Florida Senate - 2019                                    SB 1194
       By Senator Broxson
       1-00541-19                                            20191194__
    1                        A bill to be entitled                      
    2         An act relating to patient safety culture surveys;
    3         amending s. 408.05, F.S.; requiring the Agency for
    4         Health Care Administration to develop surveys to
    5         assess patient safety culture in certain health care
    6         facilities; amending s. 408.061, F.S.; revising
    7         requirements for the submission of health care data to
    8         the agency; amending s. 408.810, F.S.; requiring the
    9         submission of facility patient safety culture surveys
   10         as a condition of licensure; amending ss. 400.991,
   11         408.8065, and 408.820, F.S.; conforming cross
   12         references; providing an appropriation; providing an
   13         effective date.
   15  Be It Enacted by the Legislature of the State of Florida:
   17         Section 1.  Present paragraphs (d) through (k) of
   18  subsection (3) of section 408.05, Florida Statutes, are
   19  redesignated as paragraphs (e) through (l), respectively,
   20  present paragraph (j) is amended, and a new paragraph (d) is
   21  added to that section, to read:
   22         408.05 Florida Center for Health Information and
   23  Transparency.—
   24         (3) HEALTH INFORMATION TRANSPARENCY.—In order to
   25  disseminate and facilitate the availability of comparable and
   26  uniform health information, the agency shall perform the
   27  following functions:
   28         (d)Design a facility patient safety culture survey or
   29  surveys to be completed annually by each hospital and ambulatory
   30  surgical center licensed under chapter 395. The survey shall be
   31  designed to measure aspects of patient safety culture, including
   32  frequency of adverse events, quality of handoffs and
   33  transitions, comfort in reporting potential problems or errors,
   34  the level of teamwork within hospital units and the facility as
   35  a whole, staff compliance with patient safety regulations and
   36  guidelines, staff perception of facility support for patient
   37  safety, and staff opinions on whether the staff member would
   38  undergo a health care service or procedure at the facility. The
   39  survey shall be anonymous to encourage staff employed by or
   40  working in the facility to complete the survey. The agency shall
   41  review and analyze nationally recognized patient safety culture
   42  survey products, including, but not limited to, the patient
   43  safety surveys developed by the federal Agency for Healthcare
   44  Research and Quality and the Safety Attitudes Questionnaire
   45  developed by the University of Texas, to develop the patient
   46  safety culture survey. This paragraph does not apply to licensed
   47  facilities operating exclusively as state facilities.
   48         (k)(j) Conduct and make available the results of special
   49  health surveys, including facility patient safety culture
   50  surveys, health care research, and health care evaluations
   51  conducted or supported under this section. Each year the center
   52  shall select and analyze one or more research topics that can be
   53  investigated using the data available pursuant to paragraph (c).
   54  The selected topics must focus on producing actionable
   55  information for improving quality of care and reducing costs.
   56  The first topic selected by the center must address preventable
   57  hospitalizations.
   58         Section 2. Paragraph (a) of subsection (1) of section
   59  408.061, Florida Statutes, is amended to read:
   60         408.061 Data collection; uniform systems of financial
   61  reporting; information relating to physician charges;
   62  confidential information; immunity.—
   63         (1) The agency shall require the submission by health care
   64  facilities, health care providers, and health insurers of data
   65  necessary to carry out the agency’s duties and to facilitate
   66  transparency in health care pricing data and quality measures.
   67  Specifications for data to be collected under this section shall
   68  be developed by the agency and applicable contract vendors, with
   69  the assistance of technical advisory panels including
   70  representatives of affected entities, consumers, purchasers, and
   71  such other interested parties as may be determined by the
   72  agency.
