Florida Senate - 2018 PROPOSED COMMITTEE SUBSTITUTE Bill No. SB 434 Ì584374=Î584374 576-01834-18 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 a neonatal abstinence syndrome 3 pilot project; creating s. 409.9134, F.S.; defining 4 terms; requiring the Agency for Health Care 5 Administration, in consultation with the Department of 6 Children and Families, to establish a pilot project to 7 license one or more facilities to treat infants who 8 suffer from neonatal abstinence syndrome in certain 9 circumstances; providing a start and end date for the 10 pilot project; requiring the agency, in consultation 11 with the department, to adopt by rule minimum 12 licensure standards for facilities providing care 13 under this section; requiring certain criteria to be 14 included in licensure standards; authorizing the 15 agency to establish by rule an initial licensure fee 16 and a biennial renewal fee; establishing minimum 17 requirements for a facility to obtain and maintain 18 licensure and to participate in the pilot project; 19 prohibiting a facility licensed under this section 20 from accepting certain infants for treatment or from 21 treating an infant for longer than 6 months; 22 specifying when a facility may require a mother or 23 visitor to vacate its premises; allowing certain 24 health care professionals to prevent the removal of an 25 infant from the facility under certain conditions; 26 requiring background screening of certain facility 27 personnel; subjecting facilities licensed under this 28 section to specified licensing requirements; providing 29 that facilities licensed under this section are not 30 required to obtain a certificate of need; requiring 31 the Department of Health to contract with a state 32 university to study certain components of the pilot 33 project and establish certain baseline data for 34 studies on the neurodevelopmental outcomes of infants 35 with neonatal abstinence syndrome; requiring the 36 Department of Health to report results of the study to 37 the Legislature by a certain date; requiring 38 facilities licensed under this section, hospitals 39 meeting certain criteria, and Medicaid managed medical 40 assistance plans to provide to the contracted 41 university relevant financial and medical data meeting 42 certain standards, under certain conditions; requiring 43 the agency to begin rulemaking and apply for certain 44 Medicaid waivers after the act becomes a law; 45 providing specific appropriations; providing an 46 effective date. 47 48 Be It Enacted by the Legislature of the State of Florida: 49 50 Section 1. Section 409.9134, Florida Statutes, is created 51 to read: 52 409.9134 Pilot project for the treatment of infants with 53 neonatal abstinence syndrome.— 54 (1) For purposes of this section, the term: 55 (a) “Infant” includes both a newborn and an infant, as 56 those terms are defined in s. 383.145. 57 (b) “Neonatal abstinence syndrome” means the postnatal 58 opioid withdrawal experienced by an infant who is exposed in 59 utero to opioids or agents used to treat maternal opioid 60 addiction. 61 (c) “Stabilized” means that, within reasonable medical 62 probability, no material deterioration of the infant’s condition 63 is likely to result from, or occur during, the transfer of the 64 infant from the hospital to a facility licensed under this 65 section for ongoing treatment as provided in this section. 66 (2) The Agency for Health Care Administration, in 67 consultation with the department, shall establish a pilot 68 project to license one or more facilities in the state to treat 69 infants who suffer from neonatal abstinence syndrome, providing 70 a community-based care option, rather than hospitalization, 71 after an infant has been stabilized. The pilot project shall 72 begin on January 1, 2019, and expire on June 30, 2021. 73 (3) The agency, in consultation with the department, shall 74 adopt by rule minimum licensure standards for facilities 75 licensed to provide care under this section. 76 (a) Licensure standards adopted by the agency must include, 77 at a minimum: 78 1. Requirements for the physical plant and maintenance of 79 facilities; 80 2. Compliance with local building and firesafety codes; 81 3. The number, training, and qualifications of essential 82 personnel employed by and working under contract with the 83 facility; 84 4. Staffing requirements intended to ensure adequate 85 staffing to protect the safety of infants being treated in the 86 facility; 87 5. Sanitation requirements for the facility; 88 6. Requirements for programs, basic services, and care 89 provided to infants treated by the facility and to their 90 parents; 91 7. Requirements for the maintenance of medical records, 92 data, and other relevant information related to infants treated 93 by the facility; and 94 8. Requirements for application for initial licensure and 95 licensure renewal. 96 (b) The agency may establish by rule an initial licensure 97 fee and a biennial renewal fee, each not to exceed $3,000. 