CODING: Words stricken are deletions; words underlined are additions.Senate Bill 0250
Florida Senate - 1998 SB 250
By the Committee on Health Care
317-381-98
1 A bill to be entitled
2 An act relating to certificates of need;
3 amending s. 400.071, F.S., relating to nursing
4 home licensure; revising certain requirements
5 for the Agency for Health Care Administration
6 in issuing a certificate of need to a nursing
7 home; deleting provisions expressing
8 legislative preference for certificate-of-need
9 applications that indicate intent to meet
10 certain needs of Medicaid recipients with
11 respect to nursing home services; requiring
12 that certain information be included on a
13 facility's license; amending s. 408.034, F.S.;
14 specifying duties and responsibilities of the
15 agency with respect to administering the
16 certificate-of-need program; requiring the
17 agency, in consultation with the Medicaid
18 program office and the Department of Elderly
19 Affairs, to establish by rule projections of
20 patient-day needs for Medicaid patients in
21 nursing homes; requiring publication of such
22 needs with the batching-cycle data for nursing
23 homes; amending s. 408.036, F.S.; providing for
24 expedited review of requests for modifications
25 of certificate-of-need conditions; amending s.
26 408.040, F.S., relating to certificate-of-need
27 conditions and monitoring of certificates of
28 need; authorizing the Agency for Health Care
29 Administration to condition issuance of a
30 certificate of need for nursing home beds on an
31 applicant's indication that it will provide a
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1 specified number of days of care for Medicaid
2 patients; requiring that such condition be
3 stated on the certificate of need; directing
4 the agency to consult with the Medicaid program
5 office and the Department of Elderly Affairs
6 when imposing conditions in an area in which a
7 community diversion pilot project is
8 implemented; requiring the agency to adopt
9 rules; requiring a letter of intent to request
10 a modification in the conditions of a
11 certificate of need; requiring that the
12 certificate-of-need program confer with the
13 Medicaid program office and the Department of
14 Elderly Affairs when reviewing modification
15 requests; requiring the certificate-of-need
16 program to develop an impact analysis for
17 affected geographic market areas; requiring
18 that modification decisions be based on the
19 impact analysis; correcting references to
20 reflect the transfer of the responsibility for
21 administering the certificate-of-need program
22 from the Department of Health and
23 Rehabilitative Services to the Agency for
24 Health Care Administration; providing an
25 effective date.
26
27 Be It Enacted by the Legislature of the State of Florida:
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29 Section 1. Subsection (7) of section 400.071, Florida
30 Statutes, is amended to read:
31 400.071 Application for license.--
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1 (7) The agency may not issue a license to a nursing
2 home that fails to receive a certificate of need under the
3 provisions of ss. 408.031-408.045. The agency must include on
4 the license the number of patient days of care a licensee
5 agrees to provide to may consider, in addition to the other
6 criteria specified in s. 408.035, the statement of intent by
7 the applicant to designate a percentage of the beds of the
8 facility for use by patients eligible for care under Title XIX
9 of the Social Security Act, the percentage to be all or a
10 portion of the need for such beds as identified in the local
11 health plan. It is the intent of the Legislature that
12 preference be given to an application which most closely meets
13 the need for such beds.
14 Section 2. Section 408.034, Florida Statutes, is
15 amended to read:
16 408.034 Duties and responsibilities of agency
17 department; rules.--
18 (1) The agency department is designated as the single
19 state agency to issue, revoke, or deny certificates of need
20 and to issue, revoke, or deny exemptions from
21 certificate-of-need review in accordance with the district
22 plans, the statewide health plan, and present and future
23 federal and state statutes. The agency department is
24 designated as the state health planning agency for purposes of
25 federal law.
26 (2) In the exercise of its authority to issue licenses
27 to health care facilities and health service providers, as
28 provided under chapters 393, 395, and parts II and VI I and V
29 of chapter 400, the agency may department shall not issue a
30 license to any health care facility, health service provider,
31 hospice, or part of a health care facility which fails to
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1 receive a certificate of need for the licensed facility or
2 service.
3 (3) The agency department shall establish, by rule,
4 uniform need methodologies for health services and health
5 facilities. In developing uniform need methodologies, the
6 agency department shall, at a minimum, consider the
7 demographic characteristics of the population, the health
8 status of the population, service use patterns, standards and
9 trends, geographic accessibility, and market economics.
