HB 2005

1	A bill to be entitled
2	An act relating to trauma care; amending s. 212.055, F.S.;
3	authorizing certain counties to levy a surtax to fund
4	trauma services by ordinance, subject to referendum
5	approval; amending s. 395.40, F.S.; requiring the
6	Department of Health to promote development of trauma
7	centers and agencies; requiring the department to update
8	the trauma system annually; amending s. 395.4001, F.S.;
9	revising definitions; amending ss. 395.401 and 401.24,
10	F.S.; removing references to center verification, referral
11	centers, and state-approved centers; amending s. 395.4015,
12	F.S.; providing boundaries for the state trauma system
13	plan; deleting requirements for defining a region;
14	amending s. 395.402, F.S.; revising legislative intent;
15	requiring the department to perform an assessment of the
16	trauma system and report its findings to the Governor and
17	Legislature; providing guidelines for such assessment and
18	annual reviews; requiring annual reviews; amending s.
19	395.4025, F.S.; deleting outdated provisions; providing
20	for centers that seek a change or redesignation in
21	approval status; amending s. 395.403, F.S.; removing
22	legislative intent; providing for funding of trauma
23	centers; requiring the department to recommend an
24	effective grant program to the Governor and the
25	Legislature by a certain date; deleting other funding
26	guidelines; providing appropriations; providing an
27	effective date.
28
29	Be It Enacted by the Legislature of the State of Florida:
30
31	Section 1.  Subsection (4) of section 212.055, Florida
32	Statutes, is amended to read:
33	212.055  Discretionary sales surtaxes; legislative intent;
34	authorization and use of proceeds.--It is the legislative intent
35	that any authorization for imposition of a discretionary sales
36	surtax shall be published in the Florida Statutes as a
37	subsection of this section, irrespective of the duration of the
38	levy. Each enactment shall specify the types of counties
39	authorized to levy; the rate or rates which may be imposed; the
40	maximum length of time the surtax may be imposed, if any; the
41	procedure which must be followed to secure voter approval, if
42	required; the purpose for which the proceeds may be expended;
43	and such other requirements as the Legislature may provide.
44	Taxable transactions and administrative procedures shall be as
45	provided in s. 212.054.
46	(4)  INDIGENT CARE AND TRAUMA CENTER SURTAX.--
47	(a)1.  The governing body in each county the government of
48	which is not consolidated with that of one or more
49	municipalities, which has a population of at least 800,000
50	residents and is not authorized to levy a surtax under
51	subsection (5), may levy, pursuant to an ordinance either
52	approved by an extraordinary vote of the governing body or
53	conditioned to take effect only upon approval by a majority vote
54	of the electors of the county voting in a referendum, a
55	discretionary sales surtax at a rate that may not exceed 0.5
56	percent.
57	2.(b)  If the ordinance is conditioned on a referendum, a
58	statement that includes a brief and general description of the
59	purposes to be funded by the surtax and that conforms to the
60	requirements of s. 101.161 shall be placed on the ballot by the
61	governing body of the county. The following questions shall be
62	placed on the ballot:
63
64	FOR THE. . . .CENTS TAX
65	AGAINST THE. . . .CENTS TAX
66
67	3.(c)  The ordinance adopted by the governing body
68	providing for the imposition of the surtax shall set forth a
69	plan for providing health care services to qualified residents,
70	as defined in subparagraph 4. paragraph (d). Such plan and
71	subsequent amendments to it shall fund a broad range of health
72	care services for both indigent persons and the medically poor,
73	including, but not limited to, primary care and preventive care
74	as well as hospital care. The plan must also address the
75	services to be provided by the Level I trauma center. It shall
76	emphasize a continuity of care in the most cost-effective
77	setting, taking into consideration both a high quality of care
78	and geographic access. Where consistent with these objectives,
79	it shall include, without limitation, services rendered by
80	physicians, clinics, community hospitals, mental health centers,
81	and alternative delivery sites, as well as at least one regional
82	referral hospital where appropriate. It shall provide that
83	agreements negotiated between the county and providers,
84	including hospitals with a Level I trauma center, will include
85	reimbursement methodologies that take into account the cost of
86	services rendered to eligible patients, recognize hospitals that
87	render a disproportionate share of indigent care, provide other
88	incentives to promote the delivery of charity care, promote the
89	advancement of technology in medical services, recognize the
90	level of responsiveness to medical needs in trauma cases, and
91	require cost containment including, but not limited to, case
92	management. It must also provide that any hospitals that are
93	owned and operated by government entities on May 21, 1991, must,
94	as a condition of receiving funds under this subsection, afford
95	public access equal to that provided under s. 286.011 as to
96	meetings of the governing board, the subject of which is
97	budgeting resources for the rendition of charity care as that
98	term is defined in the Florida Hospital Uniform Reporting System
99	(FHURS) manual referenced in s. 408.07. The plan shall also
100	include innovative health care programs that provide cost-
101	effective alternatives to traditional methods of service
102	delivery and funding.
103	4.(d)  For the purpose of this paragraph subsection, the
104	term "qualified resident" means residents of the authorizing
105	county who are:
106	a.1.  Qualified as indigent persons as certified by the
107	authorizing county;
108	b.2.  Certified by the authorizing county as meeting the
109	definition of the medically poor, defined as persons having
110	insufficient income, resources, and assets to provide the needed
111	medical care without using resources required to meet basic
112	needs for shelter, food, clothing, and personal expenses; or not
113	being eligible for any other state or federal program, or having
114	medical needs that are not covered by any such program; or
115	having insufficient third-party insurance coverage. In all
116	cases, the authorizing county is intended to serve as the payor
117	of last resort; or
118	c.3.  Participating in innovative, cost-effective programs
119	approved by the authorizing county.
120	5.(e)  Moneys collected pursuant to this paragraph
121	subsection remain the property of the state and shall be
122	distributed by the Department of Revenue on a regular and
123	periodic basis to the clerk of the circuit court as ex officio
124	custodian of the funds of the authorizing county. The clerk of
125	the circuit court shall:
126	a.1.  Maintain the moneys in an indigent health care trust
127	fund;
128	b.2.  Invest any funds held on deposit in the trust fund
129	pursuant to general law;
130	c.3.  Disburse the funds, including any interest earned, to
131	any provider of health care services, as provided in
132	subparagraphs 3. and 4. paragraphs (c) and (d), upon directive
133	from the authorizing county. However, if a county has a
134	population of at least 800,000 residents and has levied the
135	surtax authorized in this paragraph subsection, notwithstanding
136	any directive from the authorizing county, on October 1 of each
137	calendar year, the clerk of the court shall issue a check in the
138	amount of $6.5 million to a hospital in its jurisdiction that
139	has a Level I trauma center or shall issue a check in the amount
140	of $3.5 million to a hospital in its jurisdiction that has a
141	Level I trauma center if that county enacts and implements a
142	hospital lien law in accordance with chapter 98-499, Laws of
143	Florida. The issuance of the checks on October 1 of each year is
144	provided in recognition of the Level I trauma center status and
145	shall be in addition to the base contract amount received during
146	fiscal year 1999-2000 and any additional amount negotiated to
147	the base contract. If the hospital receiving funds for its Level
148	I trauma center status requests such funds to be used to
149	generate federal matching funds under Medicaid, the clerk of the
150	court shall instead issue a check to the Agency for Health Care
151	Administration to accomplish that purpose to the extent that it
152	is allowed through the General Appropriations Act; and
153	d.4.  Prepare on a biennial basis an audit of the trust
154	fund specified in sub-subparagraph a. subparagraph 1. Commencing
155	February 1, 2004, such audit shall be delivered to the governing
156	body and to the chair of the legislative delegation of each
157	authorizing county.
