Senate Bill sb0424
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Florida Senate - 2007 SB 424
By Senator Peaden
2-307A-07
1 A bill to be entitled
2 An act relating to rural health care; amending
3 s. 381.0405, F.S.; revising the purpose and
4 functions of the Office of Rural Health in the
5 Department of Health; requiring the Secretary
6 of Health and the Secretary of Health Care
7 Administration to appoint an advisory council
8 to advise the Office of Rural Health; providing
9 for terms of office of the members of the
10 advisory council; authorizing per diem and
11 travel reimbursement for members of the
12 advisory council; requiring the Office of Rural
13 Health to submit an annual report to the
14 Governor and the Legislature; amending s.
15 381.0406, F.S.; revising legislative findings
16 and intent with respect to rural health
17 networks; redefining the term "rural health
18 network"; establishing requirements for
19 membership in rural health networks; adding
20 functions for the rural health networks;
21 revising requirements for the governance and
22 organization of rural health networks; revising
23 the services to be provided by provider members
24 of rural health networks; requiring
25 coordination among rural health networks and
26 area health education centers, health planning
27 councils, and regional education consortia;
28 establishing requirements for funding rural
29 health networks; establishing performance
30 standards for rural health networks;
31 establishing requirements for the receipt of
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1 grant funding; requiring the Office of Rural
2 Health to monitor rural health networks;
3 authorizing the Department of Health to
4 establish rules governing rural health network
5 grant programs and performance standards;
6 amending s. 395.602, F.S.; defining the term
7 "critical access hospital"; deleting the
8 definitions of "emergency care hospital," and
9 "essential access community hospital"; revising
10 the definition of "rural primary care
11 hospital"; amending s. 395.603, F.S.; deleting
12 a requirement that the Agency for Health Care
13 Administration adopt a rule relating to
14 deactivation of rural hospital beds under
15 certain circumstances; requiring that critical
16 access hospitals and rural primary care
17 hospitals maintain a certain number of actively
18 licensed beds; amending s. 395.604, F.S.;
19 removing emergency care hospitals and essential
20 access community hospitals from certain
21 licensure requirements; specifying certain
22 special conditions for rural primary care
23 hospitals; amending s. 395.6061, F.S.;
24 specifying the purposes of capital improvement
25 grants for rural hospitals; modifying the
26 conditions for receiving a grant; authorizing
27 the Department of Health to award grants for
28 remaining funds to certain rural hospitals;
29 requiring a rural hospital that receives any
30 remaining funds to be bound by certain terms of
31 a participation agreement in order to receive
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1 remaining funds; amending s. 409.908, F.S.;
2 requiring the Agency for Health Care
3 Administration to pay certain physicians a
4 bonus for Medicaid physician services provided
5 within a rural county; amending ss. 408.07,
6 409.9116, and 1009.65, F.S.; conforming
7 cross-references; requiring the Office of
8 Program Policy Analysis and Government
9 Accountability to contract for a study of the
10 financing options for replacing or changing the
11 use of certain rural hospitals; requiring a
12 report to the Legislature by a specified date;
13 repealing s. 395.605, F.S., relating to the
14 licensure of emergency care hospitals;
15 providing appropriations and authorizing
16 additional positions; providing an effective
17 date.
18
19 Be It Enacted by the Legislature of the State of Florida:
20
21 Section 1. Section 381.0405, Florida Statutes, is
22 amended to read:
23 381.0405 Office of Rural Health.--
24 (1) ESTABLISHMENT.--The Department of Health shall
25 establish an Office of Rural Health, which shall assist rural
26 health care providers in improving the health status and
27 health care of rural residents of this state and help rural
28 health care providers to integrate their efforts and prepare
29 for prepaid and at-risk reimbursement. The Office of Rural
30 Health shall coordinate its activities with rural health
31 networks established under s. 381.0406, local health councils
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1 established under s. 408.033, the area health education center
2 network established under pursuant to s. 381.0402, and with
3 any appropriate research and policy development centers within
4 universities that have state-approved medical schools. The
5 Office of Rural Health may enter into a formal relationship
6 with any center that designates the office as an affiliate of
7 the center.
8 (2) PURPOSE.--The Office of Rural Health shall
9 actively foster the development of service-delivery systems
10 and cooperative agreements to enhance the provision of
11 high-quality health care services in rural areas and serve as
12 a catalyst for improved health services to residents citizens
13 in rural areas of the state.
14 (3) GENERAL FUNCTIONS.--The office shall:
15 (a) Integrate policies related to physician workforce,
16 hospitals, public health, and state regulatory functions.
17 (b) Work with rural stakeholders in order to foster
18 the development of strategic planning that addresses Propose
19 solutions to problems affecting health care delivery in rural
20 areas.
21 (c) Develop, in coordination with the rural health
22 networks, standards, guidelines, and performance objectives
23 for rural health networks.
24 (d) Foster the expansion of rural health network
25 service areas to include rural counties that are not covered
26 by a rural health network.
27 (e)(c) Seek grant funds from foundations and the
28 Federal Government.
29 (f) Administer state grant programs for rural
30 hospitals and rural health networks.
31 (4) COORDINATION.--The office shall:
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1 (a) Identify federal and state rural health programs
2 and provide information and technical assistance to rural
3 providers regarding participation in such programs.
4 (b) Act as a clearinghouse for collecting and
5 disseminating information on rural health care issues,
6 research findings on rural health care, and innovative
7 approaches to the delivery of health care in rural areas.
8 (c) Foster the creation of regional health care
9 systems that promote cooperation through cooperative
10 agreements, rather than competition.
11 (d) Coordinate the department's rural health care
12 activities, programs, and policies.
13 (e) Design initiatives and promote cooperative
14 agreements in order to improve access to primary care,
15 prehospital emergency care, inpatient acute care, and
16 emergency medical services and promote the coordination of
17 such services in rural areas.
18 (f) Assume responsibility for state coordination of
19 the Rural Hospital Transition Grant Program, the Essential
20 Access Community Hospital Program, and other federal rural
21 hospital and rural health care grant programs.
22 (5) TECHNICAL ASSISTANCE.--The office shall:
23 (a) Assist Help rural health care providers in
24 recruiting obtain health care practitioners by promoting the
25 location and relocation of health care practitioners in rural
26 areas and promoting policies that create incentives for
27 practitioners to serve in rural areas.
