Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2214
Barcode 825990
CHAMBER ACTION
Senate House
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05/03/2006 12:44 PM .
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11 Senator Saunders moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 38, lines 17 and 18, delete those lines
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16 and insert:
17 Section 16. Paragraph (b) of subsection (1) of section
18 395.003, Florida Statutes, is amended to read:
19 395.003 Licensure; issuance, renewal, denial,
20 modification, suspension, and revocation.--
21 (1)
22 (b)1. It is unlawful for a person to use or advertise
23 to the public, in any way or by any medium whatsoever, any
24 facility as a "hospital," "ambulatory surgical center," or
25 "mobile surgical facility" unless such facility has first
26 secured a license under the provisions of this part.
27 2. This part does not apply to veterinary hospitals or
28 to commercial business establishments using the word
29 "hospital," "ambulatory surgical center," or "mobile surgical
30 facility" as a part of a trade name if no treatment of human
31 beings is performed on the premises of such establishments.
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2214
Barcode 825990
1 3. Until July 1, 2006, Additional emergency
2 departments located off the premises of licensed hospitals may
3 not be authorized by the agency until the agency has adopted
4 rules required under s. 395.1055(9).
5 Section 17. Subsection (9) is added to section
6 395.1055, Florida Statutes, to read:
7 395.1055 Rules and enforcement.--
8 (9) The agency shall adopt rules pursuant to ss.
9 120.536(1) and 120.54 which establish licensure standards for
10 emergency departments located off the premises of licensed
11 hospitals. The rules must:
12 (a) Include minimum criteria for patient care and
13 safety, quality improvement, infection control, building
14 design and construction, location and proximity to existing
15 emergency departments, staffing, including availability of
16 physicians, the extent to which approval will enhance access
17 for Medicaid and underserved populations, impact on existing
18 hospitals, and appropriate transport of patients from the
19 emergency department located off the premises consistent with
20 chapter 401.
21 (b) Require the hospital to maintain an emergency
22 department on its premises that is licensed and operated in
23 accordance with agency rules.
24 (c) Specify that an emergency department located off
25 the premises of a licensed hospital that was authorized prior
26 to the adoption of rules shall continue to operate in
27 accordance with the licensure criteria under which it was
28 originally authorized.
29 Section 18. Section 395.4001, Florida Statutes, is
30 amended to read:
31 395.4001 Definitions.--As used in this part, the term:
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2214
Barcode 825990
1 (1) "Agency" means the Agency for Health Care
2 Administration.
3 (2) "Charity care" or "uncompensated trauma care"
4 means that portion of hospital charges reported to the agency
5 for which there is no compensation, other than restricted or
6 unrestricted revenues provided to a hospital by local
7 governments or tax districts regardless of method of payment,
8 for care provided to a patient whose family income for the 12
9 months preceding the determination is less than or equal to
10 200 percent of the federal poverty level, unless the amount of
11 hospital charges due from the patient exceeds 25 percent of
12 the annual family income. However, in no case shall the
13 hospital charges for a patient whose family income exceeds
14 four times the federal poverty level for a family of four be
15 considered charity.
16 (3) "Department" means the Department of Health.
17 (4) "Interfacility trauma transfer" means the transfer
18 of a trauma victim between two facilities licensed under this
19 chapter, pursuant to this part.
20 (5) "International Classification Injury Severity
21 Score" means the statistical method for computing the severity
22 of injuries sustained by trauma patients. The International
23 Classification Injury Severity Score shall be the methodology
24 used by the department and trauma centers to report the
25 severity of an injury.
26 (6)(5) "Level I trauma center" means a trauma center
27 that:
28 (a) Has formal research and education programs for the
29 enhancement of trauma care; is verified by the department to
30 be in substantial compliance with Level I trauma center and
31 pediatric trauma center standards; and has been approved by
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2214
Barcode 825990
1 the department to operate as a Level I trauma center.
2 (b) Serves as a resource facility to Level II trauma
3 centers, pediatric trauma centers, and general hospitals
4 through shared outreach, education, and quality improvement
5 activities.
6 (c) Participates in an inclusive system of trauma
7 care, including providing leadership, system evaluation, and
8 quality improvement activities.
9 (7)(6) "Level II trauma center" means a trauma center
10 that:
11 (a) Is verified by the department to be in substantial
12 compliance with Level II trauma center standards and has been
13 approved by the department to operate as a Level II trauma
14 center.
15 (b) Serves as a resource facility to general hospitals
16 through shared outreach, education, and quality improvement
17 activities.
18 (c) Participates in an inclusive system of trauma
19 care.
