HB 0081A 2003
1	A bill to be entitled
2	An act relating to health care facilities; creating s.
3	400.244, F.S.; allowing nursing homes to convert beds to
4	alternative uses as specified; providing restrictions on
5	uses of funding under assisted-living Medicaid waivers;
6	providing procedures; providing for the applicability of
7	certain fire and life safety codes; providing
8	applicability of certain laws; requiring a nursing home to
9	submit to the Agency for Health Care Administration a
10	written request for permission to convert beds to
11	alternative uses; providing conditions for disapproving
12	such a request; providing for periodic review; providing
13	for retention of nursing home licensure for converted
14	beds; providing for reconversion of the beds; providing
15	applicability of licensure fees; requiring quarterly
16	reports to the agency relating to patient days; amending
17	s. 400.021, F.S.; redefining the term "resident care
18	plan," as used in part II of ch. 400, F.S.; amending s.
19	400.23, F.S.; providing that certain information from the
20	Agency for Health Care Administration must reflect the
21	most current agency actions; amending s. 400.211, F.S.;
22	revising inservice training requirements for persons
23	employed as nursing assistants in a nursing home facility;
24	amending s. 408.032, F.S.; revising the definition of
25	"tertiary health service" under the Health Facility and
26	Services Development Act; amending s. 408.034, F.S.;
27	requiring the nursing-home-bed-need methodology
28	established by the Agency for Health Care Administration
29	by rule to include a goal of maintaining a specified
30	district average occupancy rate; amending s. 408.036,
31	F.S., relating to health-care-related projects subject to
32	review for a certificate of need; removing shared services
33	contracts or projects from expedited review; revising
34	expedited review requirements for transfer of a
35	certificate of need and conversion of beds for mental
36	health services or general acute care; subjecting projects
37	relating to replacement of a nursing home and relocation
38	of nursing home beds to expedited review; removing the
39	exemption from review for establishment of certain
40	specialty hospitals and a satellite facility; revising
41	requirements for certain projects that are exempt from
42	review; exempting from review projects relating to
43	provision of percutaneous coronary intervention,
44	replacement of a statutory rural hospital, and conversion
45	of mental health services beds; amending s. 408.038, F.S.;
46	increasing fees of the certificate-of-need program;
47	amending s. 408.039, F.S.; providing for approval of
48	recommended orders of the Division of Administrative
49	Hearings when the Agency for Health Care Administration
50	fails to take action on an application for a certificate
51	of need within a specified time period; providing for
52	payment of attorney's fees and costs when a hospital is
53	the losing party; providing for review of an application
54	for a certificate of need pending on the effective date of
55	the act; creating the Hospital Statutory and Regulatory
56	Reform Council; providing legislative intent; providing
57	for membership and duties of the council; providing for
58	construction of the act in pari materia with laws enacted
59	during the 2003 Regular Session of the Legislature;
60	providing an effective date.
61
62	Be It Enacted by the Legislature of the State of Florida:
63
64	Section 1. Section 400.244, Florida Statutes, is created
65	to read:
66	400.244 Alternative uses of nursing home beds; funding
67	limitations; applicable codes and requirements; procedures;
68	reconversion; quarterly reports.--
69	(1) It is the intent of the Legislature to allow nursing
70	home facilities to use licensed nursing home facility beds for
71	alternative uses other than nursing home care for extended
72	periods of time exceeding 48 hours.
73	(2) A nursing home may use a contiguous portion of the
74	nursing home facility to meet the needs of the elderly through
75	the use of less restrictive and less institutional methods of
76	long-term care, including, but not limited to, adult day care,
77	assisted living, extended congregate care, or limited nursing
78	services.
79	(3) Funding under assisted-living Medicaid waivers for
80	nursing home facility beds that are used to provide extended
81	congregate care or limited nursing services under this section
82	may be provided only for residents who have resided in the
83	nursing home facility for a minimum of 90 consecutive days.
84	(4) Nursing home facility beds that are used in providing
85	alternative services may share common areas, services, and staff
86	with beds that are designated for nursing home care. Fire codes
87	and life safety codes applicable to nursing home facilities also
88	apply to beds used for alternative purposes under this section.
89	Any alternative use must meet other requirements specified by
90	law for that use.
