Senate Bill sb1252e1
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1 A bill to be entitled
2 An act relating to nursing homes; creating s.
3 400.244, F.S.; allowing nursing homes to
4 convert beds to alternative uses as specified;
5 providing restrictions on uses of funding under
6 assisted-living Medicaid waivers; providing
7 procedures; providing for the applicability of
8 certain fire and life safety codes; providing
9 applicability of certain laws; requiring a
10 nursing home to submit to the Agency for Health
11 Care Administration a written request for
12 permission to convert beds to alternative uses;
13 providing conditions for disapproving such a
14 request; providing for periodic review;
15 providing for retention of nursing home
16 licensure for converted beds; providing for
17 reconversion of the beds; providing
18 applicability of licensure fees; requiring a
19 report to the agency; amending s. 400.021,
20 F.S.; redefining the term "resident care plan,"
21 as used in part I of ch. 400, F.S.; amending s.
22 400.23, F.S.; providing that certain
23 information from the Agency for Health Care
24 Administration must reflect final agency
25 actions; amending s. 400.147, F.S.; amending
26 the definition of the term "adverse incident";
27 requiring certain incident reports to be filed;
28 deleting provisions requiring the facility to
29 provide notice of an investigation to the
30 Agency for Health Care Administration; revising
31 requirements for a facility's report to the
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1 agency on adverse incidents; providing
2 guidelines for the agency's report to a
3 regulatory board that the agency has a
4 reasonable belief that there are grounds for
5 regulatory action; amending s. 400.211, F.S.;
6 revising inservice training requirements for
7 persons employed as nursing assistants in a
8 nursing home facility; amending s. 408.032,
9 F.S.; revising the definition of "tertiary
10 health service" under the Health Facility and
11 Services Development Act; amending s. 408.034,
12 F.S.; requiring the nursing-home-bed-need
13 methodology established by the Agency for
14 Health Care Administration by rule to include a
15 goal of maintaining a specified district
16 average occupancy rate; amending s. 408.036,
17 F.S., relating to health-care-related projects
18 subject to review for a certificate of need;
19 removing certain projects from and subjection
20 certain projects to expedited review and
21 revising requirements for other projects
22 subject to expedited review; removing the
23 exemption from review for certain projects;
24 revising requirements for certain projects that
25 are exempt from review; exempting certain
26 projects from review; amending s. 408.038,
27 F.S.; increasing fees of the
28 certificate-of-need program; amending s.
29 408.039, F.S.; providing for approval of
30 recommended orders of the Division of
31 Administrative Hearings when the Agency for
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1 Health Care Administration fails to take action
2 on an application for a certificate of need
3 within a specified time period; creating the
4 Hospital Statutory and Regulatory Reform
5 Council; providing for review of an application
6 for a certificate of need pending on the
7 effective date of the act; providing
8 legislative intent; providing for membership
9 and duties of the council; amending s. 415.102,
10 F.S.; revising the definition of "vulnerable
11 adult" under the Adult Protective Services Act;
12 providing an effective date.
13
14 Be It Enacted by the Legislature of the State of Florida:
15
16 Section 1. Section 400.244, Florida Statutes, is
17 created to read:
18 400.244 Alternative uses of nursing home beds; funding
19 limitations; applicable codes and requirements; procedures;
20 reconversion.--
21 (1) It is the intent of the Legislature to allow
22 nursing home facilities to use licensed nursing home facility
23 beds for alternative uses other than nursing home care for
24 extended periods of time exceeding 48 hours.
25 (2) A nursing home may use a contiguous portion of the
26 nursing home facility to meet the needs of the elderly through
27 the use of less restrictive and less institutional methods of
28 long-term care, including, but not limited to, adult day care,
29 assisted living, extended congregate care, or limited nursing
30 services.
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1 (3) Funding under assisted-living Medicaid waivers for
2 nursing home facility beds that are used to provide extended
3 congregate care or limited nursing services under this section
4 may be provided only for residents who have resided in the
5 nursing home facility for a minimum of 90 consecutive days.
6 (4) Nursing home facility beds that are used in
7 providing alternative services may share common areas,
8 services, and staff with beds that are designated for nursing
9 home care. Fire codes and life safety codes applicable to
10 nursing home facilities also apply to beds used for
11 alternative purposes under this section. Any alternative use
12 must meet other requirements specified by law for that use.
13 (5) In order to take beds out of service for nursing
14 home care and use them to provide alternative services under
15 this section, a nursing home must submit a written request for
16 approval to the Agency for Health Care Administration in a
17 format specified by the agency. The agency shall approve the
18 request unless it determines that such action will adversely
19 affect access to nursing home care in the geographical area in
20 which the nursing home is located. The agency shall, in its
21 review, consider a district average occupancy of 94 percent or
22 greater at the time of the application as an indicator of an
23 adverse impact. The agency shall review the request for
24 alternative use at each annual license renewal.
25 (6) A nursing home facility that converts beds to an
26 alternative use under this section retains its license for all
27 of the nursing home facility beds and may return those beds to
28 nursing home operation upon 60 days' written notice to the
29 agency unless notice requirements are specified elsewhere in
30 law. The nursing home facility shall continue to pay all
31 licensure fees as required by s. 400.062 and applicable rules
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1 but is not required to pay any other state licensure fee for
2 the alternative service.
