Senate Bill sb2092
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Florida Senate - 2001 SB 2092
By Senator Sanderson
31-1224B-01
1 A bill to be entitled
2 An act relating to hospitals and community
3 hospital education; amending ss. 381.0403,
4 409.908, F.S.; transferring the community
5 hospital education program from the Board of
6 Regents to the Department of Health;
7 prescribing membership of a committee reporting
8 on graduate medical education; amending s.
9 409.911, F.S.; redefining the term "charity
10 care days" for purposes of the disproportionate
11 share program; amending s. 409.9117, F.S.;
12 revising eligibility criteria for payments
13 under the primary care disproportionate share
14 program; providing an effective date.
15
16 Be It Enacted by the Legislature of the State of Florida:
17
18 Section 1. Subsections (3), (4), (5), (6), (7), and
19 (9) of section 381.0403, Florida Statutes, are amended to
20 read:
21 381.0403 The Community Hospital Education Act.--
22 (3) PROGRAM FOR COMMUNITY HOSPITAL EDUCATION; STATE
23 AND LOCAL PLANNING.--
24 (a) There is established under the Department of
25 Health Board of Regents a program for statewide graduate
26 medical education. It is intended that continuing graduate
27 medical education programs for interns and residents be
28 established on a statewide basis. The program shall provide
29 financial support for primary care specialty interns and
30 residents based on policies recommended and approved by the
31 Community Hospital Education Council, herein established, and
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Florida Senate - 2001 SB 2092
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1 the Department of Health Board of Regents. Only those programs
2 with at least three residents or interns in each year of the
3 training program are qualified to apply for financial support.
4 Programs with fewer than three residents or interns per
5 training year are qualified to apply for financial support,
6 but only if the appropriate accrediting entity for the
7 particular specialty has approved the program for fewer
8 positions. Programs added after fiscal year 1997-1998 shall
9 have 5 years to attain the requisite number of residents or
10 interns. When feasible and to the extent allowed through the
11 General Appropriations Act, state funds shall be used to
12 generate federal matching funds under Medicaid, or other
13 federal programs, and the resulting combined state and federal
14 funds shall be allocated to participating hospitals for the
15 support of graduate medical education. The department may
16 spend up to $75,000 of the state appropriation, for
17 administrative costs associated with the production of the
18 annual report as specified in subsection (9), and for
19 administration of the council.
20 (b) For the purposes of this section, primary care
21 specialties include emergency medicine, family practice,
22 internal medicine, pediatrics, psychiatry,
23 obstetrics/gynecology, and combined pediatrics and internal
24 medicine, and other primary care specialties as may be
25 included by the council and Department of Health Board of
26 Regents.
27 (c) Medical institutions throughout the state may
28 apply to the Community Hospital Education Council for
29 grants-in-aid for financial support of their approved
30 programs. Recommendations for funding of approved programs
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Florida Senate - 2001 SB 2092
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1 shall be forwarded to the Department of Health Board of
2 Regents.
3 (d) The program shall provide a plan for community
4 clinical teaching and training with the cooperation of the
5 medical profession, hospitals, and clinics. The plan shall
6 also include formal teaching opportunities for intern and
7 resident training. In addition, the plan shall establish an
8 off-campus medical faculty with university faculty review to
9 be located throughout the state in local communities.
10 (4) PROGRAM FOR GRADUATE MEDICAL EDUCATION
11 INNOVATIONS.--
12 (a) There is established under the Department of
13 Health Board of Regents a program for fostering graduate
14 medical education innovations. Funds appropriated annually by
15 the Legislature for this purpose shall be distributed to
16 participating hospitals or consortia of participating
17 hospitals and Florida medical schools or to a Florida medical
18 school for the direct costs of providing graduate medical
19 education in community-based clinical settings on a
20 competitive grant or formula basis to achieve state health
21 care workforce policy objectives, including, but not limited
22 to:
23 1. Increasing the number of residents in primary care
24 and other high demand specialties or fellowships;
25 2. Enhancing retention of primary care physicians in
26 Florida practice;
27 3. Promoting practice in medically underserved areas
28 of the state;
29 4. Encouraging racial and ethnic diversity within the
30 state's physician workforce; and
31 5. Encouraging increased production of geriatricians.
