HB 7215

A bill to be entitled
2An act relating to rural health care; amending s.
3381.0405, F.S.; revising the purpose and functions of the
4Office of Rural Health in the Department of Health;
5requiring the Secretary of Health and the Secretary of
6Health Care Administration to appoint an advisory council
7to advise the office; providing for terms of office of the
8members of the advisory council; authorizing per diem and
9travel reimbursement for members of the advisory council;
10requiring the advisory council to work with certain
11stakeholders; requiring a report to the Governor and
12Legislature; amending s. 381.0406, F.S.; revising
13legislative findings and intent with respect to rural
14health networks; revising the definition of "rural health
15network"; providing additional functions of and
16requirements for membership in rural health networks;
17requiring rural health networks to submit rural health
18infrastructure development plans to the office by a
19specified date; revising provisions relating to the
20governance and organization of rural health networks;
21revising the services to be provided by provider members
22of rural health networks; requiring coordination among
23rural health networks and area health education centers,
24health planning councils, and regional education
25consortia; establishing a grant program for funding rural
26health networks; defining projects that may be funded
27through the grant program; requiring the department to
28establish rules governing rural health network grant
29programs and performance standards; amending s. 395.602,
30F.S.; defining "critical access hospital"; revising and
31deleting definitions; amending s. 395.603, F.S.; deleting
32a requirement that the Agency for Health Care
33Administration adopt a rule relating to deactivation of
34rural hospital beds under certain circumstances; requiring
35that rural critical access hospitals maintain a certain
36number of actively licensed beds; amending s. 395.604,
37F.S.; removing emergency care hospitals and essential
38access community hospitals from certain licensure
39requirements; specifying certain special conditions for
40rural primary care hospitals; amending s. 395.6061, F.S.;
41specifying the purpose of the rural hospital capital
42improvement grant program; providing for grant management
43by the agency; modifying the conditions for receiving a
44grant; deleting a requirement for a minimum grant for
45every rural hospital; establishing an assistance program
46within the agency for financially distressed rural and
47critical access hospitals; providing purpose of the
48program; providing requirements for receiving certain
49assistance; requiring a participation agreement and
50providing for contents thereof; creating s. 395.6070,
51F.S.; authorizing the agency to petition for the
52appointment of a receiver for a rural hospital when
53certain conditions exist; providing for hearings and
54notice; providing qualification of a receiver and time
55limitations; providing duties of the agency; providing
56powers and duties of the receiver with respect to the
57hospital and related contracts and the patients and their
58property; specifying liability of certain persons to pay a
59receiver for goods and services provided; providing that
60the receiver may petition to avoid certain contracts and
61specifying liabilities associated therewith; providing for
62compensation and liability of the receiver; providing for
63bond; providing conditions for termination of
64receivership; requiring an accounting to the court;
65providing liabilities of the owner, operator, and
66employees of a rural hospital placed in receivership;
67providing applicability of the Rural Hospital Patient
68Protection Trust Fund; creating s. 395.6071, F.S.;
69establishing the Rural Hospital Patient Protection Trust
70Fund; providing for funds collected to be used for
71specified purposes; providing for the expenditure of funds
72upon a declaration of local emergency; authorizing the
73agency to establish certain accounts for moneys received
74and for the disbursement thereof for certain purposes;
75providing limitations on expenditure of funds; providing
76for limited liability under certain circumstances;
77providing rulemaking authority to the agency; creating s.
78408.7054, F.S.; establishing the Rural Provider Service
79Network Development Program; providing purposes and
80responsibilities; authorizing the agency to provide
81funding through a grant program for the establishment of
82rural provider service networks; providing eligibility
83requirements; authorizing preferential funding to certain
84providers; authorizing the agency to adopt rules; amending
85s. 409.908, F.S.; requiring the agency to pay certain
86physicians a bonus for Medicaid physician services
87provided within a rural county; amending ss. 408.07,
88409.9116, and 1009.65, F.S.; conforming cross-references;
89repealing s. 395.605, F.S., relating to the licensure of
90emergency care hospitals; providing an effective date.
92Be It Enacted by the Legislature of the State of Florida:
94     Section 1.  Section 381.0405, Florida Statutes, is amended
95to read:
96     381.0405  Office of Rural Health.--
97     (1)  ESTABLISHMENT.--The Department of Health shall
98establish an Office of Rural Health, which shall assist rural
99health care providers in improving the health status and health
100care of rural residents of this state and assist rural health
101care providers in integrating their efforts. The Office of Rural
102Health shall coordinate its activities with rural health
103networks established under s. 381.0406, local health councils
104established under s. 408.033, the area health education center
105network established under pursuant to s. 381.0402, and with any
106appropriate research and policy development centers within
107universities that have state-approved medical schools. The
108Office of Rural Health may enter into a formal relationship with
109any center that designates the office as an affiliate of the
111     (2)  PURPOSE.--The Office of Rural Health shall actively
112foster the provision of high-quality health care services in
113rural areas and serve as a catalyst for improved health services
114to residents citizens in rural areas of the state.
115     (3)  GENERAL FUNCTIONS.--The office shall:
116     (a)  Integrate policies related to physician workforce,
117hospitals, public health, and state regulatory functions.
118     (b)  Work with rural stakeholders in order to foster the
119development of strategic planning that addresses Propose
120solutions to problems affecting health care delivery in rural
122     (c)  Foster the expansion of rural health network service
123areas to include rural counties that are not served by a rural
124health network.
125     (d)(c)  Seek grant funds from foundations and the Federal
127     (e)  Administer state grant programs for rural health
129     (4)  COORDINATION.--The office shall:
130     (a)  Identify federal and state rural health programs and
131provide information and technical assistance to rural providers
132regarding participation in such programs.
133     (b)  Act as a clearinghouse for collecting and
134disseminating information on rural health care issues, research
135findings on rural health care, and innovative approaches to the
136delivery of health care in rural areas.
137     (c)  Foster the creation of regional health care systems
138that promote cooperation, rather than competition.
139     (d)  Coordinate the department's rural health care
140activities, programs, and policies.
141     (e)  Design initiatives to improve access to primary,
142acute, and emergency medical services and promote the
143coordination of such services in rural areas.
144     (f)  Assume responsibility for state coordination of the
145Rural Hospital Transition Grant Program, the Essential Access
146Community Hospital Program, and other federal rural health care
147grant programs.
148     (5)  TECHNICAL ASSISTANCE.--The office shall:
149     (a)  Assist Help rural health care providers in recruiting
150obtain health care practitioners by promoting the location and
151relocation of health care practitioners in rural areas and
152promoting policies that create incentives for practitioners to
153serve in rural areas.
154     (b)  Provide technical assistance to hospitals, community
155and migrant health centers, and other health care providers that
156serve residents in rural areas.
157     (c)  Assist with the design of strategies to improve health
158care workforce recruitment and placement programs.
159     (d)  Provide technical assistance to rural health networks
160in the formulation of their rural health infrastructure
161development plans.
162     (e)  Provide links to best practices and other technical
163assistance resources on the office's Internet website.
164     (6)  ADVISORY COUNCIL.--
165     (a)  The Secretary of Health and the Secretary of Health
166Care Administration shall each appoint no more than five members
167with relevant health care operations management, practice, and
168policy experience to an advisory council to advise the office
169regarding its responsibilities under this section and ss.
