Senate Bill sb1762c1

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    Florida Senate - 2004                           CS for SB 1762

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




    317-2058-04

  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. 381.745, F.S.; defining

  7         "department" for purposes of the "Charlie Mack

  8         Overstreet Brain or Spinal Cord Injuries Act";

  9         amending s. 395.40, F.S.; revising legislative

10         findings; revising duties of the Department of

11         Health to implement and plan for a statewide

12         trauma system; amending s. 395.4001, F.S.;

13         revising definitions; amending s. 395.401,

14         F.S.; revising components for local and

15         regional trauma services system plans;

16         correcting references to the term "trauma

17         center"; amending s. 395.4015, F.S.; requiring

18         that the boundaries of the trauma regions

19         administered by the Department of Health be

20         coterminous with the boundaries of the regional

21         domestic security task forces established

22         within the Department of Law Enforcement;

23         providing exceptions for certain interlocal

24         agreements for trauma services in a regional

25         system; eliminating requirements for the

26         Department of Health to develop the minimum

27         components for systems plans in defined trauma

28         regions; amending s. 395.402, F.S.; revising

29         requirements for the Department of Health to

30         review trauma service areas; deleting an

31         obsolete requirement that the department's

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 1         assignment of counties for the purposes of

 2         developing a system of trauma centers remain as

 3         established by ch. 90-284, Laws of Florida,

 4         until completion of the department's initial

 5         review; correcting references to the term

 6         "trauma center"; amending s. 395.4025, F.S.;

 7         revising requirements for the Department of

 8         Health's development of a state trauma system

 9         plan; deleting obsolete references; correcting

10         references to the term "trauma center";

11         revising requirements for the department's

12         approval and verification of a facility as a

13         trauma center; granting the department

14         authority to adopt rules for the procedures and

15         process for notification, duration, and

16         explanation of a trauma center's termination of

17         trauma services; amending s. 395.403, F.S.;

18         correcting references to the term "trauma

19         center"; revising legislative intent; revising

20         eligibility requirements for state funding of

21         trauma centers; amending s. 395.4035, F.S.;

22         correcting references to the term "trauma

23         center"; amending s. 395.404, F.S.; revising

24         reporting requirements to the trauma registry

25         data system maintained by the Department of

26         Health; providing that hospitals and trauma

27         centers subject to reporting trauma registry

28         data to the department are required to comply

29         with other duties concerning the

30         moderate-to-severe brain or spinal cord injury

31         registry maintained by the department;

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 1         correcting references to the term "trauma

 2         center"; amending s. 395.405, F.S.; authorizing

 3         the Department of Health to adopt and enforce

 4         rules necessary to administer part II of ch.

 5         395, F.S.; providing an effective date.

 6  

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

 8  

 9         Section 1.  Subsection (1) of section 381.74, Florida

10  Statutes, is amended to read:

11         381.74  Establishment and maintenance of a central

12  registry.--The department shall establish and maintain a

13  central registry of persons who have moderate-to-severe brain

14  or spinal cord injuries.

15         (1)  Every public health agency, private health agency,

16  public social agency, private social agency, hospital, trauma

17  center, and attending physician shall report to the department

18  division within 5 days after identification or diagnosis of

19  any person who has a moderate-to-severe brain or spinal cord

20  injury. The consent of such person shall not be required.

21         Section 2.  Present subsections (2) through (10) of

22  section 381.745, Florida Statutes, are redesignated as

23  subsections (3) through (11), respectively, and a new

24  subsection (2) is added to that section, to read:

25         381.745  Definitions; ss. 381.739-381.79.--As used in

26  ss. 381.739-381.79, the term:

27         (2)  "Department"  means the Department of Health.

28         Section 3.  Subsection (5) of section 395.40, Florida

29  Statutes, is amended to read:

30         395.40  Legislative findings and intent.--

31  

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 1         (5)  In addition, the agencies listed in subsection (4)

 2  should undertake to:

 3         (a)  Establish a coordinated methodology for

 4  monitoring, evaluating, and enforcing the requirements of the

 5  state's inclusive trauma system which recognizes the interests

 6  of each agency.

 7         (b)  Develop appropriate roles for trauma agencies, to

 8  assist in furthering the operation of trauma systems at the

 9  regional level. This should include issues of system

10  evaluation as well as managed care.

11         (c)  Develop and submit appropriate requests for

12  waivers of federal requirements which will facilitate the

13  delivery of trauma care.

14         (d)  Develop criteria that will become the future basis

15  for mandatory consultation between acute care hospitals and

16  trauma centers on the care of trauma victims and the mandatory

17  transfer of appropriate trauma victims to trauma centers.

18         (e)  Develop a coordinated approach to the care of the

19  trauma victim. This shall include the movement of the trauma

20  victim through the system of care and the identification of

21  medical responsibility for each phase of care for

22  out-of-hospital and in-hospital trauma care.

23         (f)  Require the medical director of an emergency

24  medical services provider to have medical accountability for a

25  trauma victim during interfacility transfer.

26         Section 4.  Section 395.4001, Florida Statutes, is

27  amended to read:

28         395.4001  Definitions.--As used in this part, the term:

29         (1)  "Agency" means the Agency for Health Care

30  Administration.

31  

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 1         (2)  "Charity care" or "uncompensated charity care"

 2  means that portion of hospital charges reported to the agency

 3  for which there is no compensation for care provided to a

 4  patient whose family income for the 12 months preceding the

 5  determination is less than or equal to 150 percent of the

 6  federal poverty level, unless the amount of hospital charges

 7  due from the patient exceeds 25 percent of the annual family

 8  income. However, in no case shall the hospital charges for a

 9  patient whose family income exceeds four times the federal

10  poverty level for a family of four be considered charity.

11         (2)(3)  "Department" means the Department of Health.

