Florida Senate - 2017                                     SB 676
       
       
        
       By Senator Bradley
       
       5-00645-17                                             2017676__
    1                        A bill to be entitled                      
    2         An act relating to the availability of health care
    3         services; repealing s. 154.245, F.S., relating to the
    4         issuance of certificates of need by the Agency for
    5         Health Care Administration; amending s. 159.27, F.S.;
    6         revising the term “health care facility”; amending s.
    7         189.08, F.S.; removing a requirement that a special
    8         district notify a local general-purpose government of
    9         its plans to build, improve, or expand a public
   10         facility that requires a certification of need;
   11         creating s. 381.4066, F.S.; establishing local health
   12         councils as public or private nonprofit agencies
   13         serving the counties of certain districts; providing
   14         for council members to be appointed by county
   15         commissions; providing that appointees must represent
   16         health care providers, health care purchasers, and
   17         nongovernmental health care consumers; requiring a
   18         certain schedule to be provided to county commissions
   19         regarding council appointments; providing terms;
   20         establishing health service planning districts;
   21         establishing duties of local health councils;
   22         requiring local health councils to enter into
   23         memoranda of agreement with certain regional planning
   24         councils and local governments in their districts;
   25         specifying a requirement for the memoranda of
   26         agreement; authorizing local health councils to employ
   27         personnel or contract for staffing services;
   28         authorizing local health councils to accept and
   29         receive funds, grants, and services from governmental
   30         agencies and from private or civic sources; requiring
   31         an annual accounting of receipts and disbursement of
   32         funds; providing legislative intent regarding funding
   33         of local health councils; authorizing fees and
   34         allowing fees to be collected from certain facilities
   35         at the time of licensure renewal and prorated;
   36         requiring the agency to adopt by rule fees for
   37         hospitals, nursing homes, and other facilities;
   38         providing penalties and authorizing fines; delegating
   39         to the agency the responsibility for planning health
   40         care services in the state; requiring the agency to
   41         develop and maintain a comprehensive health care
   42         database; requiring the Department of Health to
   43         contract with local health councils for certain
   44         services; specifying that certain funds must be
   45         distributed according to an allocation plan the
   46         department develops; authorizing the department to
   47         withhold funds or cancel contracts if certain
   48         standards are not met; amending s. 395.1055, F.S.;
   49         removing a requirement that hospitals must submit
   50         certain data related to certificate-of-need reviews;
   51         requiring providers of adult diagnostic cardiac
   52         catheterization services to comply with the most
   53         recent guidelines of the American College of
   54         Cardiology, the American Heart Association Guidelines
   55         for Cardiac Catheterization and Cardiac
   56         Catheterization Laboratories, and the rules of the
   57         agency; providing rule requirements; amending s.
   58         395.602, F.S.; deleting the terms “emergency care
   59         hospital,” “essential access community hospital,”
   60         “inactive rural hospital bed,” and “rural primary care
   61         hospital”; repealing s. 395.6025, F.S., relating to
   62         rural hospital replacement facilities; amending s.
   63         395.603, F.S.; removing a requirement that the agency
   64         adopt by rule a process by which a rural hospital may
   65         deactivate general hospital beds; removing a
   66         requirement that rural primary care hospitals and
   67         emergency care hospitals maintain a number of actively
   68         licensed general hospital beds necessary for
   69         certification for Medicare reimbursement; repealing s.
   70         395.604, F.S., relating to other rural hospital
   71         programs; repealing s. 395.605, F.S., relating to
   72         emergency care hospitals; amending s. 400.071, F.S.;
   73         removing a statement of legislative intent that
   74         preference be given to certain applications when
   75         reviewing certificate-of-need applications; amending
   76         s. 400.606, F.S.; requiring hospices that are
   77         initially licensed after a certain date to be
   78         accredited by a national accreditation organization;
   79         requiring such hospices to establish and maintain
   80         freestanding hospice facilities that are engaged in
   81         providing inpatient and related services; removing the
   82         authority of the agency to deny a license to an
   83         applicant that fails to meet any condition for the
   84         provision of hospice care or services imposed by the
   85         agency on a certificate of need; amending s. 400.6085,
   86         F.S.; removing a provision prohibiting hospices
   87         contracting for inpatient care beds from being
   88         required to obtain an additional certificate of need
   89         for the number of designated beds; repealing s.
   90         408.031, F.S., relating to a short title for the
   91         Health Facility and Services Development Act;
   92         repealing s. 408.032, F.S., relating to definitions
   93         for the act; repealing s. 408.033, F.S., relating to
   94         local and state health planning; repealing s. 408.034,
   95         F.S., relating to the duties and responsibilities of
   96         the agency; repealing s. 408.035, F.S., relating to
   97         review criteria for certificate-of-need
   98         determinations; repealing s. 408.036, F.S., relating
   99         to health-care-related projects subject to review;
  100         repealing s. 408.0361, F.S., relating to
  101         cardiovascular services and burn unit licensure;
  102         repealing s. 408.037, F.S., relating to content of
  103         certificate-of-need applications; repealing s.
  104         408.038, F.S., relating to fees for certificate-of
  105         need applications; repealing s. 408.039, F.S.,
  106         relating to the review process for certificates of
  107         need; repealing s. 408.040, F.S., relating to
  108         conditions imposed on certificates of need; repealing
  109         s. 408.041, F.S., relating to the penalties for
  110         failing to obtain a valid certificate of need;
  111         repealing s. 408.042, F.S., relating to limitations on
  112         transfers of certificates of need; repealing s.
  113         408.043, F.S., relating to special provisions relating
  114         to certificates of need; repealing s. 408.0436, F.S.,
  115         relating to a limitation on nursing home certificates
  116         of need; repealing s. 408.044, F.S., relating to the
  117         authority of the agency to obtain an injunction to
  118         restrain or prevent the pursuit of a project in the
  119         absence of a valid certificate of need; repealing s.
  120         408.045, F.S., relating to competitive sealed
  121         proposals for certificates of need; repealing s.
  122         408.0455, F.S., relating to rules of the agency in
  123         effect as of a certain date; amending s. 408.808,
  124         F.S.; authorizing the agency to issue an inactive
  125         license to a hospital, nursing home, intermediate care
  126         facility for the developmentally disabled, or an
  127         ambulatory surgical center under certain
  128         circumstances; removing authority for the agency to
  129         renew an inactive designation for a statutory rural
  130         hospital under certain circumstances; repealing s.
  131         651.118, F.S., relating to sheltered nursing home beds
  132         and community beds; amending ss. 154.246, 186.503,
  133         220.1845, 376.30781, 376.86, 383.216, 395.0191,
  134         395.1065, 408.07, 408.806, 408.810, 408.820, 409.9116,
  135         641.60, and 1009.65 F.S.; conforming provisions to
  136         changes made by the act; providing an effective date.
  137          
  138  Be It Enacted by the Legislature of the State of Florida:
  139  
  140         Section 1. Section 154.245, Florida Statutes, is repealed.
  141         Section 2. Subsection (16) of section 159.27, Florida
  142  Statutes, is amended to read:
  143         159.27 Definitions.—The following words and terms, unless
  144  the context clearly indicates a different meaning, shall have
  145  the following meanings:
  146         (16) “Health care facility” means property operated in the
  147  private sector, whether operated for profit or not, used for or
  148  useful in connection with the diagnosis, treatment, therapy,
  149  rehabilitation, housing, or care of or for aged, sick, ill,
  150  injured, infirm, impaired, disabled, or handicapped persons,
  151  without discrimination among such persons due to race, religion,
  152  or national origin; or for the prevention, detection, and
  153  control of disease, including, without limitation thereto,
  154  hospital, clinic, emergency, outpatient, and intermediate care,
  155  including, but not limited to, facilities for the elderly such
  156  as assisted living facilities, facilities defined in s.
  157  154.205(8), day care and share-a-home facilities, nursing homes,
  158  and the following related property when used for or in
  159  connection with the foregoing: laboratory; research; pharmacy;
  160  laundry; health personnel training and lodging; patient, guest,
  161  and health personnel food service facilities; and offices and
  162  office buildings for persons engaged in health care professions
  163  or services; provided, if required by ss. 400.601-400.611 and
  164  ss. 408.031-408.045, a certificate of need therefor is obtained
  165  prior to the issuance of the bonds.
