CS/HB 1575

1	A bill to be entitled
2	An act relating to health care; amending s. 381.0405,
3	F.S.; revising the purpose and functions of the Office of
4	Rural Health in the Department of Health; requiring the
5	Secretary of Health and the Secretary of Health Care
6	Administration to appoint an advisory council to advise
7	the Office of Rural Health; providing for terms of office
8	of the members of the advisory council; authorizing per
9	diem and travel reimbursement for members of the advisory
10	council; requiring the Office of Rural Health to submit an
11	annual report to the Governor and the Legislature;
12	amending s. 381.0406, F.S.; revising legislative findings
13	and intent with respect to rural health networks;
14	redefining the term "rural health network"; establishing
15	requirements for membership in rural health networks;
16	adding functions for the rural health networks; revising
17	requirements for the governance and organization of rural
18	health networks; revising the services to be provided by
19	provider members of rural health networks; requiring
20	coordination among rural health networks and area health
21	education centers, health planning councils, and regional
22	education consortia; establishing requirements for funding
23	rural health networks; establishing performance standards
24	for rural health networks; establishing requirements for
25	the receipt of grant funding; requiring the Office of
26	Rural Health to monitor rural health networks; authorizing
27	the Department of Health to establish rules governing
28	rural health network grant programs and performance
29	standards; creating s. 381.7366, F.S.; creating the Office
30	of Minority Health within the Department of Health;
31	providing legislative intent; providing for organization
32	and duties of the office; providing for responsibilities
33	of the office and the department and coordination with
34	other agencies; amending s. 395.602, F.S.; defining the
35	term "critical access hospital"; deleting the definitions
36	of "emergency care hospital," and "essential access
37	community hospital"; revising the definition of "rural
38	primary care hospital"; amending s. 395.603, F.S.;
39	deleting a requirement that the Agency for Health Care
40	Administration adopt a rule relating to deactivation of
41	rural hospital beds under certain circumstances; requiring
42	that critical access hospitals and rural primary care
43	hospitals maintain a certain number of actively licensed
44	beds; amending s. 395.604, F.S.; removing emergency care
45	hospitals and essential access community hospitals from
46	certain licensure requirements; specifying certain special
47	conditions for rural primary care hospitals; amending s.
48	395.6061, F.S.; specifying the purposes of capital
49	improvement grants for rural hospitals; modifying the
50	conditions for receiving a grant; authorizing the
51	Department of Health to award grants for remaining funds
52	to certain rural hospitals; amending s. 409.908, F.S.;
53	revising a provision relating to the phase-in of a
54	Medicaid physician fee schedule to delete obsolete
55	language; amending ss. 408.07, 409.9116, and 1009.65,
56	F.S.; conforming cross-references; requiring the
57	Legislative Committee on Intergovernmental Relations to
58	contract for a study of the financing options for
59	replacing or changing the use of certain rural hospitals;
60	requiring a report to the Legislature by a specified date;
61	repealing s. 395.605, F.S., relating to the licensure of
62	emergency care hospitals; providing a contingent effective
63	date.
64
65	Be It Enacted by the Legislature of the State of Florida:
66
67	Section 1.  Section 381.0405, Florida Statutes, is amended
68	to read:
69	381.0405  Office of Rural Health.--
70	(1)  ESTABLISHMENT.--The Department of Health shall
71	establish an Office of Rural Health, which shall assist rural
72	health care providers in improving the health status and health
73	care of rural residents of this state and help rural health care
74	providers to integrate their efforts and prepare for prepaid and
75	at-risk reimbursement. The Office of Rural Health shall
76	coordinate its activities with rural health networks established
77	under s. 381.0406, local health councils established under s.
78	408.033, the area health education center network established
79	under pursuant to s. 381.0402, and with any appropriate research
80	and policy development centers within universities that have
81	state-approved medical schools. The Office of Rural Health may
82	enter into a formal relationship with any center that designates
83	the office as an affiliate of the center.
84	(2)  PURPOSE.--The Office of Rural Health shall actively
85	foster the development of service-delivery systems and
86	cooperative agreements to enhance the provision of high-quality
87	health care services in rural areas and serve as a catalyst for
88	improved health services to residents citizens in rural areas of
89	the state.
90	(3)  GENERAL FUNCTIONS.--The office shall:
91	(a)  Integrate policies related to physician workforce,
92	hospitals, public health, and state regulatory functions.
93	(b)  Work with rural stakeholders in order to foster the
94	development of strategic planning that addresses Propose
95	solutions to problems affecting health care delivery in rural
96	areas.
97	(c)  Develop, in coordination with the rural health
98	networks, standards, guidelines, and performance objectives for
99	rural health networks.
100	(d)  Foster the expansion of rural health network service
101	areas to include rural counties that are not covered by a rural
102	health network.
103	(e)(c)  Seek grant funds from foundations and the Federal
104	Government.
105	(f)  Administer state grant programs for rural hospitals
106	and rural health networks.
107	(4)  COORDINATION.--The office shall:
108	(a)  Identify federal and state rural health programs and
109	provide information and technical assistance to rural providers
110	regarding participation in such programs.
111	(b)  Act as a clearinghouse for collecting and
112	disseminating information on rural health care issues, research
113	findings on rural health care, and innovative approaches to the
114	delivery of health care in rural areas.
115	(c)  Foster the creation of regional health care systems
116	that promote cooperation through cooperative agreements, rather
117	than competition.
118	(d)  Coordinate the department's rural health care
119	activities, programs, and policies.
120	(e)  Design initiatives and promote cooperative agreements
121	in order to improve access to primary care, prehospital
122	emergency care, inpatient acute care, and emergency medical
123	services and promote the coordination of such services in rural
124	areas.
125	(f)  Assume responsibility for state coordination of the
126	Rural Hospital Transition Grant Program, the Essential Access
127	Community Hospital Program, and other federal rural hospital and
128	rural health care grant programs.
129	(5)  TECHNICAL ASSISTANCE.--The office shall:
130	(a)  Assist Help rural health care providers in recruiting
131	obtain health care practitioners by promoting the location and
132	relocation of health care practitioners in rural areas and
133	promoting policies that create incentives for practitioners to
134	serve in rural areas.
