Florida Senate - 2019 COMMITTEE AMENDMENT
Bill No. PCS (192902) for SB 7078
Senate . House
Comm: RCS .
The Committee on Appropriations (Bean) recommended the
1 Senate Amendment to Amendment (520116) (with title
4 Delete lines 46 - 206
5 and insert:
6 Section 3. Subsection (3) of section 395.002, Florida
7 Statutes, is amended to read:
8 395.002 Definitions.—As used in this chapter:
9 (3) “Ambulatory surgical center” means a facility the
10 primary purpose of which is to provide elective surgical care,
11 in which the patient is admitted to and discharged from such
12 facility within 24 hours
the same working day and is not
13 permitted to stay overnight, and which is not part of a
14 hospital. However, a facility existing for the primary purpose
15 of performing terminations of pregnancy, an office maintained by
16 a physician for the practice of medicine, or an office
17 maintained for the practice of dentistry may not be construed to
18 be an ambulatory surgical center, provided that any facility or
19 office which is certified or seeks certification as a Medicare
20 ambulatory surgical center shall be licensed as an ambulatory
21 surgical center pursuant to s. 395.003.
22 Section 4. Section 395.1055, Florida Statutes, is amended
23 to read:
24 395.1055 Rules and enforcement.—
25 (1) The agency shall adopt rules pursuant to ss. 120.536(1)
26 and 120.54 to implement the provisions of this part, which shall
27 include reasonable and fair minimum standards for ensuring that:
28 (a) Sufficient numbers and qualified types of personnel and
29 occupational disciplines are on duty and available at all times
30 to provide necessary and adequate patient care and safety.
31 (b) Infection control, housekeeping, sanitary conditions,
32 and medical record procedures that will adequately protect
33 patient care and safety are established and implemented.
34 (c) A comprehensive emergency management plan is prepared
35 and updated annually. Such standards must be included in the
36 rules adopted by the agency after consulting with the Division
37 of Emergency Management. At a minimum, the rules must provide
38 for plan components that address emergency evacuation
39 transportation; adequate sheltering arrangements; postdisaster
40 activities, including emergency power, food, and water;
41 postdisaster transportation; supplies; staffing; emergency
42 equipment; individual identification of residents and transfer
43 of records, and responding to family inquiries. The
44 comprehensive emergency management plan is subject to review and
45 approval by the local emergency management agency. During its
46 review, the local emergency management agency shall ensure that
47 the following agencies, at a minimum, are given the opportunity
48 to review the plan: the Department of Elderly Affairs, the
49 Department of Health, the Agency for Health Care Administration,
50 and the Division of Emergency Management. Also, appropriate
51 volunteer organizations must be given the opportunity to review
52 the plan. The local emergency management agency shall complete
53 its review within 60 days and either approve the plan or advise
54 the facility of necessary revisions.
55 (d) Licensed facilities are established, organized, and
56 operated consistent with established standards and rules.
57 (e) Licensed facility beds conform to minimum space,
58 equipment, and furnishings standards as specified by the
60 (f) All hospitals submit such data as necessary to conduct
61 certificate-of-need reviews required under part I of chapter
62 408. Such data shall include, but shall not be limited to,
63 patient origin data, hospital utilization data, type of service
64 reporting, and facility staffing data. The agency may not
65 collect data that identifies or could disclose the identity of
66 individual patients. The agency shall utilize existing uniform
67 statewide data sources when available and shall minimize
68 reporting costs to hospitals.
69 (g) Each hospital has a quality improvement program
70 designed according to standards established by their current
71 accrediting organization. This program will enhance quality of
72 care and emphasize quality patient outcomes, corrective action
73 for problems, governing board review, and reporting to the
74 agency of standardized data elements necessary to analyze
75 quality of care outcomes. The agency shall use existing data,
76 when available, and shall not duplicate the efforts of other
77 state agencies in order to obtain such data.
78 (h) Licensed facilities make available on their Internet
79 websites, no later than October 1, 2004, and in a hard copy
80 format upon request, a description of and a link to the patient
81 charge and performance outcome data collected from licensed
82 facilities pursuant to s. 408.061.
