HB 7215

1	A bill to be entitled
2	An act relating to rural health care; amending s.
3	381.0405, F.S.; revising the purpose and functions of the
4	Office of Rural Health in the Department of Health;
5	requiring the Secretary of Health and the Secretary of
6	Health Care Administration to appoint an advisory council
7	to advise the office; providing for terms of office of the
8	members of the advisory council; authorizing per diem and
9	travel reimbursement for members of the advisory council;
10	requiring a report to the Governor and Legislature;
11	amending s. 381.0406, F.S.; revising legislative findings
12	and intent with respect to rural health networks; revising
13	definitions; providing additional functions of and
14	requirements for membership in rural health networks;
15	requiring rural health networks to submit rural health
16	infrastructure development plans to the office by a
17	specified date; revising provisions relating to the
18	governance and organization of rural health networks;
19	revising the services to be provided by provider members
20	of rural health networks; requiring coordination among
21	rural health networks and area health education centers
22	and health planning councils; establishing performance
23	standards; establishing a grant program for funding rural
24	health networks; defining projects that may be funded
25	through the grant program; requiring the department to
26	establish rules governing rural health network grant
27	programs and performance standards; amending s. 395.602,
28	F.S.; defining "critical access hospital"; revising and
29	deleting definitions; amending s. 395.603, F.S.; deleting
30	a requirement that the Agency for Health Care
31	Administration adopt a rule relating to deactivation of
32	rural hospital beds under certain circumstances; requiring
33	that rural critical access hospitals maintain a certain
34	number of actively licensed beds; amending s. 395.604,
35	F.S.; removing emergency care hospitals and essential
36	access community hospitals from certain licensure
37	requirements; specifying certain special conditions for
38	rural primary care hospitals; amending s. 395.6061, F.S.;
39	specifying the purpose of the rural hospital capital
40	improvement grant program; providing for grant management
41	by the department; modifying the conditions for receiving
42	a grant; providing for preferential assistance for
43	financially distressed rural hospitals; providing purpose
44	of the program; providing requirements for receiving
45	certain assistance; requiring a participation agreement
46	and providing for contents thereof; amending ss. 408.07,
47	409.9116, and 1009.65, F.S.; conforming cross-references;
48	repealing s. 395.605, F.S., relating to the licensure of
49	emergency care hospitals; creating s. 381.7366, F.S.;
50	establishing the Office of Minority Health; providing
51	legislative intent; providing for organization, duties,
52	and responsibilities; requiring a report to the Governor
53	and Legislature; providing an effective date.
54
55	Be It Enacted by the Legislature of the State of Florida:
56
57	Section 1.  Section 381.0405, Florida Statutes, is amended
58	to read:
59	381.0405  Office of Rural Health.--
60	(1)  ESTABLISHMENT.--The Department of Health shall
61	establish an Office of Rural Health, which shall assist rural
62	health care providers in improving the health status and health
63	care of rural residents of this state and assist rural health
64	care providers in integrating their efforts. The Office of Rural
65	Health shall coordinate its activities with rural health
66	networks established under s. 381.0406, local health councils
67	established under s. 408.033, the area health education center
68	network established under pursuant to s. 381.0402, and with any
69	appropriate research and policy development centers within
70	universities that have state-approved medical schools. The
71	Office of Rural Health may enter into a formal relationship with
72	any center that designates the office as an affiliate of the
73	center.
74	(2)  PURPOSE.--The Office of Rural Health shall actively
75	foster the provision of high-quality health care services in
76	rural areas and serve as a catalyst for improved health services
77	to residents citizens in rural areas of the state.
78	(3)  GENERAL FUNCTIONS.--The office shall:
79	(a)  Integrate policies related to physician workforce,
80	hospitals, public health, and state regulatory functions.
81	(b)  Work with rural stakeholders in order to foster the
82	development of strategic planning that addresses Propose
83	solutions to problems affecting health care delivery in rural
84	areas.
85	(c)  Foster the expansion of rural health network service
86	areas to include rural counties that are not served by a rural
87	health network.
88	(d)(c)  Seek grant funds from foundations and the Federal
89	Government.
90	(e)  Administer state grant programs for rural health
91	networks.
92	(4)  COORDINATION.--The office shall:
93	(a)  Identify federal and state rural health programs and
94	provide information and technical assistance to rural providers
95	regarding participation in such programs.
96	(b)  Act as a clearinghouse for collecting and
97	disseminating information on rural health care issues, research
98	findings on rural health care, and innovative approaches to the
99	delivery of health care in rural areas.
100	(c)  Foster the creation of regional health care systems
101	that promote cooperation, rather than competition.
102	(d)  Coordinate the department's rural health care
103	activities, programs, and policies.
104	(e)  Design initiatives to improve access to primary,
105	acute, and emergency medical services and promote the
106	coordination of such services in rural areas.
107	(f)  Assume responsibility for state coordination of the
108	Rural Hospital Transition Grant Program, the Essential Access
109	Community Hospital Program, and other federal rural health care
110	grant programs.
111	(5)  TECHNICAL ASSISTANCE.--The office shall:
112	(a)  Assist Help rural health care providers in recruiting
113	obtain health care practitioners by promoting the location and
114	relocation of health care practitioners in rural areas and
115	promoting policies that create incentives for practitioners to
116	serve in rural areas.
117	(b)  Provide technical assistance to hospitals, community
118	and migrant health centers, and other health care providers that
119	serve residents in rural areas.
120	(c)  Assist with the design of strategies to improve health
121	care workforce recruitment and placement programs.
122	(d)  Provide technical assistance to rural health networks
123	in the formulation of their rural health infrastructure
124	development plans.
125	(e)  Provide links to best practices and other technical
126	assistance resources on the office's Internet website.
