Bill Text: FL S1876 | 2018 | Regular Session | Comm Sub
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Trauma Services
Spectrum: Slight Partisan Bill (? 3-1)
Status: (Introduced - Dead) 2018-03-06 - Laid on Table, refer to CS/CS/HB 1165 [S1876 Detail]
Download: Florida-2018-S1876-Comm_Sub.html
Bill Title: Trauma Services
Spectrum: Slight Partisan Bill (? 3-1)
Status: (Introduced - Dead) 2018-03-06 - Laid on Table, refer to CS/CS/HB 1165 [S1876 Detail]
Download: Florida-2018-S1876-Comm_Sub.html
Florida Senate - 2018 CS for CS for SB 1876 By the Committees on Appropriations; and Health Policy; and Senator Young 576-03559-18 20181876c2 1 A bill to be entitled 2 An act relating to trauma services; amending ss. 3 318.14, 318.18, and 318.21, F.S.; requiring that 4 moneys received from specified penalties be allocated 5 to certain trauma centers by a calculation that uses 6 the Agency for Health Care Administration’s hospital 7 discharge data; amending s. 395.4001, F.S.; conforming 8 cross-references; defining and redefining terms; 9 amending s. 395.402, F.S.; revising legislative 10 intent; revising the trauma service areas and 11 provisions relating to the number and location of 12 trauma centers; prohibiting the Department of Health 13 from designating an existing Level II trauma center as 14 a new pediatric trauma center or from designating an 15 existing Level II trauma center as a Level I trauma 16 center in a trauma service area that already has an 17 existing Level I or pediatric trauma center; 18 apportioning trauma centers within each trauma service 19 area; requiring the department to establish the 20 Florida Trauma System Advisory Council by a specified 21 date; authorizing the council to submit certain 22 recommendations to the department; providing for the 23 membership of the council; requiring the council to 24 meet no later than a specified date and to meet at 25 least quarterly; amending s. 395.4025, F.S.; 26 conforming provisions to changes made by the act; 27 requiring the department to periodically prepare an 28 analysis of the state trauma system using the agency’s 29 hospital discharge data and specified population data; 30 specifying contents of the report; requiring the 31 department to make available all data, formulas, 32 methodologies, calculations, and risk adjustment tools 33 used in preparing the data in the report; requiring 34 the department to notify each acute care general 35 hospital and local and regional trauma agency in a 36 trauma service area that has an identified need for an 37 additional trauma center that the department is 38 accepting letters of intent; prohibiting the 39 department from accepting a letter of intent and from 40 approving an application for a trauma center if there 41 is not statutory capacity for an additional trauma 42 center; revising the department’s review process for 43 hospitals seeking designation as a trauma center; 44 authorizing the department to approve certain 45 applications for designation as a trauma center if 46 specified requirements are met; providing that a 47 hospital applicant that meets such requirements must 48 be ready to operate in compliance with specified 49 trauma standards by a specified date; deleting a 50 provision authorizing the department to grant a 51 hospital applicant an extension of time to meet 52 certain standards and requirements; requiring the 53 department to select one or more hospitals for 54 approval to prepare to operate as a trauma center; 55 providing selection requirements; prohibiting an 56 applicant from operating as a provisional trauma 57 center until the department has completed its review 58 process and approved the application; requiring a 59 specified review team to make onsite visits to newly 60 operational trauma centers within a certain timeframe; 61 requiring the department, based on recommendations 62 from the review team, to designate a trauma center 63 that is in compliance with specified requirements; 64 deleting the date by which the department must select 65 trauma centers; providing that only certain hospitals 66 may protest a decision made by the department; 67 providing that certain trauma centers that were 68 verified by the department or determined by the 69 department to be in substantial compliance with 70 specified standards before specified dates are deemed 71 to have met application and operational requirements; 72 requiring the department to designate a certain 73 provisionally approved Level II trauma center as a 74 trauma center if certain criteria are met; prohibiting 75 such designated trauma center from being required to 76 cease trauma operations unless the department or a 77 court determines that it has failed to meet certain 78 standards; providing construction; amending ss. 79 395.403 and 395.4036, F.S.; conforming provisions to 80 changes made by the act; amending s. 395.404, F.S.; 81 requiring trauma centers to participate in the 82 National Trauma Data Bank; requiring trauma centers 83 and acute care hospitals to report trauma patient 84 transfer and outcome data to the department; deleting 85 provisions relating to the department review of trauma 86 registry data; amending ss. 395.401, 408.036, and 87 409.975, F.S.; conforming cross-references; requiring 88 the department to work with the Office of Program 89 Policy Analysis and Government Accountability to study 90 the department’s licensure requirements, rules, 91 regulations, standards, and guidelines for pediatric 92 trauma services and compare them to those of the 93 American College of Surgeons; requiring the office to 94 submit a report of the findings of the study to the 95 Governor, Legislature, and advisory council by a 96 specified date; providing for the expiration of 97 provisions relating to the study; providing for 98 invalidity; providing an effective date. 99 100 Be It Enacted by the Legislature of the State of Florida: 101 102 Section 1. Paragraph (b) of subsection (5) of section 103 318.14, Florida Statutes, is amended to read: 104 318.14 Noncriminal traffic infractions; exception; 105 procedures.— 106 (5) Any person electing to appear before the designated 107 official or who is required so to appear shall be deemed to have 108 waived his or her right to the civil penalty provisions of s. 109 318.18. The official, after a hearing, shall make a 110 determination as to whether an infraction has been committed. If 111 the commission of an infraction has been proven, the official 112 may impose a civil penalty not to exceed $500, except that in 113 cases involving unlawful speed in a school zone or involving 114 unlawful speed in a construction zone, the civil penalty may not 115 exceed $1,000; or require attendance at a driver improvement 116 school, or both. If the person is required to appear before the 117 designated official pursuant to s. 318.19(1) and is found to 118 have committed the infraction, the designated official shall 119 impose a civil penalty of $1,000 in addition to any other 120 penalties and the person’s driver license shall be suspended for 121 6 months. If the person is required to appear before the 122 designated official pursuant to s. 318.19(2) and is found to 123 have committed the infraction, the designated official shall 124 impose a civil penalty of $500 in addition to any other 125 penalties and the person’s driver license shall be suspended for 126 3 months. If the official determines that no infraction has been 127 committed, no costs or penalties shall be imposed and any costs 128 or penalties that have been paid shall be returned. Moneys 129 received from the mandatory civil penalties imposed pursuant to 130 this subsection upon persons required to appear before a 131 designated official pursuant to s. 318.19(1) or (2) shall be 132 remitted to the Department of Revenue and deposited into the 133 Department of Health Emergency Medical Services Trust Fund to 134 provide financial support to certified trauma centers to assure 135 the availability and accessibility of trauma services throughout 136 the state. Funds deposited into the Emergency Medical Services 137 Trust Fund under this section shall be allocated as follows: 138 (b) Fifty percent shall be allocated among Level I, Level 139 II, and pediatric trauma centers based on each center’s relative 140 volume of trauma cases as calculated using the Agency for Health 141 Care Administration’s hospital discharge data collected pursuant 142 to s. 408.061reported in the Department of Health Trauma143Registry. 144 Section 2. Paragraph (h) of subsection (3) of section 145 318.18, Florida Statutes, is amended to read: 146 318.18 Amount of penalties.