House Bill 0349
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Florida House of Representatives - 1997 HB 349
By Representative Saunders
1 A bill to be entitled
2 An act relating to the regulation of health
3 care facilities; amending s. 20.42, F.S.;
4 deleting the responsibility of the Division of
5 Health Policy and Cost Control within the
6 Agency for Health Care Administration for
7 reviewing hospital budgets; abolishing the
8 Health Care Board; amending s. 112.153, F.S.,
9 relating to local governmental group insurance
10 plans; updating provisions to reflect the
11 assumption by the Agency for Health Care
12 Administration of duties formerly performed by
13 the Health Care Cost Containment Board;
14 amending s. 154.304, F.S., relating to health
15 care for indigent persons; revising
16 definitions; amending ss. 212.055 and 394.4788,
17 F.S., relating to discretionary sales surtaxes
18 and mental health services; updating provisions
19 relating to duties of the agency formerly
20 performed by the Health Care Cost Containment
21 Board; amending s. 240.4076, F.S.; conforming a
22 cross reference to changes made by the act;
23 amending s. 395.0163, F.S.; providing
24 exemptions from construction inspections and
25 investigations by the Agency for Health Care
26 Administration for certain outpatient
27 facilities; providing exceptions; amending s.
28 395.0197, F.S.; exempting ambulatory surgical
29 centers and hospitals from certain staffing
30 requirements in surgical recovery rooms;
31 amending s. 395.1055, F.S.; requiring the
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1 Agency for Health Care Administration to adopt
2 rules to assure that, following a disaster,
3 licensed facilities are capable of serving as
4 shelters only for patients, staff, and the
5 families of staff; providing for applicability;
6 providing for a report by the agency to the
7 Governor and Legislature; amending s. 395.401,
8 F.S.; providing for certain reports formerly
9 made to the Health Care Board to be made to the
10 agency; amending s. 395.701, F.S., relating to
11 the Public Medical Assistance Trust Fund;
12 revising definitions; amending s. 395.806,
13 F.S.; providing for the agency to assume the
14 board's duties in reviewing family practice
15 teaching hospitals; amending s. 408.033, F.S.;
16 revising membership on the Statewide Health
17 Council to reflect the abolishment of the
18 Health Care Board; amending ss. 408.05,
19 408.061, 408.062, and 408.063, F.S., relating
20 to the State Center for Health Statistics and
21 the collection and dissemination of health care
22 information; updating provisions to reflect the
23 assumption by the Agency for Health Care
24 Administration of duties formerly performed by
25 the Health Care Board and the former Department
26 of Health and Rehabilitative Services;
27 authorizing the agency to conduct data-based
28 studies and make recommendations; deleting
29 obsolete provisions; amending s. 408.07, F.S.;
30 deleting definitions made obsolete by the
31 repeal of requirements with respect to hospital
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1 budget reviews; amending s. 408.08, F.S.;
2 deleting provisions requiring the Health Care
3 Board to review the budgets of certain
4 hospitals; deleting requirements that a
5 hospital file budget letters; deleting certain
6 administrative penalties; amending s. 408.40,
7 F.S.; removing a reference to the duties of the
8 Public Counsel with respect to hospital budget
9 review proceedings; amending ss. 409.2673 and
10 409.9113, F.S., relating to health care
11 programs for low-income persons and the
12 disproportionate share program for teaching
13 hospitals; updating provisions to reflect the
14 abolishment of the Health Care Cost Containment
15 Board and the assumption of its duties by the
16 agency; amending s. 440.13, F.S., relating to
17 reimbursements for medical services under the
18 Workers' Compensation Law; deleting a reference
19 to reviews of hospital budgets made obsolete by
20 the act; repealing ss. 395.403(9), 407.61,
21 408.003, 408.072, and 408.085, F.S., relating
22 to reimbursement of state-sponsored trauma
23 centers, studies by the Health Care Board,
24 appointment of members to the Health Care
25 Board, review of hospital budgets, and budget
26 reviews of comprehensive inpatient
27 rehabilitation hospitals; providing for
28 retroactive application of the act; providing
29 an effective date.
30
31 Be It Enacted by the Legislature of the State of Florida:
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1 Section 1. Paragraphs (b), (d), and (e) of subsection
2 (2) and subsections (6) and (7) of section 20.42, Florida
3 Statutes, 1996 Supplement, are amended to read:
4 20.42 Agency for Health Care Administration.--There is
5 created the Agency for Health Care Administration within the
6 Department of Business and Professional Regulation. The agency
7 shall be a separate budget entity, and the director of the
8 agency shall be the agency head for all purposes. The agency
9 shall not be subject to control, supervision, or direction by
10 the Department of Business and Professional Regulation in any
11 manner, including, but not limited to, personnel, purchasing,
12 transactions involving real or personal property, and
13 budgetary matters.
14 (2) ORGANIZATION OF THE AGENCY.--The agency shall be
15 organized as follows:
16 (b) The Division of Health Policy and Cost Control,
17 which shall be responsible for health policy, the State Center
18 for Health Statistics, the development of The Florida Health
19 Plan, certificate of need, hospital budget review, state and
20 local health planning under s. 408.033, and research and
21 analysis.
22 (d) The Health Care Board, which shall be responsible
23 for hospital budget review, nursing home financial analysis,
24 and special studies as assigned by the secretary or the
25 Legislature.
26 (d)(e) The Division of Administrative Services, which
27 shall be responsible for revenue management, budget,
28 personnel, and general services.
29 (6) HEALTH CARE BOARD.--The Health Care Board shall be
30 composed of 11 members appointed by the Governor, subject to
31 confirmation by the Senate. The members of the board shall
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1 biennially elect a chairperson and a vice chairperson from its
2 membership. The board shall be responsible for hospital budget
3 review, nursing home financial review and analysis, and
4 special studies requested by the Governor, the Legislature, or
5 the director.
6 (6)(7) DEPUTY DIRECTOR OF ADMINISTRATIVE
7 SERVICES.--The director shall appoint a Deputy Director of
8 Administrative Services who shall serve at the pleasure of,
9 and be directly responsible to, the director. The deputy
10 director shall be responsible for the Division of
11 Administrative Services.
12 Section 2. Section 112.153, Florida Statutes, is
13 amended to read:
14 112.153 Local governmental group insurance plans;
15 refunds with respect to overcharges by providers.--A
16 participant in a group insurance plan offered by a county,
17 municipality, school board, local governmental unit, and
18 special taxing unit, who discovers that he or she was
19 overcharged by a hospital, physician, clinical lab, and other
20 health care providers, shall receive a refund of 50 percent of
21 any amount recovered as a result of such overcharge, up to a
22 maximum of $1,000 per admission. All such instances of
23 overcharge shall be reported to the Agency for Health Care
24 Administration Health Care Cost Containment Board for action
25 it deems appropriate.
26 Section 3. Subsections (1), (4), and (8) of section
27 154.304, Florida Statutes, are amended to read:
28 154.304 Definitions.--For the purpose of this act:
29 (1) "Agency" means the Agency for Health Care
30 Administration "Board" means the Health Care Board as
31 established in chapter 408.
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1 (4) "Charity care obligation" means the minimum amount
2 of uncompensated charity care as reported to the agency Health
3 Care Cost Containment Board, based on the hospital's most
4 recent audited actual experience, which must be provided by a
5 participating hospital or a regional referral hospital before
6 the hospital is eligible to be reimbursed by a county under
7 the provisions of this act. That amount shall be the ratio of
8 uncompensated charity care days compared to total acute care
9 inpatient days, which shall be equal to or greater than 2
10 percent.
11 (8) "Participating hospital" means a hospital which is
12 eligible to receive reimbursement under the provisions of this
13 act because it has been certified by the agency board as
14 having met its charity care obligation and has either:
15 (a) A formal signed agreement with a county or
16 counties to treat such county's indigent patients; or
17 (b) Demonstrated to the agency board that at least 2.5
18 percent of its uncompensated charity care, as reported to the
19 board, is generated by out-of-county residents.
20 Section 4. Paragraph (d) of subsection (4) and
21 paragraph (c) of subsection (6) of section 212.055, Florida
22 Statutes, 1996 Supplement, are amended to read:
23 212.055 Discretionary sales surtaxes; legislative
24 intent; authorization and use of proceeds.--It is the
25 legislative intent that any authorization for imposition of a
26 discretionary sales surtax shall be published in the Florida
27 Statutes as a subsection of this section, irrespective of the
28 duration of the levy. Each enactment shall specify the types
29 of counties authorized to levy; the rate or rates which may be
30 imposed; the maximum length of time the surtax may be imposed,
31 if any; the procedure which must be followed to secure voter
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1 approval, if required; the purpose for which the proceeds may
2 be expended; and such other requirements as the Legislature
3 may provide. Taxable transactions and administrative
4 procedures shall be as provided in s. 212.054.