170381.0406, 395.6061, and 395.6063. Members must be appointed for
1714-year staggered terms and may be reappointed to a second term
172of office. Members shall serve without compensation but are
173entitled to reimbursement for per diem and travel expenses as
174provided in s. 112.061. The council may appoint technical
175advisory teams as needed. The department shall provide staff and
176other administrative assistance reasonably necessary to assist
177the advisory council in carrying out its duties.
178     (b)  The advisory council shall work with stakeholders to
179develop recommendations that address barriers and identify
180options for establishing provider networks in rural counties and
181submit a report to the Governor, the President of the Senate,
182and the Speaker of the House of Representatives, by February 1,
185office shall:
186     (a)  Conduct policy and research studies.
187     (b)  Conduct health status studies of rural residents.
188     (c)  Collect relevant data on rural health care issues for
189use in department policy development.
190     (8)(7)  APPROPRIATION.--The Legislature shall appropriate
191such sums as are necessary to support the Office of Rural
193     Section 2.  Section 381.0406, Florida Statutes, is amended
194to read:
195     381.0406  Rural health networks.--
197     (a)  The Legislature finds that, in rural areas, access to
198health care is limited and the quality of health care is
199negatively affected by inadequate financing, difficulty in
200recruiting and retaining skilled health professionals, and the
201because of a migration of patients to urban areas for general
202acute care and specialty services.
203     (b)  The Legislature further finds that the efficient and
204effective delivery of health care services in rural areas
206     1.  The integration of public and private resources.
207     2.  The adoption of quality improvement and cost-
208effectiveness measures. and
209     3.  The coordination of health care providers.
210     (c)  The Legislature further finds that the availability of
211a continuum of quality health care services, including
212preventive, primary, secondary, tertiary, and long-term care, is
213essential to the economic and social vitality of rural
215     (d)  The Legislature further finds that health care
216providers in rural areas are not prepared for market changes
217such as the introduction of managed care and capitation
218reimbursement methodologies into health care services.
219     (e)(d)  The Legislature further finds that the creation of
220rural health networks can help to alleviate these problems.
221Rural health networks shall act in the broad public interest
222and, to the extent possible, seek to improve the accessibility,
223quality, and cost-effectiveness of rural health care by planning
224and coordinating be structured to provide a continuum of quality
225health care services for rural residents through the cooperative
226efforts of rural health network members and other health care
228     (e)  The Legislature further finds that rural health
229networks shall have the goal of increasing the utilization of
230statutory rural hospitals for appropriate health care services
231whenever feasible, which shall help to ensure their survival and
232thereby support the economy and protect the health and safety of
233rural residents.
234     (f)  Finally, the Legislature finds that rural health
235networks may serve as "laboratories" to determine the best way
236of organizing rural health services, to move the state closer to
237ensuring that everyone has access to health care, and to promote
238cost containment efforts. The ultimate goal of rural health
239networks shall be to ensure that quality health care is
240available and efficiently delivered to all persons in rural
242     (2)  DEFINITIONS.--
243     (a)  "Rural" means an area with a population density of
244fewer less than 100 individuals per square mile or an area
245defined by the most recent United States Census as rural.
246     (b)  "Health care provider" means any individual, group, or
247entity, public or private, that provides health care, including:
248preventive health care, primary health care, secondary and
249tertiary health care, in-hospital health care, public health
250care, and health promotion and education.
251     (c)  "Rural health network" or "network" means a nonprofit
252legal entity whose principal place of business is in a rural
253county, whose members consist consisting of rural and urban
254health care providers and others, and that is established
255organized to plan the delivery of and deliver health care
256services on a cooperative basis in a rural area, except for some
257secondary and tertiary care services.
258     (3)  NETWORK MEMBERSHIP.--
259     (a)  Because each rural area is unique, with a different
260health care provider mix, health care provider membership may
261vary, but all networks shall include members that provide public
262health care, comprehensive primary care, emergency medical care,
263and acute inpatient care.
264     (b)  Federally qualified health centers, emergency medical
265services providers, and county health departments are expected
266to participate in rural health networks in the areas in which
267their patients reside or receive services.
268     (4)  Network membership shall be available to all health
269care providers, provided that they render care to all patients
270referred to them from other network members, comply with network
271quality assurance and risk management requirements, abide by the
272terms and conditions of network provider agreements in paragraph
273(11)(c), and provide services at a rate or price equal to the
274rate or price negotiated by the network.
275     (4)(5)  NETWORK SERVICE AREAS.--Network service areas are
276do not required need to conform to local political boundaries or
277state administrative district boundaries. The geographic area of
278one rural health network, however, may not overlap the territory
279of any other rural health network.
280     (5)(6)  NETWORK FUNCTIONS.--Networks shall:
281     (a)  Seek to develop linkages with provisions for referral
282to tertiary inpatient care, specialty physician care, and to
283other services that are not available in rural service areas.
284     (b)(7)  Seek to Networks shall make available health
285promotion, disease prevention, and primary care services
286accessible to all residents in order to improve the health
287status of rural residents and to contain health care costs.
288     (8)  Networks may have multiple points of entry, such as
289through private physicians, community health centers, county
290health departments, certified rural health clinics, hospitals,
291or other providers; or they may have a single point of entry.
292     (c)(9)  Encourage members through training and educational
293programs to adopt standards of care, promote the evidence-based
294practice of medicine Networks shall establish standard
295protocols, coordinate and share patient records, and develop
296patient information exchange systems in order to improve the
297quality of and access to services.
298     (d)  Develop quality improvement programs and train network
299members and other health care providers in the implementation of
300such programs.
301     (e)  Develop disease management systems and train network
302members and other health care providers in the implementation of
303such systems.
304     (f)  Promote outreach to areas with a high need for
306     (g)  Seek to develop community care alternatives for elders
307who would otherwise be placed in nursing homes.
308     (h)  Emphasize community care alternatives for persons with
309mental health and substance abuse disorders who are at risk of
310being admitted to an institution.
311     (i)  Develop a rural health infrastructure development plan
312for an integrated system of care that is responsive to the
313unique local health care needs and the area health care services
314market. Each rural health infrastructure development plan must
315address strategies to improve access to specialty care, train
316health care providers to use standards of care for chronic
317illness, develop disease management capacity, and link to state
318and national quality improvement initiatives. The initial
319development plan must be submitted to the Office of Rural Health
320for review and comment no later than July 1, 2007; thereafter,
321the plan must be updated and submitted to the Office of Rural
322Health every 3 years.
323     (10)  Networks shall develop risk management and quality
324assurance programs for network providers.
326     (a)  Networks shall be incorporated under the laws of the
328     (b)  Each network Networks shall have a board of directors
329that derives membership from local government, health care
330providers, businesses, consumers, and others.
331     (c)  Network boards of directors shall have the
332responsibility of determining the content of health care
333provider agreements that link network members. The agreements
334shall specify:
335     1.  Who provides what services.
336     2.  The extent to which the health care provider provides
337care to persons who lack health insurance or are otherwise
338unable to pay for care.
339     3.  The procedures for transfer of medical records.
340     4.  The method used for the transportation of patients
341between providers.
342     5.  Referral and patient flow including appointments and
344     6.  Payment arrangements for the transfer or referral of
346     (c)(d)  There shall be no liability on the part of, and no
347cause of action of any nature shall arise against, any member of
348a network board of directors, or its employees or agents, for
349any lawful action taken by them in the performance of their
350administrative powers and duties under this subsection.
