HB 7215CS


1The Health & Families Council recommends the following:
3     Council/Committee Substitute
4     Remove the entire bill and insert:
A bill to be entitled
6An act relating to rural health care; amending s.
7381.0405, F.S.; revising the purpose and functions of the
8Office of Rural Health in the Department of Health;
9requiring the Secretary of Health and the Secretary of
10Health Care Administration to appoint an advisory council
11to advise the office; providing for terms of office of the
12members of the advisory council; authorizing per diem and
13travel reimbursement for members of the advisory council;
14requiring a report to the Governor and Legislature;
15amending s. 381.0406, F.S.; revising legislative findings
16and intent with respect to rural health networks; revising
17definitions; providing additional functions of and
18requirements for membership in rural health networks;
19requiring rural health networks to submit rural health
20infrastructure development plans to the office by a
21specified date; revising provisions relating to the
22governance and organization of rural health networks;
23revising the services to be provided by provider members
24of rural health networks; requiring coordination among
25rural health networks and area health education centers
26and health planning councils; establishing performance
27standards; establishing a grant program for funding rural
28health networks; defining projects that may be funded
29through the grant program; requiring the department to
30establish rules governing rural health network grant
31programs and performance standards; amending s. 395.602,
32F.S.; defining "critical access hospital"; revising and
33deleting definitions; amending s. 395.603, F.S.; deleting
34a requirement that the Agency for Health Care
35Administration adopt a rule relating to deactivation of
36rural hospital beds under certain circumstances; requiring
37that rural critical access hospitals maintain a certain
38number of actively licensed beds; amending s. 395.604,
39F.S.; removing emergency care hospitals and essential
40access community hospitals from certain licensure
41requirements; specifying certain special conditions for
42rural primary care hospitals; amending s. 395.6061, F.S.;
43specifying the purpose of the rural hospital capital
44improvement grant program; providing for grant management
45by the department; modifying the conditions for receiving
46a grant; providing for preferential assistance for
47financially distressed rural hospitals; providing purpose
48of the program; providing requirements for receiving
49certain assistance; requiring a participation agreement
50and providing for contents thereof; creating s. 408.7054,
51F.S.; establishing the Rural Provider Service Network
52Development Program; providing purposes; authorizing the
53agency to provide funding through a grant program for the
54establishment of rural provider service networks;
55providing eligibility requirements; authorizing
56preferential funding to certain providers; authorizing the
57agency to adopt rules; amending ss. 408.07, 409.9116, and
581009.65, F.S.; conforming cross-references; repealing s.
59395.605, F.S., relating to the licensure of emergency care
60hospitals; creating s. 381.7366, F.S.; establishing the
61Office of Minority Health; providing legislative intent;
62providing for organization, duties, and responsibilities;
63requiring a report to the Governor and Legislature;
64providing an effective date.
66Be It Enacted by the Legislature of the State of Florida:
68     Section 1.  Section 381.0405, Florida Statutes, is amended
69to read:
70     381.0405  Office of Rural Health.--
71     (1)  ESTABLISHMENT.--The Department of Health shall
72establish an Office of Rural Health, which shall assist rural
73health care providers in improving the health status and health
74care of rural residents of this state and assist rural health
75care providers in integrating their efforts. The Office of Rural
76Health shall coordinate its activities with rural health
77networks established under s. 381.0406, local health councils
78established under s. 408.033, the area health education center
79network established under pursuant to s. 381.0402, and with any
80appropriate research and policy development centers within
81universities that have state-approved medical schools. The
82Office of Rural Health may enter into a formal relationship with
83any center that designates the office as an affiliate of the
85     (2)  PURPOSE.--The Office of Rural Health shall actively
86foster the provision of high-quality health care services in
87rural areas and serve as a catalyst for improved health services
88to residents citizens in rural areas of the state.
89     (3)  GENERAL FUNCTIONS.--The office shall:
90     (a)  Integrate policies related to physician workforce,
91hospitals, public health, and state regulatory functions.
92     (b)  Work with rural stakeholders in order to foster the
93development of strategic planning that addresses Propose
94solutions to problems affecting health care delivery in rural
96     (c)  Foster the expansion of rural health network service
97areas to include rural counties that are not served by a rural
98health network.
99     (d)(c)  Seek grant funds from foundations and the Federal
101     (e)  Administer state grant programs for rural health
103     (4)  COORDINATION.--The office shall:
104     (a)  Identify federal and state rural health programs and
105provide information and technical assistance to rural providers
106regarding participation in such programs.
107     (b)  Act as a clearinghouse for collecting and
108disseminating information on rural health care issues, research
109findings on rural health care, and innovative approaches to the
110delivery of health care in rural areas.
111     (c)  Foster the creation of regional health care systems
112that promote cooperation, rather than competition.
113     (d)  Coordinate the department's rural health care
114activities, programs, and policies.
115     (e)  Design initiatives to improve access to primary,
116acute, and emergency medical services and promote the
117coordination of such services in rural areas.
118     (f)  Assume responsibility for state coordination of the
119Rural Hospital Transition Grant Program, the Essential Access
120Community Hospital Program, and other federal rural health care
121grant programs.
122     (5)  TECHNICAL ASSISTANCE.--The office shall:
123     (a)  Assist Help rural health care providers in recruiting
124obtain health care practitioners by promoting the location and
125relocation of health care practitioners in rural areas and
126promoting policies that create incentives for practitioners to
127serve in rural areas.
128     (b)  Provide technical assistance to hospitals, community
129and migrant health centers, and other health care providers that
130serve residents in rural areas.
131     (c)  Assist with the design of strategies to improve health
132care workforce recruitment and placement programs.