—The penalties required for a 147 noncriminal disposition pursuant to s. 318.14 or a criminal 148 offense listed in s. 318.17 are as follows: 149 (3) 150 (h) A person cited for a second or subsequent conviction of 151 speed exceeding the limit by 30 miles per hour and above within 152 a 12-month period shall pay a fine that is double the amount 153 listed in paragraph (b). For purposes of this paragraph, the 154 term “conviction” means a finding of guilt as a result of a jury 155 verdict, nonjury trial, or entry of a plea of guilty. Moneys 156 received from the increased fine imposed by this paragraph shall 157 be remitted to the Department of Revenue and deposited into the 158 Department of Health Emergency Medical Services Trust Fund to 159 provide financial support to certified trauma centers to assure 160 the availability and accessibility of trauma services throughout 161 the state. Funds deposited into the Emergency Medical Services 162 Trust Fund under this section shall be allocated as follows: 163 1. Fifty percent shall be allocated equally among all Level 164 I, Level II, and pediatric trauma centers in recognition of 165 readiness costs for maintaining trauma services. 166 2. Fifty percent shall be allocated among Level I, Level 167 II, and pediatric trauma centers based on each center’s relative 168 volume of trauma cases as calculated using the Agency for Health 169 Care Administration’s hospital discharge data collected pursuant 170 to s. 408.061reported in the Department of Health Trauma171Registry. 172 Section 3. Paragraph (b) of subsection (15) of section 173 318.21, Florida Statutes, is amended to read: 174 318.21 Disposition of civil penalties by county courts.—All 175 civil penalties received by a county court pursuant to the 176 provisions of this chapter shall be distributed and paid monthly 177 as follows: 178 (15) Of the additional fine assessed under s. 318.18(3)(e) 179 for a violation of s. 316.1893, 50 percent of the moneys 180 received from the fines shall be appropriated to the Agency for 181 Health Care Administration as general revenue to provide an 182 enhanced Medicaid payment to nursing homes that serve Medicaid 183 recipients with brain and spinal cord injuries. The remaining 50 184 percent of the moneys received from the enhanced fine imposed 185 under s. 318.18(3)(e) shall be remitted to the Department of 186 Revenue and deposited into the Department of Health Emergency 187 Medical Services Trust Fund to provide financial support to 188 certified trauma centers in the counties where enhanced penalty 189 zones are established to ensure the availability and 190 accessibility of trauma services. Funds deposited into the 191 Emergency Medical Services Trust Fund under this subsection 192 shall be allocated as follows: 193 (b) Fifty percent shall be allocated among Level I, Level 194 II, and pediatric trauma centers based on each center’s relative 195 volume of trauma cases as calculated using the Agency for Health 196 Care Administration’s hospital discharge data collected pursuant 197 to s. 408.061reported in the Department of Health Trauma198Registry. 199 Section 4. Present subsections (4) through (18) of section 200 395.4001, Florida Statutes, are renumbered as subsections (5) 201 through (19), respectively, paragraph (a) of present subsection 202 (7) and present subsections (13) and (14) of that section are 203 amended, and a new subsection (4) is added to that section, to 204 read: 205 395.4001 Definitions.—As used in this part, the term: 206 (4) “High-risk patient” means a trauma patient with an 207 International Classification Injury Severity Score of less than 208 0.85. 209 (8)(7)“Level II trauma center” means a trauma center that: 210 (a) Is verified by the department to be in substantial 211 compliance with Level II trauma center standards and has been 212 approved by the department to operate as a Level II trauma 213 center or is designated pursuant to s. 395.4025(15)s.214395.4025(14). 215 (14)(13)“Trauma caseload volume” means the number of 216 trauma patients calculated by the department using the data 217 reported by each designated trauma center to the hospital 218 discharge database maintained by the agency pursuant to s. 219 408.061reported by individual trauma centers to the Trauma220Registry and validated by the department. 221 (15)(14)“Trauma center” means a hospital that has been 222 verified by the department to be in substantial compliance with 223 the requirements in s. 395.4025 and has been approved by the 224 department to operate as a Level I trauma center, Level II 225 trauma center, or pediatric trauma center, or is designated by 226 the department as a Level II trauma center pursuant to s. 227 395.4025(15)s. 395.4025(14). 228 Section 5. Section 395.402, Florida Statutes, is amended to 229 read: 230 395.402 Trauma service areas; number and location of trauma 231 centers.— 232 (1) The Legislature recognizes the need for a statewide, 233 cohesive, uniform, and integrated trauma system, as well as the 234 need to ensure the viability of existing trauma centers when 235 designating new trauma centers. Consistent with national 236 standards, future trauma center designations must be based on 237 need as a factor of demand and capacity.Within the trauma238service areas, Level I and Level II trauma centers shall each be239capable of annually treating a minimum of 1,000 and 500240patients, respectively, with an injury severity score (ISS) of 9241or greater. Level II trauma centers in counties with a242population of more than 500,000 shall have the capacity to care243for 1,000 patients per year.244(2)Trauma service areas as defined in this section are to245be utilized until the Department of Health completes an246assessment of the trauma system and reports its finding to the247Governor, the President of the Senate, the Speaker of the House248of Representatives, and the substantive legislative committees.249The report shall be submitted by February 1, 2005. The250department shall review the existing trauma system and determine251whether it is effective in providing trauma care uniformly252throughout the state. The assessment shall:253(a)Consider aligning trauma service areas within the254trauma region boundaries as established in July 2004.255(b)Review the number and level of trauma centers needed256for each trauma service area to provide a statewide integrated257trauma system.258(c)Establish criteria for determining the number and level259of trauma centers needed to serve the population in a defined260trauma service area or region.261(d)Consider including criteria within trauma center262approval standards based upon the number of trauma victims263served within a service area.264(e)Review the Regional Domestic Security Task Force265structure and determine whether integrating the trauma system266planning with interagency regional emergency and disaster267planning efforts is feasible and identify any duplication of268efforts between the two entities.269(f)Make recommendations regarding a continued revenue270source which shall include a local participation requirement.271(g)Make recommendations regarding a formula for the272distribution of funds identified for trauma centers which shall273address incentives for new centers where needed and the need to274maintain effective trauma care in areas served by existing275centers, with consideration for the volume of trauma patients276served, and the amount of charity care provided.277(3)In conducting such assessment and subsequent annual278reviews, the department shall consider:279(a)The recommendations made as part of the regional trauma280system plans submitted by regional trauma agencies.281(b)Stakeholder recommendations.282(c)The geographical composition of an area to ensure rapid283access to trauma care by patients.284(d)Historical patterns of patient referral and transfer in285an area.286(e)Inventories of available trauma care resources,287including professional medical staff.288(f)Population growth characteristics.289(g)Transportation capabilities, including ground and air290transport.291(h)Medically appropriate ground and air travel times.292(i)Recommendations of the Regional Domestic Security Task293Force.294(j)The actual number of trauma victims currently being295served by each trauma center.296(k)Other appropriate criteria.297(4)Annually thereafter, the department shall review the298assignment of the 67 counties to trauma service areas, in299addition to the requirements of paragraphs (2)(b)-(g) and300subsection (3). County assignments are made for the purpose of301developing a system of trauma centers. Revisions made by the302department shall take into consideration the recommendations303made as part of the regional trauma system plans approved by the304department and the recommendations made as part of the state305trauma system plan. In cases where a trauma service area is306located within the boundaries of more than one trauma region,307the trauma service area’s needs, response capability, and system308requirements shall be considered by each trauma region served by309that trauma service area in its regional system plan. Until the310department completes the February 2005 assessment, the311assignment of counties shall remain as established in this312section.313 (a) The following trauma service areas arehereby314 established: 315 1. Trauma service area 1 shall consist of Escambia, 316 Okaloosa, Santa Rosa, and Walton Counties. 