HB 7215

A bill to be entitled
2An act relating to rural health care; amending s.
3381.0405, F.S.; revising the purpose and functions of the
4Office of Rural Health in the Department of Health;
5requiring the Secretary of Health and the Secretary of
6Health Care Administration to appoint an advisory council
7to advise the office; providing for terms of office of the
8members of the advisory council; authorizing per diem and
9travel reimbursement for members of the advisory council;
10requiring a report to the Governor and Legislature;
11amending s. 381.0406, F.S.; revising legislative findings
12and intent with respect to rural health networks; revising
13definitions; providing additional functions of and
14requirements for membership in rural health networks;
15requiring rural health networks to submit rural health
16infrastructure development plans to the office by a
17specified date; revising provisions relating to the
18governance and organization of rural health networks;
19revising the services to be provided by provider members
20of rural health networks; requiring coordination among
21rural health networks and area health education centers
22and health planning councils; establishing performance
23standards; establishing a grant program for funding rural
24health networks; defining projects that may be funded
25through the grant program; requiring the department to
26establish rules governing rural health network grant
27programs and performance standards; amending s. 395.602,
28F.S.; defining "critical access hospital"; revising and
29deleting definitions; amending s. 395.603, F.S.; deleting
30a requirement that the Agency for Health Care
31Administration adopt a rule relating to deactivation of
32rural hospital beds under certain circumstances; requiring
33that rural critical access hospitals maintain a certain
34number of actively licensed beds; amending s. 395.604,
35F.S.; removing emergency care hospitals and essential
36access community hospitals from certain licensure
37requirements; specifying certain special conditions for
38rural primary care hospitals; amending s. 395.6061, F.S.;
39specifying the purpose of the rural hospital capital
40improvement grant program; providing for grant management
41by the department; modifying the conditions for receiving
42a grant; providing for preferential assistance for
43financially distressed rural hospitals; providing purpose
44of the program; providing requirements for receiving
45certain assistance; requiring a participation agreement
46and providing for contents thereof; creating s. 408.7054,
47F.S.; establishing the Rural Provider Service Network
48Development Program; providing purposes; authorizing the
49agency to provide funding through a grant program for the
50establishment of rural provider service networks;
51providing eligibility requirements; authorizing
52preferential funding to certain providers; authorizing the
53agency to adopt rules; amending ss. 408.07, 409.9116, and
541009.65, F.S.; conforming cross-references; repealing s.
55395.605, F.S., relating to the licensure of emergency care
56hospitals; creating s. 381.7366, F.S.; establishing the
57Office of Minority Health; providing legislative intent;
58providing for organization, duties, and responsibilities;
59requiring a report to the Governor and Legislature;
60providing an effective date.
62Be It Enacted by the Legislature of the State of Florida:
64     Section 1.  Section 381.0405, Florida Statutes, is amended
65to read:
66     381.0405  Office of Rural Health.--
67     (1)  ESTABLISHMENT.--The Department of Health shall
68establish an Office of Rural Health, which shall assist rural
69health care providers in improving the health status and health
70care of rural residents of this state and assist rural health
71care providers in integrating their efforts. The Office of Rural
72Health shall coordinate its activities with rural health
73networks established under s. 381.0406, local health councils
74established under s. 408.033, the area health education center
75network established under pursuant to s. 381.0402, and with any
76appropriate research and policy development centers within
77universities that have state-approved medical schools. The
78Office of Rural Health may enter into a formal relationship with
79any center that designates the office as an affiliate of the
81     (2)  PURPOSE.--The Office of Rural Health shall actively
82foster the provision of high-quality health care services in
83rural areas and serve as a catalyst for improved health services
84to residents citizens in rural areas of the state.
85     (3)  GENERAL FUNCTIONS.--The office shall:
86     (a)  Integrate policies related to physician workforce,
87hospitals, public health, and state regulatory functions.
88     (b)  Work with rural stakeholders in order to foster the
89development of strategic planning that addresses Propose
90solutions to problems affecting health care delivery in rural
92     (c)  Foster the expansion of rural health network service
93areas to include rural counties that are not served by a rural
94health network.
95     (d)(c)  Seek grant funds from foundations and the Federal
97     (e)  Administer state grant programs for rural health
99     (4)  COORDINATION.--The office shall:
100     (a)  Identify federal and state rural health programs and
101provide information and technical assistance to rural providers
102regarding participation in such programs.
103     (b)  Act as a clearinghouse for collecting and
104disseminating information on rural health care issues, research
105findings on rural health care, and innovative approaches to the
106delivery of health care in rural areas.
107     (c)  Foster the creation of regional health care systems
108that promote cooperation, rather than competition.
109     (d)  Coordinate the department's rural health care
110activities, programs, and policies.
111     (e)  Design initiatives to improve access to primary,
112acute, and emergency medical services and promote the
113coordination of such services in rural areas.
114     (f)  Assume responsibility for state coordination of the
115Rural Hospital Transition Grant Program, the Essential Access
116Community Hospital Program, and other federal rural health care
117grant programs.
118     (5)  TECHNICAL ASSISTANCE.--The office shall:
119     (a)  Assist Help rural health care providers in recruiting
120obtain health care practitioners by promoting the location and
121relocation of health care practitioners in rural areas and
122promoting policies that create incentives for practitioners to
123serve in rural areas.
124     (b)  Provide technical assistance to hospitals, community
125and migrant health centers, and other health care providers that
126serve residents in rural areas.
