Florida Senate - 2018                        COMMITTEE AMENDMENT
       Bill No. PCS (584374) for SB 434
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  02/01/2018           .                                

       The Committee on Appropriations (Passidomo) recommended the
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsections (1) and (6) of section 400.902,
    6  Florida Statutes, are amended to read:
    7         400.902 Definitions.—As used in this part, the term:
    8         (1) “Prescribed pediatric extended care center,”
    9  hereinafter referred to as a “PPEC center,” means any building
   10  or buildings, or other place, whether operated for profit or
   11  not, which undertakes through its ownership or management to
   12  provide:
   13         (a) Basic nonresidential services to three or more
   14  medically dependent or technologically dependent children who
   15  are not related to the owner or operator by blood, marriage, or
   16  adoption and who require such services; or
   17         (b) Residential services to infants with neonatal
   18  abstinence syndrome as described in s. 400.917.
   20  To be Infants and children considered for admission to a PPEC
   21  center, infants and children must have complex medical
   22  conditions that require continual care. Prerequisites for
   23  admission are a prescription from the child’s attending
   24  physician and consent of a parent or guardian. For the purpose
   25  of providing treatment for infants with neonatal abstinence
   26  syndrome pursuant to s. 400.917, the sole prerequisite for
   27  admission is a transfer order from the infant’s attending
   28  physician at the hospital.
   29         (6) “Medically dependent or technologically dependent
   30  child” means a child who because of a medical condition requires
   31  continuous therapeutic interventions or skilled nursing
   32  supervision which must be prescribed by a licensed physician and
   33  administered by, or under the direct supervision of, a licensed
   34  registered nurse. The term includes infants diagnosed with
   35  neonatal abstinence syndrome, as defined in s. 400.917.
   36         Section 2. Paragraph (a) of subsection (2) of section
   37  400.914, Florida Statutes, is amended to read:
   38         400.914 Rules establishing standards.—
   39         (2) The agency shall adopt rules to ensure that:
   40         (a) Except as provided in s. 400.917, no child attends a
   41  PPEC center for more than 12 hours within a 24-hour period.
   42         Section 3. Section 400.917, Florida Statutes, is created to
   43  read:
   44         400.917 Pilot project for the treatment of infants with
   45  neonatal abstinence syndrome.—
   46         (1)For purposes of this section, the term:
   47         (a)“Eligible” means an infant who:
   48         1.Has a gestational age or a corrected age (gestational
   49  age plus chronological age) of 37 weeks or greater;
   50         2.Is being treated for neonatal abstinence syndrome as the
   51  primary active diagnosis;
   52         3.If he or she requires pharmacologic therapy, has been
   53  treated through the initial escalation phase of treatment for
   54  signs of neonatal abstinence syndrome, and is in the weaning
   55  phase of management; and
   56         4.Is not taking medications for treatment of any medical
   57  condition other than:
   58         a. Neonatal abstinence syndrome;
   59         b. Any side effects caused by neonatal abstinence syndrome
   60  or its treatment; or
   61         c. Vitamin or mineral deficiencies that are common in
   62  infants.
   63         (b)“Infant” includes both a newborn and an infant, as
   64  those terms are defined in s. 383.145.
   65         (c)“Neonatal abstinence syndrome” means the postnatal
   66  withdrawal symptoms experienced by an infant who is exposed to
   67  opioids in utero or in neonatal hospitalization; agents used to
   68  treat maternal opioid addiction; or to one or more other drugs
   69  including, but not limited to, barbiturates, selective serotonin
   70  re-uptake inhibitors, and benzodiazepines.
   71         (d)“Pharmacologic therapy” means the use of prescribed
   72  medications recognized by the American Academy of Pediatrics to
   73  relieve moderate to severe signs and symptoms of neonatal
   74  abstinence syndrome and to prevent complications common to
   75  neonatal abstinence syndrome.
   76         (e) “Stabilized” means that, within reasonable medical
   77  probability, no material deterioration of the infant’s condition
   78  is likely to result from, or occur during, the transfer of the
   79  infant from the hospital to a facility licensed under this
   80  section for ongoing treatment as provided in this section.
   81         (2)The agency, in consultation with the Department of
   82  Children and Families, shall establish a pilot project to
   83  approve one or more facilities licensed to provide PPEC services
   84  in this state to provide inpatient treatment for eligible
   85  infants. The purpose of the pilot project is to provide a
   86  community-based care option for eligible infants, rather than
   87  hospitalization, after an infant has been stabilized. The pilot
   88  project shall begin on January 1, 2019, and expire on June 30,
   89  2021.