127	(6)  ADVISORY COUNCIL.--The Secretary of Health and the
128	Secretary of Health Care Administration shall each appoint no
129	more than five members with relevant health care operations
130	management, practice, and policy experience to an advisory
131	council to advise the office regarding its responsibilities
132	under this section and ss. 381.0406, 395.6061, and 395.6063.
133	Members must be appointed for 4-year staggered terms and may be
134	reappointed to a second term of office. Members shall serve
135	without compensation but are entitled to reimbursement for per
136	diem and travel expenses as provided in s. 112.061. The council
137	may appoint technical advisory teams as needed. The department
138	shall provide staff and other administrative assistance
139	reasonably necessary to assist the advisory council in carrying
140	out its duties.
141	(7)  REPORTS.--Beginning January 1, 2007, and annually
142	thereafter, the Office of Rural Health shall submit a report to
143	the Governor, the President of the Senate, and the Speaker of
144	the House of Representatives summarizing the activities of the
145	office, including the grants obtained or administered by the
146	office and the status of rural health networks and rural
147	hospitals in the state. The report must also include
148	recommendations for improvements in health care delivery in
149	rural areas of the state.
150	(8)(6)  RESEARCH PUBLICATIONS AND SPECIAL STUDIES.--The
151	office shall:
152	(a)  Conduct policy and research studies.
153	(b)  Conduct health status studies of rural residents.
154	(c)  Collect relevant data on rural health care issues for
155	use in department policy development.
156	(9)(7)  APPROPRIATION.--The Legislature shall appropriate
157	such sums as are necessary to support the Office of Rural
158	Health.
159	Section 2.  Section 381.0406, Florida Statutes, is amended
160	to read:
161	381.0406  Rural health networks.--
162	(1)  LEGISLATIVE FINDINGS AND INTENT.--
163	(a)  The Legislature finds that, in rural areas, access to
164	health care is limited and the quality of health care is
165	negatively affected by inadequate financing, difficulty in
166	recruiting and retaining skilled health professionals, and the
167	because of a migration of patients to urban areas for general
168	acute care and specialty services.
169	(b)  The Legislature further finds that the efficient and
170	effective delivery of health care services in rural areas
171	requires:
172	1.  The integration of public and private resources;
173	2.  The introduction of innovative outreach methods;
174	3.  The adoption of quality improvement and cost-
175	effectiveness measures;
176	4.  The organization of health care providers into joint
177	contracting entities;
178	5.  The establishment of referral linkages;
179	6.  The analysis of costs and services in order to prepare
180	health care providers for prepaid and at-risk financing; and
181	7.  The coordination of health care providers.
182	(c)  The Legislature further finds that the availability of
183	a continuum of quality health care services, including
184	preventive, primary, secondary, tertiary, and long-term care, is
185	essential to the economic and social vitality of rural
186	communities.
187	(d)  The Legislature further finds that health care
188	providers in rural areas are not prepared for market changes
189	such as the introduction of managed care and capitation-
190	reimbursement methodologies into health care services.
191	(e)(d)  The Legislature further finds that the creation of
192	rural health networks can help to alleviate these problems.
193	Rural health networks shall act in the broad public interest
194	and, to the extent possible, seek to improve the accessibility,
195	quality, and cost-effectiveness of rural health care by
196	planning, developing, coordinating, and providing be structured
197	to provide a continuum of quality health care services for rural
198	residents through the cooperative efforts of rural health
199	network members and other health care providers.
200	(f)(e)  The Legislature further finds that rural health
201	networks shall have the goal of increasing the financial
202	stability of statutory rural hospitals by linking rural hospital
203	services to other services in a continuum of health care
204	services and by increasing the utilization of statutory rural
205	hospitals whenever for appropriate health care services whenever
206	feasible, which shall help to ensure their survival and thereby
207	support the economy and protect the health and safety of rural
208	residents.
209	(g)(f)  Finally, the Legislature finds that rural health
210	networks may serve as "laboratories" to determine the best way
211	of organizing rural health services and linking to out-of-area
212	services that are not available locally in order, to move the
213	state closer to ensuring that everyone has access to health
214	care, and to promote cost containment efforts.  The ultimate
215	goal of rural health networks shall be to ensure that quality
216	health care is available and efficiently delivered to all
217	persons in rural areas.
218	(2)  DEFINITIONS.--
219	(a)  "Rural" means an area having with a population density
220	of fewer less than 100 individuals per square mile or an area
221	defined by the most recent United States Census as rural.
222	(b)  "Health care provider" means any individual, group, or
223	entity, public or private, which that provides health care,
224	including: preventive health care, primary health care,
225	secondary and tertiary health care, hospital in-hospital health
226	care, public health care, and health promotion and education.
227	(c)  "Rural health network" or "network" means a nonprofit
228	legal entity, whose members consist consisting of rural and
229	urban health care providers and others, and which that is
230	established organized to plan, develop, organize, and deliver
231	health care services on a cooperative basis in a rural area,
232	except for some secondary and tertiary care services.
233	(3)  NETWORK MEMBERSHIP.--
234	(a)  Because each rural area is unique, with a different
235	health care provider mix, health care provider membership may
236	vary, but all networks shall include members that provide health
237	promotion and disease prevention services, public health
238	services, comprehensive primary care, emergency medical care,
239	and acute inpatient care.
240	(b)  Each county health department shall be a member of the
241	rural health network whose service area includes the county in
242	which the county health department is located. Federally
243	qualified health centers and emergency medical services
244	providers are encouraged to become members of the rural health
245	networks in the areas in which their patients reside or receive
246	services.
