Florida Senate - 2017 SB 676 By Senator Bradley 5-00645-17 1 2017676__ A bill to be entitled 2 An act relating to the availability of health care 3 services; repealing s. 154.245, F.S., relating to the 4 issuance of certificates of need by the Agency for 5 Health Care Administration; amending s. 159.27, F.S.; 6 revising the term “health care facility”; amending s. 7 189.08, F.S.; removing a requirement that a special 8 district notify a local general-purpose government of 9 its plans to build, improve, or expand a public 10 facility that requires a certification of need; 11 creating s. 381.4066, F.S.; establishing local health 12 councils as public or private nonprofit agencies 13 serving the counties of certain districts; providing 14 for council members to be appointed by county 15 commissions; providing that appointees must represent 16 health care providers, health care purchasers, and 17 nongovernmental health care consumers; requiring a 18 certain schedule to be provided to county commissions 19 regarding council appointments; providing terms; 20 establishing health service planning districts; 21 establishing duties of local health councils; 22 requiring local health councils to enter into 23 memoranda of agreement with certain regional planning 24 councils and local governments in their districts; 25 specifying a requirement for the memoranda of 26 agreement; authorizing local health councils to employ 27 personnel or contract for staffing services; 28 authorizing local health councils to accept and 29 receive funds, grants, and services from governmental 30 agencies and from private or civic sources; requiring 31 an annual accounting of receipts and disbursement of 32 funds; providing legislative intent regarding funding Page 1 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 33 of local health councils; authorizing fees and 34 allowing fees to be collected from certain facilities 35 at the time of licensure renewal and prorated; 36 requiring the agency to adopt by rule fees for 37 hospitals, nursing homes, and other facilities; 38 providing penalties and authorizing fines; delegating 39 to the agency the responsibility for planning health 40 care services in the state; requiring the agency to 41 develop and maintain a comprehensive health care 42 database; requiring the Department of Health to 43 contract with local health councils for certain 44 services; specifying that certain funds must be 45 distributed according to an allocation plan the 46 department develops; authorizing the department to 47 withhold funds or cancel contracts if certain 48 standards are not met; amending s. 395.1055, F.S.; 49 removing a requirement that hospitals must submit 50 certain data related to certificate-of-need reviews; 51 requiring providers of adult diagnostic cardiac 52 catheterization services to comply with the most 53 recent guidelines of the American College of 54 Cardiology, the American Heart Association Guidelines 55 for Cardiac Catheterization and Cardiac 56 Catheterization Laboratories, and the rules of the 57 agency; providing rule requirements; amending s. 58 395.602, F.S.; deleting the terms “emergency care 59 hospital,” “essential access community hospital,” 60 “inactive rural hospital bed,” and “rural primary care 61 hospital”; repealing s. 395.6025, F.S., relating to Page 2 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 62 rural hospital replacement facilities; amending s. 63 395.603, F.S.; removing a requirement that the agency 64 adopt by rule a process by which a rural hospital may 65 deactivate general hospital beds; removing a 66 requirement that rural primary care hospitals and 67 emergency care hospitals maintain a number of actively 68 licensed general hospital beds necessary for 69 certification for Medicare reimbursement; repealing s. 70 395.604, F.S., relating to other rural hospital 71 programs; repealing s. 395.605, F.S., relating to 72 emergency care hospitals; amending s. 400.071, F.S.; 73 removing a statement of legislative intent that 74 preference be given to certain applications when 75 reviewing certificate-of-need applications; amending 76 s. 400.606, F.S.; requiring hospices that are 77 initially licensed after a certain date to be 78 accredited by a national accreditation organization; 79 requiring such hospices to establish and maintain 80 freestanding hospice facilities that are engaged in 81 providing inpatient and related services; removing the 82 authority of the agency to deny a license to an 83 applicant that fails to meet any condition for the 84 provision of hospice care or services imposed by the 85 agency on a certificate of need; amending s. 400.6085, 86 F.S.; removing a provision prohibiting hospices 87 contracting for inpatient care beds from being 88 required to obtain an additional certificate of need 89 for the number of designated beds; repealing s. 90 408.031, F.S., relating to a short title for the Page 3 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 91 Health Facility and Services Development Act; 92 repealing s. 408.032, F.S., relating to definitions 93 for the act; repealing s. 408.033, F.S., relating to 94 local and state health planning; repealing s. 408.034, 95 F.S., relating to the duties and responsibilities of 96 the agency; repealing s. 408.035, F.S., relating to 97 review criteria for certificate-of-need 98 determinations; repealing s. 408.036, F.S., relating 99 to health-care-related projects subject to review; 100 repealing s. 408.0361, F.S., relating to 101 cardiovascular services and burn unit licensure; 102 repealing s. 408.037, F.S., relating to content of 103 certificate-of-need applications; repealing s. 104 408.038, F.S., relating to fees for certificate-of- 105 need applications; repealing s. 408.039, F.S., 106 relating to the review process for certificates of 107 need; repealing s. 408.040, F.S., relating to 108 conditions imposed on certificates of need; repealing 109 s. 408.041, F.S., relating to the penalties for 110 failing to obtain a valid certificate of need; 111 repealing s. 408.042, F.S., relating to limitations on 112 transfers of certificates of need; repealing s. 113 408.043, F.S., relating to special provisions relating 114 to certificates of need; repealing s. 408.0436, F.S., 115 relating to a limitation on nursing home certificates 116 of need; repealing s. 408.044, F.S., relating to the 117 authority of the agency to obtain an injunction to 118 restrain or prevent the pursuit of a project in the 119 absence of a valid certificate of need; repealing s. 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Florida Senate - 2017 SB 676 5-00645-17 2017676__ 120 408.045, F.S., relating to competitive sealed 121 proposals for certificates of need; repealing s. 122 408.0455, F.S., relating to rules of the agency in 123 effect as of a certain date; amending s. 408.808, 124 F.S.; authorizing the agency to issue an inactive 125 license to a hospital, nursing home, intermediate care 126 facility for the developmentally disabled, or an 127 ambulatory surgical center under certain 128 circumstances; removing authority for the agency to 129 renew an inactive designation for a statutory rural 130 hospital under certain circumstances; repealing s. 131 651.118, F.S., relating to sheltered nursing home beds 132 and community beds; amending ss. 154.246, 186.503, 133 220.1845, 376.30781, 376.86, 383.216, 395.0191, 134 395.1065, 408.07, 408.806, 408.810, 408.820, 409.9116, 135 641.60, and 1009.65 F.S.; conforming provisions to 136 changes made by the act; providing an effective date. 137 138 Be It Enacted by the Legislature of the State of Florida: 139 140 Section 1. Section 154.245, Florida Statutes, is repealed. 141 Section 2. Subsection (16) of section 159.27, Florida 142 143 Statutes, is amended to read: 159.27 Definitions.—The following words and terms, unless 144 the context clearly indicates a different meaning, shall have 145 the following meanings: 146 (16) “Health care facility” means property operated in the 147 private sector, whether operated for profit or not, used for or 148 useful in connection with the diagnosis, treatment, therapy, Page 5 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 149 rehabilitation, housing, or care of or for aged, sick, ill, 150 injured, infirm, impaired, disabled, or handicapped persons, 151 without discrimination among such persons due to race, religion, 152 or national origin; or for the prevention, detection, and 153 control of disease, including, without limitation thereto, 154 hospital, clinic, emergency, outpatient, and intermediate care, 155 including, but not limited to, facilities for the elderly such 156 as assisted living facilities, facilities defined in s. 157 154.205(8), day care and share-a-home facilities, nursing homes, 158 and the following related property when used for or in 159 connection with the foregoing: laboratory; research; pharmacy; 160 laundry; health personnel training and lodging; patient, guest, 161 and health personnel food service facilities; and offices and 162 office buildings for persons engaged in health care professions 163 or services; provided, if required by ss. 400.601-400.611 and 164 ss. 408.031-408.045, a certificate of need therefor is obtained 165 prior to the issuance of the bonds. 166 Section 3. Subsection (3) of section 189.08, Florida 167 Statutes, is amended, and present subsections (4) through (10) 168 are redesignated as subsections (3) through (9), respectively, 169 to read: 170 189.08 Special district public facilities report.— 171 (3) A special district proposing to build, improve, or 172 expand a public facility which requires a certificate of need 173 pursuant to chapter 408 shall elect to notify the appropriate 174 local general-purpose government of its plans either in its 7- 175 year plan or at the time the letter of intent is filed with the 176 Agency for Health Care Administration pursuant to s. 408.039. 177 Section 4. Section 381.4066, Florida Statutes, is created Page 6 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 178 2017676__ to read: 179 381.4066 Local and state health planning.