1 | A bill to be entitled |
2 | An act relating to certificate of need; amending s. |
3 | 395.003, F.S.; providing additional conditions for the |
4 | licensure or relicensure of hospitals; exempting currently |
5 | licensed hospitals; amending s. 408.032, F.S.; redefining |
6 | terms relating to the Health Facility and Services |
7 | Development Act; deleting the term "regional area"; |
8 | amending s. 408.033, F.S.; deleting provisions relating to |
9 | regional area health plans; transferring certain duties |
10 | from the Agency for Health Care Administration to the |
11 | Department of Health; deleting an agency responsibility |
12 | relating to orientation of local health council members; |
13 | deleting a requirement that local health councils be |
14 | partly funded by application fees for certificates of |
15 | need; adding sources of funding for local health councils; |
16 | amending s. 408.034, F.S.; revising criteria for |
17 | certificate-of-need review and for issuing licenses to |
18 | health care facilities and health service providers; |
19 | revising criteria for the nursing-home-bed-need |
20 | methodology; amending s. 408.035, F.S.; revising the |
21 | criteria for reviewing applications for certificate-of- |
22 | need determinations; amending s. 408.036, F.S.; revising |
23 | criteria for determining whether a health-care-related |
24 | project is subject to review; providing that the |
25 | replacement or relocation of a nursing home is subject to |
26 | expedited review under specified conditions; revising the |
27 | criteria for determining whether a project is subject to |
28 | exemption from review upon request; repealing the |
29 | exemption for specified services; adding an optional |
30 | exemption for neonatal intensive care units that meet |
31 | certain requirements; providing exemptions for adding beds |
32 | for comprehensive rehabilitation, for beds in state mental |
33 | health treatment facilities, for beds in state mental |
34 | health treatment facilities and state mental health |
35 | forensic facilities, and for beds in state developmental |
36 | services institutions; revising the criteria for optional |
37 | exemption of adult open-heart services; requiring the |
38 | agency to report annually to the Legislature specified |
39 | information concerning exemptions requested and granted |
40 | during the preceding calendar year; adding an optional |
41 | exemption for the provision of percutaneous coronary |
42 | intervention under certain conditions; requiring health |
43 | care facilities and providers to provide to the agency |
44 | notice of the replacement of a health care facility or a |
45 | nursing home, in specified circumstances, consolidation of |
46 | nursing homes, the termination of a health care service, |
47 | and the addition or delicensure of beds; amending s. |
48 | 408.0361, F.S., relating to compliance with requirements |
49 | imposed on diagnostic cardiac catheterization services |
50 | providers; revising the scope of application, to include |
51 | the compliance required of cardiology services and the |
52 | licensure of burn units; requiring the Secretary of Health |
53 | Care Administration to appoint an advisory group to study |
54 | replacing certificate-of-need review of organ transplant |
55 | programs with licensure regulation of organ transplant |
56 | providers; requiring a report to the secretary and the |
57 | Legislature; requiring the secretary to appoint a work |
58 | group to study certificate-of-need regulation and changing |
59 | market conditions related to the supply and distribution |
60 | of hospital beds; requiring a report to the secretary and |
61 | the Legislature; amending s. 408.038, F.S.; revising fees |
62 | assessed on certificate-of-need applications; amending s. |
63 | 408.039, F.S.; revising the review process for |
64 | certificates of need; requiring shorter review cycles; |
65 | deleting a requirement to file a copy of the application |
66 | with the local health council; deleting a requirement to |
67 | consider the district health plan in reviewing and taking |
68 | action on the applications; amending s. 408.040, F.S.; |
69 | applying the conditions to the issuance of a certificate |
70 | of need to the issuance of an exemption; providing that |
71 | certain failures to annually report compliance with |
72 | certain conditions to receiving a certificate of need or |
73 | an exemption constitute noncompliance; repealing s. |
74 | 408.043(5), F.S., relating to the authority of a sole |
75 | acute care hospital in a high growth county to add beds |
76 | without agency review; amending s. 408.0455, F.S.; |
77 | providing for the rules of the agency which are in effect |
78 | on June 30, 2004, rather than those in effect on June 30, |
79 | 1997, to remain in effect; providing for severability; |
80 | amending s. 52, ch. 2001-45, Laws of Florida, as amended; |
81 | specifying nonapplication of moratoriums on certificates |
82 | of need and authorizing approval of certain certificates |
83 | of need for certain counties under certain circumstances; |
84 | providing review requirements and bed limitations; |
85 | providing for future expiration of the moratoriums; |
86 | providing an effective date. |
87 |
|
88 | WHEREAS, appropriate access to adult cardiac care is an |
89 | issue of critical state importance to all residents of the state |
90 | and to all health service planning districts of the state, and |
91 | WHEREAS, the certificate-of-need process, for most |
92 | geographic areas in the state, has provided adequate access to |
93 | adult open-heart-surgery services to Floridians as well as |
94 | tourists, business travelers, indigents, and migrant workers who |
95 | receive such services, and |
96 | WHEREAS, the number of adult open-heart-surgery programs in |
97 | certain health service planning districts has not kept pace with |
98 | the dramatic increase in population in those areas, and |
99 | WHEREAS, there have been numerous technological advances in |
100 | the area of primary angioplasty and stent procedures known |
101 | collectively as percutaneous coronary interventions, and these |
102 | advanced interventional treatments provide the highest standard |
103 | of care for people suffering acute myocardial infarctions, and |
104 | WHEREAS, the success of these interventional treatments |
105 | requires immediate access (within 1 hour) to hospitals having |
106 | interventional technology and a backup open-heart-surgery |
107 | program, and |
108 | WHEREAS, hospitals that cannot perform percutaneous |
109 | coronary interventions must resort to the use of thrombolytics, |
110 | a less effective treatment in many instances, and therefore |
111 | adults in need of percutaneous coronary interventions are being |
112 | denied these procedures due to lack of access, and |
113 | WHEREAS, diagnosis; discharge from the transferring |
114 | hospital; transfer arrangements, including, but not limited to, |
115 | insurance and administrative approval; transportation |
116 | availability; admission to the receiving hospital; staff |
117 | availability at the receiving hospital; and, most importantly, |
118 | bed availability at the receiving hospital as well as travel |
119 | delays to the receiving hospital contribute to the time taken to |
120 | effectuate a transfer of a cardiac patient, and |
121 | WHEREAS, the Legislature finds that timely access and |
122 | availability for every adult in this state, regardless of |
123 | socioeconomic class or geographic location, to these |
124 | interventional treatments and open-heart surgery is of critical |
125 | state concern, especially because myocardial infarctions and |
126 | related coronary disease are no respecters of location or time, |
127 | and |
128 | WHEREAS, to ensure that it provides the quality of care |
129 | desired, each hospital that qualifies for the exemption provided |
130 | by this act will be subject to more stringent criteria and will |
131 | also be subject to continual monitoring by the Agency for Health |
132 | Care Administration, and |
133 | WHEREAS, the Legislature intends to ensure that standards |
134 | of quality are maintained while promoting competition in the |
135 | provision of adult cardiac care, NOW, THEREFORE, |
136 |
|
137 | Be It Enacted by the Legislature of the State of Florida: |
138 |
|
139 | Section 1. Subsections (9), (10), and (11) are added to |
140 | section 395.003, Florida Statutes, to read: |
141 | 395.003 Licensure; issuance, renewal, denial, |
142 | modification, suspension, and revocation.-- |
143 | (9) A hospital may not be licensed or relicensed if: |
144 | (a) The diagnosis-related groups for 65 percent or more of |
145 | the discharges from the hospital, in the most recent year for |
146 | which data is available to the Agency for Health Care |
147 | Administration pursuant to s. 408.061, are for diagnosis, care, |
148 | and treatment of patients who have: |
149 | 1. Cardiac-related diseases and disorders classified as |
150 | diagnosis-related groups 103-145, 478-479, 514-518, or 525-527; |
151 | 2. Orthopedic-related diseases and disorders classified as |
152 | diagnosis-related groups 209-256, 471, 491, 496-503, or 519-520; |
153 | 3. Cancer-related diseases and disorders classified as |
154 | diagnosis-related groups 64, 82, 172, 173, 199, 200, 203, 257- |
155 | 260, 274, 275, 303, 306, 307, 318, 319, 338, 344, 346, 347, 363, |
156 | 366, 367, 400-414, 473, or 492; or |
157 | 4. Any combination of the above discharges. |
158 | (b) The hospital restricts its medical and surgical |
159 | services to primarily or exclusively cardiac, orthopedic, |
160 | surgical, or oncology specialties. |
161 | (10) A hospital licensed as of June 1, 2004, shall be |
162 | exempt from subsection (9) as long as the hospital maintains the |
163 | same ownership, facility street address, and range of services |
164 | that were in existence on June 1, 2004. Any transfer of beds, or |
165 | other agreements that result in the establishment of a hospital |
166 | or hospital services within the intent of this section, shall be |
167 | subject to subsection (9). Unless the hospital is otherwise |
168 | exempt under subsection (9), the agency shall deny or revoke the |
169 | license of a hospital that violates any of the criteria set |
170 | forth in that subsection. |
171 | (11) The agency may adopt rules implementing the licensure |
172 | requirements set forth in subsection (9). Within 14 days after |
173 | rendering its decision on a license application or revocation, |
174 | the agency shall publish its proposed decision in the Florida |
175 | Administrative Weekly. Within 21 days after publication of the |
176 | agency's decision, any authorized person may file a request for |
177 | an administrative hearing. In administrative proceedings |
178 | challenging the approval, denial, or revocation of a license |
179 | pursuant to subsection (9), the hearing must be based on the |
180 | facts and law existing at the time of the agency's proposed |
