Bill Text: FL S0746 | 2017 | Regular Session | Introduced
Bill Title: Trauma Care
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2017-04-27 - Withdrawn from further consideration [S0746 Detail]
Download: Florida-2017-S0746-Introduced.html
Florida Senate - 2017 SB 746
By Senator Hutson
7-00647-17 2017746__
1 A bill to be entitled
2 An act relating to trauma care; amending s. 395.40,
3 F.S.; deleting provisions relating to legislative
4 findings and intent; deleting the definition of the
5 term “inclusive trauma center”; requiring the
6 Department of Health to designate trauma centers,
7 publish a statewide trauma plan, establish and
8 maintain a statewide trauma registry, solicit input
9 from stakeholders and experts, and foster the
10 provision of trauma care; amending s. 395.4001, F.S.;
11 defining and redefining terms; deleting the definition
12 of the term “provisional trauma center”; amending s.
13 395.401, F.S.; requiring a trauma agency to submit a
14 trauma agency plan to the department; revising the
15 required components of a trauma agency plan;
16 prohibiting the establishment of more than one trauma
17 agency in any county; amending s. 395.4015, F.S.;
18 requiring the department to coordinate the development
19 of a statewide trauma system plan and to update it in
20 every odd-numbered year by a specified date; repealing
21 s. 395.402, F.S., relating to trauma service areas and
22 number and location of trauma centers; amending s.
23 395.4025, F.S.; revising guidelines for the
24 designation of a hospital as a trauma center by the
25 department; deleting provision granting immunity for
26 out-of-state experts acting as agents of the
27 department; requiring hospitals designated as trauma
28 centers to accept all trauma victims requiring care;
29 prohibiting an undesignated hospital from holding
30 itself out as a trauma center; prohibiting information
31 supplied by a hospital to a national trauma center
32 accreditation body from being withheld from the
33 department; providing a penalty; extending rulemaking
34 authority to the department; amending s. 395.403,
35 F.S.; conforming provisions to changes made by the
36 act; amending s. 395.4036, F.S.; deleting a provision
37 clarifying legislative intent; amending s. 395.404,
38 F.S.; expanding the public records exemption to
39 include emergency medical service transport and
40 treatment records of trauma alert victims; amending s.
41 395.4045, F.S.; deleting provisions relating to the
42 air transportation of trauma victims; amending s.
43 395.405, F.S.; conforming provisions to changes made
44 by the act; amending s. 395.50, F.S.; deleting
45 provisions relating to the admission of patient
46 records into evidence in any civil or administrative
47 action brought by or involving the department;
48 amending ss. 320.0801, 408.036, and 409.975, F.S.;
49 conforming provisions to changes made by the act;
50 conforming cross-references; providing an effective
51 date.
52
53 Be It Enacted by the Legislature of the State of Florida:
54
55 Section 1. Section 395.40, Florida Statutes, is amended to
56 read:
57 395.40 Duties Legislative findings and intent.—
58 (1) The Legislature finds that there has been a lack of
59 timely access to trauma care due to the state’s fragmented
60 trauma system. This finding is based on the 1999 Trauma System
61 Report on Timely Access to Trauma Care submitted by the
62 department in response to the request of the Legislature.
63 (2) The Legislature finds that it is necessary to plan for
64 and to establish an inclusive trauma system to meet the needs of
65 trauma victims. An “inclusive trauma system” means a system
66 designed to meet the needs of all injured trauma victims who
67 require care in an acute-care setting and into which every
68 health care provider or facility with resources to care for the
69 injured trauma victim is incorporated. The Legislature deems the
70 benefits of trauma care provided within an inclusive trauma
71 system to be of vital significance to the outcome of a trauma
72 victim.
73 (3) It is the intent of the Legislature to place The
74 department has primary responsibility for the planning,
75 coordination, and oversight and establishment of a statewide
76 inclusive trauma system with the department. The department
77 shall do all of the following: undertake the implementation of a
78 statewide inclusive trauma system as funding is available.
79 (1) Designate trauma centers in the state.
80 (2) Publish and update a statewide trauma plan in
81 accordance with s. 395.4015.
82 (3) Establish and maintain a statewide trauma registry for
83 monitoring, evaluating, and enforcing the requirements of the
84 state’s inclusive trauma system.
85 (4) Solicit input from stakeholders and experts for the
86 enhancement of a coordinated approach to the care of trauma
87 victims, including input on the movement of a trauma victim
88 through the system of care and on the transfer of a trauma
89 victim from an acute care hospital into the trauma care system.
90 (5) Actively foster the provision of trauma care and serve
91 as a catalyst for improvements in the outcomes and treatment of
92 trauma patients in an inclusive trauma system.
93 (4) The Legislature finds that significant benefits are to
94 be obtained by directing the coordination of activities by
95 several state agencies, relative to access to trauma care and
96 the provision of trauma care to all trauma victims. It is the
97 intent of the Legislature that the department, the Agency for
98 Health Care Administration, the Board of Medicine, and the Board
99 of Nursing establish interagency teams and agreements for the
100 development of guidelines, standards, and rules for those
101 portions of the inclusive state trauma system within the
102 statutory authority of each agency. This coordinated approach
103 will provide the necessary continuum of care for the trauma
104 victim from injury to final hospital discharge. The department
105 has the leadership responsibility for this activity.
106 (5) In addition, the agencies listed in subsection (4)
107 should undertake to:
108 (a) Establish a coordinated methodology for monitoring,
109 evaluating, and enforcing the requirements of the state’s
110 inclusive trauma system which recognizes the interests of each
111 agency.
112 (b) Develop appropriate roles for trauma agencies, to
113 assist in furthering the operation of trauma systems at the
114 regional level. This should include issues of system evaluation
115 as well as managed care.
116 (c) Develop and submit appropriate requests for waivers of
117 federal requirements which will facilitate the delivery of
118 trauma care.
119 (d) Develop criteria that will become the future basis for
120 consultation between acute care hospitals and trauma centers on
121 the care of trauma victims and the mandatory transfer of
122 appropriate trauma victims to trauma centers.
123 (e) Develop a coordinated approach to the care of the
124 trauma victim. This shall include the movement of the trauma
125 victim through the system of care and the identification of
126 medical responsibility for each phase of care for out-of
127 hospital and in-hospital trauma care.
128 (f) Require the medical director of an emergency medical
129 services provider to have medical accountability for a trauma
130 victim during interfacility transfer.
131 (6) Furthermore, the Legislature encourages the department
132 to actively foster the provision of trauma care and serve as a
133 catalyst for improvements in the process and outcome of the
134 provision of trauma care in an inclusive trauma system. Among
135 other considerations, the department is required to:
136 (a) Promote the development of at least one trauma center
137 in every trauma service area.
