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.