83 (i) All hospitals providing organ transplantation, neonatal
84 intensive care services, inpatient psychiatric services,
85 inpatient substance abuse services, or comprehensive medical
86 rehabilitation meet the minimum licensure requirements adopted
87 by the agency. Such licensure requirements must include quality
88 of care, nurse staffing, physician staffing, physical plant,
89 equipment, emergency transportation, and data reporting
91 (2) Separate standards may be provided for general and
92 specialty hospitals, ambulatory surgical centers, and statutory
93 rural hospitals as defined in s. 395.602.
94 (3)(a) The agency, in consultation with the Board of
95 Medicine and the Board of Osteopathic Medicine, shall adopt
96 rules that establish requirements to ensure the safe and
97 effective delivery of surgical care to children kept past
98 midnight in ambulatory surgical centers. The rules must be
99 consistent with the American College of Surgeons’ 2015 standards
100 document entitled “Optimal Resources for Children’s Surgical
101 Care” and must establish minimum standards for pediatric patient
102 care in ambulatory surgical centers.
103 (b) Ambulatory surgical centers may provide operative
104 procedures that require a length of stay past midnight on the
105 day of surgery for children younger than 18 years of age only if
106 the agency authorizes the performance of such procedures by
108 (4) (3) The agency shall adopt rules with respect to the
109 care and treatment of patients residing in distinct part nursing
110 units of hospitals which are certified for participation in
111 Title XVIII (Medicare) and Title XIX (Medicaid) of the Social
112 Security Act skilled nursing facility program. Such rules shall
113 take into account the types of patients treated in hospital
114 skilled nursing units, including typical patient acuity levels
115 and the average length of stay in such units, and shall be
116 limited to the appropriate portions of the Omnibus Budget
117 Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,
118 1987), Title IV (Medicare, Medicaid, and Other Health-Related
119 Programs), Subtitle C (Nursing Home Reform), as amended. The
120 agency shall require level 2 background screening as specified
121 in s. 408.809(1)(e) pursuant to s. 408.809 and chapter 435 for
122 personnel of distinct part nursing units.
123 (5) (4) The agency shall adopt rules with respect to the
124 care and treatment of clients in intensive residential treatment
125 programs for children and adolescents and with respect to the
126 safe and healthful development, operation, and maintenance of
127 such programs.
128 (6) (5) The agency shall enforce the provisions of part I of
129 chapter 394, and rules adopted thereunder, with respect to the
130 rights, standards of care, and examination and placement
131 procedures applicable to patients voluntarily or involuntarily
132 admitted to hospitals providing psychiatric observation,
133 evaluation, diagnosis, or treatment.
134 (7) (6) No rule shall be adopted under this part by the
135 agency which would have the effect of denying a license to a
136 facility required to be licensed under this part, solely by
137 reason of the school or system of practice employed or permitted
138 to be employed by physicians therein, provided that such school
139 or system of practice is recognized by the laws of this state.
140 However, nothing in this subsection shall be construed to limit
141 the powers of the agency to provide and require minimum
142 standards for the maintenance and operation of, and for the
143 treatment of patients in, those licensed facilities which
144 receive federal aid, in order to meet minimum standards related
145 to such matters in such licensed facilities which may now or
146 hereafter be required by appropriate federal officers or
147 agencies in pursuance of federal law or promulgated in pursuance
148 of federal law.
149 (8) (7) Any licensed facility which is in operation at the
150 time of promulgation of any applicable rules under this part
151 shall be given a reasonable time, under the particular
152 circumstances, but not to exceed 1 year from the date of such
153 promulgation, within which to comply with such rules.
154 (9) (8) The agency may not adopt any rule governing the
155 design, construction, erection, alteration, modification,
156 repair, or demolition of any public or private hospital,
157 intermediate residential treatment facility, or ambulatory
158 surgical center. It is the intent of the Legislature to preempt
159 that function to the Florida Building Commission and the State
160 Fire Marshal through adoption and maintenance of the Florida
161 Building Code and the Florida Fire Prevention Code. However, the
162 agency shall provide technical assistance to the commission and
163 the State Fire Marshal in updating the construction standards of
164 the Florida Building Code and the Florida Fire Prevention Code
165 which govern hospitals, intermediate residential treatment
166 facilities, and ambulatory surgical centers.