91	(5) In order to take beds out of service for nursing home
92	care and use them to provide alternative services under this
93	section, a nursing home must submit a written request for
94	approval to the Agency for Health Care Administration in a
95	format specified by the agency. The agency shall approve the
96	request unless it determines that such action will adversely
97	affect access to nursing home care in the geographical area in
98	which the nursing home is located. The agency shall, in its
99	review, consider a district average occupancy of 94 percent or
100	greater at the time of the application as an indicator of an
101	adverse impact. The agency shall review the request for
102	alternative use at each annual license renewal.
103	(6) A nursing home facility that converts beds to an
104	alternative use under this section retains its license for all
105	of the nursing home facility beds and may return those beds to
106	nursing home operation upon 60 days' written notice to the
107	agency unless notice requirements are specified elsewhere in
108	law. The nursing home facility shall continue to pay all
109	licensure fees as required by s. 400.062 and applicable rules
110	but is not required to pay any other state licensure fee for the
111	alternative use.
112	(7) Within 45 days after the end of each calendar quarter,
113	each facility that has nursing home facility beds licensed under
114	this chapter shall report to the agency or its designee the
115	total number of patient days that occurred in each month of the
116	quarter and the number of such days that were Medicaid patient
117	days.
118	Section 2. Subsection (17) of section 400.021, Florida
119	Statutes, is amended to read:
120	400.021 Definitions.--When used in this part, unless the
121	context otherwise requires, the term:
122	(17) "Resident care plan" means a written plan developed,
123	maintained, and reviewed not less than quarterly by a registered
124	nurse, with participation from other facility staff and the
125	resident or his or her designee or legal representative, which
126	includes a comprehensive assessment of the needs of an
127	individual resident; the type and frequency of services required
128	to provide the necessary care for the resident to attain or
129	maintain the highest practicable physical, mental, and
130	psychosocial well-being; a listing of services provided within
131	or outside the facility to meet those needs; and an explanation
132	of service goals. The resident care plan must be signed by the
133	director of nursing or another registered nurse employed by the
134	facility to whom institutional responsibilities have been
135	delegated and bythe resident, the resident's designee, or the
136	resident's legal representative. The facility may not use an
137	agency or temporary registered nurse to satisfy the foregoing
138	requirement and must document the institutional responsibilities
139	that have been delegated to the registered nurse.
140	Section 3. Subsection (10) is added to section 400.23,
141	Florida Statutes, to read:
142	400.23 Rules; evaluation and deficiencies; licensure
143	status.--
144	(10) Agency records, reports, ranking systems, Internet
145	information, and publications must reflect the most current
146	agency actions.
147	Section 4. Subsection (4) of section 400.211, Florida
148	Statutes, is amended to read:
149	400.211 Persons employed as nursing assistants;
150	certification requirement.--
151	(4) When employed by a nursing home facility for a 12-
152	month period or longer, a nursing assistant, to maintain
153	certification, shall submit to a performance review every 12
154	months and must receive regular inservice education based on the
155	outcome of such reviews. The inservice training must:
156	(a) Be sufficient to ensure the continuing competence of
157	nursing assistants and must meet the standard specified in s.
158	464.203(7), must be at least 18 hours per year, and may include
159	hours accrued under s. 464.203(8);
160	(b) Include, at a minimum:
161	1. Techniques for assisting with eating and proper
162	feeding;
163	2. Principles of adequate nutrition and hydration;
164	3. Techniques for assisting and responding to the
165	cognitively impaired resident or the resident with difficult
166	behaviors;
167	4. Techniques for caring for the resident at the end-of-
168	life; and
169	5. Recognizing changes that place a resident at risk for
170	pressure ulcers and falls; and
171	(c) Address areas of weakness as determined in nursing
172	assistant performance reviews and may address the special needs
173	of residents as determined by the nursing home facility staff.
174
175	Costs associated with this training may not be reimbursed from
176	additional Medicaid funding through interim rate adjustments.
177	Section 5. Subsection (17) of section 408.032, Florida
178	Statutes, is amended to read:
179	408.032 Definitions relating to Health Facility and
180	Services Development Act.--As used in ss. 408.031-408.045, the
181	term:
182	(17) "Tertiary health service" means a health service
183	which, due to its high level of intensity, complexity,
184	specialized or limited applicability, and cost, should be
185	limited to, and concentrated in, a limited number of hospitals
186	to ensure the quality, availability, and cost-effectiveness of
187	such service. Examples of such service include, but are not
188	limited to, organ transplantation, adult and pediatric open
189	heart surgery,specialty burn units, neonatal intensive care
190	units, comprehensive rehabilitation, and medical or surgical
191	services which are experimental or developmental in nature to
192	the extent that the provision of such services is not yet
193	contemplated within the commonly accepted course of diagnosis or
194	treatment for the condition addressed by a given service. The
195	agency shall establish by rule a list of all tertiary health
196	services.
