Senate Bill sb1762
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Florida Senate - 2004 SB 1762
By Senator Saunders
37-1202-04
1 A bill to be entitled
2 An act relating to trauma care; amending s.
3 381.74, F.S.; requiring hospitals and trauma
4 centers to provide data on moderate-to-severe
5 brain or spinal cord injuries to the Department
6 of Health; amending s. 395.40, F.S.; revising
7 legislative findings; revising duties of the
8 Department of Health to implement and plan for
9 a statewide trauma system; amending s.
10 395.4001, F.S.; revising definitions; amending
11 s. 395.401, F.S.; revising components for local
12 and regional trauma services system plans;
13 correcting references to the term "trauma
14 center"; revising provisions prohibiting a
15 hospital or facility from holding itself out as
16 a trauma center unless it is approved and
17 verified by the Department of Health to have
18 met specified requirements to operate as a
19 trauma center; amending s. 395.4015, F.S.;
20 eliminating requirements for the Department of
21 Health to develop the minimum components for
22 systems plans in defined trauma regions;
23 requiring the department to consider the
24 regional approach of the domestic security
25 initiatives when establishing a state trauma
26 system plan; amending s. 395.402, F.S.;
27 revising requirements for the Department of
28 Health to review trauma service areas; deleting
29 an obsolete requirement that the department's
30 assignment of counties for the purposes of
31 developing a system of trauma centers remain as
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1 established by ch. 90-284, Laws of Florida,
2 until completion of the department's initial
3 review; correcting references to the term
4 "trauma center"; amending s. 395.4025, F.S.;
5 revising requirements for the Department of
6 Health's development of a state trauma system
7 plan; deleting obsolete references; correcting
8 references to the term "trauma center";
9 revising requirements for the department's
10 approval and verification of a facility as a
11 trauma center; granting the department
12 authority to adopt rules for the procedures and
13 process for notification, duration, and
14 explanation of a trauma center's termination of
15 trauma services; amending s. 395.403, F.S.;
16 correcting references to the term "trauma
17 center"; revising legislative intent; revising
18 eligibility requirements for state funding of
19 trauma centers; amending s. 395.4035, F.S.;
20 correcting references to the term "trauma
21 center"; amending s. 395.404, F.S.; revising
22 reporting requirements to the trauma registry
23 data system maintained by the Department of
24 Health; providing that hospitals and trauma
25 centers subject to reporting trauma registry
26 data to the department are required to comply
27 with other duties concerning the
28 moderate-to-severe brain or spinal cord injury
29 registry maintained by the department;
30 correcting references to the term "trauma
31 center"; amending s. 395.405, F.S.; authorizing
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1 the Department of Health to adopt and enforce
2 rules necessary to administer part II of ch.
3 395, F.S.; providing an effective date.
4
5 Be It Enacted by the Legislature of the State of Florida:
6
7 Section 1. Subsection (1) of section 381.74, Florida
8 Statutes, is amended to read:
9 381.74 Establishment and maintenance of a central
10 registry.--The department shall establish and maintain a
11 central registry of persons who have moderate-to-severe brain
12 or spinal cord injuries.
13 (1) Every public health agency, private health agency,
14 public social agency, private social agency, hospital, trauma
15 center, and attending physician shall report to the division
16 within 5 days after identification or diagnosis of any person
17 who has a moderate-to-severe brain or spinal cord injury. The
18 consent of such person shall not be required.
19 Section 2. Subsection (5) of section 395.40, Florida
20 Statutes, is amended to read:
21 395.40 Legislative findings and intent.--
22 (5) In addition, the agencies listed in subsection (4)
23 should undertake to:
24 (a) Establish a coordinated methodology for
25 monitoring, evaluating, and enforcing the requirements of the
26 state's inclusive trauma system which recognizes the interests
27 of each agency.
28 (b) Develop appropriate roles for trauma agencies, to
29 assist in furthering the operation of trauma systems at the
30 regional level. This should include issues of system
31 evaluation as well as managed care.
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1 (c) Develop and submit appropriate requests for
2 waivers of federal requirements which will facilitate the
3 delivery of trauma care.
4 (d) Develop criteria that will become the future basis
5 for mandatory consultation between acute care hospitals and
6 trauma centers on the care of trauma victims and the mandatory
7 transfer of appropriate trauma victims to trauma centers.
8 (e) Develop a coordinated approach to the care of the
9 trauma victim. This shall include the movement of the trauma
10 victim through the system of care and the identification of
11 medical responsibility for each phase of care for
12 out-of-hospital and in-hospital trauma care.
13 (f) Require the medical director of an emergency
14 medical services provider to have medical accountability for a
15 trauma victim during interfacility transfer.
16 Section 3. Section 395.4001, Florida Statutes, is
17 amended to read:
18 395.4001 Definitions.--As used in this part, the term:
19 (1) "Agency" means the Agency for Health Care
20 Administration.
21 (2) "Charity care" or "uncompensated charity care"
22 means that portion of hospital charges reported to the agency
23 for which there is no compensation for care provided to a
24 patient whose family income for the 12 months preceding the
25 determination is less than or equal to 150 percent of the
26 federal poverty level, unless the amount of hospital charges
27 due from the patient exceeds 25 percent of the annual family
28 income. However, in no case shall the hospital charges for a
29 patient whose family income exceeds four times the federal
30 poverty level for a family of four be considered charity.
31 (2)(3) "Department" means the Department of Health.
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1 (3)(4) "Interfacility trauma transfer" means the
2 transfer of a trauma victim between two facilities licensed
3 under this chapter, pursuant to this part.