28 (b) Provide technical assistance to hospitals,
29 community and migrant health centers, and other health care
30 providers that serve residents of rural areas.
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1 (c) Assist with the design of strategies to improve
2 health care workforce recruitment and placement programs.
3 (d) Provide technical assistance to rural health
4 networks in the development of their long-range development
5 plans.
6 (e) Provide links to best practices and other
7 technical-assistance resources on its website.
8 (6) RESEARCH PUBLICATIONS AND SPECIAL STUDIES.--The
9 office shall:
10 (a) Conduct policy and research studies.
11 (b) Conduct health status studies of rural residents.
12 (c) Collect relevant data on rural health care issues
13 for use in program planning and department policy development.
14 (7) ADVISORY COUNCIL.--The Secretary of Health and the
15 Secretary of Health Care Administration shall each appoint no
16 more than five members having relevant health care operations
17 management, practice, and policy experience to an advisory
18 council to advise the office regarding its responsibilities
19 under this section and ss. 381.0406 and 395.6061. Members
20 shall be appointed for 4-year staggered terms and may be
21 reappointed to a second term of office. Members shall serve
22 without compensation, but are entitled to reimbursement for
23 per diem and travel expenses as provided in s. 112.061. The
24 department shall provide staff and other administrative
25 assistance reasonably necessary to assist the advisory council
26 in carrying out its duties. The advisory council shall work
27 with stakeholders to develop recommendations that address
28 barriers and identify options for establishing provider
29 networks in rural counties.
30 (8) REPORTS.--Beginning January 1, 2008, and annually
31 thereafter, the Office of Rural Health shall submit a report
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1 to the Governor, the President of the Senate, and the Speaker
2 of the House of Representatives summarizing the activities of
3 the office, including the grants obtained or administered by
4 the office and the status of rural health networks and rural
5 hospitals in the state. The report must also include
6 recommendations that address barriers and identify options for
7 establishing provider networks in rural counties.
8 (9)(7) APPROPRIATION.--The Legislature shall
9 appropriate such sums as are necessary to support the Office
10 of Rural Health.
11 Section 2. Section 381.0406, Florida Statutes, is
12 amended to read:
13 381.0406 Rural health networks.--
14 (1) LEGISLATIVE FINDINGS AND INTENT.--
15 (a) The Legislature finds that, in rural areas, access
16 to health care is limited and the quality of health care is
17 negatively affected by inadequate financing, difficulty in
18 recruiting and retaining skilled health professionals, and the
19 because of a migration of patients to urban areas for general
20 acute care and specialty services.
21 (b) The Legislature further finds that the efficient
22 and effective delivery of health care services in rural areas
23 requires:
24 1. The integration of public and private resources;
25 2. The introduction of innovative outreach methods;
26 3. The adoption of quality improvement and
27 cost-effectiveness measures;
28 4. The organization of health care providers into
29 joint contracting entities;
30 5. Establishing referral linkages;
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1 6. The analysis of costs and services in order to
2 prepare health care providers for prepaid and at-risk
3 financing; and
4 7. The coordination of health care providers.
5 (c) The Legislature further finds that the
6 availability of a continuum of quality health care services,
7 including preventive, primary, secondary, tertiary, and
8 long-term care, is essential to the economic and social
9 vitality of rural communities.
10 (d) The Legislature further finds that health care
11 providers in rural areas are not prepared for market changes
12 such as the introduction of managed care and
13 capitation-reimbursement methodologies into health care
14 services.
15 (e)(d) The Legislature further finds that the creation
16 of rural health networks can help to alleviate these problems.
17 Rural health networks shall act in the broad public interest
18 and, to the extent possible, seek to improve the
19 accessibility, quality, and cost-effectiveness of rural health
20 care by planning, developing, coordinating, and providing be
21 structured to provide a continuum of quality health care
22 services for rural residents through the cooperative efforts
23 of rural health network members and other health care
24 providers.
25 (f)(e) The Legislature further finds that rural health
26 networks shall have the goal of increasing the financial
27 stability of statutory rural hospitals by linking rural
28 hospital services to other services in a continuum of health
29 care services and by increasing the utilization of statutory
30 rural hospitals whenever for appropriate health care services
31 whenever feasible, which shall help to ensure their survival
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1 and thereby support the economy and protect the health and
2 safety of rural residents.
3 (g)(f) Finally, the Legislature finds that rural
4 health networks may serve as "laboratories" to determine the
5 best way of organizing rural health services and linking to
6 out-of-area services that are not available locally in order,
7 to move the state closer to ensuring that everyone has access
8 to health care, and to promote cost-containment cost
9 containment efforts. The ultimate goal of rural health
10 networks shall be to ensure that quality health care is
11 available and efficiently delivered to all persons in rural
12 areas.
13 (2) DEFINITIONS.--
14 (a) "Rural" means an area having with a population
15 density of fewer less than 100 individuals per square mile or
16 an area defined by the most recent United States Census as
17 rural.
18 (b) "Health care provider" means any individual,
19 group, or entity, public or private, which that provides
20 health care, including: preventive health care, primary health
21 care, secondary and tertiary health care, hospital in-hospital
22 health care, public health care, and health promotion and
23 education.
24 (c) "Rural health network" or "network" means a
25 nonprofit legal entity whose principal place of business is in
26 a rural area, whose members consist consisting of rural and
27 urban health care providers and others, and which that is
28 established organized to plan, develop, organize, and deliver
29 health care services on a cooperative basis in a rural area,
30 except for some secondary and tertiary care services.
31 (3) NETWORK MEMBERSHIP.--
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1 (a) Because each rural area is unique, with a
2 different health care provider mix, health care provider
3 membership may vary, but all networks shall include members
4 that provide health promotion and disease-prevention services,
5 public health services, comprehensive primary care, emergency
6 medical care, and acute inpatient care.
7 (b) Each county health department shall be a member of
8 the rural health network whose service area includes the
9 county in which the county health department is located.
10 Federally qualified health centers and emergency medical
11 services providers are encouraged to become members of the
12 rural health networks in the areas in which their patients
13 reside or receive services.
14 (c)(4) Network membership shall be available to all
15 health care providers in the network service area if, provided
16 that they render care to all patients referred to them from
17 other network members;, comply with network quality assurance,
18 quality improvement, and utilization-management and risk
19 management requirements; and, abide by the terms and
20 conditions of network provider agreements in paragraph
21 (11)(c), and provide services at a rate or price equal to the
22 rate or price negotiated by the network.