  166         Section 3. Subsection (3) of section 189.08, Florida
  167  Statutes, is amended, and present subsections (4) through (10)
  168  are redesignated as subsections (3) through (9), respectively,
  169  to read:
  170         189.08 Special district public facilities report.—
  171         (3) A special district proposing to build, improve, or
  172  expand a public facility which requires a certificate of need
  173  pursuant to chapter 408 shall elect to notify the appropriate
  174  local general-purpose government of its plans either in its 7
  175  year plan or at the time the letter of intent is filed with the
  176  Agency for Health Care Administration pursuant to s. 408.039.
  177         Section 4. Section 381.4066, Florida Statutes, is created
  178  to read:
  179         381.4066Local and state health planning.—
  180         (1)LOCAL HEALTH COUNCILS.—
  181         (a)Local health councils are hereby established as public
  182  or private nonprofit agencies serving the counties of a district
  183  as described in paragraph (b). The members of each council shall
  184  be appointed in an equitable manner by the county commissions
  185  having jurisdiction in the respective district. Each council
  186  shall be composed of a number of members equal to one and one
  187  half times the number of counties comprising the district or 12
  188  members, whichever is greater. Each county in a district shall
  189  be entitled to at least one member on the council. The balance
  190  of the council’s membership shall be allocated among the
  191  counties of the district on the basis of population, with the
  192  number of council seats rounded to the nearest whole number,
  193  except that in a district composed of only two counties, no
  194  county shall have fewer than four members. The appointees shall
  195  be representatives of health care providers, health care
  196  purchasers, and nongovernmental health care consumers, but not
  197  excluding elected government officials. The members who are
  198  health care consumers shall include a representative number of
  199  persons over 60 years of age. A majority of the council members
  200  must consist of health care purchasers and health care
  201  consumers. Each local health council shall provide each county
  202  commission a schedule for appointing council members to ensure
  203  that council membership complies with this paragraph. The
  204  members of the local health council shall elect a chair and
  205  vice-chair. Members shall serve for terms of 2 years and may be
  206  eligible for reappointment.
  207         (b)Health service planning districts are composed of the
  208  following counties:
  209         1. District 1.—Escambia, Santa Rosa, Okaloosa, and Walton
  210  Counties.
  211         2. District 2.—Holmes, Washington, Bay, Jackson, Franklin,
  212  Gulf, Gadsden, Liberty, Calhoun, Leon, Wakulla, Jefferson,
  213  Madison, and Taylor Counties.
  214         3. District 3.—Hamilton, Suwannee, Lafayette, Dixie,
  215  Columbia, Gilchrist, Levy, Union, Bradford, Putnam, Alachua,
  216  Marion, Citrus, Hernando, Sumter, and Lake Counties.
  217         4. District 4.—Baker, Nassau, Duval, Clay, St. Johns,
  218  Flagler, and Volusia Counties.
  219         5. District 5.—Pasco and Pinellas Counties.
  220         6. District 6.—Hillsborough, Manatee, Polk, Hardee, and
  221  Highlands Counties.
  222         7. District 7.—Seminole, Orange, Osceola, and Brevard
  223  Counties.
  224         8. District 8.—Sarasota, DeSoto, Charlotte, Lee, Glades,
  225  Hendry, and Collier Counties.
  226         9. District 9.—Indian River, Okeechobee, St. Lucie, Martin,
  227  and Palm Beach Counties.
  228         10. District 10.—Broward County.
  229         11. District 11.—Miami-Dade and Monroe Counties.
  230         (c) Each local health council may:
  231         1.Develop a district area health plan that includes
  232  strategies and sets priorities for the council’s implementation
  233  based on that district’s unique local health needs.
  234         2.Advise the Agency for Health Care Administration on
  235  health care issues and resource allocations.
  236         3.Promote public awareness of community health needs,
  237  emphasizing health promotion and cost-effective health service
  238  selection.
  239         4.Collect data and conduct analyses and studies related to
  240  health care needs of the district, including the needs of
  241  medically indigent persons, and assist the agency and other
  242  state offices in carrying out data collection activities that
  243  relate to the functions in this subsection.
  244         5.Advise and assist any regional planning councils within
  245  each district which have elected to address health issues in
  246  their strategic regional policy plans, including the development
  247  of the plans’ health elements that address the health goals and
  248  policies in the state comprehensive plan.
  249         6.Advise and assist local governments within each district
  250  on the development of an optional health plan element of the
  251  state comprehensive plan provided in chapter 163, to assure
  252  compatibility with the health goals and policies in the state
  253  comprehensive plan and district health plan. To facilitate the
  254  implementation of this section, the local health council shall
  255  annually provide the local governments in its service area, upon
  256  request, with:
  257         a.A copy and appropriate updates of the district health
  258  plan;
  259         b.A report of hospital and nursing home utilization
  260  statistics for facilities within the local government
  261  jurisdiction.
  262         7. Monitor and evaluate the adequacy, appropriateness, and
  263  effectiveness of local, state, federal, and private funds
  264  distributed within the district to meet the needs of the
  265  medically indigent and other underserved population groups.
  266         8. In conjunction with the Department of Health, plan for
  267  services at the local level for persons infected with the human
  268  immunodeficiency virus.
  269         9. Provide technical assistance to encourage and support
  270  activities by providers, purchasers, consumers, and local,
  271  regional, and state agencies in meeting the health care goals,
  272  objectives, and policies adopted by the local health council.
  273         (d)Each local health council shall enter into a memorandum
  274  of agreement with each regional planning council in its district
  275  which elects to address health issues in its strategic regional
  276  policy plan. In addition, each local health council shall enter
  277  into a memorandum of agreement with each local government that
  278  includes an optional health element in its comprehensive plan.
  279  Each memorandum of agreement must specify the manner in which
  280  each local government, regional planning council, and local
  281  health council will coordinate its activities to ensure a
  282  unified approach to health planning and implementation efforts.
  283         (e)Local health councils may employ personnel or contract
  284  for staffing services with persons who possess appropriate
  285  qualifications to carry out the councils’ purposes. However,
  286  such personnel are not state employees.
  287         (f)Personnel of the local health councils shall provide an
  288  annual orientation to council members about council member
  289  responsibilities.
  290         (g)Each local health council may accept and receive, in
  291  furtherance of its health planning functions, funds, grants, and
  292  services from governmental agencies and from private or civic
  293  sources and to perform studies related to local health planning
  294  in exchange for such funds, grants, or services. Each council
  295  shall, no later than January 30 of each year, prepare an
  296  accounting of the receipt and disbursement of funds it received
  297  during the previous calendar year and submit that report to the
  298  Department of Health.
  299         (2)FUNDING.—
  300         (a)The Legislature intends that the cost of local health
  301  councils be borne by assessments on selected health care
  302  facilities subject to licensure by the Agency for Health Care
  303  Administration, including abortion clinics, assisted living
  304  facilities, ambulatory surgical centers, birthing centers;
  305  clinical laboratories, except community nonprofit blood banks
  306  and clinical laboratories operated by practitioners for their
  307  exclusive use under s. 483.035; home health agencies, hospices,
  308  hospitals, intermediate care facilities for the developmentally
  309  disabled, nursing homes, health care clinics, and multiphasic
  310  testing centers, and by assessments on organizations subject to
  311  certification by the agency pursuant to chapter 641, part III,
  312  including health maintenance organizations and prepaid health
  313  clinics. Fees assessed may be collected prospectively at the
  314  time of licensure renewal and prorated for the licensure period.
  315         (b)1.A hospital licensed under chapter 395, a nursing home
  316  licensed under chapter 400, and an assisted living facility
  317  licensed under chapter 429 shall be assessed an annual fee based
  318  on number of beds.
  319         2.All other facilities and organizations listed in
  320  paragraph (a) shall each be assessed an annual fee of $150.
  321         3.Facilities operated by the Department of Children and
  322  Families, the Department of Health, or the Department of
  323  Corrections and any hospital that meets the definition of rural
  324  hospital pursuant to s. 395.602 are exempt from the assessment
  325  required in this subsection.
  326         (c)1.The agency shall by rule establish fees for hospitals
  327  and nursing homes based on an assessment of $2 per bed. However,
  328  no such facility shall be assessed more than a total of $500
  329  annually under this subsection.
  330         2.The agency shall by rule establish fees for assisted
  331  living facilities based on an assessment of $1 per bed. However,
  332  no such facility shall be assessed more than a total of $150
  333  annually under this subsection.
  334         3.The agency shall by rule establish an annual fee of $150
  335  for all other facilities and organizations listed in paragraph
  336  (a).
  337         (d)The agency shall by rule establish a facility billing
  338  and collection process for the health facility fees authorized
  339  by this subsection.
  340         (e)A health facility that is assessed a fee under this
  341  subsection is subject to a fine of $100 per day for each day the
  342  facility is late in submitting its annual fee up to the maximum
  343  of the annual fee owed by the facility. A facility that refuses
  344  to pay the fee or fine is subject to the forfeiture of its
  345  license.
  346         (f)The agency shall deposit in the Health Care Trust Fund
  347  all health care facility assessments that are collected pursuant
  348  to this subsection and shall transfer such funds to the
  349  Department of Health for funding of the local health councils.
  350         (3)DUTIES AND RESPONSIBILITIES OF THE AGENCY.—
  351         (a)The Agency for Health Care Administration is
  352  responsible for the coordinated planning of health care services
  353  in the state.