158	6.(f)  Notwithstanding any other provision of this section,
159	a county shall not levy local option sales surtaxes authorized
160	in this paragraph subsection and subsections (2) and (3) in
161	excess of a combined rate of 1 percent.
162	(b)  Notwithstanding any other provision of this section,
163	the governing body in each county the government of which is not
164	consolidated with that of one or more municipalities and which
165	has a population of less than 800,000 residents, may levy, by
166	ordinance subject to approval by a majority of the electors of
167	the county voting in a referendum, a discretionary sales surtax
168	at a rate that may not exceed 0.25 percent for the sole purpose
169	of funding trauma services provided by a trauma center licensed
170	pursuant to chapter 395.
171	1.  A statement that includes a brief and general
172	description of the purposes to be funded by the surtax and that
173	conforms to the requirements of s. 101.161 shall be placed on
174	the ballot by the governing body of the county. The following
175	shall be placed on the ballot:
176
177	FOR THE. . . .CENTS TAX
178	AGAINST THE. . . .CENTS TAX
179
180	2.  The ordinance adopted by the governing body of the
181	county providing for the imposition of the surtax shall set
182	forth a plan for providing trauma services to trauma victims
183	presenting in the trauma service area in which such county is
184	located.
185	3.  Moneys collected pursuant to this paragraph remain the
186	property of the state and shall be distributed by the Department
187	of Revenue on a regular and periodic basis to the clerk of the
188	circuit court as ex officio custodian of the funds of the
189	authorizing county. The clerk of the circuit court shall:
190	a.  Maintain the moneys in the Administrative Trust Fund
191	under s. 20.435.
192	b.  Invest any funds held on deposit in the trust fund
193	pursuant to general law.
194	c.  Disburse the funds, including any interest earned on
195	such funds, to the trauma center in its trauma service area, as
196	provided in the plan set forth pursuant to subparagraph 2., upon
197	directive from the authorizing county. If the trauma center
198	receiving funds requests such funds be used to generate federal
199	matching funds under Medicaid, the custodian of the funds shall
200	instead issue a check to the Agency for Health Care
201	Administration to accomplish that purpose to the extent that the
202	agency is allowed through the General Appropriations Act.
203	d.  Prepare on a biennial basis an audit of the trauma
204	services trust fund specified in sub-subparagraph a., to be
205	delivered to the authorizing county.
206	4.  A discretionary sales surtax imposed pursuant to this
207	paragraph shall expire 4 years after the effective date of the
208	surtax, unless reenacted by ordinance subject to approval by a
209	majority of the electors of the county voting in a subsequent
210	referendum.
211	5.  Notwithstanding any other provision of this section, a
212	county shall not levy local option sales surtaxes authorized in
213	this paragraph and subsections (2) and (3) in excess of a
214	combined rate of 1 percent.
215	Section 2.  Subsections (5) and (6) of section 395.40,
216	Florida Statutes, are amended to read:
217	395.40  Legislative findings and intent.--
218	(5)  In addition, the agencies listed in subsection (4)
219	should undertake to:
220	(a)  Establish a coordinated methodology for monitoring,
221	evaluating, and enforcing the requirements of the state's
222	inclusive trauma system which recognizes the interests of each
223	agency.
224	(b)  Develop appropriate roles for trauma agencies, to
225	assist in furthering the operation of trauma systems at the
226	regional level. This should include issues of system evaluation
227	as well as managed care.
228	(c)  Develop and submit appropriate requests for waivers of
229	federal requirements which will facilitate the delivery of
230	trauma care.
231	(d)  Develop criteria that will become the future basis for
232	mandatory consultation between acute care hospitals and trauma
233	centers on the care of trauma victims and the mandatory transfer
234	of appropriate trauma victims to trauma centers.
235	(e)  Develop a coordinated approach to the care of the
236	trauma victim. This shall include the movement of the trauma
237	victim through the system of care and the identification of
238	medical responsibility for each phase of care for out-of-
239	hospital and in-hospital trauma care.
240	(f)  Require the medical director of an emergency medical
241	services provider to have medical accountability for a trauma
242	victim during interfacility transfer.
243	(6)  Furthermore, the Legislature encourages the department
244	to actively foster the provision of trauma care and serve as a
245	catalyst for improvements in the process and outcome of the
246	provision of trauma care in an inclusive trauma system. Among
247	other considerations, the department is required encouraged to:
248	(a)  Promote the development of at least one trauma center
249	in every trauma service area.
250	(b)  Promote the development of a trauma agency for each
251	trauma region.
252	(c)  Update the state trauma system plan by February 2005
253	December 2000 and at least annually every 5th year thereafter.
254	Section 3.  Section 395.4001, Florida Statutes, is amended
255	to read:
256	395.4001  Definitions.--As used in this part, the term:
257	(1)  "Agency" means the Agency for Health Care
258	Administration.
259	(2)  "Charity care" or "uncompensated trauma charity care"
260	means that portion of hospital charges reported to the agency
261	for which there is no compensation, other than restricted or
262	unrestricted revenues provided to a hospital by local
263	governments or tax districts regardless of method of payment,
264	for care provided to a patient whose family income for the 12
265	months preceding the determination is less than or equal to 200
266	150 percent of the federal poverty level, unless the amount of
267	hospital charges due from the patient exceeds 25 percent of the
268	annual family income. However, in no case shall the hospital
269	charges for a patient whose family income exceeds four times the
270	federal poverty level for a family of four be considered
271	charity.
272	(3)  "Department" means the Department of Health.
273	(4)  "Interfacility trauma transfer" means the transfer of
274	a trauma victim between two facilities licensed under this
275	chapter, pursuant to this part.
276	(5)  "Level I trauma center" means a trauma center that:
277	(a)  Has formal research and education programs for the
278	enhancement of trauma care; and is verified determined by the
279	department to be in substantial compliance with Level I trauma
280	center and pediatric trauma referral center standards; and has
281	been approved by the department to operate as a Level I trauma
282	center.