23 (4)(5) NETWORK SERVICE AREAS.--Network service areas
24 are do not required need to conform to local political
25 boundaries or state administrative district boundaries. The
26 geographic area of one rural health network, however, may not
27 overlap the territory of any other rural health network.
28 (5)(6) NETWORK FUNCTIONS.-- Networks shall:
29 (a) Seek to develop linkages with provisions for
30 referral to tertiary inpatient care, specialty physician care,
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1 and to other services that are not available in rural service
2 areas.
3 (b)(7) Networks shall Make available health promotion,
4 disease prevention, and primary care services, in order to
5 improve the health status of rural residents and to contain
6 health care costs.
7 (8) Networks may have multiple points of entry, such
8 as through private physicians, community health centers,
9 county health departments, certified rural health clinics,
10 hospitals, or other providers; or they may have a single point
11 of entry.
12 (c)(9) Encourage members through training and
13 educational programs to adopt standards of care, and promote
14 the evidence-based practice of medicine. Networks shall
15 establish standard protocols, coordinate and share patient
16 records, and develop patient information exchange systems in
17 order to improve quality and access to services.
18 (d) Develop quality-improvement programs and train
19 network members and other health care providers in the use of
20 such programs.
21 (e) Develop disease-management systems and train
22 network members and other health care providers in the use of
23 such systems.
24 (f) Promote outreach to areas that have a high need
25 for services.
26 (g) Seek to develop community care alternatives for
27 elders who would otherwise be placed in nursing homes.
28 (h) Emphasize community care alternatives for persons
29 with mental health and substance abuse disorders who are at
30 risk of being admitted to an institution.
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1 (i) Develop and implement a long-range development
2 plan for an integrated system of care that is responsive to
3 the unique local health needs and the area health care
4 services market. Each rural health network long-range
5 development plan must address strategies to improve access to
6 specialty care, train health care providers to use standards
7 of care for chronic illness, develop disease-management
8 capacity, and link to state and national quality-improvement
9 initiatives. The initial long-range development plan must be
10 submitted to the Office of Rural Health for review and
11 approval no later than July 1, 2008, and thereafter the plans
12 must be updated and submitted to the Office of Rural Health
13 every 3 years.
14 (10) Networks shall develop risk management and
15 quality assurance programs for network providers.
16 (6)(11) NETWORK GOVERNANCE AND ORGANIZATION.--
17 (a) Networks shall be incorporated as not-for-profit
18 corporations under chapter 617, with articles of incorporation
19 that set forth purposes consistent with this section the laws
20 of the state.
21 (b) Each network Networks shall have an independent a
22 board of directors that derives membership from local
23 government, health care providers, businesses, consumers,
24 advocacy groups, and others. Boards of other community health
25 care entities may not serve in whole as the board of a rural
26 health network; however, some overlap of board membership with
27 other community organizations is encouraged. Network staff
28 must provide an annual orientation and strategic planning
29 activity for board members.
30 (c) Network boards of directors shall have the
31 responsibility of determining the content of health care
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1 provider agreements that link network members. The written
2 agreements between the network and its health care provider
3 members must specify participation in the essential functions
4 of the network and shall specify:
5 1. Who provides what services.
6 2. The extent to which the health care provider
7 provides care to persons who lack health insurance or are
8 otherwise unable to pay for care.
9 3. The procedures for transfer of medical records.
10 4. The method used for the transportation of patients
11 between providers.
12 5. Referral and patient flow including appointments
13 and scheduling.
14 6. Payment arrangements for the transfer or referral
15 of patients.
16 (d) There shall be no liability on the part of, and no
17 cause of action of any nature shall arise against, any member
18 of a network board of directors, or its employees or agents,
19 for any lawful action taken by them in the performance of
20 their administrative powers and duties under this subsection.
21 (7)(12) NETWORK PROVIDER MEMBER SERVICES.--
22 (a) Networks, to the extent feasible, shall seek to
23 develop services that provide for a continuum of care for all
24 residents patients served by the network. Each network shall
25 recruit members that can provide include the following core
26 services: disease prevention, health promotion, comprehensive
27 primary care, emergency medical care, and acute inpatient
28 care. Each network shall seek to ensure the availability of
29 comprehensive maternity care, including prenatal, delivery,
30 and postpartum care for uncomplicated pregnancies, either
31 directly, by contract, or through referral agreements.
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1 Networks shall, to the extent feasible, develop local services
2 and linkages among health care providers in order to also
3 ensure the availability of the following services: within the
4 specified timeframes, either directly, by contract, or through
5 referral agreements:
6 1. Services available in the home.
7 1.a. Home health care.
8 2.b. Hospice care.
9 2. Services accessible within 30 minutes travel time
10 or less.
11 3.a. Emergency medical services, including advanced
12 life support, ambulance, and basic emergency room services.
13 4.b. Primary care, including.
14 c. prenatal and postpartum care for uncomplicated
15 pregnancies.
16 5.d. Community-based services for elders, such as
17 adult day care and assistance with activities of daily living.
18 6.e. Public health services, including communicable
19 disease control, disease prevention, health education, and
20 health promotion.
21 7.f. Outpatient mental health psychiatric and
22 substance abuse treatment services.
23 3. Services accessible within 45 minutes travel time
24 or less.
25 8.a. Hospital acute inpatient care for persons whose
26 illnesses or medical problems are not severe.
27 9.b. Level I obstetrical care, which is Labor and
28 delivery for low-risk patients.
29 10.c. Skilled nursing services and, long-term care,
30 including nursing home care.
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1 (b) Networks shall seek to foster linkages with
2 out-of-area services to the extent feasible in order to ensure
3 the availability of:
4 1.d. Dialysis.
5 2.e. Osteopathic and chiropractic manipulative
6 therapy.
7 4. Services accessible within 2 hours travel time or
8 less.
9 3.a. Specialist physician care.
10 4.b. Hospital acute inpatient care for severe
11 illnesses and medical problems.
12 5.c. Level II and III obstetrical care, which is Labor
13 and delivery care for high-risk patients and neonatal
14 intensive care.
15 6.d. Comprehensive medical rehabilitation.
16 7.e. Inpatient mental health psychiatric and substance
17 abuse treatment services.
