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.
27
28 Be It Enacted by the Legislature of the State of Florida:
29
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.
52
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.
100
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.