133     (d)  Provide technical assistance to rural health networks
134in the formulation of their rural health infrastructure
135development plans.
136     (e)  Provide links to best practices and other technical
137assistance resources on the office's Internet website.
138     (6)  ADVISORY COUNCIL.--The Secretary of Health and the
139Secretary of Health Care Administration shall each appoint no
140more than five members with relevant health care operations
141management, practice, and policy experience to an advisory
142council to advise the office regarding its responsibilities
143under this section and ss. 381.0406, 395.6061, and 395.6063.
144Members must be appointed for 4-year staggered terms and may be
145reappointed to a second term of office. Members shall serve
146without compensation but are entitled to reimbursement for per
147diem and travel expenses as provided in s. 112.061. The council
148may appoint technical advisory teams as needed. The department
149shall provide staff and other administrative assistance
150reasonably necessary to assist the advisory council in carrying
151out its duties.
152     (7)  REPORTS.--Beginning January 1, 2007, and annually
153thereafter, the Office of Rural Health shall submit a report to
154the Governor, the President of the Senate, and the Speaker of
155the House of Representatives summarizing the activities of the
156office, including the grants obtained or administered by the
157office and the status of rural health networks and rural
158hospitals in the state. The report must also include
159recommendations for improvements in health care delivery in
160rural areas of the state.
162office shall:
163     (a)  Conduct policy and research studies.
164     (b)  Conduct health status studies of rural residents.
165     (c)  Collect relevant data on rural health care issues for
166use in department policy development.
167     (9)(7)  APPROPRIATION.--The Legislature shall appropriate
168such sums as are necessary to support the Office of Rural
170     Section 2.  Section 381.0406, Florida Statutes, is amended
171to read:
172     381.0406  Rural health networks.--
174     (a)  The Legislature finds that, in rural areas, access to
175health care is limited and the quality of health care is
176negatively affected by inadequate financing, difficulty in
177recruiting and retaining skilled health professionals, and the
178because of a migration of patients to urban areas for general
179acute care and specialty services.
180     (b)  The Legislature further finds that the efficient and
181effective delivery of health care services in rural areas
183     1.  The integration of public and private resources;
184     2.  The introduction of innovative outreach methods;
185     3.  The adoption of quality improvement and cost-
186effectiveness measures;
187     4.  The organization of health care providers into joint
188contracting entities;
189     5.  The establishment of referral linkages;
190     6.  The analysis of costs and services in order to prepare
191health care providers for prepaid and at-risk financing; and
192     7.  The coordination of health care providers.
193     (c)  The Legislature further finds that the availability of
194a continuum of quality health care services, including
195preventive, primary, secondary, tertiary, and long-term care, is
196essential to the economic and social vitality of rural
198     (d)  The Legislature further finds that health care
199providers in rural areas are not prepared for market changes
200such as the introduction of managed care and capitation-
201reimbursement methodologies into health care services.
202     (e)(d)  The Legislature further finds that the creation of
203rural health networks can help to alleviate these problems.
204Rural health networks shall act in the broad public interest
205and, to the extent possible, seek to improve the accessibility,
206quality, and cost-effectiveness of rural health care by
207planning, developing, coordinating, and providing be structured
208to provide a continuum of quality health care services for rural
209residents through the cooperative efforts of rural health
210network members and other health care providers.
211     (f)(e)  The Legislature further finds that rural health
212networks shall have the goal of increasing the financial
213stability of statutory rural hospitals by linking rural hospital
214services to other services in a continuum of health care
215services and by increasing the utilization of statutory rural
216hospitals whenever for appropriate health care services whenever
217feasible, which shall help to ensure their survival and thereby
218support the economy and protect the health and safety of rural
220     (g)(f)  Finally, the Legislature finds that rural health
221networks may serve as "laboratories" to determine the best way
222of organizing rural health services and linking to out-of-area
223services that are not available locally in order, to move the
224state closer to ensuring that everyone has access to health
225care, and to promote cost containment efforts.  The ultimate
226goal of rural health networks shall be to ensure that quality
227health care is available and efficiently delivered to all
228persons in rural areas.
229     (2)  DEFINITIONS.--
230     (a)  "Rural" means an area having with a population density
231of fewer less than 100 individuals per square mile or an area
232defined by the most recent United States Census as rural.
233     (b)  "Health care provider" means any individual, group, or
234entity, public or private, which that provides health care,
235including: preventive health care, primary health care,
236secondary and tertiary health care, hospital in-hospital health
237care, public health care, and health promotion and education.
238     (c)  "Rural health network" or "network" means a nonprofit
239legal entity, whose members consist consisting of rural and
240urban health care providers and others, and which that is
241established organized to plan, develop, organize, and deliver
242health care services on a cooperative basis in a rural area,
243except for some secondary and tertiary care services.
244     (3)  NETWORK MEMBERSHIP.--
245     (a)  Because each rural area is unique, with a different
246health care provider mix, health care provider membership may
247vary, but all networks shall include members that provide health
248promotion and disease prevention services, public health
249services, comprehensive primary care, emergency medical care,
250and acute inpatient care.
251     (b)  Each county health department shall be a member of the
252rural health network whose service area includes the county in
253which the county health department is located. Federally
254qualified health centers and emergency medical services
255providers are encouraged to become members of the rural health
256networks in the areas in which their patients reside or receive
258     (c)(4)  Network membership shall be available to all health
259care providers in the network service area if, provided that
260they render care to all patients referred to them from other
261network members;, comply with network quality assurance, quality
262improvement, and utilization-management and risk management
263requirements; and, abide by the terms and conditions of network
264provider agreements in paragraph (11)(c), and provide services
265at a rate or price equal to the rate or price negotiated by the
267     (4)(5)  NETWORK SERVICE AREAS.--Network service areas are
268do not required need to conform to local political boundaries or
269state administrative district boundaries. The geographic area of
270one rural health network, however, may not overlap the territory
271of any other rural health network.