4 (4)(5) "Level I trauma center" means a trauma center
5 that:
6 (a) Has formal research and education programs for the
7 enhancement of trauma care; and is verified determined by the
8 department to be in substantial compliance with Level I trauma
9 center and pediatric trauma referral center standards; and has
10 been approved by the department to operate as a Level I trauma
11 center.
12 (b) Serves as a resource facility to Level II trauma
13 centers, pediatric trauma referral centers, and general
14 hospitals through shared outreach, education, and quality
15 improvement activities.
16 (c) Participates in an inclusive system of trauma
17 care, including providing leadership, system evaluation, and
18 quality improvement activities.
19 (5)(6) "Level II trauma center" means a trauma center
20 that:
21 (a) Is verified determined by the department to be in
22 substantial compliance with Level II trauma center standards
23 and has been approved by the department to operate as a Level
24 II trauma center.
25 (b) Serves as a resource facility to general hospitals
26 through shared outreach, education, and quality improvement
27 activities.
28 (c) Participates in an inclusive system of trauma
29 care.
30 (6)(7) "Pediatric trauma referral center" means a
31 hospital that is verified determined by the department to be
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1 in substantial compliance with pediatric trauma referral
2 center standards as established by rule of the department and
3 has been approved by the department to operate as a pediatric
4 trauma center.
5 (7) "Provisional trauma center" means a hospital that
6 has been verified by the department to be in substantial
7 compliance with the requirements in s. 395.4025 and has been
8 approved by the department to operate as a provisional Level I
9 trauma center, Level II trauma center, or pediatric trauma
10 center.
11 (8) "State-approved trauma center" means a hospital
12 that has successfully completed the selection process pursuant
13 to s. 395.4025 and has been approved by the department to
14 operate as a trauma center in the state.
15 (9) "State-sponsored trauma center" means a trauma
16 center or pediatric trauma referral center that receives state
17 funding for trauma care services under s. 395.403.
18 (8)(10) "Trauma agency" means a department-approved
19 agency established and operated by one or more counties, or a
20 department-approved entity with which one or more counties
21 contract, for the purpose of administering an inclusive
22 regional trauma system.
23 (9)(11) "Trauma alert victim" means a person who has
24 incurred a single or multisystem injury due to blunt or
25 penetrating means or burns, who requires immediate medical
26 intervention or treatment, and who meets one or more of the
27 adult or pediatric scorecard criteria established by the
28 department by rule.
29 (10)(12) "Trauma center" means a any hospital that has
30 been verified determined by the department to be in
31 substantial compliance with the requirements in s. 395.4025
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1 and has been approved by the department to operate as a Level
2 I trauma center, Level II trauma center, or pediatric trauma
3 center verification standards as either state-approved or
4 provisional state-approved.
5 (11)(13) "Trauma scorecard" means a statewide
6 methodology adopted by the department by rule under which a
7 person who has incurred a traumatic injury is graded as to the
8 severity of his or her injuries or illness and which
9 methodology is used as the basis for making destination
10 decisions.
11 (12)(14) "Trauma transport protocol" means a document
12 which describes the policies, processes, and procedures
13 governing the dispatch of vehicles, the triage, prehospital
14 transport, and interfacility trauma transfer of trauma
15 victims.
16 (13)(15) "Trauma victim" means any person who has
17 incurred a single or multisystem injury due to blunt or
18 penetrating means or burns and who requires immediate medical
19 intervention or treatment.
20 Section 4. Section 395.401, Florida Statutes, is
21 amended to read:
22 395.401 Trauma services system plans; verification of
23 trauma centers and pediatric trauma referral centers;
24 procedures; renewal.--
25 (1)(a) The local and regional trauma agencies shall
26 plan, implement, and evaluate trauma services systems, in
27 accordance with this section and ss. 395.4015, 395.404, and
28 395.4045, which consist of organized patterns of readiness and
29 response services based on public and private agreements and
30 operational procedures. The department shall establish, by
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1 rule, processes and procedures for establishing a trauma
2 agency and obtaining its approval from the department.
3 (b) The local and regional trauma agencies shall
4 develop and submit to the department plans for local and
5 regional trauma services systems. The plans must include, at a
6 minimum, the following components:
7 1. The organizational structure of the trauma system.
8 2. Prehospital care management guidelines for triage
9 and transportation of trauma cases.
10 3. Flow patterns of trauma cases and transportation
11 system design and resources, including air transportation
12 services, provision for interfacility trauma transfer, and the
13 prehospital transportation of trauma victims. The trauma
14 agency shall plan for the development of a system of
15 transportation of trauma alert victims to trauma centers where
16 the distance or time to a trauma center or transportation
17 resources diminish access by trauma alert victims.
18 4. The number and location of needed state-approved
19 trauma centers based on local needs, population, and location
20 and distribution of resources.
21 5. Data collection regarding system operation and
22 patient outcome.
23 6. Periodic performance evaluation of the trauma
24 system and its components.
25 7. The use of air transport services within the
26 jurisdiction of the local trauma agency.
27 8. Public information and education about the trauma
28 system.
29 9. Emergency medical services communication system
30 usage and dispatching.
31
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1 10. The coordination and integration between the
2 verified trauma center care facility and other acute care
3 hospitals the nonverified health care facilities.
4 11. Medical control and accountability.
5 12. Quality control and system evaluation.
