House Bill 0591e1

CODING: Words stricken are deletions; words underlined are additions.







                                     CS/CS/HB 591, First Engrossed



  1                      A bill to be entitled

  2         An act relating to health care services;

  3         amending s. 400.471, F.S.; deleting the

  4         certificate-of-need requirement for licensure

  5         of Medicare-certified home health agencies;

  6         amending s. 400.606, F.S.; conforming to the

  7         act provisions relating to certificate-of-need

  8         requirements for hospice licensure; amending s.

  9         408.032, F.S.; revising definitions; amending

10         s. 408.033, F.S.; deleting references to the

11         state health plan; amending s. 408.034, F.S.;

12         deleting a reference to licensing of home

13         health agencies by the Agency for Health Care

14         Administration; amending s. 408.035, F.S.;

15         deleting obsolete certificate-of-need review

16         criteria and revising other criteria; amending

17         s. 408.036, F.S.; revising provisions relating

18         to projects subject to review; deleting

19         references to Medicare-certified home health

20         agencies; deleting the review of certain

21         acquisitions; specifying the types of bed

22         increases subject to review; deleting cost

23         overruns from review; deleting review of

24         combinations or division of nursing home

25         certificates of need; providing for expedited

26         review of certain conversions of licensed

27         hospital beds; deleting the requirement for an

28         exemption for initiation or expansion of

29         obstetric services, provision of respite care

30         services, establishment of a Medicare-certified

31         home health agency, or provision of a health


                                  1

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         service exclusively on an outpatient basis;

  2         providing exemption for combinations or

  3         divisions of nursing home certificates of need

  4         and additions of certain hospital beds and

  5         nursing home beds within specified limitations;

  6         providing an additional exemption for

  7         construction of certain skilled nursing

  8         facilities; requiring a fee for each request

  9         for exemption; amending s. 408.037, F.S.;

10         deleting reference to the state health plan;

11         amending ss. 408.038, 408.039, 408.044, and

12         408.045, F.S.; replacing "department" with

13         "agency"; clarifying the opportunity to

14         challenge an intended award of a certificate of

15         need; amending s. 408.040, F.S.; deleting an

16         obsolete reference; revising the format of

17         conditions related to Medicaid; creating a

18         certificate-of-need workgroup within the Agency

19         for Health Care Administration; providing for

20         expenses; providing membership, duties, and

21         meetings; providing for termination; amending

22         s. 651.118, F.S.; excluding a specified number

23         of beds from a time limit imposed on extension

24         of authorization for continuing care

25         residential community providers to use

26         sheltered beds for nonresidents; requiring a

27         facility to report such use after the

28         expiration of the extension; creating the

29         Public Cord Blood Tissue Bank as a statewide

30         consortium; providing purposes, membership, and

31         duties of the consortium; providing duties of


                                  2

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         the Agency for Health Care Administration;

  2         providing requirements of specified

  3         state-funded health care programs; providing an

  4         exception from provisions of the act; requiring

  5         specified written disclosure by certain health

  6         care facilities and providers; specifying that

  7         donation under the act is voluntary;

  8         authorizing the consortium to charge fees;

  9         repealing s. 400.464(3), F.S., relating to home

10         health agency licenses provided to

11         certificate-of-need exempt entities; reducing

12         allocation of positions and funds; providing

13         effective dates.

14

15  Be It Enacted by the Legislature of the State of Florida:

16

17         Section 1.  Subsections (2) and (11) of section

18  400.471, Florida Statutes, are amended to read:

19         400.471  Application for license; fee; provisional

20  license; temporary permit.--

21         (2)  The applicant must file with the application

22  satisfactory proof that the home health agency is in

23  compliance with this part and applicable rules, including:

24         (a)  A listing of services to be provided, either

25  directly by the applicant or through contractual arrangements

26  with existing providers;

27         (b)  The number and discipline of professional staff to

28  be employed; and

29         (c)  Proof of financial ability to operate.

30

31


                                  3

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  If the applicant has applied for a certificate of need under

  2  ss. 408.0331-408.045 within the preceding 12 months, the

  3  applicant may submit the proof required during the

  4  certificate-of-need process along with an attestation that

  5  there has been no substantial change in the facts and

  6  circumstances underlying the original submission.

  7         (11)  The agency may not issue a license designated as

  8  certified to a home health agency that fails to receive a

  9  certificate of need under ss. 408.031-408.045 or that fails to

10  satisfy the requirements of a Medicare certification survey

11  from the agency.

12         Section 2.  Subsections (5) and (6) of section 400.606,

13  Florida Statutes, are amended to read:

14         400.606  License; application; renewal; conditional

15  license or permit; certificate of need.--

16         (5)  The agency shall not issue a license to a hospice

17  that fails to receive a certificate of need if required under

18  the provisions of ss. 408.031-408.045. A licensed hospice is a

19  health care facility as that term is used in s. 408.039(5) and

20  is entitled to initiate or intervene in an administrative

21  hearing.

22         (6)  A freestanding hospice facility that is primarily

23  engaged in providing inpatient and related services and that

24  is not otherwise licensed as a health care facility shall be

25  required to obtain a certificate of need if required under the

26  provisions of ss. 408.031-408.045. However, a freestanding

27  hospice facility with six or fewer beds shall not be required

28  to comply with institutional standards such as, but not

29  limited to, standards requiring sprinkler systems, emergency

30  electrical systems, or special lavatory devices.

31


                                  4

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         Section 3.  Section 408.032, Florida Statutes, is

  2  amended to read:

  3         408.032  Definitions.--As used in ss. 408.031-408.045,

  4  the term:

  5         (1)  "Agency" means the Agency for Health Care

  6  Administration.

  7         (2)  "Capital expenditure" means an expenditure,

  8  including an expenditure for a construction project undertaken

  9  by a health care facility as its own contractor, which, under

10  generally accepted accounting principles, is not properly

11  chargeable as an expense of operation and maintenance, which

12  is made to change the bed capacity of the facility, or

13  substantially change the services or service area of the

14  health care facility, health service provider, or hospice, and

15  which includes the cost of the studies, surveys, designs,

16  plans, working drawings, specifications, initial financing

17  costs, and other activities essential to acquisition,

18  improvement, expansion, or replacement of the plant and

19  equipment.

20         (3)  "Certificate of need" means a written statement

21  issued by the agency evidencing community need for a new,

22  converted, expanded, or otherwise significantly modified

23  health care facility, health service, or hospice.

24         (4)  "Commenced construction" means initiation of and

25  continuous activities beyond site preparation associated with

26  erecting or modifying a health care facility, including

27  procurement of a building permit applying the use of

28  agency-approved construction documents, proof of an executed

29  owner/contractor agreement or an irrevocable or binding forced

30  account, and actual undertaking of foundation forming with

31  steel installation and concrete placing.


