HB 1911

1	A bill to be entitled
2	An act relating to trauma regions; amending s. 395.4015,
3	F.S.; requiring that trauma region boundaries be
4	coterminous with the boundaries of the regional domestic
5	security task forces; providing an exception; removing
6	other requirements for such boundaries; deleting the
7	authority to accept state trauma system plan components
8	developed by other entities; amending s. 395.402, F.S.;
9	providing additional legislative intent with respect to
10	trauma service areas; providing a treatment capacity for
11	certain trauma centers; providing that current trauma
12	service areas shall be used until the Department of Health
13	completes an assessment of the trauma system; requiring a
14	report; providing guidelines for such assessment;
15	requiring annual review; amending s. 395.40, F.S.;
16	requiring an annual update of the state trauma system
17	plan; amending s. 395.403, F.S.; correcting a cross
18	reference; providing an effective date.
19
20	Be It Enacted by the Legislature of the State of Florida:
21
22	Section 1.  Section 395.4015, Florida Statutes, is amended
23	to read:
24	395.4015  State regional trauma planning; trauma regions.--
25	(1)  The department shall establish a state trauma system
26	plan. As part of the state trauma system plan, the department
27	shall establish trauma regions that which cover all geographical
28	areas of the state and have boundaries that are coterminous with
29	the boundaries of the regional domestic security task forces
30	established under s. 943.0312. However, the delivery of trauma
31	services by or in coordination with a trauma agency established
32	before July 1, 2004, may continue in accordance with any public
33	or private agreements and operational procedures entered into as
34	provided in s. 395.401. These regions may serve as the basis for
35	the development of department-approved local or regional trauma
36	plans. The department shall base its definition of the regions
37	upon:
38	(a)  Geographical considerations so as to ensure rapid
39	access to trauma care by patients;
40	(b)  Historical patterns of patient referral and transfer
41	in an area;
42	(c)  Inventories of available trauma care resources;
43	(d)  Predicted population growth characteristics;
44	(e)  Transportation capabilities, including ground and air
45	transport;
46	(f)  Medically appropriate ground and air travel times; and
47	(g)  Other appropriate criteria.
48	(2)  The department shall develop trauma systems plans for
49	the department-defined trauma regions which include at a minimum
50	the following components:
51	(a)  An assessment of current and future trauma care needs
52	of the population, based upon incidence rates and acuity
53	indicators developed by the department, as well as other
54	relevant characteristics of the region.
55	(b)  The organizational structure of the regional trauma
56	system, including the identification of local trauma agency
57	service areas within the region.
58	(c)  Prehospital care management guidelines for triage and
59	transportation of trauma cases.
60	(d)  Flow patterns of trauma cases and transportation
61	system design and resources, including air transportation
62	services, provision for interfacility trauma transfer, and the
63	prehospital transportation of trauma victims. The department
64	shall plan for the development of a system of transportation of
65	trauma alert victims to trauma centers where the distance or
66	time to a trauma center or transportation resources diminish
67	access by trauma alert victims.
68	(e)  The current and projected number, acuity level, and
69	geographic location of trauma cases expected so as to assure
70	that the assessed current and future trauma care needs of the
71	population are adequately met and that state-sponsored trauma
72	centers will maintain the volume of cases sufficient to provide
73	quality care to trauma cases referred to them.
74	(f)  The availability of qualified health professionals,
75	including physicians and surgeons, capable of staffing trauma
76	centers to the level of current and future assessed needs.
77	(g)  Data collection regarding system operation and patient
78	outcome, as well as the number, type, and generalized locations
79	of state-sponsored trauma centers needed to meet the needs of
80	the population.
81	(h)  Periodic performance evaluation of the trauma system
82	and its components.
83	(i)  The type and extent of air transport services
84	available and needed in each region.
85	(j)  Public information and education about the trauma
86	system.
87	(k)  Emergency medical services communication system usage
88	and dispatching.
89	(l)  The coordination and integration between the trauma
90	centers and other health care facilities which may provide
91	services to trauma victims.
92	(m)  Medical control and accountability.
93	(n)  Quality management and system evaluation.
