HB 851

1	A bill to be entitled
2	An act relating to decisionmaking in health care;
3	providing a short title; providing legislative purpose;
4	amending s. 408.063, F.S.; providing definitions;
5	requiring the Agency for Health Care Administration to
6	publish and disseminate to the public information
7	concerning violations of federal regulations, complaints
8	made to regulatory agencies, and nurse staffing levels and
9	turnover rates; requiring the agency to adopt rules
10	governing the data to be submitted by hospitals; requiring
11	the agency to calculate and make available upon request
12	hospital staffing levels and staffing schedules; providing
13	certain requirements for the staffing schedule; requiring
14	that the records and methods used to determine staffing
15	levels be made available to the public; providing an
16	effective date.
17
18	Be It Enacted by the Legislature of the State of Florida:
19
20	Section 1.  This act may be cited as the "Patients' Right-
21	to-Know Act."
22	Section 2.  The purpose of this act is to improve health
23	care in this state by providing information concerning the
24	financial health, staffing levels, and safety of hospitals in
25	this state.
26	Section 3.  Subsection (2) of section 408.063, Florida
27	Statutes, is amended to read:
28	408.063  Dissemination of health care information.--
29	(2)(a)  As used in this subsection, the term:
30	1.  "Agency nurse" means any direct care nurse, not
31	directly employed by the hospital, who provides care in a
32	hospital and is working for the purpose of providing
33	supplemental staffing in the hospital.
34	2.  "Average daily census" means the average number of
35	patients receiving service in any given 24-hour period beginning
36	at midnight in each clinical service area of the hospital.
37	3.  "Average daily CNA staffing level" means the average
38	numerical certified nursing assistant-to-patient ratio within a
39	nursing department or unit. The ratio is calculated by dividing
40	the annual average daily census for the nursing department or
41	unit by the average number of direct care CNA FTE's per shift
42	for the nursing department or unit.
43	4.  "Average daily LPN staffing level" means the average
44	numerical licensed professional nurse-to-patient ratio within a
45	nursing department or unit. The ratio is calculated by dividing
46	the annual average daily census for the nursing department or
47	unit by the average number of direct care LPN FTE's per shift
48	for the nursing department or unit.
49	5.  "Average daily RN staffing level" means the average
50	numerical direct care nurse-to-patient ratio within a nursing
51	department or unit. The ratio is calculated by dividing the
52	annual average daily census for the nursing department or unit
53	by the average number of direct care RN FTE's per shift for the
54	nursing department or unit.
55	6.  "Direct care nurse" means any registered nurse who has
56	direct responsibility to oversee or carry out medical regimens
57	or nursing care for one or more patients. A nurse administrator,
58	nurse supervisor, nurse educator, charge nurse, or other
59	registered nurse who does not have a specific patient assignment
60	may not be included in the calculation of the staffing level.
61	7.  "Hospital" means an acute care hospital licensed under
62	s. 395.003.
63	8.  "Registered nurse turnover rate" means the number of
64	registered nurses who are no longer employed at the hospital
65	during the year divided by the average of registered nurses
66	employed on the first day of the year and the last day of the
67	year.
68	9.  "Registered nurse vacancy rate" means the number of
69	vacant registered nurse positions within a hospital divided by
70	the total number of filled positions plus the total number of
71	vacant positions within that hospital.
72	10.  "Unit" means a functional division or area of a
73	hospital in which nursing care is provided.
74	(b)  The agency shall publish and disseminate information
75	to the public which will enhance informed decisionmaking in the
76	selection of health care providers, facilities, and services.
77	Such information shall include, but need not be limited to, the
78	number and description of violations of regulations of the
79	Occupational Safety and Health Administration, the registered
80	nurse vacancy rate, the registered nurse turnover rate, the
81	results of the Consumer Assessment of Healthcare Providers and
82	Systems hospital survey, the number and description of
83	complaints made to the Joint Commission on Accreditation of
84	Healthcare Organizations and the Agency for Health Care
85	Administration, specific average daily RN staffing levels,
86	specific average daily LPN staffing levels, specific average
87	daily CNA levels, and the percent of nursing hours that are
88	completed by agency nurses for the following hospital units:
89	medical-surgical, adult critical care, pediatrics, pediatric
90	intensive care, neonatal intensive care, trauma intensive care,
91	mother-baby unit, psychiatric unit, ambulatory care and
92	outpatient, dialysis, cardiac catheterization laboratory,
93	operating room, medical oncology, burn unit, transplant unit,
94	rehabilitation unit, gastrointestinal laboratory, emergency,
95	telemetry, and recovery unit, including postanesthesia care.
96	Such publications may identify average charges for specified
97	services, lengths of stay associated with established diagnostic
98	groups, readmission rates, mortality rates, recommended
99	guidelines for selection and use of health care providers,
100	health care facilities, and health care services, and such other
101	information as the agency deems appropriate.
102	(c)  The agency shall adopt rules regarding the reporting
103	requirements enumerated in this subsection, including, but not
104	limited to, additional data to be submitted by hospitals and the
105	format and timetable for making reports. The agency may
106	calculate and make available the average daily staffing levels
107	by unit in a manner that health care research has shown to have
108	a significant effect on the quality of patient care and patient
109	outcomes.
110	(d)  The agency shall ensure that the nurse-staffing data
111	made available pursuant to paragraph (c) is risk-adjusted for
112	patient acuity using the risk-adjustment methodology described
113	in s. 408.061(1) or an equivalent methodology that is consistent
114	with national standards employed by the Agency for Healthcare
115	Research and Quality.
116	(e)  The current staffing level and anticipated staffing
117	schedule shall be available upon request for each patient care
118	unit for the effective date of that schedule. Each schedule
119	shall list the assigned nursing personnel and the average daily
120	census for each patient care unit. All records required under
121	this subsection, including anticipated staffing schedules and
122	the methods used to determine and adjust staffing levels, shall
123	be made available to the public upon request.
124	Section 4.  This act shall take effect July 1, 2008.

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