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A bill to be entitled |
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An act relating to health care facilities; creating s. |
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400.244, F.S.; allowing nursing homes to convert beds to |
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alternative uses as specified; providing restrictions on |
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uses of funding under assisted-living Medicaid waivers; |
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providing procedures; providing for the applicability of |
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certain fire and life safety codes; providing |
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applicability of certain laws; requiring a nursing home |
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to submit to the Agency for Health Care Administration a |
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written request for permission to convert beds to |
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alternative uses; providing conditions for disapproving |
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such a request; providing for periodic review; providing |
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for retention of nursing home licensure for converted |
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beds; providing for reconversion of the beds; providing |
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applicability of licensure fees; requiring quarterly |
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reports to the agency relating to patient days; amending |
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s. 400.021, F.S.; redefining the term "resident care |
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plan," as used in part II of ch. 400, F.S.; amending s. |
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400.23, F.S.; providing that certain information from the |
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Agency for Health Care Administration must reflect the |
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most current agency actions; amending s. 400.211, F.S.; |
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revising inservice training requirements for persons |
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employed as nursing assistants in a nursing home |
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facility; amending s. 408.032, F.S.; revising the |
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definition of "tertiary health service" under the Health |
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Facility and Services Development Act; amending s. |
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408.034, F.S.; requiring the nursing-home-bed-need |
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methodology established by the Agency for Health Care |
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Administration by rule to include a goal of maintaining a |
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specified district average occupancy rate; amending s. |
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408.036, F.S., relating to health-care-related projects |
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subject to review for a certificate of need; removing |
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shared services contracts or projects from expedited |
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review; revising expedited review requirements for |
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transfer of a certificate of need and conversion of beds |
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for mental health services or general acute care; |
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subjecting projects relating to replacement of a nursing |
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home and relocation of nursing home beds to expedited |
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review; removing the exemption from review for |
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establishment of certain specialty hospitals and a |
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satellite facility; revising requirements for certain |
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projects that are exempt from review; exempting from |
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review projects relating to provision of percutaneous |
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coronary intervention, replacement of a statutory rural |
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hospital, and conversion of mental health services beds; |
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amending s. 52, ch. 2001-45, Laws of Florida; specifying |
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nonapplication of a moratorium on certificates of need |
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and authorizing approval of certain certificates of need |
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for certain counties under certain circumstances; |
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providing review requirements and bed limitations; |
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amending s. 408.038, F.S.; increasing fees of the |
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certificate-of-need program; amending s. 408.039, F.S.; |
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providing for approval of recommended orders of the |
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Division of Administrative Hearings when the Agency for |
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Health Care Administration fails to take action on an |
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application for a certificate of need within a specified |
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time period; providing for payment of attorney's fees and |
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costs when a hospital is the losing party; providing for |
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review of an application for a certificate of need |
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pending on the effective date of the act; creating the |
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Hospital Statutory and Regulatory Reform Council; |
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providing legislative intent; providing for membership |
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and duties of the council; providing for construction of |
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the act in pari materia with laws enacted during the 2003 |
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Regular Session or the 2003 Special Session A of the |
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Legislature; providing an effective date. |
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Be It Enacted by the Legislature of the State of Florida: |
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Section 1. Section 400.244, Florida Statutes, is created |
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to read: |
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400.244 Alternative uses of nursing home beds; funding |
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limitations; applicable codes and requirements; procedures; |
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reconversion; quarterly reports.-- |
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(1) It is the intent of the Legislature to allow nursing |
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home facilities to use licensed nursing home facility beds for |
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alternative uses other than nursing home care for extended |
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periods of time exceeding 48 hours. |
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(2) A nursing home may use a contiguous portion of the |
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nursing home facility to meet the needs of the elderly through |
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the use of less restrictive and less institutional methods of |
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long-term care, including, but not limited to, adult day care, |
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assisted living, extended congregate care, or limited nursing |
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services. |
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(3) Funding under assisted-living Medicaid waivers for |
