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House Bill 1999

Florida House of Representatives - 1997 HB 1999 By the Committee on Health Care Services and Representatives Albright, Lippman and Peaden 1 A bill to be entitled 2 An act relating to certificates of need; 3 amending s. 408.032, F.S.; deleting the 4 definition of the terms "health maintenance 5 organization" and "major medical equipment" for 6 purposes of the review for a certificate of 7 need by the Agency for Health Care 8 Administration; redefining the term "health 9 care facility" to include a hospice and 10 long-term care hospital; defining the terms 11 "home health agency," "long-term care 12 hospital," and "respite care"; amending s. 13 408.033, F.S.; deleting provisions relating to 14 the Statewide Health Council and duties 15 thereof; amending s. 408.035, F.S., relating to 16 review criteria; revising provisions; deleting 17 reference to hospice and health maintenance 18 organizations; adding replacement of facilities 19 as reviewable activity; deleting a requirement 20 to approve certain facility consolidations or 21 divisions; amending s. 408.036, F.S., relating 22 to health care projects that are subject to 23 certificate-of-need review; requiring the 24 review of certain replacement health care 25 facilities; requiring the review of 26 Medicare-certified home health agencies; 27 providing an exception; eliminating 28 certificate-of-need review for projects 29 exceeding a specified expenditure threshold and 30 for acquisition of major medical equipment; 31 requiring certificate-of-need review of cost 1 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 increases exceeding a specified threshold and 2 for increase in number of psychiatric or 3 rehabilitation beds; deleting a reference to 4 expedited review of transfer of a certificate 5 of need; modifying requirements relating to 6 expedited review of cost overruns; eliminating 7 the expedited review of donations, acquisition 8 of land for health care facilities or health 9 care provider offices, and termination of 10 health care services; eliminating the expedited 11 review of emergency projects and unforeseen 12 major public health hazards; requiring 13 expedited review of replacement of certain 14 health care facilities; eliminating the 15 exemption from review granted for certain 16 facilities not directly used for health care 17 services; eliminating expedited review of 18 expenditures to address safety hazards, repair 19 of facility or equipment resulting from certain 20 occurrences, and replacement of major medical 21 equipment; deleting an obsolete date relating 22 to expansion of obstetric services; requiring 23 expedited review of replacing or renovating 24 health care facilities; exempting from review 25 certain facilities establishing 26 Medicare-certified home health agencies; 27 exempting from review the establishment of 28 Medicare-certified home health agencies 29 contingent upon specified future actions; 30 exempting from review inmate health care 31 facilities, the termination of a health care 2 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 service, delicensure of beds, adult inpatient 2 diagnostic cardiac catheterization services 3 contingent upon specified future actions, and 4 certain expenditures for outpatient services; 5 amending s. 408.037, F.S.; revising 6 requirements for the detailed description and 7 financial projection; requiring that an 8 applicant for a certificate of need certify 9 that it will license and operate the health 10 care facility; requiring that certain 11 applicants for a certificate of need be the 12 licenseholder of the health care facility; 13 deleting requirements with respect to the 14 applicant's board of directors; amending s. 15 408.038, F.S.; providing for the refundability 16 of certain certificate-of-need application 17 fees; amending s. 408.039, F.S.; revising the 18 scope of review cycles and requirements for an 19 applicant with respect to letters of intent and 20 administrative hearings; eliminating review of 21 equipment from review cycles; eliminating a 22 requirement that letters of intent be filed 23 with local health councils; revising content 24 requirements of letters of intent; revising 25 publication requirements for letters of intent; 26 providing a timeframe for submitting a final 27 order; amending s. 408.040, F.S.; extending the 28 length of time that a certificate of need 29 remains effective; deleting authority to extend 30 the time that a certificate of need remains 31 valid; amending s. 408.042, F.S.; increasing 3 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 the validity period of a certificate of need; 2 amending s. 408.043, F.S.; deleting a provision 3 providing for the validity of a certificate of 4 need; providing that private accreditation is 5 not required for issuance or maintenance of a 6 certificate of need; amending s. 408.0455, 7 F.S.; providing for continuation of certain 8 rules and pending administrative or judicial 9 proceedings; amending ss. 240.5121 and 395.604, 10 F.S.; conforming references and cross 11 references relating to the Statewide Health 12 Council and state health plan; amending s. 13 408.702, F.S., relating to project monitoring 14 and community health purchasing alliances; 15 conforming cross references; amending ss. 16 400.602 and 641.60, F.S., relating to hospice 17 licensure for certain entities and the 18 Statewide Managed Care Ombudsman Committee; 19 conforming cross references; repealing ss. 20 186.003(9) and 186.503(9), relating to the 21 Statewide Health Council; repealing ss. 22 408.0365 and 408.0366, F.S., relating to 23 certain exemptions from certificate-of-need 24 regulation; providing applicability; providing 25 an effective date. 26 27 Be It Enacted by the Legislature of the State of Florida: 28 29 Section 1. Section 408.032, Florida Statutes, is 30 amended to read: 31 4 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 408.032 Definitions.--As used in ss. 408.031-408.045, 2 the term: 3 (1) "Agency" means the Agency for Health Care 4 Administration. 5 (2)(1) "Capital expenditure" means an expenditure, 6 including an expenditure for a construction project undertaken 7 by a health care facility as its own contractor, which, under 8 generally accepted accounting principles, is not properly 9 chargeable as an expense of operation and maintenance, which 10 is made to change; or an expenditure which exceeds the minimum 11 as specified in s. 408.036(1)(c), changes the bed capacity of 12 the facility, or substantially change changes the services or 13 service area of the health care facility, health service 14 provider, or hospice, and which includes the cost of the 15 studies, surveys, designs, plans, working drawings, 16 specifications, initial financing costs, and other activities 17 essential to acquisition, improvement, expansion, or 18 replacement of the plant and equipment. The agency shall, by 19 rule, adjust the capital expenditure threshold annually using 20 an appropriate inflation index. 21 (3)(2) "Certificate of need" means a written statement 22 issued by the agency evidencing community need for a new, 23 converted, expanded, or otherwise significantly modified 24 health care facility, health service, or hospice. 25 (4)(3) "Commenced construction" means initiation of 26 and continuous activities beyond site preparation associated 27 with erecting or modifying a health care facility, including 28 procurement of a building permit applying the use of 29 agency-approved construction documents, proof of an executed 30 owner/contractor agreement or an irrevocable or binding forced 31 5 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 account, and actual undertaking of foundation forming with 2 steel installation and concrete placing. 3 (4) "Department" means the Agency for Health Care 4 Administration. 5 (5) "District" means a health service planning 6 district composed of the following counties: 7 District 1.--Escambia, Santa Rosa, Okaloosa, and Walton 8 Counties. 9 District 2.--Holmes, Washington, Bay, Jackson, 10 Franklin, Gulf, Gadsden, Liberty, Calhoun, Leon, Wakulla, 11 Jefferson, Madison, and Taylor Counties. 12 District 3.--Hamilton, Suwannee, Lafayette, Dixie, 13 Columbia, Gilchrist, Levy, Union, Bradford, Putnam, Alachua, 14 Marion, Citrus, Hernando, Sumter, and Lake Counties. 15 District 4.--Baker, Nassau, Duval, Clay, St. Johns, 16 Flagler, and Volusia Counties. 17 District 5.--Pasco and Pinellas Counties. 18 District 6.--Hillsborough, Manatee, Polk, Hardee, and 19 Highlands Counties. 20 District 7.--Seminole, Orange, Osceola, and Brevard 21 Counties. 22 District 8.--Sarasota, DeSoto, Charlotte, Lee, Glades, 23 Hendry, and Collier Counties. 24 District 9.--Indian River, Okeechobee, St. Lucie, 25 Martin, and Palm Beach Counties. 26 District 10.--Broward County. 27 District 11.--Dade and Monroe Counties. 28 (6) "Expedited review" means the process by which 29 certain types of applications are not subject to the review 30 cycle requirements contained in s. 408.039(1), and the letter 31 of intent requirements contained in s. 408.039(2). 6 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 (7) "Health care facility" means a hospital, long-term 2 care hospital, skilled nursing facility, hospice, intermediate 3 care facility, or intermediate care facility for the 4 developmentally disabled. A facility relying solely on 5 spiritual means through prayer for healing is not included as 6 a health care facility. 7 (8) "Health maintenance organization" means a health 8 care provider organization defined and authorized in part I of 9 chapter 641. 10 (8)(9) "Health services" means diagnostic, curative, 11 or rehabilitative services and includes alcohol treatment, 12 drug abuse treatment, and mental health services. 13 (9) "Home health agency" means an organization, as 14 defined in s. 400.462(4), that is certified or seeks 15 certification as a Medicare home health service provider. 