Senate Bill sb1762er

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  1                                 

  2         An act relating to trauma care; amending s.

  3         212.055, F.S.; authorizing certain counties to

  4         levy a surtax to fund trauma services by

  5         ordinance, subject to referendum approval;

  6         amending s. 395.40, F.S.; requiring the

  7         Department of Health to promote development of

  8         trauma centers and agencies; requiring the

  9         department to update the trauma system

10         annually; amending s. 395.4001, F.S.; revising

11         definitions; amending ss. 395.401 and 401.24,

12         F.S.; removing references to center

13         verification, referral centers, and

14         state-approved centers; amending s. 395.4015,

15         F.S.; providing boundaries for the state trauma

16         system plan; deleting requirements for defining

17         a region; amending s. 395.402, F.S.; revising

18         legislative intent; requiring the department to

19         perform an assessment of the trauma system and

20         report its findings to the Governor and

21         Legislature; providing guidelines for such

22         assessment and annual reviews; requiring annual

23         reviews; amending s. 395.4025, F.S.; deleting

24         outdated provisions; providing for centers that

25         seek a change or redesignation in approval

26         status; amending s. 395.403, F.S.; removing

27         legislative intent; providing for funding of

28         trauma centers; requiring the department to

29         recommend an effective grant program to the

30         Governor and the Legislature by a certain date;

31  


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 1         deleting other funding guidelines; providing

 2         appropriations; providing an effective date.

 3  

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

 5  

 6         Section 1.  Subsection (4) of section 212.055, Florida

 7  Statutes, is amended to read:

 8         212.055  Discretionary sales surtaxes; legislative

 9  intent; authorization and use of proceeds.--It is the

10  legislative intent that any authorization for imposition of a

11  discretionary sales surtax shall be published in the Florida

12  Statutes as a subsection of this section, irrespective of the

13  duration of the levy. Each enactment shall specify the types

14  of counties authorized to levy; the rate or rates which may be

15  imposed; the maximum length of time the surtax may be imposed,

16  if any; the procedure which must be followed to secure voter

17  approval, if required; the purpose for which the proceeds may

18  be expended; and such other requirements as the Legislature

19  may provide. Taxable transactions and administrative

20  procedures shall be as provided in s. 212.054.

21         (4)  INDIGENT CARE AND TRAUMA CENTER SURTAX.--

22         (a)1.  The governing body in each county the government

23  of which is not consolidated with that of one or more

24  municipalities, which has a population of at least 800,000

25  residents and is not authorized to levy a surtax under

26  subsection (5), may levy, pursuant to an ordinance either

27  approved by an extraordinary vote of the governing body or

28  conditioned to take effect only upon approval by a majority

29  vote of the electors of the county voting in a referendum, a

30  discretionary sales surtax at a rate that may not exceed 0.5

31  percent.


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 1         2.(b)  If the ordinance is conditioned on a referendum,

 2  a statement that includes a brief and general description of

 3  the purposes to be funded by the surtax and that conforms to

 4  the requirements of s. 101.161 shall be placed on the ballot

 5  by the governing body of the county. The following questions

 6  shall be placed on the ballot:

 7  

 8                     FOR THE. . . .CENTS TAX

 9  

10                   AGAINST THE. . . .CENTS TAX

11  

12         3.(c)  The ordinance adopted by the governing body

13  providing for the imposition of the surtax shall set forth a

14  plan for providing health care services to qualified

15  residents, as defined in subparagraph 4. paragraph (d). Such

16  plan and subsequent amendments to it shall fund a broad range

17  of health care services for both indigent persons and the

18  medically poor, including, but not limited to, primary care

19  and preventive care as well as hospital care. The plan must

20  also address the services to be provided by the Level I trauma

21  center. It shall emphasize a continuity of care in the most

22  cost-effective setting, taking into consideration both a high

23  quality of care and geographic access. Where consistent with

24  these objectives, it shall include, without limitation,

25  services rendered by physicians, clinics, community hospitals,

26  mental health centers, and alternative delivery sites, as well

27  as at least one regional referral hospital where appropriate.

28  It shall provide that agreements negotiated between the county

29  and providers, including hospitals with a Level I trauma

30  center, will include reimbursement methodologies that take

31  into account the cost of services rendered to eligible


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 1  patients, recognize hospitals that render a disproportionate

 2  share of indigent care, provide other incentives to promote

 3  the delivery of charity care, promote the advancement of

 4  technology in medical services, recognize the level of

 5  responsiveness to medical needs in trauma cases, and require

 6  cost containment including, but not limited to, case

 7  management. It must also provide that any hospitals that are

 8  owned and operated by government entities on May 21, 1991,

 9  must, as a condition of receiving funds under this subsection,

10  afford public access equal to that provided under s. 286.011

11  as to meetings of the governing board, the subject of which is

12  budgeting resources for the rendition of charity care as that

13  term is defined in the Florida Hospital Uniform Reporting

14  System (FHURS) manual referenced in s. 408.07. The plan shall

15  also include innovative health care programs that provide

16  cost-effective alternatives to traditional methods of service

17  delivery and funding.

18         4.(d)  For the purpose of this paragraph subsection,

19  the term "qualified resident" means residents of the

20  authorizing county who are:

21         a.1.  Qualified as indigent persons as certified by the

22  authorizing county;

23         b.2.  Certified by the authorizing county as meeting

24  the definition of the medically poor, defined as persons

25  having insufficient income, resources, and assets to provide

26  the needed medical care without using resources required to

27  meet basic needs for shelter, food, clothing, and personal

28  expenses; or not being eligible for any other state or federal

29  program, or having medical needs that are not covered by any

30  such program; or having insufficient third-party insurance

31  


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 1  coverage. In all cases, the authorizing county is intended to

 2  serve as the payor of last resort; or

 3         c.3.  Participating in innovative, cost-effective

 4  programs approved by the authorizing county.

