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