16 (10) "Hospice" or "hospice program" means a hospice as 17 defined in part VI of chapter 400. 18 (11) "Hospital" means a health care facility licensed 19 under chapter 395. 20 (12) "Institutional health service" means a health 21 service which is provided by or through a health care facility 22 and which entails an annual operating cost of $500,000 or 23 more. The agency shall, by rule, adjust the annual operating 24 cost threshold annually using an appropriate inflation index. 25 (13) "Intermediate care facility" means an institution 26 which provides, on a regular basis, health-related care and 27 services to individuals who do not require the degree of care 28 and treatment which a hospital or skilled nursing facility is 29 designed to provide, but who, because of their mental or 30 physical condition, require health-related care and services 31 above the level of room and board. 7 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 (14) "Intermediate care facility for the 2 developmentally disabled" means a residential facility 3 licensed under chapter 393 and certified by the Federal 4 Government pursuant to the Social Security Act as a provider 5 of Medicaid services to persons who are mentally retarded or 6 who have a related condition. 7 (15) "Long-term care hospital" means a hospital 8 licensed under chapter 395 which meets the requirements of 42 9 C.F.R. s. 412.23(e) and seeks exclusion from the Medicare 10 prospective payment system for inpatient hospital services. 11 (15) "Major medical equipment" means equipment which 12 is used to provide medical and other health services, which 13 has been approved for general usage by the United States Food 14 and Drug Administration for less than 3 years and which costs 15 in excess of $1 million. The agency shall, by rule, adjust 16 the equipment threshold annually using an appropriate 17 inflation index. 18 (16) "Multifacility project" means an integrated 19 residential and health care facility consisting of independent 20 living units, assisted living facility units, and nursing home 21 beds certificated on or after January 1, 1987, where: 22 (a) The aggregate total number of independent living 23 units and assisted living facility units exceeds the number of 24 nursing home beds. 25 (b) The developer of the project has expended the sum 26 of $500,000 or more on the certificated and noncertificated 27 elements of the project combined, exclusive of land costs, by 28 the conclusion of the 18th month of the life of the 29 certificate of need. 30 31 8 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 (c) The total aggregate cost of construction of the 2 certificated element of the project, when combined with other, 3 noncertificated elements, is $10 million or more. 4 (d) All elements of the project are contiguous or 5 immediately adjacent to each other and construction of all 6 elements will be continuous. 7 (17) "Nursing home geographically underserved area" 8 means: 9 (a) A county in which there is no existing or approved 10 nursing home; 11 (b) An area with a radius of at least 20 miles in 12 which there is no existing or approved nursing home; or 13 (c) An area with a radius of at least 20 miles in 14 which all existing nursing homes have maintained at least a 95 15 percent occupancy rate for the most recent 6 months or a 90 16 percent occupancy rate for the most recent 12 months. 17 (18) "Respite care" means short-term care in a 18 licensed health care facility which is personal or custodial 19 and is provided for chronic illness, physical infirmity, or 20 advanced age for the purpose of temporarily relieving family 21 members of the burden of providing care and attendance. 22 (19)(18) "Skilled nursing facility" means an 23 institution, or a distinct part of an institution, which is 24 primarily engaged in providing, to inpatients, skilled nursing 25 care and related services for patients who require medical or 26 nursing care, or rehabilitation services for the 27 rehabilitation of injured, disabled, or sick persons. 28 (20)(19) "Tertiary health service" means a health 29 service which, due to its high level of intensity, complexity, 30 specialized or limited applicability, and cost, should be 31 limited to, and concentrated in, a limited number of hospitals 9 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 to ensure the quality, availability, and cost-effectiveness of 2 such service. Examples of such service include, but are not 3 limited to, organ transplantation, specialty burn units, 4 neonatal intensive care units, comprehensive rehabilitation, 5 and medical or surgical services which are experimental or 6 developmental in nature to the extent that the provision of 7 such services is not yet contemplated within the commonly 8 accepted course of diagnosis or treatment for the condition 9 addressed by a given service. The agency shall establish by 10 rule a list of all tertiary health services. 11 (20) "Agency" means the department or agency which has 12 responsibility for health planning and health regulation. 13 (21) "Regional area" means any of those regional 14 health planning areas established by the agency to which local 15 and district health planning funds are directed to local 16 health councils through the General Appropriations Act. 17 Section 2. Paragraphs (b) and (g) of subsection (1), 18 subsection (2), paragraphs (a), (b), and (f) of subsection 19 (3), and subsection (4) of section 408.033, Florida Statutes, 20 are amended to read: 21 408.033 Local and state health planning.-- 22 (1) LOCAL HEALTH COUNCILS.-- 23 (b) Each local health council may: 24 1. Develop a district or regional area health plan 25 that is consistent with the objectives and strategies in the 26 state health plan, but that shall permit each local health 27 council to develop strategies and set priorities for 28 implementation based on its unique local health needs. The 29 district or regional area health plan must contain preferences 30 for the development of health services and facilities, which 31 may be considered by the agency in its review of 10 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 certificate-of-need applications. The district health plan 2 shall be submitted to the agency and updated periodically. The 3 district health plans shall use a uniform format and be 4 submitted to the agency according to a schedule developed by 5 the agency in conjunction with the Statewide Health Council 6 and the local health councils. The schedule must provide for 7 coordination between the development of the state health plan 8 and the district health plans and for the development of 9 district health plans by major sections over a multiyear 10 period. The elements of a district plan which are necessary 11 to the review of certificate-of-need applications for proposed 12 projects within the district may be adopted by the agency as a 13 part of its rules. 14 2. Advise the agency on health care issues and 15 resource allocations. 16 3. Promote public awareness of community health needs, 17 emphasizing health promotion and cost-effective health service 18 selection. 19 4. Collect data and conduct analyses and studies 20 related to health care needs of the district, including the 21 needs of medically indigent persons, and assist the agency and 22 other state agencies in carrying out data collection 23 activities that relate to the functions in this subsection. 24 5. Monitor the onsite construction progress, if any, 25 of certificate-of-need approved projects and report council 26 findings to the agency on forms provided by the agency. 27 6. Advise and assist any regional planning councils 28 within each district that have elected to address health 29 issues in their strategic regional policy plans with the 30 development of the health element of the plans to address the 31 health goals and policies in the State Comprehensive Plan. 11 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 7. Advise and assist local governments within each 2 district on the development of an optional health plan element 3 of the comprehensive plan provided in chapter 163, to assure 4 compatibility with the health goals and policies in the State 5 Comprehensive Plan and district health plan. To facilitate 6 the implementation of this section, the local health council 7 shall annually provide the local governments in its service 8 area, upon request, with: 9 a. A copy and appropriate updates of the district 10 health plan; 11 b. A report of hospital and nursing home utilization 12 statistics for facilities within the local government 13 jurisdiction; and 14 c. Applicable agency rules and calculated need 15 methodologies for health facilities and services regulated 16 under s. 408.034 for the district served by the local health 17 council. 18 8. Monitor and evaluate the adequacy, appropriateness, 19 and effectiveness, within the district, of local, state, 20 federal, and private funds distributed to meet the needs of 21 the medically indigent and other underserved population 22 groups. 23 9. In conjunction with the Department of Health and 24 Rehabilitative Services and Statewide Health Council, plan for 25 services at the local level for persons infected with the 26 human immunodeficiency virus. 27 10. Provide technical assistance to encourage and 28 support activities by providers, purchasers, consumers, and 29 local, regional, and state agencies in meeting the health care 30 goals, objectives, and policies adopted by the local health 31 council. 12 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 11. Provide the agency with data required by rule for 2 the review of certificate-of-need applications and the 3 projection of need for health services and facilities in the 4 district. 5 (g) Each local health council is authorized to accept 6 and receive, in furtherance of its health planning functions, 7 funds, grants, and services from governmental agencies and 8 from private or civic sources and to perform studies related 9 to local health planning in exchange for such funds, grants, 10 or services. Each local health council shall, no later than 11 January 30 of each year, render an accounting of the receipt 12 and disbursement of such funds received by it to the agency. 