 5         5.(e)  Moneys collected pursuant to this paragraph

 6  subsection remain the property of the state and shall be

 7  distributed by the Department of Revenue on a regular and

 8  periodic basis to the clerk of the circuit court as ex officio

 9  custodian of the funds of the authorizing county. The clerk of

10  the circuit court shall:

11         a.1.  Maintain the moneys in an indigent health care

12  trust fund;

13         b.2.  Invest any funds held on deposit in the trust

14  fund pursuant to general law;

15         c.3.  Disburse the funds, including any interest

16  earned, to any provider of health care services, as provided

17  in subparagraphs 3. and 4. paragraphs (c) and (d), upon

18  directive from the authorizing county. However, if a county

19  has a population of at least 800,000 residents and has levied

20  the surtax authorized in this paragraph subsection,

21  notwithstanding any directive from the authorizing county, on

22  October 1 of each calendar year, the clerk of the court shall

23  issue a check in the amount of $6.5 million to a hospital in

24  its jurisdiction that has a Level I trauma center or shall

25  issue a check in the amount of $3.5 million to a hospital in

26  its jurisdiction that has a Level I trauma center if that

27  county enacts and implements a hospital lien law in accordance

28  with chapter 98-499, Laws of Florida. The issuance of the

29  checks on October 1 of each year is provided in recognition of

30  the Level I trauma center status and shall be in addition to

31  the base contract amount received during fiscal year 1999-2000


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 1  and any additional amount negotiated to the base contract. If

 2  the hospital receiving funds for its Level I trauma center

 3  status requests such funds to be used to generate federal

 4  matching funds under Medicaid, the clerk of the court shall

 5  instead issue a check to the Agency for Health Care

 6  Administration to accomplish that purpose to the extent that

 7  it is allowed through the General Appropriations Act; and

 8         d.4.  Prepare on a biennial basis an audit of the trust

 9  fund specified in sub-subparagraph a. subparagraph 1.

10  Commencing February 1, 2004, such audit shall be delivered to

11  the governing body and to the chair of the legislative

12  delegation of each authorizing county.

13         6.(f)  Notwithstanding any other provision of this

14  section, a county shall not levy local option sales surtaxes

15  authorized in this paragraph subsection and subsections (2)

16  and (3) in excess of a combined rate of 1 percent.

17         (b)  Notwithstanding any other provision of this

18  section, the governing body in each county the government of

19  which is not consolidated with that of one or more

20  municipalities and which has a population of less than 800,000

21  residents, may levy, by ordinance subject to approval by a

22  majority of the electors of the county voting in a referendum,

23  a discretionary sales surtax at a rate that may not exceed

24  0.25 percent for the sole purpose of funding trauma services

25  provided by a trauma center licensed pursuant to chapter 395.

26         1.  A statement that includes a brief and general

27  description of the purposes to be funded by the surtax and

28  that conforms to the requirements of s. 101.161 shall be

29  placed on the ballot by the governing body of the county. The

30  following shall be placed on the ballot:

31  


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 1                     FOR THE. . . .CENTS TAX

 2                   AGAINST THE. . . .CENTS TAX

 3  

 4         2.  The ordinance adopted by the governing body of the

 5  county providing for the imposition of the surtax shall set

 6  forth a plan for providing trauma services to trauma victims

 7  presenting in the trauma service area in which such county is

 8  located.

 9         3.  Moneys collected pursuant to this paragraph remain

10  the property of the state and shall be distributed by the

11  Department of Revenue on a regular and periodic basis to the

12  clerk of the circuit court as ex officio custodian of the

13  funds of the authorizing county. The clerk of the circuit

14  court shall:

15         a.  Maintain the moneys in a trauma services trust

16  fund.

17         b.  Invest any funds held on deposit in the trust fund

18  pursuant to general law.

19         c.  Disburse the funds, including any interest earned

20  on such funds, to the trauma center in its trauma service

21  area, as provided in the plan set forth pursuant to

22  subparagraph 2., upon directive from the authorizing county.

23  If the trauma center receiving funds requests such funds be

24  used to generate federal matching funds under Medicaid, the

25  custodian of the funds shall instead issue a check to the

26  Agency for Health Care Administration to accomplish that

27  purpose to the extent that the agency is allowed through the

28  General Appropriations Act.

29         d.  Prepare on a biennial basis an audit of the trauma

30  services trust fund specified in sub-subparagraph a., to be

31  delivered to the authorizing county.


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 1         4.  A discretionary sales surtax imposed pursuant to

 2  this paragraph shall expire 4 years after the effective date

 3  of the surtax, unless reenacted by ordinance subject to

 4  approval by a majority of the electors of the county voting in

 5  a subsequent referendum.

 6         5.  Notwithstanding any other provision of this

 7  section, a county shall not levy local option sales surtaxes

 8  authorized in this paragraph and subsections (2) and (3) in

 9  excess of a combined rate of 1 percent.

10         Section 2.  Subsections (5) and (6) of section 395.40,

11  Florida Statutes, are amended to read:

12         395.40  Legislative findings and intent.--

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

14  should undertake to:

15         (a)  Establish a coordinated methodology for

16  monitoring, evaluating, and enforcing the requirements of the

17  state's inclusive trauma system which recognizes the interests

18  of each agency.