352     (a)  Networks, to the extent feasible, shall seek to
353develop services that provide for a continuum of care for all
354residents patients served by the network. Each network shall
355recruit members that can provide include the following core
356services: disease prevention, health promotion, comprehensive
357primary care, emergency medical care, and acute inpatient care.
358Each network shall seek to ensure the availability of
359comprehensive maternity care, including prenatal, delivery, and
360postpartum care for uncomplicated pregnancies, either directly,
361by contract, or through referral agreements. Networks shall, to
362the extent feasible, develop local services and linkages among
363health care providers to also ensure the availability of the
364following services within the specified timeframes, either
365directly, by contract, or through referral agreements:
366     1.  Services available in the home.
367     1.a.  Home health care.
368     2.b.  Hospice care.
369     2.  Services accessible within 30 minutes travel time or
371     3.a.  Emergency medical services, including advanced life
372support, ambulance, and basic emergency room services.
373     4.b.  Primary care, including.
374     c.  prenatal and postpartum care for uncomplicated
376     5.d.  Community-based services for elders, such as adult
377day care and assistance with activities of daily living.
378     6.e.  Public health services, including communicable
379disease control, disease prevention, health education, and
380health promotion.
381     7.f.  Outpatient mental health psychiatric and substance
382abuse services.
383     3.  Services accessible within 45 minutes travel time or
385     8.a.  Hospital acute inpatient care for persons whose
386illnesses or medical problems are not severe.
387     9.b.  Level I obstetrical care, which is Labor and delivery
388care for low-risk patients.
389     10.c.  Skilled nursing services and, long-term care,
390including nursing home care.
391     (b)  Networks shall seek to foster linkages with out-of-
392area services to the extent feasible to ensure the availability
394     d.  Dialysis.
395     e.  Osteopathic and chiropractic manipulative therapy.
396     4.  Services accessible within 2 hours travel time or less.
397     1.a.  Specialist physician care.
398     2.b.  Hospital acute inpatient care for severe illnesses
399and medical problems.
400     3.c.  Level II and III obstetrical care, which is Labor and
401delivery care for high-risk patients and neonatal intensive
403     4.d.  Comprehensive medical rehabilitation.
404     5.e.  Inpatient mental health psychiatric and substance
405abuse services.
406     6.f.  Magnetic resonance imaging, lithotripter treatment,
407oncology, advanced radiology, and other technologically advanced
409     g.  Subacute care.
411     (a)  Area health education centers, health planning
412councils, and regional education consortia are expected to
413participate in the rural health networks' preparation of rural
414health infrastructure development plans. The Department of
415Health may require a written memorandum of agreement between a
416network and an area health education center or health planning
418     (b)  Rural health networks shall initiate activities, in
419coordination with area health education centers, to carry out
420the objectives of the adopted development plan, including
421continuing education for health care practitioners performing
422functions such as disease management, continuous quality
423improvement, telemedicine, distance learning, and the treatment
424of chronic illness using standards of care. For the purposes of
425this section, the term "telemedicine" means the use of
426telecommunications to deliver or expedite the delivery of health
427care services.
428     (c)  Health planning councils shall support the preparation
429of rural health infrastructure development plans through data
430collection and analysis in order to assess the health status of
431area residents and the capacity of local health services.
432     (d)  Regional education consortia that have the technology
433available to assist rural health networks in establishing
434systems for exchange of patient information and distance
435learning shall provide technical assistance upon the request of
436a rural health network.
437     (b)  Networks shall actively participate with area health
438education center programs, whenever feasible, in developing and
439implementing recruitment, training, and retention programs
440directed at positively influencing the supply and distribution
441of health care professionals serving in, or receiving training
442in, network areas.
443     (c)  As funds become available, networks shall emphasize
444community care alternatives for elders who would otherwise be
445placed in nursing homes.
446     (d)  To promote the most efficient use of resources,
447networks shall emphasize disease prevention, early diagnosis and
448treatment of medical problems, and community care alternatives
449for persons with mental health and substance abuse disorders who
450are at risk to be institutionalized.
451     (e)(13)  TRAUMA SERVICES.--In those network areas that
452which have an established trauma agency approved by the
453Department of Health, the network shall seek the participation
454of that trauma agency must be a participant in the network.
455Trauma services provided within the network area must comply
456with s. 395.405.
457     (9)(14)  NETWORK FINANCING.--
458     (a)  Networks may use all sources of public and private
459funds to support network activities. Nothing in this section
460prohibits networks from becoming managed care providers.
461     (b)  The Department of Health shall establish a grant
462program to provide funding to support the administrative cost of
463operating and developing rural health networks. Rural health
464networks may qualify for funding provided through:
465     1.  Network operations grants to support development of a
466rural health infrastructure development plan in a network
467service area and to support network functions identified in
468subsection (5).
469     2.  Rural health infrastructure development grants to
470support the development of clinical and administrative
471infrastructure in the following priority areas:
472     a.  Formation of joint contracting entities composed of
473rural physicians, rural hospitals, and other rural providers.
474     b.  Establishing disease management programs that meet
475Medicaid requirements.
476     c.  Establishing regional quality improvement programs
477involving physicians and hospitals consistent with state and
478national initiatives.
479     d.  Establishing specialty networks connecting rural
480primary care physicians and urban specialists.
481     e.  Developing regional broadband telecommunications
482systems with the capacity to share patient information in a
483secure network.
484     f.  Telemedicine and distance learning capacity.
485     (15)  NETWORK IMPLEMENTATION.--As funds become available,
486networks shall be developed and implemented in two phases.
487     (a)  Phase I shall consist of a network planning and
488development grant program. Planning grants shall be used to
489organize networks, incorporate network boards, and develop
490formal provider agreements as provided for in this section. The
491Department of Health shall develop a request-for-proposal
492process to solicit grant applications.
493     (b)  Phase II shall consist of network operations. As funds
494become available, certified networks shall be eligible to
495receive grant funds to be used to help defray the costs of
496network infrastructure development, patient care, and network
497administration. Infrastructure development includes, but is not
498limited to: recruitment and retention of primary care
499practitioners; development of preventive health care programs;
500linkage of urban and rural health care systems; design and
501implementation of automated patient records, outcome
502measurement, quality assurance, and risk management systems;
503establishment of one-stop service delivery sites; upgrading of
504medical technology available to network providers; enhancement
505of emergency medical systems; enhancement of medical
506transportation; and development of telecommunication
507capabilities. A Phase II award may occur in the same fiscal year
508as a Phase I award.
509     (16)  CERTIFICATION.--For the purpose of certifying
510networks that are eligible for Phase II funding, the Department
511of Health shall certify networks that meet the criteria
512delineated in this section and the rules governing rural health
514     (10)(17)  RULES.--The Department of Health shall establish
515rules that govern the creation and certification of networks,
516the provision of grant funds, and the establishment of
517performance standards including establishing outcome measures
518for networks.