13 The agency shall consolidate all such reports and submit such 14 consolidated report to the Legislature no later than March 1 15 of each year. Funds received by a local health council 16 pursuant to this paragraph shall not be deemed to be a 17 substitute for, or an offset against, any funding provided 18 pursuant to subsection (2)(3). 19 (2) STATEWIDE HEALTH COUNCIL.--The Statewide Health 20 Council is hereby established as a state-level comprehensive 21 health planning and policy advisory board. For administrative 22 purposes, the council shall be located within the agency. The 23 Statewide Health Council shall be composed of: the State 24 Health Officer; the Deputy Director for Health Policy and Cost 25 Control and the Deputy Director for Health Quality Assurance 26 of the department; the director of the Health Care Board; the 27 Insurance Commissioner or his designee; the Vice Chancellor 28 for Health Affairs of the Board of Regents; three chairmen of 29 regional planning councils, selected by the regional planning 30 councils; five chairmen of local health councils, selected by 31 the local health councils; four members appointed by the 13 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 Governor, one of whom is a consumer over 60 years of age, one 2 of whom is a representative of organized labor, one of whom is 3 a physician, and one of whom represents the nursing home 4 industry; five members appointed by the President of the 5 Senate, one of whom is a representative of the insurance 6 industry in this state, one of whom is the chief executive 7 officer of a business with more than 300 employees in this 8 state, one of whom represents the hospital industry, one of 9 whom is a primary care physician, and one of whom is a nurse, 10 and five members appointed by the Speaker of the House of 11 Representatives, one of whom is a consumer who represents a 12 minority group in this state, one of whom represents the home 13 health care industry in this state, one of whom is an allied 14 health care professional, one of whom is the chief executive 15 officer of a business with fewer than 25 employees in this 16 state, and one of whom represents a county social services 17 program that provides health care services to the indigent. 18 Appointed members of the council shall serve for 2-year terms 19 commencing October 1 of each even-numbered year. The council 20 shall elect a president from among the members who are not 21 state employees. The Statewide Health Council shall: 22 (a) Advise the Governor, the Legislature, and the 23 department on state health policy issues, state and local 24 health planning activities, and state health regulation 25 programs; 26 (b) Prepare a state health plan that specifies 27 subgoals, quantifiable objectives, strategies, and resource 28 requirements to implement the goals and policies of the health 29 element of the State Comprehensive Plan. The plan must assess 30 the health status of residents of this state; evaluate the 31 adequacy, accessibility, and affordability of health services 14 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 and facilities; assess government-financed programs and 2 private health care insurance coverages; and address other 3 topical local and state health care issues. Within 2 years 4 after the health element of the State Comprehensive Plan is 5 amended, and by July 1 of every 3rd year, if it is not 6 amended, the Statewide Health Council shall submit the state 7 health plan to the Executive Office of the Governor, the 8 secretary of the department, the President of the Senate, and 9 the Speaker of the House of Representatives; 10 (c) Promote public awareness of state health care 11 issues and, in conjunction with the local health councils, 12 conduct public forums throughout the state to solicit the 13 comments and advice of the public on the adequacy, 14 accessibility, and affordability of health care services in 15 this state and other health care issues; 16 (d) Consult with local health councils, the Department 17 of Insurance, the Department of Health and Rehabilitative 18 Services, and other appropriate public and private entities, 19 including health care industry representatives regarding the 20 development of health policies; 21 (e) Serve as a forum for the discussion of local 22 health planning issues of concern to the local health councils 23 and regional planning councils; 24 (f) Review district health plans for consistency with 25 the State Comprehensive Plan and the state health plan; 26 (g) Review the health components of agency functional 27 plans for consistency with the health element of the State 28 Comprehensive Plan, advise the Executive Office of the 29 Governor regarding inconsistencies, and recommend revisions to 30 agency functional plans to make them consistent with the State 31 Comprehensive Plan; 15 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 (h) Review any strategic regional plans that address 2 health issues for consistency with the health element of the 3 State Comprehensive Plan, advise the Executive Office of the 4 Governor regarding inconsistencies, and recommend revisions to 5 strategic regional policy plans to make them consistent with 6 the State Comprehensive Plan; 7 (i) Assist the Department of Community Affairs in the 8 review of local government comprehensive plans to ensure 9 consistency with policy developed in the district health 10 plans; 11 (j) With the assistance of the local health councils, 12 conduct public forums and use other means to determine the 13 opinions of health care consumers, providers, payors, and 14 insurers regarding the state's health care goals and policies 15 and develop suggested revisions to the health element of the 16 State Comprehensive Plan. The council shall submit the 17 proposed revisions to the health element of the State 18 Comprehensive Plan to the Governor, the President of the 19 Senate, and the Speaker of the House of Representatives by 20 February 1, 1993, and shall widely circulate the proposed 21 revisions to affected parties. The council shall periodically 22 assess the progress made in achieving the goals and policies 23 contained in the health element of the State Comprehensive 24 Plan and report to the department, the Governor, the President 25 of the Senate, and the Speaker of the House of 26 Representatives; and 27 (k) Conduct any other functions or studies and 28 analyses falling under the duties listed above. 29 (2)(3) FUNDING.-- 30 (a) The Legislature intends that the cost of local 31 health councils and the Statewide Health Council be borne by 16 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 application fees for certificates of need and by assessments 2 on selected health care facilities subject to facility 3 licensure by the Agency for Health Care Administration, 4 including abortion clinics, assisted living facilities, 5 ambulatory surgical centers, birthing centers, clinical 6 laboratories except community nonprofit blood banks, home 7 health agencies, hospices, hospitals, intermediate care 8 facilities for the developmentally disabled, nursing homes, 9 and multiphasic testing centers and by assessments on 10 organizations subject to certification by the agency pursuant 11 to chapter 641, part III, including health maintenance 12 organizations and prepaid health clinics. 13 (b)1. A hospital licensed under chapter 395, a nursing 14 home licensed under chapter 400, and an assisted living 15 facility licensed under chapter 400 shall be assessed an 16 annual fee based on number of beds. 17 2. All other facilities and organizations listed in 18 paragraph (a) shall each be assessed an annual fee of $150. 19 3. Facilities operated by the Department of Health and 20 Rehabilitative Services or the Department of Corrections and 21 any hospital which meets the definition of rural hospital 22 pursuant to s. 395.602 are exempt from the assessment required 23 in this subsection. 24 (f) The agency shall deposit in the Health Care Trust 25 Fund all health care facility assessments that are assessed 26 under this subsection and proceeds from the 27 certificate-of-need application fees which are sufficient to 28 maintain the aggregate funding level for the local health 29 councils and the Statewide Health Council as specified in the 30 General Appropriations Act. The remaining certificate-of-need 31 application fees shall be used only for the purpose of 17 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 administering the Health Facility and Services Development 2 Act. 3 (3)(4) DUTIES AND RESPONSIBILITIES OF THE AGENCY 4 DEPARTMENT.-- 5 (a) The agency department, in conjunction with the 6 Statewide Health Council and the local health councils, is 7 responsible for the planning of all health care services in 8 the state and for assisting the Statewide Health Council in 9 the preparation of the state health plan. 10 (b) The agency department shall develop and maintain a 11 comprehensive health care database for the purpose of health 12 planning and for certificate-of-need determinations. The 13 agency department or its contractor is authorized to require 14 the submission of information from health facilities, health 15 service providers, and licensed health professionals which is 16 determined by the agency department, through rule, to be 17 necessary for meeting the agency's department's 18 responsibilities as established in this section. 19 (c) The agency department shall assist personnel of 20 the local health councils in providing an annual orientation 21 to council members about council member responsibilities. 