272     (5)(6)  NETWORK FUNCTIONS.--Networks shall:
273     (a)  Seek to develop linkages with provisions for referral
274to tertiary inpatient care, specialty physician care, and to
275other services that are not available in rural service areas.
276     (b)(7)  Networks shall Make available health promotion,
277disease prevention, and primary care services, in order to
278improve the health status of rural residents and to contain
279health care costs.
280     (8)  Networks may have multiple points of entry, such as
281through private physicians, community health centers, county
282health departments, certified rural health clinics, hospitals,
283or other providers; or they may have a single point of entry.
284     (c)(9)  Encourage members through training and educational
285programs to adopt standards of care, and promote the evidence-
286based practice of medicine. Networks shall establish standard
287protocols, coordinate and share patient records, and develop
288patient information exchange systems in order to improve quality
289and access to services.
290     (d)  Develop quality-improvement programs and train network
291members and other health care providers in the use of such
293     (e)  Develop disease-management systems and train network
294members and other health care providers in the use of such
296     (f)  Promote outreach to areas with a high need for
298     (g)  Seek to develop community care alternatives for elders
299who would otherwise be placed in nursing homes.
300     (h)  Emphasize community care alternatives for persons with
301mental health and substance abuse disorders who are at risk of
302being admitted to an institution.
303     (i)  Develop and implement a rural health infrastructure
304development plan for an integrated system of care that is
305responsive to the unique local health needs and the area health
306care services market. Each rural health infrastructure
307development plan must address strategies to improve access to
308specialty care, train health care providers to use standards of
309care for chronic illness, develop disease-management capacity,
310and link to state and national quality-improvement initiatives.
311The initial development plan must be submitted to the Office of
312Rural Health for review and approval no later than July 1, 2007,
313and thereafter the plans must be updated and submitted to the
314Office of Rural Health every 3 years.
315     (10)  Networks shall develop risk management and quality
316assurance programs for network providers.
318     (a)  Networks shall be incorporated as not-for-profit
319corporations under chapter 617, with articles of incorporation
320that set forth purposes consistent with this section the laws of
321the state.
322     (b)  Each network Networks shall have an independent a
323board of directors that derives membership from local
324government, health care providers, businesses, consumers,
325advocacy groups, and others. Boards of other community health
326care entities may not serve in whole as the board of a rural
327health network; however, some overlap of board membership with
328other community organizations is encouraged. Network staff must
329provide an annual orientation and strategic planning activity
330for board members.
331     (c)  Network boards of directors shall have the
332responsibility of determining the content of health care
333provider agreements that link network members.  The written
334agreements between the network and its health care provider
335members must specify participation in the essential functions of
336the network and shall specify:
337     1.  Who provides what services.
338     2.  The extent to which the health care provider provides
339care to persons who lack health insurance or are otherwise
340unable to pay for care.
341     3.  The procedures for transfer of medical records.
342     4.  The method used for the transportation of patients
343between providers.
344     5.  Referral and patient flow including appointments and
346     6.  Payment arrangements for the transfer or referral of
348     (d)  There shall be no liability on the part of, and no
349cause of action of any nature shall arise against, any member of
350a network board of directors, or its employees or agents, for
351any lawful action taken by them in the performance of their
352administrative powers and duties under this subsection.
354     (a)  Networks, to the extent feasible, shall seek to
355develop services that provide for a continuum of care for all
356residents patients served by the network. Each network shall
357recruit members that can provide include the following core
358services: disease prevention, health promotion, comprehensive
359primary care, emergency medical care, and acute inpatient care.
360Each network shall seek to ensure the availability of
361comprehensive maternity care, including prenatal, delivery, and
362postpartum care for uncomplicated pregnancies, either directly,
363by contract, or through referral agreements. Networks shall, to
364the extent feasible, develop local services and linkages among
365health care providers to also ensure the availability of the
366following services: within the specified timeframes, either
367directly, by contract, or through referral agreements:
368     1.  Services available in the home.
369     1.a.  Home health care.
370     2.b.  Hospice care.
371     2.  Services accessible within 30 minutes travel time or
373     3.a.  Emergency medical services, including advanced life
374support, ambulance, and basic emergency room services.
375     4.b.  Primary care, including.
376     c.  prenatal and postpartum care for uncomplicated
378     5.d.  Community-based services for elders, such as adult
379day care and assistance with activities of daily living.
380     6.e.  Public health services, including communicable
381disease control, disease prevention, health education, and
382health promotion.
383     7.f.  Outpatient mental health psychiatric and substance
384abuse services.
385     3.  Services accessible within 45 minutes travel time or
387     8.a.  Hospital acute inpatient care for persons whose
388illnesses or medical problems are not severe.
389     9.b.  Level I obstetrical care, which is Labor and delivery
390for low-risk patients.
391     10.c.  Skilled nursing services and, long-term care,
392including nursing home care.
393     (b)  Networks shall seek to foster linkages with out-of-
394area services to the extent feasible to ensure the availability
396     1.d.  Dialysis.
397     2.e.  Osteopathic and chiropractic manipulative therapy.
398     4.  Services accessible within 2 hours travel time or less.
399     3.a.  Specialist physician care.
400     4.b.  Hospital acute inpatient care for severe illnesses
401and medical problems.
