HB 0081A, Engrossed 1 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. 51, Ch. 2001-
46	45, Laws of Florida; specifying nonapplication of a
47	moratorium of certificates of need and authorizing
48	approval of certain certificates of need for certain
49	counties under certain circumstances; providing review
50	requirements and bed limitations; amending s. 408.038,
51	F.S.; increasing fees of the certificate-of-need program;
52	amending s. 408.039, F.S.; providing for approval of
53	recommended orders of the Division of Administrative
54	Hearings when the Agency for Health Care Administration
55	fails to take action on an application for a certificate
56	of need within a specified time period; providing for
57	payment of attorney's fees and costs when a hospital is
58	the losing party; providing for review of an application
59	for a certificate of need pending on the effective date of
60	the act; creating the Hospital Statutory and Regulatory
61	Reform Council; providing legislative intent; providing
62	for membership and duties of the council; authorizing and
63	establishing an additional regional perinatal intensive
64	care center in Tampa; providing for construction of the
65	act in pari materia with laws enacted during the 2003
66	Regular Session of the Legislature; providing an effective
67	date.
68
69	Be It Enacted by the Legislature of the State of Florida:
70
71	Section 1. Section 400.244, Florida Statutes, is created
72	to read:
73	400.244 Alternative uses of nursing home beds; funding
74	limitations; applicable codes and requirements; procedures;
75	reconversion; quarterly reports.--
76	(1) It is the intent of the Legislature to allow nursing
77	home facilities to use licensed nursing home facility beds for
78	alternative uses other than nursing home care for extended
79	periods of time exceeding 48 hours.
80	(2) A nursing home may use a contiguous portion of the
81	nursing home facility to meet the needs of the elderly through
82	the use of less restrictive and less institutional methods of
83	long-term care, including, but not limited to, adult day care,
84	assisted living, extended congregate care, or limited nursing
85	services.
86	(3) Funding under assisted-living Medicaid waivers for
87	nursing home facility beds that are used to provide extended
88	congregate care or limited nursing services under this section
89	may be provided only for residents who have resided in the
90	nursing home facility for a minimum of 90 consecutive days.
91	(4) Nursing home facility beds that are used in providing
92	alternative services may share common areas, services, and staff
93	with beds that are designated for nursing home care. Fire codes
94	and life safety codes applicable to nursing home facilities also
95	apply to beds used for alternative purposes under this section.
96	Any alternative use must meet other requirements specified by
97	law for that use.
98	(5) In order to take beds out of service for nursing home
99	care and use them to provide alternative services under this
100	section, a nursing home must submit a written request for
101	approval to the Agency for Health Care Administration in a
102	format specified by the agency. The agency shall approve the
103	request unless it determines that such action will adversely
104	affect access to nursing home care in the geographical area in
105	which the nursing home is located. The agency shall, in its
106	review, consider a district average occupancy of 94 percent or
107	greater at the time of the application as an indicator of an
108	adverse impact. The agency shall review the request for
109	alternative use at each annual license renewal.
110	(6) A nursing home facility that converts beds to an
111	alternative use under this section retains its license for all
112	of the nursing home facility beds and may return those beds to
113	nursing home operation upon 60 days' written notice to the
114	agency unless notice requirements are specified elsewhere in
115	law. The nursing home facility shall continue to pay all
116	licensure fees as required by s. 400.062 and applicable rules
117	but is not required to pay any other state licensure fee for the
118	alternative use.
119	(7) Within 45 days after the end of each calendar quarter,
120	each facility that has nursing home facility beds licensed under
121	this chapter shall report to the agency or its designee the
122	total number of patient days that occurred in each month of the
123	quarter and the number of such days that were Medicaid patient
124	days.
125	Section 2. Subsection (17) of section 400.021, Florida
126	Statutes, is amended to read:
127	400.021 Definitions.--When used in this part, unless the
128	context otherwise requires, the term:
129	(17) "Resident care plan" means a written plan developed,
130	maintained, and reviewed not less than quarterly by a registered
131	nurse, with participation from other facility staff and the
132	resident or his or her designee or legal representative, which
133	includes a comprehensive assessment of the needs of an
134	individual resident; the type and frequency of services required
135	to provide the necessary care for the resident to attain or
136	maintain the highest practicable physical, mental, and
137	psychosocial well-being; a listing of services provided within
138	or outside the facility to meet those needs; and an explanation
139	of service goals. The resident care plan must be signed by the
140	director of nursing or another registered nurse employed by the
141	facility to whom institutional responsibilities have been
142	delegated and bythe resident, the resident's designee, or the
143	resident's legal representative. The facility may not use an
144	agency or temporary registered nurse to satisfy the foregoing
145	requirement and must document the institutional responsibilities
146	that have been delegated to the registered nurse.