138 (b) Promote the development of a trauma agency for each
139 trauma region.
140 (c) Update the state trauma system plan by February 2005
141 and at least annually thereafter.
142 Section 2. Section 395.4001, Florida Statutes, is amended
143 to read:
144 395.4001 Definitions.—As used in this part, the term:
145 (1) “Agency” means the Agency for Health Care
146 Administration.
147 (2) “Certificate of trauma center verification” means
148 documentation issued by a national trauma center accreditation
149 body which certifies a hospital’s compliance with published
150 standards for the administration of trauma care and the
151 treatment of injured patients.
152 (3)(2) “Charity care” or “uncompensated trauma care” means
153 that portion of hospital charges reported to the agency for
154 which there is no compensation, other than restricted or
155 unrestricted revenues provided to a hospital by local
156 governments or tax districts regardless of method of payment,
157 for care provided to a patient whose family income for the 12
158 months preceding the determination is less than or equal to 200
159 percent of the federal poverty level, unless the amount of
160 hospital charges due from the patient exceeds 25 percent of the
161 annual family income. However, in no case shall the hospital
162 charges for a patient whose family income exceeds four times the
163 federal poverty level for a family of four be considered
164 charity.
165 (4)(3) “Department” means the Department of Health.
166 (5) “Designated” means approved by the department to
167 operate as a Level I, Level II, or pediatric trauma center based
168 on verification by a national trauma center accreditation body.
169 (6) “Inclusive trauma system” means a system designed to
170 meet the needs of all injured trauma victims who require care in
171 an acute care setting and into which every health care provider
172 or facility with resources to care for the injured trauma victim
173 is incorporated.
174 (7)(4) “Interfacility trauma transfer” means the transfer
175 of a trauma victim between two facilities licensed under this
176 chapter, pursuant to this part.
177 (8)(5) “International Classification Injury Severity Score”
178 means the statistical method for computing the severity of
179 injuries sustained by trauma patients. The International
180 Classification Injury Severity Score shall be the methodology
181 used by the department and trauma centers to report the severity
182 of an injury.
183 (9)(6) “Level I trauma center” means a trauma center that:
184 (a) Has formal research and education programs for the
185 enhancement of trauma care; Is verified by the department to be
186 in substantial compliance with Level I trauma center and
187 pediatric trauma center standards; and has been designated
188 approved by the department to operate as a Level I trauma
189 center.
190 (b) Serves as a resource facility to Level II trauma
191 centers, pediatric trauma centers, and general hospitals through
192 shared outreach, education, and quality improvement activities.
193 (c) Participates in an inclusive system of trauma care,
194 including providing leadership, system evaluation, and quality
195 improvement activities.
196 (10)(7) “Level II trauma center” means a trauma center
197 that:
198 (a) Is verified by the department to be in substantial
199 compliance with Level II trauma center standards and has been
200 designated approved by the department to operate as a Level II
201 trauma center or is designated pursuant to s. 395.4025(14).
202 (b) Serves as a resource facility to general hospitals
203 through shared outreach, education, and quality improvement
204 activities.
205 (c) Participates in an inclusive system of trauma care.
206 (11)(8) “Local funding contribution” means local municipal,
207 county, or tax district funding exclusive of any patient
208 specific funds received pursuant to ss. 154.301-154.316, private
209 foundation funding, or public or private grant funding of at
210 least $150,000 received by a hospital or health care system that
211 operates a trauma center.
212 (12) “National trauma center accreditation body” or
213 “accreditation body” means an organization with optimal trauma
214 center accreditation standards approved by the department which
215 publishes national guidelines for trauma center verification,
216 has an active national trauma center verification program that
217 has verified trauma centers in at least 25 states, and is not
218 affiliated with any entity that is engaged in the delivery of
219 health care services. The accreditation body must have standards
220 relating to facilities, trauma system integration, equipment,
221 staffing, physician response requirements, interfacility
222 transfer, education, and performance improvement.
223 (13)(9) “Pediatric trauma center” means a hospital that is
224 verified by the department to be in substantial compliance with
225 pediatric trauma center standards as published by the
226 accreditation body established by rule of the department and has
227 been designated approved by the department to operate as a
228 pediatric trauma center.
229 (10) “Provisional trauma center” means a hospital that has
230 been verified by the department to be in substantial compliance
231 with the requirements in s. 395.4025 and has been approved by
232 the department to operate as a provisional Level I trauma
233 center, Level II trauma center, or pediatric trauma center.
234 (14)(11) “Trauma agency” means an entity a department
235 approved agency established and operated by one or more counties
236 and approved by the department, or a department-approved entity
237 with which one or more counties contract, for the purpose of
238 administering an inclusive regional trauma system.
239 (15)(12) “Trauma alert victim” means a person who has
240 incurred a single or multisystem injury due to blunt or
241 penetrating means or burns, who requires immediate medical
242 intervention or treatment, and who meets one or more of the
243 adult or pediatric scorecard criteria established by the
244 department by rule.
245 (16)(13) “Trauma caseload volume” means the number of
246 trauma patients reported by designated individual trauma centers
247 to the Trauma Registry and validated by the department.
248 (17)(14) “Trauma center” means a hospital that has been
249 designated verified by the department to be in substantial
250 compliance with the requirements in s. 395.4025 and has been
251 approved by the department to operate as a Level I trauma
252 center, Level II trauma center, or pediatric trauma center, or
253 is designated by the department as a Level II trauma center
254 pursuant to s. 395.4025(14).
255 (18)(15) “Trauma patient” means a person who has incurred a
256 physical injury or wound caused by trauma and has accessed a
257 trauma center.
258 (19)(16) “Trauma scorecard” means a statewide methodology
259 adopted by the department by rule under which a person who has
260 incurred a traumatic injury is graded as to the severity of his
261 or her injuries or illness and which methodology is used as the
262 basis for making destination decisions.
263 (20)(17) “Trauma transport protocol” means a document that
264 which describes the policies, processes, and procedures
265 governing the dispatch of vehicles, the triage, prehospital
266 transport, and interfacility trauma transfer of trauma victims.
267 (21)(18) “Trauma victim” means any person who has incurred
268 a single or multisystem injury due to blunt or penetrating means
269 or burns and who requires immediate medical intervention or
270 treatment.
271 (22) “Verified” means a hospital has received a certificate
272 of trauma center verification and maintains compliance with all
273 standards set forth as a condition of receiving the certificate.