5 (4) INDIGENT CARE SURTAX.--
6 (d) The ordinance adopted by the governing body
7 providing for the imposition of the surtax shall set forth a
8 plan for providing health care services to qualified
9 residents, as defined in paragraph (e). Such plan and
10 subsequent amendments to it shall fund a broad range of health
11 care services for both indigent persons and the medically
12 poor, including, but not limited to, primary care and
13 preventive care as well as hospital care. It shall emphasize
14 a continuity of care in the most cost-effective setting,
15 taking into consideration both a high quality of care and
16 geographic access. Where consistent with these objectives, it
17 shall include, without limitation, services rendered by
18 physicians, clinics, community hospitals, mental health
19 centers, and alternative delivery sites, as well as at least
20 one regional referral hospital where appropriate. It shall
21 provide that agreements negotiated between the county and
22 providers will include reimbursement methodologies that take
23 into account the cost of services rendered to eligible
24 patients, recognize hospitals that render a disproportionate
25 share of indigent care, provide other incentives to promote
26 the delivery of charity care, and require cost containment
27 including, but not limited to, case management. It must also
28 provide that any hospitals that are owned and operated by
29 government entities on May 21, 1991, must, as a condition of
30 receiving funds under this subsection, afford public access
31 equal to that provided under s. 286.011 as to meetings of the
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1 governing board, the subject of which is budgeting resources
2 for the rendition of charity care as that term is defined in
3 the rules of the Agency for Health Care Administration Health
4 Care Cost Containment Board. The plan must shall also include
5 innovative health care programs that provide cost-effective
6 alternatives to traditional methods of service delivery and
7 funding.
8 (6) SMALL COUNTY INDIGENT CARE SURTAX.--
9 (c) The ordinance adopted by the governing body
10 providing for the imposition of the surtax shall set forth a
11 brief plan for providing health care services to qualified
12 residents, as defined in paragraph (d). Such plan and
13 subsequent amendments to it shall fund a broad range of health
14 care services for both indigent persons and the medically
15 poor, including, but not limited to, primary care and
16 preventive care as well as hospital care. It shall emphasize
17 a continuity of care in the most cost-effective setting,
18 taking into consideration both a high quality of care and
19 geographic access. Where consistent with these objectives, it
20 shall include, without limitation, services rendered by
21 physicians, clinics, community hospitals, mental health
22 centers, and alternative delivery sites, as well as at least
23 one regional referral hospital where appropriate. It shall
24 provide that agreements negotiated between the county and
25 providers will include reimbursement methodologies that take
26 into account the cost of services rendered to eligible
27 patients, recognize hospitals that render a disproportionate
28 share of indigent care, provide other incentives to promote
29 the delivery of charity care, and require cost containment
30 including, but not limited to, case management. It shall also
31 provide that any hospitals that are owned and operated by
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1 government entities on May 21, 1991, must, as a condition of
2 receiving funds under this subsection, afford public access
3 equal to that provided under s. 286.011 as to meetings of the
4 governing board, the subject of which is budgeting resources
5 for the rendition of charity care as that term is defined in
6 the rules of the Agency for Health Care Administration Health
7 Care Cost Containment Board. The plan must shall also include
8 innovative health care programs that provide cost-effective
9 alternatives to traditional methods of service delivery and
10 funding.
11 Section 5. Subsections (2) and (3) of section
12 394.4788, Florida Statutes, 1996 Supplement, are amended to
13 read:
14 394.4788 Use of certain PMATF funds for the purchase
15 of acute care mental health services.--
16 (2) By October 1, 1989, and annually thereafter, The
17 agency shall annually calculate a per diem reimbursement rate
18 for each specialty psychiatric hospital to be paid to the
19 specialty psychiatric hospitals for the provision of acute
20 mental health services provided to indigent mentally ill
21 patients who meet the criteria in subsection (1). After the
22 first rate period, providers shall be notified of new
23 reimbursement rates for each new state fiscal year by June 1.
24 The new reimbursement rates shall commence July 1.
25 (3) Reimbursement rates shall be calculated using the
26 most recent audited actual costs received by the agency. Cost
27 data received as of August 15, 1989, and each April 15
28 thereafter shall be used in the calculation of the rates.
29 Historic costs shall be inflated from the midpoint of a
30 hospital's fiscal year to the midpoint of the state fiscal
31 year. The inflation adjustment shall be made utilizing the
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1 latest available projections as of March 31 for the Data
2 Resources Incorporated National and Regional Hospital Input
3 Price Indices as calculated by the Medicaid program office.
4 Section 6. Paragraph (a) of subsection (4) of section
5 240.4076, Florida Statutes, is amended to read:
6 240.4076 Nursing scholarship loan program.--
7 (4) Credit for repayment of a scholarship loan shall
8 be on a year-for-year basis as follows:
9 (a) For each year of scholarship loan assistance, the
10 recipient agrees to work for 12 months at a health care
11 facility in a medically underserved area as approved by the
12 Department of Health and Rehabilitative Services. Eligible
13 health care facilities include state-operated medical or
14 health care facilities, county public health units, federally
15 sponsored community health centers, or teaching hospitals as
16 defined in s. 408.07 s. 408.07(49).
17 Section 7. Subsection (1) of section 395.0163, Florida
18 Statutes, is amended to read:
19 395.0163 Construction inspections; plan submission and
20 approval; fees.--
21 (1) The agency shall make, or cause to be made, such
22 construction inspections and investigations as it deems
23 necessary. The agency may prescribe by rule that any licensee
24 or applicant desiring to make specified types of alterations
25 or additions to its facilities or to construct new facilities
26 shall, before commencing such alteration, addition, or new
27 construction, submit plans and specifications therefor to the
28 agency for preliminary inspection and approval or
29 recommendation with respect to compliance with agency rules
30 and standards. The agency shall approve or disapprove the
31 plans and specifications within 60 days after receipt of the
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1 fee for review of plans as required in subsection (2). The
2 agency may be granted one 15-day extension for the review
3 period if the director of the agency approves the extension.
4 If the agency fails to act within the specified time, it shall
5 be deemed to have approved the plans and specifications. When
6 the agency disapproves plans and specifications, it shall set
7 forth in writing the reasons for its disapproval. Conferences
8 and consultations may be provided as necessary. Outpatient
9 facilities that provide surgical treatments requiring general
10 anesthesia or intravenous conscious sedation or that provide
11 cardiac catheterization services shall submit plans and
12 specifications to the agency for review under this section.
13 All other outpatient facilities that are physically detached
14 from the hospital with no utility connections and that do not
15 block emergency egress from or create a fire hazard to the
16 hospital are exempt from review under this section.
17 Applications pending review on the effective date of this act
18 shall be governed by the exemption provided in this
19 subsection.
20 Section 8. Paragraph (b) of subsection (1) of section
21 395.0197, Florida Statutes, 1996 Supplement, is amended to
22 read:
23 395.0197 Internal risk management program.--
24 (1) Every licensed facility shall, as a part of its
25 administrative functions, establish an internal risk
26 management program that includes all of the following
27 components:
28 (b) The development of appropriate measures to
29 minimize the risk of injuries and adverse incidents to
30 patients, including, but not limited to:
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1 1. Risk management and risk prevention education and
2 training of all nonphysician personnel as follows:
3 a. Such education and training of all nonphysician
4 personnel as part of their initial orientation; and
5 b. At least 1 hour of such education and training
6 annually for all nonphysician personnel of the licensed
7 facility working in clinical areas and providing patient care.
8 2. A prohibition, except when emergency circumstances
9 require otherwise, against a staff member of the licensed
10 facility attending a patient in the recovery room, unless the
11 staff member is authorized to attend the patient in the
12 recovery room and is in the company of at least one other
13 person. However, a licensed facility hospital is exempt from
14 the two-person requirement if it has:
15 a. Live visual observation;
16 b. Electronic observation; or
17 c. Any other reasonable measure taken to ensure
18 patient protection and privacy.
19 Section 9. Paragraph (d) of subsection (1) of section
20 395.1055, Florida Statutes, 1996 Supplement, is amended to
21 read:
22 395.1055 Rules and enforcement.--
23 (1) The agency shall adopt, amend, promulgate, and
24 enforce rules to implement the provisions of this part, which
25 shall include reasonable and fair minimum standards for
26 ensuring that:
27 (d) New facilities and a new wing or floor added to an
28 existing facility after July 1, 1997, are structurally capable
29 of serving as shelters only for patients, staff, and families
30 of staff, and equipped to be self-supporting during and
31 immediately following disasters.
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1 Section 10. The Agency for Health Care Administration
2 shall work with persons affected by section 9 and report to
3 the Governor and Legislature by March 1, 1998, its
4 recommendations for cost-effective renovation standards to be
5 applied to existing facilities.
6 Section 11. Paragraphs (a) and (b) of subsection (1)
7 of section 395.401, Florida Statutes, are amended to read:
8 395.401 Trauma services system plans; verification of
9 trauma centers and pediatric trauma referral centers;
10 procedures; renewal.--
11 (1) As used in this part, the term:
12 (a) "Agency" means the Agency for Health Care
13 Administration "Board" means the Health Care Board.
14 (b) "Charity care" or "uncompensated charity care"
15 means that portion of hospital charges reported to the agency
16 board for which there is no compensation for care provided to
17 a patient whose family income for the 12 months preceding the
18 determination is less than or equal to 150 percent of the
19 federal poverty level, unless the amount of hospital charges
20 due from the patient exceeds 25 percent of the annual family
21 income. However, in no case shall the hospital charges for a
22 patient whose family income exceeds 4 times the federal
23 poverty level for a family of four be considered charity.
24 Section 12. Subsections (1), (2), (3), and (4) of
25 section 395.701, Florida Statutes, are amended to read:
26 395.701 Annual assessments on net operating revenues
27 to fund public medical assistance; administrative fines for
28 failure to pay assessments when due.--
29 (1) For the purposes of this section, the term:
30 (a) "Agency" means the Agency for Health Care
31 Administration.
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1 (b)(a) "Gross operating revenue" or "gross revenue"
2 means the sum of daily hospital service charges, ambulatory
3 service charges, ancillary service charges, and other
4 operating revenue.
