HB 0267 2004
1	A bill to be entitled
2	An act relating to health care facilities; creating s.
3	400.244, F.S.; allowing nursing homes to convert beds to
4	alternative uses as specified; providing restrictions on
5	uses of funding under assisted-living Medicaid waivers;
6	providing procedures; providing for the applicability of
7	certain fire and life safety codes; providing
8	applicability of certain laws; requiring a nursing home to
9	submit to the Agency for Health Care Administration a
10	written request for permission to convert beds to
11	alternative uses; providing conditions for disapproving
12	such a request; providing for periodic review; providing
13	for retention of nursing home licensure for converted
14	beds; providing for reconversion of the beds; providing
15	applicability of licensure fees; requiring quarterly
16	reports to the agency relating to patient days; amending
17	s. 400.021, F.S.; redefining the term "resident care
18	plan," as used in part II of ch. 400, F.S.; amending s.
19	400.23, F.S.; providing that certain information from the
20	Agency for Health Care Administration must reflect the
21	most current agency actions; amending s. 400.211, F.S.;
22	revising inservice training requirements for persons
23	employed as nursing assistants in a nursing home facility;
24	amending s. 408.034, F.S.; requiring the nursing-home-bed-
25	need methodology established by the Agency for Health Care
26	Administration by rule to include a goal of maintaining a
27	specified district average occupancy rate; amending s.
28	408.036, F.S., relating to health-care-related projects
29	subject to review for a certificate of need; subjecting
30	certain projects relating to replacement of a nursing home
31	and relocation of nursing home beds to expedited review;
32	revising requirements for certain projects relating to the
33	addition of nursing home beds which are exempt from
34	review; exempting from review certain projects relating to
35	provision of percutaneous coronary intervention for
36	certain emergency patients, replacement of a licensed
37	nursing home bed on the same site or nearby, and
38	consolidation or combination of licensed nursing homes or
39	transfer of beds between licensed nursing homes within the
40	same planning subdistrict; providing rulemaking authority;
41	providing for assessment of exemption-request fees;
42	amending s. 52, ch. 2001-45, Laws of Florida; specifying
43	nonapplication of a moratorium on certificates of need and
44	authorizing approval of certain certificates of need for
45	certain counties under certain circumstances; providing
46	review requirements and bed limitations; providing an
47	effective date.
48
49	Be It Enacted by the Legislature of the State of Florida:
50
51	Section 1. Section 400.244, Florida Statutes, is created
52	to read:
53	400.244 Alternative uses of nursing home beds; funding
54	limitations; applicable codes and requirements; procedures;
55	reconversion; quarterly reports.--
56	(1) It is the intent of the Legislature to allow nursing
57	home facilities to use licensed nursing home facility beds for
58	alternative uses other than nursing home care for extended
59	periods of time exceeding 48 hours.
60	(2) A nursing home may use a contiguous portion of the
61	nursing home facility to meet the needs of the elderly through
62	the use of less restrictive and less institutional methods of
63	long-term care, including, but not limited to, adult day care,
64	assisted living, extended congregate care, or limited nursing
65	services.
66	(3) Funding under assisted-living Medicaid waivers for
67	nursing home facility beds that are used to provide extended
68	congregate care or limited nursing services under this section
69	may be provided only for residents who have resided in the
70	nursing home facility for a minimum of 90 consecutive days.
71	(4) Nursing home facility beds that are used in providing
72	alternative services may share common areas, services, and staff
73	with beds that are designated for nursing home care. Fire codes
74	and life safety codes applicable to nursing home facilities also
75	apply to beds used for alternative purposes under this section.
76	Any alternative use must meet other requirements specified by
77	law for that use.
78	(5) In order to take beds out of service for nursing home
79	care and use them to provide alternative services under this
80	section, a nursing home must submit a written request for
81	approval to the Agency for Health Care Administration in a
82	format specified by the agency. The agency shall approve the
83	request unless it determines that such action will adversely
84	affect access to nursing home care in the geographical area in
85	which the nursing home is located. The agency shall, in its
86	review, consider a district average occupancy of 94 percent or
87	greater at the time of the application as an indicator of an
88	adverse impact. The agency shall review the request for
89	alternative use at each annual license renewal.
