Florida Senate - 2014                                    SB 1276
       By Senator Grimsley
       21-01447-14                                           20141276__
    1                        A bill to be entitled                      
    2         An act relating to trauma service areas; amending s.
    3         395.402, F.S.; requiring the Department of Health to
    4         provide an annual report assessing the trauma system;
    5         revising factors for the department to consider when
    6         conducting the assessment; limiting the total number
    7         of trauma centers for each trauma service area;
    8         deleting a provision that limits the total trauma
    9         areas allowed in the state; reconfiguring certain
   10         trauma service areas; amending s. 395.4025, F.S.;
   11         revising application requirements for the department
   12         to consider when selecting a hospital to be recognized
   13         as a trauma center; deleting a provision relating to
   14         the procedure for protesting an application decision
   15         by the department; conforming cross-references;
   16         requiring the department to redesignate certain
   17         hospitals as Level II trauma centers; providing an
   18         exception; providing an effective date.
   20  Be It Enacted by the Legislature of the State of Florida:
   22         Section 1. Section 395.402, Florida Statutes, is amended to
   23  read:
   24         395.402 Trauma service areas; number and location of trauma
   25  centers.—
   26         (1) The Legislature recognizes the need for a statewide,
   27  cohesive, uniform, and integrated trauma system. Within the
   28  trauma service areas, Level I and Level II trauma centers shall
   29  each be capable of annually treating a minimum of 1,000 and 500
   30  patients, respectively, with an injury severity score (ISS) of 9
   31  or greater. Level II trauma centers in counties with a
   32  population of more than 500,000 shall have the capacity to care
   33  for 1,000 patients per year.
   34         (2) Trauma service areas as defined in this section are to
   35  be used by utilized until the Department of Health to complete
   36  completes an annual assessment of the trauma system. This
   37  assessment shall be reported and reports its finding to the
   38  Governor, the President of the Senate, the Speaker of the House
   39  of Representatives, and the substantive legislative committees.
   40  The report shall be submitted by February 1 of each year, 2005.
   41  The department shall review the existing trauma system and
   42  determine whether it is effective in providing trauma care
   43  uniformly throughout the state. The assessment shall:
   44         (a) Consider aligning trauma service areas within the
   45  trauma region boundaries as established in July 2004.
   46         (a)(b) Review the number and level of trauma centers needed
   47  for each trauma service area to provide a statewide integrated
   48  trauma system.
   49         (b)(c)Identify Establish criteria used for determining the
   50  number and level of trauma centers needed to serve the
   51  population in a defined trauma service area or region.
   52         (d) Consider including criteria within trauma center
   53  approval standards based upon the number of trauma victims
   54  served within a service area.
   55         (c)(e)Evaluate the level of integration of Review the
   56  Regional Domestic Security Task Force structure and determine
   57  whether integrating the trauma system planning with interagency
   58  regional emergency and disaster planning efforts is feasible and
   59  identify any action needed to reduce duplication of planning
   60  efforts and to promote effective response to mass casualty
   61  events between the two entities.
   62         (d)(f)Report the amounts, sources, and uses of financial
   63  support for the trauma system Make recommendations regarding a
   64  continued revenue source which shall include a local
   65  participation requirement.
   66         (e)(g) Make recommendations regarding the a formula for the
   67  distribution of state funds identified for trauma centers which
   68  shall address incentives for new centers where needed and the
   69  need to maintain effective trauma care in areas served by
   70  existing centers, with consideration for the volume of trauma
   71  patients served, and the amount of charity care provided.
   72         (3) In conducting the annual such assessment and subsequent
   73  annual reviews, the department shall consider:
   74         (a) The Recommendations made as part of the regional trauma
   75  system plans submitted by regional trauma agencies.
   76         (b) Stakeholder recommendations.
   77         (c) The performance of the trauma system compared to
   78  specific standards for access and quality geographical
   79  composition of an area to ensure rapid access to trauma care by
   80  patients.
   81         (d) Historical patterns of patient referral and transfer in
   82  an area.
   83         (e) Inventories of available trauma care resources,
   84  including professional medical staff.
   85         (f) Population growth characteristics.
   86         (g) Transportation capabilities, including ground and air
   87  transport.
   88         (h) Medically appropriate ground and air travel times.
   89         (i) Recommendations of the Regional Domestic Security Task
   90  Force.
   91         (j) The actual number of trauma victims currently being
   92  served by each trauma center.
   93         (k) Other appropriate criteria.
