CS/HB 1575

1	A bill to be entitled
2	An act relating to health care; amending s. 381.0402,
3	F.S.; requiring the Department of Health to cooperate with
4	specified medical schools in maintaining and evaluating
5	the area health education center network; expanding the
6	purposes of the network; requiring the department to
7	contract with the medical schools to provide funds to the
8	network; providing that the persons to be served by the
9	network are "medically underserved populations" rather
10	than "low-income people"; requiring that the center assist
11	in linking the provision of primary care services to
12	medically underserved populations and to provide for the
13	education of students in the health care professions and
14	health care providers serving medically underserved
15	populations, as well as medical students, interns, and
16	residents; reducing the percentage of funds that the
17	department is authorized to spend on administering and
18	evaluating the network; amending s. 381.0405, F.S.;
19	revising the purpose and functions of the Office of Rural
20	Health in the Department of Health; requiring the
21	Secretary of Health and the Secretary of Health Care
22	Administration to appoint an advisory council to advise
23	the Office of Rural Health; providing for terms of office
24	of the members of the advisory council; authorizing per
25	diem and travel reimbursement for members of the advisory
26	council; requiring the Office of Rural Health to submit an
27	annual report to the Governor and the Legislature;
28	amending s. 381.0406, F.S.; revising legislative findings
29	and intent with respect to rural health networks;
30	redefining the term "rural health network"; establishing
31	requirements for membership in rural health networks;
32	adding functions for the rural health networks; revising
33	requirements for the governance and organization of rural
34	health networks; revising the services to be provided by
35	provider members of rural health networks; requiring
36	coordination among rural health networks and area health
37	education centers, health planning councils, and regional
38	education consortia; establishing requirements for funding
39	rural health networks; establishing performance standards
40	for rural health networks; establishing requirements for
41	the receipt of grant funding; requiring the Office of
42	Rural Health to monitor rural health networks; authorizing
43	the Department of Health to establish rules governing
44	rural health network grant programs and performance
45	standards; creating s. 381.7366, F.S.; creating the Office
46	of Minority Health within the Department of Health;
47	providing legislative intent; providing for organization
48	and duties of the office; providing for responsibilities
49	of the office and the department and coordination with
50	other agencies; amending s. 395.602, F.S.; defining the
51	term "critical access hospital"; deleting the definitions
52	of "emergency care hospital," and "essential access
53	community hospital"; revising the definition of "rural
54	primary care hospital"; amending s. 395.603, F.S.;
55	deleting a requirement that the Agency for Health Care
56	Administration adopt a rule relating to deactivation of
57	rural hospital beds under certain circumstances; requiring
58	that critical access hospitals and rural primary care
59	hospitals maintain a certain number of actively licensed
60	beds; amending s. 395.604, F.S.; removing emergency care
61	hospitals and essential access community hospitals from
62	certain licensure requirements; specifying certain special
63	conditions for rural primary care hospitals; amending s.
64	395.6061, F.S.; specifying the purposes of capital
65	improvement grants for rural hospitals; modifying the
66	conditions for receiving a grant; authorizing the
67	Department of Health to award grants for remaining funds
68	to certain rural hospitals; amending s. 409.908, F.S.;
69	revising a provision relating to the phase-in of a
70	Medicaid physician fee schedule to delete obsolete
71	language; amending s. 499.012, F.S.; revising permit
72	requirements for a limited prescription drug veterinary
73	wholesaler; providing for certain certification to the
74	Department of Health by a limited prescription drug
75	veterinary wholesaler; amending ss. 408.07, 409.9116, and
76	1009.65, F.S.; conforming cross-references; repealing s.
77	395.605, F.S., relating to the licensure of emergency care
78	hospitals; repealing s. 468.807, F.S., relating to
79	temporary licenses to practice orthotics, prosthetics, or
80	pedorthics; providing a contingent effective date.
81
82	Be It Enacted by the Legislature of the State of Florida:
83
84	Section 1.  Section 381.0402, Florida Statutes, is amended
85	to read:
86	381.0402  Area health education center network.--The
87	department, in cooperation with the state-approved medical
88	schools located in this state which form the area health
89	education center network in this state, shall maintain and
90	evaluate organize an area health education center network
91	focused based on earlier medically indigent demonstration
92	projects and shall evaluate the impact of each network on
93	improving access to health services by persons who are medically
94	underserved. The network shall serve as be a catalyst for the
95	primary care training of health professionals by increasing
96	through increased opportunities for training in medically
97	underserved areas, increasing access to primary care services,
98	providing health workforce recruitment, enhancing the quality of
99	health care, and addressing current and emerging public health
100	issues.
101	(1)  The department shall contract with the medical schools
102	to assist in funding the an area health education center
103	network, which links the provision of primary care services to
104	medically underserved populations, and which provides for low-
105	income persons with the education of:
106	(a)  Medical students, interns, and residents. The network
107	shall:
108	(a)  Be coordinated with and under contract with the state-
109	approved medical schools, which shall be responsible for the
110	clinical training and supervision.
111	1.(b)  Divide the state into service areas within the
112	network for with each state-approved medical school coordinating
113	the recruitment recruiting, training, and retention of medical
114	students within its assigned area.
115	(c)  Use a multidisciplinary approach with appropriate
116	medical supervision.
117	2.(d)  Use current community resources, such as county
118	health departments, federally funded community or migrant health
119	primary care centers, and or other primary health care
120	providers, as community-based sites for training medical
121	students, interns, and residents.
122	3.  Use a multidisciplinary approach with appropriate
123	medical supervision.
124	(b)  Students in the health care professions. The network
125	shall:
126	1.  Facilitate the recruitment, training, and retention of
127	students in the health care professions within service areas.
128	2.  Use community resources, such as county health
129	departments, federally funded community or migrant health
130	centers, and other primary health care providers, as sites for
131	training students in the health care professions.
132	3.  Use a multidisciplinary approach with appropriate
133	supervision.
134	(c)  Health care providers serving medically underserved
135	populations. The network shall:
136	1.  Assist providers in medically underserved areas and
137	other safety net providers in remaining current in their fields
138	through a variety of community resource initiatives.
139	2.  Strengthen the health care safety net in this state by
140	enhancing services and increasing access to care in medically
141	underserved areas.
142	3.  Provide other services, such as library and information
143	resources, continuing professional education, technical
144	assistance, and other support services, for providers who serve
145	in medically underserved areas.
146	(2)  The department shall establish criteria and procedures
147	for quality assurance, performance evaluations, periodic audits,
148	and other appropriate safeguards for the network.
149	(3)  The department shall make every effort to assure that
150	the network does participating medical schools do not
151	discriminate among enrollees with respect to age, race, sex, or
152	health status. However, the network such schools may target
153	high-risk medically needy population groups.
154	(4)  The department may use no more than 2 5 percent of the
155	annual appropriation for administering and evaluating the
156	network.
157	(5)  Notwithstanding subsection (4), the department may not
158	use any portion of the annual appropriation to administer and
159	evaluate the network. This subsection expires July 1, 2007.