247	(c)(4)  Network membership shall be available to all health
248	care providers in the network service area if, provided that
249	they render care to all patients referred to them from other
250	network members;, comply with network quality assurance, quality
251	improvement, and utilization-management and risk management
252	requirements; and, abide by the terms and conditions of network
253	provider agreements in paragraph (11)(c), and provide services
254	at a rate or price equal to the rate or price negotiated by the
255	network.
256	(4)(5)  NETWORK SERVICE AREAS.--Network service areas are
257	do not required need to conform to local political boundaries or
258	state administrative district boundaries. The geographic area of
259	one rural health network, however, may not overlap the territory
260	of any other rural health network.
261	(5)(6)  NETWORK FUNCTIONS.--Networks shall:
262	(a)  Seek to develop linkages with provisions for referral
263	to tertiary inpatient care, specialty physician care, and to
264	other services that are not available in rural service areas.
265	(b)(7)  Networks shall Make available health promotion,
266	disease prevention, and primary care services, in order to
267	improve the health status of rural residents and to contain
268	health care costs.
269	(8)  Networks may have multiple points of entry, such as
270	through private physicians, community health centers, county
271	health departments, certified rural health clinics, hospitals,
272	or other providers; or they may have a single point of entry.
273	(c)(9)  Encourage members through training and educational
274	programs to adopt standards of care, and promote the evidence-
275	based practice of medicine. Networks shall establish standard
276	protocols, coordinate and share patient records, and develop
277	patient information exchange systems in order to improve quality
278	and access to services.
279	(d)  Develop quality-improvement programs and train network
280	members and other health care providers in the use of such
281	programs.
282	(e)  Develop disease-management systems and train network
283	members and other health care providers in the use of such
284	systems.
285	(f)  Promote outreach to areas with a high need for
286	services.
287	(g)  Seek to develop community care alternatives for elders
288	who would otherwise be placed in nursing homes.
289	(h)  Emphasize community care alternatives for persons with
290	mental health and substance abuse disorders who are at risk of
291	being admitted to an institution.
292	(i)  Develop and implement a rural health infrastructure
293	development plan for an integrated system of care that is
294	responsive to the unique local health needs and the area health
295	care services market. Each rural health infrastructure
296	development plan must address strategies to improve access to
297	specialty care, train health care providers to use standards of
298	care for chronic illness, develop disease-management capacity,
299	and link to state and national quality-improvement initiatives.
300	The initial development plan must be submitted to the Office of
301	Rural Health for review and approval no later than July 1, 2007,
302	and thereafter the plans must be updated and submitted to the
303	Office of Rural Health every 3 years.
304	(10)  Networks shall develop risk management and quality
305	assurance programs for network providers.
306	(6)(11)  NETWORK GOVERNANCE AND ORGANIZATION.--
307	(a)  Networks shall be incorporated as not-for-profit
308	corporations under chapter 617, with articles of incorporation
309	that set forth purposes consistent with this section the laws of
310	the state.
311	(b)  Each network Networks shall have an independent a
312	board of directors that derives membership from local
313	government, health care providers, businesses, consumers,
314	advocacy groups, and others. Boards of other community health
315	care entities may not serve in whole as the board of a rural
316	health network; however, some overlap of board membership with
317	other community organizations is encouraged. Network staff must
318	provide an annual orientation and strategic planning activity
319	for board members.
320	(c)  Network boards of directors shall have the
321	responsibility of determining the content of health care
322	provider agreements that link network members.  The written
323	agreements between the network and its health care provider
324	members must specify participation in the essential functions of
325	the network and shall specify:
326	1.  Who provides what services.
327	2.  The extent to which the health care provider provides
328	care to persons who lack health insurance or are otherwise
329	unable to pay for care.
330	3.  The procedures for transfer of medical records.
331	4.  The method used for the transportation of patients
332	between providers.
333	5.  Referral and patient flow including appointments and
334	scheduling.
335	6.  Payment arrangements for the transfer or referral of
336	patients.
337	(d)  There shall be no liability on the part of, and no
338	cause of action of any nature shall arise against, any member of
339	a network board of directors, or its employees or agents, for
340	any lawful action taken by them in the performance of their
341	administrative powers and duties under this subsection.
342	(7)(12)  NETWORK PROVIDER MEMBER SERVICES.--
343	(a)  Networks, to the extent feasible, shall seek to
344	develop services that provide for a continuum of care for all
345	residents patients served by the network. Each network shall
346	recruit members that can provide include the following core
347	services: disease prevention, health promotion, comprehensive
348	primary care, emergency medical care, and acute inpatient care.
349	Each network shall seek to ensure the availability of
350	comprehensive maternity care, including prenatal, delivery, and
351	postpartum care for uncomplicated pregnancies, either directly,
352	by contract, or through referral agreements. Networks shall, to
353	the extent feasible, develop local services and linkages among
354	health care providers to also ensure the availability of the
355	following services: within the specified timeframes, either
356	directly, by contract, or through referral agreements:
357	1.  Services available in the home.
358	1.a.  Home health care.
359	2.b.  Hospice care.
360	2.  Services accessible within 30 minutes travel time or
361	less.
362	3.a.  Emergency medical services, including advanced life
363	support, ambulance, and basic emergency room services.
364	4.b.  Primary care, including.
365	c.  prenatal and postpartum care for uncomplicated
366	pregnancies.
367	5.d.  Community-based services for elders, such as adult
368	day care and assistance with activities of daily living.
369	6.e.  Public health services, including communicable
370	disease control, disease prevention, health education, and
371	health promotion.
372	7.f.  Outpatient mental health psychiatric and substance
373	abuse services.
374	3.  Services accessible within 45 minutes travel time or
375	less.
376	8.a.  Hospital acute inpatient care for persons whose
377	illnesses or medical problems are not severe.
