Senate Bill sb2842c2

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    Florida Senate - 2004                    CS for CS for SB 2842

    By the Committees on Appropriations; Health, Aging, and
    Long-Term Care; and Senators Atwater and Cowin




    309-2687-04

  1                      A bill to be entitled

  2         An act relating to trauma care center care

  3         services; amending s. 381.74, F.S.; requiring

  4         hospitals and trauma centers to provide data on

  5         moderate-to-severe brain or spinal cord

  6         injuries to the Department of Health; amending

  7         s. 381.745, F.S.; defining "department" for

  8         purposes of the "Charlie Mack Overstreet Brain

  9         or Spinal Cord Injuries Act"; amending s.

10         395.40, F.S.; revising legislative findings;

11         revising duties of the Department of Health to

12         implement and plan for a statewide trauma

13         system; amending s. 395.4001, F.S.; revising

14         definitions; amending s. 395.401, F.S.;

15         revising components for local and regional

16         trauma services system plans; correcting

17         references to the term "trauma center";

18         amending s. 395.4015, F.S.; requiring that the

19         boundaries of the trauma regions administered

20         by the Department of Health be coterminous with

21         the boundaries of the regional domestic

22         security task forces established within the

23         Department of Law Enforcement; providing

24         exceptions for certain interlocal agreements

25         for trauma services in a regional system;

26         eliminating requirements for the Department of

27         Health to develop the minimum components for

28         systems plans in defined trauma regions;

29         amending s. 395.402, F.S.; providing additional

30         legislative intent with respect to trauma

31         service areas; providing a treatment capacity

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 1         for certain trauma centers; providing that

 2         current trauma service areas shall be used

 3         until the Department of Health completes an

 4         assessment of the trauma system; requiring a

 5         report; providing guidelines for such

 6         assessment; requiring annual review; amending

 7         s. 395.4025, F.S.; revising requirements for

 8         the Department of Health's development of a

 9         state trauma system plan; deleting obsolete

10         references; correcting references to the term

11         "trauma center"; revising requirements for the

12         department's approval and verification of a

13         facility as a trauma center; granting the

14         department authority to adopt rules for the

15         procedures and process for notification,

16         duration, and explanation of a trauma center's

17         termination of trauma services; revising the

18         requirements for notice that a hospital must

19         give before it terminates or substantially

20         reduces trauma service; exempting from certain

21         time limits on applications to operate as

22         trauma centers certain hospitals in areas

23         having no trauma center; limiting applications

24         until the completion of a specified review;

25         amending s. 395.403, F.S.; correcting

26         references to the term "trauma center";

27         revising eligibility requirements for state

28         funding of trauma centers; providing that

29         trauma centers may request that their

30         distributions from the Administrative Trust

31         Fund be used as intergovernmental transfer

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 1         funds in the Medicaid program; amending s.

 2         395.404, F.S.; revising reporting requirements

 3         to the trauma registry data system maintained

 4         by the Department of Health; providing that

 5         hospitals and trauma centers subject to

 6         reporting trauma registry data to the

 7         department are required to comply with other

 8         duties concerning the moderate-to-severe brain

 9         or spinal cord injury registry maintained by

10         the department; correcting references to the

11         term "trauma center"; amending s. 395.405,

12         F.S.; authorizing the Department of Health to

13         adopt and enforce rules necessary to administer

14         part II of ch. 395, F.S.; establishing a task

15         force on distribution of funds; providing for a

16         trauma center matching grant program; amending

17         s. 318.14, F.S.; providing additional civil

18         penalties for certain traffic infractions;

19         providing for disposition of such penalties;

20         amending s. 318.21, F.S.; providing for

21         disposition of mandatory civil penalties;

22         amending s. 322.0261, F.S.; revising provisions

23         relating to driver-improvement courses;

24         amending s. 322.27, F.S.; prescribing points

25         for violation of a traffic-control signal;

26         amending s. 318.18, F.S.; providing penalty for

27         specified violation of traffic control signal

28         devices and for failure to submit to test for

29         impairment or intoxication; providing for

30         distribution of moneys collected; directing the

31         clerk of court to collect a fee for each civil

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 1         and criminal violation of ch. 316, F.S.;

 2         creating s. 322.751, F.S.; directing the

 3         Department of Highway Safety and Motor Vehicles

 4         to assess specified annual surcharges against a

 5         motor vehicle licensee who accumulates eight or

 6         more points against his or her license within

 7         the previous 36 months; requiring the

 8         department to notify a licensee by first-class

 9         mail upon receipt of four points against his or

10         her license; directing the department to remit

11         all such penalties to the Administrative Trust

12         Fund in the Department of Health; amending s.

13         316.193, F.S.; directing the department to

14         assess specified annual surcharges against

15         motor vehicle licensees who have a final

16         conviction within the previous 36 months for a

17         DUI offense; directing the department to remit

18         all such penalties to the Administrative Trust

19         Fund in the Department of Health; amending s.

20         794.056, F.S.; providing that funds credited to

21         the Rape Crisis Program Trust Fund shall

22         include both funds collected as an additional

23         court assessment in certain cases and certain

24         funds deposited in the Administrative Trust

25         Fund in the Department of Health; revising a

26         requirement relating to the distribution of

27         moneys from the trust fund pursuant to a rule

28         by the Department of Health; creating s.

29         322.7525, F.S.; requiring the department to

30         notify licensees of the surcharges and the time

31         period in which to pay the surcharges; creating

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 1         s. 322.753, F.S.; requiring the department to

 2         accept installment payments for the surcharges;

 3         providing sanctions for a licensee's failure to

 4         pay an installment; allowing the department to

 5         permit licensees to pay assessed surcharges

 6         with credit cards; requiring the department to

 7         suspend a driver's license if the licensee does

 8         not pay the surcharge or arrange for

 9         installment payments within a specified time

10         after the notice of surcharge is sent;

11         repealing s. 395.4035, F.S., relating to the

12         Trauma Services Trust Fund; providing for

13         distribution of collections in the

14         Administrative Trust Fund in the Department of

15         Health; providing an appropriation; providing

16         an effective date.

17  

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

19  

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

21  Statutes, is amended to read:

22         381.74  Establishment and maintenance of a central

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

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

25  or spinal cord injuries.

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

27  public social agency, private social agency, hospital, trauma

28  center, and attending physician shall report to the department

29  division within 5 days after identification or diagnosis of

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

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

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

 2  section 381.745, Florida Statutes, are redesignated as

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

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

 5         381.745  Definitions; ss. 381.739-381.79.--As used in

 6  ss. 381.739-381.79, the term:

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

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

 9  Statutes, is amended to read:

10         395.40  Legislative findings and intent.--

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

12  should undertake to:

13         (a)  Establish a coordinated methodology for

14  monitoring, evaluating, and enforcing the requirements of the

15  state's inclusive trauma system which recognizes the interests

16  of each agency.

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

18  assist in furthering the operation of trauma systems at the

19  regional level. This should include issues of system

20  evaluation as well as managed care.

21         (c)  Develop and submit appropriate requests for

22  waivers of federal requirements which will facilitate the

23  delivery of trauma care.

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

25  for mandatory consultation between acute care hospitals and

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

27  transfer of appropriate trauma victims to trauma centers.

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

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

30  victim through the system of care and the identification of

31  

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 1  medical responsibility for each phase of care for

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

 3         (f)  Require the medical director of an emergency

 4  medical services provider to have medical accountability for a

 5  trauma victim during interfacility transfer.