147	Section 3. Subsection (10) is added to section 400.23,
148	Florida Statutes, to read:
149	400.23 Rules; evaluation and deficiencies; licensure
150	status.--
151	(10) Agency records, reports, ranking systems, Internet
152	information, and publications must reflect the most current
153	agency actions.
154	Section 4. Subsection (4) of section 400.211, Florida
155	Statutes, is amended to read:
156	400.211 Persons employed as nursing assistants;
157	certification requirement.--
158	(4) When employed by a nursing home facility for a 12-
159	month period or longer, a nursing assistant, to maintain
160	certification, shall submit to a performance review every 12
161	months and must receive regular inservice education based on the
162	outcome of such reviews. The inservice training must:
163	(a) Be sufficient to ensure the continuing competence of
164	nursing assistants and must meet the standard specified in s.
165	464.203(7), must be at least 18 hours per year, and may include
166	hours accrued under s. 464.203(8);
167	(b) Include, at a minimum:
168	1. Techniques for assisting with eating and proper
169	feeding;
170	2. Principles of adequate nutrition and hydration;
171	3. Techniques for assisting and responding to the
172	cognitively impaired resident or the resident with difficult
173	behaviors;
174	4. Techniques for caring for the resident at the end-of-
175	life; and
176	5. Recognizing changes that place a resident at risk for
177	pressure ulcers and falls; and
178	(c) Address areas of weakness as determined in nursing
179	assistant performance reviews and may address the special needs
180	of residents as determined by the nursing home facility staff.
181
182	Costs associated with this training may not be reimbursed from
183	additional Medicaid funding through interim rate adjustments.
184	Section 5. Subsection (17) of section 408.032, Florida
185	Statutes, is amended to read:
186	408.032 Definitions relating to Health Facility and
187	Services Development Act.--As used in ss. 408.031-408.045, the
188	term:
189	(17) "Tertiary health service" means a health service
190	which, due to its high level of intensity, complexity,
191	specialized or limited applicability, and cost, should be
192	limited to, and concentrated in, a limited number of hospitals
193	to ensure the quality, availability, and cost-effectiveness of
194	such service. Examples of such service include, but are not
195	limited to, organ transplantation, adult and pediatric open
196	heart surgery,specialty burn units, neonatal intensive care
197	units, comprehensive rehabilitation, and medical or surgical
198	services which are experimental or developmental in nature to
199	the extent that the provision of such services is not yet
200	contemplated within the commonly accepted course of diagnosis or
201	treatment for the condition addressed by a given service. The
202	agency shall establish by rule a list of all tertiary health
203	services.
204	Section 6. Subsection (5) of section 408.034, Florida
205	Statutes, is amended to read:
206	408.034 Duties and responsibilities of agency; rules.--
207	(5) The agency shall establish by rule a nursing-home-bed-
208	need methodology that has a goal of maintaining a district
209	average occupancy rate of 94 percent and thatreduces the
210	community nursing home bed need for the areas of the state where
211	the agency establishes pilot community diversion programs
212	through the Title XIX aging waiver program.
213	Section 7. Section 408.036, Florida Statutes, is amended
214	to read:
215	408.036 Projects subject to review; exemptions.--
216	(1) APPLICABILITY.--Unless exempt under subsection (3),
217	all health-care-related projects, as described in paragraphs
218	(a)-(h), are subject to review and must file an application for
219	a certificate of need with the agency. The agency is exclusively
220	responsible for determining whether a health-care-related
221	project is subject to review under ss. 408.031-408.045.
222	(a) The addition of beds by new construction or
223	alteration.
224	(b) The new construction or establishment of additional
225	health care facilities, including a replacement health care
226	facility when the proposed project site is not located on the
227	same site as the existing health care facility.
228	(c) The conversion from one type of health care facility
229	to another.
230	(d) An increase in the total licensed bed capacity of a
231	health care facility.
232	(e) The establishment of a hospice or hospice inpatient
233	facility, except as provided in s. 408.043.
234	(f) The establishment of inpatient health services by a
235	health care facility, or a substantial change in such services.
