Florida Senate - 2018                        COMMITTEE AMENDMENT
       Bill No. PCS (452688) for SB 622
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  02/01/2018           .                                

       The Committee on Appropriations (Bean) recommended the
    1         Senate Amendment (with directory and title amendments)
    3         Between lines 921 and 922
    4  insert:
    5         (9) The agency shall establish a technical advisory panel,
    6  pursuant to s. 20.052, to develop procedures and standards for
    7  measuring outcomes of pediatric cardiac catheterization programs
    8  and pediatric cardiovascular open-heart surgery programs.
    9         (a) Members of the panel must have technical expertise in
   10  pediatric cardiac medicine and shall serve without compensation
   11  and shall not be reimbursed for per diem and travel expenses.
   12  composed
   13         (b) Voting members of the panel shall include: 3 at-large
   14  members, including 1 cardiologist who is board certified in
   15  caring for adults with congenital heart disease and 2 board
   16  certified pediatric cardiologists, neither of whom may be
   17  employed by any of the hospitals specified in subparagraphs 1.
   18  10. or their affiliates, each of whom is appointed by the
   19  Secretary of Health Care Administration, and 10 members, and an
   20  alternate for each member, each of whom is a pediatric
   21  cardiologist or a pediatric cardiovascular surgeon, each
   22  appointed by the chief executive officer of one of the following
   23  hospitals:
   24         1. Johns Hopkins All Children’s Hospital in St. Petersburg.
   25         2. Arnold Palmer Hospital for Children in Orlando.
   26         3. Joe DiMaggio Children’s Hospital in Hollywood.
   27         4. Nicklaus Children’s Hospital in Miami.
   28         5. St. Joseph’s Children’s Hospital in Tampa.
   29         6. University of Florida Health Shands Hospital in
   30  Gainesville.
   31         7. University of Miami Holtz Children’s Hospital in Miami.
   32         8. Wolfson Children’s Hospital in Jacksonville.
   33         9. Florida Hospital for Children in Orlando.
   34         10. Nemours Children’s Hospital in Orlando.
   36  Appointments made under subparagraphs 1.-10. are contingent upon
   37  the hospital’s maintenance of pediatric certificates of need and
   38  the hospital’s compliance with this section and rules adopted
   39  thereunder, as determined by the Secretary of Health Care
   40  Administration. A member appointed under subparagraphs 1.-10.
   41  whose hospital fails to maintain such certificates or comply
   42  with standards may serve only as a nonvoting member until the
   43  hospital restores such certificates or complies with such
   44  standards.
   45         (c) The Secretary of Health Care Administration may appoint
   46  nonvoting members to the panel. Nonvoting members may include:
   47         1. The Secretary of Health Care Administration.
   48         2. The Surgeon General.
   49         3. The Deputy Secretary of Children’s Medical Services.
   50         4. Any current or past Division Director of Children’s
   51  Medical Services.
   52         5. A parent of a child with congenital heart disease.
   53         6. An adult with congenital heart disease.
   54         7. A representative from each of the following
   55  organizations: the Florida Chapter of the American Academy of
   56  Pediatrics, the Florida Chapter of the American College of
   57  Cardiology, the Greater Southeast Affiliate of the American
   58  Heart Association, the Adult Congenital Heart Association, the
   59  March of Dimes, the Florida Association of Children’s Hospitals,
   60  and the Florida Society of Thoracic and Cardiovascular Surgeons.
   61         (d)The panel shall meet biannually, or more frequently
   62  upon the call of the Secretary of Health Care Administration.
   63  Such meetings may be conducted telephonically, or by other
   64  electronic means.
   65         (e) The duties of the panel include recommending to the
   66  agency standards for quality of care, personnel, physical plant,
   67  equipment, emergency transportation, and data reporting for
   68  hospitals that provide pediatric cardiac services.
   69         (f) Beginning in January 1, 2020, and annually thereafter,
   70  the panel shall submit a report to the Governor, the President
   71  of the Senate, the Speaker of the House of Representatives, the
   72  Secretary of Health Care Administration, and the State Surgeon
   73  General. The report must summarize the panel’s activities during
   74  the preceding fiscal year and include data and performance
   75  measures on surgical morbidity and mortality for all pediatric
   76  cardiac programs.