90	(6) A nursing home facility that converts beds to an
91	alternative use under this section retains its license for all
92	of the nursing home facility beds and may return those beds to
93	nursing home operation upon 60 days' written notice to the
94	agency unless notice requirements are specified elsewhere in
95	law. The nursing home facility shall continue to pay all
96	licensure fees as required by s. 400.062 and applicable rules
97	but is not required to pay any other state licensure fee for the
98	alternative use.
99	(7) Within 45 days after the end of each calendar quarter,
100	each facility that has nursing home facility beds licensed under
101	this chapter shall report to the agency or its designee the
102	total number of patient days that occurred in each month of the
103	quarter and the number of such days that were Medicaid patient
104	days.
105	Section 2. Subsection (17) of section 400.021, Florida
106	Statutes, is amended to read:
107	400.021 Definitions.--When used in this part, unless the
108	context otherwise requires, the term:
109	(17) "Resident care plan" means a written plan developed,
110	maintained, and reviewed not less than quarterly by a registered
111	nurse, with participation from other facility staff and the
112	resident or his or her designee or legal representative, which
113	includes a comprehensive assessment of the needs of an
114	individual resident; the type and frequency of services required
115	to provide the necessary care for the resident to attain or
116	maintain the highest practicable physical, mental, and
117	psychosocial well-being; a listing of services provided within
118	or outside the facility to meet those needs; and an explanation
119	of service goals. The resident care plan must be signed by the
120	director of nursing or another registered nurse employed by the
121	facility to whom institutional responsibilities have been
122	delegated and bythe resident, the resident's designee, or the
123	resident's legal representative. The facility may not use an
124	agency or temporary registered nurse to satisfy the foregoing
125	requirement and must document the institutional responsibilities
126	that have been delegated to the registered nurse.
127	Section 3. Subsection (10) is added to section 400.23,
128	Florida Statutes, to read:
129	400.23 Rules; evaluation and deficiencies; licensure
130	status.--
131	(10) Agency records, reports, ranking systems, Internet
132	information, and publications must reflect the most current
133	agency actions.
134	Section 4. Subsection (4) of section 400.211, Florida
135	Statutes, is amended to read:
136	400.211 Persons employed as nursing assistants;
137	certification requirement.--
138	(4) When employed by a nursing home facility for a 12-
139	month period or longer, a nursing assistant, to maintain
140	certification, shall submit to a performance review every 12
141	months and must receive regular inservice education based on the
142	outcome of such reviews. The inservice training must:
143	(a) Be sufficient to ensure the continuing competence of
144	nursing assistants and must meet the standard specified in s.
145	464.203(7), must be at least 18 hours per year, and may include
146	hours accrued under s. 464.203(8);
147	(b) Include, at a minimum:
148	1. Techniques for assisting with eating and proper
149	feeding;
150	2. Principles of adequate nutrition and hydration;
151	3. Techniques for assisting and responding to the
152	cognitively impaired resident or the resident with difficult
153	behaviors;
154	4. Techniques for caring for the resident at the end-of-
155	life; and
156	5. Recognizing changes that place a resident at risk for
157	pressure ulcers and falls; and
158	(c) Address areas of weakness as determined in nursing
159	assistant performance reviews and may address the special needs
160	of residents as determined by the nursing home facility staff.
161
162	Costs associated with this training may not be reimbursed from
163	additional Medicaid funding through interim rate adjustments.
164	Section 5. Subsection (5) of section 408.034, Florida
165	Statutes, is amended to read:
166	408.034 Duties and responsibilities of agency; rules.--
167	(5) The agency shall establish by rule a nursing-home-bed-
168	need methodology that has a goal of maintaining a district
169	average occupancy rate of 94 percent and thatreduces the
170	community nursing home bed need for the areas of the state where
171	the agency establishes pilot community diversion programs
172	through the Title XIX aging waiver program.
