Senate Bill sb1590
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 SB 1590
By Senator Fasano
11-1064A-04
1 A bill to be entitled
2 An act relating to certified stroke treatment
3 centers; providing legislative intent with
4 respect to certified stroke treatment centers;
5 providing definitions; directing the Department
6 of Health to adopt, by a specified date,
7 certain guidelines as minimal clinical
8 standards for stroke centers; directing the
9 department to notify hospitals that are
10 eligible to become certified stroke treatment
11 centers; requiring a hospital to file a letter
12 of intent; directing hospitals to file
13 completed applications with the department by a
14 specified date; directing the department to
15 issue certificates to stroke treatment centers
16 that meet the guidelines; authorizing the
17 department to issue provisional certifications;
18 providing that a stroke center's certification
19 automatically expires 2 years after the date of
20 issuance; providing that a certification may be
21 renewed; limiting the certification to the
22 hospital to which it was issued; directing the
23 department to post a listing of certified
24 stroke treatment centers on its website;
25 requiring the department to mail the list to
26 certain persons and entities; requiring a
27 hospital to notify the department at least 6
28 months in advance of its decision to terminate
29 stroke treatment; prohibiting a person from
30 claiming that a facility is a stroke treatment
31 center unless the facility is certified as
1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 SB 1590
11-1064A-04
1 provided by law; authorizing the department to
2 inspect stroke treatment centers; requiring
3 emergency medical services to transport
4 identified stroke victims to certified stroke
5 treatment centers; requiring the department to
6 adopt rules; providing an effective date.
7
8 WHEREAS, stroke is the third leading killer in the
9 United States and in Florida, and
10 WHEREAS, stroke is also the leading cause of serious
11 long-term disability in this state, and
12 WHEREAS, 165,000 people die from stroke in the United
13 States every year, including 10,000 persons in this state, and
14 WHEREAS, 60 percent of death from strokes occur in
15 women, and
16 WHEREAS, approximately 4.5 million survivors of a
17 stroke are alive today, and as many as 25 percent are
18 permanently disabled, and
19 WHEREAS, nearly 30 percent of all people who suffer a
20 stroke are under age 65, and
21 WHEREAS, it is estimated that strokes cost the United
22 States nearly $50 billion a year in total costs, with direct
23 costs estimated at $28 billion, and
24 WHEREAS, the state Medicaid budget pays a significant
25 share of the direct cost of stroke, and
26 WHEREAS, as the population ages, death and disability
27 from stroke will increase dramatically if this state does not
28 implement strategies that will improve the survival of victims
29 of stroke in all communities across this state, and
30
31
2
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 SB 1590
11-1064A-04
1 WHEREAS, emergency medical services may be transporting
2 stroke victims to hospitals that are not properly equipped to
3 provide timely and effective treatment for stroke victims, and
4 WHEREAS, many hospitals are not properly equipped to
5 render timely and effective treatment for stroke victims, and
6 WHEREAS, many hospitals that treat stroke victims do
7 not discharge stroke patients with the proper information and
8 tools on how to prevent recurrent strokes, NOW, THEREFORE,
9
10 Be It Enacted by the Legislature of the State of Florida:
11
12 Section 1. Legislative intent.--
13 (1) The Legislature finds that rapid identification,
14 diagnosis, and treatment of ischemic stroke can save the lives
15 of stroke victims and in many cases can reverse paralysis,
16 leaving them with few or no neurological deficits.
17 (2) The Legislature further finds that a strong system
18 for stroke survival is needed in our communities in order to
19 treat stroke victims in a timely manner and to improve the
20 overall treatment of stroke victims. Therefore, the
21 Legislature intends to construct an emergency treatment system
22 in this state in order that stroke victims may be quickly
23 identified and transported to and treated in appropriate
24 stroke treatment facilities.
25 Section 2. Definitions.--As used in this act, the
26 term:
27 (1) "Accrediting organization" means the Joint
28 Commission on Accreditation of Healthcare Organizations, the
29 American Osteopathic Association, the Commission on
30 Accreditation of Rehabilitation Facilities, or the
31 Accreditation Association for Ambulatory Health Care, Inc.
3
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 SB 1590
11-1064A-04
1 (2) "Certified stroke treatment center" or "stroke
2 treatment center" means any hospital licensed under chapter
3 395, Florida Statutes, which meets the guidelines adopted by
4 the department to provide minimum standards for the
5 24-hour-a-day, year-round emergency treatment of ischemic
6 stroke. The term includes all levels of stroke treatment
7 centers certified by the department including primary and
8 comprehensive stroke centers.