 6         Section 4.  Section 395.4001, Florida Statutes, is

 7  amended to read:

 8         395.4001  Definitions.--As used in this part, the term:

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

10  Administration.

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

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

13  agency for which there is no compensation, other than

14  restricted or unrestricted revenues provided to a hospital by

15  local governments or tax districts regardless of method of

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

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

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

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

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

21  the hospital charges for a patient whose family income exceeds

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

23  considered charity.

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

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

26  of a trauma victim between two facilities licensed under this

27  chapter, pursuant to this part.

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

29  that:

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

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

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 1  department to be in substantial compliance with Level I trauma

 2  center and pediatric trauma referral center standards; and has

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

 4  center.

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

 6  centers, pediatric trauma referral centers, and general

 7  hospitals through shared outreach, education, and quality

 8  improvement activities.

 9         (c)  Participates in an inclusive system of trauma

10  care, including providing leadership, system evaluation, and

11  quality improvement activities.

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

13  that:

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

15  substantial compliance with Level II trauma center standards

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

17  II trauma center.

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

19  through shared outreach, education, and quality improvement

20  activities.

21         (c)  Participates in an inclusive system of trauma

22  care.

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

24  hospital that is verified determined by the department to be

25  in substantial compliance with pediatric trauma referral

26  center standards as established by rule of the department and

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

28  trauma center.

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

30  has been verified by the department to be in substantial

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

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

 2  trauma center, Level II trauma center, or pediatric trauma

 3  center.

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

 5  that has successfully completed the selection process pursuant

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

 7  operate as a trauma center in the state.

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

 9  center or pediatric trauma referral center that receives state

10  funding for trauma care services under s. 395.403.

11         (9)(10)  "Trauma agency" means a department-approved

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

13  department-approved entity with which one or more counties

14  contract, for the purpose of administering an inclusive

15  regional trauma system.

16         (10)(11)  "Trauma alert victim" means a person who has

17  incurred a single or multisystem injury due to blunt or

18  penetrating means or burns, who requires immediate medical

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

20  adult or pediatric scorecard criteria established by the

21  department by rule.

22         (11)(12)  "Trauma center" means a any hospital that has

23  been verified determined by the department to be in

24  substantial compliance with the requirements in s. 395.4025

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

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

27  center verification standards as either state-approved or

28  provisional state-approved.

29         (12)(13)  "Trauma scorecard" means a statewide

30  methodology adopted by the department by rule under which a

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

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 1  severity of his or her injuries or illness and which

 2  methodology is used as the basis for making destination

 3  decisions.

 4         (13)(14)  "Trauma transport protocol" means a document

 5  which describes the policies, processes, and procedures

 6  governing the dispatch of vehicles, the triage, prehospital

 7  transport, and interfacility trauma transfer of trauma

 8  victims.

 9         (14)(15)  "Trauma victim" means any person who has

10  incurred a single or multisystem injury due to blunt or

11  penetrating means or burns and who requires immediate medical

12  intervention or treatment.

13         Section 5.  Section 395.401, Florida Statutes, is

14  amended to read:

15         395.401  Trauma services system plans; verification of

16  trauma centers and pediatric trauma referral centers;

17  procedures; renewal.--

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

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

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

21  395.4045, which consist of organized patterns of readiness and

22  response services based on public and private agreements and

23  operational procedures. The department shall establish, by

24  rule, processes and procedures for establishing a trauma

25  agency and obtaining its approval from the department.

26         (b)  The local and regional trauma agencies shall

27  develop and submit to the department plans for local and

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

29  minimum, the following components:

30         1.  The organizational structure of the trauma system.

31  

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 1         2.  Prehospital care management guidelines for triage

 2  and transportation of trauma cases.

 3         3.  Flow patterns of trauma cases and transportation

 4  system design and resources, including air transportation

 5  services, provision for interfacility trauma transfer, and the

 6  prehospital transportation of trauma victims. The trauma

 7  agency shall plan for the development of a system of

 8  transportation of trauma alert victims to trauma centers where

 9  the distance or time to a trauma center or transportation

10  resources diminish access by trauma alert victims.

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

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

13  and distribution of resources.

14         5.  Data collection regarding system operation and

15  patient outcome.

16         6.  Periodic performance evaluation of the trauma

17  system and its components.

18         7.  The use of air transport services within the

19  jurisdiction of the local trauma agency.

20         8.  Public information and education about the trauma

21  system.

22         9.  Emergency medical services communication system

23  usage and dispatching.

24         10.  The coordination and integration between the

25  verified trauma center care facility and other acute care

26  hospitals the nonverified health care facilities.

27         11.  Medical control and accountability.

28         12.  Quality control and system evaluation.

29         (c)  The department shall receive plans for the

30  implementation of inclusive trauma systems from trauma

31  agencies.  The department may approve or not approve trauma

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

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

 3  and definitions adopted by the department pursuant to those

 4  sections.  The department shall approve or disapprove the

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

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

 7  application process for establishing a trauma agency. The

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

 9  trauma agency plan submitted for review, a process for

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

11  a process for reviewing the trauma transport protocols for the

12  trauma agency, and a process for reviewing the staffing

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

14  establish minimum requirements for a trauma agency to conduct

15  an annual performance evaluation and submit the results to the

16  department.

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

18  department has approved the local or regional trauma services

19  system plan of the agency.

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

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

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

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

24  the best interest of the persons served within the affected

25  local or regional trauma area.

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

27  trauma care system only if the system meets the minimum

28  standards set forth in the rules for implementation

29  established by the department and if the plan has been

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

31  days before the local or regional trauma agency submits the

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

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

 3  adequate notice of the public hearing to all hospitals and

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

 5  proposed system.

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

 7  contracts for the purpose of implementing the local or

 8  regional plan.  If local or regional agencies contract with

 9  hospitals for trauma services, such agencies must contract

10  only with hospitals which are verified trauma centers.

11         (h)  Local or regional trauma agencies providing

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

13  formation, establish interlocal agreements between or among

14  the several counties in the regional system.

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

16  health care facility to provide service for which it has

17  received a license pursuant to this chapter.

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

19  shall accept all trauma victims that are appropriate for the

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

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

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

23  verified.

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

25  regional trauma agency, may adopt ordinances governing the

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

27  prehospital emergency medical personnel when the patient meets

28  specific criteria for trauma, burn, or pediatric centers

29  adopted by the local or regional trauma agency.  These

30  ordinances must be consistent with s. 395.4045, ordinances

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

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

 2  that individual patients receive appropriate medical care

 3  while protecting the interests of the community at large by

 4  making maximum use of available emergency medical care

 5  resources.

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

 7  consistent with the regional trauma system plan, coordinate

 8  and otherwise facilitate arrangements necessary to develop a

 9  trauma services system.

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

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

12  department for approval an updated plan that identifies the

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

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

15  trauma agency from adopting trauma care system standards.

