| 1 | The Health Care Regulation Committee 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 trauma services; amending s. 395.4001, |
| 7 | F.S.; providing definitions; repealing s. 395.4035, F.S., |
| 8 | to terminate the Trauma Services Trust Fund; amending s. |
| 9 | 395.4036, F.S.; revising provisions relating to |
| 10 | distribution of funds to trauma centers and use thereof; |
| 11 | creating s. 395.65, F.S.; establishing a trauma center |
| 12 | startup grant program; providing conditions for the |
| 13 | receipt of a startup grant; providing limitations; |
| 14 | providing an appropriation; providing an effective date. |
| 15 |
|
| 16 | Be It Enacted by the Legislature of the State of Florida: |
| 17 |
|
| 18 | Section 1. Section 395.4001, Florida Statutes, is amended |
| 19 | to read: |
| 20 | 395.4001 Definitions.--As used in this part, the term: |
| 21 | (1) "Agency" means the Agency for Health Care |
| 22 | Administration. |
| 23 | (2) "Charity care" or "uncompensated trauma care" means |
| 24 | that portion of hospital charges reported to the agency for |
| 25 | which there is no compensation, other than restricted or |
| 26 | unrestricted revenues provided to a hospital by local |
| 27 | governments or tax districts regardless of method of payment, |
| 28 | for care provided to a patient whose family income for the 12 |
| 29 | months preceding the determination is less than or equal to 200 |
| 30 | percent of the federal poverty level, unless the amount of |
| 31 | hospital charges due from the patient exceeds 25 percent of the |
| 32 | annual family income. However, in no case shall the hospital |
| 33 | charges for a patient whose family income exceeds four times the |
| 34 | federal poverty level for a family of four be considered |
| 35 | charity. |
| 36 | (3) "Department" means the Department of Health. |
| 37 | (4) "Interfacility trauma transfer" means the transfer of |
| 38 | a trauma victim between two facilities licensed under this |
| 39 | chapter, pursuant to this part. |
| 40 | (5) "International Classification Injury Severity Score" |
| 41 | means the statistical method for computing the severity of |
| 42 | injuries sustained by trauma patients. The International |
| 43 | Classification Injury Severity Score shall be the methodology |
| 44 | used by the department and trauma centers to report the severity |
| 45 | of an injury. |
| 46 | (6)(5) "Level I trauma center" means a trauma center that: |
| 47 | (a) Has formal research and education programs for the |
| 48 | enhancement of trauma care; is verified by the department to be |
| 49 | in substantial compliance with Level I trauma center and |
| 50 | pediatric trauma center standards; and has been approved by the |
| 51 | department to operate as a Level I trauma center. |
| 52 | (b) Serves as a resource facility to Level II trauma |
| 53 | centers, pediatric trauma centers, and general hospitals through |
| 54 | shared outreach, education, and quality improvement activities. |
| 55 | (c) Participates in an inclusive system of trauma care, |
| 56 | including providing leadership, system evaluation, and quality |
| 57 | improvement activities. |
| 58 | (7)(6) "Level II trauma center" means a trauma center |
| 59 | that: |
| 60 | (a) Is verified by the department to be in substantial |
| 61 | compliance with Level II trauma center standards and has been |
| 62 | approved by the department to operate as a Level II trauma |
| 63 | center. |
| 64 | (b) Serves as a resource facility to general hospitals |
| 65 | through shared outreach, education, and quality improvement |
| 66 | activities. |
| 67 | (c) Participates in an inclusive system of trauma care. |
| 68 | (8) "Local funding contribution" means local municipal, |
| 69 | county, or tax district funding exclusive of any patient- |
| 70 | specific funds received pursuant to ss. 154.301-154.316, private |
| 71 | foundation funding, or public or private grant funding of at |
| 72 | least $150,000 received by a hospital or health care system that |
| 73 | operates a trauma center. |
| 74 | (9)(7) "Pediatric trauma center" means a hospital that is |
| 75 | verified by the department to be in substantial compliance with |
| 76 | pediatric trauma center standards as established by rule of the |
| 77 | department and has been approved by the department to operate as |
| 78 | a pediatric trauma center. |
| 79 | (10)(8) "Provisional trauma center" means a hospital that |
| 80 | has been verified by the department to be in substantial |
| 81 | compliance with the requirements in s. 395.4025 and has been |
