SENATE AMENDMENT
Bill No. CS for CS for SB 1252, 1st Eng.
Amendment No. ___ Barcode 394936
CHAMBER ACTION
Senate House
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04/28/2003 02:47 PM .
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11 Senator Bennett moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 9, line 28, through
15 page 30, line 15, delete those lines
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17 and insert:
18 Section 6. Subsection (5) of section 408.034, Florida
19 Statutes, is amended to read:
20 408.034 Duties and responsibilities of agency;
21 rules.--
22 (5) The agency shall establish by rule a
23 nursing-home-bed-need methodology that has a goal of
24 maintaining a district average occupancy rate of 94 percent
25 and that reduces the community nursing home bed need for the
26 areas of the state where the agency establishes pilot
27 community diversion programs through the Title XIX aging
28 waiver program.
29 Section 7. Subsections (2) and (3) of section 408.036,
30 Florida Statutes, are amended to read:
31 408.036 Projects subject to review; exemptions.--
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SENATE AMENDMENT
Bill No. CS for CS for SB 1252, 1st Eng.
Amendment No. ___ Barcode 394936
1 (2) PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless
2 exempt pursuant to subsection (3), projects subject to an
3 expedited review shall include, but not be limited to:
4 (a) Research, education, and training programs.
5 (b) Shared services contracts or projects.
6 (c) A transfer of a certificate of need.
7 (d) A 50-percent increase in nursing home beds for a
8 facility incorporated and operating in this state for at least
9 60 years on or before July 1, 1988, which has a licensed
10 nursing home facility located on a campus providing a variety
11 of residential settings and supportive services. The
12 increased nursing home beds shall be for the exclusive use of
13 the campus residents. Any application on behalf of an
14 applicant meeting this requirement shall be subject to the
15 base fee of $5,000 provided in s. 408.038.
16 (e) Replacement of a health care facility when the
17 proposed project site is located in the same district and
18 within a 1-mile radius of the replaced health care facility.
19 (f) The conversion of mental health services beds
20 licensed under chapter 395 or hospital-based distinct part
21 skilled nursing unit beds to general acute care beds; the
22 conversion of mental health services beds between or among the
23 licensed bed categories defined as beds for mental health
24 services; or the conversion of general acute care beds to beds
25 for mental health services.
26 1. Conversion under this paragraph shall not establish
27 a new licensed bed category at the hospital but shall apply
28 only to categories of beds licensed at that hospital.
29 2. Beds converted under this paragraph must be
30 licensed and operational for at least 12 months before the
31 hospital may apply for additional conversion affecting beds of
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SENATE AMENDMENT
Bill No. CS for CS for SB 1252, 1st Eng.
Amendment No. ___ Barcode 394936
1 the same type.
2 (g) Replacement of a nursing home within the same
3 district provided the proposed project site is located within
4 a geographic area that contains at least 65 percent of the
5 facilities current residents and is within a 30-mile radius of
6 the replaced nursing home.
7 (h) Relocation of a portion of a nursing home's
8 licensed beds to a replacement facility within the same
9 district provided the relocation is within a 30-mile radius of
10 the existing facility and the total number of nursing home
11 beds in the district does not increase.
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13 The agency shall develop rules to implement the provisions for
14 expedited review, including time schedule, application content
15 which may be reduced from the full requirements of s.
16 408.037(1), and application processing.
17 (3) EXEMPTIONS.--Upon request, the following projects
18 are subject to exemption from the provisions of subsection
19 (1):
20 (a) For replacement of a licensed health care facility
21 on the same site, provided that the number of beds in each
22 licensed bed category will not increase.
23 (b) For hospice services or for swing beds in a rural
24 hospital, as defined in s. 395.602, in a number that does not
25 exceed one-half of its licensed beds.
26 (c) For the conversion of licensed acute care hospital
27 beds to Medicare and Medicaid certified skilled nursing beds
28 in a rural hospital, as defined in s. 395.602, so long as the
29 conversion of the beds does not involve the construction of
30 new facilities. The total number of skilled nursing beds,
31 including swing beds, may not exceed one-half of the total
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SENATE AMENDMENT
Bill No. CS for CS for SB 1252, 1st Eng.