5 (b) "Health Care Board" or "board" means the Health
6 Care Board created by s. 20.42.
7 (c) "Hospital" means a health care institution as
8 defined in s. 395.002(12), but does not include any hospital
9 operated by the agency or the Department of Corrections.
10 (d) "Net operating revenue" or "net revenue" means
11 gross revenue less deductions from revenue.
12 (e) "Total deductions from gross revenue" or
13 "deductions from revenue" means reductions from gross revenue
14 resulting from inability to collect payment of charges. Such
15 reductions include bad debts; contractual adjustments;
16 uncompensated care; administrative, courtesy, and policy
17 discounts and adjustments; and other such revenue deductions,
18 but also includes the offset of restricted donations and
19 grants for indigent care.
20 (2) There is hereby imposed upon each hospital an
21 assessment in an amount equal to 1.5 percent of the annual net
22 operating revenue for each hospital, such revenue to be
23 determined by the agency department, based on the actual
24 experience of the hospital as reported to the agency
25 department. Within 6 months after the end of each hospital
26 fiscal year, the agency department shall certify the amount of
27 the assessment for each hospital. The assessment shall be
28 payable to and collected by the agency department in equal
29 quarterly amounts, on or before the first day of each calendar
30 quarter, beginning with the first full calendar quarter that
31 occurs after the agency department certifies the amount of the
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1 assessment for each hospital. All moneys collected pursuant to
2 this subsection shall be deposited into the Public Medical
3 Assistance Trust Fund.
4 (3) The agency department shall impose an
5 administrative fine, not to exceed $500 per day, for failure
6 of any hospital to pay its assessment by the first day of the
7 calendar quarter on which it is due. The failure of a
8 hospital to pay its assessment within 30 days after the
9 assessment is due is ground for the agency department to
10 impose an administrative fine not to exceed $5,000 per day.
11 (4) The purchaser, successor, or assignee of a
12 facility subject to the agency's board's jurisdiction shall
13 assume full liability for any assessments, fines, or penalties
14 of the facility or its employees, regardless of when
15 identified. Such assessments, fines, or penalties shall be
16 paid by the employee, owner, or licensee who incurred them,
17 within 15 days of the sale, transfer, or assignment. However,
18 the purchaser, successor, or assignee of the facility may
19 withhold such assessments, fines, or penalties from purchase
20 moneys or payment due to the seller, transferor, or employee,
21 and shall make such payment on behalf of the seller,
22 transferor, or employee. Any employer, purchaser, successor,
23 or assignee who fails to withhold sufficient funds to pay
24 assessments, fines, or penalties arising under the provisions
25 of chapter 408 shall make such payments within 15 days of the
26 date of the transfer, purchase, or assignment. Failure by the
27 transferee to make payments as provided in this subsection
28 shall subject such transferee to the penalties and assessments
29 provided in chapter 408. Further, in the event of sale,
30 transfer, or assignment of any facility under the agency's
31 board's jurisdiction, future assessments shall be based upon
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1 the most recently available prior year report or audited
2 actual experience for the facility. It shall be the
3 responsibility of the new owner or licensee to require the
4 production of the audited financial data for the period of
5 operation of the prior owner. If the transferee fails to
6 obtain current audited financial data from the previous owner
7 or licensee, the new owner shall be assessed based upon the
8 most recent year of operation for which 12 months of audited
9 actual experience are available or upon a reasonable estimate
10 of 12 months of full operation as calculated by the agency
11 board.
12 Section 13. Subsection (3) of section 395.806, Florida
13 Statutes, is amended to read:
14 395.806 Designation of family practice teaching
15 hospitals.--
16 (3) The agency shall create a separate review category
17 for family practice teaching hospitals for the purpose of
18 review by the agency Health Care Board.
19 Section 14. Subsection (2) of section 408.033, Florida
20 Statutes, is amended to read:
21 408.033 Local and state health planning.--
22 (2) STATEWIDE HEALTH COUNCIL.--The Statewide Health
23 Council is hereby established as a state-level comprehensive
24 health planning and policy advisory board. For administrative
25 purposes, the council shall be located within the agency. The
26 Statewide Health Council shall be composed of: the State
27 Health Officer; the Deputy Director for Health Policy and Cost
28 Control and the Deputy Director for Health Quality Assurance
29 of the agency department; the director of the Health Care
30 Board; the Insurance Commissioner or his designee; the Vice
31 Chancellor for Health Affairs of the Board of Regents; three
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1 chairmen of regional planning councils, selected by the
2 regional planning councils; five chairmen of local health
3 councils, selected by the local health councils; four members
4 appointed by the Governor, one of whom is a consumer over 60
5 years of age, one of whom is a representative of organized
6 labor, one of whom is a physician, and one of whom represents
7 the nursing home industry; five members appointed by the
8 President of the Senate, one of whom is a representative of
9 the insurance industry in this state, one of whom is the chief
10 executive officer of a business with more than 300 employees
11 in this state, one of whom represents the hospital industry,
12 one of whom is a primary care physician, and one of whom is a
13 nurse, and five members appointed by the Speaker of the House
14 of Representatives, one of whom is a consumer who represents a
15 minority group in this state, one of whom represents the home
16 health care industry in this state, one of whom is an allied
17 health care professional, one of whom is the chief executive
18 officer of a business with fewer than 25 employees in this
19 state, and one of whom represents a county social services
20 program that provides health care services to the indigent.
21 Appointed members of the council shall serve for 2-year terms
22 commencing October 1 of each even-numbered year. The council
23 shall elect a president from among the members who are not
24 state employees. The Statewide Health Council shall:
25 (a) Advise the Governor, the Legislature, and the
26 agency department on state health policy issues, state and
27 local health planning activities, and state health regulation
28 programs;
29 (b) Prepare a state health plan that specifies
30 subgoals, quantifiable objectives, strategies, and resource
31 requirements to implement the goals and policies of the health
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1 element of the State Comprehensive Plan. The plan must assess
2 the health status of residents of this state; evaluate the
3 adequacy, accessibility, and affordability of health services
4 and facilities; assess government-financed programs and
5 private health care insurance coverages; and address other
6 topical local and state health care issues. Within 2 years
7 after the health element of the State Comprehensive Plan is
8 amended, and by July 1 of every 3rd year, if it is not
9 amended, the Statewide Health Council shall submit the state
10 health plan to the Executive Office of the Governor, the
11 director of the agency secretary of the department, the
12 President of the Senate, and the Speaker of the House of
13 Representatives;
14 (c) Promote public awareness of state health care
15 issues and, in conjunction with the local health councils,
16 conduct public forums throughout the state to solicit the
17 comments and advice of the public on the adequacy,
18 accessibility, and affordability of health care services in
19 this state and other health care issues;
20 (d) Consult with local health councils, the Department
21 of Insurance, the Department of Health and Rehabilitative
22 Services, and other appropriate public and private entities,
23 including health care industry representatives regarding the
24 development of health policies;
25 (e) Serve as a forum for the discussion of local
26 health planning issues of concern to the local health councils
27 and regional planning councils;
28 (f) Review district health plans for consistency with
29 the State Comprehensive Plan and the state health plan;
30 (g) Review the health components of agency functional
31 plans for consistency with the health element of the State
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1 Comprehensive Plan, advise the Executive Office of the
2 Governor regarding inconsistencies, and recommend revisions to
3 agency functional plans to make them consistent with the State
4 Comprehensive Plan;
5 (h) Review any strategic regional plans that address
6 health issues for consistency with the health element of the
7 State Comprehensive Plan, advise the Executive Office of the
8 Governor regarding inconsistencies, and recommend revisions to
9 strategic regional policy plans to make them consistent with
10 the State Comprehensive Plan;
11 (i) Assist the Department of Community Affairs in the
12 review of local government comprehensive plans to ensure
13 consistency with policy developed in the district health
14 plans;
15 (j) With the assistance of the local health councils,
16 conduct public forums and use other means to determine the
17 opinions of health care consumers, providers, payors, and
18 insurers regarding the state's health care goals and policies
19 and develop suggested revisions to the health element of the
20 State Comprehensive Plan. The council shall submit the
21 proposed revisions to the health element of the State
22 Comprehensive Plan to the Governor, the President of the
23 Senate, and the Speaker of the House of Representatives by
24 February 1, 1993, and shall widely circulate the proposed
25 revisions to affected parties. The council shall periodically
26 assess the progress made in achieving the goals and policies
27 contained in the health element of the State Comprehensive
28 Plan and report to the agency department, the Governor, the
29 President of the Senate, and the Speaker of the House of
30 Representatives; and
31
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1 (k) Conduct any other functions or studies and
2 analyses falling under the duties listed above.
3 Section 15. Subsection (1), paragraphs (e) and (f) of
4 subsection (3), subsection (6), and paragraphs (c) and (d) of
5 subsection (7) of section 408.05, Florida Statutes, are
6 amended to read:
7 408.05 State Center for Health Statistics.--
8 (1) ESTABLISHMENT.--The agency department shall
9 establish a State Center for Health Statistics. The center
10 shall establish a comprehensive health information system to
11 provide for the collection, compilation, coordination,
12 analysis, indexing, dissemination, and utilization of both
13 purposefully collected and extant health-related data and
14 statistics. The center shall be staffed with public health
15 experts, biostatisticians, information system analysts, health
16 policy experts, economists, and other staff necessary to carry
17 out its functions.
18 (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order
19 to produce comparable and uniform health information and
20 statistics, the agency shall perform the following functions:
21 (e) The agency department shall establish by rule the
22 types of data collected, compiled, processed, used, or shared.
