Amendment

Bill No. 1762

Amendment No. 543191

CHAMBER ACTION
Senate		House
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1	Representative Kyle offered the following:
2
3	Amendment (with title amendment)
4	Remove everything after the enacting clause and insert:
5	Section 1.  Subsection (4) of section 212.055, Florida
6	Statutes, is amended to read:
7	212.055  Discretionary sales surtaxes; legislative intent;
8	authorization and use of proceeds.--It is the legislative intent
9	that any authorization for imposition of a discretionary sales
10	surtax shall be published in the Florida Statutes as a
11	subsection of this section, irrespective of the duration of the
12	levy. Each enactment shall specify the types of counties
13	authorized to levy; the rate or rates which may be imposed; the
14	maximum length of time the surtax may be imposed, if any; the
15	procedure which must be followed to secure voter approval, if
16	required; the purpose for which the proceeds may be expended;
17	and such other requirements as the Legislature may provide.
18	Taxable transactions and administrative procedures shall be as
19	provided in s. 212.054.
20	(4)  INDIGENT CARE AND TRAUMA CENTER SURTAX.--
21	(a)1.  The governing body in each county the government of
22	which is not consolidated with that of one or more
23	municipalities, which has a population of at least 800,000
24	residents and is not authorized to levy a surtax under
25	subsection (5), may levy, pursuant to an ordinance either
26	approved by an extraordinary vote of the governing body or
27	conditioned to take effect only upon approval by a majority vote
28	of the electors of the county voting in a referendum, a
29	discretionary sales surtax at a rate that may not exceed 0.5
30	percent.
31	2.(b)  If the ordinance is conditioned on a referendum, a
32	statement that includes a brief and general description of the
33	purposes to be funded by the surtax and that conforms to the
34	requirements of s. 101.161 shall be placed on the ballot by the
35	governing body of the county. The following questions shall be
36	placed on the ballot:
37
38	FOR THE. . . .CENTS TAX
39
40	AGAINST THE. . . .CENTS TAX
41
42	3.(c)  The ordinance adopted by the governing body
43	providing for the imposition of the surtax shall set forth a
44	plan for providing health care services to qualified residents,
45	as defined in subparagraph 4. paragraph (d). Such plan and
46	subsequent amendments to it shall fund a broad range of health
47	care services for both indigent persons and the medically poor,
48	including, but not limited to, primary care and preventive care
49	as well as hospital care. The plan must also address the
50	services to be provided by the Level I trauma center. It shall
51	emphasize a continuity of care in the most cost-effective
52	setting, taking into consideration both a high quality of care
53	and geographic access. Where consistent with these objectives,
54	it shall include, without limitation, services rendered by
55	physicians, clinics, community hospitals, mental health centers,
56	and alternative delivery sites, as well as at least one regional
57	referral hospital where appropriate. It shall provide that
58	agreements negotiated between the county and providers,
59	including hospitals with a Level I trauma center, will include
60	reimbursement methodologies that take into account the cost of
61	services rendered to eligible patients, recognize hospitals that
62	render a disproportionate share of indigent care, provide other
63	incentives to promote the delivery of charity care, promote the
64	advancement of technology in medical services, recognize the
65	level of responsiveness to medical needs in trauma cases, and
66	require cost containment including, but not limited to, case
67	management. It must also provide that any hospitals that are
68	owned and operated by government entities on May 21, 1991, must,
69	as a condition of receiving funds under this subsection, afford
70	public access equal to that provided under s. 286.011 as to
71	meetings of the governing board, the subject of which is
72	budgeting resources for the rendition of charity care as that
73	term is defined in the Florida Hospital Uniform Reporting System
74	(FHURS) manual referenced in s. 408.07. The plan shall also
75	include innovative health care programs that provide cost-
76	effective alternatives to traditional methods of service
77	delivery and funding.
78	4.(d)  For the purpose of this paragraph subsection, the
79	term "qualified resident" means residents of the authorizing
80	county who are:
81	a.1.  Qualified as indigent persons as certified by the
82	authorizing county;
83	b.2.  Certified by the authorizing county as meeting the
84	definition of the medically poor, defined as persons having
85	insufficient income, resources, and assets to provide the needed
86	medical care without using resources required to meet basic
87	needs for shelter, food, clothing, and personal expenses; or not
88	being eligible for any other state or federal program, or having
89	medical needs that are not covered by any such program; or
90	having insufficient third-party insurance coverage. In all
91	cases, the authorizing county is intended to serve as the payor
92	of last resort; or
93	c.3.  Participating in innovative, cost-effective programs
94	approved by the authorizing county.
95	5.(e)  Moneys collected pursuant to this paragraph
96	subsection remain the property of the state and shall be
97	distributed by the Department of Revenue on a regular and
98	periodic basis to the clerk of the circuit court as ex officio
99	custodian of the funds of the authorizing county. The clerk of
100	the circuit court shall:
101	a.1.  Maintain the moneys in an indigent health care trust
102	fund;
103	b.2.  Invest any funds held on deposit in the trust fund
104	pursuant to general law;
105	c.3.  Disburse the funds, including any interest earned, to
106	any provider of health care services, as provided in
107	subparagraphs 3. and 4. paragraphs (c) and (d), upon directive
108	from the authorizing county. However, if a county has a
109	population of at least 800,000 residents and has levied the
110	surtax authorized in this paragraph subsection, notwithstanding
111	any directive from the authorizing county, on October 1 of each
112	calendar year, the clerk of the court shall issue a check in the
113	amount of $6.5 million to a hospital in its jurisdiction that
114	has a Level I trauma center or shall issue a check in the amount
115	of $3.5 million to a hospital in its jurisdiction that has a
116	Level I trauma center if that county enacts and implements a
117	hospital lien law in accordance with chapter 98-499, Laws of
118	Florida. The issuance of the checks on October 1 of each year is
119	provided in recognition of the Level I trauma center status and
120	shall be in addition to the base contract amount received during
121	fiscal year 1999-2000 and any additional amount negotiated to
122	the base contract. If the hospital receiving funds for its Level
123	I trauma center status requests such funds to be used to
124	generate federal matching funds under Medicaid, the clerk of the
125	court shall instead issue a check to the Agency for Health Care
126	Administration to accomplish that purpose to the extent that it
127	is allowed through the General Appropriations Act; and
128	d.4.  Prepare on a biennial basis an audit of the trust
129	fund specified in sub-subparagraph a. subparagraph 1. Commencing
130	February 1, 2004, such audit shall be delivered to the governing
131	body and to the chair of the legislative delegation of each
132	authorizing county.
133	6.(f)  Notwithstanding any other provision of this section,
134	a county shall not levy local option sales surtaxes authorized
135	in this paragraph subsection and subsections (2) and (3) in
136	excess of a combined rate of 1 percent.
