HB 7215

1	A bill to be entitled
2	An act relating to rural health care; amending s.
3	381.0405, F.S.; revising the purpose and functions of the
4	Office of Rural Health in the Department of Health;
5	requiring the Secretary of Health and the Secretary of
6	Health Care Administration to appoint an advisory council
7	to advise the office; providing for terms of office of the
8	members of the advisory council; authorizing per diem and
9	travel reimbursement for members of the advisory council;
10	requiring the advisory council to work with certain
11	stakeholders; requiring a report to the Governor and
12	Legislature; amending s. 381.0406, F.S.; revising
13	legislative findings and intent with respect to rural
14	health networks; revising the definition of "rural health
15	network"; providing additional functions of and
16	requirements for membership in rural health networks;
17	requiring rural health networks to submit rural health
18	infrastructure development plans to the office by a
19	specified date; revising provisions relating to the
20	governance and organization of rural health networks;
21	revising the services to be provided by provider members
22	of rural health networks; requiring coordination among
23	rural health networks and area health education centers,
24	health planning councils, and regional education
25	consortia; establishing a grant program for funding rural
26	health networks; defining projects that may be funded
27	through the grant program; requiring the department to
28	establish rules governing rural health network grant
29	programs and performance standards; amending s. 395.602,
30	F.S.; defining "critical access hospital"; revising and
31	deleting definitions; amending s. 395.603, F.S.; deleting
32	a requirement that the Agency for Health Care
33	Administration adopt a rule relating to deactivation of
34	rural hospital beds under certain circumstances; requiring
35	that rural critical access hospitals maintain a certain
36	number of actively licensed beds; amending s. 395.604,
37	F.S.; removing emergency care hospitals and essential
38	access community hospitals from certain licensure
39	requirements; specifying certain special conditions for
40	rural primary care hospitals; amending s. 395.6061, F.S.;
41	specifying the purpose of the rural hospital capital
42	improvement grant program; providing for grant management
43	by the agency; modifying the conditions for receiving a
44	grant; deleting a requirement for a minimum grant for
45	every rural hospital; establishing an assistance program
46	within the agency for financially distressed rural and
47	critical access hospitals; providing purpose of the
48	program; providing requirements for receiving certain
49	assistance; requiring a participation agreement and
50	providing for contents thereof; creating s. 395.6070,
51	F.S.; authorizing the agency to petition for the
52	appointment of a receiver for a rural hospital when
53	certain conditions exist; providing for hearings and
54	notice; providing qualification of a receiver and time
55	limitations; providing duties of the agency; providing
56	powers and duties of the receiver with respect to the
57	hospital and related contracts and the patients and their
58	property; specifying liability of certain persons to pay a
59	receiver for goods and services provided; providing that
60	the receiver may petition to avoid certain contracts and
61	specifying liabilities associated therewith; providing for
62	compensation and liability of the receiver; providing for
63	bond; providing conditions for termination of
64	receivership; requiring an accounting to the court;
65	providing liabilities of the owner, operator, and
66	employees of a rural hospital placed in receivership;
67	providing applicability of the Rural Hospital Patient
68	Protection Trust Fund; creating s. 395.6071, F.S.;
69	establishing the Rural Hospital Patient Protection Trust
70	Fund; providing for funds collected to be used for
71	specified purposes; providing for the expenditure of funds
72	upon a declaration of local emergency; authorizing the
73	agency to establish certain accounts for moneys received
74	and for the disbursement thereof for certain purposes;
75	providing limitations on expenditure of funds; providing
76	for limited liability under certain circumstances;
77	providing rulemaking authority to the agency; creating s.
78	408.7054, F.S.; establishing the Rural Provider Service
79	Network Development Program; providing purposes and
80	responsibilities; authorizing the agency to provide
81	funding through a grant program for the establishment of
82	rural provider service networks; providing eligibility
83	requirements; authorizing preferential funding to certain
84	providers; authorizing the agency to adopt rules; amending
85	s. 409.908, F.S.; requiring the agency to pay certain
86	physicians a bonus for Medicaid physician services
87	provided within a rural county; amending ss. 408.07,
88	409.9116, and 1009.65, F.S.; conforming cross-references;
89	repealing s. 395.605, F.S., relating to the licensure of
90	emergency care hospitals; providing an effective date.
91
92	Be It Enacted by the Legislature of the State of Florida:
93
94	Section 1.  Section 381.0405, Florida Statutes, is amended
95	to read:
96	381.0405  Office of Rural Health.--
97	(1)  ESTABLISHMENT.--The Department of Health shall
98	establish an Office of Rural Health, which shall assist rural
99	health care providers in improving the health status and health
100	care of rural residents of this state and assist rural health
101	care providers in integrating their efforts. The Office of Rural
102	Health shall coordinate its activities with rural health
103	networks established under s. 381.0406, local health councils
104	established under s. 408.033, the area health education center
105	network established under pursuant to s. 381.0402, and with any
106	appropriate research and policy development centers within
107	universities that have state-approved medical schools. The
108	Office of Rural Health may enter into a formal relationship with
109	any center that designates the office as an affiliate of the
110	center.
111	(2)  PURPOSE.--The Office of Rural Health shall actively
112	foster the provision of high-quality health care services in
113	rural areas and serve as a catalyst for improved health services
114	to residents citizens in rural areas of the state.
115	(3)  GENERAL FUNCTIONS.--The office shall:
116	(a)  Integrate policies related to physician workforce,
117	hospitals, public health, and state regulatory functions.
118	(b)  Work with rural stakeholders in order to foster the
119	development of strategic planning that addresses Propose
120	solutions to problems affecting health care delivery in rural
121	areas.
122	(c)  Foster the expansion of rural health network service
123	areas to include rural counties that are not served by a rural
124	health network.
125	(d)(c)  Seek grant funds from foundations and the Federal
126	Government.
127	(e)  Administer state grant programs for rural health
128	networks.
129	(4)  COORDINATION.--The office shall:
130	(a)  Identify federal and state rural health programs and
131	provide information and technical assistance to rural providers
132	regarding participation in such programs.
133	(b)  Act as a clearinghouse for collecting and
134	disseminating information on rural health care issues, research
135	findings on rural health care, and innovative approaches to the
136	delivery of health care in rural areas.
137	(c)  Foster the creation of regional health care systems
138	that promote cooperation, rather than competition.
139	(d)  Coordinate the department's rural health care
140	activities, programs, and policies.
141	(e)  Design initiatives to improve access to primary,
142	acute, and emergency medical services and promote the
143	coordination of such services in rural areas.
144	(f)  Assume responsibility for state coordination of the
145	Rural Hospital Transition Grant Program, the Essential Access
146	Community Hospital Program, and other federal rural health care
147	grant programs.
148	(5)  TECHNICAL ASSISTANCE.--The office shall:
149	(a)  Assist Help rural health care providers in recruiting
150	obtain health care practitioners by promoting the location and
151	relocation of health care practitioners in rural areas and
152	promoting policies that create incentives for practitioners to
153	serve in rural areas.
154	(b)  Provide technical assistance to hospitals, community
155	and migrant health centers, and other health care providers that
156	serve residents in rural areas.
157	(c)  Assist with the design of strategies to improve health
158	care workforce recruitment and placement programs.
159	(d)  Provide technical assistance to rural health networks
160	in the formulation of their rural health infrastructure
161	development plans.
162	(e)  Provide links to best practices and other technical
163	assistance resources on the office's Internet website.
164	(6)  ADVISORY COUNCIL.--
165	(a)  The Secretary of Health and the Secretary of Health
166	Care Administration shall each appoint no more than five members
167	with relevant health care operations management, practice, and
168	policy experience to an advisory council to advise the office
169	regarding its responsibilities under this section and ss.