                                  5

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (5)  "District" means a health service planning

  2  district composed of the following counties:

  3         District 1.--Escambia, Santa Rosa, Okaloosa, and Walton

  4  Counties.

  5         District 2.--Holmes, Washington, Bay, Jackson,

  6  Franklin, Gulf, Gadsden, Liberty, Calhoun, Leon, Wakulla,

  7  Jefferson, Madison, and Taylor Counties.

  8         District 3.--Hamilton, Suwannee, Lafayette, Dixie,

  9  Columbia, Gilchrist, Levy, Union, Bradford, Putnam, Alachua,

10  Marion, Citrus, Hernando, Sumter, and Lake Counties.

11         District 4.--Baker, Nassau, Duval, Clay, St. Johns,

12  Flagler, and Volusia Counties.

13         District 5.--Pasco and Pinellas Counties.

14         District 6.--Hillsborough, Manatee, Polk, Hardee, and

15  Highlands Counties.

16         District 7.--Seminole, Orange, Osceola, and Brevard

17  Counties.

18         District 8.--Sarasota, DeSoto, Charlotte, Lee, Glades,

19  Hendry, and Collier Counties.

20         District 9.--Indian River, Okeechobee, St. Lucie,

21  Martin, and Palm Beach Counties.

22         District 10.--Broward County.

23         District 11.--Dade and Monroe Counties.

24         (6)  "Exemption" means the process by which a proposal

25  that would otherwise require a certificate of need may proceed

26  without a certificate of need.

27         (7)(6)  "Expedited review" means the process by which

28  certain types of applications are not subject to the review

29  cycle requirements contained in s. 408.039(1), and the letter

30  of intent requirements contained in s. 408.039(2).

31


                                  6

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (8)(7)  "Health care facility" means a hospital,

  2  long-term care hospital, skilled nursing facility, hospice,

  3  intermediate care facility, or intermediate care facility for

  4  the developmentally disabled. A facility relying solely on

  5  spiritual means through prayer for healing is not included as

  6  a health care facility.

  7         (9)(8)  "Health services" means diagnostic, curative,

  8  or rehabilitative services and includes alcohol treatment,

  9  drug abuse treatment, and mental health services. Obstetric

10  services are not health services for purposes of ss.

11  408.031-408.045.

12         (9)  "Home health agency" means an organization, as

13  defined in s. 400.462(4), that is certified or seeks

14  certification as a Medicare home health service provider.

15         (10)  "Hospice" or "hospice program" means a hospice as

16  defined in part VI of chapter 400.

17         (11)  "Hospital" means a health care facility licensed

18  under chapter 395.

19         (12)  "Institutional health service" means a health

20  service which is provided by or through a health care facility

21  and which entails an annual operating cost of $500,000 or

22  more.  The agency shall, by rule, adjust the annual operating

23  cost threshold annually using an appropriate inflation index.

24         (13)  "Intermediate care facility" means an institution

25  which provides, on a regular basis, health-related care and

26  services to individuals who do not require the degree of care

27  and treatment which a hospital or skilled nursing facility is

28  designed to provide, but who, because of their mental or

29  physical condition, require health-related care and services

30  above the level of room and board.

31


                                  7

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (12)(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         (13)(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         (14)  "Mental health services" means inpatient services

12  provided in a hospital licensed under chapter 395 and listed

13  on the hospital license as psychiatric beds for adults;

14  psychiatric beds for children and adolescents; intensive

15  residential treatment beds for children and adolescents;

16  substance abuse beds for adults; or substance abuse beds for

17  children and adolescents.

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.






                                     CS/CS/HB 591, First Engrossed



  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         (15)(17)  "Nursing home geographically underserved

  8  area" 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         (16)(19)  "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         (17)(20)  "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.






                                     CS/CS/HB 591, First Engrossed



  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         (18)(21)  "Regional area" means any of those regional

12  health planning areas established by the agency to which local

13  and district health planning funds are directed to local

14  health councils through the General Appropriations Act.

15         Section 4.  Paragraph (b) of subsection (1) and

16  paragraph (a) of subsection (3) of section 408.033, Florida

17  Statutes, are amended to read:

18         408.033  Local and state health planning.--

19         (1)  LOCAL HEALTH COUNCILS.--

20         (b)  Each local health council may:

21         1.  Develop a district or regional area health plan

22  that permits is consistent with the objectives and strategies

23  in the state health plan, but that shall permit each local

24  health council to develop strategies and set priorities for

25  implementation based on its unique local health needs.  The

26  district or regional area health plan must contain preferences

27  for the development of health services and facilities, which

28  may be considered by the agency in its review of

29  certificate-of-need applications.  The district health plan

30  shall be submitted to the agency and updated periodically. The

31  district health plans shall use a uniform format and be


                                  10

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  submitted to the agency according to a schedule developed by

  2  the agency in conjunction with the local health councils. The

  3  schedule must provide for coordination between the development

  4  of the state health plan and the district health plans and for

  5  the development of district health plans by major sections

  6  over a multiyear period.  The elements of a district plan

  7  which are necessary to the review of certificate-of-need

  8  applications for proposed projects within the district may be

  9  adopted by the agency as a part of its rules.

10         2.  Advise the agency on health care issues and

11  resource allocations.

12         3.  Promote public awareness of community health needs,

13  emphasizing health promotion and cost-effective health service

14  selection.

15         4.  Collect data and conduct analyses and studies

16  related to health care needs of the district, including the

17  needs of medically indigent persons, and assist the agency and

18  other state agencies in carrying out data collection

19  activities that relate to the functions in this subsection.

20         5.  Monitor the onsite construction progress, if any,

21  of certificate-of-need approved projects and report council

22  findings to the agency on forms provided by the agency.

23         6.  Advise and assist any regional planning councils

24  within each district that have elected to address health

25  issues in their strategic regional policy plans with the

26  development of the health element of the plans to address the

27  health goals and policies in the State Comprehensive Plan.

28         7.  Advise and assist local governments within each

29  district on the development of an optional health plan element

30  of the comprehensive plan provided in chapter 163, to assure

31  compatibility with the health goals and policies in the State


                                  11

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  Comprehensive Plan and district health plan.  To facilitate

  2  the implementation of this section, the local health council

  3  shall annually provide the local governments in its service

  4  area, upon request, with:

  5         a.  A copy and appropriate updates of the district

  6  health plan;

  7         b.  A report of hospital and nursing home utilization

  8  statistics for facilities within the local government

  9  jurisdiction; and

10         c.  Applicable agency rules and calculated need

11  methodologies for health facilities and services regulated

12  under s. 408.034 for the district served by the local health

13  council.

14         8.  Monitor and evaluate the adequacy, appropriateness,

15  and effectiveness, within the district, of local, state,

16  federal, and private funds distributed to meet the needs of

17  the medically indigent and other underserved population

18  groups.

19         9.  In conjunction with the Agency for Health Care

20  Administration, plan for services at the local level for

21  persons infected with the human immunodeficiency virus.

22         10.  Provide technical assistance to encourage and

23  support activities by providers, purchasers, consumers, and

24  local, regional, and state agencies in meeting the health care

25  goals, objectives, and policies adopted by the local health

26  council.

27         11.  Provide the agency with data required by rule for

28  the review of certificate-of-need applications and the

29  projection of need for health services and facilities in the

30  district.