6 (c) The department shall receive plans for the
7 implementation of inclusive trauma systems from trauma
8 agencies. The department may approve or not approve trauma
9 agency plans based on the conformance of the plan with this
10 section and ss. 395.4015, 395.404, and 395.4045 and the rules
11 and definitions adopted by the department pursuant to those
12 sections. The department shall approve or disapprove the
13 plans within 120 days after the date the plans are submitted
14 to the department. The department shall, by rule, provide an
15 application process for establishing a trauma agency. The
16 application must, at a minimum, provide requirements for the
17 trauma agency plan submitted for review, a process for
18 reviewing the application for a state-approved trauma agency,
19 a process for reviewing the trauma transport protocols for the
20 trauma agency, and a process for reviewing the staffing
21 requirements for the agency. The department shall, by rule,
22 establish minimum requirements for a trauma agency to conduct
23 an annual performance evaluation and submit the results to the
24 department.
25 (d) A trauma agency shall not operate unless the
26 department has approved the local or regional trauma services
27 system plan of the agency.
28 (e) The department may grant an exception to a portion
29 of the rules adopted pursuant to this section or s. 395.4015
30 if the local or regional trauma agency proves that, as defined
31 in the rules, compliance with that requirement would not be in
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1 the best interest of the persons served within the affected
2 local or regional trauma area.
3 (f) A local or regional trauma agency may implement a
4 trauma care system only if the system meets the minimum
5 standards set forth in the rules for implementation
6 established by the department and if the plan has been
7 submitted to, and approved by, the department. At least 60
8 days before the local or regional trauma agency submits the
9 plan for the trauma care system to the department, the local
10 or regional trauma agency shall hold a public hearing and give
11 adequate notice of the public hearing to all hospitals and
12 other interested parties in the area to be included in the
13 proposed system.
14 (g) Local or regional trauma agencies may enter into
15 contracts for the purpose of implementing the local or
16 regional plan. If local or regional agencies contract with
17 hospitals for trauma services, such agencies must contract
18 only with hospitals which are verified trauma centers.
19 (h) Local or regional trauma agencies providing
20 service for more than one county shall, as part of their
21 formation, establish interlocal agreements between or among
22 the several counties in the regional system.
23 (i) This section does not restrict the authority of a
24 health care facility to provide service for which it has
25 received a license pursuant to this chapter.
26 (j) Any hospital which is verified as a trauma center
27 shall accept all trauma victims that are appropriate for the
28 facility regardless of race, sex, creed, or ability to pay.
29 (k) It is unlawful for any hospital or other facility
30 to indicate in any oral or written communications that the
31 hospital or other facility is a trauma center, advertise using
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1 the term "trauma center" through any medium, or hold itself
2 out to the public as a trauma center unless the hospital or
3 other facility it has been so verified by the department as
4 having met the requirements of s. 395.4025 and has been
5 approved by the department to operate as a trauma center.
6 (l) A county, upon the recommendations of the local or
7 regional trauma agency, may adopt ordinances governing the
8 transport of a patient who is receiving care in the field from
9 prehospital emergency medical personnel when the patient meets
10 specific criteria for trauma, burn, or pediatric centers
11 adopted by the local or regional trauma agency. These
12 ordinances must be consistent with s. 395.4045, ordinances
13 adopted under s. 401.25(6), and the local or regional trauma
14 system plan and, to the furthest possible extent, must ensure
15 that individual patients receive appropriate medical care
16 while protecting the interests of the community at large by
17 making maximum use of available emergency medical care
18 resources.
19 (m) The local or regional trauma agency shall,
20 consistent with the regional trauma system plan, coordinate
21 and otherwise facilitate arrangements necessary to develop a
22 trauma services system.
23 (n) After the submission of the initial trauma system
24 plan, each trauma agency shall, every 5th year, submit to the
25 department for approval an updated plan that identifies the
26 changes, if any, to be made in the regional trauma system.
27 (o) This section does not preclude a local or regional
28 trauma agency from adopting trauma care system standards.
29 (2) The department shall adopt, by rule, standards for
30 verification of trauma centers based on national guidelines,
31 including those established by the American College of
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1 Surgeons entitled "Hospital and Prehospital Resources for
2 Optimal Care of the Injured Patient" and published appendices
3 thereto. Standards specific to pediatric trauma referral
4 centers shall be developed in conjunction with Children's
5 Medical Services and adopted by rule of the department.
6 (3) The department may withdraw local or regional
7 agency authority, prescribe corrective actions, or use the
8 administrative remedies as provided in s. 395.1065 for the
9 violation of any provision of this section and ss. 395.4015,
10 395.402, 395.4025, 395.403, 395.404, and 395.4045 or rules
11 adopted thereunder. All amounts collected pursuant to this
12 subsection shall be deposited into the Emergency Medical
13 Services Trust Fund provided in s. 401.34.
14 Section 5. Section 395.4015, Florida Statutes, is
15 amended to read:
16 395.4015 State regional trauma planning; trauma
17 regions.--
18 (1) The department shall establish a state trauma
19 system plan. As part of the state trauma system plan, the
20 department shall establish trauma regions which cover all
21 geographical areas of the state. The department shall consider
22 a regional approach to trauma planning which integrates with
23 the domestic security regions established under chapter 943.
24 These regions may serve as the basis for the development of
25 department-approved local or regional trauma plans. The
26 department shall base its definition of the regions upon:
27 (a) Geographical considerations so as to ensure rapid
28 access to trauma care by patients;
29 (b) Historical patterns of patient referral and
30 transfer in an area;
31 (c) Inventories of available trauma care resources;
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1 (d) Predicted population growth characteristics;
2 (e) Transportation capabilities, including ground and
3 air transport;
4 (f) Medically appropriate ground and air travel times;
5 and
6 (g) Other appropriate criteria.
7 (2) The department shall develop trauma systems plans
8 for the department-defined trauma regions which include at a
9 minimum the following components:
10 (a) An assessment of current and future trauma care
11 needs of the population, based upon incidence rates and acuity
12 indicators developed by the department, as well as other
13 relevant characteristics of the region.