170	381.0406, 395.6061, and 395.6063. Members must be appointed for
171	4-year staggered terms and may be reappointed to a second term
172	of office. Members shall serve without compensation but are
173	entitled to reimbursement for per diem and travel expenses as
174	provided in s. 112.061. The council may appoint technical
175	advisory teams as needed. The department shall provide staff and
176	other administrative assistance reasonably necessary to assist
177	the advisory council in carrying out its duties.
178	(b)  The advisory council shall work with stakeholders to
179	develop recommendations that address barriers and identify
180	options for establishing provider networks in rural counties and
181	submit a report to the Governor, the President of the Senate,
182	and the Speaker of the House of Representatives, by February 1,
183	2007.
184	(7)(6)  RESEARCH PUBLICATIONS AND SPECIAL STUDIES.--The
185	office 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
189	use in department policy development.
190	(8)(7)  APPROPRIATION.--The Legislature shall appropriate
191	such sums as are necessary to support the Office of Rural
192	Health.
193	Section 2.  Section 381.0406, Florida Statutes, is amended
194	to read:
195	381.0406  Rural health networks.--
196	(1)  LEGISLATIVE FINDINGS AND INTENT.--
197	(a)  The Legislature finds that, in rural areas, access to
198	health care is limited and the quality of health care is
199	negatively affected by inadequate financing, difficulty in
200	recruiting and retaining skilled health professionals, and the
201	because of a migration of patients to urban areas for general
202	acute care and specialty services.
203	(b)  The Legislature further finds that the efficient and
204	effective delivery of health care services in rural areas
205	requires:
206	1.  The integration of public and private resources.
207	2.  The adoption of quality improvement and cost-
208	effectiveness measures. and
209	3.  The coordination of health care providers.
210	(c)  The Legislature further finds that the availability of
211	a continuum of quality health care services, including
212	preventive, primary, secondary, tertiary, and long-term care, is
213	essential to the economic and social vitality of rural
214	communities.
215	(d)  The Legislature further finds that health care
216	providers in rural areas are not prepared for market changes
217	such as the introduction of managed care and capitation
218	reimbursement methodologies into health care services.
219	(e)(d)  The Legislature further finds that the creation of
220	rural health networks can help to alleviate these problems.
221	Rural health networks shall act in the broad public interest
222	and, to the extent possible, seek to improve the accessibility,
223	quality, and cost-effectiveness of rural health care by planning
224	and coordinating be structured to provide a continuum of quality
225	health care services for rural residents through the cooperative
226	efforts of rural health network members and other health care
227	providers.
228	(e)  The Legislature further finds that rural health
229	networks shall have the goal of increasing the utilization of
230	statutory rural hospitals for appropriate health care services
231	whenever feasible, which shall help to ensure their survival and
232	thereby support the economy and protect the health and safety of
233	rural residents.
234	(f)  Finally, the Legislature finds that rural health
235	networks may serve as "laboratories" to determine the best way
236	of organizing rural health services, to move the state closer to
237	ensuring that everyone has access to health care, and to promote
238	cost containment efforts. The ultimate goal of rural health
239	networks shall be to ensure that quality health care is
240	available and efficiently delivered to all persons in rural
241	areas.
242	(2)  DEFINITIONS.--
243	(a)  "Rural" means an area with a population density of
244	fewer less than 100 individuals per square mile or an area
245	defined by the most recent United States Census as rural.
246	(b)  "Health care provider" means any individual, group, or
247	entity, public or private, that provides health care, including:
248	preventive health care, primary health care, secondary and
249	tertiary health care, in-hospital health care, public health
250	care, and health promotion and education.
251	(c)  "Rural health network" or "network" means a nonprofit
252	legal entity whose principal place of business is in a rural
253	county, whose members consist consisting of rural and urban
254	health care providers and others, and that is established
255	organized to plan the delivery of and deliver health care
256	services on a cooperative basis in a rural area, except for some
257	secondary and tertiary care services.
258	(3)  NETWORK MEMBERSHIP.--
259	(a)  Because each rural area is unique, with a different
260	health care provider mix, health care provider membership may
261	vary, but all networks shall include members that provide public
262	health care, comprehensive primary care, emergency medical care,
263	and acute inpatient care.
264	(b)  Federally qualified health centers, emergency medical
265	services providers, and county health departments are expected
266	to participate in rural health networks in the areas in which
267	their patients reside or receive services.
268	(4)  Network membership shall be available to all health
269	care providers, provided that they render care to all patients
270	referred to them from other network members, comply with network
271	quality assurance and risk management requirements, abide by the
272	terms and conditions of network provider agreements in paragraph
273	(11)(c), and provide services at a rate or price equal to the
274	rate or price negotiated by the network.
275	(4)(5)  NETWORK SERVICE AREAS.--Network service areas are
276	do not required need to conform to local political boundaries or
277	state administrative district boundaries. The geographic area of
278	one rural health network, however, may not overlap the territory
279	of any other rural health network.
280	(5)(6)  NETWORK FUNCTIONS.--Networks shall:
281	(a)  Seek to develop linkages with provisions for referral
282	to tertiary inpatient care, specialty physician care, and to
283	other services that are not available in rural service areas.
284	(b)(7)  Seek to Networks shall make available health
285	promotion, disease prevention, and primary care services
286	accessible to all residents in order to improve the health
287	status of rural residents and to contain health care costs.
288	(8)  Networks may have multiple points of entry, such as
289	through private physicians, community health centers, county
290	health departments, certified rural health clinics, hospitals,
291	or other providers; or they may have a single point of entry.
292	(c)(9)  Encourage members through training and educational
293	programs to adopt standards of care, promote the evidence-based
294	practice of medicine Networks shall establish standard
295	protocols, coordinate and share patient records, and develop
296	patient information exchange systems in order to improve the
297	quality of and access to services.
298	(d)  Develop quality improvement programs and train network
299	members and other health care providers in the implementation of
300	such programs.
301	(e)  Develop disease management systems and train network
302	members and other health care providers in the implementation of
303	such systems.
304	(f)  Promote outreach to areas with a high need for
305	services.
306	(g)  Seek to develop community care alternatives for elders
307	who would otherwise be placed in nursing homes.
308	(h)  Emphasize community care alternatives for persons with
309	mental health and substance abuse disorders who are at risk of
310	being admitted to an institution.
311	(i)  Develop a rural health infrastructure development plan
312	for an integrated system of care that is responsive to the
313	unique local health care needs and the area health care services
314	market. Each rural health infrastructure development plan must
315	address strategies to improve access to specialty care, train
316	health care providers to use standards of care for chronic
317	illness, develop disease management capacity, and link to state
318	and national quality improvement initiatives. The initial
319	development plan must be submitted to the Office of Rural Health
320	for review and comment no later than July 1, 2007; thereafter,
321	the plan must be updated and submitted to the Office of Rural
322	Health every 3 years.
323	(10)  Networks shall develop risk management and quality
324	assurance programs for network providers.
325	(6)(11)  NETWORK GOVERNANCE AND ORGANIZATION.--
326	(a)  Networks shall be incorporated under the laws of the
327	state.
328	(b)  Each network Networks shall have a board of directors
329	that derives membership from local government, health care
330	providers, businesses, consumers, and others.
331	(c)  Network boards of directors shall have the
332	responsibility of determining the content of health care
333	provider agreements that link network members. The agreements
334	shall specify:
335	1.  Who provides what services.
336	2.  The extent to which the health care provider provides
337	care to persons who lack health insurance or are otherwise
338	unable to pay for care.