— 180 (1) LOCAL HEALTH COUNCILS.— 181 (a) Local health councils are hereby established as public 182 or private nonprofit agencies serving the counties of a district 183 as described in paragraph (b). The members of each council shall 184 be appointed in an equitable manner by the county commissions 185 having jurisdiction in the respective district. Each council 186 shall be composed of a number of members equal to one and one- 187 half times the number of counties comprising the district or 12 188 members, whichever is greater. Each county in a district shall 189 be entitled to at least one member on the council. The balance 190 of the council’s membership shall be allocated among the 191 counties of the district on the basis of population, with the 192 number of council seats rounded to the nearest whole number, 193 except that in a district composed of only two counties, no 194 county shall have fewer than four members. The appointees shall 195 be representatives of health care providers, health care 196 purchasers, and nongovernmental health care consumers, but not 197 excluding elected government officials. The members who are 198 health care consumers shall include a representative number of 199 persons over 60 years of age. A majority of the council members 200 must consist of health care purchasers and health care 201 consumers. Each local health council shall provide each county 202 commission a schedule for appointing council members to ensure 203 that council membership complies with this paragraph. The 204 members of the local health council shall elect a chair and 205 vice-chair. Members shall serve for terms of 2 years and may be 206 eligible for reappointment. Page 7 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 207 208 209 210 211 2017676__ (b) Health service planning districts are composed of the following counties: 1. District 1.—Escambia, Santa Rosa, Okaloosa, and Walton Counties. 2. District 2.—Holmes, Washington, Bay, Jackson, Franklin, 212 Gulf, Gadsden, Liberty, Calhoun, Leon, Wakulla, Jefferson, 213 Madison, and Taylor Counties. 214 3. District 3.—Hamilton, Suwannee, Lafayette, Dixie, 215 Columbia, Gilchrist, Levy, Union, Bradford, Putnam, Alachua, 216 Marion, Citrus, Hernando, Sumter, and Lake Counties. 217 218 4. District 4.—Baker, Nassau, Duval, Clay, St. Johns, Flagler, and Volusia Counties. 219 5. District 5.—Pasco and Pinellas Counties. 220 6. District 6.—Hillsborough, Manatee, Polk, Hardee, and 221 222 223 224 225 226 227 Highlands Counties. 7. District 7.—Seminole, Orange, Osceola, and Brevard Counties. 8. District 8.—Sarasota, DeSoto, Charlotte, Lee, Glades, Hendry, and Collier Counties. 9. District 9.—Indian River, Okeechobee, St. Lucie, Martin, and Palm Beach Counties. 228 10. District 10.—Broward County. 229 11. District 11.—Miami-Dade and Monroe Counties. 230 (c) Each local health council may: 231 1. Develop a district area health plan that includes 232 strategies and sets priorities for the council’s implementation 233 based on that district’s unique local health needs. 234 235 2. Advise the Agency for Health Care Administration on health care issues and resource allocations. Page 8 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 236 2017676__ 3. Promote public awareness of community health needs, 237 emphasizing health promotion and cost-effective health service 238 selection. 239 4. Collect data and conduct analyses and studies related to 240 health care needs of the district, including the needs of 241 medically indigent persons, and assist the agency and other 242 state offices in carrying out data collection activities that 243 relate to the functions in this subsection. 244 5. Advise and assist any regional planning councils within 245 each district which have elected to address health issues in 246 their strategic regional policy plans, including the development 247 of the plans’ health elements that address the health goals and 248 policies in the state comprehensive plan. 249 6. Advise and assist local governments within each district 250 on the development of an optional health plan element of the 251 state comprehensive plan provided in chapter 163, to assure 252 compatibility with the health goals and policies in the state 253 comprehensive plan and district health plan. To facilitate the 254 implementation of this section, the local health council shall 255 annually provide the local governments in its service area, upon 256 request, with: 257 258 259 a. A copy and appropriate updates of the district health plan; b. A report of hospital and nursing home utilization 260 statistics for facilities within the local government 261 jurisdiction. 262 7. Monitor and evaluate the adequacy, appropriateness, and 263 effectiveness of local, state, federal, and private funds 264 distributed within the district to meet the needs of the Page 9 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 265 266 2017676__ medically indigent and other underserved population groups. 8. In conjunction with the Department of Health, plan for 267 services at the local level for persons infected with the human 268 immunodeficiency virus. 269 9. Provide technical assistance to encourage and support 270 activities by providers, purchasers, consumers, and local, 271 regional, and state agencies in meeting the health care goals, 272 objectives, and policies adopted by the local health council. 273 (d) Each local health council shall enter into a memorandum 274 of agreement with each regional planning council in its district 275 which elects to address health issues in its strategic regional 276 policy plan. In addition, each local health council shall enter 277 into a memorandum of agreement with each local government that 278 includes an optional health element in its comprehensive plan. 279 Each memorandum of agreement must specify the manner in which 280 each local government, regional planning council, and local 281 health council will coordinate its activities to ensure a 282 unified approach to health planning and implementation efforts. 283 (e) Local health councils may employ personnel or contract 284 for staffing services with persons who possess appropriate 285 qualifications to carry out the councils’ purposes. However, 286 such personnel are not state employees. 287 (f) Personnel of the local health councils shall provide an 288 annual orientation to council members about council member 289 responsibilities. 290 (g) Each local health council may accept and receive, in 291 furtherance of its health planning functions, funds, grants, and 292 services from governmental agencies and from private or civic 293 sources and to perform studies related to local health planning Page 10 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 294 in exchange for such funds, grants, or services. Each council 295 shall, no later than January 30 of each year, prepare an 296 accounting of the receipt and disbursement of funds it received 297 during the previous calendar year and submit that report to the 298 Department of Health. 299 (2) FUNDING.— 300 (a) The Legislature intends that the cost of local health 301 councils be borne by assessments on selected health care 302 facilities subject to licensure by the Agency for Health Care 303 Administration, including abortion clinics, assisted living 304 facilities, ambulatory surgical centers, birthing centers; 305 clinical laboratories, except community nonprofit blood banks 306 and clinical laboratories operated by practitioners for their 307 exclusive use under s. 483.035; home health agencies, hospices, 308 hospitals, intermediate care facilities for the developmentally 309 disabled, nursing homes, health care clinics, and multiphasic 310 testing centers, and by assessments on organizations subject to 311 certification by the agency pursuant to chapter 641, part III, 312 including health maintenance organizations and prepaid health 313 clinics. Fees assessed may be collected prospectively at the 314 time of licensure renewal and prorated for the licensure period. 315 (b)1. A hospital licensed under chapter 395, a nursing home 316 licensed under chapter 400, and an assisted living facility 317 licensed under chapter 429 shall be assessed an annual fee based 318 on number of beds. 319 320 321 322 2. All other facilities and organizations listed in paragraph (a) shall each be assessed an annual fee of $150. 3. Facilities operated by the Department of Children and Families, the Department of Health, or the Department of Page 11 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 323 Corrections and any hospital that meets the definition of rural 324 hospital pursuant to s. 395.602 are exempt from the assessment 325 required in this subsection. 326 (c)1. The agency shall by rule establish fees for hospitals 327 and nursing homes based on an assessment of $2 per bed. However, 328 no such facility shall be assessed more than a total of $500 329 annually under this subsection. 330 2. The agency shall by rule establish fees for assisted 331 living facilities based on an assessment of $1 per bed. However, 332 no such facility shall be assessed more than a total of $150 333 annually under this subsection. 334 3. The agency shall by rule establish an annual fee of $150 335 for all other facilities and organizations listed in paragraph 336 (a). 337 (d) The agency shall by rule establish a facility billing 338 and collection process for the health facility fees authorized 339 by this subsection. 340 (e) A health facility that is assessed a fee under this 341 subsection is subject to a fine of $100 per day for each day the 342 facility is late in submitting its annual fee up to the maximum 343 of the annual fee owed by the facility. A facility that refuses 344 to pay the fee or fine is subject to the forfeiture of its 345 license. 346 (f) The agency shall deposit in the Health Care Trust Fund 347 all health care facility assessments that are collected pursuant 348 to this subsection and shall transfer such funds to the 349 Department of Health for funding of the local health councils. 