127     (c)  Assist with the design of strategies to improve health
128care workforce recruitment and placement programs.
129     (d)  Provide technical assistance to rural health networks
130in the formulation of their rural health infrastructure
131development plans.
132     (e)  Provide links to best practices and other technical
133assistance resources on the office's Internet website.
134     (6)  ADVISORY COUNCIL.--The Secretary of Health and the
135Secretary of Health Care Administration shall each appoint no
136more than five members with relevant health care operations
137management, practice, and policy experience to an advisory
138council to advise the office regarding its responsibilities
139under this section and ss. 381.0406, 395.6061, and 395.6063.
140Members must be appointed for 4-year staggered terms and may be
141reappointed to a second term of office. Members shall serve
142without compensation but are entitled to reimbursement for per
143diem and travel expenses as provided in s. 112.061. The council
144may appoint technical advisory teams as needed. The department
145shall provide staff and other administrative assistance
146reasonably necessary to assist the advisory council in carrying
147out its duties.
148     (7)  REPORTS.--Beginning January 1, 2007, and annually
149thereafter, the Office of Rural Health shall submit a report to
150the Governor, the President of the Senate, and the Speaker of
151the House of Representatives summarizing the activities of the
152office, including the grants obtained or administered by the
153office and the status of rural health networks and rural
154hospitals in the state. The report must also include
155recommendations for improvements in health care delivery in
156rural areas of the state.
158office 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
162use in department policy development.
163     (9)(7)  APPROPRIATION.--The Legislature shall appropriate
164such sums as are necessary to support the Office of Rural
166     Section 2.  Section 381.0406, Florida Statutes, is amended
167to read:
168     381.0406  Rural health networks.--
170     (a)  The Legislature finds that, in rural areas, access to
171health care is limited and the quality of health care is
172negatively affected by inadequate financing, difficulty in
173recruiting and retaining skilled health professionals, and the
174because of a migration of patients to urban areas for general
175acute care and specialty services.
176     (b)  The Legislature further finds that the efficient and
177effective delivery of health care services in rural areas
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-
182effectiveness measures;
183     4.  The organization of health care providers into joint
184contracting entities;
185     5.  The establishment of referral linkages;
186     6.  The analysis of costs and services in order to prepare
187health 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
190a continuum of quality health care services, including
191preventive, primary, secondary, tertiary, and long-term care, is
192essential to the economic and social vitality of rural
194     (d)  The Legislature further finds that health care
195providers in rural areas are not prepared for market changes
196such as the introduction of managed care and capitation-
197reimbursement methodologies into health care services.
198     (e)(d)  The Legislature further finds that the creation of
199rural health networks can help to alleviate these problems.
200Rural health networks shall act in the broad public interest
201and, to the extent possible, seek to improve the accessibility,
202quality, and cost-effectiveness of rural health care by
203planning, developing, coordinating, and providing be structured
204to provide a continuum of quality health care services for rural
205residents through the cooperative efforts of rural health
206network members and other health care providers.
207     (f)(e)  The Legislature further finds that rural health
208networks shall have the goal of increasing the financial
209stability of statutory rural hospitals by linking rural hospital
210services to other services in a continuum of health care
211services and by increasing the utilization of statutory rural
212hospitals whenever for appropriate health care services whenever
213feasible, which shall help to ensure their survival and thereby
214support the economy and protect the health and safety of rural
216     (g)(f)  Finally, the Legislature finds that rural health
217networks may serve as "laboratories" to determine the best way
218of organizing rural health services and linking to out-of-area
219services that are not available locally in order, to move the
220state closer to ensuring that everyone has access to health
221care, and to promote cost containment efforts.  The ultimate
222goal of rural health networks shall be to ensure that quality
223health care is available and efficiently delivered to all
224persons in rural areas.
225     (2)  DEFINITIONS.--
226     (a)  "Rural" means an area having with a population density
227of fewer less than 100 individuals per square mile or an area
228defined by the most recent United States Census as rural.
229     (b)  "Health care provider" means any individual, group, or
230entity, public or private, which that provides health care,
231including: preventive health care, primary health care,
232secondary and tertiary health care, hospital in-hospital health
233care, public health care, and health promotion and education.
234     (c)  "Rural health network" or "network" means a nonprofit
235legal entity, whose members consist consisting of rural and
236urban health care providers and others, and which that is
237established organized to plan, develop, organize, and deliver
238health care services on a cooperative basis in a rural area,
239except for some secondary and tertiary care services.
240     (3)  NETWORK MEMBERSHIP.--
241     (a)  Because each rural area is unique, with a different
242health care provider mix, health care provider membership may
243vary, but all networks shall include members that provide health
244promotion and disease prevention services, public health
245services, comprehensive primary care, emergency medical care,
246and acute inpatient care.
247     (b)  Each county health department shall be a member of the
248rural health network whose service area includes the county in
249which the county health department is located. Federally
250qualified health centers and emergency medical services
251providers are encouraged to become members of the rural health
252networks in the areas in which their patients reside or receive
254     (c)(4)  Network membership shall be available to all health
255care providers in the network service area if, provided that
256they render care to all patients referred to them from other
257network members;, comply with network quality assurance, quality
258improvement, and utilization-management and risk management
259requirements; and, abide by the terms and conditions of network
260provider agreements in paragraph (11)(c), and provide services
261at a rate or price equal to the rate or price negotiated by the
263     (4)(5)  NETWORK SERVICE AREAS.--Network service areas are
264do not required need to conform to local political boundaries or
265state administrative district boundaries. The geographic area of
266one rural health network, however, may not overlap the territory
267of any other rural health network.