181 | agency action. Existing hospitals may initiate or intervene in |
182 | an administrative hearing to approve, deny, or revoke licensure |
183 | under subsection (9) based upon a showing that an established |
184 | program will be substantially affected by the issuance or |
185 | renewal of a license to a hospital within the same district or |
186 | service area. |
187 | Section 2. Subsections (9), (13), and (17) of section |
188 | 408.032, Florida Statutes, are amended, and subsection (18) of |
189 | that section is repealed, to read: |
190 | 408.032 Definitions relating to Health Facility and |
191 | Services Development Act.--As used in ss. 408.031-408.045, the |
192 | term: |
193 | (9) "Health services" means inpatient diagnostic, |
194 | curative, or comprehensive medical rehabilitative services and |
195 | includes mental health services. Obstetric services are not |
196 | health services for purposes of ss. 408.031-408.045. |
197 | (13) "Long-term care hospital" means a hospital licensed |
198 | under chapter 395 which meets the requirements of 42 C.F.R. s. |
199 | 412.23(e) and seeks exclusion from the acute care Medicare |
200 | prospective payment system for inpatient hospital services. |
201 | (17) "Tertiary health service" means a health service |
202 | which, due to its high level of intensity, complexity, |
203 | specialized or limited applicability, and cost, should be |
204 | limited to, and concentrated in, a limited number of hospitals |
205 | to ensure the quality, availability, and cost-effectiveness of |
206 | such service. Examples of such service include, but are not |
207 | limited to, pediatric cardiac catheterization, pediatric open- |
208 | heart surgery, organ transplantation, specialty burn units, |
209 | neonatal intensive care units, comprehensive rehabilitation, and |
210 | medical or surgical services which are experimental or |
211 | developmental in nature to the extent that the provision of such |
212 | services is not yet contemplated within the commonly accepted |
213 | course of diagnosis or treatment for the condition addressed by |
214 | a given service. The agency shall establish by rule a list of |
215 | all tertiary health services. |
216 | (18) "Regional area" means any of those regional health |
217 | planning areas established by the agency to which local and |
218 | district health planning funds are directed to local health |
219 | councils through the General Appropriations Act. |
220 | Section 3. Section 408.033, Florida Statutes, is amended |
221 | to read: |
222 | 408.033 Local and state health planning.-- |
223 | (1) LOCAL HEALTH COUNCILS.-- |
224 | (a) Local health councils are hereby established as public |
225 | or private nonprofit agencies serving the counties of a district |
226 | or regional area of the agency. The members of each council |
227 | shall be appointed in an equitable manner by the county |
228 | commissions having jurisdiction in the respective district. Each |
229 | council shall be composed of a number of persons equal to 1 1/2 |
230 | times the number of counties which compose the district or 12 |
231 | members, whichever is greater. Each county in a district shall |
232 | be entitled to at least one member on the council. The balance |
233 | of the membership of the council shall be allocated among the |
234 | counties of the district on the basis of population rounded to |
235 | the nearest whole number; except that in a district composed of |
236 | only two counties, no county shall have fewer than four members. |
237 | The appointees shall be representatives of health care |
238 | providers, health care purchasers, and nongovernmental health |
239 | care consumers, but not excluding elected government officials. |
240 | The members of the consumer group shall include a representative |
241 | number of persons over 60 years of age. A majority of council |
242 | members shall consist of health care purchasers and health care |
243 | consumers. The local health council shall provide each county |
244 | commission a schedule for appointing council members to ensure |
245 | that council membership complies with the requirements of this |
246 | paragraph. The members of the local health council shall elect |
247 | a chair. Members shall serve for terms of 2 years and may be |
248 | eligible for reappointment. |
249 | (b) Each local health council may: |
250 | 1. Develop a district or regional area health plan that |
251 | permits each local health council to develop strategies and set |
252 | priorities for implementation based on its unique local health |
253 | needs. The district or regional area health plan must contain |
254 | preferences for the development of health services and |
255 | facilities, which may be considered by the agency in its review |
256 | of certificate-of-need applications. The district health plan |
257 | shall be submitted to the agency and updated periodically. The |
258 | district health plans shall use a uniform format and be |
259 | submitted to the agency according to a schedule developed by the |
260 | agency in conjunction with the local health councils. The |
261 | schedule must provide for the development of district health |
262 | plans by major sections over a multiyear period. The elements |
263 | of a district plan which are necessary to the review of |
264 | certificate-of-need applications for proposed projects within |
265 | the district may be adopted by the agency as a part of its |
266 | rules. |
267 | 2. Advise the agency on health care issues and resource |
268 | allocations. |
269 | 3. Promote public awareness of community health needs, |
270 | emphasizing health promotion and cost-effective health service |
271 | selection. |
272 | 4. Collect data and conduct analyses and studies related |
273 | to health care needs of the district, including the needs of |
274 | medically indigent persons, and assist the agency and other |
275 | state agencies in carrying out data collection activities that |
276 | relate to the functions in this subsection. |
277 | 5. Monitor the onsite construction progress, if any, of |
278 | certificate-of-need approved projects and report council |
279 | findings to the agency on forms provided by the agency. |
280 | 6. Advise and assist any regional planning councils within |
281 | each district that have elected to address health issues in |
282 | their strategic regional policy plans with the development of |
283 | the health element of the plans to address the health goals and |
284 | policies in the State Comprehensive Plan. |
285 | 7. Advise and assist local governments within each |
286 | district on the development of an optional health plan element |
287 | of the comprehensive plan provided in chapter 163, to assure |
288 | compatibility with the health goals and policies in the State |
289 | Comprehensive Plan and district health plan. To facilitate the |
290 | implementation of this section, the local health council shall |
291 | annually provide the local governments in its service area, upon |
292 | request, with: |
293 | a. A copy and appropriate updates of the district health |
294 | plan; |
295 | b. A report of hospital and nursing home utilization |
296 | statistics for facilities within the local government |
297 | jurisdiction; and |
298 | c. Applicable agency rules and calculated need |
299 | methodologies for health facilities and services regulated under |
300 | s. 408.034 for the district served by the local health council. |
301 | 8. Monitor and evaluate the adequacy, appropriateness, and |
302 | effectiveness, within the district, of local, state, federal, |
303 | and private funds distributed to meet the needs of the medically |
304 | indigent and other underserved population groups. |
305 | 9. In conjunction with the Department of Health Agency for |
306 | Health Care Administration, plan for services at the local level |
307 | for persons infected with the human immunodeficiency virus. |
308 | 10. Provide technical assistance to encourage and support |
309 | activities by providers, purchasers, consumers, and local, |
310 | regional, and state agencies in meeting the health care goals, |
311 | objectives, and policies adopted by the local health council. |
312 | 11. Provide the agency with data required by rule for the |
313 | review of certificate-of-need applications and the projection of |
314 | need for health services and facilities in the district. |
315 | (c) Local health councils may conduct public hearings |
316 | pursuant to s. 408.039(3)(b). |
317 | (d) Each local health council shall enter into a |
318 | memorandum of agreement with each regional planning council in |
319 | its district that elects to address health issues in its |
320 | strategic regional policy plan. In addition, each local health |
321 | council shall enter into a memorandum of agreement with each |
322 | local government that includes an optional health element in its |
323 | comprehensive plan. Each memorandum of agreement must specify |
324 | the manner in which each local government, regional planning |
325 | council, and local health council will coordinate its activities |
326 | to ensure a unified approach to health planning and |
327 | implementation efforts. |
328 | (e) Local health councils may employ personnel or contract |
329 | for staffing services with persons who possess appropriate |
330 | qualifications to carry out the councils' purposes. However, |
331 | such personnel are not state employees. |
332 | (f) Personnel of the local health councils shall provide |
333 | an annual orientation to council members about council member |
334 | responsibilities. The orientation shall include presentations |
335 | and participation by agency staff. |
336 | (g) Each local health council is authorized to accept and |
337 | receive, in furtherance of its health planning functions, funds, |
338 | grants, and services from governmental agencies and from private |
339 | or civic sources and to perform studies related to local health |
340 | planning in exchange for such funds, grants, or services. Each |
341 | local health council shall, no later than January 30 of each |
342 | year, render an accounting of the receipt and disbursement of |
343 | such funds received by it to the Department of Health agency. |
344 | The department agency shall consolidate all such reports and |
345 | submit such consolidated report to the Legislature no later than |
346 | March 1 of each year. Funds received by a local health council |
347 | pursuant to this paragraph shall not be deemed to be a |
348 | substitute for, or an offset against, any funding provided |
349 | pursuant to subsection (2). |
350 | (2) FUNDING.-- |
351 | (a) The Legislature intends that the cost of local health |
352 | councils be borne by application fees for certificates of need |
353 | and by assessments on selected health care facilities subject to |
354 | facility licensure by the Agency for Health Care Administration, |
355 | including abortion clinics, assisted living facilities, |
