Bill Text: FL S1876 | 2018 | Regular Session | Comm Sub
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 CS for SB 1876 By the Committees on Rules; Appropriations; and Health Policy; and Senator Young 595-03969-18 20181876c3 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.; defining 8 and redefining terms; conforming a cross-reference; 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 (5), (13), and (14) of that section 203 are amended, and a new subsection (4) is added to that section, 204 to read: 205 395.4001 Definitions.—As used in this part, the term: 206 (4) “High-risk patient” means an injured patient with an 207 International Classification Injury Severity Score of less than 208 0.85. 209 (6)(5)“International Classification Injury Severity Score” 210 means thestatisticalmethod for computing the severity of 211 injuries sustained by trauma patients, based on.the 212 International Statistical Classification of Diseases and Related 213 Health Problems, 10th revision, Clinical Modification, and 214 adopted by the department by rule, in consultation with the 215 Florida Trauma System Advisory Council, along with any 216 conversion tables or analytical tools used in its computation 217Injury Severity Score shall be the methodologyused by the218department and trauma centersto report theseverity of an219injury. 220 (8)(7)“Level II trauma center” means a trauma center that: 221 (a) Is verified by the department to be in substantial 222 compliance with Level II trauma center standards and has been 223 approved by the department to operate as a Level II trauma 224 center or is designated pursuant to s. 395.4025(15)s.225395.4025(14). 226 (14)(13)“Trauma caseload volume” means the number of 227 trauma patients calculated by the department using the data 228 reported by each designated trauma center to the hospital 229 discharge database maintained by the agency pursuant to s. 230 408.061reported by individual trauma centers to the Trauma231Registry and validated by the department. 232 (15)(14)“Trauma center” means a hospital that has been 233 verified by the department to be in substantial compliance with 234 the requirements in s. 395.4025 and has been approved by the 235 department to operate as a Level I trauma center, Level II 236 trauma center, or pediatric trauma center, or is designated by 237 the department as a Level II trauma center pursuant to s. 238 395.4025(15)s. 395.4025(14). 239 Section 5. Section 395.402, Florida Statutes, is amended to 240 read: 241 395.402 Trauma service areas; number and location of trauma 242 centers.— 243 (1) The Legislature recognizes the need for a statewide, 244 cohesive, uniform, and integrated trauma system, as well as the 245 need to ensure the viability of existing trauma centers when 246 designating new trauma centers. Consistent with national 247 standards, future trauma center designations must be based on 248 need as a factor of demand and capacity.Within the trauma249service areas, Level I and Level II trauma centers shall each be250capable of annually treating a minimum of 1,000 and 500251patients, respectively, with an injury severity score (ISS) of 9252or greater. Level II trauma centers in counties with a253population of more than 500,000 shall have the capacity to care254for 1,000 patients per year.255(2)Trauma service areas as defined in this section are to256be utilized until the Department of Health completes an257assessment of the trauma system and reports its finding to the258Governor, the President of the Senate, the Speaker of the House259of Representatives, and the substantive legislative committees.260The report shall be submitted by February 1, 2005. The261department shall review the existing trauma system and determine262whether it is effective in providing trauma care uniformly263throughout the state. The assessment shall:264(a)Consider aligning trauma service areas within the265trauma region boundaries as established in July 2004.266(b)Review the number and level of trauma centers needed267for each trauma service area to provide a statewide integrated268trauma system.269(c)Establish criteria for determining the number and level270of trauma centers needed to serve the population in a defined271trauma service area or region.272(d)Consider including criteria within trauma center273approval standards based upon the number of trauma victims274served within a service area.275(e)Review the Regional Domestic Security Task Force276structure and determine whether integrating the trauma system277planning with interagency regional emergency and disaster278planning efforts is feasible and identify any duplication of279efforts between the two entities.280(f)Make recommendations regarding a continued revenue281source which shall include a local participation requirement.282(g)Make recommendations regarding a formula for the283distribution of funds identified for trauma centers which shall284address incentives for new centers where needed and the need to285maintain effective trauma care in areas served by existing286centers, with consideration for the volume of trauma patients287served, and the amount of charity care provided.288(3)In conducting such assessment and subsequent annual289reviews, the department shall consider:290(a)The recommendations made as part of the regional trauma291system plans submitted by regional trauma agencies.292(b)Stakeholder recommendations.293(c)The geographical composition of an area to ensure rapid294access to trauma care by patients.295(d)Historical patterns of patient referral and transfer in296an area.297(e)Inventories of available trauma care resources,298including professional medical staff.299(f)Population growth characteristics.300(g)Transportation capabilities, including ground and air301transport.302(h)Medically appropriate ground and air travel times.303(i)Recommendations of the Regional Domestic Security Task304Force.305(j)The actual number of trauma victims currently being306served by each trauma center.307(k)Other appropriate criteria.308(4)Annually thereafter, the department shall review the309assignment of the 67 counties to trauma service areas, in310addition to the requirements of paragraphs (2)(b)-(g) and311subsection (3). County assignments are made for the purpose of312developing a system of trauma centers. Revisions made by the313department shall take into consideration the recommendations314made as part of the regional trauma system plans approved by the315department and the recommendations made as part of the state316trauma system plan. In cases where a trauma service area is317located within the boundaries of more than one trauma region,318the trauma service area’s needs, response capability, and system319requirements shall be considered by each trauma region served by320that trauma service area in its regional system plan. Until the321department completes the February 2005 assessment, the322assignment of counties shall remain as established in this323section.324 (a) The following trauma service areas arehereby325 established: 326 1. Trauma service area 1 shall consist of Escambia, 327 Okaloosa, Santa Rosa, and Walton Counties. 328 2. Trauma service area 2 shall consist of Bay, Gulf, 329 Holmes, and Washington Counties. 330 3. Trauma service area 3 shall consist of Calhoun, 331 Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison, 332 Taylor, and Wakulla Counties. 