| 1 | Representative(s) Holloway offered the following: |
| 2 |
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| 3 | Amendment (with title amendment) |
| 4 | Remove everything after the enacting clause and insert: |
| 5 | Section 1. Paragraph (a) of subsection (1) and subsection |
| 6 | (4) of section 408.061, Florida Statutes, are amended to read: |
| 7 | 408.061 Data collection; uniform systems of financial |
| 8 | reporting; information relating to physician charges; |
| 9 | confidential information; immunity.-- |
| 10 | (1) The agency shall require the submission by health care |
| 11 | facilities, health care providers, and health insurers of data |
| 12 | necessary to carry out the agency's duties. Specifications for |
| 13 | data to be collected under this section shall be developed by |
| 14 | the agency with the assistance of technical advisory panels |
| 15 | including representatives of affected entities, consumers, |
| 16 | purchasers, and such other interested parties as may be |
| 17 | determined by the agency. |
| 18 | (a) Data submitted by health care facilities, including |
| 19 | the facilities as defined in chapter 395, shall include, but are |
| 20 | not limited to: case-mix data, patient admission and discharge |
| 21 | data, hospital emergency department data which shall include the |
| 22 | number of patients treated in the emergency department of a |
| 23 | licensed hospital reported by patient acuity level, data on |
| 24 | hospital-acquired infections as specified by rule, data on the |
| 25 | number of patients assigned to each direct care registered nurse |
| 26 | in each unit of the facility for each shift, data on |
| 27 | complications as specified by rule, data on readmissions as |
| 28 | specified by rule, with patient and provider-specific |
| 29 | identifiers included, actual charge data by diagnostic groups, |
| 30 | financial data, accounting data, operating expenses, expenses |
| 31 | incurred for rendering services to patients who cannot or do not |
| 32 | pay, interest charges, depreciation expenses based on the |
| 33 | expected useful life of the property and equipment involved, and |
| 34 | demographic data. The agency shall adopt nationally recognized |
| 35 | risk adjustment methodologies or software consistent with the |
| 36 | standards of the Agency for Healthcare Research and Quality and |
| 37 | as selected by the agency for all data submitted as required by |
| 38 | this section. Data may be obtained from documents such as, but |
| 39 | not limited to: leases, contracts, debt instruments, itemized |
| 40 | patient bills, medical record abstracts, and related diagnostic |
| 41 | information. Reported data elements shall be reported |
| 42 | electronically in accordance with rule 59E-7.012, Florida |
| 43 | Administrative Code. Data submitted shall be certified by the |
| 44 | chief executive officer or an appropriate and duly authorized |
| 45 | representative or employee of the licensed facility that the |
| 46 | information submitted is true and accurate. |
| 47 |
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| 48 | (4) Within 120 days after the end of its fiscal year, each |
| 49 | health care facility, excluding continuing care facilities and |
| 50 | nursing homes as defined in s. 408.07(14) and (37) (36), shall |
| 51 | file with the agency, on forms adopted by the agency and based |
| 52 | on the uniform system of financial reporting, its actual |
| 53 | financial experience for that fiscal year, including |
| 54 | expenditures, revenues, and statistical measures. Such data may |
| 55 | be based on internal financial reports which are certified to be |
| 56 | complete and accurate by the provider. However, hospitals' |
| 57 | actual financial experience shall be their audited actual |
| 58 | experience. Every nursing home shall submit to the agency, in a |
| 59 | format designated by the agency, a statistical profile of the |
| 60 | nursing home residents. The agency, in conjunction with the |
| 61 | Department of Elderly Affairs and the Department of Health, |
| 62 | shall review these statistical profiles and develop |
| 63 | recommendations for the types of residents who might more |
| 64 | appropriately be placed in their homes or other noninstitutional |
| 65 | settings. |
| 66 | Section 2. Paragraph (j) of subsection (1) of section |
| 67 | 408.062, Florida Statutes, is amended to read: |
| 68 | 408.062 Research, analyses, studies, and reports.-- |
| 69 | (1) The agency shall conduct research, analyses, and |
| 70 | studies relating to health care costs and access to and quality |
| 71 | of health care services as access and quality are affected by |
| 72 | changes in health care costs. Such research, analyses, and |
| 73 | studies shall include, but not be limited to: |
