Florida Senate - 2018 CS for SB 434
By the Committee on Appropriations; and Senators Passidomo,
Book, Young, Hutson, and Campbell
576-02718-18 2018434c1
1 A bill to be entitled
2 An act relating to a neonatal abstinence syndrome
3 pilot project; amending s. 400.902, F.S.; revising the
4 definition of the term “prescribed pediatric extended
5 care center” or “PPEC center” to include certain
6 buildings that provide certain residential services to
7 infants with neonatal abstinence syndrome;
8 establishing a prerequisite for the admission of an
9 infant with neonatal abstinence syndrome to a PPEC
10 center; expanding the definition of the term
11 “medically dependent or technologically dependent
12 child” to include certain infants diagnosed with
13 neonatal abstinence syndrome; amending s. 400.914,
14 F.S.; providing that a specified Agency for Health
15 Care Administration rule include an exception for
16 infants being treated for neonatal abstinence
17 syndrome; creating s. 400.917, F.S.; defining terms;
18 requiring the agency, in consultation with the
19 Department of Children and Families, to establish a
20 pilot project to approve one or more facilities
21 licensed to provide PPEC services to treat certain
22 eligible infants; providing the purpose of the pilot
23 project; providing a start and end date for the pilot
24 project; requiring the agency, in consultation with
25 the department, to adopt by rule minimum standards for
26 facilities approved to provide certain services to
27 eligible infants; requiring certain criteria to be
28 included in such standards; specifying that a PPEC
29 center is not required to obtain a certificate of need
30 to be approved to provide services under this section;
31 establishing minimum requirements for a PPEC center to
32 be eligible to provide services to eligible infants
33 and to participate in the pilot project; prohibiting a
34 PPEC center providing such services from treating an
35 infant for longer than a specified period of time;
36 providing that a PPEC center may require a mother or
37 visitor to vacate its premises under specified
38 circumstances; allowing certain health care
39 professionals to prevent the removal of an infant from
40 the facility under certain circumstances; requiring
41 the agency to require approved PPEC centers to meet
42 and maintain representations in the facility’s plan
43 submitted for approval; requiring the Department of
44 Health to contract with a state university to study
45 certain components of the pilot project and establish
46 certain baseline data for studies on the
47 neurodevelopmental outcomes of infants with neonatal
48 abstinence syndrome; requiring the department to
49 report results of the study to the Legislature by a
50 certain date; requiring approved PPEC centers,
51 hospitals meeting certain criteria, and Medicaid
52 managed medical assistance plans to provide to the
53 contracted university relevant financial and medical
54 data consistent with federal law; requiring the agency
55 to begin rulemaking and to apply for certain Medicaid
56 waivers after the act becomes a law; providing
57 appropriations; providing an effective date.
58
59 Be It Enacted by the Legislature of the State of Florida:
60
61 Section 1. Subsections (1) and (6) of section 400.902,
62 Florida Statutes, are amended to read:
63 400.902 Definitions.—As used in this part, the term:
64 (1) “Prescribed pediatric extended care center,”
65 hereinafter referred to as a “PPEC center,” means any building
66 or buildings, or other place, whether operated for profit or
67 not, which undertakes through its ownership or management to
68 provide:
69 (a) Basic nonresidential services to three or more
70 medically dependent or technologically dependent children who
71 are not related to the owner or operator by blood, marriage, or
72 adoption and who require such services; or
73 (b) Residential services to infants with neonatal
74 abstinence syndrome as described in s. 400.917.
75
76 To be Infants and children considered for admission to a PPEC
77 center, infants and children must have complex medical
78 conditions that require continual care. Prerequisites for
79 admission are a prescription from the child’s attending
80 physician and consent of a parent or guardian. For the purpose
81 of providing treatment for infants with neonatal abstinence
82 syndrome pursuant to s. 400.917, the sole prerequisite for
83 admission is a transfer order from the infant’s attending
84 physician at the hospital.
85 (6) “Medically dependent or technologically dependent
86 child” means a child who because of a medical condition requires
87 continuous therapeutic interventions or skilled nursing
88 supervision which must be prescribed by a licensed physician and
89 administered by, or under the direct supervision of, a licensed
90 registered nurse. The term includes infants diagnosed with
91 neonatal abstinence syndrome, as defined in s. 400.917.