9 (3) "Comprehensive stroke center" means any hospital
10 licensed under chapter 395, Florida Statutes, which meets the
11 guidelines adopted by the department to treat stroke patients
12 who require a high intensity of medical and surgical care.
13 These standards shall include, but not be limited to, the
14 hospital meeting all criteria for a primary stroke center and
15 having health care personnel available with specific expertise
16 in neurosurgery and vascular neurology, advanced neuroimaging
17 capabilities, surgical and endovascular techniques, and other
18 specific infrastructure and programmatic elements such as an
19 intensive care unit.
20 (4) "Department" means the Department of Health.
21 (5) "Hospital" means any establishment that:
22 (a) Offers services more intensive than those required
23 for room, board, personal services, and general nursing care,
24 and offers facilities and beds for use beyond 24 hours by
25 individuals requiring diagnosis, treatment, or care for
26 illness, injury, deformity, infirmity, abnormality, disease,
27 or pregnancy; and
28 (b) Regularly makes available at least clinical
29 laboratory services, diagnostic X-ray services, and treatment
30 facilities for surgery or obstetrical care, or other
31 definitive medical treatment of similar extent.
4
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 SB 1590
11-1064A-04
1
2 The term does not include an institution conducted by or for
3 the adherents of any well-recognized church or religious
4 denomination that depends exclusively upon prayer or spiritual
5 means to heal, care for, or treat any person.
6 (6) "Primary stroke center" means any hospital
7 licensed under chapter 395, Florida Statutes, which meets the
8 guidelines adopted by the department to provide minimum
9 standards for the 24-hour emergency treatment of stroke
10 victims. These standards shall include, but not be limited to,
11 hospitals having on duty acute stroke teams with the ability
12 to administer intravenous thrombolytics, the availability and
13 interpretation of computed tomography scans 24 hours each day,
14 rapid laboratory testing, and use of a stroke registry in
15 order to monitor performance of stroke care.
16 (7) "Validation inspection" means an inspection of the
17 premises of a certified stroke treatment center by the
18 department to assess whether a review by an accrediting
19 organization has adequately evaluated the certified stroke
20 treatment center according to the department's minimum
21 standards.
22 Section 3. Stroke treatment center hospitals;
23 certification guidelines.--The department shall adopt by rule
24 one or more sets of guidelines published by nationally
25 recognized stroke centers no later than January 1, 2005. The
26 guidelines adopted by the department shall be the minimum
27 clinical standards in this state for treating ischemic stroke
28 patients. The department may adopt guidelines for certifying
29 different levels of stroke treatment including primary and
30 comprehensive stroke centers.
31
5
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 SB 1590
11-1064A-04
1 Section 4. Certified stroke treatment centers;
2 selection; quality assurance; records.--
3 (1)(a) The department shall annually notify each acute
4 care general hospital in the state that the department is
5 accepting letters of intent from any hospital that proposes to
6 become a stroke treatment center. To be eligible for
7 certification as a stroke treatment center, a hospital must
8 state that its intent to operate as a stroke treatment center
9 is consistent with the certification guidelines adopted by the
10 department. Letters of intent must be postmarked by midnight
11 on October 1 of each year.
12 (b) The department shall send an application package
13 to any hospital submitting a letter of intent by October 15.
14 The application package shall include instructions for
15 submitting specified information to the department in order to
16 become a stroke treatment center. The certification guidelines
17 adopted by the department shall be the basis for these
18 instructions.
19 (c) Completed applications from a hospital must be
20 received by the department by April 1 of each year. The
21 department shall review each application to determine if the
22 hospital's application is complete and whether the hospital
23 meets the department's guidelines for certification as a
24 stroke treatment center as either a primary or comprehensive
25 stroke center.
26 (d) On April 30 of each year, a hospital must be
27 certified as a stroke treatment center if the hospital meets
28 the requirements set forth in this act.
29 (e) The department may issue a provisional
30 certification to a new stroke treatment center or to a
31 renewing stroke treatment center that is in substantial
6
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 SB 1590
11-1064A-04
1 compliance with this act and the rules of the department. A
2 provisional certification may be granted for not more than 1
3 year and expires automatically at the end of its term. A
4 provisional certification may not be renewed.