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Florida Senate - 2001 SB 2092
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1 (b) Participating hospitals or consortia of
2 participating hospitals and Florida medical schools or a
3 Florida medical school providing graduate medical education in
4 community-based clinical settings may apply to the Community
5 Hospital Education Council for funding under this innovations
6 program, except when such innovations directly compete with
7 services or programs provided by participating hospitals or
8 consortia of participating hospitals, or by both hospitals and
9 consortia. Innovations program funding shall provide funding
10 based on policies recommended and approved by the Community
11 Hospital Education Council and the Department of Health Board
12 of Regents.
13 (c) Participating hospitals or consortia of
14 participating hospitals and Florida medical schools or Florida
15 medical schools awarded an innovations grant shall provide the
16 Community Hospital Education Council and Department of Health
17 Board of Regents with an annual report on their project.
18 (5) FAMILY PRACTICE RESIDENCIES.--In addition to the
19 programs established in subsection (3), the Community Hospital
20 Education Council and the Department of Health Board of
21 Regents shall establish an ongoing statewide program of family
22 practice residencies. The administration of this program
23 shall be in the manner described in this section.
24 (6) COUNCIL AND DIRECTOR.--
25 (a) There is established the Community Hospital
26 Education Council, hereinafter referred to as the council,
27 which shall consist of 11 members, as follows:
28 1. Seven members must be program directors of
29 accredited graduate medical education programs or practicing
30 physicians who have faculty appointments in accredited
31 graduate medical education programs. Six of these members
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1 must be board certified or board eligible in family practice,
2 internal medicine, pediatrics, emergency medicine,
3 obstetrics-gynecology, and psychiatry, respectively, and
4 licensed pursuant to chapter 458. No more than one of these
5 members may be appointed from any one specialty. One member
6 must be licensed pursuant to chapter 459.
7 2. One member must be a representative of the
8 administration of a hospital with an approved community
9 hospital medical education program;
10 3. One member must be the dean of a medical school in
11 this state; and
12 4. Two members must be consumer representatives.
13
14 All of the members shall be appointed by the Governor for
15 terms of 4 years each.
16 (b) Council membership shall cease when a member's
17 representative status no longer exists. Members of similar
18 representative status shall be appointed to replace retiring
19 or resigning members of the council.
20 (c) The Secretary of the Department of Health
21 Chancellor of the State University System shall designate an
22 administrator to serve as staff director. The council shall
23 elect a chair from among its membership. Such other personnel
24 as may be necessary to carry out the program shall be employed
25 as authorized by the Department of Health Board of Regents.
26 (7) DEPARTMENT OF HEALTH BOARD OF REGENTS;
27 STANDARDS.--
28 (a) The Department of Health Board of Regents, with
29 recommendations from the council, shall establish standards
30 and policies for the use and expenditure of graduate medical
31 education funds appropriated pursuant to subsection (8) for a
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1 program of community hospital education. The Department of
2 Health board shall establish requirements for hospitals to be
3 qualified for participation in the program which shall
4 include, but not be limited to:
5 1. Submission of an educational plan and a training
6 schedule.
7 2. A determination by the council to ascertain that
8 each portion of the program of the hospital provides a high
9 degree of academic excellence and is accredited by the
10 Accreditation Council for Graduate Medical Education of the
11 American Medical Association or is accredited by the American
12 Osteopathic Association.
13 3. Supervision of the educational program of the
14 hospital by a physician who is not the hospital administrator.
15 (b) The Department of Health Board of Regents shall
16 periodically review the educational program provided by a
17 participating hospital to assure that the program includes a
18 reasonable amount of both formal and practical training and
19 that the formal sessions are presented as scheduled in the
20 plan submitted by each hospital.
21 (c) In years that funds are transferred to the Agency
22 for Health Care Administration, the Department of Health Board
23 of Regents shall certify to the Agency for Health Care
24 Administration on a quarterly basis the number of primary care
25 specialty residents and interns at each of the participating
26 hospitals for which the Community Hospital Education Council
27 and the board recommends funding.
