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; amending ss. 408.07,
47409.9116, and 1009.65, F.S.; conforming cross-references;
48repealing s. 395.605, F.S., relating to the licensure of
49emergency care hospitals; creating s. 381.7366, F.S.;
50establishing the Office of Minority Health; providing
51legislative intent; providing for organization, duties,
52and responsibilities; requiring a report to the Governor
53and Legislature; providing an effective date.
55Be It Enacted by the Legislature of the State of Florida:
57     Section 1.  Section 381.0405, Florida Statutes, is amended
58to read:
59     381.0405  Office of Rural Health.--
60     (1)  ESTABLISHMENT.--The Department of Health shall
61establish an Office of Rural Health, which shall assist rural
62health care providers in improving the health status and health
63care of rural residents of this state and assist rural health
64care providers in integrating their efforts. The Office of Rural
65Health shall coordinate its activities with rural health
66networks established under s. 381.0406, local health councils
67established under s. 408.033, the area health education center
68network established under pursuant to s. 381.0402, and with any
69appropriate research and policy development centers within
70universities that have state-approved medical schools. The
71Office of Rural Health may enter into a formal relationship with
72any center that designates the office as an affiliate of the
74     (2)  PURPOSE.--The Office of Rural Health shall actively
75foster the provision of high-quality health care services in
76rural areas and serve as a catalyst for improved health services
77to residents citizens in rural areas of the state.
78     (3)  GENERAL FUNCTIONS.--The office shall:
79     (a)  Integrate policies related to physician workforce,
80hospitals, public health, and state regulatory functions.
81     (b)  Work with rural stakeholders in order to foster the
82development of strategic planning that addresses Propose
83solutions to problems affecting health care delivery in rural
85     (c)  Foster the expansion of rural health network service
86areas to include rural counties that are not served by a rural
87health network.
88     (d)(c)  Seek grant funds from foundations and the Federal
90     (e)  Administer state grant programs for rural health
92     (4)  COORDINATION.--The office shall:
93     (a)  Identify federal and state rural health programs and
94provide information and technical assistance to rural providers
95regarding participation in such programs.
96     (b)  Act as a clearinghouse for collecting and
97disseminating information on rural health care issues, research
98findings on rural health care, and innovative approaches to the
99delivery of health care in rural areas.
100     (c)  Foster the creation of regional health care systems
101that promote cooperation, rather than competition.
102     (d)  Coordinate the department's rural health care
103activities, programs, and policies.
104     (e)  Design initiatives to improve access to primary,
105acute, and emergency medical services and promote the
106coordination of such services in rural areas.
107     (f)  Assume responsibility for state coordination of the
108Rural Hospital Transition Grant Program, the Essential Access
109Community Hospital Program, and other federal rural health care
110grant programs.
111     (5)  TECHNICAL ASSISTANCE.--The office shall:
112     (a)  Assist Help rural health care providers in recruiting
113obtain health care practitioners by promoting the location and
114relocation of health care practitioners in rural areas and
115promoting policies that create incentives for practitioners to
116serve in rural areas.
117     (b)  Provide technical assistance to hospitals, community
118and migrant health centers, and other health care providers that
119serve residents in rural areas.
120     (c)  Assist with the design of strategies to improve health
121care workforce recruitment and placement programs.
122     (d)  Provide technical assistance to rural health networks
123in the formulation of their rural health infrastructure
124development plans.
125     (e)  Provide links to best practices and other technical
126assistance resources on the office's Internet website.
127     (6)  ADVISORY COUNCIL.--The Secretary of Health and the
128Secretary of Health Care Administration shall each appoint no
129more than five members with relevant health care operations
130management, practice, and policy experience to an advisory
131council to advise the office regarding its responsibilities
132under this section and ss. 381.0406, 395.6061, and 395.6063.
133Members must be appointed for 4-year staggered terms and may be
134reappointed to a second term of office. Members shall serve
135without compensation but are entitled to reimbursement for per
136diem and travel expenses as provided in s. 112.061. The council
137may appoint technical advisory teams as needed. The department
138shall provide staff and other administrative assistance
139reasonably necessary to assist the advisory council in carrying
140out its duties.
141     (7)  REPORTS.--Beginning January 1, 2007, and annually
142thereafter, the Office of Rural Health shall submit a report to
143the Governor, the President of the Senate, and the Speaker of
144the House of Representatives summarizing the activities of the
145office, including the grants obtained or administered by the
146office and the status of rural health networks and rural
147hospitals in the state. The report must also include
148recommendations for improvements in health care delivery in
149rural areas of the state.
151office shall:
152     (a)  Conduct policy and research studies.
153     (b)  Conduct health status studies of rural residents.
154     (c)  Collect relevant data on rural health care issues for
155use in department policy development.
156     (9)(7)  APPROPRIATION.--The Legislature shall appropriate
157such sums as are necessary to support the Office of Rural
159     Section 2.  Section 381.0406, Florida Statutes, is amended
160to read:
161     381.0406  Rural health networks.--
163     (a)  The Legislature finds that, in rural areas, access to
164health care is limited and the quality of health care is
165negatively affected by inadequate financing, difficulty in
166recruiting and retaining skilled health professionals, and the
167because of a migration of patients to urban areas for general
168acute care and specialty services.