519     Section 3.  Subsection (2) of section 395.602, Florida
520Statutes, is amended to read:
521     395.602  Rural hospitals.--
522     (2)  DEFINITIONS.--As used in this part:
523     (a)  "Critical access hospital" means a hospital that meets
524the definition of rural hospital in paragraph (d) and meets the
525requirements for reimbursement by Medicare and Medicaid under 42
526C.F.R. ss. 485.601-485.647. "Emergency care hospital" means a
527medical facility which provides:
528     1.  Emergency medical treatment; and
529     2.  Inpatient care to ill or injured persons prior to their
530transportation to another hospital or provides inpatient medical
531care to persons needing care for a period of up to 96 hours. The
53296-hour limitation on inpatient care does not apply to respite,
533skilled nursing, hospice, or other nonacute care patients.
534     (b)  "Essential access community hospital" means any
535facility which:
536     1.  Has at least 100 beds;
537     2.  Is located more than 35 miles from any other essential
538access community hospital, rural referral center, or urban
539hospital meeting criteria for classification as a regional
540referral center;
541     3.  Is part of a network that includes rural primary care
543     4.  Provides emergency and medical backup services to rural
544primary care hospitals in its rural health network;
545     5.  Extends staff privileges to rural primary care hospital
546physicians in its network; and
547     6.  Accepts patients transferred from rural primary care
548hospitals in its network.
549     (b)(c)  "Inactive rural hospital bed" means a licensed
550acute care hospital bed, as defined in s. 395.002(14), that is
551inactive in that it cannot be occupied by acute care inpatients.
552     (c)(d)  "Rural area health education center" means an area
553health education center (AHEC), as authorized by Pub. L. No. 94-
554484, that which provides services in a county with a population
555density of no greater than 100 persons per square mile.
556     (d)(e)  "Rural hospital" means an acute care hospital
557licensed under this chapter, having 100 or fewer licensed beds
558and an emergency room, that which is:
559     1.  The sole provider within a county with a population
560density of no greater than 100 persons per square mile;
561     2.  An acute care hospital, in a county with a population
562density of no greater than 100 persons per square mile, that
563which is at least 30 minutes of travel time, on normally
564traveled roads under normal traffic conditions, from any other
565acute care hospital within the same county;
566     3.  A hospital supported by a tax district or subdistrict
567whose boundaries encompass a population of 100 persons or fewer
568per square mile;
569     4.  A hospital in a constitutional charter county with a
570population of over 1 million persons that has imposed a local
571option health service tax pursuant to law and in an area that
572was directly impacted by a catastrophic event on August 24,
5731992, for which the Governor of Florida declared a state of
574emergency pursuant to chapter 125, and has 120 beds or fewer
575less that serves an agricultural community with an emergency
576room utilization of no less than 20,000 visits and a Medicaid
577inpatient utilization rate greater than 15 percent;
578     5.  A hospital with a service area that has a population of
579100 persons or fewer per square mile. As used in this
580subparagraph, the term "service area" means the fewest number of
581zip codes that account for 75 percent of the hospital's
582discharges for the most recent 5-year period, based on
583information available from the hospital inpatient discharge
584database in the State Center for Health Statistics at the Agency
585for Health Care Administration; or
586     6.  A hospital designated as a critical access hospital, as
587defined in s. 408.07(15).
589Population densities used in this paragraph must be based upon
590the most recently completed United States census. A hospital
591that received funds under s. 409.9116 for a quarter beginning no
592later than July 1, 2002, is deemed to have been and shall
593continue to be a rural hospital from that date through June 30,
5942012, if the hospital continues to have 100 or fewer licensed
595beds and an emergency room, or meets the criteria of
596subparagraph 4. An acute care hospital that has not previously
597been designated as a rural hospital and that meets the criteria
598of this paragraph shall be granted such designation upon
599application, including supporting documentation to the Agency
600for Health Care Administration.
601     (e)(f)  "Rural primary care hospital" means any facility
602that meeting the criteria in paragraph (e) or s. 395.605 which
604     1.  Twenty-four-hour emergency medical care;
605     2.  Temporary inpatient care for periods of 96 72 hours or
606less to patients requiring stabilization before discharge or
607transfer to another hospital. The 96-hour 72-hour limitation
608does not apply to respite, skilled nursing, hospice, or other
609nonacute care patients; and
610     3.  Has at least no more than six licensed acute care
611inpatient beds.
612     (f)(g)  "Swing-bed" means a bed that which can be used
613interchangeably as either a hospital, skilled nursing facility
614(SNF), or intermediate care facility (ICF) bed pursuant to 42
615C.F.R. parts 405, 435, 440, 442, and 447.
616     Section 4.  Subsection (1) of section 395.603, Florida
617Statutes, is amended to read:
618     395.603  Deactivation of general hospital beds; rural
619hospital impact statement.--
620     (1)  The agency shall establish, by rule, a process by
621which A rural hospital, as defined in s. 395.602, that seeks
622licensure as a rural primary care hospital or as an emergency
623care hospital, or becomes a certified rural health clinic as
624defined in Pub. L. No. 95-210, or becomes a primary care program
625such as a county health department, community health center, or
626other similar outpatient program that provides preventive and
627curative services, may deactivate general hospital beds. A rural
628critical access hospital Rural primary care hospitals and
629emergency care hospitals shall maintain the number of actively
630licensed general hospital beds necessary for the facility to be
631certified for Medicare reimbursement. Hospitals that discontinue
632inpatient care to become rural health care clinics or primary
633care programs shall deactivate all licensed general hospital
634beds. All hospitals, clinics, and programs with inactive beds
635shall provide 24-hour emergency medical care by staffing an
636emergency room. Providers with inactive beds shall be subject to
637the criteria in s. 395.1041. The agency shall specify in rule
638requirements for making 24-hour emergency care available.
639Inactive general hospital beds shall be included in the acute
640care bed inventory, maintained by the agency for certificate-of-
641need purposes, for 10 years from the date of deactivation of the
642beds. After 10 years have elapsed, inactive beds shall be
643excluded from the inventory. The agency shall, at the request of
644the licensee, reactivate the inactive general beds upon a
645showing by the licensee that licensure requirements for the
646inactive general beds are met.
647     Section 5.  Section 395.604, Florida Statutes, is amended
648to read:
649     395.604  Other Rural primary care hospitals hospital
651     (1)  The agency may license rural primary care hospitals
652subject to federal approval for participation in the Medicare
653and Medicaid programs. Rural primary care hospitals shall be
654treated in the same manner as emergency care hospitals and rural
655hospitals with respect to ss. 395.605(2)-(8)(a),
656408.033(2)(b)3., and 408.038.
657     (2)  The agency may designate essential access community
659     (2)(3)  The agency may adopt licensure rules for rural
660primary care hospitals and essential access community hospitals.
661Such rules must conform to s. 395.1055.
662     (3)  For the purpose of Medicaid swing-bed reimbursement
663pursuant to the Medicaid program, the agency shall treat rural
664primary care hospitals in the same manner as rural hospitals.
665     (4)  For the purpose of participation in the Medical
666Education Reimbursement and Loan Repayment Program as defined in
667s. 1009.65 or other loan repayment or incentive programs
668designed to relieve medical workforce shortages, the department
669shall treat rural primary care hospitals in the same manner as
670rural hospitals.
671     (5)  For the purpose of coordinating primary care services
672described in s. 154.011(1)(c)10., the department shall treat
673rural primary care hospitals in the same manner as rural
675     (6)  Rural hospitals that make application under the
676certificate-of-need program to be licensed as rural primary care
677hospitals shall receive expedited review as defined in s.