   90         (3)The agency, in consultation with the department, shall
   91  adopt by rule minimum standards for facilities approved to
   92  provide services under this section. Standards adopted by the
   93  agency are in addition to the standards for licensure as a PPEC
   94  center and must include, at a minimum:
   95         (a)Any additional requirements for the physical plant and
   96  facility maintenance, compliance with local building and
   97  firesafety codes, and sanitation requirements as needed to
   98  ensure the safety and wellbeing of infants being treated at the
   99  facility, facility staff, and visitors to the facility;
  100         (b)The number of, and the training and qualifications
  101  required for, essential personnel employed by and working under
  102  contract with the facility, including a requirement that all
  103  clinical staff providing care under this section be certified by
  104  the Neonatal Resuscitation Program;
  105         (c)Staffing requirements intended to ensure adequate
  106  staffing and appropriate medical supervision to protect the
  107  safety of infants being treated in the facility;
  108         (d)Requirements for programs, services, and care provided
  109  to infants treated by the facility and to their parents,
  110  including a requirement that the facility have a policy to
  111  ensure safe medication practices;
  112         (e)Requirements for the maintenance of medical records,
  113  data, and other relevant information related to infants treated
  114  by the facility; and
  115         (f)Requirements for application for approval to provide
  116  the services described by this section.
  117         (4) A PPEC center is not required to obtain a certificate
  118  of need to be approved to provide services under this section.
  119         (5)To be approved to provide services under this section
  120  and to participate in the pilot project, a PPEC center must, at
  121  a minimum:
  122         (a)Be a private, nonprofit Florida corporation;
  123         (b)Have an on-call medical director;
  124         (c)Adhere to all applicable standards for a PPEC center
  125  and all standards established by the agency by rule pursuant to
  126  subsection (3); and
  127         (d)Provide the agency with a plan to:
  128         1.Provide 24-hour nursing and nurturing care to infants
  129  with neonatal abstinence syndrome;
  130         2.Provide for the medical needs of an infant being treated
  131  at the facility, including, but not limited to, pharmacologic
  132  therapy and nutrition management;
  133         3.Maintain a transfer agreement with a hospital that is
  134  not more than a 30-minute drive from the licensed facility;
  135         4.Provide comfortable, safe, residential-type
  136  accommodations that encourage a mother to breastfeed her infant
  137  or to reside at the facility while her infant is being treated
  138  at that facility, if not contraindicated and if funding is
  139  available for residential services for the mother;
  140         5.Provide or make available parenting education,
  141  breastfeeding education, counseling, and other resources to the
  142  parents of infants being treated at the facility, including, if
  143  necessary, a referral for addiction treatment services;
  144         6.Contract and coordinate with Medicaid managed medical
  145  assistance plans as appropriate to ensure that services for both
  146  the infant and the parent or the infant’s representative are
  147  timely and unduplicated;
  148         7.Identify, and refer parents to, social service providers
  149  such as Healthy Start or the MomCare network, Healthy Families,
  150  Early Steps, and Head Start programs, before discharge, if
  151  appropriate; and
  152         8.Become a Medicaid provider, if the PPEC center is not
  153  already a Medicaid provider.
  154         (6)A PPEC center approved under this section may not
  155  accept an infant for treatment if the infant is not eligible or
  156  if the infant has a serious or life-threatening condition other
  157  than neonatal abstinence syndrome.
  158         (7)A PPEC center approved under this section may not treat
  159  an infant for longer than 6 months.
  160         (8)A PPEC center approved under this section may require
  161  the mother or visitors to vacate the facility at any time if:
  162         (a)The facility requests that the mother’s breast milk be
  163  tested for contaminants and she refuses to allow her breast milk
  164  to be tested or the breast milk tests positive for one or more
  165  nonprescription medications;
  166         (b)The facility requests that the mother be drug tested
  167  and the mother refuses to consent to a drug test or the mother
  168  tests positive for one or more nonprescription medications;
  169         (c)The facility determines that the mother poses a risk to
  170  her infant; or
  171         (d)The facility determines that the mother or a visitor is
  172  threatening, intimidating, or posing a risk to any infant in the
  173  facility, any other mother or visitor in the facility, or
  174  facility staff.
  176  If the facility requires the mother or other visitor to vacate
  177  its premises, a licensed health care professional who is an
  178  employee or contracted staff at the facility may refuse to allow
  179  the mother, parent, caregiver, or legal custodian to remove the
  180  infant from the facility and may detain the infant at the
  181  facility pursuant to s. 39.395, if the provisions of that
  182  section are met.
  183         (9)The agency shall require each PPEC center approved
  184  under this section to meet and maintain the representations made
  185  in the facility’s plan submitted for approval pursuant to
  186  paragraph (5)(d) or substantially similar provisions that do not
  187  degrade the facility’s ability to provide the same level of
  188  service.
  189         (10)(a)The Department of Health shall contract with a
  190  state university to study the risks, benefits, cost
  191  differentials, and the transition of infants to the social
  192  service providers identified in subparagraph (5)(d)7. for the
  193  treatment of infants with neonatal abstinence syndrome in
  194  hospital settings and PPEC centers approved under this section.
  195  By June 30, 2020, the Department of Health shall report to the
  196  President of the Senate and the Speaker of the House of
  197  Representatives the study results and recommendations regarding
  198  the continuation or expansion of the pilot project.
