Florida Senate - 2018 PROPOSED COMMITTEE SUBSTITUTE
Bill No. CS for SB 1876
Proposed Committee Substitute by the Committee on Appropriations
(Appropriations Subcommittee on Health and Human Services)
1 A bill to be entitled
2 An act relating to trauma services; amending ss.
3 318.14, 318.18, and 318.21, F.S.; requiring that
4 moneys received from specified penalties be allocated
5 to certain trauma centers by a calculation that uses
6 the Agency of Health Care Administration’s hospital
7 discharge data; amending s. 395.4001, F.S.; conforming
8 cross-references; redefining the term “trauma caseload
9 volume”; amending s. 395.402, F.S.; revising
10 legislative intent; revising the trauma service areas
11 and provisions relating to the number and location of
12 trauma centers; prohibiting the Department of Health
13 from designating an existing Level II trauma center as
14 a new pediatric trauma center or from designating an
15 existing Level II trauma center as a Level I trauma
16 center in a trauma service area that already has an
17 existing Level I or pediatric trauma center;
18 apportioning trauma centers within each trauma service
19 area; requiring the department to establish the
20 Florida Trauma System Advisory Council by a specified
21 date; authorizing the council to submit certain
22 recommendations to the department; providing for the
23 membership of the council; requiring the council to
24 meet no later than a specified date and to meet at
25 least quarterly; amending s. 395.4025, F.S.;
26 conforming provisions to changes made by the act;
27 requiring the department to periodically prepare an
28 analysis of the state trauma system using the agency’s
29 hospital discharge data and specified population data;
30 specifying contents of the report; requiring the
31 department to make available all data, formulas,
32 methodologies, and risk adjustment tools used in
33 analyzing the data in the report; requiring the
34 department to notify each acute care general hospital
35 and local and regional trauma agency in a trauma
36 service area that has an identified need for an
37 additional trauma center that the department is
38 accepting letters of intent; prohibiting the
39 department from accepting a letter of intent and from
40 approving an application for a trauma center if there
41 is not statutory capacity for an additional trauma
42 center; revising the department’s review process for
43 hospitals seeking designation as a trauma center;
44 authorizing the department to approve certain
45 applications for designation as a trauma center if
46 specified requirements are met; providing that a
47 hospital applicant that meets such requirements must
48 be ready to operate in compliance with specified
49 trauma standards by a specified date; deleting a
50 provision authorizing the department to grant a
51 hospital applicant an extension time to meet certain
52 standards and requirements; requiring the department
53 to select one or more hospitals for approval to
54 prepare to operate as a trauma center; providing
55 selection requirements; prohibiting an applicant from
56 operating as a trauma center until the department has
57 completed its review process and approved the
58 application; requiring a specified review team to make
59 onsite visits to newly operational trauma centers
60 within a certain timeframe; requiring the department,
61 based on recommendations from the review team, to
62 designate a trauma center that is in compliance with
63 specified requirements; deleting the date by which the
64 department must select trauma centers; providing that
65 only certain hospitals may protest a decision made by
66 the department; providing that certain trauma centers
67 that were verified by the department or determined by
68 the department to be in substantial compliance with
69 specified standards before specified dates are deemed
70 to have met application and operational requirements;
71 requiring the department to designate a certain
72 provisionally approved Level II trauma center as a
73 trauma center if certain criteria are met; prohibiting
74 such designated trauma center from being required to
75 cease trauma operations unless the department or a
76 court determines that it has failed to meet certain
77 standards; providing construction; amending ss.
78 395.403 and 395.4036, F.S.; conforming provisions to
79 changes made by the act; amending s. 395.404, F.S.;
80 requiring trauma centers to participate in the
81 National Trauma Data Bank; requiring trauma centers
82 and acute care hospitals to report trauma patient
83 transfer and outcome data to the department; deleting
84 provisions relating to the department review of trauma
85 registry data; amending s. 395.401, F.S.; conforming a
86 cross-reference; providing for invalidity; providing
87 an effective date.
89 Be It Enacted by the Legislature of the State of Florida:
91 Section 1. Paragraph (b) of subsection (5) of section
92 318.14, Florida Statutes, is amended to read:
93 318.14 Noncriminal traffic infractions; exception;
95 (5) Any person electing to appear before the designated
96 official or who is required so to appear shall be deemed to have
97 waived his or her right to the civil penalty provisions of s.
