Senate Bill sb0424c1
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Florida Senate - 2007 CS for SB 424
By the Committee on Health Regulation; and Senator Peaden
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1 A bill to be entitled
2 An act relating to the provision of health care
3 services; amending s. 381.0402, F.S.; revising
4 provisions governing the area health education
5 center network; requiring that the Department
6 of Health maintain and evaluate the network in
7 cooperation with medical schools; providing for
8 expanded purposes and responsibilities of the
9 network; requiring the department to enter
10 contracts concerning funding of certain
11 initiatives of the network; providing
12 requirements governing certain network
13 activities concerning medical students,
14 students in the health care professions, and
15 persons providing health care to medically
16 underserved populations; specifying the
17 percentage of funds that the department may
18 spend to administer and evaluate the network;
19 amending s. 381.0405, F.S.; revising the
20 purpose and functions of the Office of Rural
21 Health in the Department of Health; requiring
22 the Secretary of Health and the Secretary of
23 Health Care Administration to appoint an
24 advisory council to advise the Office of Rural
25 Health; providing for terms of office of the
26 members of the advisory council; authorizing
27 per diem and travel reimbursement for members
28 of the advisory council; requiring the Office
29 of Rural Health to submit an annual report to
30 the Governor and the Legislature; amending s.
31 381.0406, F.S.; revising legislative findings
1
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1 and intent with respect to rural health
2 networks; redefining the term "rural health
3 network"; establishing requirements for
4 membership in rural health networks; adding
5 functions for the rural health networks;
6 revising requirements for the governance and
7 organization of rural health networks; revising
8 the services to be provided by provider members
9 of rural health networks; requiring
10 coordination among rural health networks and
11 area health education centers, health planning
12 councils, and regional education consortia;
13 establishing requirements for funding rural
14 health networks; establishing performance
15 standards for rural health networks;
16 establishing requirements for the receipt of
17 grant funding; requiring the Office of Rural
18 Health to monitor rural health networks;
19 authorizing the Department of Health to
20 establish rules governing rural health network
21 grant programs and performance standards;
22 amending s. 395.602, F.S.; defining the term
23 "critical access hospital"; deleting the
24 definitions of "emergency care hospital," and
25 "essential access community hospital"; revising
26 the definition of "rural primary care
27 hospital"; amending s. 395.603, F.S.; deleting
28 a requirement that the Agency for Health Care
29 Administration adopt a rule relating to
30 deactivation of rural hospital beds under
31 certain circumstances; requiring that critical
2
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1 access hospitals and rural primary care
2 hospitals maintain a certain number of actively
3 licensed beds; amending s. 395.604, F.S.;
4 removing emergency care hospitals and essential
5 access community hospitals from certain
6 licensure requirements; specifying certain
7 special conditions for rural primary care
8 hospitals; amending s. 395.6061, F.S.;
9 specifying the purposes of capital improvement
10 grants for rural hospitals; modifying the
11 conditions for receiving a grant; authorizing
12 the Department of Health to award grants for
13 remaining funds to certain rural hospitals;
14 requiring a rural hospital that receives any
15 remaining funds to be bound by certain terms of
16 a participation agreement in order to receive
17 remaining funds; amending s. 409.908, F.S.;
18 requiring the Agency for Health Care
19 Administration to pay certain physicians a
20 bonus for Medicaid physician services provided
21 within a rural county; amending ss. 408.07,
22 409.9116, and 1009.65, F.S.; conforming
23 cross-references; requiring the Office of
24 Program Policy Analysis and Government
25 Accountability to contract for a study of the
26 financing options for replacing or changing the
27 use of certain rural hospitals; requiring a
28 report to the Legislature by a specified date;
29 repealing s. 395.605, F.S., relating to the
30 licensure of emergency care hospitals;
31 providing appropriations and authorizing
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1 additional positions; providing an effective
2 date.
3
4 Be It Enacted by the Legislature of the State of Florida:
5
6 Section 1. Section 381.0402, Florida Statutes, is
7 amended to read:
8 381.0402 Area health education center network.--The
9 department, in cooperation with the state-approved medical
10 schools in this state which form the area health education
11 center network, shall maintain and evaluate organize an area
12 health education center network focused based on earlier
13 medically indigent demonstration projects and shall evaluate
14 the impact of each network on improving access to health
15 services by persons who are medically underserved. The network
16 shall serve as be a catalyst for the primary care training of
17 health professionals by increasing through increased
18 opportunities for training in medically underserved areas,
19 increasing access to primary care services, providing health
20 workforce recruitment, enhancing the quality of health care,
21 and addressing current and emerging public health issues.
22 (1) The department shall contract with medical schools
23 to assist in funding the an area health education center
24 network in a manner that which links the provision of primary
25 care services to medically underserved populations and
26 provides for low-income persons with the education of:
27 (a) Medical students, interns, and residents. The
28 network shall:
29 (a) Be coordinated with and under contract with the
30 state-approved medical schools, which shall be responsible for
31 the clinical training and supervision.
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1 1.(b) Divide the state into service areas with the
2 network for each state-approved medical school coordinating
3 the recruitment recruiting, training, and retention of medical
4 students within its assigned area.
5 (c) Use a multidisciplinary approach with appropriate
6 medical supervision.
7 2.(d) Use current community resources such as county
8 health departments, federally funded community or migrant
9 health primary care centers, and or other primary health care
10 providers as community-based sites for training medical
11 students, interns, and residents.
12 3. Use a multidisciplinary approach with appropriate
13 medical supervision.
14 (b) Students in the health care professions. The
15 network shall:
16 1. Facilitate the recruitment, training, and retention
17 of students in the health care professions within service
18 areas.
19 2. Use community resources such as county health
20 departments, federally funded community or migrant health
21 centers, and other primary health care providers as sites for
22 training students in the health care professions.
23 3. Use a multidisciplinary approach with appropriate
24 supervision.
25 (c) Health care providers serving medically
26 underserved populations. The network shall:
27 1. Assist providers in medically underserved areas and
28 other safety-net providers in remaining current in their
29 fields through a variety of community resource initiatives.
30
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1 2. Strengthen the health care safety net in this state
2 by enhancing services and increasing access to care in
3 medically underserved areas.
4 3. Provide other services, such as library and
5 information resources, continuing professional education,
6 technical assistance, and other support services, for
7 providers serving in medically underserved areas.
8 (2) The department shall establish criteria and
9 procedures for quality assurance, performance evaluations,
10 periodic audits, and other appropriate safeguards for the
11 network.
12 (3) The department shall make every effort to ensure
13 assure that the network does participating medical schools do
14 not discriminate among enrollees with respect to age, race,
15 gender sex, or health status. However, the network such
16 schools may target high-risk medically needy population
17 groups.
18 (4) The department may use no more than 1 5 percent of
19 the annual appropriation for administering and evaluating the
20 network.