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

20  assist in furthering the operation of trauma systems at the

21  regional level. This should include issues of system

22  evaluation as well as managed care.

23         (c)  Develop and submit appropriate requests for

24  waivers of federal requirements which will facilitate the

25  delivery of trauma care.

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

27  for mandatory consultation between acute care hospitals and

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

29  transfer of appropriate trauma victims to trauma centers.

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

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


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 1  victim through the system of care and the identification of

 2  medical responsibility for each phase of care for

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

 4         (f)  Require the medical director of an emergency

 5  medical services provider to have medical accountability for a

 6  trauma victim during interfacility transfer.

 7         (6)  Furthermore, the Legislature encourages the

 8  department to actively foster the provision of trauma care and

 9  serve as a catalyst for improvements in the process and

10  outcome of the provision of trauma care in an inclusive trauma

11  system. Among other considerations, the department is required

12  encouraged to:

13         (a)  Promote the development of at least one trauma

14  center in every trauma service area.

15         (b)  Promote the development of a trauma agency for

16  each trauma region.

17         (c)  Update the state trauma system plan by February

18  2005 December 2000 and at least annually every 5th year

19  thereafter.

20         Section 3.  Section 395.4001, Florida Statutes, is

21  amended to read:

22         395.4001  Definitions.--As used in this part, the term:

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

24  Administration.

25         (2)  "Charity care" or "uncompensated trauma charity

26  care" means that portion of hospital charges reported to the

27  agency for which there is no compensation, other than

28  restricted or unrestricted revenues provided to a hospital by

29  local governments or tax districts regardless of method of

30  payment, for care provided to a patient whose family income

31  for the 12 months preceding the determination is less than or


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 1  equal to 200 150 percent of the federal poverty level, unless

 2  the amount of hospital charges due from the patient exceeds 25

 3  percent of the annual family income. However, in no case shall

 4  the hospital charges for a patient whose family income exceeds

 5  four times the federal poverty level for a family of four be

 6  considered charity.

 7         (3)  "Department" means the Department of Health.

 8         (4)  "Interfacility trauma transfer" means the transfer

 9  of a trauma victim between two facilities licensed under this

10  chapter, pursuant to this part.

11         (5)  "Level I trauma center" means a trauma center

12  that:

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

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

15  department to be in substantial compliance with Level I trauma

16  center and pediatric trauma referral center standards; and has

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

18  center.

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

20  centers, pediatric trauma referral centers, and general

21  hospitals through shared outreach, education, and quality

22  improvement activities.

23         (c)  Participates in an inclusive system of trauma

24  care, including providing leadership, system evaluation, and

25  quality improvement activities.

26         (6)  "Level II trauma center" means a trauma center

27  that:

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

29  substantial compliance with Level II trauma center standards

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

31  II trauma center.


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

 2  through shared outreach, education, and quality improvement

 3  activities.

 4         (c)  Participates in an inclusive system of trauma

 5  care.

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

 7  hospital that is verified determined by the department to be

 8  in substantial compliance with pediatric trauma referral

 9  center standards as established by rule of the department and

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

11  trauma center.

12         (8)  "Provisional trauma center" means a hospital that

13  has been verified by the department to be in substantial

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

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

16  trauma center, Level II trauma center, or pediatric trauma

17  center.

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

19  that has successfully completed the selection process pursuant

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

21  operate as a trauma center in the state.

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

23  center or pediatric trauma referral center that receives state

24  funding for trauma care services under s. 395.403.

25         (9)(10)  "Trauma agency" means a department-approved

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

27  department-approved entity with which one or more counties

28  contract, for the purpose of administering an inclusive

29  regional trauma system.

30         (10)(11)  "Trauma alert victim" means a person who has

31  incurred a single or multisystem injury due to blunt or


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 1  penetrating means or burns, who requires immediate medical

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

 3  adult or pediatric scorecard criteria established by the

 4  department by rule.

 5         (11)(12)  "Trauma center" means a any hospital that has

 6  been verified determined by the department to be in

 7  substantial compliance with the requirements in s. 395.4025

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

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

10  center verification standards as either state-approved or

11  provisional state-approved.

12         (12)(13)  "Trauma scorecard" means a statewide

13  methodology adopted by the department by rule under which a

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

15  severity of his or her injuries or illness and which

16  methodology is used as the basis for making destination

17  decisions.

18         (13)(14)  "Trauma transport protocol" means a document

19  which describes the policies, processes, and procedures

20  governing the dispatch of vehicles, the triage, prehospital

21  transport, and interfacility trauma transfer of trauma

22  victims.

23         (14)(15)  "Trauma victim" means any person who has

24  incurred a single or multisystem injury due to blunt or

25  penetrating means or burns and who requires immediate medical

26  intervention or treatment.

27         Section 4.  Subsection (1) of section 395.401, Florida

28  Statutes, is amended to read:

29         395.401  Trauma services system plans; approval

30  verification of trauma centers and pediatric trauma referral

31  centers; procedures; renewal.--


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

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

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

 4  395.4045, which consist of organized patterns of readiness and

 5  response services based on public and private agreements and

 6  operational procedures. The department shall establish, by

 7  rule, processes and procedures for establishing a trauma

 8  agency and obtaining its approval from the department.

 9         (b)  The local and regional trauma agencies shall

10  develop and submit to the department plans for local and

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

12  minimum, the following components:

13         1.  The organizational structure of the trauma system.

14         2.  Prehospital care management guidelines for triage

15  and transportation of trauma cases.