Amendment No. ___ Barcode 394936
1 number of licensed beds in the rural hospital as of July 1,
2 1993. Certified skilled nursing beds designated under this
3 paragraph, excluding swing beds, shall be included in the
4 community nursing home bed inventory. A rural hospital which
5 subsequently decertifies any acute care beds exempted under
6 this paragraph shall notify the agency of the decertification,
7 and the agency shall adjust the community nursing home bed
8 inventory accordingly.
9 (d) For the addition of nursing home beds at a skilled
10 nursing facility that is part of a retirement community that
11 provides a variety of residential settings and supportive
12 services and that has been incorporated and operated in this
13 state for at least 65 years on or before July 1, 1994. All
14 nursing home beds must not be available to the public but must
15 be for the exclusive use of the community residents.
16 (e) For an increase in the bed capacity of a nursing
17 facility licensed for at least 50 beds as of January 1, 1994,
18 under part II of chapter 400 which is not part of a continuing
19 care facility if, after the increase, the total licensed bed
20 capacity of that facility is not more than 60 beds and if the
21 facility has been continuously licensed since 1950 and has
22 received a superior rating on each of its two most recent
23 licensure surveys.
24 (f) For an inmate health care facility built by or for
25 the exclusive use of the Department of Corrections as provided
26 in chapter 945. This exemption expires when such facility is
27 converted to other uses.
28 (g) For the termination of an inpatient health care
29 service, upon 30 days' written notice to the agency.
30 (h) For the delicensure of beds, upon 30 days' written
31 notice to the agency. A request for exemption submitted under
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SENATE AMENDMENT
Bill No. CS for CS for SB 1252, 1st Eng.
Amendment No. ___ Barcode 394936
1 this paragraph must identify the number, the category of beds,
2 and the name of the facility in which the beds to be
3 delicensed are located.
4 (i) For the provision of adult inpatient diagnostic
5 cardiac catheterization services in a hospital.
6 1. In addition to any other documentation otherwise
7 required by the agency, a request for an exemption submitted
8 under this paragraph must comply with the following criteria:
9 a. The applicant must certify it will not provide
10 therapeutic cardiac catheterization pursuant to the grant of
11 the exemption.
12 b. The applicant must certify it will meet and
13 continuously maintain the minimum licensure requirements
14 adopted by the agency governing such programs pursuant to
15 subparagraph 2.
16 c. The applicant must certify it will provide a
17 minimum of 2 percent of its services to charity and Medicaid
18 patients.
19 2. The agency shall adopt licensure requirements by
20 rule which govern the operation of adult inpatient diagnostic
21 cardiac catheterization programs established pursuant to the
22 exemption provided in this paragraph. The rules shall ensure
23 that such programs:
24 a. Perform only adult inpatient diagnostic cardiac
25 catheterization services authorized by the exemption and will
26 not provide therapeutic cardiac catheterization or any other
27 services not authorized by the exemption.
28 b. Maintain sufficient appropriate equipment and
29 health personnel to ensure quality and safety.
30 c. Maintain appropriate times of operation and
31 protocols to ensure availability and appropriate referrals in
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SENATE AMENDMENT
Bill No. CS for CS for SB 1252, 1st Eng.
Amendment No. ___ Barcode 394936
1 the event of emergencies.
2 d. Maintain appropriate program volumes to ensure
3 quality and safety.
4 e. Provide a minimum of 2 percent of its services to
5 charity and Medicaid patients each year.
6 3.a. The exemption provided by this paragraph shall
7 not apply unless the agency determines that the program is in
8 compliance with the requirements of subparagraph 1. and that
9 the program will, after beginning operation, continuously
10 comply with the rules adopted pursuant to subparagraph 2. The
11 agency shall monitor such programs to ensure compliance with
12 the requirements of subparagraph 2.
13 b.(I) The exemption for a program shall expire
14 immediately when the program fails to comply with the rules
15 adopted pursuant to sub-subparagraphs 2.a., b., and c.