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

17  verification of trauma centers based on national guidelines,

18  including those established by the American College of

19  Surgeons entitled "Hospital and Prehospital Resources for

20  Optimal Care of the Injured Patient" and published appendices

21  thereto. Standards specific to pediatric trauma referral

22  centers shall be developed in conjunction with Children's

23  Medical Services and adopted by rule of the department.

24         (3)  The department may withdraw local or regional

25  agency authority, prescribe corrective actions, or use the

26  administrative remedies as provided in s. 395.1065 for the

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

28  395.402, 395.4025, 395.403, 395.404, and 395.4045 or rules

29  adopted thereunder.  All amounts collected pursuant to this

30  subsection shall be deposited into the Emergency Medical

31  Services Trust Fund provided in s. 401.34.

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 1         Section 6.  Section 395.4015, Florida Statutes, is

 2  amended to read:

 3         395.4015  State regional trauma planning; trauma

 4  regions.--

 5         (1)  The department shall establish a state trauma

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

 7  department shall establish trauma regions that which cover all

 8  geographical areas of the state and have boundaries that are

 9  coterminous with the boundaries of the regional domestic

10  security task forces established under s. 943.0312. These

11  regions may serve as the basis for the development of

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

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

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

15  accordance with public and private agreements and operational

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

17  department shall base its definition of the regions upon:

18         (a)  Geographical considerations so as to ensure rapid

19  access to trauma care by patients;

20         (b)  Historical patterns of patient referral and

21  transfer in an area;

22         (c)  Inventories of available trauma care resources;

23         (d)  Predicted population growth characteristics;

24         (e)  Transportation capabilities, including ground and

25  air transport;

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

27  and

28         (g)  Other appropriate criteria.

29         (2)  The department shall develop trauma systems plans

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

31  minimum the following components:

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

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

 3  indicators developed by the department, as well as other

 4  relevant characteristics of the region.

 5         (b)  The organizational structure of the regional

 6  trauma system, including the identification of local trauma

 7  agency service areas within the region.

 8         (c)  Prehospital care management guidelines for triage

 9  and transportation of trauma cases.

10         (d)  Flow patterns of trauma cases and transportation

11  system design and resources, including air transportation

12  services, provision for interfacility trauma transfer, and the

13  prehospital transportation of trauma victims. The department

14  shall plan for the development of a system of transportation

15  of trauma alert victims to trauma centers where the distance

16  or time to a trauma center or transportation resources

17  diminish access by trauma alert victims.

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

19  and geographic location of trauma cases expected so as to

20  assure that the assessed current and future trauma care needs

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

22  trauma centers will maintain the volume of cases sufficient to

23  provide quality care to trauma cases referred to them.

24         (f)  The availability of qualified health

25  professionals, including physicians and surgeons, capable of

26  staffing trauma centers to the level of current and future

27  assessed needs.

28         (g)  Data collection regarding system operation and

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

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

31  needs of the population.

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 1         (h)  Periodic performance evaluation of the trauma

 2  system and its components.

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

 4  available and needed in each region.

 5         (j)  Public information and education about the trauma

 6  system.

 7         (k)  Emergency medical services communication system

 8  usage and dispatching.

 9         (l)  The coordination and integration between the

10  trauma centers and other health care facilities which may

11  provide services to trauma victims.

12         (m)  Medical control and accountability.

13         (n)  Quality management and system evaluation.

14         (2)(3)  The department shall consider the advice and

15  recommendations of any affected local or regional trauma

16  agency in developing the state trauma system systems plan.

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

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

19  trauma agencies.

20         (3)(4)  The department shall use the state trauma

21  system plan as the basis for establishing a statewide

22  inclusive trauma system.

23         Section 7.  Section 395.402, Florida Statutes, is

24  amended to read:

25         395.402  Trauma service areas; number and location of

26  trauma centers.--

27         (1)  The Legislature recognizes the need for a

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

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

30  trauma centers shall should each be capable of annually

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

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

 2  trauma centers in counties with a population of more than

 3  500,000 shall have the capacity to care for a minimum of 1,000

 4  patients per year. Further, the Legislature finds that, based

 5  on the numbers and locations of trauma victims with these

 6  injury severity scores, there should be 19 trauma service

 7  areas in the state, and, at a minimum, there should be at

 8  least one trauma center in each service area.

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

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

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

12  500 patients, respectively. Level II trauma centers in

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

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

15  guideline.

16         (2)(3)  Trauma service areas as described in this

17  section are to be utilized until the Department of Health

18  completes an assessment of the trauma system and reports its

19  findings to the Governor, the President of the Senate, the

20  Speaker of the House of Representatives, and the substantive

21  legislative committees. The report shall be submitted by

22  December 1, 2004. The department shall review the existing

23  trauma system and determine whether it is effective in

24  providing trauma care uniformly throughout the state. The

25  assessment shall:

26         (a)  Consider aligning trauma service areas within the

27  trauma region boundaries as established in July 2004.

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

29  needed for each trauma service area to provide a statewide

30  integrated trauma system.

31  

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 1         (c)  Establish criteria for determining the number and

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

 3  defined trauma service area or region.

 4         (d)  Consider including a criteria within trauma center

 5  verification standards based upon the number of trauma victims

 6  served within a service area.

 7         (3)  In conducting this assessment and subsequent

 8  annual reviews, the department shall consider:

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

10  trauma system plans submitted by regional trauma agencies.

11         (b)  Stakeholder recommendations.

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

13  rapid access to trauma care by patients.

14         (d)  Historical patterns of patient referral and

15  transfer in an area.

16         (e)  Inventories of available trauma care resources,

17  including professional medical staff.

18         (f)  Population growth characteristics.

19         (g)  Transportation capabilities, including ground and

20  air transport.

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

22         (i)  Recommendations of the Regional Domestic Security

23  Task Force.

24         (j)  The actual number of trauma victims currently

25  being served by each trauma center.

26         (k)  Other appropriate criteria.

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

28  periodically review the assignment of the 67 counties to

29  trauma service areas, in addition to the requirements of

30  paragraphs (2)(b)-(e) and subsection (3). County These

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

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 1  trauma centers. Revisions made by the department shall should

 2  take into consideration the recommendations made as part of

 3  the regional trauma system plans approved by the department,

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

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

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

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

 8  system requirements shall be considered by each trauma region

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

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

11  and every 5 years thereafter. Until the department completes

12  the December 2004 assessment its initial review, the

13  assignment of counties shall remain as established in this

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

15         (a)  The following trauma service areas are hereby

16  established:

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

18  Okaloosa, Santa Rosa, and Walton Counties.

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

20  Holmes, and Washington Counties.

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

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

23  Taylor, and Wakulla Counties.

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

25  Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette,

26  Levy, Putnam, Suwannee, and Union Counties.

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

28  Duval, Nassau, and St. Johns Counties.

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

30  Hernando, and Marion Counties.

31  

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

 2  Volusia Counties.

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

 4  Orange, Osceola, Seminole, and Sumter Counties.

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

 6  Pinellas Counties.

 7         10.  Trauma service area 10 shall consist of

 8  Hillsborough County.

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

10  Highlands, and Polk Counties.

11         12.  Trauma service area 12 shall consist of Brevard

12  and Indian River Counties.

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

14  Manatee, and Sarasota Counties.

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

16  Okeechobee, and St. Lucie Counties.

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

18  Glades, Hendry, and Lee Counties.

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

20  County.

21         17.  Trauma service area 17 shall consist of Collier

22  County.

23         18.  Trauma service area 18 shall consist of Broward

24  County.

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

26  Monroe Counties.

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

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

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

30  each trauma service area.

31  

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

 2  state-sponsored trauma centers in the state.

 3         Section 8.  Section 395.4025, Florida Statutes, is

 4  amended to read:

 5         395.4025  State-approved Trauma centers; selection;

 6  quality assurance; records.--

 7         (1)  For purposes of developing a system of

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

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

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

11  local or regional trauma services system plan, and

12  recommendations of the local or regional trauma agency, and

13  the 1990 Report and Proposal for Funding State-Sponsored

14  Trauma Centers, the department shall establish the approximate

15  number of state-approved trauma centers needed to ensure

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

17  the guidelines and procedures outlined in the 1990 report,

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

19  the department shall select those hospitals that are to be

20  recognized as state-approved trauma centers and shall include

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

22  subsequently, subject to specific programmatic and quality of

23  care standards.

