Florida Senate - 2018 COMMITTEE AMENDMENT Bill No. PCS (584374) for SB 434 Ì863290'Î863290 LEGISLATIVE ACTION Senate . House Comm: RCS . 02/01/2018 . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— The Committee on Appropriations (Passidomo) recommended the following: 1 Senate Amendment (with title amendment) 2 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. 19 20 To be
Infants and childrenconsidered 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. 175 176 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. 236 237 238 ================= 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.