135	(b)  Provide technical assistance to hospitals, community
136	and migrant health centers, and other health care providers that
137	serve residents of rural areas.
138	(c)  Assist with the design of strategies to improve health
139	care workforce recruitment and placement programs.
140	(d)  Provide technical assistance to rural health networks
141	in the development of their long-range development plans.
142	(e)  Provide links to best practices and other technical-
143	assistance resources on its website.
144	(6)  RESEARCH PUBLICATIONS AND SPECIAL STUDIES.--The office
145	shall:
146	(a)  Conduct policy and research studies.
147	(b)  Conduct health status studies of rural residents.
148	(c)  Collect relevant data on rural health care issues for
149	use in program planning and department policy development.
150	(7)  ADVISORY COUNCIL.--The Secretary of Health and the
151	Secretary of Health Care Administration shall each appoint no
152	more than five members having relevant health care operations
153	management, practice, and policy experience to an advisory
154	council to advise the office regarding its responsibilities
155	under this section and ss. 381.0406 and 395.6061. Members shall
156	be appointed for 4-year staggered terms and may be reappointed
157	to a second term of office. Members shall serve without
158	compensation, but are entitled to reimbursement for per diem and
159	travel expenses as provided in s. 112.061. The department shall
160	provide staff and other administrative assistance reasonably
161	necessary to assist the advisory council in carrying out its
162	duties. The advisory council shall work with stakeholders to
163	develop recommendations that address barriers and identify
164	options for establishing provider networks in rural counties.
165	(8)  REPORTS.--Beginning January 1, 2008, and annually
166	thereafter, the Office of Rural Health shall submit a report to
167	the Governor, the President of the Senate, and the Speaker of
168	the House of Representatives summarizing the activities of the
169	office, including the grants obtained or administered by the
170	office and the status of rural health networks and rural
171	hospitals in the state. The report must also include
172	recommendations that address barriers and identify options for
173	establishing provider networks in rural counties.
174	(9)(7)  APPROPRIATION.--The Legislature shall appropriate
175	such sums as are necessary to support the Office of Rural
176	Health.
177	Section 2.  Section 381.0406, Florida Statutes, is amended
178	to read:
179	381.0406  Rural health networks.--
180	(1)  LEGISLATIVE FINDINGS AND INTENT.--
181	(a)  The Legislature finds that, in rural areas, access to
182	health care is limited and the quality of health care is
183	negatively affected by inadequate financing, difficulty in
184	recruiting and retaining skilled health professionals, and the
185	because of a migration of patients to urban areas for general
186	acute care and specialty services.
187	(b)  The Legislature further finds that the efficient and
188	effective delivery of health care services in rural areas
189	requires:
190	1.  The integration of public and private resources;
191	2.  The introduction of innovative outreach methods;
192	3.  The adoption of quality improvement and cost-
193	effectiveness measures;
194	4.  The organization of health care providers into joint
195	contracting entities;
196	5.  Establishing referral linkages;
197	6.  The analysis of costs and services in order to prepare
198	health care providers for prepaid and at-risk financing; and
199	7.  The coordination of health care providers.
200	(c)  The Legislature further finds that the availability of
201	a continuum of quality health care services, including
202	preventive, primary, secondary, tertiary, and long-term care, is
203	essential to the economic and social vitality of rural
204	communities.
205	(d)  The Legislature further finds that health care
206	providers in rural areas are not prepared for market changes
207	such as the introduction of managed care and capitation-
208	reimbursement methodologies into health care services.
209	(e)(d)  The Legislature further finds that the creation of
210	rural health networks can help to alleviate these problems.
211	Rural health networks shall act in the broad public interest
212	and, to the extent possible, seek to improve the accessibility,
213	quality, and cost-effectiveness of rural health care by
214	planning, developing, coordinating, and providing be structured
215	to provide a continuum of quality health care services for rural
216	residents through the cooperative efforts of rural health
217	network members and other health care providers.
218	(f)(e)  The Legislature further finds that rural health
219	networks shall have the goal of increasing the financial
220	stability of statutory rural hospitals by linking rural hospital
221	services to other services in a continuum of health care
222	services and by increasing the utilization of statutory rural
223	hospitals whenever for appropriate health care services whenever
224	feasible, which shall help to ensure their survival and thereby
225	support the economy and protect the health and safety of rural
226	residents.
227	(g)(f)  Finally, the Legislature finds that rural health
228	networks may serve as "laboratories" to determine the best way
229	of organizing rural health services and linking to out-of-area
230	services that are not available locally in order, to move the
231	state closer to ensuring that everyone has access to health
232	care, and to promote cost-containment cost containment efforts.
233	The ultimate goal of rural health networks shall be to ensure
234	that quality health care is available and efficiently delivered
235	to all persons in rural areas.
236	(2)  DEFINITIONS.--
237	(a)  "Rural" means an area having with a population density
238	of fewer less than 100 individuals per square mile or an area
239	defined by the most recent United States Census as rural.
240	(b)  "Health care provider" means any individual, group, or
241	entity, public or private, which that provides health care,
242	including: preventive health care, primary health care,
243	secondary and tertiary health care, hospital in-hospital health
244	care, public health care, and health promotion and education.
245	(c)  "Rural health network" or "network" means a nonprofit
246	legal entity whose principal place of business is in a rural
247	area, whose members consist consisting of rural and urban health
248	care providers and others, and which that is established
249	organized to plan, develop, organize, and deliver health care
250	services on a cooperative basis in a rural area, except for some
251	secondary and tertiary care services.
252	(3)  NETWORK MEMBERSHIP.--
253	(a)  Because each rural area is unique, with a different
254	health care provider mix, health care provider membership may
255	vary, but all networks shall include members that provide health
256	promotion and disease-prevention services, public health
257	services, comprehensive primary care, emergency medical care,
258	and acute inpatient care.
259	(b)  Each county health department shall be a member of the
260	rural health network whose service area includes the county in
261	which the county health department is located. Federally
262	qualified health centers and emergency medical services
263	providers are encouraged to become members of the rural health
264	networks in the areas in which their patients reside or receive
265	services.