197	Section 6. Subsection (5) of section 408.034, Florida
198	Statutes, is amended to read:
199	408.034 Duties and responsibilities of agency; rules.--
200	(5) The agency shall establish by rule a nursing-home-bed-
201	need methodology that has a goal of maintaining a district
202	average occupancy rate of 94 percent and thatreduces the
203	community nursing home bed need for the areas of the state where
204	the agency establishes pilot community diversion programs
205	through the Title XIX aging waiver program.
206	Section 7. Section 408.036, Florida Statutes, is amended
207	to read:
208	408.036 Projects subject to review; exemptions.--
209	(1) APPLICABILITY.--Unless exempt under subsection (3),
210	all health-care-related projects, as described in paragraphs
211	(a)-(h), are subject to review and must file an application for
212	a certificate of need with the agency. The agency is exclusively
213	responsible for determining whether a health-care-related
214	project is subject to review under ss. 408.031-408.045.
215	(a) The addition of beds by new construction or
216	alteration.
217	(b) The new construction or establishment of additional
218	health care facilities, including a replacement health care
219	facility when the proposed project site is not located on the
220	same site as the existing health care facility.
221	(c) The conversion from one type of health care facility
222	to another.
223	(d) An increase in the total licensed bed capacity of a
224	health care facility.
225	(e) The establishment of a hospice or hospice inpatient
226	facility, except as provided in s. 408.043.
227	(f) The establishment of inpatient health services by a
228	health care facility, or a substantial change in such services.
229	(g) An increase in the number of beds for acute care,
230	nursing home care beds, specialty burn units, neonatal intensive
231	care units, comprehensive rehabilitation, mental health
232	services, or hospital-based distinct part skilled nursing units,
233	or at a long-term care hospital.
234	(h) The establishment of tertiary health services.
235	(2) PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless exempt
236	pursuant to subsection (3), projects subject to an expedited
237	review shall include, but not be limited to:
238	(a) Research, education, and training programs.
239	(b) Shared services contracts or projects.
240	(b)(c) A transfer of a certificate of need, except when an
241	existing hospital is acquired by a purchaser, in which case all
242	pending certificates of need filed by the existing hospital and
243	all approved certificates of need owned by that hospital would
244	be acquired by the purchaser.
245	(c)(d)A 50-percent increase in nursing home beds for a
246	facility incorporated and operating in this state for at least
247	60 years on or before July 1, 1988, which has a licensed nursing
248	home facility located on a campus providing a variety of
249	residential settings and supportive services. The increased
250	nursing home beds shall be for the exclusive use of the campus
251	residents. Any application on behalf of an applicant meeting
252	this requirement shall be subject to the base fee of $5,000
253	provided in s. 408.038.
254	(d)(e)Replacement of a health care facility when the
255	proposed project site is located in the same district and within
256	a 1-mile radius of the replaced health care facility.
257	(e)(f)The conversion of mental health services beds
258	licensed under chapter 395 or hospital-based distinct part
259	skilled nursing unit beds to general acute care beds; the
260	conversion of mental health services beds between or among the
261	licensed bed categories defined as beds for mental health
262	services;or the conversion of general acute care beds to beds
263	for mental health services.
264	1. Conversion under this paragraph shall not establish a
265	new licensed bed category at the hospital but shall apply only
266	to categories of beds licensed at that hospital.
267	2. Beds converted under this paragraph must be licensed
268	and operational for at least 12 months before the hospital may
269	apply for additional conversion affecting beds of the same type.
270	(f) Replacement of a nursing home within the same
271	district, provided the proposed project site is located within a
272	geographic area that contains at least 65 percent of the
273	facility's current residents and is within a 30-mile radius of
274	the replaced nursing home.
275	(g) Relocation of a portion of a nursing home's licensed
276	beds to a replacement facility within the same district,
277	provided the relocation is within a 30-mile radius of the
278	existing facility and the total number of nursing home beds in
279	the district does not increase.
280
281	The agency shall develop rules to implement the provisions for
282	expedited review, including time schedule, application content
283	which may be reduced from the full requirements of s.
284	408.037(1), and application processing.