274 Section 3. Section 395.401, Florida Statutes, is amended to
275 read:
276 395.401 Trauma agencies services system plans; approval of
277 trauma centers and pediatric trauma centers; procedures;
278 renewal.—
279 (1)(a) A The local and regional trauma agency agencies
280 shall plan, implement, and evaluate trauma services systems, in
281 accordance with this section and ss. 395.4015, 395.404, and
282 395.4045, which consist of organized patterns of readiness and
283 response services based on public and private agreements and
284 operational procedures. The department shall establish, by rule,
285 processes and procedures for establishing a trauma agency and
286 obtaining its approval from the department.
287 (b) A The local and regional trauma agency agencies shall
288 develop and submit to the department a trauma agency plan plans
289 for local and regional trauma services systems. The plan plans
290 must include, at a minimum, the following components:
291 1. The organizational structure of the trauma system.
292 2. Prehospital care management guidelines for triage and
293 transportation of trauma cases.
294 3. Flow patterns of trauma cases and transportation system
295 design and resources, including air transportation services,
296 provision for interfacility trauma transfer, and the prehospital
297 transportation of trauma victims. The trauma agency shall plan
298 for the development of a system of transportation of trauma
299 alert victims to trauma centers where the distance or time to a
300 trauma center or transportation resources is in the best
301 interest of the diminish access by trauma alert victims.
302 4. The number and location of needed trauma centers based
303 on local needs, population, and location and distribution of
304 resources.
305 4.5. Data collection regarding system operation and patient
306 outcome.
307 5.6. Annual Periodic performance evaluations evaluation of
308 the trauma system and its components.
309 6.7. The use of air transport services within the
310 jurisdiction of the local trauma agency.
311 7.8. Public information and education about the trauma
312 system.
313 8.9. Emergency medical services communication system usage
314 and dispatching.
315 9.10. The coordination and integration between the trauma
316 center and other acute care hospitals.
317 10.11. Medical control and accountability.
318 11.12. Quality control and system evaluation.
319 12. A uniform trauma transport protocol, or an approved
320 trauma transport protocol from each emergency medical service
321 provider in the geographic area served by the trauma agency,
322 which incorporates all trauma centers and other resources
323 required to implement an inclusive trauma system.
324 13. List of all participating health care facilities,
325 organizations, and emergency medical providers.
326 (c) The department shall receive applications plans for the
327 implementation of inclusive trauma systems from trauma agencies.
328 The applications shall be limited to the trauma agency plan and
329 information about the plan’s developer. The department shall may
330 approve or not approve trauma agency plans based on the
331 conformance of the plan with this section and ss. 395.4015,
332 395.404, and 395.4045 and the rules and definitions adopted by
333 the department pursuant to those sections. The department shall
334 approve or deny disapprove the applications plans within 120
335 days after the date the plans are submitted to the department
336 notifies the developer of the trauma agency plan that the plan
337 is complete. For the purposes of s. 120.60, the plans do not
338 constitute licensure and are not to be considered approved in
339 the absence of department approval.
340 (d) The department shall, by rule, establish provide an
341 application process for establishing a trauma agency. The
342 application must, at a minimum, provide requirements for the
343 trauma agency plan submitted for review, a process for reviewing
344 the application for a trauma agency, a process for reviewing the
345 trauma transport protocols for the trauma agency, and a process
346 for reviewing the staffing requirements for the agency. The
347 department shall, by rule, establish minimum requirements for a
348 trauma agency to conduct an annual performance evaluation and
349 submit the results to the department.
350 (e)(d) A trauma agency may shall not operate unless the
351 department has approved the local or regional trauma services
352 system plan of the agency.
353 (e) The department may grant an exception to a portion of
354 the rules adopted pursuant to this section or s. 395.4015 if the
355 local or regional trauma agency proves that, as defined in the
356 rules, compliance with that requirement would not be in the best
357 interest of the persons served within the affected local or
358 regional trauma area.
359 (f) A local or regional trauma agency may implement a
360 trauma care system only if the system meets the minimum
361 standards set forth in the rules for implementation established
362 by the department and if the plan has been submitted to, and
363 approved by, the department. At least 60 days before the local
364 or regional trauma agency submits the plan for the trauma care
365 system to the department, the local or regional trauma agency
366 shall hold a public hearing and give adequate notice of the
367 public hearing to all hospitals and other interested parties in
368 the area to be included in the proposed system.
369 (g) Local or regional trauma agencies may enter into
370 contracts for the purpose of implementing the local or regional
371 plan. If local or regional agencies contract with hospitals for
372 trauma services, such agencies must contract only with hospitals
373 which are verified trauma centers.
374 (f)(h) A Local or regional trauma agency agencies providing
375 service for more than one county shall, as part of its their
376 formation, establish interlocal agreements between or among the
377 several counties in the trauma regional system.
378 (g)(i) This section does not restrict the authority of a
379 health care facility to provide service for which it has
380 received a license pursuant to this chapter.
381 (j) Any hospital which is verified as a trauma center shall
382 accept all trauma victims that are appropriate for the facility
383 regardless of race, sex, creed, or ability to pay.
384 (k) It is unlawful for any hospital or other facility to
385 hold itself out as a trauma center unless it has been so
386 verified or designated pursuant to s. 395.4025(14).
387 (h)(l) A county, upon the recommendations of the local or
388 regional trauma agency, may adopt ordinances governing the
389 transport of a patient who is receiving care in the field from
390 prehospital emergency medical personnel when the patient meets
391 specific criteria for trauma, burn, or pediatric centers adopted
392 by a the local or regional trauma agency. These ordinances must
393 be consistent with s. 395.4045, ordinances adopted under s.
394 401.25(6), and a the local or regional trauma agency system plan
395 and, to the furthest possible extent, must ensure that
396 individual patients receive appropriate medical care while
397 protecting the interests of the community at large by making
398 maximum use of available emergency medical care resources.
399 (i)(m) A The local or regional trauma agency plan must be
400 shall, consistent with the state regional trauma system plan,
401 coordinate trauma care at the county level, and otherwise
402 facilitate arrangements necessary to develop an inclusive a
403 trauma services system.
404 (j)(n) After the submission of the initial trauma system
405 plan, each trauma agency shall, every 5th year, submit to the
406 department by July 1 of every even-numbered year for approval an
407 updated plan that identifies the changes, if any, to be made in
408 the plan regional trauma system.
409 (k)(o) This section does not preclude a local or regional
410 trauma agency from adopting trauma care system protocols
411 standards.
