Florida Senate - 2024                                     SB 644
       By Senator Simon
       3-00959-24                                             2024644__
    1                        A bill to be entitled                      
    2         An act relating to rural hospitals; amending s.
    3         395.002, F.S.; revising the definition of the term
    4         “hospital”; amending s. 395.602, F.S.; defining the
    5         term “rural emergency hospital”; revising the
    6         definition of the term “rural hospital”; specifying
    7         eligibility requirements for licensure of rural
    8         emergency hospitals; authorizing rural emergency
    9         hospitals to enter into any contracts required for
   10         certain federal reimbursement; authorizing the Agency
   11         for Health Care Administration to seek federal
   12         approval to provide Medicaid reimbursements to
   13         licensed rural emergency hospitals; amending s.
   14         395.0163, F.S.; requiring facilities that are to be
   15         licensed as rural emergency hospitals to submit
   16         certain construction plans and specifications to the
   17         agency; deleting obsolete language; creating ss.
   18         627.6051, 627.6614, and 641.31078, F.S.; requiring
   19         that individual health insurance policies, group
   20         health insurance policies, and health maintenance
   21         contracts, respectively, issued in this state on or
   22         after a specified date provide coverage for services
   23         performed in rural emergency hospitals under certain
   24         conditions; amending ss. 409.9116 and 1009.65, F.S.;
   25         conforming cross-references; providing an effective
   26         date.
   28  Be It Enacted by the Legislature of the State of Florida:
   30         Section 1. Subsection (12) of section 395.002, Florida
   31  Statutes, is amended to read:
   32         395.002 Definitions.—As used in this chapter:
   33         (12) “Hospital” means any establishment that:
   34         (a) Offers services more intensive than those required for
   35  room, board, personal services, and general nursing care, and
   36  offers facilities and beds for use beyond 24 hours by
   37  individuals requiring diagnosis, treatment, or care for illness,
   38  injury, deformity, infirmity, abnormality, disease, or
   39  pregnancy; and
   40         (b) Regularly makes available at least clinical laboratory
   41  services, diagnostic X-ray services, and treatment facilities
   42  for surgery or obstetrical care, or other definitive medical
   43  treatment of similar extent, except that a critical access
   44  hospital, as defined in s. 408.07, shall not be required to make
   45  available treatment facilities for surgery, obstetrical care, or
   46  similar services as long as it maintains its critical access
   47  hospital designation and shall be required to make such
   48  facilities available only if it ceases to be designated as a
   49  critical access hospital; or
   50         (c) Is licensed as a rural emergency hospital under s.
   51  395.602.
   53  However, the provisions of this chapter does do not apply to any
   54  institution conducted by or for the adherents of any well
   55  recognized church or religious denomination that depends
   56  exclusively upon prayer or spiritual means to heal, care for, or
   57  treat any person. For purposes of local zoning matters, the term
   58  “hospital” includes a medical office building located on the
   59  same premises as a hospital facility, provided the land on which
   60  the medical office building is constructed is zoned for use as a
   61  hospital; provided the premises were zoned for hospital purposes
   62  on January 1, 1992.
   63         Section 2. Present paragraphs (b) and (c) of subsection (2)
   64  of section 395.602, Florida Statutes, are redesignated as
   65  paragraphs (c) and (d), respectively, a new paragraph (b) is
   66  added to that subsection, subsections (4) and (5) are added to
   67  that section, and present paragraph (b) of subsection (2) of
   68  that section is amended, to read:
   69         395.602 Rural hospitals.—
   70         (2) DEFINITIONS.—As used in this part, the term:
   71         (b) “Rural emergency hospital” means a hospital that meets
   72  the criteria specified in 42 U.S.C. s. 1395x(kkk)(2) and is
   73  certified as a rural emergency hospital by the United States
   74  Secretary of Health and Human Services.
   75         (c)(b) “Rural hospital” means an acute care hospital
   76  licensed under this chapter, having 100 or fewer licensed beds
   77  and an emergency room, which is:
   78         1. The sole provider within a county with a population
   79  density of up to 100 persons per square mile;
   80         2. An acute care hospital, in a county with a population
   81  density of up to 100 persons per square mile, which is at least
   82  30 minutes of travel time, on normally traveled roads under
   83  normal traffic conditions, from any other acute care hospital
   84  within the same county;
   85         3. A hospital supported by a tax district or subdistrict
   86  whose boundaries encompass a population of up to 100 persons per
   87  square mile;
   88         4. A hospital classified as a sole community hospital under
   89  42 C.F.R. s. 412.92, regardless of the number of licensed beds;
   90         5. A hospital with a service area that has a population of
   91  up to 100 persons per square mile. As used in this subparagraph,
   92  the term “service area” means the fewest number of zip codes
   93  that account for 75 percent of the hospital’s discharges for the
   94  most recent 5-year period, based on information available from
   95  the hospital inpatient discharge database in the Florida Center
   96  for Health Information and Transparency at the agency; or
   97         6. A hospital designated as a critical access hospital, as
   98  defined in s. 408.07; or
   99         7. A hospital designated as a rural emergency hospital.
  101  Population densities used in this paragraph must be based upon
  102  the most recently completed United States census. A hospital
  103  that received funds under s. 409.9116 for a quarter beginning no
  104  later than July 1, 2002, is deemed to have been and continues
  105  shall continue to be a rural hospital from that date through
  106  June 30, 2021, if the hospital continues to have up to 100
  107  licensed beds and an emergency room. An acute care hospital that
  108  has not previously been designated as a rural hospital and that
  109  meets the criteria of this paragraph shall be granted such
  110  designation upon application, including supporting
  111  documentation, to the agency. A hospital that was licensed as a
  112  rural hospital during the 2010-2011 or 2011-2012 fiscal year
  113  continues shall continue to be a rural hospital from the date of
  114  designation through June 30, 2025, if the hospital continues to
  115  have up to 100 licensed beds and an emergency room.
  116         (4)A facility is eligible for licensure as a rural
  117  emergency hospital if it meets all of the criteria specified in
  118  42 U.S.C. s. 1395x(kkk)(2) and is certified as a rural emergency
  119  hospital by the United States Secretary of Health and Human
  120  Services.
  121         (5)Licensed rural emergency hospitals may enter into any
  122  contracts necessary to be eligible for federal reimbursement as
  123  a rural emergency hospital.
  124         Section 3. The Agency for Health Care Administration may
  125  seek federal approval to provide Medicaid reimbursements to
  126  licensed rural emergency hospitals.
  127         Section 4. Paragraph (b) of subsection (1) of section
  128  395.0163, Florida Statutes, is amended to read:
  129         395.0163 Construction inspections; plan submission and
  130  approval; fees.—
  131         (1) 
  132         (b) All outpatient facilities that provide surgical
  133  treatments requiring general anesthesia or IV conscious
  134  sedation, that provide cardiac catheterization services, or that
  135  are to be licensed as rural emergency hospitals or ambulatory
  136  surgical centers shall submit plans and specifications to the
  137  agency for review under this section. All other outpatient
  138  facilities must be reviewed under this section, except that
  139  those that are physically detached from, and have no utility
  140  connections with, the hospital and that do not block emergency
  141  egress from or create a fire hazard to the hospital are exempt
  142  from review under this section. This paragraph applies to
  143  applications for which review is pending on or after July 1,
  144  1998.
  145         Section 5. Section 627.6051, Florida Statutes, is created
  146  to read:
  147         627.6051 Coverage for rural emergency hospital services.—To
  148  the extent not preempted by federal or state law, any individual
  149  health insurance policy issued or renewed in this state on or
  150  after July 1, 2024, must provide coverage for any service
  151  performed in a rural emergency hospital licensed under s.
  152  395.602 if such service performed in a general hospital would be
  153  covered by the policy.
  154         Section 6. Section 627.6614, Florida Statutes, is created
  155  to read:
  156         627.6614 Coverage for rural emergency hospital services.—To
  157  the extent not preempted by federal or state law, any group
  158  health insurance policy issued or renewed in this state on or
  159  after July 1, 2024, must provide coverage for any service
  160  performed in a rural emergency hospital licensed under s.
  161  395.602 if such service performed in a general hospital would be
  162  covered by the policy.
  163         Section 7. Section 641.31078, Florida Statutes, is created
  164  to read:
  165         641.31078 Coverage for rural emergency hospital services.
  166  To the extent not preempted by federal or state law, any health
  167  maintenance contract issued or renewed in this state on or after
  168  July 1, 2024, must provide coverage for any service performed in
  169  a rural emergency hospital licensed under s. 395.602 if such
  170  service performed in a general hospital would be covered by the
  171  contract.