23 Decisions regarding center data sets should be made based on
24 consultation with the Comprehensive Health Information System
25 Advisory Council and other public and private users regarding
26 the types of data which should be collected and their uses.
27 (f) The center shall establish standardized means for
28 collecting health information and statistics under laws and
29 rules administered by the agency department.
30 (6) PROVIDER DATA REPORTING.--This section does not
31 confer on the agency department the power to demand or require
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1 that a health care provider or professional furnish
2 information, records of interviews, written reports,
3 statements, notes, memoranda, or data other than as expressly
4 required by law.
5 (7) BUDGET; FEES; TRUST FUND.--
6 (c) The center may charge such reasonable fees for
7 services as the agency department prescribes by rule. The
8 established fees may shall not exceed the reasonable cost for
9 such services. Fees collected may not be used to offset
10 annual appropriations from the General Revenue Fund.
11 (d) The agency department shall establish a
12 Comprehensive Health Information System Trust Fund as the
13 repository of all funds appropriated to, and fees and grants
14 collected for, services of the State Center for Health
15 Statistics. Any funds, other than funds appropriated to the
16 center from the General Revenue Fund, which are raised or
17 collected by the agency department for the operation of the
18 center and which are not needed to meet the expenses of the
19 center for its current fiscal year shall be available to the
20 agency board in succeeding years.
21 Section 16. Subsections (10) and (11) of section
22 408.061, Florida Statutes, 1996 Supplement, are amended to
23 read:
24 408.061 Data collection; uniform systems of financial
25 reporting; information relating to physician charges;
26 confidentiality of patient records; immunity.--
27 (10) No health care facility, health care provider,
28 health insurer, or other reporting entity or its employees or
29 agents shall be held liable for civil damages or subject to
30 criminal penalties either for the reporting of patient data to
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1 the agency board or for the release of such data by the agency
2 board as authorized by this chapter.
3 (11) The agency shall be the primary source for
4 collection and dissemination of health care data. No other
5 agency of state government may gather data from a health care
6 provider licensed or regulated under this chapter without
7 first determining if the data is currently being collected by
8 the agency and affirmatively demonstrating that it would be
9 more cost-effective for an agency of state government other
10 than the agency to gather the health care data. The director
11 secretary shall ensure that health care data collected by the
12 divisions within the agency is coordinated. It is the express
13 intent of the Legislature that all health care data be
14 collected by a single source within the agency and that other
15 divisions within the agency, and all other agencies of state
16 government, obtain data for analysis, regulation, and public
17 dissemination purposes from that single source. Confidential
18 information may be released to other governmental entities or
19 to parties contracting with the agency to perform agency
20 duties or functions as needed in connection with the
21 performance of the duties of the receiving entity. The
22 receiving entity or party shall retain the confidentiality of
23 such information as provided for herein.
24 Section 17. Subsections (2) and (5) of section
25 408.062, Florida Statutes, are amended to read:
26 408.062 Research, analyses, studies, and reports.--
27 (2) The agency board shall evaluate data from nursing
28 home financial reports and shall document and monitor:
29 (a) Total revenues, annual change in revenues, and
30 revenues by source and classification, including contributions
31 for a resident's care from the resident's resources and from
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1 the family and contributions not directed toward any specific
2 resident's care.
3 (b) Average resident charges by geographic region,
4 payor, and type of facility ownership.
5 (c) Profit margins by geographic region and type of
6 facility ownership.
7 (d) Amount of charity care provided by geographic
8 region and type of facility ownership.
9 (e) Resident days by payor category.
10 (f) Experience related to Medicaid conversion as
11 reported under s. 408.061.
12 (g) Other information pertaining to nursing home
13 revenues and expenditures.
14
15 The findings of the agency board shall be included in an
16 annual report to the Governor and Legislature by January 1
17 each year.
18 (5)(a) The agency is empowered to conduct data-based
19 studies and evaluations and to make recommendations to the
20 Legislature and the Governor concerning exemptions, the
21 effectiveness of limitations of referrals, restrictions on
22 investment interests and compensation arrangements, and the
23 effectiveness of public disclosure. Such analysis may
24 include, but need not be limited to, utilization of services,
25 cost of care, quality of care, and access to care. The agency
26 may require the submission of data necessary to carry out this
27 duty, which may include, but need not be limited to, data
28 concerning ownership, Medicare and Medicaid, charity care,
29 types of services offered to patients, revenues and expenses,
30 patient-encounter data, and other data reasonably necessary to
31 study utilization patterns and the impact of health care
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1 provider ownership interests in health-care-related entities
2 on the cost, quality, and accessibility of health care.
3 (b) The agency may collect such data from any health
4 facility as a special study. The board is directed to research
5 hospital financial and nonfinancial data in order to determine
6 the need for establishing a category of inpatient hospital
7 patients defined as medically indigent. For purposes of this
8 section, a medically indigent patient is an individual who is
9 admitted as an inpatient to a hospital, who is not classified
10 as a Medicare beneficiary, a Medicaid recipient, or a charity
11 care patient, but who has insufficient financial resources to
12 pay for needed medical care. In its determination of the need
13 for establishing a category of medically indigent patients,
14 the board shall consider the creation of income and asset
15 levels that would establish a person as medically indigent.
16 The board shall submit a report and recommendations to the
17 Governor and the Legislature on the establishment of a
18 category of medically indigent inpatient hospital patients on
19 or before January 1, 1994. If the board recommends the
20 establishment of a category of medically indigent patients, it
21 shall provide a specific recommendation for the eligibility
22 determination process to be used in classifying a patient as
23 medically indigent.
24 Section 18. Subsection (1) of section 408.063, Florida
25 Statutes, is amended to read:
26 408.063 Dissemination of health care information.--
27 (1) The agency, relying on data collected pursuant to
28 this chapter, shall establish a reliable, timely, and
29 consistent information system which distributes information
30 and serves as the basis for the agency's board's public
31 education programs. The agency shall seek advice from
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1 consumers, health care purchasers, health care providers,
2 health care facilities, health insurers, and local health
3 councils in the development and implementation of its
4 information system. Whenever appropriate, the agency shall use
5 the local health councils for the dissemination of information
6 and education of the public.
7 Section 19. Section 408.07, Florida Statutes, is
8 amended to read:
9 408.07 Definitions.--As used in this chapter, with the
10 exception of ss. 408.031-408.045, the term:
11 (1) "Accepted" means that the agency board has found
12 that a report or data submitted by a health care facility or a
13 health care provider contains all schedules and data required
14 by the agency board and has been prepared in the format
15 specified by the agency board, and otherwise conforms to
16 applicable rule or Florida Hospital Uniform Reporting System
17 manual requirements regarding reports in effect at the time
18 such report was submitted, and the data are mathematically
19 reasonable and accurate.
20 (2) "Adjusted admission" means the sum of acute and
21 intensive care admissions divided by the ratio of inpatient
22 revenues generated from acute, intensive, ambulatory, and
23 ancillary patient services to gross revenues. If a hospital
24 reports only subacute admissions, then "adjusted admission"
25 means the sum of subacute admissions divided by the ratio of
26 total inpatient revenues to gross revenues.
27 (3) "Agency" means the Agency for Health Care
28 Administration.
29 (4) "Alcohol or chemical dependency treatment center"
30 means an organization licensed under chapter 397.
31
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1 (5) "Ambulatory care center" means an organization
2 which employs or contracts with licensed health care
3 professionals to provide diagnosis or treatment services
4 predominantly on a walk-in basis and the organization holds
5 itself out as providing care on a walk-in basis. Such an
6 organization is not an ambulatory care center if it is wholly
7 owned and operated by five or fewer health care providers.
8 (6) "Ambulatory surgical center" means a facility
9 licensed as an ambulatory surgical center under chapter 395.
10 (7) "Applicable rate of increase" means the maximum
11 allowable rate of increase (MARI) when applied to gross
12 revenue per adjusted admission, unless the board has approved
13 a different rate of increase, in which case the board-approved
14 rate of increase shall apply.
15 (7)(8) "Audited actual data" means information
16 contained within financial statements examined by an
17 independent, Florida-licensed, certified public accountant in
18 accordance with generally accepted auditing standards, but
19 does not include data within a financial statement about which
20 the certified public accountant does not express an opinion or
21 issues a disclaimer.
22 (9) "Banked points" means the percentage points earned
23 by a hospital when the actual rate of increase in gross
24 revenue per adjusted admission (GRAA) is less than the maximum
25 allowable rate of increase (MARI) or the actual rate of
26 increase in the net revenue per adjusted admission (NRAA) is
27 less than the market basket index.
28 (8)(10) "Birth center" means an organization licensed
29 under s. 383.305.
30 (11) "Board" means the Health Care Board established
31 under s. 408.003.
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1 (12) "Budget" means the projections by the hospital,
2 for a specified future time period, of expenditures and
3 revenues, with supporting statistical indicators, or a budget
4 letter verified by the board pursuant to s. 408.072(3)(a).
5 (9)(13) "Cardiac catheterization laboratory" means a
6 freestanding facility that which employs or contracts with
7 licensed health care professionals to provide diagnostic or
8 therapeutic services for cardiac conditions such as cardiac
9 catheterization or balloon angioplasty.
10 (10)(14) "Case mix" means a calculated index for each
11 health care facility or health care provider, based on patient
12 data, reflecting the relative costliness of the mix of cases
13 to that facility or provider compared to a state or national
14 mix of cases.