268     (5)(6)  NETWORK FUNCTIONS.--Networks shall:
269     (a)  Seek to develop linkages with provisions for referral
270to tertiary inpatient care, specialty physician care, and to
271other services that are not available in rural service areas.
272     (b)(7)  Networks shall Make available health promotion,
273disease prevention, and primary care services, in order to
274improve the health status of rural residents and to contain
275health care costs.
276     (8)  Networks may have multiple points of entry, such as
277through private physicians, community health centers, county
278health departments, certified rural health clinics, hospitals,
279or other providers; or they may have a single point of entry.
280     (c)(9)  Encourage members through training and educational
281programs to adopt standards of care, and promote the evidence-
282based practice of medicine. Networks shall establish standard
283protocols, coordinate and share patient records, and develop
284patient information exchange systems in order to improve quality
285and access to services.
286     (d)  Develop quality-improvement programs and train network
287members and other health care providers in the use of such
289     (e)  Develop disease-management systems and train network
290members and other health care providers in the use of such
292     (f)  Promote outreach to areas with a high need for
294     (g)  Seek to develop community care alternatives for elders
295who would otherwise be placed in nursing homes.
296     (h)  Emphasize community care alternatives for persons with
297mental health and substance abuse disorders who are at risk of
298being admitted to an institution.
299     (i)  Develop and implement a rural health infrastructure
300development plan for an integrated system of care that is
301responsive to the unique local health needs and the area health
302care services market. Each rural health infrastructure
303development plan must address strategies to improve access to
304specialty care, train health care providers to use standards of
305care for chronic illness, develop disease-management capacity,
306and link to state and national quality-improvement initiatives.
307The initial development plan must be submitted to the Office of
308Rural Health for review and approval no later than July 1, 2007,
309and thereafter the plans must be updated and submitted to the
310Office of Rural Health every 3 years.
311     (10)  Networks shall develop risk management and quality
312assurance programs for network providers.
314     (a)  Networks shall be incorporated as not-for-profit
315corporations under chapter 617, with articles of incorporation
316that set forth purposes consistent with this section the laws of
317the state.
318     (b)  Each network Networks shall have an independent a
319board of directors that derives membership from local
320government, health care providers, businesses, consumers,
321advocacy groups, and others. Boards of other community health
322care entities may not serve in whole as the board of a rural
323health network; however, some overlap of board membership with
324other community organizations is encouraged. Network staff must
325provide an annual orientation and strategic planning activity
326for board members.
327     (c)  Network boards of directors shall have the
328responsibility of determining the content of health care
329provider agreements that link network members.  The written
330agreements between the network and its health care provider
331members must specify participation in the essential functions of
332the network and shall specify:
333     1.  Who provides what services.
334     2.  The extent to which the health care provider provides
335care to persons who lack health insurance or are otherwise
336unable to pay for care.
337     3.  The procedures for transfer of medical records.
338     4.  The method used for the transportation of patients
339between providers.
340     5.  Referral and patient flow including appointments and
342     6.  Payment arrangements for the transfer or referral of
344     (d)  There shall be no liability on the part of, and no
345cause of action of any nature shall arise against, any member of
346a network board of directors, or its employees or agents, for
347any lawful action taken by them in the performance of their
348administrative powers and duties under this subsection.
350     (a)  Networks, to the extent feasible, shall seek to
351develop services that provide for a continuum of care for all
352residents patients served by the network. Each network shall
353recruit members that can provide include the following core
354services: disease prevention, health promotion, comprehensive
355primary care, emergency medical care, and acute inpatient care.
356Each network shall seek to ensure the availability of
357comprehensive maternity care, including prenatal, delivery, and
358postpartum care for uncomplicated pregnancies, either directly,
359by contract, or through referral agreements. Networks shall, to
360the extent feasible, develop local services and linkages among
361health care providers to also ensure the availability of the
362following services: within the specified timeframes, either
363directly, 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
369     3.a.  Emergency medical services, including advanced life
370support, ambulance, and basic emergency room services.
371     4.b.  Primary care, including.
372     c.  prenatal and postpartum care for uncomplicated
374     5.d.  Community-based services for elders, such as adult
375day care and assistance with activities of daily living.
376     6.e.  Public health services, including communicable
377disease control, disease prevention, health education, and
378health promotion.
379     7.f.  Outpatient mental health psychiatric and substance
380abuse services.
381     3.  Services accessible within 45 minutes travel time or
383     8.a.  Hospital acute inpatient care for persons whose
384illnesses or medical problems are not severe.
385     9.b.  Level I obstetrical care, which is Labor and delivery
386for low-risk patients.
387     10.c.  Skilled nursing services and, long-term care,
388including nursing home care.
389     (b)  Networks shall seek to foster linkages with out-of-
390area services to the extent feasible to ensure the availability
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
397and medical problems.
398     5.c.  Level II and III obstetrical care, which is Labor and
399delivery care for high-risk patients and neonatal intensive
401     6.d.  Comprehensive medical rehabilitation.
402     7.e.  Inpatient mental health psychiatric and substance
403abuse services.
404     8.f.  Magnetic resonance imaging, lithotripter treatment,
405oncology, advanced radiology, and other technologically advanced
407     9.g.  Subacute care.
409     (a)  Area health education centers and health planning
410councils shall participate in the rural health networks'
411preparation of development plans. The Department of Health may
412require a written memorandum of agreement between a network and
413an area health education center or health planning council.