137	(b)  Notwithstanding any other provision of this section,
138	the governing body in each county the government of which is not
139	consolidated with that of one or more municipalities and which
140	has a population of less than 800,000 residents, may levy, by
141	ordinance subject to approval by a majority of the electors of
142	the county voting in a referendum, a discretionary sales surtax
143	at a rate that may not exceed 0.25 percent for the sole purpose
144	of funding trauma services provided by a trauma center licensed
145	pursuant to chapter 395.
146	1.  A statement that includes a brief and general
147	description of the purposes to be funded by the surtax and that
148	conforms to the requirements of s. 101.161 shall be placed on
149	the ballot by the governing body of the county. The following
150	shall be placed on the ballot:
151
152	FOR THE. . . .CENTS TAX
153	AGAINST THE. . . .CENTS TAX
154
155	2.  The ordinance adopted by the governing body of the
156	county providing for the imposition of the surtax shall set
157	forth a plan for providing trauma services to trauma victims
158	presenting in the trauma service area in which such county is
159	located.
160	3.  Moneys collected pursuant to this paragraph remain the
161	property of the state and shall be distributed by the Department
162	of Revenue on a regular and periodic basis to the clerk of the
163	circuit court as ex officio custodian of the funds of the
164	authorizing county. The clerk of the circuit court shall:
165	a.  Maintain the moneys in a trauma services trust fund.
166	b.  Invest any funds held on deposit in the trust fund
167	pursuant to general law.
168	c.  Disburse the funds, including any interest earned on
169	such funds, to the trauma center in its trauma service area, as
170	provided in the plan set forth pursuant to subparagraph 2., upon
171	directive from the authorizing county. If the trauma center
172	receiving funds requests such funds be used to generate federal
173	matching funds under Medicaid, the custodian of the funds shall
174	instead issue a check to the Agency for Health Care
175	Administration to accomplish that purpose to the extent that the
176	agency is allowed through the General Appropriations Act.
177	d.  Prepare on a biennial basis an audit of the trauma
178	services trust fund specified in sub-subparagraph a., to be
179	delivered to the authorizing county.
180	4.  A discretionary sales surtax imposed pursuant to this
181	paragraph shall expire 4 years after the effective date of the
182	surtax, unless reenacted by ordinance subject to approval by a
183	majority of the electors of the county voting in a subsequent
184	referendum.
185	5.  Notwithstanding any other provision of this section, a
186	county shall not levy local option sales surtaxes authorized in
187	this paragraph and subsections (2) and (3) in excess of a
188	combined rate of 1 percent.
189	Section 2.  Subsections (5) and (6) of section 395.40,
190	Florida Statutes, are amended to read:
191	395.40  Legislative findings and intent.--
192	(5)  In addition, the agencies listed in subsection (4)
193	should undertake to:
194	(a)  Establish a coordinated methodology for monitoring,
195	evaluating, and enforcing the requirements of the state's
196	inclusive trauma system which recognizes the interests of each
197	agency.
198	(b)  Develop appropriate roles for trauma agencies, to
199	assist in furthering the operation of trauma systems at the
200	regional level. This should include issues of system evaluation
201	as well as managed care.
202	(c)  Develop and submit appropriate requests for waivers of
203	federal requirements which will facilitate the delivery of
204	trauma care.
205	(d)  Develop criteria that will become the future basis for
206	mandatory consultation between acute care hospitals and trauma
207	centers on the care of trauma victims and the mandatory transfer
208	of appropriate trauma victims to trauma centers.
209	(e)  Develop a coordinated approach to the care of the
210	trauma victim. This shall include the movement of the trauma
211	victim through the system of care and the identification of
212	medical responsibility for each phase of care for out-of-
213	hospital and in-hospital trauma care.
214	(f)  Require the medical director of an emergency medical
215	services provider to have medical accountability for a trauma
216	victim during interfacility transfer.
217	(6)  Furthermore, the Legislature encourages the department
218	to actively foster the provision of trauma care and serve as a
219	catalyst for improvements in the process and outcome of the
220	provision of trauma care in an inclusive trauma system. Among
221	other considerations, the department is required encouraged to:
222	(a)  Promote the development of at least one trauma center
223	in every trauma service area.
224	(b)  Promote the development of a trauma agency for each
225	trauma region.
226	(c)  Update the state trauma system plan by February 2005
227	December 2000 and at least annually every 5th year thereafter.
228	Section 3.  Section 395.4001, Florida Statutes, is amended
229	to read:
230	395.4001  Definitions.--As used in this part, the term:
231	(1)  "Agency" means the Agency for Health Care
232	Administration.
233	(2)  "Charity care" or "uncompensated trauma charity care"
234	means that portion of hospital charges reported to the agency
235	for which there is no compensation, other than restricted or
236	unrestricted revenues provided to a hospital by local
237	governments or tax districts regardless of method of payment,
238	for care provided to a patient whose family income for the 12
239	months preceding the determination is less than or equal to 200
240	150 percent of the federal poverty level, unless the amount of
241	hospital charges due from the patient exceeds 25 percent of the
242	annual family income. However, in no case shall the hospital
243	charges for a patient whose family income exceeds four times the
244	federal poverty level for a family of four be considered
245	charity.
246	(3)  "Department" means the Department of Health.
247	(4)  "Interfacility trauma transfer" means the transfer of
248	a trauma victim between two facilities licensed under this
249	chapter, pursuant to this part.
250	(5)  "Level I trauma center" means a trauma center that:
251	(a)  Has formal research and education programs for the
252	enhancement of trauma care; and is verified determined by the
253	department to be in substantial compliance with Level I trauma
254	center and pediatric trauma referral center standards; and has
255	been approved by the department to operate as a Level I trauma
256	center.
257	(b)  Serves as a resource facility to Level II trauma
258	centers, pediatric trauma referral centers, and general
259	hospitals through shared outreach, education, and quality
260	improvement activities.
261	(c)  Participates in an inclusive system of trauma care,
262	including providing leadership, system evaluation, and quality
263	improvement activities.
264	(6)  "Level II trauma center" means a trauma center that:
265	(a)  Is verified determined by the department to be in
266	substantial compliance with Level II trauma center standards and
267	has been approved by the department to operate as a Level II
268	trauma center.
269	(b)  Serves as a resource facility to general hospitals
270	through shared outreach, education, and quality improvement
271	activities.
272	(c)  Participates in an inclusive system of trauma care.
273	(7)  "Pediatric trauma referral center" means a hospital
274	that is verified determined by the department to be in
275	substantial compliance with pediatric trauma referral center
276	standards as established by rule of the department and has been
277	approved by the department to operate as a pediatric trauma
278	center.
279	(8)  "Provisional trauma center" means a hospital that has
280	been verified by the department to be in substantial compliance
281	with the requirements in s. 395.4025 and has been approved by
282	the department to operate as a provisional Level I trauma
283	center, Level II trauma center, or pediatric trauma center.
284	(8)  "State-approved trauma center" means a hospital that
285	has successfully completed the selection process pursuant to s.