21 (5) Notwithstanding subsection (4), the department may
22 not use any portion of the annual appropriation to administer
23 and evaluate the network. This subsection expires July 1,
24 2007.
25 Section 2. Section 381.0405, Florida Statutes, is
26 amended to read:
27 381.0405 Office of Rural Health.--
28 (1) ESTABLISHMENT.--The Department of Health shall
29 establish an Office of Rural Health, which shall assist rural
30 health care providers in improving the health status and
31 health care of rural residents of this state and help rural
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1 health care providers to integrate their efforts and prepare
2 for prepaid and at-risk reimbursement. The Office of Rural
3 Health shall coordinate its activities with rural health
4 networks established under s. 381.0406, local health councils
5 established under s. 408.033, the area health education center
6 network established under pursuant to s. 381.0402, and with
7 any appropriate research and policy development centers within
8 universities that have state-approved medical schools. The
9 Office of Rural Health may enter into a formal relationship
10 with any center that designates the office as an affiliate of
11 the center.
12 (2) PURPOSE.--The Office of Rural Health shall
13 actively foster the development of service-delivery systems
14 and cooperative agreements to enhance the provision of
15 high-quality health care services in rural areas and serve as
16 a catalyst for improved health services to residents citizens
17 in rural areas of the state.
18 (3) GENERAL FUNCTIONS.--The office shall:
19 (a) Integrate policies related to physician workforce,
20 hospitals, public health, and state regulatory functions.
21 (b) Work with rural stakeholders in order to foster
22 the development of strategic planning that addresses Propose
23 solutions to problems affecting health care delivery in rural
24 areas.
25 (c) Develop, in coordination with the rural health
26 networks, standards, guidelines, and performance objectives
27 for rural health networks.
28 (d) Foster the expansion of rural health network
29 service areas to include rural counties that are not covered
30 by a rural health network.
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1 (e)(c) Seek grant funds from foundations and the
2 Federal Government.
3 (f) Administer state grant programs for rural
4 hospitals and rural health networks.
5 (4) COORDINATION.--The office shall:
6 (a) Identify federal and state rural health programs
7 and provide information and technical assistance to rural
8 providers regarding participation in such programs.
9 (b) Act as a clearinghouse for collecting and
10 disseminating information on rural health care issues,
11 research findings on rural health care, and innovative
12 approaches to the delivery of health care in rural areas.
13 (c) Foster the creation of regional health care
14 systems that promote cooperation through cooperative
15 agreements, rather than competition.
16 (d) Coordinate the department's rural health care
17 activities, programs, and policies.
18 (e) Design initiatives and promote cooperative
19 agreements in order to improve access to primary care,
20 prehospital emergency care, inpatient acute care, and
21 emergency medical services and promote the coordination of
22 such services in rural areas.
23 (f) Assume responsibility for state coordination of
24 the Rural Hospital Transition Grant Program, the Essential
25 Access Community Hospital Program, and other federal rural
26 hospital and rural health care grant programs.
27 (5) TECHNICAL ASSISTANCE.--The office shall:
28 (a) Assist Help rural health care providers in
29 recruiting obtain health care practitioners by promoting the
30 location and relocation of health care practitioners in rural
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1 areas and promoting policies that create incentives for
2 practitioners to serve in rural areas.
3 (b) Provide technical assistance to hospitals,
4 community and migrant health centers, and other health care
5 providers that serve residents of rural areas.
6 (c) Assist with the design of strategies to improve
7 health care workforce recruitment and placement programs.
8 (d) Provide technical assistance to rural health
9 networks in the development of their long-range development
10 plans.
11 (e) Provide links to best practices and other
12 technical-assistance resources on its website.
13 (6) RESEARCH PUBLICATIONS AND SPECIAL STUDIES.--The
14 office shall:
15 (a) Conduct policy and research studies.
16 (b) Conduct health status studies of rural residents.
17 (c) Collect relevant data on rural health care issues
18 for use in program planning and department policy development.
19 (7) ADVISORY COUNCIL.--The Secretary of Health and the
20 Secretary of Health Care Administration shall each appoint no
21 more than five members having relevant health care operations
22 management, practice, and policy experience to an advisory
23 council to advise the office regarding its responsibilities
24 under this section and ss. 381.0406 and 395.6061. Members
25 shall be appointed for 4-year staggered terms and may be
26 reappointed to a second term of office. Members shall serve
27 without compensation, but are entitled to reimbursement for
28 per diem and travel expenses as provided in s. 112.061. The
29 department shall provide staff and other administrative
30 assistance reasonably necessary to assist the advisory council
31 in carrying out its duties. The advisory council shall work
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1 with stakeholders to develop recommendations that address
2 barriers and identify options for establishing provider
3 networks in rural counties.
4 (8) REPORTS.--Beginning January 1, 2008, and annually
5 thereafter, the Office of Rural Health shall submit a report
6 to the Governor, the President of the Senate, and the Speaker
7 of the House of Representatives summarizing the activities of
8 the office, including the grants obtained or administered by
9 the office and the status of rural health networks and rural
10 hospitals in the state. The report must also include
11 recommendations that address barriers and identify options for
12 establishing provider networks in rural counties.
13 (9)(7) APPROPRIATION.--The Legislature shall
14 appropriate such sums as are necessary to support the Office
15 of Rural Health.
16 Section 3. Section 381.0406, Florida Statutes, is
17 amended to read:
18 381.0406 Rural health networks.--
19 (1) LEGISLATIVE FINDINGS AND INTENT.--
20 (a) The Legislature finds that, in rural areas, access
21 to health care is limited and the quality of health care is
22 negatively affected by inadequate financing, difficulty in
23 recruiting and retaining skilled health professionals, and the
24 because of a migration of patients to urban areas for general
25 acute care and specialty services.
26 (b) The Legislature further finds that the efficient
27 and effective delivery of health care services in rural areas
28 requires:
29 1. The integration of public and private resources;
30 2. The introduction of innovative outreach methods;
31
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1 3. The adoption of quality improvement and
2 cost-effectiveness measures;
3 4. The organization of health care providers into
4 joint contracting entities;
5 5. Establishing referral linkages;
6 6. The analysis of costs and services in order to
7 prepare health care providers for prepaid and at-risk
8 financing; and
9 7. The coordination of health care providers.
10 (c) The Legislature further finds that the
11 availability of a continuum of quality health care services,
12 including preventive, primary, secondary, tertiary, and
13 long-term care, is essential to the economic and social
14 vitality of rural communities.
15 (d) The Legislature further finds that health care
16 providers in rural areas are not prepared for market changes
17 such as the introduction of managed care and
18 capitation-reimbursement methodologies into health care
19 services.
20 (e)(d) The Legislature further finds that the creation
21 of rural health networks can help to alleviate these problems.