414     (b)  Rural health networks shall initiate activities, in
415coordination with area health education centers, to carry out
416the objectives of the adopted development plan, including
417continuing education for health care practitioners performing
418functions such as disease management, continuous quality
419improvement, telemedicine, long-distance learning, and the
420treatment of chronic illness using standards of care. As used in
421this section, the term "telemedicine" means the use of
422telecommunications to deliver or expedite the delivery of health
423care services.
424     (c)  Rural health networks shall contract with local health
425planning councils to support the preparation of development
426plans through data collection and analysis in order to assess
427the health status of area residents and the capacity of local
428health services.
429     (d)(b)  Networks shall actively participate with area
430health education center programs, whenever feasible, in
431developing and implementing recruitment, training, and retention
432programs directed at positively influencing the supply and
433distribution of health care professionals serving in, or
434receiving training in, network areas.
435     (c)  As funds become available, networks shall emphasize
436community care alternatives for elders who would otherwise be
437placed in nursing homes.
438     (d)  To promote the most efficient use of resources,
439networks shall emphasize disease prevention, early diagnosis and
440treatment of medical problems, and community care alternatives
441for persons with mental health and substance abuse disorders who
442are at risk to be institutionalized.
443     (e)(13)  TRAUMA SERVICES.--In those network areas having
444which have an established trauma agency approved by the
445Department of Health, the network shall seek the participation
446of that trauma agency must be a participant in the network.
447Trauma services provided within the network area must comply
448with s. 395.405.
449     (9)(14)  NETWORK FINANCING.--
450     (a)  Networks may use all sources of public and private
451funds to support network activities. Nothing in this section
452prohibits networks from becoming managed care providers.
453     (b)  The Department of Health shall establish grant
454programs to provide funding to support the administrative costs
455of developing and operating rural health networks.
456     (10)  NETWORK PERFORMANCE STANDARDS.--The Department of
457Health shall develop and enforce performance standards for rural
458health network operations grants and rural health infrastructure
459development grants.
460     (a)  Operations grant performance standards must include,
461but are not limited to, standards that require the rural health
462network to:
463     1.  Have a qualified board of directors that meets at least
465     2.  Have sufficient staff who have the qualifications and
466experience to perform the requirements of this section, as
467assessed by the Office of Rural Health, or a written plan to
468obtain such staff.
469     3.  Comply with the department's grant management standards
470in a timely and responsive manner.
471     4.  Comply with the department's standards for the
472administration of federal grant funding, including assistance to
473rural hospitals.
474     5.  Demonstrate a commitment to network activities from
475area health care providers and other stakeholders, as described
476in letters of support.
477     (b)  Rural health infrastructure development grant
478performance standards must include, but are not limited to,
479standards that require the rural health network to:
480     1.  During the 2006-2007 fiscal year prepare a development
481plan and, after July 1, 2007, have a development plan that has
482been reviewed and approved by the Office of Rural Health.
483     2.  Have two or more successful network-development
484activities, such as:
485     a.  Management of a network development or outreach grant
486from the federal Office of Rural Health Policy;
487     b.  Implementation of outreach programs to address chronic
488disease, infant mortality, or assistance with prescription
490     c.  Development of partnerships with community and faith-
491based organizations to address area health problems;
492     d.  Provision of direct services, such as clinics or mobile
494     e.  Operation of credentialing services for health care
495providers or quality assurance and quality improvement
496initiatives that, whenever possible, are consistent with state
497or federal quality initiatives;
498     f.  Support for the development of community health
499centers, local community health councils, federal designation as
500a rural critical access hospital, or comprehensive community
501health planning initiatives; and
502     g.  Development of the capacity to obtain federal, state,
503and foundation grants.
504     (11)(15)  NETWORK IMPLEMENTATION.--As funds become
505available, networks shall be developed and implemented in two
507     (a)  Phase I shall consist of a network planning and
508development grant program. Planning grants shall be used to
509organize networks, incorporate network boards, and develop
510formal provider agreements as provided for in this section.  The
511Department of Health shall develop a request-for-proposal
512process to solicit grant applications.
513     (b)  Phase II shall consist of a network operations grant
514program. As funds become available, certified networks that meet
515performance standards shall be eligible to receive grant funds
516to be used to help defray the costs of rural health network
517infrastructure development, patient care, and network
518administration. Rural health network infrastructure development
519includes, but is not limited to: recruitment and retention of
520primary care practitioners; enhancements of primary care
521services through the use of mobile clinics; development of
522preventive health care programs; linkage of urban and rural
523health care systems; design and implementation of automated
524patient records, outcome measurement, quality assurance, and
525risk management systems; establishment of one-stop service
526delivery sites; upgrading of medical technology available to
527network providers; enhancement of emergency medical systems;
528enhancement of medical transportation; formation of joint
529contracting entities composed of rural physicians, rural
530hospitals, and other rural health care providers; establishment
531of comprehensive disease management programs that meet Medicaid
532requirements; establishment of regional quality improvement
533programs involving physicians and hospitals consistent with
534state and national initiatives; establishment of specialty
535networks connecting rural primary care physicians and urban
536specialists; development of regional broadband
537telecommunications systems that have the capacity to share
538patient information in a secure network, telemedicine, and long-
539distance learning capacity; and linkage between training
540programs for health care practitioners and the delivery of
541health care services in rural areas and development of
542telecommunication capabilities. A Phase II award may occur in
543the same fiscal year as a Phase I award.