356 | ambulatory surgical centers, birthing centers, clinical |
357 | laboratories except community nonprofit blood banks and clinical |
358 | laboratories operated by practitioners for exclusive use |
359 | regulated under s. 483.035, home health agencies, hospices, |
360 | hospitals, intermediate care facilities for the developmentally |
361 | disabled, nursing homes, health care clinics, and multiphasic |
362 | testing centers and by assessments on organizations subject to |
363 | certification by the agency pursuant to chapter 641, part III, |
364 | including health maintenance organizations and prepaid health |
365 | clinics. |
366 | (b)1. A hospital licensed under chapter 395, a nursing |
367 | home licensed under chapter 400, and an assisted living facility |
368 | licensed under chapter 400 shall be assessed an annual fee based |
369 | on number of beds. |
370 | 2. All other facilities and organizations listed in |
371 | paragraph (a) shall each be assessed an annual fee of $150. |
372 | 3. Facilities operated by the Department of Children and |
373 | Family Services, the Department of Health, or the Department of |
374 | Corrections and any hospital which meets the definition of rural |
375 | hospital pursuant to s. 395.602 are exempt from the assessment |
376 | required in this subsection. |
377 | (c)1. The agency shall, by rule, establish fees for |
378 | hospitals and nursing homes based on an assessment of $2 per |
379 | bed. However, no such facility shall be assessed more than a |
380 | total of $500 under this subsection. |
381 | 2. The agency shall, by rule, establish fees for assisted |
382 | living facilities based on an assessment of $1 per bed. However, |
383 | no such facility shall be assessed more than a total of $150 |
384 | under this subsection. |
385 | 3. The agency shall, by rule, establish an annual fee of |
386 | $150 for all other facilities and organizations listed in |
387 | paragraph (a). |
388 | (d) The agency shall, by rule, establish a facility |
389 | billing and collection process for the billing and collection of |
390 | the health facility fees authorized by this subsection. |
391 | (e) A health facility which is assessed a fee under this |
392 | subsection is subject to a fine of $100 per day for each day in |
393 | which the facility is late in submitting its annual fee up to |
394 | maximum of the annual fee owed by the facility. A facility |
395 | which refuses to pay the fee or fine is subject to the |
396 | forfeiture of its license. |
397 | (f) The agency shall deposit in the Health Care Trust Fund |
398 | all health care facility assessments that are assessed under |
399 | this subsection and proceeds from the certificate-of-need |
400 | application fees. The agency shall transfer such funds to the |
401 | Department of Health for an amount sufficient to maintain the |
402 | aggregate funding of level for the local health councils as |
403 | specified in the General Appropriations Act. The remaining |
404 | certificate-of-need application fees shall be used only for the |
405 | purpose of administering the certificate-of-need program Health |
406 | Facility and Services Development Act. |
407 | (3) DUTIES AND RESPONSIBILITIES OF THE AGENCY.-- |
408 | (a) The agency, in conjunction with the local health |
409 | councils, is responsible for the coordinated planning of health |
410 | care services in the state. |
411 | (b) The agency shall develop and maintain a comprehensive |
412 | health care database for the purpose of health planning and for |
413 | certificate-of-need determinations. The agency or its |
414 | contractor is authorized to require the submission of |
415 | information from health facilities, health service providers, |
416 | and licensed health professionals which is determined by the |
417 | agency, through rule, to be necessary for meeting the agency's |
418 | responsibilities as established in this section. |
419 | (c) The agency shall assist personnel of the local health |
420 | councils in providing an annual orientation to council members |
421 | about council member responsibilities. |
422 | (c)(d) The Department of Health agency shall contract with |
423 | the local health councils for the services specified in |
424 | subsection (1). All contract funds shall be distributed |
425 | according to an allocation plan developed by the department |
426 | agency that provides for a minimum and equal funding base for |
427 | each local health council. Any remaining funds shall be |
428 | distributed based on adjustments for workload. The agency may |
429 | also make grants to or reimburse local health councils from |
430 | federal funds provided to the state for activities related to |
431 | those functions set forth in this section. The department agency |
432 | may withhold funds from a local health council or cancel its |
433 | contract with a local health council which does not meet |
434 | performance standards agreed upon by the department agency and |
435 | local health councils. |
436 | Section 4. Subsections (1), (2), and (5) of section |
437 | 408.034, Florida Statutes, are amended to read: |
438 | 408.034 Duties and responsibilities of agency; rules.-- |
439 | (1) The agency is designated as the single state agency to |
440 | issue, revoke, or deny certificates of need and to issue, |
441 | revoke, or deny exemptions from certificate-of-need review in |
442 | accordance with the district plans and present and future |
443 | federal and state statutes. The agency is designated as the |
444 | state health planning agency for purposes of federal law. |
445 | (2) In the exercise of its authority to issue licenses to |
446 | health care facilities and health service providers, as provided |
447 | under chapters 393, 395, and parts II and VI of chapter 400, the |
448 | agency may not issue a license to any health care facility or, |
449 | health service provider that, hospice, or part of a health care |
450 | facility which fails to receive a certificate of need or an |
451 | exemption for the licensed facility or service. |
452 | (5) The agency shall establish by rule a nursing-home-bed- |
453 | need methodology that has a goal of maintaining a subdistrict |
454 | average occupancy rate of 94 percent and that reduces the |
455 | community nursing home bed need for the areas of the state where |
456 | the agency establishes pilot community diversion programs |
457 | through the Title XIX aging waiver program. |
458 | Section 5. Section 408.035, Florida Statutes, is amended |
459 | to read: |
460 | 408.035 Review criteria.--The agency shall determine the |
461 | reviewability of applications and shall review applications for |
462 | certificate-of-need determinations for health care facilities |
463 | and health services in context with the following criteria: |
464 | (1) The need for the health care facilities and health |
465 | services being proposed in relation to the applicable district |
466 | health plan. |
467 | (2) The availability, quality of care, accessibility, and |
468 | extent of utilization of existing health care facilities and |
469 | health services in the service district of the applicant. |
470 | (3) The ability of the applicant to provide quality of |
471 | care and the applicant's record of providing quality of care. |
472 | (4) The need in the service district of the applicant for |
473 | special health care services that are not reasonably and |
474 | economically accessible in adjoining areas. |
475 | (5) The needs of research and educational facilities, |
476 | including, but not limited to, facilities with institutional |
477 | training programs and community training programs for health |
478 | care practitioners and for doctors of osteopathic medicine and |
479 | medicine at the student, internship, and residency training |
480 | levels. |
481 | (4)(6) The availability of resources, including health |
482 | personnel, management personnel, and funds for capital and |
483 | operating expenditures, for project accomplishment and |
484 | operation. |
485 | (5)(7) The extent to which the proposed services will |
486 | enhance access to health care for residents of the service |
487 | district. |
488 | (6)(8) The immediate and long-term financial feasibility |
489 | of the proposal. |
490 | (7)(9) The extent to which the proposal will foster |
491 | competition that promotes quality and cost-effectiveness. |
492 | (8)(10) The costs and methods of the proposed |
493 | construction, including the costs and methods of energy |
494 | provision and the availability of alternative, less costly, or |
495 | more effective methods of construction. |
496 | (9)(11) The applicant's past and proposed provision of |
497 | health care services to Medicaid patients and the medically |
498 | indigent. |
499 | (10)(12) The applicant's designation as a Gold Seal |
500 | Program nursing facility pursuant to s. 400.235, when the |
501 | applicant is requesting additional nursing home beds at that |
502 | facility. |
503 | Section 6. Section 408.036, Florida Statutes, is amended |
504 | to read: |
505 | 408.036 Projects subject to review; exemptions.-- |
506 | (1) APPLICABILITY.--Unless exempt under subsection (3), |
507 | all health-care-related projects, as described in paragraphs |
508 | (a)-(g) (a)-(h), are subject to review and must file an |
509 | application for a certificate of need with the agency. The |
510 | agency is exclusively responsible for determining whether a |
511 | health-care-related project is subject to review under ss. |
512 | 408.031-408.045. |
513 | (a) The addition of beds in community nursing homes or |
514 | intermediate care facilities for the developmentally disabled by |
515 | new construction or alteration. |
516 | (b) The new construction or establishment of additional |
517 | health care facilities, including a replacement health care |
518 | facility when the proposed project site is not located on the |
519 | same site as or within 1 mile of the existing health care |
520 | facility, if the number of beds in each licensed bed category |
521 | will not increase. |
522 | (c) The conversion from one type of health care facility |
523 | to another, including the conversion from a general hospital, a |
524 | specialty hospital, or a long-term care hospital. |
525 | (d) An increase in the total licensed bed capacity of a |
526 | health care facility. |
527 | (d)(e) The establishment of a hospice or hospice inpatient |
528 | facility, except as provided in s. 408.043. |
529 | (f) The establishment of inpatient health services by a |
530 | health care facility, or a substantial change in such services. |
531 | (e)(g) An increase in the number of beds for acute care, |
532 | nursing home care beds, specialty burn units, neonatal intensive |
533 | care units, comprehensive rehabilitation, mental health |
534 | services, or hospital-based distinct part skilled nursing units, |
535 | or at a long-term care hospital. |
536 | (f)(h) The establishment of tertiary health services, |
537 | including inpatient comprehensive rehabilitation services. |