31         (3)  DUTIES AND RESPONSIBILITIES OF THE AGENCY.--


                                  12

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (a)  The agency, in conjunction with the local health

  2  councils, is responsible for the coordinated planning of all

  3  health care services in the state and for the preparation of

  4  the state health plan.

  5         Section 5.  Subsection (2) of section 408.034, Florida

  6  Statutes, is amended to read:

  7         408.034  Duties and responsibilities of agency;

  8  rules.--

  9         (2)  In the exercise of its authority to issue licenses

10  to health care facilities and health service providers, as

11  provided under chapters 393, 395, and parts II, IV, and VI of

12  chapter 400, the agency may not issue a license to any health

13  care facility, health service provider, hospice, or part of a

14  health care facility which fails to receive a certificate of

15  need or an exemption for the licensed facility or service.

16         Section 6.  Section 408.035, Florida Statutes, is

17  amended to read:

18         408.035  Review criteria.--

19         (1)  The agency shall determine the reviewability of

20  applications and shall review applications for

21  certificate-of-need determinations for health care facilities

22  and health services in context with the following criteria:

23         (1)(a)  The need for the health care facilities and

24  health services being proposed in relation to the applicable

25  district health plan, except in emergency circumstances that

26  pose a threat to the public health.

27         (2)(b)  The availability, quality of care, efficiency,

28  appropriateness, accessibility, and extent of utilization of,

29  and adequacy of like and existing health care facilities and

30  health services in the service district of the applicant.

31


                                  13

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (3)(c)  The ability of the applicant to provide quality

  2  of care and the applicant's record of providing quality of

  3  care.

  4         (d)  The availability and adequacy of other health care

  5  facilities and health services in the service district of the

  6  applicant, such as outpatient care and ambulatory or home care

  7  services, which may serve as alternatives for the health care

  8  facilities and health services to be provided by the

  9  applicant.

10         (e)  Probable economies and improvements in service

11  which may be derived from operation of joint, cooperative, or

12  shared health care resources.

13         (4)(f)  The need in the service district of the

14  applicant for special health care equipment and services that

15  are not reasonably and economically accessible in adjoining

16  areas.

17         (5)(g)  The needs of need for research and educational

18  facilities, including, but not limited to, facilities with

19  institutional training programs and community training

20  programs for health care practitioners and for doctors of

21  osteopathic medicine and medicine at the student, internship,

22  and residency training levels.

23         (6)(h)  The availability of resources, including health

24  personnel, management personnel, and funds for capital and

25  operating expenditures, for project accomplishment and

26  operation.; the effects the project will have on clinical

27  needs of health professional training programs in the service

28  district; the extent to which the services will be accessible

29  to schools for health professions in the service district for

30  training purposes if such services are available in a limited

31


                                  14

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  number of facilities; the availability of alternative uses of

  2  such resources for the provision of other health services; and

  3         (7)  The extent to which the proposed services will

  4  enhance access to health care for be accessible to all

  5  residents of the service district.

  6         (8)(i)  The immediate and long-term financial

  7  feasibility of the proposal.

  8         (j)  The special needs and circumstances of health

  9  maintenance organizations.

10         (k)  The needs and circumstances of those entities that

11  provide a substantial portion of their services or resources,

12  or both, to individuals not residing in the service district

13  in which the entities are located or in adjacent service

14  districts.  Such entities may include medical and other health

15  professions, schools, multidisciplinary clinics, and specialty

16  services such as open-heart surgery, radiation therapy, and

17  renal transplantation.

18         (9)(l)  The extent to which the proposal will foster

19  competition that promotes quality and cost-effectiveness. The

20  probable impact of the proposed project on the costs of

21  providing health services proposed by the applicant, upon

22  consideration of factors including, but not limited to, the

23  effects of competition on the supply of health services being

24  proposed and the improvements or innovations in the financing

25  and delivery of health services which foster competition and

26  service to promote quality assurance and cost-effectiveness.

27         (10)(m)  The costs and methods of the proposed

28  construction, including the costs and methods of energy

29  provision and the availability of alternative, less costly, or

30  more effective methods of construction.

31


                                  15

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (11)(n)  The applicant's past and proposed provision of

  2  health care services to Medicaid patients and the medically

  3  indigent.

  4         (o)  The applicant's past and proposed provision of

  5  services that promote a continuum of care in a multilevel

  6  health care system, which may include, but are not limited to,

  7  acute care, skilled nursing care, home health care, and

  8  assisted living facilities.

  9         (12)(p)  The applicant's designation as a Gold Seal

10  Program nursing facility pursuant to s. 400.235, when the

11  applicant is requesting additional nursing home beds at that

12  facility.

13         (2)  In cases of capital expenditure proposals for the

14  provision of new health services to inpatients, the agency

15  shall also reference each of the following in its findings of

16  fact:

17         (a)  That less costly, more efficient, or more

18  appropriate alternatives to such inpatient services are not

19  available and the development of such alternatives has been

20  studied and found not practicable.

21         (b)  That existing inpatient facilities providing

22  inpatient services similar to those proposed are being used in

23  an appropriate and efficient manner.

24         (c)  In the case of new construction or replacement

25  construction, that alternatives to the construction, for

26  example, modernization or sharing arrangements, have been

27  considered and have been implemented to the maximum extent

28  practicable.

29         (d)  That patients will experience serious problems in

30  obtaining inpatient care of the type proposed, in the absence

31  of the proposed new service.


                                  16

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (e)  In the case of a proposal for the addition of beds

  2  for the provision of skilled nursing or intermediate care

  3  services, that the addition will be consistent with the plans

  4  of other agencies of the state responsible for the provision

  5  and financing of long-term care, including home health

  6  services.

  7         Section 7.  Section 408.036, Florida Statutes, is

  8  amended to read:

  9         408.036  Projects subject to review.--

10         (1)  APPLICABILITY.--Unless exempt under subsection

11  (3), all health-care-related projects, as described in

12  paragraphs (a)-(h)(k), are subject to review and must file an

13  application for a certificate of need with the agency. The

14  agency is exclusively responsible for determining whether a

15  health-care-related project is subject to review under ss.

16  408.031-408.045.

17         (a)  The addition of beds by new construction or

18  alteration.

19         (b)  The new construction or establishment of

20  additional health care facilities, including a replacement

21  health care facility when the proposed project site is not

22  located on the same site as the existing health care facility.

23         (c)  The conversion from one type of health care

24  facility to another, including the conversion from one level

25  of care to another, in a skilled or intermediate nursing

26  facility, if the conversion effects a change in the level of

27  care of 10 beds or 10 percent of total bed capacity of the

28  skilled or intermediate nursing facility within a 2-year

29  period.  If the nursing facility is certified for both skilled

30  and intermediate nursing care, the provisions of this

31  paragraph do not apply.


                                  17

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (d)  An Any increase in the total licensed bed capacity

  2  of a health care facility.

