HB 7215

CS

CHAMBER ACTION

1	The Health & Families Council recommends the following:
2
3	Council/Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to rural health care; amending s.
7	381.0405, F.S.; revising the purpose and functions of the
8	Office of Rural Health in the Department of Health;
9	requiring the Secretary of Health and the Secretary of
10	Health Care Administration to appoint an advisory council
11	to advise the office; providing for terms of office of the
12	members of the advisory council; authorizing per diem and
13	travel reimbursement for members of the advisory council;
14	requiring a report to the Governor and Legislature;
15	amending s. 381.0406, F.S.; revising legislative findings
16	and intent with respect to rural health networks; revising
17	definitions; providing additional functions of and
18	requirements for membership in rural health networks;
19	requiring rural health networks to submit rural health
20	infrastructure development plans to the office by a
21	specified date; revising provisions relating to the
22	governance and organization of rural health networks;
23	revising the services to be provided by provider members
24	of rural health networks; requiring coordination among
25	rural health networks and area health education centers
26	and health planning councils; establishing performance
27	standards; establishing a grant program for funding rural
28	health networks; defining projects that may be funded
29	through the grant program; requiring the department to
30	establish rules governing rural health network grant
31	programs and performance standards; amending s. 395.602,
32	F.S.; defining "critical access hospital"; revising and
33	deleting definitions; amending s. 395.603, F.S.; deleting
34	a requirement that the Agency for Health Care
35	Administration adopt a rule relating to deactivation of
36	rural hospital beds under certain circumstances; requiring
37	that rural critical access hospitals maintain a certain
38	number of actively licensed beds; amending s. 395.604,
39	F.S.; removing emergency care hospitals and essential
40	access community hospitals from certain licensure
41	requirements; specifying certain special conditions for
42	rural primary care hospitals; amending s. 395.6061, F.S.;
43	specifying the purpose of the rural hospital capital
44	improvement grant program; providing for grant management
45	by the department; modifying the conditions for receiving
46	a grant; providing for preferential assistance for
47	financially distressed rural hospitals; providing purpose
48	of the program; providing requirements for receiving
49	certain assistance; requiring a participation agreement
50	and providing for contents thereof; creating s. 408.7054,
51	F.S.; establishing the Rural Provider Service Network
52	Development Program; providing purposes; authorizing the
53	agency to provide funding through a grant program for the
54	establishment of rural provider service networks;
55	providing eligibility requirements; authorizing
56	preferential funding to certain providers; authorizing the
57	agency to adopt rules; amending ss. 408.07, 409.9116, and
58	1009.65, F.S.; conforming cross-references; repealing s.
59	395.605, F.S., relating to the licensure of emergency care
60	hospitals; creating s. 381.7366, F.S.; establishing the
61	Office of Minority Health; providing legislative intent;
62	providing for organization, duties, and responsibilities;
63	requiring a report to the Governor and Legislature;
64	providing an effective date.
65
66	Be It Enacted by the Legislature of the State of Florida:
67
68	Section 1.  Section 381.0405, Florida Statutes, is amended
69	to read:
70	381.0405  Office of Rural Health.--
71	(1)  ESTABLISHMENT.--The Department of Health shall
72	establish an Office of Rural Health, which shall assist rural
73	health care providers in improving the health status and health
74	care of rural residents of this state and assist rural health
75	care providers in integrating their efforts. The Office of Rural
76	Health shall coordinate its activities with rural health
77	networks established under s. 381.0406, local health councils
78	established under s. 408.033, the area health education center
79	network established under pursuant to s. 381.0402, and with any
80	appropriate research and policy development centers within
81	universities that have state-approved medical schools. The
82	Office of Rural Health may enter into a formal relationship with
83	any center that designates the office as an affiliate of the
84	center.
85	(2)  PURPOSE.--The Office of Rural Health shall actively
86	foster the provision of high-quality health care services in
87	rural areas and serve as a catalyst for improved health services
88	to residents citizens in rural areas of the state.
89	(3)  GENERAL FUNCTIONS.--The office shall:
90	(a)  Integrate policies related to physician workforce,
91	hospitals, public health, and state regulatory functions.
92	(b)  Work with rural stakeholders in order to foster the
93	development of strategic planning that addresses Propose
94	solutions to problems affecting health care delivery in rural
95	areas.
96	(c)  Foster the expansion of rural health network service
97	areas to include rural counties that are not served by a rural
98	health network.
99	(d)(c)  Seek grant funds from foundations and the Federal
100	Government.
101	(e)  Administer state grant programs for rural health
102	networks.
103	(4)  COORDINATION.--The office shall:
104	(a)  Identify federal and state rural health programs and
105	provide information and technical assistance to rural providers
106	regarding participation in such programs.
107	(b)  Act as a clearinghouse for collecting and
108	disseminating information on rural health care issues, research
109	findings on rural health care, and innovative approaches to the
110	delivery of health care in rural areas.
111	(c)  Foster the creation of regional health care systems
112	that promote cooperation, rather than competition.
113	(d)  Coordinate the department's rural health care
114	activities, programs, and policies.
115	(e)  Design initiatives to improve access to primary,
116	acute, and emergency medical services and promote the
117	coordination of such services in rural areas.
118	(f)  Assume responsibility for state coordination of the
119	Rural Hospital Transition Grant Program, the Essential Access
120	Community Hospital Program, and other federal rural health care
121	grant programs.
122	(5)  TECHNICAL ASSISTANCE.--The office shall:
123	(a)  Assist Help rural health care providers in recruiting
124	obtain health care practitioners by promoting the location and
125	relocation of health care practitioners in rural areas and
126	promoting policies that create incentives for practitioners to
127	serve in rural areas.
128	(b)  Provide technical assistance to hospitals, community
129	and migrant health centers, and other health care providers that
130	serve residents in rural areas.
