HB 715

1
A bill to be entitled
2An act relating to hospital licensing and regulation;
3amending s. 395.003, F.S.; prohibiting authorization of
4additional emergency departments located off the premises
5of licensed hospitals until the Agency for Health Care
6Administration adopts rules; amending s. 395.1055, F.S.;
7requiring the agency to adopt rules to establish licensure
8standards for emergency departments located off the
9premises of licensed hospitals; requiring the rules to
10address certain topics; amending s. 395.4001, F.S.;
11providing definitions; repealing s. 395.4035, F.S., to
12terminate the Trauma Services Trust Fund; amending s.
13395.4036, F.S.; revising provisions relating to
14distribution of funds to trauma centers and use thereof;
15creating s. 395.41, F.S.; establishing a trauma center
16startup grant program; providing conditions for the
17receipt of a startup grant; providing limitations; making
18the trauma center startup grant program subject to an
19appropriation in the General Appropriations Act; providing
20a contingent effective date.
21
22Be It Enacted by the Legislature of the State of Florida:
23
24     Section 1.  Paragraph (b) of subsection (1) of section
25395.003, Florida Statutes, is amended to read:
26     395.003  Licensure; issuance, renewal, denial,
27modification, suspension, and revocation.--
28     (1)
29     (b)1.  It is unlawful for a person to use or advertise to
30the public, in any way or by any medium whatsoever, any facility
31as a "hospital," "ambulatory surgical center," or "mobile
32surgical facility" unless such facility has first secured a
33license under the provisions of this part.
34     2.  This part does not apply to veterinary hospitals or to
35commercial business establishments using the word "hospital,"
36"ambulatory surgical center," or "mobile surgical facility" as a
37part of a trade name if no treatment of human beings is
38performed on the premises of such establishments.
39     3.  Until July 1, 2006, Additional emergency departments
40located off the premises of licensed hospitals may not be
41authorized by the agency until the agency has adopted rules
42required under s. 395.1055(9).
43     Section 2.  Subsection (9) is added to section 395.1055,
44Florida Statutes, to read:
45     395.1055  Rules and enforcement.--
46     (9)  The agency shall adopt rules pursuant to ss.
47120.536(1) and 120.54 that establish licensure standards for
48emergency departments located off the premises of licensed
49hospitals. The rules must:
50     (a)  Include minimum criteria for patient care and safety,
51quality improvement, infection control, building design and
52construction, location, and appropriate transport of patients
53from the emergency department located off the premises
54consistent with chapter 401.
55     (b)  Require the hospital to maintain an emergency
56department on its premises that is licensed and operated in
57accordance with agency rules.
58     (c)  Specify that an emergency department located off the
59premises of a licensed hospital that was authorized prior to the
60adoption of rules shall continue to operate in accordance with
61the licensure criteria under which it was originally authorized.
62     Section 3.  Section 395.4001, Florida Statutes, is amended
63to read:
64     395.4001  Definitions.--As used in this part, the term:
65     (1)  "Agency" means the Agency for Health Care
66Administration.
67     (2)  "Charity care" or "uncompensated trauma care" means
68that portion of hospital charges reported to the agency for
69which there is no compensation, other than restricted or
70unrestricted revenues provided to a hospital by local
71governments or tax districts regardless of method of payment,
72for care provided to a patient whose family income for the 12
73months preceding the determination is less than or equal to 200
74percent of the federal poverty level, unless the amount of
75hospital charges due from the patient exceeds 25 percent of the
76annual family income. However, in no case shall the hospital
77charges for a patient whose family income exceeds four times the
78federal poverty level for a family of four be considered
79charity.
80     (3)  "Department" means the Department of Health.
81     (4)  "Interfacility trauma transfer" means the transfer of
82a trauma victim between two facilities licensed under this
83chapter, pursuant to this part.
84     (5)  "International Classification Injury Severity Score"
85means the statistical method for computing the severity of
86injuries sustained by trauma patients. The International
87Classification Injury Severity Score shall be the methodology
88used by the department and trauma centers to report the severity
89of an injury.