  3         (e)  Subject to the provisions of paragraph (3)(i), the

  4  establishment of a Medicare-certified home health agency, The

  5  establishment of a hospice or hospice inpatient facility, or

  6  the direct provision of such services by a health care

  7  facility or health maintenance organization for those other

  8  than the subscribers of the health maintenance organization;

  9  except that this paragraph does not apply to the establishment

10  of a Medicare-certified home health agency by a facility

11  described in paragraph (3)(h).

12         (f)  An acquisition by or on behalf of a health care

13  facility or health maintenance organization, by any means,

14  which acquisition would have required review if the

15  acquisition had been by purchase.

16         (f)(g)  The establishment of inpatient institutional

17  health services by a health care facility, or a substantial

18  change in such services.

19         (h)  The acquisition by any means of an existing health

20  care facility by any person, unless the person provides the

21  agency with at least 30 days' written notice of the proposed

22  acquisition, which notice is to include the services to be

23  offered and the bed capacity of the facility, and unless the

24  agency does not determine, within 30 days after receipt of

25  such notice, that the services to be provided and the bed

26  capacity of the facility will be changed.

27         (i)  An increase in the cost of a project for which a

28  certificate of need has been issued when the increase in cost

29  exceeds 20 percent of the originally approved cost of the

30  project, except that a cost overrun review is not necessary

31  when the cost overrun is less than $20,000.


                                  18

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (g)(j)  An increase in the number of beds for acute

  2  care, specialty burn units, neonatal intensive care units,

  3  comprehensive rehabilitation, mental health services, or

  4  hospital-based distinct part skilled nursing units, or at a

  5  long-term care hospital psychiatric or rehabilitation beds.

  6         (h)(k)  The establishment of tertiary health services.

  7         (2)  PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless

  8  exempt pursuant to subsection (3), projects subject to an

  9  expedited review shall include, but not be limited to:

10         (a)  Cost overruns, as defined in paragraph (1)(i).

11         (a)(b)  Research, education, and training programs.

12         (b)(c)  Shared services contracts or projects.

13         (c)(d)  A transfer of a certificate of need.

14         (d)(e)  A 50-percent increase in nursing home beds for

15  a facility incorporated and operating in this state for at

16  least 60 years on or before July 1, 1988, which has a licensed

17  nursing home facility located on a campus providing a variety

18  of residential settings and supportive services.  The

19  increased nursing home beds shall be for the exclusive use of

20  the campus residents.  Any application on behalf of an

21  applicant meeting this requirement shall be subject to the

22  base fee of $5,000 provided in s. 408.038.

23         (f)  Combination within one nursing home facility of

24  the beds or services authorized by two or more certificates of

25  need issued in the same planning subdistrict.

26         (g)  Division into two or more nursing home facilities

27  of beds or services authorized by one certificate of need

28  issued in the same planning subdistrict.  Such division shall

29  not be approved if it would adversely affect the original

30  certificate's approved cost.

31


                                  19

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (e)(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         (f)  The conversion of mental health services beds

  5  licensed under chapter 395 or hospital-based distinct part

  6  skilled nursing unit beds to general acute care beds; the

  7  conversion of mental health services beds between or among the

  8  licensed bed categories defined as beds for mental health

  9  services; or the conversion of general acute care beds to beds

10  for mental health services.

11         1.  Conversion under this paragraph shall not establish

12  a new licensed bed category at the hospital but shall apply

13  only to categories of beds licensed at that hospital.

14         2.  Beds converted under this paragraph must be

15  licensed and operational for at least 12 months before the

16  hospital may apply for additional conversion affecting beds of

17  the same type.

18

19  The agency shall develop rules to implement the provisions for

20  expedited review, including time schedule, application content

21  which may be reduced from the full requirements of s.

22  408.037(1), and application processing.

23         (3)  EXEMPTIONS.--Upon request, the following projects

24  are subject to supported by such documentation as the agency

25  requires, the agency shall grant an exemption from the

26  provisions of subsection (1):

27         (a)  For the initiation or expansion of obstetric

28  services.

29         (a)(b)  For replacement of any expenditure to replace

30  or renovate any part of a licensed health care facility on the

31  same site, provided that the number of licensed beds in each


                                  20

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  licensed bed category will not increase and, in the case of a

  2  replacement facility, the project site is the same as the

  3  facility being replaced.

  4         (c)  For providing respite care services. An individual

  5  may be admitted to a respite care program in a hospital

  6  without regard to inpatient requirements relating to admitting

  7  order and attendance of a member of a medical staff.

  8         (b)(d)  For hospice services or home health services

  9  provided by a rural hospital, as defined in s. 395.602, or for

10  swing beds in such rural hospital in a number that does not

11  exceed one-half of its licensed beds.

12         (c)(e)  For the conversion of licensed acute care

13  hospital beds to Medicare and Medicaid certified skilled

14  nursing beds in a rural hospital as defined in s. 395.602, so

15  long as the conversion of the beds does not involve the

16  construction of new facilities. The total number of skilled

17  nursing beds, including swing beds, may not exceed one-half of

18  the total number of licensed beds in the rural hospital as of

19  July 1, 1993. Certified skilled nursing beds designated under

20  this paragraph, excluding swing beds, shall be included in the

21  community nursing home bed inventory.  A rural hospital which

22  subsequently decertifies any acute care beds exempted under

23  this paragraph shall notify the agency of the decertification,

24  and the agency shall adjust the community nursing home bed

25  inventory accordingly.

26         (d)(f)  For the addition of nursing home beds at a

27  skilled nursing facility that is part of a retirement

28  community that provides a variety of residential settings and

29  supportive services and that has been incorporated and

30  operated in this state for at least 65 years on or before July

31  1, 1994. All nursing home beds must not be available to the


                                  21

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  public but must be for the exclusive use of the community

  2  residents.

  3         (e)(g)  For an increase in the bed capacity of a

  4  nursing facility licensed for at least 50 beds as of January

  5  1, 1994, under part II of chapter 400 which is not part of a

  6  continuing care facility if, after the increase, the total

  7  licensed bed capacity of that facility is not more than 60

  8  beds and if the facility has been continuously licensed since

  9  1950 and has received a superior rating on each of its two

10  most recent licensure surveys.

11         (h)  For the establishment of a Medicare-certified home

12  health agency by a facility certified under chapter 651; a

13  retirement community, as defined in s. 400.404(2)(g); or a

14  residential facility that serves only retired military

15  personnel, their dependents, and the surviving dependents of

16  deceased military personnel. Medicare-reimbursed home health

17  services provided through such agency shall be offered

18  exclusively to residents of the facility or retirement

19  community or to residents of facilities or retirement

20  communities owned, operated, or managed by the same corporate

21  entity. Each visit made to deliver Medicare-reimbursable home

22  health services to a home health patient who, at the time of

23  service, is not a resident of the facility or retirement

24  community shall be a deceptive and unfair trade practice and

25  constitutes a violation of ss. 501.201-501.213.

26         (i)  For the establishment of a Medicare-certified home

27  health agency. This paragraph shall take effect 90 days after

28  the adjournment sine die of the next regular session of the

29  Legislature occurring after the legislative session in which

30  the Legislature receives a report from the Director of Health

31  Care Administration certifying that the federal Health Care


                                  22

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  Financing Administration has implemented a per-episode

  2  prospective pay system for Medicare-certified home health

  3  agencies.