18 8.f. Magnetic resonance imaging, lithotripter
19 treatment, oncology, advanced radiology, and other
20 technologically advanced services.
21 9.g. Subacute care.
22 (8) COORDINATION WITH OTHER ENTITIES.--
23 (a) Area health education centers, health planning
24 councils, and regional education consortia having
25 technological expertise in continuing education shall
26 participate in the rural health networks' preparation of
27 long-range development plans. The Department of Health may
28 require written memoranda of agreement between a network and
29 an area health education center or health planning council.
30 (b) Rural health networks shall initiate activities,
31 in coordination with area health education centers, to carry
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1 out the objectives of the adopted long-range development plan,
2 including continuing education for health care practitioners
3 performing functions such as disease management, continuous
4 quality improvement, telemedicine, long-distance learning, and
5 the treatment of chronic illness using standards of care. As
6 used in this section, the term "telemedicine" means the use of
7 telecommunications to deliver or expedite the delivery of
8 health care services.
9 (c) Health planning councils shall support the
10 preparation of network long-range development plans through
11 data collection and analysis in order to assess the health
12 status of area residents and the capacity of local health
13 services.
14 (d) Regional education consortia that have the
15 technology available to assist rural health networks in
16 establishing systems for the exchange of patient information
17 and for long-distance learning are encouraged to provide
18 technical assistance upon the request of a rural health
19 network.
20 (e)(b) Networks shall actively participate with area
21 health education center programs, whenever feasible, in
22 developing and implementing recruitment, training, and
23 retention programs directed at positively influencing the
24 supply and distribution of health care professionals serving
25 in, or receiving training in, network areas.
26 (c) As funds become available, networks shall
27 emphasize community care alternatives for elders who would
28 otherwise be placed in nursing homes.
29 (d) To promote the most efficient use of resources,
30 networks shall emphasize disease prevention, early diagnosis
31 and treatment of medical problems, and community care
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1 alternatives for persons with mental health and substance
2 abuse disorders who are at risk to be institutionalized.
3 (f)(13) TRAUMA SERVICES.--In those network areas
4 having which have an established trauma agency approved by the
5 Department of Health, the network shall seek the participation
6 of that trauma agency must be a participant in the network.
7 Trauma services provided within the network area must comply
8 with s. 395.405.
9 (9)(14) NETWORK FINANCING.--
10 (a) Networks may use all sources of public and private
11 funds to support network activities. Nothing in this section
12 prohibits networks from becoming managed care providers.
13 (b) The Department of Health shall establish grant
14 programs to provide funding to support the administrative
15 costs of developing and operating rural health networks.
16 (10) NETWORK PERFORMANCE STANDARDS.--The Department of
17 Health shall develop and enforce performance standards for
18 rural health network operations grants and rural health
19 infrastructure development grants.
20 (a) Operations grant performance standards must
21 include, but are not limited to, standards that require the
22 rural health network to:
23 1. Have a qualified board of directors that meets at
24 least quarterly.
25 2. Have sufficient staff who have the qualifications
26 and experience to perform the requirements of this section, as
27 assessed by the Office of Rural Health, or a written plan to
28 obtain such staff.
29 3. Comply with the department's grant-management
30 standards in a timely and responsive manner.
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1 4. Comply with the department's standards for the
2 administration of federal grant funding, including assistance
3 to rural hospitals.
4 5. Demonstrate a commitment to network activities from
5 area health care providers and other stakeholders, as
6 described in letters of support.
7 (b) Rural health infrastructure development grant
8 performance standards must include, but are not limited to,
9 standards that require the rural health network to:
10 1. During the 2007-2008 fiscal year develop a
11 long-range development plan and, after July 1, 2008, have a
12 long-range development plan that has been reviewed and
13 approved by the Office of Rural Health.
14 2. Have two or more successful network-development
15 activities, such as:
16 a. Management of a network-development or outreach
17 grant from the federal Office of Rural Health Policy;
18 b. Implementation of outreach programs to address
19 chronic disease, infant mortality, or assistance with
20 prescription medication;
21 c. Development of partnerships with community and
22 faith-based organizations to address area health problems;
23 d. Provision of direct services, such as clinics or
24 mobile units;
25 e. Operation of credentialing services for health care
26 providers or quality-assurance and quality-improvement
27 initiatives that, whenever possible, are consistent with state
28 or federal quality initiatives;
29 f. Support for the development of community health
30 centers, local community health councils, federal designation
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1 as a rural critical access hospital, or comprehensive
2 community health planning initiatives; and
3 g. Development of the capacity to obtain federal,
4 state, and foundation grants.
5 (11)(15) NETWORK IMPLEMENTATION.--As funds become
6 available, networks shall be developed and implemented in two
7 phases.
8 (a) Phase I shall consist of a network planning and
9 development grant program. Planning grants shall be used to
10 organize networks, incorporate network boards, and develop
11 formal provider agreements as provided for in this section.
12 The Department of Health shall develop a request-for-proposal
13 process to solicit grant applications.
14 (b) Phase II shall consist of a network operations
15 grant program. As funds become available, certified networks
16 that meet performance standards shall be eligible to receive
17 grant funds to be used to help defray the costs of rural
18 health network infrastructure development, patient care, and
19 network administration. Rural health network infrastructure
20 development includes, but is not limited to: recruitment and
21 retention of primary care practitioners; enhancements of
22 primary care services through the use of mobile clinics;
23 development of preventive health care programs; linkage of
24 urban and rural health care systems; design and implementation
25 of automated patient records, outcome measurement, quality
26 assurance, and risk management systems; establishment of
27 one-stop service delivery sites; upgrading of medical
28 technology available to network providers; enhancement of
29 emergency medical systems; enhancement of medical
30 transportation; formation of joint contracting entities
31 composed of rural physicians, rural hospitals, and other rural
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1 health care providers; establishment of comprehensive
2 disease-management programs that meet Medicaid requirements;
3 establishment of regional quality-improvement programs
4 involving physicians and hospitals consistent with state and
5 national initiatives; establishment of speciality networks
6 connecting rural primary care physicians and urban
7 specialists; development of regional broadband
8 telecommunications systems that have the capacity to share
9 patient information in a secure network, telemedicine, and
10 long-distance learning capacity; and linkage between training
11 programs for health care practitioners and the delivery of
12 health care services in rural areas and development of
13 telecommunication capabilities. A Phase II award may occur in
14 the same fiscal year as a Phase I award.