131	(c)  Assist with the design of strategies to improve health
132	care workforce recruitment and placement programs.
133	(d)  Provide technical assistance to rural health networks
134	in the formulation of their rural health infrastructure
135	development plans.
136	(e)  Provide links to best practices and other technical
137	assistance resources on the office's Internet website.
138	(6)  ADVISORY COUNCIL.--The Secretary of Health and the
139	Secretary of Health Care Administration shall each appoint no
140	more than five members with relevant health care operations
141	management, practice, and policy experience to an advisory
142	council to advise the office regarding its responsibilities
143	under this section and ss. 381.0406, 395.6061, and 395.6063.
144	Members must be appointed for 4-year staggered terms and may be
145	reappointed to a second term of office. Members shall serve
146	without compensation but are entitled to reimbursement for per
147	diem and travel expenses as provided in s. 112.061. The council
148	may appoint technical advisory teams as needed. The department
149	shall provide staff and other administrative assistance
150	reasonably necessary to assist the advisory council in carrying
151	out its duties.
152	(7)  REPORTS.--Beginning January 1, 2007, and annually
153	thereafter, the Office of Rural Health shall submit a report to
154	the Governor, the President of the Senate, and the Speaker of
155	the House of Representatives summarizing the activities of the
156	office, including the grants obtained or administered by the
157	office and the status of rural health networks and rural
158	hospitals in the state. The report must also include
159	recommendations for improvements in health care delivery in
160	rural areas of the state.
161	(8)(6)  RESEARCH PUBLICATIONS AND SPECIAL STUDIES.--The
162	office 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
166	use in department policy development.
167	(9)(7)  APPROPRIATION.--The Legislature shall appropriate
168	such sums as are necessary to support the Office of Rural
169	Health.
170	Section 2.  Section 381.0406, Florida Statutes, is amended
171	to read:
172	381.0406  Rural health networks.--
173	(1)  LEGISLATIVE FINDINGS AND INTENT.--
174	(a)  The Legislature finds that, in rural areas, access to
175	health care is limited and the quality of health care is
176	negatively affected by inadequate financing, difficulty in
177	recruiting and retaining skilled health professionals, and the
178	because of a migration of patients to urban areas for general
179	acute care and specialty services.
180	(b)  The Legislature further finds that the efficient and
181	effective delivery of health care services in rural areas
182	requires:
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-
186	effectiveness measures;
187	4.  The organization of health care providers into joint
188	contracting entities;
189	5.  The establishment of referral linkages;
190	6.  The analysis of costs and services in order to prepare
191	health 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
194	a continuum of quality health care services, including
195	preventive, primary, secondary, tertiary, and long-term care, is
196	essential to the economic and social vitality of rural
197	communities.
198	(d)  The Legislature further finds that health care
199	providers in rural areas are not prepared for market changes
200	such as the introduction of managed care and capitation-
201	reimbursement methodologies into health care services.
202	(e)(d)  The Legislature further finds that the creation of
203	rural health networks can help to alleviate these problems.
204	Rural health networks shall act in the broad public interest
205	and, to the extent possible, seek to improve the accessibility,
206	quality, and cost-effectiveness of rural health care by
207	planning, developing, coordinating, and providing be structured
208	to provide a continuum of quality health care services for rural
209	residents through the cooperative efforts of rural health
210	network members and other health care providers.
211	(f)(e)  The Legislature further finds that rural health
212	networks shall have the goal of increasing the financial
213	stability of statutory rural hospitals by linking rural hospital
214	services to other services in a continuum of health care
215	services and by increasing the utilization of statutory rural
216	hospitals whenever for appropriate health care services whenever
217	feasible, which shall help to ensure their survival and thereby
218	support the economy and protect the health and safety of rural
219	residents.
220	(g)(f)  Finally, the Legislature finds that rural health
221	networks may serve as "laboratories" to determine the best way
222	of organizing rural health services and linking to out-of-area
223	services that are not available locally in order, to move the
224	state closer to ensuring that everyone has access to health
225	care, and to promote cost containment efforts.  The ultimate
226	goal of rural health networks shall be to ensure that quality
227	health care is available and efficiently delivered to all
228	persons in rural areas.
229	(2)  DEFINITIONS.--
230	(a)  "Rural" means an area having with a population density
231	of fewer less than 100 individuals per square mile or an area
232	defined by the most recent United States Census as rural.
233	(b)  "Health care provider" means any individual, group, or
234	entity, public or private, which that provides health care,
235	including: preventive health care, primary health care,
236	secondary and tertiary health care, hospital in-hospital health
237	care, public health care, and health promotion and education.
238	(c)  "Rural health network" or "network" means a nonprofit
239	legal entity, whose members consist consisting of rural and
240	urban health care providers and others, and which that is
241	established organized to plan, develop, organize, and deliver
242	health care services on a cooperative basis in a rural area,
243	except for some secondary and tertiary care services.
244	(3)  NETWORK MEMBERSHIP.--
245	(a)  Because each rural area is unique, with a different
246	health care provider mix, health care provider membership may
247	vary, but all networks shall include members that provide health
248	promotion and disease prevention services, public health
249	services, comprehensive primary care, emergency medical care,
250	and acute inpatient care.
251	(b)  Each county health department shall be a member of the
252	rural health network whose service area includes the county in
253	which the county health department is located. Federally
254	qualified health centers and emergency medical services
255	providers are encouraged to become members of the rural health
256	networks in the areas in which their patients reside or receive
257	services.
258	(c)(4)  Network membership shall be available to all health
259	care providers in the network service area if, provided that
260	they render care to all patients referred to them from other
261	network members;, comply with network quality assurance, quality
262	improvement, and utilization-management and risk management
263	requirements; and, abide by the terms and conditions of network
264	provider agreements in paragraph (11)(c), and provide services
265	at a rate or price equal to the rate or price negotiated by the
266	network.