  199         (b)The contract must also require the establishment of
  200  baseline data for longitudinal studies on the neurodevelopmental
  201  outcomes of infants with neonatal abstinence syndrome, and may
  202  require the evaluation of outcomes and length of stay in
  203  facilities for nonpharmacologic and pharmacologic therapy for
  204  neonatal abstinence syndrome.
  205         (c)PPEC centers approved under this section, licensed
  206  hospitals providing services for infants born with neonatal
  207  abstinence syndrome, and Medicaid managed medical assistance
  208  plans shall provide relevant financial and medical data
  209  consistent with the Health Insurance Portability and
  210  Accountability Act of 1996 (HIPAA) and related regulations to
  211  the contracted university for research and studies authorized
  212  pursuant to this subsection.
  213         Section 4. Upon this act becoming law, the Agency for
  214  Health Care Administration shall begin the process of adopting
  215  rules pursuant to s. 400.917, Florida Statutes, and shall begin
  216  the process of applying for any Medicaid waivers or other
  217  similar permissions necessary to ensure that PPEC centers that
  218  provide care to eligible infants under s. 400.917, Florida
  219  Statutes, are eligible for Medicaid reimbursement for such care.
  220         Section 5. For the 2018-2019 fiscal year, the sum of
  221  $200,000 is appropriated from the Health Care Trust Fund to the
  222  Agency for Health Care Administration for the purpose of
  223  implementing s. 400.917, Florida Statutes.
  224         Section 6. For the 2018-2019 fiscal year, the sum of
  225  $140,000 in nonrecurring funds is appropriated from the Maternal
  226  and Child Health Block Grant Trust Fund to the Department of
  227  Health for the purpose of contracting with a state university to
  228  conduct the study required pursuant to s. 400.917(10), Florida
  229  Statutes.
  230         Section 7. For the 2019-2020 fiscal year, the sum of
  231  $70,000 in nonrecurring funds is appropriated from the Maternal
  232  and Child Health Block Grant Trust Fund to the Department of
  233  Health for the purpose of completing the study required pursuant
  234  to s. 400.917(10), Florida Statutes.
  235         Section 8. This act shall take effect upon becoming a law.
  238  ================= T I T L E  A M E N D M E N T ================
  239  And the title is amended as follows:
  240         Delete everything before the enacting clause
  241  and insert:
  242                        A bill to be entitled                      
  243         An act relating to a neonatal abstinence syndrome
  244         pilot project; amending s. 400.902, F.S.; revising the
  245         definition of the term “prescribed pediatric extended
  246         care center” or “PPEC center” to include certain
  247         buildings that provide certain residential services to
  248         infants with neonatal abstinence syndrome;
  249         establishing a prerequisite for the admission of an
  250         infant with neonatal abstinence syndrome to a PPEC
  251         center; expanding the definition of the term
  252         “medically dependent or technologically dependent
  253         child” to include certain infants diagnosed with
  254         neonatal abstinence syndrome; amending s. 400.914,
  255         F.S.; providing that a specified Agency for Health
  256         Care Administration rule include an exception for
  257         infants being treated for neonatal abstinence
  258         syndrome; creating s. 400.917, F.S.; defining terms;
  259         requiring the agency, in consultation with the
  260         Department of Children and Families, to establish a
  261         pilot project to approve one or more facilities
  262         licensed to provide PPEC services to treat certain
  263         eligible infants; providing the purpose of the pilot
  264         project; providing a start and end date for the pilot
  265         project; requiring the agency, in consultation with
  266         the department, to adopt by rule minimum standards for
  267         facilities approved to provide certain services to
  268         eligible infants; requiring certain criteria to be
  269         included in such standards; specifying that a PPEC
  270         center is not required to obtain a certificate of need
  271         to be approved to provide services under this section;
  272         establishing minimum requirements for a PPEC center to
  273         be eligible to provide services to eligible infants
  274         and to participate in the pilot project; prohibiting a
  275         PPEC center providing such services from treating an
  276         infant for longer than a specified period of time;
  277         providing that a PPEC center may require a mother or
  278         visitor to vacate its premises under specified
  279         circumstances; allowing certain health care
  280         professionals to prevent the removal of an infant from
  281         the facility under certain circumstances; requiring
  282         the agency to require approved PPEC centers to meet
  283         and maintain representations in the facility’s plan
  284         submitted for approval; requiring the Department of
  285         Health to contract with a state university to study
  286         certain components of the pilot project and establish
  287         certain baseline data for studies on the
  288         neurodevelopmental outcomes of infants with neonatal
  289         abstinence syndrome; requiring the department to
  290         report results of the study to the Legislature by a
  291         certain date; requiring approved PPEC centers,
  292         hospitals meeting certain criteria, and Medicaid
  293         managed medical assistance plans to provide to the
  294         contracted university relevant financial and medical
  295         data consistent with federal law; requiring the agency
  296         to begin rulemaking and to apply for certain Medicaid
  297         waivers after the act becomes a law; providing
  298         appropriations; providing an effective date.