15 (11)(15) "Clinical laboratory" means a facility
16 licensed under s. 483.091, excluding: any hospital laboratory
17 defined under s. 483.041(5); any clinical laboratory operated
18 by the state or a political subdivision of the state; any
19 blood or tissue bank where the majority of revenues are
20 received from the sale of blood or tissue and where blood,
21 plasma, or tissue is procured from volunteer donors and
22 donated, processed, stored, or distributed on a nonprofit
23 basis; and any clinical laboratory which is wholly owned and
24 operated by physicians who are licensed pursuant to chapter
25 458 or chapter 459 and who practice in the same group
26 practice, and at which no clinical laboratory work is
27 performed for patients referred by any health care provider
28 who is not a member of that same group practice.
29 (12)(16) "Comprehensive rehabilitative hospital" or
30 "rehabilitative hospital" means a hospital licensed by the
31 agency for Health Care Administration as a specialty hospital
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1 as defined in s. 395.002; provided that the hospital provides
2 a program of comprehensive medical rehabilitative services and
3 is designed, equipped, organized, and operated solely to
4 deliver comprehensive medical rehabilitative services, and
5 further provided that all licensed beds in the hospital are
6 classified as "comprehensive rehabilitative beds" pursuant to
7 s. 395.003(4), and are not classified as "general beds."
8 (13)(17) "Consumer" means any person other than a
9 person who administers health activities, is a member of the
10 governing body of a health care facility, provides health
11 services, has a fiduciary interest in a health facility or
12 other health agency or its affiliated entities, or has a
13 material financial interest in the rendering of health
14 services.
15 (14)(18) "Continuing care facility" means a facility
16 licensed under chapter 651.
17 (15)(19) "Cross-subsidization" means that the revenues
18 from one type of hospital service are sufficiently higher than
19 the costs of providing such service as to offset some of the
20 costs of providing another type of service in the hospital.
21 Cross-subsidization results from the lack of a direct
22 relationship between charges and the costs of providing a
23 particular hospital service or type of service.
24 (16)(20) "Deductions from gross revenue" or
25 "deductions from revenue" means reductions from gross revenue
26 resulting from inability to collect payment of charges. For
27 hospitals, such reductions include contractual adjustments;
28 uncompensated care; administrative, courtesy, and policy
29 discounts and adjustments; and other such revenue deductions,
30 but also includes the offset of restricted donations and
31 grants for indigent care.
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1 (17)(21) "Diagnostic-imaging center" means a
2 freestanding outpatient facility that provides specialized
3 services for the diagnosis of a disease by examination and
4 also provides radiological services. Such a facility is not a
5 diagnostic-imaging center if it is wholly owned and operated
6 by physicians who are licensed pursuant to chapter 458 or
7 chapter 459 and who practice in the same group practice and no
8 diagnostic-imaging work is performed at such facility for
9 patients referred by any health care provider who is not a
10 member of that same group practice.
11 (18)(22) "FHURS" means the Florida Hospital Uniform
12 Reporting System developed by the agency board.
13 (19)(23) "Freestanding" means that a health facility
14 bills and receives revenue which is not directly subject to
15 the hospital assessment for the Public Medical Assistance
16 Trust Fund as described in s. 395.701.
17 (20)(24) "Freestanding radiation therapy center" means
18 a facility where treatment is provided through the use of
19 radiation therapy machines that are registered under s. 404.22
20 and the provisions of the Florida Administrative Code
21 implementing s. 404.22. Such a facility is not a freestanding
22 radiation therapy center if it is wholly owned and operated by
23 physicians licensed pursuant to chapter 458 or chapter 459 who
24 practice within the specialty of diagnostic or therapeutic
25 radiology.
26 (21)(25) "GRAA" means gross revenue per adjusted
27 admission.
28 (22)(26) "Gross revenue" means the sum of daily
29 hospital service charges, ambulatory service charges,
30 ancillary service charges, and other operating revenue. Gross
31
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1 revenues do not include contributions, donations, legacies, or
2 bequests made to a hospital without restriction by the donors.
3 (23)(27) "Health care facility" means an ambulatory
4 surgical center, a hospice, a nursing home, a hospital, a
5 diagnostic-imaging center, a freestanding or hospital-based
6 therapy center, a clinical laboratory, a home health agency, a
7 cardiac catheterization laboratory, a medical equipment
8 supplier, an alcohol or chemical dependency treatment center,
9 a physical rehabilitation center, a lithotripsy center, an
10 ambulatory care center, a birth center, or a nursing home
11 component licensed under chapter 400 within a continuing care
12 facility licensed under chapter 651.
13 (24)(28) "Health care provider" means a health care
14 professional licensed under chapter 458, chapter 459, chapter
15 460, chapter 461, chapter 463, chapter 464, chapter 465,
16 chapter 466, part I, part III, part IV, part V, or part X of
17 chapter 468, chapter 483, chapter 484, chapter 486, chapter
18 490, or chapter 491.
19 (25)(29) "Health care purchaser" means an employer in
20 the state, other than a health care facility, health insurer,
21 or health care provider, who provides health care coverage for
22 his employees.
23 (26)(30) "Health insurer" means any insurance company
24 authorized to transact health insurance in the state, any
25 insurance company authorized to transact health insurance or
26 casualty insurance in the state that is offering a minimum
27 premium plan or stop-loss coverage for any person or entity
28 providing health care benefits, any self-insurance plan as
29 defined in s. 624.031, any health maintenance organization
30 authorized to transact business in the state pursuant to part
31 I of chapter 641, any prepaid health clinic authorized to
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1 transact business in the state pursuant to part II of chapter
2 641, any multiple-employer welfare arrangement authorized to
3 transact business in the state pursuant to ss. 624.436-624.45,
4 or any fraternal benefit society providing health benefits to
5 its members as authorized pursuant to chapter 632.
6 (27)(31) "Home health agency" means an organization
7 licensed under part IV of chapter 400.
8 (28)(32) "Hospice" means an organization licensed
9 under part VI of chapter 400.
10 (29)(33) "Hospital" means a health care institution
11 licensed by the Agency for Health Care Administration as a
12 hospital under chapter 395.
13 (30)(34) "Lithotripsy center" means a freestanding
14 facility that which employs or contracts with licensed health
15 care professionals to provide diagnosis or treatment services
16 using electro-hydraulic shock waves.
17 (31)(35) "Local health council" means the agency
18 defined in s. 408.033.
19 (32)(36) "Market basket index" means the Florida
20 hospital input price index (FHIPI), which is a statewide
21 market basket index used to measure inflation in hospital
22 input prices weighted for the Florida-specific experience
23 which uses multistate regional and state-specific price
24 measures, when available. The index shall be constructed in
25 the same manner as the index employed by the Secretary of the
26 United States Department of Health and Human Services for
27 determining the inflation in hospital input prices for
28 purposes of Medicare reimbursement.
29 (37) "Maximum allowable rate of increase" or "MARI"
30 means the maximum rate at which a hospital is normally
31 expected to increase its average gross revenues per adjusted
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1 admission for a given period. The board, using the most
2 recent audited actual data for each hospital, shall calculate
3 the MARI for each hospital as follows: The projected rate of
4 increase in the market basket index shall be divided by a
5 number which is determined by subtracting the sum of one-half
6 of the proportion of Medicare days plus one-half of the
7 proportion of CHAMPUS days plus the proportion of Medicaid
8 days plus 1.5 times the proportion of charity care days from
9 the number one. The formula to be employed by the board to
10 calculate the MARI shall take the following form:
11
12 FHIPI
13 MARI = (....................................)
14 1-[(Me x 0.5) + (Cp x 0.5) + Md + (Cc x 1.5)]
15
16 where:
17 MARI = maximum allowable rate of increase applied to
18 gross revenue.
19 FHIPI = Florida hospital input price index, which shall
20 be the projected rate of change in the market basket index.
21 Me = proportion of Medicare days, including when
22 available and reported to the board Medicare HMO days, to
23 total days.
24 Cp = proportion of Civilian Health and Medical Program
25 of the Uniformed Services (CHAMPUS) days to total days.
26 Md = proportion of Medicaid days, including when
27 available and reported to the board Medicaid HMO days, to
28 total days.
29 Cc = proportion of charity care days to total days with
30 a 50-percent offset for restricted grants for charity care and
31 unrestricted grants from local governments.
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1 (33)(38) "Medical equipment supplier" means an
2 organization that which provides medical equipment and
3 supplies used by health care providers and health care
4 facilities in the diagnosis or treatment of disease.
5 (34)(39) "Net revenue" means gross revenue minus
6 deductions from revenue.
7 (35)(40) "New hospital" means a hospital in its
8 initial year of operation as a licensed hospital and does not
9 include any facility which has been in existence as a licensed
10 hospital, regardless of changes in ownership, for over 1
11 calendar year.
12 (36)(41) "Nursing home" means a facility licensed
13 under s. 400.062 or, for resident level and financial data
14 collection purposes only, any institution licensed under
15 chapter 395 and which has a Medicare or Medicaid certified
16 distinct part used for skilled nursing home care, but does not
17 include a facility licensed under chapter 651.
18 (37)(42) "Operating expenses" means total expenses
19 excluding income taxes.
20 (38)(43) "Other operating revenue" means all revenue
21 generated from hospital operations other than revenue directly
22 associated with patient care.
23 (39)(44) "Physical rehabilitation center" means an
24 organization that which employs or contracts with health care
25 professionals licensed under part I or part III of chapter 468
26 or chapter 486 to provide speech, occupational, or physical
27 therapy services on an outpatient or ambulatory basis.