538 | (g) An increase in the number of beds for acute care in a |
539 | hospital that is located in a low-growth county. A low-growth |
540 | county is defined as a county that has: |
541 | 1. A hospital with an occupancy rate for licensed acute |
542 | care which has been below 60 percent for the previous 5 years; |
543 | 2. Experienced a growth rate of 4 percent or less for the |
544 | most recent 3-year period for which data are available, as |
545 | determined using the population statistics published in the most |
546 | recent edition of the Florida Statistical Abstract; |
547 | 3. A population of 400,000 or fewer according to the most |
548 | recent edition of the Florida Statistical Abstract; and |
549 | 4. A hospital that has combined gross revenue from |
550 | Medicaid and charity patients which exceeds $60 million per year |
551 | for the previous 2 years. |
552 |
|
553 | This paragraph is repealed effective July 1, 2009. |
554 | (2) PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless exempt |
555 | pursuant to subsection (3), projects subject to an expedited |
556 | review shall include, but not be limited to: |
557 | (a) Research, education, and training programs. |
558 | (b) Shared services contracts or projects. |
559 | (a)(c) A transfer of a certificate of need, except that |
560 | when an existing hospital is acquired by a purchaser, all |
561 | certificates of need issued to the hospital which are not yet |
562 | operational shall be acquired by the purchaser, without need for |
563 | a transfer. |
564 | (b) Replacement of a nursing home within the same |
565 | district, if the proposed project site is located within a |
566 | geographic area that contains at least 65 percent of the |
567 | facility's current residents and is within a 30-mile radius of |
568 | the replaced nursing home. |
569 | (c) Relocation of a portion of a nursing home's licensed |
570 | beds to a facility within the same district, if the relocation |
571 | is within a 30-mile radius of the existing facility and the |
572 | total number of nursing home beds in the district does not |
573 | increase. |
574 | (d) A 50-percent increase in nursing home beds for a |
575 | facility incorporated and operating in this state for at least |
576 | 60 years on or before July 1, 1988, which has a licensed nursing |
577 | home facility located on a campus providing a variety of |
578 | residential settings and supportive services. The increased |
579 | nursing home beds shall be for the exclusive use of the campus |
580 | residents. Any application on behalf of an applicant meeting |
581 | this requirement shall be subject to the base fee of $5,000 |
582 | provided in s. 408.038. |
583 | (e) Replacement of a health care facility when the |
584 | proposed project site is located in the same district and within |
585 | a 1-mile radius of the replaced health care facility. |
586 | (f) The conversion of mental health services beds licensed |
587 | under chapter 395 or hospital-based distinct part skilled |
588 | nursing unit beds to general acute care beds; the conversion of |
589 | mental health services beds between or among the licensed bed |
590 | categories defined as beds for mental health services; or the |
591 | conversion of general acute care beds to beds for mental health |
592 | services. |
593 | 1. Conversion under this paragraph shall not establish a |
594 | new licensed bed category at the hospital but shall apply only |
595 | to categories of beds licensed at that hospital. |
596 | 2. Beds converted under this paragraph must be licensed |
597 | and operational for at least 12 months before the hospital may |
598 | apply for additional conversion affecting beds of the same type. |
599 |
|
600 | The agency shall develop rules to implement the provisions for |
601 | expedited review, including time schedule, application content |
602 | which may be reduced from the full requirements of s. |
603 | 408.037(1), and application processing. |
604 | (3) EXEMPTIONS.--Upon request, the following projects are |
605 | subject to exemption from the provisions of subsection (1): |
606 | (a) For replacement of a licensed health care facility on |
607 | the same site, provided that the number of beds in each licensed |
608 | bed category will not increase. |
609 | (a)(b) For hospice services or for swing beds in a rural |
610 | hospital, as defined in s. 395.602, in a number that does not |
611 | exceed one-half of its licensed beds. |
612 | (b)(c) For the conversion of licensed acute care hospital |
613 | beds to Medicare and Medicaid certified skilled nursing beds in |
614 | a rural hospital, as defined in s. 395.602, so long as the |
615 | conversion of the beds does not involve the construction of new |
616 | facilities. The total number of skilled nursing beds, including |
617 | swing beds, may not exceed one-half of the total number of |
618 | licensed beds in the rural hospital as of July 1, 1993. |
619 | Certified skilled nursing beds designated under this paragraph, |
620 | excluding swing beds, shall be included in the community nursing |
621 | home bed inventory. A rural hospital that which subsequently |
622 | decertifies any acute care beds exempted under this paragraph |
623 | shall notify the agency of the decertification, and the agency |
624 | shall adjust the community nursing home bed inventory |
625 | accordingly. |
626 | (c)(d) For the addition of nursing home beds at a skilled |
627 | nursing facility that is part of a retirement community that |
628 | provides a variety of residential settings and supportive |
629 | services and that has been incorporated and operated in this |
630 | state for at least 65 years on or before July 1, 1994. All |
631 | nursing home beds must not be available to the public but must |
632 | be for the exclusive use of the community residents. |
633 | (e) For an increase in the bed capacity of a nursing |
634 | facility licensed for at least 50 beds as of January 1, 1994, |
635 | under part II of chapter 400 which is not part of a continuing |
636 | care facility if, after the increase, the total licensed bed |
637 | capacity of that facility is not more than 60 beds and if the |
638 | facility has been continuously licensed since 1950 and has |
639 | received a superior rating on each of its two most recent |
640 | licensure surveys. |
641 | (d)(f) For an inmate health care facility built by or for |
642 | the exclusive use of the Department of Corrections as provided |
643 | in chapter 945. This exemption expires when such facility is |
644 | converted to other uses. |
645 | (g) For the termination of an inpatient health care |
646 | service, upon 30 days' written notice to the agency. |
647 | (h) For the delicensure of beds, upon 30 days' written |
648 | notice to the agency. A request for exemption submitted under |
649 | this paragraph must identify the number, the category of beds, |
650 | and the name of the facility in which the beds to be delicensed |
651 | are located. |
652 | (i) For the provision of adult inpatient diagnostic |
653 | cardiac catheterization services in a hospital. |
654 | 1. In addition to any other documentation otherwise |
655 | required by the agency, a request for an exemption submitted |
656 | under this paragraph must comply with the following criteria: |
657 | a. The applicant must certify it will not provide |
658 | therapeutic cardiac catheterization pursuant to the grant of the |
659 | exemption. |
660 | b. The applicant must certify it will meet and |
661 | continuously maintain the minimum licensure requirements adopted |
662 | by the agency governing such programs pursuant to subparagraph |
663 | 2. |
664 | c. The applicant must certify it will provide a minimum of |
665 | 2 percent of its services to charity and Medicaid patients. |
666 | 2. The agency shall adopt licensure requirements by rule |
667 | which govern the operation of adult inpatient diagnostic cardiac |
668 | catheterization programs established pursuant to the exemption |
669 | provided in this paragraph. The rules shall ensure that such |
670 | programs: |
671 | a. Perform only adult inpatient diagnostic cardiac |
672 | catheterization services authorized by the exemption and will |
673 | not provide therapeutic cardiac catheterization or any other |
674 | services not authorized by the exemption. |
675 | b. Maintain sufficient appropriate equipment and health |
676 | personnel to ensure quality and safety. |
677 | c. Maintain appropriate times of operation and protocols |
678 | to ensure availability and appropriate referrals in the event of |
679 | emergencies. |
680 | d. Maintain appropriate program volumes to ensure quality |
681 | and safety. |
682 | e. Provide a minimum of 2 percent of its services to |
683 | charity and Medicaid patients each year. |
684 | 3.a. The exemption provided by this paragraph shall not |
685 | apply unless the agency determines that the program is in |
686 | compliance with the requirements of subparagraph 1. and that the |
687 | program will, after beginning operation, continuously comply |
688 | with the rules adopted pursuant to subparagraph 2. The agency |
689 | shall monitor such programs to ensure compliance with the |
690 | requirements of subparagraph 2. |
691 | b.(I) The exemption for a program shall expire immediately |
692 | when the program fails to comply with the rules adopted pursuant |
693 | to sub-subparagraphs 2.a., b., and c. |
694 | (II) Beginning 18 months after a program first begins |
695 | treating patients, the exemption for a program shall expire when |
696 | the program fails to comply with the rules adopted pursuant to |
697 | sub-subparagraphs 2.d. and e. |
698 | (III) If the exemption for a program expires pursuant to |
699 | sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the |
700 | agency shall not grant an exemption pursuant to this paragraph |
701 | for an adult inpatient diagnostic cardiac catheterization |
702 | program located at the same hospital until 2 years following the |
703 | date of the determination by the agency that the program failed |
704 | to comply with the rules adopted pursuant to subparagraph 2. |
705 | (e)(j) For mobile surgical facilities and related health |
706 | care services provided under contract with the Department of |
707 | Corrections or a private correctional facility operating |
708 | pursuant to chapter 957. |
709 | (f)(k) For state veterans' nursing homes operated by or on |
710 | behalf of the Florida Department of Veterans' Affairs in |
711 | accordance with part II of chapter 296 for which at least 50 |
712 | percent of the construction cost is federally funded and for |
713 | which the Federal Government pays a per diem rate not to exceed |
714 | one-half of the cost of the veterans' care in such state nursing |
715 | homes. These beds shall not be included in the nursing home bed |
716 | inventory. |
717 | (g)(l) For combination within one nursing home facility of |
718 | the beds or services authorized by two or more certificates of |
719 | need issued in the same planning subdistrict. An exemption |