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

25  care general hospital and each local and each regional trauma

26  agency in the state that the department is accepting letters

27  of intent from hospitals that are interested in becoming

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

29  the department, a hospital that operates within the geographic

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

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

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 1  consistent with the trauma services plan of the local or

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

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

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

 5  hospital that is a provisional or verified trauma center on

 6  January 1, 1992.

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

 8  hospitals that submitted a letter of intent an application

 9  package that will provide the hospitals with instructions for

10  submitting information to the department for selection as a

11  state-approved trauma center. The standards for verification

12  of trauma centers and pediatric trauma referral centers

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

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

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

16  applications from those hospitals seeking selection as

17  state-approved trauma centers, including those current

18  verified trauma centers that seek a change or redesignation in

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

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

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

22  provisional review of each application for the purpose of

23  determining that the hospital's application is complete and

24  that the hospital has the critical elements required for a

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

26  based on trauma center verification standards and shall

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

28  hospital has:

29         1.  Equipment and physical facilities necessary to

30  provide trauma services.

31  

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 1         2.  Personnel in sufficient numbers and with proper

 2  qualifications to provide trauma services.

 3         3.  An effective quality assurance process.

 4         4.  Submitted written confirmation by the local or

 5  regional trauma agency that the verification of the hospital

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

 7  consistent with the plan of the local or regional trauma

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

 9  This subparagraph applies to any hospital that is not a

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

11         (d)1.  Notwithstanding other provisions in this

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

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

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

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

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

17  service area allocation, as provided by rule of the

18  department. An applicant that is granted additional time

19  pursuant to this paragraph shall submit a plan for

20  departmental approval which includes timelines and activities

21  that the applicant proposes to complete in order to meet

22  application requirements. Any applicant that demonstrates an

23  ongoing effort to complete the activities within the timelines

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

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

26  has conducted a provisional review of the application and has

27  determined that the application is complete and that the

28  hospital has the critical elements required for a

29  state-approved trauma center.

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

31  stayed until the department determines that the application is

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 1  complete and that the hospital has the critical elements

 2  required for a state-approved trauma center.

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

 4  application found acceptable by the department based on

 5  provisional review, including all trauma centers verified as

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

 7  provisional state-approved trauma center.

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

 9  department shall conduct an in-depth evaluation of all

10  applications found acceptable in the provisional review. The

11  applications shall be evaluated against criteria enumerated in

12  the application packages as provided to the hospitals by the

13  department.

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

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

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

17  onsite visits to all provisional state-approved trauma

18  centers. The department shall develop a survey instrument to

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

20  include objective criteria and guidelines for reviewers based

21  on existing trauma center and pediatric trauma referral center

22  verification standards such that all trauma centers and

23  pediatric trauma referral centers are assessed equally. The

24  survey instrument shall also include a uniform rating system

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

26  compliance of each trauma center with specific standards, and

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

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

29  hospitals being considered as provisional state-approved

30  trauma centers shall meet all the requirements of a verified

31  trauma center or pediatric trauma referral center, and shall

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

 2  trauma center.

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

 4  department shall select state-approved trauma centers by July

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

 6  center or a state-approved pediatric trauma referral center

 7  may request an extension of its provisional status if it

 8  submits a corrective action plan to the department. The

 9  corrective action plan must demonstrate the ability of the

10  applicant to correct deficiencies noted during the applicant's

11  onsite review conducted by the department between the previous

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

13  provisional status of an applicant for designation as a

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

15  trauma referral center through December 31 if the applicant

16  provides a corrective action plan acceptable to the

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

18  assembled by the department shall conduct an onsite visit on

19  or before November 1 to confirm that the deficiencies have

20  been corrected. The provisional state-approved trauma center

21  or the provisional state-approved pediatric trauma referral

22  center is responsible for all costs associated with the onsite

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

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

25  of any provisional applicant granted an extension. Each

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

27  approval verification period during which time it must

28  continue to maintain trauma center verification standards and

29  acceptable patient outcomes as determined by department rule.

30  An approval A verification, unless sooner suspended or

31  revoked, automatically expires 7 years after the date of

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 1  issuance and is renewable upon application for renewal as

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

 3  those hospitals selected as state-approved trauma centers may

 4  operate as trauma centers.

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

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

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

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

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

10  subsection shall be conducted in the same manner as provided

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

12  combine all disputes between parties.

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

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

15  state-approved trauma center may not terminate or

16  substantially reduce the availability of trauma service

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

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

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

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

21  hospitals, and emergency medical service providers in the

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

23  procedures and process for notification, duration, and

24  explanation of the termination of trauma services.

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

26  the department or its agent may collect trauma care and

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

28  trauma centers, pediatric trauma referral centers, hospitals,

29  emergency medical service providers, local or regional trauma

30  agencies, or medical examiners for the purposes of evaluating

31  trauma system effectiveness, ensuring compliance with the

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 1  standards of verification, and monitoring patient outcomes. A

 2  trauma center, pediatric trauma referral center, hospital,

 3  emergency medical service provider, medical examiner, or local

 4  trauma agency or regional trauma agency, or a panel or

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

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

 7  care quality assurance proceedings, records, or reports.

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

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

10  such an agency to disclose to the department patient care

11  quality assurance proceedings, records, or reports that the

12  department needs solely to conduct quality assurance

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

14  quality assurance component of the trauma agency's plan

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

16  proceedings, records, or reports that the department may

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

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

19  quality assurance activities, and any recommendation for

20  improving or modifying the overall trauma system, if the

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

22  hospital, emergency medical service provider, medical

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

24  disclosed.

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

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

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

28  agent of the department under this subsection is not liable

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

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

31  

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 1  scope of the authority and responsibility assigned by the

 2  department.

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

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

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

 6  centers, pediatric trauma referral centers, hospitals,

 7  emergency medical service providers, local or regional trauma

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

 9  treatment, or examination of trauma patients.

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

11  reports, or patient care quality assurance proceedings,

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

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

14  395.403, s. 395.404, s. 395.4045, s. 395.405, s. 395.50, or s.

15  395.51 must be held confidential by the department or its

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

17  Patient care quality assurance proceedings, records, or

18  reports obtained or made pursuant to these sections are not

19  subject to discovery or introduction into evidence in any

20  civil or administrative action.

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

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

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

24  selecting state-approved trauma centers and must be consistent

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

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

27  applicants within a service area and the department to reduce

28  the timeframes.

29         (14)  Notwithstanding any other provision of this

30  section and rules adopted pursuant to this section that impose

31  time limits on the applications by hospitals seeking approval

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 1  and verification to operate as a trauma center, any acute care

 2  general or pediatric hospital that is located in a trauma

 3  service area where there is no existing trauma center and that

 4  has not already been previously approved may apply beginning

 5  on July 1, 2004, to the Department of Health for approval and

 6  verification to operate as a provisional trauma center or

 7  trauma center within the framework and substantive

 8  requirements under this part. Likewise, until the department

 9  has conducted the review provided under s. 395.402, only

10  hospitals located in trauma service areas where there is no

11  existing trauma center may apply.

