HB 0715

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 hospital licensing and regulation;
7	amending s. 395.003, F.S.; prohibiting authorization of
8	additional emergency departments located off the premises
9	of licensed hospitals until the Agency for Health Care
10	Administration adopts rules; amending s. 395.1055, F.S.;
11	requiring the agency to adopt rules by a specified date to
12	establish licensure standards for emergency departments
13	located off the premises of licensed hospitals; requiring
14	the rules to address certain topics; amending s. 395.4001,
15	F.S.; providing definitions; repealing s. 395.4035, F.S.,
16	to terminate the Trauma Services Trust Fund; amending s.
17	395.4036, F.S.; revising provisions relating to
18	distribution of funds to trauma centers and use thereof;
19	creating s. 395.41, F.S.; establishing a trauma center
20	startup grant program; providing conditions for the
21	receipt of a startup grant; providing limitations; making
22	the trauma center startup grant program subject to an
23	appropriation in the General Appropriations Act; providing
24	a contingent effective date.
25
26	Be It Enacted by the Legislature of the State of Florida:
27
28	Section 1.  Paragraph (b) of subsection (1) of section
29	395.003, Florida Statutes, is amended to read:
30	395.003  Licensure; issuance, renewal, denial,
31	modification, suspension, and revocation.--
32	(1)
33	(b)1.  It is unlawful for a person to use or advertise to
34	the public, in any way or by any medium whatsoever, any facility
35	as a "hospital," "ambulatory surgical center," or "mobile
36	surgical facility" unless such facility has first secured a
37	license under the provisions of this part.
38	2.  This part does not apply to veterinary hospitals or to
39	commercial business establishments using the word "hospital,"
40	"ambulatory surgical center," or "mobile surgical facility" as a
41	part of a trade name if no treatment of human beings is
42	performed on the premises of such establishments.
43	3.  Until July 1, 2006, Additional emergency departments
44	located off the premises of licensed hospitals may not be
45	authorized by the agency until the agency has adopted rules
46	required under s. 395.1055(9).
47	Section 2.  Subsection (9) is added to section 395.1055,
48	Florida Statutes, to read:
49	395.1055  Rules and enforcement.--
50	(9)  The agency shall adopt rules pursuant to ss.
51	120.536(1) and 120.54 no later than January 1, 2007, that
52	establish licensure standards for emergency departments located
53	off the premises of licensed hospitals. The rules must:
54	(a)  Include minimum criteria for patient care and safety,
55	quality improvement, infection control, building design and
56	construction, location, and appropriate transport of patients
57	from the emergency department located off the premises
58	consistent with chapter 401.
59	(b)  Require the hospital to maintain an emergency
60	department on its premises that is licensed and operated in
61	accordance with agency rules.
62	(c)  Specify that an emergency department located off the
63	premises of a licensed hospital that was authorized prior to the
64	adoption of rules shall continue to operate in accordance with
65	the licensure criteria under which it was originally authorized.
66	Section 3.  Section 395.4001, Florida Statutes, is amended
67	to read:
68	395.4001  Definitions.--As used in this part, the term:
69	(1)  "Agency" means the Agency for Health Care
70	Administration.
71	(2)  "Charity care" or "uncompensated trauma care" means
72	that portion of hospital charges reported to the agency for
73	which there is no compensation, other than restricted or
74	unrestricted revenues provided to a hospital by local
75	governments or tax districts regardless of method of payment,
76	for care provided to a patient whose family income for the 12
77	months preceding the determination is less than or equal to 200
78	percent of the federal poverty level, unless the amount of
79	hospital charges due from the patient exceeds 25 percent of the
80	annual family income. However, in no case shall the hospital
81	charges for a patient whose family income exceeds four times the
82	federal poverty level for a family of four be considered
83	charity.
84	(3)  "Department" means the Department of Health.
85	(4)  "Interfacility trauma transfer" means the transfer of
86	a trauma victim between two facilities licensed under this
87	chapter, pursuant to this part.
88	(5)  "International Classification Injury Severity Score"
89	means the statistical method for computing the severity of
90	injuries sustained by trauma patients. The International
91	Classification Injury Severity Score shall be the methodology
92	used by the department and trauma centers to report the severity
93	of an injury.