| 82 | approved by the department to operate as a provisional Level I |
| 83 | trauma center, Level II trauma center, or pediatric trauma |
| 84 | center. |
| 85 | (11)(9) "Trauma agency" means a department-approved agency |
| 86 | established and operated by one or more counties, or a |
| 87 | department-approved entity with which one or more counties |
| 88 | contract, for the purpose of administering an inclusive regional |
| 89 | trauma system. |
| 90 | (12)(10) "Trauma alert victim" means a person who has |
| 91 | incurred a single or multisystem injury due to blunt or |
| 92 | penetrating means or burns, who requires immediate medical |
| 93 | intervention or treatment, and who meets one or more of the |
| 94 | adult or pediatric scorecard criteria established by the |
| 95 | department by rule. |
| 96 | (13) "Trauma caseload volume" means the number of trauma |
| 97 | patients reported by individual trauma centers to the Trauma |
| 98 | Registry and validated by the department. |
| 99 | (14)(11) "Trauma center" means a hospital that has been |
| 100 | verified by the department to be in substantial compliance with |
| 101 | the requirements in s. 395.4025 and has been approved by the |
| 102 | department to operate as a Level I trauma center, Level II |
| 103 | trauma center, or pediatric trauma center. |
| 104 | (15) "Trauma patient" means a person who has incurred a |
| 105 | physical injury or wound caused by trauma and has accessed a |
| 106 | trauma center. |
| 107 | (16)(12) "Trauma scorecard" means a statewide methodology |
| 108 | adopted by the department by rule under which a person who has |
| 109 | incurred a traumatic injury is graded as to the severity of his |
| 110 | or her injuries or illness and which methodology is used as the |
| 111 | basis for making destination decisions. |
| 112 | (17)(13) "Trauma transport protocol" means a document |
| 113 | which describes the policies, processes, and procedures |
| 114 | governing the dispatch of vehicles, the triage, prehospital |
| 115 | transport, and interfacility trauma transfer of trauma victims. |
| 116 | (18)(14) "Trauma victim" means any person who has incurred |
| 117 | a single or multisystem injury due to blunt or penetrating means |
| 118 | or burns and who requires immediate medical intervention or |
| 119 | treatment. |
| 120 | Section 2. Section 395.4035, Florida Statutes, is |
| 121 | repealed. |
| 122 | Section 3. Subsection (1) of section 395.4036, Florida |
| 123 | Statutes, is amended to read: |
| 124 | 395.4036 Trauma payments.-- |
| 125 | (1) Recognizing the Legislature's stated intent to provide |
| 126 | financial support to the current verified trauma centers and to |
| 127 | provide incentives for the establishment of additional trauma |
| 128 | centers as part of a system of state-sponsored trauma centers, |
| 129 | the department shall utilize funds collected under s. |
| 130 | 318.18(15)(14) and deposited into the Administrative Trust Fund |
| 131 | of the department to ensure the availability and accessibility |
| 132 | of trauma services throughout the state as provided in this |
| 133 | subsection. |
| 134 | (a) Twenty percent of the total funds collected under this |
| 135 | subsection during the state fiscal year shall be distributed to |
| 136 | verified trauma centers located in a region that have has a |
| 137 | local funding contribution as of December 31. Distribution of |
| 138 | funds under this paragraph shall be based on trauma caseload |
| 139 | volume for the most recent calendar year available. |
| 140 | (b) Forty percent of the total funds collected under this |
| 141 | subsection shall be distributed to verified trauma centers based |
| 142 | on trauma caseload volume for of the most recent previous |
| 143 | calendar year available. The determination of caseload volume |
| 144 | for distribution of funds under this paragraph shall be based on |
| 145 | the department's Trauma Registry data. |
| 146 | (c) Forty percent of the total funds collected under this |
| 147 | subsection shall be distributed to verified trauma centers based |
| 148 | on severity of trauma patients for the most recent calendar year |
| 149 | available. The determination of severity for distribution of |
| 150 | funds under this paragraph shall be based on the department's |
| 151 | International Classification Injury Severity Scores or another |
| 152 | statistically valid and scientifically accepted method of |
| 153 | stratifying a trauma patient's severity of injury, risk of |