12         Section 9.  Section 395.403, Florida Statutes, is

13  amended to read:

14         395.403  Reimbursement of state-sponsored trauma

15  centers.--

16         (1)  The Legislature finds that many hospitals which

17  provide services to trauma victims are not adequately

18  compensated for such treatment. The Legislature also

19  recognizes that the current verified trauma centers are

20  providing such services without adequate reimbursement.

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

22  financial support to the current verified trauma centers and

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

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

25  Legislature that this system of state-sponsored trauma centers

26  be assisted financially based on the volume and acuity of

27  uncompensated trauma care provided.

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

29  trauma centers shall be considered eligible to receive state

30  funding state-sponsored trauma centers when state revenues

31  dedicated for trauma centers funds are specifically

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 1  appropriated for state-sponsored trauma centers in the General

 2  Appropriations Act. The department shall make annual payments

 3  from the Administrative Trust Fund under s. 20.435 to the

 4  trauma centers and provisional trauma centers in recognition

 5  of the trauma centers' meeting the standards of trauma

 6  readiness and preparedness as prescribed in this part. The

 7  payments established in the General Appropriations Act shall

 8  be in equal amounts for the provisional trauma centers and

 9  trauma centers approved by the department during the fiscal

10  year in which funding is appropriated. If a provisional trauma

11  center or trauma center does not maintain its status as a

12  trauma center for any state fiscal year in which such funding

13  is appropriated, the provisional trauma center or trauma

14  center shall repay the state for the portion of the year

15  during which it was not a trauma center.

16         (3)  For fiscal year 2005-2006 and thereafter, the

17  department shall allocate funds not disbursed under subsection

18  (1) for trauma readiness and preparedness to provisional

19  trauma centers and trauma centers based on volume, acuity, and

20  levels of uncompensated trauma care. Distribution to a

21  provisional trauma center or trauma center shall be in an

22  amount that bears the same ratio to the total amount of such

23  distributions as the volume, acuity, and uncompensated trauma

24  care provided by the center bears to the total volume, acuity,

25  and uncompensated trauma care provided by all trauma centers

26  and provisional trauma centers in the state, as indicated in

27  the most recent year for which data is available.

28         (4)  Provisional trauma centers and trauma centers

29  eligible to receive distributions from the Administrative

30  Trust Fund under s. 20.435 in accordance with subsections (2)

31  

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 1  and (3) may request that such funds be used as

 2  intergovernmental transfer funds in the Medicaid program.

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

 4  center shall submit a claim electronically via the Trauma

 5  Claims Processing System, designed, developed, implemented,

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

 7  department's Medicaid program upon discharge of a trauma

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

 9  separate hospital claim shall be submitted for the hospital

10  days incurred in each fiscal year.

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

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

13  the submission of a claim.

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

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

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

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

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

19  that patient.

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

21  appropriate documentation showing a trauma patient's

22  eligibility for state funding. Documentation recognized by the

23  department as appropriate shall be limited to one of the

24  following:

25         1.  W-2 withholding forms.

26         2.  Payroll stubs.

27         3.  Income tax returns.

28         4.  Forms approving or denying unemployment

29  compensation or workers' compensation.

30         5.  Written verification of wages from employer.

31  

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 1         6.  Written verification from public welfare agencies

 2  or any other governmental agency which can attest to the

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

 4         7.  A witnessed statement signed by the patient or

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

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

 7  statement need not be obtained within 48 hours of the

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

 9  Hill-Burton Act.  The statement shall include acknowledgment

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

11  information to defraud a hospital for the purposes of

12  obtaining goods or services is a misdemeanor of the second

13  degree.

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

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

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

17  funding was only provided for eligible trauma patients and

18  medically necessary services.

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

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

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

22  Trauma Services Trust Fund.  Trauma patients who are eligible

23  for the Medicaid program shall not be considered eligible for

24  the state-sponsored trauma center program except for Medicaid

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

26  Claims Processing System as a result of Medicaid eligibility

27  for Medicaid covered services, the hospital shall submit a

28  claim to the Medicaid fiscal agent for payment.

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

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

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

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 1  of funding, after which time payment to provisional

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

 3  based on a trauma cost-based reimbursement methodology

 4  developed by the department. The department shall consult with

 5  representatives from the hospital industry including the

 6  Florida Hospital Association, the Association of Voluntary

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

 8  the development of the reimbursement methodology.

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

10  appropriated for state-sponsored trauma centers and to ensure

11  that no state-sponsored trauma center gains an unfair

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

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

14  state funds appropriated in the General Appropriations Act for

15  this section shall be divided into 19 trauma fund accounts

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

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

18  shall be based on the following formula: 

19  

20  

21              SAAA =   SATD   x TA

22                       TTD

23  where:

24         SAAA = service area appropriation amount.

25         SATD = uncompensated service area trauma days with ISS

26  score of 9 or greater.

27         TTD = uncompensated total trauma days with ISS score of

28  9 or greater for all 19 service areas.

29         TA = total dollars appropriated for state-sponsored

30  trauma centers.

31  

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

 2  be the detailed patient discharge data of the most recently

 3  completed calendar year for which the board possesses data.

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

 5  allocated to the service area where the treating hospital is

 6  located.

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

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

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

10  trauma centers proportionately based on volume and acuity of

11  uncompensated trauma care provided during the most recently

12  completed calendar year for which the board possesses data in

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

14  These trauma centers shall submit claims pursuant to

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

16  months after funding becomes available, any trauma center

17  which fails to submit claims for reimbursement equal to or

18  greater than the amount the trauma center received under the

19  initial allocation shall return any unearned funds to the

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

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

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

23  original allocation.

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

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

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

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

28  service area on a pro rata basis.

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

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

31  trauma account from which all remaining claims are paid

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

 2  funds are depleted.

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

 4  patient residing outside the trauma service area of the

 5  state-sponsored trauma center where the patient is treated

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

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

 8  shall be paid from the service area where the treating

 9  hospital is located.

10         (5)(7)  In order to receive state funding payments

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

12  trauma center and shall:

13         (a)  Agree to conform to all departmental requirements

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

15         (b)  Agree to provide information concerning the

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

17  manner prescribed by rule of the department.

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

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

20         (6)(8)  A state-sponsored trauma center that which

21  fails to comply with any of the conditions listed in

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

23  shall not receive payments under this section for the period

24  in which it was not in compliance.

25         Section 10.  Section 395.404, Florida Statutes, is

26  amended to read:

27         395.404  Review of trauma registry data; report to

28  central registry; confidentiality and limited release.--

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

30  request of the department, all acute care hospitals shall

31  furnish for department review, trauma registry data as

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 1  prescribed by rule of the department for the purpose of

 2  monitoring patient outcome and ensuring compliance with the

 3  standards of approval.

 4         (b)  Trauma registry data obtained pursuant to this

 5  subsection are confidential and exempt from the provisions of

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

 7  However, the department may provide such trauma registry data

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

 9  service provider, local or regional trauma agency, medical

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

11  The department may also use or provide trauma registry data

12  for purposes of research in accordance with the provisions of

13  chapter 405.

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

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

16  central registry, consistent with the procedures and

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

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

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

20  disability of the individual and any additional information

21  that the department finds necessary. Notwithstanding the

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

23  hospital shall submit severe disability and head-injury

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

25  trauma center and acute care hospital shall continue to

26  provide initial notification of persons who have severe

27  disabilities and head injuries to the Department of Health

28  within timeframes provided in chapter 413. Such initial

29  notification shall be made in the manner prescribed by the

30  Department of Health for the purpose of providing timely

31  

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 1  vocational rehabilitation services to the severely disabled or

 2  head-injured person.