266	(c)(4)  Network membership shall be available to all health
267	care providers in the network service area if, provided that
268	they render care to all patients referred to them from other
269	network members;, comply with network quality assurance, quality
270	improvement, and utilization-management and risk management
271	requirements; and, abide by the terms and conditions of network
272	provider agreements in paragraph (11)(c), and provide services
273	at a rate or price equal to the rate or price negotiated by the
274	network.
275	(4)(5)  NETWORK SERVICE AREAS.--Network service areas are
276	do not required need to conform to local political boundaries or
277	state administrative district boundaries. The geographic area of
278	one rural health network, however, may not overlap the territory
279	of any other rural health network.
280	(5)(6)  NETWORK FUNCTIONS.--Networks shall:
281	(a)  Seek to develop linkages with provisions for referral
282	to tertiary inpatient care, specialty physician care, and to
283	other services that are not available in rural service areas.
284	(b)(7)  Networks shall Make available health promotion,
285	disease prevention, and primary care services, in order to
286	improve the health status of rural residents and to contain
287	health care costs.
288	(8)  Networks may have multiple points of entry, such as
289	through private physicians, community health centers, county
290	health departments, certified rural health clinics, hospitals,
291	or other providers; or they may have a single point of entry.
292	(c)(9)  Encourage members through training and educational
293	programs to adopt standards of care and promote the evidence-
294	based practice of medicine. Networks shall establish standard
295	protocols, coordinate and share patient records, and develop
296	patient information exchange systems in order to improve the
297	quality of and access to services.
298	(d)  Develop quality-improvement programs and train network
299	members and other health care providers in the use of such
300	programs.
301	(e)  Develop disease-management systems and train network
302	members and other health care providers in the use of such
303	systems.
304	(f)  Promote outreach to areas that have a high need for
305	services.
306	(g)  Seek to develop community care alternatives for elders
307	who would otherwise be placed in nursing homes.
308	(h)  Emphasize community care alternatives for persons with
309	mental health and substance abuse disorders who are at risk of
310	being admitted to an institution.
311	(i)  Develop and implement a long-range development plan
312	for an integrated system of care that is responsive to the
313	unique local health needs and the area health care services
314	market. Each rural health network long-range development plan
315	must address strategies to improve access to specialty care,
316	train health care providers to use standards of care for chronic
317	illness, develop disease-management capacity, and link to state
318	and national quality-improvement initiatives. The initial long-
319	range development plan must be submitted to the Office of Rural
320	Health for review and approval no later than July 1, 2008, and
321	thereafter the plans must be updated and submitted to the Office
322	of Rural Health every 3 years.
323	(10)  Networks shall develop risk management and quality
324	assurance programs for network providers.
325	(6)(11)  NETWORK GOVERNANCE AND ORGANIZATION.--
326	(a)  Networks shall be incorporated as not-for-profit
327	corporations under chapter 617, with articles of incorporation
328	that set forth purposes consistent with this section the laws of
329	the state.
330	(b)  Each network Networks shall have an independent a
331	board of directors that derives membership from local
332	government, health care providers, businesses, consumers,
333	advocacy groups, and others. Boards of other community health
334	care entities may not serve in whole as the board of a rural
335	health network; however, some overlap of board membership with
336	other community organizations is encouraged. Network staff must
337	provide an annual orientation and strategic planning activity
338	for board members.
339	(c)  Network boards of directors shall have the
340	responsibility of determining the content of health care
341	provider agreements that link network members. The written
342	agreements between the network and its health care provider
343	members must specify participation in the essential functions of
344	the network and shall specify:
345	1.  Who provides what services.
346	2.  The extent to which the health care provider provides
347	care to persons who lack health insurance or are otherwise
348	unable to pay for care.
349	3.  The procedures for transfer of medical records.
350	4.  The method used for the transportation of patients
351	between providers.
352	5.  Referral and patient flow including appointments and
353	scheduling.
354	6.  Payment arrangements for the transfer or referral of
355	patients.
356	(d)  There shall be no liability on the part of, and no
357	cause of action of any nature shall arise against, any member of
358	a network board of directors, or its employees or agents, for
359	any lawful action taken by them in the performance of their
360	administrative powers and duties under this subsection.
361	(7)(12)  NETWORK PROVIDER MEMBER SERVICES.--
362	(a)  Networks, to the extent feasible, shall seek to
363	develop services that provide for a continuum of care for all
364	residents patients served by the network. Each network shall
365	recruit members that can provide include the following core
366	services:  disease prevention, health promotion, comprehensive
367	primary care, emergency medical care, and acute inpatient care.
368	Each network shall seek to ensure the availability of
369	comprehensive maternity care, including prenatal, delivery, and
370	postpartum care for uncomplicated pregnancies, either directly,
371	by contract, or through referral agreements. Networks shall, to
372	the extent feasible, develop local services and linkages among
373	health care providers in order to also ensure the availability
374	of the following services: within the specified timeframes,
375	either directly, by contract, or through referral agreements:
376	1.  Services available in the home.
377	1.a.  Home health care.
378	2.b.  Hospice care.
379	2.  Services accessible within 30 minutes travel time or
380	less.
381	3.a.  Emergency medical services, including advanced life
382	support, ambulance, and basic emergency room services.
383	4.b.  Primary care, including.
384	c.  prenatal and postpartum care for uncomplicated
385	pregnancies.
386	5.d.  Community-based services for elders, such as adult
387	day care and assistance with activities of daily living.
388	6.e.  Public health services, including communicable
389	disease control, disease prevention, health education, and
390	health promotion.
391	7.f.  Outpatient mental health psychiatric and substance
392	abuse treatment services.
393	3.  Services accessible within 45 minutes travel time or
394	less.
395	8.a.  Hospital acute inpatient care for persons whose
396	illnesses or medical problems are not severe.
397	9.b.  Level I obstetrical care, which is Labor and delivery
398	for low-risk patients.
399	10.c.  Skilled nursing services and, long-term care,
400	including nursing home care.
401	(b)  Networks shall seek to foster linkages with out-of-
402	area services to the extent feasible in order to ensure the
403	availability of:
404	1.d.  Dialysis.
405	2.e.  Osteopathic and chiropractic manipulative therapy.