283	(b)  Serves as a resource facility to Level II trauma
284	centers, pediatric trauma referral centers, and general
285	hospitals through shared outreach, education, and quality
286	improvement activities.
287	(c)  Participates in an inclusive system of trauma care,
288	including providing leadership, system evaluation, and quality
289	improvement activities.
290	(6)  "Level II trauma center" means a trauma center that:
291	(a)  Is verified determined by the department to be in
292	substantial compliance with Level II trauma center standards and
293	has been approved by the department to operate as a Level II
294	trauma center.
295	(b)  Serves as a resource facility to general hospitals
296	through shared outreach, education, and quality improvement
297	activities.
298	(c)  Participates in an inclusive system of trauma care.
299	(7)  "Pediatric trauma referral center" means a hospital
300	that is verified determined by the department to be in
301	substantial compliance with pediatric trauma referral center
302	standards as established by rule of the department and has been
303	approved by the department to operate as a pediatric trauma
304	center.
305	(8)  "Provisional trauma center" means a hospital that has
306	been verified by the department to be in substantial compliance
307	with the requirements in s. 395.4025 and has been approved by
308	the department to operate as a provisional Level I trauma
309	center, Level II trauma center, or pediatric trauma center.
310	(8)  "State-approved trauma center" means a hospital that
311	has successfully completed the selection process pursuant to s.
312	395.4025 and has been approved by the department to operate as a
313	trauma center in the state.
314	(9)  "State-sponsored trauma center" means a trauma center
315	or pediatric trauma referral center that receives state funding
316	for trauma care services under s. 395.403.
317	(9)(10)  "Trauma agency" means a department-approved agency
318	established and operated by one or more counties, or a
319	department-approved entity with which one or more counties
320	contract, for the purpose of administering an inclusive regional
321	trauma system.
322	(10)(11)  "Trauma alert victim" means a person who has
323	incurred a single or multisystem injury due to blunt or
324	penetrating means or burns, who requires immediate medical
325	intervention or treatment, and who meets one or more of the
326	adult or pediatric scorecard criteria established by the
327	department by rule.
328	(11)(12)  "Trauma center" means a any hospital that has
329	been verified determined by the department to be in substantial
330	compliance with the requirements in s. 395.4025 and has been
331	approved by the department to operate as a Level I trauma
332	center, Level II trauma center, or pediatric trauma center
333	verification standards as either state-approved or provisional
334	state-approved.
335	(12)(13)  "Trauma scorecard" means a statewide methodology
336	adopted by the department by rule under which a person who has
337	incurred a traumatic injury is graded as to the severity of his
338	or her injuries or illness and which methodology is used as the
339	basis for making destination decisions.
340	(13)(14)  "Trauma transport protocol" means a document
341	which describes the policies, processes, and procedures
342	governing the dispatch of vehicles, the triage, prehospital
343	transport, and interfacility trauma transfer of trauma victims.
344	(14)(15)  "Trauma victim" means any person who has incurred
345	a single or multisystem injury due to blunt or penetrating means
346	or burns and who requires immediate medical intervention or
347	treatment.
348	Section 4.  Subsection (1) of section 395.401, Florida
349	Statutes, is amended to read:
350	395.401  Trauma services system plans; approval
351	verification of trauma centers and pediatric trauma referral
352	centers; procedures; renewal.--
353	(1)(a)  The local and regional trauma agencies shall plan,
354	implement, and evaluate trauma services systems, in accordance
355	with this section and ss. 395.4015, 395.404, and 395.4045, which
356	consist of organized patterns of readiness and response services
357	based on public and private agreements and operational
358	procedures. The department shall establish, by rule, processes
359	and procedures for establishing a trauma agency and obtaining
360	its approval from the department.
361	(b)  The local and regional trauma agencies shall develop
362	and submit to the department plans for local and regional trauma
363	services systems. The plans must include, at a minimum, the
364	following components:
365	1.  The organizational structure of the trauma system.
366	2.  Prehospital care management guidelines for triage and
367	transportation of trauma cases.
368	3.  Flow patterns of trauma cases and transportation system
369	design and resources, including air transportation services,
370	provision for interfacility trauma transfer, and the prehospital
371	transportation of trauma victims. The trauma agency shall plan
372	for the development of a system of transportation of trauma
373	alert victims to trauma centers where the distance or time to a
374	trauma center or transportation resources diminish access by
375	trauma alert victims.
376	4.  The number and location of needed state-approved trauma
377	centers based on local needs, population, and location and
378	distribution of resources.
379	5.  Data collection regarding system operation and patient
380	outcome.
381	6.  Periodic performance evaluation of the trauma system
382	and its components.
383	7.  The use of air transport services within the
384	jurisdiction of the local trauma agency.
385	8.  Public information and education about the trauma
386	system.
387	9.  Emergency medical services communication system usage
388	and dispatching.
389	10.  The coordination and integration between the verified
390	trauma center care facility and other acute care hospitals the
391	nonverified health care facilities.
392	11.  Medical control and accountability.
393	12.  Quality control and system evaluation.
394	(c)  The department shall receive plans for the
395	implementation of inclusive trauma systems from trauma agencies.
396	The department may approve or not approve trauma agency plans
397	based on the conformance of the plan with this section and ss.
398	395.4015, 395.404, and 395.4045 and the rules and definitions
399	adopted by the department pursuant to those sections. The
400	department shall approve or disapprove the plans within 120 days
401	after the date the plans are submitted to the department. The
402	department shall, by rule, provide an application process for
403	establishing a trauma agency. The application must, at a
404	minimum, provide requirements for the trauma agency plan
405	submitted for review, a process for reviewing the application
406	for a state-approved trauma agency, a process for reviewing the
407	trauma transport protocols for the trauma agency, and a process
408	for reviewing the staffing requirements for the agency. The
409	department shall, by rule, establish minimum requirements for a
410	trauma agency to conduct an annual performance evaluation and
411	submit the results to the department.
412	(d)  A trauma agency shall not operate unless the
413	department has approved the local or regional trauma services
414	system plan of the agency.
415	(e)  The department may grant an exception to a portion of
416	the rules adopted pursuant to this section or s. 395.4015 if the
417	local or regional trauma agency proves that, as defined in the
418	rules, compliance with that requirement would not be in the best
419	interest of the persons served within the affected local or
420	regional trauma area.
421	(f)  A local or regional trauma agency may implement a
422	trauma care system only if the system meets the minimum
423	standards set forth in the rules for implementation established
424	by the department and if the plan has been submitted to, and
425	approved by, the department. At least 60 days before the local
426	or regional trauma agency submits the plan for the trauma care
427	system to the department, the local or regional trauma agency
428	shall hold a public hearing and give adequate notice of the
429	public hearing to all hospitals and other interested parties in
430	the area to be included in the proposed system.
