Senate Bill 2624
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 SB 2624
By Senator Myers
27-1088-00 See HB 1991
1 A bill to be entitled
2 An act relating to trauma services; creating s.
3 395.4001, F.S.; providing definitions; amending
4 s. 395.401, F.S.; deleting definitions;
5 revising minimum components for local and
6 regional trauma services system plans; amending
7 s. 395.4015, F.S.; revising minimum components
8 for state regional trauma system plans;
9 providing for a statewide inclusive trauma
10 system; amending s. 395.4045, F.S.; revising
11 requirements relating to trauma transport
12 protocols; providing for uniform protocols;
13 revising requirements relating to the trauma
14 scoring system and rules related thereto;
15 revising requirements relating to trauma
16 transport protocols and rules related thereto;
17 providing medical responsibility and
18 accountability for trauma victims during
19 interfacility trauma transfer; requiring the
20 Department of Health to adopt and enforce
21 certain rules; amending s. 395.405, F.S.;
22 providing rulemaking and enforcement authority;
23 amending ss. 395.4025, 395.50, 322.0602, and
24 440.13, F.S.; conforming cross-references;
25 providing an effective date.
26
27 Be It Enacted by the Legislature of the State of Florida:
28
29 Section 1. Section 395.4001, Florida Statutes, is
30 created to read:
31 395.4001 Definitions.--As used in this part, the term:
1
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Florida Senate - 2000 SB 2624
27-1088-00 See HB 1991
1 (1) "Agency" means the Agency for Health Care
2 Administration.
3 (2) "Charity care" or "uncompensated charity care"
4 means that portion of hospital charges reported to the agency
5 for which there is no compensation for care provided to a
6 patient whose family income for the 12 months preceding the
7 determination is less than or equal to 150 percent of the
8 federal poverty level, unless the amount of hospital charges
9 due from the patient exceeds 25 percent of the annual family
10 income. However, in no case shall the hospital charges for a
11 patient whose family income exceeds four times the federal
12 poverty level for a family of four be considered charity.
13 (3) "Department" means the Department of Health.
14 (4) "Interfacility trauma transfer" means the transfer
15 of a trauma victim between two facilities licensed under this
16 chapter, pursuant to this part.
17 (5) "Level I trauma center" means a trauma center
18 that:
19 (a) Has formal research and education programs for the
20 enhancement of trauma care and is determined by the department
21 to be in substantial compliance with Level I trauma center and
22 pediatric trauma referral center standards.
23 (b) Serves as a resource facility to Level II trauma
24 centers, pediatric trauma referral centers, and general
25 hospitals through shared outreach, education, and quality
26 improvement activities.
27 (c) Participates in an inclusive system of trauma
28 care, including providing leadership, system evaluation, and
29 quality improvement activities.
30 (6) "Level II trauma center" means a trauma center
31 that:
2
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Florida Senate - 2000 SB 2624
27-1088-00 See HB 1991
1 (a) Is determined by the department to be in
2 substantial compliance with Level II trauma center standards.
3 (b) Serves as a resource facility to general hospitals
4 through shared outreach, education, and quality improvement
5 activities.
6 (c) Participates in an inclusive system of trauma
7 care.
8 (7) "Pediatric trauma referral center" means a
9 hospital that is determined by the department to be in
10 substantial compliance with pediatric trauma referral center
11 standards as established by rule of the department.
12 (8) "State-approved trauma center" means a hospital
13 that has successfully completed the selection process pursuant
14 to s. 395.4025 and has been approved by the department to
15 operate as a trauma center in the state.
16 (9) "State-sponsored trauma center" means a trauma
17 center or pediatric trauma referral center that receives state
18 funding for trauma care services under s. 395.403.
19 (10) "Trauma agency" means a department-approved
20 agency established and operated by one or more counties, or a
21 department-approved entity with which one or more counties
22 contract, for the purpose of administering an inclusive
23 regional trauma system.
24 (11) "Trauma alert victim" means a person who has
25 incurred a single or multisystem injury due to blunt or
26 penetrating means or burns, who requires immediate medical
27 intervention or treatment, and who meets one or more of the
28 adult or pediatric scorecard criteria established by the
29 department by rule.