160	Section 2.  Section 381.0405, Florida Statutes, is amended
161	to read:
162	381.0405  Office of Rural Health.--
163	(1)  ESTABLISHMENT.--The Department of Health shall
164	establish an Office of Rural Health, which shall assist rural
165	health care providers in improving the health status and health
166	care of rural residents of this state and help rural health care
167	providers to integrate their efforts and prepare for prepaid and
168	at-risk reimbursement. The Office of Rural Health shall
169	coordinate its activities with rural health networks established
170	under s. 381.0406, local health councils established under s.
171	408.033, the area health education center network established
172	under pursuant to s. 381.0402, and with any appropriate research
173	and policy development centers within universities that have
174	state-approved medical schools. The Office of Rural Health may
175	enter into a formal relationship with any center that designates
176	the office as an affiliate of the center.
177	(2)  PURPOSE.--The Office of Rural Health shall actively
178	foster the development of service-delivery systems and
179	cooperative agreements to enhance the provision of high-quality
180	health care services in rural areas and serve as a catalyst for
181	improved health services to residents citizens in rural areas of
182	the state.
183	(3)  GENERAL FUNCTIONS.--The office shall:
184	(a)  Integrate policies related to physician workforce,
185	hospitals, public health, and state regulatory functions.
186	(b)  Work with rural stakeholders in order to foster the
187	development of strategic planning that addresses Propose
188	solutions to problems affecting health care delivery in rural
189	areas.
190	(c)  Develop, in coordination with the rural health
191	networks, standards, guidelines, and performance objectives for
192	rural health networks.
193	(d)  Foster the expansion of rural health network service
194	areas to include rural counties that are not covered by a rural
195	health network.
196	(e)(c)  Seek grant funds from foundations and the Federal
197	Government.
198	(f)  Administer state grant programs for rural hospitals
199	and rural health networks.
200	(4)  COORDINATION.--The office shall:
201	(a)  Identify federal and state rural health programs and
202	provide information and technical assistance to rural providers
203	regarding participation in such programs.
204	(b)  Act as a clearinghouse for collecting and
205	disseminating information on rural health care issues, research
206	findings on rural health care, and innovative approaches to the
207	delivery of health care in rural areas.
208	(c)  Foster the creation of regional health care systems
209	that promote cooperation through cooperative agreements, rather
210	than competition.
211	(d)  Coordinate the department's rural health care
212	activities, programs, and policies.
213	(e)  Design initiatives and promote cooperative agreements
214	in order to improve access to primary care, prehospital
215	emergency care, inpatient acute care, and emergency medical
216	services and promote the coordination of such services in rural
217	areas.
218	(f)  Assume responsibility for state coordination of the
219	Rural Hospital Transition Grant Program, the Essential Access
220	Community Hospital Program, and other federal rural hospital and
221	rural health care grant programs.
222	(5)  TECHNICAL ASSISTANCE.--The office shall:
223	(a)  Assist Help rural health care providers in recruiting
224	obtain health care practitioners by promoting the location and
225	relocation of health care practitioners in rural areas and
226	promoting policies that create incentives for practitioners to
227	serve in rural areas.
228	(b)  Provide technical assistance to hospitals, community
229	and migrant health centers, and other health care providers that
230	serve residents of rural areas.
231	(c)  Assist with the design of strategies to improve health
232	care workforce recruitment and placement programs.
233	(d)  Provide technical assistance to rural health networks
234	in the development of their long-range development plans.
235	(e)  Provide links to best practices and other technical-
236	assistance resources on its website.
237	(6)  RESEARCH PUBLICATIONS AND SPECIAL STUDIES.--The office
238	shall:
239	(a)  Conduct policy and research studies.
240	(b)  Conduct health status studies of rural residents.
241	(c)  Collect relevant data on rural health care issues for
242	use in program planning and department policy development.
243	(7)  ADVISORY COUNCIL.--The Secretary of Health and the
244	Secretary of Health Care Administration shall each appoint no
245	more than five members. In making appointments, the Secretary of
246	Health and the Secretary of Health Care Administration shall
247	solicit nominations from interested parties and ensure, to the
248	extent practicable, that the council membership reflects a
249	balance of expertise in health care operations management,
250	practice, health policy, and public health service in rural
251	communities. The council shall advise the office regarding its
252	responsibilities under this section and ss. 381.0406 and
253	395.6061. Members shall be appointed for 4-year staggered terms
254	and may be reappointed to a second term of office. Members shall
255	serve without compensation, but are entitled to reimbursement
256	for per diem and travel expenses as provided in s. 112.061. The
257	department shall provide staff and other administrative
258	assistance reasonably necessary to assist the advisory council
259	in carrying out its duties. The advisory council shall work with
260	stakeholders to develop recommendations that address barriers
261	and identify options for establishing provider networks in rural
262	counties.
263	(8)  REPORTS.--Beginning January 1, 2008, and annually
264	thereafter, the Office of Rural Health shall submit a report to
265	the Governor, the President of the Senate, and the Speaker of
266	the House of Representatives summarizing the activities of the
267	office, including the grants obtained or administered by the
268	office and the status of rural health networks and rural
269	hospitals in the state. The report must also include
270	recommendations that address barriers and identify options for
271	establishing provider networks in rural counties.
272	(9)(7)  APPROPRIATION.--The Legislature shall appropriate
273	such sums as are necessary to support the Office of Rural
274	Health.
275	Section 3.  Section 381.0406, Florida Statutes, is amended
276	to read:
277	381.0406  Rural health networks.--
278	(1)  LEGISLATIVE FINDINGS AND INTENT.--
279	(a)  The Legislature finds that, in rural areas, access to
280	health care is limited and the quality of health care is
281	negatively affected by inadequate financing, difficulty in
282	recruiting and retaining skilled health professionals, and the
283	because of a migration of patients to urban areas for general
284	acute care and specialty services.
285	(b)  The Legislature further finds that the efficient and
286	effective delivery of health care services in rural areas
287	requires:
288	1.  The integration of public and private resources;
289	2.  The introduction of innovative outreach methods;
290	3.  The adoption of quality improvement and cost-
291	effectiveness measures;
292	4.  The organization of health care providers into joint
293	contracting entities;
294	5.  Establishing referral linkages;
295	6.  The analysis of costs and services in order to prepare
296	health care providers for prepaid and at-risk financing; and
297	7.  The coordination of health care providers.
298	(c)  The Legislature further finds that the availability of
299	a continuum of quality health care services, including
300	preventive, primary, secondary, tertiary, and long-term care, is
301	essential to the economic and social vitality of rural
302	communities.
303	(d)  The Legislature further finds that health care
304	providers in rural areas are not prepared for market changes
305	such as the introduction of managed care and capitation-
306	reimbursement methodologies into health care services.
307	(e)(d)  The Legislature further finds that the creation of
308	rural health networks can help to alleviate these problems.
309	Rural health networks shall act in the broad public interest
310	and, to the extent possible, seek to improve the accessibility,
311	quality, and cost-effectiveness of rural health care by
312	planning, developing, coordinating, and providing be structured
313	to provide a continuum of quality health care services for rural
314	residents through the cooperative efforts of rural health
315	network members and other health care providers.
316	(f)(e)  The Legislature further finds that rural health
317	networks shall have the goal of increasing the financial
318	stability of statutory rural hospitals by linking rural hospital
319	services to other services in a continuum of health care
320	services and by increasing the utilization of statutory rural
321	hospitals whenever for appropriate health care services whenever
322	feasible, which shall help to ensure their survival and thereby
323	support the economy and protect the health and safety of rural
324	residents.
