HB 0001B 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
9	to 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
24	facility; amending s. 408.032, F.S.; revising the
25	definition of "tertiary health service" under the Health
26	Facility and Services Development Act; amending s.
27	408.034, F.S.; requiring the nursing-home-bed-need
28	methodology established by the Agency for Health Care
29	Administration by rule to include a goal of maintaining a
30	specified district average occupancy rate; amending s.
31	408.036, F.S., relating to health-care-related projects
32	subject to review for a certificate of need; removing
33	shared services contracts or projects from expedited
34	review; revising expedited review requirements for
35	transfer of a certificate of need and conversion of beds
36	for mental health services or general acute care;
37	subjecting projects relating to replacement of a nursing
38	home and relocation of nursing home beds to expedited
39	review; removing the exemption from review for
40	establishment of certain specialty hospitals and a
41	satellite facility; revising requirements for certain
42	projects that are exempt from review; exempting from
43	review projects relating to provision of percutaneous
44	coronary intervention, replacement of a statutory rural
45	hospital, and conversion of mental health services beds;
46	amending s. 52, ch. 2001-45, Laws of Florida; specifying
47	nonapplication of a moratorium on certificates of need
48	and authorizing approval of certain certificates of need
49	for certain counties under certain circumstances;
50	providing review requirements and bed limitations;
51	amending s. 408.038, F.S.; increasing fees of the
52	certificate-of-need program; amending s. 408.039, F.S.;
53	providing for approval of recommended orders of the
54	Division of Administrative Hearings when the Agency for
55	Health Care Administration fails to take action on an
56	application for a certificate of need within a specified
57	time period; providing for payment of attorney's fees and
58	costs when a hospital is the losing party; providing for
59	review of an application for a certificate of need
60	pending on the effective date of the act; creating the
61	Hospital Statutory and Regulatory Reform Council;
62	providing legislative intent; providing for membership
63	and duties of the council; providing for construction of
64	the act in pari materia with laws enacted during the 2003
65	Regular Session or the 2003 Special Session A of the
66	Legislature; providing an effective date.
67
68	Be It Enacted by the Legislature of the State of Florida:
69
70	Section 1. Section 400.244, Florida Statutes, is created
71	to read:
72	400.244 Alternative uses of nursing home beds; funding
73	limitations; applicable codes and requirements; procedures;
74	reconversion; quarterly reports.--
75	(1) It is the intent of the Legislature to allow nursing
76	home facilities to use licensed nursing home facility beds for
77	alternative uses other than nursing home care for extended
78	periods of time exceeding 48 hours.
79	(2) A nursing home may use a contiguous portion of the
80	nursing home facility to meet the needs of the elderly through
81	the use of less restrictive and less institutional methods of
82	long-term care, including, but not limited to, adult day care,
83	assisted living, extended congregate care, or limited nursing
84	services.
85	(3) Funding under assisted-living Medicaid waivers for
86	nursing home facility beds that are used to provide extended
87	congregate care or limited nursing services under this section
88	may be provided only for residents who have resided in the
89	nursing home facility for a minimum of 90 consecutive days.
90	(4) Nursing home facility beds that are used in providing
91	alternative services may share common areas, services, and staff
92	with beds that are designated for nursing home care. Fire codes
93	and life safety codes applicable to nursing home facilities also
94	apply to beds used for alternative purposes under this section.
95	Any alternative use must meet other requirements specified by
96	law for that use.
97	(5) In order to take beds out of service for nursing home
98	care and use them to provide alternative services under this
99	section, a nursing home must submit a written request for
100	approval to the Agency for Health Care Administration in a
101	format specified by the agency. The agency shall approve the
102	request unless it determines that such action will adversely
103	affect access to nursing home care in the geographical area in
104	which the nursing home is located. The agency shall, in its
105	review, consider a district average occupancy of 94 percent or
106	greater at the time of the application as an indicator of an
107	adverse impact. The agency shall review the request for
108	alternative use at each annual license renewal.
109	(6) A nursing home facility that converts beds to an
110	alternative use under this section retains its license for all
111	of the nursing home facility beds and may return those beds to
112	nursing home operation upon 60 days' written notice to the
113	agency unless notice requirements are specified elsewhere in
114	law. The nursing home facility shall continue to pay all
115	licensure fees as required by s. 400.062 and applicable rules
116	but is not required to pay any other state licensure fee for the
117	alternative use.
118	(7) Within 45 days after the end of each calendar quarter,
119	each facility that has nursing home facility beds licensed under
120	this chapter shall report to the agency or its designee the
121	total number of patient days that occurred in each month of the
122	quarter and the number of such days that were Medicaid patient
123	days.