286	395.4025 and has been approved by the department to operate as a
287	trauma center in the state.
288	(9)  "State-sponsored trauma center" means a trauma center
289	or pediatric trauma referral center that receives state funding
290	for trauma care services under s. 395.403.
291	(9)(10)  "Trauma agency" means a department-approved agency
292	established and operated by one or more counties, or a
293	department-approved entity with which one or more counties
294	contract, for the purpose of administering an inclusive regional
295	trauma system.
296	(10)(11)  "Trauma alert victim" means a person who has
297	incurred a single or multisystem injury due to blunt or
298	penetrating means or burns, who requires immediate medical
299	intervention or treatment, and who meets one or more of the
300	adult or pediatric scorecard criteria established by the
301	department by rule.
302	(11)(12)  "Trauma center" means a any hospital that has
303	been verified determined by the department to be in substantial
304	compliance with the requirements in s. 395.4025 and has been
305	approved by the department to operate as a Level I trauma
306	center, Level II trauma center, or pediatric trauma center
307	verification standards as either state-approved or provisional
308	state-approved.
309	(12)(13)  "Trauma scorecard" means a statewide methodology
310	adopted by the department by rule under which a person who has
311	incurred a traumatic injury is graded as to the severity of his
312	or her injuries or illness and which methodology is used as the
313	basis for making destination decisions.
314	(13)(14)  "Trauma transport protocol" means a document
315	which describes the policies, processes, and procedures
316	governing the dispatch of vehicles, the triage, prehospital
317	transport, and interfacility trauma transfer of trauma victims.
318	(14)(15)  "Trauma victim" means any person who has incurred
319	a single or multisystem injury due to blunt or penetrating means
320	or burns and who requires immediate medical intervention or
321	treatment.
322	Section 4.  Subsection (1) of section 395.401, Florida
323	Statutes, is amended to read:
324	395.401  Trauma services system plans; approval
325	verification of trauma centers and pediatric trauma referral
326	centers; procedures; renewal.--
327	(1)(a)  The local and regional trauma agencies shall plan,
328	implement, and evaluate trauma services systems, in accordance
329	with this section and ss. 395.4015, 395.404, and 395.4045, which
330	consist of organized patterns of readiness and response services
331	based on public and private agreements and operational
332	procedures. The department shall establish, by rule, processes
333	and procedures for establishing a trauma agency and obtaining
334	its approval from the department.
335	(b)  The local and regional trauma agencies shall develop
336	and submit to the department plans for local and regional trauma
337	services systems. The plans must include, at a minimum, the
338	following components:
339	1.  The organizational structure of the trauma system.
340	2.  Prehospital care management guidelines for triage and
341	transportation of trauma cases.
342	3.  Flow patterns of trauma cases and transportation system
343	design and resources, including air transportation services,
344	provision for interfacility trauma transfer, and the prehospital
345	transportation of trauma victims. The trauma agency shall plan
346	for the development of a system of transportation of trauma
347	alert victims to trauma centers where the distance or time to a
348	trauma center or transportation resources diminish access by
349	trauma alert victims.
350	4.  The number and location of needed state-approved trauma
351	centers based on local needs, population, and location and
352	distribution of resources.
353	5.  Data collection regarding system operation and patient
354	outcome.
355	6.  Periodic performance evaluation of the trauma system
356	and its components.
357	7.  The use of air transport services within the
358	jurisdiction of the local trauma agency.
359	8.  Public information and education about the trauma
360	system.
361	9.  Emergency medical services communication system usage
362	and dispatching.
363	10.  The coordination and integration between the verified
364	trauma center care facility and other acute care hospitals the
365	nonverified health care facilities.
366	11.  Medical control and accountability.
367	12.  Quality control and system evaluation.
368	(c)  The department shall receive plans for the
369	implementation of inclusive trauma systems from trauma agencies.
370	The department may approve or not approve trauma agency plans
371	based on the conformance of the plan with this section and ss.
372	395.4015, 395.404, and 395.4045 and the rules and definitions
373	adopted by the department pursuant to those sections. The
374	department shall approve or disapprove the plans within 120 days
375	after the date the plans are submitted to the department. The
376	department shall, by rule, provide an application process for
377	establishing a trauma agency. The application must, at a
378	minimum, provide requirements for the trauma agency plan
379	submitted for review, a process for reviewing the application
380	for a state-approved trauma agency, a process for reviewing the
381	trauma transport protocols for the trauma agency, and a process
382	for reviewing the staffing requirements for the agency. The
383	department shall, by rule, establish minimum requirements for a
384	trauma agency to conduct an annual performance evaluation and
385	submit the results to the department.
386	(d)  A trauma agency shall not operate unless the
387	department has approved the local or regional trauma services
388	system plan of the agency.
389	(e)  The department may grant an exception to a portion of
390	the rules adopted pursuant to this section or s. 395.4015 if the
391	local or regional trauma agency proves that, as defined in the
392	rules, compliance with that requirement would not be in the best
393	interest of the persons served within the affected local or
394	regional trauma area.
395	(f)  A local or regional trauma agency may implement a
396	trauma care system only if the system meets the minimum
397	standards set forth in the rules for implementation established
398	by the department and if the plan has been submitted to, and
399	approved by, the department. At least 60 days before the local
400	or regional trauma agency submits the plan for the trauma care
401	system to the department, the local or regional trauma agency
402	shall hold a public hearing and give adequate notice of the
403	public hearing to all hospitals and other interested parties in
404	the area to be included in the proposed system.
405	(g)  Local or regional trauma agencies may enter into
406	contracts for the purpose of implementing the local or regional
407	plan. If local or regional agencies contract with hospitals for
408	trauma services, such agencies must contract only with hospitals
409	which are verified trauma centers.
410	(h)  Local or regional trauma agencies providing service
411	for more than one county shall, as part of their formation,
412	establish interlocal agreements between or among the several
413	counties in the regional system.
414	(i)  This section does not restrict the authority of a
415	health care facility to provide service for which it has
416	received a license pursuant to this chapter.
417	(j)  Any hospital which is verified as a trauma center
418	shall accept all trauma victims that are appropriate for the
419	facility regardless of race, sex, creed, or ability to pay.
420	(k)  It is unlawful for any hospital or other facility to
421	hold itself out as a trauma center unless it has been so
422	verified.
423	(l)  A county, upon the recommendations of the local or
424	regional trauma agency, may adopt ordinances governing the
425	transport of a patient who is receiving care in the field from
426	prehospital emergency medical personnel when the patient meets
427	specific criteria for trauma, burn, or pediatric centers adopted
428	by the local or regional trauma agency. These ordinances must be
429	consistent with s. 395.4045, ordinances adopted under s.
430	401.25(6), and the local or regional trauma system plan and, to
431	the furthest possible extent, must ensure that individual
432	patients receive appropriate medical care while protecting the
433	interests of the community at large by making maximum use of
434	available emergency medical care resources.