98 318.18. The official, after a hearing, shall make a
99 determination as to whether an infraction has been committed. If
100 the commission of an infraction has been proven, the official
101 may impose a civil penalty not to exceed $500, except that in
102 cases involving unlawful speed in a school zone or involving
103 unlawful speed in a construction zone, the civil penalty may not
104 exceed $1,000; or require attendance at a driver improvement
105 school, or both. If the person is required to appear before the
106 designated official pursuant to s. 318.19(1) and is found to
107 have committed the infraction, the designated official shall
108 impose a civil penalty of $1,000 in addition to any other
109 penalties and the person’s driver license shall be suspended for
110 6 months. If the person is required to appear before the
111 designated official pursuant to s. 318.19(2) and is found to
112 have committed the infraction, the designated official shall
113 impose a civil penalty of $500 in addition to any other
114 penalties and the person’s driver license shall be suspended for
115 3 months. If the official determines that no infraction has been
116 committed, no costs or penalties shall be imposed and any costs
117 or penalties that have been paid shall be returned. Moneys
118 received from the mandatory civil penalties imposed pursuant to
119 this subsection upon persons required to appear before a
120 designated official pursuant to s. 318.19(1) or (2) shall be
121 remitted to the Department of Revenue and deposited into the
122 Department of Health Emergency Medical Services Trust Fund to
123 provide financial support to certified trauma centers to assure
124 the availability and accessibility of trauma services throughout
125 the state. Funds deposited into the Emergency Medical Services
126 Trust Fund under this section shall be allocated as follows:
127 (b) Fifty percent shall be allocated among Level I, Level
128 II, and pediatric trauma centers based on each center’s relative
129 volume of trauma cases as calculated using the agency’s hospital
130 discharge data collected pursuant to s. 408.061
reported in the
131 Department of Health Trauma Registry.
132 Section 2. Paragraph (h) of subsection (3) of section
133 318.18, Florida Statutes, is amended to read:
134 318.18 Amount of penalties.—The penalties required for a
135 noncriminal disposition pursuant to s. 318.14 or a criminal
136 offense listed in s. 318.17 are as follows:
138 (h) A person cited for a second or subsequent conviction of
139 speed exceeding the limit by 30 miles per hour and above within
140 a 12-month period shall pay a fine that is double the amount
141 listed in paragraph (b). For purposes of this paragraph, the
142 term “conviction” means a finding of guilt as a result of a jury
143 verdict, nonjury trial, or entry of a plea of guilty. Moneys
144 received from the increased fine imposed by this paragraph shall
145 be remitted to the Department of Revenue and deposited into the
146 Department of Health Emergency Medical Services Trust Fund to
147 provide financial support to certified trauma centers to assure
148 the availability and accessibility of trauma services throughout
149 the state. Funds deposited into the Emergency Medical Services
150 Trust Fund under this section shall be allocated as follows:
151 1. Fifty percent shall be allocated equally among all Level
152 I, Level II, and pediatric trauma centers in recognition of
153 readiness costs for maintaining trauma services.
154 2. Fifty percent shall be allocated among Level I, Level
155 II, and pediatric trauma centers based on each center’s relative
156 volume of trauma cases as calculated using the agency’s hospital
157 discharge data collected pursuant to s. 408.061 reported in the
158 Department of Health Trauma Registry.
159 Section 3. Paragraph (b) of subsection (15) of section
160 318.21, Florida Statutes, is amended to read:
161 318.21 Disposition of civil penalties by county courts.—All
162 civil penalties received by a county court pursuant to the
163 provisions of this chapter shall be distributed and paid monthly
164 as follows:
165 (15) Of the additional fine assessed under s. 318.18(3)(e)
166 for a violation of s. 316.1893, 50 percent of the moneys
167 received from the fines shall be appropriated to the Agency for
168 Health Care Administration as general revenue to provide an
169 enhanced Medicaid payment to nursing homes that serve Medicaid
170 recipients with brain and spinal cord injuries. The remaining 50
171 percent of the moneys received from the enhanced fine imposed
172 under s. 318.18(3)(e) shall be remitted to the Department of
173 Revenue and deposited into the Department of Health Emergency
174 Medical Services Trust Fund to provide financial support to
175 certified trauma centers in the counties where enhanced penalty
176 zones are established to ensure the availability and
177 accessibility of trauma services. Funds deposited into the
178 Emergency Medical Services Trust Fund under this subsection
179 shall be allocated as follows:
180 (b) Fifty percent shall be allocated among Level I, Level
181 II, and pediatric trauma centers based on each center’s relative
182 volume of trauma cases as calculated using the agency’s hospital
183 discharge data collected pursuant to s. 408.061 reported in the
184 Department of Health Trauma Registry.
185 Section 4. Paragraph (a) of subsection (7) and subsections
186 (13) and (14) of section 395.4001, Florida Statutes, are amended
187 to read:
188 395.4001 Definitions.—As used in this part, the term:
189 (7) “Level II trauma center” means a trauma center that:
190 (a) Is verified by the department to be in substantial
191 compliance with Level II trauma center standards and has been
192 approved by the department to operate as a Level II trauma
193 center or is designated pursuant to s. 395.4025(15) s.
195 (13) “Trauma caseload volume” means the number of trauma
196 patients calculated by the department using the data reported by
197 each designated trauma center to the hospital discharge data
198 reported to the agency pursuant to s. 408.061 reported by
199 individual trauma centers to the Trauma Registry and validated
200 by the department.
201 (14) “Trauma center” means a hospital that has been
202 verified by the department to be in substantial compliance with
203 the requirements in s. 395.4025 and has been approved by the
204 department to operate as a Level I trauma center, Level II
205 trauma center, or pediatric trauma center, or is designated by
206 the department as a Level II trauma center pursuant to s.
207 395.4025(15) s. 395.4025(14).
208 Section 5. Section 395.402, Florida Statutes, is amended to
210 395.402 Trauma service areas; number and location of trauma
212 (1) The Legislature recognizes the need for a statewide,
213 cohesive, uniform, and integrated trauma system, as well as the
214 need to ensure the viability of existing trauma centers when
215 designating new trauma centers. Consistent with national
216 standards, future trauma center designations must be based on
217 need as a factor of demand and capacity. Within the trauma
218 service areas, Level I and Level II trauma centers shall each be
219 capable of annually treating a minimum of 1,000 and 500
220 patients, respectively, with an injury severity score (ISS) of 9
221 or greater. Level II trauma centers in counties with a
222 population of more than 500,000 shall have the capacity to care
223 for 1,000 patients per year.
224 (2) Trauma service areas as defined in this section are to
225 be utilized until the Department of Health completes an
226 assessment of the trauma system and reports its finding to the
227 Governor, the President of the Senate, the Speaker of the House
228 of Representatives, and the substantive legislative committees.
229 The report shall be submitted by February 1, 2005. The
230 department shall review the existing trauma system and determine
231 whether it is effective in providing trauma care uniformly
232 throughout the state. The assessment shall:
233 (a) Consider aligning trauma service areas within the
234 trauma region boundaries as established in July 2004.
235 (b) Review the number and level of trauma centers needed
236 for each trauma service area to provide a statewide integrated
237 trauma system.
238 (c) Establish criteria for determining the number and level
239 of trauma centers needed to serve the population in a defined
240 trauma service area or region.
241 (d) Consider including criteria within trauma center
242 approval standards based upon the number of trauma victims
243 served within a service area.
244 (e) Review the Regional Domestic Security Task Force
245 structure and determine whether integrating the trauma system
246 planning with interagency regional emergency and disaster
247 planning efforts is feasible and identify any duplication of
248 efforts between the two entities.
249 (f) Make recommendations regarding a continued revenue
250 source which shall include a local participation requirement.
251 (g) Make recommendations regarding a formula for the
252 distribution of funds identified for trauma centers which shall
253 address incentives for new centers where needed and the need to
254 maintain effective trauma care in areas served by existing
255 centers, with consideration for the volume of trauma patients
256 served, and the amount of charity care provided.