267	(4)(5)  NETWORK SERVICE AREAS.--Network service areas are
268	do not required need to conform to local political boundaries or
269	state administrative district boundaries. The geographic area of
270	one rural health network, however, may not overlap the territory
271	of any other rural health network.
272	(5)(6)  NETWORK FUNCTIONS.--Networks shall:
273	(a)  Seek to develop linkages with provisions for referral
274	to tertiary inpatient care, specialty physician care, and to
275	other services that are not available in rural service areas.
276	(b)(7)  Networks shall Make available health promotion,
277	disease prevention, and primary care services, in order to
278	improve the health status of rural residents and to contain
279	health care costs.
280	(8)  Networks may have multiple points of entry, such as
281	through private physicians, community health centers, county
282	health departments, certified rural health clinics, hospitals,
283	or other providers; or they may have a single point of entry.
284	(c)(9)  Encourage members through training and educational
285	programs to adopt standards of care, and promote the evidence-
286	based practice of medicine. Networks shall establish standard
287	protocols, coordinate and share patient records, and develop
288	patient information exchange systems in order to improve quality
289	and access to services.
290	(d)  Develop quality-improvement programs and train network
291	members and other health care providers in the use of such
292	programs.
293	(e)  Develop disease-management systems and train network
294	members and other health care providers in the use of such
295	systems.
296	(f)  Promote outreach to areas with a high need for
297	services.
298	(g)  Seek to develop community care alternatives for elders
299	who would otherwise be placed in nursing homes.
300	(h)  Emphasize community care alternatives for persons with
301	mental health and substance abuse disorders who are at risk of
302	being admitted to an institution.
303	(i)  Develop and implement a rural health infrastructure
304	development plan for an integrated system of care that is
305	responsive to the unique local health needs and the area health
306	care services market. Each rural health infrastructure
307	development plan must address strategies to improve access to
308	specialty care, train health care providers to use standards of
309	care for chronic illness, develop disease-management capacity,
310	and link to state and national quality-improvement initiatives.
311	The initial development plan must be submitted to the Office of
312	Rural Health for review and approval no later than July 1, 2007,
313	and thereafter the plans must be updated and submitted to the
314	Office of Rural Health every 3 years.
315	(10)  Networks shall develop risk management and quality
316	assurance programs for network providers.
317	(6)(11)  NETWORK GOVERNANCE AND ORGANIZATION.--
318	(a)  Networks shall be incorporated as not-for-profit
319	corporations under chapter 617, with articles of incorporation
320	that set forth purposes consistent with this section the laws of
321	the state.
322	(b)  Each network Networks shall have an independent a
323	board of directors that derives membership from local
324	government, health care providers, businesses, consumers,
325	advocacy groups, and others. Boards of other community health
326	care entities may not serve in whole as the board of a rural
327	health network; however, some overlap of board membership with
328	other community organizations is encouraged. Network staff must
329	provide an annual orientation and strategic planning activity
330	for board members.
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 written
334	agreements between the network and its health care provider
335	members must specify participation in the essential functions of
336	the network and shall specify:
337	1.  Who provides what services.
338	2.  The extent to which the health care provider provides
339	care to persons who lack health insurance or are otherwise
340	unable to pay for care.
341	3.  The procedures for transfer of medical records.
342	4.  The method used for the transportation of patients
343	between providers.
344	5.  Referral and patient flow including appointments and
345	scheduling.
346	6.  Payment arrangements for the transfer or referral of
347	patients.
348	(d)  There shall be no liability on the part of, and no
349	cause of action of any nature shall arise against, any member of
350	a network board of directors, or its employees or agents, for
351	any lawful action taken by them in the performance of their
352	administrative powers and duties under this subsection.
353	(7)(12)  NETWORK PROVIDER MEMBER SERVICES.--
354	(a)  Networks, to the extent feasible, shall seek to
355	develop services that provide for a continuum of care for all
356	residents patients served by the network. Each network shall
357	recruit members that can provide include the following core
358	services: disease prevention, health promotion, comprehensive
359	primary care, emergency medical care, and acute inpatient care.
360	Each network shall seek to ensure the availability of
361	comprehensive maternity care, including prenatal, delivery, and
362	postpartum care for uncomplicated pregnancies, either directly,
363	by contract, or through referral agreements. Networks shall, to
364	the extent feasible, develop local services and linkages among
365	health care providers to also ensure the availability of the
366	following services: within the specified timeframes, either
367	directly, 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
372	less.
373	3.a.  Emergency medical services, including advanced life
374	support, ambulance, and basic emergency room services.
375	4.b.  Primary care, including.
376	c.  prenatal and postpartum care for uncomplicated
377	pregnancies.
378	5.d.  Community-based services for elders, such as adult
379	day care and assistance with activities of daily living.
380	6.e.  Public health services, including communicable
381	disease control, disease prevention, health education, and
382	health promotion.
383	7.f.  Outpatient mental health psychiatric and substance
384	abuse services.
385	3.  Services accessible within 45 minutes travel time or
386	less.
387	8.a.  Hospital acute inpatient care for persons whose
388	illnesses or medical problems are not severe.
389	9.b.  Level I obstetrical care, which is Labor and delivery
390	for low-risk patients.
391	10.c.  Skilled nursing services and, long-term care,
392	including nursing home care.
393	(b)  Networks shall seek to foster linkages with out-of-
394	area services to the extent feasible to ensure the availability
395	of:
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
401	and medical problems.
402	5.c.  Level II and III obstetrical care, which is Labor and
403	delivery care for high-risk patients and neonatal intensive
404	care.
405	6.d.  Comprehensive medical rehabilitation.