412 (2) The delivery of trauma services in coordination with a
413 trauma agency established before July 1, 2018, may continue in
414 accordance with the public and private agreements and
415 operational procedures entered into as provided in this section
416 The department shall adopt, by rule, standards for verification
417 of trauma centers based on national guidelines, including those
418 established by the American College of Surgeons entitled
419 “Hospital and Prehospital Resources for Optimal Care of the
420 Injured Patient” and published appendices thereto. Standards
421 specific to pediatric trauma referral centers shall be developed
422 in conjunction with Children’s Medical Services and adopted by
423 rule of the department.
424 (3) There may not be more than one trauma agency in any
425 county The department may withdraw local or regional agency
426 authority, prescribe corrective actions, or use the
427 administrative remedies as provided in s. 395.1065 for the
428 violation of any provision of this section and ss. 395.4015,
429 395.402, 395.4025, 395.403, 395.404, and 395.4045 or rules
430 adopted thereunder. All amounts collected pursuant to this
431 subsection shall be deposited into the Emergency Medical
432 Services Trust Fund provided in s. 401.34.
433 Section 4. Section 395.4015, Florida Statutes, is amended
434 to read:
435 395.4015 State regional trauma planning; trauma regions.—
436 (1) The department shall coordinate the development of
437 establish a statewide state trauma system plan. As part of the
438 state trauma system plan, the department shall establish trauma
439 regions that cover all geographical areas of the state and have
440 boundaries that are coterminous with the boundaries of the
441 regional domestic security task forces established under s.
442 943.0312. These regions may serve as the basis for the
443 development of department-approved local or regional trauma
444 plans. However, the delivery of trauma services by or in
445 coordination with a trauma agency established before July 1,
446 2004, may continue in accordance with public and private
447 agreements and operational procedures entered into as provided
448 in s. 395.401.
449 (2) The department shall update consider the advice and
450 recommendations of any affected local or regional trauma agency
451 in developing the statewide state trauma system plan by December
452 31 of every odd-numbered year.
453 (3) The statewide department shall use the state trauma
454 system plan shall serve as the basis for establishing a
455 statewide inclusive trauma system.
456 Section 5. Section 395.402, Florida Statutes, is repealed.
457 Section 6. Section 395.4025, Florida Statutes, is amended
458 to read:
459 395.4025 Trauma centers; selection; quality assurance;
460 records.—
461 (1) Any hospital that has received a provisional or
462 verified status from the department before July 1, 2016, has
463 until July 1, 2022, to obtain verification from a national
464 trauma center accreditation body and upon presentation of such
465 verification shall be designated by the department.
466 Notwithstanding any other law or the provisions of chapter 120,
467 any hospital in receipt of a provisional or verified status as a
468 trauma center from the department before July 1, 2016, shall be
469 approved to operate in accordance with this section.
470 (2) An application filed with the department for the
471 designation of a hospital as a trauma center must contain all of
472 the following:
473 (a) Name and physical address of the hospital seeking
474 designation as a trauma center.
475 (b) Names, telephone numbers, and e-mail addresses of the
476 hospital’s chief executive officer, trauma medical director, and
477 trauma program manager. A Level I trauma center must include
478 information for both adult and pediatric services.
479 (c) List of all trauma victim-related interfacility
480 transfer agreements with other designated trauma centers, acute
481 care hospitals, burn centers, and rehabilitation facilities.
482 (d) Description of the hospital’s trauma surge capacity in
483 the event of a natural disaster or mass causality event.
484 (e) Copy of the application materials submitted to the
485 national trauma center accreditation body for verification as a
486 trauma center.
487 (f) Copy of the reports and evaluations issued to the
488 hospital by the national trauma center accreditation body
489 relating to verification as a trauma center.
490 (g) Certificate of trauma center verification.
491 (3) The application for designation as a trauma center may
492 be denied by the department only in the case of missing
493 information or documentation.
494 (4) The department shall designate a hospital as a trauma
495 center upon receipt of:
496 (a) A completed application for designation as a trauma
497 center; and
498 (b) A valid certificate of trauma center verification.
499 (5) The department’s designation of a hospital as a Level
500 I, Level II, or pediatric trauma center must correspond with the
501 certificate of trauma center verification.
502 (6) The designation of a hospital as a trauma center
503 remains valid only as long as the hospital holds a valid
504 certificate of trauma center verification and maintains the
505 standards required to obtain verification from the national
506 trauma center accreditation body. If a trauma center fails to
507 maintain the certification or the standards, as determined by
508 the department, the department’s subcontractor, or the national
509 trauma center accreditation body, the department may take
510 corrective actions against the hospital, including revocation of
511 its trauma center designation.
512 (1) For purposes of developing a system of trauma centers,
513 the department shall use the 19 trauma service areas established
514 in s. 395.402. Within each service area and based on the state
515 trauma system plan, the local or regional trauma services system
516 plan, and recommendations of the local or regional trauma
517 agency, the department shall establish the approximate number of
518 trauma centers needed to ensure reasonable access to high
519 quality trauma services. The department shall select those
520 hospitals that are to be recognized as trauma centers.
521 (2)(a) The department shall annually notify each acute care
522 general hospital and each local and each regional trauma agency
523 in the state that the department is accepting letters of intent
524 from hospitals that are interested in becoming trauma centers.
525 In order to be considered by the department, a hospital that
526 operates within the geographic area of a local or regional
527 trauma agency must certify that its intent to operate as a
528 trauma center is consistent with the trauma services plan of the
529 local or regional trauma agency, as approved by the department,
530 if such agency exists. Letters of intent must be postmarked no
531 later than midnight October 1.
532 (b) By October 15, the department shall send to all
533 hospitals that submitted a letter of intent an application
534 package that will provide the hospitals with instructions for
535 submitting information to the department for selection as a
536 trauma center. The standards for trauma centers provided for in
537 s. 395.401(2), as adopted by rule of the department, shall serve
538 as the basis for these instructions.
539 (c) In order to be considered by the department,
540 applications from those hospitals seeking selection as trauma
541 centers, including those current verified trauma centers that
542 seek a change or redesignation in approval status as a trauma
543 center, must be received by the department no later than the
544 close of business on April 1. The department shall conduct a
545 provisional review of each application for the purpose of
546 determining that the hospital’s application is complete and that
547 the hospital has the critical elements required for a trauma
548 center. This critical review will be based on trauma center
549 standards and shall include, but not be limited to, a review of
550 whether the hospital has:
551 1. Equipment and physical facilities necessary to provide
552 trauma services.
553 2. Personnel in sufficient numbers and with proper
554 qualifications to provide trauma services.
555 3. An effective quality assurance process.
556 4. Submitted written confirmation by the local or regional
557 trauma agency that the hospital applying to become a trauma
558 center is consistent with the plan of the local or regional
559 trauma agency, as approved by the department, if such agency
560 exists.