14 (b) The organizational structure of the regional
15 trauma system, including the identification of local trauma
16 agency service areas within the region.
17 (c) Prehospital care management guidelines for triage
18 and transportation of trauma cases.
19 (d) Flow patterns of trauma cases and transportation
20 system design and resources, including air transportation
21 services, provision for interfacility trauma transfer, and the
22 prehospital transportation of trauma victims. The department
23 shall plan for the development of a system of transportation
24 of trauma alert victims to trauma centers where the distance
25 or time to a trauma center or transportation resources
26 diminish access by trauma alert victims.
27 (e) The current and projected number, acuity level,
28 and geographic location of trauma cases expected so as to
29 assure that the assessed current and future trauma care needs
30 of the population are adequately met and that state-sponsored
31
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1 trauma centers will maintain the volume of cases sufficient to
2 provide quality care to trauma cases referred to them.
3 (f) The availability of qualified health
4 professionals, including physicians and surgeons, capable of
5 staffing trauma centers to the level of current and future
6 assessed needs.
7 (g) Data collection regarding system operation and
8 patient outcome, as well as the number, type, and generalized
9 locations of state-sponsored trauma centers needed to meet the
10 needs of the population.
11 (h) Periodic performance evaluation of the trauma
12 system and its components.
13 (i) The type and extent of air transport services
14 available and needed in each region.
15 (j) Public information and education about the trauma
16 system.
17 (k) Emergency medical services communication system
18 usage and dispatching.
19 (l) The coordination and integration between the
20 trauma centers and other health care facilities which may
21 provide services to trauma victims.
22 (m) Medical control and accountability.
23 (n) Quality management and system evaluation.
24 (2)(3) The department shall consider the advice and
25 recommendations of any affected local or regional trauma
26 agency in developing the state trauma system systems plan.
27 The department may, in lieu of specific regional components of
28 its own plan, accept components developed by local or regional
29 trauma agencies.
30
31
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1 (3)(4) The department shall use the state trauma
2 system plan as the basis for establishing a statewide
3 inclusive trauma system.
4 Section 6. Subsection (3) of section 395.402, Florida
5 Statutes, is amended to read:
6 395.402 Trauma service areas; number and location of
7 trauma centers.--
8 (3) Trauma service areas are to be used. The
9 department shall periodically review the assignment of the 67
10 counties to trauma service areas. These assignments are made
11 for the purpose of developing a system of trauma centers.
12 Revisions made by the department should take into
13 consideration the recommendations made as part of the regional
14 trauma system plans approved by the department, as well as the
15 recommendations made as part of the state trauma system plan.
16 These areas must, at a minimum, be reviewed in the year 2000
17 and every 5 years thereafter. Until the department completes
18 its initial review, the assignment of counties shall remain as
19 established pursuant to chapter 90-284, Laws of Florida.
20 (a) The following trauma service areas are hereby
21 established:
22 1. Trauma service area 1 shall consist of Escambia,
23 Okaloosa, Santa Rosa, and Walton Counties.
24 2. Trauma service area 2 shall consist of Bay, Gulf,
25 Holmes, and Washington Counties.
26 3. Trauma service area 3 shall consist of Calhoun,
27 Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison,
28 Taylor, and Wakulla Counties.
29 4. Trauma service area 4 shall consist of Alachua,
30 Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette,
31 Levy, Putnam, Suwannee, and Union Counties.
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1 5. Trauma service area 5 shall consist of Baker, Clay,
2 Duval, Nassau, and St. Johns Counties.
3 6. Trauma service area 6 shall consist of Citrus,
4 Hernando, and Marion Counties.
5 7. Trauma service area 7 shall consist of Flagler and
6 Volusia Counties.
7 8. Trauma service area 8 shall consist of Lake,
8 Orange, Osceola, Seminole, and Sumter Counties.
9 9. Trauma service area 9 shall consist of Pasco and
10 Pinellas Counties.
11 10. Trauma service area 10 shall consist of
12 Hillsborough County.
13 11. Trauma service area 11 shall consist of Hardee,
14 Highlands, and Polk Counties.
15 12. Trauma service area 12 shall consist of Brevard
16 and Indian River Counties.
17 13. Trauma service area 13 shall consist of DeSoto,
18 Manatee, and Sarasota Counties.
19 14. Trauma service area 14 shall consist of Martin,
20 Okeechobee, and St. Lucie Counties.
21 15. Trauma service area 15 shall consist of Charlotte,
22 Glades, Hendry, and Lee Counties.
23 16. Trauma service area 16 shall consist of Palm Beach
24 County.
25 17. Trauma service area 17 shall consist of Collier
26 County.
27 18. Trauma service area 18 shall consist of Broward
28 County.
29 19. Trauma service area 19 shall consist of Dade and
30 Monroe Counties.
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1 (b) Each trauma service area should have at least one
2 Level I or Level II trauma center. The department shall
3 allocate, by rule, the number of trauma centers needed for
4 each trauma service area.
5 (c) There shall be no more than a total of 44
6 state-sponsored trauma centers in the state.
7 Section 7. Section 395.4025, Florida Statutes, is
8 amended to read:
9 395.4025 State-approved Trauma centers; selection;
10 quality assurance; records.--
11 (1) For purposes of developing a system of
12 state-approved trauma centers, the department shall use the 19
13 trauma service areas established in s. 395.402. Within each
14 service area and based on the state trauma system plan, the
15 local or regional trauma services system plan, and
16 recommendations of the local or regional trauma agency, and
17 the 1990 Report and Proposal for Funding State-Sponsored
18 Trauma Centers, the department shall establish the approximate
19 number of state-approved trauma centers needed to ensure
20 reasonable access to high-quality trauma services. The Using
21 the guidelines and procedures outlined in the 1990 report,
22 except when in conflict with those prescribed in this section,
23 the department shall select those hospitals that are to be
24 recognized as state-approved trauma centers and shall include
25 all trauma centers verified as of October 1, 1990, and
26 subsequently, subject to specific programmatic and quality of
27 care standards.