350 (3) DUTIES AND RESPONSIBILITIES OF THE AGENCY.— 351 (a) The Agency for Health Care Administration is Page 12 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 352 responsible for the coordinated planning of health care services 353 in the state. 354 (b) The agency shall develop and maintain a comprehensive 355 health care database. The agency or its contractor is authorized 356 to require the submission of information from health facilities, 357 health service providers, and licensed health professionals 358 which is determined by the agency through rule to be necessary 359 for meeting the agency’s responsibilities as established in this 360 section. 361 (c) The Department of Health shall contract with the local 362 health councils for services that may be performed by the local 363 health councils under subsection (1). All contract funds shall 364 be distributed according to an allocation plan developed by the 365 department. The department may withhold funds from a local 366 health council or cancel its contract with a local health 367 council that does not meet performance standards agreed upon by 368 the department and the local health council. 369 Section 5. Paragraphs (f), (g), and (h) of subsection (1) 370 of section 395.1055, Florida Statutes, are amended, and 371 subsections (10) through (14) are added to that section, to 372 read: 373 395.1055 Rules and enforcement.— 374 (1) The agency shall adopt rules pursuant to ss. 120.536(1) 375 and 120.54 to implement the provisions of this part, which shall 376 include reasonable and fair minimum standards for ensuring that: 377 (f) All hospitals submit such data as necessary to conduct 378 certificate-of-need reviews required under part I of chapter 379 408. Such data shall include, but shall not be limited to, 380 patient origin data, hospital utilization data, type of service Page 13 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 381 reporting, and facility staffing data. The agency may not 382 collect data that identifies or could disclose the identity of 383 individual patients. The agency shall utilize existing uniform 384 statewide data sources when available and shall minimize 385 reporting costs to hospitals. 386 (f)(g) Each hospital has a quality improvement program 387 designed according to standards established by their current 388 accrediting organization. This program will enhance quality of 389 care and emphasize quality patient outcomes, corrective action 390 for problems, governing board review, and reporting to the 391 agency of standardized data elements necessary to analyze 392 quality of care outcomes. The agency shall use existing data, 393 when available, and shall not duplicate the efforts of other 394 state agencies in order to obtain such data. 395 (g)(h) Licensed facilities make available on their Internet 396 websites, no later than October 1, 2004, and in a hard copy 397 format upon request, a description of and a link to the patient 398 charge and performance outcome data collected from licensed 399 facilities pursuant to s. 408.061. 400 (10) Each provider of adult diagnostic cardiac 401 catheterization services shall comply with the most recent 402 guidelines of the American College of Cardiology, the American 403 Heart Association Guidelines for Cardiac Catheterization and 404 Cardiac Catheterization Laboratories, and rules adopted by the 405 agency which establish licensure standards governing the 406 operation of adult inpatient diagnostic cardiac catheterization 407 programs. The rules shall ensure that such programs: 408 409 (a) Perform only adult inpatient diagnostic cardiac catheterization services and will not provide therapeutic Page 14 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 410 411 412 413 2017676__ cardiac catheterization or any other cardiology services. (b) Maintain sufficient appropriate equipment and health care personnel to ensure quality of care and patient safety. (c) Maintain appropriate times of operation and protocols 414 to ensure availability and appropriate referrals in the event of 415 emergencies. 416 417 418 (d) Demonstrate a plan to provide services to Medicaid and charity care patients. (11) Each provider of adult cardiovascular services or 419 operator of a burn unit shall comply with rules adopted by the 420 agency which establish licensure standards that govern the 421 provision of adult cardiovascular services or the operation of a 422 burn unit. Such rules shall consider, at a minimum, staffing, 423 equipment, physical plant, operating protocols, the provision of 424 services to Medicaid and charity care patients, accreditation, 425 licensure period and fees, and enforcement of minimum standards. 426 (12) In establishing rules for adult cardiovascular 427 services, the agency shall include provisions that allow for: 428 (a) Establishment of two hospital program licensure levels: 429 a Level I program authorizing the performance of adult 430 percutaneous cardiac intervention without onsite cardiac 431 surgery, and a Level II program authorizing the performance of 432 percutaneous cardiac intervention with onsite cardiac surgery. 433 (b) Demonstration that, for the most recent 12-month period 434 as reported to the agency, a hospital seeking a Level I program 435 has provided a minimum of 300 adult inpatient and outpatient 436 diagnostic cardiac catheterizations or, for the most recent 12- 437 month period, has discharged or transferred at least 300 438 inpatients with the principal diagnosis of ischemic heart Page 15 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 439 disease and that it has a formalized, written transfer agreement 440 with a hospital that has a Level II program, including written 441 transport protocols to ensure safe and efficient transfer of a 442 patient within 60 minutes. However, a hospital located more than 443 100 road miles from the closest Level II adult cardiovascular 444 services program does not need to meet the 60-minute transfer 445 time protocol if the hospital demonstrates that it has a 446 formalized, written transfer agreement with a hospital that has 447 a Level II program. The agreement must include written transport 448 protocols to ensure the safe and efficient transfer of a 449 patient, taking into consideration the patient’s clinical and 450 physical characteristics, road and weather conditions, and 451 viability of ground and air ambulance service to transfer the 452 patient. 453 (c) Demonstration that, for the most recent 12-month period 454 as reported to the agency, a hospital seeking a Level II program 455 has performed a minimum of 1,100 adult inpatient and outpatient 456 cardiac catheterizations, of which at least 400 must be 457 therapeutic catheterizations, or, for the most recent 12-month 458 period, has discharged at least 800 patients with the principal 459 diagnosis of ischemic heart disease. 460 (d) Compliance with the most recent guidelines of the 461 American College of Cardiology and American Heart Association 462 guidelines for staffing, physician training and experience, 463 operating procedures, equipment, physical plant, and patient 464 selection criteria to ensure quality of care and patient safety. 465 (e) Establishment of appropriate hours of operation and 466 protocols to ensure availability and timely referral in the 467 event of emergencies. Page 16 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 468 469 470 2017676__ (f) Demonstration of a plan to provide services to Medicaid and charity care patients. (13) Hospitals licensed for Level I or Level II adult 471 cardiovascular services shall participate in clinical outcome 472 reporting systems operated by the American College of Cardiology 473 and the Society of Thoracic Surgeons. 474 (14) Each provider of pediatric cardiac catheterization, 475 pediatric open heart surgery, neonatal intensive care, 476 comprehensive medical rehabilitation, and pediatric and adult 477 organ transplant services shall comply with rules adopted by the 478 agency which establish licensure standards governing the 479 operation of such programs. The rules must ensure that such 480 programs: 481 (a) Comply with established applicable practice guidelines. 482 (b) Maintain sufficient appropriate equipment and health 483 484 care personnel to ensure quality of care and patient safety. (c) Maintain appropriate times of operation and protocols 485 to ensure availability and appropriate referrals in the event of 486 emergencies. 487 488 489 490 (d) Demonstrate a plan to provide services to Medicaid and charity care patients. Section 6. Subsection (2) of section 395.602, Florida Statutes, is amended to read: 491 395.602 Rural hospitals.— 492 (2) DEFINITIONS.—As used in this part, the term: 493 (a) “Emergency care hospital” means a medical facility 494 which provides: 495 1. Emergency medical treatment; and 496 2. Inpatient care to ill or injured persons prior to their Page 17 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 497 transportation to another hospital or provides inpatient medical 498 care to persons needing care for a period of up to 96 hours. The 499 96-hour limitation on inpatient care does not apply to respite, 500 skilled nursing, hospice, or other nonacute care patients. 501 502 (b) “Essential access community hospital” means any facility which: 503 1. Has at least 100 beds; 504 2. Is located more than 35 miles from any other essential 505 access community hospital, rural referral center, or urban 506 hospital meeting criteria for classification as a regional 507 referral center; 508 509 510 511 512 513 514 515 516 3. Is part of a network that includes rural primary care hospitals; 4. Provides emergency and medical backup services to rural primary care hospitals in its rural health network; 5. Extends staff privileges to rural primary care hospital physicians in its network; and 6. Accepts patients transferred from rural primary care hospitals in its network. (c) “Inactive rural hospital bed” means a licensed acute 517 care hospital bed, as defined in s. 395.002(13), that is 518 inactive in that it cannot be occupied by acute care inpatients. 