544     (12)(16)  CERTIFICATION.--For the purpose of certifying
545networks that are eligible for Phase II funding, the Department
546of Health shall certify networks that meet the criteria
547delineated in this section and the rules governing rural health
548networks. The Office of Rural Health in the Department of Health
549shall monitor rural health networks in order to ensure continued
550compliance with established certification and performance
552     (13)(17)  RULES.--The Department of Health shall establish
553rules pursuant to s. 120.536(1) and 120.54 that govern the
554creation and certification of networks, the provision of grant
555funds under Phase I and Phase II, and the establishment of
556performance standards including establishing outcome measures
557for networks.
558     Section 3.  Subsection (2) of section 395.602, Florida
559Statutes, 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
563the definition of rural hospital in paragraph (d) and meets the
564requirements for reimbursement by Medicare and Medicaid under 42
565C.F.R. ss. 485.601-485.647. "Emergency care hospital" means a
566medical facility which provides:
567     1.  Emergency medical treatment; and
568     2.  Inpatient care to ill or injured persons prior to their
569transportation to another hospital or provides inpatient medical
570care to persons needing care for a period of up to 96 hours. The
57196-hour limitation on inpatient care does not apply to respite,
572skilled nursing, hospice, or other nonacute care patients.
573     (b)  "Essential access community hospital" means any
574facility which:
575     1.  Has at least 100 beds;
576     2.  Is located more than 35 miles from any other essential
577access community hospital, rural referral center, or urban
578hospital meeting criteria for classification as a regional
579referral center;
580     3.  Is part of a network that includes rural primary care
582     4.  Provides emergency and medical backup services to rural
583primary care hospitals in its rural health network;
584     5.  Extends staff privileges to rural primary care hospital
585physicians in its network; and
586     6.  Accepts patients transferred from rural primary care
587hospitals in its network.
588     (b)(c)  "Inactive rural hospital bed" means a licensed
589acute care hospital bed, as defined in s. 395.002(14), that is
590inactive in that it cannot be occupied by acute care inpatients.
591     (c)(d)  "Rural area health education center" means an area
592health education center (AHEC), as authorized by Pub. L. No. 94-
593484, that which provides services in a county with a population
594density of no greater than 100 persons per square mile.
595     (d)(e)  "Rural hospital" means an acute care hospital
596licensed under this chapter, having 100 or fewer licensed beds
597and an emergency room, that which is:
598     1.  The sole provider within a county with a population
599density of no greater than 100 persons per square mile;
600     2.  An acute care hospital, in a county with a population
601density of no greater than 100 persons per square mile, that
602which is at least 30 minutes of travel time, on normally
603traveled roads under normal traffic conditions, from any other
604acute care hospital within the same county;
605     3.  A hospital supported by a tax district or subdistrict
606whose boundaries encompass a population of 100 persons or fewer
607per square mile;
608     4.  A hospital in a constitutional charter county with a
609population of over 1 million persons that has imposed a local
610option health service tax pursuant to law and in an area that
611was directly impacted by a catastrophic event on August 24,
6121992, for which the Governor of Florida declared a state of
613emergency pursuant to chapter 125, and has 120 beds or fewer
614less that serves an agricultural community with an emergency
615room utilization of no less than 20,000 visits and a Medicaid
616inpatient utilization rate greater than 15 percent;
617     5.  A hospital with a service area that has a population of
618100 persons or fewer per square mile. As used in this
619subparagraph, the term "service area" means the fewest number of
620zip codes that account for 75 percent of the hospital's
621discharges for the most recent 5-year period, based on
622information available from the hospital inpatient discharge
623database in the State Center for Health Statistics at the Agency
624for Health Care Administration; or
625     6.  A hospital designated as a critical access hospital, as
626defined in s. 408.07(15).
628Population densities used in this paragraph must be based upon
629the most recently completed United States census. A hospital
630that received funds under s. 409.9116 for a quarter beginning no
631later than July 1, 2002, is deemed to have been and shall
632continue to be a rural hospital from that date through June 30,
6332012, if the hospital continues to have 100 or fewer licensed
634beds and an emergency room, or meets the criteria of
635subparagraph 4. An acute care hospital that has not previously
636been designated as a rural hospital and that meets the criteria
637of this paragraph shall be granted such designation upon
638application, including supporting documentation to the Agency
639for Health Care Administration.
640     (e)(f)  "Rural primary care hospital" means any facility
641that meeting the criteria in paragraph (e) or s. 395.605 which
643     1.  Twenty-four-hour emergency medical care;
644     2.  Temporary inpatient care for periods of 96 72 hours or
645less to patients requiring stabilization before discharge or
646transfer to another hospital. The 96-hour 72-hour limitation
647does not apply to respite, skilled nursing, hospice, or other
648nonacute care patients; and
649     3.  Has at least no more than six licensed acute care
650inpatient beds.
651     (f)(g)  "Swing-bed" means a bed that which can be used
652interchangeably as either a hospital, skilled nursing facility
653(SNF), or intermediate care facility (ICF) bed pursuant to 42
654C.F.R. parts 405, 435, 440, 442, and 447.