16         3.  Flow patterns of trauma cases and transportation

17  system design and resources, including air transportation

18  services, provision for interfacility trauma transfer, and the

19  prehospital transportation of trauma victims. The trauma

20  agency shall plan for the development of a system of

21  transportation of trauma alert victims to trauma centers where

22  the distance or time to a trauma center or transportation

23  resources diminish access by trauma alert victims.

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

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

26  and distribution of resources.

27         5.  Data collection regarding system operation and

28  patient outcome.

29         6.  Periodic performance evaluation of the trauma

30  system and its components.

31  


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 1         7.  The use of air transport services within the

 2  jurisdiction of the local trauma agency.

 3         8.  Public information and education about the trauma

 4  system.

 5         9.  Emergency medical services communication system

 6  usage and dispatching.

 7         10.  The coordination and integration between the

 8  verified trauma center care facility and other acute care

 9  hospitals the nonverified health care facilities.

10         11.  Medical control and accountability.

11         12.  Quality control and system evaluation.

12         (c)  The department shall receive plans for the

13  implementation of inclusive trauma systems from trauma

14  agencies. The department may approve or not approve trauma

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

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

17  and definitions adopted by the department pursuant to those

18  sections. The department shall approve or disapprove the plans

19  within 120 days after the date the plans are submitted to the

20  department. The department shall, by rule, provide an

21  application process for establishing a trauma agency. The

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

23  trauma agency plan submitted for review, a process for

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

25  a process for reviewing the trauma transport protocols for the

26  trauma agency, and a process for reviewing the staffing

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

28  establish minimum requirements for a trauma agency to conduct

29  an annual performance evaluation and submit the results to the

30  department.

31  


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

 2  department has approved the local or regional trauma services

 3  system plan of the agency.

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

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

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

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

 8  the best interest of the persons served within the affected

 9  local or regional trauma area.

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

11  trauma care system only if the system meets the minimum

12  standards set forth in the rules for implementation

13  established by the department and if the plan has been

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

15  days before the local or regional trauma agency submits the

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

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

18  adequate notice of the public hearing to all hospitals and

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

20  proposed system.

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

22  contracts for the purpose of implementing the local or

23  regional plan. If local or regional agencies contract with

24  hospitals for trauma services, such agencies must contract

25  only with hospitals which are verified trauma centers.

26         (h)  Local or regional trauma agencies providing

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

28  formation, establish interlocal agreements between or among

29  the several counties in the regional system.

30  

31  


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

 2  health care facility to provide service for which it has

 3  received a license pursuant to this chapter.

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

 5  shall accept all trauma victims that are appropriate for the

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

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

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

 9  verified.

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

11  regional trauma agency, may adopt ordinances governing the

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

13  prehospital emergency medical personnel when the patient meets

14  specific criteria for trauma, burn, or pediatric centers

15  adopted by the local or regional trauma agency. These

16  ordinances must be consistent with s. 395.4045, ordinances

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

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

19  that individual patients receive appropriate medical care

20  while protecting the interests of the community at large by

21  making maximum use of available emergency medical care

22  resources.

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

24  consistent with the regional trauma system plan, coordinate

25  and otherwise facilitate arrangements necessary to develop a

26  trauma services system.

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

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

29  department for approval an updated plan that identifies the

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

31  


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

 2  trauma agency from adopting trauma care system standards.

 3         Section 5.  Section 395.4015, Florida Statutes, is

 4  amended to read:

 5         395.4015  State regional trauma planning; trauma

 6  regions.--

 7         (1)  The department shall establish a state trauma

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

 9  department shall establish trauma regions that which cover all

10  geographical areas of the state and have boundaries that are

11  coterminous with the boundaries of the regional domestic

12  security task forces established under s. 943.0312. These

13  regions may serve as the basis for the development of

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

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

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

17  accordance with public and private agreements and operational

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

19  department shall base its definition of the regions upon:

20         (a)  Geographical considerations so as to ensure rapid

21  access to trauma care by patients;

22         (b)  Historical patterns of patient referral and

23  transfer in an area;

24         (c)  Inventories of available trauma care resources;

25         (d)  Predicted population growth characteristics;

26         (e)  Transportation capabilities, including ground and

27  air transport;

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

29  and

30         (g)  Other appropriate criteria.

31  


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



 1         (2)  The department shall develop trauma systems plans

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

 3  minimum the following components:

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

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

 6  indicators developed by the department, as well as other

 7  relevant characteristics of the region.

 8         (b)  The organizational structure of the regional

 9  trauma system, including the identification of local trauma

10  agency service areas within the region.

11         (c)  Prehospital care management guidelines for triage

12  and transportation of trauma cases.

13         (d)  Flow patterns of trauma cases and transportation

14  system design and resources, including air transportation

15  services, provision for interfacility trauma transfer, and the

16  prehospital transportation of trauma victims. The department

17  shall plan for the development of a system of transportation

18  of trauma alert victims to trauma centers where the distance

19  or time to a trauma center or transportation resources

20  diminish access by trauma alert victims.

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

22  and geographic location of trauma cases expected so as to

23  assure that the assessed current and future trauma care needs

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

25  trauma centers will maintain the volume of cases sufficient to

26  provide quality care to trauma cases referred to them.

27         (f)  The availability of qualified health

28  professionals, including physicians and surgeons, capable of

29  staffing trauma centers to the level of current and future

30  assessed needs.

31  


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



 1         (g)  Data collection regarding system operation and

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

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

 4  needs of the population.

 5         (h)  Periodic performance evaluation of the trauma

 6  system and its components.

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

 8  available and needed in each region.

 9         (j)  Public information and education about the trauma

10  system.