12         (3)(4)  "Interfacility trauma transfer" means the

13  transfer of a trauma victim between two facilities licensed

14  under this chapter, pursuant to this part.

15         (4)(5)  "Level I trauma center" means a trauma center

16  that:

17         (a)  Has formal research and education programs for the

18  enhancement of trauma care; and is verified determined by the

19  department to be in substantial compliance with Level I trauma

20  center and pediatric trauma referral center standards; and has

21  been approved by the department to operate as a Level I trauma

22  center.

23         (b)  Serves as a resource facility to Level II trauma

24  centers, pediatric trauma referral centers, and general

25  hospitals through shared outreach, education, and quality

26  improvement activities.

27         (c)  Participates in an inclusive system of trauma

28  care, including providing leadership, system evaluation, and

29  quality improvement activities.

30         (5)(6)  "Level II trauma center" means a trauma center

31  that:

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 1         (a)  Is verified determined by the department to be in

 2  substantial compliance with Level II trauma center standards

 3  and has been approved by the department to operate as a Level

 4  II trauma center.

 5         (b)  Serves as a resource facility to general hospitals

 6  through shared outreach, education, and quality improvement

 7  activities.

 8         (c)  Participates in an inclusive system of trauma

 9  care.

10         (6)(7)  "Pediatric trauma referral center" means a

11  hospital that is verified determined by the department to be

12  in substantial compliance with pediatric trauma referral

13  center standards as established by rule of the department and

14  has been approved by the department to operate as a pediatric

15  trauma center.

16         (7)  "Provisional trauma center" means a hospital that

17  has been verified by the department to be in substantial

18  compliance with the requirements in s. 395.4025 and has been

19  approved by the department to operate as a provisional Level I

20  trauma center, Level II trauma center, or pediatric trauma

21  center.

22         (8)  "State-approved trauma center" means a hospital

23  that has successfully completed the selection process pursuant

24  to s. 395.4025 and has been approved by the department to

25  operate as a trauma center in the state.

26         (9)  "State-sponsored trauma center" means a trauma

27  center or pediatric trauma referral center that receives state

28  funding for trauma care services under s. 395.403.

29         (8)(10)  "Trauma agency" means a department-approved

30  agency established and operated by one or more counties, or a

31  department-approved entity with which one or more counties

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 1  contract, for the purpose of administering an inclusive

 2  regional trauma system.

 3         (9)(11)  "Trauma alert victim" means a person who has

 4  incurred a single or multisystem injury due to blunt or

 5  penetrating means or burns, who requires immediate medical

 6  intervention or treatment, and who meets one or more of the

 7  adult or pediatric scorecard criteria established by the

 8  department by rule.

 9         (10)(12)  "Trauma center" means a any hospital that has

10  been verified determined by the department to be in

11  substantial compliance with the requirements in s. 395.4025

12  and has been approved by the department to operate as a Level

13  I trauma center, Level II trauma center, or pediatric trauma

14  center verification standards as either state-approved or

15  provisional state-approved.

16         (11)(13)  "Trauma scorecard" means a statewide

17  methodology adopted by the department by rule under which a

18  person who has incurred a traumatic injury is graded as to the

19  severity of his or her injuries or illness and which

20  methodology is used as the basis for making destination

21  decisions.

22         (12)(14)  "Trauma transport protocol" means a document

23  which describes the policies, processes, and procedures

24  governing the dispatch of vehicles, the triage, prehospital

25  transport, and interfacility trauma transfer of trauma

26  victims.

27         (13)(15)  "Trauma victim" means any person who has

28  incurred a single or multisystem injury due to blunt or

29  penetrating means or burns and who requires immediate medical

30  intervention or treatment.

31  

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 1         Section 5.  Section 395.401, Florida Statutes, is

 2  amended to read:

 3         395.401  Trauma services system plans; verification of

 4  trauma centers and pediatric trauma referral centers;

 5  procedures; renewal.--

 6         (1)(a)  The local and regional trauma agencies shall

 7  plan, implement, and evaluate trauma services systems, in

 8  accordance with this section and ss. 395.4015, 395.404, and

 9  395.4045, which consist of organized patterns of readiness and

10  response services based on public and private agreements and

11  operational procedures. The department shall establish, by

12  rule, processes and procedures for establishing a trauma

13  agency and obtaining its approval from the department.

14         (b)  The local and regional trauma agencies shall

15  develop and submit to the department plans for local and

16  regional trauma services systems. The plans must include, at a

17  minimum, the following components:

18         1.  The organizational structure of the trauma system.

19         2.  Prehospital care management guidelines for triage

20  and transportation of trauma cases.

21         3.  Flow patterns of trauma cases and transportation

22  system design and resources, including air transportation

23  services, provision for interfacility trauma transfer, and the

24  prehospital transportation of trauma victims. The trauma

25  agency shall plan for the development of a system of

26  transportation of trauma alert victims to trauma centers where

27  the distance or time to a trauma center or transportation

28  resources diminish access by trauma alert victims.

29         4.  The number and location of needed state-approved

30  trauma centers based on local needs, population, and location

31  and distribution of resources.

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 1         5.  Data collection regarding system operation and

 2  patient outcome.

 3         6.  Periodic performance evaluation of the trauma

 4  system and its components.

 5         7.  The use of air transport services within the

 6  jurisdiction of the local trauma agency.

 7         8.  Public information and education about the trauma

 8  system.

 9         9.  Emergency medical services communication system

10  usage and dispatching.

11         10.  The coordination and integration between the

12  verified trauma center care facility and other acute care

13  hospitals the nonverified health care facilities.

14         11.  Medical control and accountability.

15         12.  Quality control and system evaluation.

