Florida Senate - 2014                        COMMITTEE AMENDMENT
       Bill No. SB 268
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  01/08/2014           .                                

    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsection (5) of section 408.034, Florida
    6  Statutes, is amended, present subsection (6) of that section is
    7  redesignated as subsection (8), and a new subsection (6) and
    8  subsection (7) are added to that section, to read:
    9         408.034 Duties and responsibilities of agency; rules.—
   10         (5) The agency shall establish by rule a nursing-home-bed
   11  need methodology that has a goal of maintaining a subdistrict
   12  average occupancy rate of 92 94 percent and that reduces the
   13  community nursing home bed need for the areas of the state where
   14  the agency establishes pilot community diversion programs
   15  through the Title XIX aging waiver program.
   16         (6) If nursing home bed need is determined to exist in
   17  geographically contiguous subdistricts within a district, an
   18  applicant may aggregate the subdistricts’ need for a new
   19  community nursing home in one of the subdistricts. If need is
   20  aggregated from two subdistricts, the proposed nursing home site
   21  must be located in the subdistrict with the greater need as
   22  published by the agency in the Florida Administrative Register.
   23  However, if need is aggregated from more than two subdistricts,
   24  the location of the proposed nursing home site must provide
   25  reasonable geographic access for residents in the respective
   26  subdistricts given the relative bed need in each.
   27         (7) If nursing home bed need is determined to exist in a
   28  subdistrict, an additional positive application factor may be
   29  recognized in the application review process for an applicant
   30  who agrees to voluntarily relinquish licensed nursing home beds
   31  in one or more subdistricts where there is no calculated need.
   32  The applicant must demonstrate that it operates, controls, or
   33  has an agreement with another licensed community nursing home to
   34  ensure that beds are voluntarily relinquished if the application
   35  is approved and the applicant is licensed.
   36         Section 2. Subsection (2) and paragraphs (f), (k), (p), and
   37  (q) of subsection (3) of section 408.036, Florida Statutes, are
   38  amended to read:
   39         408.036 Projects subject to review; exemptions.—
   40         (2) PROJECTS SUBJECT TO EXPEDITED REVIEW.—Unless exempt
   41  pursuant to subsection (3), the following projects are subject
   42  to an expedited review shall include, but not be limited to:
   43         (a) A Transfer of a certificate of need, except that when
   44  an existing hospital is acquired by a purchaser, all
   45  certificates of need issued to the hospital which are not yet
   46  operational shall be acquired by the purchaser, without need for
   47  a transfer.
   48         (b) Replacement of a nursing home within the same district,
   49  if the proposed project site is located within a geographic area
   50  that contains at least 65 percent of the facility’s current
   51  residents and is within a 30-mile radius of the replaced nursing
   52  home. If the proposed project site is outside the subdistrict
   53  where the replaced nursing home is located, the prior 6-month
   54  occupancy rate for licensed community nursing homes in the
   55  proposed subdistrict must be at least 85 percent in accordance
   56  with the agency’s most recently published inventory.
   57         (c) Replacement of a nursing home within the same district,
   58  if the proposed project site is outside a 30-mile radius of the
   59  replaced nursing home but within the same subdistrict or a
   60  geographically contiguous subdistrict. If the proposed project
   61  site is in the geographically contiguous subdistrict, the prior
   62  6-month occupancy rate for licensed community nursing homes for
   63  that subdistrict must be at least 85 percent in accordance with
   64  the agency’s most recently published inventory.
   65         (d)(c) Relocation of a portion of a nursing home’s licensed
   66  beds to another a facility or to establish a new facility within
   67  the same district or within a geographically contiguous
   68  district, if the relocation is within a 30-mile radius of the
   69  existing facility and the total number of nursing home beds in
   70  the state district does not increase.
   71         (e)(d)The New construction of a community nursing home in
   72  a retirement community as further provided in this paragraph.
   73         1. Expedited review under this paragraph is available if
   74  all of the following criteria are met:
   75         a. The residential use area of the retirement community is
   76  deed-restricted as housing for older persons as defined in s.
   77  760.29(4)(b).
   78         b. The retirement community is located in a county in which
   79  25 percent or more of its population is age 65 and older.
   80         c. The retirement community is located in a county that has
   81  a rate of no more than 16.1 beds per 1,000 persons age 65 years
   82  or older. The rate shall be determined by using the current
   83  number of licensed and approved community nursing home beds in
   84  the county per the agency’s most recent published inventory.
   85         d. The retirement community has a population of at least
   86  8,000 residents within the county, based on a population data
   87  source accepted by the agency.