124	Section 2. Subsection (17) of section 400.021, Florida
125	Statutes, is amended to read:
126	400.021 Definitions.--When used in this part, unless the
127	context otherwise requires, the term:
128	(17) "Resident care plan" means a written plan developed,
129	maintained, and reviewed not less than quarterly by a registered
130	nurse, with participation from other facility staff and the
131	resident or his or her designee or legal representative, which
132	includes a comprehensive assessment of the needs of an
133	individual resident; the type and frequency of services required
134	to provide the necessary care for the resident to attain or
135	maintain the highest practicable physical, mental, and
136	psychosocial well-being; a listing of services provided within
137	or outside the facility to meet those needs; and an explanation
138	of service goals. The resident care plan must be signed by the
139	director of nursing or another registered nurse employed by the
140	facility to whom institutional responsibilities have been
141	delegated and bythe resident, the resident's designee, or the
142	resident's legal representative. The facility may not use an
143	agency or temporary registered nurse to satisfy the foregoing
144	requirement and must document the institutional responsibilities
145	that have been delegated to the registered nurse.
146	Section 3. Subsection (10) is added to section 400.23,
147	Florida Statutes, to read:
148	400.23 Rules; evaluation and deficiencies; licensure
149	status.--
150	(10) Agency records, reports, ranking systems, Internet
151	information, and publications must reflect the most current
152	agency actions.
153	Section 4. Subsection (4) of section 400.211, Florida
154	Statutes, is amended to read:
155	400.211 Persons employed as nursing assistants;
156	certification requirement.--
157	(4) When employed by a nursing home facility for a 12-
158	month period or longer, a nursing assistant, to maintain
159	certification, shall submit to a performance review every 12
160	months and must receive regular inservice education based on the
161	outcome of such reviews. The inservice training must:
162	(a) Be sufficient to ensure the continuing competence of
163	nursing assistants and must meet the standard specified in s.
164	464.203(7), must be at least 18 hours per year, and may include
165	hours accrued under s. 464.203(8);
166	(b) Include, at a minimum:
167	1. Techniques for assisting with eating and proper
168	feeding;
169	2. Principles of adequate nutrition and hydration;
170	3. Techniques for assisting and responding to the
171	cognitively impaired resident or the resident with difficult
172	behaviors;
173	4. Techniques for caring for the resident at the end-of-
174	life; and
175	5. Recognizing changes that place a resident at risk for
176	pressure ulcers and falls; and
177	(c) Address areas of weakness as determined in nursing
178	assistant performance reviews and may address the special needs
179	of residents as determined by the nursing home facility staff.
180
181	Costs associated with this training may not be reimbursed from
182	additional Medicaid funding through interim rate adjustments.
183	Section 5. Subsection (17) of section 408.032, Florida
184	Statutes, is amended to read:
185	408.032 Definitions relating to Health Facility and
186	Services Development Act.--As used in ss. 408.031-408.045, the
187	term:
188	(17) "Tertiary health service" means a health service
189	which, due to its high level of intensity, complexity,
190	specialized or limited applicability, and cost, should be
191	limited to, and concentrated in, a limited number of hospitals
192	to ensure the quality, availability, and cost-effectiveness of
193	such service. Examples of such service include, but are not
194	limited to, organ transplantation, adult and pediatric open
195	heart surgery,specialty burn units, neonatal intensive care
196	units, comprehensive rehabilitation, and medical or surgical
197	services which are experimental or developmental in nature to
198	the extent that the provision of such services is not yet
199	contemplated within the commonly accepted course of diagnosis or
200	treatment for the condition addressed by a given service. The
201	agency shall establish by rule a list of all tertiary health
202	services.
203	Section 6. Subsection (5) of section 408.034, Florida
204	Statutes, is amended to read:
205	408.034 Duties and responsibilities of agency; rules.--
206	(5) The agency shall establish by rule a nursing-home-bed-
207	need methodology that has a goal of maintaining a district
208	average occupancy rate of 94 percent and thatreduces the
209	community nursing home bed need for the areas of the state where
210	the agency establishes pilot community diversion programs
211	through the Title XIX aging waiver program.
212	Section 7. Section 408.036, Florida Statutes, is amended
213	to read:
214	408.036 Projects subject to review; exemptions.--
215	(1) APPLICABILITY.--Unless exempt under subsection (3),
216	all health-care-related projects, as described in paragraphs
217	(a)-(h), are subject to review and must file an application for
218	a certificate of need with the agency. The agency is exclusively
219	responsible for determining whether a health-care-related
220	project is subject to review under ss. 408.031-408.045.