257 (3) In conducting such assessment and subsequent annual
258 reviews, the department shall consider:
259 (a) The recommendations made as part of the regional trauma
260 system plans submitted by regional trauma agencies.
261 (b) Stakeholder recommendations.
262 (c) The geographical composition of an area to ensure rapid
263 access to trauma care by patients.
264 (d) Historical patterns of patient referral and transfer in
265 an area.
266 (e) Inventories of available trauma care resources,
267 including professional medical staff.
268 (f) Population growth characteristics.
269 (g) Transportation capabilities, including ground and air
271 (h) Medically appropriate ground and air travel times.
272 (i) Recommendations of the Regional Domestic Security Task
274 (j) The actual number of trauma victims currently being
275 served by each trauma center.
276 (k) Other appropriate criteria.
277 (4) Annually thereafter, the department shall review the
278 assignment of the 67 counties to trauma service areas, in
279 addition to the requirements of paragraphs (2)(b)-(g) and
280 subsection (3). County assignments are made for the purpose of
281 developing a system of trauma centers. Revisions made by the
282 department shall take into consideration the recommendations
283 made as part of the regional trauma system plans approved by the
284 department and the recommendations made as part of the state
285 trauma system plan. In cases where a trauma service area is
286 located within the boundaries of more than one trauma region,
287 the trauma service area’s needs, response capability, and system
288 requirements shall be considered by each trauma region served by
289 that trauma service area in its regional system plan. Until the
290 department completes the February 2005 assessment, the
291 assignment of counties shall remain as established in this
293 (a) The following trauma service areas are hereby
295 1. Trauma service area 1 shall consist of Escambia,
296 Okaloosa, Santa Rosa, and Walton Counties.
297 2. Trauma service area 2 shall consist of Bay, Gulf,
298 Holmes, and Washington Counties.
299 3. Trauma service area 3 shall consist of Calhoun,
300 Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison,
301 Taylor, and Wakulla Counties.
302 4. Trauma service area 4 shall consist of Alachua,
303 Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy,
304 Putnam, Suwannee, and Union Counties.
305 5. Trauma service area 5 shall consist of Baker, Clay,
306 Duval, Nassau, and St. Johns Counties.
307 6. Trauma service area 6 shall consist of Citrus, Hernando,
308 and Marion Counties.
309 7. Trauma service area 7 shall consist of Flagler and
310 Volusia Counties.
311 8. Trauma service area 8 shall consist of Lake, Orange,
312 Osceola, Seminole, and Sumter Counties.
313 9. Trauma service area 9 shall consist of Pasco and
314 Pinellas Counties.
315 10. Trauma service area 10 shall consist of Hillsborough
317 11. Trauma service area 11 shall consist of Hardee,
318 Highlands, and Polk Counties.
319 12. Trauma service area 12 shall consist of Brevard and
320 Indian River Counties.
321 13. Trauma service area 13 shall consist of DeSoto,
322 Manatee, and Sarasota Counties.
323 14. Trauma service area 14 shall consist of Martin,
324 Okeechobee, and St. Lucie Counties.
325 15. Trauma service area 15 shall consist of Charlotte,
326 Collier, Glades, Hendry, and Lee Counties.
327 16. Trauma service area 16 shall consist of Palm Beach
329 17. Trauma service area 17 shall consist of Broward Collier
331 18. Trauma service area 18 shall consist of Broward County.
332 19. Trauma service area 19 shall consist of Miami-Dade and
333 Monroe Counties.
334 (b) Each trauma service area must should have at least one
335 Level I or Level II trauma center. Except as otherwise provided
336 in s. 395.4025(16), the department may not designate an existing
337 Level II trauma center as a new pediatric trauma center or
338 designate an existing Level II trauma center as a Level I trauma
339 center in a trauma service area that already has an existing
340 Level I or pediatric trauma center The department shall
341 allocate, by rule, the number of trauma centers needed for each
342 trauma service area.
343 (c) Trauma centers, including Level I, Level II, Level
344 II/pediatric, and stand-alone pediatric trauma centers, shall be
345 apportioned as follows:
346 1. Trauma service area 1 shall have three trauma centers.
347 2. Trauma service area 2 shall have one trauma center.
348 3. Trauma service area 3 shall have one trauma center.
349 4. Trauma service area 4 shall have one trauma center.
350 5. Trauma service area 5 shall have three trauma centers.
351 6. Trauma service area 6 shall have one trauma center.
352 7. Trauma service area 7 shall have one trauma center.
353 8. Trauma service area 8 shall have three trauma centers.
354 9. Trauma service area 9 shall have three trauma centers.
355 10. Trauma service area 10 shall have two trauma centers.
356 11. Trauma service area 11 shall have one trauma center.
357 12. Trauma service area 12 shall have one trauma center.
358 13. Trauma service area 13 shall have two trauma centers.
359 14. Trauma service area 14 shall have one trauma center.
360 15. Trauma service area 15 shall have one trauma center.
361 16. Trauma service area 16 shall have two trauma centers.
362 17. Trauma service area 17 shall have three trauma centers.
363 18. Trauma service area 18 shall have five trauma centers.
365 Notwithstanding other provisions of this chapter, a trauma
366 service area may not have more than a total of five Level I,
367 Level II, Level II/pediatric, and stand-alone pediatric trauma
368 centers. A trauma service area may not have more than one stand
369 alone pediatric trauma center There shall be no more than a
370 total of 44 trauma centers in the state.
371 (2)(a) By October 1, 2018, the department shall establish
372 the Florida Trauma System Advisory Council to promote an
373 inclusive trauma system and enhance cooperation among trauma
374 system stakeholders. The advisory council may submit
375 recommendations to the department on how to maximize existing
376 trauma center, emergency department, and emergency medical
377 services infrastructure and personnel to achieve the statutory
378 goal of developing an inclusive trauma system.