20 (8) "Local funding contribution" means local
21 municipal, county, or tax district funding exclusive of any
22 patient-specific funds received pursuant to ss.
23 154.301-154.316, private foundation funding, or public or
24 private grant funding of at least $150,000 received by a
25 hospital or health care system that operates a trauma center.
26 (9)(7) "Pediatric trauma center" means a hospital that
27 is verified by the department to be in substantial compliance
28 with pediatric trauma center standards as established by rule
29 of the department and has been approved by the department to
30 operate as a pediatric trauma center.
31 (10)(8) "Provisional trauma center" means a hospital
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2214
Barcode 825990
1 that has been verified by the department to be in substantial
2 compliance with the requirements in s. 395.4025 and has been
3 approved by the department to operate as a provisional Level I
4 trauma center, Level II trauma center, or pediatric trauma
5 center.
6 (11)(9) "Trauma agency" means a department-approved
7 agency established and operated by one or more counties, or a
8 department-approved entity with which one or more counties
9 contract, for the purpose of administering an inclusive
10 regional trauma system.
11 (12)(10) "Trauma alert victim" means a person who has
12 incurred a single or multisystem injury due to blunt or
13 penetrating means or burns, who requires immediate medical
14 intervention or treatment, and who meets one or more of the
15 adult or pediatric scorecard criteria established by the
16 department by rule.
17 (13) "Trauma caseload volume" means the number of
18 trauma patients reported by individual trauma centers to the
19 Trauma Registry and validated by the department.
20 (14)(11) "Trauma center" means a hospital that has
21 been verified by the department to be in substantial
22 compliance with the requirements in s. 395.4025 and has been
23 approved by the department to operate as a Level I trauma
24 center, Level II trauma center, or pediatric trauma center.
25 (15) "Trauma patient" means a person who has incurred
26 a physical injury or wound caused by trauma and has accessed a
27 trauma center.
28 (16)(12) "Trauma scorecard" means a statewide
29 methodology adopted by the department by rule under which a
30 person who has incurred a traumatic injury is graded as to the
31 severity of his or her injuries or illness and which
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2214
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1 methodology is used as the basis for making destination
2 decisions.
3 (17)(13) "Trauma transport protocol" means a document
4 which describes the policies, processes, and procedures
5 governing the dispatch of vehicles, the triage, prehospital
6 transport, and interfacility trauma transfer of trauma
7 victims.
8 (18)(14) "Trauma victim" means any person who has
9 incurred a single or multisystem injury due to blunt or
10 penetrating means or burns and who requires immediate medical
11 intervention or treatment.
12 Section 19. Section 395.4035, Florida Statutes, is
13 repealed.
14 Section 20. Subsection (1) of section 395.4036,
15 Florida Statutes, is amended to read:
16 395.4036 Trauma payments.--
17 (1) Recognizing the Legislature's stated intent to
18 provide financial support to the current verified trauma
19 centers and to provide incentives for the establishment of
20 additional trauma centers as part of a system of
21 state-sponsored trauma centers, the department shall utilize
22 funds collected under s. 318.18(15)(14) and deposited into the
23 Administrative Trust Fund of the department to ensure the
24 availability and accessibility of trauma services throughout
25 the state as provided in this subsection.
26 (a) Twenty percent of the total funds collected under
27 this subsection during the state fiscal year shall be
28 distributed to verified trauma centers located in a region
29 that have has a local funding contribution as of December 31.
30 Distribution of funds under this paragraph shall be based on
31 trauma caseload volume for the most recent calendar year
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2214
Barcode 825990
1 available.
2 (b) Forty percent of the total funds collected under
3 this subsection shall be distributed to verified trauma
4 centers based on trauma caseload volume for of the most recent
5 previous calendar year available. The determination of
6 caseload volume for distribution of funds under this paragraph
7 shall be based on the department's Trauma Registry data.
8 (c) Forty percent of the total funds collected under
9 this subsection shall be distributed to verified trauma
10 centers based on severity of trauma patients for the most
11 recent calendar year available. The determination of severity
12 for distribution of funds under this paragraph shall be based
13 on the department's International Classification Injury
14 Severity Scores or another statistically valid and
15 scientifically accepted method of stratifying a trauma
16 patient's severity of injury, risk of mortality, and resource
17 consumption as adopted by the department by rule, weighted
18 based on the costs associated with and incurred by the trauma
19 center in treating trauma patients. The weighting of scores
20 shall be established by the department by rule scores of 1-14
21 and 15 plus.