92 Section 2. Paragraph (a) of subsection (2) of section
93 400.914, Florida Statutes, is amended to read:
94 400.914 Rules establishing standards.—
95 (2) The agency shall adopt rules to ensure that:
96 (a) Except as provided in s. 400.917, no child attends a
97 PPEC center for more than 12 hours within a 24-hour period.
98 Section 3. Section 400.917, Florida Statutes, is created to
99 read:
100 400.917 Pilot project for the treatment of infants with
101 neonatal abstinence syndrome.—
102 (1) For purposes of this section, the term:
103 (a) “Eligible” means an infant who:
104 1. Has a gestational age or a corrected age (gestational
105 age plus chronological age) of 37 weeks or greater;
106 2. Is being treated for neonatal abstinence syndrome as the
107 primary active diagnosis;
108 3. If he or she requires pharmacologic therapy, has been
109 treated through the initial escalation phase of treatment for
110 signs of neonatal abstinence syndrome, and is in the weaning
111 phase of management; and
112 4. Is not taking medications for treatment of any medical
113 condition other than:
114 a. Neonatal abstinence syndrome;
115 b. Any side effects caused by neonatal abstinence syndrome
116 or its treatment; or
117 c. Vitamin or mineral deficiencies that are common in
118 infants.
119 (b) “Infant” includes both a newborn and an infant, as
120 those terms are defined in s. 383.145.
121 (c) “Neonatal abstinence syndrome” means the postnatal
122 withdrawal symptoms experienced by an infant who is exposed to
123 opioids in utero or in neonatal hospitalization; agents used to
124 treat maternal opioid addiction; or to one or more other drugs
125 including, but not limited to, barbiturates, selective serotonin
126 re-uptake inhibitors, and benzodiazepines.
127 (d) “Pharmacologic therapy” means the use of prescribed
128 medications recognized by the American Academy of Pediatrics to
129 relieve moderate to severe signs and symptoms of neonatal
130 abstinence syndrome and to prevent complications common to
131 neonatal abstinence syndrome.
132 (e) “Stabilized” means that, within reasonable medical
133 probability, no material deterioration of the infant’s condition
134 is likely to result from, or occur during, the transfer of the
135 infant from the hospital to a facility licensed under this
136 section for ongoing treatment as provided in this section.
137 (2) The agency, in consultation with the Department of
138 Children and Families, shall establish a pilot project to
139 approve one or more facilities licensed to provide PPEC services
140 in this state to provide inpatient treatment for eligible
141 infants. The purpose of the pilot project is to provide a
142 community-based care option for eligible infants, rather than
143 hospitalization, after an infant has been stabilized. The pilot
144 project shall begin on January 1, 2019, and expire on June 30,
145 2021.
146 (3) The agency, in consultation with the department, shall
147 adopt by rule minimum standards for facilities approved to
148 provide services under this section. Standards adopted by the
149 agency are in addition to the standards for licensure as a PPEC
150 center and must include, at a minimum:
151 (a) Any additional requirements for the physical plant and
152 facility maintenance, compliance with local building and
153 firesafety codes, and sanitation requirements as needed to
154 ensure the safety and wellbeing of infants being treated at the
155 facility, facility staff, and visitors to the facility;
156 (b) The number of, and the training and qualifications
157 required for, essential personnel employed by and working under
158 contract with the facility, including a requirement that all
159 clinical staff providing care under this section be certified by
160 the Neonatal Resuscitation Program;
161 (c) Staffing requirements intended to ensure adequate
162 staffing and appropriate medical supervision to protect the
163 safety of infants being treated in the facility;
164 (d) Requirements for programs, services, and care provided
165 to infants treated by the facility and to their parents,
166 including a requirement that the facility have a policy to
167 ensure safe medication practices;
168 (e) Requirements for the maintenance of medical records,
169 data, and other relevant information related to infants treated
170 by the facility; and
171 (f) Requirements for application for approval to provide
172 the services described by this section.
173 (4) A PPEC center is not required to obtain a certificate
174 of need to be approved to provide services under this section.
175 (5) To be approved to provide services under this section
176 and to participate in the pilot project, a PPEC center must, at
177 a minimum:
178 (a) Be a private, nonprofit Florida corporation;
179 (b) Have an on-call medical director;
180 (c) Adhere to all applicable standards for a PPEC center
181 and all standards established by the agency by rule pursuant to
182 subsection (3); and
183 (d) Provide the agency with a plan to:
184 1. Provide 24-hour nursing and nurturing care to infants
185 with neonatal abstinence syndrome;
186 2. Provide for the medical needs of an infant being treated
187 at the facility, including, but not limited to, pharmacologic
188 therapy and nutrition management;
189 3. Maintain a transfer agreement with a hospital that is
190 not more than a 30-minute drive from the licensed facility;
191 4. Provide comfortable, safe, residential-type
192 accommodations that encourage a mother to breastfeed her infant
193 or to reside at the facility while her infant is being treated
194 at that facility, if not contraindicated and if funding is
195 available for residential services for the mother;
196 5. Provide or make available parenting education,
197 breastfeeding education, counseling, and other resources to the
198 parents of infants being treated at the facility, including, if
199 necessary, a referral for addiction treatment services;
200 6. Contract and coordinate with Medicaid managed medical
201 assistance plans as appropriate to ensure that services for both
202 the infant and the parent or the infant’s representative are
203 timely and unduplicated;
204 7. Identify, and refer parents to, social service providers
205 such as Healthy Start or the MomCare network, Healthy Families,
206 Early Steps, and Head Start programs, before discharge, if
207 appropriate; and
208 8. Become a Medicaid provider, if the PPEC center is not
209 already a Medicaid provider.