519 (a)(d) “Rural area health education center” means an area 520 health education center (AHEC), as authorized by Pub. L. No. 94- 521 484, which provides services in a county with a population 522 density of no greater than 100 persons per square mile. 523 (b)(e) “Rural hospital” means an acute care hospital 524 licensed under this chapter, having 100 or fewer licensed beds 525 and an emergency room, which is: Page 18 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 526 527 528 2017676__ 1. The sole provider within a county with a population density of up to 100 persons per square mile; 2. An acute care hospital, in a county with a population 529 density of up to 100 persons per square mile, which is at least 530 30 minutes of travel time, on normally traveled roads under 531 normal traffic conditions, from any other acute care hospital 532 within the same county; 533 3. A hospital supported by a tax district or subdistrict 534 whose boundaries encompass a population of up to 100 persons per 535 square mile; 536 537 538 4. A hospital classified as a sole community hospital under 42 C.F.R. s. 412.92 which has up to 175 licensed beds; 5. A hospital with a service area that has a population of 539 up to 100 persons per square mile. As used in this subparagraph, 540 the term “service area” means the fewest number of zip codes 541 that account for 75 percent of the hospital’s discharges for the 542 most recent 5-year period, based on information available from 543 the hospital inpatient discharge database in the Florida Center 544 for Health Information and Transparency at the agency; or 545 546 6. A hospital designated as a critical access hospital, as defined in s. 408.07. 547 548 Population densities used in this paragraph must be based upon 549 the most recently completed United States census. A hospital 550 that received funds under s. 409.9116 for a quarter beginning no 551 later than July 1, 2002, is deemed to have been and shall 552 continue to be a rural hospital from that date through June 30, 553 2021, if the hospital continues to have up to 100 licensed beds 554 and an emergency room. An acute care hospital that has not Page 19 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 555 previously been designated as a rural hospital and that meets 556 the criteria of this paragraph shall be granted such designation 557 upon application, including supporting documentation, to the 558 agency. A hospital that was licensed as a rural hospital during 559 the 2010-2011 or 2011-2012 fiscal year shall continue to be a 560 rural hospital from the date of designation through June 30, 561 2021, if the hospital continues to have up to 100 licensed beds 562 and an emergency room. 563 (f) “Rural primary care hospital” means any facility 564 meeting the criteria in paragraph (e) or s. 395.605 which 565 provides: 566 1. Twenty-four-hour emergency medical care; 567 2. Temporary inpatient care for periods of 72 hours or less 568 to patients requiring stabilization before discharge or transfer 569 to another hospital. The 72-hour limitation does not apply to 570 respite, skilled nursing, hospice, or other nonacute care 571 patients; and 572 3. Has no more than six licensed acute care inpatient beds. 573 (c)(g) “Swing-bed” means a bed that which can be used 574 interchangeably as either a hospital, skilled nursing facility 575 (SNF), or intermediate care facility (ICF) bed pursuant to 42 576 C.F.R. parts 405, 435, 440, 442, and 447. 577 Section 7. Section 395.6025, Florida Statutes, is repealed. 578 Section 8. Section 395.603, Florida Statutes, is amended to 579 580 581 read: 395.603 Deactivation of general hospital beds; rural hospital impact statement.— 582 (1) The agency shall establish, by rule, a process by which 583 a rural hospital, as defined in s. 395.602, that seeks licensure Page 20 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 584 as a rural primary care hospital or as an emergency care 585 hospital, or becomes a certified rural health clinic as defined 586 in Pub. L. No. 95-210, or becomes a primary care program such as 587 a county health department, community health center, or other 588 similar outpatient program that provides preventive and curative 589 services, may deactivate general hospital beds. Rural primary 590 care hospitals and emergency care hospitals shall maintain the 591 number of actively licensed general hospital beds necessary for 592 the facility to be certified for Medicare reimbursement. 593 Hospitals that discontinue inpatient care to become rural health 594 care clinics or primary care programs shall deactivate all 595 licensed general hospital beds. All hospitals, clinics, and 596 programs with inactive beds shall provide 24-hour emergency 597 medical care by staffing an emergency room. Providers with 598 inactive beds shall be subject to the criteria in s. 395.1041. 599 The agency shall specify in rule requirements for making 24-hour 600 emergency care available. Inactive general hospital beds shall 601 be included in the acute care bed inventory, maintained by the 602 agency for certificate-of-need purposes, for 10 years from the 603 date of deactivation of the beds. After 10 years have elapsed, 604 inactive beds shall be excluded from the inventory. The agency 605 shall, at the request of the licensee, reactivate the inactive 606 general beds upon a showing by the licensee that licensure 607 requirements for the inactive general beds are met. 608 (2) In formulating and implementing policies and rules that 609 may have significant impact on the ability of rural hospitals to 610 continue to provide health care services in rural communities, 611 the agency, the department, or the respective regulatory board 612 adopting policies or rules regarding the licensure or Page 21 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 613 certification of health care professionals shall provide a rural 614 hospital impact statement. The rural hospital impact statement 615 shall assess the proposed action in light of the following 616 questions: 617 (1)(a) Do the health personnel affected by the proposed 618 action currently practice in rural hospitals or are they likely 619 to in the near future? 620 (2)(b) What are the current numbers of the affected health 621 personnel in this state, their geographic distribution, and the 622 number practicing in rural hospitals? 623 (3)(c) What are the functions presently performed by the 624 affected health personnel, and are such functions presently 625 performed in rural hospitals? 626 (4)(d) What impact will the proposed action have on the 627 ability of rural hospitals to recruit the affected personnel to 628 practice in their facilities? 629 (5)(e) What impact will the proposed action have on the 630 limited financial resources of rural hospitals through increased 631 salaries and benefits necessary to recruit or retain such health 632 personnel? 633 634 635 (6)(f) Is there a less stringent requirement which could apply to practice in rural hospitals? (7)(g) Will this action create staffing shortages, which 636 could result in a loss to the public of health care services in 637 rural hospitals or result in closure of any rural hospitals? 638 Section 9. Section 395.604, Florida Statutes, is repealed. 639 Section 10. Section 395.605, Florida Statutes, is repealed. 640 Section 11. Present subsection (3) of section 400.071, 641 Florida Statutes, is amended, and present subsections (4) and Page 22 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 642 (5) of that section are redesignated as (3) and (4), 643 respectively, to read: 644 400.071 Application for license.— 645 (3) It is the intent of the Legislature that, in reviewing 646 a certificate-of-need application to add beds to an existing 647 nursing home facility, preference be given to the application of 648 a licensee who has been awarded a Gold Seal as provided for in 649 s. 400.235, if the applicant otherwise meets the review criteria 650 specified in s. 408.035. 651 652 653 654 655 Section 12. Subsections (3), (4), and (5) of section 400.606, Florida Statutes, are amended to read: 400.606 License; application; renewal; conditional license or permit; certificate of need.— (3) Any hospice initially licensed on or after July 1, 656 2017, must be accredited by a national accreditation 657 organization that is recognized by the Centers for Medicare and 658 Medicaid Services and whose standards incorporate comparable 659 licensure regulations as required by this state. Such 660 accreditation must be maintained as a requirement of licensure. 661 The agency shall not issue a license to a hospice that fails to 662 receive a certificate of need under the provisions of part I of 663 chapter 408. A licensed hospice is a health care facility as 664 that term is used in s. 408.039(5) and is entitled to initiate 665 or intervene in an administrative hearing. 666 (4) Any hospice initially licensed on or after July 1, 667 2017, must establish and maintain a freestanding hospice 668 facility that is engaged in providing inpatient and related 669 services and that is not otherwise licensed as a health care 670 facility shall obtain a certificate of need. However, a Page 23 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 671 freestanding hospice facility that has six or fewer beds is not 672 required to comply with institutional standards such as, but not 673 limited to, standards requiring sprinkler systems, emergency 674 electrical systems, or special lavatory devices. 675 (5) The agency may deny a license to an applicant that 676 fails to meet any condition for the provision of hospice care or 677 services imposed by the agency on a certificate of need by final 678 agency action, unless the applicant can demonstrate that good 679 cause exists for the applicant’s failure to meet such condition. 