678408.032. Rural primary care hospitals seeking relicensure as
679acute care general hospitals shall also receive expedited
681     (7)  Rural primary care hospitals are exempt from
682certificate-of-need requirements for home health and hospice
683services and for swing beds in a number that does not exceed
684one-half of the facility's licensed beds.
685     (8)  Rural primary care hospitals shall have agreements
686with other hospitals, skilled nursing facilities, home health
687agencies, and providers of diagnostic-imaging and laboratory
688services that are not provided on site but are needed by
690     (4)  The department may seek federal recognition of
691emergency care hospitals authorized by s. 395.605 under the
692essential access community hospital program authorized by the
693Omnibus Budget Reconciliation Act of 1989.
694     Section 6.  Section 395.6061, Florida Statutes, is amended
695to read:
696     395.6061  Rural hospital capital improvement.--There is
697established a rural hospital capital improvement grant program.
698     (1)(a)  The purpose of the program is to provide targeted
699funding to rural hospitals to enable them to adapt to changes in
700health care delivery and funding and address disparities in
701rural health care by:
702     1.  Assisting in the development of needed infrastructure.
703     2.  Assisting financially distressed rural hospitals.
704     3.  Ensuring accountability for state and federal funding.
705     (b)  The rural hospital capital improvement grant program
706includes technical assistance and grants managed by the agency.
707     (2)(1)  A rural hospital as defined in s. 395.602 may apply
708to the agency department for a capital improvement grant to
709acquire, repair, improve, or upgrade systems, facilities, or
710equipment. The grant application must provide information that
712     (a)  A statement indicating the problem the rural hospital
713proposes to solve with the grant funds.;
714     (b)  The strategy proposed to resolve the problem.;
715     (c)  The organizational structure, financial system, and
716facilities that are essential to the proposed solution.;
717     (d)  The projected longevity of the proposed solution after
718the grant funds are expended.;
719     (e)  Evidence of participation in a rural health network as
720defined in s. 381.0406;
721     (e)(f)  Evidence that the rural hospital has difficulty in
722obtaining funding or that funds available for the proposed
723solution are inadequate.;
724     (f)(g)  Evidence that the grant funds will assist in
725maintaining or returning the hospital to an economically stable
726condition or enable the transition to the status of rural
727primary care hospital or that any plan for closure of the
728hospital or realignment of services will involve development of
729innovative alternatives for the provision of needed discontinued
731     (g)(h)  Evidence of a satisfactory record-keeping system to
732account for grant fund expenditures within the rural county.;
733     (h)(i)  A rural health network plan that includes a
734description of how the plan was developed, the goals of the
735plan, the links with existing health care providers under the
736plan, Indicators quantifying the hospital's financial status
737well-being, measurable outcome targets, and the current physical
738and operational condition of the hospital.
739     (2)  Each rural hospital as defined in s. 395.602 shall
740receive a minimum of $100,000 annually, subject to legislative
741appropriation, upon application to the Department of Health, for
742projects to acquire, repair, improve, or upgrade systems,
743facilities, or equipment.
744     (3)  Any remaining funds shall annually be disbursed to
745rural hospitals in accordance with this section. The agency
746Department of Health shall establish, by rule, criteria for
747awarding grants for any remaining funds, which must be used
748exclusively for the support and assistance of rural hospitals as
749defined in s. 395.602, including criteria relating to the level
750of charity uncompensated care rendered by the hospital, the
751financial status of the hospital, the performance standards of
752the hospital the participation in a rural health network as
753defined in s. 381.0406, and the proposed use of the grant by the
754rural hospital to resolve a specific problem. Up to 30 percent
755of rural hospital capital improvement funds may be allocated to
756assist financially distressed rural hospitals that meet the
757requirements of this subsection. The agency department must
758consider any information submitted in an application for the
759grants in accordance with subsection (2) (1) in determining
760eligibility for and the amount of the grant, and none of the
761individual items of information by itself may be used to deny
762grant eligibility.
763     (4)  Financially distressed rural hospitals and critical
764access hospitals that have an annual occupancy rate of less than
76530 percent may receive preferential assistance under the capital
766improvement grant program to provide planning, management, and
767financial support. To receive this assistance the hospital must:
768     (a)  Provide additional information that includes:
769     1.  A statement of support from the board of directors of
770the hospital, the county commission, and the city commission.
771     2.  Evidence that the rural hospital and the community have
772difficulty obtaining funding or that funds available for the
773proposed solution are inadequate.
774     (b)  Agree to be bound by the terms of a participation
775agreement with the agency, which may include:
776     1.  The appointment of a health care expert under contract
777with the agency to analyze and monitor the hospital operations
778during the period of distress.
779     2.  The establishment of minimum standards for the
780education and experience of the managers and administrators of
781the hospital.
782     3.  The oversight and monitoring of a strategic plan to
783restore the hospital to an economically stable condition or
784transition to an alternative means to provide services.
785     4.  The establishment of a board orientation and
786development program.
787     5.  The approval of any facility relocation plans.
788     (5)(4)  The agency department shall ensure that the funds
789are used solely for the purposes specified in this section. The
790total grants awarded pursuant to this section shall not exceed
791the amount appropriated for this program.
792     Section 7.  Section 395.6070, Florida Statutes, is created
793to read:
794     395.6070  Rural hospital receivership proceedings.--
795     (1)  As an alternative to or in conjunction with an
796injunctive proceeding, the agency may petition a court of
797competent jurisdiction for the appointment of a receiver for a
798rural hospital, as defined by s. 408.07, when any of the
799following conditions exist:
800     (a)  A person is operating a hospital without a license and
801refuses to make application for a license as required by chapter
803     (b)  The agency determines that conditions exist in the
804hospital that present an imminent danger to the health, safety,
805or welfare of the patients in the hospital or a substantial
806probability that death or serious physical harm would result
808     (c)  The licensee cannot meet its financial obligation for
809providing food, shelter, care, and utilities. Evidence such as
810the issuance of bad checks or an accumulation of delinquent
811bills for such items as personnel salaries, food, drugs, or
812utilities shall constitute prima facie evidence that the
813ownership of the hospital lacks the financial ability to operate
814the hospital.
815     (2)  Petitions for receivership shall take precedence over
816other court business unless the court determines that some other
817pending proceeding, having similar statutory precedence, shall
818have priority. A hearing shall be conducted within 5 days after
819the filing of the petition, at which time all interested parties
820shall have the opportunity to present evidence pertaining to the
821petition. The agency shall notify the owner or administrator of
822the hospital named in the petition of the filing of the petition
823and the date set for the hearing. The court may grant the
824petition only upon finding that the health, safety, or welfare
825of patients of the hospital would be threatened if a condition
826existing at the time the petition was filed is permitted to
827continue. A receiver may not be appointed when the owner or
828administrator, or a representative of the owner or
829administrator, is not present at the hearing on the petition,
830unless the court determines that one or more of the conditions
831in subsection (1) exist and that the hospital owner or
832administrator cannot be found, that all reasonable means of
833locating the owner or the administrator and notifying him or her
834of the petition and hearing have been exhausted, or that the
835owner or administrator, after notification of the hearing,
836chooses not to attend. After such findings, the court may
837appoint any person qualified by education, training, or
838experience to carry out the responsibilities of a receiver
839pursuant to this section, except that the court may not appoint
840any owner or affiliate of a hospital that is in receivership.