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nursing home facility beds that are used to provide extended |
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congregate care or limited nursing services under this section |
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may be provided only for residents who have resided in the |
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nursing home facility for a minimum of 90 consecutive days. |
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(4) Nursing home facility beds that are used in providing |
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alternative services may share common areas, services, and staff |
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with beds that are designated for nursing home care. Fire codes |
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and life safety codes applicable to nursing home facilities also |
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apply to beds used for alternative purposes under this section. |
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Any alternative use must meet other requirements specified by |
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law for that use. |
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(5) In order to take beds out of service for nursing home |
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care and use them to provide alternative services under this |
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section, a nursing home must submit a written request for |
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approval to the Agency for Health Care Administration in a |
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format specified by the agency. The agency shall approve the |
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request unless it determines that such action will adversely |
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affect access to nursing home care in the geographical area in |
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which the nursing home is located. The agency shall, in its |
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review, consider a district average occupancy of 94 percent or |
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greater at the time of the application as an indicator of an |
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adverse impact. The agency shall review the request for |
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alternative use at each annual license renewal. |
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(6) A nursing home facility that converts beds to an |
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alternative use under this section retains its license for all |
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of the nursing home facility beds and may return those beds to |
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nursing home operation upon 60 days' written notice to the |
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agency unless notice requirements are specified elsewhere in |
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law. The nursing home facility shall continue to pay all |
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licensure fees as required by s. 400.062 and applicable rules |
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but is not required to pay any other state licensure fee for the |
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alternative use. |
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(7) Within 45 days after the end of each calendar quarter, |
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each facility that has nursing home facility beds licensed under |
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this chapter shall report to the agency or its designee the |
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total number of patient days that occurred in each month of the |
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quarter and the number of such days that were Medicaid patient |
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days. |
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Section 2. Subsection (17) of section 400.021, Florida |
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Statutes, is amended to read: |
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400.021 Definitions.--When used in this part, unless the |
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context otherwise requires, the term: |
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(17) "Resident care plan" means a written plan developed, |
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maintained, and reviewed not less than quarterly by a registered |
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nurse, with participation from other facility staff and the |
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resident or his or her designee or legal representative, which |
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includes a comprehensive assessment of the needs of an |
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individual resident; the type and frequency of services required |
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to provide the necessary care for the resident to attain or |
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maintain the highest practicable physical, mental, and |
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psychosocial well-being; a listing of services provided within |
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or outside the facility to meet those needs; and an explanation |
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of service goals. The resident care plan must be signed by the |
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director of nursing or another registered nurse employed by the |
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facility to whom institutional responsibilities have been |
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delegated and bythe resident, the resident's designee, or the |
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resident's legal representative. The facility may not use an |
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agency or temporary registered nurse to satisfy the foregoing |
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requirement and must document the institutional responsibilities |
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that have been delegated to the registered nurse. |
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Section 3. Subsection (10) is added to section 400.23, |
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Florida Statutes, to read: |
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400.23 Rules; evaluation and deficiencies; licensure |
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status.-- |
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(10) Agency records, reports, ranking systems, Internet |
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information, and publications must reflect the most current |
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agency actions. |
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Section 4. Subsection (4) of section 400.211, Florida |
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Statutes, is amended to read: |
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400.211 Persons employed as nursing assistants; |
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certification requirement.-- |
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(4) When employed by a nursing home facility for a 12- |
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month period or longer, a nursing assistant, to maintain |
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certification, shall submit to a performance review every 12 |
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months and must receive regular inservice education based on the |
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outcome of such reviews. The inservice training must: |
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(a) Be sufficient to ensure the continuing competence of |
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nursing assistants and must meet the standard specified in s. |
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464.203(7), must be at least 18 hours per year, and may include |
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hours accrued under s. 464.203(8); |
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(b) Include, at a minimum: |
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1. Techniques for assisting with eating and proper |
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feeding; |