339	3.  The procedures for transfer of medical records.
340	4.  The method used for the transportation of patients
341	between providers.
342	5.  Referral and patient flow including appointments and
343	scheduling.
344	6.  Payment arrangements for the transfer or referral of
345	patients.
346	(c)(d)  There shall be no liability on the part of, and no
347	cause of action of any nature shall arise against, any member of
348	a network board of directors, or its employees or agents, for
349	any lawful action taken by them in the performance of their
350	administrative powers and duties under this subsection.
351	(7)(12)  NETWORK PROVIDER MEMBER SERVICES.--
352	(a)  Networks, to the extent feasible, shall seek to
353	develop services that provide for a continuum of care for all
354	residents patients served by the network. Each network shall
355	recruit members that can provide include the following core
356	services: disease prevention, health promotion, comprehensive
357	primary care, emergency medical care, and acute inpatient care.
358	Each network shall seek to ensure the availability of
359	comprehensive maternity care, including prenatal, delivery, and
360	postpartum care for uncomplicated pregnancies, either directly,
361	by contract, or through referral agreements. Networks shall, to
362	the extent feasible, develop local services and linkages among
363	health care providers to also ensure the availability of the
364	following services within the specified timeframes, either
365	directly, 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
370	less.
371	3.a.  Emergency medical services, including advanced life
372	support, ambulance, and basic emergency room services.
373	4.b.  Primary care, including.
374	c.  prenatal and postpartum care for uncomplicated
375	pregnancies.
376	5.d.  Community-based services for elders, such as adult
377	day care and assistance with activities of daily living.
378	6.e.  Public health services, including communicable
379	disease control, disease prevention, health education, and
380	health promotion.
381	7.f.  Outpatient mental health psychiatric and substance
382	abuse services.
383	3.  Services accessible within 45 minutes travel time or
384	less.
385	8.a.  Hospital acute inpatient care for persons whose
386	illnesses or medical problems are not severe.
387	9.b.  Level I obstetrical care, which is Labor and delivery
388	care for low-risk patients.
389	10.c.  Skilled nursing services and, long-term care,
390	including nursing home care.
391	(b)  Networks shall seek to foster linkages with out-of-
392	area services to the extent feasible to ensure the availability
393	of:
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
399	and medical problems.
400	3.c.  Level II and III obstetrical care, which is Labor and
401	delivery care for high-risk patients and neonatal intensive
402	care.
403	4.d.  Comprehensive medical rehabilitation.
404	5.e.  Inpatient mental health psychiatric and substance
405	abuse services.
406	6.f.  Magnetic resonance imaging, lithotripter treatment,
407	oncology, advanced radiology, and other technologically advanced
408	services.
409	g.  Subacute care.
410	(8)  COORDINATION WITH OTHER ENTITIES.--
411	(a)  Area health education centers, health planning
412	councils, and regional education consortia are expected to
413	participate in the rural health networks' preparation of rural
414	health infrastructure development plans. The Department of
415	Health may require a written memorandum of agreement between a
416	network and an area health education center or health planning
417	council.
418	(b)  Rural health networks shall initiate activities, in
419	coordination with area health education centers, to carry out
420	the objectives of the adopted development plan, including
421	continuing education for health care practitioners performing
422	functions such as disease management, continuous quality
423	improvement, telemedicine, distance learning, and the treatment
424	of chronic illness using standards of care. For the purposes of
425	this section, the term "telemedicine" means the use of
426	telecommunications to deliver or expedite the delivery of health
427	care services.
428	(c)  Health planning councils shall support the preparation
429	of rural health infrastructure development plans through data
430	collection and analysis in order to assess the health status of
431	area residents and the capacity of local health services.
432	(d)  Regional education consortia that have the technology
433	available to assist rural health networks in establishing
434	systems for exchange of patient information and distance
435	learning shall provide technical assistance upon the request of
436	a rural health network.
437	(b)  Networks shall actively participate with area health
438	education center programs, whenever feasible, in developing and
439	implementing recruitment, training, and retention programs
440	directed at positively influencing the supply and distribution
441	of health care professionals serving in, or receiving training
442	in, network areas.
443	(c)  As funds become available, networks shall emphasize
444	community care alternatives for elders who would otherwise be
445	placed in nursing homes.
446	(d)  To promote the most efficient use of resources,
447	networks shall emphasize disease prevention, early diagnosis and
448	treatment of medical problems, and community care alternatives
449	for persons with mental health and substance abuse disorders who
450	are at risk to be institutionalized.
451	(e)(13)  TRAUMA SERVICES.--In those network areas that
452	which have an established trauma agency approved by the
453	Department of Health, the network shall seek the participation
454	of that trauma agency must be a participant in the network.
455	Trauma services provided within the network area must comply
456	with s. 395.405.
457	(9)(14)  NETWORK FINANCING.--
458	(a)  Networks may use all sources of public and private
459	funds to support network activities. Nothing in this section
460	prohibits networks from becoming managed care providers.
461	(b)  The Department of Health shall establish a grant
462	program to provide funding to support the administrative cost of
463	operating and developing rural health networks. Rural health
464	networks may qualify for funding provided through:
465	1.  Network operations grants to support development of a
466	rural health infrastructure development plan in a network
467	service area and to support network functions identified in
468	subsection (5).
469	2.  Rural health infrastructure development grants to
470	support the development of clinical and administrative
471	infrastructure in the following priority areas:
472	a.  Formation of joint contracting entities composed of
473	rural physicians, rural hospitals, and other rural providers.
474	b.  Establishing disease management programs that meet
475	Medicaid requirements.
476	c.  Establishing regional quality improvement programs
477	involving physicians and hospitals consistent with state and
478	national initiatives.
479	d.  Establishing specialty networks connecting rural
480	primary care physicians and urban specialists.
481	e.  Developing regional broadband telecommunications
482	systems with the capacity to share patient information in a
483	secure network.
484	f.  Telemedicine and distance learning capacity.
485	(15)  NETWORK IMPLEMENTATION.--As funds become available,
486	networks shall be developed and implemented in two phases.
487	(a)  Phase I shall consist of a network planning and
488	development grant program. Planning grants shall be used to
489	organize networks, incorporate network boards, and develop
490	formal provider agreements as provided for in this section. The
491	Department of Health shall develop a request-for-proposal
492	process to solicit grant applications.
493	(b)  Phase II shall consist of network operations. As funds
494	become available, certified networks shall be eligible to
495	receive grant funds to be used to help defray the costs of
496	network infrastructure development, patient care, and network
497	administration. Infrastructure development includes, but is not
498	limited to: recruitment and retention of primary care
499	practitioners; development of preventive health care programs;
500	linkage of urban and rural health care systems; design and
501	implementation of automated patient records, outcome
502	measurement, quality assurance, and risk management systems;
503	establishment of one-stop service delivery sites; upgrading of
504	medical technology available to network providers; enhancement
505	of emergency medical systems; enhancement of medical
506	transportation; and development of telecommunication
507	capabilities. A Phase II award may occur in the same fiscal year
508	as a Phase I award.
509	(16)  CERTIFICATION.--For the purpose of certifying
510	networks that are eligible for Phase II funding, the Department
511	of Health shall certify networks that meet the criteria
512	delineated in this section and the rules governing rural health
513	networks.
514	(10)(17)  RULES.--The Department of Health shall establish
515	rules that govern the creation and certification of networks,
516	the provision of grant funds, and the establishment of
517	performance standards including establishing outcome measures
518	for networks.