431	(g)  Local or regional trauma agencies may enter into
432	contracts for the purpose of implementing the local or regional
433	plan. If local or regional agencies contract with hospitals for
434	trauma services, such agencies must contract only with hospitals
435	which are verified trauma centers.
436	(h)  Local or regional trauma agencies providing service
437	for more than one county shall, as part of their formation,
438	establish interlocal agreements between or among the several
439	counties in the regional system.
440	(i)  This section does not restrict the authority of a
441	health care facility to provide service for which it has
442	received a license pursuant to this chapter.
443	(j)  Any hospital which is verified as a trauma center
444	shall accept all trauma victims that are appropriate for the
445	facility regardless of race, sex, creed, or ability to pay.
446	(k)  It is unlawful for any hospital or other facility to
447	hold itself out as a trauma center unless it has been so
448	verified.
449	(l)  A county, upon the recommendations of the local or
450	regional trauma agency, may adopt ordinances governing the
451	transport of a patient who is receiving care in the field from
452	prehospital emergency medical personnel when the patient meets
453	specific criteria for trauma, burn, or pediatric centers adopted
454	by the local or regional trauma agency. These ordinances must be
455	consistent with s. 395.4045, ordinances adopted under s.
456	401.25(6), and the local or regional trauma system plan and, to
457	the furthest possible extent, must ensure that individual
458	patients receive appropriate medical care while protecting the
459	interests of the community at large by making maximum use of
460	available emergency medical care resources.
461	(m)  The local or regional trauma agency shall, consistent
462	with the regional trauma system plan, coordinate and otherwise
463	facilitate arrangements necessary to develop a trauma services
464	system.
465	(n)  After the submission of the initial trauma system
466	plan, each trauma agency shall, every 5th year, submit to the
467	department for approval an updated plan that identifies the
468	changes, if any, to be made in the regional trauma system.
469	(o)  This section does not preclude a local or regional
470	trauma agency from adopting trauma care system standards.
471	Section 5.  Section 395.4015, Florida Statutes, is amended
472	to read:
473	395.4015  State regional trauma planning; trauma regions.--
474	(1)  The department shall establish a state trauma system
475	plan. As part of the state trauma system plan, the department
476	shall establish trauma regions that which cover all geographical
477	areas of the state and have boundaries that are coterminous with
478	the boundaries of the regional domestic security task forces
479	established under s. 943.0312. These regions may serve as the
480	basis for the development of department-approved local or
481	regional trauma plans. However, the delivery of trauma services
482	by or in coordination with a trauma agency established before
483	July 1, 2004, may continue in accordance with public and private
484	agreements and operational procedures entered into as provided
485	in s. 395.401. The department shall base its definition of the
486	regions upon:
487	(a)  Geographical considerations so as to ensure rapid
488	access to trauma care by patients;
489	(b)  Historical patterns of patient referral and transfer
490	in an area;
491	(c)  Inventories of available trauma care resources;
492	(d)  Predicted population growth characteristics;
493	(e)  Transportation capabilities, including ground and air
494	transport;
495	(f)  Medically appropriate ground and air travel times; and
496	(g)  Other appropriate criteria.
497	(2)  The department shall develop trauma systems plans for
498	the department-defined trauma regions which include at a minimum
499	the following components:
500	(a)  An assessment of current and future trauma care needs
501	of the population, based upon incidence rates and acuity
502	indicators developed by the department, as well as other
503	relevant characteristics of the region.
504	(b)  The organizational structure of the regional trauma
505	system, including the identification of local trauma agency
506	service areas within the region.
507	(c)  Prehospital care management guidelines for triage and
508	transportation of trauma cases.
509	(d)  Flow patterns of trauma cases and transportation
510	system design and resources, including air transportation
511	services, provision for interfacility trauma transfer, and the
512	prehospital transportation of trauma victims. The department
513	shall plan for the development of a system of transportation of
514	trauma alert victims to trauma centers where the distance or
515	time to a trauma center or transportation resources diminish
516	access by trauma alert victims.
517	(e)  The current and projected number, acuity level, and
518	geographic location of trauma cases expected so as to assure
519	that the assessed current and future trauma care needs of the
520	population are adequately met and that state-sponsored trauma
521	centers will maintain the volume of cases sufficient to provide
522	quality care to trauma cases referred to them.
523	(f)  The availability of qualified health professionals,
524	including physicians and surgeons, capable of staffing trauma
525	centers to the level of current and future assessed needs.
526	(g)  Data collection regarding system operation and patient
527	outcome, as well as the number, type, and generalized locations
528	of state-sponsored trauma centers needed to meet the needs of
529	the population.
530	(h)  Periodic performance evaluation of the trauma system
531	and its components.
532	(i)  The type and extent of air transport services
533	available and needed in each region.
534	(j)  Public information and education about the trauma
535	system.
536	(k)  Emergency medical services communication system usage
537	and dispatching.
538	(l)  The coordination and integration between the trauma
539	centers and other health care facilities which may provide
540	services to trauma victims.
541	(m)  Medical control and accountability.
542	(n)  Quality management and system evaluation.
543	(2)(3)  The department shall consider the advice and
544	recommendations of any affected local or regional trauma agency
545	in developing the state trauma system systems plan. The
546	department may, in lieu of specific regional components of its
547	own plan, accept components developed by local or regional
548	trauma agencies.
549	(3)(4)  The department shall use the state trauma system
550	plan as the basis for establishing a statewide inclusive trauma
551	system.
552	Section 6.  Section 395.402, Florida Statutes, is amended
553	to read:
554	395.402  Trauma service areas; number and location of
555	trauma centers.--
556	(1)  The Legislature recognizes the need for a statewide,
557	cohesive, uniform, and integrated trauma system. Within the
558	trauma service areas, that Level I and Level II trauma centers
559	shall should each be capable of annually treating a minimum of
560	1,000 and 500 patients, respectively, with an injury severity
561	score (ISS) of 9 or greater. Level II trauma centers in counties
562	with a population of more than 500,000 shall have the capacity
563	to care for 1,000 patients per year. Further, the Legislature
564	finds that, based on the numbers and locations of trauma victims
565	with these injury severity scores, there should be 19 trauma
566	service areas in the state, and, at a minimum, there should be
567	at least one trauma center in each service area.
568	(2)  It is the intent of the Legislature that, as a
569	planning guideline, Level I and Level II trauma centers should
570	generally each provide care annually to a minimum of 1,000 and
571	500 patients, respectively. Level II trauma centers in counties
572	of more than 500,000 population are expected to be able to care
573	for 1,000 patients per year, as a planning guideline.
574	(2)(3)  Trauma service areas as defined in this section are
575	to be utilized until the Department of Health completes an
576	assessment of the trauma system and reports its finding to the
577	Governor, the President of the Senate, the Speaker of the House
578	of Representatives, and the substantive legislative committees.