333 4. Trauma service area 4 shall consist of Alachua, 334 Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy, 335 Putnam, Suwannee, and Union Counties. 336 5. Trauma service area 5 shall consist of Baker, Clay, 337 Duval, Nassau, and St. Johns Counties. 338 6. Trauma service area 6 shall consist of Citrus, Hernando, 339 and Marion Counties. 340 7. Trauma service area 7 shall consist of Flagler and 341 Volusia Counties. 342 8. Trauma service area 8 shall consist of Lake, Orange, 343 Osceola, Seminole, and Sumter Counties. 344 9. Trauma service area 9 shall consist of Pasco and 345 Pinellas Counties. 346 10. Trauma service area 10 shall consist of Hillsborough 347 County. 348 11. Trauma service area 11 shall consist of Hardee, 349 Highlands, and Polk Counties. 350 12. Trauma service area 12 shall consist of Brevard and 351 Indian River Counties. 352 13. Trauma service area 13 shall consist of DeSoto, 353 Manatee, and Sarasota Counties. 354 14. Trauma service area 14 shall consist of Martin, 355 Okeechobee, and St. Lucie Counties. 356 15. Trauma service area 15 shall consist of Charlotte, 357 Collier, Glades, Hendry, and Lee Counties. 358 16. Trauma service area 16 shall consist of Palm Beach 359 County. 360 17. Trauma service area 17 shall consist of BrowardCollier361 County. 362 18. Trauma service area 18 shall consist ofBroward County.36319.Trauma service area 19 shall consist ofMiami-Dade and 364 Monroe Counties. 365 (b) Each trauma service area mustshouldhave at least one 366 Level I or Level II trauma center. Except as otherwise provided 367 in s. 395.4025(16), the department may not designate an existing 368 Level II trauma center as a new pediatric trauma center or 369 designate an existing Level II trauma center as a Level I trauma 370 center in a trauma service area that already has an existing 371 Level I or pediatric trauma centerThe department shall372allocate, by rule, the number of trauma centers needed for each373trauma service area. 374 (c) Trauma centers, including Level I, Level II, Level II 375 with a pediatric trauma center, jointly certified pediatric 376 trauma centers, and stand-alone pediatric trauma centers, shall 377 be apportioned as follows: 378 1. Trauma service area 1 shall have three trauma centers. 379 2. Trauma service area 2 shall have one trauma center. 380 3. Trauma service area 3 shall have one trauma center. 381 4. Trauma service area 4 shall have one trauma center. 382 5. Trauma service area 5 shall have three trauma centers. 383 6. Trauma service area 6 shall have one trauma center. 384 7. Trauma service area 7 shall have one trauma center. 385 8. Trauma service area 8 shall have three trauma centers. 386 9. Trauma service area 9 shall have three trauma centers. 387 10. Trauma service area 10 shall have two trauma centers. 388 11. Trauma service area 11 shall have one trauma center. 389 12. Trauma service area 12 shall have one trauma center. 390 13. Trauma service area 13 shall have two trauma centers. 391 14. Trauma service area 14 shall have one trauma center. 392 15. Trauma service area 15 shall have one trauma center. 393 16. Trauma service area 16 shall have two trauma centers. 394 17. Trauma service area 17 shall have three trauma centers. 395 18. Trauma service area 18 shall have five trauma centers. 396 397 Notwithstanding other provisions of this chapter, a trauma 398 service area may not have more than a total of five Level I, 399 Level II, Level II with a pediatric trauma center, jointly 400 certified pediatric trauma centers, and stand-alone pediatric 401 trauma centers. A trauma service area may not have more than one 402 stand-alone pediatric trauma centerThere shall be no more than403a total of 44 trauma centers in the state. 404 (2)(a) By October 1, 2018, the department shall establish 405 the Florida Trauma System Advisory Council to promote an 406 inclusive trauma system and enhance cooperation among trauma 407 system stakeholders. The advisory council may submit 408 recommendations to the department on how to maximize existing 409 trauma center, emergency department, and emergency medical 410 services infrastructure and personnel to achieve the statutory 411 goal of developing an inclusive trauma system. 412 (b)1. The advisory council shall consist of 12 members 413 appointed by the Governor, including: 414 a. The State Trauma Medical Director; 415 b. A standing member of the Emergency Medical Services 416 Advisory Council; 417 c. A representative of a local or regional trauma agency; 418 d. A trauma program manager or trauma medical director who 419 is actively working in a trauma center and who represents an 420 investor-owned hospital with a trauma center; 421 e. A trauma program manager or trauma medical director 422 actively working in a trauma center who represents a nonprofit 423 or public hospital with a trauma center; 424 f. A trauma surgeon who is board-certified in an 425 appropriate trauma or critical care specialty and who is 426 actively practicing medicine in a Level II trauma center who 427 represents an investor-owned hospital with a trauma center; 428 g. A trauma surgeon who is board-certified in an 429 appropriate trauma or critical care specialty and actively 430 practicing medicine who represents a nonprofit or public 431 hospital with a trauma center; 432 h. A representative of the American College of Surgeons 433 Committee on Trauma who has pediatric expertise; 434 i. A representative of the Safety Net Hospital Alliance of 435 Florida; 436 j. A representative of the Florida Hospital Association; 437 k. A Florida-licensed, board-certified emergency medicine 438 physician who is not affiliated with a trauma center; and 439 l. A trauma surgeon who is board-certified in an 440 appropriate trauma or critical care specialty and actively 441 practicing medicine in a Level I trauma center. 442 2. No two members may be employed by the same health care 443 facility. 444 3. Each council member shall be appointed to a 3-year term; 445 however, for the purpose of providing staggered terms, of the 446 initial appointments, four members shall be appointed to 1-year 447 terms, four members shall be appointed to 2-year terms, and four 448 members shall be appointed to 3-year terms. 449 (c) The department shall use existing and available 450 resources to administer and support the activities of the 451 advisory council. Members of the advisory council shall serve 452 without compensation and are not entitled to reimbursement for 453 per diem or travel expenses. 454 (d) The advisory council shall convene no later than 455 January 5, 2019, and shall meet at least quarterly. 456 Section 6. Section 395.4025, Florida Statutes, is amended 457 to read: 458 395.4025 Trauma centers; selection; quality assurance; 459 records.— 460 (1) For purposes of developing a system of trauma centers, 461 the department shall use the 1819trauma service areas 462 established in s. 395.402.Within each service area and based on463the state trauma system plan, the local or regional trauma464services system plan, and recommendations of the local or465regional trauma agency, the department shall establish the466approximate number of trauma centers needed to ensure reasonable467access to high-quality trauma services.The department shall 468 designateselectthose hospitals that are to be recognized as 469 trauma centers. 