HB 0763

CS

CHAMBER ACTION

1	The Health & Families Council recommends the following:
2
3	Council/Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to critical access hospitals; amending s.
7	395.002, F.S.; revising the definition of "hospital" to
8	provide an exception with regard to facilities offered by
9	a critical access hospital; revising the definition of
10	"intensive residential treatment programs for children and
11	adolescents" to include additional accrediting
12	organizations for purposes of licensure of such programs;
13	correcting a cross reference; amending s. 395.003, F.S.;
14	extending the moratorium on approving additional emergency
15	departments located off the premises of licensed
16	hospitals; providing for additional accrediting
17	organizations for purposes of licensure of intensive
18	residential treatment programs; correcting a cross
19	reference; amending s. 395.602, F.S.; revising the
20	definition of "rural hospital" to conform to changes made
21	by the act; amending s. 408.07, F.S.; defining the term
22	"critical access hospital"; revising the definition of
23	"rural hospital"; amending ss. 408.061, 458.345, and
24	459.021, F.S.; conforming cross references; providing an
25	effective date.
26
27	Be It Enacted by the Legislature of the State of Florida:
28
29	Section 1.  Subsections (13), (16), and (24) of section
30	395.002, Florida Statutes, are amended to read:
31	395.002  Definitions.--As used in this chapter:
32	(13)  "Hospital" means any establishment that:
33	(a)  Offers services more intensive than those required for
34	room, board, personal services, and general nursing care, and
35	offers facilities and beds for use beyond 24 hours by
36	individuals requiring diagnosis, treatment, or care for illness,
37	injury, deformity, infirmity, abnormality, disease, or
38	pregnancy; and
39	(b)  Regularly makes available at least clinical laboratory
40	services, diagnostic X-ray services, and treatment facilities
41	for surgery or obstetrical care, or other definitive medical
42	treatment of similar extent, except that a critical access
43	hospital, as defined in s. 408.07, shall not be required to make
44	available treatment facilities for surgery, obstetrical care, or
45	similar services as long as it maintains its critical access
46	hospital designation and shall be required to make such
47	facilities available only if it ceases to be designated as a
48	critical access hospital.
49
50	However, the provisions of this chapter do not apply to any
51	institution conducted by or for the adherents of any well-
52	recognized church or religious denomination that depends
53	exclusively upon prayer or spiritual means to heal, care for, or
54	treat any person. For purposes of local zoning matters, the term
55	"hospital" includes a medical office building located on the
56	same premises as a hospital facility, provided the land on which
57	the medical office building is constructed is zoned for use as a
58	hospital; provided the premises were zoned for hospital purposes
59	on January 1, 1992.
60	(16)  "Intensive residential treatment programs for
61	children and adolescents" means a specialty hospital accredited
62	by an accrediting organization as defined in subsection (1) the
63	Joint Commission on Accreditation of Healthcare Organizations
64	which provides 24-hour care and which has the primary functions
65	of diagnosis and treatment of patients under the age of 18
66	having psychiatric disorders in order to restore such patients
67	to an optimal level of functioning.
68	(24)  "Premises" means those buildings, beds, and equipment
69	located at the address of the licensed facility and all other
70	buildings, beds, and equipment for the provision of hospital,
71	ambulatory surgical, or mobile surgical care located in such
72	reasonable proximity to the address of the licensed facility as
73	to appear to the public to be under the dominion and control of
74	the licensee. For any licensee that is a teaching hospital as
75	defined in s. 408.07(45)(44), reasonable proximity includes any
76	buildings, beds, services, programs, and equipment under the
77	dominion and control of the licensee that are located at a site
78	with a main address that is within 1 mile of the main address of
79	the licensed facility; and all such buildings, beds, and
80	equipment may, at the request of a licensee or applicant, be
81	included on the facility license as a single premises.
82	Section 2.  Paragraph (b) of subsection (1) and paragraphs
83	(e) and (f) of subsection (2) of section 395.003, Florida
84	Statutes, are amended to read:
85	395.003  Licensure; issuance, renewal, denial,
86	modification, suspension, and revocation.--
87	(1)
88	(b)1.  It is unlawful for a person to use or advertise to
89	the public, in any way or by any medium whatsoever, any facility
90	as a "hospital," "ambulatory surgical center," or "mobile
91	surgical facility" unless such facility has first secured a
92	license under the provisions of this part.
93	2.  This part does not apply to veterinary hospitals or to
94	commercial business establishments using the word "hospital,"
95	"ambulatory surgical center," or "mobile surgical facility" as a
96	part of a trade name if no treatment of human beings is
97	performed on the premises of such establishments.