285	(3) EXEMPTIONS.--Upon request, the following projects are
286	subject to exemption from the provisions of subsection (1):
287	(a) For replacement of a licensed health care facility on
288	the same site, provided that the number of beds in each licensed
289	bed category will not increase.
290	(b) For hospice services or for swing beds in a rural
291	hospital, as defined in s. 395.602, in a number that does not
292	exceed one-half of its licensed beds.
293	(c) For the conversion of licensed acute care hospital
294	beds to Medicare and Medicaid certified skilled nursing beds in
295	a rural hospital, as defined in s. 395.602, so long as the
296	conversion of the beds does not involve the construction of new
297	facilities. The total number of skilled nursing beds, including
298	swing beds, may not exceed one-half of the total number of
299	licensed beds in the rural hospital as of July 1, 1993.
300	Certified skilled nursing beds designated under this paragraph,
301	excluding swing beds, shall be included in the community nursing
302	home bed inventory. A rural hospital which subsequently
303	decertifies any acute care beds exempted under this paragraph
304	shall notify the agency of the decertification, and the agency
305	shall adjust the community nursing home bed inventory
306	accordingly.
307	(d) For the addition of nursing home beds at a skilled
308	nursing facility that is part of a retirement community that
309	provides a variety of residential settings and supportive
310	services and that has been incorporated and operated in this
311	state for at least 65 years on or before July 1, 1994. All
312	nursing home beds must not be available to the public but must
313	be for the exclusive use of the community residents.
314	(e) For an increase in the bed capacity of a nursing
315	facility licensed for at least 50 beds as of January 1, 1994,
316	under part II of chapter 400 which is not part of a continuing
317	care facility if, after the increase, the total licensed bed
318	capacity of that facility is not more than 60 beds and if the
319	facility has been continuously licensed since 1950 and has
320	received a superior rating on each of its two most recent
321	licensure surveys.
322	(f) For an inmate health care facility built by or for the
323	exclusive use of the Department of Corrections as provided in
324	chapter 945. This exemption expires when such facility is
325	converted to other uses.
326	(g) For the termination of an inpatient health care
327	service, upon 30 days' written notice to the agency.
328	(h) For the delicensure of beds, upon 30 days' written
329	notice to the agency. A request for exemption submitted under
330	this paragraph must identify the number, the category of beds,
331	and the name of the facility in which the beds to be delicensed
332	are located.
333	(i) For the provision of adult inpatient diagnostic
334	cardiac catheterization services in a hospital.
335	1. In addition to any other documentation otherwise
336	required by the agency, a request for an exemption submitted
337	under this paragraph must comply with the following criteria:
338	a. The applicant must certify it will not provide
339	therapeutic cardiac catheterization pursuant to the grant of the
340	exemption.
341	b. The applicant must certify it will meet and
342	continuously maintain the minimum licensure requirements adopted
343	by the agency governing such programs pursuant to subparagraph
344	2.
345	c. The applicant must certify it will provide a minimum of
346	2 percent of its services to charity and Medicaid patients.
347	2. The agency shall adopt licensure requirements by rule
348	which govern the operation of adult inpatient diagnostic cardiac
349	catheterization programs established pursuant to the exemption
350	provided in this paragraph. The rules shall ensure that such
351	programs:
352	a. Perform only adult inpatient diagnostic cardiac
353	catheterization services authorized by the exemption and will
354	not provide therapeutic cardiac catheterization or any other
355	services not authorized by the exemption.
356	b. Maintain sufficient appropriate equipment and health
357	personnel to ensure quality and safety.
358	c. Maintain appropriate times of operation and protocols
359	to ensure availability and appropriate referrals in the event of
360	emergencies.
361	d. Maintain appropriate program volumes to ensure quality
362	and safety.
363	e. Provide a minimum of 2 percent of its services to
364	charity and Medicaid patients each year.
365	3.a. The exemption provided by this paragraph shall not
366	apply unless the agency determines that the program is in
367	compliance with the requirements of subparagraph 1. and that the
368	program will, after beginning operation, continuously comply
369	with the rules adopted pursuant to subparagraph 2. The agency
370	shall monitor such programs to ensure compliance with the
371	requirements of subparagraph 2.
372	b.(I) The exemption for a program shall expire immediately
373	when the program fails to comply with the rules adopted pursuant
374	to sub-subparagraphs 2.a., b., and c.