28 (2)(a) The department shall annually notify each acute
29 care general hospital and each local and each regional trauma
30 agency in the state that the department is accepting letters
31 of intent from hospitals that are interested in becoming
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1 state-approved trauma centers. In order to be considered by
2 the department, a hospital that operates within the geographic
3 area of a local or regional trauma agency must certify that
4 its intent to operate as a state-approved trauma center is
5 consistent with the trauma services plan of the local or
6 regional trauma agency, as approved by the department, if such
7 agency exists. Letters of intent must be postmarked no later
8 than midnight October 1. This paragraph does not apply to any
9 hospital that is a provisional or verified trauma center on
10 January 1, 1992.
11 (b) By October 15, the department shall send to all
12 hospitals that submitted a letter of intent an application
13 package that will provide the hospitals with instructions for
14 submitting information to the department for selection as a
15 state-approved trauma center. The standards for verification
16 of trauma centers and pediatric trauma referral centers
17 provided for in s. 395.401(2), as adopted by rule of the
18 department, shall serve as the basis for these instructions.
19 (c) In order to be considered by the department,
20 applications from those hospitals seeking selection as
21 state-approved trauma centers, including those current
22 verified trauma centers that seek a change or redesignation in
23 approval status as a trauma center to be state-approved trauma
24 centers, must be received by the department no later than the
25 close of business on April 1. The department shall conduct a
26 provisional review of each application for the purpose of
27 determining that the hospital's application is complete and
28 that the hospital has the critical elements required for a
29 state-approved trauma center. This critical review will be
30 based on trauma center verification standards and shall
31
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1 include, but not be limited to, a review of whether the
2 hospital has:
3 1. Equipment and physical facilities necessary to
4 provide trauma services.
5 2. Personnel in sufficient numbers and with proper
6 qualifications to provide trauma services.
7 3. An effective quality assurance process.
8 4. Submitted written confirmation by the local or
9 regional trauma agency that the verification of the hospital
10 applying to become as a state-approved trauma center is
11 consistent with the plan of the local or regional trauma
12 agency, as approved by the department, if such agency exists.
13 This subparagraph applies to any hospital that is not a
14 provisional or verified trauma center on January 1, 1992.
15 (d)1. Notwithstanding other provisions in this
16 section, the department may grant up to an additional 18
17 months to a hospital applicant that is unable to meet all
18 requirements as provided in paragraph (c) at the time of
19 application if the number of applicants in the service area in
20 which the applicant is located is equal to or less than the
21 service area allocation, as provided by rule of the
22 department. An applicant that is granted additional time
23 pursuant to this paragraph shall submit a plan for
24 departmental approval which includes timelines and activities
25 that the applicant proposes to complete in order to meet
26 application requirements. Any applicant that demonstrates an
27 ongoing effort to complete the activities within the timelines
28 outlined in the plan shall be included in the number of
29 state-approved trauma centers at such time that the department
30 has conducted a provisional review of the application and has
31 determined that the application is complete and that the
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1 hospital has the critical elements required for a
2 state-approved trauma center.
3 2. Timeframes provided in subsections (1)-(8) shall be
4 stayed until the department determines that the application is
5 complete and that the hospital has the critical elements
6 required for a state-approved trauma center.
7 (3) After April 30, any hospital that submitted an
8 application found acceptable by the department based on
9 provisional review, including all trauma centers verified as
10 of December 1, 1989, shall be eligible to operate as a
11 provisional state-approved trauma center.
12 (4) Between May 1 and October 1 of each year, the
13 department shall conduct an in-depth evaluation of all
14 applications found acceptable in the provisional review. The
15 applications shall be evaluated against criteria enumerated in
16 the application packages as provided to the hospitals by the
17 department.
18 (5) Beginning October 1 of each year and ending no
19 later than June 1 of the following year, a review team of
20 out-of-state experts assembled by the department shall make
21 onsite visits to all provisional state-approved trauma
22 centers. The department shall develop a survey instrument to
23 be used by the expert team of reviewers. The instrument shall
24 include objective criteria and guidelines for reviewers based
25 on existing trauma center and pediatric trauma referral center
26 verification standards such that all trauma centers and
27 pediatric trauma referral centers are assessed equally. The
28 survey instrument shall also include a uniform rating system
29 that will be used by reviewers to indicate the degree of
30 compliance of each trauma center with specific standards, and
31 to indicate the quality of care provided by each trauma center
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1 as determined through an audit of patient charts. In addition,
2 hospitals being considered as provisional state-approved
3 trauma centers shall meet all the requirements of a verified
4 trauma center or pediatric trauma referral center, and shall
5 be located in a trauma service area that has a need for such a
6 trauma center.
