HB 7215

1	A bill to be entitled
2	An act relating to rural health care; amending s.
3	381.0405, F.S.; revising the purpose and functions of the
4	Office of Rural Health in the Department of Health;
5	requiring the Secretary of Health and the Secretary of
6	Health Care Administration to appoint an advisory council
7	to advise the office; providing for terms of office of the
8	members of the advisory council; authorizing per diem and
9	travel reimbursement for members of the advisory council;
10	requiring a report to the Governor and Legislature;
11	amending s. 381.0406, F.S.; revising legislative findings
12	and intent with respect to rural health networks; revising
13	definitions; providing additional functions of and
14	requirements for membership in rural health networks;
15	requiring rural health networks to submit rural health
16	infrastructure development plans to the office by a
17	specified date; revising provisions relating to the
18	governance and organization of rural health networks;
19	revising the services to be provided by provider members
20	of rural health networks; requiring coordination among
21	rural health networks and area health education centers
22	and health planning councils; establishing performance
23	standards; establishing a grant program for funding rural
24	health networks; defining projects that may be funded
25	through the grant program; requiring the department to
26	establish rules governing rural health network grant
27	programs and performance standards; amending s. 395.602,
28	F.S.; defining "critical access hospital"; revising and
29	deleting definitions; amending s. 395.603, F.S.; deleting
30	a requirement that the Agency for Health Care
31	Administration adopt a rule relating to deactivation of
32	rural hospital beds under certain circumstances; requiring
33	that rural critical access hospitals maintain a certain
34	number of actively licensed beds; amending s. 395.604,
35	F.S.; removing emergency care hospitals and essential
36	access community hospitals from certain licensure
37	requirements; specifying certain special conditions for
38	rural primary care hospitals; amending s. 395.6061, F.S.;
39	specifying the purpose of the rural hospital capital
40	improvement grant program; providing for grant management
41	by the department; modifying the conditions for receiving
42	a grant; providing for preferential assistance for
43	financially distressed rural hospitals; providing purpose
44	of the program; providing requirements for receiving
45	certain assistance; requiring a participation agreement
46	and providing for contents thereof; creating s. 408.7054,
47	F.S.; establishing the Rural Provider Service Network
48	Development Program; providing purposes; authorizing the
49	agency to provide funding through a grant program for the
50	establishment of rural provider service networks;
51	providing eligibility requirements; authorizing
52	preferential funding to certain providers; authorizing the
53	agency to adopt rules; amending ss. 408.07, 409.9116, and
54	1009.65, F.S.; conforming cross-references; repealing s.
55	395.605, F.S., relating to the licensure of emergency care
56	hospitals; creating s. 381.7366, F.S.; establishing the
57	Office of Minority Health; providing legislative intent;
58	providing for organization, duties, and responsibilities;
59	requiring a report to the Governor and Legislature;
60	providing an effective date.
61
62	Be It Enacted by the Legislature of the State of Florida:
63
64	Section 1.  Section 381.0405, Florida Statutes, is amended
65	to read:
66	381.0405  Office of Rural Health.--
67	(1)  ESTABLISHMENT.--The Department of Health shall
68	establish an Office of Rural Health, which shall assist rural
69	health care providers in improving the health status and health
70	care of rural residents of this state and assist rural health
71	care providers in integrating their efforts. The Office of Rural
72	Health shall coordinate its activities with rural health
73	networks established under s. 381.0406, local health councils
74	established under s. 408.033, the area health education center
75	network established under pursuant to s. 381.0402, and with any
76	appropriate research and policy development centers within
77	universities that have state-approved medical schools. The
78	Office of Rural Health may enter into a formal relationship with
79	any center that designates the office as an affiliate of the
80	center.
81	(2)  PURPOSE.--The Office of Rural Health shall actively
82	foster the provision of high-quality health care services in
83	rural areas and serve as a catalyst for improved health services
84	to residents citizens in rural areas of the state.
85	(3)  GENERAL FUNCTIONS.--The office shall:
86	(a)  Integrate policies related to physician workforce,
87	hospitals, public health, and state regulatory functions.
88	(b)  Work with rural stakeholders in order to foster the
89	development of strategic planning that addresses Propose
90	solutions to problems affecting health care delivery in rural
91	areas.
92	(c)  Foster the expansion of rural health network service
93	areas to include rural counties that are not served by a rural
94	health network.
95	(d)(c)  Seek grant funds from foundations and the Federal
96	Government.
97	(e)  Administer state grant programs for rural health
98	networks.
99	(4)  COORDINATION.--The office shall:
100	(a)  Identify federal and state rural health programs and
101	provide information and technical assistance to rural providers
102	regarding participation in such programs.
103	(b)  Act as a clearinghouse for collecting and
104	disseminating information on rural health care issues, research
105	findings on rural health care, and innovative approaches to the
106	delivery of health care in rural areas.
107	(c)  Foster the creation of regional health care systems
108	that promote cooperation, rather than competition.
109	(d)  Coordinate the department's rural health care
110	activities, programs, and policies.
111	(e)  Design initiatives to improve access to primary,
112	acute, and emergency medical services and promote the
113	coordination of such services in rural areas.
114	(f)  Assume responsibility for state coordination of the
115	Rural Hospital Transition Grant Program, the Essential Access
116	Community Hospital Program, and other federal rural health care
117	grant programs.
118	(5)  TECHNICAL ASSISTANCE.--The office shall:
119	(a)  Assist Help rural health care providers in recruiting
120	obtain health care practitioners by promoting the location and
121	relocation of health care practitioners in rural areas and
122	promoting policies that create incentives for practitioners to
123	serve in rural areas.
124	(b)  Provide technical assistance to hospitals, community
125	and migrant health centers, and other health care providers that
126	serve residents in rural areas.
127	(c)  Assist with the design of strategies to improve health
128	care workforce recruitment and placement programs.
129	(d)  Provide technical assistance to rural health networks
130	in the formulation of their rural health infrastructure
131	development plans.