| 74 | (j) The making available on its Internet website no later |
| 75 | than October 1, 2004, and in a hard-copy format upon request, of |
| 76 | the number of patients assigned per direct care registered nurse |
| 77 | and patient charge, volumes, length of stay, and performance |
| 78 | outcome indicators collected from health care facilities |
| 79 | pursuant to s. 408.061(1)(a) for specific medical conditions, |
| 80 | surgeries, and procedures provided in inpatient and outpatient |
| 81 | facilities as determined by the agency. In making the |
| 82 | determination of specific medical conditions, surgeries, and |
| 83 | procedures to include, the agency shall consider such factors as |
| 84 | volume, severity of the illness, urgency of admission, |
| 85 | individual and societal costs, and whether the condition is |
| 86 | acute or chronic. Performance outcome indicators shall be risk |
| 87 | adjusted or severity adjusted, as applicable, using nationally |
| 88 | recognized risk adjustment methodologies or software consistent |
| 89 | with the standards of the Agency for Healthcare Research and |
| 90 | Quality and as selected by the agency. The website shall also |
| 91 | provide an interactive search that allows consumers to view and |
| 92 | compare the information for specific facilities, a map that |
| 93 | allows consumers to select a county or region, definitions of |
| 94 | all of the data, descriptions of each procedure, and an |
| 95 | explanation about why the data may differ from facility to |
| 96 | facility. Such public data shall be updated quarterly. The |
| 97 | agency shall submit an annual status report on the collection of |
| 98 | data and publication of performance outcome indicators to the |
| 99 | Governor, the Speaker of the House of Representatives, the |
| 100 | President of the Senate, and the substantive legislative |
| 101 | committees with the first status report due January 1, 2005. |
| 102 | Section 3. Subsection (2) of section 408.063, Florida |
| 103 | Statutes, is amended to read: |
| 104 | 408.063 Dissemination of health care information.-- |
| 105 | (2) The agency shall publish and disseminate information |
| 106 | to the public which will enhance informed decisionmaking in the |
| 107 | selection of health care providers, facilities, and services. |
| 108 | Such publications may identify average charges for specified |
| 109 | services, average number of patients assigned to each direct |
| 110 | care nurse in each unit of the hospital, lengths of stay |
| 111 | associated with established diagnostic groups, readmission |
| 112 | rates, mortality rates, recommended guidelines for selection and |
| 113 | use of health care providers, health care facilities, and health |
| 114 | care services, and such other information as the agency deems |
| 115 | appropriate. |
| 116 | Section 4. Present subsections (18) through (44) of |
| 117 | section 408.07, Florida Statutes, are renumbered as subsections |
| 118 | (19) through (45), respectively, and a new subsection (18) is |
| 119 | added to said section to read: |
| 120 | 408.07 Definitions.--As used in this chapter, with the |
| 121 | exception of ss. 408.031-408.045, the term: |
| 122 | (18) "Direct care registered nurse" or "direct care nurse" |
| 123 | means a registered nurse who has direct responsibility for |
| 124 | overseeing or carrying out medical regimens or nursing care for |
| 125 | one or more patients. A nurse administrator, nurse supervisor, |
| 126 | nurse educator, charge nurse, or other registered nurse who does |
| 127 | not have a specific patient assignment may not be included in |
| 128 | the calculation of the number of patients assigned to each |
| 129 | direct care registered nurse on a unit. |
| 130 | Section 5. Subsection (24) of section 395.002, Florida |
| 131 | Statutes, is amended to read: |
| 132 | 395.002 Definitions.--As used in this chapter: |
| 133 | (24) "Premises" means those buildings, beds, and equipment |
| 134 | located at the address of the licensed facility and all other |
| 135 | buildings, beds, and equipment for the provision of hospital, |
| 136 | ambulatory surgical, or mobile surgical care located in such |
| 137 | reasonable proximity to the address of the licensed facility as |
| 138 | to appear to the public to be under the dominion and control of |
| 139 | the licensee. For any licensee that is a teaching hospital as |
| 140 | defined in s. 408.07(45)(44), reasonable proximity includes any |
| 141 | buildings, beds, services, programs, and equipment under the |
| 142 | dominion and control of the licensee that are located at a site |
| 143 | with a main address that is within 1 mile of the main address of |
| 144 | the licensed facility; and all such buildings, beds, and |