  354         (b)The agency shall develop and maintain a comprehensive
  355  health care database. The agency or its contractor is authorized
  356  to require the submission of information from health facilities,
  357  health service providers, and licensed health professionals
  358  which is determined by the agency through rule to be necessary
  359  for meeting the agency’s responsibilities as established in this
  360  section.
  361         (c)The Department of Health shall contract with the local
  362  health councils for services that may be performed by the local
  363  health councils under subsection (1). All contract funds shall
  364  be distributed according to an allocation plan developed by the
  365  department. The department may withhold funds from a local
  366  health council or cancel its contract with a local health
  367  council that does not meet performance standards agreed upon by
  368  the department and the local health council.
  369         Section 5. Paragraphs (f), (g), and (h) of subsection (1)
  370  of section 395.1055, Florida Statutes, are amended, and
  371  subsections (10) through (14) are added to that section, to
  372  read:
  373         395.1055 Rules and enforcement.—
  374         (1) The agency shall adopt rules pursuant to ss. 120.536(1)
  375  and 120.54 to implement the provisions of this part, which shall
  376  include reasonable and fair minimum standards for ensuring that:
  377         (f) All hospitals submit such data as necessary to conduct
  378  certificate-of-need reviews required under part I of chapter
  379  408. Such data shall include, but shall not be limited to,
  380  patient origin data, hospital utilization data, type of service
  381  reporting, and facility staffing data. The agency may not
  382  collect data that identifies or could disclose the identity of
  383  individual patients. The agency shall utilize existing uniform
  384  statewide data sources when available and shall minimize
  385  reporting costs to hospitals.
  386         (f)(g) Each hospital has a quality improvement program
  387  designed according to standards established by their current
  388  accrediting organization. This program will enhance quality of
  389  care and emphasize quality patient outcomes, corrective action
  390  for problems, governing board review, and reporting to the
  391  agency of standardized data elements necessary to analyze
  392  quality of care outcomes. The agency shall use existing data,
  393  when available, and shall not duplicate the efforts of other
  394  state agencies in order to obtain such data.
  395         (g)(h) Licensed facilities make available on their Internet
  396  websites, no later than October 1, 2004, and in a hard copy
  397  format upon request, a description of and a link to the patient
  398  charge and performance outcome data collected from licensed
  399  facilities pursuant to s. 408.061.
  400         (10) Each provider of adult diagnostic cardiac
  401  catheterization services shall comply with the most recent
  402  guidelines of the American College of Cardiology, the American
  403  Heart Association Guidelines for Cardiac Catheterization and
  404  Cardiac Catheterization Laboratories, and rules adopted by the
  405  agency which establish licensure standards governing the
  406  operation of adult inpatient diagnostic cardiac catheterization
  407  programs. The rules shall ensure that such programs:
  408         (a) Perform only adult inpatient diagnostic cardiac
  409  catheterization services and will not provide therapeutic
  410  cardiac catheterization or any other cardiology services.
  411         (b) Maintain sufficient appropriate equipment and health
  412  care personnel to ensure quality of care and patient safety.
  413         (c) Maintain appropriate times of operation and protocols
  414  to ensure availability and appropriate referrals in the event of
  415  emergencies.
  416         (d) Demonstrate a plan to provide services to Medicaid and
  417  charity care patients.
  418         (11) Each provider of adult cardiovascular services or
  419  operator of a burn unit shall comply with rules adopted by the
  420  agency which establish licensure standards that govern the
  421  provision of adult cardiovascular services or the operation of a
  422  burn unit. Such rules shall consider, at a minimum, staffing,
  423  equipment, physical plant, operating protocols, the provision of
  424  services to Medicaid and charity care patients, accreditation,
  425  licensure period and fees, and enforcement of minimum standards.
  426         (12) In establishing rules for adult cardiovascular
  427  services, the agency shall include provisions that allow for:
  428         (a) Establishment of two hospital program licensure levels:
  429  a Level I program authorizing the performance of adult
  430  percutaneous cardiac intervention without onsite cardiac
  431  surgery, and a Level II program authorizing the performance of
  432  percutaneous cardiac intervention with onsite cardiac surgery.
  433         (b) Demonstration that, for the most recent 12-month period
  434  as reported to the agency, a hospital seeking a Level I program
  435  has provided a minimum of 300 adult inpatient and outpatient
  436  diagnostic cardiac catheterizations or, for the most recent 12
  437  month period, has discharged or transferred at least 300
  438  inpatients with the principal diagnosis of ischemic heart
  439  disease and that it has a formalized, written transfer agreement
  440  with a hospital that has a Level II program, including written
  441  transport protocols to ensure safe and efficient transfer of a
  442  patient within 60 minutes. However, a hospital located more than
  443  100 road miles from the closest Level II adult cardiovascular
  444  services program does not need to meet the 60-minute transfer
  445  time protocol if the hospital demonstrates that it has a
  446  formalized, written transfer agreement with a hospital that has
  447  a Level II program. The agreement must include written transport
  448  protocols to ensure the safe and efficient transfer of a
  449  patient, taking into consideration the patient’s clinical and
  450  physical characteristics, road and weather conditions, and
  451  viability of ground and air ambulance service to transfer the
  452  patient.
  453         (c) Demonstration that, for the most recent 12-month period
  454  as reported to the agency, a hospital seeking a Level II program
  455  has performed a minimum of 1,100 adult inpatient and outpatient
  456  cardiac catheterizations, of which at least 400 must be
  457  therapeutic catheterizations, or, for the most recent 12-month
  458  period, has discharged at least 800 patients with the principal
  459  diagnosis of ischemic heart disease.
  460         (d) Compliance with the most recent guidelines of the
  461  American College of Cardiology and American Heart Association
  462  guidelines for staffing, physician training and experience,
  463  operating procedures, equipment, physical plant, and patient
  464  selection criteria to ensure quality of care and patient safety.
  465         (e) Establishment of appropriate hours of operation and
  466  protocols to ensure availability and timely referral in the
  467  event of emergencies.
  468         (f) Demonstration of a plan to provide services to Medicaid
  469  and charity care patients.
  470         (13) Hospitals licensed for Level I or Level II adult
  471  cardiovascular services shall participate in clinical outcome
  472  reporting systems operated by the American College of Cardiology
  473  and the Society of Thoracic Surgeons.
  474         (14) Each provider of pediatric cardiac catheterization,
  475  pediatric open heart surgery, neonatal intensive care,
  476  comprehensive medical rehabilitation, and pediatric and adult
  477  organ transplant services shall comply with rules adopted by the
  478  agency which establish licensure standards governing the
  479  operation of such programs. The rules must ensure that such
  480  programs:
  481         (a) Comply with established applicable practice guidelines.
  482         (b) Maintain sufficient appropriate equipment and health
  483  care personnel to ensure quality of care and patient safety.
  484         (c) Maintain appropriate times of operation and protocols
  485  to ensure availability and appropriate referrals in the event of
  486  emergencies.
  487         (d) Demonstrate a plan to provide services to Medicaid and
  488  charity care patients.
  489         Section 6. Subsection (2) of section 395.602, Florida
  490  Statutes, is amended to read:
  491         395.602 Rural hospitals.—
  492         (2) DEFINITIONS.—As used in this part, the term:
  493         (a) “Emergency care hospital” means a medical facility
  494  which provides:
  495         1. Emergency medical treatment; and
  496         2. Inpatient care to ill or injured persons prior to their
  497  transportation to another hospital or provides inpatient medical
  498  care to persons needing care for a period of up to 96 hours. The
  499  96-hour limitation on inpatient care does not apply to respite,
  500  skilled nursing, hospice, or other nonacute care patients.
  501         (b) “Essential access community hospital” means any
  502  facility which:
  503         1. Has at least 100 beds;
  504         2. Is located more than 35 miles from any other essential
  505  access community hospital, rural referral center, or urban
  506  hospital meeting criteria for classification as a regional
  507  referral center;
  508         3. Is part of a network that includes rural primary care
  509  hospitals;
  510         4. Provides emergency and medical backup services to rural
  511  primary care hospitals in its rural health network;
  512         5. Extends staff privileges to rural primary care hospital
  513  physicians in its network; and
  514         6. Accepts patients transferred from rural primary care
  515  hospitals in its network.
  516         (c) “Inactive rural hospital bed” means a licensed acute
  517  care hospital bed, as defined in s. 395.002(13), that is
  518  inactive in that it cannot be occupied by acute care inpatients.
  519         (a)(d) “Rural area health education center” means an area
  520  health education center (AHEC), as authorized by Pub. L. No. 94
  521  484, which provides services in a county with a population
  522  density of no greater than 100 persons per square mile.