16 (II) Beginning 18 months after a program first begins
17 treating patients, the exemption for a program shall expire
18 when the program fails to comply with the rules adopted
19 pursuant to sub-subparagraphs 2.d. and e.
20 (III) If the exemption for a program expires pursuant
21 to sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the
22 agency shall not grant an exemption pursuant to this paragraph
23 for an adult inpatient diagnostic cardiac catheterization
24 program located at the same hospital until 2 years following
25 the date of the determination by the agency that the program
26 failed to comply with the rules adopted pursuant to
27 subparagraph 2.
28 (j) For mobile surgical facilities and related health
29 care services provided under contract with the Department of
30 Corrections or a private correctional facility operating
31 pursuant to chapter 957.
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SENATE AMENDMENT
Bill No. CS for CS for SB 1252, 1st Eng.
Amendment No. ___ Barcode 394936
1 (k) For state veterans' nursing homes operated by or
2 on behalf of the Florida Department of Veterans' Affairs in
3 accordance with part II of chapter 296 for which at least 50
4 percent of the construction cost is federally funded and for
5 which the Federal Government pays a per diem rate not to
6 exceed one-half of the cost of the veterans' care in such
7 state nursing homes. These beds shall not be included in the
8 nursing home bed inventory.
9 (l) For combination within one nursing home facility
10 of the beds or services authorized by two or more certificates
11 of need issued in the same planning subdistrict. An exemption
12 granted under this paragraph shall extend the validity period
13 of the certificates of need to be consolidated by the length
14 of the period beginning upon submission of the exemption
15 request and ending with issuance of the exemption. The
16 longest validity period among the certificates shall be
17 applicable to each of the combined certificates.
18 (m) For division into two or more nursing home
19 facilities of beds or services authorized by one certificate
20 of need issued in the same planning subdistrict. An exemption
21 granted under this paragraph shall extend the validity period
22 of the certificate of need to be divided by the length of the
23 period beginning upon submission of the exemption request and
24 ending with issuance of the exemption.
25 (n) For the addition of hospital beds licensed under
26 chapter 395 for acute care, mental health services, or a
27 hospital-based distinct part skilled nursing unit in a number
28 that may not exceed 10 total beds or 10 percent of the
29 licensed capacity of the bed category being expanded,
30 whichever is greater. Beds for specialty burn units, neonatal
31 intensive care units, or comprehensive rehabilitation, or at a
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SENATE AMENDMENT
Bill No. CS for CS for SB 1252, 1st Eng.
Amendment No. ___ Barcode 394936
1 long-term care hospital, may not be increased under this
2 paragraph.
3 1. In addition to any other documentation otherwise
4 required by the agency, a request for exemption submitted
5 under this paragraph must:
6 a. Certify that the prior 12-month average occupancy
7 rate for the category of licensed beds being expanded at the
8 facility meets or exceeds 80 percent or, for a hospital-based
9 distinct part skilled nursing unit, the prior 12-month average
10 occupancy rate meets or exceeds 96 percent.
11 b. Certify that any beds of the same type authorized
12 for the facility under this paragraph before the date of the
13 current request for an exemption have been licensed and
14 operational for at least 12 months.
15 2. The timeframes and monitoring process specified in
16 s. 408.040(2)(a)-(c) apply to any exemption issued under this
17 paragraph.
18 3. The agency shall count beds authorized under this
19 paragraph as approved beds in the published inventory of
20 hospital beds until the beds are licensed.
21 (o) For the addition of acute care beds, as authorized
22 by rule consistent with s. 395.003(4), in a number that may
23 not exceed 10 total beds or 10 percent of licensed bed
24 capacity, whichever is greater, for temporary beds in a
25 hospital that has experienced high seasonal occupancy within
26 the prior 12-month period or in a hospital that must respond
27 to emergency circumstances.
28 (p) For the addition of nursing home beds licensed
29 under chapter 400 in a number not exceeding 10 total beds or
30 10 percent of the number of beds licensed in the facility
31 being expanded, whichever is greater.
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SENATE AMENDMENT
Bill No. CS for CS for SB 1252, 1st Eng.