841The receiver may be selected from a list of persons qualified to
842act as receivers developed by the agency and presented to the
843court with each petition for receivership. Under no
844circumstances shall the agency or a designated agency employee
845be appointed as a receiver.
846     (3)  The receiver shall make provisions for the continued
847health, safety, and welfare of all patients of the hospital and:
848     (a)  Shall exercise those powers and perform those duties
849set out by the court.
850     (b)  Shall operate the hospital in such a manner as to
851ensure safety and adequate health care for the patients.
852     (c)  Shall take such action as is reasonably necessary to
853protect or conserve the assets or property of the hospital for
854which the receiver is appointed, or the proceeds from any
855transfer thereof, and may use them only in the performance of
856the powers and duties set forth in this section and by order of
857the court.
858     (d)  May use the building, fixtures, furnishings, and any
859accompanying consumable goods in the provision of care and
860services to patients and to any other persons receiving services
861from the hospital at the time the petition for receivership was
862filed. The receiver shall collect payments for all goods and
863services provided to patients or others during the period of the
864receivership at the same rate of payment charged by the owners
865at the time the petition for receivership was filed, or at a
866fair and reasonable rate otherwise approved by the court for
867private-pay patients. The receiver may apply to the agency for a
868rate increase for patients eligible for care under Title XIX of
869the Social Security Act if the hospital is not receiving the
870maximum allowable payment and expenditures justify an increase
871in the rate.
872     (e)  May correct or eliminate any deficiency in the
873structure or furnishings of the hospital that endangers the
874safety or health of patients while they remain in the hospital,
875provided the total cost of correction does not exceed $100,000.
876The court may order expenditures for this purpose in excess of
877$100,000 on application from the receiver after notice to the
878owner and a hearing.
879     (f)  May let contracts and hire agents and employees to
880carry out the powers and duties of the receiver under this
882     (g)  Shall honor all leases, mortgages, and secured
883transactions governing the building in which the hospital is
884located and all goods and fixtures in the building of which the
885receiver has taken possession, but only to the extent of
886payments that, in the case of a rental agreement, are for the
887use of the property during the period of receivership, or that,
888in the case of a purchase agreement, become due during the
889period of receivership.
890     (h)  Shall have full power to direct, manage, and discharge
891employees of the hospital, subject to any contract rights they
892may have. The receiver shall pay employees at the rate of
893compensation, including benefits, approved by the court. A
894receivership does not relieve the owner of any obligation to
895employees made prior to the appointment of a receiver that has
896not been carried out by the receiver.
897     (i)  Shall be entitled to take possession of all property
898or assets of patients that are in the possession of a hospital
899or its owner. The receiver shall preserve all property or assets
900and all patient records of which the receiver takes possession
901and shall provide for the prompt transfer of the property,
902assets, and records to the new placement of any transferred
903patient. An inventory list certified by the owner and receiver
904shall be made at the time the receiver takes possession of the
906     (4)(a)  A person who is served with notice of an order of
907the court appointing a receiver and of the receiver's name and
908address shall be liable to pay the receiver for any goods or
909services provided by the receiver after the date of the order if
910the person would have been liable for the goods or services as
911supplied by the owner. The receiver shall give a receipt for
912each payment and shall keep a copy of each receipt on file. The
913receiver shall deposit accounts received in a separate account
914and shall use this account for all disbursements.
915     (b)  The receiver may bring an action to enforce the
916liability created by paragraph (a).
917     (c)  A payment to the receiver of any sum owing to the
918hospital or its owner shall discharge any obligation to the
919hospital to the extent of the payment.
920     (5)(a)  A receiver may petition the court that he or she
921not be required to honor any lease, mortgage, secured
922transaction, or other wholly or partially executory contract
923entered into by the owner of the hospital if the rent, price, or
924rate of interest required to be paid under the agreement was
925substantially in excess of a reasonable rent, price, or rate of
926interest at the time the contract was entered into or if any
927material provision of the agreement was unreasonable when
928compared to contracts negotiated under similar conditions. Any
929relief in this form provided by the court shall be limited to
930the life of the receivership, unless otherwise determined by the
932     (b)  If the receiver is in possession of real estate or
933goods subject to a lease, mortgage, or security interest which
934the receiver has obtained a court order to avoid under paragraph
935(a), and if the real estate or goods are necessary for the
936continued operation of the hospital under this section, the
937receiver may apply to the court to set a reasonable rental,
938price, or rate of interest to be paid by the receiver during the
939duration of the receivership. The court shall hold a hearing on
940the application within 15 days. The receiver shall send notice
941of the application to any known persons who own the property
942involved or mortgage holders at least 10 days prior to the
943hearing. Payment by the receiver of the amount determined by the
944court to be reasonable is a defense to any action against the
945receiver for payment or for possession of the goods or real
946estate subject to the lease, security interest, or mortgage
947involved by any person who received such notice, but the payment
948does not relieve the owner of the hospital of any liability for
949the difference between the amount paid by the receiver and the
950amount due under the original lease, security interest, or
951mortgage involved.
952     (6)  The court shall set the compensation of the receiver,
953which shall be considered a necessary expense of a receivership.
954     (7)  A receiver may be held liable in a personal capacity
955only for the receiver's own gross negligence, intentional acts,
956or breach of fiduciary duty.
957     (8)  The court may require a receiver to post a bond.
958     (9)  The court may terminate a receivership when:
959     (a)  The court determines that the receivership is no
960longer necessary because the conditions that gave rise to the
961receivership no longer exist; or
962     (b)  All of the patients in the hospital have been
963transferred or discharged.
964     (10)  Within 30 days after the termination of a
965receivership, unless this time period is extended by the court,
966the receiver shall give the court a complete accounting of all
967property of which the receiver has taken possession, of all
968funds collected and disbursed, and of the expenses of the
970     (11)  Nothing in this section shall be deemed to relieve
971any owner, administrator, or employee of a hospital placed in
972receivership of any civil or criminal liability incurred, or of
973any duty imposed by law, by reason of acts or omissions of the
974owner, administrator, or employee prior to the appointment of a
975receiver; nor shall anything contained in this section be
976construed to suspend during the receivership any obligation of
977the owner, administrator, or employee for payment of taxes or
978other operating and maintenance expenses of the hospital, or of
979the owner, administrator, employee, or any other person for the
980payment of mortgages or liens. The owner shall retain the right
981to sell or mortgage any hospital under receivership, subject to
982approval of the court that ordered the receivership. A licensee
983that is placed in receivership by the court is liable for all
984expenses and costs incurred by the Rural Hospital Patient
985Protection Trust Fund that are related to capital improvement
986and operating costs and are no more than 10 percent above the
987hospital's Medicaid rate and which occur as a result of the
989     Section 8.  Section 395.6071, Florida Statutes, is created
990to read:
991     395.6071  Rural Hospital Patient Protection Trust Fund.--
992     (1)  A Rural Hospital Patient Protection Trust Fund shall
993be established for the purpose of collecting and disbursing
994funds generated from a $1 fee assessed on each inpatient
995discharge from a rural hospital as defined in s. 408.07. Such
996funds shall be used for the continued operation of the hospital
997and transition to another owner. Such funds may be used for the
998purpose of paying for the appropriate alternate placement, care,
999and treatment of patients who are removed from a facility
1000licensed under this part in which the agency determines that
1001existing conditions or practices constitute an immediate danger
1002to the health, safety, or security of the patients. If the
1003agency determines that it is in the best interest of the health,
1004safety, or security of the patients to provide for an orderly
1005removal of the patients from the facility, the agency may use
1006such funds to maintain and care for the patients in the facility
1007pending removal and alternative placement. The maintenance and
1008care of the patients shall be under the direction and control of
1009a receiver appointed pursuant to s. 395.6070. However, funds may
1010be expended in an emergency upon the filing of a petition for a
1011receiver, upon the declaration of a state of local emergency
1012pursuant to s. 252.38(3)(a)5., or upon a duly authorized local
1013order of evacuation of a facility by emergency personnel to
1014protect the health and safety of the patients.