325	(g)(f)  Finally, the Legislature finds that rural health
326	networks may serve as "laboratories" to determine the best way
327	of organizing rural health services and linking to out-of-area
328	services that are not available locally in order, to move the
329	state closer to ensuring that everyone has access to health
330	care, and to promote cost-containment cost containment efforts.
331	The ultimate goal of rural health networks shall be to ensure
332	that quality health care is available and efficiently delivered
333	to all persons in rural areas.
334	(2)  DEFINITIONS.--
335	(a)  "Rural" means an area having with a population density
336	of fewer less than 100 individuals per square mile or an area
337	defined by the most recent United States Census as rural.
338	(b)  "Health care provider" means any individual, group, or
339	entity, public or private, which that provides health care,
340	including: preventive health care, primary health care,
341	secondary and tertiary health care, hospital in-hospital health
342	care, public health care, and health promotion and education.
343	(c)  "Rural health network" or "network" means a nonprofit
344	legal entity whose principal place of business is in a rural
345	area, whose members consist consisting of rural and urban health
346	care providers and others, and which that is established
347	organized to plan, develop, organize, and deliver health care
348	services on a cooperative basis in a rural area, except for some
349	secondary and tertiary care services.
350	(3)  NETWORK MEMBERSHIP.--
351	(a)  Because each rural area is unique, with a different
352	health care provider mix, health care provider membership may
353	vary, but all networks shall include members that provide health
354	promotion and disease-prevention services, public health
355	services, comprehensive primary care, emergency medical care,
356	and acute inpatient care.
357	(b)  Each county health department shall be a member of the
358	rural health network whose service area includes the county in
359	which the county health department is located. Federally
360	qualified health centers and emergency medical services
361	providers are encouraged to become members of the rural health
362	networks in the areas in which their patients reside or receive
363	services.
364	(c)(4)  Network membership shall be available to all health
365	care providers in the network service area if, provided that
366	they render care to all patients referred to them from other
367	network members;, comply with network quality assurance, quality
368	improvement, and utilization-management and risk management
369	requirements; and, abide by the terms and conditions of network
370	provider agreements in paragraph (11)(c), and provide services
371	at a rate or price equal to the rate or price negotiated by the
372	network.
373	(4)(5)  NETWORK SERVICE AREAS.--Network service areas are
374	do not required need to conform to local political boundaries or
375	state administrative district boundaries. The geographic area of
376	one rural health network, however, may not overlap the territory
377	of any other rural health network.
378	(5)(6)  NETWORK FUNCTIONS.--Networks shall:
379	(a)  Seek to develop linkages with provisions for referral
380	to tertiary inpatient care, specialty physician care, and to
381	other services that are not available in rural service areas.
382	(b)(7)  Networks shall Make available health promotion,
383	disease prevention, and primary care services, in order to
384	improve the health status of rural residents and to contain
385	health care costs.
386	(8)  Networks may have multiple points of entry, such as
387	through private physicians, community health centers, county
388	health departments, certified rural health clinics, hospitals,
389	or other providers; or they may have a single point of entry.
390	(c)(9)  Encourage members through training and educational
391	programs to adopt standards of care and promote the evidence-
392	based practice of medicine. Networks shall establish standard
393	protocols, coordinate and share patient records, and develop
394	patient information exchange systems in order to improve the
395	quality of and access to services.
396	(d)  Develop quality-improvement programs and train network
397	members and other health care providers in the use of such
398	programs.
399	(e)  Develop disease-management systems and train network
400	members and other health care providers in the use of such
401	systems.
402	(f)  Promote outreach to areas that have a high need for
403	services.
404	(g)  Seek to develop community care alternatives for elders
405	who would otherwise be placed in nursing homes.
406	(h)  Emphasize community care alternatives for persons with
407	mental health and substance abuse disorders who are at risk of
408	being admitted to an institution.
409	(i)  Develop and implement a long-range development plan
410	for an integrated system of care that is responsive to the
411	unique local health needs and the area health care services
412	market. Each rural health network long-range development plan
413	must address strategies to improve access to specialty care,
414	train health care providers to use standards of care for chronic
415	illness, develop disease-management capacity, and link to state
416	and national quality-improvement initiatives. The initial long-
417	range development plan must be submitted to the Office of Rural
418	Health for review and approval no later than July 1, 2008, and
419	thereafter the plans must be updated and submitted to the Office
420	of Rural Health every 3 years.
421	(10)  Networks shall develop risk management and quality
422	assurance programs for network providers.
423	(6)(11)  NETWORK GOVERNANCE AND ORGANIZATION.--
424	(a)  Networks shall be incorporated as not-for-profit
425	corporations under chapter 617, with articles of incorporation
426	that set forth purposes consistent with this section the laws of
427	the state.
428	(b)  Each network Networks shall have an independent a
429	board of directors that derives membership from local
430	government, health care providers, businesses, consumers,
431	advocacy groups, and others. Boards of other community health
432	care entities may not serve in whole as the board of a rural
433	health network; however, some overlap of board membership with
434	other community organizations is encouraged. Network staff must
435	provide an annual orientation and strategic planning activity
436	for board members.
437	(c)  Network boards of directors shall have the
438	responsibility of determining the content of health care
439	provider agreements that link network members. The written
440	agreements between the network and its health care provider
441	members must specify participation in the essential functions of
442	the network and shall specify:
443	1.  Who provides what services.
444	2.  The extent to which the health care provider provides
445	care to persons who lack health insurance or are otherwise
446	unable to pay for care.
447	3.  The procedures for transfer of medical records.
448	4.  The method used for the transportation of patients
449	between providers.
450	5.  Referral and patient flow including appointments and
451	scheduling.
452	6.  Payment arrangements for the transfer or referral of
453	patients.
454	(d)  There shall be no liability on the part of, and no
455	cause of action of any nature shall arise against, any member of
456	a network board of directors, or its employees or agents, for
457	any lawful action taken by them in the performance of their
458	administrative powers and duties under this subsection.
459	(7)(12)  NETWORK PROVIDER MEMBER SERVICES.--
460	(a)  Networks, to the extent feasible, shall seek to
461	develop services that provide for a continuum of care for all
462	residents patients served by the network. Each network shall
463	recruit members that can provide include the following core
464	services:  disease prevention, health promotion, comprehensive
465	primary care, emergency medical care, and acute inpatient care.
466	Each network shall seek to ensure the availability of
467	comprehensive maternity care, including prenatal, delivery, and
468	postpartum care for uncomplicated pregnancies, either directly,
469	by contract, or through referral agreements. Networks shall, to
470	the extent feasible, develop local services and linkages among
471	health care providers in order to also ensure the availability
472	of the following services: within the specified timeframes,
473	either directly, by contract, or through referral agreements:
474	1.  Services available in the home.
475	1.a.  Home health care.
476	2.b.  Hospice care.
477	2.  Services accessible within 30 minutes travel time or
478	less.
479	3.a.  Emergency medical services, including advanced life
480	support, ambulance, and basic emergency room services.
481	4.b.  Primary care, including.
482	c.  prenatal and postpartum care for uncomplicated
483	pregnancies.