173	Section 6. Section 408.036, Florida Statutes, is amended
174	to read:
175	408.036 Projects subject to review; exemptions.--
176	(1) APPLICABILITY.--Unless exempt under subsection (3),
177	all health-care-related projects, as described in paragraphs
178	(a)-(h), are subject to review and must file an application for
179	a certificate of need with the agency. The agency is exclusively
180	responsible for determining whether a health-care-related
181	project is subject to review under ss. 408.031-408.045.
182	(a) The addition of beds by new construction or
183	alteration.
184	(b) The new construction or establishment of additional
185	health care facilities, including a replacement health care
186	facility when the proposed project site is not located on the
187	same site as the existing health care facility.
188	(c) The conversion from one type of health care facility
189	to another.
190	(d) An increase in the total licensed bed capacity of a
191	health care facility.
192	(e) The establishment of a hospice or hospice inpatient
193	facility, except as provided in s. 408.043.
194	(f) The establishment of inpatient health services by a
195	health care facility, or a substantial change in such services.
196	(g) An increase in the number of beds for acute care,
197	nursing home care beds, specialty burn units, neonatal intensive
198	care units, comprehensive rehabilitation, mental health
199	services, or hospital-based distinct part skilled nursing units,
200	or at a long-term care hospital.
201	(h) The establishment of tertiary health services.
202	(2) PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless exempt
203	pursuant to subsection (3), projects subject to an expedited
204	review shall include, but not be limited to:
205	(a) Research, education, and training programs.
206	(b) Shared services contracts or projects.
207	(c) A transfer of a certificate of need.
208	(d) A 50-percent increase in nursing home beds for a
209	facility incorporated and operating in this state for at least
210	60 years on or before July 1, 1988, which has a licensed nursing
211	home facility located on a campus providing a variety of
212	residential settings and supportive services. The increased
213	nursing home beds shall be for the exclusive use of the campus
214	residents. Any application on behalf of an applicant meeting
215	this requirement shall be subject to the base fee of $5,000
216	provided in s. 408.038.
217	(e) Replacement of a health care facility when the
218	proposed project site is located in the same district and within
219	a 1-mile radius of the replaced health care facility.
220	(f) The conversion of mental health services beds licensed
221	under chapter 395 or hospital-based distinct part skilled
222	nursing unit beds to general acute care beds; the conversion of
223	mental health services beds between or among the licensed bed
224	categories defined as beds for mental health services; or the
225	conversion of general acute care beds to beds for mental health
226	services.
227	1. Conversion under this paragraph shall not establish a
228	new licensed bed category at the hospital but shall apply only
229	to categories of beds licensed at that hospital.
230	2. Beds converted under this paragraph must be licensed
231	and operational for at least 12 months before the hospital may
232	apply for additional conversion affecting beds of the same type.
233	(g) Replacement of a nursing home within the same
234	district, provided the proposed project site is located within a
235	geographic area that contains at least 65 percent of the
236	facility's current residents and is within a 30-mile radius of
237	the replaced nursing home.
238	(h) Relocation of a portion of a nursing home's licensed
239	beds to a facility within the same district, provided the
240	relocation is within a 30-mile radius of the existing facility
241	and the total number of nursing home beds in the district does
242	not increase.
243
244	The agency shall develop rules to implement the provisions for
245	expedited review, including time schedule, application content
246	which may be reduced from the full requirements of s.
247	408.037(1), and application processing.
248	(3) EXEMPTIONS.--Upon request, the following projects are
249	subject to exemption from the provisions of subsection (1):
250	(a) For replacement of a licensed health care facility on
251	the same site, provided that the number of beds in each licensed
252	bed category will not increase.
253	(b) For hospice services or for swing beds in a rural
254	hospital, as defined in s. 395.602, in a number that does not
255	exceed one-half of its licensed beds.
256	(c) For the conversion of licensed acute care hospital
257	beds to Medicare and Medicaid certified skilled nursing beds in
258	a rural hospital, as defined in s. 395.602, so long as the
259	conversion of the beds does not involve the construction of new
260	facilities. The total number of skilled nursing beds, including
261	swing beds, may not exceed one-half of the total number of
262	licensed beds in the rural hospital as of July 1, 1993.