236	(g) An increase in the number of beds for acute care,
237	nursing home care beds, specialty burn units, neonatal intensive
238	care units, comprehensive rehabilitation, mental health
239	services, or hospital-based distinct part skilled nursing units,
240	or at a long-term care hospital.
241	(h) The establishment of tertiary health services.
242	(2) PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless exempt
243	pursuant to subsection (3), projects subject to an expedited
244	review shall include, but not be limited to:
245	(a) Research, education, and training programs.
246	(b) Shared services contracts or projects.
247	(b)(c) A transfer of a certificate of need, except when an
248	existing hospital is acquired by a purchaser, in which case all
249	pending certificates of need filed by the existing hospital and
250	all approved certificates of need owned by that hospital would
251	be acquired by the purchaser.
252	(c)(d)A 50-percent increase in nursing home beds for a
253	facility incorporated and operating in this state for at least
254	60 years on or before July 1, 1988, which has a licensed nursing
255	home facility located on a campus providing a variety of
256	residential settings and supportive services. The increased
257	nursing home beds shall be for the exclusive use of the campus
258	residents. Any application on behalf of an applicant meeting
259	this requirement shall be subject to the base fee of $5,000
260	provided in s. 408.038.
261	(d)(e)Replacement of a health care facility when the
262	proposed project site is located in the same district and within
263	a 1-mile radius of the replaced health care facility.
264	(e)(f)The conversion of mental health services beds
265	licensed under chapter 395 or hospital-based distinct part
266	skilled nursing unit beds to general acute care beds; the
267	conversion of mental health services beds between or among the
268	licensed bed categories defined as beds for mental health
269	services;or the conversion of general acute care beds to beds
270	for mental health services.
271	1. Conversion under this paragraph shall not establish a
272	new licensed bed category at the hospital but shall apply only
273	to categories of beds licensed at that hospital.
274	2. Beds converted under this paragraph must be licensed
275	and operational for at least 12 months before the hospital may
276	apply for additional conversion affecting beds of the same type.
277	(f) Replacement of a nursing home within the same
278	district, provided the proposed project site is located within a
279	geographic area that contains at least 65 percent of the
280	facility's current residents and is within a 30-mile radius of
281	the replaced nursing home.
282	(g) Relocation of a portion of a nursing home's licensed
283	beds to a replacement facility within the same district,
284	provided the relocation is within a 30-mile radius of the
285	existing facility and the total number of nursing home beds in
286	the district does not increase.
287
288	The agency shall develop rules to implement the provisions for
289	expedited review, including time schedule, application content
290	which may be reduced from the full requirements of s.
291	408.037(1), and application processing.
292	(3) EXEMPTIONS.--Upon request, the following projects are
293	subject to exemption from the provisions of subsection (1):
294	(a) For replacement of a licensed health care facility on
295	the same site, provided that the number of beds in each licensed
296	bed category will not increase.
297	(b) For hospice services or for swing beds in a rural
298	hospital, as defined in s. 395.602, in a number that does not
299	exceed one-half of its licensed beds.
300	(c) For the conversion of licensed acute care hospital
301	beds to Medicare and Medicaid certified skilled nursing beds in
302	a rural hospital, as defined in s. 395.602, so long as the
303	conversion of the beds does not involve the construction of new
304	facilities. The total number of skilled nursing beds, including
305	swing beds, may not exceed one-half of the total number of
306	licensed beds in the rural hospital as of July 1, 1993.
307	Certified skilled nursing beds designated under this paragraph,
308	excluding swing beds, shall be included in the community nursing
309	home bed inventory. A rural hospital which subsequently
310	decertifies any acute care beds exempted under this paragraph
311	shall notify the agency of the decertification, and the agency
312	shall adjust the community nursing home bed inventory
313	accordingly.
314	(d) For the addition of nursing home beds at a skilled
315	nursing facility that is part of a retirement community that
316	provides a variety of residential settings and supportive
317	services and that has been incorporated and operated in this
318	state for at least 65 years on or before July 1, 1994. All
319	nursing home beds must not be available to the public but must
320	be for the exclusive use of the community residents.
321	(e) For an increase in the bed capacity of a nursing
322	facility licensed for at least 50 beds as of January 1, 1994,
323	under part II of chapter 400 which is not part of a continuing
324	care facility if, after the increase, the total licensed bed
325	capacity of that facility is not more than 60 beds and if the
326	facility has been continuously licensed since 1950 and has
327	received a superior rating on each of its two most recent
328	licensure surveys.