169     (b)  The Legislature further finds that the efficient and
170effective delivery of health care services in rural areas
172     1.  The integration of public and private resources;
173     2.  The introduction of innovative outreach methods;
174     3.  The adoption of quality improvement and cost-
175effectiveness measures;
176     4.  The organization of health care providers into joint
177contracting entities;
178     5.  The establishment of referral linkages;
179     6.  The analysis of costs and services in order to prepare
180health care providers for prepaid and at-risk financing; and
181     7.  The coordination of health care providers.
182     (c)  The Legislature further finds that the availability of
183a continuum of quality health care services, including
184preventive, primary, secondary, tertiary, and long-term care, is
185essential to the economic and social vitality of rural
187     (d)  The Legislature further finds that health care
188providers in rural areas are not prepared for market changes
189such as the introduction of managed care and capitation-
190reimbursement methodologies into health care services.
191     (e)(d)  The Legislature further finds that the creation of
192rural health networks can help to alleviate these problems.
193Rural health networks shall act in the broad public interest
194and, to the extent possible, seek to improve the accessibility,
195quality, and cost-effectiveness of rural health care by
196planning, developing, coordinating, and providing be structured
197to provide a continuum of quality health care services for rural
198residents through the cooperative efforts of rural health
199network members and other health care providers.
200     (f)(e)  The Legislature further finds that rural health
201networks shall have the goal of increasing the financial
202stability of statutory rural hospitals by linking rural hospital
203services to other services in a continuum of health care
204services and by increasing the utilization of statutory rural
205hospitals whenever for appropriate health care services whenever
206feasible, which shall help to ensure their survival and thereby
207support the economy and protect the health and safety of rural
209     (g)(f)  Finally, the Legislature finds that rural health
210networks may serve as "laboratories" to determine the best way
211of organizing rural health services and linking to out-of-area
212services that are not available locally in order, to move the
213state closer to ensuring that everyone has access to health
214care, and to promote cost containment efforts.  The ultimate
215goal of rural health networks shall be to ensure that quality
216health care is available and efficiently delivered to all
217persons in rural areas.
218     (2)  DEFINITIONS.--
219     (a)  "Rural" means an area having with a population density
220of fewer less than 100 individuals per square mile or an area
221defined by the most recent United States Census as rural.
222     (b)  "Health care provider" means any individual, group, or
223entity, public or private, which that provides health care,
224including: preventive health care, primary health care,
225secondary and tertiary health care, hospital in-hospital health
226care, public health care, and health promotion and education.
227     (c)  "Rural health network" or "network" means a nonprofit
228legal entity, whose members consist consisting of rural and
229urban health care providers and others, and which that is
230established organized to plan, develop, organize, and deliver
231health care services on a cooperative basis in a rural area,
232except for some secondary and tertiary care services.
233     (3)  NETWORK MEMBERSHIP.--
234     (a)  Because each rural area is unique, with a different
235health care provider mix, health care provider membership may
236vary, but all networks shall include members that provide health
237promotion and disease prevention services, public health
238services, comprehensive primary care, emergency medical care,
239and acute inpatient care.
240     (b)  Each county health department shall be a member of the
241rural health network whose service area includes the county in
242which the county health department is located. Federally
243qualified health centers and emergency medical services
244providers are encouraged to become members of the rural health
245networks in the areas in which their patients reside or receive
247     (c)(4)  Network membership shall be available to all health
248care providers in the network service area if, provided that
249they render care to all patients referred to them from other
250network members;, comply with network quality assurance, quality
251improvement, and utilization-management and risk management
252requirements; and, abide by the terms and conditions of network
253provider agreements in paragraph (11)(c), and provide services
254at a rate or price equal to the rate or price negotiated by the
256     (4)(5)  NETWORK SERVICE AREAS.--Network service areas are
257do not required need to conform to local political boundaries or
258state administrative district boundaries. The geographic area of
259one rural health network, however, may not overlap the territory
260of any other rural health network.
261     (5)(6)  NETWORK FUNCTIONS.--Networks shall:
262     (a)  Seek to develop linkages with provisions for referral
263to tertiary inpatient care, specialty physician care, and to
264other services that are not available in rural service areas.
265     (b)(7)  Networks shall Make available health promotion,
266disease prevention, and primary care services, in order to
267improve the health status of rural residents and to contain
268health care costs.
269     (8)  Networks may have multiple points of entry, such as
270through private physicians, community health centers, county
271health departments, certified rural health clinics, hospitals,
272or other providers; or they may have a single point of entry.
273     (c)(9)  Encourage members through training and educational
274programs to adopt standards of care, and promote the evidence-
275based practice of medicine. Networks shall establish standard
276protocols, coordinate and share patient records, and develop
277patient information exchange systems in order to improve quality
278and access to services.
279     (d)  Develop quality-improvement programs and train network
280members and other health care providers in the use of such
282     (e)  Develop disease-management systems and train network
283members and other health care providers in the use of such
285     (f)  Promote outreach to areas with a high need for
287     (g)  Seek to develop community care alternatives for elders
288who would otherwise be placed in nursing homes.