1015     (2)  The agency is authorized to establish for each
1016facility, subject to intervention by the agency, a separate bank
1017account for the deposit to the credit of the agency of any
1018moneys received from the Rural Hospital Patient Protection Trust
1019Fund or any other moneys received for the maintenance and care
1020of patients in the facility, and the agency is authorized to
1021disburse moneys from such account to pay obligations incurred
1022for the purposes of this section. The agency is authorized to
1023requisition moneys from the Rural Hospital Patient Protection
1024Trust Fund in advance of an actual need for cash on the basis of
1025an estimate by the agency of moneys to be spent under the
1026authority of this section. Any bank account established under
1027this section need not be approved in advance of its creation as
1028required by s. 17.58, but shall be secured by depository
1029insurance equal to or greater than the balance of such account
1030or by the pledge of collateral security as provided in chapter
1031280. The agency shall notify the Chief Financial Officer of any
1032account so established and shall make a quarterly accounting to
1033the Chief Financial Officer for all moneys deposited in such
1035     (3)  Funds authorized under this section shall be expended
1036on behalf of all patients transferred to an alternate placement,
1037at the usual and customary charges of the facility used for the
1038alternate placement, provided no other source of private or
1039public funding is available. However, such funds may not be
1040expended on behalf of a patient who is eligible for Title XIX of
1041the Social Security Act, if the alternate placement accepts
1042Title XIX of the Social Security Act. Funds shall be used for
1043maintenance and care of patients in a facility in receivership
1044only to the extent private or public funds, including funds
1045available under Title XIX of the Social Security Act, are not
1046available or are not sufficient to adequately manage and operate
1047the facility, as determined by the agency. The existence of the
1048Rural Hospital Patient Protection Trust Fund shall not make the
1049agency liable for the maintenance of any patient in any
1050facility. The state shall be liable for the cost of alternate
1051placement of patients removed from a deficient facility, or for
1052the maintenance of patients in a facility in receivership, only
1053to the extent that funds are available in the Rural Hospital
1054Patient Protection Trust Fund.
1055     (4)  The agency is authorized to adopt rules pursuant to s.
1056120.53(1) and 120.54 necessary to implement this section.
1057     Section 9.  Section 408.7054, Florida Statutes, is created
1058to read:
1059     408.7054  Rural Provider Service Network Development
1061     (1)  There is established within the Agency for Health Care
1062Administration the Rural Provider Service Network Development
1063Program to support the implementation of provider service
1064networks in rural counties of the state. The purpose of the
1065program is to assist in the establishment of the infrastructure
1066needed for Medicaid reform relating to prepaid and at-risk
1067reimbursement plans to improve access to quality health care in
1068rural areas.
1069     (2)  The responsibilities of the program are to:
1070     (a)  Administer the rural hospital capital improvement
1071grant program established under s. 395.6061.
1072     (b)  Administer the assistance program for financially
1073distressed rural and critical access hospitals established under
1074s. 395.6061(4).
1075     (c)  Administer the rural provider service network
1076development grant program established in subsection (3).
1077     (3)  There is established a rural provider service network
1078development grant program. The agency is authorized to provide
1079funding through a grant program to entities seeking to establish
1080rural provider service networks that have demonstrated an
1081interest and have experience in organizing rural health care
1082providers for this purpose.
1083     (4)  Entities eligible for rural provider service network
1084development grants must:
1085     (a)  Have a written agreement signed by prospective
1086members, 45 percent of whom must be providers in the targeted
1087service area.
1088     (b)  Include all rural hospitals, at least one federally
1089qualified health center, and one county health department
1090located in the service area.
1091     (c)  Have a defined service area, 80 percent of which
1092consists of rural counties.
1093     (5)  Each applicant for this funding shall provide the
1094agency with a detailed written proposal that includes, at a
1095minimum, a statement of need; a defined purpose; identification
1096and explanation of the role of prospective partners; a signed
1097memorandum of agreement or similar document attesting to the
1098role of prospective partners; documented actions related to
1099provider service network development; measurable objectives for
1100the development of clinical and administrative infrastructure; a
1101process of evaluation; and a process for developing a business
1102plan and securing additional funding.
1103     (6)  The agency is authorized to grant preferential funding
1104to a rural provider service network based on the number of rural
1105counties within the network's proposed service area that are
1106Medically Underserved Areas or Health Professional Shortage
1107Areas as defined by the Health Resources Services
1108Administration, Office of Rural Health Policy, and based on
1109whether the provider service network has a principal place of
1110business located in a rural county in the state.
1111     (7)  The agency is granted authority to develop rules
1112pursuant to s. 120.53(1) and 120.54 necessary to implement this
1114     Section 10.  Subsection (43) of section 408.07, Florida
1115Statutes, is amended to read:
1116     408.07  Definitions.--As used in this chapter, with the
1117exception of ss. 408.031-408.045, the term:
1118     (43)  "Rural hospital" means an acute care hospital
1119licensed under chapter 395, having 100 or fewer licensed beds
1120and an emergency room, and which is:
1121     (a)  The sole provider within a county with a population
1122density of no greater than 100 persons per square mile;
1123     (b)  An acute care hospital, in a county with a population
1124density of no greater than 100 persons per square mile, which is
1125at least 30 minutes of travel time, on normally traveled roads
1126under normal traffic conditions, from another acute care
1127hospital within the same county;
1128     (c)  A hospital supported by a tax district or subdistrict
1129whose boundaries encompass a population of 100 persons or fewer
1130per square mile;
1131     (d)  A hospital with a service area that has a population
1132of 100 persons or fewer per square mile. As used in this
1133paragraph, the term "service area" means the fewest number of
1134zip codes that account for 75 percent of the hospital's
1135discharges for the most recent 5-year period, based on
1136information available from the hospital inpatient discharge
1137database in the State Center for Health Statistics at the Agency
1138for Health Care Administration; or
1139     (e)  A critical access hospital.
1141Population densities used in this subsection must be based upon
1142the most recently completed United States census. A hospital
1143that received funds under s. 409.9116 for a quarter beginning no
1144later than July 1, 2002, is deemed to have been and shall
1145continue to be a rural hospital from that date through June 30,
11462012, if the hospital continues to have 100 or fewer licensed
1147beds and an emergency room, or meets the criteria of s.
1148395.602(2)(d)(e)4. An acute care hospital that has not
1149previously been designated as a rural hospital and that meets
1150the criteria of this subsection shall be granted such
1151designation upon application, including supporting
1152documentation, to the Agency for Health Care Administration.