561 (d)1. Notwithstanding other provisions in this section, the
562 department may grant up to an additional 18 months to a hospital
563 applicant that is unable to meet all requirements as provided in
564 paragraph (c) at the time of application if the number of
565 applicants in the service area in which the applicant is located
566 is equal to or less than the service area allocation, as
567 provided by rule of the department. An applicant that is granted
568 additional time pursuant to this paragraph shall submit a plan
569 for departmental approval which includes timelines and
570 activities that the applicant proposes to complete in order to
571 meet application requirements. Any applicant that demonstrates
572 an ongoing effort to complete the activities within the
573 timelines outlined in the plan shall be included in the number
574 of trauma centers at such time that the department has conducted
575 a provisional review of the application and has determined that
576 the application is complete and that the hospital has the
577 critical elements required for a trauma center.
578 2. Timeframes provided in subsections (1)-(8) shall be
579 stayed until the department determines that the application is
580 complete and that the hospital has the critical elements
581 required for a trauma center.
582 (3) After April 30, any hospital that submitted an
583 application found acceptable by the department based on
584 provisional review shall be eligible to operate as a provisional
585 trauma center.
586 (4) Between May 1 and October 1 of each year, the
587 department shall conduct an in-depth evaluation of all
588 applications found acceptable in the provisional review. The
589 applications shall be evaluated against criteria enumerated in
590 the application packages as provided to the hospitals by the
591 department.
592 (5) Beginning October 1 of each year and ending no later
593 than June 1 of the following year, a review team of out-of-state
594 experts assembled by the department shall make onsite visits to
595 all provisional trauma centers. The department shall develop a
596 survey instrument to be used by the expert team of reviewers.
597 The instrument shall include objective criteria and guidelines
598 for reviewers based on existing trauma center standards such
599 that all trauma centers are assessed equally. The survey
600 instrument shall also include a uniform rating system that will
601 be used by reviewers to indicate the degree of compliance of
602 each trauma center with specific standards, and to indicate the
603 quality of care provided by each trauma center as determined
604 through an audit of patient charts. In addition, hospitals being
605 considered as provisional trauma centers shall meet all the
606 requirements of a trauma center and shall be located in a trauma
607 service area that has a need for such a trauma center.
608 (6) Based on recommendations from the review team, the
609 department shall select trauma centers by July 1. An applicant
610 for designation as a trauma center may request an extension of
611 its provisional status if it submits a corrective action plan to
612 the department. The corrective action plan must demonstrate the
613 ability of the applicant to correct deficiencies noted during
614 the applicant’s onsite review conducted by the department
615 between the previous October 1 and June 1. The department may
616 extend the provisional status of an applicant for designation as
617 a trauma center through December 31 if the applicant provides a
618 corrective action plan acceptable to the department. The
619 department or a team of out-of-state experts assembled by the
620 department shall conduct an onsite visit on or before November 1
621 to confirm that the deficiencies have been corrected. The
622 provisional trauma center is responsible for all costs
623 associated with the onsite visit in a manner prescribed by rule
624 of the department. By January 1, the department must approve or
625 deny the application of any provisional applicant granted an
626 extension. Each trauma center shall be granted a 7-year approval
627 period during which time it must continue to maintain trauma
628 center standards and acceptable patient outcomes as determined
629 by department rule. An approval, unless sooner suspended or
630 revoked, automatically expires 7 years after the date of
631 issuance and is renewable upon application for renewal as
632 prescribed by rule of the department.
633 (7) Any hospital that wishes to protest a decision made by
634 the department based on the department’s preliminary or in-depth
635 review of applications or on the recommendations of the site
636 visit review team pursuant to this section shall proceed as
637 provided in chapter 120. Hearings held under this subsection
638 shall be conducted in the same manner as provided in ss. 120.569
639 and 120.57. Cases filed under chapter 120 may combine all
640 disputes between parties.
641 (7)(8) Notwithstanding any provision of chapter 381, a
642 hospital licensed under ss. 395.001-395.3025 which that operates
643 a trauma center may not terminate or substantially reduce the
644 availability of trauma service without providing at least 180
645 days’ notice of its intent to terminate such service. Such
646 notice shall be given to the department, to all affected local
647 or regional trauma agencies, and to all trauma centers,
648 hospitals, and emergency medical service providers in the trauma
649 service area. The department shall adopt by rule the procedures
650 and process for notification, duration, and explanation of the
651 termination of trauma services.
652 (8)(9) Except as otherwise provided in this subsection, the
653 department or its agent may collect trauma care and registry
654 data, as prescribed by rule of the department, from trauma
655 centers, hospitals, emergency medical service providers, local
656 or regional trauma agencies, or medical examiners for the
657 purposes of evaluating trauma system effectiveness, ensuring
658 compliance with the standards, and monitoring patient outcomes.
659 A trauma center, hospital, emergency medical service provider,
660 medical examiner, or local trauma agency or regional trauma
661 agency, or a panel or committee assembled by such an agency
662 under s. 395.50(1) may, but is not required to, disclose to the
663 department patient care quality assurance proceedings, records,
664 or reports. However, the department may require a local trauma
665 agency or a regional trauma agency, or a panel or committee
666 assembled by such an agency to disclose to the department
667 patient care quality assurance proceedings, records, or reports
668 that the department needs solely to conduct quality assurance
669 activities under s. 395.4015, or to ensure compliance with the
670 quality assurance component of a the trauma agency’s plan
671 approved under s. 395.401. The patient care quality assurance
672 proceedings, records, or reports that the department may require
673 for these purposes include, but are not limited to, the
674 structure, processes, and procedures of the agency’s quality
675 assurance activities, and any recommendation for improving or
676 modifying the overall trauma system, if the identity of a trauma
677 center, hospital, emergency medical service provider, medical
678 examiner, or an individual who provides trauma services is not
679 disclosed.
680 (10) Out-of-state experts assembled by the department to
681 conduct onsite visits are agents of the department for the
682 purposes of s. 395.3025. An out-of-state expert who acts as an
683 agent of the department under this subsection is not liable for
684 any civil damages as a result of actions taken by him or her,
685 unless he or she is found to be operating outside the scope of
686 the authority and responsibility assigned by the department.
687 (9)(11) Onsite visits by the department or its agent may be
688 conducted at any reasonable time and may include, but are not be
689 limited to, a review of records in the possession of trauma
690 centers, hospitals, emergency medical service providers, local
691 or regional trauma agencies, or medical examiners regarding the
692 care, transport, treatment, or examination of trauma patients.
693 (10)(12) Patient care, transport, or treatment records or
694 reports, or patient care quality assurance proceedings, records,
695 or reports obtained or made pursuant to this section, s.