   88         e. The number of proposed community nursing home beds in an
   89  application does not exceed the projected bed need after
   90  applying the rate of 16.1 beds per 1,000 persons aged 65 years
   91  and older projected for the county 3 years into the future using
   92  the estimates adopted by the agency reduced by, after
   93  subtracting the agency’s most recently published inventory of
   94  licensed and approved community nursing home beds in the county
   95  per the agency’s most recent published inventory.
   96         2. No more than 120 community nursing home beds shall be
   97  approved for a qualified retirement community under each request
   98  for application for expedited review. Subsequent requests for
   99  expedited review under this process may shall not be made until
  100  2 years after construction of the facility has commenced or 1
  101  year after the beds approved through the initial request are
  102  licensed, whichever occurs first.
  103         3. The total number of community nursing home beds which
  104  may be approved for any single deed-restricted community
  105  pursuant to this paragraph may shall not exceed 240, regardless
  106  of whether the retirement community is located in more than one
  107  qualifying county.
  108         4. Each nursing home facility approved under this paragraph
  109  must shall be dually certified for participation in the Medicare
  110  and Medicaid programs.
  111         5. Each nursing home facility approved under this paragraph
  112  must shall be at least 1 mile, as measured over publicly owned
  113  roadways, from an existing approved and licensed community
  114  nursing home, measured over publicly owned roadways.
  115         6. Section 408.0435 does not apply to this paragraph.
  116         6.7. A retirement community requesting expedited review
  117  under this paragraph shall submit a written request to the
  118  agency for an expedited review. The request must shall include
  119  the number of beds to be added and provide evidence of
  120  compliance with the criteria specified in subparagraph 1.
  121         7.8. After verifying that the retirement community meets
  122  the criteria for expedited review specified in subparagraph 1.,
  123  the agency shall publicly notice in the Florida Administrative
  124  Register that a request for an expedited review has been
  125  submitted by a qualifying retirement community and that the
  126  qualifying retirement community intends to make land available
  127  for the construction and operation of a community nursing home.
  128  The agency’s notice must shall identify where potential
  129  applicants can obtain information describing the sales price of,
  130  or terms of the land lease for, the property on which the
  131  project will be located and the requirements established by the
  132  retirement community. The agency notice must shall also specify
  133  the deadline for submission of the any certificate-of-need
  134  application, which may shall not be earlier than the 91st day or
  135  and not be later than the 125th day after the date the notice
  136  appears in the Florida Administrative Register.
  137         8.9. The qualified retirement community shall make land
  138  available to applicants it deems to have met its requirements
  139  for the construction and operation of a community nursing home
  140  but may will sell or lease the land only to the applicant that
  141  is issued a certificate of need by the agency under the
  142  provisions of this paragraph.
  143         a. A certificate-of-need certificate of need application
  144  submitted under pursuant to this paragraph must shall identify
  145  the intended site for the project within the retirement
  146  community and the anticipated costs for the project based on
  147  that site. The application must shall also include written
  148  evidence that the retirement community has determined that both
  149  the provider submitting the application and the project satisfy
  150  proposed by that provider satisfies its requirements for the
  151  project.
  152         b. If the retirement community determines community’s
  153  determination that more than one provider satisfies its
  154  requirements for the project, it may notify does not preclude
  155  the retirement community from notifying the agency of the
  156  provider it prefers.
  157         9.10.The agency shall review each submitted application
  158  submitted shall be reviewed by the agency. If multiple
  159  applications are submitted for a the project as published
  160  pursuant to subparagraph 7. 8., then the agency shall review the
  161  competing applications shall be reviewed by the agency.
  163  The agency shall develop rules to implement the provisions for
  164  expedited review process, including time schedule, application
  165  content that which may be reduced from the full requirements of
  166  s. 408.037(1), and application processing.
  167         (3) EXEMPTIONS.—Upon request, the following projects are
  168  subject to exemption from the provisions of subsection (1):
  169         (f) For the addition of nursing home beds licensed under
  170  chapter 400 in a number not exceeding 30 total beds or 25
  171  percent of the number of beds licensed in the facility being
  172  replaced under paragraph (2)(b), paragraph (2)(c), or paragraph
  173  (p), whichever is less For the creation of a single nursing home
  174  within a district by combining licensed beds from two or more
  175  licensed nursing homes within such district, regardless of
  176  subdistrict boundaries, if 50 percent of the beds in the created
  177  nursing home are transferred from the only nursing home in a
  178  county and its utilization data demonstrate that it had an
  179  occupancy rate of less than 75 percent for the 12-month period
  180  ending 90 days before the request for the exemption. This
  181  paragraph is repealed upon the expiration of the moratorium
  182  established in s. 408.0435(1).