15 (12)(16) CERTIFICATION.--For the purpose of certifying
16 networks that are eligible for Phase II funding, the
17 Department of Health shall certify networks that meet the
18 criteria delineated in this section and the rules governing
19 rural health networks. The Office of Rural Health in the
20 Department of Health shall monitor rural health networks in
21 order to ensure continued compliance with established
22 certification and performance standards.
23 (13)(17) RULES.--The Department of Health shall
24 establish rules that govern the creation and certification of
25 networks, the provision of grant funds under Phase I and Phase
26 II, and the establishment of performance standards including
27 establishing outcome measures for networks.
28 Section 3. Subsection (2) of section 395.602, Florida
29 Statutes, is amended to read:
30 395.602 Rural hospitals.--
31 (2) DEFINITIONS.--As used in this part:
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1 (a) "Critical access hospital" means a hospital that
2 meets the definition of rural hospital in paragraph (d) and
3 meets the requirements for reimbursement by Medicare and
4 Medicaid under 42 C.F.R. ss. 485.601-485.647. "Emergency care
5 hospital" means a medical facility which provides:
6 1. Emergency medical treatment; and
7 2. Inpatient care to ill or injured persons prior to
8 their transportation to another hospital or provides inpatient
9 medical care to persons needing care for a period of up to 96
10 hours. The 96-hour limitation on inpatient care does not
11 apply to respite, skilled nursing, hospice, or other nonacute
12 care patients.
13 (b) "Essential access community hospital" means any
14 facility which:
15 1. Has at least 100 beds;
16 2. Is located more than 35 miles from any other
17 essential access community hospital, rural referral center, or
18 urban hospital meeting criteria for classification as a
19 regional referral center;
20 3. Is part of a network that includes rural primary
21 care hospitals;
22 4. Provides emergency and medical backup services to
23 rural primary care hospitals in its rural health network;
24 5. Extends staff privileges to rural primary care
25 hospital physicians in its network; and
26 6. Accepts patients transferred from rural primary
27 care hospitals in its network.
28 (b)(c) "Inactive rural hospital bed" means a licensed
29 acute care hospital bed, as defined in s. 395.002(14), that is
30 inactive in that it cannot be occupied by acute care
31 inpatients.
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1 (c)(d) "Rural area health education center" means an
2 area health education center (AHEC), as authorized by Pub. L.
3 No. 94-484, which provides services in a county with a
4 population density of no greater than 100 persons per square
5 mile.
6 (d)(e) "Rural hospital" means an acute care hospital
7 licensed under this chapter, having 100 or fewer licensed beds
8 and an emergency room, which is:
9 1. The sole provider within a county with a population
10 density of no greater than 100 persons per square mile;
11 2. An acute care hospital, in a county with a
12 population density of no greater than 100 persons per square
13 mile, which is at least 30 minutes of travel time, on normally
14 traveled roads under normal traffic conditions, from any other
15 acute care hospital within the same county;
16 3. A hospital supported by a tax district or
17 subdistrict whose boundaries encompass a population of 100
18 persons or fewer per square mile;
19 4. A hospital in a constitutional charter county with
20 a population of over 1 million persons that has imposed a
21 local option health service tax pursuant to law and in an area
22 that was directly impacted by a catastrophic event on August
23 24, 1992, for which the Governor of Florida declared a state
24 of emergency pursuant to chapter 125, and has 120 beds or less
25 that serves an agricultural community with an emergency room
26 utilization of no less than 20,000 visits and a Medicaid
27 inpatient utilization rate greater than 15 percent;
28 5. A hospital with a service area that has a
29 population of 100 persons or fewer per square mile. As used in
30 this subparagraph, the term "service area" means the fewest
31 number of zip codes that account for 75 percent of the
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1 hospital's discharges for the most recent 5-year period, based
2 on information available from the hospital inpatient discharge
3 database in the Florida Center for Health Information and
4 Policy Analysis at the Agency for Health Care Administration;
5 or
6 6. A hospital designated as a critical access
7 hospital, as defined in s. 408.07(15).
8
9 Population densities used in this paragraph must be based upon
10 the most recently completed United States census. A hospital
11 that received funds under s. 409.9116 for a quarter beginning
12 no later than July 1, 2002, is deemed to have been and shall
13 continue to be a rural hospital from that date through June
14 30, 2012, if the hospital continues to have 100 or fewer
15 licensed beds and an emergency room, or meets the criteria of
16 subparagraph 4. An acute care hospital that has not previously
17 been designated as a rural hospital and that meets the
18 criteria of this paragraph shall be granted such designation
19 upon application, including supporting documentation to the
20 Agency for Health Care Administration.
21 (e)(f) "Rural primary care hospital" means any
22 facility that meeting the criteria in paragraph (e) or s.
23 395.605 which provides:
24 1. Twenty-four-hour emergency medical care;
25 2. Temporary inpatient care for periods of 96 72 hours
26 or less to patients requiring stabilization before discharge
27 or transfer to another hospital. The 96-hour 72-hour
28 limitation does not apply to respite, skilled nursing,
29 hospice, or other nonacute care patients; and
30 3. Has at least no more than six licensed acute care
31 inpatient beds.
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1 (f)(g) "Swing-bed" means a bed which can be used
2 interchangeably as either a hospital, skilled nursing facility
3 (SNF), or intermediate care facility (ICF) bed pursuant to 42
4 C.F.R. parts 405, 435, 440, 442, and 447.
5 Section 4. Subsection (1) of section 395.603, Florida
6 Statutes, is amended to read:
7 395.603 Deactivation of general hospital beds; rural
8 hospital impact statement.--
9 (1) The agency shall establish, by rule, a process by
10 which A rural hospital, as defined in s. 395.602, which that
11 seeks licensure as a rural primary care hospital or as an
12 emergency care hospital, or becomes a certified rural health
13 clinic as defined in Pub. L. No. 95-210, or becomes a primary
14 care program such as a county health department, community
15 health center, or other similar outpatient program that
16 provides preventive and curative services, may deactivate
17 general hospital beds. A critical access hospital or a rural
18 primary care hospital hospitals and emergency care hospitals
19 shall maintain the number of actively licensed general
20 hospital beds necessary for the facility to be certified for
21 Medicare reimbursement. Hospitals that discontinue inpatient
22 care to become rural health care clinics or primary care
23 programs shall deactivate all licensed general hospital beds.