484	5.d.  Community-based services for elders, such as adult
485	day care and assistance with activities of daily living.
486	6.e.  Public health services, including communicable
487	disease control, disease prevention, health education, and
488	health promotion.
489	7.f.  Outpatient mental health psychiatric and substance
490	abuse treatment services.
491	3.  Services accessible within 45 minutes travel time or
492	less.
493	8.a.  Hospital acute inpatient care for persons whose
494	illnesses or medical problems are not severe.
495	9.b.  Level I obstetrical care, which is Labor and delivery
496	for low-risk patients.
497	10.c.  Skilled nursing services and, long-term care,
498	including nursing home care.
499	(b)  Networks shall seek to foster linkages with out-of-
500	area services to the extent feasible in order to ensure the
501	availability of:
502	1.d.  Dialysis.
503	2.e.  Osteopathic and chiropractic manipulative therapy.
504	4.  Services accessible within 2 hours travel time or less.
505	3.a.  Specialist physician care.
506	4.b.  Hospital acute inpatient care for severe illnesses
507	and medical problems.
508	5.c.  Level II and III obstetrical care, which is Labor and
509	delivery care for high-risk patients and neonatal intensive
510	care.
511	6.d.  Comprehensive medical rehabilitation.
512	7.e.  Inpatient mental health psychiatric and substance
513	abuse treatment services.
514	8.f.  Magnetic resonance imaging, lithotripter treatment,
515	oncology, advanced radiology, and other technologically advanced
516	services.
517	9.g.  Subacute care.
518	(8)  COORDINATION WITH OTHER ENTITIES.--
519	(a)  Area health education centers, health planning
520	councils, and regional education consortia having technological
521	expertise in continuing education shall participate in the rural
522	health networks' preparation of long-range development plans.
523	The Department of Health may require written memoranda of
524	agreement between a network and an area health education center
525	or health planning council.
526	(b)  Rural health networks shall initiate activities, in
527	coordination with area health education centers, to carry out
528	the objectives of the adopted long-range development plan,
529	including continuing education for health care practitioners
530	performing functions such as disease management, continuous
531	quality improvement, telemedicine, long-distance learning, and
532	the treatment of chronic illness using standards of care. As
533	used in this section, the term "telemedicine" means the use of
534	telecommunications to deliver or expedite the delivery of health
535	care services.
536	(c)  Health planning councils shall support the preparation
537	of network long-range development plans through data collection
538	and analysis in order to assess the health status of area
539	residents and the capacity of local health services.
540	(d)  Regional education consortia that have the technology
541	available to assist rural health networks in establishing
542	systems for the exchange of patient information and for long-
543	distance learning are encouraged to provide technical assistance
544	upon the request of a rural health network.
545	(e)(b)  Networks shall actively participate with area
546	health education center programs, whenever feasible, in
547	developing and implementing recruitment, training, and retention
548	programs directed at positively influencing the supply and
549	distribution of health care professionals serving in, or
550	receiving training in, network areas.
551	(c)  As funds become available, networks shall emphasize
552	community care alternatives for elders who would otherwise be
553	placed in nursing homes.
554	(d)  To promote the most efficient use of resources,
555	networks shall emphasize disease prevention, early diagnosis and
556	treatment of medical problems, and community care alternatives
557	for persons with mental health and substance abuse disorders who
558	are at risk to be institutionalized.
559	(f)(13)  TRAUMA SERVICES.--In those network areas having
560	which have an established trauma agency approved by the
561	Department of Health, the network shall seek the participation
562	of that trauma agency must be a participant in the network.
563	Trauma services provided within the network area must comply
564	with s. 395.405.
565	(9)(14)  NETWORK FINANCING.--
566	(a)  Networks may use all sources of public and private
567	funds to support network activities. Nothing in this section
568	prohibits networks from becoming managed care providers.
569	(b)  The Department of Health shall establish grant
570	programs to provide funding to support the administrative costs
571	of developing and operating rural health networks.
572	(10)  NETWORK PERFORMANCE STANDARDS.--The Department of
573	Health shall develop and enforce performance standards for rural
574	health network operations grants and rural health infrastructure
575	development grants.
576	(a)  Operations grant performance standards must include,
577	but are not limited to, standards that require the rural health
578	network to:
579	1.  Have a qualified board of directors that meets at least
580	quarterly.
581	2.  Have sufficient staff who have the qualifications and
582	experience to perform the requirements of this section, as
583	assessed by the Office of Rural Health, or a written plan to
584	obtain such staff.
585	3.  Comply with the department's grant-management standards
586	in a timely and responsive manner.
587	4.  Comply with the department's standards for the
588	administration of federal grant funding, including assistance to
589	rural hospitals.
590	5.  Demonstrate a commitment to network activities from
591	area health care providers and other stakeholders, as described
592	in letters of support.
593	(b)  Rural health infrastructure development grant
594	performance standards must include, but are not limited to,
595	standards that require the rural health network to:
596	1.  During the 2007-2008 fiscal year, develop a long-range
597	development plan and, after July 1, 2008, have a long-range
598	development plan that has been reviewed and approved by the
599	Office of Rural Health.
600	2.  Have two or more successful network-development
601	activities, such as:
602	a.  Management of a network-development or outreach grant
603	from the federal Office of Rural Health Policy;
604	b.  Implementation of outreach programs to address chronic
605	disease, infant mortality, or assistance with prescription
606	medication;
607	c.  Development of partnerships with community and faith-
608	based organizations to address area health problems;
609	d.  Provision of direct services, such as clinics or mobile
610	units;
611	e.  Operation of credentialing services for health care
612	providers or quality-assurance and quality-improvement
613	initiatives that, whenever possible, are consistent with state
614	or federal quality initiatives;
615	f.  Support for the development of community health
616	centers, local community health councils, federal designation as
617	a rural critical access hospital, or comprehensive community
618	health planning initiatives; and
619	g.  Development of the capacity to obtain federal, state,
620	and foundation grants.
621	(11)(15)  NETWORK IMPLEMENTATION.--As funds become
622	available, networks shall be developed and implemented in two
623	phases.
624	(a)  Phase I shall consist of a network planning and
625	development grant program. Planning grants shall be used to
626	organize networks, incorporate network boards, and develop
627	formal provider agreements as provided for in this section. The
628	Department of Health shall develop a request-for-proposal
629	process to solicit grant applications.
630	(b)  Phase II shall consist of a network operations grant
631	program. As funds become available, certified networks that meet
632	performance standards shall be eligible to receive grant funds
633	to be used to help defray the costs of rural health network
634	infrastructure development, patient care, and network
635	administration. Rural health network infrastructure development
636	includes, but is not limited to: recruitment and retention of
637	primary care practitioners; enhancement of primary care services
638	through the use of mobile clinics; development of preventive
639	health care programs; linkage of urban and rural health care
640	systems; design and implementation of automated patient records,
641	outcome measurement, quality assurance, and risk management
642	systems; establishment of one-stop service delivery sites;
643	upgrading of medical technology available to network providers;
644	enhancement of emergency medical systems; enhancement of medical
645	transportation; formation of joint contracting entities composed
646	of rural physicians, rural hospitals, and other rural health
647	care providers; establishment of comprehensive disease-
648	management programs that meet Medicaid requirements;
649	establishment of regional quality-improvement programs involving
650	physicians and hospitals consistent with state and national
651	initiatives; establishment of specialty networks connecting
652	rural primary care physicians and urban specialists; development
653	of regional broadband telecommunications systems that have the
654	capacity to share patient information in a secure network,
655	telemedicine, and long-distance learning capacity; and linkage
656	between training programs for health care practitioners and the
657	delivery of health care services in rural areas and development
658	of telecommunication capabilities. A Phase II award may occur in
659	the same fiscal year as a Phase I award.