655     Section 4.  Subsection (1) of section 395.603, Florida
656Statutes, is amended to read:
657     395.603  Deactivation of general hospital beds; rural
658hospital impact statement.--
659     (1)  The agency shall establish, by rule, a process by
660which A rural hospital, as defined in s. 395.602, that seeks
661licensure as a rural primary care hospital or as an emergency
662care hospital, or becomes a certified rural health clinic as
663defined in Pub. L. No. 95-210, or becomes a primary care program
664such as a county health department, community health center, or
665other similar outpatient program that provides preventive and
666curative services, may deactivate general hospital beds. A rural
667critical access hospital Rural primary care hospitals and
668emergency care hospitals shall maintain the number of actively
669licensed general hospital beds necessary for the facility to be
670certified for Medicare reimbursement. Hospitals that discontinue
671inpatient care to become rural health care clinics or primary
672care programs shall deactivate all licensed general hospital
673beds. All hospitals, clinics, and programs with inactive beds
674shall provide 24-hour emergency medical care by staffing an
675emergency room. Providers with inactive beds shall be subject to
676the criteria in s. 395.1041. The agency shall specify in rule
677requirements for making 24-hour emergency care available.
678Inactive general hospital beds shall be included in the acute
679care bed inventory, maintained by the agency for certificate-of-
680need purposes, for 10 years from the date of deactivation of the
681beds. After 10 years have elapsed, inactive beds shall be
682excluded from the inventory. The agency shall, at the request of
683the licensee, reactivate the inactive general beds upon a
684showing by the licensee that licensure requirements for the
685inactive general beds are met.
686     Section 5.  Section 395.604, Florida Statutes, is amended
687to read:
688     395.604  Other Rural primary care hospitals hospital
690     (1)  The agency may license rural primary care hospitals
691subject to federal approval for participation in the Medicare
692and Medicaid programs. Rural primary care hospitals shall be
693treated in the same manner as emergency care hospitals and rural
694hospitals with respect to ss. 395.605(2)-(8)(a),
695408.033(2)(b)3., and 408.038.
696     (2)  The agency may designate essential access community
698     (2)(3)  The agency may adopt licensure rules for rural
699primary care hospitals and essential access community hospitals.
700Such rules must conform to s. 395.1055.
701     (3)  For the purpose of Medicaid swing-bed reimbursement
702pursuant to the Medicaid program, the agency shall treat rural
703primary care hospitals in the same manner as rural hospitals.
704     (4)  For the purpose of participation in the Medical
705Education Reimbursement and Loan Repayment Program as defined in
706s. 1009.65 or other loan repayment or incentive programs
707designed to relieve medical workforce shortages, the department
708shall treat rural primary care hospitals in the same manner as
709rural hospitals.
710     (5)  For the purpose of coordinating primary care services
711described in s. 154.011(1)(c)10., the department shall treat
712rural primary care hospitals in the same manner as rural
714     (6)  Rural hospitals that make application under the
715certificate-of-need program to be licensed as rural primary care
716hospitals shall receive expedited review as defined in s.
717408.032. Rural primary care hospitals seeking relicensure as
718acute care general hospitals shall also receive expedited
720     (7)  Rural primary care hospitals are exempt from
721certificate-of-need requirements for home health and hospice
722services and for swing beds in a number that does not exceed
723one-half of the facility's licensed beds.
724     (8)  Rural primary care hospitals shall have agreements
725with other hospitals, skilled nursing facilities, home health
726agencies, and providers of diagnostic-imaging and laboratory
727services that are not provided on site but are needed by
729     (4)  The department may seek federal recognition of
730emergency care hospitals authorized by s. 395.605 under the
731essential access community hospital program authorized by the
732Omnibus Budget Reconciliation Act of 1989.
733     Section 6.  Section 395.6061, Florida Statutes, is amended
734to read:
735     395.6061  Rural hospital capital improvement.--There is
736established a rural hospital capital improvement grant program.
737     (1)(a)  The purpose of the program is to provide targeted
738funding to rural hospitals to enable them to adapt to changes in
739health care delivery and funding and address disparities in
740rural 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
745includes technical assistance and grants managed by the agency.
746     (2)(1)  A rural hospital as defined in s. 395.602 may apply
747to the department for a capital improvement grant to acquire,
748repair, improve, or upgrade systems, facilities, or equipment.
749The grant application must provide information that includes:
750     (a)  A statement indicating the problem the rural hospital
751proposes to solve with the grant funds.;
752     (b)  The strategy proposed to resolve the problem.;
753     (c)  The organizational structure, financial system, and
754facilities that are essential to the proposed solution.;
755     (d)  The projected longevity of the proposed solution after
756the grant funds are expended.;
757     (e)  Evidence of participation in a rural health network as
758defined in s. 381.0406 and evidence that the application is
759consistent with the required rural health infrastructure
760development plan.;
761     (f)  Evidence that the rural hospital has difficulty in
762obtaining funding or that funds available for the proposed
763solution are inadequate.;
764     (g)  Evidence that the grant funds will assist in
765maintaining or returning the hospital to an economically stable
766condition or enable the transition to the status of rural
767primary care hospital or that any plan for closure of the
768hospital or realignment of services will involve development of
769innovative alternatives for the provision of needed discontinued
771     (h)  Evidence of a satisfactory record-keeping system to
772account for grant fund expenditures within the rural county.;
773     (i)  A rural health network plan that includes a
774description of how the plan was developed, the goals of the
775plan, the links with existing health care providers under the
776plan, Indicators quantifying the hospital's financial status
777well-being, measurable outcome targets, and the current physical
778and operational condition of the hospital.
779     (3)(2)  Each rural hospital as defined in s. 395.602 shall
780receive a minimum of $100,000 annually, subject to legislative
781appropriation, upon application to the Department of Health, for
782projects to acquire, repair, improve, or upgrade systems,
783facilities, or equipment.