289     (h)  Emphasize community care alternatives for persons with
290mental health and substance abuse disorders who are at risk of
291being admitted to an institution.
292     (i)  Develop and implement a rural health infrastructure
293development plan for an integrated system of care that is
294responsive to the unique local health needs and the area health
295care services market. Each rural health infrastructure
296development plan must address strategies to improve access to
297specialty care, train health care providers to use standards of
298care for chronic illness, develop disease-management capacity,
299and link to state and national quality-improvement initiatives.
300The initial development plan must be submitted to the Office of
301Rural Health for review and approval no later than July 1, 2007,
302and thereafter the plans must be updated and submitted to the
303Office of Rural Health every 3 years.
304     (10)  Networks shall develop risk management and quality
305assurance programs for network providers.
307     (a)  Networks shall be incorporated as not-for-profit
308corporations under chapter 617, with articles of incorporation
309that set forth purposes consistent with this section the laws of
310the state.
311     (b)  Each network Networks shall have an independent a
312board of directors that derives membership from local
313government, health care providers, businesses, consumers,
314advocacy groups, and others. Boards of other community health
315care entities may not serve in whole as the board of a rural
316health network; however, some overlap of board membership with
317other community organizations is encouraged. Network staff must
318provide an annual orientation and strategic planning activity
319for board members.
320     (c)  Network boards of directors shall have the
321responsibility of determining the content of health care
322provider agreements that link network members.  The written
323agreements between the network and its health care provider
324members must specify participation in the essential functions of
325the network and shall specify:
326     1.  Who provides what services.
327     2.  The extent to which the health care provider provides
328care to persons who lack health insurance or are otherwise
329unable to pay for care.
330     3.  The procedures for transfer of medical records.
331     4.  The method used for the transportation of patients
332between providers.
333     5.  Referral and patient flow including appointments and
335     6.  Payment arrangements for the transfer or referral of
337     (d)  There shall be no liability on the part of, and no
338cause of action of any nature shall arise against, any member of
339a network board of directors, or its employees or agents, for
340any lawful action taken by them in the performance of their
341administrative powers and duties under this subsection.
343     (a)  Networks, to the extent feasible, shall seek to
344develop services that provide for a continuum of care for all
345residents patients served by the network. Each network shall
346recruit members that can provide include the following core
347services: disease prevention, health promotion, comprehensive
348primary care, emergency medical care, and acute inpatient care.
349Each network shall seek to ensure the availability of
350comprehensive maternity care, including prenatal, delivery, and
351postpartum care for uncomplicated pregnancies, either directly,
352by contract, or through referral agreements. Networks shall, to
353the extent feasible, develop local services and linkages among
354health care providers to also ensure the availability of the
355following services: within the specified timeframes, either
356directly, by contract, or through referral agreements:
357     1.  Services available in the home.
358     1.a.  Home health care.
359     2.b.  Hospice care.
360     2.  Services accessible within 30 minutes travel time or
362     3.a.  Emergency medical services, including advanced life
363support, ambulance, and basic emergency room services.
364     4.b.  Primary care, including.
365     c.  prenatal and postpartum care for uncomplicated
367     5.d.  Community-based services for elders, such as adult
368day care and assistance with activities of daily living.
369     6.e.  Public health services, including communicable
370disease control, disease prevention, health education, and
371health promotion.
372     7.f.  Outpatient mental health psychiatric and substance
373abuse services.
374     3.  Services accessible within 45 minutes travel time or
376     8.a.  Hospital acute inpatient care for persons whose
377illnesses or medical problems are not severe.
378     9.b.  Level I obstetrical care, which is Labor and delivery
379for low-risk patients.
380     10.c.  Skilled nursing services and, long-term care,
381including nursing home care.
382     (b)  Networks shall seek to foster linkages with out-of-
383area services to the extent feasible to ensure the availability
385     1.d.  Dialysis.
386     2.e.  Osteopathic and chiropractic manipulative therapy.
387     4.  Services accessible within 2 hours travel time or less.
388     3.a.  Specialist physician care.
389     4.b.  Hospital acute inpatient care for severe illnesses
390and medical problems.
391     5.c.  Level II and III obstetrical care, which is Labor and
392delivery care for high-risk patients and neonatal intensive
394     6.d.  Comprehensive medical rehabilitation.
395     7.e.  Inpatient mental health psychiatric and substance
396abuse services.
397     8.f.  Magnetic resonance imaging, lithotripter treatment,
398oncology, advanced radiology, and other technologically advanced
400     9.g.  Subacute care.
402     (a)  Area health education centers and health planning
403councils shall participate in the rural health networks'
404preparation of development plans. The Department of Health may
405require a written memorandum of agreement between a network and
406an area health education center or health planning council.
407     (b)  Rural health networks shall initiate activities, in
408coordination with area health education centers, to carry out
409the objectives of the adopted development plan, including
410continuing education for health care practitioners performing
411functions such as disease management, continuous quality
412improvement, telemedicine, long-distance learning, and the
413treatment of chronic illness using standards of care. As used in
414this section, the term "telemedicine" means the use of
415telecommunications to deliver or expedite the delivery of health
416care services.