402     5.c.  Level II and III obstetrical care, which is Labor and
403delivery care for high-risk patients and neonatal intensive
405     6.d.  Comprehensive medical rehabilitation.
406     7.e.  Inpatient mental health psychiatric and substance
407abuse services.
408     8.f.  Magnetic resonance imaging, lithotripter treatment,
409oncology, advanced radiology, and other technologically advanced
411     9.g.  Subacute care.
413     (a)  Area health education centers and health planning
414councils shall participate in the rural health networks'
415preparation of development plans. The Department of Health may
416require a written memorandum of agreement between a network and
417an area health education center or health planning council.
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, long-distance learning, and the
424treatment of chronic illness using standards of care. As used in
425this section, the term "telemedicine" means the use of
426telecommunications to deliver or expedite the delivery of health
427care services.
428     (c)  Rural health networks shall contract with local health
429planning councils to support the preparation of development
430plans through data collection and analysis in order to assess
431the health status of area residents and the capacity of local
432health services.
433     (d)(b)  Networks shall actively participate with area
434health education center programs, whenever feasible, in
435developing and implementing recruitment, training, and retention
436programs directed at positively influencing the supply and
437distribution of health care professionals serving in, or
438receiving training in, network areas.
439     (c)  As funds become available, networks shall emphasize
440community care alternatives for elders who would otherwise be
441placed in nursing homes.
442     (d)  To promote the most efficient use of resources,
443networks shall emphasize disease prevention, early diagnosis and
444treatment of medical problems, and community care alternatives
445for persons with mental health and substance abuse disorders who
446are at risk to be institutionalized.
447     (e)(13)  TRAUMA SERVICES.--In those network areas having
448which have an established trauma agency approved by the
449Department of Health, the network shall seek the participation
450of that trauma agency must be a participant in the network.
451Trauma services provided within the network area must comply
452with s. 395.405.
453     (9)(14)  NETWORK FINANCING.--
454     (a)  Networks may use all sources of public and private
455funds to support network activities. Nothing in this section
456prohibits networks from becoming managed care providers.
457     (b)  The Department of Health shall establish grant
458programs to provide funding to support the administrative costs
459of developing and operating rural health networks.
460     (10)  NETWORK PERFORMANCE STANDARDS.--The Department of
461Health shall develop and enforce performance standards for rural
462health network operations grants and rural health infrastructure
463development grants.
464     (a)  Operations grant performance standards must include,
465but are not limited to, standards that require the rural health
466network to:
467     1.  Have a qualified board of directors that meets at least
469     2.  Have sufficient staff who have the qualifications and
470experience to perform the requirements of this section, as
471assessed by the Office of Rural Health, or a written plan to
472obtain such staff.
473     3.  Comply with the department's grant management standards
474in a timely and responsive manner.
475     4.  Comply with the department's standards for the
476administration of federal grant funding, including assistance to
477rural hospitals.
478     5.  Demonstrate a commitment to network activities from
479area health care providers and other stakeholders, as described
480in letters of support.
481     (b)  Rural health infrastructure development grant
482performance standards must include, but are not limited to,
483standards that require the rural health network to:
484     1.  During the 2006-2007 fiscal year prepare a development
485plan and, after July 1, 2007, have a development plan that has
486been reviewed and approved by the Office of Rural Health.
487     2.  Have two or more successful network-development
488activities, such as:
489     a.  Management of a network development or outreach grant
490from the federal Office of Rural Health Policy;
491     b.  Implementation of outreach programs to address chronic
492disease, infant mortality, or assistance with prescription
494     c.  Development of partnerships with community and faith-
495based organizations to address area health problems;
496     d.  Provision of direct services, such as clinics or mobile
498     e.  Operation of credentialing services for health care
499providers or quality assurance and quality improvement
500initiatives that, whenever possible, are consistent with state
501or federal quality initiatives;
502     f.  Support for the development of community health
503centers, local community health councils, federal designation as
504a rural critical access hospital, or comprehensive community
505health planning initiatives; and
506     g.  Development of the capacity to obtain federal, state,
507and foundation grants.
508     (11)(15)  NETWORK IMPLEMENTATION.--As funds become
509available, networks shall be developed and implemented in two
511     (a)  Phase I shall consist of a network planning and
512development grant program. Planning grants shall be used to
513organize networks, incorporate network boards, and develop
514formal provider agreements as provided for in this section.  The
515Department of Health shall develop a request-for-proposal
516process to solicit grant applications.
517     (b)  Phase II shall consist of a network operations grant
518program. As funds become available, certified networks that meet
519performance standards shall be eligible to receive grant funds
520to be used to help defray the costs of rural health network
521infrastructure development, patient care, and network
522administration. Rural health network infrastructure development
523includes, but is not limited to: recruitment and retention of
524primary care practitioners; enhancements of primary care
525services through the use of mobile clinics; development of
526preventive health care programs; linkage of urban and rural
527health care systems; design and implementation of automated
528patient records, outcome measurement, quality assurance, and
529risk management systems; establishment of one-stop service
530delivery sites; upgrading of medical technology available to
531network providers; enhancement of emergency medical systems;
532enhancement of medical transportation; formation of joint
533contracting entities composed of rural physicians, rural
534hospitals, and other rural health care providers; establishment
535of comprehensive disease management programs that meet Medicaid
536requirements; establishment of regional quality improvement
537programs involving physicians and hospitals consistent with
538state and national initiatives; establishment of specialty
539networks connecting rural primary care physicians and urban
540specialists; development of regional broadband
541telecommunications systems that have the capacity to share
542patient information in a secure network, telemedicine, and long-
543distance learning capacity; and linkage between training
544programs for health care practitioners and the delivery of
545health care services in rural areas and development of
546telecommunication capabilities. A Phase II award may occur in
547the same fiscal year as a Phase I award.
