Senate Bill sb1308

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    Florida Senate - 2004                                  SB 1308

    By Senator Pruitt





    28-869-04                                               See HB

  1                      A bill to be entitled

  2         An act relating to health care; amending s.

  3         408.036, F.S.; revising an exemption from

  4         certificate-of-need requirements for certain

  5         open-heart-surgery programs to apply the

  6         exemption to any hospital located within a

  7         specified health service planning district or a

  8         specified acute care subdistrict; providing

  9         criteria for qualifying for the exemption;

10         requiring the Agency for Health Care

11         Administration to report to the Legislature

12         regarding the number of such exemptions

13         requested and the number granted or denied each

14         year; providing an effective date.

15  

16         WHEREAS, appropriate access to adult cardiac care is an

17  issue of critical state importance to all citizens of the

18  state and to all health service planning districts of the

19  state, and

20         WHEREAS, the certificate-of-need process, for most

21  geographic areas in the state, has provided adequate access to

22  adult open-heart-surgery services to Floridians as well as

23  tourists, business travelers, indigents, and migrant workers

24  who receive such services, and

25         WHEREAS, the Legislature has found an anomaly in the

26  state's health care network of adult cardiac care which has

27  created a lack of geographic and temporal access to such care

28  within Health Service Planning District 9 and Acute Care

29  Subdistrict 6-2, and

30         WHEREAS, the assurance of timely and appropriate access

31  to adult cardiac care is critical not only to the citizens

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    Florida Senate - 2004                                  SB 1308
    28-869-04                                               See HB




 1  residing in Health Service Planning District 9 and Acute Care

 2  Subdistrict 6-2, but also to the entire state, since it has a

 3  direct effect on commerce, seasonal visitors, the tourist

 4  industry, the migrant population, the working poor, and

 5  indigents from all parts of the state as well as outside its

 6  borders, and

 7         WHEREAS, the number of adult open-heart-surgery

 8  programs in Health Service Planning District 9 and Acute Care

 9  Subdistrict 6-2 has not kept pace with the dramatic increase

10  in population in those areas, and

11         WHEREAS, the disparity in the number of adult

12  open-heart-surgery programs has significantly contributed to

13  the lack of geographic and temporal access to adult cardiac

14  care in Health Service Planning District 9 and Acute Care

15  Subdistrict 6-2, and

16         WHEREAS, there have been numerous technological

17  advances in the area of primary angioplasty and stent

18  procedures known collectively as percutaneous coronary

19  interventions, and these advanced interventional treatments

20  provide the highest standard of care for people suffering

21  acute myocardial infarctions, and

22         WHEREAS, the success of these interventional treatments

23  requires immediate access (within 1 hour) to hospitals having

24  interventional technology and backup open-heart-surgery

25  programs, and

26         WHEREAS, in Florida a hospital is prohibited from

27  performing these advanced interventional cardiac services

28  without having onsite adult open-heart-surgery capabilities,

29  and

30         WHEREAS, hospitals that cannot perform percutaneous

31  coronary interventions must resort to the use of

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    Florida Senate - 2004                                  SB 1308
    28-869-04                                               See HB




 1  thrombolytics, a less effective treatment in many instances;

 2  therefore, adults in need of percutaneous coronary

 3  interventions are being denied these procedures due to

 4  artificial barriers to geographic and temporal access, and

 5         WHEREAS, because a sufficient number of open-heart

 6  procedures for adults are being performed by existing

 7  open-heart providers, the addition of new open-heart units

 8  through the exemption provided by this act will not reduce the

 9  standard of care and quality associated with the standard

10  volume of procedures, and

11         WHEREAS, the lack of geographic and temporal access to

12  adult cardiac care is caused not only by physical distance

13  between those hospitals that do not have open-heart programs

14  and those hospitals that have available open-heart programs,

15  but also by the actual time taken to transfer an emergent

16  cardiac patient to a receiving facility, and

17         WHEREAS, diagnosis; discharge from the transferring

18  hospital; transfer arrangements, including, but not limited

19  to, insurance and administrative approval; transportation

20  availability; admission to the receiving hospital; staff

21  availability at the receiving hospital; and, most importantly,

22  bed availability at the receiving hospital as well as travel

23  delays to the receiving hospital contribute to the time taken

24  to effectuate a transfer of a cardiac patient, and

25         WHEREAS, these and other factors have contributed to

26  the inadequate geographic and temporal access to adult cardiac

27  care in Health Service Planning District 9 and Acute Care

28  Subdistrict 6-2, and

29         WHEREAS, particular to Acute Care Subdistrict 6-2 is

30  the added impediment to geographic and temporal access in that

31  the main transportation corridors to open-heart-surgery

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    Florida Senate - 2004                                  SB 1308
    28-869-04                                               See HB




