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.