11         (k)  Emergency medical services communication system

12  usage and dispatching.

13         (l)  The coordination and integration between the

14  trauma centers and other health care facilities which may

15  provide services to trauma victims.

16         (m)  Medical control and accountability.

17         (n)  Quality management and system evaluation.

18         (2)(3)  The department shall consider the advice and

19  recommendations of any affected local or regional trauma

20  agency in developing the state trauma system systems plan. The

21  department may, in lieu of specific regional components of its

22  own plan, accept components developed by local or regional

23  trauma agencies.

24         (3)(4)  The department shall use the state trauma

25  system plan as the basis for establishing a statewide

26  inclusive trauma system.

27         Section 6.  Section 395.402, Florida Statutes, is

28  amended to read:

29         395.402  Trauma service areas; number and location of

30  trauma centers.--

31  


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



 1         (1)  The Legislature recognizes the need for a

 2  statewide, cohesive, uniform, and integrated trauma system.

 3  Within the trauma service areas, that Level I and Level II

 4  trauma centers shall should each be capable of annually

 5  treating a minimum of 1,000 and 500 patients, respectively,

 6  with an injury severity score (ISS) of 9 or greater. Level II

 7  trauma centers in counties with a population of more than

 8  500,000 shall have the capacity to care for 1,000 patients per

 9  year. Further, the Legislature finds that, based on the

10  numbers and locations of trauma victims with these injury

11  severity scores, there should be 19 trauma service areas in

12  the state, and, at a minimum, there should be at least one

13  trauma center in each service area.

14         (2)  It is the intent of the Legislature that, as a

15  planning guideline, Level I and Level II trauma centers should

16  generally each provide care annually to a minimum of 1,000 and

17  500 patients, respectively. Level II trauma centers in

18  counties of more than 500,000 population are expected to be

19  able to care for 1,000 patients per year, as a planning

20  guideline.

21         (2)(3)  Trauma service areas as defined in this section

22  are to be utilized until the Department of Health completes an

23  assessment of the trauma system and reports its finding to the

24  Governor, the President of the Senate, the Speaker of the

25  House of Representatives, and the substantive legislative

26  committees. The report shall be submitted by February 1, 2005.

27  The department shall review the existing trauma system and

28  determine whether it is effective in providing trauma care

29  uniformly throughout the state. The assessment shall:

30         (a)  Consider aligning trauma service areas within the

31  trauma region boundaries as established in July 2004.


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



 1         (b)  Review the number and level of trauma centers

 2  needed for each trauma service area to provide a statewide

 3  integrated trauma system.

 4         (c)  Establish criteria for determining the number and

 5  level of trauma centers needed to serve the population in a

 6  defined trauma service area or region.

 7         (d)  Consider including a criteria within trauma center

 8  approval standards based upon the number of trauma victims

 9  served within a service area.

10         (e)  Review the Regional Domestic Security Task Force

11  structure and determine whether integrating the trauma system

12  planning with interagency regional emergency and disaster

13  planning efforts is feasible and identify any duplication of

14  efforts between the two entities.

15         (f)  Make recommendations regarding a continued revenue

16  source which shall include a local participation requirement.

17         (g)  Make recommendations regarding a formula for the

18  distribution of funds identified for trauma centers which

19  shall address incentives for new centers where needed and the

20  need to maintain effective trauma care in areas served by

21  existing centers, with consideration for the volume of trauma

22  patients served, and the amount of charity care provided.

23         (3)  In conducting such assessment and subsequent

24  annual reviews, the department shall consider:

25         (a)  The recommendations made as part of the regional

26  trauma system plans submitted by regional trauma agencies.

27         (b)  Stakeholder recommendations.

28         (c)  The geographical composition of an area to ensure

29  rapid access to trauma care by patients.

30         (d)  Historical patterns of patient referral and

31  transfer in an area.


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



 1         (e)  Inventories of available trauma care resources,

 2  including professional medical staff.

 3         (f)  Population growth characteristics.

 4         (g)  Transportation capabilities, including ground and

 5  air transport.

 6         (h)  Medically appropriate ground and air travel times.

 7         (i)  Recommendations of the Regional Domestic Security

 8  Task Force.

 9         (j)  The actual number of trauma victims currently

10  being served by each trauma center.

11         (k)  Other appropriate criteria.

12         (4)  Annually thereafter, used. the department shall

13  periodically review the assignment of the 67 counties to

14  trauma service areas, in addition to the requirements of

15  paragraphs (2)(b)-(g) and subsection (3). County These

16  assignments are made for the purpose of developing a system of

17  trauma centers. Revisions made by the department shall should

18  take into consideration the recommendations made as part of

19  the regional trauma system plans approved by the department,

20  and as well as the recommendations made as part of the state

21  trauma system plan. In cases where a trauma service area is

22  located within the boundaries of more than one trauma region,

23  the trauma service area's needs, response capability, and

24  system requirements shall be considered by each trauma region

25  served by that trauma service area in its regional system plan

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

27  and every 5 years thereafter. Until the department completes

28  the February 2005 assessment its initial review, the

29  assignment of counties shall remain as established in this

30  section pursuant to chapter 90-284, Laws of Florida.