90     (6)(5)  "Level I trauma center" means a trauma center that:
91     (a)  Has formal research and education programs for the
92enhancement of trauma care; is verified by the department to be
93in substantial compliance with Level I trauma center and
94pediatric trauma center standards; and has been approved by the
95department to operate as a Level I trauma center.
96     (b)  Serves as a resource facility to Level II trauma
97centers, pediatric trauma centers, and general hospitals through
98shared outreach, education, and quality improvement activities.
99     (c)  Participates in an inclusive system of trauma care,
100including providing leadership, system evaluation, and quality
101improvement activities.
102     (7)(6)  "Level II trauma center" means a trauma center
103that:
104     (a)  Is verified by the department to be in substantial
105compliance with Level II trauma center standards and has been
106approved by the department to operate as a Level II trauma
107center.
108     (b)  Serves as a resource facility to general hospitals
109through shared outreach, education, and quality improvement
110activities.
111     (c)  Participates in an inclusive system of trauma care.
112     (8)  "Local funding contribution" means local municipal,
113county, or tax district funding exclusive of any patient-
114specific funds received pursuant to ss. 154.301-154.316, private
115foundation funding, or public or private grant funding of at
116least $150,000 received by a hospital or health care system that
117operates a trauma center.
118     (9)(7)  "Pediatric trauma center" means a hospital that is
119verified by the department to be in substantial compliance with
120pediatric trauma center standards as established by rule of the
121department and has been approved by the department to operate as
122a pediatric trauma center.
123     (10)(8)  "Provisional trauma center" means a hospital that
124has been verified by the department to be in substantial
125compliance with the requirements in s. 395.4025 and has been
126approved by the department to operate as a provisional Level I
127trauma center, Level II trauma center, or pediatric trauma
128center.
129     (11)(9)  "Trauma agency" means a department-approved agency
130established and operated by one or more counties, or a
131department-approved entity with which one or more counties
132contract, for the purpose of administering an inclusive regional
133trauma system.
134     (12)(10)  "Trauma alert victim" means a person who has
135incurred a single or multisystem injury due to blunt or
136penetrating means or burns, who requires immediate medical
137intervention or treatment, and who meets one or more of the
138adult or pediatric scorecard criteria established by the
139department by rule.
140     (13)  "Trauma caseload volume" means the number of trauma
141patients reported by individual trauma centers to the Trauma
142Registry and validated by the department.
143     (14)(11)  "Trauma center" means a hospital that has been
144verified by the department to be in substantial compliance with
145the requirements in s. 395.4025 and has been approved by the
146department to operate as a Level I trauma center, Level II
147trauma center, or pediatric trauma center.
148     (15)  "Trauma patient" means a person who has incurred a
149physical injury or wound caused by trauma and has accessed a
150trauma center.
151     (16)(12)  "Trauma scorecard" means a statewide methodology
152adopted by the department by rule under which a person who has
153incurred a traumatic injury is graded as to the severity of his
154or her injuries or illness and which methodology is used as the
155basis for making destination decisions.
156     (17)(13)  "Trauma transport protocol" means a document
157which describes the policies, processes, and procedures
158governing the dispatch of vehicles, the triage, prehospital
159transport, and interfacility trauma transfer of trauma victims.
160     (18)(14)  "Trauma victim" means any person who has incurred
161a single or multisystem injury due to blunt or penetrating means
162or burns and who requires immediate medical intervention or
163treatment.
164     Section 4.  Section 395.4035, Florida Statutes, is
165repealed.
166     Section 5.  Subsection (1) of section 395.4036, Florida
167Statutes, is amended to read:
168     395.4036  Trauma payments.--
169     (1)  Recognizing the Legislature's stated intent to provide
170financial support to the current verified trauma centers and to
171provide incentives for the establishment of additional trauma
172centers as part of a system of state-sponsored trauma centers,
173the department shall utilize funds collected under s.
174318.18(15)(14) and deposited into the Administrative Trust Fund
175of the department to ensure the availability and accessibility
176of trauma services throughout the state as provided in this
177subsection.
178     (a)  Twenty percent of the total funds collected under this
179subsection during the state fiscal year shall be distributed to
180verified trauma centers located in a region that have has a
181local funding contribution as of December 31. Distribution of
182funds under this paragraph shall be based on trauma caseload
183volume for the most recent calendar year available.