  523         (b)(e) “Rural hospital” means an acute care hospital
  524  licensed under this chapter, having 100 or fewer licensed beds
  525  and an emergency room, which is:
  526         1. The sole provider within a county with a population
  527  density of up to 100 persons per square mile;
  528         2. An acute care hospital, in a county with a population
  529  density of up to 100 persons per square mile, which is at least
  530  30 minutes of travel time, on normally traveled roads under
  531  normal traffic conditions, from any other acute care hospital
  532  within the same county;
  533         3. A hospital supported by a tax district or subdistrict
  534  whose boundaries encompass a population of up to 100 persons per
  535  square mile;
  536         4. A hospital classified as a sole community hospital under
  537  42 C.F.R. s. 412.92 which has up to 175 licensed beds;
  538         5. A hospital with a service area that has a population of
  539  up to 100 persons per square mile. As used in this subparagraph,
  540  the term “service area” means the fewest number of zip codes
  541  that account for 75 percent of the hospital’s discharges for the
  542  most recent 5-year period, based on information available from
  543  the hospital inpatient discharge database in the Florida Center
  544  for Health Information and Transparency at the agency; or
  545         6. A hospital designated as a critical access hospital, as
  546  defined in s. 408.07.
  547  
  548  Population densities used in this paragraph must be based upon
  549  the most recently completed United States census. A hospital
  550  that received funds under s. 409.9116 for a quarter beginning no
  551  later than July 1, 2002, is deemed to have been and shall
  552  continue to be a rural hospital from that date through June 30,
  553  2021, if the hospital continues to have up to 100 licensed beds
  554  and an emergency room. An acute care hospital that has not
  555  previously been designated as a rural hospital and that meets
  556  the criteria of this paragraph shall be granted such designation
  557  upon application, including supporting documentation, to the
  558  agency. A hospital that was licensed as a rural hospital during
  559  the 2010-2011 or 2011-2012 fiscal year shall continue to be a
  560  rural hospital from the date of designation through June 30,
  561  2021, if the hospital continues to have up to 100 licensed beds
  562  and an emergency room.
  563         (f) “Rural primary care hospital” means any facility
  564  meeting the criteria in paragraph (e) or s. 395.605 which
  565  provides:
  566         1. Twenty-four-hour emergency medical care;
  567         2. Temporary inpatient care for periods of 72 hours or less
  568  to patients requiring stabilization before discharge or transfer
  569  to another hospital. The 72-hour limitation does not apply to
  570  respite, skilled nursing, hospice, or other nonacute care
  571  patients; and
  572         3. Has no more than six licensed acute care inpatient beds.
  573         (c)(g) “Swing-bed” means a bed that which can be used
  574  interchangeably as either a hospital, skilled nursing facility
  575  (SNF), or intermediate care facility (ICF) bed pursuant to 42
  576  C.F.R. parts 405, 435, 440, 442, and 447.
  577         Section 7. Section 395.6025, Florida Statutes, is repealed.
  578         Section 8. Section 395.603, Florida Statutes, is amended to
  579  read:
  580         395.603 Deactivation of general hospital beds; rural
  581  hospital impact statement.—
  582         (1) The agency shall establish, by rule, a process by which
  583  a rural hospital, as defined in s. 395.602, that seeks licensure
  584  as a rural primary care hospital or as an emergency care
  585  hospital, or becomes a certified rural health clinic as defined
  586  in Pub. L. No. 95-210, or becomes a primary care program such as
  587  a county health department, community health center, or other
  588  similar outpatient program that provides preventive and curative
  589  services, may deactivate general hospital beds. Rural primary
  590  care hospitals and emergency care hospitals shall maintain the
  591  number of actively licensed general hospital beds necessary for
  592  the facility to be certified for Medicare reimbursement.
  593  Hospitals that discontinue inpatient care to become rural health
  594  care clinics or primary care programs shall deactivate all
  595  licensed general hospital beds. All hospitals, clinics, and
  596  programs with inactive beds shall provide 24-hour emergency
  597  medical care by staffing an emergency room. Providers with
  598  inactive beds shall be subject to the criteria in s. 395.1041.
  599  The agency shall specify in rule requirements for making 24-hour
  600  emergency care available. Inactive general hospital beds shall
  601  be included in the acute care bed inventory, maintained by the
  602  agency for certificate-of-need purposes, for 10 years from the
  603  date of deactivation of the beds. After 10 years have elapsed,
  604  inactive beds shall be excluded from the inventory. The agency
  605  shall, at the request of the licensee, reactivate the inactive
  606  general beds upon a showing by the licensee that licensure
  607  requirements for the inactive general beds are met.
  608         (2) In formulating and implementing policies and rules that
  609  may have significant impact on the ability of rural hospitals to
  610  continue to provide health care services in rural communities,
  611  the agency, the department, or the respective regulatory board
  612  adopting policies or rules regarding the licensure or
  613  certification of health care professionals shall provide a rural
  614  hospital impact statement. The rural hospital impact statement
  615  shall assess the proposed action in light of the following
  616  questions:
  617         (1)(a) Do the health personnel affected by the proposed
  618  action currently practice in rural hospitals or are they likely
  619  to in the near future?
  620         (2)(b) What are the current numbers of the affected health
  621  personnel in this state, their geographic distribution, and the
  622  number practicing in rural hospitals?
  623         (3)(c) What are the functions presently performed by the
  624  affected health personnel, and are such functions presently
  625  performed in rural hospitals?
  626         (4)(d) What impact will the proposed action have on the
  627  ability of rural hospitals to recruit the affected personnel to
  628  practice in their facilities?
  629         (5)(e) What impact will the proposed action have on the
  630  limited financial resources of rural hospitals through increased
  631  salaries and benefits necessary to recruit or retain such health
  632  personnel?
  633         (6)(f) Is there a less stringent requirement which could
  634  apply to practice in rural hospitals?
  635         (7)(g) Will this action create staffing shortages, which
  636  could result in a loss to the public of health care services in
  637  rural hospitals or result in closure of any rural hospitals?
  638         Section 9. Section 395.604, Florida Statutes, is repealed.
  639         Section 10. Section 395.605, Florida Statutes, is repealed.
  640         Section 11. Present subsection (3) of section 400.071,
  641  Florida Statutes, is amended, and present subsections (4) and
  642  (5) of that section are redesignated as (3) and (4),
  643  respectively, to read:
  644         400.071 Application for license.—
  645         (3) It is the intent of the Legislature that, in reviewing
  646  a certificate-of-need application to add beds to an existing
  647  nursing home facility, preference be given to the application of
  648  a licensee who has been awarded a Gold Seal as provided for in
  649  s. 400.235, if the applicant otherwise meets the review criteria
  650  specified in s. 408.035.
  651         Section 12. Subsections (3), (4), and (5) of section
  652  400.606, Florida Statutes, are amended to read:
  653         400.606 License; application; renewal; conditional license
  654  or permit; certificate of need.—
  655         (3) Any hospice initially licensed on or after July 1,
  656  2017, must be accredited by a national accreditation
  657  organization that is recognized by the Centers for Medicare and
  658  Medicaid Services and whose standards incorporate comparable
  659  licensure regulations as required by this state. Such
  660  accreditation must be maintained as a requirement of licensure.
  661  The agency shall not issue a license to a hospice that fails to
  662  receive a certificate of need under the provisions of part I of
  663  chapter 408. A licensed hospice is a health care facility as
  664  that term is used in s. 408.039(5) and is entitled to initiate
  665  or intervene in an administrative hearing.
  666         (4) Any hospice initially licensed on or after July 1,
  667  2017, must establish and maintain a freestanding hospice
  668  facility that is engaged in providing inpatient and related
  669  services and that is not otherwise licensed as a health care
  670  facility shall obtain a certificate of need. However, a
  671  freestanding hospice facility that has six or fewer beds is not
  672  required to comply with institutional standards such as, but not
  673  limited to, standards requiring sprinkler systems, emergency
  674  electrical systems, or special lavatory devices.
  675         (5) The agency may deny a license to an applicant that
  676  fails to meet any condition for the provision of hospice care or
  677  services imposed by the agency on a certificate of need by final
  678  agency action, unless the applicant can demonstrate that good
  679  cause exists for the applicant’s failure to meet such condition.
  680         Section 13. Paragraphs (b), (c), and (d) of subsection (2)
  681  of section 400.6085, Florida Statutes, are amended to read:
  682         400.6085 Contractual services.—A hospice may contract out
  683  for some elements of its services. However, the core services,
  684  as set forth in s. 400.609(1), with the exception of physician
  685  services, shall be provided directly by the hospice. Any
  686  contract entered into between a hospice and a health care
  687  facility or service provider must specify that the hospice
  688  retains the responsibility for planning, coordinating, and
  689  prescribing hospice care and services for the hospice patient
  690  and family. A hospice that contracts for any hospice service is
  691  prohibited from charging fees for services provided directly by
  692  the hospice care team that duplicate contractual services
  693  provided to the patient and family.