5 (f) A hospital may protest a decision made by the
6 department based on the department's review of an application
7 pursuant to this section and shall proceed as provided in
8 chapter 120, Florida Statutes. A hearing held under this
9 section shall be conducted in the same manner as provided in
10 ss. 120.569 and 120.57, Florida Statutes. The case filed under
11 chapter 120, Florida Statutes, may combine all disputes
12 between parties.
13 (2) A stroke center's certification, unless sooner
14 suspended or revoked, automatically expires 2 years after the
15 date of issuance. The certification may be renewed biennially
16 upon application by the stroke treatment center. The
17 certification shall be renewed if the center continues to meet
18 the requirements set forth in this act and in the rules
19 adopted by the department. An application for renewal of a
20 certification must be received by the department 90 days
21 before expiration of the current certification on forms
22 provided by the department.
23 (3)(a) A stroke treatment center's certification is
24 valid only for the hospital to which it was issued and may not
25 be sold, assigned, or otherwise transferred, voluntarily or
26 involuntarily, to any other hospital. A certification is valid
27 only for the location for which it was originally issued.
28 (b) An application for a new certification is required
29 if:
30
31
7
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 SB 1590
11-1064A-04
1 1. A majority of the ownership or the controlling
2 interest of a stroke treatment center is transferred or
3 assigned; or
4 2. A lessee agrees to undertake or provide services to
5 the extent that legal liability for operation of the facility
6 rests with the lessee.
7
8 An application for certification showing these changes must be
9 made at least 60 days before the date of the sale, transfer,
10 assignment, or lease.
11 (4) A current list of all certified stroke treatment
12 centers shall be published on the department's website with a
13 clearly marked link on the website's front page. The
14 department shall send, by certified mail, the current list of
15 certified stroke treatment centers to the medical director of
16 all emergency medical services providers, fire departments,
17 and
18 (5) Except as provided in this subsection, property
19 assessed under this section shall be assessed at just value as
20 of January 1 of the year following a change of ownership.
21 Thereafter, the annual changes in the assessed value of the
22 property are subject to the limitations in subsections (1) and
23 (2). For the purpose of this section, a change in ownership
24 means any sale, foreclosure, or transfer of legal title or
25 beneficial title in equity to any person, except as provided
26 in this subsection. There is no change of ownership if:
27 (a) Subsequent to the change or transfer, the same
28 person is entitled to the homestead exemption as was
29 previously entitled and:
30 1. The transfer of title is to correct an error; or
31 2. The transfer is between legal and equitable title;
8
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 SB 1590
11-1064A-04
1 (b) The transfer is between husband and wife,
2 including a transfer to a surviving spouse or a transfer due
3 to a dissolution of marriage;
4 (c) The transfer occurs by operation of law under s.
5 732.4015; or
6 (d) Upon the death of the owner, the transfer is
7 between the owner and another who is a permanent resident and
8 is legally or naturally dependent upon the owner. private
9 ambulance companies in the state. Whenever the list changes,
10 the revised list must be sent to the designated recipients as
11 soon as possible.
12 (6)(a) Notwithstanding any provision of chapter 381,
13 Florida Statutes, a hospital licensed under ss.
14 395.001-395.3025, Florida Statutes, which operates a certified
15 stroke treatment center may not permanently terminate stroke
16 treatment services without providing the department at least 6
17 months' written notice of its intent to terminate these
18 services. The notice must be given to the department, to all
19 hospitals and emergency medical service providers, and to the
20 medical directors of emergency medical services located in the
21 service area of the state treatment center.
22 (b) This subsection does not apply to a short-term
23 unavailability of stroke treatment services. A hospital shall
24 notify all local emergency medical services providers whenever
25 a stroke treatment center is unable to provide stroke
26 treatment services.
27 (7) Except as otherwise provided by law, the
28 department or its agent may collect stroke registry data, as
29 prescribed by rule of the department, for the purposes of
30 evaluating stroke triage, evaluating transportation and
31
9
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 SB 1590
11-1064A-04
1 treatment effectiveness, ensuring compliance with the
2 standards of verification, and monitoring patient outcomes.
3 (8) An onsite visit by the department or its agent may
4 be conducted at any reasonable time and may include, but need
5 not be limited to, a review of records in the possession of a
6 stroke treatment center, emergency medical service provider,
7 or medical examiner regarding the care, transportation,
8 examination, or treatment of stroke patients. A visit must be
9 announced in advance and incorporated as a part of regular
10 inspection of emergency medical services whenever possible.