31  


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



 1         (a)  The following trauma service areas are hereby

 2  established:

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

 4  Okaloosa, Santa Rosa, and Walton Counties.

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

 6  Holmes, and Washington Counties.

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

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

 9  Taylor, and Wakulla Counties.

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

11  Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette,

12  Levy, Putnam, Suwannee, and Union Counties.

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

14  Duval, Nassau, and St. Johns Counties.

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

16  Hernando, and Marion Counties.

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

18  Volusia Counties.

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

20  Orange, Osceola, Seminole, and Sumter Counties.

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

22  Pinellas Counties.

23         10.  Trauma service area 10 shall consist of

24  Hillsborough County.

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

26  Highlands, and Polk Counties.

27         12.  Trauma service area 12 shall consist of Brevard

28  and Indian River Counties.

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

30  Manatee, and Sarasota Counties.

31  


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



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

 2  Okeechobee, and St. Lucie Counties.

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

 4  Glades, Hendry, and Lee Counties.

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

 6  County.

 7         17.  Trauma service area 17 shall consist of Collier

 8  County.

 9         18.  Trauma service area 18 shall consist of Broward

10  County.

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

12  Monroe Counties.

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

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

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

16  each trauma service area.

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

18  state-sponsored trauma centers in the state.

19         Section 7.  Section 395.4025, Florida Statutes, is

20  amended to read:

21         395.4025  State-approved Trauma centers; selection;

22  quality assurance; records.--

23         (1)  For purposes of developing a system of

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

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

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

27  local or regional trauma services system plan, and

28  recommendations of the local or regional trauma agency, and

29  the 1990 Report and Proposal for Funding State-Sponsored

30  Trauma Centers, the department shall establish the approximate

31  number of state-approved trauma centers needed to ensure


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



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

 2  the guidelines and procedures outlined in the 1990 report,

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

 4  the department shall select those hospitals that are to be

 5  recognized as state-approved trauma centers and shall include

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

 7  subsequently, subject to specific programmatic and quality of

 8  care standards.

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

10  care general hospital and each local and each regional trauma

11  agency in the state that the department is accepting letters

12  of intent from hospitals that are interested in becoming

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

14  the department, a hospital that operates within the geographic

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

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

17  consistent with the trauma services plan of the local or

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

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

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

21  hospital that is a provisional or verified trauma center on

22  January 1, 1992.

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

24  hospitals that submitted a letter of intent an application

25  package that will provide the hospitals with instructions for

26  submitting information to the department for selection as a

27  state-approved trauma center. The standards for verification

28  of trauma centers and pediatric trauma referral centers

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

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

31  


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    ENROLLED

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

 2  applications from those hospitals seeking selection as

 3  state-approved trauma centers, including those current

 4  verified trauma centers that seek a change or redesignation in

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

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

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

 8  provisional review of each application for the purpose of

 9  determining that the hospital's application is complete and

10  that the hospital has the critical elements required for a

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

12  based on trauma center verification standards and shall

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

14  hospital has:

15         1.  Equipment and physical facilities necessary to

16  provide trauma services.

17         2.  Personnel in sufficient numbers and with proper

18  qualifications to provide trauma services.

19         3.  An effective quality assurance process.

20         4.  Submitted written confirmation by the local or

21  regional trauma agency that the verification of the hospital

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

23  consistent with the plan of the local or regional trauma

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

25  This subparagraph applies to any hospital that is not a

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

27         (d)1.  Notwithstanding other provisions in this

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

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

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

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


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



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

 2  service area allocation, as provided by rule of the

 3  department. An applicant that is granted additional time

 4  pursuant to this paragraph shall submit a plan for

 5  departmental approval which includes timelines and activities

 6  that the applicant proposes to complete in order to meet

 7  application requirements. Any applicant that demonstrates an

 8  ongoing effort to complete the activities within the timelines

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

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

11  has conducted a provisional review of the application and has

12  determined that the application is complete and that the

13  hospital has the critical elements required for a

14  state-approved trauma center.

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

16  stayed until the department determines that the application is

17  complete and that the hospital has the critical elements

18  required for a state-approved trauma center.

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

20  application found acceptable by the department based on

21  provisional review, including all trauma centers verified as

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

23  provisional state-approved trauma center.

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

25  department shall conduct an in-depth evaluation of all

26  applications found acceptable in the provisional review. The

27  applications shall be evaluated against criteria enumerated in

28  the application packages as provided to the hospitals by the

29  department.

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

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


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



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

 2  onsite visits to all provisional state-approved trauma

 3  centers. The department shall develop a survey instrument to

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

 5  include objective criteria and guidelines for reviewers based

 6  on existing trauma center and pediatric trauma referral center

 7  verification standards such that all trauma centers and

 8  pediatric trauma referral centers are assessed equally. The

 9  survey instrument shall also include a uniform rating system

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

11  compliance of each trauma center with specific standards, and

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

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

14  hospitals being considered as provisional state-approved

15  trauma centers shall meet all the requirements of a verified

16  trauma center or pediatric trauma referral center, and shall

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

18  trauma center.

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

20  department shall select state-approved trauma centers by July

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

22  center or a state-approved pediatric trauma referral center

23  may request an extension of its provisional status if it

24  submits a corrective action plan to the department. The

25  corrective action plan must demonstrate the ability of the

26  applicant to correct deficiencies noted during the applicant's

27  onsite review conducted by the department between the previous

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

29  provisional status of an applicant for designation as a

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

31  trauma referral center through December 31 if the applicant


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



 1  provides a corrective action plan acceptable to the

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

 3  assembled by the department shall conduct an onsite visit on

 4  or before November 1 to confirm that the deficiencies have

 5  been corrected. The provisional state-approved trauma center

 6  or the provisional state-approved pediatric trauma referral

 7  center is responsible for all costs associated with the onsite

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

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

10  of any provisional applicant granted an extension. Each

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

12  approval verification period during which time it must

13  continue to maintain trauma center verification standards and

14  acceptable patient outcomes as determined by department rule.