548     (12)(16)  CERTIFICATION.--For the purpose of certifying
549networks that are eligible for Phase II funding, the Department
550of Health shall certify networks that meet the criteria
551delineated in this section and the rules governing rural health
552networks. The Office of Rural Health in the Department of Health
553shall monitor rural health networks in order to ensure continued
554compliance with established certification and performance
556     (13)(17)  RULES.--The Department of Health shall establish
557rules pursuant to s. 120.536(1) and 120.54 that govern the
558creation and certification of networks, the provision of grant
559funds under Phase I and Phase II, and the establishment of
560performance standards including establishing outcome measures
561for networks.
562     Section 3.  Subsection (2) of section 395.602, Florida
563Statutes, is amended to read:
564     395.602  Rural hospitals.--
565     (2)  DEFINITIONS.--As used in this part:
566     (a)  "Critical access hospital" means a hospital that meets
567the definition of rural hospital in paragraph (d) and meets the
568requirements for reimbursement by Medicare and Medicaid under 42
569C.F.R. ss. 485.601-485.647. "Emergency care hospital" means a
570medical facility which provides:
571     1.  Emergency medical treatment; and
572     2.  Inpatient care to ill or injured persons prior to their
573transportation to another hospital or provides inpatient medical
574care to persons needing care for a period of up to 96 hours. The
57596-hour limitation on inpatient care does not apply to respite,
576skilled nursing, hospice, or other nonacute care patients.
577     (b)  "Essential access community hospital" means any
578facility which:
579     1.  Has at least 100 beds;
580     2.  Is located more than 35 miles from any other essential
581access community hospital, rural referral center, or urban
582hospital meeting criteria for classification as a regional
583referral center;
584     3.  Is part of a network that includes rural primary care
586     4.  Provides emergency and medical backup services to rural
587primary care hospitals in its rural health network;
588     5.  Extends staff privileges to rural primary care hospital
589physicians in its network; and
590     6.  Accepts patients transferred from rural primary care
591hospitals in its network.
592     (b)(c)  "Inactive rural hospital bed" means a licensed
593acute care hospital bed, as defined in s. 395.002(14), that is
594inactive in that it cannot be occupied by acute care inpatients.
595     (c)(d)  "Rural area health education center" means an area
596health education center (AHEC), as authorized by Pub. L. No. 94-
597484, that which provides services in a county with a population
598density of no greater than 100 persons per square mile.
599     (d)(e)  "Rural hospital" means an acute care hospital
600licensed under this chapter, having 100 or fewer licensed beds
601and an emergency room, that which is:
602     1.  The sole provider within a county with a population
603density of no greater than 100 persons per square mile;
604     2.  An acute care hospital, in a county with a population
605density of no greater than 100 persons per square mile, that
606which is at least 30 minutes of travel time, on normally
607traveled roads under normal traffic conditions, from any other
608acute care hospital within the same county;
609     3.  A hospital supported by a tax district or subdistrict
610whose boundaries encompass a population of 100 persons or fewer
611per square mile;
612     4.  A hospital in a constitutional charter county with a
613population of over 1 million persons that has imposed a local
614option health service tax pursuant to law and in an area that
615was directly impacted by a catastrophic event on August 24,
6161992, for which the Governor of Florida declared a state of
617emergency pursuant to chapter 125, and has 120 beds or fewer
618less that serves an agricultural community with an emergency
619room utilization of no less than 20,000 visits and a Medicaid
620inpatient utilization rate greater than 15 percent;
621     5.  A hospital with a service area that has a population of
622100 persons or fewer per square mile. As used in this
623subparagraph, the term "service area" means the fewest number of
624zip codes that account for 75 percent of the hospital's
625discharges for the most recent 5-year period, based on
626information available from the hospital inpatient discharge
627database in the State Center for Health Statistics at the Agency
628for Health Care Administration; or
629     6.  A hospital designated as a critical access hospital, as
630defined in s. 408.07(15).
632Population densities used in this paragraph must be based upon
633the most recently completed United States census. A hospital
634that received funds under s. 409.9116 for a quarter beginning no
635later than July 1, 2002, is deemed to have been and shall
636continue to be a rural hospital from that date through June 30,
6372012, if the hospital continues to have 100 or fewer licensed
638beds and an emergency room, or meets the criteria of
639subparagraph 4. An acute care hospital that has not previously
640been designated as a rural hospital and that meets the criteria
641of this paragraph shall be granted such designation upon
642application, including supporting documentation to the Agency
643for Health Care Administration.
644     (e)(f)  "Rural primary care hospital" means any facility
645that meeting the criteria in paragraph (e) or s. 395.605 which
647     1.  Twenty-four-hour emergency medical care;
648     2.  Temporary inpatient care for periods of 96 72 hours or
649less to patients requiring stabilization before discharge or
650transfer to another hospital. The 96-hour 72-hour limitation
651does not apply to respite, skilled nursing, hospice, or other
652nonacute care patients; and
653     3.  Has at least no more than six licensed acute care
654inpatient beds.
655     (f)(g)  "Swing-bed" means a bed that which can be used
656interchangeably as either a hospital, skilled nursing facility
657(SNF), or intermediate care facility (ICF) bed pursuant to 42
658C.F.R. parts 405, 435, 440, 442, and 447.
