CODING: Words stricken are deletions; words underlined are additions.
HOUSE AMENDMENT
Bill No. HB 2329, 1st Eng.
Amendment No. (for drafter's use only)
CHAMBER ACTION
Senate House
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5 ORIGINAL STAMP BELOW
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11 Representative(s) Murman offered the following:
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13 Amendment (with title amendment)
14 On page 26, between lines 18 and 19, of the bill
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16 insert:
17 Section 26. Section 381.0403, Florida Statutes, is
18 amended to read:
19 381.0403 The Community Hospital Education Act.--
20 (1) SHORT TITLE.--This section shall be known and
21 cited as "The Community Hospital Education Act."
22 (2) LEGISLATIVE INTENT.--
23 (a) It is the intent of the Legislature that health
24 care services for the citizens of this state be upgraded and
25 that a program for continuing these services be maintained
26 through a plan for community medical education. The program
27 is intended to provide additional outpatient and inpatient
28 services, a continuing supply of highly trained physicians,
29 and graduate medical education.
30 (b) The Legislature further acknowledges the critical
31 need for increased numbers of primary care family physicians
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HOUSE AMENDMENT
Bill No. HB 2329, 1st Eng.
Amendment No. (for drafter's use only)
1 to provide the necessary current and projected health and
2 medical services. In order to meet both present and
3 anticipated needs, the Legislature supports an expansion in
4 the number of family practice residency positions. The
5 Legislature intends that the funding for graduate education in
6 family practice be maintained and that funding for all primary
7 care specialties be provided at a minimum of $10,000 per
8 resident per year. Should funding for this act remain
9 constant or be reduced, it is intended that all programs
10 funded by this act be maintained or reduced proportionately.
11 (3) PROGRAM FOR COMMUNITY HOSPITAL EDUCATION; STATE
12 AND LOCAL PLANNING.--
13 (a) There is established under the Board of Regents a
14 program for statewide graduate medical education. It is
15 intended that continuing graduate medical education programs
16 for interns and residents be established on a statewide basis.
17 The program shall provide financial support for primary care
18 specialty interns and residents based on policies recommended
19 and approved by the Community Hospital Education Council,
20 herein established, and the Board of Regents. Only those
21 programs with at least three residents or interns in each year
22 of the training program are qualified to apply for financial
23 support. Programs with fewer than three residents or interns
24 per training year are qualified to apply for financial
25 support, but only if the appropriate accrediting entity for
26 the particular specialty has approved the program for fewer
27 positions. Programs added after fiscal year 1997-1998 shall
28 have 5 years to attain the requisite number of residents or
29 interns. When feasible and to the extent allowed through the
30 General Appropriations Act, state funds shall be used to
31 generate federal matching funds under Medicaid, or other
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HOUSE AMENDMENT
Bill No. HB 2329, 1st Eng.
Amendment No. (for drafter's use only)
1 federal programs, and the resulting combined state and federal
2 funds shall be allocated to participating hospitals for the
3 support of graduate medical education, for administrative
4 costs associated with the production of the annual report as
5 specified in subsection (9), and for administration of the
6 council.
7 (b) For the purposes of this section, primary care
8 specialties include emergency medicine, family practice,
9 internal medicine, pediatrics, psychiatry,
10 obstetrics/gynecology, and combined pediatrics and internal
11 medicine, and other primary care specialties as may be
12 included by the council and Board of Regents.
13 (c)(b) Medical institutions throughout the state may
14 apply to the Community Hospital Education Council for
15 grants-in-aid for financial support of their approved
16 programs. Recommendations for funding of approved programs
17 shall be forwarded to the Board of Regents.
18 (d)(c) The program shall provide a plan for community
19 clinical teaching and training with the cooperation of the
20 medical profession, hospitals, and clinics. The plan shall
21 also include formal teaching opportunities for intern and
22 resident training. In addition, the plan shall establish an
23 off-campus medical faculty with university faculty review to
24 be located throughout the state in local communities.
25 (4) PROGRAM FOR GRADUATE MEDICAL EDUCATION
26 INNOVATIONS.--
27 (a) There is established under the Board of Regents a
28 program for fostering graduate medical education innovations.