98	3.  By December 31, 2004, the agency shall submit a report
99	to the President of the Senate and the Speaker of the House of
100	Representatives recommending whether it is in the public
101	interest to allow a hospital to license or operate an emergency
102	department located off the premises of the hospital. If the
103	agency finds it to be in the public interest, the report shall
104	also recommend licensure criteria for such medical facilities,
105	including criteria related to quality of care and, if deemed
106	necessary, the elimination of the possibility of confusion
107	related to the service capabilities of such facility in
108	comparison to the service capabilities of an emergency
109	department located on the premises of the hospital. Until July
110	1, 2006 2005, additional emergency departments located off the
111	premises of licensed hospitals may not be authorized by the
112	agency.
113	(2)
114	(e)  The agency shall, at the request of a licensee that is
115	a teaching hospital as defined in s. 408.07(45)(44), issue a
116	single license to a licensee for facilities that have been
117	previously licensed as separate premises, provided such
118	separately licensed facilities, taken together, constitute the
119	same premises as defined in s. 395.002(24). Such license for the
120	single premises shall include all of the beds, services, and
121	programs that were previously included on the licenses for the
122	separate premises. The granting of a single license under this
123	paragraph shall not in any manner reduce the number of beds,
124	services, or programs operated by the licensee.
125	(f)  Intensive residential treatment programs for children
126	and adolescents which have received accreditation from an
127	accrediting organization as defined in s. 395.002(1) the Joint
128	Commission on Accreditation of Healthcare Organizations and
129	which meet the minimum standards developed by rule of the agency
130	for such programs shall be licensed by the agency under this
131	part.
132	Section 3.  Paragraph (e) of subsection (2) of section
133	395.602, Florida Statutes, is amended to read:
134	395.602  Rural hospitals.--
135	(2)  DEFINITIONS.--As used in this part:
136	(e)  "Rural hospital" means an acute care hospital licensed
137	under this chapter, having 100 or fewer licensed beds and an
138	emergency room, which is:
139	1.  The sole provider within a county with a population
140	density of no greater than 100 persons per square mile;
141	2.  An acute care hospital, in a county with a population
142	density of no greater than 100 persons per square mile, which is
143	at least 30 minutes of travel time, on normally traveled roads
144	under normal traffic conditions, from any other acute care
145	hospital within the same county;
146	3.  A hospital supported by a tax district or subdistrict
147	whose boundaries encompass a population of 100 persons or fewer
148	per square mile;
149	4.  A hospital in a constitutional charter county with a
150	population of over 1 million persons that has imposed a local
151	option health service tax pursuant to law and in an area that
152	was directly impacted by a catastrophic event on August 24,
153	1992, for which the Governor of Florida declared a state of
154	emergency pursuant to chapter 125, and has 120 beds or less that
155	serves an agricultural community with an emergency room
156	utilization of no less than 20,000 visits and a Medicaid
157	inpatient utilization rate greater than 15 percent;
158	5.  A hospital with a service area that has a population of
159	100 persons or fewer per square mile. As used in this
160	subparagraph, the term "service area" means the fewest number of
161	zip codes that account for 75 percent of the hospital's
162	discharges for the most recent 5-year period, based on
163	information available from the hospital inpatient discharge
164	database in the State Center for Health Statistics at the Agency
165	for Health Care Administration; or
166	6.  A hospital designated as a critical access hospital, as
167	defined in s. 408.07(15) by the Department of Health in
168	accordance with federal regulations and state requirements.
169
170	Population densities used in this paragraph must be based upon
171	the most recently completed United States census. A hospital
172	that received funds under s. 409.9116 for a quarter beginning no
173	later than July 1, 2002, is deemed to have been and shall
174	continue to be a rural hospital from that date through June 30,
175	2012, if the hospital continues to have 100 or fewer licensed
176	beds and an emergency room, or meets the criteria of
177	subparagraph 4. An acute care hospital that has not previously
178	been designated as a rural hospital and that meets the criteria
179	of this paragraph shall be granted such designation upon
180	application, including supporting documentation to the Agency
181	for Health Care Administration.