263	Certified skilled nursing beds designated under this paragraph,
264	excluding swing beds, shall be included in the community nursing
265	home bed inventory. A rural hospital which subsequently
266	decertifies any acute care beds exempted under this paragraph
267	shall notify the agency of the decertification, and the agency
268	shall adjust the community nursing home bed inventory
269	accordingly.
270	(d) For the addition of nursing home beds at a skilled
271	nursing facility that is part of a retirement community that
272	provides a variety of residential settings and supportive
273	services and that has been incorporated and operated in this
274	state for at least 65 years on or before July 1, 1994. All
275	nursing home beds must not be available to the public but must
276	be for the exclusive use of the community residents.
277	(e) For an increase in the bed capacity of a nursing
278	facility licensed for at least 50 beds as of January 1, 1994,
279	under part II of chapter 400 which is not part of a continuing
280	care facility if, after the increase, the total licensed bed
281	capacity of that facility is not more than 60 beds and if the
282	facility has been continuously licensed since 1950 and has
283	received a superior rating on each of its two most recent
284	licensure surveys.
285	(f) For an inmate health care facility built by or for the
286	exclusive use of the Department of Corrections as provided in
287	chapter 945. This exemption expires when such facility is
288	converted to other uses.
289	(g) For the termination of an inpatient health care
290	service, upon 30 days' written notice to the agency.
291	(h) For the delicensure of beds, upon 30 days' written
292	notice to the agency. A request for exemption submitted under
293	this paragraph must identify the number, the category of beds,
294	and the name of the facility in which the beds to be delicensed
295	are located.
296	(i) For the provision of adult inpatient diagnostic
297	cardiac catheterization services in a hospital.
298	1. In addition to any other documentation otherwise
299	required by the agency, a request for an exemption submitted
300	under this paragraph must comply with the following criteria:
301	a. The applicant must certify it will not provide
302	therapeutic cardiac catheterization pursuant to the grant of the
303	exemption.
304	b. The applicant must certify it will meet and
305	continuously maintain the minimum licensure requirements adopted
306	by the agency governing such programs pursuant to subparagraph
307	2.
308	c. The applicant must certify it will provide a minimum of
309	2 percent of its services to charity and Medicaid patients.
310	2. The agency shall adopt licensure requirements by rule
311	which govern the operation of adult inpatient diagnostic cardiac
312	catheterization programs established pursuant to the exemption
313	provided in this paragraph. The rules shall ensure that such
314	programs:
315	a. Perform only adult inpatient diagnostic cardiac
316	catheterization services authorized by the exemption and will
317	not provide therapeutic cardiac catheterization or any other
318	services not authorized by the exemption.
319	b. Maintain sufficient appropriate equipment and health
320	personnel to ensure quality and safety.
321	c. Maintain appropriate times of operation and protocols
322	to ensure availability and appropriate referrals in the event of
323	emergencies.
324	d. Maintain appropriate program volumes to ensure quality
325	and safety.
326	e. Provide a minimum of 2 percent of its services to
327	charity and Medicaid patients each year.
328	3.a. The exemption provided by this paragraph shall not
329	apply unless the agency determines that the program is in
330	compliance with the requirements of subparagraph 1. and that the
331	program will, after beginning operation, continuously comply
332	with the rules adopted pursuant to subparagraph 2. The agency
333	shall monitor such programs to ensure compliance with the
334	requirements of subparagraph 2.
335	b.(I) The exemption for a program shall expire immediately
336	when the program fails to comply with the rules adopted pursuant
337	to sub-subparagraphs 2.a., b., and c.
338	(II) Beginning 18 months after a program first begins
339	treating patients, the exemption for a program shall expire when
340	the program fails to comply with the rules adopted pursuant to
341	sub-subparagraphs 2.d. and e.
342	(III) If the exemption for a program expires pursuant to
343	sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the
344	agency shall not grant an exemption pursuant to this paragraph
345	for an adult inpatient diagnostic cardiac catheterization
346	program located at the same hospital until 2 years following the
347	date of the determination by the agency that the program failed
348	to comply with the rules adopted pursuant to subparagraph 2.