329	(f) For an inmate health care facility built by or for the
330	exclusive use of the Department of Corrections as provided in
331	chapter 945. This exemption expires when such facility is
332	converted to other uses.
333	(g) For the termination of an inpatient health care
334	service, upon 30 days' written notice to the agency.
335	(h) For the delicensure of beds, upon 30 days' written
336	notice to the agency. A request for exemption submitted under
337	this paragraph must identify the number, the category of beds,
338	and the name of the facility in which the beds to be delicensed
339	are located.
340	(i) For the provision of adult inpatient diagnostic
341	cardiac catheterization services in a hospital.
342	1. In addition to any other documentation otherwise
343	required by the agency, a request for an exemption submitted
344	under this paragraph must comply with the following criteria:
345	a. The applicant must certify it will not provide
346	therapeutic cardiac catheterization pursuant to the grant of the
347	exemption.
348	b. The applicant must certify it will meet and
349	continuously maintain the minimum licensure requirements adopted
350	by the agency governing such programs pursuant to subparagraph
351	2.
352	c. The applicant must certify it will provide a minimum of
353	2 percent of its services to charity and Medicaid patients.
354	2. The agency shall adopt licensure requirements by rule
355	which govern the operation of adult inpatient diagnostic cardiac
356	catheterization programs established pursuant to the exemption
357	provided in this paragraph. The rules shall ensure that such
358	programs:
359	a. Perform only adult inpatient diagnostic cardiac
360	catheterization services authorized by the exemption and will
361	not provide therapeutic cardiac catheterization or any other
362	services not authorized by the exemption.
363	b. Maintain sufficient appropriate equipment and health
364	personnel to ensure quality and safety.
365	c. Maintain appropriate times of operation and protocols
366	to ensure availability and appropriate referrals in the event of
367	emergencies.
368	d. Maintain appropriate program volumes to ensure quality
369	and safety.
370	e. Provide a minimum of 2 percent of its services to
371	charity and Medicaid patients each year.
372	3.a. The exemption provided by this paragraph shall not
373	apply unless the agency determines that the program is in
374	compliance with the requirements of subparagraph 1. and that the
375	program will, after beginning operation, continuously comply
376	with the rules adopted pursuant to subparagraph 2. The agency
377	shall monitor such programs to ensure compliance with the
378	requirements of subparagraph 2.
379	b.(I) The exemption for a program shall expire immediately
380	when the program fails to comply with the rules adopted pursuant
381	to sub-subparagraphs 2.a., b., and c.
382	(II) Beginning 18 months after a program first begins
383	treating patients, the exemption for a program shall expire when
384	the program fails to comply with the rules adopted pursuant to
385	sub-subparagraphs 2.d. and e.
386	(III) If the exemption for a program expires pursuant to
387	sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the
388	agency shall not grant an exemption pursuant to this paragraph
389	for an adult inpatient diagnostic cardiac catheterization
390	program located at the same hospital until 2 years following the
391	date of the determination by the agency that the program failed
392	to comply with the rules adopted pursuant to subparagraph 2.
393	(j) For the provision of percutaneous coronary
394	intervention for patients presenting with emergency myocardial
395	infarctions in a hospital without an approved adult open heart
396	surgery program. In addition to any other documentation required
397	by the agency, a request for an exemption submitted under this
398	paragraph must comply with the following:
399	1. The applicant must certify that it will meet and
400	continuously maintain the requirements adopted by the agency for
401	the provision of these services. These licensure requirements
402	are to be adopted by rule pursuant to ss. 120.536(1) and 120.54
403	and are to be consistent with the guidelines published by the
404	American College of Cardiology and the American Heart
405	Association for the provision of percutaneous coronary
406	interventions in hospitals without adult open heart services. At
407	a minimum, the rules shall require the following:
408	a. Cardiologists must be experienced interventionalists
409	who have performed a minimum of 75 interventions within the
410	previous 12 months.
411	b. The hospital must provide a minimum of 36 emergency
412	interventions annually in order to continue to provide the
413	service.
414	c. The hospital must offer sufficient physician, nursing,
415	and laboratory staff to provide the services 24 hours a day, 7
416	days a week.
417	d. Nursing and technical staff must have demonstrated
418	experience in handling acutely ill patients requiring
419	intervention based on previous experience in dedicated
420	interventional laboratories or surgical centers.
421	e. Cardiac care nursing staff must be adept in hemodynamic
422	monitoring and intra-aortic balloon pump (IABP) management.