 3         (3)  Trauma registry data obtained pursuant to this

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

 5  119.07(1) and s. 24(a), Art. I of the State Constitution.

 6  However, the department may provide such trauma registry data

 7  to the person, trauma center, pediatric trauma referral

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

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

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

11  provide trauma registry data for purposes of research in

12  accordance with the provisions of chapter 405.

13         Section 11.  Section 395.405, Florida Statutes, is

14  amended to read:

15         395.405  Rulemaking.--The department shall adopt and

16  enforce all rules necessary to administer this part ss.

17  395.0199, 395.401, 395.4015, 395.402, 395.4025, 395.403,

18  395.404, and 395.4045.

19         Section 12.  The Department of Health shall establish a

20  task force by August 1, 2004 for the purpose of studying and

21  making recommendations regarding the formula for the

22  distribution of funds deposited in the Administrative Trust

23  Fund in the Department of Health for distribution pursuant to

24  section 395.403, Florida Statutes, and alternative financing

25  options.  The task force shall include representatives of the

26  Governor's Office, the Department of Health, the Agency for

27  Health Care Administration, and representatives from Level I,

28  Level II, and pediatric trauma centers, and at least two

29  surgeons.  The report of the task force shall be submitted to

30  the Governor, the President of the Senate, and the Speaker of

31  the House of Representatives by January 15, 2005.

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 1         Section 13.  Trauma Center Matching Grant

 2  Program.--  It is the intent of the Legislature to promote the

 3  development of at least one trauma center in every trauma

 4  service area.  The Trauma Center matching grant program shall

 5  be established and administered by the Department of Health.

 6  The purpose of the program is to provide start-up funds as an

 7  incentive to encourage development of new trauma centers.  The

 8  grant program shall function as a partnership between state

 9  and local governments and private-sector health care

10  providers.  Private providers shall provide $1 in local

11  matching funds for each $1 grant payment made by the state.

12  Hospitals may apply for matching grant funds by submitting a

13  grant application to the department.  Applications shall be

14  competitively reviewed by an independent panel appointed by

15  the secretary of the department. The department may use up to

16  $2 million annually from the Administrative Trust Fund for

17  this program.

18         Section 14.  Subsection (5) of section 318.14, Florida

19  Statutes, is amended to read:

20         318.14  Noncriminal traffic infractions; exception;

21  procedures.--

22         (5)  Any person electing to appear before the

23  designated official or who is required so to appear shall be

24  deemed to have waived his or her right to the civil penalty

25  provisions of s. 318.18. The official, after a hearing, shall

26  make a determination as to whether an infraction has been

27  committed. If the commission of an infraction has been proven,

28  the official may impose a civil penalty not to exceed $500,

29  except that in cases involving unlawful speed in a school zone

30  or, involving unlawful speed in a construction zone, or

31  involving a death, the civil penalty may not exceed $1,000; or

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 1  require attendance at a driver improvement school, or both. If

 2  the person is required to appear before the designated

 3  official pursuant to s. 318.19(1) and is found to have

 4  committed the infraction, the designated official shall impose

 5  a civil penalty of $1,000 in addition to any other penalties.

 6  If the person is required to appear before the designated

 7  official pursuant to s. 318.19(2) and is found to have

 8  committed the infraction, the designated official shall impose

 9  a civil penalty of $500 in addition to any other penalties. If

10  the official determines that no infraction has been committed,

11  no costs or penalties shall be imposed and any costs or

12  penalties that have been paid shall be returned. Moneys

13  received from the mandatory civil penalties imposed pursuant

14  to this subsection upon persons required to appear before a

15  designated official pursuant to s. 318.19(1) or (2) shall be

16  remitted to the Department of Revenue and distributed into the

17  Administrative Trust Fund created under s. 20.435 to be used

18  by the Department of Health as required under s. 395.403.

19         Section 15.  Subsection (13) is added to section

20  318.21, Florida Statutes, to read:

21         318.21  Disposition of civil penalties by county

22  courts.--All civil penalties received by a county court

23  pursuant to the provisions of this chapter shall be

24  distributed and paid monthly as follows:

25         (13)(a)  Notwithstanding subsections (1) and (2), the

26  proceeds from the mandatory civil penalties imposed pursuant

27  to s. 318.14(5) shall be distributed as provided in that

28  section.

29         (b)  Notwithstanding subsections (1) and (2), the

30  proceeds from the fines imposed under s. 318.18(13) and (14)

31  shall be distributed as provided in that section.

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 1         Section 16.  Section 322.0261, Florida Statutes, is

 2  amended to read:

 3         322.0261  Mandatory Driver improvement course;

 4  requirement to maintain driving privileges; failure to

 5  complete; department approval of course certain crashes.--

 6         (1)  The department shall screen crash reports received

 7  under s. 316.066 or s. 324.051 to identify crashes involving

 8  the following:

 9         (a)  A crash involving death or a bodily injury

10  requiring transport to a medical facility; or

11         (b)  A second crash by the same operator within the

12  previous 2-year period involving property damage in an

13  apparent amount of at least $500.

14         (2)  With respect to an operator convicted of, or who

15  pleaded nolo contendere to, a traffic offense giving rise to a

16  crash identified pursuant to subsection (1), the department

17  shall require that the operator, in addition to other

18  applicable penalties, attend a department-approved

19  departmentally approved driver improvement course in order to

20  maintain driving privileges. If the operator fails to complete

21  the course within 90 days of receiving notice from the

22  department, the operator's driver's license shall be canceled

23  by the department until the course is successfully completed.

24         (3)  The department shall identify any operator

25  convicted of, or who pleaded nolo contendere to, a second

26  violation of s. 316.075(1)(c)1. or convicted of, or who

27  pleaded nolo contendere to, a second steady red signal

28  violation as provided in s. 316.074(1), which violation

29  occurred within 12 months after the first violation, and shall

30  require that operator, in addition to other applicable

31  penalties, to attend a department-approved driver improvement

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 1  course in order to maintain driving privileges. If the

 2  operator fails to complete the course within 90 days after

 3  receiving notice from the department, the operator's driver's

 4  license shall be canceled by the department until the course

 5  is successfully completed.

 6         (4)(3)  In determining whether to approve a driver

 7  improvement course for the purposes of this section, the

 8  department shall consider course content designed to promote

 9  safety, driver awareness, crash avoidance techniques, and

10  other factors or criteria to improve driver performance from a

11  safety viewpoint.

12         Section 17.  Paragraph (d) of subsection (3) of section

13  322.27, Florida Statutes, is amended to read:

14         322.27  Authority of department to suspend or revoke

15  license.--

16         (3)  There is established a point system for evaluation

17  of convictions of violations of motor vehicle laws or

18  ordinances, and violations of applicable provisions of s.

19  403.413(6)(b) when such violations involve the use of motor

20  vehicles, for the determination of the continuing

21  qualification of any person to operate a motor vehicle. The

22  department is authorized to suspend the license of any person

23  upon showing of its records or other good and sufficient

24  evidence that the licensee has been convicted of violation of

25  motor vehicle laws or ordinances, or applicable provisions of

26  s. 403.413(6)(b), amounting to 12 or more points as determined

27  by the point system. The suspension shall be for a period of

28  not more than 1 year.

29         (d)  The point system shall have as its basic element a

30  graduated scale of points assigning relative values to

31  convictions of the following violations:

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 1         1.  Reckless driving, willful and wanton--4 points.

 2         2.  Leaving the scene of a crash resulting in property

 3  damage of more than $50--6 points.

