Florida Senate - 2018                        COMMITTEE AMENDMENT
       Bill No. SB 434
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       Appropriations Subcommittee on Health and Human Services
       (Passidomo) recommended the following:
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 409.9134, Florida Statutes, is created
    6  to read:
    7         409.9134Pilot project for the treatment of infants with
    8  neonatal abstinence syndrome.—
    9         (1)For purposes of this section, the term:
   10         (a)“Infant” includes both a newborn and an infant, as
   11  those terms are defined in s. 383.145.
   12         (b)“Neonatal abstinence syndrome” means the postnatal
   13  opioid withdrawal experienced by an infant who is exposed in
   14  utero to opioids or agents used to treat maternal opioid
   15  addiction.
   16         (c) “Stabilized” means that, within reasonable medical
   17  probability, no material deterioration of the infant’s condition
   18  is likely to result from, or occur during, the transfer of the
   19  infant from the hospital to a facility licensed under this
   20  section for ongoing treatment as provided in this section.
   21         (2)The Agency for Health Care Administration, in
   22  consultation with the department, shall establish a pilot
   23  project to license one or more facilities in the state to treat
   24  infants who suffer from neonatal abstinence syndrome, providing
   25  a community-based care option, rather than hospitalization,
   26  after an infant has been stabilized. The pilot project shall
   27  begin on January 1, 2019, and expire on June 30, 2021.
   28         (3)The agency, in consultation with the department, shall
   29  adopt by rule minimum licensure standards for facilities
   30  licensed to provide care under this section.
   31         (a)Licensure standards adopted by the agency must include,
   32  at a minimum:
   33         1.Requirements for the physical plant and maintenance of
   34  facilities;
   35         2.Compliance with local building and firesafety codes;
   36         3.The number, training, and qualifications of essential
   37  personnel employed by and working under contract with the
   38  facility;
   39         4.Staffing requirements intended to ensure adequate
   40  staffing to protect the safety of infants being treated in the
   41  facility;
   42         5.Sanitation requirements for the facility;
   43         6.Requirements for programs, basic services, and care
   44  provided to infants treated by the facility and to their
   45  parents;
   46         7.Requirements for the maintenance of medical records,
   47  data, and other relevant information related to infants treated
   48  by the facility; and
   49         8.Requirements for application for initial licensure and
   50  licensure renewal.
   51         (b)The agency may establish by rule an initial licensure
   52  fee and a biennial renewal fee, each not to exceed $3,000.
   53         (4)In order to obtain a license and participate in the
   54  pilot project, a facility must, at a minimum:
   55         (a)Be a private, nonprofit Florida corporation;
   56         (b)Have an on-call medical director;
   57         (c)Adhere to all applicable standards established by the
   58  agency by rule pursuant to subsection (3); and
   59         (d)Provide the agency with a plan to:
   60         1.Provide 24-hour nursing and nurturing care to infants
   61  with neonatal abstinence syndrome;
   62         2.Provide for the medical needs of an infant being treated
   63  at the facility, including, but not limited to, pharmacotherapy
   64  and nutrition management;
   65         3.Maintain a transfer agreement with a nearby hospital
   66  that is not more than a 30-minute drive from the licensed
   67  facility;
   68         4.Provide comfortable, residential-type accommodations for
   69  an eligible mother to breastfeed her infant or to reside at the
   70  facility while her infant is being treated at that facility, if
   71  not contraindicated and if funding is available for residential
   72  services for the mother;
   73         5.Provide or make available parenting education,
   74  breastfeeding education, counseling, and other resources to the
   75  parents of infants being treated at the facility, including, if
   76  necessary, a referral for addiction treatment services;
   77         6.Contract and coordinate with Medicaid managed medical
   78  assistance plans as appropriate to ensure that services for both
   79  the infant and the parent or the infant’s representative are
   80  timely and unduplicated;
   81         7.Identify, and refer parents to, social service
   82  providers, such as Healthy Start or the MomCare network, Healthy
   83  Families, Early Steps, and Head Start programs, before
   84  discharge, if appropriate; and
   85         8.Apply to enroll as a Medicaid provider by no later than
   86  30 days after receiving a license.
   87         (5)A facility licensed under this section may not accept
   88  an infant for treatment if the infant has a serious or life
   89  threatening condition other than neonatal abstinence syndrome.
   90         (6)A facility licensed under this section may not treat an
   91  infant for longer than 6 months.
   92         (7)The facility may require the mother or visitors to
   93  vacate the facility at any time if:
   94         (a)The facility requests that the mother’s breast milk be
   95  tested for contaminants and she refuses to allow her breast milk
   96  to be tested;
   97         (b)The facility requests that the mother be drug tested
   98  and the mother refuses to consent to a drug test;
   99         (c)The facility determines that the mother poses a risk to
  100  her infant; or
  101         (d)The facility determines that the mother or a visitor is
  102  threatening, intimidating, or posing a risk to any infant in the
  103  facility, any other mother or visitor in the facility, or
  104  facility staff.
  106  If the facility requires the mother or other visitor to vacate
  107  its premises, a licensed health care professional who is an
  108  employee or contracted staff at the facility may refuse to allow
  109  the mother, parent, caregiver, or legal custodian to remove the
  110  infant from the facility and may detain the infant at the
  111  facility pursuant to s. 39.395, if the provisions of that
  112  section are met.