423	f. Formalized written transfer agreements must be
424	developed with a hospital with an adult open heart surgery
425	program, and written transport protocols must be in place to
426	ensure safe and efficient transfer of a patient within 60
427	minutes. Transfer and transport agreements must be reviewed and
428	tested, with appropriate documentation maintained at least every
429	3 months.
430	g. Hospitals implementing the service must first undertake
431	a training program of 3 to 6 months that includes establishing
432	standards, testing logistics, creating quality assessment and
433	error management practices, and formalizing patient selection
434	criteria.
435	2. The applicant must certify that it will utilize at all
436	times the patient selection criteria for the performance of
437	primary angioplasty at hospitals without adult open heart
438	surgery programs issued by the American College of Cardiology
439	and the American Heart Association. At a minimum, these criteria
440	would provide for the following:
441	a. Avoidance of interventions in hemodynamically stable
442	patients presenting with identified symptoms or medical
443	histories.
444	b. Transfer of patients presenting with a history of
445	coronary disease and clinical presentation of hemodynamic
446	instability.
447	3. The applicant must agree to submit a quarterly report
448	to the agency detailing patient characteristics, treatment, and
449	outcomes for all patients receiving emergency percutaneous
450	coronary interventions pursuant to this paragraph. This report
451	must be submitted within 15 days after the close of each
452	calendar quarter.
453	4. The exemption provided by this paragraph shall not
454	apply unless the agency determines that the hospital has taken
455	all necessary steps to be in compliance with all requirements of
456	this paragraph, including the training program required pursuant
457	to sub-subparagraph 1.g.
458	5. Failure of the hospital to continuously comply with the
459	requirements of sub-subparagraphs 1.c.-f. and subparagraphs 2.
460	and 3. will result in the immediate expiration of this
461	exemption.
462	6. Failure of the hospital to meet the volume requirements
463	of sub-subparagraphs 1.a.-b. within 18 months after the program
464	begins offering the service will result in the immediate
465	expiration of the exemption.
466	7. If the exemption for this service expires pursuant to
467	subparagraph 5. or subparagraph 6., the agency shall not grant
468	another exemption for this service to the same hospital for a
469	period of 2 years and then only upon a showing that the hospital
470	will remain in compliance with the requirements of this
471	paragraph through a demonstration of corrections to the
472	deficiencies that caused expiration of the exemption. Compliance
473	with the requirements of this paragraph includes compliance with
474	the rules adopted pursuant to this paragraph.
475	(k)(j)For mobile surgical facilities and related health
476	care services provided under contract with the Department of
477	Corrections or a private correctional facility operating
478	pursuant to chapter 957.
479	(l)(k)For state veterans' nursing homes operated by or on
480	behalf of the Florida Department of Veterans' Affairs in
481	accordance with part II of chapter 296 for which at least 50
482	percent of the construction cost is federally funded and for
483	which the Federal Government pays a per diem rate not to exceed
484	one-half of the cost of the veterans' care in such state nursing
485	homes. These beds shall not be included in the nursing home bed
486	inventory.
487	(m)(l)For combination within one nursing home facility of
488	the beds or services authorized by two or more certificates of
489	need issued in the same planning subdistrict. An exemption
490	granted under this paragraph shall extend the validity period of
491	the certificates of need to be consolidated by the length of the
492	period beginning upon submission of the exemption request and
493	ending with issuance of the exemption. The longest validity
494	period among the certificates shall be applicable to each of the
495	combined certificates.
496	(n)(m)For division into two or more nursing home
497	facilities of beds or services authorized by one certificate of
498	need issued in the same planning subdistrict. An exemption
499	granted under this paragraph shall extend the validity period of
500	the certificate of need to be divided by the length of the
501	period beginning upon submission of the exemption request and
502	ending with issuance of the exemption.
503	(o)(n)For the addition of hospital beds licensed under
504	chapter 395 for acute care, mental health services,or a
505	hospital-based distinct part skilled nursing unit in a number
506	that may not exceed 10 total beds or 10 percent of the licensed
507	capacity of the bed category being expanded, whichever is
508	greater; for the addition of medical rehabilitation beds
509	licensed under chapter 395 in a number that may not exceed eight
510	total beds or 10 percent of capacity, whichever is greater; or
511	for the addition of mental health services beds licensed under
512	chapter 395 in a number that may not exceed 10 total beds or 10
513	percent of the licensed capacity of the bed category being
514	expanded, whichever is greater. Beds for specialty burn units
515	or, neonatal intensive care units, or comprehensive
516	rehabilitation, or at a long-term care hospital,may not be
517	increased under this paragraph.