406	7.e.  Inpatient mental health psychiatric and substance
407	abuse services.
408	8.f.  Magnetic resonance imaging, lithotripter treatment,
409	oncology, advanced radiology, and other technologically advanced
410	services.
411	9.g.  Subacute care.
412	(8)  COORDINATION WITH OTHER ENTITIES.--
413	(a)  Area health education centers and health planning
414	councils shall participate in the rural health networks'
415	preparation of development plans. The Department of Health may
416	require a written memorandum of agreement between a network and
417	an area health education center or health planning 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, long-distance learning, and the
424	treatment of chronic illness using standards of care. As used in
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)  Rural health networks shall contract with local health
429	planning councils to support the preparation of development
430	plans through data collection and analysis in order to assess
431	the health status of area residents and the capacity of local
432	health services.
433	(d)(b)  Networks shall actively participate with area
434	health education center programs, whenever feasible, in
435	developing and implementing recruitment, training, and retention
436	programs directed at positively influencing the supply and
437	distribution of health care professionals serving in, or
438	receiving training in, network areas.
439	(c)  As funds become available, networks shall emphasize
440	community care alternatives for elders who would otherwise be
441	placed in nursing homes.
442	(d)  To promote the most efficient use of resources,
443	networks shall emphasize disease prevention, early diagnosis and
444	treatment of medical problems, and community care alternatives
445	for persons with mental health and substance abuse disorders who
446	are at risk to be institutionalized.
447	(e)(13)  TRAUMA SERVICES.--In those network areas having
448	which have an established trauma agency approved by the
449	Department of Health, the network shall seek the participation
450	of that trauma agency must be a participant in the network.
451	Trauma services provided within the network area must comply
452	with s. 395.405.
453	(9)(14)  NETWORK FINANCING.--
454	(a)  Networks may use all sources of public and private
455	funds to support network activities. Nothing in this section
456	prohibits networks from becoming managed care providers.
457	(b)  The Department of Health shall establish grant
458	programs to provide funding to support the administrative costs
459	of developing and operating rural health networks.
460	(10)  NETWORK PERFORMANCE STANDARDS.--The Department of
461	Health shall develop and enforce performance standards for rural
462	health network operations grants and rural health infrastructure
463	development grants.
464	(a)  Operations grant performance standards must include,
465	but are not limited to, standards that require the rural health
466	network to:
467	1.  Have a qualified board of directors that meets at least
468	quarterly.
469	2.  Have sufficient staff who have the qualifications and
470	experience to perform the requirements of this section, as
471	assessed by the Office of Rural Health, or a written plan to
472	obtain such staff.
473	3.  Comply with the department's grant management standards
474	in a timely and responsive manner.
475	4.  Comply with the department's standards for the
476	administration of federal grant funding, including assistance to
477	rural hospitals.
478	5.  Demonstrate a commitment to network activities from
479	area health care providers and other stakeholders, as described
480	in letters of support.
481	(b)  Rural health infrastructure development grant
482	performance standards must include, but are not limited to,
483	standards that require the rural health network to:
484	1.  During the 2006-2007 fiscal year prepare a development
485	plan and, after July 1, 2007, have a development plan that has
486	been reviewed and approved by the Office of Rural Health.
487	2.  Have two or more successful network-development
488	activities, such as:
489	a.  Management of a network development or outreach grant
490	from the federal Office of Rural Health Policy;
491	b.  Implementation of outreach programs to address chronic
492	disease, infant mortality, or assistance with prescription
493	medication;
494	c.  Development of partnerships with community and faith-
495	based organizations to address area health problems;
496	d.  Provision of direct services, such as clinics or mobile
497	units;
498	e.  Operation of credentialing services for health care
499	providers or quality assurance and quality improvement
500	initiatives that, whenever possible, are consistent with state
501	or federal quality initiatives;
502	f.  Support for the development of community health
503	centers, local community health councils, federal designation as
504	a rural critical access hospital, or comprehensive community
505	health planning initiatives; and
506	g.  Development of the capacity to obtain federal, state,
507	and foundation grants.
508	(11)(15)  NETWORK IMPLEMENTATION.--As funds become
509	available, networks shall be developed and implemented in two
510	phases.
511	(a)  Phase I shall consist of a network planning and
512	development grant program. Planning grants shall be used to
513	organize networks, incorporate network boards, and develop
514	formal provider agreements as provided for in this section.  The
515	Department of Health shall develop a request-for-proposal
516	process to solicit grant applications.
517	(b)  Phase II shall consist of a network operations grant
518	program. As funds become available, certified networks that meet
519	performance standards shall be eligible to receive grant funds
520	to be used to help defray the costs of rural health network
521	infrastructure development, patient care, and network
522	administration. Rural health network infrastructure development
523	includes, but is not limited to: recruitment and retention of
524	primary care practitioners; enhancements of primary care
525	services through the use of mobile clinics; development of
526	preventive health care programs; linkage of urban and rural
527	health care systems; design and implementation of automated
528	patient records, outcome measurement, quality assurance, and
529	risk management systems; establishment of one-stop service
530	delivery sites; upgrading of medical technology available to
531	network providers; enhancement of emergency medical systems;
532	enhancement of medical transportation; formation of joint
533	contracting entities composed of rural physicians, rural
534	hospitals, and other rural health care providers; establishment
535	of comprehensive disease management programs that meet Medicaid
536	requirements; establishment of regional quality improvement
537	programs involving physicians and hospitals consistent with
538	state and national initiatives; establishment of specialty
539	networks connecting rural primary care physicians and urban
540	specialists; development of regional broadband
541	telecommunications systems that have the capacity to share
542	patient information in a secure network, telemedicine, and long-
543	distance learning capacity; and linkage between training
544	programs for health care practitioners and the delivery of
545	health care services in rural areas and development of
546	telecommunication capabilities. A Phase II award may occur in
547	the same fiscal year as a Phase I award.