720 | granted under this paragraph shall extend the validity period of |
721 | the certificates of need to be consolidated by the length of the |
722 | period beginning upon submission of the exemption request and |
723 | ending with issuance of the exemption. The longest validity |
724 | period among the certificates shall be applicable to each of the |
725 | combined certificates. |
726 | (h)(m) For division into two or more nursing home |
727 | facilities of beds or services authorized by one certificate of |
728 | need issued in the same planning subdistrict. An exemption |
729 | granted under this paragraph shall extend the validity period of |
730 | the certificate of need to be divided by the length of the |
731 | period beginning upon submission of the exemption request and |
732 | ending with issuance of the exemption. |
733 | (i)(n) For the addition of hospital beds licensed under |
734 | chapter 395 for comprehensive rehabilitation acute care, mental |
735 | health services, or a hospital-based distinct part skilled |
736 | nursing unit in a number that may not exceed 10 total beds or 10 |
737 | percent of the licensed capacity of the bed category being |
738 | expanded, whichever is greater. Beds for specialty burn units, |
739 | neonatal intensive care units, or comprehensive rehabilitation, |
740 | or at a long-term care hospital, may not be increased under this |
741 | paragraph. |
742 | 1. In addition to any other documentation otherwise |
743 | required by the agency, a request for exemption submitted under |
744 | this paragraph must: |
745 | a. Certify that the prior 12-month average occupancy rate |
746 | for the category of licensed beds being expanded at the facility |
747 | meets or exceeds 80 percent or, for a hospital-based distinct |
748 | part skilled nursing unit, the prior 12-month average occupancy |
749 | rate meets or exceeds 96 percent. |
750 | b. Certify that the any beds of the same type authorized |
751 | for the facility under this paragraph before the date of the |
752 | current request for an exemption have been licensed and |
753 | operational for at least 12 months. |
754 | 2. The timeframes and monitoring process specified in s. |
755 | 408.040(2)(a)-(c) apply to any exemption issued under this |
756 | paragraph. |
757 | 3. The agency shall count beds authorized under this |
758 | paragraph as approved beds in the published inventory of |
759 | hospital beds until the beds are licensed. |
760 | (o) For the addition of acute care beds, as authorized by |
761 | rule consistent with s. 395.003(4), in a number that may not |
762 | exceed 10 total beds or 10 percent of licensed bed capacity, |
763 | whichever is greater, for temporary beds in a hospital that has |
764 | experienced high seasonal occupancy within the prior 12-month |
765 | period or in a hospital that must respond to emergency |
766 | circumstances. |
767 | (j)(p) For the addition of nursing home beds licensed |
768 | under chapter 400 in a number not exceeding 10 total beds or 10 |
769 | percent of the number of beds licensed in the facility being |
770 | expanded, whichever is greater; or, for the addition of nursing |
771 | home beds licensed under chapter 400 at a facility that has been |
772 | designated as a Gold Seal nursing home under s. 400.235 in a |
773 | number not exceeding 20 total beds or 10 percent of the number |
774 | of licensed beds in the facility being expanded, whichever is |
775 | greater. |
776 | 1. In addition to any other documentation required by the |
777 | agency, a request for exemption submitted under this paragraph |
778 | must: |
779 | a. Effective until June 30, 2001, Certify that the |
780 | facility has not had any class I or class II deficiencies within |
781 | the 30 months preceding the request for addition. |
782 | b. Effective on July 1, 2001, certify that the facility |
783 | has been designated as a Gold Seal nursing home under s. |
784 | 400.235. |
785 | b.c. Certify that the prior 12-month average occupancy |
786 | rate for the nursing home beds at the facility meets or exceeds |
787 | 96 percent. |
788 | c.d. Certify that any beds authorized for the facility |
789 | under this paragraph before the date of the current request for |
790 | an exemption have been licensed and operational for at least 12 |
791 | months. |
792 | 2. The timeframes and monitoring process specified in s. |
793 | 408.040(2)(a)-(c) apply to any exemption issued under this |
794 | paragraph. |
795 | 3. The agency shall count beds authorized under this |
796 | paragraph as approved beds in the published inventory of nursing |
797 | home beds until the beds are licensed. |
798 | (k) For the establishment of: |
799 | 1. A Level II neonatal intensive care unit with at least |
800 | 10 beds, upon documentation to the agency that the applicant |
801 | hospital had a minimum of 1,500 births during the previous 12 |
802 | months; or |
803 | 2. A Level III neonatal intensive care unit with at least |
804 | 15 beds, upon documentation to the agency that the applicant |
805 | hospital has a Level II neonatal intensive care unit of at least |
806 | 10 beds and had a minimum of 3,500 births during the previous 12 |
807 | months, |
808 |
|
809 | if the applicant demonstrates that it meets the requirements for |
810 | quality of care, nurse staffing, physician staffing, physical |
811 | plant, equipment, emergency transportation, and data reporting |
812 | found in agency certificate-of-need rules for Level II and Level |
813 | III neonatal intensive care units and if the applicant commits |
814 | to the provision of services to Medicaid and charity patients at |
815 | a level equal to or greater than the district average. Such a |
816 | commitment is subject to s. 408.040. |
817 | (q) For establishment of a specialty hospital offering a |
818 | range of medical service restricted to a defined age or gender |
819 | group of the population or a restricted range of services |
820 | appropriate to the diagnosis, care, and treatment of patients |
821 | with specific categories of medical illnesses or disorders, |
822 | through the transfer of beds and services from an existing |
823 | hospital in the same county. |
824 | (r) For the conversion of hospital-based Medicare and |
825 | Medicaid certified skilled nursing beds to acute care beds, if |
826 | the conversion does not involve the construction of new |
827 | facilities. |
828 | (l) Notwithstanding any other provisions of this chapter |
829 | to the contrary:(s) |
830 | 1. For an adult open-heart-surgery program to be located |
831 | in a new hospital provided the new hospital is being established |
832 | in the location of an existing hospital with an adult open- |
833 | heart-surgery program, the existing hospital and the existing |
834 | adult open-heart-surgery program are being relocated to a |
835 | replacement hospital, and the replacement hospital will utilize |
836 | a closed-staff model. A hospital is exempt from the certificate- |
837 | of-need review for the establishment of an open-heart-surgery |
838 | program if the application for exemption submitted under this |
839 | paragraph complies with the following criteria: |
840 | a. The applicant must certify that it will meet and |
841 | continuously maintain the minimum Florida Administrative Code |
842 | and any future licensure requirements governing adult open-heart |
843 | programs adopted by the agency, including the most current |
844 | guidelines of the American College of Cardiology and American |
845 | Heart Association Guidelines for Adult Open Heart Programs. |
846 | b. The applicant must certify that it will maintain |
847 | sufficient appropriate equipment and health personnel to ensure |
848 | quality and safety. |
849 | c. The applicant must certify that it will maintain |
850 | appropriate times of operation and protocols to ensure |
851 | availability and appropriate referrals in the event of |
852 | emergencies. |
853 | d. The applicant is a newly licensed hospital in a |
854 | physical location previously owned and licensed to a hospital |
855 | performing more than 300 open-heart procedures each year, |
856 | including heart transplants. |
857 | e. The applicant must certify that it can perform more |
858 | than 300 diagnostic cardiac catheterization procedures per year, |
859 | combined inpatient and outpatient, by the end of the third year |
860 | of its operation. |
861 | f. The applicant's payor mix at a minimum reflects the |
862 | community average for Medicaid, charity care, and self-pay |
863 | patients or the applicant must certify that it will provide a |
864 | minimum of 5 percent of Medicaid, charity care, and self-pay to |
865 | open-heart-surgery patients. |
866 | g. If the applicant fails to meet the established criteria |
867 | for open-heart programs or fails to reach 300 surgeries per year |
868 | by the end of its third year of operation, it must show cause |
869 | why its exemption should not be revoked. |
870 | h. In order to ensure continuity of available services, |
871 | the applicant of the newly licensed hospital may apply for this |
872 | certificate-of-need before taking possession of the physical |
873 | facilities. The effective date of the certificate-of-need will |
874 | be concurrent with the effective date of the newly issued |
875 | hospital license. |
876 | 2. By December 31, 2004, and annually thereafter, the |
877 | agency shall submit a report to the Legislature providing |
878 | information concerning the number of requests for exemption |
879 | received under this paragraph and the number of exemptions |
880 | granted or denied. |
881 | 3. This paragraph is repealed effective January 1, 2008. |
882 | (m)(t)1. For the provision of adult open-heart services in |
883 | a hospital located within the boundaries of a health service |
884 | planning district, as defined in s. 408.032(5), which has |
885 | experienced an annual net out-migration of at least 600 open- |
886 | heart-surgery cases for 3 consecutive years according to the |
887 | most recent data reported to the agency, and the district's |
888 | population per licensed and operational open-heart programs |
889 | exceeds the state average of population per licensed and |
890 | operational open-heart programs by at least 25 percent Palm |
891 | Beach, Polk, Martin, St. Lucie, and Indian River Counties if the |
892 | following conditions are met: The exemption must be based upon |
893 | objective criteria and address and solve the twin problems of |
894 | geographic and temporal access. All hospitals within a health |
895 | service planning district which meet the criteria reference in |
896 | sub-subparagraphs 2.a.-h. shall be eligible for this exemption |
897 | on July 1, 2004, and shall receive the exemption upon filing for |
898 | it and subject to the following: |
899 | a. A hospital that has received a notice of intent to |
900 | grant a certificate of need or a final order of the agency |
901 | granting a certificate of need for the establishment of an open- |