Amendment No. ___ Barcode 394936
1 1. In addition to any other documentation required by
2 the agency, a request for exemption submitted under this
3 paragraph must:
4 a. Effective until June 30, 2001, Certify that the
5 facility has not had any class I or class II deficiencies
6 within the 30 months preceding the request for addition.
7 b. Effective on July 1, 2001, certify that the
8 facility has been designated as a Gold Seal nursing home under
9 s. 400.235.
10 b.c. Certify that the prior 12-month average occupancy
11 rate for the nursing home beds at the facility meets or
12 exceeds 96 percent.
13 c.d. Certify that any beds authorized for the facility
14 under this paragraph before the date of the current request
15 for an exemption have been licensed and operational for at
16 least 12 months.
17 2. The timeframes and monitoring process specified in
18 s. 408.040(2)(a)-(c) apply to any exemption issued under this
19 paragraph.
20 3. The agency shall count beds authorized under this
21 paragraph as approved beds in the published inventory of
22 nursing home beds until the beds are licensed.
23 (q) For establishment of a specialty hospital offering
24 a range of medical service restricted to a defined age or
25 gender group of the population or a restricted range of
26 services appropriate to the diagnosis, care, and treatment of
27 patients with specific categories of medical illnesses or
28 disorders, through the transfer of beds and services from an
29 existing hospital in the same county.
30 (r) For the conversion of hospital-based Medicare and
31 Medicaid certified skilled nursing beds to acute care beds, if
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SENATE AMENDMENT
Bill No. CS for CS for SB 1252, 1st Eng.
Amendment No. ___ Barcode 394936
1 the conversion does not involve the construction of new
2 facilities.
3 (s) For fiscal year 2001-2002 only, for transfer by a
4 health care system of existing services and not more than 100
5 licensed and approved beds from a hospital in district 1,
6 subdistrict 1, to another location within the same subdistrict
7 in order to establish a satellite facility that will improve
8 access to outpatient and inpatient care for residents of the
9 district and subdistrict and that will use new medical
10 technologies, including advanced diagnostics, computer
11 assisted imaging, and telemedicine to improve care. This
12 paragraph is repealed on July 1, 2002.
13 (t) For replacement of a licensed nursing home on the
14 same site, or within 3 miles of the same site, provided the
15 number of licensed beds does not increase.
16 (u) For consolidation or combination of licensed
17 nursing homes or transfer of beds between licensed nursing
18 homes within the same district, by providers that operate
19 multiple nursing homes within that district, provided there is
20 no increase in the district total of nursing home beds and the
21 relocation does not exceed 30 miles from the original
22 location.
23 Section 8. Paragraph (c) of subsection (1) of section
24 408.037, Florida Statutes, is amended to read:
25 408.037 Application content.--
26 (1) An application for a certificate of need must
27 contain:
28 (c) An audited financial statement of the applicant,
29 or an audited financial statement of the parent company if the
30 applicant is included in a parent company's consolidated audit
31 which details each entity separately. In an application
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SENATE AMENDMENT
Bill No. CS for CS for SB 1252, 1st Eng.
Amendment No. ___ Barcode 394936
1 submitted by an existing health care facility, health
2 maintenance organization, or hospice, financial condition
3 documentation must include, but need not be limited to, a
4 balance sheet and a profit-and-loss statement of the 2
5 previous fiscal years' operation.
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7 (Redesignate subsequent sections.)
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10 ================ T I T L E A M E N D M E N T ===============
11 And the title is amended as follows:
12 On page 2, line 8, through
13 page 3, line 11, delete those lines
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15 and insert:
16 nursing home facility; amending s. 408.034,
17 F.S.; specifying the district average occupancy
18 rate in the agency's rulemaking authority for
19 nursing-home-bed-need methodology; amending s.
20 408.036, F.S.; providing for additional
21 projects that are subject to expedited review;
22 establishing the agency's rulemaking authority
23 to implement provisions for expedited review;
24 deleting obsolete dates; providing for
25 additional projects that are exempt from
26 review; amending s. 408.037, F.S.; providing
27 that an audited financial statement of the
28 parent company may be used to fulfill an
29 application for a certificate of need;
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