182	Section 4.  Subsection (4) of section 408.061, Florida
183	Statutes, is amended to read:
184	408.061  Data collection; uniform systems of financial
185	reporting; information relating to physician charges;
186	confidential information; immunity.--
187	(4)  Within 120 days after the end of its fiscal year, each
188	health care facility, excluding continuing care facilities and
189	nursing homes as defined in s. 408.07(14) and (37)(36), shall
190	file with the agency, on forms adopted by the agency and based
191	on the uniform system of financial reporting, its actual
192	financial experience for that fiscal year, including
193	expenditures, revenues, and statistical measures. Such data may
194	be based on internal financial reports which are certified to be
195	complete and accurate by the provider. However, hospitals'
196	actual financial experience shall be their audited actual
197	experience. Every nursing home shall submit to the agency, in a
198	format designated by the agency, a statistical profile of the
199	nursing home residents. The agency, in conjunction with the
200	Department of Elderly Affairs and the Department of Health,
201	shall review these statistical profiles and develop
202	recommendations for the types of residents who might more
203	appropriately be placed in their homes or other noninstitutional
204	settings.
205	Section 5.  Subsections (15) through (44) of section
206	408.07, Florida Statutes, are renumbered as subsections (16)
207	through (45), respectively, paragraph (e) of subsection (42) is
208	amended, and a new subsection (15) is added to said section, to
209	read:
210	408.07  Definitions.--As used in this chapter, with the
211	exception of ss. 408.031-408.045, the term:
212	(15)  "Critical access hospital" means a hospital that
213	meets the definition of "critical access hospital" in s.
214	1861(mm)(1) of the Social Security Act and that is certified by
215	the Secretary of Health and Human Services as a critical access
216	hospital.
217	(43)(42)  "Rural hospital" means an acute care hospital
218	licensed under chapter 395, having 100 or fewer licensed beds
219	and an emergency room, and which is:
220	(e)  A hospital designated as a critical access hospital by
221	the Department of Health in accordance with federal regulations
222	and state requirements.
223
224	Population densities used in this subsection must be based upon
225	the most recently completed United States census. A hospital
226	that received funds under s. 409.9116 for a quarter beginning no
227	later than July 1, 2002, is deemed to have been and shall
228	continue to be a rural hospital from that date through June 30,
229	2012, if the hospital continues to have 100 or fewer licensed
230	beds and an emergency room, or meets the criteria of s.
231	395.602(2)(e)4. An acute care hospital that has not previously
232	been designated as a rural hospital and that meets the criteria
233	of this subsection shall be granted such designation upon
234	application, including supporting documentation, to the Agency
235	for Health Care Administration.
236	Section 6.  Subsection (1) of section 458.345, Florida
237	Statutes, is amended to read:
238	458.345  Registration of resident physicians, interns, and
239	fellows; list of hospital employees; prescribing of medicinal
240	drugs; penalty.--
241	(1)  Any person desiring to practice as a resident
242	physician, assistant resident physician, house physician,
243	intern, or fellow in fellowship training which leads to
244	subspecialty board certification in this state, or any person
245	desiring to practice as a resident physician, assistant resident
246	physician, house physician, intern, or fellow in fellowship
247	training in a teaching hospital in this state as defined in s.
248	408.07(45)(44) or s. 395.805(2), who does not hold a valid,
249	active license issued under this chapter shall apply to the
250	department to be registered and shall remit a fee not to exceed
251	$300 as set by the board. The department shall register any
252	applicant the board certifies has met the following
253	requirements:
254	(a)  Is at least 21 years of age.
255	(b)  Has not committed any act or offense within or without
256	the state which would constitute the basis for refusal to
257	certify an application for licensure pursuant to s. 458.331.
258	(c)  Is a graduate of a medical school or college as
259	specified in s. 458.311(1)(f).
260	Section 7.  Subsection (1) of section 459.021, Florida
261	Statutes, is amended to read:
262	459.021  Registration of resident physicians, interns, and
263	fellows; list of hospital employees; penalty.--
264	(1)  Any person who holds a degree of Doctor of Osteopathic
265	Medicine from a college of osteopathic medicine recognized and
266	approved by the American Osteopathic Association who desires to
267	practice as a resident physician, assistant resident physician,
268	house physician, intern, or fellow in fellowship training which
269	leads to subspecialty board certification in this state, or any
270	person desiring to practice as a resident physician, assistant
271	resident physician, house physician, intern, or fellow in
272	fellowship training in a teaching hospital in this state as
273	defined in s. 408.07(45)(44) or s. 395.805(2), who does not hold
274	an active license issued under this chapter shall apply to the
275	department to be registered, on an application provided by the
276	department, within 30 days of commencing such a training program
277	and shall remit a fee not to exceed $300 as set by the board.
278	Section 8.  This act shall take effect July 1, 2005.

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