417     (c)  Rural health networks shall contract with local health
418planning councils to support the preparation of development
419plans through data collection and analysis in order to assess
420the health status of area residents and the capacity of local
421health services.
422     (d)(b)  Networks shall actively participate with area
423health education center programs, whenever feasible, in
424developing and implementing recruitment, training, and retention
425programs directed at positively influencing the supply and
426distribution of health care professionals serving in, or
427receiving training in, network areas.
428     (c)  As funds become available, networks shall emphasize
429community care alternatives for elders who would otherwise be
430placed in nursing homes.
431     (d)  To promote the most efficient use of resources,
432networks shall emphasize disease prevention, early diagnosis and
433treatment of medical problems, and community care alternatives
434for persons with mental health and substance abuse disorders who
435are at risk to be institutionalized.
436     (e)(13)  TRAUMA SERVICES.--In those network areas having
437which have an established trauma agency approved by the
438Department of Health, the network shall seek the participation
439of that trauma agency must be a participant in the network.
440Trauma services provided within the network area must comply
441with s. 395.405.
442     (9)(14)  NETWORK FINANCING.--
443     (a)  Networks may use all sources of public and private
444funds to support network activities. Nothing in this section
445prohibits networks from becoming managed care providers.
446     (b)  The Department of Health shall establish grant
447programs to provide funding to support the administrative costs
448of developing and operating rural health networks.
449     (10)  NETWORK PERFORMANCE STANDARDS.--The Department of
450Health shall develop and enforce performance standards for rural
451health network operations grants and rural health infrastructure
452development grants.
453     (a)  Operations grant performance standards must include,
454but are not limited to, standards that require the rural health
455network to:
456     1.  Have a qualified board of directors that meets at least
458     2.  Have sufficient staff who have the qualifications and
459experience to perform the requirements of this section, as
460assessed by the Office of Rural Health, or a written plan to
461obtain such staff.
462     3.  Comply with the department's grant management standards
463in a timely and responsive manner.
464     4.  Comply with the department's standards for the
465administration of federal grant funding, including assistance to
466rural hospitals.
467     5.  Demonstrate a commitment to network activities from
468area health care providers and other stakeholders, as described
469in letters of support.
470     (b)  Rural health infrastructure development grant
471performance standards must include, but are not limited to,
472standards that require the rural health network to:
473     1.  During the 2006-2007 fiscal year prepare a development
474plan and, after July 1, 2007, have a development plan that has
475been reviewed and approved by the Office of Rural Health.
476     2.  Have two or more successful network-development
477activities, such as:
478     a.  Management of a network development or outreach grant
479from the federal Office of Rural Health Policy;
480     b.  Implementation of outreach programs to address chronic
481disease, infant mortality, or assistance with prescription
483     c.  Development of partnerships with community and faith-
484based organizations to address area health problems;
485     d.  Provision of direct services, such as clinics or mobile
487     e.  Operation of credentialing services for health care
488providers or quality assurance and quality improvement
489initiatives that, whenever possible, are consistent with state
490or federal quality initiatives;
491     f.  Support for the development of community health
492centers, local community health councils, federal designation as
493a rural critical access hospital, or comprehensive community
494health planning initiatives; and
495     g.  Development of the capacity to obtain federal, state,
496and foundation grants.
497     (11)(15)  NETWORK IMPLEMENTATION.--As funds become
498available, networks shall be developed and implemented in two
500     (a)  Phase I shall consist of a network planning and
501development grant program. Planning grants shall be used to
502organize networks, incorporate network boards, and develop
503formal provider agreements as provided for in this section.  The
504Department of Health shall develop a request-for-proposal
505process to solicit grant applications.
506     (b)  Phase II shall consist of a network operations grant
507program. As funds become available, certified networks that meet
508performance standards shall be eligible to receive grant funds
509to be used to help defray the costs of rural health network
510infrastructure development, patient care, and network
511administration. Rural health network infrastructure development
512includes, but is not limited to: recruitment and retention of
513primary care practitioners; enhancements of primary care
514services through the use of mobile clinics; development of
515preventive health care programs; linkage of urban and rural
516health care systems; design and implementation of automated
517patient records, outcome measurement, quality assurance, and
518risk management systems; establishment of one-stop service
519delivery sites; upgrading of medical technology available to
520network providers; enhancement of emergency medical systems;
521enhancement of medical transportation; formation of joint
522contracting entities composed of rural physicians, rural
523hospitals, and other rural health care providers; establishment
524of comprehensive disease management programs that meet Medicaid
525requirements; establishment of regional quality improvement
526programs involving physicians and hospitals consistent with
527state and national initiatives; establishment of specialty
528networks connecting rural primary care physicians and urban
529specialists; development of regional broadband
530telecommunications systems that have the capacity to share
531patient information in a secure network, telemedicine, and long-
532distance learning capacity; and linkage between training
533programs for health care practitioners and the delivery of
534health care services in rural areas and development of
535telecommunication capabilities. A Phase II award may occur in
536the same fiscal year as a Phase I award.