  4         (f)(j)  For an inmate health care facility built by or

  5  for the exclusive use of the Department of Corrections as

  6  provided in chapter 945. This exemption expires when such

  7  facility is converted to other uses.

  8         (k)  For an expenditure by or on behalf of a health

  9  care facility to provide a health service exclusively on an

10  outpatient basis.

11         (g)(l)  For the termination of an inpatient a health

12  care service, upon 30 days' written notice to the agency.

13         (h)(m)  For the delicensure of beds, upon 30 days'

14  written notice to the agency. A request for exemption An

15  application submitted under this paragraph must identify the

16  number, the category of beds classification, and the name of

17  the facility in which the beds to be delicensed are located.

18         (i)(n)  For the provision of adult inpatient diagnostic

19  cardiac catheterization services in a hospital.

20         1.  In addition to any other documentation otherwise

21  required by the agency, a request for an exemption submitted

22  under this paragraph must comply with the following criteria:

23         a.  The applicant must certify it will not provide

24  therapeutic cardiac catheterization pursuant to the grant of

25  the exemption.

26         b.  The applicant must certify it will meet and

27  continuously maintain the minimum licensure requirements

28  adopted by the agency governing such programs pursuant to

29  subparagraph 2.

30

31


                                  23

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         c.  The applicant must certify it will provide a

  2  minimum of 2 percent of its services to charity and Medicaid

  3  patients.

  4         2.  The agency shall adopt licensure requirements by

  5  rule which govern the operation of adult inpatient diagnostic

  6  cardiac catheterization programs established pursuant to the

  7  exemption provided in this paragraph. The rules shall ensure

  8  that such programs:

  9         a.  Perform only adult inpatient diagnostic cardiac

10  catheterization services authorized by the exemption and will

11  not provide therapeutic cardiac catheterization or any other

12  services not authorized by the exemption.

13         b.  Maintain sufficient appropriate equipment and

14  health personnel to ensure quality and safety.

15         c.  Maintain appropriate times of operation and

16  protocols to ensure availability and appropriate referrals in

17  the event of emergencies.

18         d.  Maintain appropriate program volumes to ensure

19  quality and safety.

20         e.  Provide a minimum of 2 percent of its services to

21  charity and Medicaid patients each year.

22         3.a.  The exemption provided by this paragraph shall

23  not apply unless the agency determines that the program is in

24  compliance with the requirements of subparagraph 1. and that

25  the program will, after beginning operation, continuously

26  comply with the rules adopted pursuant to subparagraph 2.  The

27  agency shall monitor such programs to ensure compliance with

28  the requirements of subparagraph 2.

29         b.(I)  The exemption for a program shall expire

30  immediately when the program fails to comply with the rules

31  adopted pursuant to sub-subparagraphs 2.a., b., and c.


                                  24

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  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.d. and e.

  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 inpatient diagnostic cardiac catheterization

  9  program located at the same hospital until 2 years following

10  the date of the determination by the agency that the program

11  failed to comply with the rules adopted pursuant to

12  subparagraph 2.

13         4.  The agency shall not grant any exemption under this

14  paragraph until the adoption of the rules required under this

15  paragraph, or until March 1, 1998, whichever comes first.

16  However, if final rules have not been adopted by March 1,

17  1998, the proposed rules governing the exemptions shall be

18  used by the agency to grant exemptions under the provisions of

19  this paragraph until final rules become effective.

20         (j)(o)  For any expenditure to provide mobile surgical

21  facilities and related health care services provided under

22  contract with the Department of Corrections or a private

23  correctional facility operating pursuant to chapter 957.

24         (k)(p)  For state veterans' nursing homes operated by

25  or on behalf of the Florida Department of Veterans' Affairs in

26  accordance with part II of chapter 296 for which at least 50

27  percent of the construction cost is federally funded and for

28  which the Federal Government pays a per diem rate not to

29  exceed one-half of the cost of the veterans' care in such

30  state nursing homes. These beds shall not be included in the

31  nursing home bed inventory.


                                  25

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (l)  For combination within one nursing home facility

  2  of the beds or services authorized by two or more certificates

  3  of need issued in the same planning subdistrict.  An exemption

  4  granted under this paragraph shall extend the validity period

  5  of the certificates of need to be consolidated by the length

  6  of the period beginning upon submission of the exemption

  7  request and ending with issuance of the exemption.  The

  8  longest validity period among the certificates shall be

  9  applicable to each of the combined certificates.

10         (m)  For division into two or more nursing home

11  facilities of beds or services authorized by one certificate

12  of need issued in the same planning subdistrict.  An exemption

13  granted under this paragraph shall extend the validity period

14  of the certificate of need to be divided by the length of the

15  period beginning upon submission of the exemption request and

16  ending with issuance of the exemption.

17         (n)  For the addition of hospital beds licensed under

18  chapter 395 for acute care, mental health services, or a

19  hospital-based distinct part skilled nursing unit in a number

20  that may not exceed 10 total beds or 10 percent of the

21  licensed capacity of the bed category being expanded,

22  whichever is greater. Beds for specialty burn units, neonatal

23  intensive care units, or comprehensive rehabilitation, or at a

24  long-term care hospital, may not be increased under this

25  paragraph.

26         1.  In addition to any other documentation otherwise

27  required by the agency, a request for exemption submitted

28  under this paragraph must:

29         a.  Certify that the prior 12-month average occupancy

30  rate for the category of licensed beds being expanded at the

31  facility meets or exceeds 80 percent or, for a hospital-based


                                  26

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  distinct part skilled nursing unit, the prior 12-month average

  2  occupancy rate meets or exceeds 96 percent.

  3         b.  Certify that any beds of the same type authorized

  4  for the facility under this paragraph before the date of the

  5  current request for an exemption have been licensed and

  6  operational for at least 12 months.

  7         2.  The timeframes and monitoring process specified in

  8  s. 408.040(2)(a)-(c) apply to any exemption issued under this

  9  paragraph.

10         3.  The agency shall count beds authorized under this

11  paragraph as approved beds in the published inventory of

12  hospital beds until the beds are licensed.

13         (o)  For the addition of acute care beds, as authorized

14  by rule consistent with s. 395.003(4), in a number that may

15  not exceed 10 total beds or 10 percent of licensed bed

16  capacity, whichever is greater, for temporary beds in a

17  hospital which has experienced high seasonal occupancy within

18  the prior 12-month period or in a hospital that must respond

19  to emergency circumstances.

20         (p)  For the addition of nursing home beds licensed

21  under chapter 400 in a number not exceeding 10 total beds or

22  10 percent of the number of beds licensed in the facility

23  being expanded, whichever is greater.

24         1.  In addition to any other documentation required by

25  the agency, a request for exemption submitted under this

26  paragraph must:

27         a.  Certify that the facility has not had any class I

28  or class II deficiencies within the 30 months preceding the

29  request for addition.