   73         (a) Data submitted by health care facilities, including the
   74  facilities as defined in chapter 395, shall include, but are not
   75  limited to: case-mix data, patient admission and discharge data,
   76  hospital emergency department data which shall include the
   77  number of patients treated in the emergency department of a
   78  licensed hospital reported by patient acuity level, data on
   79  hospital-acquired infections as specified by rule, data on
   80  complications as specified by rule, data on readmissions as
   81  specified by rule, with patient and provider-specific
   82  identifiers included, actual charge data by diagnostic groups or
   83  other bundled groupings as specified by rule, facility patient
   84  safety culture surveys, financial data, accounting data,
   85  operating expenses, expenses incurred for rendering services to
   86  patients who cannot or do not pay, interest charges,
   87  depreciation expenses based on the expected useful life of the
   88  property and equipment involved, and demographic data. The
   89  agency shall adopt nationally recognized risk adjustment
   90  methodologies or software consistent with the standards of the
   91  Agency for Healthcare Research and Quality and as selected by
   92  the agency for all data submitted as required by this section.
   93  Data may be obtained from documents such as, but not limited to:
   94  leases, contracts, debt instruments, itemized patient statements
   95  or bills, medical record abstracts, and related diagnostic
   96  information. Reported data elements shall be reported
   97  electronically in accordance with rule 59E-7.012, Florida
   98  Administrative Code. Data submitted shall be certified by the
   99  chief executive officer or an appropriate and duly authorized
  100  representative or employee of the licensed facility that the
  101  information submitted is true and accurate.
  102         Section 3. Present subsections (8) through (13) of section
  103  408.810, Florida Statutes, are redesignated as subsections (9)
  104  through (14), respectively, and a new subsection (8) is added to
  105  that section, to read:
  106         408.810 Minimum licensure requirements.—In addition to the
  107  licensure requirements specified in this part, authorizing
  108  statutes, and applicable rules, each applicant and licensee must
  109  comply with the requirements of this section in order to obtain
  110  and maintain a license.
  111         (8)Each licensee subject to s. 408.05(3)(d) shall submit
  112  facility patient safety culture surveys to the agency in
  113  accordance with applicable rules.
  114         Section 4. Paragraph (c) of subsection (4) of section
  115  400.991, Florida Statutes, is amended to read:
  116         400.991 License requirements; background screenings;
  117  prohibitions.—
  118         (4) In addition to the requirements of part II of chapter
  119  408, the applicant must file with the application satisfactory
  120  proof that the clinic is in compliance with this part and
  121  applicable rules, including:
  122         (c) Proof of financial ability to operate as required under
  123  s. 408.810(9) s. 408.810(8). As an alternative to submitting
  124  proof of financial ability to operate as required under s.
  125  408.810(9) s. 408.810(8), the applicant may file a surety bond
  126  of at least $500,000 which guarantees that the clinic will act
  127  in full conformity with all legal requirements for operating a
  128  clinic, payable to the agency. The agency may adopt rules to
  129  specify related requirements for such surety bond.
  130         Section 5. Paragraph (a) of subsection (1) of section
  131  408.8065, Florida Statutes, is amended to read:
  132         408.8065 Additional licensure requirements for home health
  133  agencies, home medical equipment providers, and health care
  134  clinics.—
  135         (1) An applicant for initial licensure, or initial
  136  licensure due to a change of ownership, as a home health agency,
  137  home medical equipment provider, or health care clinic shall:
  138         (a) Demonstrate financial ability to operate, as required
  139  under s. 408.810(9) s. 408.810(8) and this section. If the
  140  applicant’s assets, credit, and projected revenues meet or
  141  exceed projected liabilities and expenses, and the applicant
  142  provides independent evidence that the funds necessary for
  143  startup costs, working capital, and contingency financing exist
  144  and will be available as needed, the applicant has demonstrated
  145  the financial ability to operate.
  147  All documents required under this subsection must be prepared in
  148  accordance with generally accepted accounting principles and may
  149  be in a compilation form. The financial statements must be
  150  signed by a certified public accountant.
  151         Section 6. Section 408.820, Florida Statutes, is amended to
  152  read:
  153         408.820 Exemptions.—Except as prescribed in authorizing
  154  statutes, the following exemptions shall apply to specified
  155  requirements of this part:
  156         (1) Laboratories authorized to perform testing under the
  157  Drug-Free Workplace Act, as provided under ss. 112.0455 and
  158  440.102, are exempt from s. 408.810(5)-(11) s. 408.810(5)-(10).
  159         (2) Birth centers, as provided under chapter 383, are
  160  exempt from s. 408.810(7)-(11) s. 408.810(7)-(10).
