The Florida Senate

¹408.062  Research, analyses, studies, and reports.--

(1)  The agency shall have the authority to conduct research, analyses, and studies relating to health care costs and access to and quality of health care services as access and quality are affected by changes in health care costs. Such research, analyses, and studies shall include, but not be limited to, research and analysis relating to:

(a)  The financial status of any health care facility or facilities subject to the provisions of this chapter.

(b)  The impact of uncompensated charity care on health care facilities and health care providers.

(c)  The state's role in assisting to fund indigent care.

(d)  The availability and affordability of health insurance for small businesses.

(e)  Total health care expenditures in the state according to the sources of payment and the type of expenditure.

(f)  The quality of health services, using techniques such as small area analysis, severity adjustments, and risk-adjusted mortality rates.

(g)  The development of physician payment systems which are capable of taking into account the amount of resources consumed and the outcomes produced in the delivery of care.

(h)  The impact of subacute admissions on hospital revenues and expenses for purposes of calculating adjusted admissions as defined in s. 408.07

(2)  The agency shall evaluate data from nursing home financial reports and shall document and monitor:

(a)  Total revenues, annual change in revenues, and revenues by source and classification, including contributions for a resident's care from the resident's resources and from the family and contributions not directed toward any specific resident's care.

(b)  Average resident charges by geographic region, payor, and type of facility ownership.

(c)  Profit margins by geographic region and type of facility ownership.

(d)  Amount of charity care provided by geographic region and type of facility ownership.

(e)  Resident days by payor category.

(f)  Experience related to Medicaid conversion as reported under s. 408.061

(g)  Other information pertaining to nursing home revenues and expenditures.

The findings of the agency shall be included in an annual report to the Governor and Legislature by January 1 each year.

(3)  The agency may assess annually the caesarean section rate in Florida hospitals using the analysis methodology that the agency determines most appropriate. To assist the agency in determining the impact of this chapter on Florida hospitals' caesarean section rates, each provider hospital, as defined in s. 383.336, shall notify the agency of the date of implementation of the practice parameters and the date of the first meeting of the hospital peer review board created pursuant to this chapter. The agency shall use these dates in monitoring any change in provider hospital caesarean section rates. An annual report based on this monitoring and assessment shall be submitted to the Governor, the Speaker of the House of Representatives, and the President of the Senate by the agency, with the first annual report due January 1, 1993.

(4)  The agency may also prepare such summaries and compilations or other supplementary reports based on the information analyzed by the agency under this section, as will advance the purposes of this chapter.

(5)(a)  The agency may conduct data-based studies and evaluations and make recommendations to the Legislature and the Governor concerning exemptions, the effectiveness of limitations of referrals, restrictions on investment interests and compensation arrangements, and the effectiveness of public disclosure. Such analysis may include, but need not be limited to, utilization of services, cost of care, quality of care, and access to care. The agency may require the submission of data necessary to carry out this duty, which may include, but need not be limited to, data concerning ownership, Medicare and Medicaid, charity care, types of services offered to patients, revenues and expenses, patient-encounter data, and other data reasonably necessary to study utilization patterns and the impact of health care provider ownership interests in health-care-related entities on the cost, quality, and accessibility of health care.

(b)  The agency may collect such data from any health facility as a special study.

History.--s. 69, ch. 92-33; s. 12, ch. 93-129; s. 12, ch. 98-89; s. 17, ch. 2000-209.

¹Note.--Sections 40 and 42, ch. 2002-400, provide that:

A.  "Section 40.(1)  The Agency for Health Care Administration shall conduct a study of health care services provided to children in the state who are medically fragile or dependent on medical technology and conduct a pilot program in Miami-Dade County to provide subacute pediatric transitional care to a maximum of 30 children at any one time. The purposes of the study and the pilot program are to determine ways to permit children who are medically fragile or dependent on medical technology to successfully make a transition from acute care in a health care institution to live with their families when possible, and to provide cost-effective, subacute transitional care services.

"(2)  The agency, in cooperation with the Children's Medical Services Program in the Department of Health, shall conduct a study to identify the total number of children who are medically fragile or dependent on medical technology, from birth through age 21, in the state. By January 1, 2003, the agency must report to the Legislature regarding the children's ages, the locations where the children are served, the types of services received, itemized costs of the services, and the sources of funding that pay for the services, including the proportional share when more than one funding source pays for a service. The study must include information regarding children who are medically fragile or dependent on medical technology residing in hospitals, nursing homes, and medical foster care, and those who live with their parents. The study must describe children served in prescribed pediatric extended-care centers, including their ages and the services they receive. The report must identify the total services provided for each child and the method for paying for those services. The report must also identify the number of such children who could, if appropriate transitional services were available, return home or move to a less institutional setting.

