Florida Senate - 2018              PROPOSED COMMITTEE SUBSTITUTE
       Bill No. SB 434
       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.
   48  Be It Enacted by the Legislature of the State of Florida:
   50         Section 1. Section 409.9134, Florida Statutes, is created
   51  to read:
   52         409.9134Pilot 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.
  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.