Florida Senate - 2018 COMMITTEE AMENDMENT Bill No. SB 434 Ì454658PÎ454658 LEGISLATIVE ACTION Senate . House . . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— Appropriations Subcommittee on Health and Human Services (Passidomo) recommended the following: 1 Senate Amendment (with title amendment) 2 3 Delete everything after the enacting clause 4 and insert: 5 Section 1. Section 409.9134, Florida Statutes, is created 6 to read: 7 409.9134 Pilot 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. 105 106 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. 172 173 ================= 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.