"(3)  Within 30 days after the effective date of this act, the agency shall establish minimum staffing standards and quality requirements for a subacute pediatric transitional care center to be operated as a 2-year pilot program in Miami-Dade County. The pilot program must operate under the license of a hospital licensed under chapter 395, Florida Statutes, or a nursing home licensed under chapter 400, Florida Statutes, and shall use existing beds in the hospital or nursing home. A child's placement in the subacute pediatric transitional care center may not exceed 90 days. The center shall arrange for an alternative placement at the end of a child's stay and a transitional plan for children expected to remain in the facility for the maximum allowed stay.

"(4)  Within 60 days after the effective date of this act, the agency must amend the state Medicaid plan and request any federal waivers necessary to implement and fund the pilot program.

"(5)  The subacute pediatric transitional care center must require level 1 background screening as provided in chapter 435, Florida Statutes, for all employees or prospective employees of the center who are expected to, or whose responsibilities may require them to, provide personal care or services to children, have access to children's living areas, or have access to children's funds or personal property.

"(6)  The subacute pediatric transitional care center must have an advisory board. Membership on the advisory board must include, but need not be limited to:

"(a)  A physician and an advanced registered nurse practitioner who is familiar with services for children who are medically fragile or dependent on medical technology.

"(b)  A registered nurse who has experience in the care of children who are medically fragile or dependent on medical technology.

"(c)  A child development specialist who has experience in the care of children who are medically fragile or dependent on medical technology, and their families.

"(d)  A social worker who has experience in the care of children who are medically fragile or dependent on medical technology, and their families.

"(e)  A consumer representative who is a parent or guardian of a child placed in the center.

"(7)  The advisory board shall:

"(a)  Review the policy and procedure components of the center to assure conformance with applicable standards developed by the agency.

"(b)  Provide consultation with respect to the operational and programmatic components of the center.

"(8)  The subacute pediatric transitional care center must have written policies and procedures governing the admission, transfer, and discharge of children.

"(9)  The admission of each child to the center must be under the supervision of the center nursing administrator or his or her designee and must be in accordance with the center's policies and procedures. Each Medicaid admission must be approved as appropriate for placement in the facility by the Children's Medical Services Multidisciplinary Assessment Team of the Department of Health, in conjunction with the agency.

"(10)  Each child admitted to the center shall be admitted upon prescription of the medical director of the center, licensed pursuant to chapter 458 or chapter 459, Florida Statutes, and the child shall remain under the care of the medical director and the advanced registered nurse practitioner for the duration of his or her stay in the center.

"(11)  Each child admitted to the center must meet at least the following criteria:

"(a)  The child must be medically fragile or dependent on medical technology.

"(b)  The child may not, prior to admission, present significant risk of infection to other children or personnel. The medical and nursing directors shall review, on a case-by-case basis, the condition of any child who is suspected of having an infectious disease to determine whether admission is appropriate.

"(c)  The child must be medically stabilized and require skilled nursing care or other interventions.

"(12)  If the child meets the criteria specified in paragraphs (11)(a), (b), and (c), the medical director or nursing director of the center shall implement a preadmission plan that delineates services to be provided and appropriate sources for such services.

"(a)  If the child is hospitalized at the time of referral, preadmission planning must include the participation of the child's parent or guardian and relevant medical, nursing, social services, and developmental staff to assure that the hospital's discharge plans will be implemented following the child's placement in the center.

"(b)  A consent form outlining the purpose of the center, family responsibilities, authorized treatment, appropriate release of liability, and emergency disposition plans must be signed by the parent or guardian and witnessed before the child is admitted to the center. The parent or guardian shall be provided a copy of the consent form.

"(13)  By January 1, 2003, the agency shall report to the Legislature concerning the progress of the pilot program. By January 1, 2004, the agency shall submit to the Legislature a report on the success of the pilot program."

B.  "Section 42.  The Agency for Health Care Administration may conduct a 2-year pilot project to authorize overnight stays in one ambulatory surgical center located in Acute Care Subdistrict 9-1. An overnight stay shall be permitted only to perform plastic and reconstructive surgeries defined by current procedural terminology code numbers 13000-19999. The total time a patient is at the ambulatory surgical center shall not exceed 23 hours and 59 minutes, including the surgery time, and the maximum planned duration of all surgical procedures combined shall not exceed 8 hours. Prior to implementation of the pilot project, the agency shall establish minimum requirements for protecting the health, safety, and welfare of patients receiving overnight care. These shall include, at a minimum, compliance with all statutes and rules applicable to ambulatory surgical centers and the requirements set forth in Rule 64B8-9.009, Florida Administrative Code, relating to Level II and Level III procedures. If the agency implements the pilot project, it shall, within 6 months after its completion, submit a report to the Legislature on whether to expand the pilot project to include all ambulatory surgical centers. The recommendation shall be based on consideration of the efficacy and impact to patient safety and quality of patient care of providing plastic and reconstructive surgeries in the ambulatory surgical center setting. The agency is authorized to obtain such data as necessary to implement this section."