30 (12) "Trauma center" means any hospital that has been
31 determined by the department to be in substantial compliance
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Florida Senate - 2000 SB 2624
27-1088-00 See HB 1991
1 with trauma center verification standards as either
2 state-approved or provisional state-approved.
3 (13) "Trauma scorecard" means a statewide methodology
4 adopted by the department by rule under which a person who has
5 incurred a traumatic injury is graded as to the severity of
6 his or her injuries or illness and which methodology is used
7 as the basis for making destination decisions.
8 (14) "Trauma transport protocol" means a document
9 which describes the policies, processes, and procedures
10 governing the dispatch of vehicles, the triage, prehospital
11 transport, and interfacility trauma transfer of trauma
12 victims.
13 (15) "Trauma victim" means any person who has incurred
14 a single or multisystem injury due to blunt or penetrating
15 means or burns and who requires immediate medical intervention
16 or treatment.
17 Section 2. Subsections (1) and (2) of section 395.401,
18 Florida Statutes, are amended to read:
19 395.401 Trauma services system plans; verification of
20 trauma centers and pediatric trauma referral centers;
21 procedures; renewal.--
22 (1) As used in this part, the term:
23 (a) "Agency" means the Agency for Health Care
24 Administration.
25 (b) "Charity care" or "uncompensated charity care"
26 means that portion of hospital charges reported to the agency
27 for which there is no compensation for care provided to a
28 patient whose family income for the 12 months preceding the
29 determination is less than or equal to 150 percent of the
30 federal poverty level, unless the amount of hospital charges
31 due from the patient exceeds 25 percent of the annual family
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Florida Senate - 2000 SB 2624
27-1088-00 See HB 1991
1 income. However, in no case shall the hospital charges for a
2 patient whose family income exceeds four times the federal
3 poverty level for a family of four be considered charity.
4 (c) "Department" means the Department of Health.
5 (d) "Level I trauma center" means a hospital that is
6 determined by the department to be in substantial compliance
7 with trauma center and pediatric trauma referral center
8 verification standards as established by rule of the
9 department, and which:
10 1. Has formal research and education programs for the
11 enhancement of trauma care.
12 2. Serves as a resource facility to Level II trauma
13 centers, pediatric trauma referral centers, and community
14 hospitals.
15 3. Ensures an organized system of trauma care.
16 (e) "Level II trauma center" means a hospital that is
17 determined by the department to be in substantial compliance
18 with trauma center verification standards as established by
19 rule of the department, and which:
20 1. Serves as a resource facility to community
21 hospitals.
22 2. Ensures an organized system of trauma care.
23 (f) "Pediatric trauma referral center" means a
24 hospital that is determined to be in substantial compliance
25 with pediatric trauma referral center standards as established
26 by rule of the department.
27 (g) "State-approved trauma center" means a hospital
28 that has successfully completed the state-approved selection
29 process pursuant to s. 395.4025 and has been approved by the
30 department to operate as a trauma center in the state.
31
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Florida Senate - 2000 SB 2624
27-1088-00 See HB 1991
1 (h) "State-sponsored trauma center" means a
2 state-approved trauma center that receives state funding for
3 trauma care services.
4 (i) "Trauma agency" means an agency established and
5 operated by one or more counties, or an entity with which one
6 or more counties contract, for the purpose of administering an
7 inclusive regional trauma system.
8 (j) "Trauma alert victim" means a person who has
9 incurred a single or multisystem injury due to blunt or
10 penetrating means or burns; who requires immediate medical
11 intervention or treatment; and who meets one or more of the
12 adult or pediatric scorecard criteria established by the
13 department by rule.
14 (k) "Trauma center" means any hospital that has been
15 determined by the department to be in substantial compliance
16 with trauma center verification standards.
17 (l) "Trauma scorecard" means a statewide methodology
18 adopted by the department by rule under which a person who has
19 incurred a traumatic injury is graded as to the severity of
20 his or her injuries or illness and which methodology is used
21 as the basis for making destination decisions.
22 (m) "Trauma victim" means any person who has incurred
23 a single or multisystem injury due to blunt or penetrating
24 means or burns and who requires immediate medical intervention
25 or treatment.
26 (1)(2)(a) The local and regional trauma agencies shall
27 plan, implement, and evaluate trauma services systems, in
28 accordance with this section and ss. 395.4015, 395.404, and
29 395.4045, which consist of organized patterns of readiness and
30 response services based on public and private agreements and
31 operational procedures.