29 Funds appropriated annually by the Legislature for this
30 purpose shall be distributed to participating hospitals or
31 consortia of participating hospitals and Florida medical
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HOUSE AMENDMENT
Bill No. HB 2329, 1st Eng.
Amendment No. (for drafter's use only)
1 schools on a competitive grant or formula basis to achieve
2 state health care workforce policy objectives, including, but
3 not limited to:
4 1. Increasing the number of residents in primary care
5 and other high demand specialties or fellowships;
6 2. Enhancing retention of primary care physicians in
7 Florida practice;
8 3. Promoting practice in medically underserved areas
9 of the state;
10 4. Encouraging racial and ethnic diversity within the
11 state's physician workforce; and
12 5. Encouraging increased production of geriatricians.
13 (b) Participating hospitals or consortia of
14 participating hospitals and Florida medical schools may apply
15 to the Community Hospital Education Council for funding under
16 this innovations program. Innovations program funding shall
17 provide funding based on policies recommended and approved by
18 the Community Hospital Education Council and the Board of
19 Regents.
20 (c) Participating hospitals or consortia of
21 participating hospitals and Florida medical schools awarded an
22 innovations grant shall provide the Community Hospital
23 Education Council and Board of Regents with an annual report
24 on their project.
25 (5)(4) FAMILY PRACTICE RESIDENCIES.--In addition to
26 the programs established in subsection (3), the Community
27 Hospital Education Council and the Board of Regents shall
28 establish an ongoing statewide program of family practice
29 residencies. The administration of this program shall be in
30 the manner described in this section.
31 (6)(5) COUNCIL AND DIRECTOR.--
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HOUSE AMENDMENT
Bill No. HB 2329, 1st Eng.
Amendment No. (for drafter's use only)
1 (a) There is established the Community Hospital
2 Education Council, hereinafter referred to as the council,
3 which shall consist of eleven members, as follows:
4 1. Seven members must be program directors of
5 accredited graduate medical education programs or practicing
6 physicians who have faculty appointments in accredited
7 graduate medical education programs. Six of these members
8 must be board certified or board eligible in family practice,
9 internal medicine, pediatrics, emergency medicine,
10 obstetrics-gynecology, and psychiatry, respectively, and
11 licensed pursuant to chapter 458. No more than one of these
12 members may be appointed from any one specialty. One member
13 must be licensed pursuant to chapter 459.
14 2. One member must be a representative of the
15 administration of a hospital with an approved community
16 hospital medical education program;
17 3. One member must be the dean of a medical school in
18 this state; and
19 4. Two members must be consumer representatives.
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21 All of the members shall be appointed by the Governor for
22 terms of 4 years each.
23 (b) Council membership shall cease when a member's
24 representative status no longer exists. Members of similar
25 representative status shall be appointed to replace retiring
26 or resigning members of the council.
27 (c) The Chancellor of the State University System
28 shall designate an administrator to serve as staff director.
29 The council shall elect a chair from among its membership.
30 Such other personnel as may be necessary to carry out the
31 program shall be employed as authorized by the Board of
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HOUSE AMENDMENT
Bill No. HB 2329, 1st Eng.
Amendment No. (for drafter's use only)
1 Regents.
2 (7)(6) BOARD OF REGENTS; STANDARDS.--
3 (a) The Board of Regents, with recommendations from
4 the council, shall establish standards and policies for the
5 use and expenditure of graduate medical education funds
6 appropriated pursuant to subsection (8) (7) for a program of
7 community hospital education. The board shall establish
8 requirements for hospitals to be qualified for participation
9 in the program which shall include, but not be limited to:
10 1. Submission of an educational plan and a training
11 schedule.
12 2. A determination by the council to ascertain that
13 each portion of the program of the hospital provides a high
14 degree of academic excellence and is accredited by the
15 Accreditation Council for Graduate Medical Education of the
16 American Medical Association or is accredited by the American
17 Osteopathic Association.
18 3. Supervision of the educational program of the
19 hospital by a physician who is not the hospital administrator.