94	(2)(3)  The department shall consider the advice and
95	recommendations of any affected local or regional trauma agency
96	in developing the state trauma systems plan. The department may,
97	in lieu of specific regional components of its own plan, accept
98	components developed by local or regional trauma agencies.
99	(3)(4)  The department shall use the state trauma system
100	plan as the basis for establishing a statewide inclusive trauma
101	system.
102	Section 2.  Section 395.402, Florida Statutes, is amended
103	to read:
104	395.402  Trauma service areas; number and location of
105	trauma centers.--
106	(1)  The Legislature recognizes the need for a statewide,
107	cohesive, uniform, and integrated trauma system. Within the
108	trauma service areas, that Level I and Level II trauma centers
109	shall should each be capable of annually treating a minimum of
110	1,000 and 500 patients, respectively, with an injury severity
111	score (ISS) of 9 or greater. Level II trauma centers in counties
112	with a population of more than 500,000 shall have the capacity
113	to care for a minimum of 1,000 patients per year. Further, the
114	Legislature finds that, based on the numbers and locations of
115	trauma victims with these injury severity scores, there should
116	be 19 trauma service areas in the state, and, at a minimum,
117	there should be at least one trauma center in each service area.
118	(2)  It is the intent of the Legislature that, as a
119	planning guideline, Level I and Level II trauma centers should
120	generally each provide care annually to a minimum of 1,000 and
121	500 patients, respectively. Level II trauma centers in counties
122	of more than 500,000 population are expected to be able to care
123	for 1,000 patients per year, as a planning guideline.
124	(2)(3)  Trauma service areas as described in this section
125	are to be utilized until the Department of Health completes an
126	assessment of the trauma system and reports its findings to the
127	Governor, the President of the Senate, the Speaker of the House
128	of Representatives, and the substantive legislative committees.
129	The report shall be submitted by December 1, 2004. The
130	department shall review the existing trauma system and determine
131	whether it is effective in providing trauma care uniformly
132	throughout the state. The assessment shall:
133	(a)  Consider aligning trauma service areas within the
134	trauma region boundaries as established in July 2004.
135	(b)  Review the number and level of trauma centers needed
136	for each trauma service area to provide a statewide integrated
137	trauma system.
138	(c)  Establish criteria for determining the number and
139	level of trauma centers needed to serve the population in a
140	defined trauma service area or region.
141	(d)  Consider including a criteria within trauma center
142	verification standards based upon the number of trauma victims
143	served within a service area.
144	(e)  Review the Regional Domestic Security Task Force
145	structure and determine whether integrating the trauma system
146	planning with interagency regional emergency and disaster
147	planning efforts is feasible and identify any duplication of
148	efforts between the two entities.
149	(3)  In conducting this assessment and subsequent annual
150	reviews, the department shall consider:
151	(a)  The recommendations made as part of the regional
152	trauma system plans submitted by regional trauma agencies.
153	(b)  Stakeholder recommendations.
154	(c)  The geographical composition of an area to ensure
155	rapid access to trauma care by patients.
156	(d)  Historical patterns of patient referral and transfer
157	in an area.
158	(e)  Inventories of available trauma care resources,
159	including professional medical staff.
160	(f)  Population growth characteristics.
161	(g)  Transportation capabilities, including ground and air
162	transport.
163	(h)  Medically appropriate ground and air travel times.
164	(i)  Recommendations of the Regional Domestic Security Task
165	Force.
166	(j)  The actual number of trauma victims currently being
167	served by each trauma center.
168	(k)  Other appropriate criteria.
169	(4)  Annually thereafter, used. the department shall
170	periodically review the assignment of the 67 counties to trauma
171	service areas, in addition to the requirements of paragraphs
172	(2)(b)-(e) and subsection (3). County These assignments are made
173	for the purpose of developing a system of trauma centers.
174	Revisions made by the department shall should take into
175	consideration the recommendations made as part of the regional
176	trauma system plans approved by the department, and as well as
177	the recommendations made as part of the state trauma system
178	plan. In cases where a trauma service area is located within the
179	boundaries of more than one trauma region, the trauma service
180	area's needs, response capability, and system requirements shall
181	be considered by each trauma region served by that trauma
182	service area in its regional system plan These areas must, at a
183	minimum, be reviewed in the year 2000 and every 5 years
184	thereafter. Until the department completes the December 2004
185	assessment its initial review, the assignment of counties shall
186	remain as established in this section pursuant to chapter 90-
187	284, Laws of Florida.