379 (b)1. The advisory council shall consist of 11 members
380 appointed by the Governor, including:
381 a. The State Trauma Medical Director;
382 b. A representative from an emergency medical services
384 c. A representative of a local or regional trauma agency;
385 d. A trauma program manager or trauma medical director
386 actively working in a trauma center who represents an investor
387 owned hospital with a trauma center;
388 e. A trauma program manager or trauma medical director
389 actively working in a trauma center who represents a nonprofit
390 or public hospital with a trauma center;
391 f. A trauma surgeon who is board-certified in critical care
392 and actively practicing medicine in a Level II trauma center who
393 represents an investor-owned hospital with a trauma center;
394 g. A trauma surgeon who is board-certified in critical care
395 and actively practicing medicine who represents a nonprofit or
396 public hospital with a trauma center;
397 h. A representative of the American College of Surgeons
398 Committee on Trauma;
399 i. A representative of the Safety Net Hospital Alliance of
401 j. A representative of the Florida Hospital Association;
403 k. A trauma surgeon who is board-certified in critical care
404 and actively practicing medicine in a Level I trauma center.
405 2. No two members may be employed by the same health care
407 3. Each council member shall be appointed to a 3-year term;
408 however, for the purpose of providing staggered terms, of the
409 initial appointments, four members shall be appointed to 1-year
410 terms, four members shall be appointed to 2-year terms, and
411 three members shall be appointed to 3-year terms.
412 (c) The advisory council shall convene no later than
413 January 5, 2019, and shall meet at least quarterly.
414 Section 6. Section 395.4025, Florida Statutes, is amended
415 to read:
416 395.4025 Trauma centers; selection; quality assurance;
418 (1) For purposes of developing a system of trauma centers,
419 the department shall use the 18 19 trauma service areas
420 established in s. 395.402. Within each service area and based on
421 the state trauma system plan, the local or regional trauma
422 services system plan, and recommendations of the local or
423 regional trauma agency, the department shall establish the
424 approximate number of trauma centers needed to ensure reasonable
425 access to high-quality trauma services. The department shall
426 select those hospitals that are to be recognized as trauma
428 (2)(a) The department shall prepare an analysis of the
429 Florida trauma system every 3 years, beginning in August 2020,
430 using the agency’s hospital discharge database described in s.
431 408.061 for the most current year and the most recent 5 years of
432 population data for Florida available from the United States
433 Census Bureau. The department’s report must include all of the
435 1. The population growth for each trauma service area and
436 for the state of Florida;
437 2. The number of severely injured patients with an Injury
438 Severity Score of 15 or greater treated at each trauma center
439 within each trauma service area, including pediatric trauma
441 3. The total number of severely injured patients with an
442 Injury Severity Score of 15 or greater treated at all acute care
443 hospitals inclusive of non-trauma centers in the trauma service
445 4. The percentage of each trauma center’s sufficient volume
446 of trauma patients, as described in subparagraph (3)(d)2., in
447 accordance with the Injury Severity Score for the trauma
448 center’s designation, inclusive of the additional caseload
449 volume required for those trauma centers with graduate medical
450 education programs.
451 (b) The department shall make available all data, formulas,
452 methodologies, and risk adjustment tools used in preparing the
454 (3)(a) (2) (a) The department shall annually notify each
455 acute care general hospital and each local and each regional
456 trauma agency in the trauma service area with an identified need
457 for an additional trauma center state that the department is
458 accepting letters of intent from hospitals that are interested
459 in becoming trauma centers. The department may accept a letter
460 of intent only if there is statutory capacity for an additional
461 trauma center in accordance with subsection (2), paragraph (d),
462 and s. 395.402. In order to be considered by the department, a
463 hospital that operates within the geographic area of a local or
464 regional trauma agency must certify that its intent to operate
465 as a trauma center is consistent with the trauma services plan
466 of the local or regional trauma agency, as approved by the
467 department, if such agency exists. Letters of intent must be
468 postmarked no later than midnight October 1 of the year in which
469 the department notifies hospitals that it plans to accept
470 letters of intent.
471 (b) By October 15, the department shall send to all
472 hospitals that submitted a letter of intent an application
473 package that will provide the hospitals with instructions for
474 submitting information to the department for selection as a
475 trauma center. The standards for trauma centers provided for in
476 s. 395.401(2), as adopted by rule of the department, shall serve
477 as the basis for these instructions.
478 (c) In order to be considered by the department,
479 applications from those hospitals seeking selection as trauma
480 centers, including those current verified trauma centers that
481 seek a change or redesignation in approval status as a trauma
482 center, must be received by the department no later than the
483 close of business on April 1 of the year following submission of
484 the letter of intent. The department shall conduct an initial a
485 provisional review of each application for the purpose of
486 determining whether that the hospital’s application is complete
487 and that the hospital is capable of constructing and operating a
488 trauma center that includes has the critical elements required
489 for a trauma center. This critical review must will be based on
490 trauma center standards and must shall include, but need not be
491 limited to, a review as to of whether the hospital is prepared
492 to attain and operate with all of the following components
493 before April 30 of the following year has:
494 1. Equipment and physical facilities necessary to provide
495 trauma services.
496 2. Personnel in sufficient numbers and with proper
497 qualifications to provide trauma services.
498 3. An effective quality assurance process.
499 4. Submitted written confirmation by the local or regional
500 trauma agency that the hospital applying to become a trauma
501 center is consistent with the plan of the local or regional
502 trauma agency, as approved by the department, if such agency
504 (d) 1. Except as otherwise provided in this act, the
505 department may not approve an application for a Level I, Level
506 II, Level II/pediatric, or stand-alone pediatric trauma center
507 if approval of the application would exceed the limits on the
508 numbers of Level I, Level II, Level II/pediatric, or stand-alone
509 pediatric trauma centers set forth in s. 395.402(1). However,
510 the department shall review and may approve an application for a
511 trauma center when approval of the application would result in a
512 number of trauma centers which exceeds the limit on the numbers
513 of trauma centers in a trauma service area as set forth in s.