349	(j) For the provision of percutaneous coronary
350	intervention for patients presenting with emergency myocardial
351	infarctions in a hospital without an approved adult open heart
352	surgery program. In addition to any other documentation required
353	by the agency, a request for an exemption submitted under this
354	paragraph must comply with the following:
355	1. The applicant must certify that it will meet and
356	continuously maintain the requirements adopted by the agency for
357	the provision of these services. These licensure requirements
358	are to be adopted by rule pursuant to ss. 120.536(1) and 120.54
359	and are to be consistent with the guidelines published by the
360	American College of Cardiology and the American Heart
361	Association for the provision of percutaneous coronary
362	interventions in hospitals without adult open heart services. At
363	a minimum, the rules shall require the following:
364	a. Cardiologists must be experienced interventionalists
365	who have performed a minimum of 75 interventions within the
366	previous 12 months.
367	b. The hospital must provide a minimum of 36 emergency
368	interventions annually in order to continue to provide the
369	service.
370	c. The hospital must offer sufficient physician, nursing,
371	and laboratory staff to provide the services 24 hours a day, 7
372	days a week.
373	d. Nursing and technical staff must have demonstrated
374	experience in handling acutely ill patients requiring
375	intervention based on previous experience in dedicated
376	interventional laboratories or surgical centers.
377	e. Cardiac care nursing staff must be adept in hemodynamic
378	monitoring and intra-aortic balloon pump (IABP) management.
379	f. Formalized written transfer agreements must be
380	developed with a hospital with an adult open heart surgery
381	program, and written transport protocols must be in place to
382	ensure safe and efficient transfer of a patient within 60
383	minutes. Transfer and transport agreements must be reviewed and
384	tested, with appropriate documentation maintained at least every
385	3 months.
386	g. Hospitals implementing the service must first undertake
387	a training program of 3 to 6 months that includes establishing
388	standards, testing logistics, creating quality assessment and
389	error management practices, and formalizing patient selection
390	criteria.
391	2. The applicant must certify that it will utilize at all
392	times the patient selection criteria for the performance of
393	primary angioplasty at hospitals without adult open heart
394	surgery programs issued by the American College of Cardiology
395	and the American Heart Association. At a minimum, these criteria
396	would provide for the following:
397	a. Avoidance of interventions in hemodynamically stable
398	patients presenting with identified symptoms or medical
399	histories.
400	b. Transfer of patients presenting with a history of
401	coronary disease and clinical presentation of hemodynamic
402	instability.
403	3. The applicant must agree to submit a quarterly report
404	to the agency detailing patient characteristics, treatment, and
405	outcomes for all patients receiving emergency percutaneous
406	coronary interventions pursuant to this paragraph. This report
407	must be submitted within 15 days after the close of each
408	calendar quarter.
409	4. The exemption provided by this paragraph shall not
410	apply unless the agency determines that the hospital has taken
411	all necessary steps to be in compliance with all requirements of
412	this paragraph, including the training program required pursuant
413	to sub-subparagraph 1.g.
414	5. Failure of the hospital to continuously comply with the
415	requirements of sub-subparagraphs 1.c.-f. and subparagraphs 2.
416	and 3. will result in the immediate expiration of this
417	exemption.
418	6. Failure of the hospital to meet the volume requirements
419	of sub-subparagraphs 1.a.-b. within 18 months after the program
420	begins offering the service will result in the immediate
421	expiration of the exemption.
422	7. If the exemption for this service expires pursuant to
423	subparagraph 5. or subparagraph 6., the agency shall not grant
424	another exemption for this service to the same hospital for a
425	period of 2 years and then only upon a showing that the hospital
426	will remain in compliance with the requirements of this
427	paragraph through a demonstration of corrections to the
428	deficiencies that caused expiration of the exemption. Compliance
429	with the requirements of this paragraph includes compliance with
430	the rules adopted pursuant to this paragraph.