28 (40)(45) "Prospective payment arrangement" means a
29 financial agreement negotiated between a hospital and an
30 insurer, health maintenance organization, preferred provider
31
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1 organization, or other third-party payor which contains, at a
2 minimum, the elements provided for in s. 408.50.
3 (41)(46) "Rate of return" means the financial
4 indicators used to determine or demonstrate reasonableness of
5 the financial requirements of a hospital. Such indicators
6 shall include, but not be limited to: return on assets,
7 return on equity, total margin, and debt service coverage.
8 (42)(47) "Rural hospital" means an acute care hospital
9 licensed under chapter 395, with 85 licensed beds or fewer,
10 which has an emergency room and is located in an area defined
11 as rural by the United States Census, and which is:
12 (a) The sole provider within a county with a
13 population density of no greater than 100 persons per square
14 mile;
15 (b) An acute care hospital, in a county with a
16 population density of no greater than 100 persons per square
17 mile, which is at least 30 minutes of travel time, on normally
18 traveled roads under normal traffic conditions, from another
19 acute care hospital within the same county; or
20 (c) A hospital supported by a tax district or
21 subdistrict whose boundaries encompass a population of 100
22 persons or less per square mile.
23 (43)(48) "Special study" means a nonrecurring
24 data-gathering and analysis effort designed to aid the agency
25 for Health Care Administration in meeting its responsibilities
26 pursuant to this chapter.
27 (44)(49) "Teaching hospital" means any hospital
28 formally affiliated with an accredited medical school which
29 that exhibits activity in the area of medical education as
30 reflected by at least seven different resident physician
31
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1 specialties and the presence of 100 or more resident
2 physicians.
3 Section 20. Section 408.08, Florida Statutes, is
4 amended to read:
5 408.08 Inspections and audits; violations; penalties;
6 fines; enforcement.--
7 (1) The agency may inspect and audit books and records
8 of individual or corporate ownership, including books and
9 records of related organizations with which a health care
10 provider or a health care facility had transactions, for
11 compliance with this chapter. Upon presentation of a written
12 request for inspection to a health care provider or a health
13 care facility by the agency or its staff, the health care
14 provider or the health care facility shall make available to
15 the agency or its staff for inspection, copying, and review
16 all books and records relevant to the determination of whether
17 the health care provider or the health care facility has
18 complied with this chapter.
19 (2) The board shall annually compare the audited
20 actual experience of each hospital to the audited actual
21 experience of that hospital for the previous year.
22 (a) For a hospital submitting a budget letter, if the
23 board determines that the audited actual experience of the
24 hospital exceeded its previous year's audited actual
25 experience by more than the maximum allowable rate of increase
26 as certified in the budget letter plus any banked points
27 utilized in the budget letter, the amount of such excess shall
28 be determined by the board and a penalty shall be levied
29 against such hospital pursuant to subsection (3).
30 (b) For a hospital subject to budget review, if the
31 board determines that the audited actual experience of the
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1 hospital exceeded its previous year's audited actual
2 experience by more than the most recent approved budget or the
3 most recent approved budget as amended, the amount of such
4 excess shall be determined by the board, and a penalty shall
5 be levied against such hospital pursuant to subsection (3).
6 (c) For a hospital submitting a budget letter and for
7 a hospital subject to budget review, the board shall annually
8 compare each hospital's audited actual experience for net
9 revenues per adjusted admission to the hospital's audited
10 actual experience for net revenues per adjusted admission for
11 the previous year. If the rate of increase in net revenues
12 per adjusted admission between the previous year and the
13 current year was less than the market basket index, the
14 hospital may carry forward the difference and earn up to a
15 cumulative maximum of 3 banked net revenue percentage points.
16 Such banked net revenue percentage points shall be available
17 to the hospital to offset, in any future year, penalties for
18 exceeding the approved budget or the maximum allowable rate of
19 increase as set forth in subsection (3). Nothing in this
20 paragraph shall be used by a hospital to justify the approval
21 of a budget or a budget amendment by the board in excess of
22 the maximum allowable rate of increase pursuant to s. 408.072.
23 (3) Penalties shall be assessed as follows:
24 (a) For the first occurrence within a 5-year period,
25 the board shall prospectively reduce the current budget of the
26 hospital by the amount of the excess up to 5 percent; and, if
27 such excess is greater than 5 percent over the maximum
28 allowable rate of increase, any amount in excess of 5 percent
29 shall be levied by the board as a fine against such hospital
30 to be deposited in the Public Medical Assistance Trust Fund.
31
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1 (b) For the second occurrence with the 5-year period
2 following the first occurrence as set forth in paragraph (a),
3 the board shall prospectively reduce the current budget of the
4 hospital by the amount of the excess up to 2 percent; and, if
5 such excess is greater than 2 percent over the maximum
6 allowable rate of increase, any amount in excess of 2 percent
7 shall be levied by the board as a fine against such hospital
8 to be deposited in the Public Medical Assistance Trust Fund.
9 (c) For the third occurrence within the 5-year period
10 following the first occurrence as set forth in paragraph (a),
11 the board shall:
12 1. Levy a fine against the hospital in the total
13 amount of the excess, to be deposited in the Public Medical
14 Assistance Trust Fund.
15 2. Notify the agency of the violation, whereupon the
16 agency shall not accept any application for a certificate of
17 need pursuant to ss. 408.031-408.045 from or on behalf of such
18 hospital until such time as the hospital has demonstrated to
19 the satisfaction of the board that, following the date the
20 penalty was imposed under subparagraph 1., the hospital has
21 stayed within its projected or amended budget or its
22 applicable maximum allowable rate of increase for a period of
23 at least 1 year. However, this provision does not apply with
24 respect to a certificate-of-need application filed to satisfy
25 a life or safety code violation.
26 3. Upon a determination that the hospital knowingly
27 and willfully generated such excess, notify the agency,
28 whereupon the agency shall initiate disciplinary proceedings
29 to deny, modify, suspend, or revoke the license of such
30 hospital or impose an administrative fine on such hospital not
31 to exceed $20,000.
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1
2 The determination of the amount of any such excess shall be
3 based upon net revenues per adjusted admission, excluding
4 funds distributed to the hospital from the Public Medical
5 Assistance Trust Fund. However, in making such determination,
6 the board shall appropriately reduce the amount of the excess
7 by the total amount of the assessment paid by such hospital
8 pursuant to s. 395.701 minus the amount of revenues received
9 by the hospital through the Public Medical Assistance Trust
10 Fund. It is the responsibility of the hospital to demonstrate
11 to the satisfaction of the board its entitlement to such
12 reduction. It is the intent of the Legislature that the
13 Health Care Board, in levying any penalty imposed against a
14 hospital for exceeding its maximum allowable rate of increase
15 or its approved budget pursuant to this subsection, consider
16 the effect of changes in the case mix of the hospital and in
17 the hospital's intensity and severity of illness as measured
18 by changes in the hospital's actual proportion of outlier
19 cases to total cases and dollar increases in outlier cases'
20 average charge per case. It is the responsibility of the
21 hospital to demonstrate to the satisfaction of the board any
22 change in its case mix and in its intensity and severity of
23 illness. For psychiatric hospitals and other hospitals not
24 reimbursed under a prospective payment system by the Federal
25 Government, until a proxy for case mix is available, the board
26 shall also reduce the amount of excess by the change in a
27 hospital's audited actual average length of stay without any
28 thresholds or limitations.
29 (4) The following factors may be used by the board to
30 reduce the amount of excess of the hospital as determined
31 pursuant to this section:
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1 (a) Unforeseen and unforeseeable events which affect
2 the net revenue per adjusted admission and which are beyond
3 the control of the hospital, such as prior year Medicare cost
4 report settlements, retroactive changes in Medicare
5 reimbursement methodology, and increases in malpractice
6 insurance premiums, which occurred in the last 3 months of the
7 hospital fiscal year during which the hospital generated the
8 excess; or
9 (b) Imposition of the penalty would have a severe
10 adverse effect which would jeopardize the continued existence
11 of an otherwise economically viable hospital.
12 (5) The board shall reduce the amount of the excess
13 for hospitals submitting budget letters pursuant to s.
14 408.072(3)(a) by the amount of any documented costs from
15 financial assistance provided to expand or supplement the
16 curriculum of a community college, university, or vocational
17 training school for the purpose of training nurses or other
18 health professionals, not including physicians. Financial
19 assistance would include, but not be limited to, the direct
20 costs for faculty salaries and expenses, books, equipment,
21 recruiting efforts, tuition assistance, and hospital
22 internships. The reduction would be based on actual
23 documented expenses increased by the gross revenues necessary
24 to generate net revenues sufficient to cover the expenses.
25 (6) If the board finds that any hospital chief
26 executive officer or any person who is in charge of hospital
27 administration or operations has knowingly and willfully
28 allowed or authorized actual operating revenues or
29 expenditures that are in excess of projected operating
30 revenues or expenditures in the hospital's approved budget,
31
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1 the board shall order such officer or person to pay an
2 administrative fine not to exceed $5,000.
3 (7) For hospitals filing budget letters, the board
4 shall annually compare the audited actual experience of each
5 hospital for the year under review to the audited actual
6 experience of that hospital for the previous year. For
7 hospitals which submitted detailed budgets or budget
8 amendments, the board shall compare the audited actual
9 experience of each hospital for the year under review to its
10 approved gross revenue per adjusted admission for the year
11 under review, for purposes of levying an administrative fine.