24 All hospitals, clinics, and programs with inactive beds shall
25 provide 24-hour emergency medical care by staffing an
26 emergency room. Providers with inactive beds shall be subject
27 to the criteria in s. 395.1041. The agency shall specify in
28 rule requirements for making 24-hour emergency care available.
29 Inactive general hospital beds shall be included in the acute
30 care bed inventory, maintained by the agency for
31 certificate-of-need purposes, for 10 years from the date of
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1 deactivation of the beds. After 10 years have elapsed,
2 inactive beds shall be excluded from the inventory. The agency
3 shall, at the request of the licensee, reactivate the inactive
4 general beds upon a showing by the licensee that licensure
5 requirements for the inactive general beds are met.
6 Section 5. Section 395.604, Florida Statutes, is
7 amended to read:
8 395.604 Other Rural primary care hospitals hospital
9 programs.--
10 (1) The agency may license rural primary care
11 hospitals subject to federal approval for participation in the
12 Medicare and Medicaid programs. Rural primary care hospitals
13 shall be treated in the same manner as emergency care
14 hospitals and rural hospitals with respect to ss.
15 395.605(2)-(8)(a), 408.033(2)(b)3., and 408.038.
16 (2) The agency may designate essential access
17 community hospitals.
18 (3) The agency may adopt licensure rules for rural
19 primary care hospitals and essential access community
20 hospitals. Such rules must conform to s. 395.1055.
21 (3) For the purpose of Medicaid swing-bed
22 reimbursement pursuant to the Medicaid program, the agency
23 shall treat rural primary care hospitals in the same manner as
24 rural hospitals.
25 (4) For the purpose of participation in the Medical
26 Education Reimbursement and Loan Repayment Program as defined
27 in s. 1009.65 or other loan repayment or incentive programs
28 designed to relieve medical workforce shortages, the
29 department shall treat rural primary care hospitals in the
30 same manner as rural hospitals.
31
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1 (5) For the purpose of coordinating primary care
2 services described in s. 154.011(1)(c)10., the department
3 shall treat rural primary care hospitals in the same manner as
4 rural hospitals.
5 (6) Rural hospitals that make application under the
6 certificate-of-need program to be licensed as rural primary
7 care hospitals shall receive expedited review as defined in s.
8 408.032. Rural primary care hospitals seeking relicensure as
9 acute care general hospitals shall also receive expedited
10 review.
11 (7) Rural primary care hospitals are exempt from
12 certificate-of-need requirements for home health and hospice
13 services and for swing beds in a number that does not exceed
14 one-half of the facility's licensed beds.
15 (8) Rural primary care hospitals shall have agreements
16 with other hospitals, skilled nursing facilities, home health
17 agencies, and providers of diagnostic-imaging and laboratory
18 services that are not provided on site but are needed by
19 patients.
20 (4) The department may seek federal recognition of
21 emergency care hospitals authorized by s. 395.605 under the
22 essential access community hospital program authorized by the
23 Omnibus Budget Reconciliation Act of 1989.
24 Section 6. Section 395.6061, Florida Statutes, is
25 amended to read:
26 395.6061 Rural hospital capital improvement.--There is
27 established a rural hospital capital improvement grant
28 program.
29 (1) A rural hospital as defined in s. 395.602 may
30 apply to the department for a grant to acquire, repair,
31
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1 improve, or upgrade systems, facilities, or equipment. The
2 grant application must provide information that includes:
3 (a) A statement indicating the problem the rural
4 hospital proposes to solve with the grant funds;
5 (b) The strategy proposed to resolve the problem;
6 (c) The organizational structure, financial system,
7 and facilities that are essential to the proposed solution;
8 (d) The projected longevity of the proposed solution
9 after the grant funds are expended;
10 (e) Evidence of participation in a rural health
11 network as defined in s. 381.0406 and evidence that, after
12 July 1, 2008, the application is consistent with the rural
13 health network long-range development plan;
14 (f) Evidence that the rural hospital has difficulty in
15 obtaining funding or that funds available for the proposed
16 solution are inadequate;
17 (g) Evidence that the grant funds will assist in
18 maintaining or returning the hospital to an economically
19 stable condition or that any plan for closure of the hospital
20 or realignment of services will involve development of
21 innovative alternatives for the provision of needed
22 discontinued services;
23 (h) Evidence of a satisfactory record-keeping system
24 to account for grant fund expenditures within the rural
25 county; and
26 (i) A rural health network plan that includes a
27 description of how the plan was developed, the goals of the
28 plan, the links with existing health care providers under the
29 plan, Indicators quantifying the hospital's financial status
30 well-being, measurable outcome targets, and the current
31 physical and operational condition of the hospital.
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1 (2) Each rural hospital as defined in s. 395.602 shall
2 receive a minimum of $200,000 $100,000 annually, subject to
3 legislative appropriation, upon application to the Department
4 of Health, for projects to acquire, repair, improve, or
5 upgrade systems, facilities, or equipment.
6 (3) Any remaining funds may shall annually be
7 disbursed to rural hospitals in accordance with this section.
8 The Department of Health shall establish, by rule, criteria
9 for awarding grants for any remaining funds, which must be
10 used exclusively for the support and assistance of rural
11 hospitals as defined in s. 395.602, including criteria
12 relating to the level of charity uncompensated care rendered
13 by the hospital, the financial stability of the hospital,
14 financial and quality indicators for the hospital, whether the
15 project is sustainable beyond the funding period, the
16 hospital's ability to improve or expand services, the
17 hospital's participation in a rural health network as defined
18 in s. 381.0406, and the proposed use of the grant by the rural
19 hospital to resolve a specific problem. The department must
20 consider any information submitted in an application for the
21 grants in accordance with subsection (1) in determining
22 eligibility for and the amount of the grant, and none of the
23 individual items of information by itself may be used to deny
24 grant eligibility.
25 (4) To receive any of the remaining funds, a rural
26 hospital must agree to be bound by the terms of a
27 participation agreement with the department, which may
28 include:
29 (a) The appointment of a health care expert under
30 contract with the department to analyze and monitor the
31 hospital's operations.
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1 (b) The establishment of an orientation and
2 development program for members of the board.