514 395.402(1), if the applicant demonstrates and the department
515 determines that:
516 1. The existing trauma centers’ actual caseload volume of
517 severely injured patients with an Injury Severity Score of 15 or
518 greater exceeds the minimum caseload volume capabilities,
519 inclusive of the additional caseload volume for graduate medical
520 education critical care and trauma surgical subspecialty
521 residents or fellows by more than two times the statutory
522 minimums listed in sub-subparagraphs 2.a.-d. and three times the
523 statutory minimum listed in sub-subparagraph 2.e., and the
524 population growth for the trauma service area exceeds the
525 statewide population growth by more than 15 percent based on the
526 United States census data for the 5-year period before the date
527 the applicant files its letter of intent; and
528 2. A sufficient volume of potential trauma patients exists
529 within the trauma service area to ensure that existing trauma
530 centers’ volumes are at the following levels:
531 a. For Level I trauma centers in trauma service areas with
532 a population of greater than 1.5 million, a minimum caseload of
533 the greater of 1,200 severely injured admitted patients with an
534 Injury Severity Score of 15 or greater per year or 1,200
535 severely injured admitted patients with an Injury Severity Score
536 of 15 or greater plus 40 cases per year for each accredited
537 critical care and trauma surgical subspecialty medical resident
538 or fellow.
539 b. For Level I trauma centers in trauma service areas with
540 a population of less than 1.5 million, the minimum caseload of
541 the greater of 1,000 severely injured admitted patients with an
542 Injury Severity Score of 15 or greater per year or 1,000
543 severely injured admitted patients with an Injury Severity Score
544 of 15 or greater plus 40 cases per year for each accredited
545 critical care and trauma surgical subspecialty medical resident
546 or fellow.
547 c. For Level II and Level II/pediatric trauma centers in
548 trauma service areas with a population of greater than 1.25
549 million, the minimum caseload of the greater of 1,000 severely
550 injured admitted patients with an Injury Severity Score of 15 or
551 greater per year or 1,000 severely injured admitted patients
552 with an Injury Severity Score of 15 or greater plus 40 cases per
553 year for each accredited critical care and trauma surgical
554 subspecialty medical resident or fellow.
555 d. For Level II and Level II/pediatric trauma centers in
556 trauma service areas with a population of less than 1.25
557 million, the minimum caseload of the greater of 500 severely
558 injured admitted patients with an Injury Severity Score of 15 or
559 greater per year or 500 severely injured admitted patients with
560 an Injury Severity Score of 15 or greater per year plus 40 cases
561 per year for each accredited critical care and trauma surgical
562 subspecialty medical resident or fellow.
563 e. For pediatric trauma centers, the minimum caseload of
564 the greater of 500 severely injured admitted patients with an
565 Injury Severity Score of 15 or greater per year or 500 severely
566 injured admitted patients with an Injury Severity Score of 15 or
567 greater per year plus 40 cases per year for each accredited
568 critical care and trauma surgical subspecialty medical resident
569 or fellow.
571 The Injury Severity Score calculations and caseload volume must
572 be calculated using the most recent available hospital discharge
573 data collected by the agency from all acute care hospitals
574 pursuant to s. 408.061.
575 (e) If the department determines that the hospital is
576 capable of attaining and operating with the components required
577 in paragraph (c), the applicant must be ready to operate in
578 compliance with Florida trauma center standards no later than
579 April 30 of the year following the department’s initial review
580 and approval of the hospital’s application to proceed with
581 preparation to operate as a trauma center. A hospital that fails
582 to comply with this subsection may not be designated as a trauma
583 center Notwithstanding other provisions in this section, the
584 department may grant up to an additional 18 months to a hospital
585 applicant that is unable to meet all requirements as provided in
586 paragraph (c) at the time of application if the number of
587 applicants in the service area in which the applicant is located
588 is equal to or less than the service area allocation, as
589 provided by rule of the department. An applicant that is granted
590 additional time pursuant to this paragraph shall submit a plan
591 for departmental approval which includes timelines and
592 activities that the applicant proposes to complete in order to
593 meet application requirements. Any applicant that demonstrates
594 an ongoing effort to complete the activities within the
595 timelines outlined in the plan shall be included in the number
596 of trauma centers at such time that the department has conducted
597 a provisional review of the application and has determined that
598 the application is complete and that the hospital has the
599 critical elements required for a trauma center.
600 2. Timeframes provided in subsections (1)-(8) shall be
601 stayed until the department determines that the application is
602 complete and that the hospital has the critical elements
603 required for a trauma center.
604 (4) (3) By May 1, the department shall select one or more
605 hospitals After April 30, any hospital that submitted an
606 application found acceptable by the department based on initial
607 provisional review for approval to prepare shall be eligible to
608 operate with the components required in paragraph (3)(c). If the
609 department receives more applications than may be approved under
610 the statutory capacity in the specified trauma service area, the
611 department must select the best applicant or applicants from the
612 available pool based on the department’s determination of the
613 capability of an applicant to provide the greatest improvement
614 in access to trauma services and the highest quality patient
615 care using the most recent technological, medical, and staffing
616 resources available. The number of applicants selected is
617 limited to available statutory need in the specified trauma
618 service area, as designated in paragraph (3)(d) or s. 395.402(1)
619 as a provisional trauma center.
620 (5) (4) Following the initial review, Between May 1 and
621 October 1 of each year, the department shall conduct an in-depth
622 evaluation of all applications found acceptable in the initial
623 provisional review. The applications shall be evaluated against
624 criteria enumerated in the application packages as provided to
625 the hospitals by the department. An applicant may not operate as
626 a provisional trauma center until the department completes the
627 initial and in-depth review and approves the application through
628 those review stages.
629 (6) (5) Within Beginning October 1 of each year and ending
630 no later than June 1 of the following year after the hospital
631 begins operating as a provisional trauma center, a review team
632 of out-of-state experts assembled by the department shall make
633 onsite visits to all provisional trauma centers. The department
634 shall develop a survey instrument to be used by the expert team
635 of reviewers. The instrument must shall include objective
636 criteria and guidelines for reviewers based on existing trauma
637 center standards such that all trauma centers are assessed
638 equally. The survey instrument must shall also include a uniform
639 rating system that will be used by reviewers must use to
640 indicate the degree of compliance of each trauma center with
641 specific standards, and to indicate the quality of care provided
642 by each trauma center as determined through an audit of patient
643 charts. In addition, hospitals being considered as provisional
644 trauma centers must shall meet all the requirements of a trauma
645 center and must shall be located in a trauma service area that
646 has a need for such a trauma center.