221	(a) The addition of beds by new construction or
222	alteration.
223	(b) The new construction or establishment of additional
224	health care facilities, including a replacement health care
225	facility when the proposed project site is not located on the
226	same site as the existing health care facility.
227	(c) The conversion from one type of health care facility
228	to another.
229	(d) An increase in the total licensed bed capacity of a
230	health care facility.
231	(e) The establishment of a hospice or hospice inpatient
232	facility, except as provided in s. 408.043.
233	(f) The establishment of inpatient health services by a
234	health care facility, or a substantial change in such services.
235	(g) An increase in the number of beds for acute care,
236	nursing home care beds, specialty burn units, neonatal intensive
237	care units, comprehensive rehabilitation, mental health
238	services, or hospital-based distinct part skilled nursing units,
239	or at a long-term care hospital.
240	(h) The establishment of tertiary health services.
241	(2) PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless exempt
242	pursuant to subsection (3), projects subject to an expedited
243	review shall include, but not be limited to:
244	(a) Research, education, and training programs.
245	(b) Shared services contracts or projects.
246	(b)(c) A transfer of a certificate of need, except when an
247	existing hospital is acquired by a purchaser, in which case all
248	pending certificates of need filed by the existing hospital and
249	all approved certificates of need owned by that hospital would
250	be acquired by the purchaser.
251	(c)(d)A 50-percent increase in nursing home beds for a
252	facility incorporated and operating in this state for at least
253	60 years on or before July 1, 1988, which has a licensed nursing
254	home facility located on a campus providing a variety of
255	residential settings and supportive services. The increased
256	nursing home beds shall be for the exclusive use of the campus
257	residents. Any application on behalf of an applicant meeting
258	this requirement shall be subject to the base fee of $5,000
259	provided in s. 408.038.
260	(d)(e)Replacement of a health care facility when the
261	proposed project site is located in the same district and within
262	a 1-mile radius of the replaced health care facility.
263	(e)(f)The conversion of mental health services beds
264	licensed under chapter 395 or hospital-based distinct part
265	skilled nursing unit beds to general acute care beds; the
266	conversion of mental health services beds between or among the
267	licensed bed categories defined as beds for mental health
268	services;or the conversion of general acute care beds to beds
269	for mental health services.
270	1. Conversion under this paragraph shall not establish a
271	new licensed bed category at the hospital but shall apply only
272	to categories of beds licensed at that hospital.
273	2. Beds converted under this paragraph must be licensed
274	and operational for at least 12 months before the hospital may
275	apply for additional conversion affecting beds of the same type.
276	(f) Replacement of a nursing home within the same
277	district, provided the proposed project site is located within a
278	geographic area that contains at least 65 percent of the
279	facility's current residents and is within a 30-mile radius of
280	the replaced nursing home.
281	(g) Relocation of a portion of a nursing home's licensed
282	beds to a replacement facility within the same district,
283	provided the relocation is within a 30-mile radius of the
284	existing facility and the total number of nursing home beds in
285	the district does not increase.
286
287	The agency shall develop rules to implement the provisions for
288	expedited review, including time schedule, application content
289	which may be reduced from the full requirements of s.
290	408.037(1), and application processing.
291	(3) EXEMPTIONS.--Upon request, the following projects are
292	subject to exemption from the provisions of subsection (1):
293	(a) For replacement of a licensed health care facility on
294	the same site, provided that the number of beds in each licensed
295	bed category will not increase.
296	(b) For hospice services or for swing beds in a rural
297	hospital, as defined in s. 395.602, in a number that does not
298	exceed one-half of its licensed beds.
299	(c) For the conversion of licensed acute care hospital
300	beds to Medicare and Medicaid certified skilled nursing beds in
301	a rural hospital, as defined in s. 395.602, so long as the
302	conversion of the beds does not involve the construction of new
303	facilities. The total number of skilled nursing beds, including
304	swing beds, may not exceed one-half of the total number of
305	licensed beds in the rural hospital as of July 1, 1993.
306	Certified skilled nursing beds designated under this paragraph,
307	excluding swing beds, shall be included in the community nursing
308	home bed inventory. A rural hospital which subsequently
309	decertifies any acute care beds exempted under this paragraph
310	shall notify the agency of the decertification, and the agency
311	shall adjust the community nursing home bed inventory
312	accordingly.