378	9.b.  Level I obstetrical care, which is Labor and delivery
379	for low-risk patients.
380	10.c.  Skilled nursing services and, long-term care,
381	including nursing home care.
382	(b)  Networks shall seek to foster linkages with out-of-
383	area services to the extent feasible to ensure the availability
384	of:
385	1.d.  Dialysis.
386	2.e.  Osteopathic and chiropractic manipulative therapy.
387	4.  Services accessible within 2 hours travel time or less.
388	3.a.  Specialist physician care.
389	4.b.  Hospital acute inpatient care for severe illnesses
390	and medical problems.
391	5.c.  Level II and III obstetrical care, which is Labor and
392	delivery care for high-risk patients and neonatal intensive
393	care.
394	6.d.  Comprehensive medical rehabilitation.
395	7.e.  Inpatient mental health psychiatric and substance
396	abuse services.
397	8.f.  Magnetic resonance imaging, lithotripter treatment,
398	oncology, advanced radiology, and other technologically advanced
399	services.
400	9.g.  Subacute care.
401	(8)  COORDINATION WITH OTHER ENTITIES.--
402	(a)  Area health education centers and health planning
403	councils shall participate in the rural health networks'
404	preparation of development plans. The Department of Health may
405	require a written memorandum of agreement between a network and
406	an area health education center or health planning council.
407	(b)  Rural health networks shall initiate activities, in
408	coordination with area health education centers, to carry out
409	the objectives of the adopted development plan, including
410	continuing education for health care practitioners performing
411	functions such as disease management, continuous quality
412	improvement, telemedicine, long-distance learning, and the
413	treatment of chronic illness using standards of care. As used in
414	this section, the term "telemedicine" means the use of
415	telecommunications to deliver or expedite the delivery of health
416	care services.
417	(c)  Rural health networks shall contract with local health
418	planning councils to support the preparation of development
419	plans through data collection and analysis in order to assess
420	the health status of area residents and the capacity of local
421	health services.
422	(d)(b)  Networks shall actively participate with area
423	health education center programs, whenever feasible, in
424	developing and implementing recruitment, training, and retention
425	programs directed at positively influencing the supply and
426	distribution of health care professionals serving in, or
427	receiving training in, network areas.
428	(c)  As funds become available, networks shall emphasize
429	community care alternatives for elders who would otherwise be
430	placed in nursing homes.
431	(d)  To promote the most efficient use of resources,
432	networks shall emphasize disease prevention, early diagnosis and
433	treatment of medical problems, and community care alternatives
434	for persons with mental health and substance abuse disorders who
435	are at risk to be institutionalized.
436	(e)(13)  TRAUMA SERVICES.--In those network areas having
437	which have an established trauma agency approved by the
438	Department of Health, the network shall seek the participation
439	of that trauma agency must be a participant in the network.
440	Trauma services provided within the network area must comply
441	with s. 395.405.
442	(9)(14)  NETWORK FINANCING.--
443	(a)  Networks may use all sources of public and private
444	funds to support network activities. Nothing in this section
445	prohibits networks from becoming managed care providers.
446	(b)  The Department of Health shall establish grant
447	programs to provide funding to support the administrative costs
448	of developing and operating rural health networks.
449	(10)  NETWORK PERFORMANCE STANDARDS.--The Department of
450	Health shall develop and enforce performance standards for rural
451	health network operations grants and rural health infrastructure
452	development grants.
453	(a)  Operations grant performance standards must include,
454	but are not limited to, standards that require the rural health
455	network to:
456	1.  Have a qualified board of directors that meets at least
457	quarterly.
458	2.  Have sufficient staff who have the qualifications and
459	experience to perform the requirements of this section, as
460	assessed by the Office of Rural Health, or a written plan to
461	obtain such staff.
462	3.  Comply with the department's grant management standards
463	in a timely and responsive manner.
464	4.  Comply with the department's standards for the
465	administration of federal grant funding, including assistance to
466	rural hospitals.
467	5.  Demonstrate a commitment to network activities from
468	area health care providers and other stakeholders, as described
469	in letters of support.
470	(b)  Rural health infrastructure development grant
471	performance standards must include, but are not limited to,
472	standards that require the rural health network to:
473	1.  During the 2006-2007 fiscal year prepare a development
474	plan and, after July 1, 2007, have a development plan that has
475	been reviewed and approved by the Office of Rural Health.
476	2.  Have two or more successful network-development
477	activities, such as:
478	a.  Management of a network development or outreach grant
479	from the federal Office of Rural Health Policy;
480	b.  Implementation of outreach programs to address chronic
481	disease, infant mortality, or assistance with prescription
482	medication;
483	c.  Development of partnerships with community and faith-
484	based organizations to address area health problems;
485	d.  Provision of direct services, such as clinics or mobile
486	units;
487	e.  Operation of credentialing services for health care
488	providers or quality assurance and quality improvement
489	initiatives that, whenever possible, are consistent with state
490	or federal quality initiatives;
491	f.  Support for the development of community health
492	centers, local community health councils, federal designation as
493	a rural critical access hospital, or comprehensive community
494	health planning initiatives; and
495	g.  Development of the capacity to obtain federal, state,
496	and foundation grants.
497	(11)(15)  NETWORK IMPLEMENTATION.--As funds become
498	available, networks shall be developed and implemented in two
499	phases.
500	(a)  Phase I shall consist of a network planning and
501	development grant program. Planning grants shall be used to
502	organize networks, incorporate network boards, and develop
503	formal provider agreements as provided for in this section.  The
504	Department of Health shall develop a request-for-proposal
505	process to solicit grant applications.