3 (c) The approval of any facility relocation plans.
4 (5)(4) The department shall ensure that the funds are
5 used solely for the purposes specified in this section. The
6 total grants awarded pursuant to this section shall not exceed
7 the amount appropriated for this program.
8 Section 7. Subsection (12) of section 409.908, Florida
9 Statutes, is amended to read:
10 409.908 Reimbursement of Medicaid providers.--Subject
11 to specific appropriations, the agency shall reimburse
12 Medicaid providers, in accordance with state and federal law,
13 according to methodologies set forth in the rules of the
14 agency and in policy manuals and handbooks incorporated by
15 reference therein. These methodologies may include fee
16 schedules, reimbursement methods based on cost reporting,
17 negotiated fees, competitive bidding pursuant to s. 287.057,
18 and other mechanisms the agency considers efficient and
19 effective for purchasing services or goods on behalf of
20 recipients. If a provider is reimbursed based on cost
21 reporting and submits a cost report late and that cost report
22 would have been used to set a lower reimbursement rate for a
23 rate semester, then the provider's rate for that semester
24 shall be retroactively calculated using the new cost report,
25 and full payment at the recalculated rate shall be effected
26 retroactively. Medicare-granted extensions for filing cost
27 reports, if applicable, shall also apply to Medicaid cost
28 reports. Payment for Medicaid compensable services made on
29 behalf of Medicaid eligible persons is subject to the
30 availability of moneys and any limitations or directions
31 provided for in the General Appropriations Act or chapter 216.
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1 Further, nothing in this section shall be construed to prevent
2 or limit the agency from adjusting fees, reimbursement rates,
3 lengths of stay, number of visits, or number of services, or
4 making any other adjustments necessary to comply with the
5 availability of moneys and any limitations or directions
6 provided for in the General Appropriations Act, provided the
7 adjustment is consistent with legislative intent.
8 (12)(a) A physician shall be reimbursed the lesser of
9 the amount billed by the provider or the Medicaid maximum
10 allowable fee established by the agency.
11 (b) The agency shall adopt a fee schedule, subject to
12 any limitations or directions provided for in the General
13 Appropriations Act, based on a resource-based relative value
14 scale for pricing Medicaid physician services. Under this fee
15 schedule, physicians shall be paid a dollar amount for each
16 service based on the average resources required to provide the
17 service, including, but not limited to, estimates of average
18 physician time and effort, practice expense, and the costs of
19 professional liability insurance. The fee schedule shall
20 provide increased reimbursement for preventive and primary
21 care services and lowered reimbursement for specialty services
22 by using at least two conversion factors, one for cognitive
23 services and another for procedural services. The fee schedule
24 shall not increase total Medicaid physician expenditures
25 unless moneys are available, and shall be phased in over a
26 2-year period beginning on July 1, 1994. The Agency for Health
27 Care Administration shall seek the advice of a 16-member
28 advisory panel in formulating and adopting the fee schedule.
29 The panel shall consist of Medicaid physicians licensed under
30 chapters 458 and 459 and shall be composed of 50 percent
31
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1 primary care physicians and 50 percent specialty care
2 physicians.
3 (c) Notwithstanding paragraph (b), reimbursement fees
4 to physicians for providing total obstetrical services to
5 Medicaid recipients, which include prenatal, delivery, and
6 postpartum care, shall be at least $1,500 per delivery for a
7 pregnant woman with low medical risk and at least $2,000 per
8 delivery for a pregnant woman with high medical risk. However,
9 reimbursement to physicians working in Regional Perinatal
10 Intensive Care Centers designated pursuant to chapter 383, for
11 services to certain pregnant Medicaid recipients with a high
12 medical risk, may be made according to obstetrical care and
13 neonatal care groupings and rates established by the agency.
14 Nurse midwives licensed under part I of chapter 464 or
15 midwives licensed under chapter 467 shall be reimbursed at no
16 less than 80 percent of the low medical risk fee. The agency
17 shall by rule determine, for the purpose of this paragraph,
18 what constitutes a high or low medical risk pregnant woman and
19 shall not pay more based solely on the fact that a caesarean
20 section was performed, rather than a vaginal delivery. The
21 agency shall by rule determine a prorated payment for
22 obstetrical services in cases where only part of the total
23 prenatal, delivery, or postpartum care was performed. The
24 Department of Health shall adopt rules for appropriate
25 insurance coverage for midwives licensed under chapter 467.
26 Prior to the issuance and renewal of an active license, or
27 reactivation of an inactive license for midwives licensed
28 under chapter 467, such licensees shall submit proof of
29 coverage with each application.
30 (d) Notwithstanding other provisions of this
31 subsection, physicians licensed under chapter 458 or chapter
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1 459 who have a provider agreement with a rural health network
2 as established in s. 381.0406 shall be paid a 10-percent bonus
3 over the Medicaid physician fee schedule for any physician
4 service provided within the geographic boundary of a rural
5 county as defined by the most recent United States Census as
6 rural.
7 Section 8. Subsection (43) of section 408.07, Florida
8 Statutes, is amended to read:
9 408.07 Definitions.--As used in this chapter, with the
10 exception of ss. 408.031-408.045, the term:
11 (43) "Rural hospital" means an acute care hospital
12 licensed under chapter 395, having 100 or fewer licensed beds
13 and an emergency room, and which is:
14 (a) The sole provider within a county with a
15 population density of no greater than 100 persons per square
16 mile;
17 (b) An acute care hospital, in a county with a
18 population density of no greater than 100 persons per square
19 mile, which is at least 30 minutes of travel time, on normally
20 traveled roads under normal traffic conditions, from another
21 acute care hospital within the same county;
22 (c) A hospital supported by a tax district or
23 subdistrict whose boundaries encompass a population of 100
24 persons or fewer per square mile;
25 (d) A hospital with a service area that has a
26 population of 100 persons or fewer per square mile. As used in
27 this paragraph, the term "service area" means the fewest
28 number of zip codes that account for 75 percent of the
29 hospital's discharges for the most recent 5-year period, based
30 on information available from the hospital inpatient discharge
31 database in the Florida Center for Health Information and
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1 Policy Analysis at the Agency for Health Care Administration;
2 or
3 (e) A critical access hospital.