3 (7) Within 45 days after the end of each calendar
4 quarter, each facility that has nursing facility beds licensed
5 under chapter 400 shall report to the agency or its designee
6 the total number of patient days which occurred in each month
7 of the quarter and the number of such days which were Medicaid
8 patient days.
9 Section 2. Subsection (17) of section 400.021, Florida
10 Statutes, is amended to read:
11 400.021 Definitions.--When used in this part, unless
12 the context otherwise requires, the term:
13 (17) "Resident care plan" means a written plan
14 developed, maintained, and reviewed not less than quarterly by
15 a registered nurse, with participation from other facility
16 staff and the resident or his or her designee or legal
17 representative, which includes a comprehensive assessment of
18 the needs of an individual resident; the type and frequency of
19 services required to provide the necessary care for the
20 resident to attain or maintain the highest practicable
21 physical, mental, and psychosocial well-being; a listing of
22 services provided within or outside the facility to meet those
23 needs; and an explanation of service goals. The resident care
24 plan must be signed by the director of nursing or another
25 registered nurse employed by the facility to whom
26 institutional responsibilities have been delegated and by the
27 resident, the resident's designee, or the resident's legal
28 representative.
29 Section 3. Subsection (10) is added to section 400.23,
30 Florida Statutes, to read:
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1 400.23 Rules; evaluation and deficiencies; licensure
2 status.--
3 (10) Agency records, reports, ranking systems,
4 Internet information, and publications must reflect final
5 agency actions.
6 Section 4. Subsections (5), (7), (8), and (12) of
7 section 400.147, Florida Statutes, are amended to read:
8 400.147 Internal risk management and quality assurance
9 program.--
10 (5) For purposes of reporting to the agency under this
11 section, the term "adverse incident" means:
12 (a) An event over which facility personnel could
13 exercise control and which is associated in whole or in part
14 with the facility's intervention, rather than the condition
15 for which such intervention occurred, and which results in one
16 of the following:
17 1. Death;
18 2. Brain or spinal damage;
19 3. Permanent disfigurement;
20 4. Fracture or dislocation of bones or joints;
21 5. A limitation of neurological, physical, or sensory
22 function;
23 6. Any condition that required medical attention to
24 which the resident has not given his or her informed consent,
25 including failure to honor advanced directives; or
26 7. Any condition that required the transfer of the
27 resident, within or outside the facility, to a unit providing
28 a more acute level of care due to the adverse incident, rather
29 than the resident's condition prior to the adverse incident;
30 (b) Abuse, neglect, or exploitation as defined in s.
31 415.102;
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1 (c) Abuse, neglect and harm as defined in s. 39.01;
2 (d) Resident elopement; or
3 (e) An event that is reported to law enforcement for
4 investigation.
5 (7) All incident reports as defined in CFR 483.13
6 shall be filed immediately with the appropriate agencies.
7 (7) The facility shall initiate an investigation and
8 shall notify the agency within 1 business day after the risk
9 manager or his or her designee has received a report pursuant
10 to paragraph (1)(d). The notification must be made in writing
11 and be provided electronically, by facsimile device or
12 overnight mail delivery. The notification must include
13 information regarding the identity of the affected resident,
14 the type of adverse incident, the initiation of an
15 investigation by the facility, and whether the events causing
16 or resulting in the adverse incident represent a potential
17 risk to any other resident. The notification is confidential
18 as provided by law and is not discoverable or admissible in
19 any civil or administrative action, except in disciplinary
20 proceedings by the agency or the appropriate regulatory board.
21 The agency may investigate, as it deems appropriate, any such
22 incident and prescribe measures that must or may be taken in
23 response to the incident. The agency shall review each
24 incident and determine whether it potentially involved conduct
25 by the health care professional who is subject to disciplinary
26 action, in which case the provisions of s. 456.073 shall
27 apply.
28 (8)(a) Each facility shall complete the investigation
29 and submit an adverse incident report to the agency for each
30 adverse incident within 15 calendar days after its occurrence.
31 If, after a complete investigation, the risk manager
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1 determines that the incident was not an adverse incident as
2 defined in subsection (5), the facility shall include this
3 information in the report. The agency shall develop a form for
4 reporting this information.
5 (b) The information reported to the agency pursuant to
6 paragraph (a) which relates to persons licensed under chapter
7 458, chapter 459, chapter 461, or chapter 466 shall be
8 reviewed by the agency. The agency shall determine whether any
9 of the incidents potentially involved conduct by a health care
10 professional who is subject to disciplinary action, in which
11 case the provisions of s. 456.073 shall apply.
12 (c) The report submitted to the agency must also
13 contain the name of the risk manager of the facility.
14 (d) The adverse incident report is confidential as
15 provided by law and is not discoverable or admissible in any
16 civil or administrative action, except in disciplinary
17 proceedings by the agency or the appropriate regulatory board.
18 (12) If the agency, through its receipt of the adverse
19 incident reports prescribed in subsection (7), or through any
20 investigation, has a reasonable belief that conduct by a staff
21 member or employee of a facility is grounds for disciplinary
22 action by the appropriate regulatory board, the agency shall
23 report this fact to the regulatory board. The agency must use
24 the 15-day report to fulfill this reporting requirement. This
25 subsection does not require dual reporting nor additional, new
26 documentation and reporting by the facility to the appropriate
27 regulatory board.