22 Rural health networks shall act in the broad public interest
23 and, to the extent possible, seek to improve the
24 accessibility, quality, and cost-effectiveness of rural health
25 care by planning, developing, coordinating, and providing be
26 structured to provide a continuum of quality health care
27 services for rural residents through the cooperative efforts
28 of rural health network members and other health care
29 providers.
30 (f)(e) The Legislature further finds that rural health
31 networks shall have the goal of increasing the financial
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1 stability of statutory rural hospitals by linking rural
2 hospital services to other services in a continuum of health
3 care services and by increasing the utilization of statutory
4 rural hospitals whenever for appropriate health care services
5 whenever feasible, which shall help to ensure their survival
6 and thereby support the economy and protect the health and
7 safety of rural residents.
8 (g)(f) Finally, the Legislature finds that rural
9 health networks may serve as "laboratories" to determine the
10 best way of organizing rural health services and linking to
11 out-of-area services that are not available locally in order,
12 to move the state closer to ensuring that everyone has access
13 to health care, and to promote cost-containment cost
14 containment efforts. The ultimate goal of rural health
15 networks shall be to ensure that quality health care is
16 available and efficiently delivered to all persons in rural
17 areas.
18 (2) DEFINITIONS.--
19 (a) "Rural" means an area having with a population
20 density of fewer less than 100 individuals per square mile or
21 an area defined by the most recent United States Census as
22 rural.
23 (b) "Health care provider" means any individual,
24 group, or entity, public or private, which that provides
25 health care, including: preventive health care, primary health
26 care, secondary and tertiary health care, hospital in-hospital
27 health care, public health care, and health promotion and
28 education.
29 (c) "Rural health network" or "network" means a
30 nonprofit legal entity whose members consist, consisting of
31 rural and urban health care providers and others, and which
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1 that is established organized to plan, develop, organize, and
2 deliver health care services on a cooperative basis in a rural
3 area, except for some secondary and tertiary care services.
4 (3) NETWORK MEMBERSHIP.--
5 (a) Because each rural area is unique, with a
6 different health care provider mix, health care provider
7 membership may vary, but all networks shall include members
8 that provide health promotion and disease-prevention services,
9 public health services, comprehensive primary care, emergency
10 medical care, and acute inpatient care.
11 (b) Each county health department shall be a member of
12 the rural health network whose service area includes the
13 county in which the county health department is located.
14 Federally qualified health centers and emergency medical
15 services providers are encouraged to become members of the
16 rural health networks in the areas in which their patients
17 reside or receive services.
18 (c)(4) Network membership shall be available to all
19 health care providers in the network service area if, provided
20 that they render care to all patients referred to them from
21 other network members, comply with network quality assurance
22 and risk management requirements, abide by the terms and
23 conditions of network provider agreements and network
24 development plans in paragraph (11)(c), and provide services
25 at a rate or price equal to the rate or price negotiated by
26 the network.
27 (4)(5) NETWORK SERVICE AREAS.--Network service areas
28 are do not required need to conform to local political
29 boundaries or state administrative district boundaries. The
30 geographic area of one rural health network, however, may not
31 overlap the territory of any other rural health network.
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1 (5)(6) NETWORK FUNCTIONS.--To the extent that
2 resources permit, networks shall:
3 (a) Seek to develop linkages with provisions for
4 referral to tertiary inpatient care, specialty physician care,
5 and to other services that are not available in rural service
6 areas.
7 (b)(7) Networks shall Make available health promotion,
8 disease prevention, and primary care services, in order to
9 improve the health status of rural residents and to contain
10 health care costs.
11 (8) Networks may have multiple points of entry, such
12 as through private physicians, community health centers,
13 county health departments, certified rural health clinics,
14 hospitals, or other providers; or they may have a single point
15 of entry.
16 (c)(9) Encourage members through training and
17 educational programs to adopt standards of care, and promote
18 the evidence-based practice of medicine. Networks shall
19 promote the adoption of standards of care and establish
20 standard protocols, coordinate and share patient records, and
21 develop patient information exchange systems in order to
22 improve quality and access to services.
23 (d) Assist members to develop initiatives that improve
24 the quality of health care services and delivery, and obtain
25 training to carry out such initiatives.
26 (e) Assist members with the implementation of disease
27 management systems and identify available resources for
28 training network members and other health care providers in
29 the use of such systems.
30 (f) Promote outreach to areas that have a high need
31 for services.
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1 (g) Seek to develop community care alternatives for
2 elders who would otherwise be placed in nursing homes.
3 (h) Emphasize community care alternatives for persons
4 with mental health and substance abuse disorders who are at
5 risk of being admitted to an institution.
6 (i) Develop a long-range development plan, in concert
7 with network health care providers and community leaders, for
8 an integrated system of care that is responsive to the unique
9 needs for services in local health care markets, and implement
10 this plan as resources permit. The initial long-range
11 development plan must be submitted to the Office of Rural
12 Health for review and comment no later than July 1, 2008, and
13 thereafter the plan must be updated and submitted to the
14 Office of Rural Health every 3 years.
15 (10) Networks shall develop risk management and
16 quality assurance programs for network providers.
17 (6)(11) NETWORK GOVERNANCE AND ORGANIZATION.--
18 (a) Networks shall be incorporated as not-for-profit
19 corporations under chapter 617, with articles of incorporation
20 that set forth purposes consistent with this section the laws
21 of the state.
22 (b) Each network Networks shall have an independent a
23 board of directors that derives membership from local
24 government, health care providers, businesses, consumers,
25 advocacy groups, and others. Boards of other community health
26 care entities may not serve in whole as the board of a rural
27 health network; however, some overlap of board membership with
28 other community organizations is encouraged. Network staff
29 must provide an annual orientation and strategic planning
30 activity for board members.
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1 (c) Network boards of directors shall have the
2 responsibility of determining the content of health care
3 provider agreements that link network members. The written
4 agreements between the network and its health care provider
5 members must specify participation in the essential functions
6 of the network and the goals and objectives of the support
7 network development plan. shall specify:
8 1. Who provides what services.
9 2. The extent to which the health care provider
10 provides care to persons who lack health insurance or are
11 otherwise unable to pay for care.
12 3. The procedures for transfer of medical records.
13 4. The method used for the transportation of patients
14 between providers.
15 5. Referral and patient flow including appointments
16 and scheduling.
17 6. Payment arrangements for the transfer or referral
18 of patients.
19 (d) There shall be no liability on the part of, and no
20 cause of action of any nature shall arise against, any member
21 of a network board of directors, or its employees or agents,
22 for any lawful action taken by them in the performance of
23 their administrative powers and duties under this subsection.