470 (2)(a) The department shall prepare an analysis of the 471 Florida trauma system by August 31, 2020, and every 3 years 472 thereafter, using the agency’s hospital discharge database 473 described in s. 408.061 for the current year and the most recent 474 5 years of population data for Florida available from the 475 American Community Survey 5-Year Estimates by the United States 476 Census Bureau. The department’s report must, at a minimum, 477 include all of the following: 478 1. The population growth for each trauma service area and 479 for this state; 480 2. The number of high-risk patients treated at each trauma 481 center within each trauma service area, including pediatric 482 trauma centers; 483 3. The total number of high-risk patients treated at all 484 acute care hospitals inclusive of nontrauma centers in the 485 trauma service area; and 486 4. The percentage of each trauma center’s sufficient volume 487 of trauma patients, as described in subparagraph (3)(d)2., in 488 accordance with the International Classification Injury Severity 489 Score for the trauma center’s designation, inclusive of the 490 additional caseload volume required for those trauma centers 491 with graduate medical education programs. 492 (b) The department shall make available all data, formulas, 493 methodologies, calculations, and risk adjustment tools used in 494 preparing the report. 495 (3)(a)(2)(a)The department shallannuallynotify each 496 acute care general hospital and each local and each regional 497 trauma agency in a trauma service area with an identified need 498 for an additional trauma centerthe statethat the department is 499 accepting letters of intent from hospitals that are interested 500 in becoming trauma centers. The department may accept a letter 501 of intent only if there is statutory capacity for an additional 502 trauma center in accordance with subsection (2), paragraph (d), 503 and s. 395.402In order to be considered by the department, a504hospital that operates within the geographic area of a local or505regional trauma agency must certify that its intent to operate506as a trauma center is consistent with the trauma services plan507of the local or regional trauma agency, as approved by the508department, if such agency exists. Letters of intent must be 509 postmarked no later than midnight October 1 of the year in which 510 the department notifies hospitals that it plans to accept 511 letters of intent. 512 (b) By October 15, the department shall send to all 513 hospitals that submitted a letter of intent an application 514 package that will provide the hospitals with instructions for 515 submitting information to the department for selection as a 516 trauma center. The standards for trauma centers provided for in 517 s. 395.401(2), as adopted by rule of the department, shall serve 518 as the basis for these instructions. 519 (c) In order to be considered by the department, 520 applications from those hospitals seeking selection as trauma 521 centers, including those current verified trauma centers that 522 seek a change or redesignation in approval status as a trauma 523 center, must be received by the department no later than the 524 close of business on April 1 of the year following submission of 525 the letter of intent. The department shall conduct an initiala526provisionalreview of each application for the purpose of 527 determining whetherthatthe hospital’s application is complete 528 and whetherthatthe hospital is capable of constructing and 529 operating a trauma center that includeshasthe critical 530 elements required for a trauma center. This critical review must 531willbe based on trauma center standards and mustshallinclude, 532 but need not be limited to, a review as toofwhether the 533 hospital is prepared to attain and operate with all of the 534 following components before April 30 of the following yearhas: 535 1. Equipment and physical facilities necessary to provide 536 trauma services. 537 2. Personnel in sufficient numbers and with proper 538 qualifications to provide trauma services. 539 3. An effective quality assurance process. 5404.Submitted written confirmation by the local or regional541trauma agency that the hospital applying to become a trauma542center is consistent with the plan of the local or regional543trauma agency, as approved by the department, if such agency544exists.545 (d)1.Except as otherwise provided in this section, the 546 department may not approve an application for a Level I, a Level 547 II, a Level II with a pediatric trauma center, a jointly 548 certified pediatric trauma center, or a stand-alone pediatric 549 trauma center if approval of the application would exceed the 550 limits on the numbers of Level I, Level II, Level II with a 551 pediatric trauma center, jointly certified pediatric trauma 552 centers, or stand-alone pediatric trauma centers established in 553 s. 395.402(1). However, the department shall review and may 554 approve an application for a trauma center when approval of the 555 application would result in a number of trauma centers which 556 exceeds the limit on the numbers of trauma centers in a trauma 557 service area imposed in s. 395.402(1), if, using the analysis 558 performed by the department as required in paragraph (2)(a), the 559 applicant demonstrates and the department determines that: 560 1. The existing trauma center actual caseload volume of 561 high-risk patients exceeds the minimum caseload volume 562 capabilities, inclusive of the additional caseload volume for 563 graduate medical education critical care and trauma surgical 564 subspecialty residents or fellows by more than two times the 565 statutory minimums listed in sub-subparagraphs 2.a.-d. or three 566 times the statutory minimum listed in sub-subparagraph 2.e., and 567 the population growth for the trauma service area exceeds the 568 statewide population growth by more than 15 percent based on the 569 American Community Survey 5-Year Estimates by the United States 570 Census Bureau for the 5-year period before the date the 571 applicant files its letter of intent; and 572 2. A sufficient caseload volume of potential trauma 573 patients exists within the trauma service area to ensure that 574 existing trauma centers caseload volumes are at the following 575 levels: 576 a. For Level I trauma centers in trauma service areas with 577 a population of greater than 1.5 million, a minimum caseload 578 volume of the greater of 1,200 high-risk patients admitted or 579 greater per year or, for a trauma center with a trauma or 580 critical care residency or fellowship program, 1,200 high-risk 581 patients admitted plus 40 cases per year for each accredited 582 critical care and trauma surgical subspecialty medical resident 583 or fellow. 584 b. For Level I trauma centers in trauma service areas with 585 a population of less than 1.5 million, a minimum caseload volume 586 of the greater of 1,000 high-risk patients admitted per year or, 587 for a trauma center with a critical care or trauma residency or 588 fellowship program, 1,000 high-risk patients admitted plus 40 589 cases per year for each accredited critical care and trauma 590 surgical subspecialty medical resident or fellow. 