548	(12)(16)  CERTIFICATION.--For the purpose of certifying
549	networks that are eligible for Phase II funding, the Department
550	of Health shall certify networks that meet the criteria
551	delineated in this section and the rules governing rural health
552	networks. The Office of Rural Health in the Department of Health
553	shall monitor rural health networks in order to ensure continued
554	compliance with established certification and performance
555	standards.
556	(13)(17)  RULES.--The Department of Health shall establish
557	rules pursuant to s. 120.536(1) and 120.54 that govern the
558	creation and certification of networks, the provision of grant
559	funds under Phase I and Phase II, and the establishment of
560	performance standards including establishing outcome measures
561	for networks.
562	Section 3.  Subsection (2) of section 395.602, Florida
563	Statutes, 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
567	the definition of rural hospital in paragraph (d) and meets the
568	requirements for reimbursement by Medicare and Medicaid under 42
569	C.F.R. ss. 485.601-485.647. "Emergency care hospital" means a
570	medical facility which provides:
571	1.  Emergency medical treatment; and
572	2.  Inpatient care to ill or injured persons prior to their
573	transportation to another hospital or provides inpatient medical
574	care to persons needing care for a period of up to 96 hours. The
575	96-hour limitation on inpatient care does not apply to respite,
576	skilled nursing, hospice, or other nonacute care patients.
577	(b)  "Essential access community hospital" means any
578	facility which:
579	1.  Has at least 100 beds;
580	2.  Is located more than 35 miles from any other essential
581	access community hospital, rural referral center, or urban
582	hospital meeting criteria for classification as a regional
583	referral center;
584	3.  Is part of a network that includes rural primary care
585	hospitals;
586	4.  Provides emergency and medical backup services to rural
587	primary care hospitals in its rural health network;
588	5.  Extends staff privileges to rural primary care hospital
589	physicians in its network; and
590	6.  Accepts patients transferred from rural primary care
591	hospitals in its network.
592	(b)(c)  "Inactive rural hospital bed" means a licensed
593	acute care hospital bed, as defined in s. 395.002(14), that is
594	inactive in that it cannot be occupied by acute care inpatients.
595	(c)(d)  "Rural area health education center" means an area
596	health education center (AHEC), as authorized by Pub. L. No. 94-
597	484, that which provides services in a county with a population
598	density of no greater than 100 persons per square mile.
599	(d)(e)  "Rural hospital" means an acute care hospital
600	licensed under this chapter, having 100 or fewer licensed beds
601	and an emergency room, that which is:
602	1.  The sole provider within a county with a population
603	density of no greater than 100 persons per square mile;
604	2.  An acute care hospital, in a county with a population
605	density of no greater than 100 persons per square mile, that
606	which is at least 30 minutes of travel time, on normally
607	traveled roads under normal traffic conditions, from any other
608	acute care hospital within the same county;
609	3.  A hospital supported by a tax district or subdistrict
610	whose boundaries encompass a population of 100 persons or fewer
611	per square mile;
612	4.  A hospital in a constitutional charter county with a
613	population of over 1 million persons that has imposed a local
614	option health service tax pursuant to law and in an area that
615	was directly impacted by a catastrophic event on August 24,
616	1992, for which the Governor of Florida declared a state of
617	emergency pursuant to chapter 125, and has 120 beds or fewer
618	less that serves an agricultural community with an emergency
619	room utilization of no less than 20,000 visits and a Medicaid
620	inpatient utilization rate greater than 15 percent;
621	5.  A hospital with a service area that has a population of
622	100 persons or fewer per square mile. As used in this
623	subparagraph, the term "service area" means the fewest number of
624	zip codes that account for 75 percent of the hospital's
625	discharges for the most recent 5-year period, based on
626	information available from the hospital inpatient discharge
627	database in the State Center for Health Statistics at the Agency
628	for Health Care Administration; or
629	6.  A hospital designated as a critical access hospital, as
630	defined in s. 408.07(15).
631
632	Population densities used in this paragraph must be based upon
633	the most recently completed United States census. A hospital
634	that received funds under s. 409.9116 for a quarter beginning no
635	later than July 1, 2002, is deemed to have been and shall
636	continue to be a rural hospital from that date through June 30,
637	2012, if the hospital continues to have 100 or fewer licensed
638	beds and an emergency room, or meets the criteria of
639	subparagraph 4. An acute care hospital that has not previously
640	been designated as a rural hospital and that meets the criteria
641	of this paragraph shall be granted such designation upon
642	application, including supporting documentation to the Agency
643	for Health Care Administration.
644	(e)(f)  "Rural primary care hospital" means any facility
645	that meeting the criteria in paragraph (e) or s. 395.605 which
646	provides:
647	1.  Twenty-four-hour emergency medical care;
648	2.  Temporary inpatient care for periods of 96 72 hours or
649	less to patients requiring stabilization before discharge or
650	transfer to another hospital. The 96-hour 72-hour limitation
651	does not apply to respite, skilled nursing, hospice, or other
652	nonacute care patients; and
653	3.  Has at least no more than six licensed acute care
654	inpatient beds.