680 681 Section 13. Paragraphs (b), (c), and (d) of subsection (2) of section 400.6085, Florida Statutes, are amended to read: 682 400.6085 Contractual services.—A hospice may contract out 683 for some elements of its services. However, the core services, 684 as set forth in s. 400.609(1), with the exception of physician 685 services, shall be provided directly by the hospice. Any 686 contract entered into between a hospice and a health care 687 facility or service provider must specify that the hospice 688 retains the responsibility for planning, coordinating, and 689 prescribing hospice care and services for the hospice patient 690 and family. A hospice that contracts for any hospice service is 691 prohibited from charging fees for services provided directly by 692 the hospice care team that duplicate contractual services 693 provided to the patient and family. 694 695 (2) With respect to contractual arrangements for inpatient hospice care: 696 (b) Hospices contracting for inpatient care beds shall not 697 be required to obtain an additional certificate of need for the 698 number of such designated beds. Such beds shall remain licensed 699 to the health care facility and be subject to the appropriate Page 24 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 700 701 2017676__ inspections. (c) Staffing standards for inpatient hospice care provided 702 through a contract may not exceed the staffing standards 703 required under the license held by the contractee. 704 (c)(d) Under no circumstances may a hospice place a patient 705 requiring inpatient care in a health care facility that is under 706 a moratorium, has had its license revoked, or has a conditional 707 license, accreditation, or rating. However, a hospice may 708 continue to provide care or initiate care for a terminally ill 709 person already residing in such a facility. 710 Section 14. Section 408.031, Florida Statutes, is repealed. 711 Section 15. Section 408.032, Florida Statutes, is repealed. 712 Section 16. Section 408.033, Florida Statutes, is repealed. 713 Section 17. Section 408.034, Florida Statutes, is repealed. 714 Section 18. Section 408.035, Florida Statutes, is repealed. 715 Section 19. Section 408.036, Florida Statutes, is repealed. 716 Section 20. Section 408.0361, Florida Statutes, is 717 repealed. 718 Section 21. Section 408.037, Florida Statutes, is repealed. 719 Section 22. Section 408.038, Florida Statutes, is repealed. 720 Section 23. Section 408.039, Florida Statutes, is repealed. 721 Section 24. Section 408.040, Florida Statutes, is repealed. 722 Section 25. Section 408.041, Florida Statutes, is repealed. 723 Section 26. Section 408.042, Florida Statutes, is repealed. 724 Section 27. Section 408.043, Florida Statutes, is repealed. 725 Section 28. Section 408.0436, Florida Statutes, is 726 repealed. 727 Section 29. Section 408.044, Florida Statutes, is repealed. 728 Section 30. Section 408.045, Florida Statutes, is repealed. Page 25 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 729 730 731 732 2017676__ Section 31. Section 408.0455, Florida Statutes, is repealed. Section 32. Subsection (3) of section 408.808, Florida Statutes, is amended to read: 733 408.808 License categories.— 734 (3) INACTIVE LICENSE.—An inactive license may be issued to 735 a hospital, nursing home, intermediate care facility for the 736 developmentally disabled, or ambulatory surgical center if 737 health care provider subject to the certificate-of-need 738 provisions in part I of this chapter when the provider is 739 currently licensed, does not have a provisional license, and 740 will be temporarily unable to provide services due to 741 construction or renovation, but is reasonably expected to resume 742 services within 12 months. Before an inactive license will be 743 issued, the licensee must have plans approved by the agency. 744 Such designation may be made for a period not to exceed 12 745 months but may be renewed by the agency for up to 12 additional 746 months upon demonstration by the licensee of the provider’s 747 progress toward reopening. However, if after 20 months in an 748 inactive license status, a statutory rural hospital, as defined 749 in s. 395.602, has demonstrated progress toward reopening, but 750 may not be able to reopen prior to the inactive license 751 expiration date, the inactive designation may be renewed again 752 by the agency for up to 12 additional months. For purposes of 753 such a second renewal, if construction or renovation is 754 required, the licensee must have had plans approved by the 755 agency and construction must have already commenced and pursuant 756 to s. 408.032(4); however, if construction or renovation is not 757 required, the licensee must provide proof of having made an Page 26 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 758 enforceable capital expenditure greater than 25 percent of the 759 total costs associated with the construction or renovation 760 hiring of staff and the purchase of equipment and supplies 761 needed to operate the facility upon opening. A request by a 762 licensee for an inactive license or to extend the previously 763 approved inactive period must be submitted to the agency and 764 must include a written justification for the inactive license 765 with the beginning and ending dates of inactivity specified, a 766 plan for the transfer of any clients to other providers, and the 767 appropriate licensure fees. The agency may not accept a request 768 that is submitted after initiating closure, after any suspension 769 of service, or after notifying clients of closure or suspension 770 of service, unless the action is a result of a disaster at the 771 licensed premises. For the purposes of this section, the term 772 “disaster” means a sudden emergency occurrence beyond the 773 control of the licensee, whether natural, technological, or 774 manmade, which renders the provider inoperable at the premises. 775 Upon agency approval, the provider shall notify clients of any 776 necessary discharge or transfer as required by authorizing 777 statutes or applicable rules. The beginning of the inactive 778 license period is the date the provider ceases operations. The 779 end of the inactive license period shall become the license 780 expiration date. All licensure fees must be current, must be 781 paid in full, and may be prorated. Reactivation of an inactive 782 license requires the approval of a renewal application, 783 including payment of licensure fees and agency inspections 784 indicating compliance with all requirements of this part, 785 authorizing statutes, and applicable rules. 786 Section 33. Section 651.118, Florida Statutes, is repealed. Page 27 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 787 788 789 2017676__ Section 34. Section 154.246, Florida Statutes, is amended to read: 154.246 Validation of certain bonds and proceedings.—The 790 Legislature finds and declares that the purpose of chapter 78- 791 115, Laws of Florida, is, in part, to clarify the original 792 meaning of the Health Facilities Authorities Law, and, 793 therefore, all bonds heretofore issued and proceedings conducted 794 pursuant thereto which would have been valid had the amendment 795 to the former s. 154.245, as set forth in s. 2 of chapter 78- 796 115, been in effect when said bonds were issued or proceedings 797 were conducted are hereby declared valid. 798 799 800 801 802 803 804 805 Section 35. Subsection (7) of section 186.503, Florida Statutes, is amended to read: 186.503 Definitions relating to Florida Regional Planning Council Act.—As used in this act, the term: (7) “Local health council” means an a regional agency established pursuant to s. 381.4066 s. 408.033. Section 36. Paragraph (k) of subsection (2) of section 220.1845, Florida Statutes, is amended to read: 806 220.1845 Contaminated site rehabilitation tax credit.— 807 (2) AUTHORIZATION FOR TAX CREDIT; LIMITATIONS.— 808 (k) In order to encourage the construction and operation of 809 a new health care facility as defined in s. 408.032 or s. 810 408.07, or a health care provider as defined in s. 408.07 or s. 811 408.7056, on a brownfield site, an applicant for a tax credit 812 may claim an additional 25 percent of the total site 813 rehabilitation costs, not to exceed $500,000, if the applicant 814 meets the requirements of this paragraph. In order to receive 815 this additional tax credit, the applicant must provide Page 28 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 816 documentation indicating that the construction of the health 817 care facility or health care provider by the applicant on the 818 brownfield site has received a certificate of occupancy or a 819 license or certificate has been issued for the operation of the 820 health care facility or health care provider. 821 822 Section 37. Paragraph (f) of subsection (3) of section 376.30781, Florida Statutes, is amended to read: 823 376.30781 Tax credits for rehabilitation of drycleaning- 824 solvent-contaminated sites and brownfield sites in designated 825 brownfield areas; application process; rulemaking authority; 826 revocation authority.— 827 (3) 828 (f) In order to encourage the construction and operation of 829 a new health care facility or a health care provider, as defined 830 in s. 408.032, s. 408.07, or s. 408.7056, on a brownfield site, 831 an applicant for a tax credit may claim an additional 25 percent 832 of the total site rehabilitation costs, not to exceed $500,000, 833 if the applicant meets the requirements of this paragraph. In 834 order to receive this additional tax credit, the applicant must 835 provide documentation indicating that the construction of the 836 health care facility or health care provider by the applicant on 837 the brownfield site has received a certificate of occupancy or a 838 license or certificate has been issued for the operation of the 839 health care facility or health care provider. 840 841 Section 38. Subsection (1) of section 376.86, Florida Statutes, is amended to read: 842 376.86 Brownfield Areas Loan Guarantee Program.