537     (12)(16)  CERTIFICATION.--For the purpose of certifying
538networks that are eligible for Phase II funding, the Department
539of Health shall certify networks that meet the criteria
540delineated in this section and the rules governing rural health
541networks. The Office of Rural Health in the Department of Health
542shall monitor rural health networks in order to ensure continued
543compliance with established certification and performance
545     (13)(17)  RULES.--The Department of Health shall establish
546rules pursuant to s. 120.536(1) and 120.54 that govern the
547creation and certification of networks, the provision of grant
548funds under Phase I and Phase II, and the establishment of
549performance standards including establishing outcome measures
550for networks.
551     Section 3.  Subsection (2) of section 395.602, Florida
552Statutes, is amended to read:
553     395.602  Rural hospitals.--
554     (2)  DEFINITIONS.--As used in this part:
555     (a)  "Critical access hospital" means a hospital that meets
556the definition of rural hospital in paragraph (d) and meets the
557requirements for reimbursement by Medicare and Medicaid under 42
558C.F.R. ss. 485.601-485.647. "Emergency care hospital" means a
559medical facility which provides:
560     1.  Emergency medical treatment; and
561     2.  Inpatient care to ill or injured persons prior to their
562transportation to another hospital or provides inpatient medical
563care to persons needing care for a period of up to 96 hours. The
56496-hour limitation on inpatient care does not apply to respite,
565skilled nursing, hospice, or other nonacute care patients.
566     (b)  "Essential access community hospital" means any
567facility which:
568     1.  Has at least 100 beds;
569     2.  Is located more than 35 miles from any other essential
570access community hospital, rural referral center, or urban
571hospital meeting criteria for classification as a regional
572referral center;
573     3.  Is part of a network that includes rural primary care
575     4.  Provides emergency and medical backup services to rural
576primary care hospitals in its rural health network;
577     5.  Extends staff privileges to rural primary care hospital
578physicians in its network; and
579     6.  Accepts patients transferred from rural primary care
580hospitals in its network.
581     (b)(c)  "Inactive rural hospital bed" means a licensed
582acute care hospital bed, as defined in s. 395.002(14), that is
583inactive in that it cannot be occupied by acute care inpatients.
584     (c)(d)  "Rural area health education center" means an area
585health education center (AHEC), as authorized by Pub. L. No. 94-
586484, that which provides services in a county with a population
587density of no greater than 100 persons per square mile.
588     (d)(e)  "Rural hospital" means an acute care hospital
589licensed under this chapter, having 100 or fewer licensed beds
590and an emergency room, that which is:
591     1.  The sole provider within a county with a population
592density of no greater than 100 persons per square mile;
593     2.  An acute care hospital, in a county with a population
594density of no greater than 100 persons per square mile, that
595which is at least 30 minutes of travel time, on normally
596traveled roads under normal traffic conditions, from any other
597acute care hospital within the same county;
598     3.  A hospital supported by a tax district or subdistrict
599whose boundaries encompass a population of 100 persons or fewer
600per square mile;
601     4.  A hospital in a constitutional charter county with a
602population of over 1 million persons that has imposed a local
603option health service tax pursuant to law and in an area that
604was directly impacted by a catastrophic event on August 24,
6051992, for which the Governor of Florida declared a state of
606emergency pursuant to chapter 125, and has 120 beds or fewer
607less that serves an agricultural community with an emergency
608room utilization of no less than 20,000 visits and a Medicaid
609inpatient utilization rate greater than 15 percent;
610     5.  A hospital with a service area that has a population of
611100 persons or fewer per square mile. As used in this
612subparagraph, the term "service area" means the fewest number of
613zip codes that account for 75 percent of the hospital's
614discharges for the most recent 5-year period, based on
615information available from the hospital inpatient discharge
616database in the State Center for Health Statistics at the Agency
617for Health Care Administration; or
618     6.  A hospital designated as a critical access hospital, as
619defined in s. 408.07(15).
621Population densities used in this paragraph must be based upon
622the most recently completed United States census. A hospital
623that received funds under s. 409.9116 for a quarter beginning no
624later than July 1, 2002, is deemed to have been and shall
625continue to be a rural hospital from that date through June 30,
6262012, if the hospital continues to have 100 or fewer licensed
627beds and an emergency room, or meets the criteria of
628subparagraph 4. An acute care hospital that has not previously
629been designated as a rural hospital and that meets the criteria
630of this paragraph shall be granted such designation upon
631application, including supporting documentation to the Agency
632for Health Care Administration.
633     (e)(f)  "Rural primary care hospital" means any facility
634that meeting the criteria in paragraph (e) or s. 395.605 which
636     1.  Twenty-four-hour emergency medical care;
637     2.  Temporary inpatient care for periods of 96 72 hours or
638less to patients requiring stabilization before discharge or
639transfer to another hospital. The 96-hour 72-hour limitation
640does not apply to respite, skilled nursing, hospice, or other
641nonacute care patients; and
642     3.  Has at least no more than six licensed acute care
643inpatient beds.