  694         (2) With respect to contractual arrangements for inpatient
  695  hospice care:
  696         (b) Hospices contracting for inpatient care beds shall not
  697  be required to obtain an additional certificate of need for the
  698  number of such designated beds. Such beds shall remain licensed
  699  to the health care facility and be subject to the appropriate
  700  inspections.
  701         (c) Staffing standards for inpatient hospice care provided
  702  through a contract may not exceed the staffing standards
  703  required under the license held by the contractee.
  704         (c)(d) Under no circumstances may a hospice place a patient
  705  requiring inpatient care in a health care facility that is under
  706  a moratorium, has had its license revoked, or has a conditional
  707  license, accreditation, or rating. However, a hospice may
  708  continue to provide care or initiate care for a terminally ill
  709  person already residing in such a facility.
  710         Section 14. Section 408.031, Florida Statutes, is repealed.
  711         Section 15. Section 408.032, Florida Statutes, is repealed.
  712         Section 16. Section 408.033, Florida Statutes, is repealed.
  713         Section 17. Section 408.034, Florida Statutes, is repealed.
  714         Section 18. Section 408.035, Florida Statutes, is repealed.
  715         Section 19. Section 408.036, Florida Statutes, is repealed.
  716         Section 20. Section 408.0361, Florida Statutes, is
  717  repealed.
  718         Section 21. Section 408.037, Florida Statutes, is repealed.
  719         Section 22. Section 408.038, Florida Statutes, is repealed.
  720         Section 23. Section 408.039, Florida Statutes, is repealed.
  721         Section 24. Section 408.040, Florida Statutes, is repealed.
  722         Section 25. Section 408.041, Florida Statutes, is repealed.
  723         Section 26. Section 408.042, Florida Statutes, is repealed.
  724         Section 27. Section 408.043, Florida Statutes, is repealed.
  725         Section 28. Section 408.0436, Florida Statutes, is
  726  repealed.
  727         Section 29. Section 408.044, Florida Statutes, is repealed.
  728         Section 30. Section 408.045, Florida Statutes, is repealed.
  729         Section 31. Section 408.0455, Florida Statutes, is
  730  repealed.
  731         Section 32. Subsection (3) of section 408.808, Florida
  732  Statutes, is amended to read:
  733         408.808 License categories.—
  734         (3) INACTIVE LICENSE.—An inactive license may be issued to
  735  a hospital, nursing home, intermediate care facility for the
  736  developmentally disabled, or ambulatory surgical center if
  737  health care provider subject to the certificate-of-need
  738  provisions in part I of this chapter when the provider is
  739  currently licensed, does not have a provisional license, and
  740  will be temporarily unable to provide services due to
  741  construction or renovation, but is reasonably expected to resume
  742  services within 12 months. Before an inactive license will be
  743  issued, the licensee must have plans approved by the agency.
  744  Such designation may be made for a period not to exceed 12
  745  months but may be renewed by the agency for up to 12 additional
  746  months upon demonstration by the licensee of the provider’s
  747  progress toward reopening. However, if after 20 months in an
  748  inactive license status, a statutory rural hospital, as defined
  749  in s. 395.602, has demonstrated progress toward reopening, but
  750  may not be able to reopen prior to the inactive license
  751  expiration date, the inactive designation may be renewed again
  752  by the agency for up to 12 additional months. For purposes of
  753  such a second renewal, if construction or renovation is
  754  required, the licensee must have had plans approved by the
  755  agency and construction must have already commenced and pursuant
  756  to s. 408.032(4); however, if construction or renovation is not
  757  required, the licensee must provide proof of having made an
  758  enforceable capital expenditure greater than 25 percent of the
  759  total costs associated with the construction or renovation
  760  hiring of staff and the purchase of equipment and supplies
  761  needed to operate the facility upon opening. A request by a
  762  licensee for an inactive license or to extend the previously
  763  approved inactive period must be submitted to the agency and
  764  must include a written justification for the inactive license
  765  with the beginning and ending dates of inactivity specified, a
  766  plan for the transfer of any clients to other providers, and the
  767  appropriate licensure fees. The agency may not accept a request
  768  that is submitted after initiating closure, after any suspension
  769  of service, or after notifying clients of closure or suspension
  770  of service, unless the action is a result of a disaster at the
  771  licensed premises. For the purposes of this section, the term
  772  “disaster” means a sudden emergency occurrence beyond the
  773  control of the licensee, whether natural, technological, or
  774  manmade, which renders the provider inoperable at the premises.
  775  Upon agency approval, the provider shall notify clients of any
  776  necessary discharge or transfer as required by authorizing
  777  statutes or applicable rules. The beginning of the inactive
  778  license period is the date the provider ceases operations. The
  779  end of the inactive license period shall become the license
  780  expiration date. All licensure fees must be current, must be
  781  paid in full, and may be prorated. Reactivation of an inactive
  782  license requires the approval of a renewal application,
  783  including payment of licensure fees and agency inspections
  784  indicating compliance with all requirements of this part,
  785  authorizing statutes, and applicable rules.
  786         Section 33. Section 651.118, Florida Statutes, is repealed.
  787         Section 34. Section 154.246, Florida Statutes, is amended
  788  to read:
  789         154.246 Validation of certain bonds and proceedings.—The
  790  Legislature finds and declares that the purpose of chapter 78
  791  115, Laws of Florida, is, in part, to clarify the original
  792  meaning of the Health Facilities Authorities Law, and,
  793  therefore, all bonds heretofore issued and proceedings conducted
  794  pursuant thereto which would have been valid had the amendment
  795  to the former s. 154.245, as set forth in s. 2 of chapter 78
  796  115, been in effect when said bonds were issued or proceedings
  797  were conducted are hereby declared valid.
  798         Section 35. Subsection (7) of section 186.503, Florida
  799  Statutes, is amended to read:
  800         186.503 Definitions relating to Florida Regional Planning
  801  Council Act.—As used in this act, the term:
  802         (7) “Local health council” means an a regional agency
  803  established pursuant to s. 381.4066 s. 408.033.
  804         Section 36. Paragraph (k) of subsection (2) of section
  805  220.1845, Florida Statutes, is amended to read:
  806         220.1845 Contaminated site rehabilitation tax credit.—
  807         (2) AUTHORIZATION FOR TAX CREDIT; LIMITATIONS.—
  808         (k) In order to encourage the construction and operation of
  809  a new health care facility as defined in s. 408.032 or s.
  810  408.07, or a health care provider as defined in s. 408.07 or s.
  811  408.7056, on a brownfield site, an applicant for a tax credit
  812  may claim an additional 25 percent of the total site
  813  rehabilitation costs, not to exceed $500,000, if the applicant
  814  meets the requirements of this paragraph. In order to receive
  815  this additional tax credit, the applicant must provide
  816  documentation indicating that the construction of the health
  817  care facility or health care provider by the applicant on the
  818  brownfield site has received a certificate of occupancy or a
  819  license or certificate has been issued for the operation of the
  820  health care facility or health care provider.
  821         Section 37. Paragraph (f) of subsection (3) of section
  822  376.30781, Florida Statutes, is amended to read:
  823         376.30781 Tax credits for rehabilitation of drycleaning
  824  solvent-contaminated sites and brownfield sites in designated
  825  brownfield areas; application process; rulemaking authority;
  826  revocation authority.—
  827         (3)
  828         (f) In order to encourage the construction and operation of
  829  a new health care facility or a health care provider, as defined
  830  in s. 408.032, s. 408.07, or s. 408.7056, on a brownfield site,
  831  an applicant for a tax credit may claim an additional 25 percent
  832  of the total site rehabilitation costs, not to exceed $500,000,
  833  if the applicant meets the requirements of this paragraph. In
  834  order to receive this additional tax credit, the applicant must
  835  provide documentation indicating that the construction of the
  836  health care facility or health care provider by the applicant on
  837  the brownfield site has received a certificate of occupancy or a
  838  license or certificate has been issued for the operation of the
  839  health care facility or health care provider.