167 (10) (9) The agency shall establish a pediatric cardiac
168 technical advisory panel, pursuant to s. 20.052, to develop
169 procedures and standards for measuring outcomes of pediatric
170 cardiac catheterization programs and pediatric cardiovascular
171 surgery programs.
172 (a) Members of the panel must have technical expertise in
173 pediatric cardiac medicine, shall serve without compensation,
174 and may not be reimbursed for per diem and travel expenses.
175 (b) Voting members of the panel shall include: 3 at-large
176 members, and 3 alternate at-large members with different program
177 affiliations, including 1 cardiologist who is board certified in
178 caring for adults with congenital heart disease and 2 board
179 certified pediatric cardiologists, neither of whom may be
180 employed by any of the hospitals specified in subparagraphs 1.
181 10. or their affiliates, each of whom is appointed by the
182 Secretary of Health Care Administration, and 10 members, and an
183 alternate for each member, each of whom is a pediatric
184 cardiologist or a pediatric cardiovascular surgeon, each
185 appointed by the chief executive officer of the following
187 1. Johns Hopkins All Children’s Hospital in St. Petersburg.
188 2. Arnold Palmer Hospital for Children in Orlando.
189 3. Joe DiMaggio Children’s Hospital in Hollywood.
190 4. Nicklaus Children’s Hospital in Miami.
191 5. St. Joseph’s Children’s Hospital in Tampa.
192 6. University of Florida Health Shands Hospital in
194 7. University of Miami Holtz Children’s Hospital in Miami.
195 8. Wolfson Children’s Hospital in Jacksonville.
196 9. Florida Hospital for Children in Orlando.
197 10. Nemours Children’s Hospital in Orlando.
199 Appointments made under subparagraphs 1.-10. are contingent upon
200 the hospital’s maintenance of pediatric certificates of need and
201 the hospital’s compliance with this section and rules adopted
202 thereunder, as determined by the Secretary of Health Care
203 Administration. A member appointed under subparagraphs 1.-10.
204 whose hospital fails to maintain such certificates or comply
205 with standards may serve only as a nonvoting member until the
206 hospital restores such certificates or complies with such
207 standards. A voting member may serve a maximum of two 2-year
208 terms and may be reappointed to the panel after being retired
209 from the panel for a full 2-year term.
210 (c) The Secretary of Health Care Administration may appoint
211 nonvoting members to the panel. Nonvoting members may include:
212 1. The Secretary of Health Care Administration.
213 2. The Surgeon General.
214 3. The Deputy Secretary of Children’s Medical Services.
215 4. Any current or past Division Director of Children’s
216 Medical Services.
217 5. A parent of a child with congenital heart disease.
218 6. An adult with congenital heart disease.
219 7. A representative from each of the following
220 organizations: the Florida Chapter of the American Academy of
221 Pediatrics, the Florida Chapter of the American College of
222 Cardiology, the Greater Southeast Affiliate of the American
223 Heart Association, the Adult Congenital Heart Association, the
224 March of Dimes, the Florida Association of Children’s Hospitals,
225 and the Florida Society of Thoracic and Cardiovascular Surgeons.
226 (d) The panel shall meet biannually, or more frequently
227 upon the call of the Secretary of Health Care Administration.
228 Such meetings may be conducted telephonically, or by other
229 electronic means.
230 (e) The duties of the panel include recommending to the
231 agency standards for quality of care, personnel, physical plant,
232 equipment, emergency transportation, and data reporting for
233 hospitals that provide pediatric cardiac services.
234 (f) Beginning on January 1, 2020, and annually thereafter,
235 the panel shall submit a report to the Governor, the President
236 of the Senate, the Speaker of the House of Representatives, the
237 Secretary of Health Care Administration, and the State Surgeon
238 General. The report must summarize the panel’s activities during
239 the preceding fiscal year and include data and performance
240 measures on surgical morbidity and mortality for all pediatric
241 cardiac programs.
242 (g) Panel members are agents of the state for purposes of
243 s. 768.28 throughout the good faith performance of the duties
244 assigned to them by the Secretary of Health Care Administration.