132	(e)  Provide links to best practices and other technical
133	assistance resources on the office's Internet website.
134	(6)  ADVISORY COUNCIL.--The Secretary of Health and the
135	Secretary of Health Care Administration shall each appoint no
136	more than five members with relevant health care operations
137	management, practice, and policy experience to an advisory
138	council to advise the office regarding its responsibilities
139	under this section and ss. 381.0406, 395.6061, and 395.6063.
140	Members must be appointed for 4-year staggered terms and may be
141	reappointed to a second term of office. Members shall serve
142	without compensation but are entitled to reimbursement for per
143	diem and travel expenses as provided in s. 112.061. The council
144	may appoint technical advisory teams as needed. The department
145	shall provide staff and other administrative assistance
146	reasonably necessary to assist the advisory council in carrying
147	out its duties.
148	(7)  REPORTS.--Beginning January 1, 2007, and annually
149	thereafter, the Office of Rural Health shall submit a report to
150	the Governor, the President of the Senate, and the Speaker of
151	the House of Representatives summarizing the activities of the
152	office, including the grants obtained or administered by the
153	office and the status of rural health networks and rural
154	hospitals in the state. The report must also include
155	recommendations for improvements in health care delivery in
156	rural areas of the state.
157	(8)(6)  RESEARCH PUBLICATIONS AND SPECIAL STUDIES.--The
158	office shall:
159	(a)  Conduct policy and research studies.
160	(b)  Conduct health status studies of rural residents.
161	(c)  Collect relevant data on rural health care issues for
162	use in department policy development.
163	(9)(7)  APPROPRIATION.--The Legislature shall appropriate
164	such sums as are necessary to support the Office of Rural
165	Health.
166	Section 2.  Section 381.0406, Florida Statutes, is amended
167	to read:
168	381.0406  Rural health networks.--
169	(1)  LEGISLATIVE FINDINGS AND INTENT.--
170	(a)  The Legislature finds that, in rural areas, access to
171	health care is limited and the quality of health care is
172	negatively affected by inadequate financing, difficulty in
173	recruiting and retaining skilled health professionals, and the
174	because of a migration of patients to urban areas for general
175	acute care and specialty services.
176	(b)  The Legislature further finds that the efficient and
177	effective delivery of health care services in rural areas
178	requires:
179	1.  The integration of public and private resources;
180	2.  The introduction of innovative outreach methods;
181	3.  The adoption of quality improvement and cost-
182	effectiveness measures;
183	4.  The organization of health care providers into joint
184	contracting entities;
185	5.  The establishment of referral linkages;
186	6.  The analysis of costs and services in order to prepare
187	health care providers for prepaid and at-risk financing; and
188	7.  The coordination of health care providers.
189	(c)  The Legislature further finds that the availability of
190	a continuum of quality health care services, including
191	preventive, primary, secondary, tertiary, and long-term care, is
192	essential to the economic and social vitality of rural
193	communities.
194	(d)  The Legislature further finds that health care
195	providers in rural areas are not prepared for market changes
196	such as the introduction of managed care and capitation-
197	reimbursement methodologies into health care services.
198	(e)(d)  The Legislature further finds that the creation of
199	rural health networks can help to alleviate these problems.
200	Rural health networks shall act in the broad public interest
201	and, to the extent possible, seek to improve the accessibility,
202	quality, and cost-effectiveness of rural health care by
203	planning, developing, coordinating, and providing be structured
204	to provide a continuum of quality health care services for rural
205	residents through the cooperative efforts of rural health
206	network members and other health care providers.
207	(f)(e)  The Legislature further finds that rural health
208	networks shall have the goal of increasing the financial
209	stability of statutory rural hospitals by linking rural hospital
210	services to other services in a continuum of health care
211	services and by increasing the utilization of statutory rural
212	hospitals whenever for appropriate health care services whenever
213	feasible, which shall help to ensure their survival and thereby
214	support the economy and protect the health and safety of rural
215	residents.
216	(g)(f)  Finally, the Legislature finds that rural health
217	networks may serve as "laboratories" to determine the best way
218	of organizing rural health services and linking to out-of-area
219	services that are not available locally in order, to move the
220	state closer to ensuring that everyone has access to health
221	care, and to promote cost containment efforts.  The ultimate
222	goal of rural health networks shall be to ensure that quality
223	health care is available and efficiently delivered to all
224	persons in rural areas.
225	(2)  DEFINITIONS.--
226	(a)  "Rural" means an area having with a population density
227	of fewer less than 100 individuals per square mile or an area
228	defined by the most recent United States Census as rural.
229	(b)  "Health care provider" means any individual, group, or
230	entity, public or private, which that provides health care,
231	including: preventive health care, primary health care,
232	secondary and tertiary health care, hospital in-hospital health
233	care, public health care, and health promotion and education.
234	(c)  "Rural health network" or "network" means a nonprofit
235	legal entity, whose members consist consisting of rural and
236	urban health care providers and others, and which that is
237	established organized to plan, develop, organize, and deliver
238	health care services on a cooperative basis in a rural area,
239	except for some secondary and tertiary care services.
240	(3)  NETWORK MEMBERSHIP.--
241	(a)  Because each rural area is unique, with a different
242	health care provider mix, health care provider membership may
243	vary, but all networks shall include members that provide health
244	promotion and disease prevention services, public health
245	services, comprehensive primary care, emergency medical care,
246	and acute inpatient care.
247	(b)  Each county health department shall be a member of the
248	rural health network whose service area includes the county in
249	which the county health department is located. Federally
250	qualified health centers and emergency medical services
251	providers are encouraged to become members of the rural health
252	networks in the areas in which their patients reside or receive
253	services.
254	(c)(4)  Network membership shall be available to all health
255	care providers in the network service area if, provided that
256	they render care to all patients referred to them from other
257	network members;, comply with network quality assurance, quality
258	improvement, and utilization-management and risk management
259	requirements; and, abide by the terms and conditions of network
260	provider agreements in paragraph (11)(c), and provide services
261	at a rate or price equal to the rate or price negotiated by the
262	network.