| 154 | mortality, and resource consumption as adopted by the department |
| 155 | by rule, weighted based on the costs associated with and |
| 156 | incurred by the trauma center in treating trauma patients. The |
| 157 | weighting of scores shall be established by the department by |
| 158 | rule scores of 1-14 and 15 plus. |
| 159 |
|
| 160 | Funds deposited in the department's Administrative Trust Fund |
| 161 | for verified trauma centers may be used to maximize the receipt |
| 162 | of federal funds that may be available for such trauma centers. |
| 163 | Notwithstanding this section and s. 318.14, distributions to |
| 164 | trauma centers may be adjusted in a manner to ensure that total |
| 165 | payments to trauma centers represent the same proportional |
| 166 | allocation as set forth in this section and s. 318.14. For |
| 167 | purposes of this section and s. 318.14, total funds distributed |
| 168 | to trauma centers may include revenue from the Administrative |
| 169 | Trust Fund and federal funds for which revenue from the |
| 170 | Administrative Trust Fund is used to meet state or local |
| 171 | matching requirements. Funds collected under ss. 318.14 and |
| 172 | 318.18(15) and deposited in the Administrative Trust Fund of the |
| 173 | department shall be distributed to trauma centers on a quarterly |
| 174 | basis using the most recent calendar year data available. Such |
| 175 | data shall not be used for more than four quarterly |
| 176 | distributions unless there are extenuating circumstances as |
| 177 | determined by the department, in which case the most recent |
| 178 | calendar year data available shall continue to be used and |
| 179 | appropriate adjustments shall be made as soon as the more recent |
| 180 | data becomes available. Trauma centers may request that their |
| 181 | distributions from the Administrative Trust Fund be used as |
| 182 | intergovernmental transfer funds in the Medicaid program. |
| 183 | Section 4. Section 395.65, Florida Statutes, is created to |
| 184 | read: |
| 185 | 395.65 Trauma center startup.--There is established a |
| 186 | trauma center startup grant program. |
| 187 | (1) The Legislature recognizes the need for a statewide, |
| 188 | cohesive, uniform, and integrated trauma system, and the |
| 189 | Legislature acknowledges that the state has been divided into |
| 190 | trauma service areas. Each of the trauma service areas should |
| 191 | have at least one trauma center; however, some trauma service |
| 192 | areas do not have a trauma center because of the significant up- |
| 193 | front investment of capital required for hospitals to develop |
| 194 | the physical space, equipment, and qualified personnel necessary |
| 195 | to provide quality trauma services. |
| 196 | (2) An acute care general hospital that has submitted a |
| 197 | letter of intent and an application to become a trauma center |
| 198 | pursuant to s. 395.4025 may apply to the department for a |
| 199 | startup grant. The grant applicant must demonstrate that: |
| 200 | (a) There are currently no other trauma centers in the |
| 201 | hospital's trauma service area as established under s. 395.402. |
| 202 | (b) There is not a trauma center within a 100-mile radius |
| 203 | of the proposed trauma center. |
| 204 | (c) The hospital has received a local funding contribution |
| 205 | as defined under s. 395.4001. |
| 206 | (d) The hospital has incurred startup costs in excess of |
| 207 | the amount of grant funding requested. |
| 208 | (e) The hospital is pursuing the establishment of a |
| 209 | residency program in emergency medicine. |
| 210 | (3) A hospital receiving startup grant funding that does |
| 211 | not become a provisional trauma center within 24 months after |
| 212 | submitting an application to become a trauma center must forfeit |
| 213 | any state grant funds received pursuant to this section. |
| 214 | (4) A hospital that receives startup grant funding may not |
| 215 | receive more than $500,000, must ensure that the startup grant |
| 216 | funding is matched on a dollar-for-dollar basis with a local |
| 217 | funding contribution, and shall receive startup grant funding |
| 218 | only one time. |
| 219 | Section 5. The sum of $500,000 is appropriated from the |
| 220 | General Revenue Fund for deposit to the Administrative Trust |
| 221 | Fund of the Department of Health for the 2006-2007 fiscal year |
| 222 | for the purpose of providing trauma center startup grants under |
| 223 | s. 395.65, Florida Statutes. |
| 224 | Section 6. This act shall take effect July 1, 2006. |