Florida Senate - 2013                          SENATOR AMENDMENT
       Bill No. CS/CS/HB 1159, 1st Eng.
                                Barcode 885832                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                Floor: 1/AD/3R         .           Floor: CA            
             05/03/2013 11:09 AM       .      05/03/2013 05:53 PM       

       Senator Hays moved the following:
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Paragraph (a) of subsection (7) and subsection
    6  (14) of section 395.4001, Florida Statutes, are amended to read:
    7         395.4001 Definitions.—As used in this part, the term:
    8         (7) “Level II trauma center” means a trauma center that:
    9         (a) Is verified by the department to be in substantial
   10  compliance with Level II trauma center standards and has been
   11  approved by the department to operate as a Level II trauma
   12  center or is designated pursuant to s. 395.4025(14).
   13         (14) “Trauma center” means a hospital that has been
   14  verified by the department to be in substantial compliance with
   15  the requirements in s. 395.4025 and has been approved by the
   16  department to operate as a Level I trauma center, Level II
   17  trauma center, or pediatric trauma center, or is designated by
   18  the department as a Level II trauma center pursuant to s.
   19  395.4025(14).
   20         Section 2. Paragraph (k) of subsection (1) of section
   21  395.401, Florida Statutes, is amended to read:
   22         395.401 Trauma services system plans; approval of trauma
   23  centers and pediatric trauma centers; procedures; renewal.—
   24         (1)
   25         (k) It is unlawful for any hospital or other facility to
   26  hold itself out as a trauma center unless it has been so
   27  verified or designated pursuant to s. 395.4025(14).
   28         Section 3. Subsection (14) of section 395.4025, Florida
   29  Statutes, is amended to read:
   30         395.4025 Trauma centers; selection; quality assurance;
   31  records.—
   32         (14) Notwithstanding the procedures established pursuant to
   33  subsections (1) through (13) in this section, hospitals located
   34  in areas with limited access to trauma center services shall be
   35  designated by the department as Level II trauma centers based on
   36  documentation of a valid certificate of trauma center
   37  verification from the American College of Surgeons. Areas with
   38  limited access to trauma center services are defined by the
   39  following criteria:
   40         (a)The hospital is located in a trauma service area with a
   41  population greater than 600,000 persons but a population density
   42  of less than 225 persons per square mile; and
   43         (b)The hospital is located in a county with no verified
   44  trauma center; and
   45         (c)The hospital is located at least 15 miles or 20 minutes
   46  travel time by ground transport from the nearest verified trauma
   47  center any other provisions of this section and rules adopted
   48  pursuant to this section, until the department has conducted the
   49  review provided under s. 395.402, only hospitals located in
   50  trauma services areas where there is no existing trauma center
   51  may apply.
   52         Section 4. Paragraphs (l) and (m) of subsection (4) of
   53  section 400.9905, Florida Statutes, are amended to read:
   54         400.9905 Definitions.—
   55         (4) “Clinic” means an entity where health care services are
   56  provided to individuals and which tenders charges for
   57  reimbursement for such services, including a mobile clinic and a
   58  portable equipment provider. As used in this part, the term does
   59  not include and the licensure requirements of this part do not
   60  apply to:
   61         (l) Orthotic, or prosthetic, pediatric cardiology, or
   62  perinatology clinical facilities or anesthesia clinical
   63  facilities that are not otherwise exempt under paragraph (a) or
   64  paragraph (k) and that are a publicly traded corporation or that
   65  are wholly owned, directly or indirectly, by a publicly traded
   66  corporation. As used in this paragraph, a publicly traded
   67  corporation is a corporation that issues securities traded on an
   68  exchange registered with the United States Securities and
   69  Exchange Commission as a national securities exchange.
   70         (m) Entities that are owned by a corporation that has $250
   71  million or more in total annual sales of health care services
   72  provided by licensed health care practitioners where one or more
   73  of the persons responsible for the operations of the entity are
   74  owners is a health care practitioner who is licensed in this
   75  state and who is responsible for supervising the business
   76  activities of the entity and is legally responsible for the
   77  entity’s compliance with state law for purposes of this part.
   79  Notwithstanding this subsection, an entity shall be deemed a
   80  clinic and must be licensed under this part in order to receive
   81  reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
   82  627.730-627.7405, unless exempted under s. 627.736(5)(h).
   83         Section 5. Subsection (2) of section 408.036, Florida
   84  Statutes, is amended to read:
   85         408.036 Projects subject to review; exemptions.—
   86         (2) PROJECTS SUBJECT TO EXPEDITED REVIEW.—Unless exempt
   87  pursuant to subsection (3), projects subject to an expedited
   88  review shall include, but not be limited to:
   89         (a) A transfer of a certificate of need, except that when
   90  an existing hospital is acquired by a purchaser, all
   91  certificates of need issued to the hospital which are not yet
   92  operational shall be acquired by the purchaser, without need for
   93  a transfer.