10 (4)(a) The certificate-of-need program, in
11 consultation with the Medicaid program office and the
12 Department of Elderly Affairs, shall develop projections of
13 the number of nursing facility patient days needed for
14 Medicaid patients. The Medicaid program office must provide
15 Medicaid patient-day statistics to the certificate-of-need
16 program and to the Department of Elderly Affairs. The
17 certificate-of-need program shall refine the statistical
18 database in consultation with the Department of Elderly
19 Affairs.
20 (b) Upon agreement of the Medicaid program office, the
21 certificate-of-need program, and the Department of Elderly
22 Affairs, the agency must publish the number of needed Medicaid
23 patient days in the Florida Administrative Weekly along with
24 the appropriate bed batching cycle data for nursing homes.
25 (5)(4) The agency department shall establish by rule a
26 nursing-home-bed-need nursing home bed need methodology that
27 which reduces the community nursing home bed need for the
28 areas of the state where the agency department establishes
29 pilot community diversion programs through the Title XIX aging
30 waiver program.
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1 (6)(5) The agency department may adopt rules necessary
2 to implement ss. 408.031-408.045.
3 Section 3. Subsection (2) of section 408.036, Florida
4 Statutes, is amended to read:
5 408.036 Projects subject to review.--
6 (2) PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless
7 exempt pursuant to subsection (3), projects subject to an
8 expedited review shall include, but not be limited to:
9 (a) Cost overruns, as defined in paragraph (1)(i).
10 (b) Research, education, and training programs.
11 (c) Shared services contracts or projects.
12 (d) A transfer of a certificate of need.
13 (e) A 50-percent increase in nursing home beds for a
14 facility incorporated and operating in this state for at least
15 60 years on or before July 1, 1988, which has a licensed
16 nursing home facility located on a campus providing a variety
17 of residential settings and supportive services. The
18 increased nursing home beds shall be for the exclusive use of
19 the campus residents. Any application on behalf of an
20 applicant meeting this requirement shall be subject to the
21 base fee of $5,000 provided in s. 408.038.
22 (f) Combination within one nursing home facility of
23 the beds or services authorized by two or more certificates of
24 need issued in the same planning subdistrict.
25 (g) Division into two or more nursing home facilities
26 of beds or services authorized by one certificate of need
27 issued in the same planning subdistrict. Such division shall
28 not be approved if it would adversely affect the original
29 certificate's approved cost.
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1 (h) Replacement of a health care facility when the
2 proposed project site is located in the same district and
3 within a 1-mile radius of the replaced health care facility.
4 (i) Modification of conditions as provided under s.
5 408.040(1).
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7 The agency shall develop rules to implement the provisions for
8 expedited review, including time schedule, application
9 content, and application processing.
10 Section 4. Section 408.040, Florida Statutes, is
11 amended to read:
12 408.040 Conditions and monitoring.--
13 (1)(a) The agency department may issue a certificate
14 of need predicated upon statements of intent expressed by an
15 applicant in the application for a certificate of need.
16 1. Any certificate of need issued for construction of
17 a new hospital or for the addition of beds to an existing
18 hospital shall include a statement of the number of beds
19 approved by category of service, including rehabilitation or
20 psychiatric service, for which the agency department has
21 adopted by rule a specialty-bed-need methodology. All beds
22 that which are approved, but are not covered by any
23 specialty-bed-need methodology, shall be designated as
24 general.
25 2. The agency may issue a certificate of need for
26 nursing home beds predicated upon statements expressed by an
27 applicant in the application for a certificate of need that it
28 will provide a specified number of patient days for use by
29 patients eligible for care under Title XIX of the Social
30 Security Act. Any certificate of need issued in reliance upon
31 an applicant's statements to provide a specified number of
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1 patient days for use by patients eligible for care under Title
2 XIX of the Social Security Act must include a statement that
3 such certification is a condition of issuance of the
4 certificate of need. The agency shall adopt rules for imposing
5 a requirement that a certificateholder provide a specified
6 number of patient days for use by patients eligible for care
7 under Title XIX of the Social Security Act as a
8 certificate-of-need condition on nursing home beds, as
9 provided in s. 408.034. The certificate-of-need program shall
10 consult with the Medicaid program office and the Department of
11 Elderly Affairs before imposing conditions provided in this
12 subparagraph in an area in which a community diversion pilot
13 project is implemented.