263	(4)(5)  NETWORK SERVICE AREAS.--Network service areas are
264	do not required need to conform to local political boundaries or
265	state administrative district boundaries. The geographic area of
266	one rural health network, however, may not overlap the territory
267	of any other rural health network.
268	(5)(6)  NETWORK FUNCTIONS.--Networks shall:
269	(a)  Seek to develop linkages with provisions for referral
270	to tertiary inpatient care, specialty physician care, and to
271	other services that are not available in rural service areas.
272	(b)(7)  Networks shall Make available health promotion,
273	disease prevention, and primary care services, in order to
274	improve the health status of rural residents and to contain
275	health care costs.
276	(8)  Networks may have multiple points of entry, such as
277	through private physicians, community health centers, county
278	health departments, certified rural health clinics, hospitals,
279	or other providers; or they may have a single point of entry.
280	(c)(9)  Encourage members through training and educational
281	programs to adopt standards of care, and promote the evidence-
282	based practice of medicine. Networks shall establish standard
283	protocols, coordinate and share patient records, and develop
284	patient information exchange systems in order to improve quality
285	and access to services.
286	(d)  Develop quality-improvement programs and train network
287	members and other health care providers in the use of such
288	programs.
289	(e)  Develop disease-management systems and train network
290	members and other health care providers in the use of such
291	systems.
292	(f)  Promote outreach to areas with a high need for
293	services.
294	(g)  Seek to develop community care alternatives for elders
295	who would otherwise be placed in nursing homes.
296	(h)  Emphasize community care alternatives for persons with
297	mental health and substance abuse disorders who are at risk of
298	being admitted to an institution.
299	(i)  Develop and implement a rural health infrastructure
300	development plan for an integrated system of care that is
301	responsive to the unique local health needs and the area health
302	care services market. Each rural health infrastructure
303	development plan must address strategies to improve access to
304	specialty care, train health care providers to use standards of
305	care for chronic illness, develop disease-management capacity,
306	and link to state and national quality-improvement initiatives.
307	The initial development plan must be submitted to the Office of
308	Rural Health for review and approval no later than July 1, 2007,
309	and thereafter the plans must be updated and submitted to the
310	Office of Rural Health every 3 years.
311	(10)  Networks shall develop risk management and quality
312	assurance programs for network providers.
313	(6)(11)  NETWORK GOVERNANCE AND ORGANIZATION.--
314	(a)  Networks shall be incorporated as not-for-profit
315	corporations under chapter 617, with articles of incorporation
316	that set forth purposes consistent with this section the laws of
317	the state.
318	(b)  Each network Networks shall have an independent a
319	board of directors that derives membership from local
320	government, health care providers, businesses, consumers,
321	advocacy groups, and others. Boards of other community health
322	care entities may not serve in whole as the board of a rural
323	health network; however, some overlap of board membership with
324	other community organizations is encouraged. Network staff must
325	provide an annual orientation and strategic planning activity
326	for board members.
327	(c)  Network boards of directors shall have the
328	responsibility of determining the content of health care
329	provider agreements that link network members.  The written
330	agreements between the network and its health care provider
331	members must specify participation in the essential functions of
332	the network and shall specify:
333	1.  Who provides what services.
334	2.  The extent to which the health care provider provides
335	care to persons who lack health insurance or are otherwise
336	unable to pay for care.
337	3.  The procedures for transfer of medical records.
338	4.  The method used for the transportation of patients
339	between providers.
340	5.  Referral and patient flow including appointments and
341	scheduling.
342	6.  Payment arrangements for the transfer or referral of
343	patients.
344	(d)  There shall be no liability on the part of, and no
345	cause of action of any nature shall arise against, any member of
346	a network board of directors, or its employees or agents, for
347	any lawful action taken by them in the performance of their
348	administrative powers and duties under this subsection.
349	(7)(12)  NETWORK PROVIDER MEMBER SERVICES.--
350	(a)  Networks, to the extent feasible, shall seek to
351	develop services that provide for a continuum of care for all
352	residents patients served by the network. Each network shall
353	recruit members that can provide include the following core
354	services: disease prevention, health promotion, comprehensive
355	primary care, emergency medical care, and acute inpatient care.
356	Each network shall seek to ensure the availability of
357	comprehensive maternity care, including prenatal, delivery, and
358	postpartum care for uncomplicated pregnancies, either directly,
359	by contract, or through referral agreements. Networks shall, to
360	the extent feasible, develop local services and linkages among
361	health care providers to also ensure the availability of the
362	following services: within the specified timeframes, either
363	directly, by contract, or through referral agreements:
364	1.  Services available in the home.
365	1.a.  Home health care.
366	2.b.  Hospice care.
367	2.  Services accessible within 30 minutes travel time or
368	less.
369	3.a.  Emergency medical services, including advanced life
370	support, ambulance, and basic emergency room services.
371	4.b.  Primary care, including.
372	c.  prenatal and postpartum care for uncomplicated
373	pregnancies.
374	5.d.  Community-based services for elders, such as adult
375	day care and assistance with activities of daily living.
376	6.e.  Public health services, including communicable
377	disease control, disease prevention, health education, and
378	health promotion.
379	7.f.  Outpatient mental health psychiatric and substance
380	abuse services.
381	3.  Services accessible within 45 minutes travel time or
382	less.
383	8.a.  Hospital acute inpatient care for persons whose
384	illnesses or medical problems are not severe.
385	9.b.  Level I obstetrical care, which is Labor and delivery
386	for low-risk patients.
387	10.c.  Skilled nursing services and, long-term care,
388	including nursing home care.
389	(b)  Networks shall seek to foster linkages with out-of-
390	area services to the extent feasible to ensure the availability
391	of:
392	1.d.  Dialysis.
393	2.e.  Osteopathic and chiropractic manipulative therapy.
394	4.  Services accessible within 2 hours travel time or less.
395	3.a.  Specialist physician care.
396	4.b.  Hospital acute inpatient care for severe illnesses
397	and medical problems.