4
5 Population densities used in this subsection must be based
6 upon the most recently completed United States census. A
7 hospital that received funds under s. 409.9116 for a quarter
8 beginning no later than July 1, 2002, is deemed to have been
9 and shall continue to be a rural hospital from that date
10 through June 30, 2012, if the hospital continues to have 100
11 or fewer licensed beds and an emergency room, or meets the
12 criteria of s. 395.602(2)(d)4. s. 395.602(2)(e)4. An acute
13 care hospital that has not previously been designated as a
14 rural hospital and that meets the criteria of this subsection
15 shall be granted such designation upon application, including
16 supporting documentation, to the Agency for Health Care
17 Administration.
18 Section 9. Subsection (6) of section 409.9116, Florida
19 Statutes, is amended to read:
20 409.9116 Disproportionate share/financial assistance
21 program for rural hospitals.--In addition to the payments made
22 under s. 409.911, the Agency for Health Care Administration
23 shall administer a federally matched disproportionate share
24 program and a state-funded financial assistance program for
25 statutory rural hospitals. The agency shall make
26 disproportionate share payments to statutory rural hospitals
27 that qualify for such payments and financial assistance
28 payments to statutory rural hospitals that do not qualify for
29 disproportionate share payments. The disproportionate share
30 program payments shall be limited by and conform with federal
31 requirements. Funds shall be distributed quarterly in each
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1 fiscal year for which an appropriation is made.
2 Notwithstanding the provisions of s. 409.915, counties are
3 exempt from contributing toward the cost of this special
4 reimbursement for hospitals serving a disproportionate share
5 of low-income patients.
6 (6) This section applies only to hospitals that were
7 defined as statutory rural hospitals, or their
8 successor-in-interest hospital, prior to January 1, 2001. Any
9 additional hospital that is defined as a statutory rural
10 hospital, or its successor-in-interest hospital, on or after
11 January 1, 2001, is not eligible for programs under this
12 section unless additional funds are appropriated each fiscal
13 year specifically to the rural hospital disproportionate share
14 and financial assistance programs in an amount necessary to
15 prevent any hospital, or its successor-in-interest hospital,
16 eligible for the programs prior to January 1, 2001, from
17 incurring a reduction in payments because of the eligibility
18 of an additional hospital to participate in the programs. A
19 hospital, or its successor-in-interest hospital, which
20 received funds pursuant to this section before January 1,
21 2001, and which qualifies under s. 395.602(2)(d) s.
22 395.602(2)(e), shall be included in the programs under this
23 section and is not required to seek additional appropriations
24 under this subsection.
25 Section 10. Paragraph (b) of subsection (2) of section
26 1009.65, Florida Statutes, is amended to read:
27 1009.65 Medical Education Reimbursement and Loan
28 Repayment Program.--
29 (2) From the funds available, the Department of Health
30 shall make payments to selected medical professionals as
31 follows:
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1 (b) All payments shall be contingent on continued
2 proof of primary care practice in an area defined in s.
3 395.602(2)(d) s. 395.602(2)(e), or an underserved area
4 designated by the Department of Health, provided the
5 practitioner accepts Medicaid reimbursement if eligible for
6 such reimbursement. Correctional facilities, state hospitals,
7 and other state institutions that employ medical personnel
8 shall be designated by the Department of Health as underserved
9 locations. Locations with high incidences of infant mortality,
10 high morbidity, or low Medicaid participation by health care
11 professionals may be designated as underserved.
12 Section 11. The Office of Program Policy Analysis and
13 Government Accountability shall contract with an entity having
14 expertise in the financing of rural hospital capital
15 improvement projects to study the financing options for
16 replacing or changing the use of rural hospital facilities
17 having 55 or fewer beds which were built before 1985 and which
18 have not had major renovations since 1985. For each such
19 hospital, the contractor shall assess the need to replace or
20 convert the facility, identify all available sources of
21 financing for such replacement or conversion and assess each
22 community's capacity to maximize these funding options,
23 propose a model replacement facility if a facility should be
24 replaced, and propose alternative uses of the facility if
25 continued operation of the hospital is not financially
26 feasible. Based on the results of the contract study, the
27 Office of Program Policy Analysis and Government
28 Accountability shall submit recommendations to the Legislature
29 by February 1, 2008, regarding whether the state should
30 provide financial assistance to replace or convert these rural
31 hospital facilities and what form that assistance should take.
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1 Section 12. Section 395.605, Florida Statutes, is
2 repealed.
3 Section 13. The sum of $440,000 from nonrecurring
4 general revenue funds is appropriated to the Office of Program
5 Policy Analysis and Government Accountability to implement
6 section 11 of this act.
7 Section 14. The sums of $3,638,709 in recurring
8 general revenue funds and $5,067,392 in recurring funds from
9 the Medical Care Trust Fund are appropriated to the Agency for
10 Health Care Administration to implement the 10-percent
11 Medicaid fee schedule bonus payment as provided in this act.
12 Section 15. The sum of $3 million in recurring general
13 revenue funds is appropriated to the Department of Health to
14 implement rural health network infrastructure development as
15 provided in section 2 of this act.
16 Section 16. The sum of $7.5 million in nonrecurring
17 general revenue funds is appropriated to the Department of
18 Health to implement the rural hospital capital improvement
19 grant program as provided in section 6 of this act.
20 Section 17. The sums of $196,818 in recurring general
21 revenue funds and $17,556 in nonrecurring general revenue
22 funds are appropriated to the Department of Health, and three
23 full-time equivalent positions and associated salary rate of
24 121,619 are authorized to implement this act.
25 Section 18. This act shall take effect July 1, 2007.
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2 SENATE SUMMARY
3 Revises various provisions relating to rural health care.
Revises the duties of the Office of Rural Health within
4 the Department of Health. Requires the appointment of an
advisory council to the Office of Rural Health. Requires
5 the office to submit an annual report to the Governor and
Legislature. Revises the functions of the rural health
6 networks and establishes requirements for funding the
networks. Requires that the Office of Rural Health
7 monitor rural health networks. Revises requirements for
rural primary care hospitals and emergency care
8 hospitals. Provides for the Department of Health to award
grants to rural hospitals. Provides for a bonus to be
9 paid for certain services provided under the Medicaid
program. Requires the Office of Program Policy Analysis
10 and Government Accountability to award a contract for a
study concerning replacing or changing the use of certain
11 rural hospitals. (See bill for details.)
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