12 (a) For a hospital submitting a budget letter pursuant
13 to s. 408.072(3)(a), if the board determines that the audited
14 actual experience for the year under review exceeded the
15 hospital's previous year's audited actual experience by more
16 than the maximum allowable rate of increase as certified in
17 the budget letter plus any banked points utilized in the
18 budget letter, the amount of the excess shall be determined
19 and an administrative fine shall be levied against such
20 hospital pursuant to subsection (8).
21 (b) For a hospital which submitted a budget pursuant
22 to s. 408.072(1), or a budget amendment pursuant to s.
23 408.072(6), if the board determines that the gross revenue per
24 adjusted admission contained in the hospital's audited actual
25 experience exceeded its board-approved gross revenue per
26 adjusted admission, the amount of the excess shall be
27 determined and an administrative fine shall be levied against
28 such hospital pursuant to subsection (8).
29 (8) If the board determines that an excess exists
30 pursuant to subsection (7), the board shall multiply the
31 excess by the number of actual adjusted admissions contained
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1 in the year at issue to determine the amount of the base fine.
2 The base fine shall be multiplied by the applicable occurrence
3 factor to determine the amount of the administrative fine
4 levied against the hospital.
5 (a) For the first occurrence within a 5-year period,
6 the applicable occurrence factor shall be 0.25. For the
7 second occurrence within a 5-year period, the applicable
8 occurrence factor shall be 0.55. For the third occurrence
9 within a 5-year period, the applicable occurrence factor shall
10 be 1.0.
11 (b) In no event shall any administrative fine levied
12 pursuant to this subsection exceed $365,000.
13 (9) In levying any administrative fine against a
14 hospital pursuant to subsection (8), the board shall consider
15 the effect of any changes in the hospital's case mix, and in
16 the hospital's intensity and severity of illness as measured
17 by changes in the hospital's actual proportion of outlier
18 cases to total cases and dollar increases in outlier cases'
19 average charge per case. The board shall adjust the amount of
20 any excess by the changes in the hospital's case mix and in
21 its intensity and severity of illness, based upon certified
22 hospital patient discharge data provided to the board pursuant
23 to s. 408.061. For psychiatric hospitals and other hospitals
24 not reimbursed under a prospective payment system by the
25 Federal Government, until a proxy for case mix is available,
26 the board shall adjust the amount of any excess by the change
27 in a hospital's audited actual average length of stay without
28 any thresholds or limitation.
29 (10) In levying any administrative fine against a
30 hospital pursuant to subsection (8), it is the intent of the
31 Legislature that if a hospital can demonstrate to the
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1 satisfaction of the board that it operated within its approved
2 gross revenue per adjusted admission for the first 8 months of
3 its fiscal year and did not increase its prices, except for
4 exceptions determined by the board during the last 5 months of
5 its fiscal year, it shall not be subject to any administrative
6 fine levied pursuant to subsection (8).
7 (11) It is the further intent of the Legislature that
8 if a hospital can demonstrate to the satisfaction of the board
9 that it did not increase its prices on average in excess of
10 the MARI for the prior year, it shall not be subject to any
11 administrative fine levied pursuant to subsection (8).
12 (12) If the board finds that any hospital chief
13 executive officer or any person who is in charge of hospital
14 administration or operations has knowingly and willfully
15 allowed or authorized gross revenue per adjusted admission,
16 net revenue per adjusted admission, or rates of increase that
17 are in excess of gross or net revenue per adjusted admission,
18 or rates of increase in the hospital's approved budget, budget
19 amendment, or budget letter, the agency shall order such
20 officer or person to pay an administrative fine not to exceed
21 $5,000.
22 (2)(13) Any health care facility that refuses to file
23 a report, fails to timely file a report, files a false report,
24 or files an incomplete report and upon notification fails to
25 timely file a complete report required under this section and
26 s. 408.061; that violates any provision of this section, s.
27 408.061, or s. 408.20, or rule adopted thereunder; or that
28 fails to provide documents or records requested by the agency
29 under the provisions of this chapter shall be punished by a
30 fine not exceeding $1,000 per day for each day in violation,
31 to be imposed and collected by the agency.
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1 (3)(14) Any health care provider that refuses to file
2 a report, fails to timely file a report, files a false report,
3 or files an incomplete report and upon notification fails to
4 timely file a complete report required under this section and
5 s. 408.061; that violates any provision of this section, s.
6 408.061, or s. 408.20, or rule adopted thereunder; or that
7 fails to provide documents or records requested by the agency
8 under the provisions of this chapter shall be referred to the
9 appropriate licensing board which shall take appropriate
10 action against the health care provider.
11 (4)(15) If In the event that a health insurer does not
12 comply with the requirements of s. 408.061, the agency shall
13 report a health insurer's failure to comply to the Department
14 of Insurance, which shall take into account the failure by the
15 health insurer to comply in conjunction with its approval
16 authority under s. 627.410. The agency shall adopt any rules
17 necessary to carry out its responsibilities required by this
18 subsection.
19 (5)(16) Refusal to file, failure to timely file, or
20 filing false or incomplete reports or other information
21 required to be filed under the provisions of this chapter,
22 failure to pay or failure to timely pay any assessment
23 authorized to be collected by the agency, or violation of any
24 other provision of this chapter or lawfully entered order of
25 the agency or rule adopted under this chapter, shall be
26 punished by a fine not exceeding $1,000 a day for each day in
27 violation, to be fixed, imposed, and collected by the agency.
28 Each day in violation shall be considered a separate offense.
29 (6)(17) Notwithstanding any other provisions of this
30 chapter, when a hospital alleges that a factual determination
31 made by the agency board is incorrect, the burden of proof
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1 shall be on the hospital to demonstrate that such
2 determination is, in light of the total record, not supported
3 by a preponderance of the evidence. The burden of proof
4 remains with the hospital in all cases involving
5 administrative agency action.
6 Section 21. Section 408.40, Florida Statutes, 1996
7 Supplement, is amended to read:
8 408.40 Budget review proceedings; duty of Public
9 Counsel.--
10 (1) Notwithstanding any other provisions of this
11 chapter, it shall be the duty of the Public Counsel shall to
12 represent the general public of the state in any proceeding
13 before the agency or its advisory panels in any administrative
14 hearing conducted pursuant to the provisions of chapter 120 or
15 before any other state and federal agencies and courts in any
16 issue before the agency, any court, or any agency. With
17 respect to any such proceeding, the Public Counsel is subject
18 to the provisions of and may use utilize the powers granted to
19 him by ss. 350.061-350.0614.
20 (2) The Public Counsel shall:
21 (a) Recommend to the agency, by petition, the
22 commencement of any proceeding or action or to appear, in the
23 name of the state or its citizens, in any proceeding or action
24 before the agency and urge therein any position that which he
25 deems to be in the public interest, whether consistent or
26 inconsistent with positions previously adopted by the agency,
27 and use utilize therein all forms of discovery available to
28 attorneys in civil actions generally, subject to protective
29 orders of the agency, which shall be reviewable by summary
30 procedure in the circuit courts of this state.
31
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1 (b) Have access to and use of all files, records, and
2 data of the agency available to any other attorney
3 representing parties in a proceeding before the agency.
4 (c) In any proceeding in which he has participated as
5 a party, seek review of any determination, finding, or order
6 of the agency, or of any administrative law judge, or any
7 hearing officer or hearing examiner designated by the agency,
8 in the name of the state or its citizens.
9 (d) Prepare and issue reports, recommendations, and
10 proposed orders to the agency, the Governor, and the
11 Legislature on any matter or subject within the jurisdiction
12 of the agency, and to make such recommendations as he deems
13 appropriate for legislation relative to agency procedures,
14 rules, jurisdiction, personnel, and functions.
15 (e) Appear before other state agencies, federal
16 agencies, and state and federal courts in connection with
17 matters under the jurisdiction of the agency, in the name of
18 the state or its citizens.
19 Section 22. Paragraph (e) of subsection (10) and
20 subsection (14) of section 409.2673, Florida Statutes, 1996
21 Supplement, are amended to read:
22 409.2673 Shared county and state health care program
23 for low-income persons; trust fund.--
24 (10) Under the shared county and state program,
25 reimbursement to a hospital for services for an eligible
26 person must:
27 (e) Be conditioned, for tax district hospitals that
28 deliver services as part of this program, on the delivery of
29 charity care, as defined in the rules of the Agency for Health
30 Care Administration Health Care Cost Containment Board, which
31 equals a minimum of 2.5 percent of the tax district hospital's
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1 net revenues; however, those tax district hospitals which by
2 virtue of the population within the geographic boundaries of
3 the tax district can not feasibly provide this level of
4 charity care shall assure an "open door" policy to those
5 residents of the geographic boundaries of the tax district who
6 would otherwise be considered charity cases.
7 (14) Any dispute among a county, the Agency for Health
8 Care Administration Health Care Cost Containment Board, the
9 department, or a participating hospital shall be resolved by
10 order as provided in chapter 120. Hearings held under this
11 subsection shall be conducted in the same manner as provided
12 in ss. 120.569 and 120.57, except that the administrative law
13 judge's or hearing officer's order constitutes final agency
14 action. Cases filed under chapter 120 may combine all relevant
15 disputes between parties.