406	4.  Services accessible within 2 hours travel time or less.
407	3.a.  Specialist physician care.
408	4.b.  Hospital acute inpatient care for severe illnesses
409	and medical problems.
410	5.c.  Level II and III obstetrical care, which is Labor and
411	delivery care for high-risk patients and neonatal intensive
412	care.
413	6.d.  Comprehensive medical rehabilitation.
414	7.e.  Inpatient mental health psychiatric and substance
415	abuse treatment services.
416	8.f.  Magnetic resonance imaging, lithotripter treatment,
417	oncology, advanced radiology, and other technologically advanced
418	services.
419	9.g.  Subacute care.
420	(8)  COORDINATION WITH OTHER ENTITIES.--
421	(a)  Area health education centers, health planning
422	councils, and regional education consortia having technological
423	expertise in continuing education shall participate in the rural
424	health networks' preparation of long-range development plans.
425	The Department of Health may require written memoranda of
426	agreement between a network and an area health education center
427	or health planning council.
428	(b)  Rural health networks shall initiate activities, in
429	coordination with area health education centers, to carry out
430	the objectives of the adopted long-range development plan,
431	including continuing education for health care practitioners
432	performing functions such as disease management, continuous
433	quality improvement, telemedicine, long-distance learning, and
434	the treatment of chronic illness using standards of care. As
435	used in this section, the term "telemedicine" means the use of
436	telecommunications to deliver or expedite the delivery of health
437	care services.
438	(c)  Health planning councils shall support the preparation
439	of network long-range development plans through data collection
440	and analysis in order to assess the health status of area
441	residents and the capacity of local health services.
442	(d)  Regional education consortia that have the technology
443	available to assist rural health networks in establishing
444	systems for the exchange of patient information and for long-
445	distance learning are encouraged to provide technical assistance
446	upon the request of a rural health network.
447	(e)(b)  Networks shall actively participate with area
448	health education center programs, whenever feasible, in
449	developing and implementing recruitment, training, and retention
450	programs directed at positively influencing the supply and
451	distribution of health care professionals serving in, or
452	receiving training in, network areas.
453	(c)  As funds become available, networks shall emphasize
454	community care alternatives for elders who would otherwise be
455	placed in nursing homes.
456	(d)  To promote the most efficient use of resources,
457	networks shall emphasize disease prevention, early diagnosis and
458	treatment of medical problems, and community care alternatives
459	for persons with mental health and substance abuse disorders who
460	are at risk to be institutionalized.
461	(f)(13)  TRAUMA SERVICES.--In those network areas having
462	which have an established trauma agency approved by the
463	Department of Health, the network shall seek the participation
464	of that trauma agency must be a participant in the network.
465	Trauma services provided within the network area must comply
466	with s. 395.405.
467	(9)(14)  NETWORK FINANCING.--
468	(a)  Networks may use all sources of public and private
469	funds to support network activities. Nothing in this section
470	prohibits networks from becoming managed care providers.
471	(b)  The Department of Health shall establish grant
472	programs to provide funding to support the administrative costs
473	of developing and operating rural health networks.
474	(10)  NETWORK PERFORMANCE STANDARDS.--The Department of
475	Health shall develop and enforce performance standards for rural
476	health network operations grants and rural health infrastructure
477	development grants.
478	(a)  Operations grant performance standards must include,
479	but are not limited to, standards that require the rural health
480	network to:
481	1.  Have a qualified board of directors that meets at least
482	quarterly.
483	2.  Have sufficient staff who have the qualifications and
484	experience to perform the requirements of this section, as
485	assessed by the Office of Rural Health, or a written plan to
486	obtain such staff.
487	3.  Comply with the department's grant-management standards
488	in a timely and responsive manner.
489	4.  Comply with the department's standards for the
490	administration of federal grant funding, including assistance to
491	rural hospitals.
492	5.  Demonstrate a commitment to network activities from
493	area health care providers and other stakeholders, as described
494	in letters of support.
495	(b)  Rural health infrastructure development grant
496	performance standards must include, but are not limited to,
497	standards that require the rural health network to:
498	1.  During the 2007-2008 fiscal year, develop a long-range
499	development plan and, after July 1, 2008, have a long-range
500	development plan that has been reviewed and approved by the
501	Office of Rural Health.
502	2.  Have two or more successful network-development
503	activities, such as:
504	a.  Management of a network-development or outreach grant
505	from the federal Office of Rural Health Policy;
506	b.  Implementation of outreach programs to address chronic
507	disease, infant mortality, or assistance with prescription
508	medication;
509	c.  Development of partnerships with community and faith-
510	based organizations to address area health problems;
511	d.  Provision of direct services, such as clinics or mobile
512	units;
513	e.  Operation of credentialing services for health care
514	providers or quality-assurance and quality-improvement
515	initiatives that, whenever possible, are consistent with state
516	or federal quality initiatives;
517	f.  Support for the development of community health
518	centers, local community health councils, federal designation as
519	a rural critical access hospital, or comprehensive community
520	health planning initiatives; and
521	g.  Development of the capacity to obtain federal, state,
522	and foundation grants.
523	(11)(15)  NETWORK IMPLEMENTATION.--As funds become
524	available, networks shall be developed and implemented in two
525	phases.
526	(a)  Phase I shall consist of a network planning and
527	development grant program. Planning grants shall be used to
528	organize networks, incorporate network boards, and develop
529	formal provider agreements as provided for in this section. The
530	Department of Health shall develop a request-for-proposal
531	process to solicit grant applications.