15  An approval A verification, unless sooner suspended or

16  revoked, automatically expires 7 years after the date of

17  issuance and is renewable upon application for renewal as

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

19  those hospitals selected as state-approved trauma centers may

20  operate as trauma centers.

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

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

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

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

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

26  subsection shall be conducted in the same manner as provided

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

28  combine all disputes between parties.

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

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

31  state-approved trauma center may not terminate or


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



 1  substantially reduce the availability of trauma service

 2  without providing at least 180 days' 6 months' notice of its

 3  intent to terminate such service. Such notice shall be given

 4  to the department of Health, to all affected local or regional

 5  trauma agencies, and to all state-approved trauma centers,

 6  hospitals, and emergency medical service providers in the

 7  trauma service area. The department shall adopt by rule the

 8  procedures and process for notification, duration, and

 9  explanation of the termination of trauma services.

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

11  the department or its agent may collect trauma care and

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

13  trauma centers, pediatric trauma referral centers, hospitals,

14  emergency medical service providers, local or regional trauma

15  agencies, or medical examiners for the purposes of evaluating

16  trauma system effectiveness, ensuring compliance with the

17  standards of verification, and monitoring patient outcomes. A

18  trauma center, pediatric trauma referral center, hospital,

19  emergency medical service provider, medical examiner, or local

20  trauma agency or regional trauma agency, or a panel or

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

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

23  care quality assurance proceedings, records, or reports.

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

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

26  such an agency to disclose to the department patient care

27  quality assurance proceedings, records, or reports that the

28  department needs solely to conduct quality assurance

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

30  quality assurance component of the trauma agency's plan

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


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



 1  proceedings, records, or reports that the department may

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

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

 4  quality assurance activities, and any recommendation for

 5  improving or modifying the overall trauma system, if the

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

 7  hospital, emergency medical service provider, medical

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

 9  disclosed.

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

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

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

13  agent of the department under this subsection is not liable

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

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

16  scope of the authority and responsibility assigned by the

17  department.

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

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

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

21  centers, pediatric trauma referral centers, hospitals,

22  emergency medical service providers, local or regional trauma

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

24  treatment, or examination of trauma patients.

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

26  reports, or patient care quality assurance proceedings,

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

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

29  395.403, s. 395.404, s. 395.4045, s. 395.405, s. 395.50, or s.

30  395.51 must be held confidential by the department or its

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


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



 1  Patient care quality assurance proceedings, records, or

 2  reports obtained or made pursuant to these sections are not

 3  subject to discovery or introduction into evidence in any

 4  civil or administrative action.

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

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

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

 8  selecting state-approved trauma centers and must be consistent

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

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

11  applicants within a service area and the department to reduce

12  the timeframes.

13         (14)  Notwithstanding any other provisions of this

14  section and rules adopted pursuant to this section, until the

15  department has conducted the review provided under s. 395.402,

16  only hospitals located in trauma services areas where there is

17  no existing trauma center may apply.

18         Section 8.  Section 395.403, Florida Statutes, is

19  amended to read:

20         395.403  Reimbursement of state-sponsored trauma

21  centers.--

22         (1)  The Legislature finds that many hospitals which

23  provide services to trauma victims are not adequately

24  compensated for such treatment. The Legislature also

25  recognizes that the current verified trauma centers are

26  providing such services without adequate reimbursement.

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

28  financial support to the current verified trauma centers and

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

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

31  Legislature that this system of state-sponsored trauma centers


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



 1  be assisted financially based on the volume and acuity of

 2  uncompensated trauma care provided.

 3         (1)(2)  All provisional trauma centers and

 4  state-approved trauma centers shall be considered eligible to

 5  receive state funding state-sponsored trauma centers when

 6  state funds are specifically appropriated for state-sponsored

 7  trauma centers in the General Appropriations Act. Effective

 8  July 1, 2004, the department shall make one-time payments from

 9  the Administrative Trust Fund under s. 20.435 to the trauma

10  centers and a hospital with a pending application for a Level

11  I trauma center in recognition of the capital investment made

12  by the hospital to establish the trauma service. Payments

13  shall be in equal amounts for the trauma centers approved by

14  the department as of July 1 of the fiscal year in which

15  funding is appropriated, with lesser amounts for the hospital

16  with an application pending for a Level I trauma center at the

17  department as of April 1, 2004. In the event a trauma center

18  does not maintain its status as a trauma center for any state

19  fiscal year in which such funding is appropriated, the

20  provisional trauma center or trauma center shall repay the

21  state for the portion of the year during which it was not a

22  trauma center.

23         (2)  Provisional trauma centers and trauma centers

24  eligible to receive distributions from the Administrative

25  Trust Fund under s. 20.435 in accordance with subsection (1)

26  may request that such funds be used as intergovernmental

27  transfer funds in the Medicaid program.

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

29  center shall submit a claim electronically via the Trauma

30  Claims Processing System, designed, developed, implemented,

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


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    ENROLLED

    2004 Legislature                 CS for SB 1762, 2nd Engrossed



 1  department's Medicaid program upon discharge of a trauma

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

 3  separate hospital claim shall be submitted for the hospital

 4  days incurred in each fiscal year.

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

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

 7  the submission of a claim.

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

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

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

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

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

13  that patient.

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

15  appropriate documentation showing a trauma patient's

16  eligibility for state funding. Documentation recognized by the

17  department as appropriate shall be limited to one of the

18  following:

19         1.  W-2 withholding forms.

20         2.  Payroll stubs.