518	1. In addition to any other documentation otherwise
519	required by the agency, a request for exemption submitted under
520	this paragraph must:
521	a. Certify that the prior 12-month average occupancy rate
522	for the category of licensed beds being expanded at the facility
523	meets or exceeds 7580percent or, for a hospital-based distinct
524	part skilled nursing unit, the prior 12-month average occupancy
525	rate meets or exceeds 96 percent or, for medical rehabilitation
526	beds, the prior 12-month average occupancy rate meets or exceeds
527	90 percent.
528	b. Certify that any beds of the same type authorized for
529	the facility under this paragraph before the date of the current
530	request for an exemption have been licensed and operational for
531	at least 12 months.
532	2. The timeframes and monitoring process specified in s.
533	408.040(2)(a)-(c) apply to any exemption issued under this
534	paragraph.
535	3. The agency shall count beds authorized under this
536	paragraph as approved beds in the published inventory of
537	hospital beds until the beds are licensed.
538	(p)(o)For the addition of acute care beds, as authorized
539	by rule consistent with s. 395.003(4), in a number that may not
540	exceed 3010total beds or 10 percent of licensed bed capacity,
541	whichever is greater, for temporary beds in a hospital that has
542	experienced high seasonal occupancy within the prior 12-month
543	period or in a hospital that must respond to emergency
544	circumstances.
545	(q)(p)For the addition of nursing home beds licensed
546	under chapter 400 in a number not exceeding 10 total beds or 10
547	percent of the number of beds licensed in the facility being
548	expanded, whichever is greater.
549	1. In addition to any other documentation required by the
550	agency, a request for exemption submitted under this paragraph
551	must:
552	a. Effective until June 30, 2001,Certify that the
553	facility has not had any class I or class II deficiencies within
554	the 30 months preceding the request for addition.
555	b. Effective on July 1, 2001, certify that the facility
556	has been designated as a Gold Seal nursing home under s.
557	400.235.
558	b.c.Certify that the prior 12-month average occupancy
559	rate for the nursing home beds at the facility meets or exceeds
560	96 percent.
561	c.d.Certify that any beds authorized for the facility
562	under this paragraph before the date of the current request for
563	an exemption have been licensed and operational for at least 12
564	months.
565	2. The timeframes and monitoring process specified in s.
566	408.040(2)(a)-(c) apply to any exemption issued under this
567	paragraph.
568	3. The agency shall count beds authorized under this
569	paragraph as approved beds in the published inventory of nursing
570	home beds until the beds are licensed.
571	(q) For establishment of a specialty hospital offering a
572	range of medical service restricted to a defined age or gender
573	group of the population or a restricted range of services
574	appropriate to the diagnosis, care, and treatment of patients
575	with specific categories of medical illnesses or disorders,
576	through the transfer of beds and services from an existing
577	hospital in the same county.
578	(r) For the conversion of hospital-based Medicare and
579	Medicaid certified skilled nursing beds to acute care beds, if
580	the conversion does not involve the construction of new
581	facilities.
582	(s) For the replacement of a statutory rural hospital, if
583	the proposed project site is located in the same district,
584	within 10 miles of the existing facility, and within the current
585	primary service area, defined as the least number of zip codes
586	comprising 75 percent of the hospital's inpatient admissions.
587	For fiscal year 2001-2002 only, for transfer by a health care
588	system of existing services and not more than 100 licensed and
589	approved beds from a hospital in district 1, subdistrict 1, to
590	another location within the same subdistrict in order to
591	establish a satellite facility that will improve access to
592	outpatient and inpatient care for residents of the district and
593	subdistrict and that will use new medical technologies,
594	including advanced diagnostics, computer assisted imaging, and
595	telemedicine to improve care. This paragraph is repealed on July
596	1, 2002.
597	(t) For the conversion of mental health services beds
598	between or among the licensed bed categories defined as beds for
599	mental health services. Beds converted under this paragraph must
600	be licensed and operational for at least 12 months before the
601	hospital may apply for additional conversion affecting beds of
602	the same type.
603	(u) For the creation of at least a 10-bed Level II
604	neonatal intensive care unit upon demonstrating to the agency
605	that the applicant hospital had a minimum of 1,500 live births
606	during the previous 12 months.