22 (d) The agency department shall contract with the 23 local health councils for the services specified in subsection 24 (1). All contract funds shall be distributed according to an 25 allocation plan developed by the agency department that 26 provides for a minimum and equal funding base for each local 27 health council. Any remaining funds shall be distributed 28 based on adjustments for workload. The agency department may 29 also make grants to or reimburse local health councils from 30 federal funds provided to the state for activities related to 31 those functions set forth in this section. The agency 18 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 department may withhold funds from a local health council or 2 cancel its contract with a local health council which does not 3 meet performance standards agreed upon by the agency 4 department and local health councils. 5 Section 3. Section 408.035, Florida Statutes, is 6 amended to read: 7 408.035 Review criteria.-- 8 (1) The agency shall determine the reviewability of 9 applications and shall review applications for 10 certificate-of-need determinations for health care facilities 11 and health services, hospices, and health maintenance 12 organizations in context with the following criteria: 13 (a) The need for the health care facilities and health 14 services and hospices being proposed in relation to the 15 applicable district plan and state health plan, except in 16 emergency circumstances that which pose a threat to the public 17 health. 18 (b) The availability, quality of care, efficiency, 19 appropriateness, accessibility, extent of utilization, and 20 adequacy of like and existing health care facilities and 21 health services and hospices in the service district of the 22 applicant. 23 (c) The ability of the applicant to provide quality of 24 care and the applicant's record of providing quality of care. 25 (d) The availability and adequacy of other health care 26 facilities and health services and hospices in the service 27 district of the applicant, such as outpatient care and 28 ambulatory or home care services, which may serve as 29 alternatives for the health care facilities and health 30 services to be provided by the applicant. 31 19 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 (e) Probable economies and improvements in service 2 which that may be derived from operation of joint, 3 cooperative, or shared health care resources. 4 (f) The need in the service district of the applicant 5 for special equipment and services that which are not 6 reasonably and economically accessible in adjoining areas. 7 (g) The need for research and educational facilities, 8 including, but not limited to, institutional training programs 9 and community training programs for health care practitioners 10 and for doctors of osteopathy and medicine at the student, 11 internship, and residency training levels. 12 (h) The availability of resources, including health 13 manpower, management personnel, and funds for capital and 14 operating expenditures, for project accomplishment and 15 operation; the effects the project will have on clinical needs 16 of health professional training programs in the service 17 district; the extent to which the services will be accessible 18 to schools for health professions in the service district for 19 training purposes if such services are available in a limited 20 number of facilities; the availability of alternative uses of 21 such resources for the provision of other health services; and 22 the extent to which the proposed services will be accessible 23 to all residents of the service district. 24 (i) The immediate and long-term financial feasibility 25 of the proposal. 26 (j) The special needs and circumstances of health 27 maintenance organizations. 28 (k) The needs and circumstances of those entities that 29 which provide a substantial portion of their services or 30 resources, or both, to individuals not residing in the service 31 district in which the entities are located or in adjacent 20 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 service districts. Such entities may include medical and 2 other health professions, schools, multidisciplinary clinics, 3 and specialty services such as open-heart surgery, radiation 4 therapy, and renal transplantation. 5 (l) The probable impact of the proposed project on the 6 costs of providing health services proposed by the applicant, 7 upon consideration of factors including, but not limited to, 8 the effects of competition on the supply of health services 9 being proposed and the improvements or innovations in the 10 financing and delivery of health services which foster 11 competition and service to promote quality assurance and 12 cost-effectiveness. 13 (m) The costs and methods of the proposed 14 construction, including the costs and methods of energy 15 provision and the availability of alternative, less costly, or 16 more effective methods of construction. 17 (n) The applicant's past and proposed provision of 18 health care services to Medicaid patients and the medically 19 indigent. 20 (o) The applicant's past and proposed provision of 21 services that which promote a continuum of care in a 22 multilevel health care system, which may include, but are is 23 not limited to, acute care, skilled nursing care, home health 24 care, and assisted living facilities. 25 (2) In cases of capital expenditure proposals for the 26 provision of new health services to inpatients, the agency 27 department shall also reference each of the following in its 28 findings of fact: 29 (a) That less costly, more efficient, or more 30 appropriate alternatives to such inpatient services are not 31 21 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 available and the development of such alternatives has been 2 studied and found not practicable. 3 (b) That existing inpatient facilities providing 4 inpatient services similar to those proposed are being used in 5 an appropriate and efficient manner. 6 (c) In the case of new construction or replacement 7 construction, that alternatives to the new construction, for 8 example, modernization or sharing arrangements, have been 9 considered and have been implemented to the maximum extent 10 practicable. 11 (d) That patients will experience serious problems in 12 obtaining inpatient care of the type proposed, in the absence 13 of the proposed new service. 14 (e) In the case of a proposal for the addition of beds 15 for the provision of skilled nursing or intermediate care 16 services, that the addition will be consistent with the plans 17 of other agencies of the state responsible for the provision 18 and financing of long-term care, including home health 19 services. 20 (3) For any application authorized by s. 381.706(2)(j) 21 or (k) involving an approved facility based on a 22 certificate-of-need application filed prior to December 31, 23 1984, the department shall approve such application unless the 24 proposed consolidation or division would result in a facility 25 or facilities not meeting the criterion of financial 26 feasibility or unless the consolidation or division would 27 result in beds or services being moved more than 15 miles from 28 their original certificated location. 29 Section 4. Section 408.036, Florida Statutes, as 30 amended by chapters 93-214, 94-206, and 95-418, Laws of 31 Florida, is amended to read: 22 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 408.036 Projects subject to review.-- 2 (1) APPLICABILITY.--Unless exempt under subsection 3 (3), all health-care-related projects, as described in 4 paragraphs (a)-(k) (a)-(n), are subject to review and must 5 file an application for a certificate of need with the agency 6 department. The agency department is exclusively responsible 7 for determining whether a health-care-related project is 8 subject to review under ss. 408.031-408.045. 9 (a) The addition of beds by new construction or 10 alteration. 11 (b) The new construction or establishment of 12 additional health care facilities, including a replacement 13 health care facility when the proposed project site is not 14 located on the same site as the existing health care facility. 15 (c) A capital expenditure of $1 million or more by or 16 on behalf of a health care facility or hospice for a purpose 17 directly related to the furnishing of health services at such 18 facility; provided that a certificate of need is not required 19 for an expenditure to provide an outpatient health service, or 20 to acquire equipment or refinance debt, for which a 21 certificate of need is not otherwise required under this 22 subsection. The department shall, by rule, adjust the capital 23 expenditure threshold annually using an appropriate inflation 24 index. 25 (c)(d) The conversion from one type of health care 26 facility to another, including the conversion from one level 27 of care to another, in a skilled or intermediate nursing 28 facility, if the conversion effects a change in the level of 29 care of 10 beds or 10 percent of total bed capacity of the 30 skilled or intermediate nursing facility within a 2-year 31 period. If the nursing facility is certified for both skilled 23 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 and intermediate nursing care, the provisions of this 2 paragraph do not apply. 3 (d)(e) Any increase change in licensed bed capacity. 4 (e)(f) Subject to the provisions of paragraph (3)(i), 5 the establishment of a Medicare-certified home health agency, 6 the establishment of a hospice, or the direct provision of 7 such services by a health care facility or health maintenance 8 organization for those other than the subscribers of the 9 health maintenance organization; except that this paragraph 10 does not apply to the establishment of a Medicare-certified 11 home health agency by a facility described in paragraph 12 (3)(h). 13 (f)(g) An acquisition by or on behalf of a health care 14 facility or health maintenance organization, by any means, 15 which acquisition would have required review if the 16 acquisition had been by purchase, including an acquisition at 17 less than fair market value if the fair market value is 18 greater than the capital expenditure threshold. 