506	(b)  Phase II shall consist of a network operations grant
507	program. As funds become available, certified networks that meet
508	performance standards shall be eligible to receive grant funds
509	to be used to help defray the costs of rural health network
510	infrastructure development, patient care, and network
511	administration. Rural health network infrastructure development
512	includes, but is not limited to: recruitment and retention of
513	primary care practitioners; enhancements of primary care
514	services through the use of mobile clinics; development of
515	preventive health care programs; linkage of urban and rural
516	health care systems; design and implementation of automated
517	patient records, outcome measurement, quality assurance, and
518	risk management systems; establishment of one-stop service
519	delivery sites; upgrading of medical technology available to
520	network providers; enhancement of emergency medical systems;
521	enhancement of medical transportation; formation of joint
522	contracting entities composed of rural physicians, rural
523	hospitals, and other rural health care providers; establishment
524	of comprehensive disease management programs that meet Medicaid
525	requirements; establishment of regional quality improvement
526	programs involving physicians and hospitals consistent with
527	state and national initiatives; establishment of specialty
528	networks connecting rural primary care physicians and urban
529	specialists; development of regional broadband
530	telecommunications systems that have the capacity to share
531	patient information in a secure network, telemedicine, and long-
532	distance learning capacity; and linkage between training
533	programs for health care practitioners and the delivery of
534	health care services in rural areas and development of
535	telecommunication capabilities. A Phase II award may occur in
536	the same fiscal year as a Phase I award.
537	(12)(16)  CERTIFICATION.--For the purpose of certifying
538	networks that are eligible for Phase II funding, the Department
539	of Health shall certify networks that meet the criteria
540	delineated in this section and the rules governing rural health
541	networks. The Office of Rural Health in the Department of Health
542	shall monitor rural health networks in order to ensure continued
543	compliance with established certification and performance
544	standards.
545	(13)(17)  RULES.--The Department of Health shall establish
546	rules pursuant to s. 120.536(1) and 120.54 that govern the
547	creation and certification of networks, the provision of grant
548	funds under Phase I and Phase II, and the establishment of
549	performance standards including establishing outcome measures
550	for networks.
551	Section 3.  Subsection (2) of section 395.602, Florida
552	Statutes, is amended to read:
553	395.602  Rural hospitals.--
554	(2)  DEFINITIONS.--As used in this part:
555	(a)  "Critical access hospital" means a hospital that meets
556	the definition of rural hospital in paragraph (d) and meets the
557	requirements for reimbursement by Medicare and Medicaid under 42
558	C.F.R. ss. 485.601-485.647. "Emergency care hospital" means a
559	medical facility which provides:
560	1.  Emergency medical treatment; and
561	2.  Inpatient care to ill or injured persons prior to their
562	transportation to another hospital or provides inpatient medical
563	care to persons needing care for a period of up to 96 hours. The
564	96-hour limitation on inpatient care does not apply to respite,
565	skilled nursing, hospice, or other nonacute care patients.
566	(b)  "Essential access community hospital" means any
567	facility which:
568	1.  Has at least 100 beds;
569	2.  Is located more than 35 miles from any other essential
570	access community hospital, rural referral center, or urban
571	hospital meeting criteria for classification as a regional
572	referral center;
573	3.  Is part of a network that includes rural primary care
574	hospitals;
575	4.  Provides emergency and medical backup services to rural
576	primary care hospitals in its rural health network;
577	5.  Extends staff privileges to rural primary care hospital
578	physicians in its network; and
579	6.  Accepts patients transferred from rural primary care
580	hospitals in its network.
581	(b)(c)  "Inactive rural hospital bed" means a licensed
582	acute care hospital bed, as defined in s. 395.002(14), that is
583	inactive in that it cannot be occupied by acute care inpatients.
584	(c)(d)  "Rural area health education center" means an area
585	health education center (AHEC), as authorized by Pub. L. No. 94-
586	484, that which provides services in a county with a population
587	density of no greater than 100 persons per square mile.
588	(d)(e)  "Rural hospital" means an acute care hospital
589	licensed under this chapter, having 100 or fewer licensed beds
590	and an emergency room, that which is:
591	1.  The sole provider within a county with a population
592	density of no greater than 100 persons per square mile;
593	2.  An acute care hospital, in a county with a population
594	density of no greater than 100 persons per square mile, that
595	which is at least 30 minutes of travel time, on normally
596	traveled roads under normal traffic conditions, from any other
597	acute care hospital within the same county;
598	3.  A hospital supported by a tax district or subdistrict
599	whose boundaries encompass a population of 100 persons or fewer
600	per square mile;
601	4.  A hospital in a constitutional charter county with a
602	population of over 1 million persons that has imposed a local
603	option health service tax pursuant to law and in an area that
604	was directly impacted by a catastrophic event on August 24,
605	1992, for which the Governor of Florida declared a state of
606	emergency pursuant to chapter 125, and has 120 beds or fewer
607	less that serves an agricultural community with an emergency
608	room utilization of no less than 20,000 visits and a Medicaid
609	inpatient utilization rate greater than 15 percent;
610	5.  A hospital with a service area that has a population of
611	100 persons or fewer per square mile. As used in this
612	subparagraph, the term "service area" means the fewest number of
613	zip codes that account for 75 percent of the hospital's
614	discharges for the most recent 5-year period, based on
615	information available from the hospital inpatient discharge
616	database in the State Center for Health Statistics at the Agency
617	for Health Care Administration; or
618	6.  A hospital designated as a critical access hospital, as
619	defined in s. 408.07(15).
