Florida Senate - 2017                               CS for SB 58
       By the Committee on Appropriations; and Senator Grimsley
       576-01981A-17                                           201758c1
    1                        A bill to be entitled                      
    2         An act relating to cardiac programs; amending s.
    3         395.1055, F.S.; requiring the Agency for Health Care
    4         Administration to establish a technical advisory panel
    5         to develop procedures and standards for measuring
    6         outcomes of pediatric cardiac catheterization programs
    7         and pediatric open-heart surgery programs;
    8         establishing membership of the technical advisory
    9         panel; requiring the agency to develop and adopt rules
   10         for pediatric cardiac catheterization programs and
   11         pediatric open-heart surgery programs based on
   12         recommendations of the technical advisory panel;
   13         amending s. 408.0361, F.S.; establishing additional
   14         criteria that must be included by the Agency for
   15         Health Care Administration in rules relating to adult
   16         cardiovascular services at hospitals seeking licensure
   17         for a Level I program; providing an appropriation;
   18         providing an effective date.
   20  Be It Enacted by the Legislature of the State of Florida:
   22         Section 1. Present subsection (9) of section 395.1055,
   23  Florida Statutes, is redesignated as subsection (10), and a new
   24  subsection (9) is added to that section, to read:
   25         395.1055 Rules and enforcement.—
   26         (9) The agency shall establish a technical advisory panel
   27  to develop procedures and standards for measuring outcomes of
   28  pediatric cardiac catheterization programs and pediatric open
   29  heart surgery programs.
   30         (a) The panel shall include 1 at-large member who has
   31  expertise in pediatric and adult congenital heart disease,
   32  appointed by the Secretary of Health Care Administration, and 10
   33  members, 1 appointed by each chief executive officer of the
   34  following hospitals, who must be pediatric cardiologists or
   35  pediatric cardiovascular surgeons:
   36         1. Johns Hopkins All Children’s Hospital in St. Petersburg.
   37         2. Arnold Palmer Hospital for Children in Orlando.
   38         3. Joe DiMaggio Children’s Hospital in Hollywood.
   39         4. Nicklaus Children’s Hospital in Miami.
   40         5. St. Joseph’s Children’s Hospital in Tampa.
   41         6. University of Florida Health Shands Hospital in
   42  Gainesville.
   43         7. University of Miami Holtz Children’s Hospital in Miami.
   44         8. Wolfson Children’s Hospital in Jacksonville.
   45         9. Florida Hospital for Children in Orlando.
   46         10. Nemours Children’s Hospital in Orlando.
   47         (b) Based on the recommendations of the panel, the agency
   48  shall develop and adopt rules for pediatric cardiac
   49  catheterization programs and pediatric open-heart surgery
   50  programs which include at least the following:
   51         1. A risk adjustment procedure that accounts for the
   52  variations in severity and case mix found in hospitals in this
   53  state;
   54         2. Outcome standards specifying expected levels of
   55  performance in pediatric cardiac programs. Such standards may
   56  include, but are not limited to, in-hospital mortality,
   57  infection rates, nonfatal myocardial infarctions, length of
   58  postoperative bleeds, and returns to surgery; and
   59         3. Specific steps to be taken by the agency and licensed
   60  facilities that do not meet the outcome standards within a
   61  specified time, including time required for detailed case
   62  reviews and development and implementation of corrective action
   63  plans.
   64         Section 2. Paragraph (b) of subsection (3) of section
   65  408.0361, Florida Statutes, is amended to read:
   66         408.0361 Cardiovascular services and burn unit licensure.—
   67         (3) In establishing rules for adult cardiovascular
   68  services, the agency shall include provisions that allow for:
   69         (b) For a hospital seeking a Level I program, demonstration
   70  that, for the most recent 12-month period as reported to the
   71  agency, it has provided a minimum of 300 adult inpatient and
   72  outpatient diagnostic cardiac catheterizations or, for the most
   73  recent 12-month period, has discharged or transferred at least
   74  300 inpatients with the principal diagnosis of ischemic heart
   75  disease and that it has a formalized, written transfer agreement
   76  with a hospital that has a Level II program, including written
   77  transport protocols to ensure safe and efficient transfer of a
   78  patient within 60 minutes. However, a hospital located more than
   79  100 road miles from the closest Level II adult cardiovascular
   80  services program does not need to meet the 60-minute transfer
   81  time protocol if the hospital demonstrates that it has a
   82  formalized, written transfer agreement with a hospital that has
   83  a Level II program. The agreement must include written transport
   84  protocols to ensure the safe and efficient transfer of a
   85  patient, taking into consideration the patient’s clinical and
   86  physical characteristics, road and weather conditions, and
   87  viability of ground and air ambulance service to transfer the
   88  patient. At a minimum, the rules for adult cardiovascular
   89  services must require nursing and technical staff to have
   90  demonstrated experience in handling acutely ill patients
   91  requiring percutaneous cardiac intervention in dedicated cardiac
   92  interventional laboratories or surgical centers. If a staff
   93  member’s previous experience was in a dedicated cardiac
   94  interventional laboratory at a hospital that did not have an
   95  approved adult open-heart-surgery program, the staff member’s
   96  previous experience does not qualify unless, at the time the
   97  staff member acquired his or her experience, the dedicated
   98  cardiac interventional laboratory:
   99         1.Had an annual volume of 500 or more percutaneous cardiac
  100  intervention procedures;
  101         2.Achieved a demonstrated success rate of 95 percent or
  102  greater for percutaneous cardiac intervention procedures;
  103         3.Experienced a complication rate of less than 5 percent
  104  for percutaneous cardiac intervention procedures; and
  105         4.Performed diverse cardiac procedures, including, but not
  106  limited to, balloon angioplasty and stenting, rotational
  107  atherectomy, cutting balloon atheroma remodeling, and procedures
  108  relating to left ventricular support capability.
  109         Section 3. For the 2017-2018 fiscal year, the sum of
  110  $95,620 is appropriated from the Health Care Trust Fund to the
  111  Agency for Health Care Administration for the purpose of
  112  implementing s. 395.1055(9), Florida Statutes.
  113         Section 4. This act shall take effect July 1, 2017.