659     Section 4.  Subsection (1) of section 395.603, Florida
660Statutes, is amended to read:
661     395.603  Deactivation of general hospital beds; rural
662hospital impact statement.--
663     (1)  The agency shall establish, by rule, a process by
664which A rural hospital, as defined in s. 395.602, that seeks
665licensure as a rural primary care hospital or as an emergency
666care hospital, or becomes a certified rural health clinic as
667defined in Pub. L. No. 95-210, or becomes a primary care program
668such as a county health department, community health center, or
669other similar outpatient program that provides preventive and
670curative services, may deactivate general hospital beds. A rural
671critical access hospital Rural primary care hospitals and
672emergency care hospitals shall maintain the number of actively
673licensed general hospital beds necessary for the facility to be
674certified for Medicare reimbursement. Hospitals that discontinue
675inpatient care to become rural health care clinics or primary
676care programs shall deactivate all licensed general hospital
677beds. All hospitals, clinics, and programs with inactive beds
678shall provide 24-hour emergency medical care by staffing an
679emergency room. Providers with inactive beds shall be subject to
680the criteria in s. 395.1041. The agency shall specify in rule
681requirements for making 24-hour emergency care available.
682Inactive general hospital beds shall be included in the acute
683care bed inventory, maintained by the agency for certificate-of-
684need purposes, for 10 years from the date of deactivation of the
685beds. After 10 years have elapsed, inactive beds shall be
686excluded from the inventory. The agency shall, at the request of
687the licensee, reactivate the inactive general beds upon a
688showing by the licensee that licensure requirements for the
689inactive general beds are met.
690     Section 5.  Section 395.604, Florida Statutes, is amended
691to read:
692     395.604  Other Rural primary care hospitals hospital
694     (1)  The agency may license rural primary care hospitals
695subject to federal approval for participation in the Medicare
696and Medicaid programs. Rural primary care hospitals shall be
697treated in the same manner as emergency care hospitals and rural
698hospitals with respect to ss. 395.605(2)-(8)(a),
699408.033(2)(b)3., and 408.038.
700     (2)  The agency may designate essential access community
702     (2)(3)  The agency may adopt licensure rules for rural
703primary care hospitals and essential access community hospitals.
704Such rules must conform to s. 395.1055.
705     (3)  For the purpose of Medicaid swing-bed reimbursement
706pursuant to the Medicaid program, the agency shall treat rural
707primary care hospitals in the same manner as rural hospitals.
708     (4)  For the purpose of participation in the Medical
709Education Reimbursement and Loan Repayment Program as defined in
710s. 1009.65 or other loan repayment or incentive programs
711designed to relieve medical workforce shortages, the department
712shall treat rural primary care hospitals in the same manner as
713rural hospitals.
714     (5)  For the purpose of coordinating primary care services
715described in s. 154.011(1)(c)10., the department shall treat
716rural primary care hospitals in the same manner as rural
718     (6)  Rural hospitals that make application under the
719certificate-of-need program to be licensed as rural primary care
720hospitals shall receive expedited review as defined in s.
721408.032. Rural primary care hospitals seeking relicensure as
722acute care general hospitals shall also receive expedited
724     (7)  Rural primary care hospitals are exempt from
725certificate-of-need requirements for home health and hospice
726services and for swing beds in a number that does not exceed
727one-half of the facility's licensed beds.
728     (8)  Rural primary care hospitals shall have agreements
729with other hospitals, skilled nursing facilities, home health
730agencies, and providers of diagnostic-imaging and laboratory
731services that are not provided on site but are needed by
733     (4)  The department may seek federal recognition of
734emergency care hospitals authorized by s. 395.605 under the
735essential access community hospital program authorized by the
736Omnibus Budget Reconciliation Act of 1989.
737     Section 6.  Section 395.6061, Florida Statutes, is amended
738to read:
739     395.6061  Rural hospital capital improvement.--There is
740established a rural hospital capital improvement grant program.
741     (1)(a)  The purpose of the program is to provide targeted
742funding to rural hospitals to enable them to adapt to changes in
743health care delivery and funding and address disparities in
744rural health care by:
745     1.  Assisting in the development of needed infrastructure.
746     2.  Assisting financially distressed rural hospitals.
747     3.  Ensuring accountability for state and federal funding.
748     (b)  The rural hospital capital improvement grant program
749includes technical assistance and grants managed by the agency.
750     (2)(1)  A rural hospital as defined in s. 395.602 may apply
751to the department for a capital improvement grant to acquire,
752repair, improve, or upgrade systems, facilities, or equipment.
753The grant application must provide information that includes:
754     (a)  A statement indicating the problem the rural hospital
755proposes to solve with the grant funds.;
756     (b)  The strategy proposed to resolve the problem.;
757     (c)  The organizational structure, financial system, and
758facilities that are essential to the proposed solution.;
759     (d)  The projected longevity of the proposed solution after
760the grant funds are expended.;
761     (e)  Evidence of participation in a rural health network as
762defined in s. 381.0406 and evidence that the application is
763consistent with the required rural health infrastructure
764development plan.;
765     (f)  Evidence that the rural hospital has difficulty in
766obtaining funding or that funds available for the proposed
767solution are inadequate.;
768     (g)  Evidence that the grant funds will assist in
769maintaining or returning the hospital to an economically stable
770condition or enable the transition to the status of rural
771primary care hospital or that any plan for closure of the
772hospital or realignment of services will involve development of
773innovative alternatives for the provision of needed discontinued
775     (h)  Evidence of a satisfactory record-keeping system to
776account for grant fund expenditures within the rural county.;
777     (i)  A rural health network plan that includes a
778description of how the plan was developed, the goals of the
779plan, the links with existing health care providers under the
780plan, Indicators quantifying the hospital's financial status
781well-being, measurable outcome targets, and the current physical
782and operational condition of the hospital.