519	Section 3.  Subsection (2) of section 395.602, Florida
520	Statutes, 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
524	the definition of rural hospital in paragraph (d) and meets the
525	requirements for reimbursement by Medicare and Medicaid under 42
526	C.F.R. ss. 485.601-485.647. "Emergency care hospital" means a
527	medical facility which provides:
528	1.  Emergency medical treatment; and
529	2.  Inpatient care to ill or injured persons prior to their
530	transportation to another hospital or provides inpatient medical
531	care to persons needing care for a period of up to 96 hours. The
532	96-hour limitation on inpatient care does not apply to respite,
533	skilled nursing, hospice, or other nonacute care patients.
534	(b)  "Essential access community hospital" means any
535	facility which:
536	1.  Has at least 100 beds;
537	2.  Is located more than 35 miles from any other essential
538	access community hospital, rural referral center, or urban
539	hospital meeting criteria for classification as a regional
540	referral center;
541	3.  Is part of a network that includes rural primary care
542	hospitals;
543	4.  Provides emergency and medical backup services to rural
544	primary care hospitals in its rural health network;
545	5.  Extends staff privileges to rural primary care hospital
546	physicians in its network; and
547	6.  Accepts patients transferred from rural primary care
548	hospitals in its network.
549	(b)(c)  "Inactive rural hospital bed" means a licensed
550	acute care hospital bed, as defined in s. 395.002(14), that is
551	inactive in that it cannot be occupied by acute care inpatients.
552	(c)(d)  "Rural area health education center" means an area
553	health education center (AHEC), as authorized by Pub. L. No. 94-
554	484, that which provides services in a county with a population
555	density of no greater than 100 persons per square mile.
556	(d)(e)  "Rural hospital" means an acute care hospital
557	licensed under this chapter, having 100 or fewer licensed beds
558	and an emergency room, that which is:
559	1.  The sole provider within a county with a population
560	density of no greater than 100 persons per square mile;
561	2.  An acute care hospital, in a county with a population
562	density of no greater than 100 persons per square mile, that
563	which is at least 30 minutes of travel time, on normally
564	traveled roads under normal traffic conditions, from any other
565	acute care hospital within the same county;
566	3.  A hospital supported by a tax district or subdistrict
567	whose boundaries encompass a population of 100 persons or fewer
568	per square mile;
569	4.  A hospital in a constitutional charter county with a
570	population of over 1 million persons that has imposed a local
571	option health service tax pursuant to law and in an area that
572	was directly impacted by a catastrophic event on August 24,
573	1992, for which the Governor of Florida declared a state of
574	emergency pursuant to chapter 125, and has 120 beds or fewer
575	less that serves an agricultural community with an emergency
576	room utilization of no less than 20,000 visits and a Medicaid
577	inpatient utilization rate greater than 15 percent;
578	5.  A hospital with a service area that has a population of
579	100 persons or fewer per square mile. As used in this
580	subparagraph, the term "service area" means the fewest number of
581	zip codes that account for 75 percent of the hospital's
582	discharges for the most recent 5-year period, based on
583	information available from the hospital inpatient discharge
584	database in the State Center for Health Statistics at the Agency
585	for Health Care Administration; or
586	6.  A hospital designated as a critical access hospital, as
587	defined in s. 408.07(15).
588
589	Population densities used in this paragraph must be based upon
590	the most recently completed United States census. A hospital
591	that received funds under s. 409.9116 for a quarter beginning no
592	later than July 1, 2002, is deemed to have been and shall
593	continue to be a rural hospital from that date through June 30,
594	2012, if the hospital continues to have 100 or fewer licensed
595	beds and an emergency room, or meets the criteria of
596	subparagraph 4. An acute care hospital that has not previously
597	been designated as a rural hospital and that meets the criteria
598	of this paragraph shall be granted such designation upon
599	application, including supporting documentation to the Agency
600	for Health Care Administration.
601	(e)(f)  "Rural primary care hospital" means any facility
602	that meeting the criteria in paragraph (e) or s. 395.605 which
603	provides:
604	1.  Twenty-four-hour emergency medical care;
605	2.  Temporary inpatient care for periods of 96 72 hours or
606	less to patients requiring stabilization before discharge or
607	transfer to another hospital. The 96-hour 72-hour limitation
608	does not apply to respite, skilled nursing, hospice, or other
609	nonacute care patients; and
610	3.  Has at least no more than six licensed acute care
611	inpatient beds.
612	(f)(g)  "Swing-bed" means a bed that which can be used
613	interchangeably as either a hospital, skilled nursing facility
614	(SNF), or intermediate care facility (ICF) bed pursuant to 42
615	C.F.R. parts 405, 435, 440, 442, and 447.
616	Section 4.  Subsection (1) of section 395.603, Florida
617	Statutes, is amended to read:
618	395.603  Deactivation of general hospital beds; rural
619	hospital impact statement.--
620	(1)  The agency shall establish, by rule, a process by
621	which A rural hospital, as defined in s. 395.602, that seeks
622	licensure as a rural primary care hospital or as an emergency
623	care hospital, or becomes a certified rural health clinic as
624	defined in Pub. L. No. 95-210, or becomes a primary care program
625	such as a county health department, community health center, or
626	other similar outpatient program that provides preventive and
627	curative services, may deactivate general hospital beds. A rural
628	critical access hospital Rural primary care hospitals and
629	emergency care hospitals shall maintain the number of actively
630	licensed general hospital beds necessary for the facility to be
631	certified for Medicare reimbursement. Hospitals that discontinue
632	inpatient care to become rural health care clinics or primary
633	care programs shall deactivate all licensed general hospital
634	beds. All hospitals, clinics, and programs with inactive beds
635	shall provide 24-hour emergency medical care by staffing an
636	emergency room. Providers with inactive beds shall be subject to
637	the criteria in s. 395.1041. The agency shall specify in rule
638	requirements for making 24-hour emergency care available.
639	Inactive general hospital beds shall be included in the acute
640	care bed inventory, maintained by the agency for certificate-of-
641	need purposes, for 10 years from the date of deactivation of the
642	beds. After 10 years have elapsed, inactive beds shall be
643	excluded from the inventory. The agency shall, at the request of
644	the licensee, reactivate the inactive general beds upon a
645	showing by the licensee that licensure requirements for the
646	inactive general beds are met.
647	Section 5.  Section 395.604, Florida Statutes, is amended
648	to read:
649	395.604  Other Rural primary care hospitals hospital
650	programs.--
651	(1)  The agency may license rural primary care hospitals
652	subject to federal approval for participation in the Medicare
653	and Medicaid programs. Rural primary care hospitals shall be
654	treated in the same manner as emergency care hospitals and rural
655	hospitals with respect to ss. 395.605(2)-(8)(a),
656	408.033(2)(b)3., and 408.038.
657	(2)  The agency may designate essential access community
658	hospitals.
659	(2)(3)  The agency may adopt licensure rules for rural
660	primary care hospitals and essential access community hospitals.
661	Such rules must conform to s. 395.1055.
662	(3)  For the purpose of Medicaid swing-bed reimbursement
663	pursuant to the Medicaid program, the agency shall treat rural
664	primary care hospitals in the same manner as rural hospitals.
665	(4)  For the purpose of participation in the Medical
666	Education Reimbursement and Loan Repayment Program as defined in
667	s. 1009.65 or other loan repayment or incentive programs
668	designed to relieve medical workforce shortages, the department
669	shall treat rural primary care hospitals in the same manner as
670	rural hospitals.
671	(5)  For the purpose of coordinating primary care services
672	described in s. 154.011(1)(c)10., the department shall treat
673	rural primary care hospitals in the same manner as rural
674	hospitals.