24 (7)(12) NETWORK PROVIDER MEMBER SERVICES.--
25 (a) Networks, to the extent feasible, shall seek to
26 develop services that provide for a continuum of care for all
27 residents patients served by the network. Each network shall
28 recruit members that can provide include the following core
29 services: disease prevention, health promotion, comprehensive
30 primary care, emergency medical care, and acute inpatient
31 care. Each network shall seek to ensure the availability of
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1 comprehensive maternity care, including prenatal, delivery,
2 and postpartum care for uncomplicated pregnancies, either
3 directly, by contract, or through referral agreements.
4 Networks shall, to the extent feasible, develop local services
5 and linkages among health care providers in order to also
6 ensure the availability of the following services: within the
7 specified timeframes, either directly, by contract, or through
8 referral agreements:
9 1. Services available in the home.
10 1.a. Home health care.
11 2.b. Hospice care.
12 2. Services accessible within 30 minutes travel time
13 or less.
14 3.a. Emergency medical services, including advanced
15 life support, ambulance, and basic emergency room services.
16 4.b. Primary care, including.
17 c. prenatal and postpartum care for uncomplicated
18 pregnancies.
19 5.d. Community-based services for elders, such as
20 adult day care and assistance with activities of daily living.
21 6.e. Public health services, including communicable
22 disease control, disease prevention, health education, and
23 health promotion.
24 7.f. Outpatient mental health psychiatric and
25 substance abuse treatment services.
26 3. Services accessible within 45 minutes travel time
27 or less.
28 8.a. Hospital acute inpatient care for persons whose
29 illnesses or medical problems are not severe.
30 9.b. Level I obstetrical care, which is Labor and
31 delivery for low-risk patients.
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1 10.c. Skilled nursing services and, long-term care,
2 including nursing home care.
3 (b) Networks shall seek to foster linkages with
4 out-of-area services to the extent feasible in order to ensure
5 the availability of:
6 1.d. Dialysis.
7 2.e. Osteopathic and chiropractic manipulative
8 therapy.
9 4. Services accessible within 2 hours travel time or
10 less.
11 3.a. Specialist physician care.
12 4.b. Hospital acute inpatient care for severe
13 illnesses and medical problems.
14 5.c. Level II and III obstetrical care, which is Labor
15 and delivery care for high-risk patients and neonatal
16 intensive care.
17 6.d. Comprehensive medical rehabilitation.
18 7.e. Inpatient mental health psychiatric and substance
19 abuse treatment services.
20 8.f. Magnetic resonance imaging, lithotripter
21 treatment, oncology, advanced radiology, and other
22 technologically advanced services.
23 9.g. Subacute care.
24 (8) COORDINATION WITH OTHER ENTITIES.--
25 (a) Area health education centers, health planning
26 councils, and regional education consortia having
27 technological expertise in continuing education shall
28 participate in the rural health networks' preparation of
29 long-range development plans. The Department of Health may
30 require written memoranda of agreement between a network and
31 an area health education center or health planning council.
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1 (b) Rural health networks shall initiate activities,
2 in coordination with area health education centers, to carry
3 out the objectives of the adopted long-range development plan,
4 including continuing education for health care practitioners
5 performing functions such as disease management, continuous
6 quality improvement, telemedicine, long-distance learning, and
7 the treatment of chronic illness using standards of care. As
8 used in this section, the term "telemedicine" means the use of
9 telecommunications to deliver or expedite the delivery of
10 health care services.
11 (c) Health planning councils shall support the
12 preparation of network long-range development plans through
13 data collection and analysis in order to assess the health
14 status of area residents and the capacity of local health
15 services.
16 (d) Regional education consortia that have the
17 technology available to assist rural health networks in
18 establishing systems for the exchange of patient information
19 and for long-distance learning are encouraged to provide
20 technical assistance upon the request of a rural health
21 network.
22 (e)(b) Networks shall actively participate with area
23 health education center programs, whenever feasible, in
24 developing and implementing recruitment, training, and
25 retention programs directed at positively influencing the
26 supply and distribution of health care professionals serving
27 in, or receiving training in, network areas.
28 (c) As funds become available, networks shall
29 emphasize community care alternatives for elders who would
30 otherwise be placed in nursing homes.
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1 (d) To promote the most efficient use of resources,
2 networks shall emphasize disease prevention, early diagnosis
3 and treatment of medical problems, and community care
4 alternatives for persons with mental health and substance
5 abuse disorders who are at risk to be institutionalized.
6 (f)(13) TRAUMA SERVICES.--In those network areas
7 having which have an established trauma agency approved by the
8 Department of Health, the network shall seek the participation
9 of that trauma agency must be a participant in the network.
10 Trauma services provided within the network area must comply
11 with s. 395.405.
12 (9)(14) NETWORK FINANCING.--
13 (a) Networks may use all sources of public and private
14 funds to support network activities. Nothing in this section
15 prohibits networks from becoming managed care providers.
16 (b) The Department of Health shall establish grant
17 programs to provide funding to support the administrative
18 costs of developing and operating rural health networks.
19 (10) NETWORK PERFORMANCE STANDARDS.--The Department of
20 Health shall develop and enforce performance standards for
21 rural health network operations grants and rural health
22 infrastructure development grants.
23 (a) Operations grant performance standards must
24 include, but are not limited to, standards that require the
25 rural health network to:
26 1. Have a qualified board of directors that meets at
27 least quarterly.
28 2. Have sufficient staff who have the qualifications
29 and experience to perform the requirements of this section, as
30 assessed by the Office of Rural Health, or a written plan to
31 obtain such staff.
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1 3. Comply with the department's grant-management
2 standards in a timely and responsive manner.
3 4. Comply with the department's standards for the
4 administration of federal grant funding, including assistance
5 to rural hospitals.
6 5. Demonstrate a commitment to network activities from
7 area health care providers and other stakeholders, as
8 described in letters of support.
9 (b) Rural health infrastructure development grant
10 performance standards must include, but are not limited to,
11 standards that require the rural health network to:
12 1. During the 2007-2008 fiscal year develop a
13 long-range development plan and, after July 1, 2008, have a
14 long-range development plan that has been reviewed and
15 approved by the Office of Rural Health.
16 2. Have two or more successful network-development
17 activities, such as:
18 a. Management of a network-development or outreach
19 grant from the federal Office of Rural Health Policy;
20 b. Implementation of outreach programs to address
21 chronic disease, infant mortality, or assistance with
22 prescription medication;
23 c. Development of partnerships with community and
24 faith-based organizations to address area health problems;
25 d. Provision of direct services, such as clinics or
26 mobile units;
27 e. Operation of credentialing services for health care
28 providers or quality-assurance and quality-improvement
29 initiatives that, whenever possible, are consistent with state
30 or federal quality initiatives;
31
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1 f. Support for the development of community health
2 centers, local community health councils, federal designation
3 as a rural critical access hospital, or comprehensive
4 community health planning initiatives; and
5 g. Development of the capacity to obtain federal,
6 state, and foundation grants.