20 (b) The Board of Regents shall periodically review the
21 educational program provided by a participating hospital to
22 assure that the program includes a reasonable amount of both
23 formal and practical training and that the formal sessions are
24 presented as scheduled in the plan submitted by each hospital.
25 (c) In years that funds are transferred to the Agency
26 for Health Care Administration, the Board of Regents shall
27 certify to the Agency for Health Care Administration on a
28 quarterly basis the number of primary care specialty residents
29 and interns at each of the participating hospitals for which
30 the Community Hospital Education Council and the board
31 recommends funding.
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HOUSE AMENDMENT
Bill No. HB 2329, 1st Eng.
Amendment No. (for drafter's use only)
1 (8)(7) MATCHING FUNDS.--State funds shall be used to
2 match funds from any local governmental or hospital source.
3 The state shall provide up to 50 percent of the funds, and the
4 community hospital medical education program shall provide the
5 remainder. However, except for fixed capital outlay, the
6 provisions of this subsection shall not apply to any program
7 authorized under the provisions of subsection (5)(4) for the
8 first 3 years after such program is in operation.
9 (9) ANNUAL REPORT ON GRADUATE MEDICAL EDUCATION;
10 COMMITTEE.--The Board of Regents, the Executive Office of the
11 Governor, the Department of Health, and the Agency for Health
12 Care Administration shall collaborate to establish a committee
13 that shall produce an annual report on graduate medical
14 education. To the maximum extent feasible, the committee shall
15 have the same membership as the Graduate Medical Education
16 Study Committee, established by proviso accompanying Specific
17 Appropriation 191 of the 1999-2000 General Appropriations Act.
18 The report shall be provided to the Governor, the President of
19 Senate, and the Speaker of the House of Representatives by
20 January 15 annually. Committee members shall serve without
21 compensation. From the funds provided pursuant to s.
22 381.0403(3), the committee is authorized to expend a maximum
23 of $75,000 per year to provide for administrative costs and
24 contractual services. The report shall address the following:
25 (a) The role of residents and medical faculty in the
26 provision of health care.
27 (b) The relationship of graduate medical education to
28 the state's physician workforce.
29 (c) The costs of training medical residents for
30 hospitals, medical schools, teaching hospitals, including all
31 hospital-medical affiliations, practice plans at all of the
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HOUSE AMENDMENT
Bill No. HB 2329, 1st Eng.
Amendment No. (for drafter's use only)
1 medical schools, and municipalities.
2 (d) The availability and adequacy of all sources of
3 revenue to support graduate medical education and recommend
4 alternative sources of funding for graduate medical education.
5 (e) The use of state and federal appropriated funds
6 for graduate medical education by hospitals receiving such
7 funds.
8 Section 27. Subsection (44) of section 408.07, Florida
9 Statutes, is amended to read:
10 408.07 Definitions.--As used in this chapter, with the
11 exception of ss. 408.031-408.045, the term:
12 (44) "Teaching hospital" means any Florida hospital
13 officially formally affiliated with an accredited Florida
14 medical school which exhibits activity in the area of graduate
15 medical education as reflected by at least seven different
16 graduate medical education programs accredited by the
17 Accreditation Council for Graduate Medical Education or the
18 Council on Postdoctoral Training of the American Osteopathic
19 Association resident physician specialties and the presence of
20 100 or more full-time equivalent resident physicians. The
21 Director of the Agency for Health Care Administration shall be
22 responsible for determining which hospitals meet this
23 definition.
24 Section 28. Subsection (6) of section 409.905, Florida
25 Statutes, is amended to read:
26 409.905 Mandatory Medicaid services.--The agency may
27 make payments for the following services, which are required
28 of the state by Title XIX of the Social Security Act,
29 furnished by Medicaid providers to recipients who are
30 determined to be eligible on the dates on which the services
31 were provided. Any service under this section shall be
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HOUSE AMENDMENT
Bill No. HB 2329, 1st Eng.