591 c. For Level II trauma centers and Level II trauma centers 592 with a pediatric trauma center in trauma service areas with a 593 population of greater than 1.25 million, a minimum caseload 594 volume of the greater of 1,000 high-risk patients admitted or 595 for a trauma center with a critical care or trauma residency or 596 fellowship program, 1,000 high-risk patients admitted plus 40 597 cases per year for each accredited critical care and trauma 598 surgical subspecialty medical resident or fellow. 599 d. For Level II trauma centers and Level II trauma centers 600 with a pediatric trauma center in trauma service areas with a 601 population of less than 1.25 million, a minimum caseload volume 602 of the greater of 500 high-risk patients admitted per year or 603 for a trauma center with a critical care or trauma residency or 604 fellowship program, 500 high-risk patients admitted plus 40 605 cases per year for each accredited critical care and trauma 606 surgical subspecialty medical resident or fellow. 607 e. For pediatric trauma centers, a minimum caseload volume 608 of the greater of 500 high-risk admitted patients per year or 609 for a trauma center with a critical care or trauma residency or 610 fellowship program, 500 high-risk admitted patients per year 611 plus 40 cases per year for each accredited critical care and 612 trauma surgical subspecialty medical resident or fellow. 613 614 The International Classification Injury Severity Score 615 calculations and caseload volume must be calculated using the 616 most recent available hospital discharge data collected by the 617 agency from all acute care hospitals pursuant to s. 408.061. The 618 agency, in consultation with the department, shall adopt rules 619 for trauma centers and acute care hospitals for the submission 620 of data required for the department to perform its duties under 621 this chapter. 622 (e) If the department determines that the hospital is 623 capable of attaining and operating with the components required 624 by paragraph (c), the applicant must be ready to operate in 625 compliance with Florida trauma center standards no later than 626 April 30 of the year following the department’s initial review 627 and approval of the hospital’s application to proceed with 628 preparation to operate as a trauma center. A hospital that fails 629 to comply with this subsection may not be designated as a trauma 630 centerNotwithstanding other provisions in this section, the631department may grant up to an additional 18 months to a hospital632applicant that is unable to meet all requirements as provided in633paragraph (c) at the time of application if the number of634applicants in the service area in which the applicant is located635is equal to or less than the service area allocation, as636provided by rule of the department. An applicant that is granted637additional time pursuant to this paragraph shall submit a plan638for departmental approval which includes timelines and639activities that the applicant proposes to complete in order to640meet application requirements. Any applicant that demonstrates641an ongoing effort to complete the activities within the642timelines outlined in the plan shall be included in the number643of trauma centers at such time that the department has conducted644a provisional review of the application and has determined that645the application is complete and that the hospital has the646critical elements required for a trauma center.6472.Timeframes provided in subsections (1)-(8) shall be648stayed until the department determines that the application is649complete and that the hospital has the critical elements650required for a trauma center. 651 (4)(3)By May 1, the department shall select one or more 652 hospitalsAfter April 30, any hospitalthat submitted an 653 application found acceptable by the department based on initial 654provisionalreview for approval to prepareshall be eligibleto 655 operate with the components required by paragraph (3)(c). If the 656 department receives more applications than may be approved, the 657 department must select the best applicant or applicants from the 658 available pool based on the department’s determination of the 659 capability of an applicant to provide the highest quality 660 patient care using the most recent technological, medical, and 661 staffing resources available, which is located the farthest away 662 from an existing trauma center in the applicant’s trauma service 663 area to maximize access. The number of applicants selected is 664 limited to available statutory need in the specified trauma 665 service area, as designated in paragraph (3)(d) or s. 395.402(1) 666as a provisional trauma center. 667 (5)(4)Following the initial review,Between May 1 and668October 1 of each year, the department shall conduct an in-depth 669 evaluation of all applications found acceptable in the initial 670provisionalreview. The applications shall be evaluated against 671 criteria enumerated in the application packages as provided to 672 the hospitals by the department. An applicant may not operate as 673 a provisional trauma center until the department completes the 674 initial and in-depth review and approves the application. 675 (6)(5)WithinBeginning October 1 of each year and ending676no later than June 1 ofthefollowingyear after the hospital 677 begins operating as a provisional trauma center, a review team 678 of out-of-state experts assembled by the department shall make 679 onsite visits to all provisional trauma centers. The department 680 shall develop a survey instrument to be used by the expert team 681 of reviewers. The instrument mustshallinclude objective 682 criteria and guidelines for reviewers based on existing trauma 683 center standards such that all trauma centers are assessed 684 equally. The survey instrument mustshallalso include a uniform 685 rating system thatwill be used byreviewers must use to 686 indicate the degree of compliance of each trauma center with 687 specific standards, and to indicate the quality of care provided 688 by each trauma center as determined through an audit of patient 689 charts. In addition, hospitals being considered as provisional 690 trauma centers mustshallmeet all the requirements of a trauma 691 center and mustshallbe located in a trauma service area that 692 has a need for such a trauma center. 693 (7)(6)Based on recommendations from the review team, the 694 department shall approve for designation a trauma center that is 695 in compliance with trauma center standards, as established by 696 department rule, and with this sectionshall select trauma697centers by July 1. An applicant for designation as a trauma698center may request an extension of its provisional status if it699submits a corrective action plan to the department. The700corrective action plan must demonstrate the ability of the701applicant to correct deficiencies noted during the applicant’s702onsite review conducted by the department between the previous703October 1 and June 1. The department may extend the provisional704status of an applicant for designation as a trauma center705through December 31 if the applicant provides a corrective706action plan acceptable to the department. The department or a707team of out-of-state experts assembled by the department shall708conduct an onsite visit on or before November 1 to confirm that709the deficiencies have been corrected. The provisional trauma710center is responsible for all costs associated with the onsite711visit in a manner prescribed by rule of the department. By712January 1, the department must approve or deny the application713of any provisional applicant granted an extension. Each trauma 714 center shall be granted a 7-year approval period during which 715 time it must continue to maintain trauma center standards and 716 acceptable patient outcomes as determined by department rule. An 717 approval, unless sooner suspended or revoked, automatically 718 expires 7 years after the date of issuance and is renewable upon 719 application for renewal as prescribed by rule of the department. 