435	(m)  The local or regional trauma agency shall, consistent
436	with the regional trauma system plan, coordinate and otherwise
437	facilitate arrangements necessary to develop a trauma services
438	system.
439	(n)  After the submission of the initial trauma system
440	plan, each trauma agency shall, every 5th year, submit to the
441	department for approval an updated plan that identifies the
442	changes, if any, to be made in the regional trauma system.
443	(o)  This section does not preclude a local or regional
444	trauma agency from adopting trauma care system standards.
445	Section 5.  Section 395.4015, Florida Statutes, is amended
446	to read:
447	395.4015  State regional trauma planning; trauma regions.--
448	(1)  The department shall establish a state trauma system
449	plan. As part of the state trauma system plan, the department
450	shall establish trauma regions that which cover all geographical
451	areas of the state and have boundaries that are coterminous with
452	the boundaries of the regional domestic security task forces
453	established under s. 943.0312. These regions may serve as the
454	basis for the development of department-approved local or
455	regional trauma plans. However, the delivery of trauma services
456	by or in coordination with a trauma agency established before
457	July 1, 2004, may continue in accordance with public and private
458	agreements and operational procedures entered into as provided
459	in s. 395.401. The department shall base its definition of the
460	regions upon:
461	(a)  Geographical considerations so as to ensure rapid
462	access to trauma care by patients;
463	(b)  Historical patterns of patient referral and transfer
464	in an area;
465	(c)  Inventories of available trauma care resources;
466	(d)  Predicted population growth characteristics;
467	(e)  Transportation capabilities, including ground and air
468	transport;
469	(f)  Medically appropriate ground and air travel times; and
470	(g)  Other appropriate criteria.
471	(2)  The department shall develop trauma systems plans for
472	the department-defined trauma regions which include at a minimum
473	the following components:
474	(a)  An assessment of current and future trauma care needs
475	of the population, based upon incidence rates and acuity
476	indicators developed by the department, as well as other
477	relevant characteristics of the region.
478	(b)  The organizational structure of the regional trauma
479	system, including the identification of local trauma agency
480	service areas within the region.
481	(c)  Prehospital care management guidelines for triage and
482	transportation of trauma cases.
483	(d)  Flow patterns of trauma cases and transportation
484	system design and resources, including air transportation
485	services, provision for interfacility trauma transfer, and the
486	prehospital transportation of trauma victims. The department
487	shall plan for the development of a system of transportation of
488	trauma alert victims to trauma centers where the distance or
489	time to a trauma center or transportation resources diminish
490	access by trauma alert victims.
491	(e)  The current and projected number, acuity level, and
492	geographic location of trauma cases expected so as to assure
493	that the assessed current and future trauma care needs of the
494	population are adequately met and that state-sponsored trauma
495	centers will maintain the volume of cases sufficient to provide
496	quality care to trauma cases referred to them.
497	(f)  The availability of qualified health professionals,
498	including physicians and surgeons, capable of staffing trauma
499	centers to the level of current and future assessed needs.
500	(g)  Data collection regarding system operation and patient
501	outcome, as well as the number, type, and generalized locations
502	of state-sponsored trauma centers needed to meet the needs of
503	the population.
504	(h)  Periodic performance evaluation of the trauma system
505	and its components.
506	(i)  The type and extent of air transport services
507	available and needed in each region.
508	(j)  Public information and education about the trauma
509	system.
510	(k)  Emergency medical services communication system usage
511	and dispatching.
512	(l)  The coordination and integration between the trauma
513	centers and other health care facilities which may provide
514	services to trauma victims.
515	(m)  Medical control and accountability.
516	(n)  Quality management and system evaluation.
517	(2)(3)  The department shall consider the advice and
518	recommendations of any affected local or regional trauma agency
519	in developing the state trauma system systems plan. The
520	department may, in lieu of specific regional components of its
521	own plan, accept components developed by local or regional
522	trauma agencies.
523	(3)(4)  The department shall use the state trauma system
524	plan as the basis for establishing a statewide inclusive trauma
525	system.
526	Section 6.  Section 395.402, Florida Statutes, is amended
527	to read:
528	395.402  Trauma service areas; number and location of
529	trauma centers.--
530	(1)  The Legislature recognizes the need for a statewide,
531	cohesive, uniform, and integrated trauma system. Within the
532	trauma service areas, that Level I and Level II trauma centers
533	shall should each be capable of annually treating a minimum of
534	1,000 and 500 patients, respectively, with an injury severity
535	score (ISS) of 9 or greater. Level II trauma centers in counties
536	with a population of more than 500,000 shall have the capacity
537	to care for 1,000 patients per year. Further, the Legislature
538	finds that, based on the numbers and locations of trauma victims
539	with these injury severity scores, there should be 19 trauma
540	service areas in the state, and, at a minimum, there should be
541	at least one trauma center in each service area.
542	(2)  It is the intent of the Legislature that, as a
543	planning guideline, Level I and Level II trauma centers should
544	generally each provide care annually to a minimum of 1,000 and
545	500 patients, respectively. Level II trauma centers in counties
546	of more than 500,000 population are expected to be able to care
547	for 1,000 patients per year, as a planning guideline.
548	(2)(3)  Trauma service areas as defined in this section are
549	to be utilized until the Department of Health completes an
550	assessment of the trauma system and reports its finding to the
551	Governor, the President of the Senate, the Speaker of the House
552	of Representatives, and the substantive legislative committees.
553	The report shall be submitted by February 1, 2005. The
554	department shall review the existing trauma system and determine
555	whether it is effective in providing trauma care uniformly
556	throughout the state. The assessment shall:
557	(a)  Consider aligning trauma service areas within the
558	trauma region boundaries as established in July 2004.
559	(b)  Review the number and level of trauma centers needed
560	for each trauma service area to provide a statewide integrated
561	trauma system.
562	(c)  Establish criteria for determining the number and
563	level of trauma centers needed to serve the population in a
564	defined trauma service area or region.
565	(d)  Consider including a criteria within trauma center
566	approval standards based upon the number of trauma victims
567	served within a service area.
568	(e)  Review the Regional Domestic Security Task Force
569	structure and determine whether integrating the trauma system
570	planning with interagency regional emergency and disaster
571	planning efforts is feasible and identify any duplication of
572	efforts between the two entities.
573	(f)  Make recommendations regarding a continued revenue
574	source which shall include a local participation requirement.
575	(g)  Make recommendations regarding a formula for the
576	distribution of funds identified for trauma centers which shall
577	address incentives for new centers where needed and the need to
578	maintain effective trauma care in areas served by existing
579	centers, with consideration for the volume of trauma patients
580	served, and the amount of charity care provided.
581	(3)  In conducting such assessment and subsequent annual
582	reviews, the department shall consider:
583	(a)  The recommendations made as part of the regional
584	trauma system plans submitted by regional trauma agencies.