313	(d) For the addition of nursing home beds at a skilled
314	nursing facility that is part of a retirement community that
315	provides a variety of residential settings and supportive
316	services and that has been incorporated and operated in this
317	state for at least 65 years on or before July 1, 1994. All
318	nursing home beds must not be available to the public but must
319	be for the exclusive use of the community residents.
320	(e) For an increase in the bed capacity of a nursing
321	facility licensed for at least 50 beds as of January 1, 1994,
322	under part II of chapter 400 which is not part of a continuing
323	care facility if, after the increase, the total licensed bed
324	capacity of that facility is not more than 60 beds and if the
325	facility has been continuously licensed since 1950 and has
326	received a superior rating on each of its two most recent
327	licensure surveys.
328	(f) For an inmate health care facility built by or for the
329	exclusive use of the Department of Corrections as provided in
330	chapter 945. This exemption expires when such facility is
331	converted to other uses.
332	(g) For the termination of an inpatient health care
333	service, upon 30 days' written notice to the agency.
334	(h) For the delicensure of beds, upon 30 days' written
335	notice to the agency. A request for exemption submitted under
336	this paragraph must identify the number, the category of beds,
337	and the name of the facility in which the beds to be delicensed
338	are located.
339	(i) For the provision of adult inpatient diagnostic
340	cardiac catheterization services in a hospital.
341	1. In addition to any other documentation otherwise
342	required by the agency, a request for an exemption submitted
343	under this paragraph must comply with the following criteria:
344	a. The applicant must certify it will not provide
345	therapeutic cardiac catheterization pursuant to the grant of the
346	exemption.
347	b. The applicant must certify it will meet and
348	continuously maintain the minimum licensure requirements adopted
349	by the agency governing such programs pursuant to subparagraph
350	2.
351	c. The applicant must certify it will provide a minimum of
352	2 percent of its services to charity and Medicaid patients.
353	2. The agency shall adopt licensure requirements by rule
354	which govern the operation of adult inpatient diagnostic cardiac
355	catheterization programs established pursuant to the exemption
356	provided in this paragraph. The rules shall ensure that such
357	programs:
358	a. Perform only adult inpatient diagnostic cardiac
359	catheterization services authorized by the exemption and will
360	not provide therapeutic cardiac catheterization or any other
361	services not authorized by the exemption.
362	b. Maintain sufficient appropriate equipment and health
363	personnel to ensure quality and safety.
364	c. Maintain appropriate times of operation and protocols
365	to ensure availability and appropriate referrals in the event of
366	emergencies.
367	d. Maintain appropriate program volumes to ensure quality
368	and safety.
369	e. Provide a minimum of 2 percent of its services to
370	charity and Medicaid patients each year.
371	3.a. The exemption provided by this paragraph shall not
372	apply unless the agency determines that the program is in
373	compliance with the requirements of subparagraph 1. and that the
374	program will, after beginning operation, continuously comply
375	with the rules adopted pursuant to subparagraph 2. The agency
376	shall monitor such programs to ensure compliance with the
377	requirements of subparagraph 2.
378	b.(I) The exemption for a program shall expire immediately
379	when the program fails to comply with the rules adopted pursuant
380	to sub-subparagraphs 2.a., b., and c.
381	(II) Beginning 18 months after a program first begins
382	treating patients, the exemption for a program shall expire when
383	the program fails to comply with the rules adopted pursuant to
384	sub-subparagraphs 2.d. and e.
385	(III) If the exemption for a program expires pursuant to
386	sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the
387	agency shall not grant an exemption pursuant to this paragraph
388	for an adult inpatient diagnostic cardiac catheterization
389	program located at the same hospital until 2 years following the
390	date of the determination by the agency that the program failed
391	to comply with the rules adopted pursuant to subparagraph 2.
392	(j) For the provision of percutaneous coronary
393	intervention for patients presenting with emergency myocardial
394	infarctions in a hospital without an approved adult open heart
395	surgery program. In addition to any other documentation required
396	by the agency, a request for an exemption submitted under this
397	paragraph must comply with the following:
398	1. The applicant must certify that it will meet and
399	continuously maintain the requirements adopted by the agency for
400	the provision of these services. These licensure requirements
401	are to be adopted by rule pursuant to ss. 120.536(1) and 120.54
402	and are to be consistent with the guidelines published by the
403	American College of Cardiology and the American Heart
404	Association for the provision of percutaneous coronary
405	interventions in hospitals without adult open heart services. At
406	a minimum, the rules shall require the following:
407	a. Cardiologists must be experienced interventionalists
408	who have performed a minimum of 75 interventions within the
409	previous 12 months.