579	The report shall be submitted by February 1, 2005. The
580	department shall review the existing trauma system and determine
581	whether it is effective in providing trauma care uniformly
582	throughout the state. The assessment shall:
583	(a)  Consider aligning trauma service areas within the
584	trauma region boundaries as established in July 2004.
585	(b)  Review the number and level of trauma centers needed
586	for each trauma service area to provide a statewide integrated
587	trauma system.
588	(c)  Establish criteria for determining the number and
589	level of trauma centers needed to serve the population in a
590	defined trauma service area or region.
591	(d)  Consider including a criteria within trauma center
592	approval standards based upon the number of trauma victims
593	served within a service area.
594	(e)  Review the Regional Domestic Security Task Force
595	structure and determine whether integrating the trauma system
596	planning with interagency regional emergency and disaster
597	planning efforts is feasible and identify any duplication of
598	efforts between the two entities.
599	(f)  Make recommendations regarding a continued revenue
600	source which shall include a local participation requirement.
601	(g)  Make recommendations regarding a formula for the
602	distribution of funds identified for trauma centers which shall
603	address incentives for new centers where needed and the need to
604	maintain effective trauma care in areas served by existing
605	centers, with consideration for the volume of trauma patients
606	served, and the amount of charity care provided.
607	(3)  In conducting such assessment and subsequent annual
608	reviews, the department shall consider:
609	(a)  The recommendations made as part of the regional
610	trauma system plans submitted by regional trauma agencies.
611	(b)  Stakeholder recommendations.
612	(c)  The geographical composition of an area to ensure
613	rapid access to trauma care by patients.
614	(d)  Historical patterns of patient referral and transfer
615	in an area.
616	(e)  Inventories of available trauma care resources,
617	including professional medical staff.
618	(f)  Population growth characteristics.
619	(g)  Transportation capabilities, including ground and air
620	transport.
621	(h)  Medically appropriate ground and air travel times.
622	(i)  Recommendations of the Regional Domestic Security Task
623	Force.
624	(j)  The actual number of trauma victims currently being
625	served by each trauma center.
626	(k)  Other appropriate criteria.
627	(4)  Annually thereafter, used. the department shall
628	periodically review the assignment of the 67 counties to trauma
629	service areas, in addition to the requirements of paragraphs
630	(2)(b)?(g) and subsection (3). County These assignments are made
631	for the purpose of developing a system of trauma centers.
632	Revisions made by the department shall should take into
633	consideration the recommendations made as part of the regional
634	trauma system plans approved by the department, and as well as
635	the recommendations made as part of the state trauma system
636	plan. In cases where a trauma service area is located within the
637	boundaries of more than one trauma region, the trauma service
638	area's needs, response capability, and system requirements shall
639	be considered by each trauma region served by that trauma
640	service area in its regional system plan These areas must, at a
641	minimum, be reviewed in the year 2000 and every 5 years
642	thereafter. Until the department completes the February 2005
643	assessment its initial review, the assignment of counties shall
644	remain as established in this section pursuant to chapter 90-
645	284, Laws of Florida.
646	(a)  The following trauma service areas are hereby
647	established:
648	1.  Trauma service area 1 shall consist of Escambia,
649	Okaloosa, Santa Rosa, and Walton Counties.
650	2.  Trauma service area 2 shall consist of Bay, Gulf,
651	Holmes, and Washington Counties.
652	3.  Trauma service area 3 shall consist of Calhoun,
653	Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison,
654	Taylor, and Wakulla Counties.
655	4.  Trauma service area 4 shall consist of Alachua,
656	Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy,
657	Putnam, Suwannee, and Union Counties.
658	5.  Trauma service area 5 shall consist of Baker, Clay,
659	Duval, Nassau, and St. Johns Counties.
660	6.  Trauma service area 6 shall consist of Citrus,
661	Hernando, and Marion Counties.
662	7.  Trauma service area 7 shall consist of Flagler and
663	Volusia Counties.
664	8.  Trauma service area 8 shall consist of Lake, Orange,
665	Osceola, Seminole, and Sumter Counties.
666	9.  Trauma service area 9 shall consist of Pasco and
667	Pinellas Counties.
668	10.  Trauma service area 10 shall consist of Hillsborough
669	County.
670	11.  Trauma service area 11 shall consist of Hardee,
671	Highlands, and Polk Counties.
672	12.  Trauma service area 12 shall consist of Brevard and
673	Indian River Counties.
674	13.  Trauma service area 13 shall consist of DeSoto,
675	Manatee, and Sarasota Counties.
676	14.  Trauma service area 14 shall consist of Martin,
677	Okeechobee, and St. Lucie Counties.
678	15.  Trauma service area 15 shall consist of Charlotte,
679	Glades, Hendry, and Lee Counties.
680	16.  Trauma service area 16 shall consist of Palm Beach
681	County.
682	17.  Trauma service area 17 shall consist of Collier
683	County.
684	18.  Trauma service area 18 shall consist of Broward
685	County.
686	19.  Trauma service area 19 shall consist of Dade and
687	Monroe Counties.
688	(b)  Each trauma service area should have at least one
689	Level I or Level II trauma center. The department shall
690	allocate, by rule, the number of trauma centers needed for each
691	trauma service area.
692	(c)  There shall be no more than a total of 44 state-
693	sponsored trauma centers in the state.
694	Section 7.  Section 395.4025, Florida Statutes, is amended
695	to read:
696	395.4025  State-approved Trauma centers; selection; quality
697	assurance; records.--
698	(1)  For purposes of developing a system of state-approved
699	trauma centers, the department shall use the 19 trauma service
700	areas established in s. 395.402. Within each service area and
701	based on the state trauma system plan, the local or regional
702	trauma services system plan, and recommendations of the local or
703	regional trauma agency, and the 1990 Report and Proposal for
704	Funding State-Sponsored Trauma Centers, the department shall
705	establish the approximate number of state-approved trauma
706	centers needed to ensure reasonable access to high-quality
707	trauma services. The Using the guidelines and procedures
708	outlined in the 1990 report, except when in conflict with those
709	prescribed in this section, the department shall select those
710	hospitals that are to be recognized as state-approved trauma
711	centers and shall include all trauma centers verified as of
712	October 1, 1990, and subsequently, subject to specific
713	programmatic and quality of care standards.
714	(2)(a)  The department shall annually notify each acute
715	care general hospital and each local and each regional trauma
716	agency in the state that the department is accepting letters of
717	intent from hospitals that are interested in becoming state-
718	approved trauma centers. In order to be considered by the
719	department, a hospital that operates within the geographic area
720	of a local or regional trauma agency must certify that its
721	intent to operate as a state-approved trauma center is
722	consistent with the trauma services plan of the local or
723	regional trauma agency, as approved by the department, if such
724	agency exists. Letters of intent must be postmarked no later
725	than midnight October 1. This paragraph does not apply to any
726	hospital that is a provisional or verified trauma center on
727	January 1, 1992.
728	(b)  By October 15, the department shall send to all
729	hospitals that submitted a letter of intent an application
730	package that will provide the hospitals with instructions for
731	submitting information to the department for selection as a
732	state-approved trauma center. The standards for verification of
733	trauma centers and pediatric trauma referral centers provided
734	for in s. 395.401(2), as adopted by rule of the department,
735	shall serve as the basis for these instructions.