  840         Section 38. Subsection (1) of section 376.86, Florida
  841  Statutes, is amended to read:
  842         376.86 Brownfield Areas Loan Guarantee Program.—
  843         (1) The Brownfield Areas Loan Guarantee Council is created
  844  to review and approve or deny, by a majority vote of its
  845  membership, the situations and circumstances for participation
  846  in partnerships by agreements with local governments, financial
  847  institutions, and others associated with the redevelopment of
  848  brownfield areas pursuant to the Brownfields Redevelopment Act
  849  for a limited state guaranty of up to 5 years of loan guarantees
  850  or loan loss reserves issued pursuant to law. The limited state
  851  loan guaranty applies only to 50 percent of the primary lenders
  852  loans for redevelopment projects in brownfield areas. If the
  853  redevelopment project is for affordable housing, as defined in
  854  s. 420.0004, in a brownfield area, the limited state loan
  855  guaranty applies to 75 percent of the primary lender’s loan. If
  856  the redevelopment project includes the construction and
  857  operation of a new health care facility or a health care
  858  provider, as defined in s. 408.032, s. 408.07, or s. 408.7056,
  859  on a brownfield site and the applicant has obtained
  860  documentation in accordance with s. 376.30781 indicating that
  861  the construction of the health care facility or health care
  862  provider by the applicant on the brownfield site has received a
  863  certificate of occupancy or a license or certificate has been
  864  issued for the operation of the health care facility or health
  865  care provider, the limited state loan guaranty applies to 75
  866  percent of the primary lender’s loan. A limited state guaranty
  867  of private loans or a loan loss reserve is authorized for
  868  lenders licensed to operate in the state upon a determination by
  869  the council that such an arrangement would be in the public
  870  interest and the likelihood of the success of the loan is great.
  871         Section 39. Subsection (1) of section 383.216, Florida
  872  Statutes, is amended to read:
  873         383.216 Community-based prenatal and infant health care.—
  874         (1) The Department of Health shall cooperate with
  875  localities which wish to establish prenatal and infant health
  876  care coalitions, and shall acknowledge and incorporate, if
  877  appropriate, existing community children’s services
  878  organizations, pursuant to this section within the resources
  879  allocated. The purpose of this program is to establish a
  880  partnership among the private sector, the public sector, state
  881  government, local government, community alliances, and maternal
  882  and child health care providers, for the provision of
  883  coordinated community-based prenatal and infant health care. The
  884  prenatal and infant health care coalitions must work in a
  885  coordinated, nonduplicative manner with local health planning
  886  councils established pursuant to s. 381.4066 s. 408.033.
  887         Section 40. Subsection (5) of section 395.1065, Florida
  888  Statutes, is amended to read:
  889         395.1065 Criminal and administrative penalties;
  890  moratorium.—
  891         (5) The agency shall impose a fine of $500 for each
  892  instance of the facility’s failure to provide the information
  893  required by rules adopted pursuant to s. 395.1055(1)(g) s.
  894  395.1055(1)(h).
  895         Section 41. Subsection (10) of section 395.0191, Florida
  896  Statutes, is amended to read:
  897         395.0191 Staff membership and clinical privileges.—
  898         (10) Nothing herein shall be construed by the agency as
  899  requiring an applicant for a certificate of need to establish
  900  proof of discrimination in the granting of or denial of hospital
  901  staff membership or clinical privileges as a precondition to
  902  obtaining such certificate of need under the provisions of s.
  903  408.043.
  904         Section 42. Section 408.07, Florida Statutes, is amended to
  905  read:
  906         408.07 Definitions.—As used in this chapter, with the
  907  exception of ss. 408.031-408.045, the term:
  908         (1) “Accepted” means that the agency has found that a
  909  report or data submitted by a health care facility or a health
  910  care provider contains all schedules and data required by the
  911  agency and has been prepared in the format specified by the
  912  agency, and otherwise conforms to applicable rule or Florida
  913  Hospital Uniform Reporting System manual requirements regarding
  914  reports in effect at the time such report was submitted, and the
  915  data are mathematically reasonable and accurate.
  916         (2) “Adjusted admission” means the sum of acute and
  917  intensive care admissions divided by the ratio of inpatient
  918  revenues generated from acute, intensive, ambulatory, and
  919  ancillary patient services to gross revenues. If a hospital
  920  reports only subacute admissions, then “adjusted admission”
  921  means the sum of subacute admissions divided by the ratio of
  922  total inpatient revenues to gross revenues.
  923         (3) “Agency” means the Agency for Health Care
  924  Administration.
  925         (4) “Alcohol or chemical dependency treatment center” means
  926  an organization licensed under chapter 397.
  927         (5) “Ambulatory care center” means an organization which
  928  employs or contracts with licensed health care professionals to
  929  provide diagnosis or treatment services predominantly on a walk
  930  in basis and the organization holds itself out as providing care
  931  on a walk-in basis. Such an organization is not an ambulatory
  932  care center if it is wholly owned and operated by five or fewer
  933  health care providers.
  934         (6) “Ambulatory surgical center” means a facility licensed
  935  as an ambulatory surgical center under chapter 395.
  936         (7) “Audited actual data” means information contained
  937  within financial statements examined by an independent, Florida
  938  licensed, certified public accountant in accordance with
  939  generally accepted auditing standards, but does not include data
  940  within a financial statement about which the certified public
  941  accountant does not express an opinion or issues a disclaimer.
  942         (8) “Birth center” means an organization licensed under s.
  943  383.305.
  944         (9) “Cardiac catheterization laboratory” means a
  945  freestanding facility that employs or contracts with licensed
  946  health care professionals to provide diagnostic or therapeutic
  947  services for cardiac conditions such as cardiac catheterization
  948  or balloon angioplasty.
  949         (10) “Case mix” means a calculated index for each health
  950  care facility or health care provider, based on patient data,
  951  reflecting the relative costliness of the mix of cases to that
  952  facility or provider compared to a state or national mix of
  953  cases.
  954         (11) “Clinical laboratory” means a facility licensed under
  955  s. 483.091, excluding: any hospital laboratory defined under s.
  956  483.041(6); any clinical laboratory operated by the state or a
  957  political subdivision of the state; any blood or tissue bank
  958  where the majority of revenues are received from the sale of
  959  blood or tissue and where blood, plasma, or tissue is procured
  960  from volunteer donors and donated, processed, stored, or
  961  distributed on a nonprofit basis; and any clinical laboratory
  962  which is wholly owned and operated by physicians who are
  963  licensed pursuant to chapter 458 or chapter 459 and who practice
  964  in the same group practice, and at which no clinical laboratory
  965  work is performed for patients referred by any health care
  966  provider who is not a member of that same group practice.
  967         (12) “Comprehensive rehabilitative hospital” or
  968  “rehabilitative hospital” means a hospital licensed by the
  969  agency as a specialty hospital as defined in s. 395.002;
  970  provided that the hospital provides a program of comprehensive
  971  medical rehabilitative services and is designed, equipped,
  972  organized, and operated solely to deliver comprehensive medical
  973  rehabilitative services, and further provided that all licensed
  974  beds in the hospital are classified as “comprehensive
  975  rehabilitative beds” pursuant to s. 395.003(4), and are not
  976  classified as “general beds.”
  977         (13) “Consumer” means any person other than a person who
  978  administers health activities, is a member of the governing body
  979  of a health care facility, provides health services, has a
  980  fiduciary interest in a health facility or other health agency
  981  or its affiliated entities, or has a material financial interest
  982  in the rendering of health services.
  983         (14) “Continuing care facility” means a facility licensed
  984  under chapter 651.
  985         (15) “Critical access hospital” means a hospital that meets
  986  the definition of “critical access hospital” in s. 1861(mm)(1)
  987  of the Social Security Act and that is certified by the
  988  Secretary of Health and Human Services as a critical access
  989  hospital.
  990         (16) “Cross-subsidization” means that the revenues from one
  991  type of hospital service are sufficiently higher than the costs
  992  of providing such service as to offset some of the costs of
  993  providing another type of service in the hospital. Cross
  994  subsidization results from the lack of a direct relationship
  995  between charges and the costs of providing a particular hospital
  996  service or type of service.
  997         (17) “Deductions from gross revenue” or “deductions from
  998  revenue” means reductions from gross revenue resulting from
  999  inability to collect payment of charges. For hospitals, such
 1000  reductions include contractual adjustments; uncompensated care;
 1001  administrative, courtesy, and policy discounts and adjustments;
 1002  and other such revenue deductions, but also includes the offset
 1003  of restricted donations and grants for indigent care.
 1004         (18) “Diagnostic-imaging center” means a freestanding
 1005  outpatient facility that provides specialized services for the
 1006  diagnosis of a disease by examination and also provides
 1007  radiological services. Such a facility is not a diagnostic
 1008  imaging center if it is wholly owned and operated by physicians
 1009  who are licensed pursuant to chapter 458 or chapter 459 and who
 1010  practice in the same group practice and no diagnostic-imaging
 1011  work is performed at such facility for patients referred by any
 1012  health care provider who is not a member of that same group
 1013  practice.
 1014         (19) “FHURS” means the Florida Hospital Uniform Reporting
 1015  System developed by the agency.
 1016         (20) “Freestanding” means that a health facility bills and
 1017  receives revenue which is not directly subject to the hospital
 1018  assessment for the Public Medical Assistance Trust Fund as
 1019  described in s. 395.701.