720 (8)(7)Only an applicant, or hospital with an existing 721 trauma center in the same trauma service area or in a trauma 722 service area contiguous to the trauma service area where the 723 applicant has applied to operate a trauma center, may protest a 724 decision made by the department with regard to whether the 725 application should be approved, or whether need has been 726 established through the criteria established in paragraph (3)(d) 727Any hospital that wishes to protest a decision made by the728department based on the department’s preliminary or in-depth729review of applications or on the recommendations of the site730visit review team pursuant to this section shall proceed as731provided in chapter 120. Hearings held under this subsection 732 shall be conducted in the same manner as provided in ss. 120.569 733 and 120.57. Cases filed under chapter 120 may combine all 734 disputes between parties. 735 (9)(8)Notwithstanding any provision of chapter 381, a 736 hospital licensed under ss. 395.001-395.3025 that operates a 737 trauma center may not terminate or substantially reduce the 738 availability of trauma service without providing at least 180 739 days’ notice of its intent to terminate such service. Such 740 notice shall be given to the department, to all affected local 741 or regional trauma agencies, and to all trauma centers, 742 hospitals, and emergency medical service providers in the trauma 743 service area. The department shall adopt by rule the procedures 744 and process for notification, duration, and explanation of the 745 termination of trauma services. 746 (10)(9)Except as otherwise provided in this subsection, 747 the department or its agent may collect trauma care and registry 748 data, as prescribed by rule of the department, from trauma 749 centers, hospitals, emergency medical service providers, local 750 or regional trauma agencies, or medical examiners for the 751 purposes of evaluating trauma system effectiveness, ensuring 752 compliance with the standards, and monitoring patient outcomes. 753 A trauma center, hospital, emergency medical service provider, 754 medical examiner, or local trauma agency or regional trauma 755 agency, or a panel or committee assembled by such an agency 756 under s. 395.50(1) may, but is not required to, disclose to the 757 department patient care quality assurance proceedings, records, 758 or reports. However, the department may require a local trauma 759 agency or a regional trauma agency, or a panel or committee 760 assembled by such an agency to disclose to the department 761 patient care quality assurance proceedings, records, or reports 762 that the department needs solely to conduct quality assurance 763 activities under s. 395.4015, or to ensure compliance with the 764 quality assurance component of the trauma agency’s plan approved 765 under s. 395.401. The patient care quality assurance 766 proceedings, records, or reports that the department may require 767 for these purposes include, but are not limited to, the 768 structure, processes, and procedures of the agency’s quality 769 assurance activities, and any recommendation for improving or 770 modifying the overall trauma system, if the identity of a trauma 771 center, hospital, emergency medical service provider, medical 772 examiner, or an individual who provides trauma services is not 773 disclosed. 774 (11)(10)Out-of-state experts assembled by the department 775 to conduct onsite visits are agents of the department for the 776 purposes of s. 395.3025. An out-of-state expert who acts as an 777 agent of the department under this subsection is not liable for 778 any civil damages as a result of actions taken by him or her, 779 unless he or she is found to be operating outside the scope of 780 the authority and responsibility assigned by the department. 781 (12)(11)Onsite visits by the department or its agent may 782 be conducted at any reasonable time and may include but not be 783 limited to a review of records in the possession of trauma 784 centers, hospitals, emergency medical service providers, local 785 or regional trauma agencies, or medical examiners regarding the 786 care, transport, treatment, or examination of trauma patients. 787 (13)(12)Patient care, transport, or treatment records or 788 reports, or patient care quality assurance proceedings, records, 789 or reports obtained or made pursuant to this section, s. 790 395.3025(4)(f), s. 395.401, s. 395.4015, s. 395.402, s. 395.403, 791 s. 395.404, s. 395.4045, s. 395.405, s. 395.50, or s. 395.51 792 must be held confidential by the department or its agent and are 793 exempt from the provisions of s. 119.07(1). Patient care quality 794 assurance proceedings, records, or reports obtained or made 795 pursuant to these sections are not subject to discovery or 796 introduction into evidence in any civil or administrative 797 action. 798 (14)(13)The department may adopt, by rule, the procedures 799 and process by which it will select trauma centers. Such 800 procedures and process must be used inannuallyselecting trauma 801 centers and must be consistent with subsections (1)-(9)(1)-(8)802 except in those situations in which it is in the best interest 803 of, and mutually agreed to by, all applicants within a service 804 area and the department to reduce the timeframes. 805 (15)(14)Notwithstanding the procedures established 806 pursuant to subsections (1) through (14)(13), hospitals located 807 in areas with limited access to trauma center services shall be 808 designated by the department as Level II trauma centers based on 809 documentation of a valid certificate of trauma center 810 verification from the American College of Surgeons. Areas with 811 limited access to trauma center services are defined by the 812 following criteria: 813 (a) The hospital is located in a trauma service area with a 814 population greater than 600,000 persons but a population density 815 of less than 225 persons per square mile; 816 (b) The hospital is located in a county with no verified 817 trauma center; and 818 (c) The hospital is located at least 15 miles or 20 minutes 819 travel time by ground transport from the nearest verified trauma 820 center. 821 (16)(a) Notwithstanding the statutory capacity limits 822 established in s. 395.402(1), the provisions of subsection (8), 823 or any other provision of this act, an adult Level I trauma 824 center, an adult Level II trauma center, a Level II trauma 825 center with a pediatric trauma center, a jointly certified 826 pediatric trauma center, or a stand-alone pediatric trauma 827 center that was verified by the department before December 15, 828 2017, is deemed to have met the trauma center application and 829 operational requirements of this section and must be verified 830 and designated as a trauma center. 