317 2. Trauma service area 2 shall consist of Bay, Gulf, 318 Holmes, and Washington Counties. 319 3. Trauma service area 3 shall consist of Calhoun, 320 Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison, 321 Taylor, and Wakulla Counties. 322 4. Trauma service area 4 shall consist of Alachua, 323 Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy, 324 Putnam, Suwannee, and Union Counties. 325 5. Trauma service area 5 shall consist of Baker, Clay, 326 Duval, Nassau, and St. Johns Counties. 327 6. Trauma service area 6 shall consist of Citrus, Hernando, 328 and Marion Counties. 329 7. Trauma service area 7 shall consist of Flagler and 330 Volusia Counties. 331 8. Trauma service area 8 shall consist of Lake, Orange, 332 Osceola, Seminole, and Sumter Counties. 333 9. Trauma service area 9 shall consist of Pasco and 334 Pinellas Counties. 335 10. Trauma service area 10 shall consist of Hillsborough 336 County. 337 11. Trauma service area 11 shall consist of Hardee, 338 Highlands, and Polk Counties. 339 12. Trauma service area 12 shall consist of Brevard and 340 Indian River Counties. 341 13. Trauma service area 13 shall consist of DeSoto, 342 Manatee, and Sarasota Counties. 343 14. Trauma service area 14 shall consist of Martin, 344 Okeechobee, and St. Lucie Counties. 345 15. Trauma service area 15 shall consist of Charlotte, 346 Collier, Glades, Hendry, and Lee Counties. 347 16. Trauma service area 16 shall consist of Palm Beach 348 County. 349 17. Trauma service area 17 shall consist of BrowardCollier350 County. 351 18. Trauma service area 18 shall consist ofBroward County.35219.Trauma service area 19 shall consist ofMiami-Dade and 353 Monroe Counties. 354 (b) Each trauma service area mustshouldhave at least one 355 Level I or Level II trauma center. Except as otherwise provided 356 in s. 395.4025(16), the department may not designate an existing 357 Level II trauma center as a new pediatric trauma center or 358 designate an existing Level II trauma center as a Level I trauma 359 center in a trauma service area that already has an existing 360 Level I or pediatric trauma centerThe department shall361allocate, by rule, the number of trauma centers needed for each362trauma service area. 363 (c) Trauma centers, including Level I, Level II, Level II 364 with a pediatric trauma center, jointly certified pediatric 365 trauma centers, and stand-alone pediatric trauma centers, shall 366 be apportioned as follows: 367 1. Trauma service area 1 shall have three trauma centers. 368 2. Trauma service area 2 shall have one trauma center. 369 3. Trauma service area 3 shall have one trauma center. 370 4. Trauma service area 4 shall have one trauma center. 371 5. Trauma service area 5 shall have three trauma centers. 372 6. Trauma service area 6 shall have one trauma center. 373 7. Trauma service area 7 shall have one trauma center. 374 8. Trauma service area 8 shall have three trauma centers. 375 9. Trauma service area 9 shall have three trauma centers. 376 10. Trauma service area 10 shall have two trauma centers. 377 11. Trauma service area 11 shall have one trauma center. 378 12. Trauma service area 12 shall have one trauma center. 379 13. Trauma service area 13 shall have two trauma centers. 380 14. Trauma service area 14 shall have one trauma center. 381 15. Trauma service area 15 shall have one trauma center. 382 16. Trauma service area 16 shall have two trauma centers. 383 17. Trauma service area 17 shall have three trauma centers. 384 18. Trauma service area 18 shall have five trauma centers. 385 386 Notwithstanding other provisions of this chapter, a trauma 387 service area may not have more than a total of five Level I, 388 Level II, Level II with a pediatric trauma center, jointly 389 certified pediatric trauma centers, and stand-alone pediatric 390 trauma centers. A trauma service area may not have more than one 391 stand-alone pediatric trauma centerThere shall be no more than392a total of 44 trauma centers in the state. 393 (2)(a) By October 1, 2018, the department shall establish 394 the Florida Trauma System Advisory Council to promote an 395 inclusive trauma system and enhance cooperation among trauma 396 system stakeholders. The advisory council may submit 397 recommendations to the department on how to maximize existing 398 trauma center, emergency department, and emergency medical 399 services infrastructure and personnel to achieve the statutory 400 goal of developing an inclusive trauma system. 401 (b)1. The advisory council shall consist of 12 members 402 appointed by the Governor, including: 403 a. The State Trauma Medical Director; 404 b. A standing member of the Emergency Medical Services 405 Advisory Council; 406 c. A representative of a local or regional trauma agency; 407 d. A trauma program manager or trauma medical director who 408 is actively working in a trauma center and who represents an 409 investor-owned hospital with a trauma center; 410 e. A trauma program manager or trauma medical director 411 actively working in a trauma center who represents a nonprofit 412 or public hospital with a trauma center; 413 f. A trauma surgeon who is board-certified in an 414 appropriate trauma or critical care specialty and who is 415 actively practicing medicine in a Level II trauma center who 416 represents an investor-owned hospital with a trauma center; 417 g. A trauma surgeon who is board-certified in an 418 appropriate trauma or critical care specialty and actively 419 practicing medicine who represents a nonprofit or public 420 hospital with a trauma center; 421 h. A representative of the American College of Surgeons 422 Committee on Trauma who has pediatric expertise; 423 i. A representative of the Safety Net Hospital Alliance of 424 Florida; 425 j. A representative of the Florida Hospital Association; 426 k. A Florida-licensed, board-certified emergency medicine 427 physician who is not affiliated with a trauma center; and 428 l. A trauma surgeon who is board-certified in an 429 appropriate trauma or critical care specialty and actively 430 practicing medicine in a Level I trauma center. 431 2. No two members may be employed by the same health care 432 facility. 433 3. Each council member shall be appointed to a 3-year term; 434 however, for the purpose of providing staggered terms, of the 435 initial appointments, four members shall be appointed to 1-year 436 terms, four members shall be appointed to 2-year terms, and four 437 members shall be appointed to 3-year terms. 438 (c) The department shall use existing and available 439 resources to administer and support the activities of the 440 advisory council. Members of the advisory council shall serve 441 without compensation and are not entitled to reimbursement for 442 per diem or travel expenses. 443 (d) The advisory council shall convene no later than 444 January 5, 2019, and shall meet at least quarterly. 445 Section 6. Section 395.4025, Florida Statutes, is amended 446 to read: 447 395.4025 Trauma centers; selection; quality assurance; 448 records.— 449 (1) For purposes of developing a system of trauma centers, 450 the department shall use the 1819trauma service areas 451 established in s. 395.402.Within each service area and based on452the state trauma system plan, the local or regional trauma453services system plan, and recommendations of the local or454regional trauma agency, the department shall establish the455approximate number of trauma centers needed to ensure reasonable456access to high-quality trauma services.The department shall 457 designateselectthose hospitals that are to be recognized as 458 trauma centers. 