7 (11)(15) NETWORK IMPLEMENTATION.--As funds become
8 available, networks shall be developed and implemented in two
9 phases.
10 (a) Phase I shall consist of a network planning and
11 development grant program. Planning grants shall be used to
12 organize networks, incorporate network boards, and develop
13 formal provider agreements as provided for in this section.
14 The Department of Health shall develop a request-for-proposal
15 process to solicit grant applications.
16 (b) Phase II shall consist of a network operations
17 grant program. As funds become available, certified networks
18 that meet performance standards shall be eligible to receive
19 grant funds to be used to help defray the costs of rural
20 health network infrastructure development, patient care, and
21 network administration. Rural health network infrastructure
22 development includes, but is not limited to: recruitment and
23 retention of primary care practitioners; enhancements of
24 primary care services through the use of mobile clinics;
25 development of preventive health care programs; linkage of
26 urban and rural health care systems; design and implementation
27 of automated patient records, outcome measurement, quality
28 assurance, and risk management systems; establishment of
29 one-stop service delivery sites; upgrading of medical
30 technology available to network providers; enhancement of
31 emergency medical systems; enhancement of medical
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1 transportation; formation of joint contracting entities
2 composed of rural physicians, rural hospitals, and other rural
3 health care providers; establishment of comprehensive
4 disease-management programs that meet Medicaid requirements;
5 establishment of regional quality-improvement programs
6 involving physicians and hospitals consistent with state and
7 national initiatives; establishment of speciality networks
8 connecting rural primary care physicians and urban
9 specialists; development of regional broadband
10 telecommunications systems that have the capacity to share
11 patient information in a secure network, telemedicine, and
12 long-distance learning capacity; and linkage between training
13 programs for health care practitioners and the delivery of
14 health care services in rural areas and development of
15 telecommunication capabilities. A Phase II award may occur in
16 the same fiscal year as a Phase I award.
17 (12)(16) CERTIFICATION.--For the purpose of certifying
18 networks that are eligible for Phase II funding, the
19 Department of Health shall certify networks that meet the
20 criteria delineated in this section and the rules governing
21 rural health networks. The Office of Rural Health in the
22 Department of Health shall monitor rural health networks in
23 order to ensure continued compliance with established
24 certification and performance standards.
25 (13)(17) RULES.--The Department of Health shall
26 establish rules that govern the creation and certification of
27 networks, the provision of grant funds under Phase I and Phase
28 II, and the establishment of performance standards including
29 establishing outcome measures for networks.
30 Section 4. Subsection (2) of section 395.602, Florida
31 Statutes, is amended to read:
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1 395.602 Rural hospitals.--
2 (2) DEFINITIONS.--As used in this part:
3 (a) "Critical access hospital" means a hospital that
4 meets the definition of rural hospital in paragraph (d) and
5 meets the requirements for reimbursement by Medicare and
6 Medicaid under 42 C.F.R. ss. 485.601-485.647. "Emergency care
7 hospital" means a medical facility which provides:
8 1. Emergency medical treatment; and
9 2. Inpatient care to ill or injured persons prior to
10 their transportation to another hospital or provides inpatient
11 medical care to persons needing care for a period of up to 96
12 hours. The 96-hour limitation on inpatient care does not
13 apply to respite, skilled nursing, hospice, or other nonacute
14 care patients.
15 (b) "Essential access community hospital" means any
16 facility which:
17 1. Has at least 100 beds;
18 2. Is located more than 35 miles from any other
19 essential access community hospital, rural referral center, or
20 urban hospital meeting criteria for classification as a
21 regional referral center;
22 3. Is part of a network that includes rural primary
23 care hospitals;
24 4. Provides emergency and medical backup services to
25 rural primary care hospitals in its rural health network;
26 5. Extends staff privileges to rural primary care
27 hospital physicians in its network; and
28 6. Accepts patients transferred from rural primary
29 care hospitals in its network.
30 (b)(c) "Inactive rural hospital bed" means a licensed
31 acute care hospital bed, as defined in s. 395.002(14), that is
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1 inactive in that it cannot be occupied by acute care
2 inpatients.
3 (c)(d) "Rural area health education center" means an
4 area health education center (AHEC), as authorized by Pub. L.
5 No. 94-484, which provides services in a county with a
6 population density of no greater than 100 persons per square
7 mile.
8 (d)(e) "Rural hospital" means an acute care hospital
9 licensed under this chapter, having 100 or fewer licensed beds
10 and an emergency room, which is:
11 1. The sole provider within a county with a population
12 density of no greater than 100 persons per square mile;
13 2. An acute care hospital, in a county with a
14 population density of no greater than 100 persons per square
15 mile, which is at least 30 minutes of travel time, on normally
16 traveled roads under normal traffic conditions, from any other
17 acute care hospital within the same county;
18 3. A hospital supported by a tax district or
19 subdistrict whose boundaries encompass a population of 100
20 persons or fewer per square mile;
21 4. A hospital in a constitutional charter county with
22 a population of over 1 million persons that has imposed a
23 local option health service tax pursuant to law and in an area
24 that was directly impacted by a catastrophic event on August
25 24, 1992, for which the Governor of Florida declared a state
26 of emergency pursuant to chapter 125, and has 120 beds or less
27 that serves an agricultural community with an emergency room
28 utilization of no less than 20,000 visits and a Medicaid
29 inpatient utilization rate greater than 15 percent;
30 5. A hospital with a service area that has a
31 population of 100 persons or fewer per square mile. As used in
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1 this subparagraph, the term "service area" means the fewest
2 number of zip codes that account for 75 percent of the
3 hospital's discharges for the most recent 5-year period, based
4 on information available from the hospital inpatient discharge
5 database in the Florida Center for Health Information and
6 Policy Analysis at the Agency for Health Care Administration;
7 or
8 6. A hospital designated as a critical access
9 hospital, as defined in s. 408.07(15).
10
11 Population densities used in this paragraph must be based upon
12 the most recently completed United States census. A hospital
13 that received funds under s. 409.9116 for a quarter beginning
14 no later than July 1, 2002, is deemed to have been and shall
15 continue to be a rural hospital from that date through June
16 30, 2012, if the hospital continues to have 100 or fewer
17 licensed beds and an emergency room, or meets the criteria of
18 subparagraph 4. An acute care hospital that has not previously
19 been designated as a rural hospital and that meets the
20 criteria of this paragraph shall be granted such designation
21 upon application, including supporting documentation to the
22 Agency for Health Care Administration.
23 (e)(f) "Rural primary care hospital" means any
24 facility that meeting the criteria in paragraph (e) or s.