675	(6)  Rural hospitals that make application under the
676	certificate-of-need program to be licensed as rural primary care
677	hospitals shall receive expedited review as defined in s.
678	408.032. Rural primary care hospitals seeking relicensure as
679	acute care general hospitals shall also receive expedited
680	review.
681	(7)  Rural primary care hospitals are exempt from
682	certificate-of-need requirements for home health and hospice
683	services and for swing beds in a number that does not exceed
684	one-half of the facility's licensed beds.
685	(8)  Rural primary care hospitals shall have agreements
686	with other hospitals, skilled nursing facilities, home health
687	agencies, and providers of diagnostic-imaging and laboratory
688	services that are not provided on site but are needed by
689	patients.
690	(4)  The department may seek federal recognition of
691	emergency care hospitals authorized by s. 395.605 under the
692	essential access community hospital program authorized by the
693	Omnibus Budget Reconciliation Act of 1989.
694	Section 6.  Section 395.6061, Florida Statutes, is amended
695	to read:
696	395.6061  Rural hospital capital improvement.--There is
697	established a rural hospital capital improvement grant program.
698	(1)(a)  The purpose of the program is to provide targeted
699	funding to rural hospitals to enable them to adapt to changes in
700	health care delivery and funding and address disparities in
701	rural 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
706	includes technical assistance and grants managed by the agency.
707	(2)(1)  A rural hospital as defined in s. 395.602 may apply
708	to the agency department for a capital improvement grant to
709	acquire, repair, improve, or upgrade systems, facilities, or
710	equipment. The grant application must provide information that
711	includes:
712	(a)  A statement indicating the problem the rural hospital
713	proposes to solve with the grant funds.;
714	(b)  The strategy proposed to resolve the problem.;
715	(c)  The organizational structure, financial system, and
716	facilities that are essential to the proposed solution.;
717	(d)  The projected longevity of the proposed solution after
718	the grant funds are expended.;
719	(e)  Evidence of participation in a rural health network as
720	defined in s. 381.0406;
721	(e)(f)  Evidence that the rural hospital has difficulty in
722	obtaining funding or that funds available for the proposed
723	solution are inadequate.;
724	(f)(g)  Evidence that the grant funds will assist in
725	maintaining or returning the hospital to an economically stable
726	condition or enable the transition to the status of rural
727	primary care hospital or that any plan for closure of the
728	hospital or realignment of services will involve development of
729	innovative alternatives for the provision of needed discontinued
730	services.;
731	(g)(h)  Evidence of a satisfactory record-keeping system to
732	account for grant fund expenditures within the rural county.;
733	(h)(i)  A rural health network plan that includes a
734	description of how the plan was developed, the goals of the
735	plan, the links with existing health care providers under the
736	plan, Indicators quantifying the hospital's financial status
737	well-being, measurable outcome targets, and the current physical
738	and operational condition of the hospital.
739	(2)  Each rural hospital as defined in s. 395.602 shall
740	receive a minimum of $100,000 annually, subject to legislative
741	appropriation, upon application to the Department of Health, for
742	projects to acquire, repair, improve, or upgrade systems,
743	facilities, or equipment.
744	(3)  Any remaining funds shall annually be disbursed to
745	rural hospitals in accordance with this section. The agency
746	Department of Health shall establish, by rule, criteria for
747	awarding grants for any remaining funds, which must be used
748	exclusively for the support and assistance of rural hospitals as
749	defined in s. 395.602, including criteria relating to the level
750	of charity uncompensated care rendered by the hospital, the
751	financial status of the hospital, the performance standards of
752	the hospital the participation in a rural health network as
753	defined in s. 381.0406, and the proposed use of the grant by the
754	rural hospital to resolve a specific problem. Up to 30 percent
755	of rural hospital capital improvement funds may be allocated to
756	assist financially distressed rural hospitals that meet the
757	requirements of this subsection. The agency department must
758	consider any information submitted in an application for the
759	grants in accordance with subsection (2) (1) in determining
760	eligibility for and the amount of the grant, and none of the
761	individual items of information by itself may be used to deny
762	grant eligibility.
763	(4)  Financially distressed rural hospitals and critical
764	access hospitals that have an annual occupancy rate of less than
765	30 percent may receive preferential assistance under the capital
766	improvement grant program to provide planning, management, and
767	financial 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
770	the hospital, the county commission, and the city commission.
771	2.  Evidence that the rural hospital and the community have
772	difficulty obtaining funding or that funds available for the
773	proposed solution are inadequate.
774	(b)  Agree to be bound by the terms of a participation
775	agreement with the agency, which may include:
776	1.  The appointment of a health care expert under contract
777	with the agency to analyze and monitor the hospital operations
778	during the period of distress.
779	2.  The establishment of minimum standards for the
780	education and experience of the managers and administrators of
781	the hospital.
782	3.  The oversight and monitoring of a strategic plan to
783	restore the hospital to an economically stable condition or
784	transition to an alternative means to provide services.
785	4.  The establishment of a board orientation and
786	development program.
787	5.  The approval of any facility relocation plans.
788	(5)(4)  The agency department shall ensure that the funds
789	are used solely for the purposes specified in this section. The
790	total grants awarded pursuant to this section shall not exceed
791	the amount appropriated for this program.
792	Section 7.  Section 395.6070, Florida Statutes, is created
793	to read:
794	395.6070  Rural hospital receivership proceedings.--
795	(1)  As an alternative to or in conjunction with an
796	injunctive proceeding, the agency may petition a court of
797	competent jurisdiction for the appointment of a receiver for a
798	rural hospital, as defined by s. 408.07, when any of the
799	following conditions exist:
800	(a)  A person is operating a hospital without a license and
801	refuses to make application for a license as required by chapter
802	395.
803	(b)  The agency determines that conditions exist in the
804	hospital that present an imminent danger to the health, safety,
805	or welfare of the patients in the hospital or a substantial
806	probability that death or serious physical harm would result
807	therefrom.
808	(c)  The licensee cannot meet its financial obligation for
809	providing food, shelter, care, and utilities. Evidence such as
810	the issuance of bad checks or an accumulation of delinquent
811	bills for such items as personnel salaries, food, drugs, or
812	utilities shall constitute prima facie evidence that the
813	ownership of the hospital lacks the financial ability to operate
814	the hospital.
815	(2)  Petitions for receivership shall take precedence over
816	other court business unless the court determines that some other
817	pending proceeding, having similar statutory precedence, shall
818	have priority. A hearing shall be conducted within 5 days after
819	the filing of the petition, at which time all interested parties
820	shall have the opportunity to present evidence pertaining to the
821	petition. The agency shall notify the owner or administrator of
822	the hospital named in the petition of the filing of the petition
823	and the date set for the hearing. The court may grant the
824	petition only upon finding that the health, safety, or welfare
825	of patients of the hospital would be threatened if a condition
826	existing at the time the petition was filed is permitted to
827	continue. A receiver may not be appointed when the owner or
828	administrator, or a representative of the owner or
829	administrator, is not present at the hearing on the petition,
830	unless the court determines that one or more of the conditions
831	in subsection (1) exist and that the hospital owner or
832	administrator cannot be found, that all reasonable means of
833	locating the owner or the administrator and notifying him or her
834	of the petition and hearing have been exhausted, or that the
835	owner or administrator, after notification of the hearing,
836	chooses not to attend. After such findings, the court may
837	appoint any person qualified by education, training, or
838	experience to carry out the responsibilities of a receiver
839	pursuant to this section, except that the court may not appoint
840	any owner or affiliate of a hospital that is in receivership.
841	The receiver may be selected from a list of persons qualified to
842	act as receivers developed by the agency and presented to the
843	court with each petition for receivership. Under no
844	circumstances shall the agency or a designated agency employee
845	be appointed as a receiver.