19 (g)(h) The establishment of inpatient institutional 20 health services by a health care facility, or a substantial 21 change in such services., or the obligation of capital 22 expenditures for the offering of, or a substantial change in, 23 any such services which entails a capital expenditure in any 24 amount, or an annual operating cost of $500,000 or more. The 25 department shall, by rule, adjust the annual operating cost 26 threshold annually using an appropriate inflation index. 27 (h)(i) The acquisition by any means of an existing 28 health care facility by any person, unless the person provides 29 the agency department with at least 30 days' written notice of 30 the proposed acquisition, which notice is to include the 31 services to be offered and the bed capacity of the facility, 24 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 and unless the agency department does not determine, within 30 2 days after receipt of such notice, that the services to be 3 provided and the bed capacity of the facility will be changed. 4 (j) The acquisition, by any means, of major medical 5 equipment by a health maintenance organization or health care 6 facility to the extent that the health maintenance 7 organization or health care facility is not exempt under 8 former s. 381.713(1). 9 (i)(k) An increase in the cost of a project for which 10 a certificate of need has been issued when the increase in 11 cost exceeds 20 the limits set forth in paragraph (c), 12 paragraph (h), or s. 408.032, or 10 percent of the originally 13 approved cost of the project, whichever is less, except that a 14 cost overrun review is not necessary when the cost overrun is 15 less than $20,000 $10,000. 16 (j)(l) An increase A change in the number of 17 psychiatric or rehabilitation beds. 18 (k)(m) The establishment of tertiary health services. 19 (n) A transfer of a certificate of need, in which case 20 an expedited review must be conducted according to rule and in 21 accordance with s. 408.042. 22 (2) PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless 23 exempt pursuant to subsection (3), projects subject to an 24 expedited review shall include, but not be limited to: 25 (a) Cost overruns, as defined in paragraph (1)(i) 26 unless such cost overruns are caused by a change in service or 27 scope which the department determines are otherwise 28 reviewable. 29 (b) Research, education, and training programs. 30 (c) Donations, when market value equals or exceeds the 31 applicable capital expenditure thresholds for operating 25 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 expenditures, or major medical equipment, as defined in this 2 act. 3 (d) Acquisition of land which is to be used for the 4 construction of a health care facility, or office facilities 5 for health care providers. 6 (e) Termination of a health care service. 7 (c)(f) Shared services contracts or projects. 8 (d)(g) A transfer of a certificate of need. 9 (h) Emergency projects and unforeseen major public 10 health hazards. 11 (e)(i) A 50-percent increase in nursing home beds for 12 a facility incorporated and operating in this state for at 13 least 60 years on or before July 1, 1988, which has a licensed 14 nursing home facility located on a campus providing a variety 15 of residential settings and supportive services. The 16 increased nursing home beds shall be for the exclusive use of 17 the campus residents. Any application on behalf of an 18 applicant meeting this requirement shall be subject to the 19 base fee of $5,000 provided in s. 408.038. 20 (f)(j) Combination within one nursing home facility of 21 the beds or services authorized by two or more certificates of 22 need issued in the same planning subdistrict. 23 (g)(k) Division into two or more nursing home 24 facilities of beds or services authorized by one certificate 25 of need issued in the same planning subdistrict. Such 26 division shall not be approved if it would adversely affect 27 the original certificate's approved cost. 28 (h) Replacement of a health care facility when the 29 proposed project site is located in the same district and 30 within a 1-mile radius of the replaced health care facility. 31 26 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 The agency department shall develop rules to implement the 2 provisions for expedited review, including time schedule, 3 application content, and application processing. 4 (3) EXEMPTIONS.--Upon request, supported by such 5 documentation as the agency department requires, the agency 6 department shall grant an exemption from the provisions of 7 subsection (1): 8 (a) For any expenditure by or on behalf of a health 9 care facility for any part of the physical plant which is not 10 to be directly used for providing health services or housing 11 health care providers. This exemption applies to expenditures 12 for parking facilities, meeting rooms, cafeterias, 13 administrative data processing facilities, research buildings, 14 landscaping, and similar projects, but does not apply to 15 expenditures for office facilities for health care providers. 16 (b) For any expenditure to eliminate or prevent safety 17 hazards as defined by federal, state, or local codes. 18 (c) For any expenditure to replace any part of a 19 facility or equipment which is destroyed as a result of fire, 20 civil disturbance, or storm or any other act of God. 21 (d) For any expenditure to acquire major medical 22 equipment that is a substantially identical replacement for 23 existing equipment being taken out of service. 24 (a)(e) For the initiation or expansion of obstetric 25 services after July 1, 1988. 26 (b)(f) For any expenditure to replace or renovate any 27 part of a licensed health care nursing facility, provided that 28 the number of licensed beds will not increase and, in the case 29 of a replacement facility, the project site is the same as the 30 facility being replaced. 31 27 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 (c)(g) For providing respite care services. As used 2 in this paragraph, the term "respite care" means short-term 3 care in a licensed health care facility which is personal or 4 custodial in nature and is provided by reason of chronic 5 illness, physical infirmity, or advanced age for the purpose 6 of temporarily relieving family members of the burden of 7 providing care and attendance in the home. In providing 8 respite care, the health care facility must be the primary 9 caregiver. An individual may be admitted to a respite care 10 program in a hospital without regard to inpatient requirements 11 relating to admitting order and attendance of a member of a 12 medical staff. 13 (d)(h) For hospice services provided by a rural 14 hospital, as defined in s. 395.602, or for swing beds in such 15 rural hospital in a number that does not exceed one-half of 16 its licensed beds. 17 (e)(i) For the conversion of licensed acute care 18 hospital beds to Medicare and Medicaid certified skilled 19 nursing beds in a rural hospital as defined in s. 395.602, so 20 long as the conversion of the beds does not involve the 21 construction of new facilities. The total number of skilled 22 nursing beds, including swing beds, may not exceed one-half of 23 the total number of licensed beds in the rural hospital as of 24 July 1, 1993. Certified skilled nursing beds designated under 25 this paragraph, excluding swing beds, shall be included in the 26 community nursing home bed inventory. A rural hospital which 27 subsequently decertifies any acute care beds exempted under 28 this paragraph shall notify the agency of the decertification, 29 and the agency shall adjust the community nursing home bed 30 inventory accordingly. 31 28 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 (f)(j) For the addition of nursing home beds at a 2 skilled nursing facility that is part of a retirement 3 community that provides a variety of residential settings and 4 supportive services and that has been incorporated and 5 operated in this state for at least 65 years on or before July 6 1, 1994. All nursing home beds must not be available to the 7 public but must be for the exclusive use of the community 8 residents. 9 (g)(k) For an increase in the bed capacity of a 10 nursing facility licensed for at least 50 beds as of January 11 1, 1994, under part II of chapter 400 which is not part of a 12 continuing care facility if, after the increase, the total 13 licensed bed capacity of that facility is not more than 60 14 beds and if the facility has been continuously licensed since 15 1950 and has received a superior rating on each of its two 16 most recent licensure surveys. 17 (h) For the establishment of a Medicare-certified home 18 health agency by a facility certified under chapter 651; a 19 retirement community, as defined in s. 400.404(2)(e); or a 20 residential facility that serves only retired military 21 personnel, their dependents, and the surviving dependents of 22 deceased military personnel. Medicare-reimbursed home health 23 services provided through such agency shall be offered 24 exclusively to residents of the facility or retirement 25 community or to residents of facilities or retirement 26 communities owned, operated, or managed by the same corporate 27 entity. Each visit made to deliver Medicare-reimbursable home 28 health services to a home health patient who, at the time of 29 service, is not a resident of the facility or retirement 30 community shall be a deceptive and unfair trade practice and 31 constitutes a violation of ss. 501.201-501.213. 29 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 (i) For the establishment of a Medicare-certified home 2 health agency. This paragraph shall take effect 90 days after 3 the adjournment sine die of the next regular session of the 4 Legislature occurring after the legislative session in which 5 the Legislature receives a report from the Director of Health 6 Care Administration certifying that the federal Health Care 7 Financing Administration has implemented a per-episode 8 prospective pay system for Medicare-certified home health 9 agencies. 