— 843 (1) The Brownfield Areas Loan Guarantee Council is created 844 to review and approve or deny, by a majority vote of its Page 29 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 845 membership, the situations and circumstances for participation 846 in partnerships by agreements with local governments, financial 847 institutions, and others associated with the redevelopment of 848 brownfield areas pursuant to the Brownfields Redevelopment Act 849 for a limited state guaranty of up to 5 years of loan guarantees 850 or loan loss reserves issued pursuant to law. The limited state 851 loan guaranty applies only to 50 percent of the primary lenders 852 loans for redevelopment projects in brownfield areas. If the 853 redevelopment project is for affordable housing, as defined in 854 s. 420.0004, in a brownfield area, the limited state loan 855 guaranty applies to 75 percent of the primary lender’s loan. If 856 the redevelopment project includes the construction and 857 operation of a new health care facility or a health care 858 provider, as defined in s. 408.032, s. 408.07, or s. 408.7056, 859 on a brownfield site and the applicant has obtained 860 documentation in accordance with s. 376.30781 indicating that 861 the construction of the health care facility or health care 862 provider by the applicant on the brownfield site has received a 863 certificate of occupancy or a license or certificate has been 864 issued for the operation of the health care facility or health 865 care provider, the limited state loan guaranty applies to 75 866 percent of the primary lender’s loan. A limited state guaranty 867 of private loans or a loan loss reserve is authorized for 868 lenders licensed to operate in the state upon a determination by 869 the council that such an arrangement would be in the public 870 interest and the likelihood of the success of the loan is great. 871 Section 39. Subsection (1) of section 383.216, Florida 872 873 Statutes, is amended to read: 383.216 Community-based prenatal and infant health care.— Page 30 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 874 2017676__ (1) The Department of Health shall cooperate with 875 localities which wish to establish prenatal and infant health 876 care coalitions, and shall acknowledge and incorporate, if 877 appropriate, existing community children’s services 878 organizations, pursuant to this section within the resources 879 allocated. The purpose of this program is to establish a 880 partnership among the private sector, the public sector, state 881 government, local government, community alliances, and maternal 882 and child health care providers, for the provision of 883 coordinated community-based prenatal and infant health care. The 884 prenatal and infant health care coalitions must work in a 885 coordinated, nonduplicative manner with local health planning 886 councils established pursuant to s. 381.4066 s. 408.033. 887 888 889 890 Section 40. Subsection (5) of section 395.1065, Florida Statutes, is amended to read: 395.1065 Criminal and administrative penalties; moratorium.— 891 (5) The agency shall impose a fine of $500 for each 892 instance of the facility’s failure to provide the information 893 required by rules adopted pursuant to s. 395.1055(1)(g) s. 894 395.1055(1)(h). 895 896 Section 41. Subsection (10) of section 395.0191, Florida Statutes, is amended to read: 897 395.0191 Staff membership and clinical privileges.— 898 (10) Nothing herein shall be construed by the agency as 899 requiring an applicant for a certificate of need to establish 900 proof of discrimination in the granting of or denial of hospital 901 staff membership or clinical privileges as a precondition to 902 obtaining such certificate of need under the provisions of s. Page 31 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 903 904 905 906 907 2017676__ 408.043. Section 42. Section 408.07, Florida Statutes, is amended to read: 408.07 Definitions.—As used in this chapter, with the exception of ss. 408.031-408.045, the term: 908 (1) “Accepted” means that the agency has found that a 909 report or data submitted by a health care facility or a health 910 care provider contains all schedules and data required by the 911 agency and has been prepared in the format specified by the 912 agency, and otherwise conforms to applicable rule or Florida 913 Hospital Uniform Reporting System manual requirements regarding 914 reports in effect at the time such report was submitted, and the 915 data are mathematically reasonable and accurate. 916 (2) “Adjusted admission” means the sum of acute and 917 intensive care admissions divided by the ratio of inpatient 918 revenues generated from acute, intensive, ambulatory, and 919 ancillary patient services to gross revenues. If a hospital 920 reports only subacute admissions, then “adjusted admission” 921 means the sum of subacute admissions divided by the ratio of 922 total inpatient revenues to gross revenues. 923 924 925 926 927 (3) “Agency” means the Agency for Health Care Administration. (4) “Alcohol or chemical dependency treatment center” means an organization licensed under chapter 397. (5) “Ambulatory care center” means an organization which 928 employs or contracts with licensed health care professionals to 929 provide diagnosis or treatment services predominantly on a walk- 930 in basis and the organization holds itself out as providing care 931 on a walk-in basis. Such an organization is not an ambulatory Page 32 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 932 care center if it is wholly owned and operated by five or fewer 933 health care providers. 934 935 936 (6) “Ambulatory surgical center” means a facility licensed as an ambulatory surgical center under chapter 395. (7) “Audited actual data” means information contained 937 within financial statements examined by an independent, Florida- 938 licensed, certified public accountant in accordance with 939 generally accepted auditing standards, but does not include data 940 within a financial statement about which the certified public 941 accountant does not express an opinion or issues a disclaimer. 942 943 944 (8) “Birth center” means an organization licensed under s. 383.305. (9) “Cardiac catheterization laboratory” means a 945 freestanding facility that employs or contracts with licensed 946 health care professionals to provide diagnostic or therapeutic 947 services for cardiac conditions such as cardiac catheterization 948 or balloon angioplasty. 949 (10) “Case mix” means a calculated index for each health 950 care facility or health care provider, based on patient data, 951 reflecting the relative costliness of the mix of cases to that 952 facility or provider compared to a state or national mix of 953 cases. 954 (11) “Clinical laboratory” means a facility licensed under 955 s. 483.091, excluding: any hospital laboratory defined under s. 956 483.041(6); any clinical laboratory operated by the state or a 957 political subdivision of the state; any blood or tissue bank 958 where the majority of revenues are received from the sale of 959 blood or tissue and where blood, plasma, or tissue is procured 960 from volunteer donors and donated, processed, stored, or Page 33 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 961 distributed on a nonprofit basis; and any clinical laboratory 962 which is wholly owned and operated by physicians who are 963 licensed pursuant to chapter 458 or chapter 459 and who practice 964 in the same group practice, and at which no clinical laboratory 965 work is performed for patients referred by any health care 966 provider who is not a member of that same group practice. 967 (12) “Comprehensive rehabilitative hospital” or 968 “rehabilitative hospital” means a hospital licensed by the 969 agency as a specialty hospital as defined in s. 395.002; 970 provided that the hospital provides a program of comprehensive 971 medical rehabilitative services and is designed, equipped, 972 organized, and operated solely to deliver comprehensive medical 973 rehabilitative services, and further provided that all licensed 974 beds in the hospital are classified as “comprehensive 975 rehabilitative beds” pursuant to s. 395.003(4), and are not 976 classified as “general beds.” 977 (13) “Consumer” means any person other than a person who 978 administers health activities, is a member of the governing body 979 of a health care facility, provides health services, has a 980 fiduciary interest in a health facility or other health agency 981 or its affiliated entities, or has a material financial interest 982 in the rendering of health services. 983 984 985 (14) “Continuing care facility” means a facility licensed under chapter 651. (15) “Critical access hospital” means a hospital that meets 986 the definition of “critical access hospital” in s. 1861(mm)(1) 987 of the Social Security Act and that is certified by the 988 Secretary of Health and Human Services as a critical access 989 hospital. Page 34 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 990 2017676__ (16) “Cross-subsidization” means that the revenues from one 991 type of hospital service are sufficiently higher than the costs 992 of providing such service as to offset some of the costs of 993 providing another type of service in the hospital. Cross- 994 subsidization results from the lack of a direct relationship 995 between charges and the costs of providing a particular hospital 996 service or type of service. 997 (17) “Deductions from gross revenue” or “deductions from 998 revenue” means reductions from gross revenue resulting from 999 inability to collect payment of charges. For hospitals, such 1000 reductions include contractual adjustments; uncompensated care; 1001 administrative, courtesy, and policy discounts and adjustments; 1002 and other such revenue deductions, but also includes the offset 1003 of restricted donations and grants for indigent care. 1004 (18) “Diagnostic-imaging center” means a freestanding 1005 outpatient facility that provides specialized services for the 1006 diagnosis of a disease by examination and also provides 1007 radiological services. Such a facility is not a diagnostic- 1008 imaging center if it is wholly owned and operated by physicians 1009 who are licensed pursuant to chapter 458 or chapter 459 and who 1010 practice in the same group practice and no diagnostic-imaging 1011 work is performed at such facility for patients referred by any 1012 health care provider who is not a member of that same group 1013 practice. 