585	(b)  Stakeholder recommendations.
586	(c)  The geographical composition of an area to ensure
587	rapid access to trauma care by patients.
588	(d)  Historical patterns of patient referral and transfer
589	in an area.
590	(e)  Inventories of available trauma care resources,
591	including professional medical staff.
592	(f)  Population growth characteristics.
593	(g)  Transportation capabilities, including ground and air
594	transport.
595	(h)  Medically appropriate ground and air travel times.
596	(i)  Recommendations of the Regional Domestic Security Task
597	Force.
598	(j)  The actual number of trauma victims currently being
599	served by each trauma center.
600	(k)  Other appropriate criteria.
601	(4)  Annually thereafter, used. the department shall
602	periodically review the assignment of the 67 counties to trauma
603	service areas, in addition to the requirements of paragraphs
604	(2)(b)?(g) and subsection (3). County These assignments are made
605	for the purpose of developing a system of trauma centers.
606	Revisions made by the department shall should take into
607	consideration the recommendations made as part of the regional
608	trauma system plans approved by the department, and as well as
609	the recommendations made as part of the state trauma system
610	plan. In cases where a trauma service area is located within the
611	boundaries of more than one trauma region, the trauma service
612	area's needs, response capability, and system requirements shall
613	be considered by each trauma region served by that trauma
614	service area in its regional system plan These areas must, at a
615	minimum, be reviewed in the year 2000 and every 5 years
616	thereafter. Until the department completes the February 2005
617	assessment its initial review, the assignment of counties shall
618	remain as established in this section pursuant to chapter 90-
619	284, Laws of Florida.
620	(a)  The following trauma service areas are hereby
621	established:
622	1.  Trauma service area 1 shall consist of Escambia,
623	Okaloosa, Santa Rosa, and Walton Counties.
624	2.  Trauma service area 2 shall consist of Bay, Gulf,
625	Holmes, and Washington Counties.
626	3.  Trauma service area 3 shall consist of Calhoun,
627	Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison,
628	Taylor, and Wakulla Counties.
629	4.  Trauma service area 4 shall consist of Alachua,
630	Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy,
631	Putnam, Suwannee, and Union Counties.
632	5.  Trauma service area 5 shall consist of Baker, Clay,
633	Duval, Nassau, and St. Johns Counties.
634	6.  Trauma service area 6 shall consist of Citrus,
635	Hernando, and Marion Counties.
636	7.  Trauma service area 7 shall consist of Flagler and
637	Volusia Counties.
638	8.  Trauma service area 8 shall consist of Lake, Orange,
639	Osceola, Seminole, and Sumter Counties.
640	9.  Trauma service area 9 shall consist of Pasco and
641	Pinellas Counties.
642	10.  Trauma service area 10 shall consist of Hillsborough
643	County.
644	11.  Trauma service area 11 shall consist of Hardee,
645	Highlands, and Polk Counties.
646	12.  Trauma service area 12 shall consist of Brevard and
647	Indian River Counties.
648	13.  Trauma service area 13 shall consist of DeSoto,
649	Manatee, and Sarasota Counties.
650	14.  Trauma service area 14 shall consist of Martin,
651	Okeechobee, and St. Lucie Counties.
652	15.  Trauma service area 15 shall consist of Charlotte,
653	Glades, Hendry, and Lee Counties.
654	16.  Trauma service area 16 shall consist of Palm Beach
655	County.
656	17.  Trauma service area 17 shall consist of Collier
657	County.
658	18.  Trauma service area 18 shall consist of Broward
659	County.
660	19.  Trauma service area 19 shall consist of Dade and
661	Monroe Counties.
662	(b)  Each trauma service area should have at least one
663	Level I or Level II trauma center. The department shall
664	allocate, by rule, the number of trauma centers needed for each
665	trauma service area.
666	(c)  There shall be no more than a total of 44 state-
667	sponsored trauma centers in the state.
668	Section 7.  Section 395.4025, Florida Statutes, is amended
669	to read:
670	395.4025  State-approved Trauma centers; selection; quality
671	assurance; records.--
672	(1)  For purposes of developing a system of state-approved
673	trauma centers, the department shall use the 19 trauma service
674	areas established in s. 395.402. Within each service area and
675	based on the state trauma system plan, the local or regional
676	trauma services system plan, and recommendations of the local or
677	regional trauma agency, and the 1990 Report and Proposal for
678	Funding State-Sponsored Trauma Centers, the department shall
679	establish the approximate number of state-approved trauma
680	centers needed to ensure reasonable access to high-quality
681	trauma services. The Using the guidelines and procedures
682	outlined in the 1990 report, except when in conflict with those
683	prescribed in this section, the department shall select those
684	hospitals that are to be recognized as state-approved trauma
685	centers and shall include all trauma centers verified as of
686	October 1, 1990, and subsequently, subject to specific
687	programmatic and quality of care standards.
688	(2)(a)  The department shall annually notify each acute
689	care general hospital and each local and each regional trauma
690	agency in the state that the department is accepting letters of
691	intent from hospitals that are interested in becoming state-
692	approved trauma centers. In order to be considered by the
693	department, a hospital that operates within the geographic area
694	of a local or regional trauma agency must certify that its
695	intent to operate as a state-approved trauma center is
696	consistent with the trauma services plan of the local or
697	regional trauma agency, as approved by the department, if such
698	agency exists. Letters of intent must be postmarked no later
699	than midnight October 1. This paragraph does not apply to any
700	hospital that is a provisional or verified trauma center on
701	January 1, 1992.
702	(b)  By October 15, the department shall send to all
703	hospitals that submitted a letter of intent an application
704	package that will provide the hospitals with instructions for
705	submitting information to the department for selection as a
706	state-approved trauma center. The standards for verification of
707	trauma centers and pediatric trauma referral centers provided
708	for in s. 395.401(2), as adopted by rule of the department,
709	shall serve as the basis for these instructions.
710	(c)  In order to be considered by the department,
711	applications from those hospitals seeking selection as state-
712	approved trauma centers, including those current verified trauma
713	centers that seek a change or redesignation in approval status
714	as a trauma center to be state-approved trauma centers, must be
715	received by the department no later than the close of business
716	on April 1. The department shall conduct a provisional review of
717	each application for the purpose of determining that the
718	hospital's application is complete and that the hospital has the
719	critical elements required for a state-approved trauma center.
720	This critical review will be based on trauma center verification
721	standards and shall include, but not be limited to, a review of
722	whether the hospital has:
723	1.  Equipment and physical facilities necessary to provide
724	trauma services.
725	2.  Personnel in sufficient numbers and with proper
726	qualifications to provide trauma services.
727	3.  An effective quality assurance process.
728	4.  Submitted written confirmation by the local or regional
729	trauma agency that the verification of the hospital applying to
730	become as a state-approved trauma center is consistent with the
731	plan of the local or regional trauma agency, as approved by the
732	department, if such agency exists. This subparagraph applies to
733	any hospital that is not a provisional or verified trauma center
734	on January 1, 1992.