98 (4) In order to obtain a license and participate in the 99 pilot project, a facility must, at a minimum: 100 (a) Be a private, nonprofit Florida corporation; 101 (b) Have an on-call medical director; 102 (c) Adhere to all applicable standards established by the 103 agency by rule pursuant to subsection (3); and 104 (d) Provide the agency with a plan to: 105 1. Provide 24-hour nursing and nurturing care to infants 106 with neonatal abstinence syndrome; 107 2. Provide for the medical needs of an infant being treated 108 at the facility, including, but not limited to, pharmacotherapy 109 and nutrition management; 110 3. Maintain a transfer agreement with a nearby hospital 111 that is not more than a 30-minute drive from the licensed 112 facility; 113 4. Provide comfortable, residential-type accommodations for 114 an eligible mother to breastfeed her infant or to reside at the 115 facility while her infant is being treated at that facility, if 116 not contraindicated and if funding is available for residential 117 services for the mother; 118 5. Provide or make available parenting education, 119 breastfeeding education, counseling, and other resources to the 120 parents of infants being treated at the facility, including, if 121 necessary, a referral for addiction treatment services; 122 6. Contract and coordinate with Medicaid managed medical 123 assistance plans as appropriate to ensure that services for both 124 the infant and the parent or the infant’s representative are 125 timely and unduplicated; 126 7. Identify, and refer parents to, social service 127 providers, such as Healthy Start or the MomCare network, Healthy 128 Families, Early Steps, and Head Start programs, before 129 discharge, if appropriate; and 130 8. Apply to enroll as a Medicaid provider by no later than 131 30 days after receiving a license. 132 (5) A facility licensed under this section may not accept 133 an infant for treatment if the infant has a serious or life 134 threatening condition other than neonatal abstinence syndrome. 135 (6) A facility licensed under this section may not treat an 136 infant for longer than 6 months. 137 (7) The facility may require the mother or visitors to 138 vacate the facility at any time if: 139 (a) The facility requests that the mother’s breast milk be 140 tested for contaminants and she refuses to allow her breast milk 141 to be tested; 142 (b) The facility requests that the mother be drug tested 143 and the mother refuses to consent to a drug test; 144 (c) The facility determines that the mother poses a risk to 145 her infant; or 146 (d) The facility determines that the mother or a visitor is 147 threatening, intimidating, or posing a risk to any infant in the 148 facility, any other mother or visitor in the facility, or 149 facility staff. 150 151 If the facility requires the mother or other visitor to vacate 152 its premises, a licensed health care professional who is an 153 employee or contracted staff at the facility may refuse to allow 154 the mother, parent, caregiver, or legal custodian to remove the 155 infant from the facility and may detain the infant at the 156 facility pursuant to s. 39.395, if the provisions of that 157 section are met. 158 (8) The agency shall require each licensed facility to meet 159 and maintain the representations made in the facility’s plan 160 submitted for licensure pursuant to paragraph (4)(d) or 161 substantially similar provisions that do not degrade the 162 facility’s ability to provide the same level of service. The 163 agency shall require level 2 background screening pursuant to 164 chapter 435 and s. 408.809 for facility personnel as required in 165 s. 408.809(1)(e). 166 (9) Facilities licensed under this section are subject to 167 part II of chapter 408. 168 (10) Facilities licensed under this section are not 169 required to obtain a certificate of need. 170 (11)(a) The Department of Health shall contract with a 171 state university to study the risks, benefits, cost 172 differentials, and the transition of infants to the social 173 service providers identified in paragraph (4)(d) for the 174 treatment of infants with neonatal abstinence syndrome in 175 hospital settings and facilities licensed under the pilot 176 project. By June 30, 2020, the Department of Health shall report 177 to the President of the Senate and the Speaker of the House of 178 Representatives the study results and recommendations for the 179 continuation or expansion of the pilot project. 180 (b) The contract must also require the establishment of 181 baseline data for longitudinal studies on the neurodevelopmental 182 outcomes of infants with neonatal abstinence syndrome, and may 183 require the evaluation of outcomes and length of stay in 184 facilities for nonpharmacologic and pharmacologic treatment of 185 neonatal abstinence syndrome. 186 (c) Facilities licensed under this section, licensed 187 hospitals providing services for infants born with neonatal 188 abstinence syndrome, and Medicaid managed medical assistance 189 plans shall provide relevant financial and medical data 190 consistent with the Health Insurance Portability and 191 Accountability Act of 1996 (HIPAA) and related regulations to 192 the contracted university for research and studies authorized 193 pursuant to this subsection. 194 Section 2. Upon this act becoming law, the Agency for 195 Health Care Administration shall begin the process of adopting 196 rules pursuant to s. 409.9134, Florida Statutes, and shall begin 197 the process of applying for any Medicaid waivers, or other 198 similar permissions, necessary to ensure that facilities 199 licensed pursuant to s. 409.9134, Florida Statutes, are able to 200 enroll as providers in the Medicaid program. 201 Section 3. For the 2018-2019 fiscal year, the sum of 202 $200,000 is appropriated from the Health Care Trust Fund to the 203 Agency for Health Care Administration for the purpose of 204 implementing s. 409.9134, Florida Statutes. 205 Section 4. For the 2018-2019 fiscal year, the sum of 206 $140,000 in nonrecurring funds is appropriated from the Maternal 207 and Child Health Block Grant Trust Fund to the Department of 208 Health for the purpose of contracting with a state university to 209 conduct the study required pursuant to s. 409.9134(11), Florida 210 Statutes. 211 Section 5. For the 2019-2020 fiscal year, the sum of 212 $70,000 in nonrecurring funds is appropriated from the Maternal 213 and Child Health Block Grant Trust Fund to the Department of 214 Health for the purpose of completing the study required pursuant 215 to s. 409.9134(11), Florida Statutes. 216 Section 6. This act shall take effect upon becoming a law.