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Florida Senate - 2000 SB 2624
27-1088-00 See HB 1991
1 (b) The local and regional trauma agencies shall
2 develop and submit to the department plans for local and
3 regional trauma services systems. The plans must include, at a
4 minimum, the following components:
5 1. The organizational structure of the trauma system.
6 2. Prehospital care management guidelines for triage
7 and transportation of trauma cases.
8 3. Flow patterns of trauma cases and transportation
9 system design and resources, including air transportation
10 services, and provision for interfacility trauma transfer, and
11 the prehospital transportation of trauma victims. The trauma
12 agency shall plan for the development of a system of
13 transportation of trauma alert victims to trauma centers where
14 the distance or time to a trauma center or transportation
15 resources diminish access by trauma alert victims.
16 4. The number and location of needed state-approved
17 trauma centers based on local needs, population, and location
18 and distribution of resources.
19 5. Data collection regarding system operation and
20 patient outcome.
21 6. Periodic performance evaluation of the trauma
22 system and its components.
23 7. The use of air transport services within the
24 jurisdiction of the local trauma agency.
25 8. Public information and education about the trauma
26 system.
27 9. Emergency medical services communication system
28 usage and dispatching.
29 10. The coordination and integration between the
30 verified trauma care facility and the nonverified health care
31 facilities.
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Florida Senate - 2000 SB 2624
27-1088-00 See HB 1991
1 11. Medical control and accountability.
2 12. Quality control and system evaluation.
3 (c) The department shall receive plans for the
4 implementation of inclusive trauma systems from trauma
5 agencies. The department may approve or not approve trauma
6 agency plans based on the conformance of the plan with this
7 section and ss. 395.4015, 395.404, and 395.4045 and the rules
8 adopted by the department pursuant to those sections. The
9 department shall approve or disapprove the plans within 120
10 days after the date the plans are submitted to the department.
11 (d) A trauma agency shall not operate unless the
12 department has approved the local or regional trauma services
13 system plan of the agency.
14 (e) The department may grant an exception to a portion
15 of the rules adopted pursuant to this section or s. 395.4015
16 if the local or regional trauma agency proves that, as defined
17 in the rules, compliance with that requirement would not be in
18 the best interest of the persons served within the affected
19 local or regional trauma area.
20 (f) A local or regional trauma agency may implement a
21 trauma care system only if the system meets the minimum
22 standards set forth in the rules for implementation
23 established by the department and if the plan has been
24 submitted to, and approved by, the department. At least 60
25 days before the local or regional trauma agency submits the
26 plan for the trauma care system to the department, the local
27 or regional trauma agency shall hold a public hearing and give
28 adequate notice of the public hearing to all hospitals and
29 other interested parties in the area to be included in the
30 proposed system.
31
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Florida Senate - 2000 SB 2624
27-1088-00 See HB 1991
1 (g) Local or regional trauma agencies may enter into
2 contracts for the purpose of implementing the local or
3 regional plan. If local or regional agencies contract with
4 hospitals for trauma services, such agencies must contract
5 only with hospitals which are verified trauma centers.
6 (h) Local or regional trauma agencies providing
7 service for more than one county shall, as part of their
8 formation, establish interlocal agreements between or among
9 the several counties in the regional system.
10 (i) This section does not restrict the authority of a
11 health care facility to provide service for which it has
12 received a license pursuant to this chapter.
13 (j) Any hospital which is verified as a trauma center
14 shall accept all trauma victims that are appropriate for the
15 facility regardless of race, sex, creed, or ability to pay.
16 (k) It is unlawful for any hospital or other facility
17 to hold itself out as a trauma center unless it has been so
18 verified.
19 (l) A county, upon the recommendations of the local or
20 regional trauma agency, may adopt ordinances governing the
21 transport of a patient who is receiving care in the field from
22 prehospital emergency medical personnel when the patient meets
23 specific criteria for trauma, burn, or pediatric centers
24 adopted by the local or regional trauma agency. These
25 ordinances must be consistent with s. 395.4045, ordinances
26 adopted under s. 401.25(6), and the local or regional trauma
27 system plan and, to the furthest possible extent, must ensure
28 that individual patients receive appropriate medical care
29 while protecting the interests of the community at large by
30 making maximum use of available emergency medical care
31 resources.
