraph (e) of subsection (2) of section
30	395.602, Florida Statutes, is amended to read:
31	395.602 Rural hospitals.--
32	(2) DEFINITIONS.--As used in this part:
33	(e) "Rural hospital" means an acute care hospital licensed
34	under this chapter, having 100 or fewer licensed beds and an
35	emergency room, which is:
36	1. The sole provider within a county with a population
37	density of no greater than 100 persons per square mile;
38	2. An acute care hospital, in a county with a population
39	density of no greater than 100 persons per square mile, which is
40	at least 30 minutes of travel time, on normally traveled roads
41	under normal traffic conditions, from any other acute care
42	hospital within the same county;
43	3. A hospital supported by a tax district or subdistrict
44	whose boundaries encompass a population of 100 persons or fewer
45	per square mile;
46	4. A hospital in a constitutional charter county with a
47	population of over 1 million persons that has imposed a local
48	option health service tax pursuant to law and in an area that
49	was directly impacted by a catastrophic event on August 24,
50	1992, for which the Governor of Florida declared a state of
51	emergency pursuant to chapter 125, and has 120 beds or less that
52	serves an agricultural community with an emergency room
53	utilization of no less than 20,000 visits and a Medicaid in-
54	patient utilization rate greater than 15 percent;
55	5. A hospital with a service area that has a population of
56	100 persons or fewer per square mile. As used in this
57	subparagraph, the term "service area" means the fewest number of
58	zip codes that account for 75 percent of the hospital's
59	discharges for the most recent 5-year period, based on
60	information available from the hospital inpatient discharge
61	database in the State Center for Health Statistics at the Agency
62	for Health Care Administration; or
63	6. A hospital designated as a Critical Access Hospital by
64	the Department of Health in accordance with federal regulations
65	and state requirements.
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67	Population densities used in this paragraph must be based upon
68	the most recently completed United States census. A hospital
69	that received funds under s. 409.9116 for a quarter beginning no
70	later than July 1, 2002, is deemed to have been and shall
71	continue to be a rural hospital from that date through June 30,
72	2012, if the hospital continues to have 100 or fewer licensed
73	beds and an emergency room, or meets the criteria of
74	subparagraph 4. An acute care hospital that has not previously
75	been designated as a rural hospital and that meets the criteria
76	of this paragraph shall be granted such designation upon
77	application, including supporting documentation, to the Agency
78	for Health Care Administration.
79	Section 2. Subsection (42) of section 408.07, Florida
80	Statutes, is amended to read:
81	408.07 Definitions.--As used in this chapter, with the
82	exception of ss. 408.031-408.045, the term:
83	(42) "Rural hospital" means an acute care hospital
84	licensed under chapter 395, having 100 or fewer licensed beds
85	and an emergency room, and which is:
86	(a) The sole provider within a county with a population
87	density of no greater than 100 persons per square mile;
88	(b) An acute care hospital, in a county with a population
89	density of no greater than 100 persons per square mile, which is
90	at least 30 minutes of travel time, on normally traveled roads
91	under normal traffic conditions, from another acute care
92	hospital within the same county;
93	(c) A hospital supported by a tax district or subdistrict
94	whose boundaries encompass a population of 100 persons or fewer
95	per square mile;
96	(d) A hospital with a service area that has a population
97	of 100 persons or fewer per square mile. As used in this
98	paragraph, the term "service area" means the fewest number of
99	zip codes that account for 75 percent of the hospital's
100	discharges for the most recent 5-year period, based on
101	information available from the hospital inpatient discharge
102	database in the State Center for Health Statistics at the Agency
103	for Health Care Administration; or
104	(e) A hospital designated as a Critical Access Hospital by
105	the Department of Health in accordance with federal regulations
106	and state requirements.
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108	Population densities used in this subsection must be based upon
109	the most recently completed United States census. A hospital
110	that received funds under s. 409.9116 for a quarter beginning no
111	later than July 1, 2002, is deemed to have been and shall
112	continue to be a rural hospital from that date through June 30,
113	2012, if the hospital continues to have 100 or fewer licensed
114	beds and an emergency room, or meets the criteria of s.
115	395.602(2)(e)4. An acute care hospital that has not previously
116	been designated as a rural hospital and that meets the criteria
117	of this subsection shall be granted such designation upon
118	application, including supporting documentation, to the Agency
119	for Health Care Administration.
120	Section 3. Section 395.6025, Florida Statutes, is created
121	to read:
122	395.6025 Rural hospitals; new or replacement
123	facilities.--Notwithstanding the provisions of s. 408.036, a
124	hospital defined as a statutory rural hospital in accordance
125	with s. 395.602, or a not-for-profit operator of rural
126	hospitals, is not required to obtain a certificate of need for
127	the construction of a new facility located in a county with a
128	population of at least 15,000 but no more than 18,000 and a
129	density of less than 30 persons per square mile, or a
130	replacement facility, provided that the new or replacement
131	facility is located within 10 miles of the site of the currently
132	licensed rural hospital and within the current primary service
133	area. As used in this section, the term "service area" means the
134	fewest number of zip codes that account for 75 percent of the
135	hospital's discharges for the most recent 5-year period, based
136	on information available from the hospital inpatient discharge
137	database in the State Center for Health Statistics at the Agency
138	for Health Care Administration.
139	Section 4. Paragraph (a) of subsection (4) of section
140	766.314, Florida Statutes, is amended to read:
141	766.314 Assessments; plan of operation.--
142	(4) The following persons and entities shall pay into the
143	association an initial assessment in accordance with the plan of
144	operation:
145	(a) On or before October 1, 1988, each hospital licensed
146	under chapter 395 shall pay an initial assessment of $50 per
147	infant delivered in the hospital during the prior calendar year,
148	as reported to the Agency for Health Care Administration;
149	provided, however, that a hospital owned or operated by the
150	state or a county, special taxing district, or other political
151	subdivision of the state shall not be required to pay the
152	initial assessment or any assessment required by subsection (5).
153	The term "infant delivered" includes live births and not
154	stillbirths, but the term does not include infants delivered by
155	employees or agents of the Board of Regents,orthose born in a
156	teaching hospital as defined in s. 408.07, or those born in a
157	family practice teaching hospital designated pursuant to s.
158	395.806 that was exempted by the association from assessments
159	for fiscal years 1997-1998 through 2001-2002. The initial
160	assessment and any assessment imposed pursuant to subsection (5)
161	may not include any infant born to a charity patient (as defined
162	by rule of the Agency for Health Care Administration) or born to
163	a patient for whom the hospital receives Medicaid reimbursement,
164	if the sum of the annual charges for charity patients plus the
165	annual Medicaid contractuals of the hospital exceeds 10 percent
166	of the total annual gross operating revenues of the hospital.
167	The hospital is responsible for documenting, to the satisfaction
168	of the association, the exclusion of any birth from the
169	computation of the assessment. Upon demonstration of financial
170	need by a hospital, the association may provide for installment
171	payments of assessments.
172	Section 5. This act shall take effect July 1, 2003.