28 Section 5. Subsection (4) of section 400.211, Florida
29 Statutes, is amended to read:
30 400.211 Persons employed as nursing assistants;
31 certification requirement.--
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1 (4) When employed by a nursing home facility for a
2 12-month period or longer, a nursing assistant, to maintain
3 certification, shall submit to a performance review every 12
4 months and must receive regular inservice education based on
5 the outcome of such reviews. The inservice training must:
6 (a) Be sufficient to ensure the continuing competence
7 of nursing assistants and must meet the standard specified in
8 s. 464.203(7), must be at least 18 hours per year, and may
9 include hours accrued under s. 464.203(8);
10 (b) Include, at a minimum:
11 1. Techniques for assisting with eating and proper
12 feeding;
13 2. Principles of adequate nutrition and hydration;
14 3. Techniques for assisting and responding to the
15 cognitively impaired resident or the resident with difficult
16 behaviors;
17 4. Techniques for caring for the resident at the
18 end-of-life; and
19 5. Recognizing changes that place a resident at risk
20 for pressure ulcers and falls; and
21 (c) Address areas of weakness as determined in nursing
22 assistant performance reviews and may address the special
23 needs of residents as determined by the nursing home facility
24 staff.
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26 Costs associated with this training may not be reimbursed from
27 additional Medicaid funding through interim rate adjustments.
28 Section 6. Subsection (17) of section 408.032, Florida
29 Statutes, is amended to read:
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1 408.032 Definitions relating to Health Facility and
2 Services Development Act.--As used in ss. 408.031-408.045, the
3 term:
4 (17) "Tertiary health service" means a health service
5 which, due to its high level of intensity, complexity,
6 specialized or limited applicability, and cost, should be
7 limited to, and concentrated in, a limited number of hospitals
8 to ensure the quality, availability, and cost-effectiveness of
9 such service. Examples of such service include, but are not
10 limited to, organ transplantation, adult and pediatric open
11 heart surgery, specialty burn units, neonatal intensive care
12 units, comprehensive rehabilitation, and medical or surgical
13 services which are experimental or developmental in nature to
14 the extent that the provision of such services is not yet
15 contemplated within the commonly accepted course of diagnosis
16 or treatment for the condition addressed by a given service.
17 The agency shall establish by rule a list of all tertiary
18 health services.
19 Section 7. Subsection (5) of section 408.034, Florida
20 Statutes, is amended to read:
21 408.034 Duties and responsibilities of agency;
22 rules.--
23 (5) The agency shall establish by rule a
24 nursing-home-bed-need methodology that has a goal of
25 maintaining a district average occupancy rate of 94 percent
26 and that reduces the community nursing home bed need for the
27 areas of the state where the agency establishes pilot
28 community diversion programs through the Title XIX aging
29 waiver program.
30 Section 8. Section 408.036, Florida Statutes, is
31 amended to read:
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1 408.036 Projects subject to review; exemptions.--
2 (1) APPLICABILITY.--Unless exempt under subsection
3 (3), all health-care-related projects, as described in
4 paragraphs (a)-(h), are subject to review and must file an
5 application for a certificate of need with the agency. The
6 agency is exclusively responsible for determining whether a
7 health-care-related project is subject to review under ss.
8 408.031-408.045.
9 (a) The addition of beds by new construction or
10 alteration.
11 (b) The new construction or establishment of
12 additional health care facilities, including a replacement
13 health care facility when the proposed project site is not
14 located on the same site as the existing health care facility.
15 (c) The conversion from one type of health care
16 facility to another.
17 (d) An increase in the total licensed bed capacity of
18 a health care facility.
19 (e) The establishment of a hospice or hospice
20 inpatient facility, except as provided in s. 408.043.
21 (f) The establishment of inpatient health services by
22 a health care facility, or a substantial change in such
23 services.
24 (g) An increase in the number of beds for acute care,
25 nursing home care beds, specialty burn units, neonatal
26 intensive care units, comprehensive rehabilitation, mental
27 health services, or hospital-based distinct part skilled
28 nursing units, or at a long-term care hospital.
29 (h) The establishment of tertiary health services.
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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 (b)(c) A transfer of a certificate of need, except
7 when an existing hospital is acquired by a purchaser, in which
8 case all pending certificates of need filed by the existing
9 hospital and all approved certificates of need owned by that
10 hospital would be acquired by the purchaser.
11 (c)(d) A 50-percent increase in nursing home beds for
12 a facility incorporated and operating in this state for at
13 least 60 years on or before July 1, 1988, which has a licensed
14 nursing home facility located on a campus providing a variety
15 of residential settings and supportive services. The increased
16 nursing home beds shall be for the exclusive use of the campus
17 residents. Any application on behalf of an applicant meeting
18 this requirement shall be subject to the base fee of $5,000
19 provided in s. 408.038.
20 (d)(e) Replacement of a health care facility when the
21 proposed project site is located in the same district and
22 within a 1-mile radius of the replaced health care facility.