188	(a)  The following trauma service areas are hereby
189	established:
190	1.  Trauma service area 1 shall consist of Escambia,
191	Okaloosa, Santa Rosa, and Walton Counties.
192	2.  Trauma service area 2 shall consist of Bay, Gulf,
193	Holmes, and Washington Counties.
194	3.  Trauma service area 3 shall consist of Calhoun,
195	Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison,
196	Taylor, and Wakulla Counties.
197	4.  Trauma service area 4 shall consist of Alachua,
198	Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy,
199	Putnam, Suwannee, and Union Counties.
200	5.  Trauma service area 5 shall consist of Baker, Clay,
201	Duval, Nassau, and St. Johns Counties.
202	6.  Trauma service area 6 shall consist of Citrus,
203	Hernando, and Marion Counties.
204	7.  Trauma service area 7 shall consist of Flagler and
205	Volusia Counties.
206	8.  Trauma service area 8 shall consist of Lake, Orange,
207	Osceola, Seminole, and Sumter Counties.
208	9.  Trauma service area 9 shall consist of Pasco and
209	Pinellas Counties.
210	10.  Trauma service area 10 shall consist of Hillsborough
211	County.
212	11.  Trauma service area 11 shall consist of Hardee,
213	Highlands, and Polk Counties.
214	12.  Trauma service area 12 shall consist of Brevard and
215	Indian River Counties.
216	13.  Trauma service area 13 shall consist of DeSoto,
217	Manatee, and Sarasota Counties.
218	14.  Trauma service area 14 shall consist of Martin,
219	Okeechobee, and St. Lucie Counties.
220	15.  Trauma service area 15 shall consist of Charlotte,
221	Glades, Hendry, and Lee Counties.
222	16.  Trauma service area 16 shall consist of Palm Beach
223	County.
224	17.  Trauma service area 17 shall consist of Collier
225	County.
226	18.  Trauma service area 18 shall consist of Broward
227	County.
228	19.  Trauma service area 19 shall consist of Dade and
229	Monroe Counties.
230	(b)  Each trauma service area should have at least one
231	Level I or Level II trauma center. The department shall
232	allocate, by rule, the number of trauma centers needed for each
233	trauma service area.
234	(c)  There shall be no more than a total of 44 state-
235	sponsored trauma centers in the state.
236	Section 3.  Subsection (6) of section 395.40, Florida
237	Statutes, is amended to read:
238	395.40  Legislative findings and intent.--
239	(6)  Furthermore, the Legislature encourages the department
240	to actively foster the provision of trauma care and serve as a
241	catalyst for improvements in the process and outcome of the
242	provision of trauma care in an inclusive trauma system. Among
243	other considerations, the department is required encouraged to:
244	(a)  Promote the development of at least one trauma center
245	in every trauma service area.
246	(b)  Promote the development of a trauma agency for each
247	trauma region.
248	(c)  Update the state trauma system plan by December 2004
249	2000 and at least annually every 5th year thereafter.
250	Section 4.  Paragraph (a) of subsection (6) of section
251	395.403, Florida Statutes, is amended to read:
252	395.403  Reimbursement of state-sponsored trauma centers.--
253	(6)(a)  To ensure a fair distribution of funds appropriated
254	for state-sponsored trauma centers and to ensure that no state-
255	sponsored trauma center gains an unfair advantage due solely to
256	its ability to bill more quickly than another state-sponsored
257	trauma center, the total amount of state funds appropriated in
258	the General Appropriations Act for this section shall be divided
259	into 19 trauma fund accounts with an account for each service
260	area established in s. 395.402(2)(3). The amount of funds
261	distributed to a service area shall be based on the following
262	formula:
	SAAA= SATDTTD x TA
263
264	where:
265	SAAA = service area appropriation amount.
266	SATD = uncompensated service area trauma days with ISS
267	score of 9 or greater.
268	TTD = uncompensated total trauma days with ISS score of 9
269	or greater for all 19 service areas.
270	TA = total dollars appropriated for state-sponsored trauma
271	centers.
272	Section 5.  This act shall take effect July 1, 2004.

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