532	(b)  Phase II shall consist of a network operations grant
533	program. As funds become available, certified networks that meet
534	performance standards shall be eligible to receive grant funds
535	to be used to help defray the costs of rural health network
536	infrastructure development, patient care, and network
537	administration. Rural health network infrastructure development
538	includes, but is not limited to: recruitment and retention of
539	primary care practitioners; enhancement of primary care services
540	through the use of mobile clinics; development of preventive
541	health care programs; linkage of urban and rural health care
542	systems; design and implementation of automated patient records,
543	outcome measurement, quality assurance, and risk management
544	systems; establishment of one-stop service delivery sites;
545	upgrading of medical technology available to network providers;
546	enhancement of emergency medical systems; enhancement of medical
547	transportation; formation of joint contracting entities composed
548	of rural physicians, rural hospitals, and other rural health
549	care providers; establishment of comprehensive disease-
550	management programs that meet Medicaid requirements;
551	establishment of regional quality-improvement programs involving
552	physicians and hospitals consistent with state and national
553	initiatives; establishment of specialty networks connecting
554	rural primary care physicians and urban specialists; development
555	of regional broadband telecommunications systems that have the
556	capacity to share patient information in a secure network,
557	telemedicine, and long-distance learning capacity; and linkage
558	between training programs for health care practitioners and the
559	delivery of health care services in rural areas and development
560	of telecommunication capabilities. A Phase II award may occur in
561	the same fiscal year as a Phase I award.
562	(12)(16)  CERTIFICATION.--For the purpose of certifying
563	networks that are eligible for Phase II funding, the Department
564	of Health shall certify networks that meet the criteria
565	delineated in this section and the rules governing rural health
566	networks. The Office of Rural Health in the Department of Health
567	shall monitor rural health networks in order to ensure continued
568	compliance with established certification and performance
569	standards.
570	(13)(17)  RULES.--The Department of Health shall establish
571	rules that govern the creation and certification of networks,
572	the provision of grant funds under Phase I and Phase II, and the
573	establishment of performance standards including establishing
574	outcome measures for networks.
575	Section 3.  Section 381.7366, Florida Statutes, is created
576	to read:
577	381.7366  Office of Minority Health; legislative intent;
578	duties.--
579	(1)  LEGISLATIVE INTENT.--The Legislature recognizes that
580	despite significant investments in health care programs certain
581	racial and ethnic populations suffer disproportionately with
582	chronic diseases when compared to the non-Hispanic white
583	population. The Legislature intends to address these disparities
584	by developing programs that target causal factors and recognize
585	the specific health care needs of racial and ethnic minorities.
586	(2)  ORGANIZATION.--The Office of Minority Health is
587	established within the Department of Health. The office shall be
588	headed by a director who shall report directly to the Secretary
589	of Health.
590	(3)  DUTIES.--The office shall:
591	(a)  Protect and promote the health and well-being of
592	racial and ethnic populations in the state.
593	(b)  Focus on the issue of health disparities between
594	racial and ethnic minority groups and the general population.
595	(c)  Coordinate the department's initiatives, programs, and
596	policies to address racial and ethnic health disparities.
597	(d)  Communicate pertinent health information to affected
598	racial and ethnic populations.
599	(e)  Collect and analyze data on the incidence and
600	frequency of racial and ethnic health disparities.
601	(f)  Promote and encourage cultural competence education
602	and training for health care professionals.
603	(g)  Serve as a clearinghouse for the collection and
604	dissemination of information and research findings relating to
605	innovative approaches to the reduction or elimination of health
606	disparities.
607	(h)  Dedicate resources to increase public awareness of
608	minority health issues.
609	(i)  Seek increased funding for local innovative
610	initiatives and administer grants designed to support
611	initiatives that address health disparities and that can be
612	duplicated.
613	(j)  Provide staffing and support for the Closing the Gap
614	grant program advisory committee.
615	(k)  Coordinate with other agencies, states, and the
616	Federal Government to reduce or eliminate health disparities.
617	(l)  Collaborate with other public health care providers,
618	community and faith-based organizations, the private health care
619	system, historically black colleges and universities and other
620	minority institutions of higher education, medical schools, and
621	other health providers to establish a comprehensive and
622	inclusive approach to reducing health disparities.
623	(m)  Encourage and support research in the causes of racial
624	and ethnic health disparities.
625	(n)  Collaborate with health professional training programs
626	to increase the number of minority health care professionals.
627	(o)  Provide an annual report to the Governor, the
628	President of the Senate, and the Speaker of the House of
629	Representatives on the activities of the office.
630	(4)  RESPONSIBILITY AND COORDINATION.--The office and the
631	department shall direct and carry out the duties established
632	under this section and shall work with other state agencies to
633	accomplish these duties.
634	Section 4.  Subsection (2) of section 395.602, Florida
635	Statutes, is amended to read:
636	395.602  Rural hospitals.--
637	(2)  DEFINITIONS.--As used in this part:
638	(a)  "Critical access hospital" means a hospital that meets
639	the definition of rural hospital in paragraph (d) and meets the
640	requirements for reimbursement by Medicare and Medicaid under 42
641	C.F.R. ss. 485.601-485.647. "Emergency care hospital" means a
642	medical facility which provides:
643	1.  Emergency medical treatment; and
644	2.  Inpatient care to ill or injured persons prior to their
645	transportation to another hospital or provides inpatient medical
646	care to persons needing care for a period of up to 96 hours. The
647	96-hour limitation on inpatient care does not apply to respite,
648	skilled nursing, hospice, or other nonacute care patients.
649	(b)  "Essential access community hospital" means any
650	facility which:
651	1.  Has at least 100 beds;
652	2.  Is located more than 35 miles from any other essential
653	access community hospital, rural referral center, or urban
654	hospital meeting criteria for classification as a regional
655	referral center;
656	3.  Is part of a network that includes rural primary care
657	hospitals;
658	4.  Provides emergency and medical backup services to rural
659	primary care hospitals in its rural health network;
660	5.  Extends staff privileges to rural primary care hospital
661	physicians in its network; and
662	6.  Accepts patients transferred from rural primary care
663	hospitals in its network.
664	(b)(c)  "Inactive rural hospital bed" means a licensed
665	acute care hospital bed, as defined in s. 395.002(14), that is
666	inactive in that it cannot be occupied by acute care inpatients.
667	(c)(d)  "Rural area health education center" means an area
668	health education center (AHEC), as authorized by Pub. L. No. 94-
669	484, which provides services in a county with a population
670	density of no greater than 100 persons per square mile.