696 395.3025(4)(f), s. 395.401, s. 395.4015, s. 395.402, s. 395.403,
697 s. 395.404, s. 395.4045, s. 395.405, s. 395.50, or s. 395.51
698 must be held confidential by the department or its agent and are
699 exempt from the provisions of s. 119.07(1). Patient care quality
700 assurance proceedings, records, or reports obtained or made
701 pursuant to these sections are not subject to discovery or
702 introduction into evidence in any civil or administrative
703 action.
704 (11) Any hospital that is designated as a trauma center
705 shall accept all trauma victims who require care regardless of
706 race, sex, creed, or ability to pay.
707 (12) A hospital or other facility may not hold itself out
708 as a trauma center unless it has been designated by the
709 department.
710 (13) A hospital may not withhold from the department any
711 information the hospital provides to a national trauma center
712 accreditation body. Withholding such information from the
713 department may result in the hospital’s loss of designation as a
714 trauma center.
715 (14) The department shall adopt rules to implement this
716 section.
717 (13) The department may adopt, by rule, the procedures and
718 process by which it will select trauma centers. Such procedures
719 and process must be used in annually selecting trauma centers
720 and must be consistent with subsections (1)-(8) except in those
721 situations in which it is in the best interest of, and mutually
722 agreed to by, all applicants within a service area and the
723 department to reduce the timeframes.
724 (14) Notwithstanding the procedures established pursuant to
725 subsections (1) through (13), hospitals located in areas with
726 limited access to trauma center services shall be designated by
727 the department as Level II trauma centers based on documentation
728 of a valid certificate of trauma center verification from the
729 American College of Surgeons. Areas with limited access to
730 trauma center services are defined by the following criteria:
731 (a) The hospital is located in a trauma service area with a
732 population greater than 600,000 persons but a population density
733 of less than 225 persons per square mile;
734 (b) The hospital is located in a county with no verified
735 trauma center; and
736 (c) The hospital is located at least 15 miles or 20 minutes
737 travel time by ground transport from the nearest verified trauma
738 center.
739 Section 7. Section 395.403, Florida Statutes, is amended to
740 read:
741 395.403 Reimbursement of trauma centers.—
742 (1) All trauma centers shall be considered eligible to
743 receive state funding when state funds are specifically
744 appropriated for state state-sponsored trauma centers in the
745 General Appropriations Act. Effective July 1, 2010, The
746 department shall make payments from the Emergency Medical
747 Services Trust Fund under s. 20.435 to the trauma centers.
748 Payments shall be in equal amounts for the trauma centers
749 designated approved by the department as of July 1 of the fiscal
750 year in which funding is appropriated. In the event a trauma
751 center does not maintain its status as a trauma center for any
752 state fiscal year in which such funding is appropriated, the
753 trauma center shall repay the state for the portion of the year
754 during which it was not a trauma center.
755 (2) Trauma centers eligible to receive distributions from
756 the Emergency Medical Services Trust Fund under s. 20.435 in
757 accordance with subsection (1) may request that such funds be
758 used as intergovernmental transfer funds in the Medicaid
759 program.
760 (3) In order to receive state funding, a hospital shall be
761 a trauma center and shall:
762 (a) Agree to conform to all departmental requirements as
763 provided by rule to assure high-quality trauma services.
764 (b) Agree to provide information concerning the provision
765 of trauma services to the department, in a form and manner
766 prescribed by rule of the department.
767 (b)(c) Agree to accept all trauma patients, regardless of
768 ability to pay, on a functional space-available basis.
769 (4) A trauma center that fails to comply with any of the
770 conditions listed in subsection (3) may or the applicable rules
771 of the department shall not receive payments under this section
772 for the period in which it was not in compliance.
773 Section 8. Subsections (1) and (2) of section 395.4036,
774 Florida Statutes, are amended to read:
775 395.4036 Trauma payments.—
776 (1) Recognizing the Legislature’s stated intent to provide
777 financial support to the current verified trauma centers and to
778 provide incentives for the establishment of additional trauma
779 centers as part of a system of state-sponsored trauma centers,
780 The department shall utilize funds collected under s. 318.18 and
781 deposited into the Emergency Medical Services Trust Fund of the
782 department to ensure the availability and accessibility of
783 trauma services throughout the state as provided in this
784 subsection.
785 (a) Funds collected under s. 318.18(15) shall be
786 distributed as follows:
787 1. Twenty percent of the total funds collected during the
788 state fiscal year shall be distributed to verified trauma
789 centers that have a local funding contribution as of December
790 31. Distribution of funds under this subparagraph shall be based
791 on trauma caseload volume for the most recent calendar year
792 available.
793 2. Forty percent of the total funds collected shall be
794 distributed to verified trauma centers based on trauma caseload
795 volume for the most recent calendar year available. The
796 determination of caseload volume for distribution of funds under
797 this subparagraph shall be based on the department’s Trauma
798 Registry data.
799 3. Forty percent of the total funds collected shall be
800 distributed to verified trauma centers based on severity of
801 trauma patients for the most recent calendar year available. The
802 determination of severity for distribution of funds under this
803 subparagraph shall be based on the department’s International
804 Classification Injury Severity Scores or another statistically
805 valid and scientifically accepted method of stratifying a trauma
806 patient’s severity of injury, risk of mortality, and resource
807 consumption as adopted by the department by rule, weighted based
808 on the costs associated with and incurred by the trauma center
809 in treating trauma patients. The weighting of scores shall be
810 established by the department by rule.
811 (b) Funds collected under s. 318.18(5)(c) and (20) shall be
812 distributed as follows:
813 1. Thirty percent of the total funds collected shall be
814 distributed to Level II trauma centers operated by a public
815 hospital governed by an elected board of directors as of
816 December 31, 2008.
817 2. Thirty-five percent of the total funds collected shall
818 be distributed to verified trauma centers based on trauma
819 caseload volume for the most recent calendar year available. The
820 determination of caseload volume for distribution of funds under
821 this subparagraph shall be based on the department’s Trauma
822 Registry data.
823 3. Thirty-five percent of the total funds collected shall
824 be distributed to verified trauma centers based on severity of
825 trauma patients for the most recent calendar year available. The
826 determination of severity for distribution of funds under this
827 subparagraph shall be based on the department’s International
828 Classification Injury Severity Scores or another statistically
829 valid and scientifically accepted method of stratifying a trauma
830 patient’s severity of injury, risk of mortality, and resource
831 consumption as adopted by the department by rule, weighted based
832 on the costs associated with and incurred by the trauma center
833 in treating trauma patients. The weighting of scores shall be
834 established by the department by rule.