846	(3)  The receiver shall make provisions for the continued
847	health, safety, and welfare of all patients of the hospital and:
848	(a)  Shall exercise those powers and perform those duties
849	set out by the court.
850	(b)  Shall operate the hospital in such a manner as to
851	ensure safety and adequate health care for the patients.
852	(c)  Shall take such action as is reasonably necessary to
853	protect or conserve the assets or property of the hospital for
854	which the receiver is appointed, or the proceeds from any
855	transfer thereof, and may use them only in the performance of
856	the powers and duties set forth in this section and by order of
857	the court.
858	(d)  May use the building, fixtures, furnishings, and any
859	accompanying consumable goods in the provision of care and
860	services to patients and to any other persons receiving services
861	from the hospital at the time the petition for receivership was
862	filed. The receiver shall collect payments for all goods and
863	services provided to patients or others during the period of the
864	receivership at the same rate of payment charged by the owners
865	at the time the petition for receivership was filed, or at a
866	fair and reasonable rate otherwise approved by the court for
867	private-pay patients. The receiver may apply to the agency for a
868	rate increase for patients eligible for care under Title XIX of
869	the Social Security Act if the hospital is not receiving the
870	maximum allowable payment and expenditures justify an increase
871	in the rate.
872	(e)  May correct or eliminate any deficiency in the
873	structure or furnishings of the hospital that endangers the
874	safety or health of patients while they remain in the hospital,
875	provided the total cost of correction does not exceed $100,000.
876	The court may order expenditures for this purpose in excess of
877	$100,000 on application from the receiver after notice to the
878	owner and a hearing.
879	(f)  May let contracts and hire agents and employees to
880	carry out the powers and duties of the receiver under this
881	section.
882	(g)  Shall honor all leases, mortgages, and secured
883	transactions governing the building in which the hospital is
884	located and all goods and fixtures in the building of which the
885	receiver has taken possession, but only to the extent of
886	payments that, in the case of a rental agreement, are for the
887	use of the property during the period of receivership, or that,
888	in the case of a purchase agreement, become due during the
889	period of receivership.
890	(h)  Shall have full power to direct, manage, and discharge
891	employees of the hospital, subject to any contract rights they
892	may have. The receiver shall pay employees at the rate of
893	compensation, including benefits, approved by the court. A
894	receivership does not relieve the owner of any obligation to
895	employees made prior to the appointment of a receiver that has
896	not been carried out by the receiver.
897	(i)  Shall be entitled to take possession of all property
898	or assets of patients that are in the possession of a hospital
899	or its owner. The receiver shall preserve all property or assets
900	and all patient records of which the receiver takes possession
901	and shall provide for the prompt transfer of the property,
902	assets, and records to the new placement of any transferred
903	patient. An inventory list certified by the owner and receiver
904	shall be made at the time the receiver takes possession of the
905	hospital.
906	(4)(a)  A person who is served with notice of an order of
907	the court appointing a receiver and of the receiver's name and
908	address shall be liable to pay the receiver for any goods or
909	services provided by the receiver after the date of the order if
910	the person would have been liable for the goods or services as
911	supplied by the owner. The receiver shall give a receipt for
912	each payment and shall keep a copy of each receipt on file. The
913	receiver shall deposit accounts received in a separate account
914	and shall use this account for all disbursements.
915	(b)  The receiver may bring an action to enforce the
916	liability created by paragraph (a).
917	(c)  A payment to the receiver of any sum owing to the
918	hospital or its owner shall discharge any obligation to the
919	hospital to the extent of the payment.
920	(5)(a)  A receiver may petition the court that he or she
921	not be required to honor any lease, mortgage, secured
922	transaction, or other wholly or partially executory contract
923	entered into by the owner of the hospital if the rent, price, or
924	rate of interest required to be paid under the agreement was
925	substantially in excess of a reasonable rent, price, or rate of
926	interest at the time the contract was entered into or if any
927	material provision of the agreement was unreasonable when
928	compared to contracts negotiated under similar conditions. Any
929	relief in this form provided by the court shall be limited to
930	the life of the receivership, unless otherwise determined by the
931	court.
932	(b)  If the receiver is in possession of real estate or
933	goods subject to a lease, mortgage, or security interest which
934	the receiver has obtained a court order to avoid under paragraph
935	(a), and if the real estate or goods are necessary for the
936	continued operation of the hospital under this section, the
937	receiver may apply to the court to set a reasonable rental,
938	price, or rate of interest to be paid by the receiver during the
939	duration of the receivership. The court shall hold a hearing on
940	the application within 15 days. The receiver shall send notice
941	of the application to any known persons who own the property
942	involved or mortgage holders at least 10 days prior to the
943	hearing. Payment by the receiver of the amount determined by the
944	court to be reasonable is a defense to any action against the
945	receiver for payment or for possession of the goods or real
946	estate subject to the lease, security interest, or mortgage
947	involved by any person who received such notice, but the payment
948	does not relieve the owner of the hospital of any liability for
949	the difference between the amount paid by the receiver and the
950	amount due under the original lease, security interest, or
951	mortgage involved.
952	(6)  The court shall set the compensation of the receiver,
953	which shall be considered a necessary expense of a receivership.
954	(7)  A receiver may be held liable in a personal capacity
955	only for the receiver's own gross negligence, intentional acts,
956	or 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
960	longer necessary because the conditions that gave rise to the
961	receivership no longer exist; or
962	(b)  All of the patients in the hospital have been
963	transferred or discharged.
964	(10)  Within 30 days after the termination of a
965	receivership, unless this time period is extended by the court,
966	the receiver shall give the court a complete accounting of all
967	property of which the receiver has taken possession, of all
968	funds collected and disbursed, and of the expenses of the
969	receivership.
970	(11)  Nothing in this section shall be deemed to relieve
971	any owner, administrator, or employee of a hospital placed in
972	receivership of any civil or criminal liability incurred, or of
973	any duty imposed by law, by reason of acts or omissions of the
974	owner, administrator, or employee prior to the appointment of a
975	receiver; nor shall anything contained in this section be
976	construed to suspend during the receivership any obligation of
977	the owner, administrator, or employee for payment of taxes or
978	other operating and maintenance expenses of the hospital, or of
979	the owner, administrator, employee, or any other person for the
980	payment of mortgages or liens. The owner shall retain the right
981	to sell or mortgage any hospital under receivership, subject to
982	approval of the court that ordered the receivership. A licensee
983	that is placed in receivership by the court is liable for all
984	expenses and costs incurred by the Rural Hospital Patient
985	Protection Trust Fund that are related to capital improvement
986	and operating costs and are no more than 10 percent above the
987	hospital's Medicaid rate and which occur as a result of the
988	receivership.
989	Section 8.  Section 395.6071, Florida Statutes, is created
990	to read:
991	395.6071  Rural Hospital Patient Protection Trust Fund.--
992	(1)  A Rural Hospital Patient Protection Trust Fund shall
993	be established for the purpose of collecting and disbursing
994	funds generated from a $1 fee assessed on each inpatient
995	discharge from a rural hospital as defined in s. 408.07. Such
996	funds shall be used for the continued operation of the hospital
997	and transition to another owner. Such funds may be used for the
998	purpose of paying for the appropriate alternate placement, care,
999	and treatment of patients who are removed from a facility
1000	licensed under this part in which the agency determines that
1001	existing conditions or practices constitute an immediate danger
1002	to the health, safety, or security of the patients. If the
1003	agency determines that it is in the best interest of the health,
1004	safety, or security of the patients to provide for an orderly
1005	removal of the patients from the facility, the agency may use
1006	such funds to maintain and care for the patients in the facility
1007	pending removal and alternative placement. The maintenance and
1008	care of the patients shall be under the direction and control of
1009	a receiver appointed pursuant to s. 395.6070. However, funds may
1010	be expended in an emergency upon the filing of a petition for a
1011	receiver, upon the declaration of a state of local emergency
1012	pursuant to s. 252.38(3)(a)5., or upon a duly authorized local
1013	order of evacuation of a facility by emergency personnel to
1014	protect the health and safety of the patients.