  113         (8)The agency shall require each licensed facility to meet
  114  and maintain the representations made in the facility’s plan
  115  submitted for licensure pursuant to paragraph (4)(d) or
  116  substantially similar provisions that do not degrade the
  117  facility’s ability to provide the same level of service. The
  118  agency shall require level 2 background screening pursuant to
  119  chapter 435 and s. 408.809 for facility personnel as required in
  120  s. 408.809(1)(e).
  121         (9)Facilities licensed under this section are subject to
  122  part II of chapter 408.
  123         (10)Facilities licensed under this section are not
  124  required to obtain a certificate of need.
  125         (11)(a)The Department of Health shall contract with a
  126  state university to study the risks, benefits, cost
  127  differentials, and the transition of infants to the social
  128  service providers identified in paragraph (4)(d) for the
  129  treatment of infants with neonatal abstinence syndrome in
  130  hospital settings and facilities licensed under the pilot
  131  project. By June 30, 2020, the Department of Health shall report
  132  to the President of the Senate and the Speaker of the House of
  133  Representatives the study results and recommendations for the
  134  continuation or expansion of the pilot project.
  135         (b)The contract must also require the establishment of
  136  baseline data for longitudinal studies on the neurodevelopmental
  137  outcomes of infants with neonatal abstinence syndrome, and may
  138  require the evaluation of outcomes and length of stay in
  139  facilities for nonpharmacologic and pharmacologic treatment of
  140  neonatal abstinence syndrome.
  141         (c)Facilities licensed under this section, licensed
  142  hospitals providing services for infants born with neonatal
  143  abstinence syndrome, and Medicaid managed medical assistance
  144  plans shall provide relevant financial and medical data
  145  consistent with the Health Insurance Portability and
  146  Accountability Act of 1996 (HIPAA) and related regulations to
  147  the contracted university for research and studies authorized
  148  pursuant to this subsection.
  149         Section 2. Upon this act becoming law, the Agency for
  150  Health Care Administration shall begin the process of adopting
  151  rules pursuant to s. 409.9134, Florida Statutes, and shall begin
  152  the process of applying for any Medicaid waivers, or other
  153  similar permissions, necessary to ensure that facilities
  154  licensed pursuant to s. 409.9134, Florida Statutes, are able to
  155  enroll as providers in the Medicaid program.
  156         Section 3. For the 2018-2019 fiscal year, the sum of
  157  $200,000 is appropriated from the Health Care Trust Fund to the
  158  Agency for Health Care Administration for the purpose of
  159  implementing s. 409.9134, Florida Statutes.
  160         Section 4. For the 2018-2019 fiscal year, the sum of
  161  $140,000 in nonrecurring funds is appropriated from the Maternal
  162  and Child Health Block Grant Trust Fund to the Department of
  163  Health for the purpose of contracting with a state university to
  164  conduct the study required pursuant to s. 409.9134(11), Florida
  165  Statutes.
  166         Section 5. For the 2019-2020 fiscal year, the sum of
  167  $70,000 in nonrecurring funds is appropriated from the Maternal
  168  and Child Health Block Grant Trust Fund to the Department of
  169  Health for the purpose of completing the study required pursuant
  170  to s. 409.9134(11), Florida Statutes.
  171         Section 6. This act shall take effect upon becoming a law.
  173  ================= T I T L E  A M E N D M E N T ================
  174  And the title is amended as follows:
  175         Delete everything before the enacting clause
  176  and insert:
  177                        A bill to be entitled                      
  178         An act relating to a neonatal abstinence syndrome
  179         pilot project; creating s. 409.9134, F.S.; defining
  180         terms; requiring the Agency for Health Care
  181         Administration, in consultation with the Department of
  182         Children and Families, to establish a pilot project to
  183         license one or more facilities to treat infants who
  184         suffer from neonatal abstinence syndrome in certain
  185         circumstances; providing a start and end date for the
  186         pilot project; requiring the agency, in consultation
  187         with the department, to adopt by rule minimum
  188         licensure standards for facilities providing care
  189         under this section; requiring certain criteria to be
  190         included in licensure standards; authorizing the
  191         agency to establish by rule an initial licensure fee
  192         and a biennial renewal fee; establishing minimum
  193         requirements for a facility to obtain and maintain
  194         licensure and to participate in the pilot project;
  195         prohibiting a facility licensed under this section
  196         from accepting certain infants for treatment or from
  197         treating an infant for longer than 6 months;
  198         specifying when a facility may require a mother or
  199         visitor to vacate its premises; allowing certain
  200         health care professionals to prevent the removal of an
  201         infant from the facility under certain conditions;
  202         requiring background screening of certain facility
  203         personnel; subjecting facilities licensed under this
  204         section to specified licensing requirements; providing
  205         that facilities licensed under this section are not
  206         required to obtain a certificate of need; requiring
  207         the Department of Health to contract with a state
  208         university to study certain components of the pilot
  209         project and establish certain baseline data for
  210         studies on the neurodevelopmental outcomes of infants
  211         with neonatal abstinence syndrome; requiring the
  212         Department of Health to report results of the study to
  213         the Legislature by a certain date; requiring
  214         facilities licensed under this section, hospitals
  215         meeting certain criteria, and Medicaid managed medical
  216         assistance plans to provide to the contracted
  217         university relevant financial and medical data meeting
  218         certain standards, under certain conditions; requiring
  219         the agency to begin rulemaking and apply for certain
  220         Medicaid waivers after the act becomes a law;
  221         providing specific appropriations; providing an
  222         effective date.