SENATE AMENDMENT
Bill No. CS for CS for SB 696
Amendment No. ___ Barcode 452396
CHAMBER ACTION
Senate House
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11 Senator Saunders moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 1, line 11, through
15 page 2, line 22, delete those lines
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17 and insert:
18 Section 1. 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 trauma 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 trauma center is located, is the
30 obligation of the county of which the qualified indigent
31 patient is a resident. Each county shall reimburse
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SENATE AMENDMENT
Bill No. CS for CS for SB 696
Amendment No. ___ Barcode 452396
1 participating hospitals or regional referral hospitals or a
2 state-approved trauma center as provided for in this part, and
3 shall provide or arrange for indigent eligibility
4 determination procedures and resident certification
5 determination procedures as provided for in rules developed to
6 implement this part. The agency, or any county determining
7 eligibility of a qualified indigent, shall provide to the
8 county of residence, upon request, a copy of any documents,
9 forms, or other information, as determined by rule, which may
10 be used in making an eligibility 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
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SENATE AMENDMENT
Bill No. CS for CS for SB 696
Amendment No. ___ Barcode 452396
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
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SENATE AMENDMENT
Bill No. CS for CS for SB 696
Amendment No. ___ Barcode 452396
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 2. 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
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SENATE AMENDMENT
Bill No. CS for CS for SB 696
Amendment No. ___ Barcode 452396
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
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5 (Redesignate subsequent sections.)
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8 ================ T I T L E A M E N D M E N T ===============
9 And the title is amended as follows:
10 On page 1, lines 3-5, delete those lines
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12 and insert:
13 amending s. 154.306, F.S.; revising
14 requirements for county responsibility for
15 certain indigent patients to include patients
16 treated at state-approved trauma centers;
17 creating s. 154.317, F.S.; requiring
18 state-approved trauma centers to be responsible
19 for determining eligibility and residency of
20 certain patients for purposes of establishing
21 reimbursement by counties; authorizing the
22 Agency for Health Care Administration to adopt
23 rules for financial eligibility for certain
24 trauma care;
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