902 | heart-surgery program is entitled to receive a letter of |
903 | exemption for the establishment of an adult open-heart-surgery |
904 | program upon filing a request for exemption and complying with |
905 | the criteria enumerated in sub-subparagraphs 2.a.-h., and is |
906 | entitled to immediately commence operation of the program. |
907 | b. An otherwise eligible hospital that has not received a |
908 | notice of intent to grant a certificate of need or a final order |
909 | of the agency granting a certificate of need for the |
910 | establishment of an open-heart-surgery program is entitled to |
911 | immediately receive a letter of exemption for the establishment |
912 | of an adult open-heart-surgery program upon filing a request for |
913 | exemption and complying with the criteria enumerated in sub- |
914 | subparagraphs 2.a.-h., but is not entitled to commence operation |
915 | of its program until December 31, 2006. |
916 | 2. A hospital shall be exempt from the certificate-of-need |
917 | review for the establishment of an open-heart-surgery program |
918 | when the application for exemption submitted under this |
919 | paragraph complies with the following criteria: |
920 | a. The applicant must certify that it will meet and |
921 | continuously maintain the minimum licensure requirements adopted |
922 | by the agency governing adult open-heart programs, including the |
923 | most current guidelines of the American College of Cardiology |
924 | and American Heart Association Guidelines for Adult Open Heart |
925 | Programs. |
926 | b. The applicant must certify that it will maintain |
927 | sufficient appropriate equipment and health personnel to ensure |
928 | quality and safety. |
929 | c. The applicant must certify that it will maintain |
930 | appropriate times of operation and protocols to ensure |
931 | availability and appropriate referrals in the event of |
932 | emergencies. |
933 | d. The applicant can demonstrate that it has discharged at |
934 | least 300 inpatients with a principal diagnosis of ischemic |
935 | heart disease for the most recent 12-month period as reported to |
936 | the agency is referring 300 or more patients per year from the |
937 | hospital, including the emergency room, for cardiac services at |
938 | a hospital with cardiac services, or that the average wait for |
939 | transfer for 50 percent or more of the cardiac patients exceeds |
940 | 4 hours. |
941 | e. The applicant is a general acute care hospital that is |
942 | in operation for 3 years or more. |
943 | f. The applicant is performing more than 300 diagnostic |
944 | cardiac catheterization procedures per year, combined inpatient |
945 | and outpatient. |
946 | g. The applicant's payor mix at a minimum reflects the |
947 | community average for Medicaid, charity care, and self-pay |
948 | patients or the applicant must certify that it will provide a |
949 | minimum of 5 percent of Medicaid, charity care, and self-pay to |
950 | open-heart-surgery patients. |
951 | h. If the applicant fails to meet the established criteria |
952 | for open-heart programs or fails to reach 300 surgeries per year |
953 | by the end of its third year of operation, it must show cause |
954 | why its exemption should not be revoked. |
955 | 3.2. By December 31, 2004, and annually thereafter, the |
956 | agency for Health Care Administration shall submit a report to |
957 | the Legislature providing information concerning the number of |
958 | requests for exemption it has received under this paragraph |
959 | during the calendar year and the number of exemptions it has |
960 | granted or denied during the calendar year. |
961 | (n) For the provision of percutaneous coronary |
962 | intervention for patients presenting with emergency myocardial |
963 | infarctions in a hospital without an approved adult open-heart- |
964 | surgery program. In addition to any other documentation required |
965 | by the agency, a request for an exemption submitted under this |
966 | paragraph must comply with the following: |
967 | 1. The applicant must certify that it will meet and |
968 | continuously maintain the requirements adopted by the agency for |
969 | the provisions of these services. These licensure requirements |
970 | must be adopted by rule pursuant to ss. 120.536(1) and 120.54 |
971 | and must be consistent with the guidelines published by the |
972 | American College of Cardiology and the American Heart |
973 | Association for the provision of percutaneous coronary |
974 | interventions in hospitals without adult open-heart services. At |
975 | a minimum, the rules shall require that: |
976 | a. Cardiologists be experienced interventionalists who |
977 | have performed a mimimum of 75 interventions within the previous |
978 | 12 months. |
979 | b. The hospital provide a minimum of 36 emergency |
980 | interventions annually in order to continue to provide the |
981 | service. |
982 | c. The hospital offer sufficient physician, nursing, and |
983 | laboratory staff to provide the services 24 hours a day, 7 days |
984 | a week. |
985 | d. Nursing and technical staff have demonstrated |
986 | experience in handling acutely ill patients requiring |
987 | intervention based on previous experience in dedicated |
988 | interventional laboratories or surgical centers. |
989 | e. Cardiac care nursing staff be adept in hemodynamic |
990 | monitoring and Intra-aortic Balloon Pump management. |
991 | f. Formalized written transfer agreements be developed |
992 | with a hospital with an adult open-heart-surgery program and |
993 | written transport protocols be in place to ensure safe and |
994 | efficient transfer of a patient within 60 minutes. Transfer and |
995 | transport agreements must be received and tested, with |
996 | appropriate documentation maintained at least every 3 months. |
997 | g. Hospitals implementing the service first undertake a |
998 | training program of 3 to 6 months' duration, which includes |
999 | establishing standard and testing logistics, creating quality |
1000 | assessment and error management practices, and formalizing |
1001 | patient-selection criteria. |
1002 | 2. The applicant must certify that it will at all times |
1003 | use the patient-selection criteria for the performance of |
1004 | primary angioplasty at hospitals without adult open-heart- |
1005 | surgery programs issued by the American College of Cardiology |
1006 | and the American Heart Association. At a minimum, these criteria |
1007 | must provide for: |
1008 | a. Avoidance of interventions in hemodynamically stable |
1009 | patients who have identified symptoms or medical histories. |
1010 | b. Transfer of patients who have a history of coronary |
1011 | disease and clinical presentation of hemodynamic instability. |
1012 | 3. The applicant must agree to submit to the agency a |
1013 | quarterly report detailing patient characteristics, treatment, |
1014 | and outcomes for all patients receiving emergency percutaneous |
1015 | coronary interventions pursuant to this paragraph. This report |
1016 | must be submitted within 15 days after the close of each |
1017 | calendar quarter. |
1018 | 4. The exemption provided by this paragraph does not apply |
1019 | unless the agency determines that the hospital has taken all |
1020 | necessary steps to be in compliance with all requirements of |
1021 | this paragraph, including the training program required under |
1022 | sub-subparagraph 1.g. |
1023 | 5. If the hospital fails to continuously comply with the |
1024 | requirements of sub-subparagraphs 1.c.-f. and subparagraphs 2. |
1025 | and 3., this exemption immediately expires. |
1026 | 6. If the hospital fails to meet the volume requirements |
1027 | of sub-subparagraphs 1.a. and b. within 18 months after the |
1028 | program begins offering the service, this exemption immediately |
1029 | expires. |
1030 |
|
1031 | If the exemption for this service expires under subparagraph 5. |
1032 | or subparagraph 6., the agency may not grant another exemption |
1033 | for this service to the same hospital for 2 years and then only |
1034 | upon a showing that the hospital will remain in compliance with |
1035 | the requirements of this paragraph through a demonstration of |
1036 | corrections to the deficiencies that caused the exemption to |
1037 | expire. Compliance with this paragraph includes compliance with |
1038 | the rules adopted pursuant to this paragraph. |
1039 | (o) For the addition of mental health services or beds if |
1040 | the applicant commits to providing services to Medicaid or |
1041 | charity care patients at a level equal to or greater than the |
1042 | district average. Such a commitment is subject to s. 408.040. |
1043 | (p) For replacement of a licensed nursing home on the same |
1044 | site, or within 3 miles of the same site, if the number of |
1045 | licensed beds does not increase. |
1046 | (q) For consolidation or combination of licensed nursing |
1047 | homes or transfer of beds between licensed nursing homes within |
1048 | the same planning subdistrict, by providers that operate |
1049 | multiple nursing homes within that planning subdistrict, if |
1050 | there is no increase in the planning subdistrict total number of |
1051 | nursing home beds and the site of the relocation is not more |
1052 | than 30 miles from the original location. |
1053 | (r) For beds in state mental health treatment facilities |
1054 | operated under s. 394.455(30) and state mental health forensic |
1055 | facilities operated under s. 916.106(8). |
1056 | (s) For beds in state developmental services institutions |
1057 | as defined in s. 393.063. |
1058 | (4) REQUESTS FOR EXEMPTION.--A request for exemption under |
1059 | subsection (3) may be made at any time and is not subject to the |
1060 | batching requirements of this section. The request shall be |
1061 | supported by such documentation as the agency requires by rule. |
1062 | The agency shall assess a fee of $250 for each request for |
1063 | exemption submitted under subsection (3). |
1064 | (5) NOTIFICATION.--Health care facilities and providers |
1065 | must provide to the agency notification of: |
1066 | (a) Replacement of a health care facility when the |
1067 | proposed project site is located in the same district and on the |
1068 | existing site or within a 1-mile radius of the replaced health |
1069 | care facility, if the number and type of beds do not increase. |
1070 | (b) The termination of a health care service, upon 30 |
1071 | days' written notice to the agency. |
1072 | (c) The addition or delicensure of beds. |
1073 |
|
1074 | Notification under this subsection may be made by electronic, |
1075 | facsimile, or written means at any time before the described |
1076 | action has been taken. |
1077 | Section 7. Section 408.0361, Florida Statutes, is amended |
1078 | to read: |
1079 | 408.0361 Cardiology services and burn unit licensure |
1080 | Diagnostic cardiac catheterization services providers; |
1081 | compliance with guidelines and requirements.-- |