398	5.c.  Level II and III obstetrical care, which is Labor and
399	delivery care for high-risk patients and neonatal intensive
400	care.
401	6.d.  Comprehensive medical rehabilitation.
402	7.e.  Inpatient mental health psychiatric and substance
403	abuse services.
404	8.f.  Magnetic resonance imaging, lithotripter treatment,
405	oncology, advanced radiology, and other technologically advanced
406	services.
407	9.g.  Subacute care.
408	(8)  COORDINATION WITH OTHER ENTITIES.--
409	(a)  Area health education centers and health planning
410	councils shall participate in the rural health networks'
411	preparation of development plans. The Department of Health may
412	require a written memorandum of agreement between a network and
413	an area health education center or health planning council.
414	(b)  Rural health networks shall initiate activities, in
415	coordination with area health education centers, to carry out
416	the objectives of the adopted development plan, including
417	continuing education for health care practitioners performing
418	functions such as disease management, continuous quality
419	improvement, telemedicine, long-distance learning, and the
420	treatment of chronic illness using standards of care. As used in
421	this section, the term "telemedicine" means the use of
422	telecommunications to deliver or expedite the delivery of health
423	care services.
424	(c)  Rural health networks shall contract with local health
425	planning councils to support the preparation of development
426	plans through data collection and analysis in order to assess
427	the health status of area residents and the capacity of local
428	health services.
429	(d)(b)  Networks shall actively participate with area
430	health education center programs, whenever feasible, in
431	developing and implementing recruitment, training, and retention
432	programs directed at positively influencing the supply and
433	distribution of health care professionals serving in, or
434	receiving training in, network areas.
435	(c)  As funds become available, networks shall emphasize
436	community care alternatives for elders who would otherwise be
437	placed in nursing homes.
438	(d)  To promote the most efficient use of resources,
439	networks shall emphasize disease prevention, early diagnosis and
440	treatment of medical problems, and community care alternatives
441	for persons with mental health and substance abuse disorders who
442	are at risk to be institutionalized.
443	(e)(13)  TRAUMA SERVICES.--In those network areas having
444	which have an established trauma agency approved by the
445	Department of Health, the network shall seek the participation
446	of that trauma agency must be a participant in the network.
447	Trauma services provided within the network area must comply
448	with s. 395.405.
449	(9)(14)  NETWORK FINANCING.--
450	(a)  Networks may use all sources of public and private
451	funds to support network activities. Nothing in this section
452	prohibits networks from becoming managed care providers.
453	(b)  The Department of Health shall establish grant
454	programs to provide funding to support the administrative costs
455	of developing and operating rural health networks.
456	(10)  NETWORK PERFORMANCE STANDARDS.--The Department of
457	Health shall develop and enforce performance standards for rural
458	health network operations grants and rural health infrastructure
459	development grants.
460	(a)  Operations grant performance standards must include,
461	but are not limited to, standards that require the rural health
462	network to:
463	1.  Have a qualified board of directors that meets at least
464	quarterly.
465	2.  Have sufficient staff who have the qualifications and
466	experience to perform the requirements of this section, as
467	assessed by the Office of Rural Health, or a written plan to
468	obtain such staff.
469	3.  Comply with the department's grant management standards
470	in a timely and responsive manner.
471	4.  Comply with the department's standards for the
472	administration of federal grant funding, including assistance to
473	rural hospitals.
474	5.  Demonstrate a commitment to network activities from
475	area health care providers and other stakeholders, as described
476	in letters of support.
477	(b)  Rural health infrastructure development grant
478	performance standards must include, but are not limited to,
479	standards that require the rural health network to:
480	1.  During the 2006-2007 fiscal year prepare a development
481	plan and, after July 1, 2007, have a development plan that has
482	been reviewed and approved by the Office of Rural Health.
483	2.  Have two or more successful network-development
484	activities, such as:
485	a.  Management of a network development or outreach grant
486	from the federal Office of Rural Health Policy;
487	b.  Implementation of outreach programs to address chronic
488	disease, infant mortality, or assistance with prescription
489	medication;
490	c.  Development of partnerships with community and faith-
491	based organizations to address area health problems;
492	d.  Provision of direct services, such as clinics or mobile
493	units;
494	e.  Operation of credentialing services for health care
495	providers or quality assurance and quality improvement
496	initiatives that, whenever possible, are consistent with state
497	or federal quality initiatives;
498	f.  Support for the development of community health
499	centers, local community health councils, federal designation as
500	a rural critical access hospital, or comprehensive community
501	health planning initiatives; and
502	g.  Development of the capacity to obtain federal, state,
503	and foundation grants.
504	(11)(15)  NETWORK IMPLEMENTATION.--As funds become
505	available, networks shall be developed and implemented in two
506	phases.
507	(a)  Phase I shall consist of a network planning and
508	development grant program. Planning grants shall be used to
509	organize networks, incorporate network boards, and develop
510	formal provider agreements as provided for in this section.  The
511	Department of Health shall develop a request-for-proposal
512	process to solicit grant applications.
513	(b)  Phase II shall consist of a network operations grant
514	program. As funds become available, certified networks that meet
515	performance standards shall be eligible to receive grant funds
516	to be used to help defray the costs of rural health network
517	infrastructure development, patient care, and network
518	administration. Rural health network infrastructure development
519	includes, but is not limited to: recruitment and retention of
520	primary care practitioners; enhancements of primary care
521	services through the use of mobile clinics; development of
522	preventive health care programs; linkage of urban and rural
523	health care systems; design and implementation of automated
524	patient records, outcome measurement, quality assurance, and
525	risk management systems; establishment of one-stop service
526	delivery sites; upgrading of medical technology available to
527	network providers; enhancement of emergency medical systems;
528	enhancement of medical transportation; formation of joint
529	contracting entities composed of rural physicians, rural
530	hospitals, and other rural health care providers; establishment
531	of comprehensive disease management programs that meet Medicaid
532	requirements; establishment of regional quality improvement
533	programs involving physicians and hospitals consistent with
534	state and national initiatives; establishment of specialty
535	networks connecting rural primary care physicians and urban
536	specialists; development of regional broadband
537	telecommunications systems that have the capacity to share
538	patient information in a secure network, telemedicine, and long-
539	distance learning capacity; and linkage between training
540	programs for health care practitioners and the delivery of
541	health care services in rural areas and development of
542	telecommunication capabilities. A Phase II award may occur in
543	the same fiscal year as a Phase I award.
