Florida Senate - 2017                        COMMITTEE AMENDMENT
       Bill No. CS for SB 1550
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       The Committee on Appropriations (Grimsley) recommended the
    1         Senate Amendment (with title amendment)
    3         Before line 34
    4  insert:
    5         Section 1. Present subsection (9) of section 395.1055,
    6  Florida Statutes, is redesignated as subsection (10), and a new
    7  subsection (9) is added to that section, to read:
    8         395.1055 Rules and enforcement.—
    9         (9) The agency shall establish a technical advisory panel
   10  to develop procedures and standards for measuring outcomes of
   11  pediatric cardiac catheterization programs and pediatric open
   12  heart surgery programs.
   13         (a) The panel must be composed of three at-large members,
   14  including one cardiologist who is board certified in caring for
   15  adults with congenital heart disease and two board-certified
   16  pediatric cardiologists, neither of whom may be employed by any
   17  of the hospitals specified in subparagraphs 1.-10. or their
   18  affiliates, each of whom is appointed by the Secretary of Health
   19  Care Administration, and 10 members, each of whom is a pediatric
   20  cardiologist or a pediatric cardiovascular surgeon, each
   21  appointed by the chief executive officer of one of the following
   22  hospitals:
   23         1. Johns Hopkins All Children’s Hospital in St. Petersburg.
   24         2. Arnold Palmer Hospital for Children in Orlando.
   25         3. Joe DiMaggio Children’s Hospital in Hollywood.
   26         4. Nicklaus Children’s Hospital in Miami.
   27         5. St. Joseph’s Children’s Hospital in Tampa.
   28         6. University of Florida Health Shands Hospital in
   29  Gainesville.
   30         7. University of Miami Holtz Children’s Hospital in Miami.
   31         8. Wolfson Children’s Hospital in Jacksonville.
   32         9. Florida Hospital for Children in Orlando.
   33         10. Nemours Children’s Hospital in Orlando.
   34         (b) Based on the recommendations of the panel, the agency
   35  shall develop and adopt rules for pediatric cardiac
   36  catheterization programs and pediatric open-heart surgery
   37  programs which include at least the following:
   38         1. A risk adjustment procedure that accounts for the
   39  variations in severity and case mix found in hospitals in this
   40  state;
   41         2. Outcome standards specifying expected levels of
   42  performance in pediatric cardiac programs. Such standards may
   43  include, but are not limited to, in-hospital mortality,
   44  infection rates, nonfatal myocardial infarctions, length of
   45  postoperative bleeds, and returns to surgery; and
   46         3. Specific steps to be taken by the agency and licensed
   47  facilities that do not meet the outcome standards within a
   48  specified time, including time required for detailed case
   49  reviews and development and implementation of corrective action
   50  plans.
   51         Section 2. Paragraph (b) of subsection (3) of section
   52  408.0361, Florida Statutes, is amended to read:
   53         408.0361 Cardiovascular services and burn unit licensure.—
   54         (3) In establishing rules for adult cardiovascular
   55  services, the agency shall include provisions that allow for:
   56         (b) For a hospital seeking a Level I program, demonstration
   57  that, for the most recent 12-month period as reported to the
   58  agency, it has provided a minimum of 300 adult inpatient and
   59  outpatient diagnostic cardiac catheterizations or, for the most
   60  recent 12-month period, has discharged or transferred at least
   61  300 inpatients with the principal diagnosis of ischemic heart
   62  disease and that it has a formalized, written transfer agreement
   63  with a hospital that has a Level II program, including written
   64  transport protocols to ensure safe and efficient transfer of a
   65  patient within 60 minutes. However, a hospital located more than
   66  100 road miles from the closest Level II adult cardiovascular
   67  services program does not need to meet the 60-minute transfer
   68  time protocol if the hospital demonstrates that it has a
   69  formalized, written transfer agreement with a hospital that has
   70  a Level II program. The agreement must include written transport
   71  protocols to ensure the safe and efficient transfer of a
   72  patient, taking into consideration the patient’s clinical and
   73  physical characteristics, road and weather conditions, and
   74  viability of ground and air ambulance service to transfer the
   75  patient. At a minimum, the rules for adult cardiovascular
   76  services must require nursing and technical staff to have
   77  demonstrated experience in handling acutely ill patients
   78  requiring percutaneous cardiac intervention in dedicated cardiac
   79  interventional laboratories or surgical centers. If a staff
   80  member’s previous experience was in a dedicated cardiac
   81  interventional laboratory at a hospital that did not have an
   82  approved adult open-heart-surgery program, the staff member’s
   83  previous experience does not qualify unless, at the time the
   84  staff member acquired his or her experience, the dedicated
   85  cardiac interventional laboratory:
   86         1.Had an annual volume of 500 or more percutaneous cardiac
   87  intervention procedures;
   88         2.Achieved a demonstrated success rate of 95 percent or
   89  greater for percutaneous cardiac intervention procedures;
   90         3.Experienced a complication rate of less than 5 percent
   91  for percutaneous cardiac intervention procedures; and
   92         4.Performed diverse cardiac procedures, including, but not
   93  limited to, balloon angioplasty and stenting, rotational
   94  atherectomy, cutting balloon atheroma remodeling, and procedures
   95  relating to left ventricular support capability.
   96         Section 3. For the 2017-2018 fiscal year, the sum of
   97  $95,620 is appropriated from the Health Care Trust Fund to the
   98  Agency for Health Care Administration for the purpose of
   99  implementing s. 395.1055(9), Florida Statutes.
  101  ================= T I T L E  A M E N D M E N T ================
  102  And the title is amended as follows:
  103         Delete line 2
  104  and insert:
  105         An act relating to health care services; amending s.
  106         395.1055, F.S.; requiring the Agency for Health Care
  107         Administration to establish a technical advisory panel
  108         to develop procedures and standards for measuring
  109         outcomes of pediatric cardiac catheterization programs
  110         and pediatric open-heart surgery programs; providing
  111         for the membership of the technical advisory panel;
  112         requiring the agency to develop and adopt rules for
  113         pediatric cardiac catheterization programs and
  114         pediatric open-heart surgery programs based on
  115         recommendations of the technical advisory panel;
  116         amending s. 408.0361, F.S.; establishing additional
  117         criteria that must be included by the agency in rules
  118         relating to adult cardiovascular services at hospitals
  119         seeking licensure for a Level I program; providing an
  120         appropriation;