7 (6) Based on recommendations from the review team, the
8 department shall select state-approved trauma centers by July
9 1. An applicant for designation as a state-approved trauma
10 center or a state-approved pediatric trauma referral center
11 may request an extension of its provisional status if it
12 submits a corrective action plan to the department. The
13 corrective action plan must demonstrate the ability of the
14 applicant to correct deficiencies noted during the applicant's
15 onsite review conducted by the department between the previous
16 October 1 and June 1. The department may extend the
17 provisional status of an applicant for designation as a
18 state-approved trauma center or a state-approved pediatric
19 trauma referral center through December 31 if the applicant
20 provides a corrective action plan acceptable to the
21 department. The department or a team of out-of-state experts
22 assembled by the department shall conduct an onsite visit on
23 or before November 1 to confirm that the deficiencies have
24 been corrected. The provisional state-approved trauma center
25 or the provisional state-approved pediatric trauma referral
26 center is responsible for all costs associated with the onsite
27 visit in a manner prescribed by rule of the department. By
28 January 1, the department must approve or deny the application
29 of any provisional applicant granted an extension. Each
30 state-approved trauma center shall be granted a 7-year
31 approval verification period during which time it must
21
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1 continue to maintain trauma center verification standards and
2 acceptable patient outcomes as determined by department rule.
3 An approval A verification, unless sooner suspended or
4 revoked, automatically expires 7 years after the date of
5 issuance and is renewable upon application for renewal as
6 prescribed by rule of the department. After July 1, 1992, only
7 those hospitals selected as state-approved trauma centers may
8 operate as trauma centers.
9 (7) Any hospital that wishes to protest a decision
10 made by the department based on the department's preliminary
11 or in-depth review of applications or on the recommendations
12 of the site visit review team pursuant to this section shall
13 proceed as provided in chapter 120. Hearings held under this
14 subsection shall be conducted in the same manner as provided
15 in ss. 120.569 and 120.57. Cases filed under chapter 120 may
16 combine all disputes between parties.
17 (8) Notwithstanding any provision of chapter 381, a
18 hospital licensed under ss. 395.001-395.3025 that operates a
19 state-approved trauma center may not terminate or
20 substantially reduce the availability of trauma service
21 without providing at least 6 months' notice of its intent to
22 terminate such service. Such notice shall be given to the
23 department of Health, to all affected local or regional trauma
24 agencies, and to all state-approved trauma centers, hospitals,
25 and emergency medical service providers in the trauma service
26 area. The department shall adopt by rule the procedures and
27 process for notification, duration, and explanation of the
28 termination of trauma services.
29 (9) Except as otherwise provided in this subsection,
30 the department or its agent may collect trauma care and
31 registry data, as prescribed by rule of the department, from
22
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1 trauma centers, pediatric trauma referral centers, hospitals,
2 emergency medical service providers, local or regional trauma
3 agencies, or medical examiners for the purposes of evaluating
4 trauma system effectiveness, ensuring compliance with the
5 standards of verification, and monitoring patient outcomes. A
6 trauma center, pediatric trauma referral center, hospital,
7 emergency medical service provider, medical examiner, or local
8 trauma agency or regional trauma agency, or a panel or
9 committee assembled by such an agency under s. 395.50(1) may,
10 but is not required to, disclose to the department patient
11 care quality assurance proceedings, records, or reports.
12 However, the department may require a local trauma agency or a
13 regional trauma agency, or a panel or committee assembled by
14 such an agency to disclose to the department patient care
15 quality assurance proceedings, records, or reports that the
16 department needs solely to conduct quality assurance
17 activities under s. 395.4015, or to ensure compliance with the
18 quality assurance component of the trauma agency's plan
19 approved under s. 395.401. The patient care quality assurance
20 proceedings, records, or reports that the department may
21 require for these purposes include, but are not limited to,
22 the structure, processes, and procedures of the agency's
23 quality assurance activities, and any recommendation for
24 improving or modifying the overall trauma system, if the
25 identity of a trauma center, pediatric trauma referral center,
26 hospital, emergency medical service provider, medical
27 examiner, or an individual who provides trauma services is not
28 disclosed.
29 (10) Out-of-state experts assembled by the department
30 to conduct onsite visits are agents of the department for the
31 purposes of s. 395.3025. An out-of-state expert who acts as an
23
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1 agent of the department under this subsection is not liable
2 for any civil damages as a result of actions taken by him or
3 her, unless he or she is found to be operating outside the
4 scope of the authority and responsibility assigned by the
5 department.
6 (11) Onsite visits by the department or its agent may
7 be conducted at any reasonable time and may include but not be
8 limited to a review of records in the possession of trauma
9 centers, pediatric trauma referral centers, hospitals,
10 emergency medical service providers, local or regional trauma
11 agencies, or medical examiners regarding the care, transport,
12 treatment, or examination of trauma patients.
13 (12) Patient care, transport, or treatment records or
14 reports, or patient care quality assurance proceedings,
15 records, or reports obtained or made pursuant to this section,
16 s. 395.3025(4)(f), s. 395.401, s. 395.4015, s. 395.402, s.
17 395.403, s. 395.404, s. 395.4045, s. 395.405, s. 395.50, or s.
18 395.51 must be held confidential by the department or its
19 agent and are exempt from the provisions of s. 119.07(1).
20 Patient care quality assurance proceedings, records, or
21 reports obtained or made pursuant to these sections are not
22 subject to discovery or introduction into evidence in any
23 civil or administrative action.
24 (13) The department may adopt, by rule, the procedures
25 and process by which it will select state-approved trauma
26 centers. Such procedures and process must be used in annually
27 selecting state-approved trauma centers and must be consistent
28 with subsections (1)-(8) except in those situations in which
29 it is in the best interest of, and mutually agreed to by, all
30 applicants within a service area and the department to reduce
31 the timeframes.
24
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1 Section 8. Section 395.403, Florida Statutes, is
2 amended to read:
3 395.403 Reimbursement of state-sponsored trauma
4 centers.--
5 (1) The Legislature finds that many hospitals which
6 provide services to trauma victims are not adequately
7 compensated for such treatment. The Legislature also
8 recognizes that the current verified trauma centers are
9 providing such services without adequate reimbursement.