544	(12)(16)  CERTIFICATION.--For the purpose of certifying
545	networks that are eligible for Phase II funding, the Department
546	of Health shall certify networks that meet the criteria
547	delineated in this section and the rules governing rural health
548	networks. The Office of Rural Health in the Department of Health
549	shall monitor rural health networks in order to ensure continued
550	compliance with established certification and performance
551	standards.
552	(13)(17)  RULES.--The Department of Health shall establish
553	rules pursuant to s. 120.536(1) and 120.54 that govern the
554	creation and certification of networks, the provision of grant
555	funds under Phase I and Phase II, and the establishment of
556	performance standards including establishing outcome measures
557	for networks.
558	Section 3.  Subsection (2) of section 395.602, Florida
559	Statutes, is amended to read:
560	395.602  Rural hospitals.--
561	(2)  DEFINITIONS.--As used in this part:
562	(a)  "Critical access hospital" means a hospital that meets
563	the definition of rural hospital in paragraph (d) and meets the
564	requirements for reimbursement by Medicare and Medicaid under 42
565	C.F.R. ss. 485.601-485.647. "Emergency care hospital" means a
566	medical facility which provides:
567	1.  Emergency medical treatment; and
568	2.  Inpatient care to ill or injured persons prior to their
569	transportation to another hospital or provides inpatient medical
570	care to persons needing care for a period of up to 96 hours. The
571	96-hour limitation on inpatient care does not apply to respite,
572	skilled nursing, hospice, or other nonacute care patients.
573	(b)  "Essential access community hospital" means any
574	facility which:
575	1.  Has at least 100 beds;
576	2.  Is located more than 35 miles from any other essential
577	access community hospital, rural referral center, or urban
578	hospital meeting criteria for classification as a regional
579	referral center;
580	3.  Is part of a network that includes rural primary care
581	hospitals;
582	4.  Provides emergency and medical backup services to rural
583	primary care hospitals in its rural health network;
584	5.  Extends staff privileges to rural primary care hospital
585	physicians in its network; and
586	6.  Accepts patients transferred from rural primary care
587	hospitals in its network.
588	(b)(c)  "Inactive rural hospital bed" means a licensed
589	acute care hospital bed, as defined in s. 395.002(14), that is
590	inactive in that it cannot be occupied by acute care inpatients.
591	(c)(d)  "Rural area health education center" means an area
592	health education center (AHEC), as authorized by Pub. L. No. 94-
593	484, that which provides services in a county with a population
594	density of no greater than 100 persons per square mile.
595	(d)(e)  "Rural hospital" means an acute care hospital
596	licensed under this chapter, having 100 or fewer licensed beds
597	and an emergency room, that which is:
598	1.  The sole provider within a county with a population
599	density of no greater than 100 persons per square mile;
600	2.  An acute care hospital, in a county with a population
601	density of no greater than 100 persons per square mile, that
602	which is at least 30 minutes of travel time, on normally
603	traveled roads under normal traffic conditions, from any other
604	acute care hospital within the same county;
605	3.  A hospital supported by a tax district or subdistrict
606	whose boundaries encompass a population of 100 persons or fewer
607	per square mile;
608	4.  A hospital in a constitutional charter county with a
609	population of over 1 million persons that has imposed a local
610	option health service tax pursuant to law and in an area that
611	was directly impacted by a catastrophic event on August 24,
612	1992, for which the Governor of Florida declared a state of
613	emergency pursuant to chapter 125, and has 120 beds or fewer
614	less that serves an agricultural community with an emergency
615	room utilization of no less than 20,000 visits and a Medicaid
616	inpatient utilization rate greater than 15 percent;
617	5.  A hospital with a service area that has a population of
618	100 persons or fewer per square mile. As used in this
619	subparagraph, the term "service area" means the fewest number of
620	zip codes that account for 75 percent of the hospital's
621	discharges for the most recent 5-year period, based on
622	information available from the hospital inpatient discharge
623	database in the State Center for Health Statistics at the Agency
624	for Health Care Administration; or
625	6.  A hospital designated as a critical access hospital, as
626	defined in s. 408.07(15).
627
628	Population densities used in this paragraph must be based upon
629	the most recently completed United States census. A hospital
630	that received funds under s. 409.9116 for a quarter beginning no
631	later than July 1, 2002, is deemed to have been and shall
632	continue to be a rural hospital from that date through June 30,
633	2012, if the hospital continues to have 100 or fewer licensed
634	beds and an emergency room, or meets the criteria of
635	subparagraph 4. An acute care hospital that has not previously
636	been designated as a rural hospital and that meets the criteria
637	of this paragraph shall be granted such designation upon
638	application, including supporting documentation to the Agency
639	for Health Care Administration.
640	(e)(f)  "Rural primary care hospital" means any facility
641	that meeting the criteria in paragraph (e) or s. 395.605 which
642	provides:
643	1.  Twenty-four-hour emergency medical care;
644	2.  Temporary inpatient care for periods of 96 72 hours or
645	less to patients requiring stabilization before discharge or
646	transfer to another hospital. The 96-hour 72-hour limitation
647	does not apply to respite, skilled nursing, hospice, or other
648	nonacute care patients; and
649	3.  Has at least no more than six licensed acute care
650	inpatient beds.
