Senate Bill sb0696c1

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    Florida Senate - 2003                            CS for SB 696

    By the Committee on Health, Aging, and Long-Term Care; and
    Senator Saunders




    317-1908-03

  1                      A bill to be entitled

  2         An act relating to indigent health care;

  3         amending s. 154.306, F.S.; increasing the cap

  4         on the financial responsibility limits of

  5         counties for the cost of indigent county

  6         residents who receive treatment at

  7         participating hospitals in other counties;

  8         creating s. 154.317, F.S.; establishing

  9         reimbursement procedures and guidelines for the

10         reimbursement of trauma centers by counties;

11         providing an effective date.

12  

13  Be It Enacted by the Legislature of the State of Florida:

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15         Section 1.  Subsection (1) of section 154.306, Florida

16  Statutes, is amended to read:

17         154.306  Financial responsibility for certified

18  residents who are qualified indigent patients treated at an

19  out-of-county participating hospital or regional referral

20  hospital.--Ultimate financial responsibility for treatment

21  received at a participating hospital or a regional referral

22  hospital by a qualified indigent patient who is a certified

23  resident of a county in the State of Florida, but is not a

24  resident of the county in which the participating hospital or

25  regional referral hospital is located, is the obligation of

26  the county of which the qualified indigent patient is a

27  resident. Each county shall reimburse participating hospitals

28  or regional referral hospitals as provided for in this part,

29  and shall provide or arrange for indigent eligibility

30  determination procedures and resident certification

31  determination procedures as provided for in rules developed to

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    Florida Senate - 2003                            CS for SB 696
    317-1908-03




 1  implement this part.  The agency, or any county determining

 2  eligibility of a qualified indigent, shall provide to the

 3  county of residence, upon request, a copy of any documents,

 4  forms, or other information, as determined by rule, which may

 5  be used in making an eligibility determination.

 6         (1)  A county's financial obligation for each certified

 7  resident who qualifies as an indigent patient under this part,

 8  and who has received treatment at an out-of-county hospital,

 9  shall not exceed 45 days per county fiscal year at a rate of

10  payment equivalent to 100 percent of the per diem

11  reimbursement rate currently in effect for the out-of-county

12  hospital under the medical assistance program for the needy

13  under Title XIX of the Social Security Act, as amended, except

14  that those counties that are at their 10-mill cap on October

15  1, 1991, shall reimburse hospitals for such services at not

16  less than 80 percent of the hospital Medicaid per diem.

17  However, nothing in this section does not shall preclude a

18  hospital that has a formal signed agreement with a county to

19  treat such county's indigents from negotiating a higher or

20  lower per diem rate with the county.  A No county may not

21  shall be required to pay more than the equivalent of $6 $4 per

22  capita in the county's fiscal year.  The agency shall

23  calculate and certify to each county by March 1 of each year,

24  the maximum amount the county may be required to pay by

25  multiplying the most recent official state population estimate

26  for the total population of the county by $6 $4 per capita.

27  Each county shall certify to the agency within 60 days after

28  the end of the county's fiscal year, or upon reaching the $6

29  $4 per capita threshold, should that occur before the end of

30  the fiscal year, the amount of reimbursement it paid to all

31  out-of-county hospitals under this part.  The maximum amount a

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    Florida Senate - 2003                            CS for SB 696
    317-1908-03




 1  county may be required to pay to out-of-county hospitals for

 2  care provided to qualified indigent residents may be reduced

 3  by up to one-half if, provided that the amount not paid has or

 4  is being spent for in-county hospital care provided to

 5  qualified indigent residents.

 6         Section 2.  Section 154.317, Florida Statutes, is

 7  created to read:

 8         154.317  County financial responsibility for trauma

 9  care.--

10         (1)  Notwithstanding ss. 154.301-154.316, each county

11  shall participate in supporting a regionalized system of

12  trauma care which provides reimbursement to hospitals that are

13  trauma centers, approved in accordance with s. 395.4025.

14  Financial responsibility shall be limited to uninsured or

15  underinsured inpatients with primary or secondary diagnoses of

16  DRG 484-487. For purposes of this section, the term,

17  "underinsured" means insurance coverage for a person who is an

18  inpatient which is inadequate to cover the cost of that

19  patient's care.

20         (2)  Payment levels may not exceed the statewide

21  average cost per trauma patient in each level of designated

22  trauma center. Initial payment rates, subject to annual

23  updates by the Agency for Health Care Administration are:

24         (a)  Level I: $14,000 per trauma patient;

25         (b)  Level II: $9,000 per trauma patient; and

26         (c)  Pediatric: $6,000 per trauma patient.

27         (3)  Counties shall be designated as responsible for

28  payment if:

29         (a)  The county of residence has unspent funds received

30  under this part at the end of the fiscal year in which the

31  hospitalization occurs.

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    Florida Senate - 2003                            CS for SB 696
    317-1908-03




 1         (b)  The responsible county is currently contributing

 2  to the financial support of a regional trauma system through

 3  direct funding of trauma care, tax district support for

 4  hospitals in the county designated as trauma centers, or under

 5  the terms of an intergovernmental agreement with other

 6  counties in the trauma region or a written agreement with the

 7  nearest trauma center.

 8         (c)  The responsible county is exempt based on the

 9  following criteria:

10         1.  The county population in the most recent United

11  States Census totals fewer than 30,000 residents and the

12  proportion of county residents with incomes below the poverty

13  level exceeds 20 percent; or

14         2.  The property tax rate, including special districts

15  and municipal service taxes, of the county equals or exceeds

16  10 mills.

17         (d)  Residence in the county at the time of the

18  hospitalization is verified by:

19         1.  Current active driver's license;

20         2.  Mortgage, lease, or rental receipt or letter from a

21  landlord;

22         3.  Water, electric, or other public utility bill in

23  the name of the patient or a family member at a residential

24  address within the county;

25         4.  A state, county, or federal document mailed to the

26  patient at a residential address within the county;

27         5.  Vehicle registration in the name of the patient or

28  a family member at a residential address within the county;

29         6.  Voter registration; or

30         7.  Proof of children enrolled in public schools within

31  the county.

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    Florida Senate - 2003                            CS for SB 696
    317-1908-03




 1         Section 3.  This act shall take effect July 1, 2003.

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 3          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
 4                         Senate Bill 696

 5                                 

 6  The Committee Substitute provides a definition for the term
    "underinsured" for the purpose of extending financial
 7  responsibility on counties to fund trauma care. An exemption
    from the trauma care funding requirement is provided for
 8  certain rural counties or counties in which the property tax
    rate equals or exceeds 10 mils.
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