94	(6)(5)  "Level I trauma center" means a trauma center that:
95	(a)  Has formal research and education programs for the
96	enhancement of trauma care; is verified by the department to be
97	in substantial compliance with Level I trauma center and
98	pediatric trauma center standards; and has been approved by the
99	department to operate as a Level I trauma center.
100	(b)  Serves as a resource facility to Level II trauma
101	centers, pediatric trauma centers, and general hospitals through
102	shared outreach, education, and quality improvement activities.
103	(c)  Participates in an inclusive system of trauma care,
104	including providing leadership, system evaluation, and quality
105	improvement activities.
106	(7)(6)  "Level II trauma center" means a trauma center
107	that:
108	(a)  Is verified by the department to be in substantial
109	compliance with Level II trauma center standards and has been
110	approved by the department to operate as a Level II trauma
111	center.
112	(b)  Serves as a resource facility to general hospitals
113	through shared outreach, education, and quality improvement
114	activities.
115	(c)  Participates in an inclusive system of trauma care.
116	(8)  "Local funding contribution" means local municipal,
117	county, or tax district funding exclusive of any patient-
118	specific funds received pursuant to ss. 154.301-154.316, private
119	foundation funding, or public or private grant funding of at
120	least $150,000 received by a hospital or health care system that
121	operates a trauma center.
122	(9)(7)  "Pediatric trauma center" means a hospital that is
123	verified by the department to be in substantial compliance with
124	pediatric trauma center standards as established by rule of the
125	department and has been approved by the department to operate as
126	a pediatric trauma center.
127	(10)(8)  "Provisional trauma center" means a hospital that
128	has been verified by the department to be in substantial
129	compliance with the requirements in s. 395.4025 and has been
130	approved by the department to operate as a provisional Level I
131	trauma center, Level II trauma center, or pediatric trauma
132	center.
133	(11)(9)  "Trauma agency" means a department-approved agency
134	established and operated by one or more counties, or a
135	department-approved entity with which one or more counties
136	contract, for the purpose of administering an inclusive regional
137	trauma system.
138	(12)(10)  "Trauma alert victim" means a person who has
139	incurred a single or multisystem injury due to blunt or
140	penetrating means or burns, who requires immediate medical
141	intervention or treatment, and who meets one or more of the
142	adult or pediatric scorecard criteria established by the
143	department by rule.
144	(13)  "Trauma caseload volume" means the number of trauma
145	patients reported by individual trauma centers to the Trauma
146	Registry and validated by the department.
147	(14)(11)  "Trauma center" means a hospital that has been
148	verified by the department to be in substantial compliance with
149	the requirements in s. 395.4025 and has been approved by the
150	department to operate as a Level I trauma center, Level II
151	trauma center, or pediatric trauma center.
152	(15)  "Trauma patient" means a person who has incurred a
153	physical injury or wound caused by trauma and has accessed a
154	trauma center.
155	(16)(12)  "Trauma scorecard" means a statewide methodology
156	adopted by the department by rule under which a person who has
157	incurred a traumatic injury is graded as to the severity of his
158	or her injuries or illness and which methodology is used as the
159	basis for making destination decisions.
160	(17)(13)  "Trauma transport protocol" means a document
161	which describes the policies, processes, and procedures
162	governing the dispatch of vehicles, the triage, prehospital
163	transport, and interfacility trauma transfer of trauma victims.
164	(18)(14)  "Trauma victim" means any person who has incurred
165	a single or multisystem injury due to blunt or penetrating means
166	or burns and who requires immediate medical intervention or
167	treatment.
168	Section 4.  Section 395.4035, Florida Statutes, is
169	repealed.
170	Section 5.  Subsection (1) of section 395.4036, Florida
171	Statutes, is amended to read:
172	395.4036  Trauma payments.--
173	(1)  Recognizing the Legislature's stated intent to provide
174	financial support to the current verified trauma centers and to
175	provide incentives for the establishment of additional trauma
176	centers as part of a system of state-sponsored trauma centers,
177	the department shall utilize funds collected under s.
178	318.18(15)(14) and deposited into the Administrative Trust Fund
179	of the department to ensure the availability and accessibility
180	of trauma services throughout the state as provided in this
181	subsection.
182	(a)  Twenty percent of the total funds collected under this
183	subsection during the state fiscal year shall be distributed to
184	verified trauma centers located in a region that have has a
185	local funding contribution as of December 31. Distribution of
186	funds under this paragraph shall be based on trauma caseload
187	volume for the most recent calendar year available.