835 (2) Funds deposited in the department’s Emergency Medical
836 Services Trust Fund for verified trauma centers may be used to
837 maximize the receipt of federal funds that may be available for
838 such trauma centers. Notwithstanding this section and s. 318.14,
839 distributions to trauma centers may be adjusted in a manner to
840 ensure that total payments to trauma centers represent the same
841 proportional allocation as set forth in this section and s.
842 318.14. For purposes of this section and s. 318.14, total funds
843 distributed to trauma centers may include revenue from the
844 Emergency Medical Services Trust Fund and federal funds for
845 which revenue from the Administrative Trust Fund is used to meet
846 state or local matching requirements. Funds collected under ss.
847 318.14 and 318.18 and deposited in the Emergency Medical
848 Services Trust Fund of the department shall be distributed to
849 trauma centers on a quarterly basis using the most recent
850 calendar year data available. Such data may shall not be used
851 for more than four quarterly distributions unless there are
852 extenuating circumstances as determined by the department, in
853 which case the most recent calendar year data available shall
854 continue to be used and appropriate adjustments shall be made as
855 soon as the more recent data becomes available.
856 Section 9. Section 395.404, Florida Statutes, is amended to
857 read:
858 395.404 Review of trauma registry data; report to central
859 registry; confidentiality and limited release.—
860 (1)(a) Each Trauma centers center shall furnish, and, upon
861 request of the department, all acute care hospitals shall
862 furnish for department review trauma registry data as prescribed
863 by rule of the department for the purpose of monitoring patient
864 outcomes outcome and ensuring compliance with the standards of
865 verification published by a national trauma center accreditation
866 body approval.
867 (b) Trauma registry data obtained pursuant to this
868 subsection and emergency medical service transport and treatment
869 records of trauma alert victims obtained pursuant to s. 401.30
870 are confidential and exempt from the provisions of s. 119.07(1)
871 and s. 24(a), Art. I of the State Constitution. However, the
872 department may provide such trauma registry data to the person,
873 trauma center, hospital, emergency medical service provider,
874 local or regional trauma agency, medical examiner, or other
875 entity from which the data were obtained. The department may
876 also use or provide trauma registry data for purposes of
877 research in accordance with the provisions of chapter 405.
878 (2) Each trauma center, pediatric trauma center, and acute
879 care hospital shall report to the department’s brain and spinal
880 cord injury central registry, consistent with the procedures and
881 timeframes of s. 381.74, any person who has a moderate-to-severe
882 brain or spinal cord injury, and shall include in the report the
883 name, age, residence, and type of disability of the individual
884 and any additional information that the department finds
885 necessary.
886 Section 10. Subsections (1) through (6) and subsection (8)
887 of section 395.4045, Florida Statutes, are amended to read:
888 395.4045 Emergency medical service providers; trauma
889 transport protocols; transport of trauma alert victims to trauma
890 centers; interfacility transfer.—
891 (1) Each emergency medical services provider licensed under
892 chapter 401 shall transport trauma alert victims to hospitals
893 designated approved as trauma centers, except as may be provided
894 for either in the department-approved trauma transport protocol
895 of a the trauma agency for the geographical area in which the
896 emergency medical services licensee provides services or, if no
897 such department-approved trauma transport protocol is in effect,
898 as provided for in a department-approved provider’s trauma
899 transport protocol.
900 (2) A trauma agency may develop a uniform trauma transport
901 protocol that is applicable to the emergency medical services
902 licensees providing services within the geographical boundaries
903 of the trauma agency. Development of a uniform trauma protocol
904 by a trauma agency shall be through consultation with interested
905 parties, including, but not limited to, each approved trauma
906 center; physicians specializing in trauma care, emergency care,
907 and surgery in the geographical area served by the trauma agency
908 region; each trauma system administrator in the geographical
909 area served by the trauma agency region; and each emergency
910 medical service provider in the region licensed under chapter
911 401, and such providers’ respective medical directors.
912 (3) Trauma alert victims shall be identified through the
913 use of a trauma scoring system, including adult and pediatric
914 assessment as specified in rule of the department. The rule must
915 shall also include the requirements of licensed emergency
916 medical services providers for performing and documenting these
917 assessments.
918 (4) The department shall specify by rule the subjects and
919 the minimum criteria related to prehospital trauma transport,
920 trauma center or hospital destination determinations, and
921 interfacility trauma transfer transport by an emergency medical
922 services provider to be included in a trauma agency’s or
923 emergency medical service provider’s trauma transport protocol
924 and shall approve or disapprove each such protocol. Trauma
925 transport protocol rules pertaining to the air transportation of
926 trauma victims shall be consistent with, but not limited to,
927 applicable Federal Aviation Administration regulation. Emergency
928 medical services licensees and trauma agencies shall be subject
929 to monitoring by the department, under ss. 395.401(2) ss.
930 395.401(3) and 401.31(1) for compliance with requirements, as
931 applicable, regarding trauma transport protocols and the
932 transport of trauma victims.
933 (5) If there is no department-approved trauma agency trauma
934 transport protocol for the geographical area in which the
935 emergency medical services license applicant intends to provide
936 services, as provided for in subsection (1), Each applicant for
937 licensure as an emergency medical services provider, under
938 chapter 401, must submit and obtain department approval of a
939 trauma transport protocol prior to the department granting a
940 license. The department shall prescribe by rule the submission
941 and approval process for an applicant’s trauma transport
942 protocols whether the applicant will be using a trauma agency’s
943 or its own trauma transport protocol.
944 (6) If an air ambulance service is available in the trauma
945 service area in which an emergency medical service provider is
946 located, trauma transport protocols shall not provide for
947 transport outside of the trauma service area unless otherwise
948 provided for by written mutual agreement. If air ambulance
949 service is not available and there is no agreement for
950 interagency transport of trauma patients between two adjacent
951 local or regional trauma agencies, both of which include at
952 least one approved trauma center, then the transport of A trauma
953 patient with an immediately life-threatening condition shall be
954 transported to the most appropriate trauma center as defined
955 pursuant to trauma transport protocols approved by the
956 department. The provisions of this subsection shall apply only
957 to those counties with a population in excess of 1 million
958 residents.
959 (8) The department shall adopt and enforce all rules
960 necessary to administer this section. The department shall adopt
961 and enforce rules to specify the submission and approval process
962 for trauma transport protocols or modifications to trauma
963 transport protocols by trauma agencies and licensed emergency
964 medical services providers.
965 Section 11. Section 395.405, Florida Statutes, is amended
966 to read:
967 395.405 Rulemaking.—The department shall adopt and enforce
968 all rules necessary to administer ss. 395.401, 395.4015,
969 395.402, 395.4025, 395.403, 395.404, and 395.4045.