831 (b) Notwithstanding the statutory capacity limits 832 established in s. 395.402(1), the provisions of subsection (8), 833 or any other provision of this act, a trauma center that was not 834 verified by the department before December 15, 2017, but that 835 was provisionally approved by the department to be in 836 substantial compliance with Level II trauma standards before 837 January 1, 2017, and which is operating as a Level II trauma 838 center, is deemed to have met the application and operational 839 requirements of this section for a trauma center and must be 840 verified and designated as a Level II trauma center. 841 (c) Notwithstanding the statutory capacity limits 842 established in s. 395.402(1), the provisions of subsection (8), 843 or any other provision of this act, a trauma center that was not 844 verified by the department before December 15, 2017, as a Level 845 I trauma center but that was provisionally approved by the 846 department to be in substantial compliance with Level I trauma 847 standards before January 1, 2017, and is operating as a Level I 848 trauma center is deemed to have met the application and 849 operational requirements of this section for a trauma center and 850 must be verified and designated as a Level I trauma center. 851 (d) Notwithstanding the statutory capacity limits 852 established in s. 395.402(1), the provisions of subsection (8), 853 or any other provision of this act, a trauma center that was not 854 verified by the department before December 15, 2017, as a 855 pediatric trauma center but was provisionally approved by the 856 department and found to be in substantial compliance with the 857 pediatric trauma standards established by rule before January 1, 858 2018, and is operating as a pediatric trauma center is deemed to 859 have met the application and operational requirements of this 860 section for a pediatric trauma center and, upon successful 861 completion of the in-depth and site review process, shall be 862 verified and designated as a pediatric trauma center. 863 Notwithstanding the provisions of subsection (8), no existing 864 trauma center in the same trauma service area or in a trauma 865 service area contiguous to the trauma service area where the 866 applicant is located may protest the in-depth review, site 867 survey, or verification decision of the department regarding an 868 applicant that meets the requirements of this paragraph. 869 (e) Notwithstanding the statutory capacity limits 870 established in s. 395.402(1) or any other provision of this act, 871 any hospital operating as a Level II trauma center after January 872 1, 2017, must be designated and verified by the department as a 873 Level II trauma center if all of the following apply: 874 1. The hospital was provisionally approved after January 1, 875 2017, to operate as a Level II trauma center and was in 876 operation on or before June 1, 2017; 877 2. The department’s decision to approve the hospital to 878 operate a provisional Level II trauma center was in litigation 879 on or before January 1, 2018; 880 3. The hospital receives a recommended order from the 881 Division of Administrative Hearings, a final order from the 882 department, or an order from a court of competent jurisdiction 883 which provides that it was entitled to be designated and 884 verified as a Level II trauma center; and 885 4. The department determines that the hospital is in 886 substantial compliance with the Level II trauma center 887 standards, including the in-depth and site reviews. 888 889 Any provisional trauma center operating under this paragraph may 890 not be required to cease trauma operations unless a court of 891 competent jurisdiction or the department determines that it has 892 failed to meet the trauma center standards, as established by 893 department rule. 894 (f) Notwithstanding the statutory capacity limits 895 established in s. 395.402(1), or any other provision of this 896 act, a joint pediatric trauma center involving a Level II trauma 897 center and a specialty licensed children’s hospital which was 898 verified by the department before December 15, 2017, is deemed 899 to have met the application and operational requirements of this 900 section for a pediatric trauma center and shall be verified and 901 designated as a pediatric trauma center even if the joint 902 program is dissolved upon the expiration of the existing 903 certificate and the pediatric trauma center continues operations 904 independently through the specialty licensed children’s 905 hospital, provided that the pediatric trauma center meets all 906 requirements for verification by the department. 907 (g) Nothing in this subsection shall limit the department’s 908 authority to review and approve trauma center applications. 909 Section 7. Section 395.403, Florida Statutes, is amended to 910 read: 911 395.403 Reimbursement of trauma centers.— 912 (1) All verified trauma centers shall be considered 913 eligible to receive state funding when state funds are 914 specifically appropriated for state-sponsored trauma centers in 915 the General Appropriations Act. Effective July 1, 2010, the 916 department shall make payments from the Emergency Medical 917 Services Trust Fund under s. 20.435 to the trauma centers. 918 Payments shall be in equal amounts for the trauma centers 919 approved by the department as of July 1 of the fiscal year in 920 which funding is appropriated. In the event a trauma center does 921 not maintain its status as a trauma center for any state fiscal 922 year in which such funding is appropriated, the trauma center 923 shall repay the state for the portion of the year during which 924 it was not a trauma center. 925 (2) Trauma centers eligible to receive distributions from 926 the Emergency Medical Services Trust Fund under s. 20.435 in 927 accordance with subsection (1) may request that such funds be 928 used as intergovernmental transfer funds in the Medicaid 929 program. 930 (3) In order to receive state funding, a hospital must 931shallbe a verified trauma center and shall: 932 (a) Agree to conform to all departmental requirements as 933 provided by rule to assure high-quality trauma services. 934 (b) Agree to report trauma data to the National Trauma Data 935 Bankprovide information concerning the provision of trauma936services to the department, in a form and manner prescribed by937rule of the department. 938 (c) Agree to accept all trauma patients, regardless of 939 ability to pay, on a functional space-available basis. 940 (4) A trauma center that fails to comply with any of the 941 conditions listed in subsection (3) or the applicable rules of 942 the department mayshallnot receive payments under this section 943 for the period in which it was not in compliance. 944 Section 8. Section 395.4036, Florida Statutes, is amended 945 to read: 946 395.4036 Trauma payments.