655	(f)(g)  "Swing-bed" means a bed that which can be used
656	interchangeably as either a hospital, skilled nursing facility
657	(SNF), or intermediate care facility (ICF) bed pursuant to 42
658	C.F.R. parts 405, 435, 440, 442, and 447.
659	Section 4.  Subsection (1) of section 395.603, Florida
660	Statutes, is amended to read:
661	395.603  Deactivation of general hospital beds; rural
662	hospital impact statement.--
663	(1)  The agency shall establish, by rule, a process by
664	which A rural hospital, as defined in s. 395.602, that seeks
665	licensure as a rural primary care hospital or as an emergency
666	care hospital, or becomes a certified rural health clinic as
667	defined in Pub. L. No. 95-210, or becomes a primary care program
668	such as a county health department, community health center, or
669	other similar outpatient program that provides preventive and
670	curative services, may deactivate general hospital beds. A rural
671	critical access hospital Rural primary care hospitals and
672	emergency care hospitals shall maintain the number of actively
673	licensed general hospital beds necessary for the facility to be
674	certified for Medicare reimbursement. Hospitals that discontinue
675	inpatient care to become rural health care clinics or primary
676	care programs shall deactivate all licensed general hospital
677	beds. All hospitals, clinics, and programs with inactive beds
678	shall provide 24-hour emergency medical care by staffing an
679	emergency room. Providers with inactive beds shall be subject to
680	the criteria in s. 395.1041. The agency shall specify in rule
681	requirements for making 24-hour emergency care available.
682	Inactive general hospital beds shall be included in the acute
683	care bed inventory, maintained by the agency for certificate-of-
684	need purposes, for 10 years from the date of deactivation of the
685	beds. After 10 years have elapsed, inactive beds shall be
686	excluded from the inventory. The agency shall, at the request of
687	the licensee, reactivate the inactive general beds upon a
688	showing by the licensee that licensure requirements for the
689	inactive general beds are met.
690	Section 5.  Section 395.604, Florida Statutes, is amended
691	to read:
692	395.604  Other Rural primary care hospitals hospital
693	programs.--
694	(1)  The agency may license rural primary care hospitals
695	subject to federal approval for participation in the Medicare
696	and Medicaid programs. Rural primary care hospitals shall be
697	treated in the same manner as emergency care hospitals and rural
698	hospitals with respect to ss. 395.605(2)-(8)(a),
699	408.033(2)(b)3., and 408.038.
700	(2)  The agency may designate essential access community
701	hospitals.
702	(2)(3)  The agency may adopt licensure rules for rural
703	primary care hospitals and essential access community hospitals.
704	Such rules must conform to s. 395.1055.
705	(3)  For the purpose of Medicaid swing-bed reimbursement
706	pursuant to the Medicaid program, the agency shall treat rural
707	primary care hospitals in the same manner as rural hospitals.
708	(4)  For the purpose of participation in the Medical
709	Education Reimbursement and Loan Repayment Program as defined in
710	s. 1009.65 or other loan repayment or incentive programs
711	designed to relieve medical workforce shortages, the department
712	shall treat rural primary care hospitals in the same manner as
713	rural hospitals.
714	(5)  For the purpose of coordinating primary care services
715	described in s. 154.011(1)(c)10., the department shall treat
716	rural primary care hospitals in the same manner as rural
717	hospitals.
718	(6)  Rural hospitals that make application under the
719	certificate-of-need program to be licensed as rural primary care
720	hospitals shall receive expedited review as defined in s.
721	408.032. Rural primary care hospitals seeking relicensure as
722	acute care general hospitals shall also receive expedited
723	review.
724	(7)  Rural primary care hospitals are exempt from
725	certificate-of-need requirements for home health and hospice
726	services and for swing beds in a number that does not exceed
727	one-half of the facility's licensed beds.
728	(8)  Rural primary care hospitals shall have agreements
729	with other hospitals, skilled nursing facilities, home health
730	agencies, and providers of diagnostic-imaging and laboratory
731	services that are not provided on site but are needed by
732	patients.
733	(4)  The department may seek federal recognition of
734	emergency care hospitals authorized by s. 395.605 under the
735	essential access community hospital program authorized by the
736	Omnibus Budget Reconciliation Act of 1989.
737	Section 6.  Section 395.6061, Florida Statutes, is amended
738	to read:
739	395.6061  Rural hospital capital improvement.--There is
740	established a rural hospital capital improvement grant program.
741	(1)(a)  The purpose of the program is to provide targeted
742	funding to rural hospitals to enable them to adapt to changes in
743	health care delivery and funding and address disparities in
744	rural 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
749	includes technical assistance and grants managed by the agency.
750	(2)(1)  A rural hospital as defined in s. 395.602 may apply
751	to the department for a capital improvement grant to acquire,
752	repair, improve, or upgrade systems, facilities, or equipment.
753	The grant application must provide information that includes:
754	(a)  A statement indicating the problem the rural hospital
755	proposes to solve with the grant funds.;
756	(b)  The strategy proposed to resolve the problem.;
757	(c)  The organizational structure, financial system, and
758	facilities that are essential to the proposed solution.;
759	(d)  The projected longevity of the proposed solution after
760	the grant funds are expended.;
761	(e)  Evidence of participation in a rural health network as
762	defined in s. 381.0406 and evidence that the application is
763	consistent with the required rural health infrastructure
764	development plan.;
765	(f)  Evidence that the rural hospital has difficulty in
766	obtaining funding or that funds available for the proposed
767	solution are inadequate.;
768	(g)  Evidence that the grant funds will assist in
769	maintaining or returning the hospital to an economically stable
770	condition or enable the transition to the status of rural
771	primary care hospital or that any plan for closure of the
772	hospital or realignment of services will involve development of
773	innovative alternatives for the provision of needed discontinued
774	services.;
775	(h)  Evidence of a satisfactory record-keeping system to
776	account for grant fund expenditures within the rural county.;
777	(i)  A rural health network plan that includes a
778	description of how the plan was developed, the goals of the
779	plan, the links with existing health care providers under the
780	plan, Indicators quantifying the hospital's financial status
781	well-being, measurable outcome targets, and the current physical
782	and operational condition of the hospital.
783	(3)(2)  Each rural hospital as defined in s. 395.602 shall
784	receive a minimum of $100,000 annually, subject to legislative
785	appropriation, upon application to the Department of Health, for
786	projects to acquire, repair, improve, or upgrade systems,
787	facilities, or equipment.