410	b. The hospital must provide a minimum of 36 emergency
411	interventions annually in order to continue to provide the
412	service.
413	c. The hospital must offer sufficient physician, nursing,
414	and laboratory staff to provide the services 24 hours a day, 7
415	days a week.
416	d. Nursing and technical staff must have demonstrated
417	experience in handling acutely ill patients requiring
418	intervention based on previous experience in dedicated
419	interventional laboratories or surgical centers.
420	e. Cardiac care nursing staff must be adept in hemodynamic
421	monitoring and intra-aortic balloon pump (IABP) management.
422	f. Formalized written transfer agreements must be
423	developed with a hospital with an adult open heart surgery
424	program, and written transport protocols must be in place to
425	ensure safe and efficient transfer of a patient within 60
426	minutes. Transfer and transport agreements must be reviewed and
427	tested, with appropriate documentation maintained at least every
428	3 months.
429	g. Hospitals implementing the service must first undertake
430	a training program of 3 to 6 months that includes establishing
431	standards, testing logistics, creating quality assessment and
432	error management practices, and formalizing patient selection
433	criteria.
434	2. The applicant must certify that it will utilize at all
435	times the patient selection criteria for the performance of
436	primary angioplasty at hospitals without adult open heart
437	surgery programs issued by the American College of Cardiology
438	and the American Heart Association. At a minimum, these criteria
439	would provide for the following:
440	a. Avoidance of interventions in hemodynamically stable
441	patients presenting with identified symptoms or medical
442	histories.
443	b. Transfer of patients presenting with a history of
444	coronary disease and clinical presentation of hemodynamic
445	instability.
446	3. The applicant must agree to submit a quarterly report
447	to the agency detailing patient characteristics, treatment, and
448	outcomes for all patients receiving emergency percutaneous
449	coronary interventions pursuant to this paragraph. This report
450	must be submitted within 15 days after the close of each
451	calendar quarter.
452	4. The exemption provided by this paragraph shall not
453	apply unless the agency determines that the hospital has taken
454	all necessary steps to be in compliance with all requirements of
455	this paragraph, including the training program required pursuant
456	to sub-subparagraph 1.g.
457	5. Failure of the hospital to continuously comply with the
458	requirements of sub-subparagraphs 1.c.-f. and subparagraphs 2.
459	and 3. will result in the immediate expiration of this
460	exemption.
461	6. Failure of the hospital to meet the volume requirements
462	of sub-subparagraphs 1.a.-b. within 18 months after the program
463	begins offering the service will result in the immediate
464	expiration of the exemption.
465	7. If the exemption for this service expires pursuant to
466	subparagraph 5. or subparagraph 6., the agency shall not grant
467	another exemption for this service to the same hospital for a
468	period of 2 years and then only upon a showing that the hospital
469	will remain in compliance with the requirements of this
470	paragraph through a demonstration of corrections to the
471	deficiencies that caused expiration of the exemption. Compliance
472	with the requirements of this paragraph includes compliance with
473	the rules adopted pursuant to this paragraph.
474	(k)(j)For mobile surgical facilities and related health
475	care services provided under contract with the Department of
476	Corrections or a private correctional facility operating
477	pursuant to chapter 957.
478	(l)(k)For state veterans' nursing homes operated by or on
479	behalf of the Florida Department of Veterans' Affairs in
480	accordance with part II of chapter 296 for which at least 50
481	percent of the construction cost is federally funded and for
482	which the Federal Government pays a per diem rate not to exceed
483	one-half of the cost of the veterans' care in such state nursing
484	homes. These beds shall not be included in the nursing home bed
485	inventory.
486	(m)(l)For combination within one nursing home facility of
487	the beds or services authorized by two or more certificates of
488	need issued in the same planning subdistrict. An exemption
489	granted under this paragraph shall extend the validity period of
490	the certificates of need to be consolidated by the length of the
491	period beginning upon submission of the exemption request and
492	ending with issuance of the exemption. The longest validity
493	period among the certificates shall be applicable to each of the
494	combined certificates.
495	(n)(m)For division into two or more nursing home
496	facilities of beds or services authorized by one certificate of
497	need issued in the same planning subdistrict. An exemption
498	granted under this paragraph shall extend the validity period of
499	the certificate of need to be divided by the length of the
500	period beginning upon submission of the exemption request and
501	ending with issuance of the exemption.