459 (2)(a) The department shall prepare an analysis of the 460 Florida trauma system by August 31, 2020, and every 3 years 461 thereafter, using the agency’s hospital discharge database 462 described in s. 408.061 for the current year and the most recent 463 5 years of population data for Florida available from the 464 American Community Survey 5-Year Estimates by the United States 465 Census Bureau. The department’s report must, at a minimum, 466 include all of the following: 467 1. The population growth for each trauma service area and 468 for this state; 469 2. The number of high-risk patients treated at each trauma 470 center within each trauma service area, including pediatric 471 trauma centers; 472 3. The total number of high-risk patients treated at all 473 acute care hospitals inclusive of nontrauma centers in the 474 trauma service area; and 475 4. The percentage of each trauma center’s sufficient volume 476 of trauma patients, as described in subparagraph (3)(d)2., in 477 accordance with the International Classification Injury Severity 478 Score for the trauma center’s designation, inclusive of the 479 additional caseload volume required for those trauma centers 480 with graduate medical education programs. 481 (b) The department shall make available all data, formulas, 482 methodologies, calculations, and risk adjustment tools used in 483 preparing the report. 484 (3)(a)(2)(a)The department shallannuallynotify each 485 acute care general hospital and each local and each regional 486 trauma agency in a trauma service area with an identified need 487 for an additional trauma centerthe statethat the department is 488 accepting letters of intent from hospitals that are interested 489 in becoming trauma centers. The department may accept a letter 490 of intent only if there is statutory capacity for an additional 491 trauma center in accordance with subsection (2), paragraph (d), 492 and s. 395.402In order to be considered by the department, a493hospital that operates within the geographic area of a local or494regional trauma agency must certify that its intent to operate495as a trauma center is consistent with the trauma services plan496of the local or regional trauma agency, as approved by the497department, if such agency exists. Letters of intent must be 498 postmarked no later than midnight October 1 of the year in which 499 the department notifies hospitals that it plans to accept 500 letters of intent. 501 (b) By October 15, the department shall send to all 502 hospitals that submitted a letter of intent an application 503 package that will provide the hospitals with instructions for 504 submitting information to the department for selection as a 505 trauma center. The standards for trauma centers provided for in 506 s. 395.401(2), as adopted by rule of the department, shall serve 507 as the basis for these instructions. 508 (c) In order to be considered by the department, 509 applications from those hospitals seeking selection as trauma 510 centers, including those current verified trauma centers that 511 seek a change or redesignation in approval status as a trauma 512 center, must be received by the department no later than the 513 close of business on April 1 of the year following submission of 514 the letter of intent. The department shall conduct an initiala515provisionalreview of each application for the purpose of 516 determining whetherthatthe hospital’s application is complete 517 and whetherthatthe hospital is capable of constructing and 518 operating a trauma center that includeshasthe critical 519 elements required for a trauma center. This critical review must 520willbe based on trauma center standards and mustshallinclude, 521 but need not be limited to, a review as toofwhether the 522 hospital is prepared to attain and operate with all of the 523 following components before April 30 of the following yearhas: 524 1. Equipment and physical facilities necessary to provide 525 trauma services. 526 2. Personnel in sufficient numbers and with proper 527 qualifications to provide trauma services. 528 3. An effective quality assurance process. 5294.Submitted written confirmation by the local or regional530trauma agency that the hospital applying to become a trauma531center is consistent with the plan of the local or regional532trauma agency, as approved by the department, if such agency533exists.534 (d)1.Except as otherwise provided in this section, the 535 department may not approve an application for a Level I, a Level 536 II, a Level II with a pediatric trauma center, a jointly 537 certified pediatric trauma center, or a stand-alone pediatric 538 trauma center if approval of the application would exceed the 539 limits on the numbers of Level I, Level II, Level II with a 540 pediatric trauma center, jointly certified pediatric trauma 541 centers, or stand-alone pediatric trauma centers established in 542 s. 395.402(1). However, the department shall review and may 543 approve an application for a trauma center when approval of the 544 application would result in a number of trauma centers which 545 exceeds the limit on the numbers of trauma centers in a trauma 546 service area imposed in s. 395.402(1), if, using the analysis 547 performed by the department as required in paragraph (2)(a), the 548 applicant demonstrates and the department determines that: 549 1. The existing trauma center actual caseload volume of 550 high-risk patients exceeds the minimum caseload volume 551 capabilities, inclusive of the additional caseload volume for 552 graduate medical education critical care and trauma surgical 553 subspecialty residents or fellows by more than two times the 554 statutory minimums listed in sub-subparagraphs 2.a.-d. or three 555 times the statutory minimum listed in sub-subparagraph 2.e., and 556 the population growth for the trauma service area exceeds the 557 statewide population growth by more than 15 percent based on the 558 American Community Survey 5-Year Estimates by the United States 559 Census Bureau for the 5-year period before the date the 560 applicant files its letter of intent; and 561 2. A sufficient caseload volume of potential trauma 562 patients exists within the trauma service area to ensure that 563 existing trauma centers caseload volumes are at the following 564 levels: 565 a. For Level I trauma centers in trauma service areas with 566 a population of greater than 1.5 million, a minimum caseload 567 volume of the greater of 1,200 high-risk patients admitted or 568 greater per year or, for a trauma center with a trauma or 569 critical care residency or fellowship program, 1,200 high-risk 570 patients admitted plus 40 cases per year for each accredited 571 critical care and trauma surgical subspecialty medical resident 572 or fellow. 573 b. For Level I trauma centers in trauma service areas with 574 a population of less than 1.5 million, a minimum caseload volume 575 of the greater of 1,000 high-risk patients admitted per year or, 576 for a trauma center with a critical care or trauma residency or 577 fellowship program, 1,000 high-risk patients admitted plus 40 578 cases per year for each accredited critical care and trauma 579 surgical subspecialty medical resident or fellow. 580 c. For Level II trauma centers and Level II trauma centers 581 with a pediatric trauma center in trauma service areas with a 582 population of greater than 1.25 million, a minimum caseload 583 volume of the greater of 1,000 high-risk patients admitted or 584 for a trauma center with a critical care or trauma residency or 585 fellowship program, 1,000 high-risk patients admitted plus 40 586 cases per year for each accredited critical care and trauma 587 surgical subspecialty medical resident or fellow. 588 d. For Level II trauma centers and Level II trauma centers 589 with a pediatric trauma center in trauma service areas with a 590 population of less than 1.25 million, a minimum caseload volume 591 of the greater of 500 high-risk patients admitted per year or 592 for a trauma center with a critical care or trauma residency or 593 fellowship program, 500 high-risk patients admitted plus 40 594 cases per year for each accredited critical care and trauma 595 surgical subspecialty medical resident or fellow. 596 e. For pediatric trauma centers, a minimum caseload volume 597 of the greater of 500 high-risk admitted patients per year or 598 for a trauma center with a critical care or trauma residency or 599 fellowship program, 500 high-risk admitted patients per year 600 plus 40 cases per year for each accredited critical care and 601 trauma surgical subspecialty medical resident or fellow. 602 603 The International Classification Injury Severity Score 604 calculations and caseload volume must be calculated using the 605 most recent available hospital discharge data collected by the 606 agency from all acute care hospitals pursuant to s. 408.061. The 607 agency, in consultation with the department, shall adopt rules 608 for trauma centers and acute care hospitals for the submission 609 of data required for the department to perform its duties under 610 this chapter. 