21         3.  Income tax returns.

22         4.  Forms approving or denying unemployment

23  compensation or workers' compensation.

24         5.  Written verification of wages from employer.

25         6.  Written verification from public welfare agencies

26  or any other governmental agency which can attest to the

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

28         7.  A witnessed statement signed by the patient or

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

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

31  statement need not be obtained within 48 hours of the


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

 2  Hill-Burton Act. The statement shall include acknowledgment

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

 4  information to defraud a hospital for the purposes of

 5  obtaining goods or services is a misdemeanor of the second

 6  degree.

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

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

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

10  funding was only provided for eligible trauma patients and

11  medically necessary services.

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

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

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

15  Trauma Services Trust Fund. Trauma patients who are eligible

16  for the Medicaid program shall not be considered eligible for

17  the state-sponsored trauma center program except for Medicaid

18  noncovered services. If a claim is denied by the Trauma Claims

19  Processing System as a result of Medicaid eligibility for

20  Medicaid covered services, the hospital shall submit a claim

21  to the Medicaid fiscal agent for payment.

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

23  $860 to provisional state-approved and state-approved trauma

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

25  of funding, after which time payment to provisional

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

27  based on a trauma cost-based reimbursement methodology

28  developed by the department. The department shall consult with

29  representatives from the hospital industry including the

30  Florida Hospital Association, the Association of Voluntary

31  


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

 2  the development of the reimbursement methodology.

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

 4  appropriated for state-sponsored trauma centers and to ensure

 5  that no state-sponsored trauma center gains an unfair

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

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

 8  state funds appropriated in the General Appropriations Act for

 9  this section shall be divided into 19 trauma fund accounts

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

11  395.402(3).  The amount of funds distributed to a service area

12  shall be based on the following formula: 

13  

14              SAAA =   SATD   x TA

15                       TTD

16  

17  where:

18         SAAA = service area appropriation amount.

19         SATD = uncompensated service area trauma days with ISS

20  score of 9 or greater.

21         TTD = uncompensated total trauma days with ISS score of

22  9 or greater for all 19 service areas.

23         TA = total dollars appropriated for state-sponsored

24  trauma centers.

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

26  be the detailed patient discharge data of the most recently

27  completed calendar year for which the board possesses data.

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

29  allocated to the service area where the treating hospital is

30  located.

31  


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    2004 Legislature                 CS for SB 1762, 2nd Engrossed



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

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

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

 4  trauma centers proportionately based on volume and acuity of

 5  uncompensated trauma care provided during the most recently

 6  completed calendar year for which the board possesses data in

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

 8  These trauma centers shall submit claims pursuant to

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

10  months after funding becomes available, any trauma center

11  which fails to submit claims for reimbursement equal to or

12  greater than the amount the trauma center received under the

13  initial allocation shall return any unearned funds to the

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

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

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

17  original allocation.

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

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

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

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

22  service area on a pro rata basis.

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

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

25  trauma account from which all remaining claims are paid

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

27  funds are depleted.

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

29  patient residing outside the trauma service area of the

30  state-sponsored trauma center where the patient is treated

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


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    2004 Legislature                 CS for SB 1762, 2nd Engrossed



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

 2  shall be paid from the service area where the treating

 3  hospital is located.

 4         (3)(7)  In order to receive state funding payments

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

 6  trauma center and shall:

 7         (a)  Agree to conform to all departmental requirements

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

 9         (b)  Agree to provide information concerning the

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

11  manner prescribed by rule of the department.

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

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

14         (4)(8)  A state-sponsored trauma center that which

15  fails to comply with any of the conditions listed in

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

17  shall not receive payments under this section for the period

18  in which it was not in compliance.

19         Section 9.  Section 401.24, Florida Statutes, is

20  amended to read:

21         401.24  Emergency medical services state plan.--The

22  department is responsible, at a minimum, for the improvement

23  and regulation of basic and advanced life support programs.

24  The department shall develop and biennially revise a

25  comprehensive state plan for basic and advanced life support

26  services, the emergency medical services grants program,

27  state-approved trauma centers, state-approved pediatric trauma

28  referral centers, the injury control program, and medical

29  disaster preparedness. The state plan shall include, but need

30  not be limited to:

31  


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    2004 Legislature                 CS for SB 1762, 2nd Engrossed



 1         (1)  Emergency medical systems planning, including the

 2  prehospital and hospital phases of patient care, and injury

 3  control effort and unification of such services into a total

 4  delivery system to include air, water, and land services.

 5         (2)  Requirements for the operation, coordination, and

 6  ongoing development of emergency medical services, which

 7  includes: basic life support or advanced life support

 8  vehicles, equipment, and supplies; communications; personnel;

 9  training; public education; state trauma system; injury

10  control; and other medical care components.

11         (3)  The definition of areas of responsibility for

12  regulating and planning the ongoing and developing delivery

13  service requirements.

14         Section 10.  The sum of $300,000 is appropriated from

15  the General Revenue Fund to the Administrative Trust Fund for

16  the Department of Health to contract with a state university

17  to conduct the study required under section 395.402, Florida

18  Statutes.

19         Section 11.  The sum of $20,700,000 is appropriated

20  from the General Revenue Fund to the Administrative Trust Fund

21  for the the Department of Health to provide equal funding for

22  each existing trauma center as of July 1, 2004, and an amount

23  not to exceed 70 percent of the amount received by an existing

24  trauma center for a hospital with a Level I trauma center

25  application pending with the department as of April 1, 2004.

26         Section 12.  This act shall take effect July 1, 2004.

27  

28  

29  

30  

31  


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