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Florida Senate - 2000 SB 2624
27-1088-00 See HB 1991
1 (m) The local or regional trauma agency shall,
2 consistent with the regional trauma system plan, coordinate
3 and otherwise facilitate arrangements necessary to develop a
4 trauma services system.
5 (n) After the submission of the initial trauma system
6 plan, each trauma agency shall, every 5th year, submit to the
7 department for approval an updated plan that identifies the
8 changes, if any, to be made in the regional trauma system.
9 (o) This section does not preclude a local or regional
10 trauma agency from adopting trauma care system standards.
11 Section 3. Paragraphs (d), (l), and (n) of subsection
12 (2) of section 395.4015, Florida Statutes, are amended, and
13 subsection (4) is added to that section, to read:
14 395.4015 State regional trauma planning; trauma
15 regions.--
16 (2) The department shall develop trauma systems plans
17 for the department-defined trauma regions which include at a
18 minimum the following components:
19 (d) Flow patterns of trauma cases and transportation
20 system design and resources, including air transportation
21 services, and provision for interfacility trauma transfer, and
22 the prehospital transportation of trauma victims. The
23 department shall plan for the development of a system of
24 transportation of trauma alert victims to trauma centers where
25 the distance or time to a trauma center or transportation
26 resources diminish access by trauma alert victims.
27 (l) The coordination and integration between the
28 state-sponsored trauma centers, verified trauma centers, and
29 other health care facilities which may provide services to
30 trauma victims.
31 (n) Quality management control and system evaluation.
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Florida Senate - 2000 SB 2624
27-1088-00 See HB 1991
1 (4) The department shall use the state trauma system
2 plan as the basis for establishing a statewide inclusive
3 trauma system.
4 Section 4. Paragraph (b) of subsection (2) of section
5 395.4025, Florida Statutes, is amended to read:
6 395.4025 Selection of state-approved trauma centers.--
7 (2)
8 (b) By October 15, the department shall send to all
9 hospitals that submitted a letter of intent an application
10 package that will provide the hospitals with instructions for
11 submitting information to the department for selection as a
12 state-approved trauma center. The standards for verification
13 of trauma centers and pediatric trauma referral centers
14 provided for in s. 395.401(2)(3), as adopted by rule of the
15 department, shall serve as the basis for these instructions.
16 Section 5. Section 395.4045, Florida Statutes, is
17 amended to read:
18 395.4045 Emergency medical service providers; trauma
19 transport protocols; transport of trauma alert victims to
20 trauma centers; interfacility transfer.--
21 (1) Each emergency medical services provider licensed
22 under chapter 401 shall transport trauma alert victims to
23 hospitals approved as trauma centers, except as may be
24 provided for either in the department-approved local or
25 regional trauma transport protocol of the trauma agency for
26 the geographical area in which the emergency medical services
27 licensee provides services or, if no such department-approved
28 local or regional trauma transport protocol is in effect, as
29 provided for in a department-approved provider's trauma
30 transport protocol.
31
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Florida Senate - 2000 SB 2624
27-1088-00 See HB 1991
1 (2) A trauma agency may develop a uniform trauma
2 transport protocol that is applicable to the emergency medical
3 services licensees providing services within the geographical
4 boundaries of the trauma agency. Development of a uniform
5 trauma protocol by a trauma agency regional trauma protocols
6 shall be through consultation with interested parties,
7 including, but not limited to, each approved trauma center;
8 physicians specializing in trauma care, emergency care, and
9 surgery in the region; each trauma system administrator in the
10 region; and each emergency medical service provider in the
11 region licensed under chapter 401, and such providers'
12 respective medical directors.
13 (3) Trauma alert victims shall be identified through
14 the use of a trauma scoring system, including adult and
15 pediatric assessment as specified in rule of the department.
16 The rule shall also include the requirements of licensed
17 emergency medical services providers for performing and
18 documenting these assessments.