16         (c)  The department shall receive plans for the

17  implementation of inclusive trauma systems from trauma

18  agencies.  The department may approve or not approve trauma

19  agency plans based on the conformance of the plan with this

20  section and ss. 395.4015, 395.404, and 395.4045 and the rules

21  and definitions adopted by the department pursuant to those

22  sections.  The department shall approve or disapprove the

23  plans within 120 days after the date the plans are submitted

24  to the department. The department shall, by rule, provide an

25  application process for establishing a trauma agency. The

26  application must, at a minimum, provide requirements for the

27  trauma agency plan submitted for review, a process for

28  reviewing the application for a state-approved trauma agency,

29  a process for reviewing the trauma transport protocols for the

30  trauma agency, and a process for reviewing the staffing

31  requirements for the agency. The department shall, by rule,

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 1  establish minimum requirements for a trauma agency to conduct

 2  an annual performance evaluation and submit the results to the

 3  department.

 4         (d)  A trauma agency shall not operate unless the

 5  department has approved the local or regional trauma services

 6  system plan of the agency.

 7         (e)  The department may grant an exception to a portion

 8  of the rules adopted pursuant to this section or s. 395.4015

 9  if the local or regional trauma agency proves that, as defined

10  in the rules, compliance with that requirement would not be in

11  the best interest of the persons served within the affected

12  local or regional trauma area.

13         (f)  A local or regional trauma agency may implement a

14  trauma care system only if the system meets the minimum

15  standards set forth in the rules for implementation

16  established by the department and if the plan has been

17  submitted to, and approved by, the department.  At least 60

18  days before the local or regional trauma agency submits the

19  plan for the trauma care system to the department, the local

20  or regional trauma agency shall hold a public hearing and give

21  adequate notice of the public hearing to all hospitals and

22  other interested parties in the area to be included in the

23  proposed system.

24         (g)  Local or regional trauma agencies may enter into

25  contracts for the purpose of implementing the local or

26  regional plan.  If local or regional agencies contract with

27  hospitals for trauma services, such agencies must contract

28  only with hospitals which are verified trauma centers.

29         (h)  Local or regional trauma agencies providing

30  service for more than one county shall, as part of their

31  

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 1  formation, establish interlocal agreements between or among

 2  the several counties in the regional system.

 3         (i)  This section does not restrict the authority of a

 4  health care facility to provide service for which it has

 5  received a license pursuant to this chapter.

 6         (j)  Any hospital which is verified as a trauma center

 7  shall accept all trauma victims that are appropriate for the

 8  facility regardless of race, sex, creed, or ability to pay.

 9         (k)  It is unlawful for any hospital or other facility

10  to hold itself out as a trauma center unless it has been so

11  verified.

12         (l)  A county, upon the recommendations of the local or

13  regional trauma agency, may adopt ordinances governing the

14  transport of a patient who is receiving care in the field from

15  prehospital emergency medical personnel when the patient meets

16  specific criteria for trauma, burn, or pediatric centers

17  adopted by the local or regional trauma agency.  These

18  ordinances must be consistent with s. 395.4045, ordinances

19  adopted under s. 401.25(6), and the local or regional trauma

20  system plan and, to the furthest possible extent, must ensure

21  that individual patients receive appropriate medical care

22  while protecting the interests of the community at large by

23  making maximum use of available emergency medical care

24  resources.

25         (m)  The local or regional trauma agency shall,

26  consistent with the regional trauma system plan, coordinate

27  and otherwise facilitate arrangements necessary to develop a

28  trauma services system.

29         (n)  After the submission of the initial trauma system

30  plan, each trauma agency shall, every 5th year, submit to the

31  

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 1  department for approval an updated plan that identifies the

 2  changes, if any, to be made in the regional trauma system.

 3         (o)  This section does not preclude a local or regional

 4  trauma agency from adopting trauma care system standards.

 5         (2)  The department shall adopt, by rule, standards for

 6  verification of trauma centers based on national guidelines,

 7  including those established by the American College of

 8  Surgeons entitled "Hospital and Prehospital Resources for

 9  Optimal Care of the Injured Patient" and published appendices

10  thereto. Standards specific to pediatric trauma referral

11  centers shall be developed in conjunction with Children's

12  Medical Services and adopted by rule of the department.

13         (3)  The department may withdraw local or regional

14  agency authority, prescribe corrective actions, or use the

15  administrative remedies as provided in s. 395.1065 for the

16  violation of any provision of this section and ss. 395.4015,

17  395.402, 395.4025, 395.403, 395.404, and 395.4045 or rules

18  adopted thereunder.  All amounts collected pursuant to this

19  subsection shall be deposited into the Emergency Medical

20  Services Trust Fund provided in s. 401.34.

21         Section 6.  Section 395.4015, Florida Statutes, is

22  amended to read:

23         395.4015  State regional trauma planning; trauma

24  regions.--

25         (1)  The department shall establish a state trauma

26  system plan. As part of the state trauma system plan, the

27  department shall establish trauma regions that which cover all

28  geographical areas of the state and have boundaries that are

29  coterminous with the boundaries of the regional domestic

30  security task forces established under s. 943.0312. These

31  regions may serve as the basis for the development of

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 1  department-approved local or regional trauma plans. However,

 2  the delivery of trauma services by or in coordination with a

 3  trauma agency established before July 1, 2004, may continue in

 4  accordance with public and private agreements and operational

 5  procedures entered into as provided in s. 395.401. The

 6  department shall base its definition of the regions upon:

 7         (a)  Geographical considerations so as to ensure rapid

 8  access to trauma care by patients;

 9         (b)  Historical patterns of patient referral and

10  transfer in an area;

11         (c)  Inventories of available trauma care resources;

12         (d)  Predicted population growth characteristics;

13         (e)  Transportation capabilities, including ground and

14  air transport;

15         (f)  Medically appropriate ground and air travel times;

16  and

17         (g)  Other appropriate criteria.

18         (2)  The department shall develop trauma systems plans

19  for the department-defined trauma regions which include at a

20  minimum the following components:

21         (a)  An assessment of current and future trauma care

22  needs of the population, based upon incidence rates and acuity

23  indicators developed by the department, as well as other

24  relevant characteristics of the region.