 4         3.  Unlawful speed resulting in a crash--6 points.

 5         4.  Passing a stopped school bus--4 points.

 6         5.  Unlawful speed:

 7         a.  Not in excess of 15 miles per hour of lawful or

 8  posted speed--3 points.

 9         b.  In excess of 15 miles per hour of lawful or posted

10  speed--4 points.

11         6.  A violation of a traffic control signal device as

12  provided in s. 316.075(1)(c)1.--4 points.

13         7.6.  All other moving violations (including parking on

14  a highway outside the limits of a municipality)--3 points.

15  However, no points shall be imposed for a violation of s.

16  316.0741 or s. 316.2065(12).

17         8.7.  Any moving violation covered above, excluding

18  unlawful speed, resulting in a crash--4 points.

19         9.8.  Any conviction under s. 403.413(5)(b)--3 points.

20         Section 18.  Subsections (13), (14), and (15) are added

21  to section 318.18, Florida Statutes, to read:

22         318.18  Amount of civil penalties.--The penalties

23  required for a noncriminal disposition pursuant to s. 318.14

24  are as follows:

25         (13)  One hundred ten dollars for a violation of s.

26  316.075(1)(c)1. or for a steady red signal violation as

27  provided in s. 316.074(1), of which $60 shall be distributed

28  as provided in s. 318.21 and the remaining $50 shall be

29  remitted to the Department of Revenue for deposit into the

30  Administrative Trust Fund created under s. 20.435 to be used

31  by the Department of Health as required under s. 395.403.

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 1         (14)  Two hundred sixty dollars for any infraction that

 2  results in a crash that causes any bodily injury other than

 3  "serious bodily injury" as defined in s. 316.1933(1), of which

 4  $60 shall be distributed as provided in s. 318.21 and the

 5  remaining $200 shall be remitted to the Department of Revenue

 6  for deposit into the Administrative Trust Fund created under

 7  s. 20.435 to be used by the Department of Health as required

 8  under s. 395.403.

 9         (15)  Notwithstanding any law to the contrary, the

10  clerk of the court shall collect an additional $10 for each

11  civil violation of chapter 316; $20 for each offense

12  specifically enumerated in s. 318.17; and $20 for any other

13  offense in chapter 316 which is classified as a criminal

14  violation. The fines collected under this subsection shall be

15  remitted to the Department of Revenue for deposit in the

16  Administrative Trust Fund under s. 20.435 to be used by the

17  Department of Health as required under s. 395.403.

18         Section 19.  Section 322.751, Florida Statutes, is

19  created to read:

20         322.751  Annual surcharge for points.--

21         (1)  Each year the department shall assess a surcharge

22  on each person who has accumulated eight or more points

23  against his or her driver's license during the preceding

24  36-month period.

25         (2)  The amount of a surcharge under this section is

26  $100 for the first eight points and $25 for each additional

27  point.

28         (3)  The department shall notify the holder of a

29  driver's license of the assignment of a fourth point on that

30  license by first-class mail sent to the person's most recent

31  address as shown on the records of the department.

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 1         (4)  This section does not apply to a conviction that

 2  becomes final before July 1, 2004.

 3         (5)  All moneys due under this section shall be billed

 4  and collected by the Department of Highway Safety and Motor

 5  Vehicles or its designee for deposit in the Highway Safety

 6  Operating Trust Fund. Of the moneys collected annually, the

 7  department shall retain the actual cost of developing,

 8  implementing, and administering the driver responsibility

 9  program. The remainder shall be transferred at least quarterly

10  to the Administrative Trust Fund created under s. 20.435 to be

11  used by the Department of Health as required under s. 395.403.

12         Section 20.  Paragraph (a) of subsection (2) of section

13  316.193, Florida Statutes, is amended to read:

14         316.193  Driving under the influence; penalties.--

15         (2)(a)  Except as provided in paragraph (b), subsection

16  (3), or subsection (4), any person who is convicted of a

17  violation of subsection (1) shall be punished:

18         1.  By a fine of:

19         a.  Not less than $250 or more than $500 for a first

20  conviction.

21         b.  Not less than $500 or more than $1,000 for a second

22  conviction; and

23         2.  By imprisonment for:

24         a.  Not more than 6 months for a first conviction.

25         b.  Not more than 9 months for a second conviction.

26         3.  For a second conviction, by mandatory placement for

27  a period of at least 1 year, at the convicted person's sole

28  expense, of an ignition interlock device approved by the

29  department in accordance with s. 316.1938 upon all vehicles

30  that are individually or jointly leased or owned and routinely

31  operated by the convicted person, when the convicted person

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 1  qualifies for a permanent or restricted license. The

 2  installation of such device may not occur before July 1, 2003.

 3         4.  In addition to the fines and penalties established

 4  in this subsection, the court shall impose a surcharge, to be

 5  collected by the department and to be subject to a court's

 6  determination of financial ability to pay, as follows:

 7         a.  Each year the department shall assess a surcharge

 8  on each person who has a final conviction during the preceding

 9  36-month period for an offense relating to s. 316.193.

10         b.  The amount of a surcharge under this section is

11  $500 per year, except that the amount of the surcharge is:

12         (I)  Seven hundred fifty dollars per year for a second

13  or subsequent conviction within a 36-month period; and

14         (II)  One thousand dollars for a first or subsequent

15  conviction if the blood-alcohol level of the person was 0.20

16  or higher at the time the analysis was performed.

17         c.  A surcharge under this section for the same

18  conviction may not be assessed in more than 3 years.

19         d.  This section does not apply to a conviction that

20  becomes final before July 1, 2004.

21         e.  All moneys due under this subparagraph shall be

22  billed and collected by the Department of Highway Safety and

23  Motor Vehicles or its designee for deposit in the Highway

24  Safety Operating Trust Fund. Of the moneys collected annually,

25  the department shall retain the actual cost of developing,

26  implementing, and administering the driver responsibility

27  program. The remainder shall be transferred at least quarterly

28  to the Administrative Trust Fund created under s. 20.435 to be

29  used by the Department of Health as required under s. 395.403.

30         Section 21.  Section 794.056, Florida Statutes, is

31  amended to read:

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 1         794.056  Rape Crisis Program Trust Fund.--

 2         (1)  The Rape Crisis Program Trust Fund is created

 3  within the Department of Health for the purpose of providing

 4  funds for rape crisis centers in this state. Trust fund moneys

 5  shall be used exclusively for the purpose of providing

 6  services for victims of sexual assault. Funds deposited in the

 7  trust fund shall include revenues as provided by law, moneys

 8  as appropriated by the Legislature, and grants from public or

 9  private entities. Funds credited to the trust fund consist of

10  those funds collected as an additional court assessment in

11  each case in which a defendant pleads guilty or nolo

12  contendere to, or is found guilty of, regardless of

13  adjudication, an offense defined in s. 784.011, s. 784.021, s.

14  784.03, s. 784.041, s. 784.045, s. 784.048, s. 784.07, s.

15  784.08, s. 784.081, s. 784.082, s. 784.083, s. 785.085, or s.

16  794.011.

17         (2)  The Department of Health shall establish by rule,

18  consistent with s. 794.055(3)(a), criteria for distributing

19  moneys from the trust fund to the statewide nonprofit

20  association the primary purpose of which is to represent and

21  provide technical assistance to rape crisis centers for

22  distribution to rape crisis centers.