736	(c)  In order to be considered by the department,
737	applications from those hospitals seeking selection as state-
738	approved trauma centers, including those current verified trauma
739	centers that seek a change or redesignation in approval status
740	as a trauma center to be state-approved trauma centers, must be
741	received by the department no later than the close of business
742	on April 1. The department shall conduct a provisional review of
743	each application for the purpose of determining that the
744	hospital's application is complete and that the hospital has the
745	critical elements required for a state-approved trauma center.
746	This critical review will be based on trauma center verification
747	standards and shall include, but not be limited to, a review of
748	whether the hospital has:
749	1.  Equipment and physical facilities necessary to provide
750	trauma services.
751	2.  Personnel in sufficient numbers and with proper
752	qualifications to provide trauma services.
753	3.  An effective quality assurance process.
754	4.  Submitted written confirmation by the local or regional
755	trauma agency that the verification of the hospital applying to
756	become as a state-approved trauma center is consistent with the
757	plan of the local or regional trauma agency, as approved by the
758	department, if such agency exists. This subparagraph applies to
759	any hospital that is not a provisional or verified trauma center
760	on January 1, 1992.
761	(d)1.  Notwithstanding other provisions in this section,
762	the department may grant up to an additional 18 months to a
763	hospital applicant that is unable to meet all requirements as
764	provided in paragraph (c) at the time of application if the
765	number of applicants in the service area in which the applicant
766	is located is equal to or less than the service area allocation,
767	as provided by rule of the department. An applicant that is
768	granted additional time pursuant to this paragraph shall submit
769	a plan for departmental approval which includes timelines and
770	activities that the applicant proposes to complete in order to
771	meet application requirements. Any applicant that demonstrates
772	an ongoing effort to complete the activities within the
773	timelines outlined in the plan shall be included in the number
774	of state-approved trauma centers at such time that the
775	department has conducted a provisional review of the application
776	and has determined that the application is complete and that the
777	hospital has the critical elements required for a state-approved
778	trauma center.
779	2.  Timeframes provided in subsections (1)-(8) shall be
780	stayed until the department determines that the application is
781	complete and that the hospital has the critical elements
782	required for a state-approved trauma center.
783	(3)  After April 30, any hospital that submitted an
784	application found acceptable by the department based on
785	provisional review, including all trauma centers verified as of
786	December 1, 1989, shall be eligible to operate as a provisional
787	state-approved trauma center.
788	(4)  Between May 1 and October 1 of each year, the
789	department shall conduct an in-depth evaluation of all
790	applications found acceptable in the provisional review. The
791	applications shall be evaluated against criteria enumerated in
792	the application packages as provided to the hospitals by the
793	department.
794	(5)  Beginning October 1 of each year and ending no later
795	than June 1 of the following year, a review team of out-of-state
796	experts assembled by the department shall make onsite visits to
797	all provisional state-approved trauma centers. The department
798	shall develop a survey instrument to be used by the expert team
799	of reviewers. The instrument shall include objective criteria
800	and guidelines for reviewers based on existing trauma center and
801	pediatric trauma referral center verification standards such
802	that all trauma centers and pediatric trauma referral centers
803	are assessed equally. The survey instrument shall also include a
804	uniform rating system that will be used by reviewers to indicate
805	the degree of compliance of each trauma center with specific
806	standards, and to indicate the quality of care provided by each
807	trauma center as determined through an audit of patient charts.
808	In addition, hospitals being considered as provisional state-
809	approved trauma centers shall meet all the requirements of a
810	verified trauma center or pediatric trauma referral center, and
811	shall be located in a trauma service area that has a need for
812	such a trauma center.
813	(6)  Based on recommendations from the review team, the
814	department shall select state-approved trauma centers by July 1.
815	An applicant for designation as a state-approved trauma center
816	or a state-approved pediatric trauma referral center may request
817	an extension of its provisional status if it submits a
818	corrective action plan to the department. The corrective action
819	plan must demonstrate the ability of the applicant to correct
820	deficiencies noted during the applicant's onsite review
821	conducted by the department between the previous October 1 and
822	June 1. The department may extend the provisional status of an
823	applicant for designation as a state-approved trauma center or a
824	state-approved pediatric trauma referral center through December
825	31 if the applicant provides a corrective action plan acceptable
826	to the department. The department or a team of out-of-state
827	experts assembled by the department shall conduct an onsite
828	visit on or before November 1 to confirm that the deficiencies
829	have been corrected. The provisional state-approved trauma
830	center or the provisional state-approved pediatric trauma
831	referral center is responsible for all costs associated with the
832	onsite visit in a manner prescribed by rule of the department.
833	By January 1, the department must approve or deny the
834	application of any provisional applicant granted an extension.
835	Each state-approved trauma center shall be granted a 7-year
836	approval verification period during which time it must continue
837	to maintain trauma center verification standards and acceptable
838	patient outcomes as determined by department rule. An approval A
839	verification, unless sooner suspended or revoked, automatically
840	expires 7 years after the date of issuance and is renewable upon
841	application for renewal as prescribed by rule of the department.
842	After July 1, 1992, only those hospitals selected as state-
843	approved trauma centers may operate as trauma centers.
844	(7)  Any hospital that wishes to protest a decision made by
845	the department based on the department's preliminary or in-depth
846	review of applications or on the recommendations of the site
847	visit review team pursuant to this section shall proceed as
848	provided in chapter 120. Hearings held under this subsection
849	shall be conducted in the same manner as provided in ss. 120.569
850	and 120.57. Cases filed under chapter 120 may combine all
851	disputes between parties.
852	(8)  Notwithstanding any provision of chapter 381, a
853	hospital licensed under ss. 395.001-395.3025 that operates a
854	state-approved trauma center may not terminate or substantially
855	reduce the availability of trauma service without providing at
856	least 180 days' 6 months' notice of its intent to terminate such
857	service. Such notice shall be given to the department of Health,
858	to all affected local or regional trauma agencies, and to all
859	state-approved trauma centers, hospitals, and emergency medical
860	service providers in the trauma service area. The department
861	shall adopt by rule the procedures and process for notification,
862	duration, and explanation of the termination of trauma services.