1015	(2)  The agency is authorized to establish for each
1016	facility, subject to intervention by the agency, a separate bank
1017	account for the deposit to the credit of the agency of any
1018	moneys received from the Rural Hospital Patient Protection Trust
1019	Fund or any other moneys received for the maintenance and care
1020	of patients in the facility, and the agency is authorized to
1021	disburse moneys from such account to pay obligations incurred
1022	for the purposes of this section. The agency is authorized to
1023	requisition moneys from the Rural Hospital Patient Protection
1024	Trust Fund in advance of an actual need for cash on the basis of
1025	an estimate by the agency of moneys to be spent under the
1026	authority of this section. Any bank account established under
1027	this section need not be approved in advance of its creation as
1028	required by s. 17.58, but shall be secured by depository
1029	insurance equal to or greater than the balance of such account
1030	or by the pledge of collateral security as provided in chapter
1031	280. The agency shall notify the Chief Financial Officer of any
1032	account so established and shall make a quarterly accounting to
1033	the Chief Financial Officer for all moneys deposited in such
1034	account.
1035	(3)  Funds authorized under this section shall be expended
1036	on behalf of all patients transferred to an alternate placement,
1037	at the usual and customary charges of the facility used for the
1038	alternate placement, provided no other source of private or
1039	public funding is available. However, such funds may not be
1040	expended on behalf of a patient who is eligible for Title XIX of
1041	the Social Security Act, if the alternate placement accepts
1042	Title XIX of the Social Security Act. Funds shall be used for
1043	maintenance and care of patients in a facility in receivership
1044	only to the extent private or public funds, including funds
1045	available under Title XIX of the Social Security Act, are not
1046	available or are not sufficient to adequately manage and operate
1047	the facility, as determined by the agency. The existence of the
1048	Rural Hospital Patient Protection Trust Fund shall not make the
1049	agency liable for the maintenance of any patient in any
1050	facility. The state shall be liable for the cost of alternate
1051	placement of patients removed from a deficient facility, or for
1052	the maintenance of patients in a facility in receivership, only
1053	to the extent that funds are available in the Rural Hospital
1054	Patient Protection Trust Fund.
1055	(4)  The agency is authorized to adopt rules pursuant to s.
1056	120.53(1) and 120.54 necessary to implement this section.
1057	Section 9.  Section 408.7054, Florida Statutes, is created
1058	to read:
1059	408.7054  Rural Provider Service Network Development
1060	Program.--
1061	(1)  There is established within the Agency for Health Care
1062	Administration the Rural Provider Service Network Development
1063	Program to support the implementation of provider service
1064	networks in rural counties of the state. The purpose of the
1065	program is to assist in the establishment of the infrastructure
1066	needed for Medicaid reform relating to prepaid and at-risk
1067	reimbursement plans to improve access to quality health care in
1068	rural areas.
1069	(2)  The responsibilities of the program are to:
1070	(a)  Administer the rural hospital capital improvement
1071	grant program established under s. 395.6061.
1072	(b)  Administer the assistance program for financially
1073	distressed rural and critical access hospitals established under
1074	s. 395.6061(4).
1075	(c)  Administer the rural provider service network
1076	development grant program established in subsection (3).
1077	(3)  There is established a rural provider service network
1078	development grant program. The agency is authorized to provide
1079	funding through a grant program to entities seeking to establish
1080	rural provider service networks that have demonstrated an
1081	interest and have experience in organizing rural health care
1082	providers for this purpose.
1083	(4)  Entities eligible for rural provider service network
1084	development grants must:
1085	(a)  Have a written agreement signed by prospective
1086	members, 45 percent of whom must be providers in the targeted
1087	service area.
1088	(b)  Include all rural hospitals, at least one federally
1089	qualified health center, and one county health department
1090	located in the service area.
1091	(c)  Have a defined service area, 80 percent of which
1092	consists of rural counties.
1093	(5)  Each applicant for this funding shall provide the
1094	agency with a detailed written proposal that includes, at a
1095	minimum, a statement of need; a defined purpose; identification
1096	and explanation of the role of prospective partners; a signed
1097	memorandum of agreement or similar document attesting to the
1098	role of prospective partners; documented actions related to
1099	provider service network development; measurable objectives for
1100	the development of clinical and administrative infrastructure; a
1101	process of evaluation; and a process for developing a business
1102	plan and securing additional funding.
1103	(6)  The agency is authorized to grant preferential funding
1104	to a rural provider service network based on the number of rural
1105	counties within the network's proposed service area that are
1106	Medically Underserved Areas or Health Professional Shortage
1107	Areas as defined by the Health Resources Services
1108	Administration, Office of Rural Health Policy, and based on
1109	whether the provider service network has a principal place of
1110	business located in a rural county in the state.
1111	(7)  The agency is granted authority to develop rules
1112	pursuant to s. 120.53(1) and 120.54 necessary to implement this
1113	section.
1114	Section 10.  Subsection (43) of section 408.07, Florida
1115	Statutes, is amended to read:
1116	408.07  Definitions.--As used in this chapter, with the
1117	exception of ss. 408.031-408.045, the term:
1118	(43)  "Rural hospital" means an acute care hospital
1119	licensed under chapter 395, having 100 or fewer licensed beds
1120	and an emergency room, and which is:
1121	(a)  The sole provider within a county with a population
1122	density of no greater than 100 persons per square mile;
1123	(b)  An acute care hospital, in a county with a population
1124	density of no greater than 100 persons per square mile, which is
1125	at least 30 minutes of travel time, on normally traveled roads
1126	under normal traffic conditions, from another acute care
1127	hospital within the same county;
1128	(c)  A hospital supported by a tax district or subdistrict
1129	whose boundaries encompass a population of 100 persons or fewer
1130	per square mile;
1131	(d)  A hospital with a service area that has a population
1132	of 100 persons or fewer per square mile. As used in this
1133	paragraph, the term "service area" means the fewest number of
1134	zip codes that account for 75 percent of the hospital's
1135	discharges for the most recent 5-year period, based on
1136	information available from the hospital inpatient discharge
1137	database in the State Center for Health Statistics at the Agency
1138	for Health Care Administration; or
1139	(e)  A critical access hospital.
1140
1141	Population densities used in this subsection must be based upon
1142	the most recently completed United States census. A hospital
1143	that received funds under s. 409.9116 for a quarter beginning no
1144	later than July 1, 2002, is deemed to have been and shall
1145	continue to be a rural hospital from that date through June 30,
1146	2012, if the hospital continues to have 100 or fewer licensed
1147	beds and an emergency room, or meets the criteria of s.
1148	395.602(2)(d)(e)4. An acute care hospital that has not
1149	previously been designated as a rural hospital and that meets
1150	the criteria of this subsection shall be granted such
1151	designation upon application, including supporting
1152	documentation, to the Agency for Health Care Administration.
1153	Section 11.  Subsection (12) of section 409.908, Florida
1154	Statutes, is amended to read:
1155	409.908  Reimbursement of Medicaid providers.--Subject to
1156	specific appropriations, the agency shall reimburse Medicaid
1157	providers, in accordance with state and federal law, according
1158	to methodologies set forth in the rules of the agency and in
1159	policy manuals and handbooks incorporated by reference therein.