620
621	Population densities used in this paragraph must be based upon
622	the most recently completed United States census. A hospital
623	that received funds under s. 409.9116 for a quarter beginning no
624	later than July 1, 2002, is deemed to have been and shall
625	continue to be a rural hospital from that date through June 30,
626	2012, if the hospital continues to have 100 or fewer licensed
627	beds and an emergency room, or meets the criteria of
628	subparagraph 4. An acute care hospital that has not previously
629	been designated as a rural hospital and that meets the criteria
630	of this paragraph shall be granted such designation upon
631	application, including supporting documentation to the Agency
632	for Health Care Administration.
633	(e)(f)  "Rural primary care hospital" means any facility
634	that meeting the criteria in paragraph (e) or s. 395.605 which
635	provides:
636	1.  Twenty-four-hour emergency medical care;
637	2.  Temporary inpatient care for periods of 96 72 hours or
638	less to patients requiring stabilization before discharge or
639	transfer to another hospital. The 96-hour 72-hour limitation
640	does not apply to respite, skilled nursing, hospice, or other
641	nonacute care patients; and
642	3.  Has at least no more than six licensed acute care
643	inpatient beds.
644	(f)(g)  "Swing-bed" means a bed that which can be used
645	interchangeably as either a hospital, skilled nursing facility
646	(SNF), or intermediate care facility (ICF) bed pursuant to 42
647	C.F.R. parts 405, 435, 440, 442, and 447.
648	Section 4.  Subsection (1) of section 395.603, Florida
649	Statutes, is amended to read:
650	395.603  Deactivation of general hospital beds; rural
651	hospital impact statement.--
652	(1)  The agency shall establish, by rule, a process by
653	which A rural hospital, as defined in s. 395.602, that seeks
654	licensure as a rural primary care hospital or as an emergency
655	care hospital, or becomes a certified rural health clinic as
656	defined in Pub. L. No. 95-210, or becomes a primary care program
657	such as a county health department, community health center, or
658	other similar outpatient program that provides preventive and
659	curative services, may deactivate general hospital beds. A rural
660	critical access hospital Rural primary care hospitals and
661	emergency care hospitals shall maintain the number of actively
662	licensed general hospital beds necessary for the facility to be
663	certified for Medicare reimbursement. Hospitals that discontinue
664	inpatient care to become rural health care clinics or primary
665	care programs shall deactivate all licensed general hospital
666	beds. All hospitals, clinics, and programs with inactive beds
667	shall provide 24-hour emergency medical care by staffing an
668	emergency room. Providers with inactive beds shall be subject to
669	the criteria in s. 395.1041. The agency shall specify in rule
670	requirements for making 24-hour emergency care available.
671	Inactive general hospital beds shall be included in the acute
672	care bed inventory, maintained by the agency for certificate-of-
673	need purposes, for 10 years from the date of deactivation of the
674	beds. After 10 years have elapsed, inactive beds shall be
675	excluded from the inventory. The agency shall, at the request of
676	the licensee, reactivate the inactive general beds upon a
677	showing by the licensee that licensure requirements for the
678	inactive general beds are met.
679	Section 5.  Section 395.604, Florida Statutes, is amended
680	to read:
681	395.604  Other Rural primary care hospitals hospital
682	programs.--
683	(1)  The agency may license rural primary care hospitals
684	subject to federal approval for participation in the Medicare
685	and Medicaid programs. Rural primary care hospitals shall be
686	treated in the same manner as emergency care hospitals and rural
687	hospitals with respect to ss. 395.605(2)-(8)(a),
688	408.033(2)(b)3., and 408.038.
689	(2)  The agency may designate essential access community
690	hospitals.
691	(2)(3)  The agency may adopt licensure rules for rural
692	primary care hospitals and essential access community hospitals.
693	Such rules must conform to s. 395.1055.
694	(3)  For the purpose of Medicaid swing-bed reimbursement
695	pursuant to the Medicaid program, the agency shall treat rural
696	primary care hospitals in the same manner as rural hospitals.
697	(4)  For the purpose of participation in the Medical
698	Education Reimbursement and Loan Repayment Program as defined in
699	s. 1009.65 or other loan repayment or incentive programs
700	designed to relieve medical workforce shortages, the department
701	shall treat rural primary care hospitals in the same manner as
702	rural hospitals.
703	(5)  For the purpose of coordinating primary care services
704	described in s. 154.011(1)(c)10., the department shall treat
705	rural primary care hospitals in the same manner as rural
706	hospitals.
707	(6)  Rural hospitals that make application under the
708	certificate-of-need program to be licensed as rural primary care
709	hospitals shall receive expedited review as defined in s.
710	408.032. Rural primary care hospitals seeking relicensure as
711	acute care general hospitals shall also receive expedited
712	review.
713	(7)  Rural primary care hospitals are exempt from
714	certificate-of-need requirements for home health and hospice
715	services and for swing beds in a number that does not exceed
716	one-half of the facility's licensed beds.
717	(8)  Rural primary care hospitals shall have agreements
718	with other hospitals, skilled nursing facilities, home health
719	agencies, and providers of diagnostic-imaging and laboratory
720	services that are not provided on site but are needed by
721	patients.
722	(4)  The department may seek federal recognition of
723	emergency care hospitals authorized by s. 395.605 under the
724	essential access community hospital program authorized by the
725	Omnibus Budget Reconciliation Act of 1989.
726	Section 6.  Section 395.6061, Florida Statutes, is amended
727	to read:
728	395.6061  Rural hospital capital improvement.--There is
729	established a rural hospital capital improvement grant program.
730	(1)(a)  The purpose of the program is to provide targeted
731	funding to rural hospitals to enable them to adapt to changes in
732	health care delivery and funding and address disparities in
733	rural health care by:
734	1.  Assisting in the development of needed infrastructure.
735	2.  Assisting financially distressed rural hospitals.
736	3.  Ensuring accountability for state and federal funding.