10 Therefore, it is the intent of the Legislature to provide
11 financial support to the current verified trauma centers and
12 to establish a system of state-sponsored trauma centers as
13 soon as feasibly possible. It is also the intent of the
14 Legislature that this system of state-sponsored trauma centers
15 be assisted financially based on the volume and acuity of
16 uncompensated trauma care provided.
17 (2) All provisional trauma centers and state-approved
18 trauma centers shall be considered eligible to receive state
19 funding state-sponsored trauma centers when state funds are
20 specifically appropriated for state-sponsored trauma centers
21 in the General Appropriations Act. When state funds are
22 appropriated without specific legislative allocation, the
23 funds shall be distributed equally to all provisional trauma
24 centers and trauma centers approved as of July 1 of the fiscal
25 year immediately following the legislative session in which
26 the funds were appropriated.
27 (3) To receive state funding, a state-sponsored trauma
28 center shall submit a claim electronically via the Trauma
29 Claims Processing System, designed, developed, implemented,
30 and operated by the department's Medicaid program, to the
31 department's Medicaid program upon discharge of a trauma
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1 patient. When a hospital stay spans a state fiscal year, a
2 separate hospital claim shall be submitted for the hospital
3 days incurred in each fiscal year.
4 (4)(a) State-sponsored trauma centers shall determine
5 each trauma patient's eligibility for state funding prior to
6 the submission of a claim.
7 (b) A trauma patient treated must meet the definition
8 of charity care, have been designated as having an ISS score
9 of 9 or greater, and have received services that are medically
10 necessary from a state-sponsored trauma center in order for
11 the state-sponsored trauma center to receive state funding for
12 that patient.
13 (c) Each state-sponsored trauma center shall retain
14 appropriate documentation showing a trauma patient's
15 eligibility for state funding. Documentation recognized by the
16 department as appropriate shall be limited to one of the
17 following:
18 1. W-2 withholding forms.
19 2. Payroll stubs.
20 3. Income tax returns.
21 4. Forms approving or denying unemployment
22 compensation or workers' compensation.
23 5. Written verification of wages from employer.
24 6. Written verification from public welfare agencies
25 or any other governmental agency which can attest to the
26 patient's income status for the past 12 months.
27 7. A witnessed statement signed by the patient or
28 responsible party, as provided for in Pub. L. No. 79-725, as
29 amended, known as the Hill-Burton Act, except that such
30 statement need not be obtained within 48 hours of the
31 patient's admission to the hospital as required by the
26
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1 Hill-Burton Act. The statement shall include acknowledgment
2 that, in accordance with s. 817.50, providing false
3 information to defraud a hospital for the purposes of
4 obtaining goods or services is a misdemeanor of the second
5 degree.
6 (d) The department shall conduct an audit or shall
7 contract with an independent party to conduct an audit of each
8 state-sponsored trauma center's claims to ensure that state
9 funding was only provided for eligible trauma patients and
10 medically necessary services.
11 (e) The department's Medicaid program office shall
12 check each claim to confirm that the patient is not covered
13 under the Medicaid program and shall pay the claim out of the
14 Trauma Services Trust Fund. Trauma patients who are eligible
15 for the Medicaid program shall not be considered eligible for
16 the state-sponsored trauma center program except for Medicaid
17 noncovered services. If a claim is denied by the Trauma
18 Claims Processing System as a result of Medicaid eligibility
19 for Medicaid covered services, the hospital shall submit a
20 claim to the Medicaid fiscal agent for payment.
21 (5) State funding shall be at a per diem rate equal to
22 $860 to provisional state-approved and state-approved trauma
23 centers. This rate shall be effective for the first 12 months
24 of funding, after which time payment to provisional
25 state-approved and state-approved trauma centers shall be
26 based on a trauma cost-based reimbursement methodology
27 developed by the department. The department shall consult with
28 representatives from the hospital industry including the
29 Florida Hospital Association, the Association of Voluntary
30 Hospitals of Florida, and the Florida League of Hospitals in
31 the development of the reimbursement methodology.
27
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1 (6)(a) To ensure a fair distribution of funds
2 appropriated for state-sponsored trauma centers and to ensure
3 that no state-sponsored trauma center gains an unfair
4 advantage due solely to its ability to bill more quickly than
5 another state-sponsored trauma center, the total amount of
6 state funds appropriated in the General Appropriations Act for
7 this section shall be divided into 19 trauma fund accounts
8 with an account for each service area established in s.
9 395.402(3). The amount of funds distributed to a service area
10 shall be based on the following formula:
11
12
13 SAAA = SATD x TA
14 TTD
15 where:
16 SAAA = service area appropriation amount.
17 SATD = uncompensated service area trauma days with ISS
18 score of 9 or greater.
19 TTD = uncompensated total trauma days with ISS score of
20 9 or greater for all 19 service areas.
21 TA = total dollars appropriated for state-sponsored
22 trauma centers.
23 (b) The database to be used for this calculation shall
24 be the detailed patient discharge data of the most recently
25 completed calendar year for which the board possesses data.
26 Out-of-state days that are included in the database shall be
27 allocated to the service area where the treating hospital is
28 located.
29 (c) Fifty percent of the funds allocated to those
30 service areas which had one or more trauma centers as of
31 December 1, 1989, shall be distributed to those verified
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1 trauma centers proportionately based on volume and acuity of
2 uncompensated trauma care provided during the most recently
3 completed calendar year for which the board possesses data in
4 a lump-sum payment on the date funding becomes available.