788	(4)(3)  Any remaining funds shall annually be disbursed to
789	rural hospitals in accordance with this section. The Department
790	of Health shall establish, by rule, criteria for awarding grants
791	for any remaining funds, which must be used exclusively for the
792	support and assistance of rural hospitals as defined in s.
793	395.602, including criteria relating to the level of charity
794	uncompensated care rendered by the hospital, the financial
795	status of the hospital, the performance standards of the
796	hospital, the participation in a rural health network as defined
797	in s. 381.0406, and the proposed use of the grant by the rural
798	hospital to resolve a specific problem. The department must
799	consider any information submitted in an application for the
800	grants in accordance with subsection (2) (1) in determining
801	eligibility for and the amount of the grant, and none of the
802	individual items of information by itself may be used to deny
803	grant eligibility.
804	(5)  Financially distressed rural hospitals may receive
805	preferential assistance under the capital improvement grant
806	program to provide planning, management, and financial support.
807	To 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
810	the hospital, the county commission, and the city commission.
811	2.  Evidence that the rural hospital and the community have
812	difficulty obtaining funding or that funds available for the
813	proposed solution are inadequate.
814	(b)  Agree to be bound by the terms of a participation
815	agreement with the agency, which may include:
816	1.  The appointment of a health care expert under contract
817	with the agency to analyze and monitor the hospital operations
818	during the period of distress.
819	2.  The establishment of minimum standards for the
820	education and experience of the managers and administrators of
821	the hospital.
822	3.  The oversight and monitoring of a strategic plan to
823	restore the hospital to an economically stable condition or
824	transition to an alternative means to provide services.
825	4.  The establishment of a board orientation and
826	development program.
827	5.  The approval of any facility relocation plans.
828	(6)(4)  The department shall ensure that the funds are used
829	solely for the purposes specified in this section. The total
830	grants awarded pursuant to this section shall not exceed the
831	amount appropriated for this program.
832	Section 7.  Section 408.7054, Florida Statutes, is created
833	to read:
834	408.7054  Rural Provider Service Network Development
835	Program.--
836	(1)  There is established within the Agency for Health Care
837	Administration the Rural Provider Service Network Development
838	Program to support the implementation of provider service
839	networks in rural counties of the state. The purpose of the
840	program is to assist in the establishment of the infrastructure
841	needed for Medicaid reform relating to prepaid and at-risk
842	reimbursement plans to improve access to quality health care in
843	rural areas.
844	(2)  The agency is authorized to provide funding through a
845	grant program to entities seeking to establish rural provider
846	service networks that have demonstrated an interest and have
847	experience in organizing rural health care providers for this
848	purpose.
849	(3)  Entities eligible for rural provider service network
850	development grants must:
851	(a)  Have a written agreement signed by prospective
852	members, 45 percent of whom must be providers in the targeted
853	service area.
854	(b)  Include all rural hospitals, at least one federally
855	qualified health center, and one county health department
856	located in the service area.
857	(c)  Have a defined service area.
858	(4)  Each applicant for this funding shall provide the
859	agency with a detailed written proposal that includes, at a
860	minimum, a statement of need; a defined purpose; identification
861	and explanation of the role of prospective partners; a signed
862	memorandum of agreement or similar document attesting to the
863	role of prospective partners; documented actions related to
864	provider service network development; measurable objectives for
865	the development of clinical and administrative infrastructure; a
866	process of evaluation; and a process for developing a business
867	plan and securing additional funding.
868	(5)  The agency is authorized to grant preferential funding
869	to a rural provider service network based on the number of rural
870	counties within the network's proposed service area that are
871	Medically Underserved Areas or Health Professional Shortage
872	Areas as defined by the Health Resources Services
873	Administration, Office of Rural Health Policy, and based on
874	whether the provider service network has a principal place of
875	business located in a rural county in the state.
876	(6)  The agency is granted authority to develop rules
877	pursuant to ss. 120.53(1) and 120.54 necessary to implement this
878	section.
879	Section 8.  Subsection (43) of section 408.07, Florida
880	Statutes, is amended to read:
881	408.07  Definitions.--As used in this chapter, with the
882	exception of ss. 408.031-408.045, the term:
883	(43)  "Rural hospital" means an acute care hospital
884	licensed under chapter 395, having 100 or fewer licensed beds
885	and an emergency room, and which is:
886	(a)  The sole provider within a county with a population
887	density of no greater than 100 persons per square mile;
888	(b)  An acute care hospital, in a county with a population
889	density of no greater than 100 persons per square mile, which is
890	at least 30 minutes of travel time, on normally traveled roads
891	under normal traffic conditions, from another acute care
892	hospital within the same county;
893	(c)  A hospital supported by a tax district or subdistrict
894	whose boundaries encompass a population of 100 persons or fewer
895	per square mile;
896	(d)  A hospital with a service area that has a population
897	of 100 persons or fewer per square mile. As used in this
898	paragraph, the term "service area" means the fewest number of
899	zip codes that account for 75 percent of the hospital's
900	discharges for the most recent 5-year period, based on
901	information available from the hospital inpatient discharge
902	database in the State Center for Health Statistics at the Agency
903	for Health Care Administration; or
904	(e)  A critical access hospital.
905
906	Population densities used in this subsection must be based upon
907	the most recently completed United States census. A hospital
908	that received funds under s. 409.9116 for a quarter beginning no
909	later than July 1, 2002, is deemed to have been and shall
910	continue to be a rural hospital from that date through June 30,
911	2012, if the hospital continues to have 100 or fewer licensed
912	beds and an emergency room, or meets the criteria of s.