1014 1015 1016 (19) “FHURS” means the Florida Hospital Uniform Reporting System developed by the agency. (20) “Freestanding” means that a health facility bills and 1017 receives revenue which is not directly subject to the hospital 1018 assessment for the Public Medical Assistance Trust Fund as Page 35 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 1019 1020 2017676__ described in s. 395.701. (21) “Freestanding radiation therapy center” means a 1021 facility where treatment is provided through the use of 1022 radiation therapy machines that are registered under s. 404.22 1023 and the provisions of the Florida Administrative Code 1024 implementing s. 404.22. Such a facility is not a freestanding 1025 radiation therapy center if it is wholly owned and operated by 1026 physicians licensed pursuant to chapter 458 or chapter 459 who 1027 practice within the specialty of diagnostic or therapeutic 1028 radiology. 1029 (22) “GRAA” means gross revenue per adjusted admission. 1030 (23) “Gross revenue” means the sum of daily hospital 1031 service charges, ambulatory service charges, ancillary service 1032 charges, and other operating revenue. Gross revenues do not 1033 include contributions, donations, legacies, or bequests made to 1034 a hospital without restriction by the donors. 1035 (24) “Health care facility” means an ambulatory surgical 1036 center, a hospice, a nursing home, a hospital, a diagnostic- 1037 imaging center, a freestanding or hospital-based therapy center, 1038 a clinical laboratory, a home health agency, a cardiac 1039 catheterization laboratory, a medical equipment supplier, an 1040 alcohol or chemical dependency treatment center, a physical 1041 rehabilitation center, a lithotripsy center, an ambulatory care 1042 center, a birth center, or a nursing home component licensed 1043 under chapter 400 within a continuing care facility licensed 1044 under chapter 651. 1045 (25) “Health care provider” means a health care 1046 professional licensed under chapter 458, chapter 459, chapter 1047 460, chapter 461, chapter 463, chapter 464, chapter 465, chapter Page 36 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 1048 466, part I, part III, part IV, part V, or part X of chapter 1049 468, chapter 483, chapter 484, chapter 486, chapter 490, or 1050 chapter 491. 1051 (26) “Health care purchaser” means an employer in the 1052 state, other than a health care facility, health insurer, or 1053 health care provider, who provides health care coverage for her 1054 or his employees. 1055 (27) “Health insurer” means any insurance company 1056 authorized to transact health insurance in the state, any 1057 insurance company authorized to transact health insurance or 1058 casualty insurance in the state that is offering a minimum 1059 premium plan or stop-loss coverage for any person or entity 1060 providing health care benefits, any self-insurance plan as 1061 defined in s. 624.031, any health maintenance organization 1062 authorized to transact business in the state pursuant to part I 1063 of chapter 641, any prepaid health clinic authorized to transact 1064 business in the state pursuant to part II of chapter 641, any 1065 multiple-employer welfare arrangement authorized to transact 1066 business in the state pursuant to ss. 624.436-624.45, or any 1067 fraternal benefit society providing health benefits to its 1068 members as authorized pursuant to chapter 632. 1069 1070 1071 1072 1073 (28) “Home health agency” means an organization licensed under part III of chapter 400. (29) “Hospice” means an organization licensed under part IV of chapter 400. (30) “Hospital” means a health care institution licensed by 1074 the Agency for Health Care Administration as a hospital under 1075 chapter 395. 1076 (31) “Lithotripsy center” means a freestanding facility Page 37 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 1077 that employs or contracts with licensed health care 1078 professionals to provide diagnosis or treatment services using 1079 electro-hydraulic shock waves. 1080 1081 1082 (32) “Local health council” means an the agency established pursuant to s. 381.4066 defined in s. 408.033. (33) “Market basket index” means the Florida hospital input 1083 price index (FHIPI), which is a statewide market basket index 1084 used to measure inflation in hospital input prices weighted for 1085 the Florida-specific experience which uses multistate regional 1086 and state-specific price measures, when available. The index 1087 shall be constructed in the same manner as the index employed by 1088 the Secretary of the United States Department of Health and 1089 Human Services for determining the inflation in hospital input 1090 prices for purposes of Medicare reimbursement. 1091 (34) “Medical equipment supplier” means an organization 1092 that provides medical equipment and supplies used by health care 1093 providers and health care facilities in the diagnosis or 1094 treatment of disease. 1095 1096 1097 (35) “Net revenue” means gross revenue minus deductions from revenue. (36) “New hospital” means a hospital in its initial year of 1098 operation as a licensed hospital and does not include any 1099 facility which has been in existence as a licensed hospital, 1100 regardless of changes in ownership, for over 1 calendar year. 1101 (37) “Nursing home” means a facility licensed under s. 1102 400.062 or, for resident level and financial data collection 1103 purposes only, any institution licensed under chapter 395 and 1104 which has a Medicare or Medicaid certified distinct part used 1105 for skilled nursing home care, but does not include a facility Page 38 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 1106 1107 1108 2017676__ licensed under chapter 651. (38) “Operating expenses” means total expenses excluding income taxes. 1109 (39) “Other operating revenue” means all revenue generated 1110 from hospital operations other than revenue directly associated 1111 with patient care. 1112 (40) “Physical rehabilitation center” means an organization 1113 that employs or contracts with health care professionals 1114 licensed under part I or part III of chapter 468 or chapter 486 1115 to provide speech, occupational, or physical therapy services on 1116 an outpatient or ambulatory basis. 1117 (41) “Prospective payment arrangement” means a financial 1118 agreement negotiated between a hospital and an insurer, health 1119 maintenance organization, preferred provider organization, or 1120 other third-party payor which contains, at a minimum, the 1121 elements provided for in s. 408.50. 1122 (42) “Rate of return” means the financial indicators used 1123 to determine or demonstrate reasonableness of the financial 1124 requirements of a hospital. Such indicators shall include, but 1125 not be limited to: return on assets, return on equity, total 1126 margin, and debt service coverage. 1127 (43) “Rural hospital” means an acute care hospital licensed 1128 under chapter 395, having 100 or fewer licensed beds and an 1129 emergency room, and which is: 1130 1131 1132 (a) The sole provider within a county with a population density of no greater than 100 persons per square mile; (b) An acute care hospital, in a county with a population 1133 density of no greater than 100 persons per square mile, which is 1134 at least 30 minutes of travel time, on normally traveled roads Page 39 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 1135 under normal traffic conditions, from another acute care 1136 hospital within the same county; 1137 (c) A hospital supported by a tax district or subdistrict 1138 whose boundaries encompass a population of 100 persons or fewer 1139 per square mile; 1140 (d) A hospital with a service area that has a population of 1141 100 persons or fewer per square mile. As used in this paragraph, 1142 the term “service area” means the fewest number of zip codes 1143 that account for 75 percent of the hospital’s discharges for the 1144 most recent 5-year period, based on information available from 1145 the hospital inpatient discharge database in the Florida Center 1146 for Health Information and Transparency at the Agency for Health 1147 Care Administration; or 1148 (e) A critical access hospital. 1149 1150 Population densities used in this subsection must be based upon 1151 the most recently completed United States census. A hospital 1152 that received funds under s. 409.9116 for a quarter beginning no 1153 later than July 1, 2002, is deemed to have been and shall 1154 continue to be a rural hospital from that date through June 30, 1155 2015, if the hospital continues to have 100 or fewer licensed 1156 beds and an emergency room. An acute care hospital that has not 1157 previously been designated as a rural hospital and that meets 1158 the criteria of this subsection shall be granted such 1159 designation upon application, including supporting 1160 documentation, to the Agency for Health Care Administration. 1161 (44) “Special study” means a nonrecurring data-gathering 1162 and analysis effort designed to aid the agency in meeting its 1163 responsibilities pursuant to this chapter. Page 40 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 1164 2017676__ (45) “Teaching hospital” means any Florida hospital 1165 officially affiliated with an accredited Florida medical school 1166 which exhibits activity in the area of graduate medical 1167 education as reflected by at least seven different graduate 1168 medical education programs accredited by the Accreditation 1169 Council for Graduate Medical Education or the Council on 1170 Postdoctoral Training of the American Osteopathic Association 1171 and the presence of 100 or more full-time equivalent resident 1172 physicians. The Director of the Agency for Health Care 1173 Administration shall be responsible for determining which 1174 hospitals meet this definition. 