737	(b)  The rural hospital capital improvement grant program
738	includes technical assistance and grants managed by the agency.
739	(2)(1)  A rural hospital as defined in s. 395.602 may apply
740	to the department for a capital improvement grant to acquire,
741	repair, improve, or upgrade systems, facilities, or equipment.
742	The grant application must provide information that includes:
743	(a)  A statement indicating the problem the rural hospital
744	proposes to solve with the grant funds.;
745	(b)  The strategy proposed to resolve the problem.;
746	(c)  The organizational structure, financial system, and
747	facilities that are essential to the proposed solution.;
748	(d)  The projected longevity of the proposed solution after
749	the grant funds are expended.;
750	(e)  Evidence of participation in a rural health network as
751	defined in s. 381.0406 and evidence that the application is
752	consistent with the required rural health infrastructure
753	development plan.;
754	(f)  Evidence that the rural hospital has difficulty in
755	obtaining funding or that funds available for the proposed
756	solution are inadequate.;
757	(g)  Evidence that the grant funds will assist in
758	maintaining or returning the hospital to an economically stable
759	condition or enable the transition to the status of rural
760	primary care hospital or that any plan for closure of the
761	hospital or realignment of services will involve development of
762	innovative alternatives for the provision of needed discontinued
763	services.;
764	(h)  Evidence of a satisfactory record-keeping system to
765	account for grant fund expenditures within the rural county.;
766	(i)  A rural health network plan that includes a
767	description of how the plan was developed, the goals of the
768	plan, the links with existing health care providers under the
769	plan, Indicators quantifying the hospital's financial status
770	well-being, measurable outcome targets, and the current physical
771	and operational condition of the hospital.
772	(3)(2)  Each rural hospital as defined in s. 395.602 shall
773	receive a minimum of $100,000 annually, subject to legislative
774	appropriation, upon application to the Department of Health, for
775	projects to acquire, repair, improve, or upgrade systems,
776	facilities, or equipment.
777	(4)(3)  Any remaining funds shall annually be disbursed to
778	rural hospitals in accordance with this section. The Department
779	of Health shall establish, by rule, criteria for awarding grants
780	for any remaining funds, which must be used exclusively for the
781	support and assistance of rural hospitals as defined in s.
782	395.602, including criteria relating to the level of charity
783	uncompensated care rendered by the hospital, the financial
784	status of the hospital, the performance standards of the
785	hospital, the participation in a rural health network as defined
786	in s. 381.0406, and the proposed use of the grant by the rural
787	hospital to resolve a specific problem. The department must
788	consider any information submitted in an application for the
789	grants in accordance with subsection (2) (1) in determining
790	eligibility for and the amount of the grant, and none of the
791	individual items of information by itself may be used to deny
792	grant eligibility.
793	(5)  Financially distressed rural hospitals may receive
794	preferential assistance under the capital improvement grant
795	program to provide planning, management, and financial support.
796	To receive this assistance the hospital must:
797	(a)  Provide additional information that includes:
798	1.  A statement of support from the board of directors of
799	the hospital, the county commission, and the city commission.
800	2.  Evidence that the rural hospital and the community have
801	difficulty obtaining funding or that funds available for the
802	proposed solution are inadequate.
803	(b)  Agree to be bound by the terms of a participation
804	agreement with the agency, which may include:
805	1.  The appointment of a health care expert under contract
806	with the agency to analyze and monitor the hospital operations
807	during the period of distress.
808	2.  The establishment of minimum standards for the
809	education and experience of the managers and administrators of
810	the hospital.
811	3.  The oversight and monitoring of a strategic plan to
812	restore the hospital to an economically stable condition or
813	transition to an alternative means to provide services.
814	4.  The establishment of a board orientation and
815	development program.
816	5.  The approval of any facility relocation plans.
817	(6)(4)  The department shall ensure that the funds are used
818	solely for the purposes specified in this section. The total
819	grants awarded pursuant to this section shall not exceed the
820	amount appropriated for this program.
821	Section 7.  Subsection (43) of section 408.07, Florida
822	Statutes, is amended to read:
823	408.07  Definitions.--As used in this chapter, with the
824	exception of ss. 408.031-408.045, the term:
825	(43)  "Rural hospital" means an acute care hospital
826	licensed under chapter 395, having 100 or fewer licensed beds
827	and an emergency room, and which is:
828	(a)  The sole provider within a county with a population
829	density of no greater than 100 persons per square mile;
830	(b)  An acute care hospital, in a county with a population
831	density of no greater than 100 persons per square mile, which is
832	at least 30 minutes of travel time, on normally traveled roads
833	under normal traffic conditions, from another acute care
834	hospital within the same county;
835	(c)  A hospital supported by a tax district or subdistrict
836	whose boundaries encompass a population of 100 persons or fewer
837	per square mile;
838	(d)  A hospital with a service area that has a population
839	of 100 persons or fewer per square mile. As used in this
840	paragraph, the term "service area" means the fewest number of
841	zip codes that account for 75 percent of the hospital's
842	discharges for the most recent 5-year period, based on
843	information available from the hospital inpatient discharge
844	database in the State Center for Health Statistics at the Agency
845	for Health Care Administration; or
846	(e)  A critical access hospital.
847
848	Population densities used in this subsection must be based upon
849	the most recently completed United States census. A hospital
850	that received funds under s. 409.9116 for a quarter beginning no
851	later than July 1, 2002, is deemed to have been and shall
852	continue to be a rural hospital from that date through June 30,
853	2012, if the hospital continues to have 100 or fewer licensed
854	beds and an emergency room, or meets the criteria of s.
855	395.602(2)(d)(e)4. An acute care hospital that has not
856	previously been designated as a rural hospital and that meets
857	the criteria of this subsection shall be granted such
858	designation upon application, including supporting
859	documentation, to the Agency for Health Care Administration.