644     (f)(g)  "Swing-bed" means a bed that which can be used
645interchangeably as either a hospital, skilled nursing facility
646(SNF), or intermediate care facility (ICF) bed pursuant to 42
647C.F.R. parts 405, 435, 440, 442, and 447.
648     Section 4.  Subsection (1) of section 395.603, Florida
649Statutes, is amended to read:
650     395.603  Deactivation of general hospital beds; rural
651hospital impact statement.--
652     (1)  The agency shall establish, by rule, a process by
653which A rural hospital, as defined in s. 395.602, that seeks
654licensure as a rural primary care hospital or as an emergency
655care hospital, or becomes a certified rural health clinic as
656defined in Pub. L. No. 95-210, or becomes a primary care program
657such as a county health department, community health center, or
658other similar outpatient program that provides preventive and
659curative services, may deactivate general hospital beds. A rural
660critical access hospital Rural primary care hospitals and
661emergency care hospitals shall maintain the number of actively
662licensed general hospital beds necessary for the facility to be
663certified for Medicare reimbursement. Hospitals that discontinue
664inpatient care to become rural health care clinics or primary
665care programs shall deactivate all licensed general hospital
666beds. All hospitals, clinics, and programs with inactive beds
667shall provide 24-hour emergency medical care by staffing an
668emergency room. Providers with inactive beds shall be subject to
669the criteria in s. 395.1041. The agency shall specify in rule
670requirements for making 24-hour emergency care available.
671Inactive general hospital beds shall be included in the acute
672care bed inventory, maintained by the agency for certificate-of-
673need purposes, for 10 years from the date of deactivation of the
674beds. After 10 years have elapsed, inactive beds shall be
675excluded from the inventory. The agency shall, at the request of
676the licensee, reactivate the inactive general beds upon a
677showing by the licensee that licensure requirements for the
678inactive general beds are met.
679     Section 5.  Section 395.604, Florida Statutes, is amended
680to read:
681     395.604  Other Rural primary care hospitals hospital
683     (1)  The agency may license rural primary care hospitals
684subject to federal approval for participation in the Medicare
685and Medicaid programs. Rural primary care hospitals shall be
686treated in the same manner as emergency care hospitals and rural
687hospitals with respect to ss. 395.605(2)-(8)(a),
688408.033(2)(b)3., and 408.038.
689     (2)  The agency may designate essential access community
691     (2)(3)  The agency may adopt licensure rules for rural
692primary care hospitals and essential access community hospitals.
693Such rules must conform to s. 395.1055.
694     (3)  For the purpose of Medicaid swing-bed reimbursement
695pursuant to the Medicaid program, the agency shall treat rural
696primary care hospitals in the same manner as rural hospitals.
697     (4)  For the purpose of participation in the Medical
698Education Reimbursement and Loan Repayment Program as defined in
699s. 1009.65 or other loan repayment or incentive programs
700designed to relieve medical workforce shortages, the department
701shall treat rural primary care hospitals in the same manner as
702rural hospitals.
703     (5)  For the purpose of coordinating primary care services
704described in s. 154.011(1)(c)10., the department shall treat
705rural primary care hospitals in the same manner as rural
707     (6)  Rural hospitals that make application under the
708certificate-of-need program to be licensed as rural primary care
709hospitals shall receive expedited review as defined in s.
710408.032. Rural primary care hospitals seeking relicensure as
711acute care general hospitals shall also receive expedited
713     (7)  Rural primary care hospitals are exempt from
714certificate-of-need requirements for home health and hospice
715services and for swing beds in a number that does not exceed
716one-half of the facility's licensed beds.
717     (8)  Rural primary care hospitals shall have agreements
718with other hospitals, skilled nursing facilities, home health
719agencies, and providers of diagnostic-imaging and laboratory
720services that are not provided on site but are needed by
722     (4)  The department may seek federal recognition of
723emergency care hospitals authorized by s. 395.605 under the
724essential access community hospital program authorized by the
725Omnibus Budget Reconciliation Act of 1989.
726     Section 6.  Section 395.6061, Florida Statutes, is amended
727to read:
728     395.6061  Rural hospital capital improvement.--There is
729established a rural hospital capital improvement grant program.
730     (1)(a)  The purpose of the program is to provide targeted
731funding to rural hospitals to enable them to adapt to changes in
732health care delivery and funding and address disparities in
733rural health care by:
734     1.  Assisting in the development of needed infrastructure.
735     2.  Assisting financially distressed rural hospitals.
736     3.  Ensuring accountability for state and federal funding.
737     (b)  The rural hospital capital improvement grant program
738includes technical assistance and grants managed by the agency.
739     (2)(1)  A rural hospital as defined in s. 395.602 may apply
740to the department for a capital improvement grant to acquire,
741repair, improve, or upgrade systems, facilities, or equipment.