184     (b)  Forty percent of the total funds collected under this
185subsection shall be distributed to verified trauma centers based
186on trauma caseload volume for of the most recent previous
187calendar year available. The determination of caseload volume
188for distribution of funds under this paragraph shall be based on
189the department's Trauma Registry data.
190     (c)  Forty percent of the total funds collected under this
191subsection shall be distributed to verified trauma centers based
192on severity of trauma patients for the most recent calendar year
193available. The determination of severity for distribution of
194funds under this paragraph shall be based on the department's
195International Classification Injury Severity Scores or another
196statistically valid and scientifically accepted method of
197stratifying a trauma patient's severity of injury, risk of
198mortality, and resource consumption as adopted by the department
199by rule, weighted based on the costs associated with and
200incurred by the trauma center in treating trauma patients. The
201weighting of scores shall be established by the department by
202rule scores of 1-14 and 15 plus.
203
204Funds deposited in the department's Administrative Trust Fund
205for verified trauma centers may be used to maximize the receipt
206of federal funds that may be available for such trauma centers.
207Notwithstanding this section and s. 318.14, distributions to
208trauma centers may be adjusted in a manner to ensure that total
209payments to trauma centers represent the same proportional
210allocation as set forth in this section and s. 318.14. For
211purposes of this section and s. 318.14, total funds distributed
212to trauma centers may include revenue from the Administrative
213Trust Fund and federal funds for which revenue from the
214Administrative Trust Fund is used to meet state or local
215matching requirements. Funds collected under ss. 318.14 and
216318.18(15) and deposited in the Administrative Trust Fund of the
217department shall be distributed to trauma centers on a quarterly
218basis using the most recent calendar year data available. Such
219data shall not be used for more than four quarterly
220distributions unless there are extenuating circumstances as
221determined by the department, in which case the most recent
222calendar year data available shall continue to be used and
223appropriate adjustments shall be made as soon as the more recent
224data becomes available. Trauma centers may request that their
225distributions from the Administrative Trust Fund be used as
226intergovernmental transfer funds in the Medicaid program.
227     Section 6.  Section 395.41, Florida Statutes, is created to
228read:
229     395.41  Trauma center startup grant program.--There is
230established a trauma center startup grant program.
231     (1)  The Legislature recognizes the need for a statewide,
232cohesive, uniform, and integrated trauma system, and the
233Legislature acknowledges that the state has been divided into
234trauma service areas. Each of the trauma service areas should
235have at least one trauma center; however, some trauma service
236areas do not have a trauma center because of the significant up-
237front investment of capital required for hospitals to develop
238the physical space, equipment, and qualified personnel necessary
239to provide quality trauma services.
240     (2)  An acute care general hospital that has submitted a
241letter of intent and an application to become a trauma center
242pursuant to s. 395.4025 may apply to the department for a
243startup grant. The grant applicant must demonstrate that:
244     (a)  There are currently no other trauma centers in the
245hospital's trauma service area as established under s. 395.402.
246     (b)  There is not a trauma center within a 100-mile radius
247of the proposed trauma center.
248     (c)  The hospital has received a local funding contribution
249as defined under s. 395.4001.
250     (d)  The hospital has incurred startup costs in excess of
251the amount of grant funding requested.
252     (e)  The hospital is pursuing the establishment of a
253residency program in internal medicine or emergency medicine.
254     (3)  A hospital receiving startup grant funding that does
255not become a provisional trauma center within 24 months after
256submitting an application to become a trauma center must forfeit
257any state grant funds received pursuant to this section.
258     (4)  A hospital that receives startup grant funding may not
259receive more than $500,000, must ensure that the startup grant
260funding is matched on a dollar-for-dollar basis with a local
261funding contribution, and shall receive startup grant funding
262only one time.
263     Section 7.  This act shall take effect July 1, 2006, except
264that section 395.41, Florida Statutes, as created by this act,
265shall take effect subject to an appropriation for the trauma
266center startup grant program in the 2006-2007 General
267Appropriations Act.


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