502	(o)(n)For the addition of hospital beds licensed under
503	chapter 395 for acute care, mental health services,or a
504	hospital-based distinct part skilled nursing unit in a number
505	that may not exceed 10 total beds or 10 percent of the licensed
506	capacity of the bed category being expanded, whichever is
507	greater; for the addition of medical rehabilitation beds
508	licensed under chapter 395 in a number that may not exceed eight
509	total beds or 10 percent of capacity, whichever is greater; or
510	for the addition of mental health services beds licensed under
511	chapter 395 in a number that may not exceed 10 total beds or 10
512	percent of the licensed capacity of the bed category being
513	expanded, whichever is greater. Beds for specialty burn units
514	or, neonatal intensive care units, or comprehensive
515	rehabilitation, or at a long-term care hospital,may not be
516	increased under this paragraph.
517	1. In addition to any other documentation otherwise
518	required by the agency, a request for exemption submitted under
519	this paragraph must:
520	a. Certify that the prior 12-month average occupancy rate
521	for the category of licensed beds being expanded at the facility
522	meets or exceeds 7580percent or, for a hospital-based distinct
523	part skilled nursing unit, the prior 12-month average occupancy
524	rate meets or exceeds 96 percent or, for medical rehabilitation
525	beds, the prior 12-month average occupancy rate meets or exceeds
526	90 percent.
527	b. Certify that any beds of the same type authorized for
528	the facility under this paragraph before the date of the current
529	request for an exemption have been licensed and operational for
530	at least 12 months.
531	2. The timeframes and monitoring process specified in s.
532	408.040(2)(a)-(c) apply to any exemption issued under this
533	paragraph.
534	3. The agency shall count beds authorized under this
535	paragraph as approved beds in the published inventory of
536	hospital beds until the beds are licensed.
537	(p)(o)For the addition of acute care beds, as authorized
538	by rule consistent with s. 395.003(4), in a number that may not
539	exceed 3010total beds or 10 percent of licensed bed capacity,
540	whichever is greater, for temporary beds in a hospital that has
541	experienced high seasonal occupancy within the prior 12-month
542	period or in a hospital that must respond to emergency
543	circumstances.
544	(q)(p)For the addition of nursing home beds licensed
545	under chapter 400 in a number not exceeding 10 total beds or 10
546	percent of the number of beds licensed in the facility being
547	expanded, whichever is greater.
548	1. In addition to any other documentation required by the
549	agency, a request for exemption submitted under this paragraph
550	must:
551	a. Effective until June 30, 2001,Certify that the
552	facility has not had any class I or class II deficiencies within
553	the 30 months preceding the request for addition.
554	b. Effective on July 1, 2001, certify that the facility
555	has been designated as a Gold Seal nursing home under s.
556	400.235.
557	b.c.Certify that the prior 12-month average occupancy
558	rate for the nursing home beds at the facility meets or exceeds
559	96 percent.
560	c.d.Certify that any beds authorized for the facility
561	under this paragraph before the date of the current request for
562	an exemption have been licensed and operational for at least 12
563	months.
564	2. The timeframes and monitoring process specified in s.
565	408.040(2)(a)-(c) apply to any exemption issued under this
566	paragraph.
567	3. The agency shall count beds authorized under this
568	paragraph as approved beds in the published inventory of nursing
569	home beds until the beds are licensed.
570	(q) For establishment of a specialty hospital offering a
571	range of medical service restricted to a defined age or gender
572	group of the population or a restricted range of services
573	appropriate to the diagnosis, care, and treatment of patients
574	with specific categories of medical illnesses or disorders,
575	through the transfer of beds and services from an existing
576	hospital in the same county.
577	(r) For the conversion of hospital-based Medicare and
578	Medicaid certified skilled nursing beds to acute care beds, if
579	the conversion does not involve the construction of new
580	facilities.
581	(s) For the replacement of a statutory rural hospital, if
582	the proposed project site is located in the same district,
583	within 10 miles of the existing facility, and within the current
584	primary service area, defined as the least number of zip codes
585	comprising 75 percent of the hospital's inpatient admissions.
586	(t) For the conversion of mental health services beds
587	between or among the licensed bed categories defined as beds for
588	mental health services. Beds converted under this paragraph must
589	be licensed and operational for at least 12 months before the
590	hospital may apply for additional conversion affecting beds of
591	the same type.
592	(u) For the creation of at least a 10-bed Level II
593	neonatal intensive care unit upon demonstrating to the agency
594	that the applicant hospital had a minimum of 1,500 live births
595	during the previous 12 months.