431	(k)(j)For mobile surgical facilities and related health
432	care services provided under contract with the Department of
433	Corrections or a private correctional facility operating
434	pursuant to chapter 957.
435	(l)(k)For state veterans' nursing homes operated by or on
436	behalf of the Florida Department of Veterans' Affairs in
437	accordance with part II of chapter 296 for which at least 50
438	percent of the construction cost is federally funded and for
439	which the Federal Government pays a per diem rate not to exceed
440	one-half of the cost of the veterans' care in such state nursing
441	homes. These beds shall not be included in the nursing home bed
442	inventory.
443	(m)(l)For combination within one nursing home facility of
444	the beds or services authorized by two or more certificates of
445	need issued in the same planning subdistrict. An exemption
446	granted under this paragraph shall extend the validity period of
447	the certificates of need to be consolidated by the length of the
448	period beginning upon submission of the exemption request and
449	ending with issuance of the exemption. The longest validity
450	period among the certificates shall be applicable to each of the
451	combined certificates.
452	(n)(m)For division into two or more nursing home
453	facilities of beds or services authorized by one certificate of
454	need issued in the same planning subdistrict. An exemption
455	granted under this paragraph shall extend the validity period of
456	the certificate of need to be divided by the length of the
457	period beginning upon submission of the exemption request and
458	ending with issuance of the exemption.
459	(o)(n)For the addition of hospital beds licensed under
460	chapter 395 for acute care, mental health services, or a
461	hospital-based distinct part skilled nursing unit in a number
462	that may not exceed 10 total beds or 10 percent of the licensed
463	capacity of the bed category being expanded, whichever is
464	greater. Beds for specialty burn units, neonatal intensive care
465	units, or comprehensive rehabilitation, or at a long-term care
466	hospital, may not be increased under this paragraph.
467	1. In addition to any other documentation otherwise
468	required by the agency, a request for exemption submitted under
469	this paragraph must:
470	a. Certify that the prior 12-month average occupancy rate
471	for the category of licensed beds being expanded at the facility
472	meets or exceeds 80 percent or, for a hospital-based distinct
473	part skilled nursing unit, the prior 12-month average occupancy
474	rate meets or exceeds 96 percent.
475	b. Certify that any beds of the same type authorized for
476	the facility under this paragraph before the date of the current
477	request for an exemption have been licensed and operational for
478	at least 12 months.
479	2. The timeframes and monitoring process specified in s.
480	408.040(2)(a)-(c) apply to any exemption issued under this
481	paragraph.
482	3. The agency shall count beds authorized under this
483	paragraph as approved beds in the published inventory of
484	hospital beds until the beds are licensed.
485	(p)(o)For the addition of acute care beds, as authorized
486	by rule consistent with s. 395.003(4), in a number that may not
487	exceed 10 total beds or 10 percent of licensed bed capacity,
488	whichever is greater, for temporary beds in a hospital that has
489	experienced high seasonal occupancy within the prior 12-month
490	period or in a hospital that must respond to emergency
491	circumstances.
492	(q)(p)For the addition of nursing home beds licensed
493	under chapter 400 in a number not exceeding 10 total beds or 10
494	percent of the number of beds licensed in the facility being
495	expanded, whichever is greater, or for the addition of nursing
496	home beds licensed under chapter 400 at a facility that has been
497	designated as a Gold Seal nursing home under s. 400.235 in a
498	number not exceeding 20 total beds or 10 percent of the number
499	of beds licensed in the facility being expanded, whichever is
500	greater.
501	1. In addition to any other documentation required by the
502	agency, a request for exemption submitted under this paragraph
503	must:
504	a. Effective until June 30, 2001,Certify that the
505	facility has not had any class I or class II deficiencies within
506	the 30 months preceding the request for addition.
507	b. Effective on July 1, 2001, certify that the facility
508	has been designated as a Gold Seal nursing home under s.
509	400.235.
510	b.c.Certify that the prior 12-month average occupancy
511	rate for the nursing home beds at the facility meets or exceeds
512	96 percent.
513	c.d.Certify that any beds authorized for the facility
514	under this paragraph before the date of the current request for
515	an exemption have been licensed and operational for at least 12
516	months.
