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 childrenconsidered 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.