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2. Principles of adequate nutrition and hydration; |
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3. Techniques for assisting and responding to the |
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cognitively impaired resident or the resident with difficult |
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behaviors; |
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4. Techniques for caring for the resident at the end-of- |
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life; and |
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5. Recognizing changes that place a resident at risk for |
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pressure ulcers and falls; and |
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(c) Address areas of weakness as determined in nursing |
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assistant performance reviews and may address the special needs |
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of residents as determined by the nursing home facility staff. |
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Costs associated with this training may not be reimbursed from |
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additional Medicaid funding through interim rate adjustments. |
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Section 5. Subsection (17) of section 408.032, Florida |
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Statutes, is amended to read: |
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408.032 Definitions relating to Health Facility and |
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Services Development Act.--As used in ss. 408.031-408.045, the |
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term: |
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(17) "Tertiary health service" means a health service |
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which, due to its high level of intensity, complexity, |
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specialized or limited applicability, and cost, should be |
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limited to, and concentrated in, a limited number of hospitals |
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to ensure the quality, availability, and cost-effectiveness of |
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such service. Examples of such service include, but are not |
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limited to, organ transplantation, adult and pediatric open |
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heart surgery,specialty burn units, neonatal intensive care |
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units, comprehensive rehabilitation, and medical or surgical |
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services which are experimental or developmental in nature to |
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the extent that the provision of such services is not yet |
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contemplated within the commonly accepted course of diagnosis or |
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treatment for the condition addressed by a given service. The |
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agency shall establish by rule a list of all tertiary health |
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services. |
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Section 6. Subsection (5) of section 408.034, Florida |
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Statutes, is amended to read: |
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408.034 Duties and responsibilities of agency; rules.-- |
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(5) The agency shall establish by rule a nursing-home-bed- |
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need methodology that has a goal of maintaining a district |
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average occupancy rate of 94 percent and thatreduces the |
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community nursing home bed need for the areas of the state where |
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the agency establishes pilot community diversion programs |
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through the Title XIX aging waiver program. |
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Section 7. Section 408.036, Florida Statutes, is amended |
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to read: |
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408.036 Projects subject to review; exemptions.-- |
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(1) APPLICABILITY.--Unless exempt under subsection (3), |
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all health-care-related projects, as described in paragraphs |
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(a)-(h), are subject to review and must file an application for |
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a certificate of need with the agency. The agency is exclusively |
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responsible for determining whether a health-care-related |
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project is subject to review under ss. 408.031-408.045. |
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(a) The addition of beds by new construction or |
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alteration. |
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(b) The new construction or establishment of additional |
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health care facilities, including a replacement health care |
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facility when the proposed project site is not located on the |
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same site as the existing health care facility. |
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(c) The conversion from one type of health care facility |
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to another. |
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(d) An increase in the total licensed bed capacity of a |
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health care facility. |
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(e) The establishment of a hospice or hospice inpatient |
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facility, except as provided in s. 408.043. |
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(f) The establishment of inpatient health services by a |
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health care facility, or a substantial change in such services. |
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(g) An increase in the number of beds for acute care, |
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nursing home care beds, specialty burn units, neonatal intensive |
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care units, comprehensive rehabilitation, mental health |
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services, or hospital-based distinct part skilled nursing units, |
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or at a long-term care hospital. |
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(h) The establishment of tertiary health services. |
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(2) PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless exempt |
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pursuant to subsection (3), projects subject to an expedited |
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review shall include, but not be limited to: |
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(a) Research, education, and training programs. |
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(b) Shared services contracts or projects. |
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(b)(c) A transfer of a certificate of need, except when an |
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existing hospital is acquired by a purchaser, in which case all |
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pending certificates of need filed by the existing hospital and |
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all approved certificates of need owned by that hospital would |
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be acquired by the purchaser. |
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(c)(d)A 50-percent increase in nursing home beds for a |
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facility incorporated and operating in this state for at least |
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60 years on or before July 1, 1988, which has a licensed nursing |