596	(v) For the addition of Level II or Level III neonatal
597	intensive care beds in a number not to exceed six beds or 10
598	percent of licensed capacity in that category, whichever is
599	greater, provided that the hospital certifies that the prior 12-
600	month average occupancy rate for the category of licensed
601	neonatal intensive care beds meets or exceeds 75 percent.
602	(w) For replacement of a licensed nursing home on the same
603	site, or within 3 miles of the same site, provided the number of
604	licensed beds does not increase.
605	(x) For consolidation or combination of licensed nursing
606	homes or transfer of beds between licensed nursing homes within
607	the same planning subdistrict, by providers that operate
608	multiple nursing homes within that planning subdistrict,
609	provided there is no increase in the planning subdistrict total
610	of nursing home beds and the relocation does not exceed 30 miles
611	from the original location.
612	(s) For fiscal year 2001-2002 only, for transfer by a
613	health care system of existing services and not more than 100
614	licensed and approved beds from a hospital in district 1,
615	subdistrict 1, to another location within the same subdistrict
616	in order to establish a satellite facility that will improve
617	access to outpatient and inpatient care for residents of the
618	district and subdistrict and that will use new medical
619	technologies, including advanced diagnostics, computer assisted
620	imaging, and telemedicine to improve care. This paragraph is
621	repealed on July 1, 2002.
622	(4) A request for exemption under subsection (3) may be
623	made at any time and is not subject to the batching requirements
624	of this section. The request shall be supported by such
625	documentation as the agency requires by rule. The agency shall
626	assess a fee of $250 for each request for exemption submitted
627	under subsection (3).
628	Section 8. Section 52 of chapter 2001-45, Laws of Florida,
629	is amended to read:
630	Section 52. (1)Notwithstanding the establishment of need
631	as provided for in chapter 408, Florida Statutes, no certificate
632	of need for additional community nursing home beds shall be
633	approved by the agency until July 1, 2006.
634	(2)The Legislature finds that the continued growth in the
635	Medicaid budget for nursing home care has constrained the
636	ability of the state to meet the needs of its elderly residents
637	through the use of less restrictive and less institutional
638	methods of long-term care. It is therefore the intent of the
639	Legislature to limit the increase in Medicaid nursing home
640	expenditures in order to provide funds to invest in long-term
641	care that is community-based and provides supportive services in
642	a manner that is both more cost-effective and more in keeping
643	with the wishes of the elderly residents of this state.
644	(3)This moratorium on certificates of need shall not
645	apply to sheltered nursing home beds in a continuing care
646	retirement community certified by the Department of Insurance
647	pursuant to chapter 651, Florida Statutes.
648	(4)(a) This moratorium on certificates of need shall not
649	apply, and a certificate of need for additional community
650	nursing home beds may be approved, for a county that meets the
651	following circumstances:
652	1. The county has no community nursing home beds.
653	2. The lack of community nursing home beds occurs because
654	all nursing home beds in the county that were licensed on July
655	1, 2001, have subsequently closed.
656	(b) The certificate-of-need review for such circumstances
657	shall be subject to the comparative review process consistent
658	with the provisions of s. 408.039, Florida Statutes, and the
659	number of beds may not exceed the number of beds lost by the
660	county after July 1, 2001.
661	Section 9. Section 408.038, Florida Statutes, is amended
662	to read:
663	408.038 Fees.--The agency shall assess fees on
664	certificate-of-need applications. Such fees shall be for the
665	purpose of funding the functions of the local health councils
666	and the activities of the agency and shall be allocated as
667	provided in s. 408.033. The fee shall be determined as follows:
668	(1) A minimum base fee of $10,000$5,000.
669	(2) In addition to the base fee of $10,000$5,000, 0.015
670	of each dollar of proposed expenditure, except that a fee may
671	not exceed $50,000$22,000.
672	Section 10. Paragraph (e) of subsection (5) and paragraph
673	(c) of subsection (6) of section 408.039, Florida Statutes, are
674	amended to read:
675	408.039 Review process.--The review process for
676	certificates of need shall be as follows:
677	(5) ADMINISTRATIVE HEARINGS.--
678	(e) The agency shall issue its final order within 45 days
679	after receipt of the recommended order. If the agency fails to
680	take action within 45 days, the recommended order of the
681	Division of Administrative Hearings is deemed approvedsuch
682	time, or as otherwise agreed to by the applicant and the agency,
683	the applicant may take appropriate legal action to compel the
684	agency to act. When making a determination on an application for
685	a certificate of need, the agency is specifically exempt from
686	the time limitations provided in s. 120.60(1).