647 (7) (6) Based on recommendations from the review team, the
648 department shall designate a trauma center that is in compliance
649 with trauma center standards, as established by department rule,
650 and with this section shall select trauma centers by July 1. An
651 applicant for designation as a trauma center may request an
652 extension of its provisional status if it submits a corrective
653 action plan to the department. The corrective action plan must
654 demonstrate the ability of the applicant to correct deficiencies
655 noted during the applicant’s onsite review conducted by the
656 department between the previous October 1 and June 1. The
657 department may extend the provisional status of an applicant for
658 designation as a trauma center through December 31 if the
659 applicant provides a corrective action plan acceptable to the
660 department. The department or a team of out-of-state experts
661 assembled by the department shall conduct an onsite visit on or
662 before November 1 to confirm that the deficiencies have been
663 corrected. The provisional trauma center is responsible for all
664 costs associated with the onsite visit in a manner prescribed by
665 rule of the department. By January 1, the department must
666 approve or deny the application of any provisional applicant
667 granted an extension. Each trauma center shall be granted a 7
668 year approval period during which time it must continue to
669 maintain trauma center standards and acceptable patient outcomes
670 as determined by department rule. An approval, unless sooner
671 suspended or revoked, automatically expires 7 years after the
672 date of issuance and is renewable upon application for renewal
673 as prescribed by rule of the department.
674 (8) (7) Only an applicant, or hospital with an existing
675 trauma center in the same trauma service area or in a trauma
676 service area contiguous to the trauma service area where the
677 applicant has applied to operate a trauma center, may protest a
678 decision made by the department with regard to whether the
679 application should be approved, or whether need has been
680 established through the criteria in paragraph (3)(d) Any
681 hospital that wishes to protest a decision made by the
682 department based o n the department’s preliminary or in-depth
683 review of applications or on the recommendations of the site
684 visit review team pursuant to this section shall proceed as
685 provided in chapter 120. Hearings held under this subsection
686 shall be conducted in the same manner as provided in ss. 120.569
687 and 120.57. Cases filed under chapter 120 may combine all
688 disputes between parties.
689 (9) (8) Notwithstanding any provision of chapter 381, a
690 hospital licensed under ss. 395.001-395.3025 that operates a
691 trauma center may not terminate or substantially reduce the
692 availability of trauma service without providing at least 180
693 days’ notice of its intent to terminate such service. Such
694 notice shall be given to the department, to all affected local
695 or regional trauma agencies, and to all trauma centers,
696 hospitals, and emergency medical service providers in the trauma
697 service area. The department shall adopt by rule the procedures
698 and process for notification, duration, and explanation of the
699 termination of trauma services.
700 (10) (9) Except as otherwise provided in this subsection,
701 the department or its agent may collect trauma care and registry
702 data, as prescribed by rule of the department, from trauma
703 centers, hospitals, emergency medical service providers, local
704 or regional trauma agencies, or medical examiners for the
705 purposes of evaluating trauma system effectiveness, ensuring
706 compliance with the standards, and monitoring patient outcomes.
707 A trauma center, hospital, emergency medical service provider,
708 medical examiner, or local trauma agency or regional trauma
709 agency, or a panel or committee assembled by such an agency
710 under s. 395.50(1) may, but is not required to, disclose to the
711 department patient care quality assurance proceedings, records,
712 or reports. However, the department may require a local trauma
713 agency or a regional trauma agency, or a panel or committee
714 assembled by such an agency to disclose to the department
715 patient care quality assurance proceedings, records, or reports
716 that the department needs solely to conduct quality assurance
717 activities under s. 395.4015, or to ensure compliance with the
718 quality assurance component of the trauma agency’s plan approved
719 under s. 395.401. The patient care quality assurance
720 proceedings, records, or reports that the department may require
721 for these purposes include, but are not limited to, the
722 structure, processes, and procedures of the agency’s quality
723 assurance activities, and any recommendation for improving or
724 modifying the overall trauma system, if the identity of a trauma
725 center, hospital, emergency medical service provider, medical
726 examiner, or an individual who provides trauma services is not
728 (11) (10) Out-of-state experts assembled by the department
729 to conduct onsite visits are agents of the department for the
730 purposes of s. 395.3025. An out-of-state expert who acts as an
731 agent of the department under this subsection is not liable for
732 any civil damages as a result of actions taken by him or her,
733 unless he or she is found to be operating outside the scope of
734 the authority and responsibility assigned by the department.
735 (12) (11) Onsite visits by the department or its agent may
736 be conducted at any reasonable time and may include but not be
737 limited to a review of records in the possession of trauma
738 centers, hospitals, emergency medical service providers, local
739 or regional trauma agencies, or medical examiners regarding the
740 care, transport, treatment, or examination of trauma patients.
741 (13) (12) Patient care, transport, or treatment records or
742 reports, or patient care quality assurance proceedings, records,
743 or reports obtained or made pursuant to this section, s.
744 395.3025(4)(f), s. 395.401, s. 395.4015, s. 395.402, s. 395.403,
745 s. 395.404, s. 395.4045, s. 395.405, s. 395.50, or s. 395.51
746 must be held confidential by the department or its agent and are
747 exempt from the provisions of s. 119.07(1). Patient care quality
748 assurance proceedings, records, or reports obtained or made
749 pursuant to these sections are not subject to discovery or
750 introduction into evidence in any civil or administrative
752 (14) (13) The department may adopt, by rule, the procedures
753 and process by which it will select trauma centers. Such
754 procedures and process must be used in annually selecting trauma
755 centers and must be consistent with subsections (1)-(9) (1)-(8)
756 except in those situations in which it is in the best interest
757 of, and mutually agreed to by, all applicants within a service
758 area and the department to reduce the timeframes.
759 (15) (14) Notwithstanding the procedures established
760 pursuant to subsections (1) through (14) (13), hospitals located
761 in areas with limited access to trauma center services shall be
762 designated by the department as Level II trauma centers based on
763 documentation of a valid certificate of trauma center
764 verification from the American College of Surgeons. Areas with
765 limited access to trauma center services are defined by the
766 following criteria:
767 (a) The hospital is located in a trauma service area with a
768 population greater than 600,000 persons but a population density
769 of less than 225 persons per square mile;
770 (b) The hospital is located in a county with no verified
771 trauma center; and
772 (c) The hospital is located at least 15 miles or 20 minutes
773 travel time by ground transport from the nearest verified trauma
775 (16)(a) Notwithstanding the statutory capacity limits
776 established in s. 395.402(1), the provisions of subsection (8),
777 or any other provision of this act, an adult Level I trauma
778 center, an adult Level II trauma center, or a pediatric trauma
779 center that was verified by the department before December 15,
780 2017, is deemed to have met the trauma center application and
781 operational requirements of this section and must be verified
782 and designated as a trauma center.
