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

31  

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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.

31  

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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

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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

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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.

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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

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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.

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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.

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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  

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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

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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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