660	(12)(16)  CERTIFICATION.--For the purpose of certifying
661	networks that are eligible for Phase II funding, the Department
662	of Health shall certify networks that meet the criteria
663	delineated in this section and the rules governing rural health
664	networks. The Office of Rural Health in the Department of Health
665	shall monitor rural health networks in order to ensure continued
666	compliance with established certification and performance
667	standards.
668	(13)(17)  RULES.--The Department of Health shall establish
669	rules that govern the creation and certification of networks,
670	the provision of grant funds under Phase I and Phase II, and the
671	establishment of performance standards including establishing
672	outcome measures for networks.
673	Section 4.  Section 381.7366, Florida Statutes, is created
674	to read:
675	381.7366  Office of Minority Health; legislative intent;
676	duties.--
677	(1)  LEGISLATIVE INTENT.--The Legislature recognizes that
678	despite significant investments in health care programs certain
679	racial and ethnic populations suffer disproportionately with
680	chronic diseases when compared to the non-Hispanic white
681	population. The Legislature intends to address these disparities
682	by developing programs that target causal factors and recognize
683	the specific health care needs of racial and ethnic minorities.
684	(2)  ORGANIZATION.--The Office of Minority Health is
685	established within the Department of Health. The office shall be
686	headed by a director who shall report directly to the Secretary
687	of Health.
688	(3)  DUTIES.--The office shall:
689	(a)  Protect and promote the health and well-being of
690	racial and ethnic populations in the state.
691	(b)  Focus on the issue of health disparities between
692	racial and ethnic minority groups and the general population.
693	(c)  Coordinate the department's initiatives, programs, and
694	policies to address racial and ethnic health disparities.
695	(d)  Communicate pertinent health information to affected
696	racial and ethnic populations.
697	(e)  Collect and analyze data on the incidence and
698	frequency of racial and ethnic health disparities.
699	(f)  Promote and encourage cultural competence education
700	and training for health care professionals.
701	(g)  Serve as a clearinghouse for the collection and
702	dissemination of information and research findings relating to
703	innovative approaches to the reduction or elimination of health
704	disparities.
705	(h)  Dedicate resources to increase public awareness of
706	minority health issues.
707	(i)  Seek increased funding for local innovative
708	initiatives and administer grants designed to support
709	initiatives that address health disparities and that can be
710	duplicated.
711	(j)  Provide staffing and support for the Closing the Gap
712	grant program advisory committee.
713	(k)  Coordinate with other agencies, states, and the
714	Federal Government to reduce or eliminate health disparities.
715	(l)  Collaborate with other public health care providers,
716	community and faith-based organizations, the private health care
717	system, historically black colleges and universities and other
718	minority institutions of higher education, medical schools, and
719	other health providers to establish a comprehensive and
720	inclusive approach to reducing health disparities.
721	(m)  Encourage and support research in the causes of racial
722	and ethnic health disparities.
723	(n)  Collaborate with health professional training programs
724	to increase the number of minority health care professionals.
725	(o)  Provide an annual report to the Governor, the
726	President of the Senate, and the Speaker of the House of
727	Representatives on the activities of the office.
728	(4)  RESPONSIBILITY AND COORDINATION.--The office and the
729	department shall direct and carry out the duties established
730	under this section and shall work with other state agencies to
731	accomplish these duties.
732	Section 5.  Subsection (2) of section 395.602, Florida
733	Statutes, is amended to read:
734	395.602  Rural hospitals.--
735	(2)  DEFINITIONS.--As used in this part:
736	(a)  "Critical access hospital" means a hospital that meets
737	the definition of rural hospital in paragraph (d) and meets the
738	requirements for reimbursement by Medicare and Medicaid under 42
739	C.F.R. ss. 485.601-485.647. "Emergency care hospital" means a
740	medical facility which provides:
741	1.  Emergency medical treatment; and
742	2.  Inpatient care to ill or injured persons prior to their
743	transportation to another hospital or provides inpatient medical
744	care to persons needing care for a period of up to 96 hours. The
745	96-hour limitation on inpatient care does not apply to respite,
746	skilled nursing, hospice, or other nonacute care patients.
747	(b)  "Essential access community hospital" means any
748	facility which:
749	1.  Has at least 100 beds;
750	2.  Is located more than 35 miles from any other essential
751	access community hospital, rural referral center, or urban
752	hospital meeting criteria for classification as a regional
753	referral center;
754	3.  Is part of a network that includes rural primary care
755	hospitals;
756	4.  Provides emergency and medical backup services to rural
757	primary care hospitals in its rural health network;
758	5.  Extends staff privileges to rural primary care hospital
759	physicians in its network; and
760	6.  Accepts patients transferred from rural primary care
761	hospitals in its network.
762	(b)(c)  "Inactive rural hospital bed" means a licensed
763	acute care hospital bed, as defined in s. 395.002(14), that is
764	inactive in that it cannot be occupied by acute care inpatients.
765	(c)(d)  "Rural area health education center" means an area
766	health education center (AHEC), as authorized by Pub. L. No. 94-
767	484, which provides services in a county with a population
768	density of no greater than 100 persons per square mile.
769	(d)(e)  "Rural hospital" means an acute care hospital
770	licensed under this chapter, having 100 or fewer licensed beds
771	and an emergency room, which is:
772	1.  The sole provider within a county with a population
773	density of no greater than 100 persons per square mile;
774	2.  An acute care hospital, in a county with a population
775	density of no greater than 100 persons per square mile, which is
776	at least 30 minutes of travel time, on normally traveled roads
777	under normal traffic conditions, from any other acute care
778	hospital within the same county;
779	3.  A hospital supported by a tax district or subdistrict
780	whose boundaries encompass a population of 100 persons or fewer
781	per square mile;
782	4.  A hospital in a constitutional charter county with a
783	population of over 1 million persons that has imposed a local
784	option health service tax pursuant to law and in an area that
785	was directly impacted by a catastrophic event on August 24,
786	1992, for which the Governor of Florida declared a state of
787	emergency pursuant to chapter 125, and has 120 beds or less that
788	serves an agricultural community with an emergency room
789	utilization of no less than 20,000 visits and a Medicaid
790	inpatient utilization rate greater than 15 percent;
791	5.  A hospital with a service area that has a population of
792	100 persons or fewer per square mile. As used in this
793	subparagraph, the term "service area" means the fewest number of
794	zip codes that account for 75 percent of the hospital's
795	discharges for the most recent 5-year period, based on
796	information available from the hospital inpatient discharge
797	database in the Florida Center for Health Information and Policy
798	Analysis at the Agency for Health Care Administration; or
799	6.  A hospital designated as a critical access hospital, as
800	defined in s. 408.07(15).