10 (j) For an inmate health care facility built by or for 11 the exclusive use of the Department of Corrections as provided 12 in chapter 945. This exemption expires when such facility is 13 converted to other uses. 14 (k) For an expenditure by or on behalf of a health 15 care facility to provide a health service exclusively on an 16 outpatient basis. 17 (l) For the termination of a health care service. 18 (m) For the delicensure of beds. An application 19 submitted under this paragraph must identify the number, the 20 classification, and the name of the facility in which the beds 21 to be delicensed are located. 22 (n) For the provision of adult inpatient diagnostic 23 cardiac catheterization services in a hospital. 24 1. In addition to any other documentation otherwise 25 required by the agency, a request for an exemption submitted 26 under this paragraph must comply with the following criteria: 27 a. The applicant must certify it will not provide 28 therapeutic cardiac catheterization pursuant to the grant of 29 the exemption. 30 b. The applicant must certify it will meet and 31 continuously maintain the minimum licensure requirements 30 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 adopted by the agency governing such programs pursuant to 2 subparagraph 2. 3 c. The applicant must certify it will provide a 4 minimum of 2 percent of its services to charity and Medicaid 5 patients. 6 2. The agency shall adopt licensure requirements by 7 rule which govern the operation of adult diagnostic cardiac 8 catheterization programs established pursuant to the exemption 9 provided in this paragraph. The rules shall ensure that such 10 programs: 11 a. Perform only adult diagnostic cardiac 12 catheterization services authorized by the exemption and will 13 not provide therapeutic cardiac catheterization or any other 14 services not authorized by the exemption. 15 b. Maintain sufficient appropriate equipment and 16 health personnel to ensure quality and safety. 17 c. Maintain appropriate program volumes to ensure 18 quality and safety. 19 d. Provide a minimum of 2 percent of its services to 20 charity and Medicaid patients each year. 21 3.a. The exemption provided by this paragraph shall 22 not apply unless the agency determines that the program is in 23 compliance with the requirements of subparagraph 1. and that 24 the program will, after beginning operation, continuously 25 comply with the rules adopted pursuant to subparagraph 2. The 26 agency shall monitor such programs to ensure compliance with 27 the requirements of subparagraph 2. 28 b.(I) The exemption for a program shall expire 29 immediately when the program fails to comply with the rules 30 adopted pursuant to sub-subparagraphs 2.a., b., and c. 31 31 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 (II) Beginning 18 months after a program first begins 2 treating patients, the exemption for a program shall expire 3 when the program fails to comply with the rules adopted 4 pursuant to sub-subparagraphs 2.c. and d. 5 (III) If the exemption for a program expires pursuant 6 to sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the 7 agency shall not grant an exemption pursuant to this paragraph 8 for an adult diagnostic cardiac catheterization program 9 located at the same hospital until 2 years following the date 10 of the determination by the agency that the program failed to 11 comply with the rules adopted pursuant to subparagraph 2. 12 4. The agency shall not grant any exemption under this 13 paragraph until the adoption of the rules required under this 14 paragraph, or until March 1, 1998, whichever comes first. 15 However, if final rules have not been adopted by March 1, 16 1998, the proposed rules governing the exemptions shall be 17 used by the agency to grant exemptions under the provisions of 18 this paragraph until final rules become effective. 19 20 A request for exemption under this subsection may be made at 21 any time and is not subject to the batching requirements of 22 this section. 23 Section 5. Section 408.037, Florida Statutes, is 24 amended to read: 25 408.037 Application content.-- 26 (1) An application for a certificate of need must 27 shall contain: 28 (a)(1) A detailed description of the proposed project 29 and statement of its purpose and need in relation to the 30 applicant's long-range plan, the local health plan, and the 31 state health plan. 32 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 (b)(2) A statement of the financial resources needed 2 by and available to the applicant to accomplish the proposed 3 project. This statement must shall include: 4 1.(a) A complete listing of all capital projects, 5 including new health facility development projects and health 6 facility acquisitions applied for, pending, approved, or 7 underway in any state at the time of application, regardless 8 of whether or not that state has a certificate-of-need program 9 or a capital expenditure review program pursuant to s. 1122 of 10 the Social Security Act. The agency department may, by rule, 11 require less-detailed information from major health care 12 providers. This listing must shall include the applicant's 13 actual or proposed financial commitment to those projects and 14 an assessment of their impact on the applicant's ability to 15 provide the proposed project. 16 2.(b) A detailed listing of the needed capital 17 expenditures, including sources of funds. 18 3.(c) A detailed financial projection, including a 19 statement of the projected revenue and expenses for the period 20 of construction and for the first 2 years of operation after 21 completion of the proposed project. This statement must shall 22 include a detailed evaluation of the impact of the proposed 23 project on the cost of other services provided by the 24 applicant. 25 (c)(3) An audited financial statement of the 26 applicant. In an application submitted by an existing health 27 care facility, health maintenance organization, or hospice, 28 financial condition documentation must shall include, but need 29 not be limited to, a balance sheet and a profit-and-loss 30 statement of the 2 previous fiscal years' operation. 31 33 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 (2) The applicant must certify that it will license 2 and operate the health care facility. For an existing health 3 care facility, the applicant must be the licenseholder of the 4 facility. 5 (4) A certified copy of a resolution by the board of 6 directors of the applicant, or other governing authority if 7 not a corporation, authorizing the filing of the application; 8 authorizing the applicant to incur the expenditures necessary 9 to accomplish the proposed project; certifying that if issued 10 a certificate, the applicant shall accomplish the proposed 11 project within the time allowed by law and at or below the 12 costs contained in the application; and certifying that the 13 applicant shall license and operate the facility. 14 Section 6. Section 408.038, Florida Statutes, is 15 amended to read: 16 408.038 Fees.--The department shall assess fees on 17 certificate-of-need applications. Such fees shall be for the 18 purpose of funding the Statewide Health Council, the functions 19 of the local health councils, and the activities of the 20 department and shall be allocated as provided in s. 408.033. 21 (1) The fee shall be determined as follows: 22 (a)(1) A minimum base fee of $5,000. 23 (b)(2) In addition to the base fee of $5,000, 0.015 of 24 each dollar of proposed expenditure, except that a fee may not 25 exceed $22,000. 26 (2) The fee is fully refundable: 27 (a) When an application is not accepted by the agency; 28 or 29 (b) When an accepted application is deemed incomplete 30 and is withdrawn by the agency as a result of the omissions 31 review. 34 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 (3) The fee is refundable, except for the $5,000 base 2 fee, when an accepted application is deemed incomplete as a 3 result of a legal challenge or is deemed complete and is 4 voluntarily withdrawn by the applicant. 5 Section 7. Subsections (1), (2), and (5) and paragraph 6 (b) of subsection (4) of section 408.039, Florida Statutes, 7 1996 Supplement, are amended to read: 8 408.039 Review process.--The review process for 9 certificates of need shall be as follows: 10 (1) REVIEW CYCLES.--The agency department by rule 11 shall provide for applications to be submitted on a timetable 12 or cycle basis; provide for review on a timely basis; and 13 provide for all completed applications pertaining to similar 14 types of services or, facilities, or equipment affecting the 15 same service district to be considered in relation to each 16 other no less often than two times a year. 17 (2) LETTERS OF INTENT.-- 18 (a) At least 30 days prior to filing an application, a 19 letter of intent shall be filed by the applicant with the 20 agency local health council and the department, respecting the 21 development of a proposal subject to review. No letter of 22 intent is required for expedited projects as defined by rule 23 by the agency department. 24 (b) The agency department shall provide a mechanism by 25 which applications may be filed to compete with proposals 26 described in filed letters of intent. 27 (c) Letters of intent must shall describe the 28 proposal; specify the with specificity, including proposed 29 capital expenditures, number of beds sought, if any; identify 30 the, services to be provided and the, specific subdistrict 31 location; and identify, identification of the applicant, 35 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 including the names of those with controlling interest in the 2 applicant, and such other information as the department may by 3 rule prescribe. The letter of intent shall contain a certified 4 copy of a resolution by the board of directors of the 5 applicant, or other governing authority if not a corporation, 6 authorizing the filing of the application described in the 7 letter of intent; authorizing the applicant to incur the 8 expenditures necessary to accomplish the proposed project; 9 certifying that if issued a certificate, the applicant shall 10 accomplish the proposed project within the time allowed by law 11 and at or below the costs contained in the application; and 12 certifying that the applicant shall license and operate the 13 facility. 