 1020         (21) “Freestanding radiation therapy center” means a
 1021  facility where treatment is provided through the use of
 1022  radiation therapy machines that are registered under s. 404.22
 1023  and the provisions of the Florida Administrative Code
 1024  implementing s. 404.22. Such a facility is not a freestanding
 1025  radiation therapy center if it is wholly owned and operated by
 1026  physicians licensed pursuant to chapter 458 or chapter 459 who
 1027  practice within the specialty of diagnostic or therapeutic
 1028  radiology.
 1029         (22) “GRAA” means gross revenue per adjusted admission.
 1030         (23) “Gross revenue” means the sum of daily hospital
 1031  service charges, ambulatory service charges, ancillary service
 1032  charges, and other operating revenue. Gross revenues do not
 1033  include contributions, donations, legacies, or bequests made to
 1034  a hospital without restriction by the donors.
 1035         (24) “Health care facility” means an ambulatory surgical
 1036  center, a hospice, a nursing home, a hospital, a diagnostic
 1037  imaging center, a freestanding or hospital-based therapy center,
 1038  a clinical laboratory, a home health agency, a cardiac
 1039  catheterization laboratory, a medical equipment supplier, an
 1040  alcohol or chemical dependency treatment center, a physical
 1041  rehabilitation center, a lithotripsy center, an ambulatory care
 1042  center, a birth center, or a nursing home component licensed
 1043  under chapter 400 within a continuing care facility licensed
 1044  under chapter 651.
 1045         (25) “Health care provider” means a health care
 1046  professional licensed under chapter 458, chapter 459, chapter
 1047  460, chapter 461, chapter 463, chapter 464, chapter 465, chapter
 1048  466, part I, part III, part IV, part V, or part X of chapter
 1049  468, chapter 483, chapter 484, chapter 486, chapter 490, or
 1050  chapter 491.
 1051         (26) “Health care purchaser” means an employer in the
 1052  state, other than a health care facility, health insurer, or
 1053  health care provider, who provides health care coverage for her
 1054  or his employees.
 1055         (27) “Health insurer” means any insurance company
 1056  authorized to transact health insurance in the state, any
 1057  insurance company authorized to transact health insurance or
 1058  casualty insurance in the state that is offering a minimum
 1059  premium plan or stop-loss coverage for any person or entity
 1060  providing health care benefits, any self-insurance plan as
 1061  defined in s. 624.031, any health maintenance organization
 1062  authorized to transact business in the state pursuant to part I
 1063  of chapter 641, any prepaid health clinic authorized to transact
 1064  business in the state pursuant to part II of chapter 641, any
 1065  multiple-employer welfare arrangement authorized to transact
 1066  business in the state pursuant to ss. 624.436-624.45, or any
 1067  fraternal benefit society providing health benefits to its
 1068  members as authorized pursuant to chapter 632.
 1069         (28) “Home health agency” means an organization licensed
 1070  under part III of chapter 400.
 1071         (29) “Hospice” means an organization licensed under part IV
 1072  of chapter 400.
 1073         (30) “Hospital” means a health care institution licensed by
 1074  the Agency for Health Care Administration as a hospital under
 1075  chapter 395.
 1076         (31) “Lithotripsy center” means a freestanding facility
 1077  that employs or contracts with licensed health care
 1078  professionals to provide diagnosis or treatment services using
 1079  electro-hydraulic shock waves.
 1080         (32) “Local health council” means an the agency established
 1081  pursuant to s. 381.4066 defined in s. 408.033.
 1082         (33) “Market basket index” means the Florida hospital input
 1083  price index (FHIPI), which is a statewide market basket index
 1084  used to measure inflation in hospital input prices weighted for
 1085  the Florida-specific experience which uses multistate regional
 1086  and state-specific price measures, when available. The index
 1087  shall be constructed in the same manner as the index employed by
 1088  the Secretary of the United States Department of Health and
 1089  Human Services for determining the inflation in hospital input
 1090  prices for purposes of Medicare reimbursement.
 1091         (34) “Medical equipment supplier” means an organization
 1092  that provides medical equipment and supplies used by health care
 1093  providers and health care facilities in the diagnosis or
 1094  treatment of disease.
 1095         (35) “Net revenue” means gross revenue minus deductions
 1096  from revenue.
 1097         (36) “New hospital” means a hospital in its initial year of
 1098  operation as a licensed hospital and does not include any
 1099  facility which has been in existence as a licensed hospital,
 1100  regardless of changes in ownership, for over 1 calendar year.
 1101         (37) “Nursing home” means a facility licensed under s.
 1102  400.062 or, for resident level and financial data collection
 1103  purposes only, any institution licensed under chapter 395 and
 1104  which has a Medicare or Medicaid certified distinct part used
 1105  for skilled nursing home care, but does not include a facility
 1106  licensed under chapter 651.
 1107         (38) “Operating expenses” means total expenses excluding
 1108  income taxes.
 1109         (39) “Other operating revenue” means all revenue generated
 1110  from hospital operations other than revenue directly associated
 1111  with patient care.
 1112         (40) “Physical rehabilitation center” means an organization
 1113  that employs or contracts with health care professionals
 1114  licensed under part I or part III of chapter 468 or chapter 486
 1115  to provide speech, occupational, or physical therapy services on
 1116  an outpatient or ambulatory basis.
 1117         (41) “Prospective payment arrangement” means a financial
 1118  agreement negotiated between a hospital and an insurer, health
 1119  maintenance organization, preferred provider organization, or
 1120  other third-party payor which contains, at a minimum, the
 1121  elements provided for in s. 408.50.
 1122         (42) “Rate of return” means the financial indicators used
 1123  to determine or demonstrate reasonableness of the financial
 1124  requirements of a hospital. Such indicators shall include, but
 1125  not be limited to: return on assets, return on equity, total
 1126  margin, and debt service coverage.
 1127         (43) “Rural hospital” means an acute care hospital licensed
 1128  under chapter 395, having 100 or fewer licensed beds and an
 1129  emergency room, and which is:
 1130         (a) The sole provider within a county with a population
 1131  density of no greater than 100 persons per square mile;
 1132         (b) An acute care hospital, in a county with a population
 1133  density of no greater than 100 persons per square mile, which is
 1134  at least 30 minutes of travel time, on normally traveled roads
 1135  under normal traffic conditions, from another acute care
 1136  hospital within the same county;
 1137         (c) A hospital supported by a tax district or subdistrict
 1138  whose boundaries encompass a population of 100 persons or fewer
 1139  per square mile;
 1140         (d) A hospital with a service area that has a population of
 1141  100 persons or fewer per square mile. As used in this paragraph,
 1142  the term “service area” means the fewest number of zip codes
 1143  that account for 75 percent of the hospital’s discharges for the
 1144  most recent 5-year period, based on information available from
 1145  the hospital inpatient discharge database in the Florida Center
 1146  for Health Information and Transparency at the Agency for Health
 1147  Care Administration; or
 1148         (e) A critical access hospital.
 1149  
 1150  Population densities used in this subsection must be based upon
 1151  the most recently completed United States census. A hospital
 1152  that received funds under s. 409.9116 for a quarter beginning no
 1153  later than July 1, 2002, is deemed to have been and shall
 1154  continue to be a rural hospital from that date through June 30,
 1155  2015, if the hospital continues to have 100 or fewer licensed
 1156  beds and an emergency room. An acute care hospital that has not
 1157  previously been designated as a rural hospital and that meets
 1158  the criteria of this subsection shall be granted such
 1159  designation upon application, including supporting
 1160  documentation, to the Agency for Health Care Administration.
 1161         (44) “Special study” means a nonrecurring data-gathering
 1162  and analysis effort designed to aid the agency in meeting its
 1163  responsibilities pursuant to this chapter.
 1164         (45) “Teaching hospital” means any Florida hospital
 1165  officially affiliated with an accredited Florida medical school
 1166  which exhibits activity in the area of graduate medical
 1167  education as reflected by at least seven different graduate
 1168  medical education programs accredited by the Accreditation
 1169  Council for Graduate Medical Education or the Council on
 1170  Postdoctoral Training of the American Osteopathic Association
 1171  and the presence of 100 or more full-time equivalent resident
 1172  physicians. The Director of the Agency for Health Care
 1173  Administration shall be responsible for determining which
 1174  hospitals meet this definition.
 1175         Section 43. Subsection (6) of section 408.806, Florida
 1176  Statutes, is amended to read:
 1177         408.806 License application process.—
 1178         (6) The agency may not issue an initial license to a health
 1179  care provider subject to the certificate-of-need provisions in
 1180  part I of this chapter if the licensee has not been issued a
 1181  certificate of need or certificate-of-need exemption, when
 1182  applicable. Failure to apply for the renewal of a license before
 1183  prior to the expiration date renders the license void.
 1184         Section 44. Subsection (10) of section 408.810, Florida
 1185  Statutes, is amended to read:
 1186         408.810 Minimum licensure requirements.—In addition to the
 1187  licensure requirements specified in this part, authorizing
 1188  statutes, and applicable rules, each applicant and licensee must
 1189  comply with the requirements of this section in order to obtain
 1190  and maintain a license.