611 (e) If the department determines that the hospital is 612 capable of attaining and operating with the components required 613 by paragraph (c), the applicant must be ready to operate in 614 compliance with Florida trauma center standards no later than 615 April 30 of the year following the department’s initial review 616 and approval of the hospital’s application to proceed with 617 preparation to operate as a trauma center. A hospital that fails 618 to comply with this subsection may not be designated as a trauma 619 centerNotwithstanding other provisions in this section, the620department may grant up to an additional 18 months to a hospital621applicant that is unable to meet all requirements as provided in622paragraph (c) at the time of application if the number of623applicants in the service area in which the applicant is located624is equal to or less than the service area allocation, as625provided by rule of the department. An applicant that is granted626additional time pursuant to this paragraph shall submit a plan627for departmental approval which includes timelines and628activities that the applicant proposes to complete in order to629meet application requirements. Any applicant that demonstrates630an ongoing effort to complete the activities within the631timelines outlined in the plan shall be included in the number632of trauma centers at such time that the department has conducted633a provisional review of the application and has determined that634the application is complete and that the hospital has the635critical elements required for a trauma center.6362.Timeframes provided in subsections (1)-(8) shall be637stayed until the department determines that the application is638complete and that the hospital has the critical elements639required for a trauma center. 640 (4)(3)By May 1, the department shall select one or more 641 hospitalsAfter April 30, any hospitalthat submitted an 642 application found acceptable by the department based on initial 643provisionalreview for approval to prepareshall be eligibleto 644 operate with the components required by paragraph (3)(c). If the 645 department receives more applications than may be approved, the 646 department must select the best applicant or applicants from the 647 available pool based on the department’s determination of the 648 capability of an applicant to provide the highest quality 649 patient care using the most recent technological, medical, and 650 staffing resources available, which is located the farthest away 651 from an existing trauma center in the applicant’s trauma service 652 area to maximize access. The number of applicants selected is 653 limited to available statutory need in the specified trauma 654 service area, as designated in paragraph (3)(d) or s. 395.402(1) 655as a provisional trauma center. 656 (5)(4)Following the initial review,Between May 1 and657October 1 of each year, the department shall conduct an in-depth 658 evaluation of all applications found acceptable in the initial 659provisionalreview. The applications shall be evaluated against 660 criteria enumerated in the application packages as provided to 661 the hospitals by the department. An applicant may not operate as 662 a provisional trauma center until the department completes the 663 initial and in-depth review and approves the application. 664 (6)(5)WithinBeginning October 1 of each year and ending665no later than June 1 ofthefollowingyear after the hospital 666 begins operating as a provisional trauma center, a review team 667 of out-of-state experts assembled by the department shall make 668 onsite visits to all provisional trauma centers. The department 669 shall develop a survey instrument to be used by the expert team 670 of reviewers. The instrument mustshallinclude objective 671 criteria and guidelines for reviewers based on existing trauma 672 center standards such that all trauma centers are assessed 673 equally. The survey instrument mustshallalso include a uniform 674 rating system thatwill be used byreviewers must use to 675 indicate the degree of compliance of each trauma center with 676 specific standards, and to indicate the quality of care provided 677 by each trauma center as determined through an audit of patient 678 charts. In addition, hospitals being considered as provisional 679 trauma centers mustshallmeet all the requirements of a trauma 680 center and mustshallbe located in a trauma service area that 681 has a need for such a trauma center. 682 (7)(6)Based on recommendations from the review team, the 683 department shall approve for designation a trauma center that is 684 in compliance with trauma center standards, as established by 685 department rule, and with this sectionshall select trauma686centers by July 1. An applicant for designation as a trauma687center may request an extension of its provisional status if it688submits a corrective action plan to the department. The689corrective action plan must demonstrate the ability of the690applicant to correct deficiencies noted during the applicant’s691onsite review conducted by the department between the previous692October 1 and June 1. The department may extend the provisional693status of an applicant for designation as a trauma center694through December 31 if the applicant provides a corrective695action plan acceptable to the department. The department or a696team of out-of-state experts assembled by the department shall697conduct an onsite visit on or before November 1 to confirm that698the deficiencies have been corrected. The provisional trauma699center is responsible for all costs associated with the onsite700visit in a manner prescribed by rule of the department. By701January 1, the department must approve or deny the application702of any provisional applicant granted an extension. Each trauma 703 center shall be granted a 7-year approval period during which 704 time it must continue to maintain trauma center standards and 705 acceptable patient outcomes as determined by department rule. An 706 approval, unless sooner suspended or revoked, automatically 707 expires 7 years after the date of issuance and is renewable upon 708 application for renewal as prescribed by rule of the department. 709 (8)(7)Only an applicant, or hospital with an existing 710 trauma center in the same trauma service area or in a trauma 711 service area contiguous to the trauma service area where the 712 applicant has applied to operate a trauma center, may protest a 713 decision made by the department with regard to whether the 714 application should be approved, or whether need has been 715 established through the criteria established in paragraph (3)(d) 716Any hospital that wishes to protest a decision made by the717department based on the department’s preliminary or in-depth718review of applications or on the recommendations of the site719visit review team pursuant to this section shall proceed as720provided in chapter 120. Hearings held under this subsection 721 shall be conducted in the same manner as provided in ss. 120.569 722 and 120.57. Cases filed under chapter 120 may combine all 723 disputes between parties. 724 (9)(8)Notwithstanding any provision of chapter 381, a 725 hospital licensed under ss. 395.001-395.3025 that operates a 726 trauma center may not terminate or substantially reduce the 727 availability of trauma service without providing at least 180 728 days’ notice of its intent to terminate such service. Such 729 notice shall be given to the department, to all affected local 730 or regional trauma agencies, and to all trauma centers, 731 hospitals, and emergency medical service providers in the trauma 732 service area. The department shall adopt by rule the procedures 733 and process for notification, duration, and explanation of the 734 termination of trauma services. 735 (10)(9)Except as otherwise provided in this subsection, 736 the department or its agent may collect trauma care and registry 737 data, as prescribed by rule of the department, from trauma 738 centers, hospitals, emergency medical service providers, local 739 or regional trauma agencies, or medical examiners for the 740 purposes of evaluating trauma system effectiveness, ensuring 741 compliance with the standards, and monitoring patient outcomes. 