Amendment No. (for drafter's use only)
1 provided only when medically necessary and in accordance with
2 state and federal law. Nothing in this section shall be
3 construed to prevent or limit the agency from adjusting fees,
4 reimbursement rates, lengths of stay, number of visits, number
5 of services, or any other adjustments necessary to comply with
6 the availability of moneys and any limitations or directions
7 provided for in the General Appropriations Act or chapter 216.
8 (6) HOSPITAL OUTPATIENT SERVICES.--The agency shall
9 pay for preventive, diagnostic, therapeutic, or palliative
10 care and other services provided to a recipient in the
11 outpatient portion of a hospital licensed under part I of
12 chapter 395, and provided under the direction of a licensed
13 physician or licensed dentist, except that payment for such
14 care and services is limited to $1,500 $1,000 per state fiscal
15 year per recipient, unless an exception has been made by the
16 agency, and with the exception of a Medicaid recipient under
17 age 21, in which case the only limitation is medical
18 necessity.
19 Section 29. Subsection (1) of section 409.908, Florida
20 Statutes, is amended to read:
21 409.908 Reimbursement of Medicaid providers.--Subject
22 to specific appropriations, the agency shall reimburse
23 Medicaid providers, in accordance with state and federal law,
24 according to methodologies set forth in the rules of the
25 agency and in policy manuals and handbooks incorporated by
26 reference therein. These methodologies may include fee
27 schedules, reimbursement methods based on cost reporting,
28 negotiated fees, competitive bidding pursuant to s. 287.057,
29 and other mechanisms the agency considers efficient and
30 effective for purchasing services or goods on behalf of
31 recipients. Payment for Medicaid compensable services made on
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HOUSE AMENDMENT
Bill No. HB 2329, 1st Eng.
Amendment No. (for drafter's use only)
1 behalf of Medicaid eligible persons is subject to the
2 availability of moneys and any limitations or directions
3 provided for in the General Appropriations Act or chapter 216.
4 Further, nothing in this section shall be construed to prevent
5 or limit the agency from adjusting fees, reimbursement rates,
6 lengths of stay, number of visits, or number of services, or
7 making any other adjustments necessary to comply with the
8 availability of moneys and any limitations or directions
9 provided for in the General Appropriations Act, provided the
10 adjustment is consistent with legislative intent.
11 (1) Reimbursement to hospitals licensed under part I
12 of chapter 395 must be made prospectively or on the basis of
13 negotiation.
14 (a) Reimbursement for inpatient care is limited as
15 provided for in s. 409.905(5), except for:.
16 1. The raising of rate reimbursement caps, excluding
17 rural hospitals.
18 2. Recognition of the costs of graduate medical
19 education.
20 3. Other methodologies recognized in the General
21 Appropriations Act.
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23 During the years funds are transferred from the Board of
24 Regents, any reimbursement supported by such funds shall be
25 subject to certification by the Board of Regents that the
26 hospital has complied with s. 381.0403. The agency is
27 authorized to receive funds from state entities, including,
28 but limited to, the Board of Regents, local governments, and
29 other local political subdivisions, for the purpose of making
30 special exception payments, including federal matching funds,
31 through the Medicaid inpatient reimbursement methodologies.
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HOUSE AMENDMENT
Bill No. HB 2329, 1st Eng.
Amendment No. (for drafter's use only)
1 Funds received from state entities or local governments for
2 this purpose shall be separately accounted for and shall not
3 be commingled with other state or local funds in any manner.
4 Notwithstanding this section and s. 409.915, counties are
5 exempt from contributing toward the cost of the special
6 exception reimbursement for hospitals serving a
7 disproportionate share of low-income persons and providing
8 graduate medical education.
9 (b) Reimbursement for hospital outpatient care is
10 limited to $1,500 $1,000 per state fiscal year per recipient,
11 except for:
12 1. Such care provided to a Medicaid recipient under
13 age 21, in which case the only limitation is medical
14 necessity.;
15 2. Renal dialysis services.; and
16 3. Other exceptions made by the agency.
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18 The agency is authorized to receive funds from state entities,
19 including, but not limited to, the Board of Regents, local
20 governments, and other local political subdivisions, for the
21 purpose of making payments, including federal matching funds,
22 through the Medicaid outpatient reimbursement methodologies.