25 395.605 which provides:
26 1. Twenty-four-hour emergency medical care;
27 2. Temporary inpatient care for periods of 96 72 hours
28 or less to patients requiring stabilization before discharge
29 or transfer to another hospital. The 96-hour 72-hour
30 limitation does not apply to respite, skilled nursing,
31 hospice, or other nonacute care patients; and
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1 3. Has at least no more than six licensed acute care
2 inpatient beds.
3 (f)(g) "Swing-bed" means a bed which can be used
4 interchangeably as either a hospital, skilled nursing facility
5 (SNF), or intermediate care facility (ICF) bed pursuant to 42
6 C.F.R. parts 405, 435, 440, 442, and 447.
7 Section 5. Subsection (1) of section 395.603, Florida
8 Statutes, is amended to read:
9 395.603 Deactivation of general hospital beds; rural
10 hospital impact statement.--
11 (1) The agency shall establish, by rule, a process by
12 which A rural hospital, as defined in s. 395.602, which that
13 seeks licensure as a rural primary care hospital or as an
14 emergency care hospital, or becomes a certified rural health
15 clinic as defined in Pub. L. No. 95-210, or becomes a primary
16 care program such as a county health department, community
17 health center, or other similar outpatient program that
18 provides preventive and curative services, may deactivate
19 general hospital beds. A critical access hospital or a rural
20 primary care hospital hospitals and emergency care hospitals
21 shall maintain the number of actively licensed general
22 hospital beds necessary for the facility to be certified for
23 Medicare reimbursement. Hospitals that discontinue inpatient
24 care to become rural health care clinics or primary care
25 programs shall deactivate all licensed general hospital beds.
26 All hospitals, clinics, and programs with inactive beds shall
27 provide 24-hour emergency medical care by staffing an
28 emergency room. Providers with inactive beds shall be subject
29 to the criteria in s. 395.1041. The agency shall specify in
30 rule requirements for making 24-hour emergency care available.
31 Inactive general hospital beds shall be included in the acute
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1 care bed inventory, maintained by the agency for
2 certificate-of-need purposes, for 10 years from the date of
3 deactivation of the beds. After 10 years have elapsed,
4 inactive beds shall be excluded from the inventory. The agency
5 shall, at the request of the licensee, reactivate the inactive
6 general beds upon a showing by the licensee that licensure
7 requirements for the inactive general beds are met.
8 Section 6. Section 395.604, Florida Statutes, is
9 amended to read:
10 395.604 Other Rural primary care hospitals hospital
11 programs.--
12 (1) The agency may license rural primary care
13 hospitals subject to federal approval for participation in the
14 Medicare and Medicaid programs. Rural primary care hospitals
15 shall be treated in the same manner as emergency care
16 hospitals and rural hospitals with respect to ss.
17 395.605(2)-(8)(a), 408.033(2)(b)3., and 408.038.
18 (2) The agency may designate essential access
19 community hospitals.
20 (3) The agency may adopt licensure rules for rural
21 primary care hospitals and essential access community
22 hospitals. Such rules must conform to s. 395.1055.
23 (3) For the purpose of Medicaid swing-bed
24 reimbursement pursuant to the Medicaid program, the agency
25 shall treat rural primary care hospitals in the same manner as
26 rural hospitals.
27 (4) For the purpose of participation in the Medical
28 Education Reimbursement and Loan Repayment Program as defined
29 in s. 1009.65 or other loan repayment or incentive programs
30 designed to relieve medical workforce shortages, the
31
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1 department shall treat rural primary care hospitals in the
2 same manner as rural hospitals.
3 (5) For the purpose of coordinating primary care
4 services described in s. 154.011(1)(c)10., the department
5 shall treat rural primary care hospitals in the same manner as
6 rural hospitals.
7 (6) Rural hospitals that make application under the
8 certificate-of-need program to be licensed as rural primary
9 care hospitals shall receive expedited review as defined in s.
10 408.032. Rural primary care hospitals seeking relicensure as
11 acute care general hospitals shall also receive expedited
12 review.
13 (7) Rural primary care hospitals are exempt from
14 certificate-of-need requirements for home health and hospice
15 services and for swing beds in a number that does not exceed
16 one-half of the facility's licensed beds.
17 (8) Rural primary care hospitals shall have agreements
18 with other hospitals, skilled nursing facilities, home health
19 agencies, and providers of diagnostic-imaging and laboratory
20 services that are not provided on site but are needed by
21 patients.
22 (4) The department may seek federal recognition of
23 emergency care hospitals authorized by s. 395.605 under the
24 essential access community hospital program authorized by the
25 Omnibus Budget Reconciliation Act of 1989.
26 Section 7. Section 395.6061, Florida Statutes, is
27 amended to read:
28 395.6061 Rural hospital capital improvement.--There is
29 established a rural hospital capital improvement grant
30 program.
31
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1 (1) A rural hospital as defined in s. 395.602 may
2 apply to the department for a grant to acquire, repair,
3 improve, or upgrade systems, facilities, or equipment. The
4 grant application must provide information that includes:
5 (a) A statement indicating the problem the rural
6 hospital proposes to solve with the grant funds;
7 (b) The strategy proposed to resolve the problem;
8 (c) The organizational structure, financial system,
9 and facilities that are essential to the proposed solution;
10 (d) The projected longevity of the proposed solution
11 after the grant funds are expended;
12 (e) Evidence of participation in a rural health
13 network as defined in s. 381.0406 and evidence that, after
14 July 1, 2008, the application is consistent with the rural
15 health network long-range development plan;
16 (f) Evidence that the rural hospital has difficulty in
17 obtaining funding or that funds available for the proposed
18 solution are inadequate;
19 (g) Evidence that the grant funds will assist in
20 maintaining or returning the hospital to an economically
21 stable condition or that any plan for closure of the hospital
22 or realignment of services will involve development of
23 innovative alternatives for the provision of needed
24 discontinued services;
25 (h) Evidence of a satisfactory record-keeping system
26 to account for grant fund expenditures within the rural
27 county; and
28 (i) A rural health network plan that includes a
29 description of how the plan was developed, the goals of the
30 plan, the links with existing health care providers under the
31 plan, Indicators quantifying the hospital's financial status
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1 well-being, measurable outcome targets, and the current
2 physical and operational condition of the hospital.
3 (2) Each rural hospital as defined in s. 395.602 shall
4 receive a minimum of $200,000 $100,000 annually, subject to
5 legislative appropriation, upon application to the Department
6 of Health, for projects to acquire, repair, improve, or
7 upgrade systems, facilities, or equipment.
8 (3) Any remaining funds may shall annually be
9 disbursed to rural hospitals in accordance with this section.