14 (d) Within 21 14 days after filing a letter of intent, 15 the agency the applicant shall publish a notice of filing to 16 be published in a newspaper of general circulation in the area 17 affected by the proposal. The notice of filing shall be 18 published once a week for 2 consecutive weeks on forms and in 19 the format and content specified by the department by rule. 20 Within 21 days after the filing, the department shall publish 21 notice of the filing of letters of intent in the Florida 22 Administrative Weekly and notice that, if requested, a public 23 hearing shall be held at the local level within 21 days after 24 the application is deemed complete. Notices under this 25 paragraph must subsection shall contain due dates applicable 26 to the cycle for filing applications and for requesting a 27 hearing. 28 (4) STAFF RECOMMENDATIONS.-- 29 (b) Within 60 days after all the applications in a 30 review cycle are determined to be complete, the department 31 shall issue its State Agency Action Report and Notice of 36 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 Intent to grant a certificate of need for the project in its 2 entirety, to grant a certificate of need for identifiable 3 portions of the project, or to deny a certificate of need. 4 The State Agency Action Report shall set forth in writing its 5 findings of fact and determinations upon which its decision is 6 based. If a finding of fact or determination by the 7 department is counter to the district plan of the local health 8 council, the department shall provide in writing its reason 9 for its findings, item by item, to the local health council 10 and the Statewide Health Council. If the department intends 11 to grant a certificate of need, the State Agency Action Report 12 or the Notice of Intent shall also include any conditions 13 which the department intends to attach to the certificate of 14 need. The department shall designate by rule a senior staff 15 person, other than the person who issues the final order, to 16 issue State Agency Action Reports and Notices of Intent. 17 (5) ADMINISTRATIVE HEARINGS.-- 18 (a) Within 21 days after publication of notice of the 19 State Agency Action Report and Notice of Intent, any person 20 authorized under paragraph (c) (b) to participate in a hearing 21 may file a request for an administrative hearing; failure to 22 file a request for hearing within 21 days of publication of 23 notice shall constitute a waiver of any right to a hearing and 24 a waiver of the right to contest the final decision of the 25 agency department. A copy of the request for hearing shall be 26 served on the applicant. 27 (b) Hearings shall be held in Tallahassee unless the 28 administrative law judge determines that changing the location 29 will facilitate the proceedings. In administrative proceedings 30 challenging the issuance or denial of a certificate of need, 31 only applicants considered by the department in the same 37 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 batching cycle are entitled to a comparative hearing on their 2 applications. Existing health care facilities may initiate or 3 intervene in such administrative hearing upon a showing that 4 an established program will be substantially affected by the 5 issuance of a certificate of need to a competing proposed 6 facility or program within the same district, provided that 7 existing health care providers, other than the applicant, have 8 no standing or right to initiate or intervene in an 9 administrative hearing involving a health care project which 10 is subject to certificate-of-need review solely on the basis 11 of s. 408.036(1)(c). The agency department shall assign 12 proceedings requiring hearings to the Division of 13 Administrative Hearings of the Department of Management 14 Services within 10 days after the time has expired for 15 requesting run to request a hearing. Except upon unanimous 16 consent of the parties or upon the granting by the 17 administrative law judge of a motion of continuance, hearings 18 shall commence within 60 days after the administrative law 19 judge has been assigned. All non-state-agency parties, except 20 the agency, shall bear their own expense of preparing a 21 transcript. In any application for a certificate of need which 22 is referred to the Division of Administrative Hearings for 23 hearing, the administrative law judge shall complete and 24 submit to the parties a recommended order as provided in ss. 25 120.569 and 120.57. The recommended order shall be issued 26 within 30 days after the receipt of the proposed recommended 27 orders or the deadline for submission of such proposed 28 recommended orders, whichever is earlier. The division shall 29 adopt procedures for administrative hearings which shall 30 maximize the use of stipulated facts and shall provide for the 31 admission of prepared testimony. 38 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 (c) In administrative proceedings challenging the 2 issuance or denial of a certificate of need, only applicants 3 considered by the agency in the same batching cycle are 4 entitled to a comparative hearing on their applications. 5 Existing health care facilities may initiate or intervene in 6 such administrative hearing upon a showing that an established 7 program will be substantially affected by the issuance of a 8 certificate of need to a competing proposed facility or 9 program within the same district. The department shall issue 10 its final order within 45 days after receipt of the 11 recommended order. 12 (d) The applicant's failure to strictly comply with 13 the requirements of s. 408.037(1) or paragraph (2)(c) is not 14 cause for dismissal of the application, unless the failure to 15 comply impairs the fairness of the proceeding or affects the 16 correctness of the action taken by the agency. If the 17 department fails to take action within the time specified in 18 paragraph (4)(a) or paragraph (5)(c), or as otherwise agreed 19 to by the applicant and the department, the applicant may take 20 appropriate legal action to compel the department to act. When 21 making a determination on an application for a certificate of 22 need, the department is specifically exempt from the time 23 limitations provided in s. 120.60(1). 24 (e) The agency shall issue its final order within 45 25 days after receipt of the recommended order. If the agency 26 fails to take action within such time, or as otherwise agreed 27 to by the applicant and the agency, the applicant may take 28 appropriate legal action to compel the agency to act. When 29 making a determination on an application for a certificate of 30 need, the agency is specifically exempt from the time 31 limitations provided in s. 120.60(1). 39 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 Section 8. Paragraphs (a), (b), and (d) of subsection 2 (2) of section 408.040, Florida Statutes, are amended to read: 3 408.040 Conditions and monitoring.-- 4 (2)(a) Unless the applicant has commenced 5 construction, if the project provides for construction, unless 6 the applicant has incurred an enforceable capital expenditure 7 commitment for a project, if the project does not provide for 8 construction, or unless subject to paragraph (b), a 9 certificate of need shall terminate 18 months 1 year after the 10 date of issuance, except in the case of a multifacility 11 project, as defined in s. 408.032(17), where the certificate 12 of need shall terminate 2 years after the date of issuance. 13 The department may extend the period of validity of the 14 certificate for an additional period of up to 6 months, upon a 15 showing of good cause, as defined by rule, by the applicant 16 for the extension. The agency department shall monitor the 17 progress of the holder of the certificate of need in meeting 18 the timetable for project development specified in the 19 application with the assistance of the local health council as 20 specified in s. 408.033(1)(b)5., and may revoke the 21 certificate of need, if the holder of the certificate is not 22 meeting such timetable and is not making a good-faith good 23 faith effort, as defined by rule, to meet it. 24 (b) A certificate of need issued to an applicant 25 holding a provisional certificate of authority under chapter 26 651 shall terminate 1 year after the applicant receives a 27 valid certificate of authority from the Department of 28 Insurance. The certificate-of-need validity period may be 29 extended by the department for an additional period of up to 6 30 months upon a showing of good cause, as defined by rule, by 31 the applicant for the extension. 40 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 (d) If an application is filed to consolidate two or 2 more certificates as authorized by s. 408.036(2)(f)(j) or to 3 divide a certificate of need into two or more facilities as 4 authorized by s. 408.036(2)(g)(k), the validity period of the 5 certificate or certificates of need to be consolidated or 6 divided shall be extended for the period beginning upon 7 submission of the application and ending when final agency 8 action and any appeal from such action has been concluded. 9 However, no such suspension shall be effected if the 10 application is withdrawn by the applicant. 11 Section 9. Section 408.042, Florida Statutes, is 12 amended to read: 13 408.042 Limitation on transfer.