23 (e)(f) The conversion of mental health services beds
24 licensed under chapter 395 or hospital-based distinct part
25 conversion of skilled nursing unit beds to general acute care
26 beds; the mental health services beds between or among the
27 licensed bed categories defined as beds for mental health
28 services; or the conversion of general acute care beds to beds
29 for mental health services.
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1 1. Conversion under this paragraph shall not establish
2 a new licensed bed category at the hospital but shall apply
3 only to categories of beds licensed at that hospital.
4 2. Beds converted under this paragraph must be
5 licensed and operational for at least 12 months before the
6 hospital may apply for additional conversion affecting beds of
7 the same type.
8 (f) Replacement of a nursing home within the same
9 district, provided the proposed project site is located within
10 a geographic area that contains at least 65 percent of the
11 facility's current residents and is within a 30-mile radius of
12 the replaced nursing home.
13 (g) Relocation of a portion of a nursing home's
14 licensed beds to a replacement facility within the same
15 district, provided the relocation is within a 30-mile radius
16 of the existing facility and the total number of nursing home
17 beds in the district does not increase.
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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 exemption from the provisions of subsection
25 (1):
26 (a) For replacement of a licensed health care facility
27 on the same site, provided that the number of beds in each
28 licensed bed category will not increase.
29 (b) For hospice services or for swing beds in a rural
30 hospital, as defined in s. 395.602, in a number that does not
31 exceed one-half of its licensed beds.
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1 (c) For the conversion of licensed acute care hospital
2 beds to Medicare and Medicaid certified skilled nursing beds
3 in a rural hospital, as defined in s. 395.602, so long as the
4 conversion of the beds does not involve the construction of
5 new facilities. The total number of skilled nursing beds,
6 including swing beds, may not exceed one-half of the total
7 number of licensed beds in the rural hospital as of July 1,
8 1993. Certified skilled nursing beds designated under this
9 paragraph, excluding swing beds, shall be included in the
10 community nursing home bed inventory. A rural hospital which
11 subsequently decertifies any acute care beds exempted under
12 this paragraph shall notify the agency of the decertification,
13 and the agency shall adjust the community nursing home bed
14 inventory accordingly.
15 (d) For the addition of nursing home beds at a skilled
16 nursing facility that is part of a retirement community that
17 provides a variety of residential settings and supportive
18 services and that has been incorporated and operated in this
19 state for at least 65 years on or before July 1, 1994. All
20 nursing home beds must not be available to the public but must
21 be for the exclusive use of the community residents.
22 (e) For an increase in the bed capacity of a nursing
23 facility licensed for at least 50 beds as of January 1, 1994,
24 under part II of chapter 400 which is not part of a continuing
25 care facility if, after the increase, the total licensed bed
26 capacity of that facility is not more than 60 beds and if the
27 facility has been continuously licensed since 1950 and has
28 received a superior rating on each of its two most recent
29 licensure surveys.
30 (f) For an inmate health care facility built by or for
31 the exclusive use of the Department of Corrections as provided
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1 in chapter 945. This exemption expires when such facility is
2 converted to other uses.
3 (g) For the termination of an inpatient health care
4 service, upon 30 days' written notice to the agency.
5 (h) For the delicensure of beds, upon 30 days' written
6 notice to the agency. A request for exemption submitted under
7 this paragraph must identify the number, the category of beds,
8 and the name of the facility in which the beds to be
9 delicensed are located.
10 (i) For the provision of adult inpatient diagnostic
11 cardiac catheterization services in a hospital.
12 1. In addition to any other documentation otherwise
13 required by the agency, a request for an exemption submitted
14 under this paragraph must comply with the following criteria:
15 a. The applicant must certify it will not provide
16 therapeutic cardiac catheterization pursuant to the grant of
17 the exemption.
18 b. The applicant must certify it will meet and
19 continuously maintain the minimum licensure requirements
20 adopted by the agency governing such programs pursuant to
21 subparagraph 2.
22 c. The applicant must certify it will provide a
23 minimum of 2 percent of its services to charity and Medicaid
24 patients.
25 2. The agency shall adopt licensure requirements by
26 rule which govern the operation of adult inpatient diagnostic
27 cardiac catheterization programs established pursuant to the
28 exemption provided in this paragraph. The rules shall ensure
29 that such programs:
30 a. Perform only adult inpatient diagnostic cardiac
31 catheterization services authorized by the exemption and will
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1 not provide therapeutic cardiac catheterization or any other
2 services not authorized by the exemption.
3 b. Maintain sufficient appropriate equipment and
4 health personnel to ensure quality and safety.
5 c. Maintain appropriate times of operation and
6 protocols to ensure availability and appropriate referrals in
7 the event of emergencies.
8 d. Maintain appropriate program volumes to ensure
9 quality and safety.
10 e. Provide a minimum of 2 percent of its services to
11 charity and Medicaid patients each year.
12 3.a. The exemption provided by this paragraph shall
13 not apply unless the agency determines that the program is in
14 compliance with the requirements of subparagraph 1. and that
15 the program will, after beginning operation, continuously
16 comply with the rules adopted pursuant to subparagraph 2. The
17 agency shall monitor such programs to ensure compliance with
18 the requirements of subparagraph 2.