   94         (4) Annually thereafter, the department shall review the
   95  assignment of the 67 counties to trauma service areas, in
   96  addition to the requirements of paragraphs (2)(b)-(g) and
   97  subsection (3). County assignments are made for the purpose of
   98  developing a system of trauma centers. Revisions made by the
   99  department shall take into consideration the recommendations
  100  made as part of the regional trauma system plans approved by the
  101  department and the recommendations made as part of the state
  102  trauma system plan. In cases where a trauma service area is
  103  located within the boundaries of more than one trauma region,
  104  the trauma service area’s needs, response capability, and system
  105  requirements shall be considered by each trauma region served by
  106  that trauma service area in its regional system plan. Until the
  107  department completes the February 2005 assessment, the
  108  assignment of counties shall remain as established in this
  109  section.
  110         (4)(a) The following trauma service areas are hereby
  111  established:
  112         (a)1. Trauma service area 1 shall consist of Escambia,
  113  Okaloosa, Santa Rosa, and Walton Counties.
  114         (b)2. Trauma service area 2 shall consist of Bay, Gulf,
  115  Holmes, and Washington Counties.
  116         (c)3. Trauma service area 3 shall consist of Calhoun,
  117  Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison,
  118  Taylor, and Wakulla Counties.
  119         (d)4. Trauma service area 4 shall consist of Alachua,
  120  Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy,
  121  Putnam, Suwannee, and Union Counties.
  122         (e)5. Trauma service area 5 shall consist of Baker, Clay,
  123  Duval, Nassau, and St. Johns Counties.
  124         (f)6. Trauma service area 6 shall consist of Citrus,
  125  Hernando, and Marion Counties.
  126         (g)7. Trauma service area 7 shall consist of Flagler and
  127  Volusia Counties.
  128         (h)8. Trauma service area 8 shall consist of Lake, Orange,
  129  Osceola, Seminole, and Sumter Counties.
  130         (i)9. Trauma service area 9 shall consist of Pasco and
  131  Pinellas Counties.
  132         (j)10. Trauma service area 10 shall consist of Hillsborough
  133  County.
  134         (k)11. Trauma service area 11 shall consist of Hardee,
  135  Highlands, and Polk Counties.
  136         (l)12. Trauma service area 12 shall consist of Brevard and
  137  Indian River Counties.
  138         (m)13. Trauma service area 13 shall consist of Charlotte,
  139  DeSoto, Manatee, and Sarasota Counties.
  140         (n)14. Trauma service area 14 shall consist of Martin,
  141  Okeechobee, and St. Lucie Counties.
  142         (o)15. Trauma service area 15 shall consist of Collier,
  143  Charlotte, Glades, Hendry, and Lee Counties.
  144         (p)16. Trauma service area 16 shall consist of Palm Beach
  145  County.
  146         17. Trauma service area 17 shall consist of Collier County.
  147         (q)18. Trauma service area 17 18 shall consist of Broward
  148  County.
  149         (r)19. Trauma service area 18 19 shall consist of Miami
  150  Dade and Monroe Counties.
  151         (5)(b)Each trauma service area should have at least one
  152  Level I or Level II trauma center. The department shall
  153  allocate, by rule, The total number of trauma centers, including
  154  both Level I and Level II trauma centers, permitted in needed
  155  for each trauma service area is limited as follows: one center
  156  in areas 2, 3, 4, 7, 11, 12, 14, and 15; two centers in areas 5,
  157  6, 10, 13, and 16; and three centers in areas 1, 8, 9, 17, and
  158  18. An area may not have more than 3 centers. An additional
  159  Level I or Level II center may not be approved if located less
  160  than 10 miles from an existing Level I or Level II center.
  161         (c) There shall be no more than a total of 44 trauma
  162  centers in the state.
  163         Section 2. Present subsections (8) through (12) of section
  164  395.4025, Florida Statutes, are redesignated as subsections (7)
  165  through (11), respectively, subsection (1), paragraphs (c) and
  166  (d) of subsection (2), and present subsection (7) of that
  167  section are amended, present subsections (13) and (14) of that
  168  section are redesignated as subsections (12) and (13),
  169  respectively, and amended, and a new subsection (14) is added to
  170  that section, to read:
  171         395.4025 Trauma centers; selection; quality assurance;
  172  records.—
  173         (1) For purposes of developing a system of trauma centers,
  174  the department shall use the 19 trauma service areas established
  175  in s. 395.402. Within each service area and based on the state
  176  trauma system plan, the local or regional trauma services system
  177  plan, and recommendations of the local or regional trauma
  178  agency, the department shall establish the approximate number of
  179  trauma centers needed to ensure reasonable access to high
  180  quality trauma services. The department shall select those
  181  hospitals that are to be recognized as trauma centers, based on
  182  documentation of the hospital’s ability to meet established
  183  quality standards.