607	(v) For the addition of Level II or Level III neonatal
608	intensive care beds in a number not to exceed six beds or 10
609	percent of licensed capacity in that category, whichever is
610	greater, provided that the hospital certifies that the prior 12-
611	month average occupancy rate for the category of licensed
612	neonatal intensive care beds meets or exceeds 75 percent.
613	(w) For replacement of a licensed nursing home on the same
614	site, or within 3 miles of the same site, provided the number of
615	licensed beds does not increase.
616	(x) For consolidation or combination of licensed nursing
617	homes or transfer of beds between licensed nursing homes within
618	the same planning subdistrict, by providers that operate
619	multiple nursing homes within that planning subdistrict,
620	provided there is no increase in the planning subdistrict total
621	of nursing home beds and the relocation does not exceed 30 miles
622	from the original location.
623	(4) A request for exemption under subsection (3) may be
624	made at any time and is not subject to the batching requirements
625	of this section. The request shall be supported by such
626	documentation as the agency requires by rule. The agency shall
627	assess a fee of $250 for each request for exemption submitted
628	under subsection (3).
629	Section 8. Section 52 of chapter 2001-45, Laws of Florida,
630	is amended to read:
631	Section 52. (1)Notwithstanding the establishment of need
632	as provided for in chapter 408, Florida Statutes, no certificate
633	of need for additional community nursing home beds shall be
634	approved by the agency until July 1, 2006.
635	(2)The Legislature finds that the continued growth in the
636	Medicaid budget for nursing home care has constrained the
637	ability of the state to meet the needs of its elderly residents
638	through the use of less restrictive and less institutional
639	methods of long-term care. It is therefore the intent of the
640	Legislature to limit the increase in Medicaid nursing home
641	expenditures in order to provide funds to invest in long-term
642	care that is community-based and provides supportive services in
643	a manner that is both more cost-effective and more in keeping
644	with the wishes of the elderly residents of this state.
645	(3)This moratorium on certificates of need shall not
646	apply to sheltered nursing home beds in a continuing care
647	retirement community certified by the Department of Insurance
648	pursuant to chapter 651, Florida Statutes.
649	(4)(a) This moratorium on certificates of need shall not
650	apply, and a certificate of need for additional community
651	nursing home beds may be approved, for a county that meets the
652	following circumstances:
653	1. The county has no community nursing home beds.
654	2. The lack of community nursing home beds occurs because
655	all nursing home beds in the county that were licensed on July
656	1, 2001, have subsequently closed.
657	(b) The certificate-of-need review for such circumstances
658	shall be subject to the comparative review process consistent
659	with the provisions of s. 408.039, Florida Statutes, and the
660	number of beds may not exceed the number of beds lost by the
661	county after July 1, 2001.
662	Section 9. Section 408.038, Florida Statutes, is amended
663	to read:
664	408.038 Fees.--The agency shall assess fees on
665	certificate-of-need applications. Such fees shall be for the
666	purpose of funding the functions of the local health councils
667	and the activities of the agency and shall be allocated as
668	provided in s. 408.033. The fee shall be determined as follows:
669	(1) A minimum base fee of $10,000$5,000.
670	(2) In addition to the base fee of $10,000$5,000, 0.015
671	of each dollar of proposed expenditure, except that a fee may
672	not exceed $50,000$22,000.
673	Section 10. Paragraph (e) of subsection (5) and paragraph
674	(c) of subsection (6) of section 408.039, Florida Statutes, are
675	amended to read:
676	408.039 Review process.--The review process for
677	certificates of need shall be as follows:
678	(5) ADMINISTRATIVE HEARINGS.--
679	(e) The agency shall issue its final order within 45 days
680	after receipt of the recommended order. If the agency fails to
681	take action within 45 days, the recommended order of the
682	Division of Administrative Hearings is deemed approvedsuch
683	time, or as otherwise agreed to by the applicant and the agency,
684	the applicant may take appropriate legal action to compel the
685	agency to act. When making a determination on an application for
686	a certificate of need, the agency is specifically exempt from
687	the time limitations provided in s. 120.60(1).
688	(6) JUDICIAL REVIEW.--
689	(c) The court, in its discretion, may award reasonable
690	attorney's fees and costs to the prevailing party if the court
691	finds that there was a complete absence of a justiciable issue
692	of law or fact raised by the losing party. If the losing party
693	is a hospital, the court shall order it to pay the reasonable
694	attorney's fees and costs of the prevailing hospital party,
695	which shall include fees and costs incurred as a result of the
696	administrative hearing and the judicial appeal.