735	(d)1.  Notwithstanding other provisions in this section,
736	the department may grant up to an additional 18 months to a
737	hospital applicant that is unable to meet all requirements as
738	provided in paragraph (c) at the time of application if the
739	number of applicants in the service area in which the applicant
740	is located is equal to or less than the service area allocation,
741	as provided by rule of the department. An applicant that is
742	granted additional time pursuant to this paragraph shall submit
743	a plan for departmental approval which includes timelines and
744	activities that the applicant proposes to complete in order to
745	meet application requirements. Any applicant that demonstrates
746	an ongoing effort to complete the activities within the
747	timelines outlined in the plan shall be included in the number
748	of state-approved trauma centers at such time that the
749	department has conducted a provisional review of the application
750	and has determined that the application is complete and that the
751	hospital has the critical elements required for a state-approved
752	trauma center.
753	2.  Timeframes provided in subsections (1)-(8) shall be
754	stayed until the department determines that the application is
755	complete and that the hospital has the critical elements
756	required for a state-approved trauma center.
757	(3)  After April 30, any hospital that submitted an
758	application found acceptable by the department based on
759	provisional review, including all trauma centers verified as of
760	December 1, 1989, shall be eligible to operate as a provisional
761	state-approved trauma center.
762	(4)  Between May 1 and October 1 of each year, the
763	department shall conduct an in-depth evaluation of all
764	applications found acceptable in the provisional review. The
765	applications shall be evaluated against criteria enumerated in
766	the application packages as provided to the hospitals by the
767	department.
768	(5)  Beginning October 1 of each year and ending no later
769	than June 1 of the following year, a review team of out-of-state
770	experts assembled by the department shall make onsite visits to
771	all provisional state-approved trauma centers. The department
772	shall develop a survey instrument to be used by the expert team
773	of reviewers. The instrument shall include objective criteria
774	and guidelines for reviewers based on existing trauma center and
775	pediatric trauma referral center verification standards such
776	that all trauma centers and pediatric trauma referral centers
777	are assessed equally. The survey instrument shall also include a
778	uniform rating system that will be used by reviewers to indicate
779	the degree of compliance of each trauma center with specific
780	standards, and to indicate the quality of care provided by each
781	trauma center as determined through an audit of patient charts.
782	In addition, hospitals being considered as provisional state-
783	approved trauma centers shall meet all the requirements of a
784	verified trauma center or pediatric trauma referral center, and
785	shall be located in a trauma service area that has a need for
786	such a trauma center.
787	(6)  Based on recommendations from the review team, the
788	department shall select state-approved trauma centers by July 1.
789	An applicant for designation as a state-approved trauma center
790	or a state-approved pediatric trauma referral center may request
791	an extension of its provisional status if it submits a
792	corrective action plan to the department. The corrective action
793	plan must demonstrate the ability of the applicant to correct
794	deficiencies noted during the applicant's onsite review
795	conducted by the department between the previous October 1 and
796	June 1. The department may extend the provisional status of an
797	applicant for designation as a state-approved trauma center or a
798	state-approved pediatric trauma referral center through December
799	31 if the applicant provides a corrective action plan acceptable
800	to the department. The department or a team of out-of-state
801	experts assembled by the department shall conduct an onsite
802	visit on or before November 1 to confirm that the deficiencies
803	have been corrected. The provisional state-approved trauma
804	center or the provisional state-approved pediatric trauma
805	referral center is responsible for all costs associated with the
806	onsite visit in a manner prescribed by rule of the department.
807	By January 1, the department must approve or deny the
808	application of any provisional applicant granted an extension.
809	Each state-approved trauma center shall be granted a 7-year
810	approval verification period during which time it must continue
811	to maintain trauma center verification standards and acceptable
812	patient outcomes as determined by department rule. An approval A
813	verification, unless sooner suspended or revoked, automatically
814	expires 7 years after the date of issuance and is renewable upon
815	application for renewal as prescribed by rule of the department.
816	After July 1, 1992, only those hospitals selected as state-
817	approved trauma centers may operate as trauma centers.
818	(7)  Any hospital that wishes to protest a decision made by
819	the department based on the department's preliminary or in-depth
820	review of applications or on the recommendations of the site
821	visit review team pursuant to this section shall proceed as
822	provided in chapter 120. Hearings held under this subsection
823	shall be conducted in the same manner as provided in ss. 120.569
824	and 120.57. Cases filed under chapter 120 may combine all
825	disputes between parties.
826	(8)  Notwithstanding any provision of chapter 381, a
827	hospital licensed under ss. 395.001-395.3025 that operates a
828	state-approved trauma center may not terminate or substantially
829	reduce the availability of trauma service without providing at
830	least 180 days' 6 months' notice of its intent to terminate such
831	service. Such notice shall be given to the department of Health,
832	to all affected local or regional trauma agencies, and to all
833	state-approved trauma centers, hospitals, and emergency medical
834	service providers in the trauma service area. The department
835	shall adopt by rule the procedures and process for notification,
836	duration, and explanation of the termination of trauma services.
837	(9)  Except as otherwise provided in this subsection, the
838	department or its agent may collect trauma care and registry
839	data, as prescribed by rule of the department, from trauma
840	centers, pediatric trauma referral centers, hospitals, emergency
841	medical service providers, local or regional trauma agencies, or
842	medical examiners for the purposes of evaluating trauma system
843	effectiveness, ensuring compliance with the standards of
844	verification, and monitoring patient outcomes. A trauma center,
845	pediatric trauma referral center, hospital, emergency medical
846	service provider, medical examiner, or local trauma agency or
847	regional trauma agency, or a panel or committee assembled by
848	such an agency under s. 395.50(1) may, but is not required to,
849	disclose to the department patient care quality assurance
850	proceedings, records, or reports. However, the department may
851	require a local trauma agency or a regional trauma agency, or a
852	panel or committee assembled by such an agency to disclose to
853	the department patient care quality assurance proceedings,
854	records, or reports that the department needs solely to conduct
855	quality assurance activities under s. 395.4015, or to ensure
856	compliance with the quality assurance component of the trauma
857	agency's plan approved under s. 395.401. The patient care
858	quality assurance proceedings, records, or reports that the
859	department may require for these purposes include, but are not
860	limited to, the structure, processes, and procedures of the
861	agency's quality assurance activities, and any recommendation
862	for improving or modifying the overall trauma system, if the
863	identity of a trauma center, pediatric trauma referral center,
864	hospital, emergency medical service provider, medical examiner,
865	or an individual who provides trauma services is not disclosed.
866	(10)  Out-of-state experts assembled by the department to
867	conduct onsite visits are agents of the department for the
868	purposes of s. 395.3025. An out-of-state expert who acts as an
869	agent of the department under this subsection is not liable for
870	any civil damages as a result of actions taken by him or her,
871	unless he or she is found to be operating outside the scope of
872	the authority and responsibility assigned by the department.