913	395.602(2)(d)(e)4. An acute care hospital that has not
914	previously been designated as a rural hospital and that meets
915	the criteria of this subsection shall be granted such
916	designation upon application, including supporting
917	documentation, to the Agency for Health Care Administration.
918	Section 9.  Subsection (6) of section 409.9116, Florida
919	Statutes, is amended to read:
920	409.9116  Disproportionate share/financial assistance
921	program for rural hospitals.--In addition to the payments made
922	under s. 409.911, the Agency for Health Care Administration
923	shall administer a federally matched disproportionate share
924	program and a state-funded financial assistance program for
925	statutory rural hospitals. The agency shall make
926	disproportionate share payments to statutory rural hospitals
927	that qualify for such payments and financial assistance payments
928	to statutory rural hospitals that do not qualify for
929	disproportionate share payments. The disproportionate share
930	program payments shall be limited by and conform with federal
931	requirements. Funds shall be distributed quarterly in each
932	fiscal year for which an appropriation is made. Notwithstanding
933	the provisions of s. 409.915, counties are exempt from
934	contributing toward the cost of this special reimbursement for
935	hospitals serving a disproportionate share of low-income
936	patients.
937	(6)  This section applies only to hospitals that were
938	defined as statutory rural hospitals, or their successor-in-
939	interest hospital, prior to January 1, 2001. Any additional
940	hospital that is defined as a statutory rural hospital, or its
941	successor-in-interest hospital, on or after January 1, 2001, is
942	not eligible for programs under this section unless additional
943	funds are appropriated each fiscal year specifically to the
944	rural hospital disproportionate share and financial assistance
945	programs in an amount necessary to prevent any hospital, or its
946	successor-in-interest hospital, eligible for the programs prior
947	to January 1, 2001, from incurring a reduction in payments
948	because of the eligibility of an additional hospital to
949	participate in the programs. A hospital, or its successor-in-
950	interest hospital, which received funds pursuant to this section
951	before January 1, 2001, and which qualifies under s.
952	395.602(2)(d)(e), shall be included in the programs under this
953	section and is not required to seek additional appropriations
954	under this subsection.
955	Section 10.  Paragraph (b) of subsection (2) of section
956	1009.65, Florida Statutes, is amended to read:
957	1009.65  Medical Education Reimbursement and Loan Repayment
958	Program.--
959	(2)  From the funds available, the Department of Health
960	shall make payments to selected medical professionals as
961	follows:
962	(b)  All payments shall be contingent on continued proof of
963	primary care practice in an area defined in s. 395.602(2)(d)(e),
964	or an underserved area designated by the Department of Health,
965	provided the practitioner accepts Medicaid reimbursement if
966	eligible for such reimbursement. Correctional facilities, state
967	hospitals, and other state institutions that employ medical
968	personnel shall be designated by the Department of Health as
969	underserved locations. Locations with high incidences of infant
970	mortality, high morbidity, or low Medicaid participation by
971	health care professionals may be designated as underserved.
972	Section 11.  Section 395.605, Florida Statutes, is
973	repealed.
974	Section 12.  Section 381.7366, Florida Statutes, is created
975	to read:
976	381.7366  Office of Minority Health; legislative intent;
977	duties.--
978	(1)  LEGISLATIVE INTENT.--The Legislature recognizes that
979	despite significant investments in health care programs certain
980	racial and ethnic populations suffer disproportionately with
981	chronic diseases when compared to non-Hispanic whites. The
982	Legislature intends to address these disparities by developing
983	programs that target causal factors and recognize the specific
984	health care needs of racial and ethnic minorities.
985	(2)  ORGANIZATION.--The Office of Minority Health is
986	established within the Department of Health. The office shall be
987	headed by a director who shall report directly to the Secretary
988	of Health.
989	(3)  DUTIES.--The office shall:
990	(a)  Protect and promote the health and well-being of
991	racial and ethnic populations in the state.
992	(b)  Focus on the issue of health disparities between
993	racial and ethnic minority groups and the general population.
994	(c)  Coordinate the department's initiatives, programs, and
995	policies to address racial and ethnic health disparities.
996	(d)  Communicate pertinent health information to affected
997	racial and ethnic populations.
998	(e)  Collect and analyze data on the incidence and
999	frequency of racial and ethnic health disparities.
1000	(f)  Promote and encourage cultural competence education
1001	and training for healthcare professionals.
1002	(g)  Serve as a clearinghouse for the collection and
1003	dissemination of information and research findings relating to
1004	innovative approaches to the reduction or elimination of health
1005	disparities.
1006	(h)  Dedicate resources to increase public awareness of
1007	minority health issues.
1008	(i)  Seek increased funding for local innovative
1009	initiatives and administer grants designed to support
1010	initiatives that address health disparities and that can be
1011	duplicated.
1012	(j)  Provide staffing and support for the Closing the Gap
1013	grant advisory council.
1014	(k)  Coordinate with other agencies, states, and the
1015	Federal Government to reduce or eliminate health disparities.
1016	(l)  Collaborate with other public healthcare providers,
1017	community and faith-based organizations, the private healthcare
1018	system, historically black colleges and universities and other
1019	minority institutions of higher education, medical schools, and
1020	other health providers to establish a comprehensive and
1021	inclusive approach to reducing health disparities.
1022	(m)  Encourage and support research into causes of racial
1023	and ethnic health disparities.
1024	(n)  Collaborate with health professional training programs
1025	to increase the number of minority healthcare professionals.
1026	(o)  Provide an annual report to the Governor, the
1027	President of the Senate, and the Speaker of the House of
1028	Representatives on the activities of the office.
1029	(4)  RESPONSIBILITY AND COORDINATION.--The office and the
1030	department shall direct and carry out the duties established
1031	under this section and shall work with other state agencies in
1032	accomplishing these tasks.
1033	Section 13.  This act shall take effect July 1, 2006.

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