11 Section 5. Prohibition; renewal, denial, modification,
12 suspension, and revocation of certification.--
13 (1) A person may not advertise to the public, by way
14 of any medium whatsoever, that a hospital is a stroke
15 treatment center, a certified stroke treatment center, or a
16 cerebral vascular specialty treatment facility unless the
17 hospital has first been certified as required by law.
18 (2) If the department finds that a stroke treatment
19 center fails to comply with the requirements of this act or
20 the rules adopted by the department, the department may deny,
21 modify, suspend, or revoke the stroke treatment center's
22 certification.
23 Section 6. Certification inspections of stroke
24 treatment centers.--
25 (1) The department shall make, or cause to be made,
26 any inspection or investigation of a stroke treatment center
27 which it deems necessary, including:
28 (a) An inspection directed by the department.
29 (b) A validation inspection.
30 (c) A complaint investigation, including a full
31 investigation of the certification of a stroke treatment
10
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 SB 1590
11-1064A-04
1 center, which includes a review of all certification
2 guidelines. All complaints received by the department are
3 subject to review and investigation by the department.
4 (d) An investigation of a stroke treatment center's
5 emergency access.
6 (2) The department shall accept, in place of its own
7 periodic inspections for certification, the survey or
8 inspection of an accrediting organization if the certification
9 of the stroke treatment center is not provisional and the
10 stroke treatment center authorizes release of, and the
11 department receives, proof of certification by the accrediting
12 organization. The department shall adopt by rule criteria for
13 accepting proof of certification by an accrediting
14 organization in place of the certification inspection
15 conducted by the department.
16 Section 7. Emergency medical service providers;
17 transportation of stroke victims to stroke treatment
18 centers.--
19 (1) Each emergency medical services provider licensed
20 under chapter 401, Florida Statutes, shall transport
21 identified stroke victims to a certified stroke treatment
22 center, except as otherwise provided for in the provider's
23 protocol for transporting stroke victims.
24 (2) All emergency medical services providers operating
25 in the state must develop a transportation protocol detailing
26 how identified stroke patients will be transported to
27 designated stroke center hospitals. Emergency medical services
28 providers must provide a copy of their stroke transportation
29 protocol to the department within 90 days after this act
30 becoming a law. The department must keep the transportation
31 protocols on file and make them available to any person upon
11
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 SB 1590
11-1064A-04
1 request. If a provider's stroke transportation protocol is
2 changed at any time, the new protocol must be filed with the
3 department within 30 days after its implementation.
4 (3) The department shall adopt guidelines for
5 identifying stroke victims. Each emergency medical services
6 provider must develop a stroke triage protocol based on the
7 published guidelines. The guidelines must include requirements
8 of licensed emergency medical services providers for
9 performing and documenting identification of stroke victims.
10 Review of stroke triage protocols shall be conducted every 3
11 years by the department and shall be conducted through
12 consultation with interested persons, including, but not
13 limited to, each approved stroke center; physicians
14 specializing in stroke care and emergency care; emergency
15 medical service providers licensed under chapter 401, Florida
16 Statutes; and the providers' respective medical directors. The
17 department shall make model stroke triage protocols available
18 to any person.
19 (4) The department shall adopt and enforce all rules
20 necessary to administer this section.
21 Section 8. This act shall take effect July 1, 2004.
22
23
24
25
26
27
28
29
30
31
12
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2004 SB 1590
11-1064A-04
1 *****************************************
2 SENATE SUMMARY
3 Provides legislative intent with respect to certified
stroke treatment centers. Directs the Department of
4 Health to adopt certain stroke-center guidelines as
minimal clinical standards. Directs the department to
5 notify hospitals that might choose to become certified
stroke treatment centers. Requires hospitals to file a
6 letter of intent. Directs hospitals to file completed
applications with the department. Directs the department
7 to issue certificates to stroke treatment centers that
meet the stroke-center guidelines. Authorizes the
8 department to issue provisional certifications. Provides
that a stroke center's certification automatically
9 expires 2 years after the date of issuance. Provides that
a stroke center's certification may be renewed. Limits a
10 stroke center's certification to the hospital to which it
was issued. Directs the department to post a listing of
11 certified stroke treatment centers on its website and to
mail the list to certain persons and entities. Requires a
12 hospital to notify the department at least 6 months in
advance of its decision to terminate stroke treatment.
13 Authorizes the department to inspect stroke treatment
centers. Requires emergency medical service providers to
14 transport identified stroke victims to certified stroke
treatment centers. (See bill for details.)
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
13
CODING: Words stricken are deletions; words underlined are additions.