CODING: Words stricken are deletions; words underlined are additions.
e2084092
House
h0900-99
h0913
2002
AA
913362
Senator Campbell moved the following amendment to amendment
(913362):
On page 79, between lines 14 and 15,
On page 85, line 26, after the semicolon




                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 084092

                            CHAMBER ACTION
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11  Senator Campbell moved the following amendment to amendment

12  (913362):

13

14         Senate Amendment (with title amendment) 

15         On page 79, between lines 14 and 15,

16

17  insert:

18         Section 27.  Subsections (1) and (2) and paragraphs (c)

19  and (d) of subsection (3) of section 395.1041, Florida

20  Statutes, are amended to read:

21         395.1041  Access to emergency services and care.--

22         (1)  LEGISLATIVE INTENT.--The Legislature finds and

23  declares it to be of vital importance that emergency services

24  and care be provided by hospitals and physicians to every

25  person in need of such care. The Legislature finds that

26  persons have been denied emergency services and care by

27  hospitals. It is the intent of the Legislature that the agency

28  vigorously enforce the ability of persons to receive all

29  necessary and appropriate emergency services and care and that

30  the agency act in a thorough and timely manner against

31  hospitals and physicians which deny persons emergency services

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 084092





  1  and care. It is further the intent of the Legislature that

  2  hospitals, emergency medical services providers, and other

  3  health care providers work together in their local communities

  4  to enter into agreements or arrangements to ensure access to

  5  emergency services and care. The Legislature further

  6  recognizes that appropriate emergency services and care often

  7  require followup consultation and treatment in order to

  8  effectively care for emergency medical conditions.

  9         (2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.--The

10  agency shall establish and maintain an inventory of hospitals

11  with emergency services.  The inventory shall list all

12  services within the service capability of the hospital, and

13  such services shall appear on the face of the hospital

14  license.  Each hospital having emergency services shall notify

15  the agency of its service capability in the manner and form

16  prescribed by the agency.  The agency, in cooperation with the

17  Department of Health shall provide use the inventory to assist

18  emergency medical services providers and shall make the

19  inventory available to others to assist in locating

20  appropriate emergency medical care.  The inventory shall also

21  be made available to the general public.  On or before August

22  1, 1992, the agency shall request that each hospital identify

23  the services which are within its service capability.  On or

24  before November 1, 1992, the agency shall notify each hospital

25  of the service capability to be included in the inventory.

26  The hospital has 15 days from the date of receipt to respond

27  to the notice.  By December 1, 1992, the agency shall publish

28  a final inventory. Each hospital shall reaffirm its service

29  capability when its license is renewed and shall notify the

30  agency of the addition of a new service or the termination of

31  a service prior to a change in its service capability.

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 084092





  1         (3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF

  2  FACILITY OR HEALTH CARE PERSONNEL.--

  3         (c)  A patient that has not been stabilized, whether

  4  stabilized or not, may be transferred to another hospital

  5  which has the requisite service capability or is not at

  6  service capacity, if:

  7         1.  The patient, or a person who is legally responsible

  8  for the patient and acting on the patient's behalf, after

  9  being informed of the hospital's obligation under this section

10  and of the risk of transfer, requests that the transfer be

11  effected;

12         2.  A physician has signed a certification that, based

13  upon the reasonable risks and benefits to the patient, and

14  based upon the information available at the time of transfer,

15  the medical benefits reasonably expected from the provision of

16  appropriate medical treatment at another hospital outweigh the

17  increased risks to the individual's medical condition from

18  effecting the transfer; or

19         3.  A physician is not physically present in the

20  emergency services area at the time an individual is

21  transferred and a qualified medical person signs a

22  certification that a physician, in consultation with

23  personnel, has determined that the medical benefits reasonably

24  expected from the provision of appropriate medical treatment

25  at another medical facility outweigh the increased risks to

26  the individual's medical condition from effecting the

27  transfer.  The consulting physician must countersign the

28  certification;

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30  provided that this paragraph shall not be construed to require

31  acceptance of a transfer that is not medically necessary.

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 084092





  1         (d)1.  Every hospital shall ensure the provision of

  2  services within the service capability of the hospital, at all

  3  times, either directly or indirectly through an arrangement

  4  with another hospital, through an arrangement with one or more

  5  physicians, or as otherwise made through prior arrangements.

  6  A hospital may enter into an agreement with another hospital

  7  for purposes of meeting its service capability requirement,

  8  and appropriate compensation or other reasonable conditions

  9  may be negotiated for these backup services.

10         2.  If any arrangement requires the provision of

11  emergency medical transportation, such arrangement must be

12  made in consultation with the applicable emergency medical

13  service provider and may not require the emergency medical

14  service provider to provide transportation that is outside the

15  routine service area of that emergency medical service

16  provider or in a manner that impairs the ability of the

17  emergency medical service provider to timely respond to

18  prehospital emergency calls. Emergency medical transportation

19  provided under this subparagraph is considered to be emergency

20  services and care as defined in s. 395.002.

21         3.  A hospital shall not be required to ensure service

22  capability at all times as required in subparagraph 1. if,

23  prior to the receiving of any patient needing such service

24  capability, such hospital has demonstrated to the agency that

25  it lacks the ability to ensure such capability and it has

26  exhausted all reasonable efforts to ensure such capability

27  through backup arrangements.  In reviewing a hospital's

28  demonstration of lack of ability to ensure service capability,

29  the agency shall consider factors relevant to the particular

30  case, including the following:

31         a.  Number and proximity of hospitals with the same

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 084092





  1  service capability.

  2         b.  Number, type, credentials, and privileges of

  3  specialists.

  4         c.  Frequency of procedures.

  5         d.  Size of hospital.

  6         4.  The agency shall publish proposed rules

  7  implementing a reasonable exemption procedure by November 1,

  8  1992.  Subparagraph 1. shall become effective upon the

  9  effective date of said rules or January 31, 1993, whichever is

10  earlier.  For a period not to exceed 1 year from the effective

11  date of subparagraph 1., a hospital requesting an exemption

12  shall be deemed to be exempt from offering the service until

13  the agency initially acts to deny or grant the original

14  request.  The agency has 45 days from the date of receipt of

15  the request for exemption to approve or deny the request.

16  After the first year from the effective date of subparagraph

17  1., If the agency fails to initially act within the time

18  period, the hospital is deemed to be exempt from offering the

19  service until the agency initially acts to deny the request.

20         5.  The agency shall convene a workgroup consisting of

21  representatives from the Florida Hospital Association, the

22  Florida Statutory Teaching Hospital Council, the Florida

23  Medical Association, the Florida Osteopathic Medical

24  Association, and the Florida College of Emergency Physicians

25  to make recommendations to the Legislature for changes to this

26  paragraph regarding:

27         a.  Services performed on an infrequent basis that

28  would not be considered to be within the service capability of

29  the hospital.

30         b.  Situations in which hospitals would be deemed

31  exempt from providing services at all times that are within

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                                                  SENATE AMENDMENT

    Bill No. CS/HB 913, 2nd Eng.

    Amendment No. ___   Barcode 084092





  1  their service capability.

  2

  3  (Redesignate subsequent sections.)

  4

  5

  6  ================ T I T L E   A M E N D M E N T ===============

  7  And the title is amended as follows:

  8         On page 85, line 26, after the semicolon

  9

10  insert:

11         amending s. 395.1041, F.S.; revising provisions

12         relating to hospital service capability and

13         access to emergency services and care;

14         directing the Agency for Health Care

15         Administration to convene a workgroup to report

16         to the Legislature regarding hospital service

17         capability requirements;

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