25         (b)  The organizational structure of the regional

26  trauma system, including the identification of local trauma

27  agency service areas within the region.

28         (c)  Prehospital care management guidelines for triage

29  and transportation of trauma cases.

30         (d)  Flow patterns of trauma cases and transportation

31  system design and resources, including air transportation

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 1  services, provision for interfacility trauma transfer, and the

 2  prehospital transportation of trauma victims. The department

 3  shall plan for the development of a system of transportation

 4  of trauma alert victims to trauma centers where the distance

 5  or time to a trauma center or transportation resources

 6  diminish access by trauma alert victims.

 7         (e)  The current and projected number, acuity level,

 8  and geographic location of trauma cases expected so as to

 9  assure that the assessed current and future trauma care needs

10  of the population are adequately met and that state-sponsored

11  trauma centers will maintain the volume of cases sufficient to

12  provide quality care to trauma cases referred to them.

13         (f)  The availability of qualified health

14  professionals, including physicians and surgeons, capable of

15  staffing trauma centers to the level of current and future

16  assessed needs.

17         (g)  Data collection regarding system operation and

18  patient outcome, as well as the number, type, and generalized

19  locations of state-sponsored trauma centers needed to meet the

20  needs of the population.

21         (h)  Periodic performance evaluation of the trauma

22  system and its components.

23         (i)  The type and extent of air transport services

24  available and needed in each region.

25         (j)  Public information and education about the trauma

26  system.

27         (k)  Emergency medical services communication system

28  usage and dispatching.

29         (l)  The coordination and integration between the

30  trauma centers and other health care facilities which may

31  provide services to trauma victims.

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 1         (m)  Medical control and accountability.

 2         (n)  Quality management and system evaluation.

 3         (2)(3)  The department shall consider the advice and

 4  recommendations of any affected local or regional trauma

 5  agency in developing the state trauma system systems plan.

 6  The department may, in lieu of specific regional components of

 7  its own plan, accept components developed by local or regional

 8  trauma agencies.

 9         (3)(4)  The department shall use the state trauma

10  system plan as the basis for establishing a statewide

11  inclusive trauma system.

12         Section 7.  Subsection (3) of section 395.402, Florida

13  Statutes, is amended to read:

14         395.402  Trauma service areas; number and location of

15  trauma centers.--

16         (3)  Trauma service areas are to be used. The

17  department shall periodically review the assignment of the 67

18  counties to trauma service areas. These assignments are made

19  for the purpose of developing a system of trauma centers.

20  Revisions made by the department should take into

21  consideration the recommendations made as part of the regional

22  trauma system plans approved by the department, as well as the

23  recommendations made as part of the state trauma system plan.

24  These areas must, at a minimum, be reviewed in the year 2000

25  and every 5 years thereafter. Until the department completes

26  its initial review, the assignment of counties shall remain as

27  established pursuant to chapter 90-284, Laws of Florida.

28         (a)  The following trauma service areas are hereby

29  established:

30         1.  Trauma service area 1 shall consist of Escambia,

31  Okaloosa, Santa Rosa, and Walton Counties.

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 1         2.  Trauma service area 2 shall consist of Bay, Gulf,

 2  Holmes, and Washington Counties.

 3         3.  Trauma service area 3 shall consist of Calhoun,

 4  Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison,

 5  Taylor, and Wakulla Counties.

 6         4.  Trauma service area 4 shall consist of Alachua,

 7  Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette,

 8  Levy, Putnam, Suwannee, and Union Counties.

 9         5.  Trauma service area 5 shall consist of Baker, Clay,

10  Duval, Nassau, and St. Johns Counties.

11         6.  Trauma service area 6 shall consist of Citrus,

12  Hernando, and Marion Counties.

13         7.  Trauma service area 7 shall consist of Flagler and

14  Volusia Counties.

15         8.  Trauma service area 8 shall consist of Lake,

16  Orange, Osceola, Seminole, and Sumter Counties.

17         9.  Trauma service area 9 shall consist of Pasco and

18  Pinellas Counties.

19         10.  Trauma service area 10 shall consist of

20  Hillsborough County.

21         11.  Trauma service area 11 shall consist of Hardee,

22  Highlands, and Polk Counties.

23         12.  Trauma service area 12 shall consist of Brevard

24  and Indian River Counties.

25         13.  Trauma service area 13 shall consist of DeSoto,

26  Manatee, and Sarasota Counties.

27         14.  Trauma service area 14 shall consist of Martin,

28  Okeechobee, and St. Lucie Counties.

29         15.  Trauma service area 15 shall consist of Charlotte,

30  Glades, Hendry, and Lee Counties.

31  

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 1         16.  Trauma service area 16 shall consist of Palm Beach

 2  County.

 3         17.  Trauma service area 17 shall consist of Collier

 4  County.

 5         18.  Trauma service area 18 shall consist of Broward

 6  County.

 7         19.  Trauma service area 19 shall consist of Dade and

 8  Monroe Counties.

 9         (b)  Each trauma service area should have at least one

10  Level I or Level II trauma center. The department shall

11  allocate, by rule, the number of trauma centers needed for

12  each trauma service area.

13         (c)  There shall be no more than a total of 44

14  state-sponsored trauma centers in the state.

15         Section 8.  Section 395.4025, Florida Statutes, is

16  amended to read:

17         395.4025  State-approved Trauma centers; selection;

18  quality assurance; records.--

19         (1)  For purposes of developing a system of

20  state-approved trauma centers, the department shall use the 19

21  trauma service areas established in s. 395.402. Within each

22  service area and based on the state trauma system plan, the

23  local or regional trauma services system plan, and

24  recommendations of the local or regional trauma agency, and

25  the 1990 Report and Proposal for Funding State-Sponsored

26  Trauma Centers, the department shall establish the approximate

27  number of state-approved trauma centers needed to ensure

28  reasonable access to high-quality trauma services. The Using

29  the guidelines and procedures outlined in the 1990 report,

30  except when in conflict with those prescribed in this section,

31  the department shall select those hospitals that are to be

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 1  recognized as state-approved trauma centers and shall include

 2  all trauma centers verified as of October 1, 1990, and

 3  subsequently, subject to specific programmatic and quality of

 4  care standards.