23         (3)  In accordance with s. 19(f)(2), Art. III of the

24  State Constitution, the Rape Crisis Program Trust Fund shall

25  be terminated on July 1, 2007, unless terminated sooner.

26  Before its scheduled termination, the trust fund shall be

27  reviewed as provided in s. 215.3206(1) and (2).

28         Section 22.  Section 322.7525, Florida Statutes, is

29  created to read:

30         322.7525  Notice of surcharge.--

31  

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 1         (1)  The department shall notify the holder of a

 2  driver's license of the assessment of a surcharge on that

 3  license by first-class mail sent to the person's most recent

 4  address as shown on the records of the department. The notice

 5  must specify the date by which the surcharge must be paid and

 6  and state the consequences of a failure to pay the surcharge.

 7         (2)  If, before the 30th day after the date the

 8  department sends a notice under s. 322.751, s. 322.7515, s.

 9  322.7516, or s. 327.732, the person fails to pay the amount of

10  a surcharge on the person's license or fails to enter into an

11  installment payment agreement with the department, the license

12  of the person is automatically suspended.

13         (3)  A license suspended under this section remains

14  suspended until the person pays the amount of the surcharge

15  and any related costs.

16         Section 23.  Section 322.753, Florida Statutes, is

17  created to read:

18         322.753  Installment payment of surcharges.--

19         (1)  The department shall by rule provide for the

20  payment of a surcharge in installments.

21         (2)  A rule under this section:

22         (a)  May not permit a person to pay a surcharge:

23         1.  Of less than $2,300 over a period of more than 12

24  consecutive months; or

25         2.  Of $2,300 or more over a period of more than 24

26  consecutive months.

27         (b)  May provide that if the person fails to make a

28  required installment payment, the department may declare the

29  amount of the unpaid surcharge immediately due and payable.

30         (3)  The department may by rule authorize the payment

31  of a surcharge by use of a credit card. The rules shall

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 1  require the person to pay all costs incurred by the department

 2  in connection with the acceptance of the credit card.

 3         (4)  If a person pays a surcharge or related cost by

 4  credit card and the amount is subsequently reversed by the

 5  issuer of the credit card, the license of that person is

 6  automatically suspended.

 7         (5)  A license suspended under this section remains

 8  suspended until the person pays the amount of the surcharge

 9  and any related costs.

10         Section 24.  Section 395.4035, Florida Statutes, is

11  repealed.

12         Section 25.  The Department of Highway Safety and Motor

13  Vehicles shall determine the level of funding necessary to

14  implement sections 19 and 20 of this act with department

15  resources. If the department determines that such services

16  could be provided more effectively or efficiently, the

17  department may consider outsourcing proposals through

18  competitive processes. Notwithstanding the provisions of

19  chapter 287, Florida Statutes, in the event that less than

20  four responsive bids are received, the department shall

21  continue implementation with in-house resources.

22         Section 26.  There is appropriated $250,000 from the

23  Highway Safety Operating Trust Fund for initial development

24  start-up costs related to sections 19 and 20 of this act. The

25  Department of Highway Safety and Motor Vehicles shall submit a

26  budget amendment for approval by the Legislative Budget

27  Commission, pursuant to chapter 216, Florida Statutes, upon

28  determination of the additional budget amounts by

29  appropriation category that are necessary for full

30  implementation.

31  

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    Florida Senate - 2004                    CS for CS for SB 2842
    309-2687-04




 1         Section 27.  Of the funds received in the

 2  Administrative Trust Fund, the Department of Health shall

 3  retain 91.67 percent of monthly collections in the

 4  Administrative Trust Fund. The remaining 8.33 percent of

 5  monthly collections shall be distributed to the Rape Crisis

 6  Program Trust Fund, up to a maximum annual distribution of $4

 7  million. Once the $4 million cap is reached for the Rape

 8  Crisis Program Trust Fund, 100 percent of collections shall be

 9  retained in the Administrative Trust Fund in the Department of

10  Health. Annual collections in excess of $55 million shall be

11  transferred as follows: $5 million to the Brain and Spinal

12  Cord Injury Program Trust Fund for the purpose set forth in

13  section 381.79, Florida Statutes, and the remainder to the

14  General Revenue Fund.

15         Section 28.  There is appropriated from the

16  Administrative Trust Fund in the Department of Health the sum

17  of $31,591,454 to provide funding for verified and provisional

18  trauma centers pursuant to section 395.403, Florida Statutes,

19  and $4 million from the Rape Crisis Program Trust Fund in the

20  Department of Health for the purpose of providing services for

21  victims of sexual assault.

22         Section 29.  This act shall take effect July 1, 2004.

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    Florida Senate - 2004                    CS for CS for SB 2842
    309-2687-04




 1          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
 2                          CS for SB 2842

 3                                 

 4  Limits applications of hospitals seeking approval to operate
    as a trauma center to those located in trauma service areas
 5  where there is no existing trauma center until completion of a
    review of the trauma system by the Department of Health.
 6  
    Expands the timeframe for which trauma centers are eligible to
 7  receive payments to those approved by the department during
    the fiscal year in which funds are appropriated rather than to
 8  only those approved as of July 1 of the year.

 9  Authorizes the Department of Highway Safety and Motor Vehicles
    to determine the level of funding necessary to implement
10  assessment of surcharges and fines; to notify drivers affected
    by additional penalties and fines; to bill and collect, and to
11  administer the driver responsibility program; and allows for
    outsourcing these functions.
12  
    Requires the Department of Health to complete an assessment of
13  the current trauma system and deletes the limitation that
    there be no more than a total of 44 state-sponsored trauma
14  centers in Florida.

15  Clarifies that for fiscal year 2005-06 and thereafter, the
    Department of Health shall allocate funds not disbursed for
16  trauma readiness and preparedness to provisional trauma
    centers and trauma centers based on volume, acuity, and levels
17  of uncompensated trauma care.

18  Appropriates $250,000 from the Highway Safety Operating Trust
    Fund for initial start-up costs related to the driver
19  responsibility program; and instructs the department to submit
    a budget amendment to the Legislative Budget Commission if the
20  appropriation is insufficient to fully implement the program.

21  Provides for distribution of collections in the Administrative
    Trust Fund in the Department of Health.  Appropriates
22  $31,591,454 from the Administrative Trust Fund for verified
    and provisional trauma centers and $4,000,000 from the Rape
23  Crisis Program Trust Fund for services for victims of sexual
    assault.
24  
    Requires the Department of Health to establish a task force to
25  study and make recommendations regarding the formula for the
    distribution of funds deposited in the Administrative Trust
26  Fund.

27  Establishes a trauma center matching grant program in the
    Department of Health.
28  
    Revises the civil penalty for all violations specified in
29  chapter 316, for offenses specifically identified in s.
    318.17, F.S., and for all criminal violations in chapter 316;
30  increases fine for running a red light and any infraction
    resulting in a crash causing bodily injury other than serious
31  bodily injury; imposes mandatory civil penalties for persons
    who are required to appear before a designated official for
                                  51

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    Florida Senate - 2004                    CS for CS for SB 2842
    309-2687-04




 1  committing a traffic infraction resulting in a crash causing
    death or serious bodily injury; increases the number of
 2  accumulated points on which the surcharge for driving under
    the influence within the preceding thirty-six month period is
 3  assessed; removes the annual monetary penalty for driving
    without a license or driving with a revoked or suspended
 4  license; removes the annual monetary penalty for driving
    without insurance, proof of insurance, or a bond to cover
 5  liability arising out of the use of a motor vehicle.

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                                  52

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