1160	These methodologies may include fee schedules, reimbursement
1161	methods based on cost reporting, negotiated fees, competitive
1162	bidding pursuant to s. 287.057, and other mechanisms the agency
1163	considers efficient and effective for purchasing services or
1164	goods on behalf of recipients. If a provider is reimbursed based
1165	on cost reporting and submits a cost report late and that cost
1166	report would have been used to set a lower reimbursement rate
1167	for a rate semester, then the provider's rate for that semester
1168	shall be retroactively calculated using the new cost report, and
1169	full payment at the recalculated rate shall be effected
1170	retroactively. Medicare-granted extensions for filing cost
1171	reports, if applicable, shall also apply to Medicaid cost
1172	reports. Payment for Medicaid compensable services made on
1173	behalf of Medicaid eligible persons is subject to the
1174	availability of moneys and any limitations or directions
1175	provided for in the General Appropriations Act or chapter 216.
1176	Further, nothing in this section shall be construed to prevent
1177	or limit the agency from adjusting fees, reimbursement rates,
1178	lengths of stay, number of visits, or number of services, or
1179	making any other adjustments necessary to comply with the
1180	availability of moneys and any limitations or directions
1181	provided for in the General Appropriations Act, provided the
1182	adjustment is consistent with legislative intent.
1183	(12)(a)  A physician shall be reimbursed the lesser of the
1184	amount billed by the provider or the Medicaid maximum allowable
1185	fee established by the agency.
1186	(b)  The agency shall adopt a fee schedule, subject to any
1187	limitations or directions provided for in the General
1188	Appropriations Act, based on a resource-based relative value
1189	scale for pricing Medicaid physician services. Under this fee
1190	schedule, physicians shall be paid a dollar amount for each
1191	service based on the average resources required to provide the
1192	service, including, but not limited to, estimates of average
1193	physician time and effort, practice expense, and the costs of
1194	professional liability insurance. The fee schedule shall provide
1195	increased reimbursement for preventive and primary care services
1196	and lowered reimbursement for specialty services by using at
1197	least two conversion factors, one for cognitive services and
1198	another for procedural services. The fee schedule shall not
1199	increase total Medicaid physician expenditures unless moneys are
1200	available, and shall be phased in over a 2-year period beginning
1201	on July 1, 1994. The Agency for Health Care Administration shall
1202	seek the advice of a 16-member advisory panel in formulating and
1203	adopting the fee schedule. The panel shall consist of Medicaid
1204	physicians licensed under chapters 458 and 459 and shall be
1205	composed of 50 percent primary care physicians and 50 percent
1206	specialty care physicians.
1207	(c)  Notwithstanding paragraph (b), reimbursement fees to
1208	physicians for providing total obstetrical services to Medicaid
1209	recipients, which include prenatal, delivery, and postpartum
1210	care, shall be at least $1,500 per delivery for a pregnant woman
1211	with low medical risk and at least $2,000 per delivery for a
1212	pregnant woman with high medical risk. However, reimbursement to
1213	physicians working in Regional Perinatal Intensive Care Centers
1214	designated pursuant to chapter 383, for services to certain
1215	pregnant Medicaid recipients with a high medical risk, may be
1216	made according to obstetrical care and neonatal care groupings
1217	and rates established by the agency. Nurse midwives licensed
1218	under part I of chapter 464 or midwives licensed under chapter
1219	467 shall be reimbursed at no less than 80 percent of the low
1220	medical risk fee. The agency shall by rule determine, for the
1221	purpose of this paragraph, what constitutes a high or low
1222	medical risk pregnant woman and shall not pay more based solely
1223	on the fact that a caesarean section was performed, rather than
1224	a vaginal delivery. The agency shall by rule determine a
1225	prorated payment for obstetrical services in cases where only
1226	part of the total prenatal, delivery, or postpartum care was
1227	performed. The Department of Health shall adopt rules for
1228	appropriate insurance coverage for midwives licensed under
1229	chapter 467. Prior to the issuance and renewal of an active
1230	license, or reactivation of an inactive license for midwives
1231	licensed under chapter 467, such licensees shall submit proof of
1232	coverage with each application.
1233	(d)  Notwithstanding other provisions of this subsection,
1234	the agency shall pay physicians licensed under chapter 458 or
1235	chapter 459 who have a provider agreement with a rural health
1236	network as established in s. 381.0406 a 10-percent bonus over
1237	the Medicaid physician fee schedule for any physician service
1238	provided within the geographic boundary of a county defined as a
1239	rural county by the most recent United States Census.
1240	Section 12.  Subsection (6) of section 409.9116, Florida
1241	Statutes, is amended to read:
1242	409.9116  Disproportionate share/financial assistance
1243	program for rural hospitals.--In addition to the payments made
1244	under s. 409.911, the Agency for Health Care Administration
1245	shall administer a federally matched disproportionate share
1246	program and a state-funded financial assistance program for
1247	statutory rural hospitals. The agency shall make
1248	disproportionate share payments to statutory rural hospitals
1249	that qualify for such payments and financial assistance payments
1250	to statutory rural hospitals that do not qualify for
1251	disproportionate share payments. The disproportionate share
1252	program payments shall be limited by and conform with federal
1253	requirements. Funds shall be distributed quarterly in each
1254	fiscal year for which an appropriation is made. Notwithstanding
1255	the provisions of s. 409.915, counties are exempt from
1256	contributing toward the cost of this special reimbursement for
1257	hospitals serving a disproportionate share of low-income
1258	patients.
1259	(6)  This section applies only to hospitals that were
1260	defined as statutory rural hospitals, or their successor-in-
1261	interest hospital, prior to January 1, 2001. Any additional
1262	hospital that is defined as a statutory rural hospital, or its
1263	successor-in-interest hospital, on or after January 1, 2001, is
1264	not eligible for programs under this section unless additional
1265	funds are appropriated each fiscal year specifically to the
1266	rural hospital disproportionate share and financial assistance
1267	programs in an amount necessary to prevent any hospital, or its
1268	successor-in-interest hospital, eligible for the programs prior
1269	to January 1, 2001, from incurring a reduction in payments
1270	because of the eligibility of an additional hospital to
1271	participate in the programs. A hospital, or its successor-in-
1272	interest hospital, which received funds pursuant to this section
1273	before January 1, 2001, and which qualifies under s.
1274	395.602(2)(d)(e), shall be included in the programs under this
1275	section and is not required to seek additional appropriations
1276	under this subsection.
1277	Section 13.  Paragraph (b) of subsection (2) of section
1278	1009.65, Florida Statutes, is amended to read:
1279	1009.65  Medical Education Reimbursement and Loan Repayment
1280	Program.--
1281	(2)  From the funds available, the Department of Health
1282	shall make payments to selected medical professionals as
1283	follows:
1284	(b)  All payments shall be contingent on continued proof of
1285	primary care practice in an area defined in s. 395.602(2)(d)(e),
1286	or an underserved area designated by the Department of Health,
1287	provided the practitioner accepts Medicaid reimbursement if
1288	eligible for such reimbursement. Correctional facilities, state
1289	hospitals, and other state institutions that employ medical
1290	personnel shall be designated by the Department of Health as
1291	underserved locations. Locations with high incidences of infant
1292	mortality, high morbidity, or low Medicaid participation by
1293	health care professionals may be designated as underserved.
1294	Section 14.  Section 395.605, Florida Statutes, is
1295	repealed.
1296	Section 15.  This act shall take effect July 1, 2006.

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