| 1 | A bill to be entitled |
| 2 | An act relating to certificates of need; transferring, |
| 3 | renumbering, and amending s. 651.1185, F.S.; extending the |
| 4 | moratorium on certificates of need for additional |
| 5 | community nursing home beds until July 1, 2011; specifying |
| 6 | nonapplication of a moratorium for the addition of nursing |
| 7 | home beds in certain specified facilities; providing |
| 8 | requirements and limitations; providing for repeal upon |
| 9 | expiration of the moratorium; amending s. 408.036, F.S.; |
| 10 | exempting a nursing home that is created by combining |
| 11 | certain licensed beds from requirements for obtaining a |
| 12 | certificate of need from the Agency for Health Care |
| 13 | Administration; amending s. 408.040, F.S.; authorizing |
| 14 | nursing homes in certain counties to request a reduction |
| 15 | in their annual Medicaid patient days; requiring the |
| 16 | Agency for Health Care Administration to automatically |
| 17 | grant such a request if the nursing home meets certain |
| 18 | conditions; providing for future repeal; providing an |
| 19 | effective date. |
| 20 |
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| 21 | Be It Enacted by the Legislature of the State of Florida: |
| 22 |
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| 23 | Section 1. Section 651.1185, Florida Statutes, is |
| 24 | transferred, renumbered as section 408.0435, Florida Statutes, |
| 25 | and amended to read: |
| 26 | 408.0435 651.1185 Moratorium on nursing home certificates |
| 27 | of need.-- |
| 28 | (1) Notwithstanding the establishment of need as provided |
| 29 | for in this chapter 408, a no certificate of need for additional |
| 30 | community nursing home beds may not shall be approved by the |
| 31 | agency until July 1, 2011 2006. |
| 32 | (2) The Legislature finds that the continued growth in the |
| 33 | Medicaid budget for nursing home care has constrained the |
| 34 | ability of the state to meet the needs of its elderly residents |
| 35 | through the use of less restrictive and less institutional |
| 36 | methods of long-term care. It is therefore the intent of the |
| 37 | Legislature to limit the increase in Medicaid nursing home |
| 38 | expenditures in order to provide funds to invest in long-term |
| 39 | care that is community-based and provides supportive services in |
| 40 | a manner that is both more cost-effective and more in keeping |
| 41 | with the wishes of the elderly residents of this state. |
| 42 | (3) This moratorium on certificates of need shall not |
| 43 | apply to sheltered nursing home beds in a continuing care |
| 44 | retirement community certified by the former Department of |
| 45 | Insurance or by the Office of Insurance Regulation pursuant to |
| 46 | chapter 651. |
| 47 | (4)(a) The moratorium on certificates of need does not |
| 48 | apply and a certificate of need for additional community nursing |
| 49 | home beds may be approved for a county that meets the following |
| 50 | circumstances: |
| 51 | 1. The county has no community nursing home beds; and |
| 52 | 2. The lack of community nursing home beds occurs because |
| 53 | all nursing home beds in the county that were licensed on July |
| 54 | 1, 2001, have subsequently closed. |
| 55 | (b) The certificate-of-need review for such circumstances |
| 56 | shall be subject to the comparative review process consistent |
| 57 | with the provisions of s. 408.039, and the number of beds may |
| 58 | not exceed the number of beds lost by the county after July 1, |
| 59 | 2001. |
| 60 |
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| 61 | This subsection shall be repealed upon the expiration of the |
| 62 | moratorium established in subsection (1). |
| 63 | (5) The moratorium on certificates of need does not apply |
| 64 | for the addition of nursing home beds licensed under chapter 400 |
| 65 | to a nursing home located in a county having up to 50,000 |
| 66 | residents, in a number not exceeding 10 total beds or 10 percent |
| 67 | of the number of beds licensed in the facility being expanded, |
| 68 | whichever is greater. In addition to any other documentation |
| 69 | required by the agency, a request submitted under this |
| 70 | subsection must: |
| 71 | (a) Certify that the facility has not had any class I or |
| 72 | class II deficiencies within the 30 months preceding the request |
| 73 | for addition. |
| 74 | (b) Certify that the prior 12-month average occupancy rate |
| 75 | for the nursing home beds at the facility meets or exceeds 94 |
| 76 | percent and the facility had not had any class I or class II |
| 77 | deficiencies since its initial licensure. |
| 78 | (c) For a facility that has been licensed for less than 24 |
| 79 | months, certify that the prior 6-month average occupancy rate |