— 947 (1) Recognizing the Legislature’s stated intent to provide 948 financial support to the current verified trauma centers and to 949 provide incentives for the establishment of additional trauma 950 centers as part of a system of state-sponsored trauma centers, 951 the department shall useutilizefunds collected under s. 318.18 952 and deposited into the Emergency Medical Services Trust Fund of 953 the department to ensure the availability and accessibility of 954 trauma services throughout the state as provided in this 955 subsection. 956 (a) Funds collected under s. 318.18(15) shall be 957 distributed as follows: 958 1. Twenty percent of the total funds collected during the 959 state fiscal year shall be distributed to verified trauma 960 centers that have a local funding contribution as of December 961 31. Distribution of funds under this subparagraph shall be based 962 on trauma caseload volume for the most recent calendar year 963 available. 964 2. Forty percent of the total funds collected shall be 965 distributed to verified trauma centers based on trauma caseload 966 volume for the most recent calendar year available. The 967 determination of caseload volume for distribution of funds under 968 this subparagraph shall be based on the agency’s hospital 969 discharge data reported by each trauma center pursuant to s. 970 408.061 and meeting the criteria for classification as a trauma 971 patientdepartment’s Trauma Registry data. 972 3. Forty percent of the total funds collected shall be 973 distributed to verified trauma centers based on severity of 974 trauma patients for the most recent calendar year available. The 975 determination of severity for distribution of funds under this 976 subparagraph shall be based on the department’s International 977 Classification Injury Severity Scores or another statistically 978 valid and scientifically accepted method of stratifying a trauma 979 patient’s severity of injury, risk of mortality, and resource 980 consumption as adopted by the department by rule, weighted based 981 on the costs associated with and incurred by the trauma center 982 in treating trauma patients. The weighting of scores shall be 983 established by the department by rule. 984 (b) Funds collected under s. 318.18(5)(c) and (20) shall be 985 distributed as follows: 986 1. Thirty percent of the total funds collected shall be 987 distributed to Level II trauma centers operated by a public 988 hospital governed by an elected board of directors as of 989 December 31, 2008. 990 2. Thirty-five percent of the total funds collected shall 991 be distributed to verified trauma centers based on trauma 992 caseload volume for the most recent calendar year available. The 993 determination of caseload volume for distribution of funds under 994 this subparagraph shall be based on the agency’s hospital 995 discharge data reported by each trauma center pursuant to s. 996 408.061 and meeting the criteria for classification as a trauma 997 patientdepartment’s Trauma Registry data. 998 3. Thirty-five percent of the total funds collected shall 999 be distributed to verified trauma centers based on severity of 1000 trauma patients for the most recent calendar year available. The 1001 determination of severity for distribution of funds under this 1002 subparagraph shall be based on the department’s International 1003 Classification Injury Severity Scores or another statistically 1004 valid and scientifically accepted method of stratifying a trauma 1005 patient’s severity of injury, risk of mortality, and resource 1006 consumption as adopted by the department by rule, weighted based 1007 on the costs associated with and incurred by the trauma center 1008 in treating trauma patients. The weighting of scores shall be 1009 established by the department by rule. 1010 (2) Funds deposited in the department’s Emergency Medical 1011 Services Trust Fund for verified trauma centers may be used to 1012 maximize the receipt of federal funds that may be available for 1013 such trauma centers. Notwithstanding this section and s. 318.14, 1014 distributions to trauma centers may be adjusted in a manner to 1015 ensure that total payments to trauma centers represent the same 1016 proportional allocation as set forth in this section and s. 1017 318.14. For purposes of this section and s. 318.14, total funds 1018 distributed to trauma centers may include revenue from the 1019 Emergency Medical Services Trust Fund and federal funds for 1020 which revenue from the Administrative Trust Fund is used to meet 1021 state or local matching requirements. Funds collected under ss. 1022 318.14 and 318.18 and deposited in the Emergency Medical 1023 Services Trust Fund of the department shall be distributed to 1024 trauma centers on a quarterly basis using the most recent 1025 calendar year data available. Such data shall not be used for 1026 more than four quarterly distributions unless there are 1027 extenuating circumstances as determined by the department, in 1028 which case the most recent calendar year data available shall 1029 continue to be used and appropriate adjustments shall be made as 1030 soon as the more recent data becomes available. 1031 (3)(a) Any trauma center not subject to audit pursuant to 1032 s. 215.97 shall annually attest, under penalties of perjury, 1033 that such proceeds were used in compliance with law. The annual 1034 attestation shall be made in a form and format determined by the 1035 department. The annual attestation shall be submitted to the 1036 department for review within 9 months after the end of the 1037 organization’s fiscal year. 1038 (b) Any trauma center subject to audit pursuant to s. 1039 215.97 shall submit an audit report in accordance with rules 1040 adopted by the Auditor General. 1041 (4) The department, working with the Agency for Health Care 1042 Administration, shall maximize resources for trauma services 1043 wherever possible. 1044 Section 9. Section 395.404, Florida Statutes, is amended to 1045 read: 1046 395.404 ReportingReviewof traumaregistrydata; report to 1047 National Trauma Data Bankcentral registry; confidentiality and1048limited release.— 1049 (1)(a)Each trauma center shall participate in the National 1050 Trauma Data Bank, and the department shall solely use the 1051 National Trauma Data Bank for quality and assessment purposes. 1052 (2) Each trauma center and acute care hospital shall report 1053 to the department all transfers of trauma patients and the 1054 outcomes of such patientsfurnish, and, upon request of the1055department, all acute care hospitals shall furnish for1056department review trauma registry data as prescribed by rule of1057the department for the purpose of monitoring patient outcome and1058ensuring compliance with the standards of approval. 1059(b)Trauma registry data obtained pursuant to this1060subsection are confidential and exempt from the provisions of s.1061119.07(1) and s. 24(a), Art. I of the State Constitution.1062However, the department may provide such trauma registry data to1063the person, trauma center, hospital, emergency medical service1064provider, local or regional trauma agency, medical examiner, or1065other entity from which the data were obtained. The department1066may also use or provide trauma registry data for purposes of1067research in accordance with the provisions of chapter 405.1068 (3)(2)Each trauma center, pediatric trauma center,and 1069 acute care hospital shall report to the department’s brain and 1070 spinal cord injury central registry, consistent with the 1071 procedures and timeframes of s. 381.74, any person who has a 1072 moderate-to-severe brain or spinal cord injury, and shall 1073 include in the report the name, age, residence, and type of 1074 disability of the individual and any additional information that 1075 the department finds necessary. 