   94         (b) Replacement of a nursing home within the same district,
   95  if the proposed project site is located within a geographic area
   96  that contains at least 65 percent of the facility’s current
   97  residents and is within a 30-mile radius of the replaced nursing
   98  home.
   99         (c) Relocation of a portion of a nursing home’s licensed
  100  beds to a facility within the same district, if the relocation
  101  is within a 30-mile radius of the existing facility and the
  102  total number of nursing home beds in the district does not
  103  increase.
  104         (d) The new construction of a community nursing home in a
  105  retirement community as further provided in this paragraph.
  106         1. Expedited review under this paragraph is available if
  107  all of the following criteria are met:
  108         a. The residential use area of the retirement community is
  109  deed-restricted as housing for older persons as defined in s.
  110  760.29(4)(b).
  111         b. The retirement community is located in a county in which
  112  25 percent or more of its population is age 65 and older.
  113         c. The retirement community is located in a county that has
  114  a rate of no more than 16.1 beds per 1,000 persons age 65 years
  115  or older. The rate shall be determined by using the current
  116  number of licensed and approved community nursing home beds in
  117  the county per the agency’s most recent published inventory.
  118         d. The retirement community has a population of at least
  119  8,000 residents within the county, based on a population data
  120  source accepted by the agency.
  121         e. The number of proposed community nursing home beds in an
  122  application does not exceed the projected bed need after
  123  applying the rate of 16.1 beds per 1,000 persons aged 65 years
  124  and older projected for the county 3 years into the future using
  125  the estimates adopted by the agency, after subtracting the
  126  inventory of licensed and approved community nursing home beds
  127  in the county per the agency’s most recent published inventory.
  128         2. No more than 120 community nursing home beds shall be
  129  approved for a qualified retirement community under each request
  130  for application for expedited review. Subsequent requests for
  131  expedited review under this process shall not be made until 2
  132  years after construction of the facility has commenced or 1 year
  133  after the beds approved through the initial request are
  134  licensed, whichever occurs first.
  135         3. The total number of community nursing home beds which
  136  may be approved for any single deed-restricted community
  137  pursuant to this paragraph shall not exceed 240, regardless of
  138  whether the retirement community is located in more than one
  139  qualifying county.
  140         4. Each nursing home facility approved under this paragraph
  141  shall be dually certified for participation in the Medicare and
  142  Medicaid programs.
  143         5. Each nursing home facility approved under this paragraph
  144  shall be at least one mile from an existing approved and
  145  licensed community nursing home, measured over publicly owned
  146  roadways.
  147         6. Section 408.0435 does not apply to this paragraph.
  148         7. A retirement community requesting expedited review under
  149  this paragraph shall submit a written request to the agency for
  150  an expedited review. The request shall include the number of
  151  beds to be added and provide evidence of compliance with the
  152  criteria specified in subparagraph 1.
  153         8. After verifying that the retirement community meets the
  154  criteria for expedited review specified in subparagraph 1., the
  155  agency shall publicly notice in the Florida Administrative
  156  Register that a request for an expedited review has been
  157  submitted by a qualifying retirement community and that the
  158  qualifying retirement community intends to make land available
  159  for the construction and operation of a community nursing home.
  160  The agency’s notice shall identify where potential applicants
  161  can obtain information describing the sales price of, or terms
  162  of the land lease for, the property on which the project will be
  163  located and the requirements established by the retirement
  164  community. The agency notice shall also specify the deadline for
  165  submission of any certificate-of-need application, which shall
  166  not be earlier than the 91st day and not be later than the 125th
  167  day after the date the notice appears in the Florida
  168  Administrative Register.
  169         9. The qualified retirement community shall make land
  170  available to applicants it deems to have met its requirements
  171  for the construction and operation of a community nursing home
  172  but will sell or lease the land only to the applicant that is
  173  issued a certificate of need by the agency under the provisions
  174  of this paragraph.
  175         a. A certificate of need application submitted pursuant to
  176  this paragraph shall identify the intended site for the project
  177  within the retirement community and the anticipated costs for
  178  the project based on that site. The application shall also
  179  include written evidence that the retirement community has
  180  determined that the provider submitting the application and the
  181  project proposed by that provider satisfies its requirements for
  182  the project.
  183         b. The retirement community’s determination that more than
  184  one provider satisfies its requirements for the project does not
  185  preclude the retirement community from notifying the agency of
  186  the provider it prefers.
  187         10. Each application submitted shall be reviewed by the
  188  agency. If multiple applications are submitted for the project
  189  as published pursuant to subparagraph 8. above, then the
  190  competing applications shall be reviewed by the agency.
  192  The agency shall develop rules to implement the provisions for
  193  expedited review, including time schedule, application content
  194  which may be reduced from the full requirements of s.