30

31


                                  27

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         b.  Certify that the prior 12-month average occupancy

  2  rate for the nursing home beds at the facility meets or

  3  exceeds 96 percent.

  4         c.  Certify that any beds authorized for the facility

  5  under this paragraph before the date of the current request

  6  for an exemption have been licensed and operational for at

  7  least 12 months.

  8         2.  The timeframes and monitoring process specified in

  9  s. 408.040(2)(a)-(c) apply to any exemption issued under this

10  paragraph.

11         3.  The agency shall count beds authorized under this

12  paragraph as approved beds in the published inventory of

13  nursing home beds until the beds are licensed.

14         (q)  For the construction of a skilled nursing facility

15  of up to 60 beds to be used to serve only retired or disabled

16  military personnel and their surviving spouses. The facility

17  must be constructed by a foundation that was incorporated and

18  operating in this state on or before December 19, 1997, to

19  serve the same population.

20         (4)  A request for exemption under this subsection (3)

21  may be made at any time and is not subject to the batching

22  requirements of this section. The request shall be supported

23  by such documentation as the agency requires by rule. The

24  agency shall assess a fee of $250 for each request for

25  exemption submitted under subsection (3).

26         Section 8.  Paragraph (a) of subsection (1) of section

27  408.037, Florida Statutes, is amended to read:

28         408.037  Application content.--

29         (1)  An application for a certificate of need must

30  contain:

31


                                  28

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (a)  A detailed description of the proposed project and

  2  statement of its purpose and need in relation to the district

  3  local health plan and the state health plan.

  4         Section 9.  Section 408.038, Florida Statutes, is

  5  amended to read:

  6         408.038  Fees.--The agency department shall assess fees

  7  on certificate-of-need applications.  Such fees shall be for

  8  the purpose of funding the functions of the local health

  9  councils and the activities of the agency department and shall

10  be allocated as provided in s. 408.033. The fee shall be

11  determined as follows:

12         (1)  A minimum base fee of $5,000.

13         (2)  In addition to the base fee of $5,000, 0.015 of

14  each dollar of proposed expenditure, except that a fee may not

15  exceed $22,000.

16         Section 10.  Subsections (3) and (4), paragraph (c) of

17  subsection (5), and paragraphs (a) and (b) of subsection (6)

18  of section 408.039, Florida Statutes, are amended to read:

19         408.039  Review process.--The review process for

20  certificates of need shall be as follows:

21         (3)  APPLICATION PROCESSING.--

22         (a)  An applicant shall file an application with the

23  agency department, and shall furnish a copy of the application

24  to the local health council and the agency department. Within

25  15 days after the applicable application filing deadline

26  established by agency department rule, the staff of the agency

27  department shall determine if the application is complete.  If

28  the application is incomplete, the staff shall request

29  specific information from the applicant necessary for the

30  application to be complete; however, the staff may make only

31  one such request. If the requested information is not filed


                                  29

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  with the agency department within 21 days of the receipt of

  2  the staff's request, the application shall be deemed

  3  incomplete and deemed withdrawn from consideration.

  4         (b)  Upon the request of any applicant or substantially

  5  affected person within 14 days after notice that an

  6  application has been filed, a public hearing may be held at

  7  the agency's department's discretion if the agency department

  8  determines that a proposed project involves issues of great

  9  local public interest. The public hearing shall allow

10  applicants and other interested parties reasonable time to

11  present their positions and to present rebuttal information. A

12  recorded verbatim record of the hearing shall be maintained.

13  The public hearing shall be held at the local level within 21

14  days after the application is deemed complete.

15         (4)  STAFF RECOMMENDATIONS.--

16         (a)  The agency's department's review of and final

17  agency action on applications shall be in accordance with the

18  district health plan, and statutory criteria, and the

19  implementing administrative rules.  In the application review

20  process, the agency department shall give a preference, as

21  defined by rule of the agency department, to an applicant

22  which proposes to develop a nursing home in a nursing home

23  geographically underserved area.

24         (b)  Within 60 days after all the applications in a

25  review cycle are determined to be complete, the agency

26  department shall issue its State Agency Action Report and

27  Notice of Intent to grant a certificate of need for the

28  project in its entirety, to grant a certificate of need for

29  identifiable portions of the project, or to deny a certificate

30  of need.  The State Agency Action Report shall set forth in

31  writing its findings of fact and determinations upon which its


                                  30

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  decision is based.  If a finding of fact or determination by

  2  the agency department is counter to the district health plan

  3  of the local health council, the agency department shall

  4  provide in writing its reason for its findings, item by item,

  5  to the local health council.  If the agency department intends

  6  to grant a certificate of need, the State Agency Action Report

  7  or the Notice of Intent shall also include any conditions

  8  which the agency department intends to attach to the

  9  certificate of need. The agency department shall designate by

10  rule a senior staff person, other than the person who issues

11  the final order, to issue State Agency Action Reports and

12  Notices of Intent.

13         (c)  The agency department shall publish its proposed

14  decision set forth in the Notice of Intent in the Florida

15  Administrative Weekly within 14 days after the Notice of

16  Intent is issued.

17         (d)  If no administrative hearing is requested pursuant

18  to subsection (5), the State Agency Action Report and the

19  Notice of Intent shall become the final order of the agency

20  department.  The agency department shall provide a copy of the

21  final order to the appropriate local health council.

22         (5)  ADMINISTRATIVE HEARINGS.--

23         (c)  In administrative proceedings challenging the

24  issuance or denial of a certificate of need, only applicants

25  considered by the agency in the same batching cycle are

26  entitled to a comparative hearing on their applications.

27  Existing health care facilities may initiate or intervene in

28  an administrative hearing upon a showing that an established

29  program will be substantially affected by the issuance of any

30  certificate of need, whether reviewed under s. 408.036(1) or

31


                                  31

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  (2), to a competing proposed facility or program within the

  2  same district.

  3         (6)  JUDICIAL REVIEW.--

  4         (a)  A party to an administrative hearing for an

  5  application for a certificate of need has the right, within

  6  not more than 30 days after the date of the final order, to

  7  seek judicial review in the District Court of Appeal pursuant

  8  to s. 120.68.  The agency department shall be a party in any

  9  such proceeding.

10         (b)  In such judicial review, the court shall affirm

11  the final order of the agency department, unless the decision

12  is arbitrary, capricious, or not in compliance with ss.

13  408.031-408.045.

14         Section 11.  Subsections (1) and (2) of section

15  408.040, Florida Statutes, are amended to read:

16         408.040  Conditions and monitoring.--

17         (1)(a)  The agency may issue a certificate of need

18  predicated upon statements of intent expressed by an applicant

19  in the application for a certificate of need. Any conditions

20  imposed on a certificate of need based on such statements of

21  intent shall be stated on the face of the certificate of need.

22         1.  Any certificate of need issued for construction of

23  a new hospital or for the addition of beds to an existing

24  hospital shall include a statement of the number of beds

25  approved by category of service, including rehabilitation or

26  psychiatric service, for which the agency has adopted by rule

27  a specialty-bed-need methodology. All beds that are approved,

28  but are not covered by any specialty-bed-need methodology,

29  shall be designated as general.