 5         (2)(a)  The department shall annually notify each acute

 6  care general hospital and each local and each regional trauma

 7  agency in the state that the department is accepting letters

 8  of intent from hospitals that are interested in becoming

 9  state-approved trauma centers. In order to be considered by

10  the department, a hospital that operates within the geographic

11  area of a local or regional trauma agency must certify that

12  its intent to operate as a state-approved trauma center is

13  consistent with the trauma services plan of the local or

14  regional trauma agency, as approved by the department, if such

15  agency exists. Letters of intent must be postmarked no later

16  than midnight October 1. This paragraph does not apply to any

17  hospital that is a provisional or verified trauma center on

18  January 1, 1992.

19         (b)  By October 15, the department shall send to all

20  hospitals that submitted a letter of intent an application

21  package that will provide the hospitals with instructions for

22  submitting information to the department for selection as a

23  state-approved trauma center. The standards for verification

24  of trauma centers and pediatric trauma referral centers

25  provided for in s. 395.401(2), as adopted by rule of the

26  department, shall serve as the basis for these instructions.

27         (c)  In order to be considered by the department,

28  applications from those hospitals seeking selection as

29  state-approved trauma centers, including those current

30  verified trauma centers that seek a change or redesignation in

31  approval status as a trauma center to be state-approved trauma

                                  18

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 1  centers, must be received by the department no later than the

 2  close of business on April 1. The department shall conduct a

 3  provisional review of each application for the purpose of

 4  determining that the hospital's application is complete and

 5  that the hospital has the critical elements required for a

 6  state-approved trauma center. This critical review will be

 7  based on trauma center verification standards and shall

 8  include, but not be limited to, a review of whether the

 9  hospital has:

10         1.  Equipment and physical facilities necessary to

11  provide trauma services.

12         2.  Personnel in sufficient numbers and with proper

13  qualifications to provide trauma services.

14         3.  An effective quality assurance process.

15         4.  Submitted written confirmation by the local or

16  regional trauma agency that the verification of the hospital

17  applying to become as a state-approved trauma center is

18  consistent with the plan of the local or regional trauma

19  agency, as approved by the department, if such agency exists.

20  This subparagraph applies to any hospital that is not a

21  provisional or verified trauma center on January 1, 1992.

22         (d)1.  Notwithstanding other provisions in this

23  section, the department may grant up to an additional 18

24  months to a hospital applicant that is unable to meet all

25  requirements as provided in paragraph (c) at the time of

26  application if the number of applicants in the service area in

27  which the applicant is located is equal to or less than the

28  service area allocation, as provided by rule of the

29  department. An applicant that is granted additional time

30  pursuant to this paragraph shall submit a plan for

31  departmental approval which includes timelines and activities

                                  19

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 1  that the applicant proposes to complete in order to meet

 2  application requirements. Any applicant that demonstrates an

 3  ongoing effort to complete the activities within the timelines

 4  outlined in the plan shall be included in the number of

 5  state-approved trauma centers at such time that the department

 6  has conducted a provisional review of the application and has

 7  determined that the application is complete and that the

 8  hospital has the critical elements required for a

 9  state-approved trauma center.

10         2.  Timeframes provided in subsections (1)-(8) shall be

11  stayed until the department determines that the application is

12  complete and that the hospital has the critical elements

13  required for a state-approved trauma center.

14         (3)  After April 30, any hospital that submitted an

15  application found acceptable by the department based on

16  provisional review, including all trauma centers verified as

17  of December 1, 1989, shall be eligible to operate as a

18  provisional state-approved trauma center.

19         (4)  Between May 1 and October 1 of each year, the

20  department shall conduct an in-depth evaluation of all

21  applications found acceptable in the provisional review. The

22  applications shall be evaluated against criteria enumerated in

23  the application packages as provided to the hospitals by the

24  department.

25         (5)  Beginning October 1 of each year and ending no

26  later than June 1 of the following year, a review team of

27  out-of-state experts assembled by the department shall make

28  onsite visits to all provisional state-approved trauma

29  centers. The department shall develop a survey instrument to

30  be used by the expert team of reviewers. The instrument shall

31  include objective criteria and guidelines for reviewers based

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 1  on existing trauma center and pediatric trauma referral center

 2  verification standards such that all trauma centers and

 3  pediatric trauma referral centers are assessed equally. The

 4  survey instrument shall also include a uniform rating system

 5  that will be used by reviewers to indicate the degree of

 6  compliance of each trauma center with specific standards, and

 7  to indicate the quality of care provided by each trauma center

 8  as determined through an audit of patient charts. In addition,

 9  hospitals being considered as provisional state-approved

10  trauma centers shall meet all the requirements of a verified

11  trauma center or pediatric trauma referral center, and shall

12  be located in a trauma service area that has a need for such a

13  trauma center.