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home facility located on a campus providing a variety of |
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residential settings and supportive services. The increased |
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nursing home beds shall be for the exclusive use of the campus |
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residents. Any application on behalf of an applicant meeting |
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this requirement shall be subject to the base fee of $5,000 |
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provided in s. 408.038. |
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(d)(e)Replacement of a health care facility when the |
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proposed project site is located in the same district and within |
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a 1-mile radius of the replaced health care facility. |
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(e)(f)The conversion of mental health services beds |
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licensed under chapter 395 or hospital-based distinct part |
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skilled nursing unit beds to general acute care beds; the |
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conversion of mental health services beds between or among the |
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licensed bed categories defined as beds for mental health |
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services;or the conversion of general acute care beds to beds |
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for mental health services. |
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1. Conversion under this paragraph shall not establish a |
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new licensed bed category at the hospital but shall apply only |
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to categories of beds licensed at that hospital. |
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2. Beds converted under this paragraph must be licensed |
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and operational for at least 12 months before the hospital may |
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apply for additional conversion affecting beds of the same type. |
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(f) Replacement of a nursing home within the same |
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district, provided the proposed project site is located within a |
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geographic area that contains at least 65 percent of the |
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facility's current residents and is within a 30-mile radius of |
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the replaced nursing home. |
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(g) Relocation of a portion of a nursing home's licensed |
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beds to a replacement facility within the same district, |
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provided the relocation is within a 30-mile radius of the |
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existing facility and the total number of nursing home beds in |
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the district does not increase. |
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The agency shall develop rules to implement the provisions for |
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expedited review, including time schedule, application content |
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which may be reduced from the full requirements of s. |
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408.037(1), and application processing. |
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(3) EXEMPTIONS.--Upon request, the following projects are |
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subject to exemption from the provisions of subsection (1): |
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(a) For replacement of a licensed health care facility on |
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the same site, provided that the number of beds in each licensed |
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bed category will not increase. |
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(b) For hospice services or for swing beds in a rural |
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hospital, as defined in s. 395.602, in a number that does not |
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exceed one-half of its licensed beds. |
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(c) For the conversion of licensed acute care hospital |
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beds to Medicare and Medicaid certified skilled nursing beds in |
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a rural hospital, as defined in s. 395.602, so long as the |
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conversion of the beds does not involve the construction of new |
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facilities. The total number of skilled nursing beds, including |
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swing beds, may not exceed one-half of the total number of |
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licensed beds in the rural hospital as of July 1, 1993. |
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Certified skilled nursing beds designated under this paragraph, |
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excluding swing beds, shall be included in the community nursing |
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home bed inventory. A rural hospital which subsequently |
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decertifies any acute care beds exempted under this paragraph |
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shall notify the agency of the decertification, and the agency |
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shall adjust the community nursing home bed inventory |
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accordingly. |
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(d) For the addition of nursing home beds at a skilled |
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nursing facility that is part of a retirement community that |
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provides a variety of residential settings and supportive |
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services and that has been incorporated and operated in this |
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state for at least 65 years on or before July 1, 1994. All |
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nursing home beds must not be available to the public but must |
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be for the exclusive use of the community residents. |
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(e) For an increase in the bed capacity of a nursing |
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facility licensed for at least 50 beds as of January 1, 1994, |
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under part II of chapter 400 which is not part of a continuing |
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care facility if, after the increase, the total licensed bed |
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capacity of that facility is not more than 60 beds and if the |
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facility has been continuously licensed since 1950 and has |
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received a superior rating on each of its two most recent |
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licensure surveys. |
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(f) For an inmate health care facility built by or for the |
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exclusive use of the Department of Corrections as provided in |
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chapter 945. This exemption expires when such facility is |
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converted to other uses. |
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(g) For the termination of an inpatient health care |
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service, upon 30 days' written notice to the agency. |
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(h) For the delicensure of beds, upon 30 days' written |
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notice to the agency. A request for exemption submitted under |
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this paragraph must identify the number, the category of beds, |