19 (4) The department shall specify by rule the subjects
20 and the minimum criteria related to prehospital trauma
21 transport, trauma center or hospital destination
22 determinations, and interfacility trauma transfer to be
23 included in a trauma agency's or an emergency medical service
24 provider's trauma transport protocol and shall approve or
25 disapprove each such protocol. Trauma transport protocol rules
26 pertaining to the air transportation of trauma victims shall
27 be consistent with, but not limited to, applicable Federal
28 Aviation Administration regulation. Emergency medical services
29 licensees and trauma agencies shall be subject to monitoring
30 by the department, under ss. 395.401(3) and 402.31(1) for
31
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Florida Senate - 2000 SB 2624
27-1088-00 See HB 1991
1 compliance with requirements, as applicable, regarding trauma
2 transport protocols and the transport of trauma victims.
3 (5) If there is no department-approved trauma agency
4 trauma transport protocol for the geographical area in which
5 the emergency medical services license applicant intends to
6 provide services, as provided for in subsection (1), each
7 applicant for licensure as an emergency medical services
8 provider, under chapter 401, must submit and obtain department
9 approval of a trauma transport protocol prior to the
10 department granting a license. The department shall prescribe
11 by rule the submission and approval process for an applicant's
12 trauma transport protocols whether the applicant will be using
13 a trauma agency's or its own trauma transport protocol.
14 (6)(2) If an air ambulance service is available in the
15 trauma service area in which an emergency medical service
16 provider is located, trauma transport protocols shall not
17 provide for transport outside of the trauma service area
18 unless otherwise provided for by written mutual agreement. If
19 air ambulance service is not available and there is no
20 agreement for interagency transport of trauma patients between
21 two adjacent local or regional trauma agencies, both of which
22 include at least one approved trauma center, then the
23 transport of a trauma patient with an immediately
24 life-threatening condition shall be to the most appropriate
25 trauma center as defined pursuant to trauma transport
26 protocols approved by the department. The provisions of this
27 subsection shall apply only to those counties with a
28 population in excess of 1 million residents.
29 (7) The medical director of an emergency medical
30 services provider licensed under chapter 401 shall have
31
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Florida Senate - 2000 SB 2624
27-1088-00 See HB 1991
1 medical responsibility and accountability for the trauma
2 victim during an interfacility trauma transfer.
3 (8) The department shall adopt and enforce all rules
4 necessary to administer this section. The department shall
5 adopt and enforce rules to specify the submission and approval
6 process for trauma transport protocols or modifications to
7 trauma transport protocols by trauma agencies and licensed
8 emergency medical services providers.
9 Section 6. Section 395.405, Florida Statutes, is
10 amended to read:
11 395.405 Rulemaking authority.--The department shall
12 adopt and enforce all rules necessary to administer to
13 implement ss. 395.0199, 395.4001, 395.401, 395.4015, 395.402,
14 395.4025, 395.403, 395.404, and 395.4045.
15 Section 7. Subsection (8) of section 395.50, Florida
16 Statutes, is amended to read:
17 395.50 Quality assurance activities of trauma
18 agencies.--
19 (8) Nothing in this section, ss. 395.4001-395.405
20 395.401-395.405, or s. 395.51 prohibits admitting into
21 evidence patient care, transport, or treatment records or
22 reports, or records or reports of the department in any civil
23 or administrative action brought by or involving the
24 department, excluding the name, residence or business address,
25 telephone number, social security or other identifying number,
26 or photograph of any person or the spouse, relative, or
27 guardian of such person or other patient-specific information
28 that otherwise identifies the patient, either directly or
29 indirectly.
30 Section 8. Paragraph (a) of subsection (4) of section
31 322.0602, Florida Statutes, is amended to read:
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Florida Senate - 2000 SB 2624
27-1088-00 See HB 1991
1 322.0602 Youthful Drunk Driver Visitation Program.--
2 (4) VISITATION REQUIREMENT.--
3 (a) To the extent that personnel and facilities are
4 made available to the court, the court may include a
5 requirement for supervised visitation by the probationer to
6 all, or any, of the following:
7 1. A trauma center, as defined in s. 395.4001 395.401,
8 or a hospital as defined in s. 395.002, which regularly
9 receives victims of vehicle accidents, between the hours of 10
10 p.m. and 2 a.m. on a Friday or Saturday night, in order to
11 observe appropriate victims of vehicle accidents involving
12 drinking drivers, under the supervision of any of the
13 following:
14 a. A registered nurse trained in providing emergency
15 trauma care or prehospital advanced life support.