  161         (3) Abortion clinics, as provided under chapter 390, are
  162  exempt from s. 408.810(7)-(11) s. 408.810(7)-(10).
  163         (4) Crisis stabilization units, as provided under parts I
  164  and IV of chapter 394, are exempt from s. 408.810(9)-(11) s.
  165  408.810(8)-(10).
  166         (5) Short-term residential treatment facilities, as
  167  provided under parts I and IV of chapter 394, are exempt from s.
  168  408.810(9)-(11) s. 408.810(8)-(10).
  169         (6) Residential treatment facilities, as provided under
  170  part IV of chapter 394, are exempt from s. 408.810(9)-(11) s.
  171  408.810(8)-(10).
  172         (7) Residential treatment centers for children and
  173  adolescents, as provided under part IV of chapter 394, are
  174  exempt from s. 408.810(9)-(11) s. 408.810(8)-(10).
  175         (8) Hospitals, as provided under part I of chapter 395, are
  176  exempt from s. 408.810(7), (9), and (10) s. 408.810(7)-(9).
  177         (9) Ambulatory surgical centers, as provided under part I
  178  of chapter 395, are exempt from s. 408.810(7), (9), (10), and
  179  (11) s. 408.810(7)-(10).
  180         (10) Nursing homes, as provided under part II of chapter
  181  400, are exempt from ss. 408.810(7) and 408.813(2).
  182         (11) Assisted living facilities, as provided under part I
  183  of chapter 429, are exempt from s. 408.810(11) s. 408.810(10).
  184         (12) Home health agencies, as provided under part III of
  185  chapter 400, are exempt from s. 408.810(11) s. 408.810(10).
  186         (13) Nurse registries, as provided under part III of
  187  chapter 400, are exempt from s. 408.810(6), (8), and (11) s.
  188  408.810(6) and (10).
  189         (14) Companion services or homemaker services providers, as
  190  provided under part III of chapter 400, are exempt from s.
  191  408.810(6)-(11) s. 408.810(6)-(10).
  192         (15) Adult day care centers, as provided under part III of
  193  chapter 429, are exempt from s. 408.810(11) s. 408.810(10).
  194         (16) Adult family-care homes, as provided under part II of
  195  chapter 429, are exempt from s. 408.810(7)-(11) s. 408.810(7)
  196  (10).
  197         (17) Homes for special services, as provided under part V
  198  of chapter 400, are exempt from s. 408.810(7)-(11) s.
  199  408.810(7)-(10).
  200         (18) Transitional living facilities, as provided under part
  201  XI of chapter 400, are exempt from s. 408.810(11) s.
  202  408.810(10).
  203         (19) Prescribed pediatric extended care centers, as
  204  provided under part VI of chapter 400, are exempt from s.
  205  408.810(11) s. 408.810(10).
  206         (20) Home medical equipment providers, as provided under
  207  part VII of chapter 400, are exempt from s. 408.810(11) s.
  208  408.810(10).
  209         (21) Intermediate care facilities for persons with
  210  developmental disabilities, as provided under part VIII of
  211  chapter 400, are exempt from s. 408.810(7).
  212         (22) Health care services pools, as provided under part IX
  213  of chapter 400, are exempt from s. 408.810(6)-(11) s.
  214  408.810(6)-(10).
  215         (23) Health care clinics, as provided under part X of
  216  chapter 400, are exempt from s. 408.810(6), (7), (8), and (11)
  217  s. 408.810(6), (7), and (10).
  218         (24) Multiphasic health testing centers, as provided under
  219  part II of chapter 483, are exempt from s. 408.810(5)-(11) s.
  220  408.810(5)-(10).
  221         (25) Organ, tissue, and eye procurement organizations, as
  222  provided under part V of chapter 765, are exempt from s.
  223  408.810(5)-(11) s. 408.810(5)-(10).
  224         Section 7. For the 2019-2020 fiscal year, one full-time
  225  equivalent position with associated salary rate of 41,106 is
  226  authorized, and the sum of $352,919 in recurring funds from the
  227  Health Care Trust Fund is appropriated to the Agency for Health
  228  Care Administration, for the purpose of implementing the
  229  requirements of this act.
  230         Section 8. This act shall take effect July 1, 2019.