801
802	Population densities used in this paragraph must be based upon
803	the most recently completed United States census. A hospital
804	that received funds under s. 409.9116 for a quarter beginning no
805	later than July 1, 2002, is deemed to have been and shall
806	continue to be a rural hospital from that date through June 30,
807	2012, if the hospital continues to have 100 or fewer licensed
808	beds and an emergency room, or meets the criteria of
809	subparagraph 4. An acute care hospital that has not previously
810	been designated as a rural hospital and that meets the criteria
811	of this paragraph shall be granted such designation upon
812	application, including supporting documentation to the Agency
813	for Health Care Administration.
814	(e)(f)  "Rural primary care hospital" means any facility
815	that meeting the criteria in paragraph (e) or s. 395.605 which
816	provides:
817	1.  Twenty-four-hour emergency medical care;
818	2.  Temporary inpatient care for periods of 96 72 hours or
819	less to patients requiring stabilization before discharge or
820	transfer to another hospital. The 96-hour 72-hour limitation
821	does not apply to respite, skilled nursing, hospice, or other
822	nonacute care patients; and
823	3.  Has at least no more than six licensed acute care
824	inpatient beds.
825	(f)(g)  "Swing-bed" means a bed which can be used
826	interchangeably as either a hospital, skilled nursing facility
827	(SNF), or intermediate care facility (ICF) bed pursuant to 42
828	C.F.R. parts 405, 435, 440, 442, and 447.
829	Section 6.  Subsection (1) of section 395.603, Florida
830	Statutes, is amended to read:
831	395.603  Deactivation of general hospital beds; rural
832	hospital impact statement.--
833	(1)  The agency shall establish, by rule, a process by
834	which A rural hospital, as defined in s. 395.602, which that
835	seeks licensure as a rural primary care hospital or as an
836	emergency care hospital, or becomes a certified rural health
837	clinic as defined in Pub. L. No. 95-210, or becomes a primary
838	care program such as a county health department, community
839	health center, or other similar outpatient program that provides
840	preventive and curative services, may deactivate general
841	hospital beds. A critical access hospital or a rural primary
842	care hospital hospitals and emergency care hospitals shall
843	maintain the number of actively licensed general hospital beds
844	necessary for the facility to be certified for Medicare
845	reimbursement. Hospitals that discontinue inpatient care to
846	become rural health care clinics or primary care programs shall
847	deactivate all licensed general hospital beds. All hospitals,
848	clinics, and programs with inactive beds shall provide 24-hour
849	emergency medical care by staffing an emergency room. Providers
850	with inactive beds shall be subject to the criteria in s.
851	395.1041. The agency shall specify in rule requirements for
852	making 24-hour emergency care available. Inactive general
853	hospital beds shall be included in the acute care bed inventory,
854	maintained by the agency for certificate-of-need purposes, for
855	10 years from the date of deactivation of the beds. After 10
856	years have elapsed, inactive beds shall be excluded from the
857	inventory. The agency shall, at the request of the licensee,
858	reactivate the inactive general beds upon a showing by the
859	licensee that licensure requirements for the inactive general
860	beds are met.
861	Section 7.  Section 395.604, Florida Statutes, is amended
862	to read:
863	395.604  Other Rural primary care hospitals hospital
864	programs.--
865	(1)  The agency may license rural primary care hospitals
866	subject to federal approval for participation in the Medicare
867	and Medicaid programs. Rural primary care hospitals shall be
868	treated in the same manner as emergency care hospitals and rural
869	hospitals with respect to ss. 395.605(2)-(8)(a),
870	408.033(2)(b)3., and 408.038.
871	(2)  The agency may designate essential access community
872	hospitals.
873	(3)  The agency may adopt licensure rules for rural primary
874	care hospitals and essential access community hospitals. Such
875	rules must conform to s. 395.1055.
876	(3)  For the purpose of Medicaid swing-bed reimbursement
877	pursuant to the Medicaid program, the agency shall treat rural
878	primary care hospitals in the same manner as rural hospitals.
879	(4)  For the purpose of participation in the Medical
880	Education Reimbursement and Loan Repayment Program as defined in
881	s. 1009.65 or other loan repayment or incentive programs
882	designed to relieve medical workforce shortages, the department
883	shall treat rural primary care hospitals in the same manner as
884	rural hospitals.
885	(5)  For the purpose of coordinating primary care services
886	described in s. 154.011(1)(c)10., the department shall treat
887	rural primary care hospitals in the same manner as rural
888	hospitals.
889	(6)  Rural hospitals that make application under the
890	certificate-of-need program to be licensed as rural primary care
891	hospitals shall receive expedited review as defined in s.
892	408.032. Rural primary care hospitals seeking relicensure as
893	acute care general hospitals shall also receive expedited
894	review.
895	(7)  Rural primary care hospitals are exempt from
896	certificate-of-need requirements for home health and hospice
897	services and for swing beds in a number that does not exceed
898	one-half of the facility's licensed beds.
899	(8)  Rural primary care hospitals shall have agreements
900	with other hospitals, skilled nursing facilities, home health
901	agencies, and providers of diagnostic-imaging and laboratory
902	services that are not provided on site but are needed by
903	patients.
904	(4)  The department may seek federal recognition of
905	emergency care hospitals authorized by s. 395.605 under the
906	essential access community hospital program authorized by the
907	Omnibus Budget Reconciliation Act of 1989.
908	Section 8.  Section 395.6061, Florida Statutes, is amended
909	to read:
910	395.6061  Rural hospital capital improvement.--There is
911	established a rural hospital capital improvement grant program.
912	(1)  A rural hospital as defined in s. 395.602 may apply to
913	the department for a grant to acquire, repair, improve, or
914	upgrade systems, facilities, or equipment. The grant application
915	must provide information that includes:
916	(a)  A statement indicating the problem the rural hospital
917	proposes to solve with the grant funds;
918	(b)  The strategy proposed to resolve the problem;
919	(c)  The organizational structure, financial system, and
920	facilities that are essential to the proposed solution;
921	(d)  The projected longevity of the proposed solution after
922	the grant funds are expended;
923	(e)  Evidence of participation in a rural health network as
924	defined in s. 381.0406 and evidence that, after July 1, 2008,
925	the application is consistent with the rural health network's
926	long-range development plan;
927	(f)  Evidence that the rural hospital has difficulty in
928	obtaining funding or that funds available for the proposed
929	solution are inadequate;
930	(g)  Evidence that the grant funds will assist in
931	maintaining or returning the hospital to an economically stable
932	condition or that any plan for closure of the hospital or
933	realignment of services will involve development of innovative
934	alternatives for the provision of needed discontinued services;
935	(h)  Evidence of a satisfactory record-keeping system to
936	account for grant fund expenditures within the rural county; and
937	(i)  A rural health network plan that includes a
938	description of how the plan was developed, the goals of the
939	plan, the links with existing health care providers under the
940	plan, Indicators quantifying the hospital's financial status
941	well-being, measurable outcome targets, and the current physical
942	and operational condition of the hospital.
943	(2)  Each rural hospital as defined in s. 395.602 shall
944	receive a minimum of $200,000 $100,000 annually, subject to
945	legislative appropriation, upon application to the Department of
946	Health, for projects to acquire, repair, improve, or upgrade
947	systems, facilities, or equipment.