 1  facilities in the subdistrict operate at extremely low to near

 2  failure of transit, which contributes to failure to transfer

 3  emergent cardiac patients within the recommended time in which

 4  to receive the highest standard of care for people suffering

 5  acute myocardial infarctions, and

 6         WHEREAS, the Legislature finds that timely access and

 7  availability for every adult citizen, regardless of

 8  socioeconomic class or geographic location, to these

 9  interventional treatments and open-heart surgery is of

10  critical state concern, especially because myocardial

11  infarctions and related coronary disease are no respecters of

12  location or time, and

13         WHEREAS, the Legislature finds that the exemption

14  provided by this act in Health Service Planning District 9 and

15  Acute Care Subdistrict 6-2 will further serve an important

16  state interest by increasing access to the appropriate

17  life-saving treatment for all adults present in those areas,

18  whether they are commercial visitors, seasonal visitors,

19  residents, tourists, migrant workers, indigents, or other

20  traditionally underserved individuals, and

21         WHEREAS, the Legislature further finds that the

22  exemption provided by this act will serve an issue of critical

23  state importance by reducing the cost of open-heart-surgery

24  and angioplasty services by increasing quality competition by

25  removing artificial barriers to entry amongst providers and

26  providing additional choices to those individuals needing

27  these services, and

28         WHEREAS, to ensure that it provides the quality of care

29  desired, each hospital that qualifies for the exemption

30  provided by this act will be subject to more stringent

31  criteria than those imposed by the current certificate-of-need

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    Florida Senate - 2004                                  SB 1308
    28-869-04                                               See HB




 1  process and will also be subject to continual monitoring by

 2  the Agency for Health Care Administration, and

 3         WHEREAS, the Legislature intends to ensure that

 4  standards of quality are maintained while promoting

 5  competition in the provision of adult cardiac care, NOW,

 6  THEREFORE,

 7  

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

 9  

10         Section 1.  Paragraph (t) of subsection (3) of section

11  408.036, Florida Statutes, is amended to read:

12         408.036  Projects subject to review; exemptions.--

13         (3)  EXEMPTIONS.--Upon request, the following projects

14  are subject to exemption from the provisions of subsection

15  (1):

16         (t)1.  For the provision of adult open-heart services

17  in a hospital located within the boundaries of Health Service

18  Planning District 9, as defined in s. 408.032(5), or Acute

19  Care Subdistrict 6-2, as defined in Rule 59C-2.100(3)(f)2.,

20  Florida Administrative Code Palm Beach, Polk, Martin, St.

21  Lucie, and Indian River Counties if the following conditions

22  are met: The exemption must be based upon objective criteria

23  and address and solve the twin problems of geographic and

24  temporal access. A hospital shall be exempt from the

25  certificate-of-need review for the establishment of an

26  open-heart-surgery program when the application for exemption

27  submitted under this paragraph complies with the following

28  criteria:

29         a.  The applicant must certify that it will meet and

30  continuously maintain the minimum licensure requirements

31  adopted by the agency governing adult open-heart programs,

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    Florida Senate - 2004                                  SB 1308
    28-869-04                                               See HB




 1  including the most current guidelines of the American College

 2  of Cardiology and American Heart Association Guidelines for

 3  Adult Open Heart Programs.

 4         b.  The applicant must certify that it will maintain

 5  sufficient appropriate equipment and health personnel to

 6  ensure quality and safety.

 7         c.  The applicant must certify that it will maintain

 8  appropriate times of operation and protocols to ensure

 9  availability and appropriate referrals in the event of

10  emergencies.

11         d.  The applicant must certify can demonstrate that it

12  is referring 300 or more patients per year from the hospital,

13  including the emergency room, for cardiac services at a

14  hospital with cardiac services, or that the average wait for

15  transfer for 50 percent or more of the cardiac patients

16  exceeds 4 hours.

17         e.  The applicant is a general acute care hospital that

18  is in operation for 3 years or more.

19         f.  The applicant is performing more than 300

20  diagnostic cardiac catheterization procedures per year,

21  combined inpatient and outpatient.

22         g.  The applicant's payor mix at a minimum reflects the

23  community average for Medicaid, charity care, and self-pay

24  patients or the applicant must certify that it will provide a

25  minimum of 5 percent of Medicaid, charity care, and self-pay

26  to open-heart-surgery patients.

27         h.  If the applicant fails to meet the established

28  criteria for open-heart programs or fails to reach 300

29  surgeries per year by the end of its third year of operation,

30  it must show cause why its exemption should not be revoked.

31  

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    Florida Senate - 2004                                  SB 1308
    28-869-04                                               See HB




 1         2.  By December 31, 2004, and annually thereafter, the

 2  agency for Health Care Administration shall submit a report to

 3  the Legislature providing information concerning the number of

 4  requests for exemption it has received under this paragraph

 5  during the calendar year and the number of exemptions it has

 6  granted or denied during the calendar year.

 7         Section 2.  This act shall take effect upon becoming a

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