1153     Section 11.  Subsection (12) of section 409.908, Florida
1154Statutes, is amended to read:
1155     409.908  Reimbursement of Medicaid providers.--Subject to
1156specific appropriations, the agency shall reimburse Medicaid
1157providers, in accordance with state and federal law, according
1158to methodologies set forth in the rules of the agency and in
1159policy manuals and handbooks incorporated by reference therein.
1160These methodologies may include fee schedules, reimbursement
1161methods based on cost reporting, negotiated fees, competitive
1162bidding pursuant to s. 287.057, and other mechanisms the agency
1163considers efficient and effective for purchasing services or
1164goods on behalf of recipients. If a provider is reimbursed based
1165on cost reporting and submits a cost report late and that cost
1166report would have been used to set a lower reimbursement rate
1167for a rate semester, then the provider's rate for that semester
1168shall be retroactively calculated using the new cost report, and
1169full payment at the recalculated rate shall be effected
1170retroactively. Medicare-granted extensions for filing cost
1171reports, if applicable, shall also apply to Medicaid cost
1172reports. Payment for Medicaid compensable services made on
1173behalf of Medicaid eligible persons is subject to the
1174availability of moneys and any limitations or directions
1175provided for in the General Appropriations Act or chapter 216.
1176Further, nothing in this section shall be construed to prevent
1177or limit the agency from adjusting fees, reimbursement rates,
1178lengths of stay, number of visits, or number of services, or
1179making any other adjustments necessary to comply with the
1180availability of moneys and any limitations or directions
1181provided for in the General Appropriations Act, provided the
1182adjustment is consistent with legislative intent.
1183     (12)(a)  A physician shall be reimbursed the lesser of the
1184amount billed by the provider or the Medicaid maximum allowable
1185fee established by the agency.
1186     (b)  The agency shall adopt a fee schedule, subject to any
1187limitations or directions provided for in the General
1188Appropriations Act, based on a resource-based relative value
1189scale for pricing Medicaid physician services. Under this fee
1190schedule, physicians shall be paid a dollar amount for each
1191service based on the average resources required to provide the
1192service, including, but not limited to, estimates of average
1193physician time and effort, practice expense, and the costs of
1194professional liability insurance. The fee schedule shall provide
1195increased reimbursement for preventive and primary care services
1196and lowered reimbursement for specialty services by using at
1197least two conversion factors, one for cognitive services and
1198another for procedural services. The fee schedule shall not
1199increase total Medicaid physician expenditures unless moneys are
1200available, and shall be phased in over a 2-year period beginning
1201on July 1, 1994. The Agency for Health Care Administration shall
1202seek the advice of a 16-member advisory panel in formulating and
1203adopting the fee schedule. The panel shall consist of Medicaid
1204physicians licensed under chapters 458 and 459 and shall be
1205composed of 50 percent primary care physicians and 50 percent
1206specialty care physicians.
1207     (c)  Notwithstanding paragraph (b), reimbursement fees to
1208physicians for providing total obstetrical services to Medicaid
1209recipients, which include prenatal, delivery, and postpartum
1210care, shall be at least $1,500 per delivery for a pregnant woman
1211with low medical risk and at least $2,000 per delivery for a
1212pregnant woman with high medical risk. However, reimbursement to
1213physicians working in Regional Perinatal Intensive Care Centers
1214designated pursuant to chapter 383, for services to certain
1215pregnant Medicaid recipients with a high medical risk, may be
1216made according to obstetrical care and neonatal care groupings
1217and rates established by the agency. Nurse midwives licensed
1218under part I of chapter 464 or midwives licensed under chapter
1219467 shall be reimbursed at no less than 80 percent of the low
1220medical risk fee. The agency shall by rule determine, for the
1221purpose of this paragraph, what constitutes a high or low
1222medical risk pregnant woman and shall not pay more based solely
1223on the fact that a caesarean section was performed, rather than
1224a vaginal delivery. The agency shall by rule determine a
1225prorated payment for obstetrical services in cases where only
1226part of the total prenatal, delivery, or postpartum care was
1227performed. The Department of Health shall adopt rules for
1228appropriate insurance coverage for midwives licensed under
1229chapter 467. Prior to the issuance and renewal of an active
1230license, or reactivation of an inactive license for midwives
1231licensed under chapter 467, such licensees shall submit proof of
1232coverage with each application.
1233     (d)  Notwithstanding other provisions of this subsection,
1234the agency shall pay physicians licensed under chapter 458 or
1235chapter 459 who have a provider agreement with a rural health
1236network as established in s. 381.0406 a 10-percent bonus over
1237the Medicaid physician fee schedule for any physician service
1238provided within the geographic boundary of a county defined as a
1239rural county by the most recent United States Census.
1240     Section 12.  Subsection (6) of section 409.9116, Florida
1241Statutes, is amended to read:
1242     409.9116  Disproportionate share/financial assistance
1243program for rural hospitals.--In addition to the payments made
1244under s. 409.911, the Agency for Health Care Administration
1245shall administer a federally matched disproportionate share
1246program and a state-funded financial assistance program for
1247statutory rural hospitals. The agency shall make
1248disproportionate share payments to statutory rural hospitals
1249that qualify for such payments and financial assistance payments
1250to statutory rural hospitals that do not qualify for
1251disproportionate share payments. The disproportionate share
1252program payments shall be limited by and conform with federal
1253requirements. Funds shall be distributed quarterly in each
1254fiscal year for which an appropriation is made. Notwithstanding
1255the provisions of s. 409.915, counties are exempt from
1256contributing toward the cost of this special reimbursement for
1257hospitals serving a disproportionate share of low-income
1259     (6)  This section applies only to hospitals that were
1260defined as statutory rural hospitals, or their successor-in-
1261interest hospital, prior to January 1, 2001. Any additional
1262hospital that is defined as a statutory rural hospital, or its
1263successor-in-interest hospital, on or after January 1, 2001, is
1264not eligible for programs under this section unless additional
1265funds are appropriated each fiscal year specifically to the
1266rural hospital disproportionate share and financial assistance
1267programs in an amount necessary to prevent any hospital, or its
1268successor-in-interest hospital, eligible for the programs prior
1269to January 1, 2001, from incurring a reduction in payments
1270because of the eligibility of an additional hospital to
1271participate in the programs. A hospital, or its successor-in-
1272interest hospital, which received funds pursuant to this section
1273before January 1, 2001, and which qualifies under s.
1274395.602(2)(d)(e), shall be included in the programs under this
1275section and is not required to seek additional appropriations
1276under this subsection.
1277     Section 13.  Paragraph (b) of subsection (2) of section
12781009.65, Florida Statutes, is amended to read:
1279     1009.65  Medical Education Reimbursement and Loan Repayment
1281     (2)  From the funds available, the Department of Health
1282shall make payments to selected medical professionals as
1284     (b)  All payments shall be contingent on continued proof of
1285primary care practice in an area defined in s. 395.602(2)(d)(e),
1286or an underserved area designated by the Department of Health,
1287provided the practitioner accepts Medicaid reimbursement if
1288eligible for such reimbursement. Correctional facilities, state
1289hospitals, and other state institutions that employ medical
1290personnel shall be designated by the Department of Health as
1291underserved locations. Locations with high incidences of infant
1292mortality, high morbidity, or low Medicaid participation by
1293health care professionals may be designated as underserved.
1294     Section 14.  Section 395.605, Florida Statutes, is
1296     Section 15.  This act shall take effect July 1, 2006.

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