671	(d)(e)  "Rural hospital" means an acute care hospital
672	licensed under this chapter, having 100 or fewer licensed beds
673	and an emergency room, which is:
674	1.  The sole provider within a county with a population
675	density of no greater than 100 persons per square mile;
676	2.  An acute care hospital, in a county with a population
677	density of no greater than 100 persons per square mile, which is
678	at least 30 minutes of travel time, on normally traveled roads
679	under normal traffic conditions, from any other acute care
680	hospital within the same county;
681	3.  A hospital supported by a tax district or subdistrict
682	whose boundaries encompass a population of 100 persons or fewer
683	per square mile;
684	4.  A hospital in a constitutional charter county with a
685	population of over 1 million persons that has imposed a local
686	option health service tax pursuant to law and in an area that
687	was directly impacted by a catastrophic event on August 24,
688	1992, for which the Governor of Florida declared a state of
689	emergency pursuant to chapter 125, and has 120 beds or less that
690	serves an agricultural community with an emergency room
691	utilization of no less than 20,000 visits and a Medicaid
692	inpatient utilization rate greater than 15 percent;
693	5.  A hospital with a service area that has a population of
694	100 persons or fewer per square mile. As used in this
695	subparagraph, the term "service area" means the fewest number of
696	zip codes that account for 75 percent of the hospital's
697	discharges for the most recent 5-year period, based on
698	information available from the hospital inpatient discharge
699	database in the Florida Center for Health Information and Policy
700	Analysis at the Agency for Health Care Administration; or
701	6.  A hospital designated as a critical access hospital, as
702	defined in s. 408.07(15).
703
704	Population densities used in this paragraph must be based upon
705	the most recently completed United States census. A hospital
706	that received funds under s. 409.9116 for a quarter beginning no
707	later than July 1, 2002, is deemed to have been and shall
708	continue to be a rural hospital from that date through June 30,
709	2012, if the hospital continues to have 100 or fewer licensed
710	beds and an emergency room, or meets the criteria of
711	subparagraph 4. An acute care hospital that has not previously
712	been designated as a rural hospital and that meets the criteria
713	of this paragraph shall be granted such designation upon
714	application, including supporting documentation to the Agency
715	for Health Care Administration.
716	(e)(f)  "Rural primary care hospital" means any facility
717	that meeting the criteria in paragraph (e) or s. 395.605 which
718	provides:
719	1.  Twenty-four-hour emergency medical care;
720	2.  Temporary inpatient care for periods of 96 72 hours or
721	less to patients requiring stabilization before discharge or
722	transfer to another hospital. The 96-hour 72-hour limitation
723	does not apply to respite, skilled nursing, hospice, or other
724	nonacute care patients; and
725	3.  Has at least no more than six licensed acute care
726	inpatient beds.
727	(f)(g)  "Swing-bed" means a bed which can be used
728	interchangeably as either a hospital, skilled nursing facility
729	(SNF), or intermediate care facility (ICF) bed pursuant to 42
730	C.F.R. parts 405, 435, 440, 442, and 447.
731	Section 5.  Subsection (1) of section 395.603, Florida
732	Statutes, is amended to read:
733	395.603  Deactivation of general hospital beds; rural
734	hospital impact statement.--
735	(1)  The agency shall establish, by rule, a process by
736	which A rural hospital, as defined in s. 395.602, which that
737	seeks licensure as a rural primary care hospital or as an
738	emergency care hospital, or becomes a certified rural health
739	clinic as defined in Pub. L. No. 95-210, or becomes a primary
740	care program such as a county health department, community
741	health center, or other similar outpatient program that provides
742	preventive and curative services, may deactivate general
743	hospital beds. A critical access hospital or a rural primary
744	care hospital hospitals and emergency care hospitals shall
745	maintain the number of actively licensed general hospital beds
746	necessary for the facility to be certified for Medicare
747	reimbursement. Hospitals that discontinue inpatient care to
748	become rural health care clinics or primary care programs shall
749	deactivate all licensed general hospital beds. All hospitals,
750	clinics, and programs with inactive beds shall provide 24-hour
751	emergency medical care by staffing an emergency room. Providers
752	with inactive beds shall be subject to the criteria in s.
753	395.1041. The agency shall specify in rule requirements for
754	making 24-hour emergency care available. Inactive general
755	hospital beds shall be included in the acute care bed inventory,
756	maintained by the agency for certificate-of-need purposes, for
757	10 years from the date of deactivation of the beds. After 10
758	years have elapsed, inactive beds shall be excluded from the
759	inventory. The agency shall, at the request of the licensee,
760	reactivate the inactive general beds upon a showing by the
761	licensee that licensure requirements for the inactive general
762	beds are met.
763	Section 6.  Section 395.604, Florida Statutes, is amended
764	to read:
765	395.604  Other Rural primary care hospitals hospital
766	programs.--
767	(1)  The agency may license rural primary care hospitals
768	subject to federal approval for participation in the Medicare
769	and Medicaid programs. Rural primary care hospitals shall be
770	treated in the same manner as emergency care hospitals and rural
771	hospitals with respect to ss. 395.605(2)-(8)(a),
772	408.033(2)(b)3., and 408.038.
773	(2)  The agency may designate essential access community
774	hospitals.
775	(3)  The agency may adopt licensure rules for rural primary
776	care hospitals and essential access community hospitals. Such
777	rules must conform to s. 395.1055.
778	(3)  For the purpose of Medicaid swing-bed reimbursement
779	pursuant to the Medicaid program, the agency shall treat rural
780	primary care hospitals in the same manner as rural hospitals.
781	(4)  For the purpose of participation in the Medical
782	Education Reimbursement and Loan Repayment Program as defined in
783	s. 1009.65 or other loan repayment or incentive programs
784	designed to relieve medical workforce shortages, the department
785	shall treat rural primary care hospitals in the same manner as
786	rural hospitals.
787	(5)  For the purpose of coordinating primary care services
788	described in s. 154.011(1)(c)10., the department shall treat
789	rural primary care hospitals in the same manner as rural
790	hospitals.
791	(6)  Rural hospitals that make application under the
792	certificate-of-need program to be licensed as rural primary care
793	hospitals shall receive expedited review as defined in s.
794	408.032. Rural primary care hospitals seeking relicensure as
795	acute care general hospitals shall also receive expedited
796	review.
797	(7)  Rural primary care hospitals are exempt from
798	certificate-of-need requirements for home health and hospice
799	services and for swing beds in a number that does not exceed
800	one-half of the facility's licensed beds.