245 (11) The Secretary of Health Care Administration shall
246 consult the pediatric cardiac technical advisory panel for an
247 advisory recommendation on all certificate of need applications
248 to establish pediatric cardiac surgical centers.
249 (12) (10) Based on the recommendations of the pediatric
250 cardiac technical advisory panel in subsection (9), the agency
251 shall adopt rules for pediatric cardiac programs which, at a
252 minimum, include:
253 (a) Standards for pediatric cardiac catheterization
254 services and pediatric cardiovascular surgery including quality
255 of care, personnel, physical plant, equipment, emergency
256 transportation, data reporting, and appropriate operating hours
257 and timeframes for mobilization for emergency procedures.
258 (b) Outcome standards consistent with nationally
259 established levels of performance in pediatric cardiac programs.
260 (c) Specific steps to be taken by the agency and licensed
261 facilities when the facilities do not meet the outcome standards
262 within a specified time, including time required for detailed
263 case reviews and the development and implementation of
264 corrective action plans.
265 (13) (11) A pediatric cardiac program shall:
266 (a) Have a pediatric cardiology clinic affiliated with a
267 hospital licensed under this chapter.
268 (b) Have a pediatric cardiac catheterization laboratory and
269 a pediatric cardiovascular surgical program located in the
271 (c) Have a risk adjustment surgical procedure protocol
272 following the guidelines established by the Society of Thoracic
274 (d) Have quality assurance and quality improvement
275 processes in place to enhance clinical operation and patient
276 satisfaction with services.
277 (e) Participate in the clinical outcome reporting systems
278 operated by the Society of Thoracic Surgeons and the American
279 College of Cardiology.
280 (14)(a) The Secretary of Health Care Administration may
281 request announced or unannounced site visits to any existing
282 pediatric cardiac surgical center or facility seeking licensure
283 as a pediatric cardiac surgical center through the certificate
284 of need process, to ensure compliance with this section and
285 rules adopted hereunder.
286 (b) At the request of the Secretary of Health Care
287 Administration, the pediatric cardiac technical advisory panel
288 shall recommend in-state physician experts to conduct an on-site
289 visit. The Secretary may also appoint up to two out-of-state
290 physician experts.
291 (c) A site visit team shall conduct an on-site inspection
292 of the designated hospital’s pediatric medical and surgical
293 programs, and each member shall submit a written report of his
294 or her findings to the panel. The panel shall discuss the
295 written reports and present an advisory opinion to the Secretary
296 of Health Care Administration which includes recommendations and
297 any suggested actions for correction.
298 (d) Each on-site inspection must include all of the
300 1. An inspection of the program’s physical facilities,
301 clinics, and laboratories.
302 2. Interviews with support staff and hospital
304 3. A review of:
305 a. Randomly selected medical records and reports,
306 including, but not limited to, advanced cardiac imaging,
307 computed tomography, magnetic resonance imaging, cardiac
308 ultrasound, cardiac catheterization, and surgical operative
310 b. The program’s clinical outcome data submitted to the
311 Society of Thoracic Surgeons and the American College of
312 Cardiology pursuant to s. 408.05(3)(k).
313 c. Mortality reports from cardiac-related deaths that
314 occurred in the previous year.
315 d. Program volume data from the preceding year for
316 interventional and electrophysiology catheterizations and
317 surgical procedures.
318 (15) The Surgeon General shall provide quarterly reports to
319 the Secretary of Health Care Administration consisting of data
320 from the Children’s Medical Services’ critical congenital heart
321 disease screening program for review by the advisory panel.
322 (16) (12) The agency may adopt rules to administer the
324 ================= T I T L E A M E N D M E N T ================
325 And the title is amended as follows:
326 Delete line 382
327 and insert:
328 395.002, F.S.; revising the definition of the term
329 “ambulatory surgical center”; amending s. 395.1055,
330 F.S.; requiring the Agency for Health Care
331 Administration, in consultation with the Board of
332 Medicine and the Board of Osteopathic Medicine, to
333 adopt rules that establish requirements related to the
334 delivery of surgical care to children in ambulatory
335 surgical centers, in accordance with specified
336 standards; specifying that ambulatory surgical centers
337 may provide certain procedures only if authorized by
338 agency rule; authorizing the