873	(11)  Onsite visits by the department or its agent may be
874	conducted at any reasonable time and may include but not be
875	limited to a review of records in the possession of trauma
876	centers, pediatric trauma referral centers, hospitals, emergency
877	medical service providers, local or regional trauma agencies, or
878	medical examiners regarding the care, transport, treatment, or
879	examination of trauma patients.
880	(12)  Patient care, transport, or treatment records or
881	reports, or patient care quality assurance proceedings, records,
882	or reports obtained or made pursuant to this section, s.
883	395.3025(4)(f), s. 395.401, s. 395.4015, s. 395.402, s. 395.403,
884	s. 395.404, s. 395.4045, s. 395.405, s. 395.50, or s. 395.51
885	must be held confidential by the department or its agent and are
886	exempt from the provisions of s. 119.07(1). Patient care quality
887	assurance proceedings, records, or reports obtained or made
888	pursuant to these sections are not subject to discovery or
889	introduction into evidence in any civil or administrative
890	action.
891	(13)  The department may adopt, by rule, the procedures and
892	process by which it will select state-approved trauma centers.
893	Such procedures and process must be used in annually selecting
894	state-approved trauma centers and must be consistent with
895	subsections (1)-(8) except in those situations in which it is in
896	the best interest of, and mutually agreed to by, all applicants
897	within a service area and the department to reduce the
898	timeframes.
899	(14)  Notwithstanding any other provisions of this section
900	and rules adopted pursuant to this section, until the department
901	has conducted the review provided under s. 395.402, only
902	hospitals located in trauma services areas where there is no
903	existing trauma center may apply.
904	Section 8.  Section 395.403, Florida Statutes, is amended
905	to read:
906	395.403  Reimbursement of state-sponsored trauma centers.--
907	(1)  The Legislature finds that many hospitals which
908	provide services to trauma victims are not adequately
909	compensated for such treatment. The Legislature also recognizes
910	that the current verified trauma centers are providing such
911	services without adequate reimbursement. Therefore, it is the
912	intent of the Legislature to provide financial support to the
913	current verified trauma centers and to establish a system of
914	state-sponsored trauma centers as soon as feasibly possible. It
915	is also the intent of the Legislature that this system of state-
916	sponsored trauma centers be assisted financially based on the
917	volume and acuity of uncompensated trauma care provided.
918	(1)(2)  All provisional trauma centers and state-approved
919	trauma centers shall be considered eligible to receive state
920	funding state-sponsored trauma centers when state funds are
921	specifically appropriated for state-sponsored trauma centers in
922	the General Appropriations Act. Effective July 1, 2004, the
923	department shall make one-time payments from the Administrative
924	Trust Fund under s. 20.435 to the trauma centers and a hospital
925	with a pending application for a Level I trauma center in
926	recognition of the capital investment made by the hospital to
927	establish the trauma service. Payments shall be in equal amounts
928	for the trauma centers approved by the department as of July 1
929	of the fiscal year in which funding is appropriated, with lesser
930	amounts for the hospital with an application pending for a Level
931	I trauma center at the department as of April 1, 2004. In the
932	event a trauma center does not maintain its status as a trauma
933	center for any state fiscal year in which such funding is
934	appropriated, the provisional trauma center or trauma center
935	shall repay the state for the portion of the year during which
936	it was not a trauma center.
937	(2)  Provisional trauma centers and trauma centers eligible
938	to receive distributions from the Administrative Trust Fund
939	under s. 20.435 in accordance with subsection (1) may request
940	that such funds be used as intergovernmental transfer funds in
941	the Medicaid program.
942	(3)  To receive state funding, a state-sponsored trauma
943	center shall submit a claim electronically via the Trauma Claims
944	Processing System, designed, developed, implemented, and
945	operated by the department's Medicaid program, to the
946	department's Medicaid program upon discharge of a trauma
947	patient. When a hospital stay spans a state fiscal year, a
948	separate hospital claim shall be submitted for the hospital days
949	incurred in each fiscal year.
950	(4)(a)  State-sponsored trauma centers shall determine each
951	trauma patient's eligibility for state funding prior to the
952	submission of a claim.
953	(b)  A trauma patient treated must meet the definition of
954	charity care, have been designated as having an ISS score of 9
955	or greater, and have received services that are medically
956	necessary from a state-sponsored trauma center in order for the
957	state-sponsored trauma center to receive state funding for that
958	patient.
959	(c)  Each state-sponsored trauma center shall retain
960	appropriate documentation showing a trauma patient's eligibility
961	for state funding. Documentation recognized by the department as
962	appropriate shall be limited to one of the following:
963	1.  W-2 withholding forms.
964	2.  Payroll stubs.
965	3.  Income tax returns.
966	4.  Forms approving or denying unemployment compensation or
967	workers' compensation.
968	5.  Written verification of wages from employer.
969	6.  Written verification from public welfare agencies or
970	any other governmental agency which can attest to the patient's
971	income status for the past 12 months.
972	7.  A witnessed statement signed by the patient or
973	responsible party, as provided for in Pub. L. No. 79-725, as
974	amended, known as the Hill-Burton Act, except that such
975	statement need not be obtained within 48 hours of the patient's
976	admission to the hospital as required by the Hill-Burton Act.
977	The statement shall include acknowledgment that, in accordance
978	with s. 817.50, providing false information to defraud a
979	hospital for the purposes of obtaining goods or services is a
980	misdemeanor of the second degree.
981	(d)  The department shall conduct an audit or shall
982	contract with an independent party to conduct an audit of each
983	state-sponsored trauma center's claims to ensure that state
984	funding was only provided for eligible trauma patients and
985	medically necessary services.
986	(e)  The department's Medicaid program office shall check
987	each claim to confirm that the patient is not covered under the
988	Medicaid program and shall pay the claim out of the Trauma
989	Services Trust Fund. Trauma patients who are eligible for the
990	Medicaid program shall not be considered eligible for the state-
991	sponsored trauma center program except for Medicaid noncovered
992	services. If a claim is denied by the Trauma Claims Processing
993	System as a result of Medicaid eligibility for Medicaid covered
994	services, the hospital shall submit a claim to the Medicaid
995	fiscal agent for payment.
996	(5)  State funding shall be at a per diem rate equal to
997	$860 to provisional state-approved and state-approved trauma
998	centers. This rate shall be effective for the first 12 months of
999	funding, after which time payment to provisional state-approved
1000	and state-approved trauma centers shall be based on a trauma
1001	cost-based reimbursement methodology developed by the
1002	department. The department shall consult with representatives
1003	from the hospital industry including the Florida Hospital
1004	Association, the Association of Voluntary Hospitals of Florida,
1005	and the Florida League of Hospitals in the development of the
1006	reimbursement methodology.