1082 | (1) Each provider of diagnostic cardiac catheterization |
1083 | services shall comply with the requirements of s. |
1084 | 408.036(3)(i)2.a.-d., and rules adopted by of the agency which |
1085 | establish licensure standards for Health Care Administration |
1086 | governing the operation of adult inpatient diagnostic cardiac |
1087 | catheterization programs. The rules must ensure that the |
1088 | programs: |
1089 | (a) Comply with, including the most recent guidelines of |
1090 | the American College of Cardiology and American Heart |
1091 | Association Guidelines for Cardiac Catheterization and Cardiac |
1092 | Catheterization Laboratories. |
1093 | (b) Perform only adult inpatient diagnostic cardiac |
1094 | catheterization services and do not provide therapeutic cardiac |
1095 | catheterization or any other cardiology services. |
1096 | (c) Maintain sufficient appropriate equipment and health |
1097 | care personnel to ensure quality and safety. |
1098 | (d) Maintain appropriate times of operation and protocols |
1099 | to ensure availability and appropriate referrals in the event of |
1100 | emergencies. |
1101 | (e) Demonstrate a plan to provide services to Medicaid and |
1102 | charity patients. |
1103 | (2) Each provider of adult interventional cardiology |
1104 | services or operator of a burn unit shall comply with rules |
1105 | adopted by the agency which establish licensure standards that |
1106 | govern the provision of adult interventional cardiology services |
1107 | or the operation of a burn unit. Such rules must consider, at a |
1108 | minimum, staffing, equipment, physical plant, operating |
1109 | protocols, the provision of services to Medicaid and charity |
1110 | patients, accreditation, licensure period and fees, and |
1111 | enforcement of minimum standards. The certificate-of-need rules |
1112 | for adult interventional cardiology services and burn units in |
1113 | effect on June 30, 2004, are ratified pursuant to this |
1114 | subsection and shall remain in effect and be enforceable by the |
1115 | agency until the licensure rules are adopted. Existing |
1116 | providers, any provider with an exemption for open heart |
1117 | surgery, and any provider with a notice of intent to grant a |
1118 | certificate of need or a final order of the agency granting a |
1119 | certificate of need for adult interventional cardiology services |
1120 | or burn units shall be considered grandfathered-in and shall |
1121 | receive a license for their programs effective on July 1, 2004, |
1122 | or the date their program becomes operational, whichever is |
1123 | later. That licensure shall remain valid for at least 3 years or |
1124 | a period specified in the rule, whichever is longer, but the |
1125 | programs must meet licensure standards applicable to existing |
1126 | programs for every subsequent licensure period. |
1127 | (3) In establishing rules for adult interventional |
1128 | cardiology services, the agency shall include provisions that |
1129 | allow for: |
1130 | (a) Establishment of two hospital program licensure |
1131 | levels: a Level I program authorizing the performance of adult |
1132 | primary percutaneous cardiac intervention for emergent patients |
1133 | without onsite cardiac surgery and a Level II program |
1134 | authorizing the performance of percutaneous cardiac intervention |
1135 | with onsite cardiac surgery. |
1136 | (b) For a hospital seeking a Level I program, |
1137 | demonstration that, for the most recent 12-month period as |
1138 | reported to the agency, it has provided a minimum of 300 adult |
1139 | inpatient and outpatient diagnostic cardiac catheterizations or |
1140 | has transferred at least 300 inpatients with the principal |
1141 | diagnosis of ischemic heart disease and that it has a |
1142 | formalized, written transfer agreement with a hospital that has |
1143 | a Level II program, including written transport protocols to |
1144 | ensure safe and efficient transfer of a patient within 60 |
1145 | minutes. |
1146 | (c) For a hospital seeking a Level II program, |
1147 | demonstration that for the most recent 12-month period as |
1148 | reported to the agency it has discharged at least 800 patients |
1149 | with the principal diagnosis of ischemic heart disease. |
1150 | (d) Compliance with the most recent guidelines of the |
1151 | American College of Cardiology and American Heart Association |
1152 | guidelines for staffing, physician training and experience, |
1153 | operating procedures, equipment, physical plant, and patient- |
1154 | selection criteria to ensure patient quality and safety. |
1155 | (e) Establishment of appropriate hours of operation and |
1156 | protocols to ensure availability and timely referral in the |
1157 | event of emergencies. |
1158 | (f) Demonstration of a plan to provide services to |
1159 | Medicaid and charity patients. |
1160 | (4) The agency shall establish a technical advisory panel |
1161 | to develop procedures and standards for measuring outcomes of |
1162 | interventional cardiac programs. Members of the panel shall |
1163 | include representatives of the Florida Hospital Association, the |
1164 | Florida Society of Thoracic and Cardiovascular Surgeons, the |
1165 | Florida Chapter of the American College of Cardiology, and the |
1166 | Florida Chapter of the American Heart Association and others who |
1167 | have experience in statistics and outcome measurement. Based |
1168 | upon recommendations from the panel, the agency shall develop |
1169 | and adopt for the interventional cardiac programs rules that |
1170 | include at least the following: |
1171 | (a) A standard data set consisting primarily of data |
1172 | elements reported to the agency in accordance with s. 408.061. |
1173 | (b) A risk-adjustment procedure that accounts for the |
1174 | variations in severity and case mix found in hospitals in this |
1175 | state. |
1176 | (c) Outcome standards specifying expected levels of |
1177 | performance in Level I and Level II adult interventional |
1178 | cardiology services. Such standards may include, but are not |
1179 | limited to, inhospital mortality, infection rates, nonfatal |
1180 | myocardial infarctions, length of stay, postoperative bleeds, |
1181 | and returns to surgery. |
1182 | (d) Specific steps to be taken by the agency and licensing |
1183 | hospitals that do not meet the outcome standards within |
1184 | specified time periods, including time periods for detailed case |
1185 | reviews and development and implementation of corrective action |
1186 | plans. |
1187 | (9) The Secretary of Health Care Administration shall |
1188 | appoint an advisory group to study the issue of replacing |
1189 | certificate-of-need review of organ transplant programs under |
1190 | this chapter with licensure regulation of organ transplant |
1191 | programs under chapter 395. The advisory group shall include |
1192 | three representatives of organ transplant providers, one |
1193 | representative of an organ procurement organization, one |
1194 | representative of the Division of Health Quality Assurance, one |
1195 | representative of Medicaid, and one advocate for organ |
1196 | transplant patients. The advisory group shall, at a minimum, |
1197 | make recommendations regarding access to organs, delivery of |
1198 | services to Medicaid and charity patients, staff training, and |
1199 | resource requirements for organ transplant programs in a report |
1200 | due to the secretary and the Legislature by July 1, 2005. |
1201 | (10) The Secretary of Health Care Administration shall |
1202 | appoint a work group to study certificate-of-need regulations |
1203 | and changing market conditions related to the supply and |
1204 | distribution of hospital beds. The assessment by the work group |
1205 | shall include, but need not be limited to: |
1206 | (a) The appropriateness of current certificate-of-need |
1207 | methodologies and other criteria for evaluating proposals for |
1208 | new hospitals and transfers of beds to new sites. |
1209 | (b) Additional factors that should be considered, |
1210 | including the viability of safety-net services, the extent of |
1211 | market competition, and the accessibility of hospital services. |
1212 |
|
1213 | The workgroup shall, by January 1, 2005, submit to the secretary |
1214 | and the Legislature a report identifying specific program areas |
1215 | and recommending needed changes in statutes and rules. |
1216 | Section 8. Section 408.038, Florida Statutes, is amended |
1217 | to read: |
1218 | 408.038 Fees.--The agency shall assess fees on |
1219 | certificate-of-need applications. Such fees shall be for the |
1220 | purpose of funding the functions of the local health councils |
1221 | and the activities of the agency and shall be allocated as |
1222 | provided in s. 408.033. The fee shall be determined as follows: |
1223 | (1) A minimum base fee of $10,000 $5,000. |
1224 | (2) In addition to the base fee of $10,000 $5,000, 0.015 |
1225 | of each dollar of proposed expenditure, except that a fee may |
1226 | not exceed $50,000 $22,000. |
1227 | Section 9. Subsections (1), paragraph (a) of subsection |
1228 | (3), and paragraph (a) and (b) of subsection (4) of section |
1229 | 408.039, are amended to read: |
1230 | 408.039 Review process.--The review process for |
1231 | certificates of need shall be as follows: |
1232 | (1) REVIEW CYCLES.--The agency by rule shall provide for |
1233 | applications to be submitted on a timetable or cycle basis; |
1234 | provide for review on a timely basis; and provide for all |
1235 | completed applications pertaining to similar types of services |
1236 | or facilities affecting the same service district to be |
1237 | considered in relation to each other no less often than annually |
1238 | two times a year. |
1239 | (3) APPLICATION PROCESSING.-- |
1240 | (a) An applicant shall file an application with the |
1241 | agency, and shall furnish a copy of the application to the local |
1242 | health council and the agency. Within 15 days after the |
1243 | applicable application filing deadline established by agency |
1244 | rule, the staff of the agency shall determine if the application |
1245 | is complete. If the application is incomplete, the staff shall |
1246 | request specific information from the applicant necessary for |
1247 | the application to be complete; however, the staff may make only |
1248 | one such request. If the requested information is not filed with |
1249 | the agency within 21 days after of the receipt of the staff's |
1250 | request, the application shall be deemed incomplete and deemed |
1251 | withdrawn from consideration. |
1252 | (4) STAFF RECOMMENDATIONS.-- |
1253 | (a) The agency's review of and final agency action on |
1254 | applications shall be in accordance with the district health |
1255 | plan, and statutory criteria, and the implementing |
1256 | administrative rules. In the application review process, the |
1257 | agency shall give a preference, as defined by rule of the |
1258 | agency, to an applicant which proposes to develop a nursing home |
