HB 0329 2004
1	A bill to be entitled
2	An act relating to health care; amending s. 408.036, F.S.;
3	revising an exemption from certificate-of-need
4	requirements for certain open-heart-surgery programs to
5	apply the exemption to any hospital located within a
6	specified health service planning district or a specified
7	acute care subdistrict; providing criteria for qualifying
8	for the exemption; requiring the Agency for Health Care
9	Administration to report to the Legislature regarding the
10	number of such exemptions requested and the number granted
11	or denied each year; providing an effective date.
12
13	WHEREAS, appropriate access to adult cardiac care is an
14	issue of critical state importance to all citizens of the state
15	and to all health service planning districts of the state, and
16	WHEREAS, the certificate-of-need process, for most
17	geographic areas in the state, has provided adequate access to
18	adult open-heart-surgery services to Floridians as well as
19	tourists, business travelers, indigents, and migrant workers who
20	receive such services, and
21	WHEREAS, the Legislature has found an anomaly in the
22	state's health care network of adult cardiac care which has
23	created a lack of geographic and temporal access to such care
24	within Health Service Planning District 9 and Acute Care
25	Subdistrict 6-2, and
26	WHEREAS, the assurance of timely and appropriate access to
27	adult cardiac care is critical not only to the citizens residing
28	in Health Service Planning District 9 and Acute Care Subdistrict
29	6-2, but also to the entire state, since it has a direct effect
30	on commerce, seasonal visitors, the tourist industry, the
31	migrant population, the working poor, and indigents from all
32	parts of the state as well as outside its borders, and
33	WHEREAS, the number of adult open-heart-surgery programs in
34	Health Service Planning District 9 and Acute Care Subdistrict 6-
35	2 has not kept pace with the dramatic increase in population in
36	those areas, and
37	WHEREAS, the disparity in the number of adult open-heart-
38	surgery programs has significantly contributed to the lack of
39	geographic and temporal access to adult cardiac care in Health
40	Service Planning District 9 and Acute Care Subdistrict 6-2, and
41	WHEREAS, there have been numerous technological advances in
42	the area of primary angioplasty and stent procedures known
43	collectively as percutaneous coronary interventions, and these
44	advanced interventional treatments provide the highest standard
45	of care for people suffering acute myocardial infarctions, and
46	WHEREAS, the success of these interventional treatments
47	requires immediate access (within 1 hour) to hospitals having
48	interventional technology and backup open-heart-surgery
49	programs, and
50	WHEREAS, in Florida a hospital is prohibited from
51	performing these advanced interventional cardiac services
52	without having onsite adult open-heart-surgery capabilities, and
53	WHEREAS, hospitals that cannot perform percutaneous
54	coronary interventions must resort to the use of thrombolytics,
55	a less effective treatment in many instances; therefore, adults
56	in need of percutaneous coronary interventions are being denied
57	these procedures due to artificial barriers to geographic and
58	temporal access, and
59	WHEREAS, because a sufficient number of open-heart
60	procedures for adults are being performed by existing open-heart
61	providers, the addition of new open-heart units through the
62	exemption provided by this act will not reduce the standard of
63	care and quality associated with the standard volume of
64	procedures, and
65	WHEREAS, the lack of geographic and temporal access to
66	adult cardiac care is caused not only by physical distance
67	between those hospitals that do not have open-heart programs and
68	those hospitals that have available open-heart programs, but
69	also by the actual time taken to transfer an emergent cardiac
70	patient to a receiving facility, and
71	WHEREAS, diagnosis; discharge from the transferring
72	hospital; transfer arrangements, including, but not limited to,
73	insurance and administrative approval; transportation
74	availability; admission to the receiving hospital; staff
75	availability at the receiving hospital; and, most importantly,
76	bed availability at the receiving hospital as well as travel
77	delays to the receiving hospital contribute to the time taken to
78	effectuate a transfer of a cardiac patient, and
79	WHEREAS, these and other factors have contributed to the
80	inadequate geographic and temporal access to adult cardiac care
81	in Health Service Planning District 9 and Acute Care Subdistrict
82	6-2, and
83	WHEREAS, particular to Acute Care Subdistrict 6-2 is the
84	added impediment to geographic and temporal access in that the
85	main transportation corridors to open-heart-surgery facilities
86	in the subdistrict operate at extremely low to near failure of
87	transit, which contributes to failure to transfer emergent
88	cardiac patients within the recommended time in which to receive
89	the highest standard of care for people suffering acute