863	(9)  Except as otherwise provided in this subsection, the
864	department or its agent may collect trauma care and registry
865	data, as prescribed by rule of the department, from trauma
866	centers, pediatric trauma referral centers, hospitals, emergency
867	medical service providers, local or regional trauma agencies, or
868	medical examiners for the purposes of evaluating trauma system
869	effectiveness, ensuring compliance with the standards of
870	verification, and monitoring patient outcomes. A trauma center,
871	pediatric trauma referral center, hospital, emergency medical
872	service provider, medical examiner, or local trauma agency or
873	regional trauma agency, or a panel or committee assembled by
874	such an agency under s. 395.50(1) may, but is not required to,
875	disclose to the department patient care quality assurance
876	proceedings, records, or reports. However, the department may
877	require a local trauma agency or a regional trauma agency, or a
878	panel or committee assembled by such an agency to disclose to
879	the department patient care quality assurance proceedings,
880	records, or reports that the department needs solely to conduct
881	quality assurance activities under s. 395.4015, or to ensure
882	compliance with the quality assurance component of the trauma
883	agency's plan approved under s. 395.401. The patient care
884	quality assurance proceedings, records, or reports that the
885	department may require for these purposes include, but are not
886	limited to, the structure, processes, and procedures of the
887	agency's quality assurance activities, and any recommendation
888	for improving or modifying the overall trauma system, if the
889	identity of a trauma center, pediatric trauma referral center,
890	hospital, emergency medical service provider, medical examiner,
891	or an individual who provides trauma services is not disclosed.
892	(10)  Out-of-state experts assembled by the department to
893	conduct onsite visits are agents of the department for the
894	purposes of s. 395.3025. An out-of-state expert who acts as an
895	agent of the department under this subsection is not liable for
896	any civil damages as a result of actions taken by him or her,
897	unless he or she is found to be operating outside the scope of
898	the authority and responsibility assigned by the department.
899	(11)  Onsite visits by the department or its agent may be
900	conducted at any reasonable time and may include but not be
901	limited to a review of records in the possession of trauma
902	centers, pediatric trauma referral centers, hospitals, emergency
903	medical service providers, local or regional trauma agencies, or
904	medical examiners regarding the care, transport, treatment, or
905	examination of trauma patients.
906	(12)  Patient care, transport, or treatment records or
907	reports, or patient care quality assurance proceedings, records,
908	or reports obtained or made pursuant to this section, s.
909	395.3025(4)(f), s. 395.401, s. 395.4015, s. 395.402, s. 395.403,
910	s. 395.404, s. 395.4045, s. 395.405, s. 395.50, or s. 395.51
911	must be held confidential by the department or its agent and are
912	exempt from the provisions of s. 119.07(1). Patient care quality
913	assurance proceedings, records, or reports obtained or made
914	pursuant to these sections are not subject to discovery or
915	introduction into evidence in any civil or administrative
916	action.
917	(13)  The department may adopt, by rule, the procedures and
918	process by which it will select state-approved trauma centers.
919	Such procedures and process must be used in annually selecting
920	state-approved trauma centers and must be consistent with
921	subsections (1)-(8) except in those situations in which it is in
922	the best interest of, and mutually agreed to by, all applicants
923	within a service area and the department to reduce the
924	timeframes.
925	(14)  Notwithstanding any other provisions of this section
926	and rules adopted pursuant to this section, until the department
927	has conducted the review provided under s. 395.402, only
928	hospitals located in trauma services areas where there is no
929	existing trauma center may apply.
930	Section 8.  Section 395.403, Florida Statutes, is amended
931	to read:
932	395.403  Reimbursement of state-sponsored trauma centers.--
933	(1)  The Legislature finds that many hospitals which
934	provide services to trauma victims are not adequately
935	compensated for such treatment. The Legislature also recognizes
936	that the current verified trauma centers are providing such
937	services without adequate reimbursement. Therefore, it is the
938	intent of the Legislature to provide financial support to the
939	current verified trauma centers and to establish a system of
940	state-sponsored trauma centers as soon as feasibly possible. It
941	is also the intent of the Legislature that this system of state-
942	sponsored trauma centers be assisted financially based on the
943	volume and acuity of uncompensated trauma care provided.
944	(1)(2)  All provisional trauma centers and state-approved
945	trauma centers shall be considered eligible to receive state
946	funding state-sponsored trauma centers when state funds are
947	specifically appropriated for state-sponsored trauma centers in
948	the General Appropriations Act. Effective July 1, 2004, the
949	department shall make one-time payments from the Administrative
950	Trust Fund under s. 20.435 to the trauma centers and a hospital
951	with a pending application for a Level I trauma center in
952	recognition of the capital investment made by the hospital to
953	establish the trauma service. Payments shall be in equal amounts
954	for the trauma centers approved by the department as of July 1
955	of the fiscal year in which funding is appropriated, with lesser
956	amounts for the hospital with an application pending for a Level
957	I trauma center at the department as of April 1, 2004. In the
958	event a trauma center does not maintain its status as a trauma
959	center for any state fiscal year in which such funding is
960	appropriated, the provisional trauma center or trauma center
961	shall repay the state for the portion of the year during which
962	it was not a trauma center.
963	(2)  Provisional trauma centers and trauma centers eligible
964	to receive distributions from the Administrative Trust Fund
965	under s. 20.435 in accordance with subsection (1) may request
966	that such funds be used as intergovernmental transfer funds in
967	the Medicaid program.
968	(3)  To receive state funding, a state-sponsored trauma
969	center shall submit a claim electronically via the Trauma Claims
970	Processing System, designed, developed, implemented, and
971	operated by the department's Medicaid program, to the
972	department's Medicaid program upon discharge of a trauma
973	patient. When a hospital stay spans a state fiscal year, a
974	separate hospital claim shall be submitted for the hospital days
975	incurred in each fiscal year.
976	(4)(a)  State-sponsored trauma centers shall determine each
977	trauma patient's eligibility for state funding prior to the
978	submission of a claim.
979	(b)  A trauma patient treated must meet the definition of
980	charity care, have been designated as having an ISS score of 9
981	or greater, and have received services that are medically
982	necessary from a state-sponsored trauma center in order for the
983	state-sponsored trauma center to receive state funding for that
984	patient.
985	(c)  Each state-sponsored trauma center shall retain
986	appropriate documentation showing a trauma patient's eligibility
987	for state funding. Documentation recognized by the department as
988	appropriate shall be limited to one of the following:
989	1.  W-2 withholding forms.
990	2.  Payroll stubs.
991	3.  Income tax returns.
992	4.  Forms approving or denying unemployment compensation or
993	workers' compensation.
994	5.  Written verification of wages from employer.
995	6.  Written verification from public welfare agencies or
996	any other governmental agency which can attest to the patient's
997	income status for the past 12 months.
998	7.  A witnessed statement signed by the patient or
999	responsible party, as provided for in Pub. L. No. 79-725, as
1000	amended, known as the Hill-Burton Act, except that such
1001	statement need not be obtained within 48 hours of the patient's
1002	admission to the hospital as required by the Hill-Burton Act.