19 b.(I) The exemption for a program shall expire
20 immediately when the program fails to comply with the rules
21 adopted pursuant to sub-subparagraphs 2.a., b., and c.
22 (II) Beginning 18 months after a program first begins
23 treating patients, the exemption for a program shall expire
24 when the program fails to comply with the rules adopted
25 pursuant to sub-subparagraphs 2.d. and e.
26 (III) If the exemption for a program expires pursuant
27 to sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the
28 agency shall not grant an exemption pursuant to this paragraph
29 for an adult inpatient diagnostic cardiac catheterization
30 program located at the same hospital until 2 years following
31 the date of the determination by the agency that the program
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1 failed to comply with the rules adopted pursuant to
2 subparagraph 2.
3 (j) For the provision of percutaneous coronary
4 intervention for patients presenting with emergency myocardial
5 infarctions in a hospital without an approved adult open heart
6 surgery program. In addition to any other documentation
7 required by the agency, a request for an exemption submitted
8 under this paragraph must comply with the following:
9 1. The applicant must certify that it will meet and
10 continuously maintain the requirements adopted by the agency
11 for the provision of these services. These licensure
12 requirements are to be adopted by rule pursuant to ss.
13 120.536(1) and 120.54 and are to be consistent with the
14 guidelines published by the American College of Cardiology and
15 the American Heart Association for the provision of
16 percutaneous coronary interventions in hospitals without adult
17 open heart services. At a minimum, the rules shall require the
18 following:
19 a. Cardiologists must be experienced
20 interventionalists who have performed a minimum of 75
21 interventions within the previous 12 months.
22 b. The hospital must provide a minimum of 36 emergency
23 interventions annually in order to continue to provide the
24 service.
25 c. The hospital must offer sufficient physician,
26 nursing, and laboratory staff to provide the services 24 hours
27 a day, 7 days a week.
28 d. Nursing and technical staff must have demonstrated
29 experience in handling acutely ill patients requiring
30 intervention based on previous experience in dedicated
31 interventional laboratories or surgical centers.
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1 e. Cardiac care nursing staff must be adept in
2 hemodynamic monitoring and Intra-aortic Balloon Pump (IABP)
3 management.
4 f. Formalized written transfer agreements must be
5 developed with a hospital with an adult open heart surgery
6 program, and written transport protocols must be in place to
7 ensure safe and efficient transfer of a patient within 60
8 minutes. Transfer and transport agreements must be reviewed
9 and tested, with appropriate documentation maintained at least
10 every 3 months.
11 g. Hospitals implementing the service must first
12 undertake a training program of 3 to 6 months which includes
13 establishing standards, testing logistics, creating quality
14 assessment and error management practices, and formalizing
15 patient selection criteria.
16 2. The applicant must certify that it will utilize at
17 all times the patient selection criteria for the performance
18 of primary angioplasty at hospitals without adult open heart
19 surgery programs issued by the American College of Cardiology
20 and the American Heart Association. At a minimum, these
21 criteria would provide for the following:
22 a. Avoidance of interventions in hemodynamically
23 stable patients presenting with identified symptoms or medical
24 histories.
25 b. Transfer of patients presenting with a history of
26 coronary disease and clinical presentation of hemodynamic
27 instability.
28 3. The applicant must agree to submit a quarterly
29 report to the agency detailing patient characteristics,
30 treatment, and outcomes for all patients receiving emergency
31 percutaneous coronary interventions pursuant to this
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1 paragraph. This report must be submitted within 15 days after
2 the close of each calendar quarter.
3 4. The exemption provided by this paragraph shall not
4 apply unless the agency determines that the hospital has taken
5 all necessary steps to be in compliance with all requirements
6 of this paragraph, including the training program required
7 pursuant to sub-subparagraph 1.g.
8 5. Failure of the hospital to continuously comply with
9 the requirements of sub-subparagraphs 1.c.-f. and
10 subparagraphs 2. and 3. will result in the immediate
11 expiration of this exemption.
12 6. Failure of the hospital to meet the volume
13 requirements of sub-subparagraphs 1.a.-b. within 18 months
14 after the program begins offering the service will result in
15 the immediate expiration of the exemption.
16 7. If the exemption for this service expires pursuant
17 to subparagraph 5. or subparagraph 6., the agency shall not
18 grant another exemption for this service to the same hospital
19 for a period of 2 years and then only upon a showing that the
20 hospital will remain in compliance with the requirements of
21 this paragraph through a demonstration of corrections to the
22 deficiencies which caused expiration of the exemption.
23 Compliance with the requirements of this paragraph includes
24 compliance with the rules adopted pursuant to this paragraph.
25 (k)(j) For mobile surgical facilities and related
26 health care services provided under contract with the
27 Department of Corrections or a private correctional facility
28 operating pursuant to chapter 957.
29 (l)(k) For state veterans' nursing homes operated by
30 or on behalf of the Florida Department of Veterans' Affairs in
31 accordance with part II of chapter 296 for which at least 50
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1 percent of the construction cost is federally funded and for
2 which the Federal Government pays a per diem rate not to
3 exceed one-half of the cost of the veterans' care in such
4 state nursing homes. These beds shall not be included in the
5 nursing home bed inventory.