28 (9) ANNUAL REPORT ON GRADUATE MEDICAL EDUCATION;
29 COMMITTEE.--The Board of Regents, the Executive Office of the
30 Governor, the Department of Health, and the Agency for Health
31 Care Administration shall collaborate to establish a committee
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1 that shall produce an annual report on graduate medical
2 education. The committee shall be comprised of 11 members:
3 five members shall be deans of the medical schools or their
4 designees; the Governor shall appoint two members, one of whom
5 must be a representative of the Florida Medical Association
6 who has supervised or currently supervises residents or
7 interns and one of whom must be a representative of the
8 Florida Hospital Association; the Secretary of Health Care
9 Administration shall appoint two members, one of whom must be
10 a representative of a statutory teaching hospital and one of
11 whom must be a physician who has supervised or is currently
12 supervising residents or interns; and the Secretary of Health
13 shall appoint two members, one of whom must be a
14 representative of a statutory family practice teaching
15 hospital and one of whom must be a physician who has
16 supervised or is currently supervising residents or interns.
17 With the exception of the deans, members shall serve 4-year
18 terms. In order to stagger the terms, the Governor's
19 appointees shall serve initial terms of 4 years, the Secretary
20 of Health's appointees shall serve initial terms of 3 years,
21 and the Secretary of Health Care Administration's appointees
22 shall serve initial terms of 2 years. A member's term shall be
23 deemed terminated when the member's representative status no
24 longer exists. Once the committee is appointed, it shall elect
25 a chair to serve for a 1-year term. To the maximum extent
26 feasible, the committee shall have the same membership as the
27 Graduate Medical Education Study Committee, established by
28 proviso accompanying Specific Appropriation 191 of the
29 1999-2000 General Appropriations Act. The report shall be
30 provided to the Governor, the President of Senate, and the
31 Speaker of the House of Representatives by January 15
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1 annually. Committee members shall serve without compensation.
2 From the funds provided pursuant to subsection (3), the
3 committee is authorized to expend a maximum of $75,000 per
4 year to provide for administrative costs and contractual
5 services. The report shall address the following:
6 (a) The role of residents and medical faculty in the
7 provision of health care.
8 (b) The relationship of graduate medical education to
9 the state's physician workforce.
10 (c) The costs of training medical residents for
11 hospitals, medical schools, teaching hospitals, including all
12 hospital-medical affiliations, practice plans at all of the
13 medical schools, and municipalities.
14 (d) The availability and adequacy of all sources of
15 revenue to support graduate medical education and recommend
16 alternative sources of funding for graduate medical education.
17 (e) The use of state and federal appropriated funds
18 for graduate medical education by hospitals receiving such
19 funds.
20 Section 2. Paragraph (a) of subsection (1) of section
21 409.908, Florida Statutes, is amended to read:
22 409.908 Reimbursement of Medicaid providers.--Subject
23 to specific appropriations, the agency shall reimburse
24 Medicaid providers, in accordance with state and federal law,
25 according to methodologies set forth in the rules of the
26 agency and in policy manuals and handbooks incorporated by
27 reference therein. These methodologies may include fee
28 schedules, reimbursement methods based on cost reporting,
29 negotiated fees, competitive bidding pursuant to s. 287.057,
30 and other mechanisms the agency considers efficient and
31 effective for purchasing services or goods on behalf of
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1 recipients. Payment for Medicaid compensable services made on
2 behalf of Medicaid eligible persons is subject to the
3 availability of moneys and any limitations or directions
4 provided for in the General Appropriations Act or chapter 216.
5 Further, nothing in this section shall be construed to prevent
6 or limit the agency from adjusting fees, reimbursement rates,
7 lengths of stay, number of visits, or number of services, or
8 making any other adjustments necessary to comply with the
9 availability of moneys and any limitations or directions
10 provided for in the General Appropriations Act, provided the
11 adjustment is consistent with legislative intent.
12 (1) Reimbursement to hospitals licensed under part I
13 of chapter 395 must be made prospectively or on the basis of
14 negotiation.
15 (a) Reimbursement for inpatient care is limited as
16 provided for in s. 409.905(5), except for:
17 1. The raising of rate reimbursement caps, excluding
18 rural hospitals.
19 2. Recognition of the costs of graduate medical
20 education.