30         (b)2.  The agency may consider, in addition to the

31  other criteria specified in s. 408.035, a statement of intent


                                  32

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  by the applicant that a specified to designate a percentage of

  2  the annual patient days at beds of the facility will be

  3  utilized for use by patients eligible for care under Title XIX

  4  of the Social Security Act. Any certificate of need issued to

  5  a nursing home in reliance upon an applicant's statements that

  6  to provide a specified percentage number of annual patient

  7  days will be utilized beds for use by residents eligible for

  8  care under Title XIX of the Social Security Act must include a

  9  statement that such certification is a condition of issuance

10  of the certificate of need. The certificate-of-need program

11  shall notify the Medicaid program office and the Department of

12  Elderly Affairs when it imposes conditions as authorized in

13  this paragraph subparagraph in an area in which a community

14  diversion pilot project is implemented.

15         (c)(b)  A certificateholder may apply to the agency for

16  a modification of conditions imposed under paragraph (a) or

17  paragraph (b). If the holder of a certificate of need

18  demonstrates good cause why the certificate should be

19  modified, the agency shall reissue the certificate of need

20  with such modifications as may be appropriate.  The agency

21  shall by rule define the factors constituting good cause for

22  modification.

23         (d)(c)  If the holder of a certificate of need fails to

24  comply with a condition upon which the issuance of the

25  certificate was predicated, the agency may assess an

26  administrative fine against the certificateholder in an amount

27  not to exceed $1,000 per failure per day.  In assessing the

28  penalty, the agency shall take into account as mitigation the

29  relative lack of severity of a particular failure.  Proceeds

30  of such penalties shall be deposited in the Public Medical

31  Assistance Trust Fund.


                                  33

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (2)(a)  Unless the applicant has commenced

  2  construction, if the project provides for construction, unless

  3  the applicant has incurred an enforceable capital expenditure

  4  commitment for a project, if the project does not provide for

  5  construction, or unless subject to paragraph (b), a

  6  certificate of need shall terminate 18 months after the date

  7  of issuance, except in the case of a multifacility project, as

  8  defined in s. 408.032, where the certificate of need shall

  9  terminate 2 years after the date of issuance. The agency shall

10  monitor the progress of the holder of the certificate of need

11  in meeting the timetable for project development specified in

12  the application with the assistance of the local health

13  council as specified in s. 408.033(1)(b)5., and may revoke the

14  certificate of need, if the holder of the certificate is not

15  meeting such timetable and is not making a good faith effort,

16  as defined by rule, to meet it.

17         (b)  A certificate of need issued to an applicant

18  holding a provisional certificate of authority under chapter

19  651 shall terminate 1 year after the applicant receives a

20  valid certificate of authority from the Department of

21  Insurance.

22         (c)  The certificate-of-need validity period for a

23  project shall be extended by the agency, to the extent that

24  the applicant demonstrates to the satisfaction of the agency

25  that good faith commencement of the project is being delayed

26  by litigation or by governmental action or inaction with

27  respect to regulations or permitting precluding commencement

28  of the project.

29         (d)  If an application is filed to consolidate two or

30  more certificates as authorized by s. 408.036(2)(f) or to

31  divide a certificate of need into two or more facilities as


                                  34

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  authorized by s. 408.036(2)(g), the validity period of the

  2  certificate or certificates of need to be consolidated or

  3  divided shall be extended for the period beginning upon

  4  submission of the application and ending when final agency

  5  action and any appeal from such action has been concluded.

  6  However, no such suspension shall be effected if the

  7  application is withdrawn by the applicant.

  8         Section 12.  Section 408.044, Florida Statutes, is

  9  amended to read:

10         408.044  Injunction.--Notwithstanding the existence or

11  pursuit of any other remedy, the agency department may

12  maintain an action in the name of the state for injunction or

13  other process against any person to restrain or prevent the

14  pursuit of a project subject to review under ss.

15  408.031-408.045, in the absence of a valid certificate of

16  need.

17         Section 13.  Section 408.045, Florida Statutes, is

18  amended to read:

19         408.045  Certificate of need; competitive sealed

20  proposals.--

21         (1)  The application, review, and issuance procedures

22  for a certificate of need for an intermediate care facility

23  for the developmentally disabled may be made by the agency

24  department by competitive sealed proposals.

25         (2)  The agency department shall make a decision

26  regarding the issuance of the certificate of need in

27  accordance with the provisions of s. 287.057(15), rules

28  adopted by the agency department relating to intermediate care

29  facilities for the developmentally disabled, and the criteria

30  in s. 408.035, as further defined by rule.

31


                                  35

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (3)  Notification of the decision shall be issued to

  2  all applicants not later than 28 calendar days after the date

  3  responses to a request for proposal are due.

  4         (4)  The procedures provided for under this section are

  5  exempt from the batching cycle requirements and the public

  6  hearing requirement of s. 408.039.

  7         (5)  The agency department may use the competitive

  8  sealed proposal procedure for determining a certificate of

  9  need for other types of health care facilities and services if

10  the agency department identifies an unmet health care need and

11  when funding in whole or in part for such health care

12  facilities or services is authorized by the Legislature.

13         Section 14.  (1)(a)  There is created a

14  certificate-of-need workgroup staffed by the Agency for Health

15  Care Administration.

16         (b)  Workgroup participants shall be responsible for

17  only the expenses that they generate individually through

18  workgroup participation.  The agency shall be responsible for

19  expenses incidental to the production of any required data or

20  reports.

21         (2)  The workgroup shall consist of 30 members, 10

22  appointed by the Governor, 10 appointed by the President of

23  the Senate, and 10 appointed by the Speaker of the House of

24  Representatives. The workgroup chair shall be selected by

25  majority vote of a quorum present. Sixteen members shall

26  constitute a quorum. The membership shall include, but not be

27  limited to, representatives from health care provider

28  organizations, health care facilities, individual health care

29  practitioners, local health councils, and consumer

30  organizations, and persons with health care market expertise

31  as private-sector consultants.


                                  36

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (3)  Appointment to the workgroup shall be as follows:

  2         (a)  The Governor shall appoint one representative each

  3  from the hospital industry; nursing home industry; hospice

  4  industry; local health councils; a consumer organization; and

  5  three health care market consultants, one of whom is a

  6  recognized expert on hospital markets, one of whom is a

  7  recognized expert on nursing home or long-term-care markets,

  8  and one of whom is a recognized expert on hospice markets; one

  9  representative from the Medicaid program; and one

10  representative from a health care facility that provides a

11  tertiary service.

12         (b)  The President of the Senate shall appoint a

13  representative of a for-profit hospital, a representative of a

14  not-for-profit hospital, a representative of a public

15  hospital, two representatives of the nursing home industry,

16  two representatives of the hospice industry, a representative

17  of a consumer organization, a representative from the

18  Department of Elderly Affairs involved with the implementation

19  of a long-term-care community diversion program, and a health

20  care market consultant with expertise in health care

21  economics.