742The grant application must provide information that includes:
743     (a)  A statement indicating the problem the rural hospital
744proposes to solve with the grant funds.;
745     (b)  The strategy proposed to resolve the problem.;
746     (c)  The organizational structure, financial system, and
747facilities that are essential to the proposed solution.;
748     (d)  The projected longevity of the proposed solution after
749the grant funds are expended.;
750     (e)  Evidence of participation in a rural health network as
751defined in s. 381.0406 and evidence that the application is
752consistent with the required rural health infrastructure
753development plan.;
754     (f)  Evidence that the rural hospital has difficulty in
755obtaining funding or that funds available for the proposed
756solution are inadequate.;
757     (g)  Evidence that the grant funds will assist in
758maintaining or returning the hospital to an economically stable
759condition or enable the transition to the status of rural
760primary care hospital or that any plan for closure of the
761hospital or realignment of services will involve development of
762innovative alternatives for the provision of needed discontinued
764     (h)  Evidence of a satisfactory record-keeping system to
765account for grant fund expenditures within the rural county.;
766     (i)  A rural health network plan that includes a
767description of how the plan was developed, the goals of the
768plan, the links with existing health care providers under the
769plan, Indicators quantifying the hospital's financial status
770well-being, measurable outcome targets, and the current physical
771and operational condition of the hospital.
772     (3)(2)  Each rural hospital as defined in s. 395.602 shall
773receive a minimum of $100,000 annually, subject to legislative
774appropriation, upon application to the Department of Health, for
775projects to acquire, repair, improve, or upgrade systems,
776facilities, or equipment.
777     (4)(3)  Any remaining funds shall annually be disbursed to
778rural hospitals in accordance with this section. The Department
779of Health shall establish, by rule, criteria for awarding grants
780for any remaining funds, which must be used exclusively for the
781support and assistance of rural hospitals as defined in s.
782395.602, including criteria relating to the level of charity
783uncompensated care rendered by the hospital, the financial
784status of the hospital, the performance standards of the
785hospital, the participation in a rural health network as defined
786in s. 381.0406, and the proposed use of the grant by the rural
787hospital to resolve a specific problem. The department must
788consider any information submitted in an application for the
789grants in accordance with subsection (2) (1) in determining
790eligibility for and the amount of the grant, and none of the
791individual items of information by itself may be used to deny
792grant eligibility.
793     (5)  Financially distressed rural hospitals may receive
794preferential assistance under the capital improvement grant
795program to provide planning, management, and financial support.
796To receive this assistance the hospital must:
797     (a)  Provide additional information that includes:
798     1.  A statement of support from the board of directors of
799the hospital, the county commission, and the city commission.
800     2.  Evidence that the rural hospital and the community have
801difficulty obtaining funding or that funds available for the
802proposed solution are inadequate.
803     (b)  Agree to be bound by the terms of a participation
804agreement with the agency, which may include:
805     1.  The appointment of a health care expert under contract
806with the agency to analyze and monitor the hospital operations
807during the period of distress.
808     2.  The establishment of minimum standards for the
809education and experience of the managers and administrators of
810the hospital.
811     3.  The oversight and monitoring of a strategic plan to
812restore the hospital to an economically stable condition or
813transition to an alternative means to provide services.
814     4.  The establishment of a board orientation and
815development program.
816     5.  The approval of any facility relocation plans.
817     (6)(4)  The department shall ensure that the funds are used
818solely for the purposes specified in this section. The total
819grants awarded pursuant to this section shall not exceed the
820amount appropriated for this program.
821     Section 7.  Subsection (43) of section 408.07, Florida
822Statutes, is amended to read:
823     408.07  Definitions.--As used in this chapter, with the
824exception of ss. 408.031-408.045, the term:
825     (43)  "Rural hospital" means an acute care hospital
826licensed under chapter 395, having 100 or fewer licensed beds
827and an emergency room, and which is:
828     (a)  The sole provider within a county with a population
829density of no greater than 100 persons per square mile;
830     (b)  An acute care hospital, in a county with a population
831density of no greater than 100 persons per square mile, which is
832at least 30 minutes of travel time, on normally traveled roads
833under normal traffic conditions, from another acute care
834hospital within the same county;
835     (c)  A hospital supported by a tax district or subdistrict
836whose boundaries encompass a population of 100 persons or fewer
837per square mile;
838     (d)  A hospital with a service area that has a population
839of 100 persons or fewer per square mile. As used in this
840paragraph, the term "service area" means the fewest number of
841zip codes that account for 75 percent of the hospital's
842discharges for the most recent 5-year period, based on
843information available from the hospital inpatient discharge
844database in the State Center for Health Statistics at the Agency
845for Health Care Administration; or
846     (e)  A critical access hospital.
848Population densities used in this subsection must be based upon
849the most recently completed United States census. A hospital
850that received funds under s. 409.9116 for a quarter beginning no
851later than July 1, 2002, is deemed to have been and shall
852continue to be a rural hospital from that date through June 30,
8532012, if the hospital continues to have 100 or fewer licensed
854beds and an emergency room, or meets the criteria of s.
855395.602(2)(d)(e)4. An acute care hospital that has not
856previously been designated as a rural hospital and that meets
857the criteria of this subsection shall be granted such
858designation upon application, including supporting
859documentation, to the Agency for Health Care Administration.