| 145 | equipment may, at the request of a licensee or applicant, be |
| 146 | included on the facility license as a single premises. |
| 147 | Section 6. Paragraph (e) of subsection (2) of section |
| 148 | 395.003, Florida Statutes, is amended to read: |
| 149 | 395.003 Licensure; issuance, renewal, denial, |
| 150 | modification, suspension, and revocation.-- |
| 151 | (2) |
| 152 | (e) The agency shall, at the request of a licensee that is |
| 153 | a teaching hospital as defined in s. 408.07(45)(44), issue a |
| 154 | single license to a licensee for facilities that have been |
| 155 | previously licensed as separate premises, provided such |
| 156 | separately licensed facilities, taken together, constitute the |
| 157 | same premises as defined in s. 395.002(24). Such license for the |
| 158 | single premises shall include all of the beds, services, and |
| 159 | programs that were previously included on the licenses for the |
| 160 | separate premises. The granting of a single license under this |
| 161 | paragraph shall not in any manner reduce the number of beds, |
| 162 | services, or programs operated by the licensee. |
| 163 | Section 7. Subsection (1) of section 458.345, Florida |
| 164 | Statutes, is amended to read: |
| 165 | 458.345 Registration of resident physicians, interns, and |
| 166 | fellows; list of hospital employees; prescribing of medicinal |
| 167 | drugs; penalty.-- |
| 168 | (1) Any person desiring to practice as a resident |
| 169 | physician, assistant resident physician, house physician, |
| 170 | intern, or fellow in fellowship training which leads to |
| 171 | subspecialty board certification in this state, or any person |
| 172 | desiring to practice as a resident physician, assistant resident |
| 173 | physician, house physician, intern, or fellow in fellowship |
| 174 | training in a teaching hospital in this state as defined in s. |
| 175 | 408.07(45)(44) or s. 395.805(2), who does not hold a valid, |
| 176 | active license issued under this chapter shall apply to the |
| 177 | department to be registered and shall remit a fee not to exceed |
| 178 | $300 as set by the board. The department shall register any |
| 179 | applicant the board certifies has met the following |
| 180 | requirements: |
| 181 | (a) Is at least 21 years of age. |
| 182 | (b) Has not committed any act or offense within or without |
| 183 | the state which would constitute the basis for refusal to |
| 184 | certify an application for licensure pursuant to s. 458.331. |
| 185 | (c) Is a graduate of a medical school or college as |
| 186 | specified in s. 458.311(1)(f). |
| 187 | Section 8. Subsection (1) of section 459.021, Florida |
| 188 | Statutes, is amended to read: |
| 189 | 459.021 Registration of resident physicians, interns, and |
| 190 | fellows; list of hospital employees; penalty.-- |
| 191 | (1) Any person who holds a degree of Doctor of Osteopathic |
| 192 | Medicine from a college of osteopathic medicine recognized and |
| 193 | approved by the American Osteopathic Association who desires to |
| 194 | practice as a resident physician, assistant resident physician, |
| 195 | house physician, intern, or fellow in fellowship training which |
| 196 | leads to subspecialty board certification in this state, or any |
| 197 | person desiring to practice as a resident physician, assistant |
| 198 | resident physician, house physician, intern, or fellow in |
| 199 | fellowship training in a teaching hospital in this state as |
| 200 | defined in s. 408.07(45)(44) or s. 395.805(2), who does not hold |
| 201 | an active license issued under this chapter shall apply to the |
| 202 | department to be registered, on an application provided by the |
| 203 | department, within 30 days of commencing such a training program |
| 204 | and shall remit a fee not to exceed $300 as set by the board. |
| 205 | Section 9. This act shall take effect July 1, 2005. |
| 206 |
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| 207 | ================= T I T L E A M E N D M E N T ================= |
| 208 | Remove the entire title and insert: |
| 209 | A bill to be entitled |
| 210 | An act relating to health care administration; amending |
| 211 | ss. 408.061, 408.062, and 408.063, F.S.; requiring that |
| 212 | data relating to the number of patients per direct care |
| 213 | nurse be reported to the Agency for Health Care |
| 214 | Administration and made available to the public; amending |
| 215 | s. 408.07, F.S.; defining the synonymous terms "direct |
| 216 | care registered nurse" and "direct care nurse" as used in |
| 217 | ch. 408, F.S., except ss. 408.031-408.045, F.S.; amending |
| 218 | ss. 395.002, 395.003, 458.345, and 459.021, F.S.; |
| 219 | correcting cross references; providing an effective date. |