16 Section 23. Section 409.9113, Florida Statutes, is
17 amended to read:
18 409.9113 Disproportionate share program for teaching
19 hospitals.--In addition to the payments made under ss. 409.911
20 and 409.9112, the Agency for Health Care Administration
21 Department of Health and Rehabilitative Services shall make
22 disproportionate share payments to statutorily defined
23 teaching hospitals for their increased costs associated with
24 medical education programs and for tertiary health care
25 services provided to the indigent. This system of payments
26 shall conform with federal requirements and shall distribute
27 funds in each fiscal year for which an appropriation is made
28 by making quarterly Medicaid payments. Notwithstanding the
29 provisions of s. 409.915, counties are exempt from
30 contributing toward the cost of this special reimbursement for
31
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1 hospitals serving a disproportionate share of low-income
2 patients.
3 (1) On or before September 15 of each year, the Agency
4 for Health Care Administration shall calculate an allocation
5 fraction to be used for distributing funds to state statutory
6 teaching hospitals. Subsequent to the end of each quarter of
7 the state fiscal year, the agency department shall distribute
8 to each statutory teaching hospital, as defined in s. 408.07,
9 an amount determined by multiplying one-fourth of the funds
10 appropriated for this purpose by the Legislature times such
11 hospital's allocation fraction. The allocation fraction for
12 each such hospital shall be determined by the sum of three
13 primary factors, divided by three. The primary factors are:
14 (a) The number of nationally accredited graduate
15 medical education programs offered by the hospital, including
16 programs accredited by the Accreditation Council for Graduate
17 Medical Education and the combined Internal Medicine and
18 Pediatrics programs acceptable to both the American Board of
19 Internal Medicine and the American Board of Pediatrics at the
20 beginning of the state fiscal year preceding the date on which
21 the allocation fraction is calculated. The numerical value of
22 this factor is the fraction that the hospital represents of
23 the total number of programs, where the total is computed for
24 all state statutory teaching hospitals.
25 (b) The number of full-time equivalent trainees in the
26 hospital, which comprises two components:
27 1. The number of trainees enrolled in nationally
28 accredited graduate medical education programs, as defined in
29 paragraph (a). Full-time equivalents are computed using the
30 fraction of the year during which each trainee is primarily
31 assigned to the given institution, over the state fiscal year
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1 preceding the date on which the allocation fraction is
2 calculated. The numerical value of this factor is the fraction
3 that the hospital represents of the total number of full-time
4 equivalent trainees enrolled in accredited graduate programs,
5 where the total is computed for all state statutory teaching
6 hospitals.
7 2. The number of medical students enrolled in
8 accredited colleges of medicine and engaged in clinical
9 activities, including required clinical clerkships and
10 clinical electives. Full-time equivalents are computed using
11 the fraction of the year during which each trainee is
12 primarily assigned to the given institution, over the course
13 of the state fiscal year preceding the date on which the
14 allocation fraction is calculated. The numerical value of this
15 factor is the fraction that the given hospital represents of
16 the total number of full-time equivalent students enrolled in
17 accredited colleges of medicine, where the total is computed
18 for all state statutory teaching hospitals.
19
20 The primary factor for full-time equivalent trainees is
21 computed as the sum of these two components, divided by two.
22 (c) A service index that which comprises three
23 components:
24 1. The Agency for Health Care Administration Health
25 Care Cost Containment Board Service Index, computed by
26 applying the standard Service Inventory Scores established by
27 the Agency for Health Care Administration Health Care Cost
28 Containment Board to services offered by the given hospital,
29 as reported on the Health Care Cost Containment Board
30 Worksheet A-2 for the last fiscal year reported to the agency
31 board before the date on which the allocation fraction is
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1 calculated. The numerical value of this factor is the
2 fraction that the given hospital represents of the total
3 Agency for Health Care Administration Health Care Cost
4 Containment Board Service Index values, where the total is
5 computed for all state statutory teaching hospitals.
6 2. A volume-weighted service index, computed by
7 applying the standard Service Inventory Scores established by
8 the Agency for Health Care Administration Health Care Cost
9 Containment Board to the volume of each service, expressed in
10 terms of the standard units of measure reported on the Health
11 Care Cost Containment Board Worksheet A-2 for the last fiscal
12 year reported to the agency board before the date on which the
13 allocation factor is calculated. The numerical value of this
14 factor is the fraction that the given hospital represents of
15 the total volume-weighted service index values, where the
16 total is computed for all state statutory teaching hospitals.
17 3. Total Medicaid payments to each hospital for direct
18 inpatient and outpatient services during the fiscal year
19 preceding the date on which the allocation factor is
20 calculated. This includes payments made to each hospital for
21 such services by Medicaid prepaid health plans, whether the
22 plan was administered by the hospital or not. The numerical
23 value of this factor is the fraction that each hospital
24 represents of the total of such Medicaid payments, where the
25 total is computed for all state statutory teaching hospitals.
26
27 The primary factor for the service index is computed as the
28 sum of these three components, divided by three.
29 (2) By October 1 of each year, the agency shall use
30 the following formula shall be utilized by the department to
31
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1 calculate the maximum additional disproportionate share
2 payment for statutorily defined teaching hospitals:
3
4 TAP = THAF x A
5
6 Where:
7 TAP = total additional payment.
8 THAF = teaching hospital allocation factor.
9 A = amount appropriated for a teaching hospital
10 disproportionate share program.
11
12 (3) The Health Care Cost Containment Board shall
13 report to the department the statutory teaching hospital
14 allocation fraction prior to October 1 of each year.
15 Section 24. Paragraph (c) of subsection (12) of
16 section 440.13, Florida Statutes, 1996 Supplement, is amended
17 to read:
18 440.13 Medical services and supplies; penalty for
19 violations; limitations.--
20 (12) CREATION OF THREE-MEMBER PANEL; GUIDES OF MAXIMUM
21 REIMBURSEMENT ALLOWANCES.--
22 (c) Reimbursement for all fees and other charges for
23 such treatment, care, and attendance, including treatment,
24 care, and attendance provided by any hospital or other health
25 care provider, ambulatory surgical center, work-hardening
26 program, or pain program, must not exceed the amounts provided
27 by the uniform schedule of maximum reimbursement allowances as
28 determined by the panel or as otherwise provided in this
29 section. This subsection also applies to independent medical
30 examinations performed by health care providers under this
31 chapter. Until the three-member panel approves a uniform
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1 schedule of maximum reimbursement allowances and it becomes
2 effective, all compensable charges for treatment, care, and
3 attendance provided by physicians, ambulatory surgical
4 centers, work-hardening programs, or pain programs shall be
5 reimbursed at the lowest maximum reimbursement allowance
6 across all 1992 schedules of maximum reimbursement allowances
7 for the services provided regardless of the place of service.
8 In determining the uniform schedule, the panel shall first
9 approve the data which it finds representative of prevailing
10 charges in the state for similar treatment, care, and
11 attendance of injured persons. Each health care provider,
12 health care facility, ambulatory surgical center,
13 work-hardening program, or pain program receiving workers'
14 compensation payments shall maintain records verifying their
15 usual charges. In establishing the uniform schedule of maximum
16 reimbursement allowances, the panel must consider:
17 1. The levels of reimbursement for similar treatment,
18 care, and attendance made by other health care programs or
19 third-party providers.;
20 2. The impact upon cost to employers for providing a
21 level of reimbursement for treatment, care, and attendance
22 which will ensure the availability of treatment, care, and
23 attendance required by injured workers.;
24 3. The financial impact of the reimbursement
25 allowances upon health care providers and health care
26 facilities, including trauma centers as defined in s. 395.401,
27 and its effect upon their ability to make available to injured
28 workers such medically necessary remedial treatment, care, and
29 attendance. The uniform schedule of maximum reimbursement
30 allowances must be reasonable, must promote health care cost
31 containment and efficiency with respect to the workers'
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1 compensation health care delivery system, and must be
2 sufficient to ensure availability of such medically necessary
3 remedial treatment, care, and attendance to injured workers.;
4 and
5 4. The most recent average maximum allowable rate of
6 increase for hospitals determined by the Health Care Board
7 under chapter 408.
8 Section 25. Subsection (9) of section 395.403, Florida
9 Statutes, sections 407.61, 408.003, and 408.085, Florida
10 Statutes, and section 408.072, Florida Statutes, as amended by
11 chapter 96-410, Laws of Florida, are hereby repealed.
12 Section 26. The repeal of laws governing the review of
13 hospital budgets and related penalties contained in this act
14 operates retroactively and applies to any hospital budget
15 prepared for a fiscal year that ended during the 1995 calendar
16 year.
17 Section 27. This act shall take effect July 1, 1997.
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1 *****************************************
2 HOUSE SUMMARY
3
Removes and repeals provisions relating to the Health
4 Care Board and review of hospital budgets. Revises,
updates, and conforms various provisions to reflect the
5 assumption by the Agency for Health Care Administration
of the duties of the Health Care Board and the former
6 Health Care Cost Containment Board and duties of the
former Department of Health and Rehabilitative Services
7 relating to indigent medical care and the State Center
for Health Statistics. Requires licensed facilities to
8 be capable of serving as disaster shelters for only
patients, staff, and families of staff, limits
9 applicability of the requirement to new facilities and
new wings or floors of existing facilities, and requires
10 the agency to recommended to the Governor and Legislature
cost-effective renovation standards for existing
11 facilities. Authorizes the agency to conduct data-based
studies and evaluations and make certain recommendations
12 to the Governor and Legislature. Exempts outpatient
facilities that meet specified criteria from agency
13 construction inspections and investigations. Provides
that surgical recovery rooms of ambulatory surgical
14 centers, as well as hospitals, are exempt from certain
staffing requirements. See bill for details.
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