16 b. An emergency room physician.
17 c. An emergency medical technician.
18 2. A licensed service provider, as defined in s.
19 397.311, which cares for substance abuse impaired persons, to
20 observe persons in the terminal stages of substance abuse
21 impairment, under the supervision of appropriately licensed
22 medical personnel. Prior to any visitation of such terminally
23 ill or disabled persons, the persons or their legal
24 representatives must give their express consent to participate
25 in the visitation program.
26 3. If approved by the county coroner, the county
27 coroner's office or the county morgue to observe appropriate
28 victims of vehicle accidents involving drinking drivers, under
29 the supervision of the coroner or a deputy coroner.
30 Section 9. Paragraph (c) of subsection (12) of section
31 440.13, Florida Statutes, is amended to read:
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Florida Senate - 2000 SB 2624
27-1088-00 See HB 1991
1 440.13 Medical services and supplies; penalty for
2 violations; limitations.--
3 (12) CREATION OF THREE-MEMBER PANEL; GUIDES OF MAXIMUM
4 REIMBURSEMENT ALLOWANCES.--
5 (c) Reimbursement for all fees and other charges for
6 such treatment, care, and attendance, including treatment,
7 care, and attendance provided by any hospital or other health
8 care provider, ambulatory surgical center, work-hardening
9 program, or pain program, must not exceed the amounts provided
10 by the uniform schedule of maximum reimbursement allowances as
11 determined by the panel or as otherwise provided in this
12 section. This subsection also applies to independent medical
13 examinations performed by health care providers under this
14 chapter. Until the three-member panel approves a uniform
15 schedule of maximum reimbursement allowances and it becomes
16 effective, all compensable charges for treatment, care, and
17 attendance provided by physicians, ambulatory surgical
18 centers, work-hardening programs, or pain programs shall be
19 reimbursed at the lowest maximum reimbursement allowance
20 across all 1992 schedules of maximum reimbursement allowances
21 for the services provided regardless of the place of service.
22 In determining the uniform schedule, the panel shall first
23 approve the data which it finds representative of prevailing
24 charges in the state for similar treatment, care, and
25 attendance of injured persons. Each health care provider,
26 health care facility, ambulatory surgical center,
27 work-hardening program, or pain program receiving workers'
28 compensation payments shall maintain records verifying their
29 usual charges. In establishing the uniform schedule of maximum
30 reimbursement allowances, the panel must consider:
31
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1 1. The levels of reimbursement for similar treatment,
2 care, and attendance made by other health care programs or
3 third-party providers;
4 2. The impact upon cost to employers for providing a
5 level of reimbursement for treatment, care, and attendance
6 which will ensure the availability of treatment, care, and
7 attendance required by injured workers;
8 3. The financial impact of the reimbursement
9 allowances upon health care providers and health care
10 facilities, including trauma centers as defined in s. 395.4001
11 395.401, and its effect upon their ability to make available
12 to injured workers such medically necessary remedial
13 treatment, care, and attendance. The uniform schedule of
14 maximum reimbursement allowances must be reasonable, must
15 promote health care cost containment and efficiency with
16 respect to the workers' compensation health care delivery
17 system, and must be sufficient to ensure availability of such
18 medically necessary remedial treatment, care, and attendance
19 to injured workers; and
20 4. The most recent average maximum allowable rate of
21 increase for hospitals determined by the Health Care Board
22 under chapter 408.
23 Section 10. This act shall take effect October 1,
24 2000.
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Florida Senate - 2000 SB 2624
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1 *****************************************
2 LEGISLATIVE SUMMARY
3
Revises definitions relating to the provision of trauma
4 services. Revises minimum components for the local and
regional trauma services system plans and the state
5 regional trauma system plans, and provides for a
statewide inclusive trauma system. Revises requirements
6 relating to trauma transport protocols, and provides for
uniform protocols. Revises requirements relating to the
7 trauma scoring system and trauma transport protocols, and
rules related thereto. Provides medical responsibility
8 and accountability of the medical director of a licensed
emergency services provider for trauma victims during
9 interfacility trauma transfer. Requires the Department of
Health to adopt and enforce certain rules. (See bill for
10 details.)
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