651	(f)(g)  "Swing-bed" means a bed that which can be used
652	interchangeably as either a hospital, skilled nursing facility
653	(SNF), or intermediate care facility (ICF) bed pursuant to 42
654	C.F.R. parts 405, 435, 440, 442, and 447.
655	Section 4.  Subsection (1) of section 395.603, Florida
656	Statutes, is amended to read:
657	395.603  Deactivation of general hospital beds; rural
658	hospital impact statement.--
659	(1)  The agency shall establish, by rule, a process by
660	which A rural hospital, as defined in s. 395.602, that seeks
661	licensure as a rural primary care hospital or as an emergency
662	care hospital, or becomes a certified rural health clinic as
663	defined in Pub. L. No. 95-210, or becomes a primary care program
664	such as a county health department, community health center, or
665	other similar outpatient program that provides preventive and
666	curative services, may deactivate general hospital beds. A rural
667	critical access hospital Rural primary care hospitals and
668	emergency care hospitals shall maintain the number of actively
669	licensed general hospital beds necessary for the facility to be
670	certified for Medicare reimbursement. Hospitals that discontinue
671	inpatient care to become rural health care clinics or primary
672	care programs shall deactivate all licensed general hospital
673	beds. All hospitals, clinics, and programs with inactive beds
674	shall provide 24-hour emergency medical care by staffing an
675	emergency room. Providers with inactive beds shall be subject to
676	the criteria in s. 395.1041. The agency shall specify in rule
677	requirements for making 24-hour emergency care available.
678	Inactive general hospital beds shall be included in the acute
679	care bed inventory, maintained by the agency for certificate-of-
680	need purposes, for 10 years from the date of deactivation of the
681	beds. After 10 years have elapsed, inactive beds shall be
682	excluded from the inventory. The agency shall, at the request of
683	the licensee, reactivate the inactive general beds upon a
684	showing by the licensee that licensure requirements for the
685	inactive general beds are met.
686	Section 5.  Section 395.604, Florida Statutes, is amended
687	to read:
688	395.604  Other Rural primary care hospitals hospital
689	programs.--
690	(1)  The agency may license rural primary care hospitals
691	subject to federal approval for participation in the Medicare
692	and Medicaid programs. Rural primary care hospitals shall be
693	treated in the same manner as emergency care hospitals and rural
694	hospitals with respect to ss. 395.605(2)-(8)(a),
695	408.033(2)(b)3., and 408.038.
696	(2)  The agency may designate essential access community
697	hospitals.
698	(2)(3)  The agency may adopt licensure rules for rural
699	primary care hospitals and essential access community hospitals.
700	Such rules must conform to s. 395.1055.
701	(3)  For the purpose of Medicaid swing-bed reimbursement
702	pursuant to the Medicaid program, the agency shall treat rural
703	primary care hospitals in the same manner as rural hospitals.
704	(4)  For the purpose of participation in the Medical
705	Education Reimbursement and Loan Repayment Program as defined in
706	s. 1009.65 or other loan repayment or incentive programs
707	designed to relieve medical workforce shortages, the department
708	shall treat rural primary care hospitals in the same manner as
709	rural hospitals.
710	(5)  For the purpose of coordinating primary care services
711	described in s. 154.011(1)(c)10., the department shall treat
712	rural primary care hospitals in the same manner as rural
713	hospitals.
714	(6)  Rural hospitals that make application under the
715	certificate-of-need program to be licensed as rural primary care
716	hospitals shall receive expedited review as defined in s.
717	408.032. Rural primary care hospitals seeking relicensure as
718	acute care general hospitals shall also receive expedited
719	review.
720	(7)  Rural primary care hospitals are exempt from
721	certificate-of-need requirements for home health and hospice
722	services and for swing beds in a number that does not exceed
723	one-half of the facility's licensed beds.
724	(8)  Rural primary care hospitals shall have agreements
725	with other hospitals, skilled nursing facilities, home health
726	agencies, and providers of diagnostic-imaging and laboratory
727	services that are not provided on site but are needed by
728	patients.
729	(4)  The department may seek federal recognition of
730	emergency care hospitals authorized by s. 395.605 under the
731	essential access community hospital program authorized by the
732	Omnibus Budget Reconciliation Act of 1989.
733	Section 6.  Section 395.6061, Florida Statutes, is amended
734	to read:
735	395.6061  Rural hospital capital improvement.--There is
736	established a rural hospital capital improvement grant program.
737	(1)(a)  The purpose of the program is to provide targeted
738	funding to rural hospitals to enable them to adapt to changes in
739	health care delivery and funding and address disparities in
740	rural health care by:
741	1.  Assisting in the development of needed infrastructure.
742	2.  Assisting financially distressed rural hospitals.
743	3.  Ensuring accountability for state and federal funding.
744	(b)  The rural hospital capital improvement grant program
745	includes technical assistance and grants managed by the agency.
746	(2)(1)  A rural hospital as defined in s. 395.602 may apply
747	to the department for a capital improvement grant to acquire,
748	repair, improve, or upgrade systems, facilities, or equipment.
749	The grant application must provide information that includes:
750	(a)  A statement indicating the problem the rural hospital
751	proposes to solve with the grant funds.;
752	(b)  The strategy proposed to resolve the problem.;
753	(c)  The organizational structure, financial system, and
754	facilities that are essential to the proposed solution.;
755	(d)  The projected longevity of the proposed solution after
756	the grant funds are expended.;
757	(e)  Evidence of participation in a rural health network as
758	defined in s. 381.0406 and evidence that the application is
759	consistent with the required rural health infrastructure
760	development plan.;
761	(f)  Evidence that the rural hospital has difficulty in
762	obtaining funding or that funds available for the proposed
763	solution are inadequate.;
764	(g)  Evidence that the grant funds will assist in
765	maintaining or returning the hospital to an economically stable
766	condition or enable the transition to the status of rural
767	primary care hospital or that any plan for closure of the
768	hospital or realignment of services will involve development of
769	innovative alternatives for the provision of needed discontinued
770	services.;
771	(h)  Evidence of a satisfactory record-keeping system to
772	account for grant fund expenditures within the rural county.;
773	(i)  A rural health network plan that includes a
774	description of how the plan was developed, the goals of the
775	plan, the links with existing health care providers under the
776	plan, Indicators quantifying the hospital's financial status
777	well-being, measurable outcome targets, and the current physical
778	and operational condition of the hospital.