783 (b) Notwithstanding the statutory capacity limits
784 established in s. 395.402(1), the provisions of subsection (8),
785 or any other provision of this act, a trauma center that was not
786 verified by the department before December 15, 2017, but that
787 was provisionally approved by the department to be in
788 substantial compliance with Level II trauma standards before
789 January 1, 2017, and is operating as a Level II trauma center,
790 is deemed to have met the application and operational
791 requirements of this section for a trauma center and must be
792 verified and designated as a Level II trauma center.
793 (c) Notwithstanding the statutory capacity limits
794 established in s. 395.402(1), the provisions of subsection (8),
795 or any other provision of this act, a trauma center that was not
796 verified by the department before December 15, 2017, as a Level
797 I trauma center but that was provisionally approved by the
798 department to be in substantial compliance with Level I trauma
799 standards before January 1, 2017, and is operating as a Level I
800 trauma center is deemed to have met the application and
801 operational requirements of this section for a trauma center and
802 must be verified and designated as a Level I trauma center.
803 (d) Notwithstanding the statutory capacity limits
804 established in s. 395.402(1), the provisions of subsection (8),
805 or any other provision of this act, a trauma center that was not
806 verified by the department before December 15, 2017, as a
807 pediatric trauma center but was provisionally approved by the
808 department to be in substantial compliance with the pediatric
809 trauma standards established by rule before January 1, 2018, and
810 is operating as a pediatric trauma center is deemed to have met
811 the application and operational requirements of this section for
812 a pediatric trauma center and, upon successful completion of the
813 in-depth and site review process, shall be verified and
814 designated as a pediatric trauma center. Notwithstanding the
815 provisions of subsection (8), no existing trauma center in the
816 same trauma service area or in a trauma service area contiguous
817 to the trauma service area where the applicant is located may
818 protest the in-depth review, site survey, or verification
819 decision of the department regarding an applicant that meets the
820 requirements of this paragraph.
821 (e) Notwithstanding the statutory capacity limits
822 established in s. 395.402(1) or any other provision of this act,
823 any hospital operating as a Level II trauma center after January
824 1, 2017, must be designated and verified by the department as a
825 Level II trauma center if all of the following apply:
826 1. The hospital was provisionally approved after January 1,
827 2017, to operate as a Level II trauma center, and was in
828 operation on or before January 1, 2018;
829 2. The department’s decision to approve the hospital to
830 operate a provisional Level II trauma center was in litigation
831 on or before January 1, 2018;
832 3. The hospital receives a recommended order from the
833 Division of Administrative Hearings, a final order from the
834 department, or an order from a court of competent jurisdiction
835 that it was entitled to be designated and verified as a Level II
836 trauma center; and
837 4. The department determines that the hospital is in
838 substantial compliance with the Level II trauma center
839 standards, including the in-depth and site reviews.
841 Any provisional trauma center operating under this paragraph may
842 not be required to cease trauma operations unless a court of
843 competent jurisdiction or the department determines that it has
844 failed to meet the trauma center standards, as established by
845 department rule.
846 (f) Nothing in this subsection shall limit the department’s
847 authority to review and approve trauma center applications.
848 Section 7. Section 395.403, Florida Statutes, is amended to
850 395.403 Reimbursement of trauma centers.—
851 (1) All verified trauma centers shall be considered
852 eligible to receive state funding when state funds are
853 specifically appropriated for state-sponsored trauma centers in
854 the General Appropriations Act. Effective July 1, 2010, the
855 department shall make payments from the Emergency Medical
856 Services Trust Fund under s. 20.435 to the trauma centers.
857 Payments shall be in equal amounts for the trauma centers
858 approved by the department as of July 1 of the fiscal year in
859 which funding is appropriated. In the event a trauma center does
860 not maintain its status as a trauma center for any state fiscal
861 year in which such funding is appropriated, the trauma center
862 shall repay the state for the portion of the year during which
863 it was not a trauma center.
864 (2) Trauma centers eligible to receive distributions from
865 the Emergency Medical Services Trust Fund under s. 20.435 in
866 accordance with subsection (1) may request that such funds be
867 used as intergovernmental transfer funds in the Medicaid
869 (3) In order to receive state funding, a hospital must
870 shall be a verified trauma center and shall:
871 (a) Agree to conform to all departmental requirements as
872 provided by rule to assure high-quality trauma services.
873 (b) Agree to report trauma data to the National Trauma Data
874 Bank provide information concerning the provision of trauma
875 services to the department, in a form and manner prescribed by
876 rule of the department.
877 (c) Agree to accept all trauma patients, regardless of
878 ability to pay, on a functional space-available basis.
879 (4) A trauma center that fails to comply with any of the
880 conditions listed in subsection (3) or the applicable rules of
881 the department may shall not receive payments under this section
882 for the period in which it was not in compliance.
883 Section 8. Section 395.4036, Florida Statutes, is amended
884 to read:
885 395.4036 Trauma payments.—
886 (1) Recognizing the Legislature’s stated intent to provide
887 financial support to the current verified trauma centers and to
888 provide incentives for the establishment of additional trauma
889 centers as part of a system of state-sponsored trauma centers,
890 the department shall utilize funds collected under s. 318.18 and
891 deposited into the Emergency Medical Services Trust Fund of the
892 department to ensure the availability and accessibility of
893 trauma services throughout the state as provided in this
895 (a) Funds collected under s. 318.18(15) shall be
896 distributed as follows:
897 1. Twenty percent of the total funds collected during the
898 state fiscal year shall be distributed to verified trauma
899 centers that have a local funding contribution as of December
900 31. Distribution of funds under this subparagraph shall be based
901 on trauma caseload volume for the most recent calendar year
903 2. Forty percent of the total funds collected shall be
904 distributed to verified trauma centers based on trauma caseload
905 volume for the most recent calendar year available. The
906 determination of caseload volume for distribution of funds under
907 this subparagraph shall be based on the agency hospital
908 discharge data reported by each trauma center pursuant to s.