742 A trauma center, hospital, emergency medical service provider, 743 medical examiner, or local trauma agency or regional trauma 744 agency, or a panel or committee assembled by such an agency 745 under s. 395.50(1) may, but is not required to, disclose to the 746 department patient care quality assurance proceedings, records, 747 or reports. However, the department may require a local trauma 748 agency or a regional trauma agency, or a panel or committee 749 assembled by such an agency to disclose to the department 750 patient care quality assurance proceedings, records, or reports 751 that the department needs solely to conduct quality assurance 752 activities under s. 395.4015, or to ensure compliance with the 753 quality assurance component of the trauma agency’s plan approved 754 under s. 395.401. The patient care quality assurance 755 proceedings, records, or reports that the department may require 756 for these purposes include, but are not limited to, the 757 structure, processes, and procedures of the agency’s quality 758 assurance activities, and any recommendation for improving or 759 modifying the overall trauma system, if the identity of a trauma 760 center, hospital, emergency medical service provider, medical 761 examiner, or an individual who provides trauma services is not 762 disclosed. 763 (11)(10)Out-of-state experts assembled by the department 764 to conduct onsite visits are agents of the department for the 765 purposes of s. 395.3025. An out-of-state expert who acts as an 766 agent of the department under this subsection is not liable for 767 any civil damages as a result of actions taken by him or her, 768 unless he or she is found to be operating outside the scope of 769 the authority and responsibility assigned by the department. 770 (12)(11)Onsite visits by the department or its agent may 771 be conducted at any reasonable time and may include but not be 772 limited to a review of records in the possession of trauma 773 centers, hospitals, emergency medical service providers, local 774 or regional trauma agencies, or medical examiners regarding the 775 care, transport, treatment, or examination of trauma patients. 776 (13)(12)Patient care, transport, or treatment records or 777 reports, or patient care quality assurance proceedings, records, 778 or reports obtained or made pursuant to this section, s. 779 395.3025(4)(f), s. 395.401, s. 395.4015, s. 395.402, s. 395.403, 780 s. 395.404, s. 395.4045, s. 395.405, s. 395.50, or s. 395.51 781 must be held confidential by the department or its agent and are 782 exempt from the provisions of s. 119.07(1). Patient care quality 783 assurance proceedings, records, or reports obtained or made 784 pursuant to these sections are not subject to discovery or 785 introduction into evidence in any civil or administrative 786 action. 787 (14)(13)The department may adopt, by rule, the procedures 788 and process by which it will select trauma centers. Such 789 procedures and process must be used inannuallyselecting trauma 790 centers and must be consistent with subsections (1)-(9)(1)-(8)791 except in those situations in which it is in the best interest 792 of, and mutually agreed to by, all applicants within a service 793 area and the department to reduce the timeframes. 794 (15)(14)Notwithstanding the procedures established 795 pursuant to subsections (1) through (14)(13), hospitals located 796 in areas with limited access to trauma center services shall be 797 designated by the department as Level II trauma centers based on 798 documentation of a valid certificate of trauma center 799 verification from the American College of Surgeons. Areas with 800 limited access to trauma center services are defined by the 801 following criteria: 802 (a) The hospital is located in a trauma service area with a 803 population greater than 600,000 persons but a population density 804 of less than 225 persons per square mile; 805 (b) The hospital is located in a county with no verified 806 trauma center; and 807 (c) The hospital is located at least 15 miles or 20 minutes 808 travel time by ground transport from the nearest verified trauma 809 center. 810 (16)(a) Notwithstanding the statutory capacity limits 811 established in s. 395.402(1), the provisions of subsection (8), 812 or any other provision of this act, an adult Level I trauma 813 center, an adult Level II trauma center, a Level II trauma 814 center with a pediatric trauma center, a jointly certified 815 pediatric trauma center, or a stand-alone pediatric trauma 816 center that was verified by the department before December 15, 817 2017, is deemed to have met the trauma center application and 818 operational requirements of this section and must be verified 819 and designated as a trauma center. 820 (b) Notwithstanding the statutory capacity limits 821 established in s. 395.402(1), the provisions of subsection (8), 822 or any other provision of this act, a trauma center that was not 823 verified by the department before December 15, 2017, but that 824 was provisionally approved by the department to be in 825 substantial compliance with Level II trauma standards before 826 January 1, 2017, and which is operating as a Level II trauma 827 center, is deemed to have met the application and operational 828 requirements of this section for a trauma center and must be 829 verified and designated as a Level II trauma center. 830 (c) Notwithstanding the statutory capacity limits 831 established in s. 395.402(1), the provisions of subsection (8), 832 or any other provision of this act, a trauma center that was not 833 verified by the department before December 15, 2017, as a Level 834 I trauma center but that was provisionally approved by the 835 department to be in substantial compliance with Level I trauma 836 standards before January 1, 2017, and is operating as a Level I 837 trauma center is deemed to have met the application and 838 operational requirements of this section for a trauma center and 839 must be verified and designated as a Level I trauma center. 840 (d) Notwithstanding the statutory capacity limits 841 established in s. 395.402(1), the provisions of subsection (8), 842 or any other provision of this act, a trauma center that was not 843 verified by the department before December 15, 2017, as a 844 pediatric trauma center but was provisionally approved by the 845 department and found to be in substantial compliance with the 846 pediatric trauma standards established by rule before January 1, 847 2018, and is operating as a pediatric trauma center is deemed to 848 have met the application and operational requirements of this 849 section for a pediatric trauma center and, upon successful 850 completion of the in-depth and site review process, shall be 851 verified and designated as a pediatric trauma center. 852 Notwithstanding the provisions of subsection (8), no existing 853 trauma center in the same trauma service area or in a trauma 854 service area contiguous to the trauma service area where the 855 applicant is located may protest the in-depth review, site 856 survey, or verification decision of the department regarding an 857 applicant that meets the requirements of this paragraph. 858 (e) Notwithstanding the statutory capacity limits 859 established in s. 395.402(1) or any other provision of this act, 860 any hospital operating as a Level II trauma center after January 861 1, 2017, must be designated and verified by the department as a 862 Level II trauma center if all of the following apply: 863 1. The hospital was provisionally approved after January 1, 864 2017, to operate as a Level II trauma center and was in 865 operation on or before June 1, 2017; 866 2. The department’s decision to approve the hospital to 867 operate a provisional Level II trauma center was in litigation 868 on or before January 1, 2018; 869 3. The hospital receives a recommended order from the 870 Division of Administrative Hearings, a final order from the 871 department, or an order from a court of competent jurisdiction 872 which provides that it was entitled to be designated and 873 verified as a Level II trauma center; and 874 4. The department determines that the hospital is in 875 substantial compliance with the Level II trauma center 876 standards, including the in-depth and site reviews. 877 878 Any provisional trauma center operating under this paragraph may 879 not be required to cease trauma operations unless a court of 880 competent jurisdiction or the department determines that it has 881 failed to meet the trauma center standards, as established by 882 department rule. 883 (f) Notwithstanding the statutory capacity limits 884 established in s. 395.402(1), or any other provision of this 885 act, a joint pediatric trauma center involving a Level II trauma 886 center and a specialty licensed children’s hospital which was 887 verified by the department before December 15, 2017, is deemed 888 to have met the application and operational requirements of this 889 section for a pediatric trauma center and shall be verified and 890 designated as a pediatric trauma center even if the joint 891 program is dissolved upon the expiration of the existing 892 certificate and the pediatric trauma center continues operations 893 independently through the specialty licensed children’s 894 hospital, provided that the pediatric trauma center meets all 895 requirements for verification by the department. 