948	(3)  Any remaining funds may shall annually be disbursed to
949	rural hospitals in accordance with this section. The Department
950	of Health shall establish, by rule, criteria for awarding grants
951	for any remaining funds, which must be used exclusively for the
952	support and assistance of rural hospitals as defined in s.
953	395.602, including criteria relating to the level of charity
954	uncompensated care rendered by the hospital, the financial
955	stability of the hospital, financial and quality indicators for
956	the hospital, whether the project is sustainable beyond the
957	funding period, the hospital's ability to improve or expand
958	services, the hospital's participation in a rural health network
959	as defined in s. 381.0406, and the proposed use of the grant by
960	the rural hospital to resolve a specific problem. The department
961	must consider any information submitted in an application for
962	the grants in accordance with subsection (1) in determining
963	eligibility for and the amount of the grant, and none of the
964	individual items of information by itself may be used to deny
965	grant eligibility.
966	(4)  The department shall ensure that the funds are used
967	solely for the purposes specified in this section. The total
968	grants awarded pursuant to this section shall not exceed the
969	amount appropriated for this program.
970	Section 9.  Paragraph (b) of subsection (12) of section
971	409.908, Florida Statutes, is amended to read:
972	409.908  Reimbursement of Medicaid providers.--Subject to
973	specific appropriations, the agency shall reimburse Medicaid
974	providers, in accordance with state and federal law, according
975	to methodologies set forth in the rules of the agency and in
976	policy manuals and handbooks incorporated by reference therein.
977	These methodologies may include fee schedules, reimbursement
978	methods based on cost reporting, negotiated fees, competitive
979	bidding pursuant to s. 287.057, and other mechanisms the agency
980	considers efficient and effective for purchasing services or
981	goods on behalf of recipients. If a provider is reimbursed based
982	on cost reporting and submits a cost report late and that cost
983	report would have been used to set a lower reimbursement rate
984	for a rate semester, then the provider's rate for that semester
985	shall be retroactively calculated using the new cost report, and
986	full payment at the recalculated rate shall be effected
987	retroactively. Medicare-granted extensions for filing cost
988	reports, if applicable, shall also apply to Medicaid cost
989	reports. Payment for Medicaid compensable services made on
990	behalf of Medicaid eligible persons is subject to the
991	availability of moneys and any limitations or directions
992	provided for in the General Appropriations Act or chapter 216.
993	Further, nothing in this section shall be construed to prevent
994	or limit the agency from adjusting fees, reimbursement rates,
995	lengths of stay, number of visits, or number of services, or
996	making any other adjustments necessary to comply with the
997	availability of moneys and any limitations or directions
998	provided for in the General Appropriations Act, provided the
999	adjustment is consistent with legislative intent.
1000	(12)
1001	(b)  The agency shall adopt a fee schedule, subject to any
1002	limitations or directions provided for in the General
1003	Appropriations Act, based on a resource-based relative value
1004	scale for pricing Medicaid physician services. Under this fee
1005	schedule, physicians shall be paid a dollar amount for each
1006	service based on the average resources required to provide the
1007	service, including, but not limited to, estimates of average
1008	physician time and effort, practice expense, and the costs of
1009	professional liability insurance. The fee schedule shall provide
1010	increased reimbursement for preventive and primary care services
1011	and lowered reimbursement for specialty services by using at
1012	least two conversion factors, one for cognitive services and
1013	another for procedural services. The fee schedule shall not
1014	increase total Medicaid physician expenditures unless moneys are
1015	available, and shall be phased in over a 2-year period beginning
1016	on July 1, 1994. The Agency for Health Care Administration shall
1017	seek the advice of a 16-member advisory panel in formulating and
1018	adopting the fee schedule. The panel shall consist of Medicaid
1019	physicians licensed under chapters 458 and 459 and shall be
1020	composed of 50 percent primary care physicians and 50 percent
1021	specialty care physicians.
1022	Section 10.  Paragraph (h) of subsection (2) of section
1023	499.012, Florida Statutes, is amended to read:
1024	499.012  Wholesale distribution; definitions; permits;
1025	applications; general requirements.--
1026	(2)  The following types of wholesaler permits are
1027	established:
1028	(h)  Limited prescription drug veterinary wholesaler
1029	permit.--Unless engaging in the activities of and permitted as a
1030	prescription drug manufacturer, nonresident prescription drug
1031	manufacturer, prescription drug wholesaler, or out-of-state
1032	prescription drug wholesaler, a limited prescription drug
1033	veterinary wholesaler permit is required for any person that
1034	engages in the distribution in or into this state of veterinary
1035	prescription drugs and prescription drugs subject to, defined
1036	by, or described by s. 503(b) of the Federal Food, Drug, and
1037	Cosmetic Act under the following conditions:
1038	1.  The limited prescription drug veterinary wholesaler,
1039	after being permitted as a limited prescription drug veterinary
1040	wholesaler, only distributes person is engaged in the business
1041	of wholesaling prescription and veterinary legend drugs to
1042	persons:
1043	a.  Licensed as veterinarians practicing on a full-time
1044	basis;
1045	b.  Owning a veterinary establishment permitted pursuant to
1046	s. 474.215;
1047	c.b.  Regularly and lawfully engaged in instruction in
1048	veterinary medicine;
1049	d.c.  Regularly and lawfully engaged in law enforcement
1050	activities;
1051	e.d.  For use in research not involving clinical use; or
1052	f.e.  For use in chemical analysis or physical testing or
1053	for purposes of instruction in law enforcement activities,
1054	research, or testing;
1055	g.  Holding a prescription drug veterinary wholesaler
1056	permit or a limited prescription drug veterinary wholesaler
1057	permit; or
1058	h.  Holding an authorization, license, or permit issued by
1059	another state to engage in the purchase or sale of prescription
1060	drugs for wholesale distribution, provided such persons are
1061	located outside of this state and are not authorized to purchase
1062	or sell prescription drugs for wholesale distribution in or into
1063	this state except as otherwise authorized in this subparagraph.
1064	2.  No more than 30 percent of total annual prescription
1065	drug sales may be prescription drugs approved for human use
1066	which are subject to, defined by, or described by s. 503(b) of
1067	the Federal Food, Drug, and Cosmetic Act.
1068	3.  The limited prescription drug veterinary wholesaler
1069	certifies under oath to the department that the wholesaler will
1070	not knowingly distribute prescription drugs defined in s. 503(b)
1071	of the Federal Food, Drug, and Cosmetic Act in any state to any
1072	person other than those specified in subparagraph 1. The person
1073	is not permitted, licensed, or otherwise authorized in any state
1074	to wholesale prescription drugs subject to, defined by, or
1075	described by s. 503(b) of the Federal Food, Drug, and Cosmetic
1076	Act to any person who is authorized to sell, distribute,
1077	purchase, trade, or use these drugs on or for humans.
1078	4.  A limited prescription drug veterinary wholesaler that
1079	applies to the department for a new permit or the renewal of a
1080	permit must submit a bond of $20,000, or other equivalent means
1081	of security acceptable to the department, such as an irrevocable
1082	letter of credit or a deposit in a trust account or financial
1083	institution, payable to the Florida Drug, Device, and Cosmetic
1084	Trust Fund. The purpose of the bond is to secure payment of any
1085	administrative penalties imposed by the department and any fees
1086	and costs incurred by the department regarding that permit which
1087	are authorized under state law and which the permittee fails to
1088	pay 30 days after the fine or costs become final. The department
1089	may make a claim against such bond or security until 1 year
1090	after the permittee's license ceases to be valid or until 60
1091	days after any administrative or legal proceeding authorized in
1092	ss. 499.001-499.081 which involves the permittee is concluded,
1093	including any appeal, whichever occurs later.