909 408.061 and meeting the criteria for classification as a trauma
910 patient department’s Trauma Registry data.
911 3. Forty percent of the total funds collected shall be
912 distributed to verified trauma centers based on severity of
913 trauma patients for the most recent calendar year available. The
914 determination of severity for distribution of funds under this
915 subparagraph shall be based on the department’s International
916 Classification Injury Severity Scores or another statistically
917 valid and scientifically accepted method of stratifying a trauma
918 patient’s severity of injury, risk of mortality, and resource
919 consumption as adopted by the department by rule, weighted based
920 on the costs associated with and incurred by the trauma center
921 in treating trauma patients. The weighting of scores shall be
922 established by the department by rule.
923 (b) Funds collected under s. 318.18(5)(c) and (20) shall be
924 distributed as follows:
925 1. Thirty percent of the total funds collected shall be
926 distributed to Level II trauma centers operated by a public
927 hospital governed by an elected board of directors as of
928 December 31, 2008.
929 2. Thirty-five percent of the total funds collected shall
930 be distributed to verified trauma centers based on trauma
931 caseload volume for the most recent calendar year available. The
932 determination of caseload volume for distribution of funds under
933 this subparagraph shall be based on the hospital discharge data
934 reported by each trauma center pursuant to s. 408.061 and
935 meeting the criteria for classification as a trauma patient
936 department’s Trauma Registry data.
937 3. Thirty-five percent of the total funds collected shall
938 be distributed to verified trauma centers based on severity of
939 trauma patients for the most recent calendar year available. The
940 determination of severity for distribution of funds under this
941 subparagraph shall be based on the department’s International
942 Classification Injury Severity Scores or another statistically
943 valid and scientifically accepted method of stratifying a trauma
944 patient’s severity of injury, risk of mortality, and resource
945 consumption as adopted by the department by rule, weighted based
946 on the costs associated with and incurred by the trauma center
947 in treating trauma patients. The weighting of scores shall be
948 established by the department by rule.
949 (2) Funds deposited in the department’s Emergency Medical
950 Services Trust Fund for verified trauma centers may be used to
951 maximize the receipt of federal funds that may be available for
952 such trauma centers. Notwithstanding this section and s. 318.14,
953 distributions to trauma centers may be adjusted in a manner to
954 ensure that total payments to trauma centers represent the same
955 proportional allocation as set forth in this section and s.
956 318.14. For purposes of this section and s. 318.14, total funds
957 distributed to trauma centers may include revenue from the
958 Emergency Medical Services Trust Fund and federal funds for
959 which revenue from the Administrative Trust Fund is used to meet
960 state or local matching requirements. Funds collected under ss.
961 318.14 and 318.18 and deposited in the Emergency Medical
962 Services Trust Fund of the department shall be distributed to
963 trauma centers on a quarterly basis using the most recent
964 calendar year data available. Such data shall not be used for
965 more than four quarterly distributions unless there are
966 extenuating circumstances as determined by the department, in
967 which case the most recent calendar year data available shall
968 continue to be used and appropriate adjustments shall be made as
969 soon as the more recent data becomes available.
970 (3)(a) Any trauma center not subject to audit pursuant to
971 s. 215.97 shall annually attest, under penalties of perjury,
972 that such proceeds were used in compliance with law. The annual
973 attestation shall be made in a form and format determined by the
974 department. The annual attestation shall be submitted to the
975 department for review within 9 months after the end of the
976 organization’s fiscal year.
977 (b) Any trauma center subject to audit pursuant to s.
978 215.97 shall submit an audit report in accordance with rules
979 adopted by the Auditor General.
980 (4) The department, working with the Agency for Health Care
981 Administration, shall maximize resources for trauma services
982 wherever possible.
983 Section 9. Section 395.404, Florida Statutes, is amended to
985 395.404 Reporting Review of trauma registry data; report to
986 National Trauma Data Bank central registry ; confidentiality and
987 limited release.—
988 (1) (a) Each trauma center shall participate in the National
989 Trauma Data Bank, and the department shall solely use the
990 National Trauma Data Bank for quality and assessment purposes.
991 (2) Each trauma center and acute care hospital shall report
992 to the department all transfers of trauma patients and the
993 outcomes of such patients furnish, and, upon request of the
994 department, all acute care hospitals shall furnish for
995 department review trauma registry data as prescribed by rule of
996 the department for the purpose of monitoring patient outcome and
997 ensuring compliance with the standards of approval.
998 (b) Trauma registry data obtained pursuant to this
999 subsection are confidential and exempt from the provisions of s.
1000 119.07(1) and s. 24(a), Art. I of the State Constitution.
1001 However, the department may provide such trauma registry data to
1002 the person, trauma center, hospital, emergency medical service
1003 provider, local or regional trauma agency, medical examiner, or
1004 other entity from which the data were obtained. The department
1005 may also use or provide trauma registry data for purposes of
1006 research in accordance with the provisions of chapter 405.
1007 (3) (2) Each trauma center , pediatric trauma center, and
1008 acute care hospital shall report to the department’s brain and
1009 spinal cord injury central registry, consistent with the
1010 procedures and timeframes of s. 381.74, any person who has a
1011 moderate-to-severe brain or spinal cord injury, and shall
1012 include in the report the name, age, residence, and type of
1013 disability of the individual and any additional information that
1014 the department finds necessary.
1015 Section 10. Paragraph (k) of subsection (1) of section
1016 395.401, Florida Statutes, is amended to read:
1017 395.401 Trauma services system plans; approval of trauma
1018 centers and pediatric trauma centers; procedures; renewal.—
1020 (k) It is unlawful for any hospital or other facility to
1021 hold itself out as a trauma center unless it has been so
1022 verified or designated pursuant to s. 395.4025(15) s.
1024 Section 11. If the provisions of this act relating to s.
1025 395.4025(16), Florida Statutes, are held to be invalid or
1026 inoperative for any reason, the remaining provisions of this act
1027 shall be deemed to be void and of no effect, it being the
1028 legislative intent that this act as a whole would not have been
1029 adopted had any provision of the act not been included.
1030 Section 12. This act shall take effect July 1, 2018.