860	Section 8.  Subsection (6) of section 409.9116, Florida
861	Statutes, is amended to read:
862	409.9116  Disproportionate share/financial assistance
863	program for rural hospitals.--In addition to the payments made
864	under s. 409.911, the Agency for Health Care Administration
865	shall administer a federally matched disproportionate share
866	program and a state-funded financial assistance program for
867	statutory rural hospitals. The agency shall make
868	disproportionate share payments to statutory rural hospitals
869	that qualify for such payments and financial assistance payments
870	to statutory rural hospitals that do not qualify for
871	disproportionate share payments. The disproportionate share
872	program payments shall be limited by and conform with federal
873	requirements. Funds shall be distributed quarterly in each
874	fiscal year for which an appropriation is made. Notwithstanding
875	the provisions of s. 409.915, counties are exempt from
876	contributing toward the cost of this special reimbursement for
877	hospitals serving a disproportionate share of low-income
878	patients.
879	(6)  This section applies only to hospitals that were
880	defined as statutory rural hospitals, or their successor-in-
881	interest hospital, prior to January 1, 2001. Any additional
882	hospital that is defined as a statutory rural hospital, or its
883	successor-in-interest hospital, on or after January 1, 2001, is
884	not eligible for programs under this section unless additional
885	funds are appropriated each fiscal year specifically to the
886	rural hospital disproportionate share and financial assistance
887	programs in an amount necessary to prevent any hospital, or its
888	successor-in-interest hospital, eligible for the programs prior
889	to January 1, 2001, from incurring a reduction in payments
890	because of the eligibility of an additional hospital to
891	participate in the programs. A hospital, or its successor-in-
892	interest hospital, which received funds pursuant to this section
893	before January 1, 2001, and which qualifies under s.
894	395.602(2)(d)(e), shall be included in the programs under this
895	section and is not required to seek additional appropriations
896	under this subsection.
897	Section 9.  Paragraph (b) of subsection (2) of section
898	1009.65, Florida Statutes, is amended to read:
899	1009.65  Medical Education Reimbursement and Loan Repayment
900	Program.--
901	(2)  From the funds available, the Department of Health
902	shall make payments to selected medical professionals as
903	follows:
904	(b)  All payments shall be contingent on continued proof of
905	primary care practice in an area defined in s. 395.602(2)(d)(e),
906	or an underserved area designated by the Department of Health,
907	provided the practitioner accepts Medicaid reimbursement if
908	eligible for such reimbursement. Correctional facilities, state
909	hospitals, and other state institutions that employ medical
910	personnel shall be designated by the Department of Health as
911	underserved locations. Locations with high incidences of infant
912	mortality, high morbidity, or low Medicaid participation by
913	health care professionals may be designated as underserved.
914	Section 10.  Section 395.605, Florida Statutes, is
915	repealed.
916	Section 11.  Section 381.7366, Florida Statutes, is created
917	to read:
918	381.7366  Office of Minority Health; legislative intent;
919	duties.--
920	(1)  LEGISLATIVE INTENT.--The Legislature recognizes that
921	despite significant investments in health care programs certain
922	racial and ethnic populations suffer disproportionately with
923	chronic diseases when compared to non-Hispanic whites. The
924	Legislature intends to address these disparities by developing
925	programs that target causal factors and recognize the specific
926	health care needs of racial and ethnic minorities.
927	(2)  ORGANIZATION.--The Office of Minority Health is
928	established within the Department of Health. The office shall be
929	headed by a director who shall report directly to the Secretary
930	of Health.
931	(3)  DUTIES.--The office shall:
932	(a)  Protect and promote the health and well-being of
933	racial and ethnic populations in the state.
934	(b)  Focus on the issue of health disparities between
935	racial and ethnic minority groups and the general population.
936	(c)  Coordinate the department's initiatives, programs, and
937	policies to address racial and ethnic health disparities.
938	(d)  Communicate pertinent health information to affected
939	racial and ethnic populations.
940	(e)  Collect and analyze data on the incidence and
941	frequency of racial and ethnic health disparities.
942	(f)  Promote and encourage cultural competence education
943	and training for healthcare professionals.
944	(g)  Serve as a clearinghouse for the collection and
945	dissemination of information and research findings relating to
946	innovative approaches to the reduction or elimination of health
947	disparities.
948	(h)  Dedicate resources to increase public awareness of
949	minority health issues.
950	(i)  Seek increased funding for local innovative
951	initiatives and administer grants designed to support
952	initiatives that address health disparities and that can be
953	duplicated.
954	(j)  Provide staffing and support for the Closing the Gap
955	grant advisory council.
956	(k)  Coordinate with other agencies, states, and the
957	Federal Government to reduce or eliminate health disparities.
958	(l)  Collaborate with other public healthcare providers,
959	community and faith-based organizations, the private healthcare
960	system, historically black colleges and universities and other
961	minority institutions of higher education, medical schools, and
962	other health providers to establish a comprehensive and
963	inclusive approach to reducing health disparities.
964	(m)  Encourage and support research into causes of racial
965	and ethnic health disparities.
966	(n)  Collaborate with health professional training programs
967	to increase the number of minority healthcare professionals.
968	(o)  Provide an annual report to the Governor, the
969	President of the Senate, and the Speaker of the House of
970	Representatives on the activities of the office.
971	(4)  RESPONSIBILITY AND COORDINATION.--The office and the
972	department shall direct and carry out the duties established
973	under this section and shall work with other state agencies in
974	accomplishing these tasks.
975	Section 12.  This act shall take effect July 1, 2006.

CODING: Words stricken are deletions; words underlined are additions.