14         (6)  Based on recommendations from the review team, the

15  department shall select state-approved trauma centers by July

16  1. An applicant for designation as a state-approved trauma

17  center or a state-approved pediatric trauma referral center

18  may request an extension of its provisional status if it

19  submits a corrective action plan to the department. The

20  corrective action plan must demonstrate the ability of the

21  applicant to correct deficiencies noted during the applicant's

22  onsite review conducted by the department between the previous

23  October 1 and June 1. The department may extend the

24  provisional status of an applicant for designation as a

25  state-approved trauma center or a state-approved pediatric

26  trauma referral center through December 31 if the applicant

27  provides a corrective action plan acceptable to the

28  department. The department or a team of out-of-state experts

29  assembled by the department shall conduct an onsite visit on

30  or before November 1 to confirm that the deficiencies have

31  been corrected. The provisional state-approved trauma center

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 1  or the provisional state-approved pediatric trauma referral

 2  center is responsible for all costs associated with the onsite

 3  visit in a manner prescribed by rule of the department. By

 4  January 1, the department must approve or deny the application

 5  of any provisional applicant granted an extension. Each

 6  state-approved trauma center shall be granted a 7-year

 7  approval verification period during which time it must

 8  continue to maintain trauma center verification standards and

 9  acceptable patient outcomes as determined by department rule.

10  An approval A verification, unless sooner suspended or

11  revoked, automatically expires 7 years after the date of

12  issuance and is renewable upon application for renewal as

13  prescribed by rule of the department. After July 1, 1992, only

14  those hospitals selected as state-approved trauma centers may

15  operate as trauma centers.

16         (7)  Any hospital that wishes to protest a decision

17  made by the department based on the department's preliminary

18  or in-depth review of applications or on the recommendations

19  of the site visit review team pursuant to this section shall

20  proceed as provided in chapter 120. Hearings held under this

21  subsection shall be conducted in the same manner as provided

22  in ss. 120.569 and 120.57. Cases filed under chapter 120 may

23  combine all disputes between parties.

24         (8)  Notwithstanding any provision of chapter 381, a

25  hospital licensed under ss. 395.001-395.3025 that operates a

26  state-approved trauma center may not terminate or

27  substantially reduce the availability of trauma service

28  without providing at least 6 months' notice of its intent to

29  terminate such service. Such notice shall be given to the

30  department of Health, to all affected local or regional trauma

31  agencies, and to all state-approved trauma centers, hospitals,

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 1  and emergency medical service providers in the trauma service

 2  area. The department shall adopt by rule the procedures and

 3  process for notification, duration, and explanation of the

 4  termination of trauma services.

 5         (9)  Except as otherwise provided in this subsection,

 6  the department or its agent may collect trauma care and

 7  registry data, as prescribed by rule of the department, from

 8  trauma centers, pediatric trauma referral centers, hospitals,

 9  emergency medical service providers, local or regional trauma

10  agencies, or medical examiners for the purposes of evaluating

11  trauma system effectiveness, ensuring compliance with the

12  standards of verification, and monitoring patient outcomes. A

13  trauma center, pediatric trauma referral center, hospital,

14  emergency medical service provider, medical examiner, or local

15  trauma agency or regional trauma agency, or a panel or

16  committee assembled by such an agency under s. 395.50(1) may,

17  but is not required to, disclose to the department patient

18  care quality assurance proceedings, records, or reports.

19  However, the department may require a local trauma agency or a

20  regional trauma agency, or a panel or committee assembled by

21  such an agency to disclose to the department patient care

22  quality assurance proceedings, records, or reports that the

23  department needs solely to conduct quality assurance

24  activities under s. 395.4015, or to ensure compliance with the

25  quality assurance component of the trauma agency's plan

26  approved under s. 395.401. The patient care quality assurance

27  proceedings, records, or reports that the department may

28  require for these purposes include, but are not limited to,

29  the structure, processes, and procedures of the agency's

30  quality assurance activities, and any recommendation for

31  improving or modifying the overall trauma system, if the

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 1  identity of a trauma center, pediatric trauma referral center,

 2  hospital, emergency medical service provider, medical

 3  examiner, or an individual who provides trauma services is not

 4  disclosed.

 5         (10)  Out-of-state experts assembled by the department

 6  to conduct onsite visits are agents of the department for the

 7  purposes of s. 395.3025. An out-of-state expert who acts as an

 8  agent of the department under this subsection is not liable

 9  for any civil damages as a result of actions taken by him or

10  her, unless he or she is found to be operating outside the

11  scope of the authority and responsibility assigned by the

12  department.

13         (11)  Onsite visits by the department or its agent may

14  be conducted at any reasonable time and may include but not be

15  limited to a review of records in the possession of trauma

16  centers, pediatric trauma referral centers, hospitals,

17  emergency medical service providers, local or regional trauma

18  agencies, or medical examiners regarding the care, transport,

19  treatment, or examination of trauma patients.

20         (12)  Patient care, transport, or treatment records or

21  reports, or patient care quality assurance proceedings,

22  records, or reports obtained or made pursuant to this section,

23  s. 395.3025(4)(f), s. 395.401, s. 395.4015, s. 395.402, s.

24  395.403, s. 395.404, s. 395.4045, s. 395.405, s. 395.50, or s.

25  395.51 must be held confidential by the department or its

26  agent and are exempt from the provisions of s. 119.07(1).

27  Patient care quality assurance proceedings, records, or

28  reports obtained or made pursuant to these sections are not

29  subject to discovery or introduction into evidence in any

30  civil or administrative action.

31  

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 1         (13)  The department may adopt, by rule, the procedures

 2  and process by which it will select state-approved trauma

 3  centers. Such procedures and process must be used in annually

 4  selecting state-approved trauma centers and must be consistent

 5  with subsections (1)-(8) except in those situations in which

 6  it is in the best interest of, and mutually agreed to by, all

 7  applicants within a service area and the department to reduce

 8  the timeframes.

 9         Section 9.  Section 395.403, Florida Statutes, is

10  amended to read:

11         395.403  Reimbursement of state-sponsored trauma

12  centers.--

13         (1)  The Legislature finds that many hospitals which

14  provide services to trauma victims are not adequately

15  compensated for such treatment. The Legislature also

16  recognizes that the current verified trauma centers are

17  providing such services without adequate reimbursement.