  184         (2)
  185         (c) In order to be considered by the department,
  186  applications from those hospitals seeking selection as trauma
  187  centers, including those current verified trauma centers that
  188  seek a change or redesignation in approval status as a trauma
  189  center, must be received by the department no later than the
  190  close of business on April 1. The department shall conduct a
  191  provisional review of each application for the purpose of
  192  determining that the hospital’s application is complete and that
  193  the hospital has the critical elements required for a trauma
  194  center. This critical review will be based on trauma center
  195  standards and shall determine include, but not be limited to, a
  196  review of whether the hospital has:
  197         1. Equipment and physical facilities necessary to provide
  198  trauma services.
  199         2. Personnel in sufficient numbers and with proper
  200  qualifications to provide trauma services.
  201         3. An effective quality assurance process.
  202         4. Submitted written confirmation by the local or regional
  203  trauma agency that the hospital applying to become a trauma
  204  center is consistent with the plan of the local or regional
  205  trauma agency, as approved by the department, if such agency
  206  exists.
  207         (d)1. Notwithstanding other provisions in this section, the
  208  department may grant up to an additional 18 months to a hospital
  209  applicant that is unable to meet all requirements as provided in
  210  paragraph (c) at the time of application if the number of
  211  applicants in the service area in which the applicant is located
  212  is equal to or less than the service area allocation, under s.
  213  395.402(4) as provided by rule of the department. An applicant
  214  that is granted additional time under pursuant to this paragraph
  215  shall submit a plan for departmental approval which includes
  216  timelines and activities that the applicant proposes to complete
  217  in order to meet application requirements. An Any applicant that
  218  demonstrates an ongoing effort to complete the activities within
  219  the timelines outlined in the plan shall be included in the
  220  number of trauma centers at such time that the department has
  221  conducted a provisional review of the application and has
  222  determined that the application is complete and that the
  223  hospital has the critical elements required for a trauma center.
  224         2. Timeframes provided in subsections (1)-(7) (8) shall be
  225  stayed until the department determines that the application is
  226  complete and that the hospital has the critical elements
  227  required for a trauma center.
  228         (7) Any hospital that wishes to protest a decision made by
  229  the department based on the department’s preliminary or in-depth
  230  review of applications or on the recommendations of the site
  231  visit review team pursuant to this section shall proceed as
  232  provided in chapter 120. Hearings held under this subsection
  233  shall be conducted in the same manner as provided in ss. 120.569
  234  and 120.57. Cases filed under chapter 120 may combine all
  235  disputes between parties.
  236         (12)(13) The department may adopt, by rule, the procedures
  237  and process by which it will select trauma centers. Such
  238  procedures and process must be used in annually selecting trauma
  239  centers and must be consistent with subsections (1)-(7) (8)
  240  except in those situations in which it is in the best interest
  241  of, and mutually agreed to by, all applicants within a service
  242  area and the department to reduce the timeframes.
  243         (13)(14) Notwithstanding the procedures established
  244  pursuant to subsections (1)-(12) through (13), hospitals located
  245  in areas with limited access to trauma center services shall be
  246  designated by the department as Level II trauma centers based on
  247  documentation of a valid certificate of trauma center
  248  verification from the American College of Surgeons. Areas with
  249  limited access to trauma center services are defined by the
  250  following criteria:
  251         (a) The hospital is located in a trauma service area with a
  252  population greater than 600,000 persons but a population density
  253  of less than 225 persons per square mile;
  254         (b) The hospital is located in a county with no verified
  255  trauma center; and
  256         (c) The hospital is located at least 15 miles or 20 minutes
  257  travel time by ground transport from the nearest verified trauma
  258  center.
  259         (14) If a hospital has operated continuously as a Level II
  260  trauma center for a consecutive 12-month period and is in
  261  operation on July 1, 2014, the department shall within 30 days
  262  after a request by the hospital, redesignate such a hospital as
  263  a Level II trauma center if such hospital has met the
  264  requirements of subsections (5) and (6) with regard to quality
  265  of care and patient outcomes. The department shall designate any
  266  such hospital as a Level II trauma center if the redesignation
  267  of the hospital does not cause the total number of trauma
  268  centers in the trauma service area to exceed the number
  269  specified in s. 395.402(5). A hospital that meets the
  270  requirements of this section shall be eligible for renewal of
  271  the 7-year approval period as provided in subsection (6).
  272         Section 3. This act shall take effect July 1, 2014.