210 (6) A PPEC center approved under this section may not
211 accept an infant for treatment if the infant is not eligible or
212 if the infant has a serious or life-threatening condition other
213 than neonatal abstinence syndrome.
214 (7) A PPEC center approved under this section may not treat
215 an infant for longer than 6 months.
216 (8) A PPEC center approved under this section may require
217 the mother or visitors to vacate the facility at any time if:
218 (a) The facility requests that the mother’s breast milk be
219 tested for contaminants and she refuses to allow her breast milk
220 to be tested or the breast milk tests positive for one or more
221 nonprescription medications;
222 (b) The facility requests that the mother be drug tested
223 and the mother refuses to consent to a drug test or the mother
224 tests positive for one or more nonprescription medications;
225 (c) The facility determines that the mother poses a risk to
226 her infant; or
227 (d) The facility determines that the mother or a visitor is
228 threatening, intimidating, or posing a risk to any infant in the
229 facility, any other mother or visitor in the facility, or
230 facility staff.
231
232 If the facility requires the mother or other visitor to vacate
233 its premises, a licensed health care professional who is an
234 employee or contracted staff at the facility may refuse to allow
235 the mother, parent, caregiver, or legal custodian to remove the
236 infant from the facility and may detain the infant at the
237 facility pursuant to s. 39.395, if the provisions of that
238 section are met.
239 (9) The agency shall require each PPEC center approved
240 under this section to meet and maintain the representations made
241 in the facility’s plan submitted for approval pursuant to
242 paragraph (5)(d) or substantially similar provisions that do not
243 degrade the facility’s ability to provide the same level of
244 service.
245 (10)(a) The Department of Health shall contract with a
246 state university to study the risks, benefits, cost
247 differentials, and the transition of infants to the social
248 service providers identified in subparagraph (5)(d)7. for the
249 treatment of infants with neonatal abstinence syndrome in
250 hospital settings and PPEC centers approved under this section.
251 By June 30, 2020, the Department of Health shall report to the
252 President of the Senate and the Speaker of the House of
253 Representatives the study results and recommendations regarding
254 the continuation or expansion of the pilot project.
255 (b) The contract must also require the establishment of
256 baseline data for longitudinal studies on the neurodevelopmental
257 outcomes of infants with neonatal abstinence syndrome, and may
258 require the evaluation of outcomes and length of stay in
259 facilities for nonpharmacologic and pharmacologic therapy for
260 neonatal abstinence syndrome.
261 (c) PPEC centers approved under this section, licensed
262 hospitals providing services for infants born with neonatal
263 abstinence syndrome, and Medicaid managed medical assistance
264 plans shall provide relevant financial and medical data
265 consistent with the Health Insurance Portability and
266 Accountability Act of 1996 (HIPAA) and related regulations to
267 the contracted university for research and studies authorized
268 pursuant to this subsection.
269 Section 4. Upon this act becoming law, the Agency for
270 Health Care Administration shall begin the process of adopting
271 rules pursuant to s. 400.917, Florida Statutes, and shall begin
272 the process of applying for any Medicaid waivers or other
273 similar permissions necessary to ensure that PPEC centers that
274 provide care to eligible infants under s. 400.917, Florida
275 Statutes, are eligible for Medicaid reimbursement for such care.
276 Section 5. For the 2018-2019 fiscal year, the sum of
277 $200,000 is appropriated from the Health Care Trust Fund to the
278 Agency for Health Care Administration for the purpose of
279 implementing s. 400.917, Florida Statutes.
280 Section 6. For the 2018-2019 fiscal year, the sum of
281 $140,000 in nonrecurring funds is appropriated from the Maternal
282 and Child Health Block Grant Trust Fund to the Department of
283 Health for the purpose of contracting with a state university to
284 conduct the study required pursuant to s. 400.917(10), Florida
285 Statutes.
286 Section 7. For the 2019-2020 fiscal year, the sum of
287 $70,000 in nonrecurring funds is appropriated from the Maternal
288 and Child Health Block Grant Trust Fund to the Department of
289 Health for the purpose of completing the study required pursuant
290 to s. 400.917(10), Florida Statutes.
291 Section 8. This act shall take effect upon becoming a law.