375	(II) Beginning 18 months after a program first begins
376	treating patients, the exemption for a program shall expire when
377	the program fails to comply with the rules adopted pursuant to
378	sub-subparagraphs 2.d. and e.
379	(III) If the exemption for a program expires pursuant to
380	sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the
381	agency shall not grant an exemption pursuant to this paragraph
382	for an adult inpatient diagnostic cardiac catheterization
383	program located at the same hospital until 2 years following the
384	date of the determination by the agency that the program failed
385	to comply with the rules adopted pursuant to subparagraph 2.
386	(j) For the provision of percutaneous coronary
387	intervention for patients presenting with emergency myocardial
388	infarctions in a hospital without an approved adult open heart
389	surgery program. In addition to any other documentation required
390	by the agency, a request for an exemption submitted under this
391	paragraph must comply with the following:
392	1. The applicant must certify that it will meet and
393	continuously maintain the requirements adopted by the agency for
394	the provision of these services. These licensure requirements
395	are to be adopted by rule pursuant to ss. 120.536(1) and 120.54
396	and are to be consistent with the guidelines published by the
397	American College of Cardiology and the American Heart
398	Association for the provision of percutaneous coronary
399	interventions in hospitals without adult open heart services. At
400	a minimum, the rules shall require the following:
401	a. Cardiologists must be experienced interventionalists
402	who have performed a minimum of 75 interventions within the
403	previous 12 months.
404	b. The hospital must provide a minimum of 36 emergency
405	interventions annually in order to continue to provide the
406	service.
407	c. The hospital must offer sufficient physician, nursing,
408	and laboratory staff to provide the services 24 hours a day, 7
409	days a week.
410	d. Nursing and technical staff must have demonstrated
411	experience in handling acutely ill patients requiring
412	intervention based on previous experience in dedicated
413	interventional laboratories or surgical centers.
414	e. Cardiac care nursing staff must be adept in hemodynamic
415	monitoring and intra-aortic balloon pump (IABP) management.
416	f. Formalized written transfer agreements must be
417	developed with a hospital with an adult open heart surgery
418	program, and written transport protocols must be in place to
419	ensure safe and efficient transfer of a patient within 60
420	minutes. Transfer and transport agreements must be reviewed and
421	tested, with appropriate documentation maintained at least every
422	3 months.
423	g. Hospitals implementing the service must first undertake
424	a training program of 3 to 6 months that includes establishing
425	standards, testing logistics, creating quality assessment and
426	error management practices, and formalizing patient selection
427	criteria.
428	2. The applicant must certify that it will utilize at all
429	times the patient selection criteria for the performance of
430	primary angioplasty at hospitals without adult open heart
431	surgery programs issued by the American College of Cardiology
432	and the American Heart Association. At a minimum, these criteria
433	would provide for the following:
434	a. Avoidance of interventions in hemodynamically stable
435	patients presenting with identified symptoms or medical
436	histories.
437	b. Transfer of patients presenting with a history of
438	coronary disease and clinical presentation of hemodynamic
439	instability.
440	3. The applicant must agree to submit a quarterly report
441	to the agency detailing patient characteristics, treatment, and
442	outcomes for all patients receiving emergency percutaneous
443	coronary interventions pursuant to this paragraph. This report
444	must be submitted within 15 days after the close of each
445	calendar quarter.
446	4. The exemption provided by this paragraph shall not
447	apply unless the agency determines that the hospital has taken
448	all necessary steps to be in compliance with all requirements of
449	this paragraph, including the training program required pursuant
450	to sub-subparagraph 1.g.
451	5. Failure of the hospital to continuously comply with the
452	requirements of sub-subparagraphs 1.c.-f. and subparagraphs 2.
453	and 3. will result in the immediate expiration of this
454	exemption.
455	6. Failure of the hospital to meet the volume requirements
456	of sub-subparagraphs 1.a.-b. within 18 months after the program
457	begins offering the service will result in the immediate
458	expiration of the exemption.
459	7. If the exemption for this service expires pursuant to
460	subparagraph 5. or subparagraph 6., the agency shall not grant
461	another exemption for this service to the same hospital for a
462	period of 2 years and then only upon a showing that the hospital
463	will remain in compliance with the requirements of this
464	paragraph through a demonstration of corrections to the
465	deficiencies that caused expiration of the exemption. Compliance
466	with the requirements of this paragraph includes compliance with
467	the rules adopted pursuant to this paragraph.