   77         (b) Based on the recommendations of the panel, the agency
   78  shall develop and adopt rules for pediatric cardiac
   79  catheterization programs and pediatric open-heart surgery
   80  programs which include at least the following:
   81         1. A risk adjustment procedure that accounts for the
   82  variations in severity and case mix found in hospitals in this
   83  state;
   84         2. Outcome standards specifying expected levels of
   85  performance in pediatric cardiac programs. Such standards may
   86  include, but are not limited to, in-hospital mortality,
   87  infection rates, nonfatal myocardial infarctions, length of
   88  postoperative bleeds, and returns to surgery; and
   89         3. Specific steps to be taken by the agency and licensed
   90  facilities that do not meet the outcome standards within a
   91  specified time, including time required for detailed case
   92  reviews and development and implementation of corrective action
   93  plans.
   94         (c) This subsection is repealed on July 1, 2022.
   95         (10) Based on the recommendations of the advisory panel in
   96  subsection (9), the agency shall adopt rules for pediatric
   97  cardiac programs that, at a minimum, include:
   98         (a) Standards for pediatric cardiac catheterization
   99  services and pediatric cardiovascular surgery including quality
  100  of care, personnel, physical plant, equipment, emergency
  101  transportation, data reporting, and appropriate operating hours
  102  and timeframes for mobilization for emergency procedures.
  103         (b) Outcome standards consistent with nationally
  104  established levels of performance in pediatric cardiac programs.
  105         (c) Specific steps to be taken by the agency and licensed
  106  facilities when the facilities do not meet the outcome standards
  107  within a specified time, including time required for detailed
  108  case reviews and development and implementation of corrective
  109  action plans.
  110         (11) A pediatric cardiac program shall:
  111         (a) Be located in a hospital licensed under this chapter
  112  and include the following co-located components: a pediatric
  113  cardiology clinic, a pediatric cardiac catheterization
  114  laboratory, and a pediatric cardiovascular surgery program.
  115         (b) Have a risk adjustment surgical procedure protocol
  116  following the guidelines established by the Society of Thoracic
  117  Surgeons.
  118         (c) Have quality assurance and quality improvement
  119  processes in place to enhance clinical operation and patient
  120  satisfaction with services.
  121         (d) Participate in the clinical outcome reporting systems
  122  operated by the Society of Thoracic Surgeons and the American
  123  College of Cardiology.
  124         (12)(10) The agency may adopt rules to administer the
  125  requirements of part II of chapter 408.
  126         Section 32. Paragraph (k) is added to subsection (3) of
  127  section 408.05, Florida Statutes, to read:
  128         408.05 Florida Center for Health Information and
  129  Transparency.—
  130         (3) HEALTH INFORMATION TRANSPARENCY.—In order to
  131  disseminate and facilitate the availability of comparable and
  132  uniform health information, the agency shall perform the
  133  following functions:
  134         (k)Contract with the Society of Thoracic Surgeons and the
  135  American College of Cardiology to obtain data reported pursuant
  136  to s. 395.1055 for publication on the agency’s website in a
  137  manner that will allow consumers to be informed of aggregate
  138  data and to compare pediatric cardiac programs.
  140  ====== D I R E C T O R Y  C L A U S E  A M E N D M E N T ======
  141  And the directory clause is amended as follows:
  142         Delete lines 888 - 890
  143  and insert:
  144         Section 31. Present subsection (10) of section 395.1055,
  145  Florida Statutes, is redesignated as subsection (12),
  146  subsections (2), (3), and (9) of that section are amended,
  147  paragraph (i) is added to subsection (1) of that section, and a
  148  new subsection (10) and subsection (11) are added to that
  149  section, to read:
  151  ================= T I T L E  A M E N D M E N T ================
  152  And the title is amended as follows:
  153         Delete line 43
  154  and insert:
  155         nursing units; requiring the agency to adopt rules
  156         establishing standards for pediatric cardiac
  157         catheterization and pediatric cardiovascular surgery
  158         programs located in licensed hospitals; providing
  159         requirements for such programs; establishing minimum
  160         standards for rules for such pediatric cardiac
  161         programs; requiring hospitals with pediatric cardiac
  162         programs to participate in the clinical outcome
  163         reporting systems; revising duties and membership of
  164         the pediatric cardiac technical advisory panel;
  165         amending s. 408.05, F.S.; requiring the agency to
  166         contract with the Society of Thoracic Surgeons and the
  167         American College of Cardiology for collection of
  168         certain data for publication on the agency’s website
  169         for certain purposes; repealing ss. 395.10971 and
  170         395.10972,