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.
   59  Be It Enacted by the Legislature of the State of Florida:
   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.
   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.
  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.