896 (g) Nothing in this subsection shall limit the department’s 897 authority to review and approve trauma center applications. 898 Section 7. Section 395.403, Florida Statutes, is amended to 899 read: 900 395.403 Reimbursement of trauma centers.— 901 (1) All verified trauma centers shall be considered 902 eligible to receive state funding when state funds are 903 specifically appropriated for state-sponsored trauma centers in 904 the General Appropriations Act. Effective July 1, 2010, the 905 department shall make payments from the Emergency Medical 906 Services Trust Fund under s. 20.435 to the trauma centers. 907 Payments shall be in equal amounts for the trauma centers 908 approved by the department as of July 1 of the fiscal year in 909 which funding is appropriated. In the event a trauma center does 910 not maintain its status as a trauma center for any state fiscal 911 year in which such funding is appropriated, the trauma center 912 shall repay the state for the portion of the year during which 913 it was not a trauma center. 914 (2) Trauma centers eligible to receive distributions from 915 the Emergency Medical Services Trust Fund under s. 20.435 in 916 accordance with subsection (1) may request that such funds be 917 used as intergovernmental transfer funds in the Medicaid 918 program. 919 (3) In order to receive state funding, a hospital must 920shallbe a verified trauma center and shall: 921 (a) Agree to conform to all departmental requirements as 922 provided by rule to assure high-quality trauma services. 923 (b) Agree to report trauma data to the National Trauma Data 924 Bankprovide information concerning the provision of trauma925services to the department, in a form and manner prescribed by926rule of the department. 927 (c) Agree to accept all trauma patients, regardless of 928 ability to pay, on a functional space-available basis. 929 (4) A trauma center that fails to comply with any of the 930 conditions listed in subsection (3) or the applicable rules of 931 the department mayshallnot receive payments under this section 932 for the period in which it was not in compliance. 933 Section 8. Section 395.4036, Florida Statutes, is amended 934 to read: 935 395.4036 Trauma payments.— 936 (1) Recognizing the Legislature’s stated intent to provide 937 financial support to the current verified trauma centers and to 938 provide incentives for the establishment of additional trauma 939 centers as part of a system of state-sponsored trauma centers, 940 the department shall useutilizefunds collected under s. 318.18 941 and deposited into the Emergency Medical Services Trust Fund of 942 the department to ensure the availability and accessibility of 943 trauma services throughout the state as provided in this 944 subsection. 945 (a) Funds collected under s. 318.18(15) shall be 946 distributed as follows: 947 1. Twenty percent of the total funds collected during the 948 state fiscal year shall be distributed to verified trauma 949 centers that have a local funding contribution as of December 950 31. Distribution of funds under this subparagraph shall be based 951 on trauma caseload volume for the most recent calendar year 952 available. 953 2. Forty percent of the total funds collected shall be 954 distributed to verified trauma centers based on trauma caseload 955 volume for the most recent calendar year available. The 956 determination of caseload volume for distribution of funds under 957 this subparagraph shall be based on the agency’s hospital 958 discharge data reported by each trauma center pursuant to s. 959 408.061 and meeting the criteria for classification as a trauma 960 patientdepartment’s Trauma Registry data. 961 3. Forty percent of the total funds collected shall be 962 distributed to verified trauma centers based on severity of 963 trauma patients for the most recent calendar year available. The 964 determination of severity for distribution of funds under this 965 subparagraph shall be based on the department’s International 966 Classification Injury Severity Scores or another statistically 967 valid and scientifically accepted method of stratifying a trauma 968 patient’s severity of injury, risk of mortality, and resource 969 consumption as adopted by the department by rule, weighted based 970 on the costs associated with and incurred by the trauma center 971 in treating trauma patients. The weighting of scores shall be 972 established by the department by rule. 973 (b) Funds collected under s. 318.18(5)(c) and (20) shall be 974 distributed as follows: 975 1. Thirty percent of the total funds collected shall be 976 distributed to Level II trauma centers operated by a public 977 hospital governed by an elected board of directors as of 978 December 31, 2008. 979 2. Thirty-five percent of the total funds collected shall 980 be distributed to verified trauma centers based on trauma 981 caseload volume for the most recent calendar year available. The 982 determination of caseload volume for distribution of funds under 983 this subparagraph shall be based on the agency’s hospital 984 discharge data reported by each trauma center pursuant to s. 985 408.061 and meeting the criteria for classification as a trauma 986 patientdepartment’s Trauma Registry data. 987 3. Thirty-five percent of the total funds collected shall 988 be distributed to verified trauma centers based on severity of 989 trauma patients for the most recent calendar year available. The 990 determination of severity for distribution of funds under this 991 subparagraph shall be based on the department’s International 992 Classification Injury Severity Scores or another statistically 993 valid and scientifically accepted method of stratifying a trauma 994 patient’s severity of injury, risk of mortality, and resource 995 consumption as adopted by the department by rule, weighted based 996 on the costs associated with and incurred by the trauma center 997 in treating trauma patients. The weighting of scores shall be 998 established by the department by rule. 999 (2) Funds deposited in the department’s Emergency Medical 1000 Services Trust Fund for verified trauma centers may be used to 1001 maximize the receipt of federal funds that may be available for 1002 such trauma centers. Notwithstanding this section and s. 318.14, 1003 distributions to trauma centers may be adjusted in a manner to 1004 ensure that total payments to trauma centers represent the same 1005 proportional allocation as set forth in this section and s. 1006 318.14. For purposes of this section and s. 318.14, total funds 1007 distributed to trauma centers may include revenue from the 1008 Emergency Medical Services Trust Fund and federal funds for 1009 which revenue from the Administrative Trust Fund is used to meet 1010 state or local matching requirements. Funds collected under ss. 1011 318.14 and 318.18 and deposited in the Emergency Medical 1012 Services Trust Fund of the department shall be distributed to 1013 trauma centers on a quarterly basis using the most recent 1014 calendar year data available. Such data shall not be used for 1015 more than four quarterly distributions unless there are 1016 extenuating circumstances as determined by the department, in 1017 which case the most recent calendar year data available shall 1018 continue to be used and appropriate adjustments shall be made as 1019 soon as the more recent data becomes available. 1020 (3)(a) Any trauma center not subject to audit pursuant to 1021 s. 215.97 shall annually attest, under penalties of perjury, 1022 that such proceeds were used in compliance with law. The annual 1023 attestation shall be made in a form and format determined by the 1024 department. The annual attestation shall be submitted to the 1025 department for review within 9 months after the end of the 1026 organization’s fiscal year. 1027 (b) Any trauma center subject to audit pursuant to s. 1028 215.97 shall submit an audit report in accordance with rules 1029 adopted by the Auditor General. 1030 (4) The department, working with the Agency for Health Care 1031 Administration, shall maximize resources for trauma services 1032 wherever possible. 1033 Section 9. Section 395.404, Florida Statutes, is amended to 1034 read: 1035 395.404 ReportingReviewof traumaregistrydata; report to 1036 National Trauma Data Bankcentral registry; confidentiality and1037limited release.