188	(b)  Forty percent of the total funds collected under this
189	subsection shall be distributed to verified trauma centers based
190	on trauma caseload volume for of the most recent previous
191	calendar year available. The determination of caseload volume
192	for distribution of funds under this paragraph shall be based on
193	the department's Trauma Registry data.
194	(c)  Forty percent of the total funds collected under this
195	subsection shall be distributed to verified trauma centers based
196	on severity of trauma patients for the most recent calendar year
197	available. The determination of severity for distribution of
198	funds under this paragraph shall be based on the department's
199	International Classification Injury Severity Scores or another
200	statistically valid and scientifically accepted method of
201	stratifying a trauma patient's severity of injury, risk of
202	mortality, and resource consumption as adopted by the department
203	by rule, weighted based on the costs associated with and
204	incurred by the trauma center in treating trauma patients. The
205	weighting of scores shall be established by the department by
206	rule scores of 1-14 and 15 plus.
207
208	Funds deposited in the department's Administrative Trust Fund
209	for verified trauma centers may be used to maximize the receipt
210	of federal funds that may be available for such trauma centers.
211	Notwithstanding this section and s. 318.14, distributions to
212	trauma centers may be adjusted in a manner to ensure that total
213	payments to trauma centers represent the same proportional
214	allocation as set forth in this section and s. 318.14. For
215	purposes of this section and s. 318.14, total funds distributed
216	to trauma centers may include revenue from the Administrative
217	Trust Fund and federal funds for which revenue from the
218	Administrative Trust Fund is used to meet state or local
219	matching requirements. Funds collected under ss. 318.14 and
220	318.18(15) and deposited in the Administrative Trust Fund of the
221	department shall be distributed to trauma centers on a quarterly
222	basis using the most recent calendar year data available. Such
223	data shall not be used for more than four quarterly
224	distributions unless there are extenuating circumstances as
225	determined by the department, in which case the most recent
226	calendar year data available shall continue to be used and
227	appropriate adjustments shall be made as soon as the more recent
228	data becomes available. Trauma centers may request that their
229	distributions from the Administrative Trust Fund be used as
230	intergovernmental transfer funds in the Medicaid program.
231	Section 6.  Section 395.41, Florida Statutes, is created to
232	read:
233	395.41  Trauma center startup grant program.--There is
234	established a trauma center startup grant program.
235	(1)  The Legislature recognizes the need for a statewide,
236	cohesive, uniform, and integrated trauma system, and the
237	Legislature acknowledges that the state has been divided into
238	trauma service areas. Each of the trauma service areas should
239	have at least one trauma center; however, some trauma service
240	areas do not have a trauma center because of the significant up-
241	front investment of capital required for hospitals to develop
242	the physical space, equipment, and qualified personnel necessary
243	to provide quality trauma services.
244	(2)  An acute care general hospital that has submitted a
245	letter of intent and an application to become a trauma center
246	pursuant to s. 395.4025 may apply to the department for a
247	startup grant. The grant applicant must demonstrate that:
248	(a)  There are currently no other trauma centers in the
249	hospital's trauma service area as established under s. 395.402.
250	(b)  There is not a trauma center within a 100-mile radius
251	of the proposed trauma center.
252	(c)  The hospital has received a local funding contribution
253	as defined under s. 395.4001.
254	(d)  The hospital has incurred startup costs in excess of
255	the amount of grant funding requested.
256	(e)  The hospital is pursuing the establishment of a
257	residency program in internal medicine or emergency medicine.
258	(3)  A hospital receiving startup grant funding that does
259	not become a provisional trauma center within 24 months after
260	submitting an application to become a trauma center must forfeit
261	any state grant funds received pursuant to this section.
262	(4)  A hospital that receives startup grant funding may not
263	receive more than $500,000, must ensure that the startup grant
264	funding is matched on a dollar-for-dollar basis with a local
265	funding contribution, and shall receive startup grant funding
266	only one time.
267	Section 7.  This act shall take effect July 1, 2006, except
268	that section 395.41, Florida Statutes, as created by this act,
269	shall take effect subject to an appropriation for the trauma
270	center startup grant program in the 2006-2007 General
271	Appropriations Act.

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