  172         Section 8. Subsection (6) of section 409.9116, Florida
  173  Statutes, is amended to read:
  174         409.9116 Disproportionate share/financial assistance
  175  program for rural hospitals.—In addition to the payments made
  176  under s. 409.911, the Agency for Health Care Administration
  177  shall administer a federally matched disproportionate share
  178  program and a state-funded financial assistance program for
  179  statutory rural hospitals. The agency shall make
  180  disproportionate share payments to statutory rural hospitals
  181  that qualify for such payments and financial assistance payments
  182  to statutory rural hospitals that do not qualify for
  183  disproportionate share payments. The disproportionate share
  184  program payments shall be limited by and conform with federal
  185  requirements. Funds shall be distributed quarterly in each
  186  fiscal year for which an appropriation is made. Notwithstanding
  187  the provisions of s. 409.915, counties are exempt from
  188  contributing toward the cost of this special reimbursement for
  189  hospitals serving a disproportionate share of low-income
  190  patients.
  191         (6) This section applies only to hospitals that were
  192  defined as statutory rural hospitals, or their successor-in
  193  interest hospital, prior to January 1, 2001. Any additional
  194  hospital that is defined as a statutory rural hospital, or its
  195  successor-in-interest hospital, on or after January 1, 2001, is
  196  not eligible for programs under this section unless additional
  197  funds are appropriated each fiscal year specifically to the
  198  rural hospital disproportionate share and financial assistance
  199  programs in an amount necessary to prevent any hospital, or its
  200  successor-in-interest hospital, eligible for the programs prior
  201  to January 1, 2001, from incurring a reduction in payments
  202  because of the eligibility of an additional hospital to
  203  participate in the programs. A hospital, or its successor-in
  204  interest hospital, which received funds pursuant to this section
  205  before January 1, 2001, and which qualifies under s.
  206  395.602(2)(c) s. 395.602(2)(b), shall be included in the
  207  programs under this section and is not required to seek
  208  additional appropriations under this subsection.
  209         Section 9. Paragraph (a) of subsection (1) of section
  210  1009.65, Florida Statutes, is amended to read:
  211         1009.65 Medical Education Reimbursement and Loan Repayment
  212  Program.—
  213         (1) To encourage qualified medical professionals to
  214  practice in underserved locations where there are shortages of
  215  such personnel, there is established the Medical Education
  216  Reimbursement and Loan Repayment Program. The function of the
  217  program is to make payments that offset loans and educational
  218  expenses incurred by students for studies leading to a medical
  219  or nursing degree, medical or nursing licensure, or advanced
  220  practice registered nurse licensure or physician assistant
  221  licensure. The following licensed or certified health care
  222  professionals are eligible to participate in this program:
  223         (a) Medical doctors with primary care specialties, doctors
  224  of osteopathic medicine with primary care specialties, physician
  225  assistants, licensed practical nurses and registered nurses, and
  226  advanced practice registered nurses with primary care
  227  specialties such as certified nurse midwives. Primary care
  228  medical specialties for physicians include obstetrics,
  229  gynecology, general and family practice, internal medicine,
  230  pediatrics, and other specialties which may be identified by the
  231  Department of Health. From the funds available, the Department
  232  of Health shall make payments as follows:
  233         1. Up to $4,000 per year for licensed practical nurses and
  234  registered nurses, up to $10,000 per year for advanced practice
  235  registered nurses and physician assistants, and up to $20,000
  236  per year for physicians. Penalties for noncompliance shall be
  237  the same as those in the National Health Services Corps Loan
  238  Repayment Program. Educational expenses include costs for
  239  tuition, matriculation, registration, books, laboratory and
  240  other fees, other educational costs, and reasonable living
  241  expenses as determined by the Department of Health.
  242         2. All payments are contingent on continued proof of
  243  primary care practice in an area defined in s. 395.602(2)(c) s.
  244  395.602(2)(b), or an underserved area designated by the
  245  Department of Health, provided the practitioner accepts Medicaid
  246  reimbursement if eligible for such reimbursement. Correctional
  247  facilities, state hospitals, and other state institutions that
  248  employ medical personnel shall be designated by the Department
  249  of Health as underserved locations. Locations with high
  250  incidences of infant mortality, high morbidity, or low Medicaid
  251  participation by health care professionals may be designated as
  252  underserved.
  253         Section 10. This act shall take effect July 1, 2024.