6 (m)(l) For combination within one nursing home
7 facility of the beds or services authorized by two or more
8 certificates of need issued in the same planning subdistrict.
9 An exemption granted under this paragraph shall extend the
10 validity period of the certificates of need to be consolidated
11 by the length of the period beginning upon submission of the
12 exemption request and ending with issuance of the exemption.
13 The longest validity period among the certificates shall be
14 applicable to each of the combined certificates.
15 (n)(m) For division into two or more nursing home
16 facilities of beds or services authorized by one certificate
17 of need issued in the same planning subdistrict. An exemption
18 granted under this paragraph shall extend the validity period
19 of the certificate of need to be divided by the length of the
20 period beginning upon submission of the exemption request and
21 ending with issuance of the exemption.
22 (o)(n) For the addition of hospital beds licensed
23 under chapter 395 for acute care, mental health services, or a
24 hospital-based distinct part skilled nursing unit in a number
25 that may not exceed 10 total beds or 10 percent of the
26 licensed capacity of the bed category being expanded,
27 whichever is greater; for the addition of medical
28 rehabilitation beds licensed under chapter 395 in a number
29 that may not exceed eight total beds or 10 percent of
30 capacity, whichever is greater; or for the addition of mental
31 health services beds licensed under chapter 395 in a number
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1 that may not exceed 10 total beds or 10 percent of the
2 licensed capacity of the bed category being expended,
3 whichever is greater. Beds for specialty burn units or,
4 neonatal intensive care units, or comprehensive
5 rehabilitation, or at a long-term care hospital, may not be
6 increased under this paragraph.
7 1. In addition to any other documentation otherwise
8 required by the agency, a request for exemption submitted
9 under this paragraph must:
10 a. Certify that the prior 12-month average occupancy
11 rate for the category of licensed beds being expanded at the
12 facility meets or exceeds 75 80 percent or, for a
13 hospital-based distinct part skilled nursing unit, the prior
14 12-month average occupancy rate meets or exceeds 96 percent
15 or, for medical rehabilitation beds, the prior 12-month
16 average occupancy meets or exceeds 90 percent.
17 b. Certify that any beds of the same type authorized
18 for the facility under this paragraph before the date of the
19 current request for an exemption have been licensed and
20 operational for at least 12 months.
21 2. The timeframes and monitoring process specified in
22 s. 408.040(2)(a)-(c) apply to any exemption issued under this
23 paragraph.
24 3. The agency shall count beds authorized under this
25 paragraph as approved beds in the published inventory of
26 hospital beds until the beds are licensed.
27 (p)(o) For the addition of acute care beds, as
28 authorized by rule consistent with s. 395.003(4), in a number
29 that may not exceed 30 10 total beds or 10 percent of licensed
30 bed capacity, whichever is greater, for temporary beds in a
31 hospital that has experienced high seasonal occupancy within
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1 the prior 12-month period or in a hospital that must respond
2 to emergency circumstances.
3 (q)(p) For the addition of nursing home beds licensed
4 under chapter 400 in a number not exceeding 10 total beds or
5 10 percent of the number of beds licensed in the facility
6 being expanded, whichever is greater.
7 1. In addition to any other documentation required by
8 the agency, a request for exemption submitted under this
9 paragraph must:
10 a. Effective until June 30, 2001, Certify that the
11 facility has not had any class I or class II deficiencies
12 within the 30 months preceding the request for addition.
13 b. Effective on July 1, 2001, certify that the
14 facility has been designated as a Gold Seal nursing home under
15 s. 400.235.
16 b.c. Certify that the prior 12-month average occupancy
17 rate for the nursing home beds at the facility meets or
18 exceeds 96 percent.
19 e.d. Certify that any beds authorized for the facility
20 under this paragraph before the date of the current request
21 for an exemption have been licensed and operational for at
22 least 12 months.
23 2. The timeframes and monitoring process specified in
24 s. 408.040(2)(a)-(c) apply to any exemption issued under this
25 paragraph.
26 3. The agency shall count beds authorized under this
27 paragraph as approved beds in the published inventory of
28 nursing home beds until the beds are licensed.
29 (q) For establishment of a specialty hospital offering
30 a range of medical service restricted to a defined age or
31 gender group of the population or a restricted range of
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1 services appropriate to the diagnosis, care, and treatment of
2 patients with specific categories of medical illnesses or
3 disorders, through the transfer of beds and services from an
4 existing hospital in the same county.
5 (r) For the conversion of hospital-based Medicare and
6 Medicaid certified skilled nursing beds to acute care beds, if
7 the conversion does not involve the construction of new
8 facilities.
9 (s) For the replacement of a statutory rural hospital
10 when the proposed project site is located in the same district
11 and within 10 miles of the existing facility and within the
12 current primary service area, defined as the least number of
13 zip codes comprising 75 percent of the hospital's inpatient
14 admissions. For fiscal year 2001-2002 only, for transfer by a
15 health care system of existing services and not more than 100
16 licensed and approved beds from a hospital in district 1,
17 subdistrict 1, to another location within the same subdistrict
18 in order to establish a satellite facility that will improve
19 access to outpatient and inpatient care for residents of the
20 district and subdistrict and that will use new medical
21 technologies, including advanced diagnostics, computer
22 assisted imaging, and telemedicine to improve care. This
23 paragraph is repealed on July 1, 2002.