784     (4)(3)  Any remaining funds shall annually be disbursed to
785rural hospitals in accordance with this section. The Department
786of Health shall establish, by rule, criteria for awarding grants
787for any remaining funds, which must be used exclusively for the
788support and assistance of rural hospitals as defined in s.
789395.602, including criteria relating to the level of charity
790uncompensated care rendered by the hospital, the financial
791status of the hospital, the performance standards of the
792hospital, the participation in a rural health network as defined
793in s. 381.0406, and the proposed use of the grant by the rural
794hospital to resolve a specific problem. The department must
795consider any information submitted in an application for the
796grants in accordance with subsection (2) (1) in determining
797eligibility for and the amount of the grant, and none of the
798individual items of information by itself may be used to deny
799grant eligibility.
800     (5)  Financially distressed rural hospitals may receive
801preferential assistance under the capital improvement grant
802program to provide planning, management, and financial support.
803To 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
806the hospital, the county commission, and the city commission.
807     2.  Evidence that the rural hospital and the community have
808difficulty obtaining funding or that funds available for the
809proposed solution are inadequate.
810     (b)  Agree to be bound by the terms of a participation
811agreement with the agency, which may include:
812     1.  The appointment of a health care expert under contract
813with the agency to analyze and monitor the hospital operations
814during the period of distress.
815     2.  The establishment of minimum standards for the
816education and experience of the managers and administrators of
817the hospital.
818     3.  The oversight and monitoring of a strategic plan to
819restore the hospital to an economically stable condition or
820transition to an alternative means to provide services.
821     4.  The establishment of a board orientation and
822development program.
823     5.  The approval of any facility relocation plans.
824     (6)(4)  The department shall ensure that the funds are used
825solely for the purposes specified in this section. The total
826grants awarded pursuant to this section shall not exceed the
827amount appropriated for this program.
828     Section 7.  Section 408.7054, Florida Statutes, is created
829to read:
830     408.7054  Rural Provider Service Network Development
832     (1)  There is established within the Agency for Health Care
833Administration the Rural Provider Service Network Development
834Program to support the implementation of provider service
835networks in rural counties of the state. The purpose of the
836program is to assist in the establishment of the infrastructure
837needed for Medicaid reform relating to prepaid and at-risk
838reimbursement plans to improve access to quality health care in
839rural areas.
840     (2)  The agency is authorized to provide funding through a
841grant program to entities seeking to establish rural provider
842service networks that have demonstrated an interest and have
843experience in organizing rural health care providers for this
845     (3)  Entities eligible for rural provider service network
846development grants must:
847     (a)  Have a written agreement signed by prospective
848members, 45 percent of whom must be providers in the targeted
849service area.
850     (b)  Include all rural hospitals, at least one federally
851qualified health center, and one county health department
852located in the service area.
853     (c)  Have a defined service area.
854     (4)  Each applicant for this funding shall provide the
855agency with a detailed written proposal that includes, at a
856minimum, a statement of need; a defined purpose; identification
857and explanation of the role of prospective partners; a signed
858memorandum of agreement or similar document attesting to the
859role of prospective partners; documented actions related to
860provider service network development; measurable objectives for
861the development of clinical and administrative infrastructure; a
862process of evaluation; and a process for developing a business
863plan and securing additional funding.
864     (5)  The agency is authorized to grant preferential funding
865to a rural provider service network based on the number of rural
866counties within the network's proposed service area that are
867Medically Underserved Areas or Health Professional Shortage
868Areas as defined by the Health Resources Services
869Administration, Office of Rural Health Policy, and based on
870whether the provider service network has a principal place of
871business located in a rural county in the state.
872     (6)  The agency is granted authority to develop rules
873pursuant to ss. 120.53(1) and 120.54 necessary to implement this
875     Section 8.  Subsection (43) of section 408.07, Florida
876Statutes, is amended to read:
877     408.07  Definitions.--As used in this chapter, with the
878exception of ss. 408.031-408.045, the term:
879     (43)  "Rural hospital" means an acute care hospital
880licensed under chapter 395, having 100 or fewer licensed beds
881and an emergency room, and which is:
882     (a)  The sole provider within a county with a population
883density of no greater than 100 persons per square mile;
884     (b)  An acute care hospital, in a county with a population
885density of no greater than 100 persons per square mile, which is
886at least 30 minutes of travel time, on normally traveled roads
887under normal traffic conditions, from another acute care
888hospital within the same county;
889     (c)  A hospital supported by a tax district or subdistrict
890whose boundaries encompass a population of 100 persons or fewer
891per square mile;
892     (d)  A hospital with a service area that has a population
893of 100 persons or fewer per square mile. As used in this
894paragraph, the term "service area" means the fewest number of
895zip codes that account for 75 percent of the hospital's
896discharges for the most recent 5-year period, based on
897information available from the hospital inpatient discharge
898database in the State Center for Health Statistics at the Agency
899for Health Care Administration; or
900     (e)  A critical access hospital.
902Population densities used in this subsection must be based upon
903the most recently completed United States census. A hospital
904that received funds under s. 409.9116 for a quarter beginning no
905later than July 1, 2002, is deemed to have been and shall
906continue to be a rural hospital from that date through June 30,
9072012, if the hospital continues to have 100 or fewer licensed
908beds and an emergency room, or meets the criteria of s.