--The holder of a 14 certificate of need shall not charge a price for the transfer 15 of the certificate of need to another person that exceeds the 16 total amount of the actual costs incurred by the holder in 17 obtaining the certificate of need. Such actual costs must be 18 documented by an affidavit executed by the transferor under 19 oath. A holder who violates this subsection is guilty of a 20 misdemeanor of the first degree, punishable as provided in s. 21 775.082, or by a fine not exceeding $10,000, or both. Nothing 22 in this section shall be construed to prevent or alter the 23 value of a transfer or sale by an existing facility of a 24 certificate of need obtained before June 17, 1987, when such 25 facility is transferred with the certificate of need. 26 Section 10. Section 408.043, Florida Statutes, is 27 amended to read: 28 408.043 Special provisions.-- 29 (1) OSTEOPATHIC ACUTE CARE HOSPITALS.--When an 30 application is made for a certificate of need to construct or 31 to expand an osteopathic acute care hospital, the need for 41 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 such hospital shall be determined on the basis of the need for 2 and availability of osteopathic services and osteopathic acute 3 care hospitals in the district. When a prior certificate of 4 need to establish an osteopathic acute care hospital has been 5 issued in a district, and the facility is no longer used for 6 that purpose, the agency department may continue to count such 7 facility and beds as an existing osteopathic facility in any 8 subsequent application for construction of an osteopathic 9 acute care hospital. 10 (2) HOSPICES.--When an application is made for a 11 certificate of need to establish or to expand a hospice, the 12 need for such hospice shall be determined on the basis of the 13 need for and availability of hospice services in the 14 community. The formula on which the certificate of need is 15 based shall discourage regional monopolies and promote 16 competition. The inpatient hospice care component of a 17 hospice which is a freestanding facility, or a part of a 18 facility, which is primarily engaged in providing inpatient 19 care and related services and is not licensed as a health care 20 facility shall also be required to obtain a certificate of 21 need. Provision of hospice care by any current provider of 22 health care is a significant change in service and therefore 23 requires a certificate of need for such services. 24 (3) VALIDITY OF CERTIFICATE OF NEED.--A certificate of 25 need issued by the department for nursing home facilities of 26 100 beds or more prior to February 14, 1986, is valid, 27 provided that such facility has expended at least $50,000 in 28 reliance upon such certificate of need, excluding legal fees, 29 prior to the initiation of proceedings under the 30 Administrative Procedure Act subsequent to February 14, 1986, 31 contesting the validity of the certificate of need. If such 42 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 nursing home certificate of need includes beds that have not 2 yet been licensed as of June 17, 1987, such beds shall not be 3 considered or utilized in the determination of need or 4 included in the inventory of licensed or approved nursing home 5 beds by the department, with respect to applications filed 6 before June 17, 1987. This subsection shall only apply to 7 nursing home beds. Nothing contained herein shall be 8 construed to deny action pursuant to s. 120.69, or to 9 eliminate any conditions of the certificate of need or time 10 requirements to commence construction, including any 11 authorized extensions. 12 (3)(4) RURAL HEALTH NETWORKS.--Preference shall be 13 given in the award of a certificate of need to members of 14 certified rural health networks, as provided for in s. 15 381.0406, subject to the following conditions: 16 (a) Need must be shown pursuant to s. 408.035. 17 (b) The proposed project must: 18 1. Strengthen health care services in rural areas 19 through partnerships between rural care providers; or 20 2. Increase access to inpatient health care services 21 for Medicaid recipients or other low-income persons who live 22 in rural areas. 23 (c) No preference shall be given under this section 24 for the establishment of skilled nursing facility services by 25 a hospital. 26 (4) PRIVATE ACCREDITATION NOT REQUIRED.--Accreditation 27 by any private organization may not be a requirement for the 28 issuance or maintenance of a certificate of need under ss. 29 408.031-408.045. 30 Section 11. Section 408.0455, Florida Statutes, is 31 amended to read: 43 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 408.0455 Effect of ss. 408.031-408.045; Rules; health 2 councils and plans; pending proceedings.-- 3 (1) Nothing contained in ss. 408.031-408.045 is 4 intended to repeal or modify any of the existing rules of the 5 Department of Health and Rehabilitative Services, which shall 6 remain in effect and shall be enforceable by the Agency for 7 Health Care Administration; the existing composition of the 8 local health councils and the Statewide Health Council; or the 9 state health plan; or any of the local district health plans, 10 unless, and only to the extent that, there is a direct 11 conflict with the provisions of ss. 408.031-408.045. 12 (2) The rules of the agency Department of Health and 13 Rehabilitative Services in effect on June 30, 1997 1992, which 14 implement the provisions of former ss. 381.701-381.715, shall 15 remain in effect and shall be enforceable by the agency for 16 Health Care Administration with respect to ss. 408.031-408.045 17 until such rules are repealed or amended by the agency for 18 Health Care Administration, and no judicial or administrative 19 proceeding pending on July 1, 1997 1992, shall be abated as a 20 result of the provisions of ss. 408.031-408.043(1) and (2); s. 21 408.044; or s. 408.045. 22 Section 12. Paragraph (i) of subsection (4) of section 23 240.5121, Florida Statutes, is amended to read: 24 240.5121 Cancer control and research.-- 25 (4) FLORIDA CANCER CONTROL AND RESEARCH ADVISORY 26 COUNCIL; CREATION; COMPOSITION.-- 27 (i) The council shall approve each year a program for 28 cancer control and research to be known as the "Florida Cancer 29 Plan" which shall be consistent with the State Health Plan 30 developed by the Statewide Health Council and integrated and 31 coordinated with existing programs in this state. 44 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 Section 13. Subsection (1) of section 395.604, Florida 2 Statutes, is amended to read: 3 395.604 Other rural hospital programs.-- 4 (1) The agency may license rural primary care 5 hospitals subject to federal approval for participation in the 6 Medicare and Medicaid programs. Rural primary care hospitals 7 shall be treated in the same manner as emergency care 8 hospitals and rural hospitals with respect to ss. 9 395.605(2)-(8)(a), 408.033(2)(b)3.(3)(b)3., and 408.038. 10 Section 14. Subsection (1) of section 408.702, Florida 11 Statutes, is amended to read: 12 408.702 Community health purchasing alliance; 13 establishment.-- 14 (1) There is hereby created a community health 15 purchasing alliance in each of the 11 health service planning 16 districts established under s. 408.032(5). Each alliance must 17 be operated as a state-chartered, nonprofit private 18 organization organized pursuant to chapter 617. 19 Section 15. Subsection (6) of section 400.602, Florida 20 Statutes, is amended to read: 21 400.602 Licensure required; prohibited acts; 22 exemptions; display, transferability of license.-- 23 (6) Notwithstanding s. 400.601(3)(2), at any time 24 after July 1, 1995, any entity entitled to licensure under 25 subsection (5) may obtain a license for up to two additional 26 hospices in accordance with the other requirements of this 27 part and upon receipt of any certificate of need that may be 28 required under the provisions of ss. 408.031-408.045. 29 Section 16. Paragraph (c) of subsection (1) of section 30 641.60, Florida Statutes, 1996 Supplement, is amended to read: 31 641.60 Statewide Managed Care Ombudsman Committee.-- 45 CODING: Words stricken are deletions; words underlined are additions. Florida House of Representatives - 1997 HB 1999 169-409-97 1 (1) As used in ss. 641.60-641.75: 2 (c) "District" means one of the health service 3 planning districts as defined in s. 408.032(5). 4 Section 17. Subsection (9) of section 186.003, 5 subsection (9) of section 186.503, and sections 408.0365 and 6 408.0366, Florida Statutes, are repealed. 7 Section 18. Subject to any final order of the Florida 8 Supreme Court, ss. 408.036(1)(b) and 408.039(5)(c), Florida 9 Statutes, as amended by this act, do not apply to any 10 replacement application filed with the Agency for Health Care 11 Administration prior to or pending a final hearing before the 12 Division of Administrative Hearings as of April 1, 1997. It is 13 the intent of the Legislature that the remaining provisions of 14 this act do not apply to applications that have been filed 15 prior to the effective date of this act. 16 Section 19. This act shall take effect July 1, 1997. 17 18 ***************************************** 19 HOUSE SUMMARY 20 With respect to certificate-of-need review: revises 21 definitions; revises review criteria; revises categories of facilities, services, and expenditures subject to 22 review or expedited review, or exempt from review; revises requirements relating to an applicant's 23 description of a proposed project, financial projection, and licensure; provides for refund of certain application 24 fees; revises scope of review cycles, and requirements and procedures relating to letters of intent and 25 administrative hearings; increases the validity period of certificates; removes a special provision relating to the 26 validity of certain nursing home facility certificates; provides that private accreditation is not required for 27 certificate issuance or maintenance; provides for continuation of certain rules and pending proceedings; 28 removes provisions relating to the Statewide Health Council and duties thereof. See bill for details. 29 30 31 46