517	2. The timeframes and monitoring process specified in s.
518	408.040(2)(a)-(c) apply to any exemption issued under this
519	paragraph.
520	3. The agency shall count beds authorized under this
521	paragraph as approved beds in the published inventory of nursing
522	home beds until the beds are licensed.
523	(r)(q)For establishment of a specialty hospital offering
524	a range of medical service restricted to a defined age or gender
525	group of the population or a restricted range of services
526	appropriate to the diagnosis, care, and treatment of patients
527	with specific categories of medical illnesses or disorders,
528	through the transfer of beds and services from an existing
529	hospital in the same county.
530	(s)(r)For the conversion of hospital-based Medicare and
531	Medicaid certified skilled nursing beds to acute care beds, if
532	the conversion does not involve the construction of new
533	facilities.
534	(t)(s)1. For an adult open-heart-surgery program to be
535	located in a new hospital provided the new hospital is being
536	established in the location of an existing hospital with an
537	adult open-heart-surgery program, the existing hospital and the
538	existing adult open-heart-surgery program are being relocated to
539	a replacement hospital, and the replacement hospital will
540	utilize a closed-staff model. A hospital is exempt from the
541	certificate-of-need review for the establishment of an open-
542	heart-surgery program if the application for exemption submitted
543	under this paragraph complies with the following criteria:
544	a. The applicant must certify that it will meet and
545	continuously maintain the minimum Florida Administrative Code
546	and any future licensure requirements governing adult open-heart
547	programs adopted by the agency, including the most current
548	guidelines of the American College of Cardiology and American
549	Heart Association Guidelines for Adult Open Heart Programs.
550	b. The applicant must certify that it will maintain
551	sufficient appropriate equipment and health personnel to ensure
552	quality and safety.
553	c. The applicant must certify that it will maintain
554	appropriate times of operation and protocols to ensure
555	availability and appropriate referrals in the event of
556	emergencies.
557	d. The applicant is a newly licensed hospital in a
558	physical location previously owned and licensed to a hospital
559	performing more than 300 open-heart procedures each year,
560	including heart transplants.
561	e. The applicant must certify that it can perform more
562	than 300 diagnostic cardiac catheterization procedures per year,
563	combined inpatient and outpatient, by the end of the third year
564	of its operation.
565	f. The applicant's payor mix at a minimum reflects the
566	community average for Medicaid, charity care, and self-pay
567	patients or the applicant must certify that it will provide a
568	minimum of 5 percent of Medicaid, charity care, and self-pay to
569	open-heart-surgery patients.
570	g. If the applicant fails to meet the established criteria
571	for open-heart programs or fails to reach 300 surgeries per year
572	by the end of its third year of operation, it must show cause
573	why its exemption should not be revoked.
574	h. In order to ensure continuity of available services,
575	the applicant of the newly licensed hospital may apply for this
576	certificate-of-need before taking possession of the physical
577	facilities. The effective date of the certificate-of-need will
578	be concurrent with the effective date of the newly issued
579	hospital license.
580	2. By December 31, 2004, and annually thereafter, the
581	agency shall submit a report to the Legislature providing
582	information concerning the number of requests for exemption
583	received under this paragraph and the number of exemptions
584	granted or denied.
585	3. This paragraph is repealed effective January 1, 2008.
586	(u)(t)1. For the provision of adult open-heart services in
587	a hospital located within the boundaries of Palm Beach, Polk,
588	Martin, St. Lucie, and Indian River Counties if the following
589	conditions are met: The exemption must be based upon objective
590	criteria and address and solve the twin problems of geographic
591	and temporal access. A hospital shall be exempt from the
592	certificate-of-need review for the establishment of an open-
593	heart-surgery program when the application for exemption
594	submitted under this paragraph complies with the following
595	criteria:
596	a. The applicant must certify that it will meet and
597	continuously maintain the minimum licensure requirements adopted
598	by the agency governing adult open-heart programs, including the
599	most current guidelines of the American College of Cardiology
600	and American Heart Association Guidelines for Adult Open Heart
601	Programs.
602	b. The applicant must certify that it will maintain
603	sufficient appropriate equipment and health personnel to ensure
604	quality and safety.