1076 Section 10. Paragraph (k) of subsection (1) of section 1077 395.401, Florida Statutes, is amended to read: 1078 395.401 Trauma services system plans; approval of trauma 1079 centers and pediatric trauma centers; procedures; renewal.— 1080 (1) 1081 (k) It is unlawful for any hospital or other facility to 1082 hold itself out as a trauma center unless it has been so 1083 verified or designated pursuant to s. 395.4025(15)s.1084395.4025(14). 1085 Section 11. Paragraph (l) of subsection (3) of section 1086 408.036, Florida Statutes, is amended to read: 1087 408.036 Projects subject to review; exemptions.— 1088 (3) EXEMPTIONS.—Upon request, the following projects are 1089 subject to exemption from the provisions of subsection (1): 1090 (l) For the establishment of: 1091 1. A Level II neonatal intensive care unit with at least 10 1092 beds, upon documentation to the agency that the applicant 1093 hospital had a minimum of 1,500 births during the previous 12 1094 months; 1095 2. A Level III neonatal intensive care unit with at least 1096 15 beds, upon documentation to the agency that the applicant 1097 hospital has a Level II neonatal intensive care unit of at least 1098 10 beds and had a minimum of 3,500 births during the previous 12 1099 months; or 1100 3. A Level III neonatal intensive care unit with at least 5 1101 beds, upon documentation to the agency that the applicant 1102 hospital is a verified trauma center pursuant to s. 395.4001(15) 1103s. 395.4001(14), and has a Level II neonatal intensive care 1104 unit, 1105 1106 if the applicant demonstrates that it meets the 1107 requirements for quality of care, nurse staffing, physician 1108 staffing, physical plant, equipment, emergency transportation, 1109 and data reporting found in agency certificate-of-need rules for 1110 Level II and Level III neonatal intensive care units and if the 1111 applicant commits to the provision of services to Medicaid and 1112 charity patients at a level equal to or greater than the 1113 district average. Such a commitment is subject to s. 408.040. 1114 Section 12. Paragraph (a) of subsection (1) of section 1115 409.975, Florida Statutes, is amended to read: 1116 409.975 Managed care plan accountability.—In addition to 1117 the requirements of s. 409.967, plans and providers 1118 participating in the managed medical assistance program shall 1119 comply with the requirements of this section. 1120 (1) PROVIDER NETWORKS.—Managed care plans must develop and 1121 maintain provider networks that meet the medical needs of their 1122 enrollees in accordance with standards established pursuant to 1123 s. 409.967(2)(c). Except as provided in this section, managed 1124 care plans may limit the providers in their networks based on 1125 credentials, quality indicators, and price. 1126 (a) Plans must include all providers in the region that are 1127 classified by the agency as essential Medicaid providers, unless 1128 the agency approves, in writing, an alternative arrangement for 1129 securing the types of services offered by the essential 1130 providers. Providers are essential for serving Medicaid 1131 enrollees if they offer services that are not available from any 1132 other provider within a reasonable access standard, or if they 1133 provided a substantial share of the total units of a particular 1134 service used by Medicaid patients within the region during the 1135 last 3 years and the combined capacity of other service 1136 providers in the region is insufficient to meet the total needs 1137 of the Medicaid patients. The agency may not classify physicians 1138 and other practitioners as essential providers. The agency, at a 1139 minimum, shall determine which providers in the following 1140 categories are essential Medicaid providers: 1141 1. Federally qualified health centers. 1142 2. Statutory teaching hospitals as defined in s. 1143 408.07(45). 1144 3. Hospitals that are trauma centers as defined in s. 1145 395.4001(15)s. 395.4001(14). 1146 4. Hospitals located at least 25 miles from any other 1147 hospital with similar services. 1148 1149 Managed care plans that have not contracted with all 1150 essential providers in the region as of the first date of 1151 recipient enrollment, or with whom an essential provider has 1152 terminated its contract, must negotiate in good faith with such 1153 essential providers for 1 year or until an agreement is reached, 1154 whichever is first. Payments for services rendered by a 1155 nonparticipating essential provider shall be made at the 1156 applicable Medicaid rate as of the first day of the contract 1157 between the agency and the plan. A rate schedule for all 1158 essential providers shall be attached to the contract between 1159 the agency and the plan. After 1 year, managed care plans that 1160 are unable to contract with essential providers shall notify the 1161 agency and propose an alternative arrangement for securing the 1162 essential services for Medicaid enrollees. The arrangement must 1163 rely on contracts with other participating providers, regardless 1164 of whether those providers are located within the same region as 1165 the nonparticipating essential service provider. If the 1166 alternative arrangement is approved by the agency, payments to 1167 nonparticipating essential providers after the date of the 1168 agency’s approval shall equal 90 percent of the applicable 1169 Medicaid rate. Except for payment for emergency services, if the 1170 alternative arrangement is not approved by the agency, payment 1171 to nonparticipating essential providers shall equal 110 percent 1172 of the applicable Medicaid rate. 1173 Section 13. Study on pediatric trauma services; report.— 1174 (1) The Department of Health shall work with the Office of 1175 Program Policy Analysis and Government Accountability to study 1176 the department’s licensure requirements, rules, regulations, 1177 standards, and guidelines for pediatric trauma services and 1178 compare them to the licensure requirements, rules, regulations, 1179 standards, and guidelines for verification of pediatric trauma 1180 services by the American College of Surgeons. 1181 (2) The Office of Program Policy Analysis and Government 1182 Accountability shall submit a report of the findings of the 1183 study to the Governor, the President of the Senate, the Speaker 1184 of the House of Representatives, and the Florida Trauma System 1185 Advisory Council established under s. 395.402, Florida Statutes, 1186 by December 31, 2018. 1187 (3) This section shall expire on January 31, 2019. 1188 Section 14. If the provisions of this act relating to s. 1189 395.4025(16), Florida Statutes, are held to be invalid or 1190 inoperative for any reason, the remaining provisions of this act 1191 shall be deemed to be void and of no effect, it being the 1192 legislative intent that this act as a whole would not have been 1193 adopted had any provision of the act not been included. 1194 Section 15. This act shall take effect upon becoming a law. 1195