10 The Department of Health shall establish, by rule, criteria
11 for awarding grants for any remaining funds, which must be
12 used exclusively for the support and assistance of rural
13 hospitals as defined in s. 395.602, including criteria
14 relating to the level of charity uncompensated care rendered
15 by the hospital, the financial stability of the hospital,
16 financial and quality indicators for the hospital, whether the
17 project is sustainable beyond the funding period, the
18 hospital's ability to improve or expand services, the
19 hospital's participation in a rural health network as defined
20 in s. 381.0406, and the proposed use of the grant by the rural
21 hospital to resolve a specific problem. The department must
22 consider any information submitted in an application for the
23 grants in accordance with subsection (1) in determining
24 eligibility for and the amount of the grant, and none of the
25 individual items of information by itself may be used to deny
26 grant eligibility.
27 (4) To receive any of the remaining funds, a rural
28 hospital must agree to be bound by the terms of a
29 participation agreement with the department, which may
30 include:
31
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1 (a) The appointment of a health care expert under
2 contract with the department to analyze and monitor the
3 hospital's operations.
4 (b) The establishment of an orientation and
5 development program for members of the board.
6 (c) The approval of any facility relocation plans.
7 (5)(4) The department shall ensure that the funds are
8 used solely for the purposes specified in this section. The
9 total grants awarded pursuant to this section shall not exceed
10 the amount appropriated for this program.
11 Section 8. Subsection (12) of section 409.908, Florida
12 Statutes, is amended to read:
13 409.908 Reimbursement of Medicaid providers.--Subject
14 to specific appropriations, the agency shall reimburse
15 Medicaid providers, in accordance with state and federal law,
16 according to methodologies set forth in the rules of the
17 agency and in policy manuals and handbooks incorporated by
18 reference therein. These methodologies may include fee
19 schedules, reimbursement methods based on cost reporting,
20 negotiated fees, competitive bidding pursuant to s. 287.057,
21 and other mechanisms the agency considers efficient and
22 effective for purchasing services or goods on behalf of
23 recipients. If a provider is reimbursed based on cost
24 reporting and submits a cost report late and that cost report
25 would have been used to set a lower reimbursement rate for a
26 rate semester, then the provider's rate for that semester
27 shall be retroactively calculated using the new cost report,
28 and full payment at the recalculated rate shall be effected
29 retroactively. Medicare-granted extensions for filing cost
30 reports, if applicable, shall also apply to Medicaid cost
31 reports. Payment for Medicaid compensable services made on
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1 behalf of Medicaid eligible persons is subject to the
2 availability of moneys and any limitations or directions
3 provided for in the General Appropriations Act or chapter 216.
4 Further, nothing in this section shall be construed to prevent
5 or limit the agency from adjusting fees, reimbursement rates,
6 lengths of stay, number of visits, or number of services, or
7 making any other adjustments necessary to comply with the
8 availability of moneys and any limitations or directions
9 provided for in the General Appropriations Act, provided the
10 adjustment is consistent with legislative intent.
11 (12)(a) A physician shall be reimbursed the lesser of
12 the amount billed by the provider or the Medicaid maximum
13 allowable fee established by the agency.
14 (b) The agency shall adopt a fee schedule, subject to
15 any limitations or directions provided for in the General
16 Appropriations Act, based on a resource-based relative value
17 scale for pricing Medicaid physician services. Under this fee
18 schedule, physicians shall be paid a dollar amount for each
19 service based on the average resources required to provide the
20 service, including, but not limited to, estimates of average
21 physician time and effort, practice expense, and the costs of
22 professional liability insurance. The fee schedule shall
23 provide increased reimbursement for preventive and primary
24 care services and lowered reimbursement for specialty services
25 by using at least two conversion factors, one for cognitive
26 services and another for procedural services. The fee schedule
27 shall not increase total Medicaid physician expenditures
28 unless moneys are available, and shall be phased in over a
29 2-year period beginning on July 1, 1994. The Agency for Health
30 Care Administration shall seek the advice of a 16-member
31 advisory panel in formulating and adopting the fee schedule.
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1 The panel shall consist of Medicaid physicians licensed under
2 chapters 458 and 459 and shall be composed of 50 percent
3 primary care physicians and 50 percent specialty care
4 physicians.
5 (c) Notwithstanding paragraph (b), reimbursement fees
6 to physicians for providing total obstetrical services to
7 Medicaid recipients, which include prenatal, delivery, and
8 postpartum care, shall be at least $1,500 per delivery for a
9 pregnant woman with low medical risk and at least $2,000 per
10 delivery for a pregnant woman with high medical risk. However,
11 reimbursement to physicians working in Regional Perinatal
12 Intensive Care Centers designated pursuant to chapter 383, for
13 services to certain pregnant Medicaid recipients with a high
14 medical risk, may be made according to obstetrical care and
15 neonatal care groupings and rates established by the agency.
16 Nurse midwives licensed under part I of chapter 464 or
17 midwives licensed under chapter 467 shall be reimbursed at no
18 less than 80 percent of the low medical risk fee. The agency
19 shall by rule determine, for the purpose of this paragraph,
20 what constitutes a high or low medical risk pregnant woman and
21 shall not pay more based solely on the fact that a caesarean
22 section was performed, rather than a vaginal delivery. The
23 agency shall by rule determine a prorated payment for
24 obstetrical services in cases where only part of the total
25 prenatal, delivery, or postpartum care was performed. The
26 Department of Health shall adopt rules for appropriate
27 insurance coverage for midwives licensed under chapter 467.
28 Prior to the issuance and renewal of an active license, or
29 reactivation of an inactive license for midwives licensed
30 under chapter 467, such licensees shall submit proof of
31 coverage with each application.
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1 (d) Notwithstanding other provisions of this
2 subsection, physicians licensed under chapter 458 or chapter
3 459 who have a provider agreement with a rural health network
4 as established in s. 381.0406 shall be paid a 10-percent bonus
5 over the Medicaid physician fee schedule for any physician
6 service provided within the geographic boundary of a rural
7 county as defined by the most recent United States Census as
8 rural.
9 Section 9. Subsection (43) of section 408.07, Florida
10 Statutes, is amended to read:
11 408.07 Definitions.--As used in this chapter, with the
12 exception of ss. 408.031-408.045, the term:
13 (43) "Rural hospital" means an acute care hospital
14 licensed under chapter 395, having 100 or fewer licensed beds
15 and an emergency room, and which is:
16 (a) The sole provider within a county with a
17 population density of no greater than 100 persons per square
18 mile;
19 (b) An acute care hospital, in a county with a
20 population density of no greater than 100 persons per square
21 mile, which is at least 30 minutes of travel time, on normally
22 traveled roads under normal traffic conditions, from another
23 acute care hospital within the same county;
24 (c) A hospital supported by a tax district or
25 subdistrict whose boundaries encompass a population of 100
26 persons or fewer per square mile;
27 (d) A hospital with a service area that has a
28 population of 100 persons or fewer per square mile. As used in
29 this paragraph, the term "service area" means the fewest
30 number of zip codes that account for 75 percent of the
31 hospital's discharges for the most recent 5-year period, based
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1 on information available from the hospital inpatient discharge
2 database in the Florida Center for Health Information and
3 Policy Analysis at the Agency for Health Care Administration;
4 or
5 (e) A critical access hospital.