605	c. The applicant must certify that it will maintain
606	appropriate times of operation and protocols to ensure
607	availability and appropriate referrals in the event of
608	emergencies.
609	d. The applicant can demonstrate that it is referring 300
610	or more patients per year from the hospital, including the
611	emergency room, for cardiac services at a hospital with cardiac
612	services, or that the average wait for transfer for 50 percent
613	or more of the cardiac patients exceeds 4 hours.
614	e. The applicant is a general acute care hospital that is
615	in operation for 3 years or more.
616	f. The applicant is performing more than 300 diagnostic
617	cardiac catheterization procedures per year, combined inpatient
618	and outpatient.
619	g. The applicant's payor mix at a minimum reflects the
620	community average for Medicaid, charity care, and self-pay
621	patients or the applicant must certify that it will provide a
622	minimum of 5 percent of Medicaid, charity care, and self-pay to
623	open-heart-surgery patients.
624	h. If the applicant fails to meet the established criteria
625	for open-heart programs or fails to reach 300 surgeries per year
626	by the end of its third year of operation, it must show cause
627	why its exemption should not be revoked.
628	2. By December 31, 2004, and annually thereafter, the
629	Agency for Health Care Administration shall submit a report to
630	the Legislature providing information concerning the number of
631	requests for exemption received under this paragraph and the
632	number of exemptions granted or denied.
633	(v) For replacement of a licensed nursing home on the same
634	site, or within 3 miles of the same site, provided the number of
635	licensed beds does not increase.
636	(w) For consolidation or combination of licensed nursing
637	homes or transfer of beds between licensed nursing homes within
638	the same planning subdistrict, by providers that operate
639	multiple nursing homes within that planning subdistrict,
640	provided there is no increase in the planning subdistrict total
641	of nursing home beds and the relocation does not exceed 30 miles
642	from the original location.
643	(4) A request for exemption under subsection (3) may be
644	made at any time and is not subject to the batching requirements
645	of this section. The request shall be supported by such
646	documentation as the agency requires by rule. The agency shall
647	assess a fee of $250 for each request for exemption submitted
648	under subsection (3).
649	Section 7. Section 52 of chapter 2001-45, Laws of Florida,
650	as amended by section 1693 of chapter 2003-261, Laws of Florida,
651	is amended to read:
652	Section 52. (1)Notwithstanding the establishment of need
653	as provided for in chapter 408, Florida Statutes, no certificate
654	of need for additional community nursing home beds shall be
655	approved by the agency until July 1, 2006.
656	(2)The Legislature finds that the continued growth in the
657	Medicaid budget for nursing home care has constrained the
658	ability of the state to meet the needs of its elderly residents
659	through the use of less restrictive and less institutional
660	methods of long-term care. It is therefore the intent of the
661	Legislature to limit the increase in Medicaid nursing home
662	expenditures in order to provide funds to invest in long-term
663	care that is community-based and provides supportive services in
664	a manner that is both more cost-effective and more in keeping
665	with the wishes of the elderly residents of this state.
666	(3)This moratorium on certificates of need shall not
667	apply to sheltered nursing home beds in a continuing care
668	retirement community certified by the former Department of
669	Insurance or by the Office of Insurance Regulation pursuant to
670	chapter 651, Florida Statutes.
671	(4)(a) This moratorium on certificates of need shall not
672	apply, and a certificate of need for additional community
673	nursing home beds may be approved, for a county that meets the
674	following circumstances:
675	1. The county has no community nursing home beds.
676	2. The lack of community nursing home beds occurs because
677	all nursing home beds in the county that were licensed on July
678	1, 2001, have subsequently closed.
679	(b) The certificate-of-need review for such circumstances
680	shall be subject to the comparative review process consistent
681	with the provisions of s. 408.039, Florida Statutes, and the
682	number of beds may not exceed the number of beds lost by the
683	county after July 1, 2001.
684	Section 8. This act shall take effect upon becoming a law.