779	(3)(2)  Each rural hospital as defined in s. 395.602 shall
780	receive a minimum of $100,000 annually, subject to legislative
781	appropriation, upon application to the Department of Health, for
782	projects to acquire, repair, improve, or upgrade systems,
783	facilities, or equipment.
784	(4)(3)  Any remaining funds shall annually be disbursed to
785	rural hospitals in accordance with this section. The Department
786	of Health shall establish, by rule, criteria for awarding grants
787	for any remaining funds, which must be used exclusively for the
788	support and assistance of rural hospitals as defined in s.
789	395.602, including criteria relating to the level of charity
790	uncompensated care rendered by the hospital, the financial
791	status of the hospital, the performance standards of the
792	hospital, the participation in a rural health network as defined
793	in s. 381.0406, and the proposed use of the grant by the rural
794	hospital to resolve a specific problem. The department must
795	consider any information submitted in an application for the
796	grants in accordance with subsection (2) (1) in determining
797	eligibility for and the amount of the grant, and none of the
798	individual items of information by itself may be used to deny
799	grant eligibility.
800	(5)  Financially distressed rural hospitals may receive
801	preferential assistance under the capital improvement grant
802	program to provide planning, management, and financial support.
803	To receive this assistance the hospital must:
804	(a)  Provide additional information that includes:
805	1.  A statement of support from the board of directors of
806	the hospital, the county commission, and the city commission.
807	2.  Evidence that the rural hospital and the community have
808	difficulty obtaining funding or that funds available for the
809	proposed solution are inadequate.
810	(b)  Agree to be bound by the terms of a participation
811	agreement with the agency, which may include:
812	1.  The appointment of a health care expert under contract
813	with the agency to analyze and monitor the hospital operations
814	during the period of distress.
815	2.  The establishment of minimum standards for the
816	education and experience of the managers and administrators of
817	the hospital.
818	3.  The oversight and monitoring of a strategic plan to
819	restore the hospital to an economically stable condition or
820	transition to an alternative means to provide services.
821	4.  The establishment of a board orientation and
822	development program.
823	5.  The approval of any facility relocation plans.
824	(6)(4)  The department shall ensure that the funds are used
825	solely for the purposes specified in this section. The total
826	grants awarded pursuant to this section shall not exceed the
827	amount appropriated for this program.
828	Section 7.  Section 408.7054, Florida Statutes, is created
829	to read:
830	408.7054  Rural Provider Service Network Development
831	Program.--
832	(1)  There is established within the Agency for Health Care
833	Administration the Rural Provider Service Network Development
834	Program to support the implementation of provider service
835	networks in rural counties of the state. The purpose of the
836	program is to assist in the establishment of the infrastructure
837	needed for Medicaid reform relating to prepaid and at-risk
838	reimbursement plans to improve access to quality health care in
839	rural areas.
840	(2)  The agency is authorized to provide funding through a
841	grant program to entities seeking to establish rural provider
842	service networks that have demonstrated an interest and have
843	experience in organizing rural health care providers for this
844	purpose.
845	(3)  Entities eligible for rural provider service network
846	development grants must:
847	(a)  Have a written agreement signed by prospective
848	members, 45 percent of whom must be providers in the targeted
849	service area.
850	(b)  Include all rural hospitals, at least one federally
851	qualified health center, and one county health department
852	located in the service area.
853	(c)  Have a defined service area.
854	(4)  Each applicant for this funding shall provide the
855	agency with a detailed written proposal that includes, at a
856	minimum, a statement of need; a defined purpose; identification
857	and explanation of the role of prospective partners; a signed
858	memorandum of agreement or similar document attesting to the
859	role of prospective partners; documented actions related to
860	provider service network development; measurable objectives for
861	the development of clinical and administrative infrastructure; a
862	process of evaluation; and a process for developing a business
863	plan and securing additional funding.
864	(5)  The agency is authorized to grant preferential funding
865	to a rural provider service network based on the number of rural
866	counties within the network's proposed service area that are
867	Medically Underserved Areas or Health Professional Shortage
868	Areas as defined by the Health Resources Services
869	Administration, Office of Rural Health Policy, and based on
870	whether the provider service network has a principal place of
871	business located in a rural county in the state.
872	(6)  The agency is granted authority to develop rules
873	pursuant to ss. 120.53(1) and 120.54 necessary to implement this
874	section.
875	Section 8.  Subsection (43) of section 408.07, Florida
876	Statutes, is amended to read:
877	408.07  Definitions.--As used in this chapter, with the
878	exception of ss. 408.031-408.045, the term:
879	(43)  "Rural hospital" means an acute care hospital
880	licensed under chapter 395, having 100 or fewer licensed beds
881	and an emergency room, and which is:
882	(a)  The sole provider within a county with a population
883	density of no greater than 100 persons per square mile;
884	(b)  An acute care hospital, in a county with a population
885	density of no greater than 100 persons per square mile, which is
886	at least 30 minutes of travel time, on normally traveled roads
887	under normal traffic conditions, from another acute care
888	hospital within the same county;
889	(c)  A hospital supported by a tax district or subdistrict
890	whose boundaries encompass a population of 100 persons or fewer
891	per square mile;
892	(d)  A hospital with a service area that has a population
893	of 100 persons or fewer per square mile. As used in this
894	paragraph, the term "service area" means the fewest number of
895	zip codes that account for 75 percent of the hospital's
896	discharges for the most recent 5-year period, based on
897	information available from the hospital inpatient discharge
898	database in the State Center for Health Statistics at the Agency
899	for Health Care Administration; or
900	(e)  A critical access hospital.
901
902	Population densities used in this subsection must be based upon
903	the most recently completed United States census. A hospital
904	that received funds under s. 409.9116 for a quarter beginning no
905	later than July 1, 2002, is deemed to have been and shall
906	continue to be a rural hospital from that date through June 30,
907	2012, if the hospital continues to have 100 or fewer licensed
908	beds and an emergency room, or meets the criteria of s.