1003	The statement shall include acknowledgment that, in accordance
1004	with s. 817.50, providing false information to defraud a
1005	hospital for the purposes of obtaining goods or services is a
1006	misdemeanor of the second degree.
1007	(d)  The department shall conduct an audit or shall
1008	contract with an independent party to conduct an audit of each
1009	state-sponsored trauma center's claims to ensure that state
1010	funding was only provided for eligible trauma patients and
1011	medically necessary services.
1012	(e)  The department's Medicaid program office shall check
1013	each claim to confirm that the patient is not covered under the
1014	Medicaid program and shall pay the claim out of the Trauma
1015	Services Trust Fund. Trauma patients who are eligible for the
1016	Medicaid program shall not be considered eligible for the state-
1017	sponsored trauma center program except for Medicaid noncovered
1018	services. If a claim is denied by the Trauma Claims Processing
1019	System as a result of Medicaid eligibility for Medicaid covered
1020	services, the hospital shall submit a claim to the Medicaid
1021	fiscal agent for payment.
1022	(5)  State funding shall be at a per diem rate equal to
1023	$860 to provisional state-approved and state-approved trauma
1024	centers. This rate shall be effective for the first 12 months of
1025	funding, after which time payment to provisional state-approved
1026	and state-approved trauma centers shall be based on a trauma
1027	cost-based reimbursement methodology developed by the
1028	department. The department shall consult with representatives
1029	from the hospital industry including the Florida Hospital
1030	Association, the Association of Voluntary Hospitals of Florida,
1031	and the Florida League of Hospitals in the development of the
1032	reimbursement methodology.
1033	(6)(a)  To ensure a fair distribution of funds appropriated
1034	for state-sponsored trauma centers and to ensure that no state-
1035	sponsored trauma center gains an unfair advantage due solely to
1036	its ability to bill more quickly than another state-sponsored
1037	trauma center, the total amount of state funds appropriated in
1038	the General Appropriations Act for this section shall be divided
1039	into 19 trauma fund accounts with an account for each service
1040	area established in s. 395.402(3). The amount of funds
1041	distributed to a service area shall be based on the following
1042	formula:
1043
1044	where:
1045	SAAA = service area appropriation amount.
1046	SATD = uncompensated service area trauma days with ISS
1047	score of 9 or greater.
1048	TTD = uncompensated total trauma days with ISS score of 9
1049	or greater for all 19 service areas.
1050	TA = total dollars appropriated for state-sponsored trauma
1051	centers.
1052	(b)  The database to be used for this calculation shall be
1053	the detailed patient discharge data of the most recently
1054	completed calendar year for which the board possesses data. Out-
1055	of-state days that are included in the database shall be
1056	allocated to the service area where the treating hospital is
1057	located.
1058	(c)  Fifty percent of the funds allocated to those service
1059	areas which had one or more trauma centers as of December 1,
1060	1989, shall be distributed to those verified trauma centers
1061	proportionately based on volume and acuity of uncompensated
1062	trauma care provided during the most recently completed calendar
1063	year for which the board possesses data in a lump-sum payment on
1064	the date funding becomes available. These trauma centers shall
1065	submit claims pursuant to subsection (3) in order to justify
1066	this funding. Effective 9 months after funding becomes
1067	available, any trauma center which fails to submit claims for
1068	reimbursement equal to or greater than the amount the trauma
1069	center received under the initial allocation shall return any
1070	unearned funds to the department for distribution pursuant to
1071	paragraph (e). Once this 50-percent lump sum is depleted, a
1072	trauma center will be reimbursed from the remaining 50 percent
1073	of the service area's original allocation.
1074	(d)  The department shall pay trauma claims on a monthly
1075	basis. In a given month when the outstanding claims will exceed
1076	the unexpended funds allocated to a service area, the department
1077	shall pay all of the submitted claims for the service area on a
1078	pro rata basis.
1079	(e)  At the end of the fiscal year, the unexpended funds
1080	for each service area shall be placed in one large state trauma
1081	account from which all remaining claims are paid without regard
1082	to service area on a pro rata basis until such funds are
1083	depleted.
1084	(f)  For any state fiscal year, reimbursement for any
1085	patient residing outside the trauma service area of the state-
1086	sponsored trauma center where the patient is treated shall be
1087	paid out of the funds allocated for the trauma service area
1088	where the patient resides. Out-of-state days shall be paid from
1089	the service area where the treating hospital is located.
1090	(3)(7)  In order to receive state funding payments under
1091	this section, a hospital shall be a state-sponsored trauma
1092	center and shall:
1093	(a)  Agree to conform to all departmental requirements as
1094	provided by rule to assure high-quality trauma services.
1095	(b)  Agree to provide information concerning the provision
1096	of trauma services to the department, in a form and manner
1097	prescribed by rule of the department.
1098	(c)  Agree to accept all trauma patients, regardless of
1099	ability to pay, on a functional space-available basis.
1100	(4)(8)  A state-sponsored trauma center that which fails to
1101	comply with any of the conditions listed in subsection (3) (7)
1102	or the applicable rules of the department shall not receive
1103	payments under this section for the period in which it was not
1104	in compliance.
1105	Section 9.  Section 401.24, Florida Statutes, is amended to
1106	read:
1107	401.24  Emergency medical services state plan.--The
1108	department is responsible, at a minimum, for the improvement and
1109	regulation of basic and advanced life support programs. The
1110	department shall develop and biennially revise a comprehensive
1111	state plan for basic and advanced life support services, the
1112	emergency medical services grants program, state-approved trauma
1113	centers, state-approved pediatric trauma referral centers, the
1114	injury control program, and medical disaster preparedness. The
1115	state plan shall include, but need not be limited to:
1116	(1)  Emergency medical systems planning, including the
1117	prehospital and hospital phases of patient care, and injury
1118	control effort and unification of such services into a total
1119	delivery system to include air, water, and land services.
1120	(2)  Requirements for the operation, coordination, and
1121	ongoing development of emergency medical services, which
1122	includes: basic life support or advanced life support vehicles,
1123	equipment, and supplies; communications; personnel; training;
1124	public education; state trauma system; injury control; and other
1125	medical care components.
1126	(3)  The definition of areas of responsibility for
1127	regulating and planning the ongoing and developing delivery
1128	service requirements.
1129	Section 10.  The sum of $300,000 is appropriated from the
1130	General Revenue Fund to the Administrative Trust Fund for the
1131	Department of Health to contract with a state university to
1132	conduct the study required under s. 395.402, Florida Statutes.
1133	Section 11.  The sum of $20,700,000 is appropriated from
1134	the General Revenue Fund to the Administrative Trust Fund for
1135	the Department of Health to provide $1 million for each existing
1136	trauma center as of July 1, 2004, and $700,000 for a hospital
1137	with a Level I trauma center application pending with the
1138	department as of April 1, 2004.
1139	Section 12.  This act shall take effect July 1, 2004.

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