(1) LEGISLATIVE FINDINGS AND INTENT.

(a) The Legislature finds that rural hospitals are the nucleus or "backbone" of rural health care systems. Public health programs and physicians depend on rural hospitals to meet many of their medical needs. Rural hospitals are usually the only source of emergency medical care in rural areas for life-threatening situations and play a crucial role in attracting physicians to rural areas. The Legislature deems the benefits derived from these features to be truly significant as rural counties with hospitals have lower accidental death rates and lower incidence of low birth weight than rural counties without hospitals. In addition, rural hospitals enhance their communities beyond the scope of health care as they are among the largest employers in rural areas and substantially foster economic development and growth. For these reasons, the Legislature finds that rural hospitals are widely viewed as integral to the welfare of rural communities. However, the rural health care system is experiencing significant instability as the financial viability of many of these hospitals is threatened. The Legislature finds that sharply declining occupancy rates, increasing dependence on Medicaid and Medicare reimbursements, liability concerns, frequent changes in ownership, high levels of bad debt, greater competition on more sophisticated levels with urban hospitals, and physician and personnel staffing problems threaten the existence of some rural hospitals.

(b) It is the intent of the Legislature to ease the burdens experienced by rural hospitals in personnel staffing by: 1. Providing financial incentives under the Medical Education Tuition Reimbursement Program in order to increase the number of primary care physicians and nurses in rural areas; and 2. Requiring a study of problems unique to rural hospitals generated by existing licensure and certification requirements for allied health care practitioners in the state.

(c) In addition, it is the intent of the Legislature to ease the severe financial constraints being experienced by some rural hospitals by extending Medicaid reimbursements to rural hospital swing-beds and establishing the full utilization, when feasible, of rural hospital services by departmental primary care programs and programs serving the elderly citizens of the state.

(d) Furthermore, the Legislature encourages the department to actively foster the provision of health care services in rural areas and serve as a catalyst for improved health services to citizens in rural areas of the state. Among other considerations, the department is encouraged to: 1. Promote the location and relocation of health care practitioners in rural areas. 2. Further analyze the financial viability of rural hospitals and their continued existence in rural counties. 3. Integrate policies related to physician workforce, hospitals, primary care, and state regulatory functions. 4. Collect relevant data on rural health care issues for use in departmental policy development. 5. Propose solutions for problems affecting health care delivery in rural areas.

(2) DEFINITIONS. As used in this part:

(a) "Emergency care hospital" means a medical facility which provides: 1. Emergency medical treatment; and 2. Inpatient care to ill or injured persons prior to their transportation to another hospital or provides inpatient medical care to persons needing care for a period of up to 96 hours. The 96-hour limitation on inpatient care does not apply to respite, skilled nursing, hospice, or other nonacute care patients.

(b) "Essential access community hospital" means any facility which: 1. Has at least 100 beds; 2. Is located more than 35 miles from any other essential access community hospital, rural referral center, or urban hospital meeting criteria for classification as a regional referral center; 3. Is part of a network that includes rural primary care hospitals; 4. Provides emergency and medical backup services to rural primary care hospitals in its rural health network; 5. Extends staff privileges to rural primary care hospital physicians in its network; and 6. Accepts patients transferred from rural primary care hospitals in its network.

(c) "Inactive rural hospital bed" means a licensed acute care hospital bed, as defined in s. 395.002(13), that is inactive in that it cannot be occupied by acute care inpatients.

(d) "Rural area health education center" means an area health education center (AHEC), as authorized by Pub. L. No. 94-484, which provides services in a county with a population density of no greater than 100 persons per square mile.

(e) "Rural hospital" means an acute care hospital licensed under this chapter, with 85 licensed beds or less, which has an emergency room and is located in an area defined as rural by the United States Census, and which is: 1. The sole provider within a county with a population density of no greater than 100 persons per square mile; or 2. An acute care hospital, in a county with a population density of no greater than 100 persons per square mile, which is at least 30 minutes of travel time, on normally traveled roads under normal traffic conditions, from any other acute care hospital within the same county; or 3. A hospital supported by a tax district or subdistrict whose boundaries encompass a population of 100 persons or less per square mile.

(f) "Rural primary care hospital" means any facility meeting the criteria in paragraph (e) or s. 395.605 which provides: 1. Twenty-four-hour emergency medical care; 2. Temporary inpatient care for periods of 72 hours or less to patients requiring stabilization before discharge or transfer to another hospital. The 72-hour limitation does not apply to respite, skilled nursing, hospice, or other nonacute care patients; and 3. Has no more than six licensed acute care inpatient beds.

(g) "Swing-bed" means a bed which can be used interchangeably as either a hospital, skilled nursing facility (SNF), or intermediate care facility (ICF) bed pursuant to the [Footnote 1] Code of Federal Regulations, parts 405, 435, 440, 442, and 447.

(3) USE OF FUNDS. It is the intent of the Legislature that funds as appropriated shall be utilized by the department for the purpose of increasing the number of primary care physicians, physician assistants, certified nurse midwives, nurse practitioners, and nurses in rural areas, either through the Medical Education Reimbursement and Loan Repayment Program as defined by s. 240.4067 or through a federal loan repayment program which requires state matching funds. The department may use funds appropriated for the Medical Education Reimbursement and Loan Repayment Program as matching funds for federal loan repayment programs for health care personnel, such as that authorized in s. 203 of Pub. L. No. 100-177. If the department receives federal matching funds, the department shall only implement the federal program. Reimbursement through either program shall be limited to:

(a) Primary care physicians, physician assistants, certified nurse midwives, nurse practitioners, and nurses employed by or affiliated with rural hospitals, as defined in this act; and

(b) Primary care physicians, physician assistants, certified nurse midwives, nurse practitioners, and nurses employed by or affiliated with rural area health education centers, as defined in this section. These personnel shall practice: 1. In a county with a population density of no greater than 100 persons per square mile; or 2. Within the boundaries of a hospital tax district which encompasses a population of no greater than 100 persons per square mile. If the department administers a federal loan repayment program, priority shall be given to obligating state and federal matching funds pursuant to paragraphs (a) and (b). The department may use federal matching funds in other health workforce shortage areas and medically underserved areas in the state for loan repayment programs for primary care physicians, physician assistants, certified nurse midwives, nurse practitioners, and nurses who are employed by publicly financed health care programs that serve medically indigent persons.