24 (t) For the conversion of mental health services beds
25 licensed under chapter 395 or hospital-based distinct part
26 skilled nursing unit beds to general acute care beds; the
27 conversion of mental health services beds between or among the
28 licensed bed categories defined as beds for mental health
29 services; or the conversion of general acute care beds to beds
30 for mental health services.
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1 1. Conversion under this paragraph does not establish
2 a new licensed bed category at the hospital but applies only
3 to categories of beds licensed at that hospital.
4 2. Beds converted under this paragraph must be
5 licensed and operational for at least 12 months before the
6 hospital may apply for additional conversion affecting beds of
7 the same type.
8 (u) For the creation of at least a 10-bed Level II
9 neonatal intensive care unit upon demonstrating to the agency
10 that the applicant hospital had a minimum of 1,500 live births
11 during the previous 12 months.
12 (v) For the addition of Level II or Level III neonatal
13 intensive care beds in a number not to exceed six beds or 10
14 percent of licensed capacity in that category, whichever is
15 greater, provided that the hospital certifies that the prior
16 12-month average occupancy rate for the category of licensed
17 neonatal intensive care beds meets or exceeds 75 percent.
18 (w) For replacement of a licensed nursing home on the
19 same site, or within 3 miles of the same site, provided the
20 number of licensed beds does not increase.
21 (x) For consolidation or combination of licensed
22 nursing homes or transfer of beds between licensed nursing
23 homes within the same district, by providers that operate
24 multiple nursing homes within that district, provided there is
25 no increase in the district total of nursing home beds and the
26 relocation does not exceed 30 miles from the original
27 location.
28 (y)1. For the provision of adult open-heart services
29 in a hospital located within the boundaries of Palm Beach,
30 Polk, Martin, St. Lucie, and Indian River Counties if the
31 following conditions are met: The exemption must be based upon
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1 objective criteria and address and solve the twin problems of
2 geographic and temporal access. A hospital shall be exempt
3 from the certificate-of-need review for the establishment of
4 an open-heart-surgery program when the application for
5 exemption submitted under this paragraph complies with the
6 following criteria:
7 a. The applicant must certify that it will meet and
8 continuously maintain the minimum licensure requirements
9 adopted by the agency governing adult open-heart programs,
10 including the most current guidelines of the American College
11 of Cardiology and American Heart Association Guidelines for
12 Adult Open Heart Programs.
13 b. The applicant must certify that it will maintain
14 sufficient appropriate equipment and health personnel to
15 ensure quality and safety.
16 c. The applicant must certify that it will maintain
17 appropriate times of operation and protocols to ensure
18 availability and appropriate referrals in the event of
19 emergencies.
20 d. The applicant can demonstrate that it is referring
21 300 or more patients per year from the hospital, including the
22 emergency room, for cardiac services at a hospital with
23 cardiac services, or that the average wait for transfer for 50
24 percent or more of the cardiac patients exceeds 4 hours.
25 e. The applicant is a general acute care hospital that
26 is in operation for 3 years or more.
27 f. The applicant is performing more than 300
28 diagnostic cardiac catheterization procedures per year,
29 combined inpatient and outpatient.
30 g. The applicant's payor mix at a minimum reflects the
31 community average for Medicaid, charity care, and self-pay
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1 patients or the applicant must certify that it will provide a
2 minimum of 5 percent of Medicaid, charity care, and self-pay
3 to open-heart-surgery patients.
4 h. If the applicant fails to meet the established
5 criteria for open-heart programs or fails to reach 300
6 surgeries per year by the end of its third year of operation,
7 it must show cause why its exemption should not be revoked.
8 2. By December 31, 2004, and annually thereafter, the
9 Agency for Health Care Administration shall submit a report to
10 the Legislature providing information concerning the number of
11 requests for exemption received under this paragraph and the
12 number of exemptions granted or denied.
13 (4) A request for exemption under subsection (3) may
14 be made at any time and is not subject to the batching
15 requirements of this section. The request shall be supported
16 by such documentation as the agency requires by rule. The
17 agency shall assess a fee of $250 for each request for
18 exemption submitted under subsection (3).
19 Section 9. Section 408.038, Florida Statutes, is
20 amended to read:
21 408.038 Fees.--The agency shall assess fees on
22 certificate-of-need applications. Such fees shall be for the
23 purpose of funding the functions of the local health councils
24 and the activities of the agency and shall be allocated as
25 provided in s. 408.033. The fee shall be determined as
26 follows:
27 (1) A minimum base fee of $10,000 $5,000.
28 (2) In addition to the base fee of $10,000 $5,000,
29 0.015 of each dollar of proposed expenditure, except that a
30 fee may not exceed $50,000 $22,000.