 1191         (10) The agency may not issue a license to a health care
 1192  provider subject to the certificate-of-need provisions in part I
 1193  of this chapter if the health care provider has not been issued
 1194  a certificate of need or an exemption. Upon initial licensure of
 1195  any such provider, the authorization contained in the
 1196  certificate of need shall be considered fully implemented and
 1197  merged into the license and shall have no force and effect upon
 1198  termination of the license for any reason.
 1199         Section 45. Section 408.820, Florida Statutes, is amended
 1200  to read:
 1201         408.820 Exemptions.—Except as prescribed in authorizing
 1202  statutes, the following exemptions shall apply to specified
 1203  requirements of this part:
 1204         (1) Laboratories authorized to perform testing under the
 1205  Drug-Free Workplace Act, as provided under ss. 112.0455 and
 1206  440.102, are exempt from s. 408.810(5)-(9) s. 408.810(5)-(10).
 1207         (2) Birth centers, as provided under chapter 383, are
 1208  exempt from s. 408.810(7)-(9) s. 408.810(7)-(10).
 1209         (3) Abortion clinics, as provided under chapter 390, are
 1210  exempt from s. 408.810(7)-(9) s. 408.810(7)-(10).
 1211         (4) Crisis stabilization units, as provided under parts I
 1212  and IV of chapter 394, are exempt from s. 408.810(8) and (9) s.
 1213  408.810(8)-(10).
 1214         (5) Short-term residential treatment facilities, as
 1215  provided under parts I and IV of chapter 394, are exempt from s.
 1216  408.810(8) and (9) s. 408.810(8)-(10).
 1217         (6) Residential treatment facilities, as provided under
 1218  part IV of chapter 394, are exempt from s. 408.810(8) and (9) s.
 1219  408.810(8)-(10).
 1220         (7) Residential treatment centers for children and
 1221  adolescents, as provided under part IV of chapter 394, are
 1222  exempt from s. 408.810(8) and (9) s. 408.810(8)-(10).
 1223         (8) Hospitals, as provided under part I of chapter 395, are
 1224  exempt from s. 408.810(7)-(9).
 1225         (9) Ambulatory surgical centers, as provided under part I
 1226  of chapter 395, are exempt from s. 408.810(7)-(9) s. 408.810(7)
 1227  (10).
 1228         (10) Mobile surgical facilities, as provided under part I
 1229  of chapter 395, are exempt from s. 408.810(7)-(9) s. 408.810(7)
 1230  (10).
 1231         (11) Health care risk managers, as provided under part I of
 1232  chapter 395, are exempt from ss. 408.806(7), 408.810(4)-(9)
 1233  408.810(4)-(10), and 408.811.
 1234         (12) Nursing homes, as provided under part II of chapter
 1235  400, are exempt from ss. 408.810(7) and 408.813(2).
 1236         (13) Assisted living facilities, as provided under part I
 1237  of chapter 429, are exempt from s. 408.810(10).
 1238         (14) Home health agencies, as provided under part III of
 1239  chapter 400, are exempt from s. 408.810(10).
 1240         (13)(15) Nurse registries, as provided under part III of
 1241  chapter 400, are exempt from s. 408.810(6) and (10).
 1242         (14)(16) Companion services or homemaker services
 1243  providers, as provided under part III of chapter 400, are exempt
 1244  from s. 408.810(6)-(9) s. 408.810(6)-(10).
 1245         (17) Adult day care centers, as provided under part III of
 1246  chapter 429, are exempt from s. 408.810(10).
 1247         (15)(18) Adult family-care homes, as provided under part II
 1248  of chapter 429, are exempt from s. 408.810(7)-(9) s. 408.810(7)
 1249  (10).
 1250         (16)(19) Homes for special services, as provided under part
 1251  V of chapter 400, are exempt from s. 408.810(7)-(9) s.
 1252  408.810(7)-(10).
 1253         (20) Transitional living facilities, as provided under part
 1254  XI of chapter 400, are exempt from s. 408.810(10).
 1255         (21) Prescribed pediatric extended care centers, as
 1256  provided under part VI of chapter 400, are exempt from s.
 1257  408.810(10).
 1258         (22) Home medical equipment providers, as provided under
 1259  part VII of chapter 400, are exempt from s. 408.810(10).
 1260         (17)(23) Intermediate care facilities for persons with
 1261  developmental disabilities, as provided under part VIII of
 1262  chapter 400, are exempt from s. 408.810(7).
 1263         (18)(24) Health care services pools, as provided under part
 1264  IX of chapter 400, are exempt from s. 408.810(6)-(9) s.
 1265  408.810(6)-(10).
 1266         (19)(25) Health care clinics, as provided under part X of
 1267  chapter 400, are exempt from s. 408.810(6), and (7), and (10).
 1268         (20)(26) Clinical laboratories, as provided under part I of
 1269  chapter 483, are exempt from s. 408.810(5)-(9) s. 408.810(5)
 1270  (10).
 1271         (21)(27) Multiphasic health testing centers, as provided
 1272  under part II of chapter 483, are exempt from s. 408.810(5)-(9)
 1273  s. 408.810(5)-(10).
 1274         (22)(28) Organ, tissue, and eye procurement organizations,
 1275  as provided under part V of chapter 765, are exempt from s.
 1276  408.810(5)-(9) s. 408.810(5)-(10).
 1277         Section 46. Subsection (6) of section 409.9116, Florida
 1278  Statutes, is amended to read:
 1279         409.9116 Disproportionate share/financial assistance
 1280  program for rural hospitals.—In addition to the payments made
 1281  under s. 409.911, the Agency for Health Care Administration
 1282  shall administer a federally matched disproportionate share
 1283  program and a state-funded financial assistance program for
 1284  statutory rural hospitals. The agency shall make
 1285  disproportionate share payments to statutory rural hospitals
 1286  that qualify for such payments and financial assistance payments
 1287  to statutory rural hospitals that do not qualify for
 1288  disproportionate share payments. The disproportionate share
 1289  program payments shall be limited by and conform with federal
 1290  requirements. Funds shall be distributed quarterly in each
 1291  fiscal year for which an appropriation is made. Notwithstanding
 1292  the provisions of s. 409.915, counties are exempt from
 1293  contributing toward the cost of this special reimbursement for
 1294  hospitals serving a disproportionate share of low-income
 1295  patients.
 1296         (6) This section applies only to hospitals that were
 1297  defined as statutory rural hospitals, or their successor-in
 1298  interest hospital, before prior to January 1, 2001. Any
 1299  additional hospital that is defined as a statutory rural
 1300  hospital, or its successor-in-interest hospital, on or after
 1301  January 1, 2001, is not eligible for programs under this section
 1302  unless additional funds are appropriated each fiscal year
 1303  specifically to the rural hospital disproportionate share and
 1304  financial assistance programs in an amount necessary to prevent
 1305  any hospital, or its successor-in-interest hospital, eligible
 1306  for the programs before prior to January 1, 2001, from incurring
 1307  a reduction in payments because of the eligibility of an
 1308  additional hospital to participate in the programs. A hospital,
 1309  or its successor-in-interest hospital, which received funds
 1310  pursuant to this section before January 1, 2001, and which
 1311  qualifies under s. 395.602(2)(b) s. 395.602(2)(e), shall be
 1312  included in the programs under this section and is not required
 1313  to seek additional appropriations under this subsection.
 1314         Section 47. Paragraph (c) of subsection (1) of section
 1315  641.60, Florida Statutes, is amended to read:
 1316         641.60 Statewide Managed Care Ombudsman Committee.—
 1317         (1) As used in ss. 641.60-641.75:
 1318         (c) “District” means one of the health service planning
 1319  districts as described defined in s. 381.4066 s. 408.032.
 1320         Section 48. Paragraph (b) of subsection (2) of section
 1321  1009.65, Florida Statutes, is amended to read:
 1322         1009.65 Medical Education Reimbursement and Loan Repayment
 1323  Program.—
 1324         (2) From the funds available, the Department of Health
 1325  shall make payments to selected medical professionals as
 1326  follows:
 1327         (b) All payments shall be contingent on continued proof of
 1328  primary care practice in an area defined in s. 395.602(2)(b) s.
 1329  395.602(2)(e), or an underserved area designated by the
 1330  Department of Health, provided the practitioner accepts Medicaid
 1331  reimbursement if eligible for such reimbursement. Correctional
 1332  facilities, state hospitals, and other state institutions that
 1333  employ medical personnel shall be designated by the Department
 1334  of Health as underserved locations. Locations with high
 1335  incidences of infant mortality, high morbidity, or low Medicaid
 1336  participation by health care professionals may be designated as
 1337  underserved.
 1338         Section 49. This act shall take effect July 1, 2017.