783     (3)(2)  Each rural hospital as defined in s. 395.602 shall
784receive a minimum of $100,000 annually, subject to legislative
785appropriation, upon application to the Department of Health, for
786projects to acquire, repair, improve, or upgrade systems,
787facilities, or equipment.
788     (4)(3)  Any remaining funds shall annually be disbursed to
789rural hospitals in accordance with this section. The Department
790of Health shall establish, by rule, criteria for awarding grants
791for any remaining funds, which must be used exclusively for the
792support and assistance of rural hospitals as defined in s.
793395.602, including criteria relating to the level of charity
794uncompensated care rendered by the hospital, the financial
795status of the hospital, the performance standards of the
796hospital, the participation in a rural health network as defined
797in s. 381.0406, and the proposed use of the grant by the rural
798hospital to resolve a specific problem. The department must
799consider any information submitted in an application for the
800grants in accordance with subsection (2) (1) in determining
801eligibility for and the amount of the grant, and none of the
802individual items of information by itself may be used to deny
803grant eligibility.
804     (5)  Financially distressed rural hospitals may receive
805preferential assistance under the capital improvement grant
806program to provide planning, management, and financial support.
807To receive this assistance the hospital must:
808     (a)  Provide additional information that includes:
809     1.  A statement of support from the board of directors of
810the hospital, the county commission, and the city commission.
811     2.  Evidence that the rural hospital and the community have
812difficulty obtaining funding or that funds available for the
813proposed solution are inadequate.
814     (b)  Agree to be bound by the terms of a participation
815agreement with the agency, which may include:
816     1.  The appointment of a health care expert under contract
817with the agency to analyze and monitor the hospital operations
818during the period of distress.
819     2.  The establishment of minimum standards for the
820education and experience of the managers and administrators of
821the hospital.
822     3.  The oversight and monitoring of a strategic plan to
823restore the hospital to an economically stable condition or
824transition to an alternative means to provide services.
825     4.  The establishment of a board orientation and
826development program.
827     5.  The approval of any facility relocation plans.
828     (6)(4)  The department shall ensure that the funds are used
829solely for the purposes specified in this section. The total
830grants awarded pursuant to this section shall not exceed the
831amount appropriated for this program.
832     Section 7.  Section 408.7054, Florida Statutes, is created
833to read:
834     408.7054  Rural Provider Service Network Development
836     (1)  There is established within the Agency for Health Care
837Administration the Rural Provider Service Network Development
838Program to support the implementation of provider service
839networks in rural counties of the state. The purpose of the
840program is to assist in the establishment of the infrastructure
841needed for Medicaid reform relating to prepaid and at-risk
842reimbursement plans to improve access to quality health care in
843rural areas.
844     (2)  The agency is authorized to provide funding through a
845grant program to entities seeking to establish rural provider
846service networks that have demonstrated an interest and have
847experience in organizing rural health care providers for this
849     (3)  Entities eligible for rural provider service network
850development grants must:
851     (a)  Have a written agreement signed by prospective
852members, 45 percent of whom must be providers in the targeted
853service area.
854     (b)  Include all rural hospitals, at least one federally
855qualified health center, and one county health department
856located in the service area.
857     (c)  Have a defined service area.
858     (4)  Each applicant for this funding shall provide the
859agency with a detailed written proposal that includes, at a
860minimum, a statement of need; a defined purpose; identification
861and explanation of the role of prospective partners; a signed
862memorandum of agreement or similar document attesting to the
863role of prospective partners; documented actions related to
864provider service network development; measurable objectives for
865the development of clinical and administrative infrastructure; a
866process of evaluation; and a process for developing a business
867plan and securing additional funding.
868     (5)  The agency is authorized to grant preferential funding
869to a rural provider service network based on the number of rural
870counties within the network's proposed service area that are
871Medically Underserved Areas or Health Professional Shortage
872Areas as defined by the Health Resources Services
873Administration, Office of Rural Health Policy, and based on
874whether the provider service network has a principal place of
875business located in a rural county in the state.
876     (6)  The agency is granted authority to develop rules
877pursuant to ss. 120.53(1) and 120.54 necessary to implement this
879     Section 8.  Subsection (43) of section 408.07, Florida
880Statutes, is amended to read:
881     408.07  Definitions.--As used in this chapter, with the
882exception of ss. 408.031-408.045, the term:
883     (43)  "Rural hospital" means an acute care hospital
884licensed under chapter 395, having 100 or fewer licensed beds
885and an emergency room, and which is:
886     (a)  The sole provider within a county with a population
887density of no greater than 100 persons per square mile;
888     (b)  An acute care hospital, in a county with a population
889density of no greater than 100 persons per square mile, which is
890at least 30 minutes of travel time, on normally traveled roads
891under normal traffic conditions, from another acute care
892hospital within the same county;
893     (c)  A hospital supported by a tax district or subdistrict
894whose boundaries encompass a population of 100 persons or fewer
895per square mile;
896     (d)  A hospital with a service area that has a population
897of 100 persons or fewer per square mile. As used in this
898paragraph, the term "service area" means the fewest number of
899zip codes that account for 75 percent of the hospital's
900discharges for the most recent 5-year period, based on
901information available from the hospital inpatient discharge
902database in the State Center for Health Statistics at the Agency
903for Health Care Administration; or
904     (e)  A critical access hospital.
906Population densities used in this subsection must be based upon
907the most recently completed United States census. A hospital
908that received funds under s. 409.9116 for a quarter beginning no
909later than July 1, 2002, is deemed to have been and shall
910continue to be a rural hospital from that date through June 30,
9112012, if the hospital continues to have 100 or fewer licensed
912beds and an emergency room, or meets the criteria of s.