909	395.602(2)(d)(e)4. An acute care hospital that has not
910	previously been designated as a rural hospital and that meets
911	the criteria of this subsection shall be granted such
912	designation upon application, including supporting
913	documentation, to the Agency for Health Care Administration.
914	Section 9.  Subsection (6) of section 409.9116, Florida
915	Statutes, is amended to read:
916	409.9116  Disproportionate share/financial assistance
917	program for rural hospitals.--In addition to the payments made
918	under s. 409.911, the Agency for Health Care Administration
919	shall administer a federally matched disproportionate share
920	program and a state-funded financial assistance program for
921	statutory rural hospitals. The agency shall make
922	disproportionate share payments to statutory rural hospitals
923	that qualify for such payments and financial assistance payments
924	to statutory rural hospitals that do not qualify for
925	disproportionate share payments. The disproportionate share
926	program payments shall be limited by and conform with federal
927	requirements. Funds shall be distributed quarterly in each
928	fiscal year for which an appropriation is made. Notwithstanding
929	the provisions of s. 409.915, counties are exempt from
930	contributing toward the cost of this special reimbursement for
931	hospitals serving a disproportionate share of low-income
932	patients.
933	(6)  This section applies only to hospitals that were
934	defined as statutory rural hospitals, or their successor-in-
935	interest hospital, prior to January 1, 2001. Any additional
936	hospital that is defined as a statutory rural hospital, or its
937	successor-in-interest hospital, on or after January 1, 2001, is
938	not eligible for programs under this section unless additional
939	funds are appropriated each fiscal year specifically to the
940	rural hospital disproportionate share and financial assistance
941	programs in an amount necessary to prevent any hospital, or its
942	successor-in-interest hospital, eligible for the programs prior
943	to January 1, 2001, from incurring a reduction in payments
944	because of the eligibility of an additional hospital to
945	participate in the programs. A hospital, or its successor-in-
946	interest hospital, which received funds pursuant to this section
947	before January 1, 2001, and which qualifies under s.
948	395.602(2)(d)(e), shall be included in the programs under this
949	section and is not required to seek additional appropriations
950	under this subsection.
951	Section 10.  Paragraph (b) of subsection (2) of section
952	1009.65, Florida Statutes, is amended to read:
953	1009.65  Medical Education Reimbursement and Loan Repayment
954	Program.--
955	(2)  From the funds available, the Department of Health
956	shall make payments to selected medical professionals as
957	follows:
958	(b)  All payments shall be contingent on continued proof of
959	primary care practice in an area defined in s. 395.602(2)(d)(e),
960	or an underserved area designated by the Department of Health,
961	provided the practitioner accepts Medicaid reimbursement if
962	eligible for such reimbursement. Correctional facilities, state
963	hospitals, and other state institutions that employ medical
964	personnel shall be designated by the Department of Health as
965	underserved locations. Locations with high incidences of infant
966	mortality, high morbidity, or low Medicaid participation by
967	health care professionals may be designated as underserved.
968	Section 11.  Section 395.605, Florida Statutes, is
969	repealed.
970	Section 12.  Section 381.7366, Florida Statutes, is created
971	to read:
972	381.7366  Office of Minority Health; legislative intent;
973	duties.--
974	(1)  LEGISLATIVE INTENT.--The Legislature recognizes that
975	despite significant investments in health care programs certain
976	racial and ethnic populations suffer disproportionately with
977	chronic diseases when compared to non-Hispanic whites. The
978	Legislature intends to address these disparities by developing
979	programs that target causal factors and recognize the specific
980	health care needs of racial and ethnic minorities.
981	(2)  ORGANIZATION.--The Office of Minority Health is
982	established within the Department of Health. The office shall be
983	headed by a director who shall report directly to the Secretary
984	of Health.
985	(3)  DUTIES.--The office shall:
986	(a)  Protect and promote the health and well-being of
987	racial and ethnic populations in the state.
988	(b)  Focus on the issue of health disparities between
989	racial and ethnic minority groups and the general population.
990	(c)  Coordinate the department's initiatives, programs, and
991	policies to address racial and ethnic health disparities.
992	(d)  Communicate pertinent health information to affected
993	racial and ethnic populations.
994	(e)  Collect and analyze data on the incidence and
995	frequency of racial and ethnic health disparities.
996	(f)  Promote and encourage cultural competence education
997	and training for healthcare professionals.
998	(g)  Serve as a clearinghouse for the collection and
999	dissemination of information and research findings relating to
1000	innovative approaches to the reduction or elimination of health
1001	disparities.
1002	(h)  Dedicate resources to increase public awareness of
1003	minority health issues.
1004	(i)  Seek increased funding for local innovative
1005	initiatives and administer grants designed to support
1006	initiatives that address health disparities and that can be
1007	duplicated.
1008	(j)  Provide staffing and support for the Closing the Gap
1009	grant advisory council.
1010	(k)  Coordinate with other agencies, states, and the
1011	Federal Government to reduce or eliminate health disparities.
1012	(l)  Collaborate with other public healthcare providers,
1013	community and faith-based organizations, the private healthcare
1014	system, historically black colleges and universities and other
1015	minority institutions of higher education, medical schools, and
1016	other health providers to establish a comprehensive and
1017	inclusive approach to reducing health disparities.
1018	(m)  Encourage and support research into causes of racial
1019	and ethnic health disparities.
1020	(n)  Collaborate with health professional training programs
1021	to increase the number of minority healthcare professionals.
1022	(o)  Provide an annual report to the Governor, the
1023	President of the Senate, and the Speaker of the House of
1024	Representatives on the activities of the office.
1025	(4)  RESPONSIBILITY AND COORDINATION.--The office and the
1026	department shall direct and carry out the duties established
1027	under this section and shall work with other state agencies in
1028	accomplishing these tasks.
1029	Section 13.  This act shall take effect July 1, 2006.

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