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23 Funds deposited in the department's Administrative Trust Fund
24 for verified trauma centers may be used to maximize the
25 receipt of federal funds that may be available for such trauma
26 centers. Notwithstanding this section and s. 318.14,
27 distributions to trauma centers may be adjusted in a manner to
28 ensure that total payments to trauma centers represent the
29 same proportional allocation as set forth in this section and
30 s. 318.14. For purposes of this section and s. 318.14, total
31 funds distributed to trauma centers may include revenue from
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2214
Barcode 825990
1 the Administrative Trust Fund and federal funds for which
2 revenue from the Administrative Trust Fund is used to meet
3 state or local matching requirements. Funds collected under
4 ss. 318.14 and 318.18(15) and deposited in the Administrative
5 Trust Fund of the department shall be distributed to trauma
6 centers on a quarterly basis using the most recent calendar
7 year data available. Such data shall not be used for more than
8 four quarterly distributions unless there are extenuating
9 circumstances as determined by the department, in which case
10 the most recent calendar year data available shall continue to
11 be used and appropriate adjustments shall be made as soon as
12 the more recent data becomes available. Trauma centers may
13 request that their distributions from the Administrative Trust
14 Fund be used as intergovernmental transfer funds in the
15 Medicaid program.
16 Section 21. Section 395.41, Florida Statutes, is
17 created to read:
18 395.41 Trauma center startup grant program.--There is
19 established a trauma center startup grant program.
20 (1) The Legislature recognizes the need for a
21 statewide, cohesive, uniform, and integrated trauma system,
22 and the Legislature acknowledges that the state has been
23 divided into trauma service areas. Each of the trauma service
24 areas should have at least one trauma center; however, some
25 trauma service areas do not have a trauma center because of
26 the significant up-front investment of capital required for
27 hospitals to develop the physical space, equipment, and
28 qualified personnel necessary to provide quality trauma
29 services.
30 (2) An acute care general hospital that has submitted
31 a letter of intent and an application to become a trauma
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2214
Barcode 825990
1 center pursuant to s. 395.4025 may apply to the department for
2 a startup grant. The grant applicant must demonstrate that:
3 (a) There are currently no other trauma centers in the
4 hospital's trauma service area as established under s.
5 395.402.
6 (b) There is not a trauma center within a 100-mile
7 radius of the proposed trauma center.
8 (c) The hospital has received a local funding
9 contribution as defined under s. 395.4001.
10 (d) The hospital has incurred startup costs in excess
11 of the amount of grant funding requested.
12 (e) The hospital is pursuing the establishment of a
13 residency program in internal medicine or emergency medicine.
14 (3) A hospital receiving startup grant funding that
15 does not become a provisional trauma center within 24 months
16 after submitting an application to become a trauma center must
17 forfeit any state grant funds received pursuant to this
18 section.
19 (4) A hospital that receives startup grant funding may
20 not receive more than $500,000, must ensure that the startup
21 grant funding is matched on a dollar-for-dollar basis with a
22 local funding contribution, and shall receive startup grant
23 funding only one time.
24 Section 22. This act shall take effect July 1, 2006,
25 except that sections 1-15 of this act shall take effect
26 October 1, 2006, and section 395.41, Florida Statutes, as
27 created by this act, shall take effect subject to an
28 appropriation for the trauma center startup grant program in
29 the 2006-2007 General Appropriations Act.
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Florida Senate - 2006 SENATOR AMENDMENT
Bill No. CS for SB 2214
Barcode 825990
1 ================ T I T L E A M E N D M E N T ===============
2 And the title is amended as follows:
3 On page 5, line 16, delete that line
4
5 and insert:
6 amending s. 395.003, F.S.; prohibiting
7 authorization of additional emergency
8 departments located off the premises of
9 licensed hospitals until the Agency for Health
10 Care Administration adopts rules; amending s.
11 395.1055, F.S.; requiring the agency to adopt
12 rules to establish licensure standards for
13 emergency departments located off the premises
14 of licensed hospitals; requiring the rules to
15 address certain topics; amending s. 395.4001,
16 F.S.; providing definitions; repealing s.
17 395.4035, F.S., to terminate the Trauma
18 Services Trust Fund; amending s. 395.4036,
19 F.S.; revising provisions relating to
20 distribution of funds to trauma centers and use
21 thereof; creating s. 395.41, F.S.; establishing
22 a trauma center startup grant program;
23 providing conditions for the receipt of a
24 startup grant; providing limitations; making
25 the trauma center startup grant program subject
26 to an appropriation in the General
27 Appropriations Act; providing effective dates.
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