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1 Section 10. Paragraph (e) of subsection (5) and
2 paragraph (c) of subsection (6) of section 408.039, Florida
3 Statutes, are amended to read:
4 408.039 Review process.--The review process for
5 certificates of need shall be as follows:
6 (5) ADMINISTRATIVE HEARINGS.--
7 (e) The agency shall issue its final order within 45
8 days after receipt of the recommended order. If the agency
9 fails to take action within 45 days, the recommended order of
10 the Division of Administrative Hearings is deemed approved
11 such time, or as otherwise agreed to by the applicant and the
12 agency, the applicant may take appropriate legal action to
13 compel the agency to act. When making a determination on an
14 application for a certificate of need, the agency is
15 specifically exempt from the time limitations provided in s.
16 120.60(1).
17 (6) JUDICIAL REVIEW.--
18 (c) The court, in its discretion, may award reasonable
19 attorney's fees and costs to the prevailing party if the court
20 finds that there was a complete absence of a justiciable issue
21 of law or fact raised by the losing party. If the losing party
22 is a hospital, the court shall order it to pay the reasonable
23 attorney's fees and costs, which shall include fees and costs
24 incurred as a result of the administrative hearing and the
25 judicial appeal, of the prevailing hospital party.
26 Section 11. This act shall not preclude review and
27 final agency actions on any certificate of need application
28 that was filed with the Agency for Health Care Administration
29 before the effective date of this act.
30 Section 12. Hospital Statutory and Regulatory Reform
31 Council; legislative intent; creation; membership; duties.--
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1 (1) It is the intent of the Legislature to provide for
2 the protection of the public health and safety in the
3 establishment, construction, maintenance, and operation of
4 hospitals. However, the Legislature further intends that the
5 police power of the state be exercised toward that purpose
6 only to the extent necessary and that regulation remain
7 current with the ever-changing standard of care and not
8 restrict the introduction and use of new medical technologies
9 and procedures.
10 (2) In order to achieve the purposes expressed in
11 subsection (1), it is necessary that the state establish a
12 mechanism for the ongoing review and updating of laws
13 regulating hospitals. The Hospital Statutory and Regulatory
14 Reform Council is created and located, for administrative
15 purposes only, within the Agency for Health Care
16 Administration. The council shall consist of no more than 15
17 members, including:
18 (a) Nine members appointed by the Florida Hospital
19 Association who represent acute care, teaching, specialty,
20 rural, government-owned, for-profit, and not-for-profit
21 hospitals.
22 (b) Two members appointed by the Governor who
23 represent patients.
24 (c) Two members appointed by the President of the
25 Senate who represent private businesses that provide health
26 insurance coverage for their employees, one of whom represents
27 small private businesses and one of whom represents large
28 private businesses. As used in this paragraph, the term
29 "private business" does not include an entity licensed under
30 chapter 627, Florida Statutes, or chapter 641, Florida
31 Statutes, or otherwise licensed or authorized to provide
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1 health insurance services, either directly or indirectly, in
2 this state.
3 (d) Two members appointed by the Speaker of the House
4 of Representatives who represent physicians.
5 (3) Council members shall be appointed to serve 2-year
6 terms and may be reappointed. A member shall serve until his
7 or her successor is appointed. The council shall annually
8 elect from among its members a chair and a vice chair. The
9 council shall meet at least twice a year and shall hold
10 additional meetings as it considers necessary. Members
11 appointed by the Florida Hospital Association may not receive
12 compensation or reimbursement of expenses for their services.
13 Members appointed by the Governor, the President of the
14 Senate, or the Speaker of the House of Representatives may be
15 reimbursed for travel expenses by the agency.
16 (4) The council, as its first priority, shall review
17 chapters 395 and 408, Florida Statutes, and shall make
18 recommendations to the Legislature for the repeal of
19 regulatory provisions that are no longer necessary or that
20 fail to promote cost-efficient, high-quality medicine.
21 (5) The council, as its second priority, shall
22 recommend to the Secretary of Health and the Secretary of
23 Health Care Administration regulatory changes relating to
24 hospital licensure and regulation to assist the Department of
25 Health and the Agency for Health Care Administration in
26 carrying out their duties and to ensure that the intent of the
27 Legislature as expressed in this section is carried out.
28 (6) In determining whether a statute or rule is
29 appropriate or necessary, the council shall consider whether:
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1 (a) The statute or rule is necessary to prevent
2 substantial harm, which is recognizable and not remote, to the
3 public health, safety, or welfare.
4 (b) The statute or rule restricts the use of new
5 medical technologies or encourages the implementation of more
6 cost-effective medical procedures.
7 (c) The statute or rule has an unreasonable effect on
8 job creation or job retention in the state.
9 (d) The public is or can be effectively protected by
10 other means.
11 (e) The overall cost-effectiveness and economic effect
12 of the proposed statute or rule, including the indirect costs
13 to consumers, will be favorable.
14 (f) A lower-cost regulatory alternative to the statute
15 or rule could be adopted.
16 Section 13. Subsection (26) of section 415.102,
17 Florida Statutes, is amended to read:
18 415.102 Definitions of terms used in ss.
19 415.101-415.113.--As used in ss. 415.101-415.113, the term:
20 (26) "Vulnerable adult" means a person 18 years of age
21 or older whose ability to perform the normal activities of
22 daily living or to provide for his or her own care or
23 protection is impaired due to a long-term mental, emotional,
24 physical, or developmental disability or dysfunctioning, or
25 brain damage, or the infirmities of aging.
26 Section 14. This act shall take effect July 1, 2003.
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