687	(6) JUDICIAL REVIEW.--
688	(c) The court, in its discretion, may award reasonable
689	attorney's fees and costs to the prevailing party if the court
690	finds that there was a complete absence of a justiciable issue
691	of law or fact raised by the losing party. If the losing party
692	is a hospital, the court shall order it to pay the reasonable
693	attorney's fees and costs of the prevailing hospital party,
694	which shall include fees and costs incurred as a result of the
695	administrative hearing and the judicial appeal.
696	Section 11. This act does not preclude review and final
697	agency actions on any certificate of need application that was
698	filed with the Agency for Health Care Administration before the
699	effective date of this act.
700	Section 12. Hospital Statutory and Regulatory Reform
701	Council; legislative intent; creation; membership; duties.--
702	(1) It is the intent of the Legislature to provide for the
703	protection of the public health and safety in the establishment,
704	construction, maintenance, and operation of hospitals. However,
705	the Legislature further intends that the police power of the
706	state be exercised toward that purpose only to the extent
707	necessary and that regulation remain current with the ever-
708	changing standard of care and not restrict the introduction and
709	use of new medical technologies and procedures.
710	(2) In order to achieve the purposes expressed in
711	subsection (1), it is necessary that the state establish a
712	mechanism for the ongoing review and updating of laws regulating
713	hospitals. The Hospital Statutory and Regulatory Reform Council
714	is created and located, for administrative purposes only, within
715	the Agency for Health Care Administration. The council shall
716	consist of no more than 15 members, including:
717	(a) Nine members appointed by the Florida Hospital
718	Association who represent acute care, teaching, specialty,
719	rural, government-owned, for-profit, and not-for-profit
720	hospitals.
721	(b) Two members appointed by the Governor who represent
722	patients.
723	(c) Two members appointed by the President of the Senate
724	who represent private businesses that provide health insurance
725	coverage for their employees, one of whom represents small
726	private businesses and one of whom represents large private
727	businesses. As used in this paragraph, the term "private
728	business" does not include an entity licensed under chapter 627,
729	Florida Statutes, or chapter 641, Florida Statutes, or otherwise
730	licensed or authorized to provide health insurance services,
731	either directly or indirectly, in this state.
732	(d) Two members appointed by the Speaker of the House of
733	Representatives who represent physicians.
734	(3) Council members shall be appointed to serve 2-year
735	terms and may be reappointed. A member shall serve until his or
736	her successor is appointed. The council shall annually elect
737	from among its members a chair and a vice chair. The council
738	shall meet at least twice a year and shall hold additional
739	meetings as it considers necessary. Members appointed by the
740	Florida Hospital Association may not receive compensation or
741	reimbursement of expenses for their services. Members appointed
742	by the Governor, the President of the Senate, or the Speaker of
743	the House of Representatives may be reimbursed for travel
744	expenses by the agency.
745	(4) The council, as its first priority, shall review
746	chapters 395 and 408, Florida Statutes, and shall make
747	recommendations to the Legislature for the repeal of regulatory
748	provisions that are no longer necessary or that fail to promote
749	cost-efficient, high-quality medicine.
750	(5) The council, as its second priority, shall recommend
751	to the Secretary of Health and the Secretary of Health Care
752	Administration regulatory changes relating to hospital licensure
753	and regulation to assist the Department of Health and the Agency
754	for Health Care Administration in carrying out their duties and
755	to ensure that the intent of the Legislature as expressed in
756	this section is carried out.
757	(6) In determining whether a statute or rule is
758	appropriate or necessary, the council shall consider whether:
759	(a) The statute or rule is necessary to prevent
760	substantial harm, which is recognizable and not remote, to the
761	public health, safety, or welfare.
762	(b) The statute or rule restricts the use of new medical
763	technologies or encourages the implementation of more cost-
764	effective medical procedures.
765	(c) The statute or rule has an unreasonable effect on job
766	creation or job retention in the state.
767	(d) The public is or can be effectively protected by other
768	means.
769	(e) The overall cost-effectiveness and economic effect of
770	the proposed statute or rule, including the indirect costs to
771	consumers, will be favorable.
772	(f) A lower-cost regulatory alternative to the statute or
773	rule could be adopted.
774	Section 13. If any law amended by this act was also
775	amended by a law enacted at the 2003 Regular Session or the 2003
776	Special Session A of the Legislature, such laws shall be
777	construed as if they had been enacted at the same session of the
778	Legislature, and full effect shall be given to each if possible.
779	Section 14. This act shall take effect July 1, 2003, or
780	upon becoming a law, whichever occurs later.