801	(8)  Rural primary care hospitals shall have agreements
802	with other hospitals, skilled nursing facilities, home health
803	agencies, and providers of diagnostic-imaging and laboratory
804	services that are not provided on site but are needed by
805	patients.
806	(4)  The department may seek federal recognition of
807	emergency care hospitals authorized by s. 395.605 under the
808	essential access community hospital program authorized by the
809	Omnibus Budget Reconciliation Act of 1989.
810	Section 7.  Section 395.6061, Florida Statutes, is amended
811	to read:
812	395.6061  Rural hospital capital improvement.--There is
813	established a rural hospital capital improvement grant program.
814	(1)  A rural hospital as defined in s. 395.602 may apply to
815	the department for a grant to acquire, repair, improve, or
816	upgrade systems, facilities, or equipment. The grant application
817	must provide information that includes:
818	(a)  A statement indicating the problem the rural hospital
819	proposes to solve with the grant funds;
820	(b)  The strategy proposed to resolve the problem;
821	(c)  The organizational structure, financial system, and
822	facilities that are essential to the proposed solution;
823	(d)  The projected longevity of the proposed solution after
824	the grant funds are expended;
825	(e)  Evidence of participation in a rural health network as
826	defined in s. 381.0406 and evidence that, after July 1, 2008,
827	the application is consistent with the rural health network's
828	long-range development plan;
829	(f)  Evidence that the rural hospital has difficulty in
830	obtaining funding or that funds available for the proposed
831	solution are inadequate;
832	(g)  Evidence that the grant funds will assist in
833	maintaining or returning the hospital to an economically stable
834	condition or that any plan for closure of the hospital or
835	realignment of services will involve development of innovative
836	alternatives for the provision of needed discontinued services;
837	(h)  Evidence of a satisfactory record-keeping system to
838	account for grant fund expenditures within the rural county; and
839	(i)  A rural health network plan that includes a
840	description of how the plan was developed, the goals of the
841	plan, the links with existing health care providers under the
842	plan, Indicators quantifying the hospital's financial status
843	well-being, measurable outcome targets, and the current physical
844	and operational condition of the hospital.
845	(2)  Each rural hospital as defined in s. 395.602 shall
846	receive a minimum of $200,000 $100,000 annually, subject to
847	legislative appropriation, upon application to the Department of
848	Health, for projects to acquire, repair, improve, or upgrade
849	systems, facilities, or equipment.
850	(3)  Any remaining funds may shall annually be disbursed to
851	rural hospitals in accordance with this section. The Department
852	of Health shall establish, by rule, criteria for awarding grants
853	for any remaining funds, which must be used exclusively for the
854	support and assistance of rural hospitals as defined in s.
855	395.602, including criteria relating to the level of charity
856	uncompensated care rendered by the hospital, the financial
857	stability of the hospital, financial and quality indicators for
858	the hospital, whether the project is sustainable beyond the
859	funding period, the hospital's ability to improve or expand
860	services, the hospital's participation in a rural health network
861	as defined in s. 381.0406, and the proposed use of the grant by
862	the rural hospital to resolve a specific problem. The department
863	must consider any information submitted in an application for
864	the grants in accordance with subsection (1) in determining
865	eligibility for and the amount of the grant, and none of the
866	individual items of information by itself may be used to deny
867	grant eligibility.
868	(4)  The department shall ensure that the funds are used
869	solely for the purposes specified in this section. The total
870	grants awarded pursuant to this section shall not exceed the
871	amount appropriated for this program.
872	Section 8.  Paragraph (b) of subsection (12) of section
873	409.908, Florida Statutes, is amended to read:
874	409.908  Reimbursement of Medicaid providers.--Subject to
875	specific appropriations, the agency shall reimburse Medicaid
876	providers, in accordance with state and federal law, according
877	to methodologies set forth in the rules of the agency and in
878	policy manuals and handbooks incorporated by reference therein.
879	These methodologies may include fee schedules, reimbursement
880	methods based on cost reporting, negotiated fees, competitive
881	bidding pursuant to s. 287.057, and other mechanisms the agency
882	considers efficient and effective for purchasing services or
883	goods on behalf of recipients. If a provider is reimbursed based
884	on cost reporting and submits a cost report late and that cost
885	report would have been used to set a lower reimbursement rate
886	for a rate semester, then the provider's rate for that semester
887	shall be retroactively calculated using the new cost report, and
888	full payment at the recalculated rate shall be effected
889	retroactively. Medicare-granted extensions for filing cost
890	reports, if applicable, shall also apply to Medicaid cost
891	reports. Payment for Medicaid compensable services made on
892	behalf of Medicaid eligible persons is subject to the
893	availability of moneys and any limitations or directions
894	provided for in the General Appropriations Act or chapter 216.
895	Further, nothing in this section shall be construed to prevent
896	or limit the agency from adjusting fees, reimbursement rates,
897	lengths of stay, number of visits, or number of services, or
898	making any other adjustments necessary to comply with the
899	availability of moneys and any limitations or directions
900	provided for in the General Appropriations Act, provided the
901	adjustment is consistent with legislative intent.
902	(12)
903	(b)  The agency shall adopt a fee schedule, subject to any
904	limitations or directions provided for in the General
905	Appropriations Act, based on a resource-based relative value
906	scale for pricing Medicaid physician services. Under this fee
907	schedule, physicians shall be paid a dollar amount for each
908	service based on the average resources required to provide the
909	service, including, but not limited to, estimates of average
910	physician time and effort, practice expense, and the costs of
911	professional liability insurance. The fee schedule shall provide
912	increased reimbursement for preventive and primary care services
913	and lowered reimbursement for specialty services by using at
914	least two conversion factors, one for cognitive services and
915	another for procedural services. The fee schedule shall not
916	increase total Medicaid physician expenditures unless moneys are
917	available, and shall be phased in over a 2-year period beginning
918	on July 1, 1994. The Agency for Health Care Administration shall
919	seek the advice of a 16-member advisory panel in formulating and
920	adopting the fee schedule. The panel shall consist of Medicaid
921	physicians licensed under chapters 458 and 459 and shall be
922	composed of 50 percent primary care physicians and 50 percent
923	specialty care physicians.