  183         (k) For the addition of nursing home beds licensed under
  184  chapter 400 in a number not exceeding 10 total beds or 10
  185  percent of the number of beds licensed in the facility being
  186  expanded, whichever is greater; or, for the addition of nursing
  187  home beds licensed under chapter 400 at a facility that has been
  188  designated as a Gold Seal nursing home under s. 400.235 in a
  189  number not exceeding 20 total beds or 10 percent of the number
  190  of licensed beds in the facility being expanded, whichever is
  191  greater.
  192         1. In addition to any other documentation required by the
  193  agency, a request for exemption submitted under this paragraph
  194  must certify that:
  195         a. Certify that The facility has not had any class I or
  196  class II deficiencies within the 30 months preceding the request
  197  for addition.
  198         b. Certify that The prior 12-month average occupancy rate
  199  for the nursing home beds at the facility meets or exceeds 94 96
  200  percent.
  201         c. Certify that Any beds authorized for the facility under
  202  this paragraph before the date of the current request for an
  203  exemption have been licensed and operational for at least 12
  204  months.
  205         2. The timeframes and monitoring process specified in s.
  206  408.040(2)(a)-(c) apply to any exemption issued under this
  207  paragraph.
  208         3. The agency shall count beds authorized under this
  209  paragraph as approved beds in the published inventory of nursing
  210  home beds until the beds are licensed.
  211         (p) For replacement of a licensed nursing home on the same
  212  site, or within 5 3 miles of the same site, if the number of
  213  licensed beds does not increase.
  214         (q) For consolidation or combination of licensed nursing
  215  homes or transfer of beds between licensed nursing homes within
  216  the same planning district subdistrict, by providers that
  217  operate multiple nursing homes with any shared controlled
  218  interest within that planning district subdistrict, if there is
  219  no increase in the planning district subdistrict total number of
  220  nursing home beds and the site of the relocation is not more
  221  than 30 miles from the original location.
  222         Section 3. Section 408.0435, Florida Statutes, is repealed.
  223         Section 4. Section 408.0436, Florida Statutes, is created
  224  to read:
  225         408.0436 Limitation on nursing home certificates of need.
  226  Notwithstanding the establishment of need as provided in this
  227  chapter, the agency may not approve a certificate-of-need
  228  application for new community nursing home beds following the
  229  batching cycle in which the total number of new community
  230  nursing home beds approved from July 1, 2014, to June 30, 2019,
  231  equals or exceeds 5,000. As used in this section and provided in
  232  rule 59C-1.002, Florida Administrative Code, the term “batching
  233  cycle” means the grouping for comparative review of certificate
  234  of-need applications submitted for beds, services, or programs
  235  having a like certificate-of-need need methodology or licensing
  236  category in the same planning horizon and the same applicable
  237  district or subdistrict. This section repeals on July 1, 2019.
  238         Section 5. This act shall take effect July 1, 2014.
  239  ================= T I T L E  A M E N D M E N T ================
  240  And the title is amended as follows:
  241         Delete everything before the enacting clause
  242  and insert:
  243                        A bill to be entitled                      
  244         An act relating to certificates of need; amending s.
  245         408.034, F.S.; decreasing the subdistrict average
  246         occupancy rate that the Agency for Health Care
  247         Administration is required to maintain as a goal of
  248         its nursing-home-bed-need methodology; conforming a
  249         provision to changes made by the act; authorizing an
  250         applicant to aggregate the need of geographically
  251         contiguous subdistricts within a district for a
  252         proposed community nursing home under certain
  253         circumstances; requiring the proposed nursing home
  254         site to be located in the subdistrict with the greater
  255         need under certain circumstances; recognizing an
  256         additional positive application factor for an
  257         applicant who voluntarily relinquishes certain nursing
  258         home beds; requiring the applicant to demonstrate that
  259         it meets certain requirements; amending s. 408.036,
  260         F.S.; providing that, under certain circumstances,
  261         replacement of a nursing home and relocation of a
  262         portion of a nursing home’s licensed beds to another
  263         facility, or to establish a new facility, is a health
  264         care-related project subject to expedited review;
  265         conforming a cross-reference; revising the
  266         requirements for projects that are exempted from
  267         applying for a certificate of need; repealing s.
  268         408.0435, F.S., relating to the moratorium on the
  269         approval of certificates of need for additional
  270         community nursing home beds; creating s. 408.0436,
  271         F.S.; prohibiting the agency from approving a
  272         certificate-of-need application for new community
  273         nursing home beds under certain circumstances;
  274         defining the term “batching cycle”; providing a
  275         repeal; providing an effective date.