697	Section 11. This act does not preclude review and final
698	agency actions on any certificate of need application that was
699	filed with the Agency for Health Care Administration before the
700	effective date of this act.
701	Section 12. Hospital Statutory and Regulatory Reform
702	Council; legislative intent; creation; membership; duties.--
703	(1) It is the intent of the Legislature to provide for the
704	protection of the public health and safety in the establishment,
705	construction, maintenance, and operation of hospitals. However,
706	the Legislature further intends that the police power of the
707	state be exercised toward that purpose only to the extent
708	necessary and that regulation remain current with the ever-
709	changing standard of care and not restrict the introduction and
710	use of new medical technologies and procedures.
711	(2) In order to achieve the purposes expressed in
712	subsection (1), it is necessary that the state establish a
713	mechanism for the ongoing review and updating of laws regulating
714	hospitals. The Hospital Statutory and Regulatory Reform Council
715	is created and located, for administrative purposes only, within
716	the Agency for Health Care Administration. The council shall
717	consist of no more than 15 members, including:
718	(a) Nine members appointed by the Florida Hospital
719	Association who represent acute care, teaching, specialty,
720	rural, government-owned, for-profit, and not-for-profit
721	hospitals.
722	(b) Two members appointed by the Governor who represent
723	patients.
724	(c) Two members appointed by the President of the Senate
725	who represent private businesses that provide health insurance
726	coverage for their employees, one of whom represents small
727	private businesses and one of whom represents large private
728	businesses. As used in this paragraph, the term "private
729	business" does not include an entity licensed under chapter 627,
730	Florida Statutes, or chapter 641, Florida Statutes, or otherwise
731	licensed or authorized to provide health insurance services,
732	either directly or indirectly, in this state.
733	(d) Two members appointed by the Speaker of the House of
734	Representatives who represent physicians.
735	(3) Council members shall be appointed to serve 2-year
736	terms and may be reappointed. A member shall serve until his or
737	her successor is appointed. The council shall annually elect
738	from among its members a chair and a vice chair. The council
739	shall meet at least twice a year and shall hold additional
740	meetings as it considers necessary. Members appointed by the
741	Florida Hospital Association may not receive compensation or
742	reimbursement of expenses for their services. Members appointed
743	by the Governor, the President of the Senate, or the Speaker of
744	the House of Representatives may be reimbursed for travel
745	expenses by the agency.
746	(4) The council, as its first priority, shall review
747	chapters 395 and 408, Florida Statutes, and shall make
748	recommendations to the Legislature for the repeal of regulatory
749	provisions that are no longer necessary or that fail to promote
750	cost-efficient, high-quality medicine.
751	(5) The council, as its second priority, shall recommend
752	to the Secretary of Health and the Secretary of Health Care
753	Administration regulatory changes relating to hospital licensure
754	and regulation to assist the Department of Health and the Agency
755	for Health Care Administration in carrying out their duties and
756	to ensure that the intent of the Legislature as expressed in
757	this section is carried out.
758	(6) In determining whether a statute or rule is
759	appropriate or necessary, the council shall consider whether:
760	(a) The statute or rule is necessary to prevent
761	substantial harm, which is recognizable and not remote, to the
762	public health, safety, or welfare.
763	(b) The statute or rule restricts the use of new medical
764	technologies or encourages the implementation of more cost-
765	effective medical procedures.
766	(c) The statute or rule has an unreasonable effect on job
767	creation or job retention in the state.
768	(d) The public is or can be effectively protected by other
769	means.
770	(e) The overall cost-effectiveness and economic effect of
771	the proposed statute or rule, including the indirect costs to
772	consumers, will be favorable.
773	(f) A lower-cost regulatory alternative to the statute or
774	rule could be adopted.
775	Section 13. Pursuant to s. 383.19(2), Florida Statutes,
776	there is hereby authorized and established an additional
777	regional perinatal intensive care center in Tampa. The
778	additional regional perinatal intensive care center shall be
779	operated in collaboration with an existing regional perinatal
780	intensive care center. Consistent with s. 383.15, Florida
781	Statutes, the additional regional perinatal intensive care
782	center shall not receive payments authorized under s. 409.9112,
783	Florida Statutes.
784	Section 14. If any law amended by this act was also
785	amended by a law enacted at the 2003 Regular Session of the
786	Legislature, such laws shall be construed as if they had been
787	enacted at the same session of the Legislature, and full effect
788	shall be given to each if possible.
789	Section 15. This act shall take effect July 1, 2003.