468	(k)(j)For mobile surgical facilities and related health
469	care services provided under contract with the Department of
470	Corrections or a private correctional facility operating
471	pursuant to chapter 957.
472	(l)(k)For state veterans' nursing homes operated by or on
473	behalf of the Florida Department of Veterans' Affairs in
474	accordance with part II of chapter 296 for which at least 50
475	percent of the construction cost is federally funded and for
476	which the Federal Government pays a per diem rate not to exceed
477	one-half of the cost of the veterans' care in such state nursing
478	homes. These beds shall not be included in the nursing home bed
479	inventory.
480	(m)(l)For combination within one nursing home facility of
481	the beds or services authorized by two or more certificates of
482	need issued in the same planning subdistrict. An exemption
483	granted under this paragraph shall extend the validity period of
484	the certificates of need to be consolidated by the length of the
485	period beginning upon submission of the exemption request and
486	ending with issuance of the exemption. The longest validity
487	period among the certificates shall be applicable to each of the
488	combined certificates.
489	(n)(m)For division into two or more nursing home
490	facilities of beds or services authorized by one certificate of
491	need issued in the same planning subdistrict. An exemption
492	granted under this paragraph shall extend the validity period of
493	the certificate of need to be divided by the length of the
494	period beginning upon submission of the exemption request and
495	ending with issuance of the exemption.
496	(o)(n)For the addition of hospital beds licensed under
497	chapter 395 for acute care, mental health services,or a
498	hospital-based distinct part skilled nursing unit in a number
499	that may not exceed 10 total beds or 10 percent of the licensed
500	capacity of the bed category being expanded, whichever is
501	greater; for the addition of medical rehabilitation beds
502	licensed under chapter 395 in a number that may not exceed eight
503	total beds or 10 percent of capacity, whichever is greater; or
504	for the addition of mental health services beds licensed under
505	chapter 395 in a number that may not exceed 10 total beds or 10
506	percent of the licensed capacity of the bed category being
507	expanded, whichever is greater. Beds for specialty burn units
508	or, neonatal intensive care units, or comprehensive
509	rehabilitation, or at a long-term care hospital,may not be
510	increased under this paragraph.
511	1. In addition to any other documentation otherwise
512	required by the agency, a request for exemption submitted under
513	this paragraph must:
514	a. Certify that the prior 12-month average occupancy rate
515	for the category of licensed beds being expanded at the facility
516	meets or exceeds 7580percent or, for a hospital-based distinct
517	part skilled nursing unit, the prior 12-month average occupancy
518	rate meets or exceeds 96 percent or, for medical rehabilitation
519	beds, the prior 12-month average occupancy rate meets or exceeds
520	90 percent.
521	b. Certify that any beds of the same type authorized for
522	the facility under this paragraph before the date of the current
523	request for an exemption have been licensed and operational for
524	at least 12 months.
525	2. The timeframes and monitoring process specified in s.
526	408.040(2)(a)-(c) apply to any exemption issued under this
527	paragraph.
528	3. The agency shall count beds authorized under this
529	paragraph as approved beds in the published inventory of
530	hospital beds until the beds are licensed.
531	(p)(o)For the addition of acute care beds, as authorized
532	by rule consistent with s. 395.003(4), in a number that may not
533	exceed 3010total beds or 10 percent of licensed bed capacity,
534	whichever is greater, for temporary beds in a hospital that has
535	experienced high seasonal occupancy within the prior 12-month
536	period or in a hospital that must respond to emergency
537	circumstances.
538	(q)(p)For the addition of nursing home beds licensed
539	under chapter 400 in a number not exceeding 10 total beds or 10
540	percent of the number of beds licensed in the facility being
541	expanded, whichever is greater.
542	1. In addition to any other documentation required by the
543	agency, a request for exemption submitted under this paragraph
544	must:
545	a. Effective until June 30, 2001,Certify that the
546	facility has not had any class I or class II deficiencies within
547	the 30 months preceding the request for addition.
548	b. Effective on July 1, 2001, certify that the facility
549	has been designated as a Gold Seal nursing home under s.
550	400.235.
551	b.c.Certify that the prior 12-month average occupancy
552	rate for the nursing home beds at the facility meets or exceeds
553	96 percent.
554	c.d.Certify that any beds authorized for the facility
555	under this paragraph before the date of the current request for
556	an exemption have been licensed and operational for at least 12
557	months.
558	2. The timeframes and monitoring process specified in s.