913395.602(2)(d)(e)4. An acute care hospital that has not
914previously been designated as a rural hospital and that meets
915the criteria of this subsection shall be granted such
916designation upon application, including supporting
917documentation, to the Agency for Health Care Administration.
918     Section 9.  Subsection (6) of section 409.9116, Florida
919Statutes, is amended to read:
920     409.9116  Disproportionate share/financial assistance
921program for rural hospitals.--In addition to the payments made
922under s. 409.911, the Agency for Health Care Administration
923shall administer a federally matched disproportionate share
924program and a state-funded financial assistance program for
925statutory rural hospitals. The agency shall make
926disproportionate share payments to statutory rural hospitals
927that qualify for such payments and financial assistance payments
928to statutory rural hospitals that do not qualify for
929disproportionate share payments. The disproportionate share
930program payments shall be limited by and conform with federal
931requirements. Funds shall be distributed quarterly in each
932fiscal year for which an appropriation is made. Notwithstanding
933the provisions of s. 409.915, counties are exempt from
934contributing toward the cost of this special reimbursement for
935hospitals serving a disproportionate share of low-income
937     (6)  This section applies only to hospitals that were
938defined as statutory rural hospitals, or their successor-in-
939interest hospital, prior to January 1, 2001. Any additional
940hospital that is defined as a statutory rural hospital, or its
941successor-in-interest hospital, on or after January 1, 2001, is
942not eligible for programs under this section unless additional
943funds are appropriated each fiscal year specifically to the
944rural hospital disproportionate share and financial assistance
945programs in an amount necessary to prevent any hospital, or its
946successor-in-interest hospital, eligible for the programs prior
947to January 1, 2001, from incurring a reduction in payments
948because of the eligibility of an additional hospital to
949participate in the programs. A hospital, or its successor-in-
950interest hospital, which received funds pursuant to this section
951before January 1, 2001, and which qualifies under s.
952395.602(2)(d)(e), shall be included in the programs under this
953section and is not required to seek additional appropriations
954under this subsection.
955     Section 10.  Paragraph (b) of subsection (2) of section
9561009.65, Florida Statutes, is amended to read:
957     1009.65  Medical Education Reimbursement and Loan Repayment
959     (2)  From the funds available, the Department of Health
960shall make payments to selected medical professionals as
962     (b)  All payments shall be contingent on continued proof of
963primary care practice in an area defined in s. 395.602(2)(d)(e),
964or an underserved area designated by the Department of Health,
965provided the practitioner accepts Medicaid reimbursement if
966eligible for such reimbursement. Correctional facilities, state
967hospitals, and other state institutions that employ medical
968personnel shall be designated by the Department of Health as
969underserved locations. Locations with high incidences of infant
970mortality, high morbidity, or low Medicaid participation by
971health care professionals may be designated as underserved.
972     Section 11.  Section 395.605, Florida Statutes, is
974     Section 12.  Section 381.7366, Florida Statutes, is created
975to read:
976     381.7366  Office of Minority Health; legislative intent;
978     (1)  LEGISLATIVE INTENT.--The Legislature recognizes that
979despite significant investments in health care programs certain
980racial and ethnic populations suffer disproportionately with
981chronic diseases when compared to non-Hispanic whites. The
982Legislature intends to address these disparities by developing
983programs that target causal factors and recognize the specific
984health care needs of racial and ethnic minorities.
985     (2)  ORGANIZATION.--The Office of Minority Health is
986established within the Department of Health. The office shall be
987headed by a director who shall report directly to the Secretary
988of Health.
989     (3)  DUTIES.--The office shall:
990     (a)  Protect and promote the health and well-being of
991racial and ethnic populations in the state.
992     (b)  Focus on the issue of health disparities between
993racial and ethnic minority groups and the general population.
994     (c)  Coordinate the department's initiatives, programs, and
995policies to address racial and ethnic health disparities.
996     (d)  Communicate pertinent health information to affected
997racial and ethnic populations.
998     (e)  Collect and analyze data on the incidence and
999frequency of racial and ethnic health disparities.
1000     (f)  Promote and encourage cultural competence education
1001and training for healthcare professionals.
1002     (g)  Serve as a clearinghouse for the collection and
1003dissemination of information and research findings relating to
1004innovative approaches to the reduction or elimination of health
1006     (h)  Dedicate resources to increase public awareness of
1007minority health issues.
1008     (i)  Seek increased funding for local innovative
1009initiatives and administer grants designed to support
1010initiatives that address health disparities and that can be
1012     (j)  Provide staffing and support for the Closing the Gap
1013grant advisory council.
1014     (k)  Coordinate with other agencies, states, and the
1015Federal Government to reduce or eliminate health disparities.
1016     (l)  Collaborate with other public healthcare providers,
1017community and faith-based organizations, the private healthcare
1018system, historically black colleges and universities and other
1019minority institutions of higher education, medical schools, and
1020other health providers to establish a comprehensive and
1021inclusive approach to reducing health disparities.
1022     (m)  Encourage and support research into causes of racial
1023and ethnic health disparities.
1024     (n)  Collaborate with health professional training programs
1025to increase the number of minority healthcare professionals.
1026     (o)  Provide an annual report to the Governor, the
1027President of the Senate, and the Speaker of the House of
1028Representatives on the activities of the office.
1029     (4)  RESPONSIBILITY AND COORDINATION.--The office and the
1030department shall direct and carry out the duties established
1031under this section and shall work with other state agencies in
1032accomplishing these tasks.
1033     Section 13.  This act shall take effect July 1, 2006.

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