22         (c)  The Speaker of the House of Representatives shall

23  appoint a representative from the Florida Hospital

24  Association, a representative of the Association of Community

25  Hospitals and Health Systems of Florida, a representative of

26  the Florida League of Health Systems, a representative of the

27  Florida Health Care Association, a representative of the

28  Florida Association of Homes for the Aging, three

29  representatives of Florida Hospices and Palliative Care, one

30  representative of local health councils, and one

31  representative of a consumer organization.


                                  37

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (4)  The workgroup shall study issues pertaining to the

  2  certificate-of-need program, including the impact of trends in

  3  health care delivery and financing. The workgroup shall study

  4  issues relating to implementation of the certificate-of-need

  5  program.

  6         (5)  The workgroup shall meet at least annually, at the

  7  request of the chair. The workgroup shall submit an interim

  8  report by December 31, 2001, and a final report by December

  9  31, 2002. The workgroup is abolished effective July 1, 2003.

10         Section 15.  Subsection (7) of section 651.118, Florida

11  Statutes, is amended to read:

12         651.118  Agency for Health Care Administration;

13  certificates of need; sheltered beds; community beds.--

14         (7)  Notwithstanding the provisions of subsection (2),

15  at the discretion of the continuing care provider, sheltered

16  nursing home beds may be used for persons who are not

17  residents of the facility and who are not parties to a

18  continuing care contract for a period of up to 5 years after

19  the date of issuance of the initial nursing home license.  A

20  provider whose 5-year period has expired or is expiring may

21  request the Agency for Health Care Administration for an

22  extension, not to exceed 30 percent of the total sheltered

23  nursing home beds, if the utilization by residents of the

24  facility in the sheltered beds will not generate sufficient

25  income to cover facility expenses, as evidenced by one of the

26  following:

27         (a)  The facility has a net loss for the most recent

28  fiscal year as determined under generally accepted accounting

29  principles, excluding the effects of extraordinary or unusual

30  items, as demonstrated in the most recently audited financial

31  statement; or


                                  38

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1         (b)  The facility would have had a pro forma loss for

  2  the most recent fiscal year, excluding the effects of

  3  extraordinary or unusual items, if revenues were reduced by

  4  the amount of revenues from persons in sheltered beds who were

  5  not residents, as reported on by a certified public

  6  accountant.

  7

  8  The agency shall be authorized to grant an extension to the

  9  provider based on the evidence required in this subsection.

10  The agency may request a facility to use up to 25 percent of

11  the patient days generated by new admissions of nonresidents

12  during the extension period to serve Medicaid recipients for

13  those beds authorized for extended use if there is a

14  demonstrated need in the respective service area and if funds

15  are available. A provider who obtains an extension is

16  prohibited from applying for additional sheltered beds under

17  the provision of subsection (2), unless additional residential

18  units are built or the provider can demonstrate need by

19  facility residents to the Agency for Health Care

20  Administration. The 5-year limit does not apply to up to 5

21  sheltered beds designated for inpatient hospice care as part

22  of a contractual arrangement with a hospice licensed under

23  part VI of chapter 400. A facility that uses such beds after

24  the 5-year period shall report such use to the Agency for

25  Health Care Administration. For purposes of this subsection,

26  "resident" means a person who, upon admission to the facility,

27  initially resides in a part of the facility not licensed under

28  part II of chapter 400.

29         Section 16.  PUBLIC CORD BLOOD TISSUE BANK.--

30         (1)  There is established a statewide consortium to be

31  known as the Public Cord Blood Tissue Bank. The Public Cord


                                  39

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  Blood Tissue Bank is established as a nonprofit legal entity

  2  to collect, screen for infectious and genetic diseases,

  3  perform tissue typing, cryopreserve, and store umbilical cord

  4  blood as a resource to the public.  The University of Florida,

  5  the University of South Florida, the University of Miami, and

  6  the Mayo Clinic, Jacksonville shall jointly form the

  7  collaborative consortium, each working with community

  8  resources such as regional blood banks, hospitals, and other

  9  health care providers to develop local and regional coalitions

10  for the purposes set forth in this act.  The consortium

11  participants shall align their outreach programs and

12  activities to all geographic areas of the state, covering the

13  entire state.  The consortium is encouraged to conduct

14  outreach and research for Hispanics, African Americans, Native

15  Americans, and other ethnic and racial minorities.

16         (2)  The Agency for Health Care Administration shall

17  develop and make available to all health care providers

18  information relating to and standardized release forms for

19  donation of umbilical cord blood. The agency and the

20  Department of Health shall encourage health care providers,

21  including, but not limited to, hospitals, birthing facilities,

22  county health departments, physicians, midwives, and nurses,

23  to disseminate information about the Public Cord Blood Tissue

24  Bank.

25         (3)  The Agency for Health Care Administration shall

26  develop training materials for agencies and state employees

27  working with pregnant women to educate and inform pregnant

28  women about the public cord blood tissue bank program.

29         (4)  All state-funded health care programs providing

30  education or services to pregnant women shall provide

31  information on the Public Cord Blood Tissue Bank program.


                                  40

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  Information regarding this program shall be provided by, but

  2  not be limited to, the Healthy Start program, county health

  3  departments, Medicaid, and MediPass.

  4         (5)  Nothing in this act creates a requirement of any

  5  health care or services program that is directly affiliated

  6  with a bona fide religious denomination that includes as an

  7  integral part of its beliefs and practices the tenet that

  8  blood transfer is contrary to the moral principles the

  9  denomination considers to be an essential part of its beliefs.

10         (6)  Any health care facility or health care provider

11  receiving financial remuneration for the collection of

12  umbilical cord blood shall provide written disclosure of this

13  information to any woman postpartum or parent of a newborn

14  from whom the umbilical cord blood is collected prior to the

15  harvesting of the umbilical cord blood.

16         (7)  All women admitted to a hospital or birthing

17  facility for obstetrical services may be offered the

18  opportunity to donate umbilical cord blood to the Public Cord

19  Blood Tissue Bank.  No woman shall be required to make such a

20  donation.

21         (8)  The consortium may charge reasonable rates and

22  fees to recipients of cord blood tissue bank products.

23         (9)  In order to fund the provisions of this section

24  the consortium participants and the Agency for Health Care

25  Administration shall seek private or federal funds or utilize

26  existing budgetary resources to the extent possible to

27  initiate program actions for fiscal year 2000-2001.

28         Section 17.  Subsection (3) of section 400.464, Florida

29  Statutes, is repealed.

30         Section 18.  The General Appropriations Act for Fiscal

31  Year 2000-2001 shall be reduced by 4 full time equivalent


                                  41

CODING: Words stricken are deletions; words underlined are additions.






                                     CS/CS/HB 591, First Engrossed



  1  positions and $260,719 from the Health Care Trust Fund in the

  2  Agency for Health Care Administration for purposes of

  3  implementing the provisions of this act.

  4         Section 19.  Except as otherwise provided herein, this

  5  act shall take effect July 1, 2000.

  6

  7

  8

  9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31


                                  42