— 1038 (1)(a)Each trauma center shall participate in the National 1039 Trauma Data Bank, and the department shall solely use the 1040 National Trauma Data Bank for quality and assessment purposes. 1041 (2) Each trauma center and acute care hospital shall report 1042 to the department all transfers of trauma patients and the 1043 outcomes of such patientsfurnish, and, upon request of the1044department, all acute care hospitals shall furnish for1045department review trauma registry data as prescribed by rule of1046the department for the purpose of monitoring patient outcome and1047ensuring compliance with the standards of approval. 1048(b)Trauma registry data obtained pursuant to this1049subsection are confidential and exempt from the provisions of s.1050119.07(1) and s. 24(a), Art. I of the State Constitution.1051However, the department may provide such trauma registry data to1052the person, trauma center, hospital, emergency medical service1053provider, local or regional trauma agency, medical examiner, or1054other entity from which the data were obtained. The department1055may also use or provide trauma registry data for purposes of1056research in accordance with the provisions of chapter 405.1057 (3)(2)Each trauma center, pediatric trauma center,and 1058 acute care hospital shall report to the department’s brain and 1059 spinal cord injury central registry, consistent with the 1060 procedures and timeframes of s. 381.74, any person who has a 1061 moderate-to-severe brain or spinal cord injury, and shall 1062 include in the report the name, age, residence, and type of 1063 disability of the individual and any additional information that 1064 the department finds necessary. 1065 Section 10. Paragraph (k) of subsection (1) of section 1066 395.401, Florida Statutes, is amended to read: 1067 395.401 Trauma services system plans; approval of trauma 1068 centers and pediatric trauma centers; procedures; renewal.— 1069 (1) 1070 (k) It is unlawful for any hospital or other facility to 1071 hold itself out as a trauma center unless it has been so 1072 verified or designated pursuant to s. 395.4025(15)s.1073395.4025(14). 1074 Section 11. Paragraph (l) of subsection (3) of section 1075 408.036, Florida Statutes, is amended to read: 1076 408.036 Projects subject to review; exemptions.— 1077 (3) EXEMPTIONS.—Upon request, the following projects are 1078 subject to exemption from the provisions of subsection (1): 1079 (l) For the establishment of: 1080 1. A Level II neonatal intensive care unit with at least 10 1081 beds, upon documentation to the agency that the applicant 1082 hospital had a minimum of 1,500 births during the previous 12 1083 months; 1084 2. A Level III neonatal intensive care unit with at least 1085 15 beds, upon documentation to the agency that the applicant 1086 hospital has a Level II neonatal intensive care unit of at least 1087 10 beds and had a minimum of 3,500 births during the previous 12 1088 months; or 1089 3. A Level III neonatal intensive care unit with at least 5 1090 beds, upon documentation to the agency that the applicant 1091 hospital is a verified trauma center pursuant to s. 395.4001(15) 1092s. 395.4001(14), and has a Level II neonatal intensive care 1093 unit, 1094 1095 if the applicant demonstrates that it meets the 1096 requirements for quality of care, nurse staffing, physician 1097 staffing, physical plant, equipment, emergency transportation, 1098 and data reporting found in agency certificate-of-need rules for 1099 Level II and Level III neonatal intensive care units and if the 1100 applicant commits to the provision of services to Medicaid and 1101 charity patients at a level equal to or greater than the 1102 district average. Such a commitment is subject to s. 408.040. 1103 Section 12. Paragraph (a) of subsection (1) of section 1104 409.975, Florida Statutes, is amended to read: 1105 409.975 Managed care plan accountability.—In addition to 1106 the requirements of s. 409.967, plans and providers 1107 participating in the managed medical assistance program shall 1108 comply with the requirements of this section. 1109 (1) PROVIDER NETWORKS.—Managed care plans must develop and 1110 maintain provider networks that meet the medical needs of their 1111 enrollees in accordance with standards established pursuant to 1112 s. 409.967(2)(c). Except as provided in this section, managed 1113 care plans may limit the providers in their networks based on 1114 credentials, quality indicators, and price. 1115 (a) Plans must include all providers in the region that are 1116 classified by the agency as essential Medicaid providers, unless 1117 the agency approves, in writing, an alternative arrangement for 1118 securing the types of services offered by the essential 1119 providers. Providers are essential for serving Medicaid 1120 enrollees if they offer services that are not available from any 1121 other provider within a reasonable access standard, or if they 1122 provided a substantial share of the total units of a particular 1123 service used by Medicaid patients within the region during the 1124 last 3 years and the combined capacity of other service 1125 providers in the region is insufficient to meet the total needs 1126 of the Medicaid patients. The agency may not classify physicians 1127 and other practitioners as essential providers. The agency, at a 1128 minimum, shall determine which providers in the following 1129 categories are essential Medicaid providers: 1130 1. Federally qualified health centers. 1131 2. Statutory teaching hospitals as defined in s. 1132 408.07(45). 1133 3. Hospitals that are trauma centers as defined in s. 1134 395.4001(15)s. 395.4001(14). 1135 4. Hospitals located at least 25 miles from any other 1136 hospital with similar services. 1137 1138 Managed care plans that have not contracted with all 1139 essential providers in the region as of the first date of 1140 recipient enrollment, or with whom an essential provider has 1141 terminated its contract, must negotiate in good faith with such 1142 essential providers for 1 year or until an agreement is reached, 1143 whichever is first. Payments for services rendered by a 1144 nonparticipating essential provider shall be made at the 1145 applicable Medicaid rate as of the first day of the contract 1146 between the agency and the plan. A rate schedule for all 1147 essential providers shall be attached to the contract between 1148 the agency and the plan. After 1 year, managed care plans that 1149 are unable to contract with essential providers shall notify the 1150 agency and propose an alternative arrangement for securing the 1151 essential services for Medicaid enrollees. The arrangement must 1152 rely on contracts with other participating providers, regardless 1153 of whether those providers are located within the same region as 1154 the nonparticipating essential service provider. If the 1155 alternative arrangement is approved by the agency, payments to 1156 nonparticipating essential providers after the date of the 1157 agency’s approval shall equal 90 percent of the applicable 1158 Medicaid rate. Except for payment for emergency services, if the 1159 alternative arrangement is not approved by the agency, payment 1160 to nonparticipating essential providers shall equal 110 percent 1161 of the applicable Medicaid rate. 1162 Section 13. Study on pediatric trauma services; report.— 1163 (1) The Department of Health shall work with the Office of 1164 Program Policy Analysis and Government Accountability to study 1165 the department’s licensure requirements, rules, regulations, 1166 standards, and guidelines for pediatric trauma services and 1167 compare them to the licensure requirements, rules, regulations, 1168 standards, and guidelines for verification of pediatric trauma 1169 services by the American College of Surgeons. 1170 (2) The Office of Program Policy Analysis and Government 1171 Accountability shall submit a report of the findings of the 1172 study to the Governor, the President of the Senate, the Speaker 1173 of the House of Representatives, and the Florida Trauma System 1174 Advisory Council established under s. 395.402, Florida Statutes, 1175 by December 31, 2018. 1176 (3) This section shall expire on January 31, 2019. 1177 Section 14. If the provisions of this act relating to s. 1178 395.4025(16), Florida Statutes, are held to be invalid or 1179 inoperative for any reason, the remaining provisions of this act 1180 shall be deemed to be void and of no effect, it being the 1181 legislative intent that this act as a whole would not have been 1182 adopted had any provision of the act not been included. 1183 Section 15. This act shall take effect upon becoming a law.