14 (b)1. A certificateholder may apply to the agency for
15 a modification of conditions imposed under paragraph (a).
16 Prior to submitting an application, a certificateholder must
17 submit a letter of intent announcing its plan to request a
18 modification of conditions imposed under this section.
19 2. The certificate-of-need program shall confer with
20 the Medicaid program office and the Department of Elderly
21 Affairs during its review of modification requests.
22 3. The certificate-of-need program, with the Medicaid
23 program office and the Department of Elderly Affairs, shall
24 develop an impact analysis for the affected geographic market
25 area in which the modification is proposed and shall base any
26 modification granted or denied on the impact analysis.
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28 If the holder of a certificate of need demonstrates good cause
29 why the certificate should be modified and the impact analysis
30 results in findings that Medicaid recipients in the geographic
31 market area will not be adversely affected, the agency
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1 department shall reissue the certificate of need with such
2 modifications as may be appropriate. The agency department
3 shall by rule define the factors constituting good cause for
4 modification.
5 (c)(b) If the holder of a certificate of need fails to
6 comply with a condition upon which the issuance of the
7 certificate was predicated, the agency department may assess
8 an administrative fine against the certificateholder in an
9 amount not to exceed $1,000 per failure per day. In assessing
10 the penalty, the agency department shall take into account as
11 mitigation the relative lack of severity of a particular
12 failure. Proceeds of such penalties shall be deposited in the
13 Public Medical Assistance Trust Fund.
14 (2)(a) Unless the applicant has commenced
15 construction, if the project provides for construction, unless
16 the applicant has incurred an enforceable capital expenditure
17 commitment for a project, if the project does not provide for
18 construction, or unless subject to paragraph (b), a
19 certificate of need shall terminate 18 months after the date
20 of issuance, except in the case of a multifacility project, as
21 defined in s. 408.032, where the certificate of need shall
22 terminate 2 years after the date of issuance. The agency shall
23 monitor the progress of the holder of the certificate of need
24 in meeting the timetable for project development specified in
25 the application with the assistance of the local health
26 council as specified in s. 408.033(1)(b)5., and may revoke the
27 certificate of need, if the holder of the certificate is not
28 meeting such timetable and is not making a good faith effort,
29 as defined by rule, to meet it.
30 (b) A certificate of need issued to an applicant
31 holding a provisional certificate of authority under chapter
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1 651 shall terminate 1 year after the applicant receives a
2 valid certificate of authority from the Department of
3 Insurance.
4 (c) The certificate-of-need validity period for a
5 project shall be extended by the agency department, to the
6 extent that the applicant demonstrates to the satisfaction of
7 the agency department that good faith commencement of the
8 project is being delayed by litigation or by governmental
9 action or inaction with respect to regulations or permitting
10 precluding commencement of the project.
11 (d) If an application is filed to consolidate two or
12 more certificates as authorized by s. 408.036(2)(f) or to
13 divide a certificate of need into two or more facilities as
14 authorized by s. 408.036(2)(g), the validity period of the
15 certificate or certificates of need to be consolidated or
16 divided shall be extended for the period beginning upon
17 submission of the application and ending when final agency
18 action and any appeal from such action has been concluded.
19 However, no such suspension shall be effected if the
20 application is withdrawn by the applicant.
21 (3) The agency department shall require the submission
22 of an executed architect's certification of final payment for
23 each certificate-of-need project approved by the agency
24 department. Each project that which involves construction
25 shall submit such certification to the agency department
26 within 30 days following completion of construction.
27 Section 5. This act shall take effect July 1, 1998.
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2 SENATE SUMMARY
3 Revises various requirements for the Agency for Health
Care Administration in issuing certificates of need to
4 nursing homes. Requires that the agency estimate the need
for nursing home beds for Medicaid patients and publish
5 the information in the Florida Administrative Weekly.
Provides procedures under which the agency may require
6 that a nursing home provide a specified number of beds
for Medicaid patients as a condition of receiving a
7 certificate of need. Provides procedures under which such
conditions may be modified. (See bill for details.)
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