970 Section 12. Subsections (1), (3), and (8) of section
971 395.50, Florida Statutes, are amended to read:
972 395.50 Quality assurance activities of trauma agencies.—
973 (1) As used in this section, the term “entity” means a
974 local trauma agency or a regional trauma agency that performs
975 quality assurance activities, or a panel or committee assembled
976 to assist a local trauma agency or a regional trauma agency in
977 performing quality assurance activities in accordance with the
978 trauma agency a plan approved under s. 395.401.
979 (3) A local trauma agency or regional trauma agency may
980 assemble a panel or committee to assist in performing the tasks
981 authorized by an approved plan under s. 395.401.
982 (8) Nothing in this section, ss. 395.4001-395.405, or s.
983 395.51 prohibits admitting into evidence patient care,
984 transport, or treatment records or reports, or records or
985 reports of the department in any civil or administrative action
986 brought by or involving the department, excluding the name,
987 residence or business address, telephone number, social security
988 or other identifying number, or photograph of any person or the
989 spouse, relative, or guardian of such person or other patient
990 specific information that otherwise identifies the patient,
991 either directly or indirectly.
992 Section 13. Subsection (1) of section 320.0801, Florida
993 Statutes, is amended to read:
994 320.0801 Additional license tax on certain vehicles.—
995 (1) In addition to the license taxes specified in s. 320.08
996 and in subsection (2), there is hereby levied and imposed an
997 annual license tax of 10 cents for the operation of a motor
998 vehicle, as defined in s. 320.01, and moped, as defined in s.
999 316.003, which tax shall be paid to the department or its agent
1000 upon the registration or renewal of registration of the vehicle.
1001 Notwithstanding s. 320.20, revenues collected from the tax
1002 imposed in this subsection shall be deposited in the Emergency
1003 Medical Services Trust Fund and used solely for the purpose of
1004 carrying out ss. 395.40, 395.401, 395.4015, 395.4025, 395.404,
1005 and 395.4045 and s. 11, chapter 87-399, Laws of Florida.
1006 Section 14. Paragraph (l) of subsection (3) of section
1007 408.036, Florida Statutes, is amended to read:
1008 408.036 Projects subject to review; exemptions.—
1009 (3) EXEMPTIONS.—Upon request, the following projects are
1010 subject to exemption from the provisions of subsection (1):
1011 (l) For the establishment of:
1012 1. A Level II neonatal intensive care unit with at least 10
1013 beds, upon documentation to the agency that the applicant
1014 hospital had a minimum of 1,500 births during the previous 12
1015 months;
1016 2. A Level III neonatal intensive care unit with at least
1017 15 beds, upon documentation to the agency that the applicant
1018 hospital has a Level II neonatal intensive care unit of at least
1019 10 beds and had a minimum of 3,500 births during the previous 12
1020 months; or
1021 3. A Level III neonatal intensive care unit with at least 5
1022 beds, upon documentation to the agency that the applicant
1023 hospital is a designated verified trauma center pursuant to s.
1024 395.4001(17) s. 395.4001(14), and has a Level II neonatal
1025 intensive care unit,
1026
1027 if the applicant demonstrates that it meets the requirements for
1028 quality of care, nurse staffing, physician staffing, physical
1029 plant, equipment, emergency transportation, and data reporting
1030 found in agency certificate-of-need rules for Level II and Level
1031 III neonatal intensive care units and if the applicant commits
1032 to the provision of services to Medicaid and charity patients at
1033 a level equal to or greater than the district average. Such a
1034 commitment is subject to s. 408.040.
1035 Section 15. Paragraph (a) of subsection (1) of section
1036 409.975, Florida Statutes, is amended to read:
1037 409.975 Managed care plan accountability.—In addition to
1038 the requirements of s. 409.967, plans and providers
1039 participating in the managed medical assistance program shall
1040 comply with the requirements of this section.
1041 (1) PROVIDER NETWORKS.—Managed care plans must develop and
1042 maintain provider networks that meet the medical needs of their
1043 enrollees in accordance with standards established pursuant to
1044 s. 409.967(2)(c). Except as provided in this section, managed
1045 care plans may limit the providers in their networks based on
1046 credentials, quality indicators, and price.
1047 (a) Plans must include all providers in the region that are
1048 classified by the agency as essential Medicaid providers, unless
1049 the agency approves, in writing, an alternative arrangement for
1050 securing the types of services offered by the essential
1051 providers. Providers are essential for serving Medicaid
1052 enrollees if they offer services that are not available from any
1053 other provider within a reasonable access standard, or if they
1054 provided a substantial share of the total units of a particular
1055 service used by Medicaid patients within the region during the
1056 last 3 years and the combined capacity of other service
1057 providers in the region is insufficient to meet the total needs
1058 of the Medicaid patients. The agency may not classify physicians
1059 and other practitioners as essential providers. The agency, at a
1060 minimum, shall determine which providers in the following
1061 categories are essential Medicaid providers:
1062 1. Federally qualified health centers.
1063 2. Statutory teaching hospitals as defined in s.
1064 408.07(45).
1065 3. Hospitals that are trauma centers as defined in s.
1066 395.4001(17) s. 395.4001(14).
1067 4. Hospitals located at least 25 miles from any other
1068 hospital with similar services.
1069
1070 Managed care plans that have not contracted with all essential
1071 providers in the region as of the first date of recipient
1072 enrollment, or with whom an essential provider has terminated
1073 its contract, must negotiate in good faith with such essential
1074 providers for 1 year or until an agreement is reached, whichever
1075 is first. Payments for services rendered by a nonparticipating
1076 essential provider shall be made at the applicable Medicaid rate
1077 as of the first day of the contract between the agency and the
1078 plan. A rate schedule for all essential providers shall be
1079 attached to the contract between the agency and the plan. After
1080 1 year, managed care plans that are unable to contract with
1081 essential providers shall notify the agency and propose an
1082 alternative arrangement for securing the essential services for
1083 Medicaid enrollees. The arrangement must rely on contracts with
1084 other participating providers, regardless of whether those
1085 providers are located within the same region as the
1086 nonparticipating essential service provider. If the alternative
1087 arrangement is approved by the agency, payments to
1088 nonparticipating essential providers after the date of the
1089 agency’s approval shall equal 90 percent of the applicable
1090 Medicaid rate. Except for payment for emergency services, if the
1091 alternative arrangement is not approved by the agency, payment
1092 to nonparticipating essential providers shall equal 110 percent
1093 of the applicable Medicaid rate.
1094 Section 16. This act shall take effect July 1, 2017.