18  Therefore, it is the intent of the Legislature to provide

19  financial support to the current verified trauma centers and

20  to establish a system of state-sponsored trauma centers as

21  soon as feasibly possible.  It is also the intent of the

22  Legislature that this system of state-sponsored trauma centers

23  be assisted financially based on the volume and acuity of

24  uncompensated trauma care provided.

25         (2)  All provisional trauma centers and state-approved

26  trauma centers shall be considered eligible to receive state

27  funding state-sponsored trauma centers when state funds are

28  specifically appropriated for state-sponsored trauma centers

29  in the General Appropriations Act. When state funds are

30  appropriated without specific legislative allocation, the

31  funds shall be distributed equally to all provisional trauma

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 1  centers and trauma centers approved as of July 1 of the fiscal

 2  year immediately following the legislative session in which

 3  the funds were appropriated.

 4         (3)  To receive state funding, a state-sponsored trauma

 5  center shall submit a claim electronically via the Trauma

 6  Claims Processing System, designed, developed, implemented,

 7  and operated by the department's Medicaid program, to the

 8  department's Medicaid program upon discharge of a trauma

 9  patient.  When a hospital stay spans a state fiscal year, a

10  separate hospital claim shall be submitted for the hospital

11  days incurred in each fiscal year.

12         (4)(a)  State-sponsored trauma centers shall determine

13  each trauma patient's eligibility for state funding prior to

14  the submission of a claim.

15         (b)  A trauma patient treated must meet the definition

16  of charity care, have been designated as having an ISS score

17  of 9 or greater, and have received services that are medically

18  necessary from a state-sponsored trauma center in order for

19  the state-sponsored trauma center to receive state funding for

20  that patient.

21         (c)  Each state-sponsored trauma center shall retain

22  appropriate documentation showing a trauma patient's

23  eligibility for state funding. Documentation recognized by the

24  department as appropriate shall be limited to one of the

25  following:

26         1.  W-2 withholding forms.

27         2.  Payroll stubs.

28         3.  Income tax returns.

29         4.  Forms approving or denying unemployment

30  compensation or workers' compensation.

31         5.  Written verification of wages from employer.

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 1         6.  Written verification from public welfare agencies

 2  or any other governmental agency which can attest to the

 3  patient's income status for the past 12 months.

 4         7.  A witnessed statement signed by the patient or

 5  responsible party, as provided for in Pub. L. No. 79-725, as

 6  amended, known as the Hill-Burton Act, except that such

 7  statement need not be obtained within 48 hours of the

 8  patient's admission to the hospital as required by the

 9  Hill-Burton Act.  The statement shall include acknowledgment

10  that, in accordance with s. 817.50, providing false

11  information to defraud a hospital for the purposes of

12  obtaining goods or services is a misdemeanor of the second

13  degree.

14         (d)  The department shall conduct an audit or shall

15  contract with an independent party to conduct an audit of each

16  state-sponsored trauma center's claims to ensure that state

17  funding was only provided for eligible trauma patients and

18  medically necessary services.

19         (e)  The department's Medicaid program office shall

20  check each claim to confirm that the patient is not covered

21  under the Medicaid program and shall pay the claim out of the

22  Trauma Services Trust Fund.  Trauma patients who are eligible

23  for the Medicaid program shall not be considered eligible for

24  the state-sponsored trauma center program except for Medicaid

25  noncovered services.  If a claim is denied by the Trauma

26  Claims Processing System as a result of Medicaid eligibility

27  for Medicaid covered services, the hospital shall submit a

28  claim to the Medicaid fiscal agent for payment.

29         (5)  State funding shall be at a per diem rate equal to

30  $860 to provisional state-approved and state-approved trauma

31  centers.  This rate shall be effective for the first 12 months

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 1  of funding, after which time payment to provisional

 2  state-approved and state-approved trauma centers shall be

 3  based on a trauma cost-based reimbursement methodology

 4  developed by the department. The department shall consult with

 5  representatives from the hospital industry including the

 6  Florida Hospital Association, the Association of Voluntary

 7  Hospitals of Florida, and the Florida League of Hospitals in

 8  the development of the reimbursement methodology.

 9         (6)(a)  To ensure a fair distribution of funds

10  appropriated for state-sponsored trauma centers and to ensure

11  that no state-sponsored trauma center gains an unfair

12  advantage due solely to its ability to bill more quickly than

13  another state-sponsored trauma center, the total amount of

14  state funds appropriated in the General Appropriations Act for

15  this section shall be divided into 19 trauma fund accounts

16  with an account for each service area established in s.

17  395.402(3).  The amount of funds distributed to a service area

18  shall be based on the following formula: 

19  

20  

21              SAAA =   SATD   x TA

22                       TTD

23  where:

24         SAAA = service area appropriation amount.

25         SATD = uncompensated service area trauma days with ISS

26  score of 9 or greater.

27         TTD = uncompensated total trauma days with ISS score of

28  9 or greater for all 19 service areas.

29         TA = total dollars appropriated for state-sponsored

30  trauma centers.

31  

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 1         (b)  The database to be used for this calculation shall

 2  be the detailed patient discharge data of the most recently

 3  completed calendar year for which the board possesses data.

 4  Out-of-state days that are included in the database shall be

 5  allocated to the service area where the treating hospital is

 6  located.

 7         (c)  Fifty percent of the funds allocated to those

 8  service areas which had one or more trauma centers as of

 9  December 1, 1989, shall be distributed to those verified

10  trauma centers proportionately based on volume and acuity of

11  uncompensated trauma care provided during the most recently

12  completed calendar year for which the board possesses data in

13  a lump-sum payment on the date funding becomes available.

14  These trauma centers shall submit claims pursuant to

15  subsection (3) in order to justify this funding. Effective 9

16  months after funding becomes available, any trauma center

17  which fails to submit claims for reimbursement equal to or

18  greater than the amount the trauma center received under the

19  initial allocation shall return any unearned funds to the

20  department for distribution pursuant to paragraph (e).  Once

21  this 50-percent lump sum is depleted, a trauma center will be

22  reimbursed from the remaining 50 percent of the service area's

23  original allocation.