860     Section 8.  Subsection (6) of section 409.9116, Florida
861Statutes, is amended to read:
862     409.9116  Disproportionate share/financial assistance
863program for rural hospitals.--In addition to the payments made
864under s. 409.911, the Agency for Health Care Administration
865shall administer a federally matched disproportionate share
866program and a state-funded financial assistance program for
867statutory rural hospitals. The agency shall make
868disproportionate share payments to statutory rural hospitals
869that qualify for such payments and financial assistance payments
870to statutory rural hospitals that do not qualify for
871disproportionate share payments. The disproportionate share
872program payments shall be limited by and conform with federal
873requirements. Funds shall be distributed quarterly in each
874fiscal year for which an appropriation is made. Notwithstanding
875the provisions of s. 409.915, counties are exempt from
876contributing toward the cost of this special reimbursement for
877hospitals serving a disproportionate share of low-income
879     (6)  This section applies only to hospitals that were
880defined as statutory rural hospitals, or their successor-in-
881interest hospital, prior to January 1, 2001. Any additional
882hospital that is defined as a statutory rural hospital, or its
883successor-in-interest hospital, on or after January 1, 2001, is
884not eligible for programs under this section unless additional
885funds are appropriated each fiscal year specifically to the
886rural hospital disproportionate share and financial assistance
887programs in an amount necessary to prevent any hospital, or its
888successor-in-interest hospital, eligible for the programs prior
889to January 1, 2001, from incurring a reduction in payments
890because of the eligibility of an additional hospital to
891participate in the programs. A hospital, or its successor-in-
892interest hospital, which received funds pursuant to this section
893before January 1, 2001, and which qualifies under s.
894395.602(2)(d)(e), shall be included in the programs under this
895section and is not required to seek additional appropriations
896under this subsection.
897     Section 9.  Paragraph (b) of subsection (2) of section
8981009.65, Florida Statutes, is amended to read:
899     1009.65  Medical Education Reimbursement and Loan Repayment
901     (2)  From the funds available, the Department of Health
902shall make payments to selected medical professionals as
904     (b)  All payments shall be contingent on continued proof of
905primary care practice in an area defined in s. 395.602(2)(d)(e),
906or an underserved area designated by the Department of Health,
907provided the practitioner accepts Medicaid reimbursement if
908eligible for such reimbursement. Correctional facilities, state
909hospitals, and other state institutions that employ medical
910personnel shall be designated by the Department of Health as
911underserved locations. Locations with high incidences of infant
912mortality, high morbidity, or low Medicaid participation by
913health care professionals may be designated as underserved.
914     Section 10.  Section 395.605, Florida Statutes, is
916     Section 11.  Section 381.7366, Florida Statutes, is created
917to read:
918     381.7366  Office of Minority Health; legislative intent;
920     (1)  LEGISLATIVE INTENT.--The Legislature recognizes that
921despite significant investments in health care programs certain
922racial and ethnic populations suffer disproportionately with
923chronic diseases when compared to non-Hispanic whites. The
924Legislature intends to address these disparities by developing
925programs that target causal factors and recognize the specific
926health care needs of racial and ethnic minorities.
927     (2)  ORGANIZATION.--The Office of Minority Health is
928established within the Department of Health. The office shall be
929headed by a director who shall report directly to the Secretary
930of Health.
931     (3)  DUTIES.--The office shall:
932     (a)  Protect and promote the health and well-being of
933racial and ethnic populations in the state.
934     (b)  Focus on the issue of health disparities between
935racial and ethnic minority groups and the general population.
936     (c)  Coordinate the department's initiatives, programs, and
937policies to address racial and ethnic health disparities.
938     (d)  Communicate pertinent health information to affected
939racial and ethnic populations.
940     (e)  Collect and analyze data on the incidence and
941frequency of racial and ethnic health disparities.
942     (f)  Promote and encourage cultural competence education
943and training for healthcare professionals.
944     (g)  Serve as a clearinghouse for the collection and
945dissemination of information and research findings relating to
946innovative approaches to the reduction or elimination of health
948     (h)  Dedicate resources to increase public awareness of
949minority health issues.
950     (i)  Seek increased funding for local innovative
951initiatives and administer grants designed to support
952initiatives that address health disparities and that can be
954     (j)  Provide staffing and support for the Closing the Gap
955grant advisory council.
956     (k)  Coordinate with other agencies, states, and the
957Federal Government to reduce or eliminate health disparities.
958     (l)  Collaborate with other public healthcare providers,
959community and faith-based organizations, the private healthcare
960system, historically black colleges and universities and other
961minority institutions of higher education, medical schools, and
962other health providers to establish a comprehensive and
963inclusive approach to reducing health disparities.
964     (m)  Encourage and support research into causes of racial
965and ethnic health disparities.
966     (n)  Collaborate with health professional training programs
967to increase the number of minority healthcare professionals.
968     (o)  Provide an annual report to the Governor, the
969President of the Senate, and the Speaker of the House of
970Representatives on the activities of the office.
971     (4)  RESPONSIBILITY AND COORDINATION.--The office and the
972department shall direct and carry out the duties established
973under this section and shall work with other state agencies in
974accomplishing these tasks.
975     Section 12.  This act shall take effect July 1, 2006.

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