HB 0715

CS

CHAMBER ACTION

1	The Health Care Appropriations Committee recommends the
2	following:
3
4	Council/Committee Substitute
5	Remove the entire bill and insert:
6	A bill to be entitled
7	An act relating to trauma services; amending s. 395.4001,
8	F.S.; providing definitions; repealing s. 395.4035, F.S.,
9	to terminate the Trauma Services Trust Fund; amending s.
10	395.4036, F.S.; revising provisions relating to
11	distribution of funds to trauma centers and use thereof;
12	creating s. 395.41, F.S.; establishing a trauma center
13	startup grant program; providing conditions for the
14	receipt of a startup grant; providing limitations; making
15	the trauma center startup grant program subject to an
16	appropriation in the General Appropriations Act; providing
17	a contingent effective date.
18
19	Be It Enacted by the Legislature of the State of Florida:
20
21	Section 1.  Section 395.4001, Florida Statutes, is amended
22	to read:
23	395.4001  Definitions.--As used in this part, the term:
24	(1)  "Agency" means the Agency for Health Care
25	Administration.
26	(2)  "Charity care" or "uncompensated trauma care" means
27	that portion of hospital charges reported to the agency for
28	which there is no compensation, other than restricted or
29	unrestricted revenues provided to a hospital by local
30	governments or tax districts regardless of method of payment,
31	for care provided to a patient whose family income for the 12
32	months preceding the determination is less than or equal to 200
33	percent of the federal poverty level, unless the amount of
34	hospital charges due from the patient exceeds 25 percent of the
35	annual family income. However, in no case shall the hospital
36	charges for a patient whose family income exceeds four times the
37	federal poverty level for a family of four be considered
38	charity.
39	(3)  "Department" means the Department of Health.
40	(4)  "Interfacility trauma transfer" means the transfer of
41	a trauma victim between two facilities licensed under this
42	chapter, pursuant to this part.
43	(5)  "International Classification Injury Severity Score"
44	means the statistical method for computing the severity of
45	injuries sustained by trauma patients. The International
46	Classification Injury Severity Score shall be the methodology
47	used by the department and trauma centers to report the severity
48	of an injury.
49	(6)(5)  "Level I trauma center" means a trauma center that:
50	(a)  Has formal research and education programs for the
51	enhancement of trauma care; is verified by the department to be
52	in substantial compliance with Level I trauma center and
53	pediatric trauma center standards; and has been approved by the
54	department to operate as a Level I trauma center.
55	(b)  Serves as a resource facility to Level II trauma
56	centers, pediatric trauma centers, and general hospitals through
57	shared outreach, education, and quality improvement activities.
58	(c)  Participates in an inclusive system of trauma care,
59	including providing leadership, system evaluation, and quality
60	improvement activities.
61	(7)(6)  "Level II trauma center" means a trauma center
62	that:
63	(a)  Is verified by the department to be in substantial
64	compliance with Level II trauma center standards and has been
65	approved by the department to operate as a Level II trauma
66	center.
67	(b)  Serves as a resource facility to general hospitals
68	through shared outreach, education, and quality improvement
69	activities.
70	(c)  Participates in an inclusive system of trauma care.
71	(8)  "Local funding contribution" means local municipal,
72	county, or tax district funding exclusive of any patient-
73	specific funds received pursuant to ss. 154.301-154.316, private
74	foundation funding, or public or private grant funding of at
75	least $150,000 received by a hospital or health care system that
76	operates a trauma center.
77	(9)(7)  "Pediatric trauma center" means a hospital that is
78	verified by the department to be in substantial compliance with
79	pediatric trauma center standards as established by rule of the
80	department and has been approved by the department to operate as
81	a pediatric trauma center.
82	(10)(8)  "Provisional trauma center" means a hospital that
83	has been verified by the department to be in substantial
84	compliance with the requirements in s. 395.4025 and has been
85	approved by the department to operate as a provisional Level I
86	trauma center, Level II trauma center, or pediatric trauma
87	center.
88	(11)(9)  "Trauma agency" means a department-approved agency
89	established and operated by one or more counties, or a
90	department-approved entity with which one or more counties
91	contract, for the purpose of administering an inclusive regional
92	trauma system.
93	(12)(10)  "Trauma alert victim" means a person who has
94	incurred a single or multisystem injury due to blunt or
95	penetrating means or burns, who requires immediate medical
96	intervention or treatment, and who meets one or more of the
97	adult or pediatric scorecard criteria established by the
98	department by rule.
99	(13)  "Trauma caseload volume" means the number of trauma
100	patients reported by individual trauma centers to the Trauma
101	Registry and validated by the department.
102	(14)(11)  "Trauma center" means a hospital that has been
103	verified by the department to be in substantial compliance with
104	the requirements in s. 395.4025 and has been approved by the
105	department to operate as a Level I trauma center, Level II
106	trauma center, or pediatric trauma center.
107	(15)  "Trauma patient" means a person who has incurred a
108	physical injury or wound caused by trauma and has accessed a
109	trauma center.
110	(16)(12)  "Trauma scorecard" means a statewide methodology
111	adopted by the department by rule under which a person who has
112	incurred a traumatic injury is graded as to the severity of his
113	or her injuries or illness and which methodology is used as the
114	basis for making destination decisions.
115	(17)(13)  "Trauma transport protocol" means a document
116	which describes the policies, processes, and procedures
117	governing the dispatch of vehicles, the triage, prehospital
118	transport, and interfacility trauma transfer of trauma victims.
119	(18)(14)  "Trauma victim" means any person who has incurred