924	Section 9.  Subsection (43) of section 408.07, Florida
925	Statutes, is amended to read:
926	408.07  Definitions.--As used in this chapter, with the
927	exception of ss. 408.031-408.045, the term:
928	(43)  "Rural hospital" means an acute care hospital
929	licensed under chapter 395, having 100 or fewer licensed beds
930	and an emergency room, and which is:
931	(a)  The sole provider within a county with a population
932	density of no greater than 100 persons per square mile;
933	(b)  An acute care hospital, in a county with a population
934	density of no greater than 100 persons per square mile, which is
935	at least 30 minutes of travel time, on normally traveled roads
936	under normal traffic conditions, from another acute care
937	hospital within the same county;
938	(c)  A hospital supported by a tax district or subdistrict
939	whose boundaries encompass a population of 100 persons or fewer
940	per square mile;
941	(d)  A hospital with a service area that has a population
942	of 100 persons or fewer per square mile. As used in this
943	paragraph, the term "service area" means the fewest number of
944	zip codes that account for 75 percent of the hospital's
945	discharges for the most recent 5-year period, based on
946	information available from the hospital inpatient discharge
947	database in the Florida Center for Health Information and Policy
948	Analysis at the Agency for Health Care Administration; or
949	(e)  A critical access hospital.
950
951	Population densities used in this subsection must be based upon
952	the most recently completed United States census. A hospital
953	that received funds under s. 409.9116 for a quarter beginning no
954	later than July 1, 2002, is deemed to have been and shall
955	continue to be a rural hospital from that date through June 30,
956	2012, if the hospital continues to have 100 or fewer licensed
957	beds and an emergency room, or meets the criteria of s.
958	395.602(2)(d)4. s. 395.602(2)(e)4. An acute care hospital that
959	has not previously been designated as a rural hospital and that
960	meets the criteria of this subsection shall be granted such
961	designation upon application, including supporting
962	documentation, to the Agency for Health Care Administration.
963	Section 10.  Subsection (6) of section 409.9116, Florida
964	Statutes, is amended to read:
965	409.9116  Disproportionate share/financial assistance
966	program for rural hospitals.--In addition to the payments made
967	under s. 409.911, the Agency for Health Care Administration
968	shall administer a federally matched disproportionate share
969	program and a state-funded financial assistance program for
970	statutory rural hospitals. The agency shall make
971	disproportionate share payments to statutory rural hospitals
972	that qualify for such payments and financial assistance payments
973	to statutory rural hospitals that do not qualify for
974	disproportionate share payments. The disproportionate share
975	program payments shall be limited by and conform with federal
976	requirements. Funds shall be distributed quarterly in each
977	fiscal year for which an appropriation is made. Notwithstanding
978	the provisions of s. 409.915, counties are exempt from
979	contributing toward the cost of this special reimbursement for
980	hospitals serving a disproportionate share of low-income
981	patients.
982	(6)  This section applies only to hospitals that were
983	defined as statutory rural hospitals, or their successor-in-
984	interest hospital, prior to January 1, 2001. Any additional
985	hospital that is defined as a statutory rural hospital, or its
986	successor-in-interest hospital, on or after January 1, 2001, is
987	not eligible for programs under this section unless additional
988	funds are appropriated each fiscal year specifically to the
989	rural hospital disproportionate share and financial assistance
990	programs in an amount necessary to prevent any hospital, or its
991	successor-in-interest hospital, eligible for the programs prior
992	to January 1, 2001, from incurring a reduction in payments
993	because of the eligibility of an additional hospital to
994	participate in the programs. A hospital, or its successor-in-
995	interest hospital, which received funds pursuant to this section
996	before January 1, 2001, and which qualifies under s.
997	395.602(2)(d) s. 395.602(2)(e), shall be included in the
998	programs under this section and is not required to seek
999	additional appropriations under this subsection.
1000	Section 11.  Paragraph (b) of subsection (2) of section
1001	1009.65, Florida Statutes, is amended to read:
1002	1009.65  Medical Education Reimbursement and Loan Repayment
1003	Program.--
1004	(2)  From the funds available, the Department of Health
1005	shall make payments to selected medical professionals as
1006	follows:
1007	(b)  All payments shall be contingent on continued proof of
1008	primary care practice in an area defined in s. 395.602(2)(d) s.
1009	395.602(2)(e), or an underserved area designated by the
1010	Department of Health, provided the practitioner accepts Medicaid
1011	reimbursement if eligible for such reimbursement. Correctional
1012	facilities, state hospitals, and other state institutions that
1013	employ medical personnel shall be designated by the Department
1014	of Health as underserved locations. Locations with high
1015	incidences of infant mortality, high morbidity, or low Medicaid
1016	participation by health care professionals may be designated as
1017	underserved.
1018	Section 12.  The Legislative Committee on Intergovernmental
1019	Relations shall study the financing options for replacing or
1020	changing the use of rural hospital facilities having 55 or fewer
1021	beds which were built before 1985 and which have not had major
1022	renovations since 1985. For each such hospital, the Legislative
1023	Committee on Intergovernmental Relations staff shall assess the
1024	need to replace or convert the facility, identify all available
1025	sources of financing for such replacement or conversion and
1026	assess each community's capacity to maximize these funding
1027	options, propose a model replacement facility if a facility
1028	should be replaced, and propose alternative uses of the facility
1029	if continued operation of the hospital is not financially
1030	feasible. Based on the results of the contract study, the
1031	Legislative Committee on Intergovernmental Relations shall
1032	submit recommendations to the Legislature by February 1, 2008,
1033	regarding whether the state should provide financial assistance
1034	to replace or convert these rural hospital facilities and what
1035	form that assistance should take.
1036	Section 13.  Section 395.605, Florida Statutes, is
1037	repealed.
1038	Section 14.  This act shall take effect July 1, 2007, only
1039	if specific appropriations are made in the General
1040	Appropriations Act for fiscal year 2007-2008 to the Department
1041	of Health to fund rural health network infrastructure
1042	implementation and the rural hospital capital improvement grant
1043	program.

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