21 3. Other methodologies recognized in the General
22 Appropriations Act.
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24 During the years funds are transferred from the Department of
25 Health Board of Regents, any reimbursement supported by such
26 funds shall be subject to certification by the Department of
27 Health Board of Regents that the hospital has complied with s.
28 381.0403. The agency is authorized to receive funds from state
29 entities, including, but not limited to, the Board of Regents,
30 the Department of Health, local governments, and other local
31 political subdivisions, for the purpose of making special
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1 exception payments, including federal matching funds, through
2 the Medicaid inpatient reimbursement methodologies. Funds
3 received from state entities or local governments for this
4 purpose shall be separately accounted for and shall not be
5 commingled with other state or local funds in any manner.
6 Notwithstanding this section and s. 409.915, counties are
7 exempt from contributing toward the cost of the special
8 exception reimbursement for hospitals serving a
9 disproportionate share of low-income persons and providing
10 graduate medical education.
11 (b) Reimbursement for hospital outpatient care is
12 limited to $1,500 per state fiscal year per recipient, except
13 for:
14 1. Such care provided to a Medicaid recipient under
15 age 21, in which case the only limitation is medical
16 necessity.
17 2. Renal dialysis services.
18 3. Other exceptions made by the agency.
19
20 The agency is authorized to receive funds from state entities,
21 including, but not limited to, the Board of Regents, local
22 governments, and other local political subdivisions, for the
23 purpose of making payments, including federal matching funds,
24 through the Medicaid outpatient reimbursement methodologies.
25 Funds received from state entities and local governments for
26 this purpose shall be separately accounted for and shall not
27 be commingled with other state or local funds in any manner.
28 (c) Hospitals that provide services to a
29 disproportionate share of low-income Medicaid recipients, or
30 that participate in the regional perinatal intensive care
31 center program under chapter 383, or that participate in the
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Florida Senate - 2001 SB 2092
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1 statutory teaching hospital disproportionate share program may
2 receive additional reimbursement. The total amount of payment
3 for disproportionate share hospitals shall be fixed by the
4 General Appropriations Act. The computation of these payments
5 must be made in compliance with all federal regulations and
6 the methodologies described in ss. 409.911, 409.9112, and
7 409.9113.
8 (d) The agency is authorized to limit inflationary
9 increases for outpatient hospital services as directed by the
10 General Appropriations Act.
11 Section 3. Paragraph (e) of subsection (1) of section
12 409.911, Florida Statutes, is amended to read:
13 409.911 Disproportionate share program.--Subject to
14 specific allocations established within the General
15 Appropriations Act and any limitations established pursuant to
16 chapter 216, the agency shall distribute, pursuant to this
17 section, moneys to hospitals providing a disproportionate
18 share of Medicaid or charity care services by making quarterly
19 Medicaid payments as required. Notwithstanding the provisions
20 of s. 409.915, counties are exempt from contributing toward
21 the cost of this special reimbursement for hospitals serving a
22 disproportionate share of low-income patients.
23 (1) Definitions.--As used in this section and s.
24 409.9112:
25 (e) "Charity care days" means the sum of the
26 deductions from revenues for charity care minus 50 percent of
27 restricted and unrestricted revenues provided to a hospital by
28 local governments or tax districts, whether paid in lump sums
29 or under contract, divided by gross revenues per adjusted
30 patient day.
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1 Section 4. Paragraph (c) of subsection (2) of section
2 409.9117, Florida Statutes, is amended to read:
3 409.9117 Primary care disproportionate share
4 program.--
5 (2) In the establishment and funding of this program,
6 the agency shall use the following criteria in addition to
7 those specified in s. 409.911, payments may not be made to a
8 hospital unless the hospital agrees to:
9 (c) Coordinate and provide primary care services free
10 of charge, except copayments, to all persons with incomes up
11 to 100 percent of the federal poverty level who are not
12 otherwise covered by Medicaid or another program administered
13 by a governmental entity, and to provide such services based
14 on a sliding fee scale to all persons with incomes up to 200
15 percent of the federal poverty level who are not otherwise
16 covered by Medicaid or another program administered by a
17 governmental entity, except that eligibility may be limited to
18 persons who reside within a more limited area, as agreed to by
19 the agency and the hospital.
20 Section 5. This act shall take effect July 1, 2001.
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23 SENATE SUMMARY
24 Transfers responsibility for the community hospital
education program from the Board of Regents to the
25 Department of Health. Redefines "charity care days" for
purposes of the disproportionate share program. Revises
26 standards relating to payments under the primary care
disproportionate share program. (See bill for details.)
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