Florida Senate - 2014                                     SB 268
       By Senator Grimsley
       21-00284A-14                                           2014268__
    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
   77  increase.
   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.
   84  760.29(4)(b).
   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.
  184  408.0435(1).
  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
  193  greater.
  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
  202  percent.
  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
  206  months.
  207         2. The timeframes and monitoring process specified in s.
  208  408.040(2)(a)-(c) apply to any exemption issued under this
  209  paragraph.
  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.