1007	(6)(a)  To ensure a fair distribution of funds appropriated
1008	for state-sponsored trauma centers and to ensure that no state-
1009	sponsored trauma center gains an unfair advantage due solely to
1010	its ability to bill more quickly than another state-sponsored
1011	trauma center, the total amount of state funds appropriated in
1012	the General Appropriations Act for this section shall be divided
1013	into 19 trauma fund accounts with an account for each service
1014	area established in s. 395.402(3). The amount of funds
1015	distributed to a service area shall be based on the following
1016	formula:
1017
1018	where:
1019	SAAA = service area appropriation amount.
1020	SATD = uncompensated service area trauma days with ISS
1021	score of 9 or greater.
1022	TTD = uncompensated total trauma days with ISS score of 9
1023	or greater for all 19 service areas.
1024	TA = total dollars appropriated for state-sponsored trauma
1025	centers.
1026	(b)  The database to be used for this calculation shall be
1027	the detailed patient discharge data of the most recently
1028	completed calendar year for which the board possesses data. Out-
1029	of-state days that are included in the database shall be
1030	allocated to the service area where the treating hospital is
1031	located.
1032	(c)  Fifty percent of the funds allocated to those service
1033	areas which had one or more trauma centers as of December 1,
1034	1989, shall be distributed to those verified trauma centers
1035	proportionately based on volume and acuity of uncompensated
1036	trauma care provided during the most recently completed calendar
1037	year for which the board possesses data in a lump-sum payment on
1038	the date funding becomes available. These trauma centers shall
1039	submit claims pursuant to subsection (3) in order to justify
1040	this funding. Effective 9 months after funding becomes
1041	available, any trauma center which fails to submit claims for
1042	reimbursement equal to or greater than the amount the trauma
1043	center received under the initial allocation shall return any
1044	unearned funds to the department for distribution pursuant to
1045	paragraph (e). Once this 50-percent lump sum is depleted, a
1046	trauma center will be reimbursed from the remaining 50 percent
1047	of the service area's original allocation.
1048	(d)  The department shall pay trauma claims on a monthly
1049	basis. In a given month when the outstanding claims will exceed
1050	the unexpended funds allocated to a service area, the department
1051	shall pay all of the submitted claims for the service area on a
1052	pro rata basis.
1053	(e)  At the end of the fiscal year, the unexpended funds
1054	for each service area shall be placed in one large state trauma
1055	account from which all remaining claims are paid without regard
1056	to service area on a pro rata basis until such funds are
1057	depleted.
1058	(f)  For any state fiscal year, reimbursement for any
1059	patient residing outside the trauma service area of the state-
1060	sponsored trauma center where the patient is treated shall be
1061	paid out of the funds allocated for the trauma service area
1062	where the patient resides. Out-of-state days shall be paid from
1063	the service area where the treating hospital is located.
1064	(3)(7)  In order to receive state funding payments under
1065	this section, a hospital shall be a state-sponsored trauma
1066	center and shall:
1067	(a)  Agree to conform to all departmental requirements as
1068	provided by rule to assure high-quality trauma services.
1069	(b)  Agree to provide information concerning the provision
1070	of trauma services to the department, in a form and manner
1071	prescribed by rule of the department.
1072	(c)  Agree to accept all trauma patients, regardless of
1073	ability to pay, on a functional space-available basis.
1074	(4)(8)  A state-sponsored trauma center that which fails to
1075	comply with any of the conditions listed in subsection (3) (7)
1076	or the applicable rules of the department shall not receive
1077	payments under this section for the period in which it was not
1078	in compliance.
1079	Section 9.  Section 401.24, Florida Statutes, is amended to
1080	read:
1081	401.24  Emergency medical services state plan.--The
1082	department is responsible, at a minimum, for the improvement and
1083	regulation of basic and advanced life support programs. The
1084	department shall develop and biennially revise a comprehensive
1085	state plan for basic and advanced life support services, the
1086	emergency medical services grants program, state-approved trauma
1087	centers, state-approved pediatric trauma referral centers, the
1088	injury control program, and medical disaster preparedness. The
1089	state plan shall include, but need not be limited to:
1090	(1)  Emergency medical systems planning, including the
1091	prehospital and hospital phases of patient care, and injury
1092	control effort and unification of such services into a total
1093	delivery system to include air, water, and land services.
1094	(2)  Requirements for the operation, coordination, and
1095	ongoing development of emergency medical services, which
1096	includes: basic life support or advanced life support vehicles,
1097	equipment, and supplies; communications; personnel; training;
1098	public education; state trauma system; injury control; and other
1099	medical care components.
1100	(3)  The definition of areas of responsibility for
1101	regulating and planning the ongoing and developing delivery
1102	service requirements.
1103	Section 10.  The sum of $300,000 is appropriated from the
1104	General Revenue Fund to the Administrative Trust Fund for the
1105	Department of Health to contract with a state university to
1106	conduct the study required under s. 395.402, Florida Statutes.
1107	Section 11.  The sum of $20,700,000 is appropriated from
1108	the General Revenue Fund to the Administrative Trust Fund for
1109	the the Department of Health to provide equal funding for each
1110	existing trauma center as of July 1, 2004, and an amount not to
1111	exceed 70 percent of the amount received by an existing trauma
1112	center for a hospital with a Level I trauma center application
1113	pending with the department as of April 1, 2004.
1114	Section 12.  This act shall take effect July 1, 2004.
1115
1116	================= T I T L E  A M E N D M E N T =================
1117	Remove the entire title and insert:
1118	A bill to be entitled
1119	An act relating to trauma care; amending s. 212.055, F.S.;
1120	authorizing certain counties to levy a surtax to fund
1121	trauma services by ordinance, subject to referendum
1122	approval; amending s. 395.40, F.S.; requiring the
1123	Department of Health to promote development of trauma
1124	centers and agencies; requiring the department to update
1125	the trauma system annually; amending s. 395.4001, F.S.;
1126	revising definitions; amending ss. 395.401 and 401.24,
1127	F.S.; removing references to center verification, referral
1128	centers, and state-approved centers; amending s. 395.4015,
1129	F.S.; providing boundaries for the state trauma system
1130	plan; deleting requirements for defining a region;
1131	amending s. 395.402, F.S.; revising legislative intent;
1132	requiring the department to perform an assessment of the
1133	trauma system and report its findings to the Governor and
1134	Legislature; providing guidelines for such assessment and
1135	annual reviews; requiring annual reviews; amending s.
1136	395.4025, F.S.; deleting outdated provisions; providing
1137	for centers that seek a change or redesignation in
1138	approval status; amending s. 395.403, F.S.; removing
1139	legislative intent; providing for funding of trauma
1140	centers; requiring the department to recommend an
1141	effective grant program to the Governor and the
1142	Legislature by a certain date; deleting other funding
1143	guidelines; providing appropriations; providing an
1144	effective date.

CODING: Words stricken are deletions; words underlined are additions.