559	408.040(2)(a)-(c) apply to any exemption issued under this
560	paragraph.
561	3. The agency shall count beds authorized under this
562	paragraph as approved beds in the published inventory of nursing
563	home beds until the beds are licensed.
564	(q) For establishment of a specialty hospital offering a
565	range of medical service restricted to a defined age or gender
566	group of the population or a restricted range of services
567	appropriate to the diagnosis, care, and treatment of patients
568	with specific categories of medical illnesses or disorders,
569	through the transfer of beds and services from an existing
570	hospital in the same county.
571	(r) For the conversion of hospital-based Medicare and
572	Medicaid certified skilled nursing beds to acute care beds, if
573	the conversion does not involve the construction of new
574	facilities.
575	(s) For the replacement of a statutory rural hospital, if
576	the proposed project site is located in the same district,
577	within 10 miles of the existing facility, and within the current
578	primary service area, defined as the least number of zip codes
579	comprising 75 percent of the hospital's inpatient admissions.
580	For fiscal year 2001-2002 only, for transfer by a health care
581	system of existing services and not more than 100 licensed and
582	approved beds from a hospital in district 1, subdistrict 1, to
583	another location within the same subdistrict in order to
584	establish a satellite facility that will improve access to
585	outpatient and inpatient care for residents of the district and
586	subdistrict and that will use new medical technologies,
587	including advanced diagnostics, computer assisted imaging, and
588	telemedicine to improve care. This paragraph is repealed on July
589	1, 2002.
590	(t) For the conversion of mental health services beds
591	between or among the licensed bed categories defined as beds for
592	mental health services. Beds converted under this paragraph must
593	be licensed and operational for at least 12 months before the
594	hospital may apply for additional conversion affecting beds of
595	the same type.
596	(u) For the creation of at least a 10-bed Level II
597	neonatal intensive care unit upon demonstrating to the agency
598	that the applicant hospital had a minimum of 1,500 live births
599	during the previous 12 months.
600	(v) For the addition of Level II or Level III neonatal
601	intensive care beds in a number not to exceed six beds or 10
602	percent of licensed capacity in that category, whichever is
603	greater, provided that the hospital certifies that the prior 12-
604	month average occupancy rate for the category of licensed
605	neonatal intensive care beds meets or exceeds 75 percent.
606	(w) For replacement of a licensed nursing home on the same
607	site, or within 3 miles of the same site, provided the number of
608	licensed beds does not increase.
609	(x) For consolidation or combination of licensed nursing
610	homes or transfer of beds between licensed nursing homes within
611	the same district, by providers that operate multiple nursing
612	homes within that district, provided there is no increase in the
613	district total of nursing home beds and the relocation does not
614	exceed 30 miles from the original location.
615	(4) A request for exemption under subsection (3) may be
616	made at any time and is not subject to the batching requirements
617	of this section. The request shall be supported by such
618	documentation as the agency requires by rule. The agency shall
619	assess a fee of $250 for each request for exemption submitted
620	under subsection (3).
621	Section 8. Section 408.038, Florida Statutes, is amended
622	to read:
623	408.038 Fees.--The agency shall assess fees on
624	certificate-of-need applications. Such fees shall be for the
625	purpose of funding the functions of the local health councils
626	and the activities of the agency and shall be allocated as
627	provided in s. 408.033. The fee shall be determined as follows:
628	(1) A minimum base fee of $10,000$5,000.
629	(2) In addition to the base fee of $10,000$5,000, 0.015
630	of each dollar of proposed expenditure, except that a fee may
631	not exceed $50,000$22,000.
632	Section 9. Paragraph (e) of subsection (5) and paragraph
633	(c) of subsection (6) of section 408.039, Florida Statutes, are
634	amended to read:
635	408.039 Review process.--The review process for
636	certificates of need shall be as follows:
637	(5) ADMINISTRATIVE HEARINGS.--
638	(e) The agency shall issue its final order within 45 days
639	after receipt of the recommended order. If the agency fails to
640	take action within 45 days, the recommended order of the
641	Division of Administrative Hearings is deemed approvedsuch
642	time, or as otherwise agreed to by the applicant and the agency,
643	the applicant may take appropriate legal action to compel the
644	agency to act. When making a determination on an application for
645	a certificate of need, the agency is specifically exempt from
646	the time limitations provided in s. 120.60(1).