6
7 Population densities used in this subsection must be based
8 upon the most recently completed United States census. A
9 hospital that received funds under s. 409.9116 for a quarter
10 beginning no later than July 1, 2002, is deemed to have been
11 and shall continue to be a rural hospital from that date
12 through June 30, 2012, if the hospital continues to have 100
13 or fewer licensed beds and an emergency room, or meets the
14 criteria of s. 395.602(2)(d)4. s. 395.602(2)(e)4. An acute
15 care hospital that has not previously been designated as a
16 rural hospital and that meets the criteria of this subsection
17 shall be granted such designation upon application, including
18 supporting documentation, to the Agency for Health Care
19 Administration.
20 Section 10. Subsection (6) of section 409.9116,
21 Florida Statutes, is amended to read:
22 409.9116 Disproportionate share/financial assistance
23 program for rural hospitals.--In addition to the payments made
24 under s. 409.911, the Agency for Health Care Administration
25 shall administer a federally matched disproportionate share
26 program and a state-funded financial assistance program for
27 statutory rural hospitals. The agency shall make
28 disproportionate share payments to statutory rural hospitals
29 that qualify for such payments and financial assistance
30 payments to statutory rural hospitals that do not qualify for
31 disproportionate share payments. The disproportionate share
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1 program payments shall be limited by and conform with federal
2 requirements. Funds shall be distributed quarterly in each
3 fiscal year for which an appropriation is made.
4 Notwithstanding the provisions of s. 409.915, counties are
5 exempt from contributing toward the cost of this special
6 reimbursement for hospitals serving a disproportionate share
7 of low-income patients.
8 (6) This section applies only to hospitals that were
9 defined as statutory rural hospitals, or their
10 successor-in-interest hospital, prior to January 1, 2001. Any
11 additional hospital that is defined as a statutory rural
12 hospital, or its successor-in-interest hospital, on or after
13 January 1, 2001, is not eligible for programs under this
14 section unless additional funds are appropriated each fiscal
15 year specifically to the rural hospital disproportionate share
16 and financial assistance programs in an amount necessary to
17 prevent any hospital, or its successor-in-interest hospital,
18 eligible for the programs prior to January 1, 2001, from
19 incurring a reduction in payments because of the eligibility
20 of an additional hospital to participate in the programs. A
21 hospital, or its successor-in-interest hospital, which
22 received funds pursuant to this section before January 1,
23 2001, and which qualifies under s. 395.602(2)(d) s.
24 395.602(2)(e), shall be included in the programs under this
25 section and is not required to seek additional appropriations
26 under this subsection.
27 Section 11. Paragraph (b) of subsection (2) of section
28 1009.65, Florida Statutes, is amended to read:
29 1009.65 Medical Education Reimbursement and Loan
30 Repayment Program.--
31
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1 (2) From the funds available, the Department of Health
2 shall make payments to selected medical professionals as
3 follows:
4 (b) All payments shall be contingent on continued
5 proof of primary care practice in an area defined in s.
6 395.602(2)(d) s. 395.602(2)(e), or an underserved area
7 designated by the Department of Health, provided the
8 practitioner accepts Medicaid reimbursement if eligible for
9 such reimbursement. Correctional facilities, state hospitals,
10 and other state institutions that employ medical personnel
11 shall be designated by the Department of Health as underserved
12 locations. Locations with high incidences of infant mortality,
13 high morbidity, or low Medicaid participation by health care
14 professionals may be designated as underserved.
15 Section 12. The Office of Program Policy Analysis and
16 Government Accountability shall contract with an entity having
17 expertise in the financing of rural hospital capital
18 improvement projects to study the financing options for
19 replacing or changing the use of rural hospital facilities
20 having 55 or fewer beds which were built before 1985 and which
21 have not had major renovations since 1985. For each such
22 hospital, the contractor shall assess the need to replace or
23 convert the facility, identify all available sources of
24 financing for such replacement or conversion and assess each
25 community's capacity to maximize these funding options,
26 propose a model replacement facility if a facility should be
27 replaced, and propose alternative uses of the facility if
28 continued operation of the hospital is not financially
29 feasible. Based on the results of the contract study, the
30 Office of Program Policy Analysis and Government
31 Accountability shall submit recommendations to the Legislature
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1 by February 1, 2008, regarding whether the state should
2 provide financial assistance to replace or convert these rural
3 hospital facilities and what form that assistance should take.
4 Section 13. Section 395.605, Florida Statutes, is
5 repealed.
6 Section 14. The sum of $440,000 from nonrecurring
7 general revenue funds is appropriated to the Office of Program
8 Policy Analysis and Government Accountability to implement
9 section 11 of this act.
10 Section 15. The sums of $3,638,709 in recurring
11 general revenue funds and $5,067,392 in recurring funds from
12 the Medical Care Trust Fund are appropriated to the Agency for
13 Health Care Administration to implement the 10-percent
14 Medicaid fee schedule bonus payment as provided in this act.
15 Section 16. The sum of $3 million in recurring general
16 revenue funds is appropriated to the Department of Health to
17 implement rural health network infrastructure development as
18 provided in section 2 of this act.
19 Section 17. The sum of $7.5 million in nonrecurring
20 general revenue funds is appropriated to the Department of
21 Health to implement the rural hospital capital improvement
22 grant program as provided in section 6 of this act.
23 Section 18. The sums of $196,818 in recurring general
24 revenue funds and $17,556 in nonrecurring general revenue
25 funds are appropriated to the Department of Health, and three
26 full-time equivalent positions and associated salary rate of
27 121,619 are authorized to implement this act.
28 Section 19. This act shall take effect July 1, 2007.
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Florida Senate - 2007 CS for SB 424
588-2158-07
1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 424
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4 The committee substitute revises the Department of Health
(DOH) duties relating to the Area Health Education Center
5 (AHEC) network in Florida. The committee substitute specifies
that the AHEC network include the AHECs at the medical schools
6 in the state. The DOH must contract with the medical schools
at these universities to assist in funding the AHEC network,
7 which links the education of medical students, interns, and
residents with the provision of primary care services to
8 medically under served populations.
9 The committee substitute establishes requirements for the AHEC
network relating to students in the health care professions
10 and health care providers serving medically underserved
populations. The committee substitute requires the DOH to make
11 every effort to assure that the network, rather than the
participating medical schools, does not discriminate among
12 enrollees with respect to age, race, sex, or health status.
The DOH may use no more than one percent of the annual
13 appropriation for administering and evaluating the network.
14 The committee substitute also modifies the functions and
activities of the rural health networks.
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