120	a single or multisystem injury due to blunt or penetrating means
121	or burns and who requires immediate medical intervention or
122	treatment.
123	Section 2.  Section 395.4035, Florida Statutes, is
124	repealed.
125	Section 3.  Subsection (1) of section 395.4036, Florida
126	Statutes, is amended to read:
127	395.4036  Trauma payments.--
128	(1)  Recognizing the Legislature's stated intent to provide
129	financial support to the current verified trauma centers and to
130	provide incentives for the establishment of additional trauma
131	centers as part of a system of state-sponsored trauma centers,
132	the department shall utilize funds collected under s.
133	318.18(15)(14) and deposited into the Administrative Trust Fund
134	of the department to ensure the availability and accessibility
135	of trauma services throughout the state as provided in this
136	subsection.
137	(a)  Twenty percent of the total funds collected under this
138	subsection during the state fiscal year shall be distributed to
139	verified trauma centers located in a region that have has a
140	local funding contribution as of December 31. Distribution of
141	funds under this paragraph shall be based on trauma caseload
142	volume for the most recent calendar year available.
143	(b)  Forty percent of the total funds collected under this
144	subsection shall be distributed to verified trauma centers based
145	on trauma caseload volume for of the most recent previous
146	calendar year available. The determination of caseload volume
147	for distribution of funds under this paragraph shall be based on
148	the department's Trauma Registry data.
149	(c)  Forty percent of the total funds collected under this
150	subsection shall be distributed to verified trauma centers based
151	on severity of trauma patients for the most recent calendar year
152	available. The determination of severity for distribution of
153	funds under this paragraph shall be based on the department's
154	International Classification Injury Severity Scores or another
155	statistically valid and scientifically accepted method of
156	stratifying a trauma patient's severity of injury, risk of
157	mortality, and resource consumption as adopted by the department
158	by rule, weighted based on the costs associated with and
159	incurred by the trauma center in treating trauma patients. The
160	weighting of scores shall be established by the department by
161	rule scores of 1-14 and 15 plus.
162
163	Funds deposited in the department's Administrative Trust Fund
164	for verified trauma centers may be used to maximize the receipt
165	of federal funds that may be available for such trauma centers.
166	Notwithstanding this section and s. 318.14, distributions to
167	trauma centers may be adjusted in a manner to ensure that total
168	payments to trauma centers represent the same proportional
169	allocation as set forth in this section and s. 318.14. For
170	purposes of this section and s. 318.14, total funds distributed
171	to trauma centers may include revenue from the Administrative
172	Trust Fund and federal funds for which revenue from the
173	Administrative Trust Fund is used to meet state or local
174	matching requirements. Funds collected under ss. 318.14 and
175	318.18(15) and deposited in the Administrative Trust Fund of the
176	department shall be distributed to trauma centers on a quarterly
177	basis using the most recent calendar year data available. Such
178	data shall not be used for more than four quarterly
179	distributions unless there are extenuating circumstances as
180	determined by the department, in which case the most recent
181	calendar year data available shall continue to be used and
182	appropriate adjustments shall be made as soon as the more recent
183	data becomes available. Trauma centers may request that their
184	distributions from the Administrative Trust Fund be used as
185	intergovernmental transfer funds in the Medicaid program.
186	Section 4.  Section 395.41, Florida Statutes, is created to
187	read:
188	395.41  Trauma center startup grant program.--There is
189	established a trauma center startup grant program.
190	(1)  The Legislature recognizes the need for a statewide,
191	cohesive, uniform, and integrated trauma system, and the
192	Legislature acknowledges that the state has been divided into
193	trauma service areas. Each of the trauma service areas should
194	have at least one trauma center; however, some trauma service
195	areas do not have a trauma center because of the significant up-
196	front investment of capital required for hospitals to develop
197	the physical space, equipment, and qualified personnel necessary
198	to provide quality trauma services.
199	(2)  An acute care general hospital that has submitted a
200	letter of intent and an application to become a trauma center
201	pursuant to s. 395.4025 may apply to the department for a
202	startup grant. The grant applicant must demonstrate that:
203	(a)  There are currently no other trauma centers in the
204	hospital's trauma service area as established under s. 395.402.
205	(b)  There is not a trauma center within a 100-mile radius
206	of the proposed trauma center.
207	(c)  The hospital has received a local funding contribution
208	as defined under s. 395.4001.
209	(d)  The hospital has incurred startup costs in excess of
210	the amount of grant funding requested.
211	(e)  The hospital is pursuing the establishment of a
212	residency program in internal medicine or emergency medicine.
213	(3)  A hospital receiving startup grant funding that does
214	not become a provisional trauma center within 24 months after
215	submitting an application to become a trauma center must forfeit
216	any state grant funds received pursuant to this section.
217	(4)  A hospital that receives startup grant funding may not
218	receive more than $500,000, must ensure that the startup grant
219	funding is matched on a dollar-for-dollar basis with a local
220	funding contribution, and shall receive startup grant funding
221	only one time.
222	Section 5.  This act shall take effect July 1, 2006, except
223	that section 395.41, Florida Statutes, as created by this act,
224	shall take effect subject to an appropriation for the trauma
225	center startup grant program in the 2006-2007 General
226	Appropriations Act.

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