1175 1176 Section 43. Subsection (6) of section 408.806, Florida Statutes, is amended to read: 1177 408.806 License application process.— 1178 (6) The agency may not issue an initial license to a health 1179 care provider subject to the certificate-of-need provisions in 1180 part I of this chapter if the licensee has not been issued a 1181 certificate of need or certificate-of-need exemption, when 1182 applicable. Failure to apply for the renewal of a license before 1183 prior to the expiration date renders the license void. 1184 1185 1186 Section 44. Subsection (10) of section 408.810, Florida Statutes, is amended to read: 408.810 Minimum licensure requirements.—In addition to the 1187 licensure requirements specified in this part, authorizing 1188 statutes, and applicable rules, each applicant and licensee must 1189 comply with the requirements of this section in order to obtain 1190 and maintain a license. 1191 1192 (10) The agency may not issue a license to a health care provider subject to the certificate-of-need provisions in part I Page 41 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 1193 of this chapter if the health care provider has not been issued 1194 a certificate of need or an exemption. Upon initial licensure of 1195 any such provider, the authorization contained in the 1196 certificate of need shall be considered fully implemented and 1197 merged into the license and shall have no force and effect upon 1198 termination of the license for any reason. 1199 1200 1201 Section 45. Section 408.820, Florida Statutes, is amended to read: 408.820 Exemptions.—Except as prescribed in authorizing 1202 statutes, the following exemptions shall apply to specified 1203 requirements of this part: 1204 (1) Laboratories authorized to perform testing under the 1205 Drug-Free Workplace Act, as provided under ss. 112.0455 and 1206 440.102, are exempt from s. 408.810(5)-(9) s. 408.810(5)-(10). 1207 (2) Birth centers, as provided under chapter 383, are 1208 1209 1210 1211 exempt from s. 408.810(7)-(9) s. 408.810(7)-(10). (3) Abortion clinics, as provided under chapter 390, are exempt from s. 408.810(7)-(9) s. 408.810(7)-(10). (4) Crisis stabilization units, as provided under parts I 1212 and IV of chapter 394, are exempt from s. 408.810(8) and (9) s. 1213 408.810(8)-(10). 1214 (5) Short-term residential treatment facilities, as 1215 provided under parts I and IV of chapter 394, are exempt from s. 1216 408.810(8) and (9) s. 408.810(8)-(10). 1217 (6) Residential treatment facilities, as provided under 1218 part IV of chapter 394, are exempt from s. 408.810(8) and (9) s. 1219 408.810(8)-(10). 1220 1221 (7) Residential treatment centers for children and adolescents, as provided under part IV of chapter 394, are Page 42 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 1222 exempt from s. 408.810(8) and (9) s. 408.810(8)-(10). 1223 1224 2017676__ (8) Hospitals, as provided under part I of chapter 395, are exempt from s. 408.810(7)-(9). 1225 (9) Ambulatory surgical centers, as provided under part I 1226 of chapter 395, are exempt from s. 408.810(7)-(9) s. 408.810(7)- 1227 (10). 1228 (10) Mobile surgical facilities, as provided under part I 1229 of chapter 395, are exempt from s. 408.810(7)-(9) s. 408.810(7)- 1230 (10). 1231 (11) Health care risk managers, as provided under part I of 1232 chapter 395, are exempt from ss. 408.806(7), 408.810(4)-(9) 1233 408.810(4)-(10), and 408.811. 1234 1235 (12) Nursing homes, as provided under part II of chapter 400, are exempt from ss. 408.810(7) and 408.813(2). 1236 1237 (13) Assisted living facilities, as provided under part I of chapter 429, are exempt from s. 408.810(10). 1238 1239 (14) Home health agencies, as provided under part III of chapter 400, are exempt from s. 408.810(10). 1240 1241 (13)(15) Nurse registries, as provided under part III of chapter 400, are exempt from s. 408.810(6) and (10). 1242 (14)(16) Companion services or homemaker services 1243 providers, as provided under part III of chapter 400, are exempt 1244 from s. 408.810(6)-(9) s. 408.810(6)-(10). 1245 1246 (17) Adult day care centers, as provided under part III of chapter 429, are exempt from s. 408.810(10). 1247 (15)(18) Adult family-care homes, as provided under part II 1248 of chapter 429, are exempt from s. 408.810(7)-(9) s. 408.810(7)- 1249 (10). 1250 (16)(19) Homes for special services, as provided under part Page 43 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 1251 V of chapter 400, are exempt from s. 408.810(7)-(9) s. 1252 408.810(7)-(10). 1253 1254 (20) Transitional living facilities, as provided under part XI of chapter 400, are exempt from s. 408.810(10). 1255 (21) Prescribed pediatric extended care centers, as 1256 provided under part VI of chapter 400, are exempt from s. 1257 408.810(10). 1258 1259 (22) Home medical equipment providers, as provided under part VII of chapter 400, are exempt from s. 408.810(10). 1260 (17)(23) Intermediate care facilities for persons with 1261 developmental disabilities, as provided under part VIII of 1262 chapter 400, are exempt from s. 408.810(7). 1263 (18)(24) Health care services pools, as provided under part 1264 IX of chapter 400, are exempt from s. 408.810(6)-(9) s. 1265 408.810(6)-(10). 1266 (19)(25) Health care clinics, as provided under part X of 1267 chapter 400, are exempt from s. 408.810(6), and (7), and (10). 1268 (20)(26) Clinical laboratories, as provided under part I of 1269 chapter 483, are exempt from s. 408.810(5)-(9) s. 408.810(5)- 1270 (10). 1271 (21)(27) Multiphasic health testing centers, as provided 1272 under part II of chapter 483, are exempt from s. 408.810(5)-(9) 1273 s. 408.810(5)-(10). 1274 (22)(28) Organ, tissue, and eye procurement organizations, 1275 as provided under part V of chapter 765, are exempt from s. 1276 408.810(5)-(9) s. 408.810(5)-(10). 1277 1278 1279 Section 46. Subsection (6) of section 409.9116, Florida Statutes, is amended to read: 409.9116 Disproportionate share/financial assistance Page 44 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 1280 program for rural hospitals.—In addition to the payments made 1281 under s. 409.911, the Agency for Health Care Administration 1282 shall administer a federally matched disproportionate share 1283 program and a state-funded financial assistance program for 1284 statutory rural hospitals. The agency shall make 1285 disproportionate share payments to statutory rural hospitals 1286 that qualify for such payments and financial assistance payments 1287 to statutory rural hospitals that do not qualify for 1288 disproportionate share payments. The disproportionate share 1289 program payments shall be limited by and conform with federal 1290 requirements. Funds shall be distributed quarterly in each 1291 fiscal year for which an appropriation is made. Notwithstanding 1292 the provisions of s. 409.915, counties are exempt from 1293 contributing toward the cost of this special reimbursement for 1294 hospitals serving a disproportionate share of low-income 1295 patients. 1296 (6) This section applies only to hospitals that were 1297 defined as statutory rural hospitals, or their successor-in- 1298 interest hospital, before prior to January 1, 2001. Any 1299 additional hospital that is defined as a statutory rural 1300 hospital, or its successor-in-interest hospital, on or after 1301 January 1, 2001, is not eligible for programs under this section 1302 unless additional funds are appropriated each fiscal year 1303 specifically to the rural hospital disproportionate share and 1304 financial assistance programs in an amount necessary to prevent 1305 any hospital, or its successor-in-interest hospital, eligible 1306 for the programs before prior to January 1, 2001, from incurring 1307 a reduction in payments because of the eligibility of an 1308 additional hospital to participate in the programs. A hospital, Page 45 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 2017676__ 1309 or its successor-in-interest hospital, which received funds 1310 pursuant to this section before January 1, 2001, and which 1311 qualifies under s. 395.602(2)(b) s. 395.602(2)(e), shall be 1312 included in the programs under this section and is not required 1313 to seek additional appropriations under this subsection. 1314 1315 Section 47. Paragraph (c) of subsection (1) of section 641.60, Florida Statutes, is amended to read: 1316 641.60 Statewide Managed Care Ombudsman Committee.— 1317 (1) As used in ss. 641.60-641.75: 1318 (c) “District” means one of the health service planning 1319 1320 1321 1322 1323 1324 districts as described defined in s. 381.4066 s. 408.032. Section 48. Paragraph (b) of subsection (2) of section 1009.65, Florida Statutes, is amended to read: 1009.65 Medical Education Reimbursement and Loan Repayment Program.— (2) From the funds available, the Department of Health 1325 shall make payments to selected medical professionals as 1326 follows: 1327 (b) All payments shall be contingent on continued proof of 1328 primary care practice in an area defined in s. 395.602(2)(b) s. 1329 395.602(2)(e), or an underserved area designated by the 1330 Department of Health, provided the practitioner accepts Medicaid 1331 reimbursement if eligible for such reimbursement. Correctional 1332 facilities, state hospitals, and other state institutions that 1333 employ medical personnel shall be designated by the Department 1334 of Health as underserved locations. Locations with high 1335 incidences of infant mortality, high morbidity, or low Medicaid 1336 participation by health care professionals may be designated as 1337 underserved. Page 46 of 47 CODING: Words stricken are deletions; words underlined are additions. Florida Senate - 2017 SB 676 5-00645-17 1338 2017676__ Section 49. This act shall take effect July 1, 2017. Page 47 of 47 CODING: Words stricken are deletions; words underlined are additions.