909395.602(2)(d)(e)4. An acute care hospital that has not
910previously been designated as a rural hospital and that meets
911the criteria of this subsection shall be granted such
912designation upon application, including supporting
913documentation, to the Agency for Health Care Administration.
914     Section 9.  Subsection (6) of section 409.9116, Florida
915Statutes, is amended to read:
916     409.9116  Disproportionate share/financial assistance
917program for rural hospitals.--In addition to the payments made
918under s. 409.911, the Agency for Health Care Administration
919shall administer a federally matched disproportionate share
920program and a state-funded financial assistance program for
921statutory rural hospitals. The agency shall make
922disproportionate share payments to statutory rural hospitals
923that qualify for such payments and financial assistance payments
924to statutory rural hospitals that do not qualify for
925disproportionate share payments. The disproportionate share
926program payments shall be limited by and conform with federal
927requirements. Funds shall be distributed quarterly in each
928fiscal year for which an appropriation is made. Notwithstanding
929the provisions of s. 409.915, counties are exempt from
930contributing toward the cost of this special reimbursement for
931hospitals serving a disproportionate share of low-income
933     (6)  This section applies only to hospitals that were
934defined as statutory rural hospitals, or their successor-in-
935interest hospital, prior to January 1, 2001. Any additional
936hospital that is defined as a statutory rural hospital, or its
937successor-in-interest hospital, on or after January 1, 2001, is
938not eligible for programs under this section unless additional
939funds are appropriated each fiscal year specifically to the
940rural hospital disproportionate share and financial assistance
941programs in an amount necessary to prevent any hospital, or its
942successor-in-interest hospital, eligible for the programs prior
943to January 1, 2001, from incurring a reduction in payments
944because of the eligibility of an additional hospital to
945participate in the programs. A hospital, or its successor-in-
946interest hospital, which received funds pursuant to this section
947before January 1, 2001, and which qualifies under s.
948395.602(2)(d)(e), shall be included in the programs under this
949section and is not required to seek additional appropriations
950under this subsection.
951     Section 10.  Paragraph (b) of subsection (2) of section
9521009.65, Florida Statutes, is amended to read:
953     1009.65  Medical Education Reimbursement and Loan Repayment
955     (2)  From the funds available, the Department of Health
956shall make payments to selected medical professionals as
958     (b)  All payments shall be contingent on continued proof of
959primary care practice in an area defined in s. 395.602(2)(d)(e),
960or an underserved area designated by the Department of Health,
961provided the practitioner accepts Medicaid reimbursement if
962eligible for such reimbursement. Correctional facilities, state
963hospitals, and other state institutions that employ medical
964personnel shall be designated by the Department of Health as
965underserved locations. Locations with high incidences of infant
966mortality, high morbidity, or low Medicaid participation by
967health care professionals may be designated as underserved.
968     Section 11.  Section 395.605, Florida Statutes, is
970     Section 12.  Section 381.7366, Florida Statutes, is created
971to read:
972     381.7366  Office of Minority Health; legislative intent;
974     (1)  LEGISLATIVE INTENT.--The Legislature recognizes that
975despite significant investments in health care programs certain
976racial and ethnic populations suffer disproportionately with
977chronic diseases when compared to non-Hispanic whites. The
978Legislature intends to address these disparities by developing
979programs that target causal factors and recognize the specific
980health care needs of racial and ethnic minorities.
981     (2)  ORGANIZATION.--The Office of Minority Health is
982established within the Department of Health. The office shall be
983headed by a director who shall report directly to the Secretary
984of Health.
985     (3)  DUTIES.--The office shall:
986     (a)  Protect and promote the health and well-being of
987racial and ethnic populations in the state.
988     (b)  Focus on the issue of health disparities between
989racial and ethnic minority groups and the general population.
990     (c)  Coordinate the department's initiatives, programs, and
991policies to address racial and ethnic health disparities.
992     (d)  Communicate pertinent health information to affected
993racial and ethnic populations.
994     (e)  Collect and analyze data on the incidence and
995frequency of racial and ethnic health disparities.
996     (f)  Promote and encourage cultural competence education
997and training for healthcare professionals.
998     (g)  Serve as a clearinghouse for the collection and
999dissemination of information and research findings relating to
1000innovative approaches to the reduction or elimination of health
1002     (h)  Dedicate resources to increase public awareness of
1003minority health issues.
1004     (i)  Seek increased funding for local innovative
1005initiatives and administer grants designed to support
1006initiatives that address health disparities and that can be
1008     (j)  Provide staffing and support for the Closing the Gap
1009grant advisory council.
1010     (k)  Coordinate with other agencies, states, and the
1011Federal Government to reduce or eliminate health disparities.
1012     (l)  Collaborate with other public healthcare providers,
1013community and faith-based organizations, the private healthcare
1014system, historically black colleges and universities and other
1015minority institutions of higher education, medical schools, and
1016other health providers to establish a comprehensive and
1017inclusive approach to reducing health disparities.
1018     (m)  Encourage and support research into causes of racial
1019and ethnic health disparities.
1020     (n)  Collaborate with health professional training programs
1021to increase the number of minority healthcare professionals.
1022     (o)  Provide an annual report to the Governor, the
1023President of the Senate, and the Speaker of the House of
1024Representatives on the activities of the office.
1025     (4)  RESPONSIBILITY AND COORDINATION.--The office and the
1026department shall direct and carry out the duties established
1027under this section and shall work with other state agencies in
1028accomplishing these tasks.
1029     Section 13.  This act shall take effect July 1, 2006.

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