5 These trauma centers shall submit claims pursuant to
6 subsection (3) in order to justify this funding. Effective 9
7 months after funding becomes available, any trauma center
8 which fails to submit claims for reimbursement equal to or
9 greater than the amount the trauma center received under the
10 initial allocation shall return any unearned funds to the
11 department for distribution pursuant to paragraph (e). Once
12 this 50-percent lump sum is depleted, a trauma center will be
13 reimbursed from the remaining 50 percent of the service area's
14 original allocation.
15 (d) The department shall pay trauma claims on a
16 monthly basis. In a given month when the outstanding claims
17 will exceed the unexpended funds allocated to a service area,
18 the department shall pay all of the submitted claims for the
19 service area on a pro rata basis.
20 (e) At the end of the fiscal year, the unexpended
21 funds for each service area shall be placed in one large state
22 trauma account from which all remaining claims are paid
23 without regard to service area on a pro rata basis until such
24 funds are depleted.
25 (f) For any state fiscal year, reimbursement for any
26 patient residing outside the trauma service area of the
27 state-sponsored trauma center where the patient is treated
28 shall be paid out of the funds allocated for the trauma
29 service area where the patient resides. Out-of-state days
30 shall be paid from the service area where the treating
31 hospital is located.
29
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1 (3)(7) In order to receive state funding payments
2 under this section, a hospital shall be a state-sponsored
3 trauma center and shall:
4 (a) Agree to conform to all departmental requirements
5 as provided by rule to assure high-quality trauma services.
6 (b) Agree to provide information concerning the
7 provision of trauma services to the department, in a form and
8 manner prescribed by rule of the department.
9 (c) Agree to accept all trauma patients, regardless of
10 ability to pay, on a functional space-available basis.
11 (4)(8) A state-sponsored trauma center that which
12 fails to comply with any of the conditions listed in
13 subsection (3) (7) or the applicable rules of the department
14 shall not receive payments under this section for the period
15 in which it was not in compliance.
16 Section 9. Subsection (1) of section 395.4035, Florida
17 Statutes, is amended to read:
18 395.4035 Trauma Services Trust Fund.--
19 (1) There is hereby created the Trauma Services Trust
20 Fund in the State Treasury, which shall be used exclusively
21 for the development and support of a system of state-sponsored
22 trauma centers. Trust fund revenue shall be used for the
23 purpose of funding trauma patient care in a provisional
24 state-sponsored trauma center, or a state-sponsored trauma
25 center as provided for in this act; for funding the associated
26 trauma claims processing costs, including the costs for the
27 design, development, implementation, and operation of a
28 payment system; and for administration of this act.
29 Section 10. Section 395.404, Florida Statutes, is
30 amended to read:
31
30
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1 395.404 Review of trauma registry data; report to
2 central registry; confidentiality and limited release.--
3 (1)(a) Each trauma center shall furnish, and, upon
4 request of the department, all acute care hospitals shall
5 furnish for department review, trauma registry data as
6 prescribed by rule of the department for the purpose of
7 monitoring patient outcome and ensuring compliance with the
8 standards of approval.
9 (b) Trauma registry data obtained pursuant to this
10 subsection are confidential and exempt from the provisions of
11 s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
12 However, the department may provide such trauma registry data
13 to the person, trauma center, hospital, emergency medical
14 service provider, local or regional trauma agency, medical
15 examiner, or other entity from which the data were obtained.
16 The department may also use or provide trauma registry data
17 for purposes of research in accordance with the provisions of
18 chapter 405.
19 (2) Each trauma center and acute care hospital shall
20 report to the department's brain and spinal cord injury
21 central registry, consistent with the procedures and
22 timeframes of s. 381.74, any person who has a
23 moderate-to-severe brain or spinal cord injury, and shall
24 include in the report the name, age, residence, and type of
25 disability of the individual and any additional information
26 that the department finds necessary. Notwithstanding the
27 provisions of s. 381.74, each trauma center and acute care
28 hospital shall submit severe disability and head-injury
29 registry data to the department as provided by rule. Each
30 trauma center and acute care hospital shall continue to
31 provide initial notification of persons who have severe
31
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1 disabilities and head injuries to the Department of Health
2 within timeframes provided in chapter 413. Such initial
3 notification shall be made in the manner prescribed by the
4 Department of Health for the purpose of providing timely
5 vocational rehabilitation services to the severely disabled or
6 head-injured person.
7 (3) Trauma registry data obtained pursuant to this
8 section are confidential and exempt from the provisions of s.
9 119.07(1) and s. 24(a), Art. I of the State Constitution.
10 However, the department may provide such trauma registry data
11 to the person, trauma center, pediatric trauma referral
12 center, hospital, emergency medical service provider, local or
13 regional trauma agency, medical examiner, or other entity from
14 which the data were obtained. The department may also use or
15 provide trauma registry data for purposes of research in
16 accordance with the provisions of chapter 405.
17 Section 11. Section 395.405, Florida Statutes, is
18 amended to read:
19 395.405 Rulemaking.--The department shall adopt and
20 enforce all rules necessary to administer this part ss.
21 395.0199, 395.401, 395.4015, 395.402, 395.4025, 395.403,
22 395.404, and 395.4045.
23 Section 12. This act shall take effect July 1, 2004.
24
25 *****************************************
26 SENATE SUMMARY
27 Revises various provisions of law governing the
administration of trauma care services and facilities by
28 the Department of Health. Requires hospitals and trauma
centers to provide data to the department concerning
29 brain and spinal cord injuries. Prohibits a hospital or
other facility from holding itself out to the public as a
30 trauma center unless the hospital or facility is approved
as a trauma center by the department. Revises
31 requirements for the state trauma plan. Authorizes the
department to adopt rules. (See bill for details.)
32
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