1259 | in a nursing home geographically underserved area. |
1260 | (b) Within 60 days after all the applications in a review |
1261 | cycle are determined to be complete, the agency shall issue its |
1262 | State Agency Action Report and Notice of Intent to grant a |
1263 | certificate of need for the project in its entirety, to grant a |
1264 | certificate of need for identifiable portions of the project, or |
1265 | to deny a certificate of need. The State Agency Action Report |
1266 | shall set forth in writing its findings of fact and |
1267 | determinations upon which its decision is based. If a finding |
1268 | of fact or determination by the agency is counter to the |
1269 | district health plan of the local health council, the agency |
1270 | shall provide in writing its reason for its findings, item by |
1271 | item, to the local health council. If the agency intends to |
1272 | grant a certificate of need, the State Agency Action Report or |
1273 | the Notice of Intent shall also include any conditions which the |
1274 | agency intends to attach to the certificate of need. The agency |
1275 | shall designate by rule a senior staff person, other than the |
1276 | person who issues the final order, to issue State Agency Action |
1277 | Reports and Notices of Intent. |
1278 | Section 10. Section 408.040, Florida Statutes, is amended |
1279 | to read: |
1280 | 408.040 Conditions and monitoring.-- |
1281 | (1)(a) The agency may issue a certificate of need, or an |
1282 | exemption, predicated upon statements of intent expressed by an |
1283 | applicant in the application for a certificate of need or an |
1284 | exemption. Any conditions imposed on a certificate of need or an |
1285 | exemption based on such statements of intent shall be stated on |
1286 | the face of the certificate of need or in the exemption |
1287 | approval. |
1288 | (b) The agency may consider, in addition to the other |
1289 | criteria specified in s. 408.035, a statement of intent by the |
1290 | applicant that a specified percentage of the annual patient days |
1291 | at the facility will be utilized by patients eligible for care |
1292 | under Title XIX of the Social Security Act. Any certificate of |
1293 | need issued to a nursing home in reliance upon an applicant's |
1294 | statements that a specified percentage of annual patient days |
1295 | will be utilized by residents eligible for care under Title XIX |
1296 | of the Social Security Act must include a statement that such |
1297 | certification is a condition of issuance of the certificate of |
1298 | need. The certificate-of-need program shall notify the Medicaid |
1299 | program office and the Department of Elderly Affairs when it |
1300 | imposes conditions as authorized in this paragraph in an area in |
1301 | which a community diversion pilot project is implemented. |
1302 | (c) A certificateholder or an exemption holder may apply |
1303 | to the agency for a modification of conditions imposed under |
1304 | paragraph (a) or paragraph (b). If the holder of a certificate |
1305 | of need or an exemption demonstrates good cause why the |
1306 | certificate or exemption should be modified, the agency shall |
1307 | reissue the certificate of need or exemption with such |
1308 | modifications as may be appropriate. The agency shall by rule |
1309 | define the factors constituting good cause for modification. |
1310 | (d) If the holder of a certificate of need or an exemption |
1311 | fails to comply with a condition upon which the issuance of the |
1312 | certificate or exemption was predicated, the agency may assess |
1313 | an administrative fine against the certificateholder or |
1314 | exemption holder in an amount not to exceed $1,000 per failure |
1315 | per day. Failure to annually report compliance with any |
1316 | condition upon which the issuance of the certificate or |
1317 | exemption was predicated constitutes noncompliance. In assessing |
1318 | the penalty, the agency shall take into account as mitigation |
1319 | the degree of noncompliance relative lack of severity of a |
1320 | particular failure. Proceeds of such penalties shall be |
1321 | deposited in the Public Medical Assistance Trust Fund. |
1322 | (2)(a) Unless the applicant has commenced construction, if |
1323 | the project provides for construction, unless the applicant has |
1324 | incurred an enforceable capital expenditure commitment for a |
1325 | project, if the project does not provide for construction, or |
1326 | unless subject to paragraph (b), a certificate of need shall |
1327 | terminate 18 months after the date of issuance. The agency shall |
1328 | monitor the progress of the holder of the certificate of need in |
1329 | meeting the timetable for project development specified in the |
1330 | application with the assistance of the local health council as |
1331 | specified in s. 408.033(1)(b)5., and may revoke the certificate |
1332 | of need, if the holder of the certificate is not meeting such |
1333 | timetable and is not making a good-faith effort, as defined by |
1334 | rule, to meet it. |
1335 | (b) A certificate of need issued to an applicant holding a |
1336 | provisional certificate of authority under chapter 651 shall |
1337 | terminate 1 year after the applicant receives a valid |
1338 | certificate of authority from the Office of Insurance Regulation |
1339 | of the Financial Services Commission. |
1340 | (c) The certificate-of-need validity period for a project |
1341 | shall be extended by the agency, to the extent that the |
1342 | applicant demonstrates to the satisfaction of the agency that |
1343 | good-faith commencement of the project is being delayed by |
1344 | litigation or by governmental action or inaction with respect to |
1345 | regulations or permitting precluding commencement of the |
1346 | project. |
1347 | (3) The agency shall require the submission of an executed |
1348 | architect's certification of final payment for each certificate- |
1349 | of-need project approved by the agency. Each project that |
1350 | involves construction shall submit such certification to the |
1351 | agency within 30 days following completion of construction. |
1352 | Section 11. Subsection (5) of section 408.043, Florida |
1353 | Statutes, is repealed. |
1354 | Section 12. Section 408.0455, Florida Statutes, is amended |
1355 | to read: |
1356 | 408.0455 Rules; pending proceedings.--The rules of the |
1357 | agency in effect on June 30, 2004 1997, shall remain in effect |
1358 | and shall be enforceable by the agency with respect to ss. |
1359 | 408.031-408.045 until such rules are repealed or amended by the |
1360 | agency, and no judicial or administrative proceeding pending on |
1361 | July 1, 1997, shall be abated as a result of the provisions of |
1362 | ss. 408.031-408.043(1) and (2); s. 408.044; or s. 408.045. |
1363 | Section 13. If any provision of this act or the |
1364 | application thereof to any person or circumstance is held |
1365 | invalid, the invalidity does not affect other provisions or |
1366 | applications of the act which can be given effect without the |
1367 | invalid provision or application, and to this end the provisions |
1368 | of this act are declared severable. |
1369 | Section 14. Section 52 of chapter 2001-45, Laws of |
1370 | Florida, as amended by section 1693 of chapter 2003-261, Laws of |
1371 | Florida, is amended to read: |
1372 | Section 52. (1) Notwithstanding the establishment of need |
1373 | as provided for in chapter 408, Florida Statutes, no certificate |
1374 | of need for additional community nursing home beds shall be |
1375 | approved by the agency until July 1, 2006. |
1376 | (2) The Legislature finds that the continued growth in the |
1377 | Medicaid budget for nursing home care has constrained the |
1378 | ability of the state to meet the needs of its elderly residents |
1379 | through the use of less restrictive and less institutional |
1380 | methods of long-term care. It is therefore the intent of the |
1381 | Legislature to limit the increase in Medicaid nursing home |
1382 | expenditures in order to provide funds to invest in long-term |
1383 | care that is community-based and provides supportive services in |
1384 | a manner that is both more cost-effective and more in keeping |
1385 | with the wishes of the elderly residents of this state. |
1386 | (3) This moratorium on certificates of need shall not |
1387 | apply to sheltered nursing home beds in a continuing care |
1388 | retirement community certified by the former Department of |
1389 | Insurance or by the Office of Insurance Regulation pursuant to |
1390 | chapter 651, Florida Statutes. |
1391 | (4)(a) This moratorium on certificates of need shall not |
1392 | apply, and a certificate of need for additional community |
1393 | nursing home beds may be approved, for a county that meets the |
1394 | following circumstances: |
1395 | 1. The county has no community nursing home beds; and |
1396 | 2. The lack of community nursing home beds occurs because |
1397 | all nursing home beds in the county which were licensed on July |
1398 | 1, 2001, have subsequently closed. |
1399 | (b) The certificate-of-need review for such circumstances |
1400 | shall be subject to the comparative review process consistent |
1401 | with the provisions of section 408.039, Florida Statutes, and |
1402 | the number of beds may not exceed the number of beds lost by the |
1403 | county after July 1, 2001. |
1404 |
|
1405 | This subsection shall be repealed upon the expiration of the |
1406 | moratorium established in subsection (1). |
1407 | (5) This moratorium on certificates of need shall not |
1408 | apply for the addition of nursing home beds licensed under |
1409 | chapter 400 to a nursing home located in a county having up to |
1410 | 50,000 residents, in a number not exceeding 10 total beds or 10 |
1411 | percent of the number of beds licensed in the facility being |
1412 | expanded, whichever is greater. In addition to any other |
1413 | documentation required by the agency, a request submitted under |
1414 | this paragraph must: |
1415 | (a) Certify that the facility has not had any class I or |
1416 | class II deficiencies within the 30 months preceding the request |
1417 | for addition. |
1418 | (b) Certify that the prior 12-month average occupancy rate |
1419 | for the nursing home beds at the facility meets or exceeds 94 |
1420 | percent and the facility had not had any class I or class II |
1421 | deficiencies since its initial licensure. |
1422 | (c) For a facility that has been licensed for less than 24 |
1423 | months, certify that the prior 6-month average occupancy rate |
1424 | for the nursing home beds at the facility meets or exceeds 94 |
1425 | percent and that the facility has not had any class I or class |
1426 | II deficiencies since its initial licensure. |
1427 |
|
1428 | This subsection shall be repealed upon the expiration of the |
1429 | moratorium established in subsection (1). |
1430 | Section 15. This act shall take effect July 1, 2004. |