  195  408.037(1), and application processing.
  196         Section 6. Paragraph (b) of subsection (2), subsection
  197  (10), and paragraph (c) of subsection (11) of section 893.055,
  198  Florida Statutes, is amended to read:
  199         893.055 Prescription drug monitoring program.—
  200         (2)
  201         (b) The department, when the direct support organization
  202  receives at least $20,000 in nonstate moneys or the state
  203  receives at least $20,000 in federal grants for the prescription
  204  drug monitoring program, shall adopt rules as necessary
  205  concerning the reporting, accessing the database, evaluation,
  206  management, development, implementation, operation, security,
  207  and storage of information within the system, including rules
  208  for when patient advisory reports are provided to pharmacies and
  209  prescribers. The patient advisory report shall be provided in
  210  accordance with s. 893.13(7)(a)8. The department shall work with
  211  the professional health care licensure boards, such as the Board
  212  of Medicine, the Board of Osteopathic Medicine, and the Board of
  213  Pharmacy; other appropriate organizations, such as the Florida
  214  Pharmacy Association, the Florida Medical Association, the
  215  Florida Retail Federation, and the Florida Osteopathic Medical
  216  Association, including those relating to pain management; and
  217  the Attorney General, the Department of Law Enforcement, and the
  218  Agency for Health Care Administration to develop rules
  219  appropriate for the prescription drug monitoring program.
  220         (10) All costs incurred by the department in administering
  221  the prescription drug monitoring program shall be funded through
  222  state funds, federal grants, or private funding applied for or
  223  received by the state. The department may not commit funds for
  224  the monitoring program without ensuring funding is available.
  225  The prescription drug monitoring program and the implementation
  226  thereof are contingent upon receipt of the nonstate funding. The
  227  department and state government shall cooperate with the direct
  228  support organization established pursuant to subsection (11) in
  229  seeking state funds, federal grant funds, other nonstate grant
  230  funds, gifts, donations, or other private moneys for the
  231  department if so long as the costs of doing so are not
  232  considered material. Nonmaterial costs for this purpose include,
  233  but are not limited to, the costs of mailing and personnel
  234  assigned to research or apply for a grant. Notwithstanding the
  235  exemptions to competitive-solicitation requirements under s.
  236  287.057(3)(f), the department shall comply with the competitive
  237  solicitation requirements under s. 287.057 for the procurement
  238  of any goods or services required by this section. Funds
  239  provided, directly or indirectly, by prescription drug
  240  manufacturers may not be used to implement the program.
  241         (11) The department may establish a direct-support
  242  organization that has a board consisting of at least five
  243  members to provide assistance, funding, and promotional support
  244  for the activities authorized for the prescription drug
  245  monitoring program.
  246         (c) The State Surgeon General shall appoint a board of
  247  directors for the direct-support organization. Members of the
  248  board shall serve at the pleasure of the State Surgeon General.
  249  The State Surgeon General shall provide guidance to members of
  250  the board to ensure that moneys received by the direct-support
  251  organization are not received from inappropriate sources.
  252  Inappropriate sources include, but are not limited to, donors,
  253  grantors, persons, or organizations, or pharmaceutical
  254  companies, that may monetarily or substantively benefit from the
  255  purchase of goods or services by the department in furtherance
  256  of the prescription drug monitoring program.
  257         Section 7. This act shall take effect upon becoming a law.
  259  ================= T I T L E  A M E N D M E N T ================
  260         And the title is amended as follows:
  261         Delete everything before the enacting clause
  262  and insert:
  263                        A bill to be entitled                      
  264         An act relating to health care facilities;
  265         amending s. 395.4001, F.S.; revising the definition of
  266         the terms “level II trauma center” and “trauma
  267         center”; amending s. 395.401, F.S.; making conforming
  268         changes; amending s. 395.4025, F.S.; establishing
  269         criteria for designating Level II trauma centers in
  270         areas with limited access to trauma center services;
  271         amending s. 400.9905, F.S.; revising a definition;
  272         amending s. 408.036, F.S.; providing for expedited
  273         review of certificate-of-need for licensed skilled
  274         nursing facilities in qualifying retirement
  275         communities; providing criteria for expedited review
  276         for licensed skilled nursing homes in qualifying
  277         retirement communities; limiting the number of beds
  278         per retirement community that can be added through
  279         expedited review; amending s. 893.055, F.S.; deleting
  280         obsolete provisions; deleting a provision that
  281         prohibits funds from prescription drug manufacturers
  282         to be used to implement the prescription drug
  283         monitoring program; authorizing the prescription drug
  284         monitoring program to be funded by state funds;
  285         revising the sources of money which are inappropriate
  286         for the direct-support organization of the
  287         prescription drug monitoring program to receive;
  288         providing an effective date.