| 80 | for the nursing home beds at the facility meets or exceeds 94 |
| 81 | percent and that the facility has not had any class I or class |
| 82 | II deficiencies since its initial licensure. |
| 83 |
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| 84 | This subsection shall be repealed upon the expiration of the |
| 85 | moratorium established in subsection (1). |
| 86 | (6) The moratorium on certificates of need does not apply |
| 87 | for the addition of nursing home beds licensed under chapter 400 |
| 88 | in a number not exceeding 10 total beds or 10 percent of the |
| 89 | number of beds licensed in the facility being expanded, |
| 90 | whichever is greater, if the facility meets the requirements of |
| 91 | paragraph (a). |
| 92 | (a) In addition to any other documentation required by the |
| 93 | agency, a request for the addition of beds under this subsection |
| 94 | must certify that: |
| 95 | 1. The facility has not had any class I or class II |
| 96 | deficiencies within the 30 months preceding the request for |
| 97 | addition; |
| 98 | 2. The prior 12-month average occupancy rate for the |
| 99 | nursing home beds at the facility meets or exceeds 96 percent; |
| 100 | 3. The occupancy rate for nursing home beds in the |
| 101 | subdistrict is 94 percent or greater; and |
| 102 | 4. Any beds authorized for the facility under this |
| 103 | subsection before the date of the current request for additional |
| 104 | beds have been licensed and operational for at least 12 months. |
| 105 | (b) A nursing home may request additional beds under this |
| 106 | subsection as an exemption from the provisions of s. 408.036(1). |
| 107 | The timeframes and monitoring process specified in s. |
| 108 | 408.040(2)(a)-(c) apply to any exemption issued under this |
| 109 | subsection. |
| 110 | (c) The agency shall count beds authorized under this |
| 111 | subsection as approved beds in the published inventory of |
| 112 | nursing home beds until the beds are licensed. |
| 113 |
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| 114 | This subsection shall be repealed upon the expiration of the |
| 115 | moratorium established in subsection (1). |
| 116 | Section 2. Present paragraphs (f)-(s) of subsection (3) of |
| 117 | section 408.036, Florida Statutes, are redesignated as |
| 118 | paragraphs (g)-(t), respectively, and a new paragraph (f) is |
| 119 | added to that subsection, to read: |
| 120 | 408.036 Projects subject to review; exemptions.-- |
| 121 | (3) EXEMPTIONS.--Upon request, the following projects are |
| 122 | subject to exemption from the provisions of subsection (1): |
| 123 | (f) For the creation of a single nursing home within a |
| 124 | district by combining licensed beds from two or more licensed |
| 125 | nursing homes within such district, regardless of subdistrict |
| 126 | boundaries, where 50 percent of the beds in the created nursing |
| 127 | home are transferred from the only nursing home in a county and |
| 128 | its utilization data demonstrate that it had an occupancy rate |
| 129 | of less than 75 percent for the 12-month period ending 90 days |
| 130 | before the request for the exemption. |
| 131 | Section 3. Paragraph (d) of subsection (1) of section |
| 132 | 408.040, Florida Statutes, is redesignated as paragraph (e), and |
| 133 | a new paragraph (d) is added to that subsection to read: |
| 134 | 408.040 Conditions and monitoring.-- |
| 135 | (1) |
| 136 | (d) If a nursing home is located in a county in which a |
| 137 | long-term care community diversion pilot project has been |
| 138 | implemented under s. 430.705 or in a county in which an |
| 139 | integrated, fixed-payment delivery system for Medicaid |
| 140 | recipients who are 60 years of age or older has been implemented |
| 141 | under s. 409.912(5), the nursing home may request a reduction in |
| 142 | the percentage of annual patient days used by residents who are |
| 143 | eligible for care under Title XIX of the Social Security Act, |
| 144 | which is a condition of the nursing home's certificate of need. |
| 145 | The agency shall automatically grant the nursing home's request |
| 146 | if the reduction is not more than 15 percent of the nursing |
| 147 | home's annual Medicaid-patient-days condition. A nursing home |
| 148 | may submit only one request every 2 years for an automatic |
| 149 | reduction. A requesting nursing home must notify the agency in |
| 150 | writing at least 60 days in advance of its intent to reduce its |
| 151 | annual Medicaid-patient-days condition by not more than 15 |
| 152 | percent. The agency must acknowledge the request in writing and |
| 153 | must change its records to reflect the revised certificate-of- |
| 154 | need condition. This paragraph expires June 30, 2011. |
| 155 | Section 4. This act shall take effect upon becoming a law. |