1094	5.  A limited prescription drug veterinary wholesaler must
1095	maintain at all times a license or permit to engage in the
1096	wholesale distribution of prescription drugs in compliance with
1097	laws of the state in which it is a resident.
1098	6.  A limited prescription drug veterinary wholesaler must
1099	comply with the requirements for wholesale distributors under s.
1100	499.0121, except that a limited prescription drug veterinary
1101	wholesaler is not required to provide a pedigree paper as
1102	required by s. 499.0121(6)(f) upon the wholesale distribution of
1103	a prescription drug to a veterinarian or to the owner of a
1104	veterinary establishment permitted pursuant to s. 474.215.
1105	7.  A limited prescription drug veterinary wholesaler may
1106	not return to inventory for subsequent wholesale distribution
1107	any prescription drug subject to, defined by, or described by s.
1108	503(b) of the Federal Food, Drug, and Cosmetic Act which has
1109	been returned by a veterinarian or by the owner of a veterinary
1110	establishment permitted pursuant to s. 474.215.
1111	8.  An out-of-state prescription drug wholesaler's permit
1112	or a limited prescription drug veterinary wholesaler permit is
1113	not required for an intracompany sale or transfer of a
1114	prescription drug from an out-of-state establishment that is
1115	duly licensed to engage in the wholesale distribution of
1116	prescription drugs in its state of residence to a licensed
1117	limited prescription drug veterinary wholesaler in this state if
1118	both wholesalers conduct wholesale distributions of prescription
1119	drugs under the same business name. The recordkeeping
1120	requirements of s. 499.0121(6) must be followed for this
1121	transaction.
1122	Section 11.  Subsection (43) of section 408.07, Florida
1123	Statutes, is amended to read:
1124	408.07  Definitions.--As used in this chapter, with the
1125	exception of ss. 408.031-408.045, the term:
1126	(43)  "Rural hospital" means an acute care hospital
1127	licensed under chapter 395, having 100 or fewer licensed beds
1128	and an emergency room, and which is:
1129	(a)  The sole provider within a county with a population
1130	density of no greater than 100 persons per square mile;
1131	(b)  An acute care hospital, in a county with a population
1132	density of no greater than 100 persons per square mile, which is
1133	at least 30 minutes of travel time, on normally traveled roads
1134	under normal traffic conditions, from another acute care
1135	hospital within the same county;
1136	(c)  A hospital supported by a tax district or subdistrict
1137	whose boundaries encompass a population of 100 persons or fewer
1138	per square mile;
1139	(d)  A hospital with a service area that has a population
1140	of 100 persons or fewer per square mile. As used in this
1141	paragraph, the term "service area" means the fewest number of
1142	zip codes that account for 75 percent of the hospital's
1143	discharges for the most recent 5-year period, based on
1144	information available from the hospital inpatient discharge
1145	database in the Florida Center for Health Information and Policy
1146	Analysis at the Agency for Health Care Administration; or
1147	(e)  A critical access hospital.
1148
1149	Population densities used in this subsection must be based upon
1150	the most recently completed United States census. A hospital
1151	that received funds under s. 409.9116 for a quarter beginning no
1152	later than July 1, 2002, is deemed to have been and shall
1153	continue to be a rural hospital from that date through June 30,
1154	2012, if the hospital continues to have 100 or fewer licensed
1155	beds and an emergency room, or meets the criteria of s.
1156	395.602(2)(d)4. s. 395.602(2)(e)4. An acute care hospital that
1157	has not previously been designated as a rural hospital and that
1158	meets the criteria of this subsection shall be granted such
1159	designation upon application, including supporting
1160	documentation, to the Agency for Health Care Administration.
1161	Section 12.  Subsection (6) of section 409.9116, Florida
1162	Statutes, is amended to read:
1163	409.9116  Disproportionate share/financial assistance
1164	program for rural hospitals.--In addition to the payments made
1165	under s. 409.911, the Agency for Health Care Administration
1166	shall administer a federally matched disproportionate share
1167	program and a state-funded financial assistance program for
1168	statutory rural hospitals. The agency shall make
1169	disproportionate share payments to statutory rural hospitals
1170	that qualify for such payments and financial assistance payments
1171	to statutory rural hospitals that do not qualify for
1172	disproportionate share payments. The disproportionate share
1173	program payments shall be limited by and conform with federal
1174	requirements. Funds shall be distributed quarterly in each
1175	fiscal year for which an appropriation is made. Notwithstanding
1176	the provisions of s. 409.915, counties are exempt from
1177	contributing toward the cost of this special reimbursement for
1178	hospitals serving a disproportionate share of low-income
1179	patients.
1180	(6)  This section applies only to hospitals that were
1181	defined as statutory rural hospitals, or their successor-in-
1182	interest hospital, prior to January 1, 2001. Any additional
1183	hospital that is defined as a statutory rural hospital, or its
1184	successor-in-interest hospital, on or after January 1, 2001, is
1185	not eligible for programs under this section unless additional
1186	funds are appropriated each fiscal year specifically to the
1187	rural hospital disproportionate share and financial assistance
1188	programs in an amount necessary to prevent any hospital, or its
1189	successor-in-interest hospital, eligible for the programs prior
1190	to January 1, 2001, from incurring a reduction in payments
1191	because of the eligibility of an additional hospital to
1192	participate in the programs. A hospital, or its successor-in-
1193	interest hospital, which received funds pursuant to this section
1194	before January 1, 2001, and which qualifies under s.
1195	395.602(2)(d) s. 395.602(2)(e), shall be included in the
1196	programs under this section and is not required to seek
1197	additional appropriations under this subsection.
1198	Section 13.  Paragraph (b) of subsection (2) of section
1199	1009.65, Florida Statutes, is amended to read:
1200	1009.65  Medical Education Reimbursement and Loan Repayment
1201	Program.--
1202	(2)  From the funds available, the Department of Health
1203	shall make payments to selected medical professionals as
1204	follows:
1205	(b)  All payments shall be contingent on continued proof of
1206	primary care practice in an area defined in s. 395.602(2)(d) s.
1207	395.602(2)(e), or an underserved area designated by the
1208	Department of Health, provided the practitioner accepts Medicaid
1209	reimbursement if eligible for such reimbursement. Correctional
1210	facilities, state hospitals, and other state institutions that
1211	employ medical personnel shall be designated by the Department
1212	of Health as underserved locations. Locations with high
1213	incidences of infant mortality, high morbidity, or low Medicaid
1214	participation by health care professionals may be designated as
1215	underserved.
1216	Section 14. Sections 395.605 and 468.807, Florida Statutes,
1217	are repealed.
1218	Section 15.  This act shall take effect July 1, 2007, only
1219	if specific appropriations are made in the General
1220	Appropriations Act for fiscal year 2007-2008 to the Department
1221	of Health to fund the rural hospital capital improvement grant
1222	program.

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