Florida agencies finalize rules for rural emergency hospitals and require non‑emergent care access plans

Chair Senator Lori Burton heard updates from the Agency for Health Care Administration on Monday about implementing recently passed laws that create a new rural emergency hospital designation and require hospitals to file non‑emergent care access plans (NCAPs).

AHCA Deputy Secretary Kimberly Smoak said the agency adopted the new hospital licensure rules on June 1 and created a “class 4” designation to align state licensing with the federal rural emergency hospital option. The federal Consolidated Appropriations Act of 2021 and recent Centers for Medicare & Medicaid Services guidance set the federal framework; AHCA’s rules reflect that framework and include limits such as a maximum of 50 beds for a rural emergency hospital and required transfer agreements with level‑1 or level‑2 trauma centers.

“The rules were adopted and became effective June 1,” Smoak told the committee. “Right now in the state, we do not have any rural emergency hospitals designated…We have the rules and requirements.”

Why it matters: the federal rural emergency hospital designation is intended to help rural facilities receive higher Medicare reimbursement for emergency and outpatient services while avoiding the operational requirements of full inpatient hospitals. AHCA said the state has 24 facilities currently classified as rural hospitals and noted at least one hospital (North Walton) has expressed interest in converting to the new designation.

NCAP requirements and early results AHCA also described the non‑emergent care access plans required under Senate Bill 7016. Smoak said every hospital with an emergency department — including hospital‑based off‑site EDs — must submit a plan that explains how the hospital will educate patients about appropriate sites of care, refer or arrange follow‑up care (for example, urgent care centers, federally qualified health centers, or a primary care physician), and document outreach and results. The plans must not conflict with federal EMTALA obligations, she said.

Smoak gave examples of NCAP practices AHCA has approved: one provider texts discharged patients within three days to arrange follow‑up if the patient lacks a primary care physician; another provides a one‑page graphic distinguishing emergency conditions (for example, high fever, head injury, severe chest pain) from problems better treated by primary care. Several hospitals included community collaboration and navigator programs to link patients to primary care.

Data and oversight: Smoak said AHCA received 83 NCAP submissions between July 1 and Sept. 30, approved 63 and has 20 still under review as part of the licensure application process. The agency revised three hospital licensure rules to require submission, review and approval of NCAPs and to collect implementation data, including counts of ED patients who report lacking regular access and activities undertaken to connect those patients to care. For Medicaid enrollees, NCAPs must include outreach to the patient’s managed care organization so the MCO can help assign an in‑network primary care clinician.

HIE role and vendor change Committee members asked whether the state’s Health Information Exchange (HIE) could handle the data and notification needs. Smoak said AHCA transitioned to a new HIE vendor (Chris Shared Services) to provide event‑notification services (ENS) and believes the new vendor can scale to support the state’s more than 300 hospitals. She also offered to follow up with more technical details about the vendor transition and earlier capacity issues.

What comes next: AHCA said it will continue training and stakeholder outreach, collect NCAP data through licensure renewals, and coordinate with Medicaid oversight if patterns appear that warrant corrective action. The committee did not take any formal votes during the presentation.