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and the name of the facility in which the beds to be delicensed |
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are located. |
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(i) For the provision of adult inpatient diagnostic |
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cardiac catheterization services in a hospital. |
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1. In addition to any other documentation otherwise |
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required by the agency, a request for an exemption submitted |
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under this paragraph must comply with the following criteria: |
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a. The applicant must certify it will not provide |
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therapeutic cardiac catheterization pursuant to the grant of the |
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exemption. |
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b. The applicant must certify it will meet and |
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continuously maintain the minimum licensure requirements adopted |
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by the agency governing such programs pursuant to subparagraph |
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2. |
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c. The applicant must certify it will provide a minimum of |
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2 percent of its services to charity and Medicaid patients. |
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2. The agency shall adopt licensure requirements by rule |
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which govern the operation of adult inpatient diagnostic cardiac |
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catheterization programs established pursuant to the exemption |
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provided in this paragraph. The rules shall ensure that such |
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programs: |
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a. Perform only adult inpatient diagnostic cardiac |
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catheterization services authorized by the exemption and will |
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not provide therapeutic cardiac catheterization or any other |
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services not authorized by the exemption. |
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b. Maintain sufficient appropriate equipment and health |
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personnel to ensure quality and safety. |
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c. Maintain appropriate times of operation and protocols |
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to ensure availability and appropriate referrals in the event of |
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emergencies. |
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d. Maintain appropriate program volumes to ensure quality |
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and safety. |
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e. Provide a minimum of 2 percent of its services to |
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charity and Medicaid patients each year. |
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3.a. The exemption provided by this paragraph shall not |
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apply unless the agency determines that the program is in |
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compliance with the requirements of subparagraph 1. and that the |
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program will, after beginning operation, continuously comply |
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with the rules adopted pursuant to subparagraph 2. The agency |
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shall monitor such programs to ensure compliance with the |
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requirements of subparagraph 2. |
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b.(I) The exemption for a program shall expire immediately |
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when the program fails to comply with the rules adopted pursuant |
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to sub-subparagraphs 2.a., b., and c. |
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(II) Beginning 18 months after a program first begins |
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treating patients, the exemption for a program shall expire when |
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the program fails to comply with the rules adopted pursuant to |
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sub-subparagraphs 2.d. and e. |
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(III) If the exemption for a program expires pursuant to |
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sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the |
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agency shall not grant an exemption pursuant to this paragraph |
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for an adult inpatient diagnostic cardiac catheterization |
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program located at the same hospital until 2 years following the |
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date of the determination by the agency that the program failed |
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to comply with the rules adopted pursuant to subparagraph 2. |
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(j) For the provision of percutaneous coronary |
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intervention for patients presenting with emergency myocardial |
394
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infarctions in a hospital without an approved adult open heart |
395
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surgery program. In addition to any other documentation required |
396
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by the agency, a request for an exemption submitted under this |
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paragraph must comply with the following: |
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1. The applicant must certify that it will meet and |
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continuously maintain the requirements adopted by the agency for |
400
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the provision of these services. These licensure requirements |
401
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are to be adopted by rule pursuant to ss. 120.536(1) and 120.54 |
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and are to be consistent with the guidelines published by the |
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American College of Cardiology and the American Heart |
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Association for the provision of percutaneous coronary |
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interventions in hospitals without adult open heart services. At |
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a minimum, the rules shall require the following: |
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a. Cardiologists must be experienced interventionalists |
408
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who have performed a minimum of 75 interventions within the |
409
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previous 12 months. |
410
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b. The hospital must provide a minimum of 36 emergency |
411
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interventions annually in order to continue to provide the |
412
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service. |
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c. The hospital must offer sufficient physician, nursing, |
414
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and laboratory staff to provide the services 24 hours a day, 7 |
415
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days a week. |
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d. Nursing and technical staff must have demonstrated |
417
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experience in handling acutely ill patients requiring |
418
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intervention based on previous experience in dedicated |
419
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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. |