HB 763

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

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