23 Funds received from state entities and local governments for
24 this purpose shall be separately accounted for and shall not
25 be commingled with other state or local funds in any manner.
26 (c)(b) Hospitals that provide services to a
27 disproportionate share of low-income Medicaid recipients, or
28 that participate in the regional perinatal intensive care
29 center program under chapter 383, or that participate in the
30 statutory teaching hospital disproportionate share program, or
31 that participate in the extraordinary disproportionate share
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HOUSE AMENDMENT
Bill No. HB 2329, 1st Eng.
Amendment No. (for drafter's use only)
1 program, may receive additional reimbursement. The total
2 amount of payment for disproportionate share hospitals shall
3 be fixed by the General Appropriations Act. The computation of
4 these payments must be made in compliance with all federal
5 regulations and the methodologies described in ss. 409.911,
6 409.9112, and 409.9113.
7 (d)(c) The agency is authorized to limit inflationary
8 increases for outpatient hospital services as directed by the
9 General Appropriations Act.
10 Section 30. The Board of Regents, the Executive Office
11 of the Governor, the Department of Health, and the Agency for
12 Health Care Administration shall collaborate to establish a
13 committee that shall produce an annual report on graduate
14 medical education. To the maximum extent feasible, the
15 committee shall have the same membership as the Graduate
16 Medical Education Study Committee, established by proviso
17 accompanying Specific Appropriation 191 of the fiscal year
18 1999-2000 General Appropriations Act. The report shall be
19 provided to the Governor, the President of the Senate, and the
20 Speaker of the House of Representatives by January 15 of each
21 year. Committee members shall serve without compensation. From
22 the funds provided in s. 381.0403(3), Florida Statutes, the
23 committee is authorized to expend a maximum of $75,000 per
24 year to provide for administrative costs and contractual
25 services. The report shall address the following topics:
26 (1) The role of residents and medical faculty in the
27 provision of health care.
28 (2) The relationship of graduate medical education to
29 the state's physician workforce.
30 (3) The costs of training medical residents for
31 hospitals, medical schools, teaching hospitals, including all
12
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HOUSE AMENDMENT
Bill No. HB 2329, 1st Eng.
Amendment No. (for drafter's use only)
1 hospital-medical affiliations, practice plans at all of the
2 medical schools, and municipalities.
3 (4) The availability and adequacy of all sources of
4 revenue to support graduate medical education and recommend
5 alternative sources of funding for graduate medical education.
6 (5) The use of state and federal appropriated funds
7 for graduate medical education by hospitals receiving such
8 funds.
9 Section 31. This act shall take effect July 1, 2000.
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12 ================ T I T L E A M E N D M E N T ===============
13 And the title is amended as follows:
14 On page 3, line 27,
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16 after the semicolon, insert:
17 amending s. 381.0403, F.S.; placing an emphasis
18 on primary care physicians rather than family
19 physicians; modifying the provisions relating
20 to the funding of graduate medical education;
21 defining primary care specialties; establishing
22 a program for graduate medical education
23 innovations; creating a process regarding the
24 release of funds; requiring an annual report on
25 graduate medical education; establishing a
26 committee for report purposes; providing
27 requirements for the report; amending s.
28 408.07, F.S.; modifying the definition of
29 "teaching hospital"; amending s. 409.905, F.S.;
30 increasing the Medicaid reimbursement
31 limitation for certain hospital outpatient
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HOUSE AMENDMENT
Bill No. HB 2329, 1st Eng.
Amendment No. (for drafter's use only)
1 services; amending s. 409.908, F.S.; providing
2 exceptions to Medicaid reimbursement
3 limitations for certain hospital inpatient
4 care; authorizing the agency to receive certain
5 funds for such exceptional reimbursements;
6 providing an exemption from county contribution
7 requirements; increasing the Medicaid
8 reimbursement limitation for certain hospital
9 outpatient care; authorizing the agency to
10 receive certain funds for such outpatient care;
11 removing authority for additional reimbursement
12 for hospitals participating in the
13 extraordinary disproportionate share program;
14 providing an exemption from county contribution
15 requirements;
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