647	(6) JUDICIAL REVIEW.--
648	(c) The court, in its discretion, may award reasonable
649	attorney's fees and costs to the prevailing party if the court
650	finds that there was a complete absence of a justiciable issue
651	of law or fact raised by the losing party. If the losing party
652	is a hospital, the court shall order it to pay the reasonable
653	attorney's fees and costs of the prevailing hospital party,
654	which shall include fees and costs incurred as a result of the
655	administrative hearing and the judicial appeal.
656	Section 10. This act does not preclude review and final
657	agency actions on any certificate of need application that was
658	filed with the Agency for Health Care Administration before the
659	effective date of this act.
660	Section 11. Hospital Statutory and Regulatory Reform
661	Council; legislative intent; creation; membership; duties.--
662	(1) It is the intent of the Legislature to provide for the
663	protection of the public health and safety in the establishment,
664	construction, maintenance, and operation of hospitals. However,
665	the Legislature further intends that the police power of the
666	state be exercised toward that purpose only to the extent
667	necessary and that regulation remain current with the ever-
668	changing standard of care and not restrict the introduction and
669	use of new medical technologies and procedures.
670	(2) In order to achieve the purposes expressed in
671	subsection (1), it is necessary that the state establish a
672	mechanism for the ongoing review and updating of laws regulating
673	hospitals. The Hospital Statutory and Regulatory Reform Council
674	is created and located, for administrative purposes only, within
675	the Agency for Health Care Administration. The council shall
676	consist of no more than 15 members, including:
677	(a) Nine members appointed by the Florida Hospital
678	Association who represent acute care, teaching, specialty,
679	rural, government-owned, for-profit, and not-for-profit
680	hospitals.
681	(b) Two members appointed by the Governor who represent
682	patients.
683	(c) Two members appointed by the President of the Senate
684	who represent private businesses that provide health insurance
685	coverage for their employees, one of whom represents small
686	private businesses and one of whom represents large private
687	businesses. As used in this paragraph, the term "private
688	business" does not include an entity licensed under chapter 627,
689	Florida Statutes, or chapter 641, Florida Statutes, or otherwise
690	licensed or authorized to provide health insurance services,
691	either directly or indirectly, in this state.
692	(d) Two members appointed by the Speaker of the House of
693	Representatives who represent physicians.
694	(3) Council members shall be appointed to serve 2-year
695	terms and may be reappointed. A member shall serve until his or
696	her successor is appointed. The council shall annually elect
697	from among its members a chair and a vice chair. The council
698	shall meet at least twice a year and shall hold additional
699	meetings as it considers necessary. Members appointed by the
700	Florida Hospital Association may not receive compensation or
701	reimbursement of expenses for their services. Members appointed
702	by the Governor, the President of the Senate, or the Speaker of
703	the House of Representatives may be reimbursed for travel
704	expenses by the agency.
705	(4) The council, as its first priority, shall review
706	chapters 395 and 408, Florida Statutes, and shall make
707	recommendations to the Legislature for the repeal of regulatory
708	provisions that are no longer necessary or that fail to promote
709	cost-efficient, high-quality medicine.
710	(5) The council, as its second priority, shall recommend
711	to the Secretary of Health and the Secretary of Health Care
712	Administration regulatory changes relating to hospital licensure
713	and regulation to assist the Department of Health and the Agency
714	for Health Care Administration in carrying out their duties and
715	to ensure that the intent of the Legislature as expressed in
716	this section is carried out.
717	(6) In determining whether a statute or rule is
718	appropriate or necessary, the council shall consider whether:
719	(a) The statute or rule is necessary to prevent
720	substantial harm, which is recognizable and not remote, to the
721	public health, safety, or welfare.
722	(b) The statute or rule restricts the use of new medical
723	technologies or encourages the implementation of more cost-
724	effective medical procedures.
725	(c) The statute or rule has an unreasonable effect on job
726	creation or job retention in the state.
727	(d) The public is or can be effectively protected by other
728	means.
729	(e) The overall cost-effectiveness and economic effect of
730	the proposed statute or rule, including the indirect costs to
731	consumers, will be favorable.
732	(f) A lower-cost regulatory alternative to the statute or
733	rule could be adopted.
734	Section 12. If any law amended by this act was also
735	amended by a law enacted at the 2003 Regular Session of the
736	Legislature, such laws shall be construed as if they had been
737	enacted at the same session of the Legislature, and full effect
738	shall be given to each if possible.
739	Section 13. This act shall take effect July 1, 2003.