24         (d)  The department shall pay trauma claims on a

25  monthly basis.  In a given month when the outstanding claims

26  will exceed the unexpended funds allocated to a service area,

27  the department shall pay all of the submitted claims for the

28  service area on a pro rata basis.

29         (e)  At the end of the fiscal year, the unexpended

30  funds for each service area shall be placed in one large state

31  trauma account from which all remaining claims are paid

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 1  without regard to service area on a pro rata basis until such

 2  funds are depleted.

 3         (f)  For any state fiscal year, reimbursement for any

 4  patient residing outside the trauma service area of the

 5  state-sponsored trauma center where the patient is treated

 6  shall be paid out of the funds allocated for the trauma

 7  service area where the patient resides.  Out-of-state days

 8  shall be paid from the service area where the treating

 9  hospital is located.

10         (3)(7)  In order to receive state funding payments

11  under this section, a hospital shall be a state-sponsored

12  trauma center and shall:

13         (a)  Agree to conform to all departmental requirements

14  as provided by rule to assure high-quality trauma services.

15         (b)  Agree to provide information concerning the

16  provision of trauma services to the department, in a form and

17  manner prescribed by rule of the department.

18         (c)  Agree to accept all trauma patients, regardless of

19  ability to pay, on a functional space-available basis.

20         (4)(8)  A state-sponsored trauma center that which

21  fails to comply with any of the conditions listed in

22  subsection (3) (7) or the applicable rules of the department

23  shall not receive payments under this section for the period

24  in which it was not in compliance.

25         Section 10.  Subsection (1) of section 395.4035,

26  Florida Statutes, is amended to read:

27         395.4035  Trauma Services Trust Fund.--

28         (1)  There is hereby created the Trauma Services Trust

29  Fund in the State Treasury, which shall be used exclusively

30  for the development and support of a system of state-sponsored

31  trauma centers.  Trust fund revenue shall be used for the

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 1  purpose of funding trauma patient care in a provisional

 2  state-sponsored trauma center, or a state-sponsored trauma

 3  center as provided for in this act; for funding the associated

 4  trauma claims processing costs, including the costs for the

 5  design, development, implementation, and operation of a

 6  payment system; and for administration of this act.

 7         Section 11.  Section 395.404, Florida Statutes, is

 8  amended to read:

 9         395.404  Review of trauma registry data; report to

10  central registry; confidentiality and limited release.--

11         (1)(a)  Each trauma center shall furnish, and, upon

12  request of the department, all acute care hospitals shall

13  furnish for department review, trauma registry data as

14  prescribed by rule of the department for the purpose of

15  monitoring patient outcome and ensuring compliance with the

16  standards of approval.

17         (b)  Trauma registry data obtained pursuant to this

18  subsection are confidential and exempt from the provisions of

19  s. 119.07(1) and s. 24(a), Art. I of the State Constitution.

20  However, the department may provide such trauma registry data

21  to the person, trauma center, hospital, emergency medical

22  service provider, local or regional trauma agency, medical

23  examiner, or other entity from which the data were obtained.

24  The department may also use or provide trauma registry data

25  for purposes of research in accordance with the provisions of

26  chapter 405.

27         (2)  Each trauma center and acute care hospital shall

28  report to the department's brain and spinal cord injury

29  central registry, consistent with the procedures and

30  timeframes of s. 381.74, any person who has a

31  moderate-to-severe brain or spinal cord injury, and shall

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 1  include in the report the name, age, residence, and type of

 2  disability of the individual and any additional information

 3  that the department finds necessary. Notwithstanding the

 4  provisions of s. 381.74, each trauma center and acute care

 5  hospital shall submit severe disability and head-injury

 6  registry data to the department as provided by rule. Each

 7  trauma center and acute care hospital shall continue to

 8  provide initial notification of persons who have severe

 9  disabilities and head injuries to the Department of Health

10  within timeframes provided in chapter 413. Such initial

11  notification shall be made in the manner prescribed by the

12  Department of Health for the purpose of providing timely

13  vocational rehabilitation services to the severely disabled or

14  head-injured person.

15         (3)  Trauma registry data obtained pursuant to this

16  section are confidential and exempt from the provisions of s.

17  119.07(1) and s. 24(a), Art. I of the State Constitution.

18  However, the department may provide such trauma registry data

19  to the person, trauma center, pediatric trauma referral

20  center, hospital, emergency medical service provider, local or

21  regional trauma agency, medical examiner, or other entity from

22  which the data were obtained. The department may also use or

23  provide trauma registry data for purposes of research in

24  accordance with the provisions of chapter 405.

25         Section 12.  Section 395.405, Florida Statutes, is

26  amended to read:

27         395.405  Rulemaking.--The department shall adopt and

28  enforce all rules necessary to administer this part ss.

29  395.0199, 395.401, 395.4015, 395.402, 395.4025, 395.403,

30  395.404, and 395.4045.

31         Section 13.  This act shall take effect July 1, 2004.

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 1          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
 2                         Senate Bill 1762

 3                                 

 4  The bill deletes a prohibition for any hospital or facility to
    hold itself out as a trauma center unless the hospital or
 5  other facility has been verified by the Department of Health
    as having met the requirements for a trauma center and has
 6  been approved by the department to operate as a trauma center.
    The bill requires the boundaries of trauma regions
 7  administered by the Department of Health to be coterminous
    with the boundaries of the regional domestic security task
 8  forces established within the Florida Department of Law
    Enforcement and provides exceptions to this requirement for
 9  coterminous boundaries for certain local trauma regional
    planning already established as of July 1, 2004.
10  

11  

12  

13  

14  

15  

16  

17  

18  

19  

20  

21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

                                  33

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