90	myocardial infarctions, and
91	WHEREAS, the Legislature finds that timely access and
92	availability for every adult citizen regardless of socioeconomic
93	class or geographic location to these interventional treatments
94	and open-heart surgery is of critical state concern, especially
95	because myocardial infarctions and related coronary disease are
96	no respecters of location or time, and
97	WHEREAS, the Legislature finds that the exemption provided
98	by this act in Health Service Planning District 9 and Acute Care
99	Subdistrict 6-2 will further serve an important state interest
100	by increasing access to the appropriate life-saving treatment
101	for all adults present in those areas, whether they are
102	commercial visitors, seasonal visitors, residents, tourists,
103	migrant workers, indigents, or other traditionally underserved
104	individuals, and
105	WHEREAS, the Legislature further finds that the exemption
106	provided by this act will serve an issue of critical state
107	importance by reducing the cost of open-heart-surgery and
108	angioplasty services by increasing quality competition by
109	removing artificial barriers to entry amongst providers and
110	providing additional choices to those individuals needing these
111	services, and
112	WHEREAS, to ensure that it provides the quality of care
113	desired, each hospital that qualifies for the exemption provided
114	by this act will be subject to more stringent criteria than
115	those imposed by the current certificate-of-need process and
116	will also be subject to continual monitoring by the Agency for
117	Health Care Administration, and
118	WHEREAS, the Legislature intends to ensure that standards
119	of quality are maintained while promoting competition in the
120	provision of adult cardiac care, NOW, THEREFORE,
121
122	Be It Enacted by the Legislature of the State of Florida:
123
124	Section 1. Paragraph (t) of subsection (3) of section
125	408.036, Florida Statutes, is amended to read:
126	408.036 Projects subject to review; exemptions.--
127	(3) EXEMPTIONS.--Upon request, the following projects are
128	subject to exemption from the provisions of subsection (1):
129	(t)1. For the provision of adult open-heart services in a
130	hospital located within the boundaries of Health Service
131	Planning District 9, as defined in s. 408.032(5), or Acute Care
132	Subdistrict 6-2, as defined in Rule 59C-2.100(3)(f)2., Florida
133	Administrative Code Palm Beach, Polk, Martin, St. Lucie, and
134	Indian River Counties if the following conditions are met: The
135	exemption must be based upon objective criteria and address and
136	solve the twin problems of geographic and temporal access. A
137	hospital shall be exempt from the certificate-of-need review for
138	the establishment of an open-heart-surgery program when the
139	application for exemption submitted under this paragraph
140	complies with the following criteria:
141	a. The applicant must certify that it will meet and
142	continuously maintain the minimum licensure requirements adopted
143	by the agency governing adult open-heart programs, including the
144	most current guidelines of the American College of Cardiology
145	and American Heart Association Guidelines for Adult Open Heart
146	Programs.
147	b. The applicant must certify that it will maintain
148	sufficient appropriate equipment and health personnel to ensure
149	quality and safety.
150	c. The applicant must certify that it will maintain
151	appropriate times of operation and protocols to ensure
152	availability and appropriate referrals in the event of
153	emergencies.
154	d. The applicant must certify can demonstratethat it is
155	referring 300 or more patients per year from the hospital,
156	including the emergency room, for cardiac services at a hospital
157	with cardiac services, or that the average wait for transfer for
158	50 percent or more of the cardiac patients exceeds 4 hours.
159	e. The applicant is a general acute care hospital that is
160	in operation for 3 years or more.
161	f. The applicant is performing more than 300 diagnostic
162	cardiac catheterization procedures per year, combined inpatient
163	and outpatient.
164	g. The applicant's payor mix at a minimum reflects the
165	community average for Medicaid, charity care, and self-pay
166	patients or the applicant must certify that it will provide a
167	minimum of 5 percent of Medicaid, charity care, and self-pay to
168	open-heart-surgery patients.
169	h. If the applicant fails to meet the established criteria
170	for open-heart programs or fails to reach 300 surgeries per year
171	by the end of its third year of operation, it must show cause
172	why its exemption should not be revoked.
173	2. By December 31, 2004, and annually thereafter, the
174	agency for Health Care Administrationshall submit a report to
175	the Legislature providing information concerning the number of
176	requests for exemption it has received under this paragraph
177	during the calendar year and the number of exemptions it has
178	granted or denied during the calendar year.
179	Section 2. This act shall take effect upon becoming a law.